ACE ALERT: Provider Reimbursement Models for The Future

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ACE Alert, August 26, 2021, Volume 35
Provider Reimbursement Models for The Future
By Donna Schlemmer

Times are changing with payment for medical services. To improve patient care while lowering costs, payors are exploring alternative payment models (APM). A goal at CMS is cultivating an affordable and accessible healthcare system that puts patients first. One of the initiatives is bundled-pay. A bundled payment methodology involves combining the payments for physician, hospital, and other health care provider services into a single bundled payment amount. The participating entities will receive bundled payments for certain episodes of care as an alternative to fee-for-service payments, which was authorized through Section 3021 of the Affordable Care Act. The intent of a single bundled payment to health care providers is to motivate health care providers to furnish services efficiently, to better coordinate care, and to improve the quality of care. The result can realize a gain or loss.
How alternate payment models can be adapted to your practice.
  1. Create a Profile for Each Managed Care Contract – Know your average case payment by specialty case types.
  2. Be Aware of Contract Negotiations—Build models around what they ask.
  3. Be Prepared to Negotiate — Each party needs to be willing to give to get.
  4. Hold Payors Accountable—Make sure you have a built-in audit process to ensure cases are billed and paid correctly.
ACE has been in the billing, coding, and managed care evaluation business for a very long time.  One of the new things that should be addressed in contracts is to negotiate out of EFT fees that are now being charged for transactions.  Our auditors have expertise in organizing your information and compiling data to help you understand where you are and what you need to get to your true goals.  If you would like help with any of the steps above, give us a call. 

ACE is here to help!
Contact us:

Want to join the ACE Team? We are hiring! 

The ACE team is growing and we are looking for: 2 auditors and 5 certified coders. If you are interested in being on the best team in the anesthesia industry we want to hear from you!

Please pass the opportunity along to anyone you feel might be the perfect fit.  We are announcing this opportunity to you all first! 

Send resumes to Kaylal@aceauditors.com 

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