The healthcare industry is in the midst of a major transition from fee-for-service reimbursement to a value-based model. By 2020, fee-for-value reimbursement is expected to represent 83% of hospital revenue, up from just 14% in 2010.
Becker’s Hospital Review says that 86% of hospitals are already participating in some sort of value-based reimbursement program. Improving documentation and coding (in the middle of the revenue cycle) is key. Here are six ways insight into the mid-cycle can help you transition to value-based reimbursement.
#1: Encourage collaboration in CDI initiatives
With the transition to value-based reimbursement, clinical and financial stakeholders need to collaborate to improve the hospital’s financial viability. There is a clear link between coding and revenue, so you need to ensure you are working together to improve coding and documentation practices.
#2: Recognize the mid-cycle opportunity
The Advisory Board Company estimates that the average 250-bed hospital could gain as much as $11.3 million in revenue through improvements to the mid-cycle. With mid-cycle insight, you can gather information on coding and financial metrics to determine implications on your profitability.
#3: Engage physicians through data
Documentation improvements are crucial to improving profitability in the mid-cycle. Benchmarking data helps your physicians see how their documentation practices compare to others within the facility and across the country.
#4: Improve coding specificity
Use your data to identify what codes are being used, how frequently they are used, and how that frequency compares to organizations of a similar size. Your data can help you analyze your CMI, unspecified codes, compliance risk, underutilized secondary diagnosis codes, and more.
#5: Target physician and coder training
ICD-10 is a new world for physicians and coders. Their work has a direct impact on your financial viability. Without data analytics, it’s difficult to connect the dots between procedures, documentation, coding, and revenue. By giving physicians and coders the right information and training, you can ensure that every claim is coded correctly and that all complications and comorbidities are specified.
#6: Measure ongoing performance
To ensure your viability in a fee-for-value world, detailed change management processes must be in place. With ICD-10 in effect for just three months, it’s difficult to truly measure the impact of the change. It can be tough to stay on top of your physicians’ documentation. But regular reviews are critical. Integrating a performance management solution with data analytics helps you create specific action and accountability plans to drive meaningful change.
Learn more about how Revenue Integrity can help you seamlessly transition to value-based reimbursement with data analytics.
AHD Acute Data, SK&A, NEJM, RWJ Foundation, HIMSS, Commonwealth Fund, Oliver Wyman
The New “Mid-Cycle,” Moving Past ICD-10 to Drive Lasting Revenue Optimization, The Advisory Board Company, 2014
Get our take on industry trends
Proactively predicting ER visit trends with augmented analytics to improve revenues, asset utilization and patient outcomes
Mission critical emergency departments (EDs) are the most valuable revenue generating asset for hospitals. While visits decreased during the pandemic,…Read on...
Conversations at HIMSS23
HIMSS23 was nothing short of outstanding. I was thrilled to see the familiar faces of colleagues and clients, mingle with…Read on...
Best practice tools to build an integrated approach to multimorbidity
The traditional model of treating single diseases no longer works. Data collected from 2016 to 2019 indicated that 32.9% of…Read on...
Will adopting a risk-based approach with augmented analytics support care gap closure?
A common challenge for healthcare systems is how to properly segment its patient populations based on risk profiles and co-morbidities. Doing this well ensures a high quality of care delivery and superior patient outcomes.Read on...
Leave a Comment