Steps added to revenue cycle management due to Afforadable Care Act

The components that make up revenue cycle management (RCM) are quickly changing, and it is being driven by healthcare reform.

Pay-for-performance programs, medical home initiatives, a push toward accountable care, and growth of high-balance patient deductibles are new layers to the traditional revenue cycle that included patient scheduling, registration, and insurance eligibility verification; medical billing; and third-party collection concerns.

"The revenue cycle is evolving," says Kenneth T. Hertz, FACMPE, principal at MGMA Health Care Consulting Group.

"To maximize revenues and ensure you receive what you are due based on the highest level of care, your attention is going to be spread among more factors now," Hertz adds.

Primary care physicians (PCPs) need to prepare for the future of RCM, some of which is already here today, he says.

TECHNOLOGY KEY TO PARTICIPATING

"Adopting technology will be an essential element of successful participation in some of the new reimbursement programs that are likely to emerge," says Samitt, who is a member of the Medicare Payment Advisory Commission. "PCPs are going to want to rely on technology, processes, medical homes, and other things to ensure they can deliver better care and then report on it."

"There is a certain extra cost involved in providing services that a medical home provides," he says, "including extra staffing, extra time and effort contacting patients, and making sure the get appropriate follow-ups."

Nonetheless, Foster says he welcomes healthcare's move toward a pay-for-performance reimbursement model because he believes it will allow good doctors to be rewarded financially for providing superior care.

"For years, we paid for procedures, not outcomes," he says. "We paid for visits, not outcomes. Now we're transitioning to paying for improved care. I think that's where it should go."