The healthcare industry is always on the move, old conventional reimbursement patterns have evolved to incorporate quality-based healthcare. CMS along with many commercial payers collect quality data reported by providers, publicly available through star ratings and physician compare portals. CMS & NCQA are two major monitoring bodies that play vital roles, resulting in either a reward or penalty, based on the quality of service they provide to their patients. These results directly affect the reimbursements that are issued to health care professionals. PQRS, MIPS, MACRA, HEDIS, PCMH, PCSP, GRIP, Meaningful Use, value-based Modifier, and Pay for Performance are all examples of advanced quality-based healthcare programs. These programs assist healthcare providers to effectively adapt to today’s advancing technology and improve overall patient health.
With the ending of the Sustainable Growth Rate, the Medicare system has taken a strong stand on monitoring the quality of health care through MACRA, MIPS, and Advanced APMs starting 2017. CMS is working hard to track provider performance on one end, while NCQA monitoring a complex chain of quality programs on the other. There are entire systems of data gathering, reporting, and performance measurements in place to impact reimbursements through different payers. With revenue cycle management and the time consumption associated with it, the process can become lengthy and complicated. P3 Healthcare Solutions steps in to combine both value-based quality programs and a revenue cycle management that simplifies and translates requirements into practical solutions. P3 solutions will ensure a hassle-free and smooth process, leaving the provider with only the patient to focus on.