To understand how value-based care models will affect your RCM, you must first understand what it is and how it differs from previous models.

What is Value-Based Care?


Value-based care is a framework that rewards providers for efficiency, effectiveness, and quality care and acts as a replacement for fee-for-service reimbursement. In a sense, it is a form of reimbursement where delivery of care is directly correlated to the quality of care provided.

How Does This Differ From Fee-For-Service Models?


In a fee-for-service model, providers are compensated for the number of services that are performed, which motivates practitioners to run more tests and procedures and take on additional patients to get paid more. In this model, each service is “a la carte” so providers would be paying for each service separately, as no bundle rates were available. As rates increased, practices were spending more money on treating patients without improvements in patient outcomes or care. With value-based care models, healthcare costs are lowered and patient outcomes are increased.


How Can I Implement This Framework Into My Practice?


As healthcare technologies transform and adapt to the new age of care, it can be confusing to try to implement these changes into practice. The new world of value-based care means providers are now responsible for taking on the entire process of care, where getting reimbursed means performing services at a high-quality level.

With these changes, revenue cycle management needs to become optimized based mainly upon value rather than volume. During this time, many providers consider outsourcing their revenue cycle management in order to reduce spending and focus their efforts on value-based care initiatives. Some changes to help with medical billing would be to highlight areas where the practice over-performs and under-performs to create financial scenarios based on those outcomes.

Denial Management Workflow


Once your practice has implemented value-based care and contracts begin to grow, new risk factors will need to be assessed. Previously, risks were mainly among encounters that happened within the office. However, with this new model, practitioners must hold themselves accountable for the entire episode costs, which may involve patient visits to other providers or various treatments.

A strong denial management program can assist in providing insights into the practice’s operations and patient experience which helps optimize the financial results when utilizing value-based care. To create the most effective denial management workflow, it is helpful to have a dedicated team to manage these denials for the entire practice. This team’s main focus should be to emphasize an improvement cycle for denied claims. By selecting an outsourcing partner that utilizes the latest technologies, skills, and experience you can be confident that your practice can thrive under the value-based care model.

Credence Global Solutions is here to help every step of the way when transforming your practice. You can rely on us for the highest level of quality care, which will reflect on your practice and make its way to your patients. For revenue cycle management, denial management workflow, and to learn more about value-based care models, contact Credence Global Solutions today.