It’s Time Value Based Payment in Otolaryngology
ENT revenue management will focus on the shift from fee-for-service (FFS) to value based payment, which will certainly turn out to be quite dramatic. The need of the hour is for the physicians to understand payment reform and make necessary plans to adapt to the new conditions. ENT billing services like all others know that the ENT physicians need high productivity along with better value.
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It is all about sharing risks and not ignoring the need to share the savings as well, which is the focus of new models including ACOs (accountable care organizations). That is probably why more and more private players are opting to enter into contracts that are similar to ACO ones. However, for small practitioners and those who practice on their own (solo), pay for performance models may not be the answer to value based reimbursement.
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The ENT billing guide based on Pay for performance models are primarily meant to reimburse physicians on clinical and cost-saving effects rather than for services rendered and procedures carried out. PCPs are not on a mission to help patients deal with their chronic maladies and avoid hospitalization whenever possible and do not prescribe a string of tests that are quite unnecessary, nor do they prescribe branded drugs that are expensive.
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Although there is an emphasis to persuade physicians to adopt these payment models, most of the physicians and small practice owners are not very sure how well it will suit their size and level. Until very recently ENT and other primary care physicians have had only paltry earnings based on performance measures as per the physician compensation and production survey conducted by the Medical Group Management Association (MGMA). www.medicalbillersandcoders.com info@medicalbillersandcoders.com
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