Risk-Based Payment Models For Healthcare Providers.pdf

Improve healthcare provider reimbursement and reduce risks with our risk-based payment models. Enhance financial stability.

1. Risk-Based Payment Models For Healthcare Providers







https://www.247medicalbillingservices.com/

2. Risk-Based Payment Models For Healthcare Providers

Risk-based payment models, also known as budget-based contracting, are evolving in the healthcare industry as an
alternative to traditional fee-for-service models. These models aim to control healthcare costs and improve care quality by
holding providers financially accountable for patient outcomes.
Risk-based payment models are structured around an estimated cost of treating a specific condition or patient population.
These estimates are based on sophisticated actuarial models and include direct and indirect practice expenses as well as a
margin. In fact, there are various risk-based payment models for healthcare providers, such as:

































https://www.247medicalbillingservices.com/

3. https://www.247medicalbillingservices.com/
Understanding Risk-Based Payment Models











































Risk-based payment models are designed to align the financial incentives of healthcare providers with the goal of delivering
value rather than volume. These models aim to improve patient outcomes, enhance care quality, and reduce unnecessary
healthcare spending. Here are the key types of risk-based payment models:
●Capitation
●Shared Savings
●Bundled Payments
Accountable Care Organizations (ACOs)
ACOs are groups of providers who voluntarily come together to give coordinated, high-quality care to their Medicare
patients. In fact, ACOs share in the savings they achieve for the Medicare program if they meet specific quality and cost
targets.
Medical Billing Impact: Providers in ACOs bill for their services as usual, but the ACO as a whole is evaluated on its
performance. If the ACO meets cost and quality benchmarks, it receives a share of the savings distributed among the
participating providers.

4. https://www.247medicalbillingservices.com/
Challenges in Adopting Risk-Based Payment Models












































A recent survey by Premier, involving 177 healthcare professionals and physicians, revealed several challenges in shifting to
risk-based payment models:
●Reimbursement Insufficiency: 23% of respondents identified inaccurate reimbursements as the primary barrier.
●Data Access and Accuracy: Only 3% of participants stated that data from commercial payers was accurate and
standardized, highlighting a significant barrier to implementation.
●Economic Incentives: The need for stronger economic incentives and more precise data access was emphasized as
crucial for advancing these models.
Role of Medicare
Medicare leads the way in risk-based payment model adoption:
●Medicare Shared Savings Program: The largest accountable care organization program, encouraging providers to
assume downside financial risk sooner.
●Multi-Payer Claims Data Access: CMS provides claims data through Innovation Center demonstrations, aiding in
value-based care delivery.

5. https://www.247medicalbillingservices.com/
Error-Free Medical Billing












































Risk-based payment models present a promising approach to managing healthcare costs and improving patient outcomes.
However, significant challenges, such as reimbursement accuracy and data access, must be addressed to accelerate their
adoption. Medicare’s initiatives and ongoing policy adjustments are steps in the right direction, but broader systemic
changes are necessary for widespread implementation.
For healthcare providers ready to transition to risk-based models, partnering with experienced medical billing and coding
experts, such as those from 24/7 Medical Billing Services, can streamline the process and ensure error-free
implementation.

6. About us
We are a medical billing company that offers ‘24/7 Medical Billing Services’ and support physicians, hospitals,
medical institutions and group practices with our end to end medical billing solutions. We help you earn more
revenue with our quick and affordable services. Our customized Revenue Cycle Management (RCM) solutions
allow physicians to attract additional revenue and reduce administrative burden or losses.

Media Contact:
24/7 Medical Billing Services
28405 Osborn Road, Cleveland, OH 44140
Phone no / Fax : [phone]
Email us: [email protected]



https://www.247medicalbillingservices.com/