Being a physician presents a plethora of challenges these days. Whether a physician owns their own practice or if another health system employs them, they have to navigate through a minefield of obstacles every day. They deal with staffing problems, issues with technology, long hours, and a great deal of burnout, among other things. One of the greatest struggles that a physician faces, though, is getting paid.
Why Getting Paid is a Challenge
It’s already hard enough to manage a practice and treat patients. The sad news is that even getting paid can often be a struggle. Getting paid means a physician has to navigate through a reimbursement landscape that is marked by myriad programs that are linked to quality metrics. This also means the physician sees that the practice is coding and documenting precisely to prevent denials and guarantee the proper reimbursement levels. On top of that, many patients have plans with high deductibles. This means that practices usually need to collect from the patients.
For those who are trying to get through these challenges, follow these tips.
Focus on Outcomes
Value-based payment is here to stay, so it’s important for any physician to understand quality metrics and value-based programs that are made for private payers as well as public ones.
Medicare is beginning to gravitate more towards value-based care, and private payers continue to incentivize physicians to focus on outcomes. For these reasons, data is becoming more crucial for any practice’s reimbursement outlook.
Reimbursement can suffer dramatically if a practice doesn’t have sufficient data to prove that patients are reaching their desired outcomes. Compounding this with private payer contracts that encourage value-based outcomes means that a large portion of practice reimbursement can be jeopardized.
Changes Coming in 2021
It looks like 2020 will be a transitional year for payments because a lot of programs and alterations initially scheduled to take effect in 2020 have been postponed until 2021. Such changes include CMS-made primary care models as well as a streamlining of various management and evaluation level of care coding.
CMS has announced that they have a new alternative payment model called Primary Care First, but it will be going into effect during January of 2021. It’s a model that is focused on primary care practices that are prepared to take on financial risk so that they can become more flexible and transparent. Practices that use this model will also get more performance-based payments that reward its participants for outcomes, as stated by CMS.
In Evaluation/Management (E/M) terms, CMS is:
- Reducing the number of office/outpatient E/M visit levels from five to four.
- Refining code definitions
- Letting clinicians decide to select the E/M visit level based on time or medical decision-making.
- Requiring performance of exam and history only when medically-appropriate.
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