Hospitals & Medical Groups
The healthcare reimbursement system is in the midst of its most significant transformation since managed care in the 1980s. The shift from fee-for-service payment models to value-based is challenging hospitals to maximize data, retool revenue cycle management and hire skilled case managers like never before.
Hospitals must balance traditional revenue cycle programs such as uninsured/underinsured eligibility, claims query, billing follow up and appeals, while navigating new bundled payments, quality metrics and data tracking requirements. The right combination of approaches, technologies, expertise and risk/reward partner can make the difference between a profitable quarter and one that ends with a loss. RISARC offers a spectrum of traditional revenue cycle programs and value-based solutions to hospitals.
Quality Measures of Value-Based Payment Models
While a single quality measure is relatively easy to track, it is the combination of a multitude of complex quality measures that makes tracking problematic for hospitals. This, coupled with a public and private payer’s right to associate different penalties and incentives with quality measures, makes tracking and reporting critical. Understanding how clinical quality, patient satisfaction, and other factors affect profitability requires a deep understanding of the value-based model.