This year, providers may be struggling with meeting deadlines on reporting for the Merit-based Incentive Payment System (MIPS) and avoiding a negative payment adjustment. In a few years, however, they’ll expect solutions to more complicated issues surrounding value-based reimbursement, according to Tim Mills, chief growth officer at revenue cycle, coding and billing software company Alpha II.
Ahead of HIMSS18, Mills spoke to HealthExec about what providers have learned from their limited experience with the Merit-based Incentive Payment System as well as other challenges they’re facing in their revenue cycle and what software capabilities they’re seeking to solve those problems—and what features may be not available for a few more years.
HealthExec: What have providers and software vendors been struggling with in reporting for MIPS for 2017? Have they been able to hit their reporting deadlines?
Tim Mills: There have been a number of clinicians who were able to hit the deadlines, but there’s still a good bit of confusion in the marketplace, especially for those who managed Meaningful Use through their electronic health record (EHR) vendor. There’s also been confusion for vendors like us offering MIPS registry solutions, but also practice management and EHR vendors like Allscripts and Cerner. They’ve spent millions of dollars to advance Meaningful Use and primarily in the transition year, have been focused on the Advancing Care Information category, which is an extension of just Meaningful Use, and haven’t really advanced their solutions on quality and some of the other environments.
For any program that’s combining previous programs, there’s going to be some transition, learning and confusion in the marketplace. We’ve seen many clinicians struggling with where they could meet all those objectives or, for 2017, should they focus on just not getting a negative payment adjustment?
You’ve spoken about providers “leaving money on the table due to poor denials management”—what are they doing wrong?
If you’re really just looking at a back-of-the-office process, the traditional approach to coding and compliance where you’re doing some kind of claims scrubbing or clearinghouse evaluation and editing, you think you’re going to catch some of those things at time of claim, it’s still 15 to 20 percent of claims are rejected or denied.
So if you’re doing averaging that, there’s an incremental cost every time you have to re-submit or do an appeal, it’s about $25 to just manage that environment. If you’re spending sometimes thousands of dollars in re-submitting for denials, there are administrative costs and administrative burdens. Since most providers have a limited administrative staff, patient care is impacted. And then they end up spending a good deal of time on denials management, when with some better tools up front and introducing tools in the clinical and coding part of an encounter, you can catch and identify more of those errors before they become denials.
You’re accelerating your cash flow and mitigating the extra expense of chasing those claims. It’s not just a back-office issue. Look at your overall clinical and financial workflow and consider those issues when you’re coding that patient visit or when you’re doing charge capture. Catching those scenarios earlier translates into better reimbursement, better cash flow management and less drain on your administrative resources.
What kind of revenue cycle capabilities will providers be looking for at HIMSS?
A lot of providers are looking for how can their vendors come around them and really help them better manage this revenue cycle process overall. Many vendors are moving towards offering a full revenue cycle outsource solution, where they get a percentage of collections and take on some of the risk. Whether it’s done as an outsource service or providing them tools, physicians’ offices need a suite of solutions that can better manage the overall workflow—the front, middle and back end of that revenue cycle.
What sort of capabilities are still a few years away from being widely available from vendors?
We still live in a world where fee-for-service is part of the reimbursement cycle with value-based programs becoming an emerging part of it. We’re looking at ways to blend the two of those together, so we can even identify opportunities, at claim and coding, which particular events and episodes are related to value-based reimbursement.
Today, value-based reimbursement is end-of-the-year reporting where you get incentives. We anticipate the evolution of reimbursement will be a blend where solutions will need to identify, at episode of care, the best combination of fee-for-service maximization coupled with value-based and outcomes-based movements. I anticipate you’ll see more blending over the next couple of years to where you’ve got true pictures of solutions that are maximizing that combination of fee-for-service and value-based reimbursement.