3 ways to prepare for value-based reimbursements

Average commercial reimbursement rates for new and established patient visits increased slightly for the first time since Physicians Practice began collecting and aggregating fee schedule data from practices more than 10 years ago, according to a February cover story about the results.

Despite the positive trend, however, practices can't afford to become complacent, according to the article, as dramatic shifts in the way providers receive payment are underway. Nearly 23 percent expect some of their 2014 revenue to come from non-fee-for-service contracts, while 24 percent expect this to be true for 2015, according to the 1,613 respondents to this year's survey. Likewise, practices expect the proportions of their pay tied to global or value-based payments to start small (less than 10 percent of total revenue for most) and gradually expand.

Attitudes about these changes vary, as 20 percent of respondents said the shift away from the fee-for-service payment methodology will be good for their practice, 23 percent report it will be a detriment and 44 percent indicate they were "not sure" of the effect.

But along with this difficult transition comes the potential opportunity for practices to enhance their reimbursement going forward. To take full advantage of reimbursement changes that may work in their favor, experts who spoke with Physicians Practice recommended medical groups take the following steps:

  • Keep tabs on contract changes. Not all payer amendments to contracts require your signature, noted Susanne Madden, president and CEO of practice-management consulting firm The Verden Group, so read promptly any mail that comes from insurers and be sure you understand it. Signing up for payers' e-newsletters--and reading them--can also help practices keep abreast of important changes that may go into effect quietly.
  • Review contracts annually. Conduct a yearly checkup not just to make sure payers send you the correct amounts but also to ensure your costs to provide services still match up to the fees you receive. Alert payers to mistakes or issues to negotiate as soon as possible to optimize revenue, recommended Mary Witt, senior vice president of healthcare consulting company The Camden Group.
  • Evaluate exchanges. Although payment rates are typically 20 percent lower than in HMO plans, it may still benefit your practice to be included if many of your established patients are insured through the exchange. If you wish to be added to an exchange plan that has excluded you, contact the health plan to explore options, said Madden. Conversely, high deductibles included with many exchange offerings may affect your practice negatively enough to consider not participating, in which case you may be able to opt out on your renewal date, she added.

To learn more:
- read the article
- see the survey