With new revenue reimbursement models forming as a result of the Affordable Care Act (ACA), Urology revenue cycle management is in a state of transition.
In June 2012, the MGMA-ACMPE released the results of a questionnaire that ranked members’ most pressing practice management challenges. No. 2 was: Preparing for revenue reimbursement models that place a greater share of financial risk on the practice.
Within the next five years, urologists will be adopting this revenue reimbursement shared-risk model (vs. fee for service) with the emergence of population health management through Accountable Care Organizations (ACO). They coordinate care and meet performance standards of care for Medicare patients in order to earn incentive payments.
In this new ACO environment, the federal government, in tandem with commercial insurance companies, is changing the way patients pay doctors and hospitals. Revenue reimbursement models for Urology medical coding and billing are transitioning from volume-based to value-based focusing on quality care and efficiency.
As reported by Ray Painter, MD, and Mark Painter, MD in the Oct. 1, 2012 online edition of Modern Medicine, Urology practices should be aware of the following revenue reimbursement changes in Urology medical billing and coding:
- Prepare for lower payment per procedure. The current focus on primary care services and prevention seems common in both the public and private sectors. It is likely that increases in primary care funding will come at the expense of specialists. Simple math dictates that less or the same amount of money in combination with more services provided requires a lower cost per service. Thus, lower reimbursement will be part of any reform.
The urology practice will need to shore up its business models, become more efficient in providing care, and get better at collections. With no fat in the system, every dollar will count. Both plans seem to include increased shifting of costs from the plan to the patient and informing the patient as to cost and value. Practices will need to focus on a value to the patient and collection services that match.
- Payment for ancillary services will be cut as well. We have already seen moves that indicate this is an issue from both public and private payers. This trend will continue. While it appears that payment to urologists for ancillary services will continue, the amount paid will likely decrease. We would recommend that any projections for revenue from ancillary services be decreased in any practice budget.
As a result of ACOs and its correlating population health management and shared risk models, proper Urology medical coding and billing is vital to maximizing revenue potential. It’s an exacting science that requires in-depth, insider industry expertise of the myriad of new Urology coding, billing and compliance regulations that only an independent third party Urology revenue cycle management specialist with decades of expertise can provide to ensure nothing falls through the cracks and revenues are optimized.
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