Non-Fee-for-Service Revenue Cycle ManagementEdition 1

Non-Fee-for-Service Revenue Cycle Management: Managing Patient Service and Clinical Performance to Maximize Healthcare Practice Profit

By Ronald B. Sterling, CPA, MBA

As the healthcare system migrates from the fee for service (FFS) model to a variety of non-fee for service (non-FFS) payment systems, practices/HCOs will be seeking strategies and tactics to fill the care gaps that exist because of the fee for service model. From more active patient engagement to establishing and maintaining collaborative patient and provider relations, practices/HCOs need to rethink their own added value strategies and how to best serve healthcare stakeholders including patients, patient caregivers, physicians and other providers.

Consequentially, practices/HCOs will need to modify a variety of processes, strategies, and tools. Using existing FFS focused tactics could inhibit the ability to analyze clinical and/or financial performance.

2017

From managing services that generate revenue to the billing process and tracking clinical and business performance, the non-FFS models present resource, patient service, billing, and reporting challenges.

In today's high-stakes healthcare practice business climate, physician leaders and healthcare organization will need to answer the following questions:

• What are the clinical and operational requirements to earn the non-FFS revenue?

• How will the practice/HCO track clinical performance and patient service that could impact non-FFS revenue?

• What are the costs incurred in producing the non-FFS revenue?

• How will the practice/HCO verify that the non-FFS payment is correct?

• How will non-FFS revenue be credited to physicians in calculating their compensation?

• What are the analytical tools needed to evaluate the financial performance of the non-FFS arrangement?

The Non-Fee for Service reimbursement changes for healthcare practices are a business challenge that you cannot afford to ignore. These transformative challenges must be addressed for health care organizations to succeed in the coming years. Leveraging his extensive knowledge of healthcare information technology and accounting, Ron Sterling provides a complete view on how to track and manage Non-FFS reimbursement and how to capitalize on the financial opportunities of Non-FFS arrangements.