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Accountable Care Organization, ACO, healthcare providers, MIPS reporting services, Quality Payment Program, MIPS reporting, MIPS 2021 reporting, ACO reporting, ACO 2021 reporting, payment incentive program, MIPS Qualified Registry, mips quality measures, mips data submission, doctors, healthcare

Why Becoming ACO Improves Your Quality Payment Reporting?

Overview

ACO or Accountable Care Organization is a group of doctors, hospitals, medical centers, and other healthcare providers. This unit works together to care for and look after a patient’s health. Their main goal is to improve the quality of care for patients. Ultimately, these add up to clinician’s MIPS reporting services, ACO reporting, or Quality Payment Program.

They are usually responsible for people under Medicare, which allows those patients access to a more coordinated care type that is cost-effective.

How Does It Work?

The main goal of an ACO is to provide you with the best healthcare services possible by a team of clinicians. It consists of

  • Primary care doctors and specialists
  • Hospitals, medical centers, and long-term care providers
  • Local services

Together they find the best solutions for your health issues and submit efforts for rendered services as MIPS 2021 reporting data or ACO 2021 reporting data.

It is also the reason why this type of care is better for patients with chronic illnesses, as they require consistent or regular checkups.

The provider considers your health conditions, consults with the team, and gives you the available treatment options. It can be in the form of medications, tests, procedures, preventative measures, etc.

A point to remember is that you can question your care at any moment. There should be transparency between you and the team working with you, and ACO reporting services reflect that.

Advantages for Patients

There are a lot of benefits that patients can get from becoming a part of an ACO, such as:

Better Quality of Care

Easily the most important one, ACO coordinated care is better for most patients as it allows their doctors to share information. This way, they know what they get prescribed for their particular health condition. Moreover, this adds points to the ACO 2021 reporting as a payment incentive program.

Transparency

There is complete transparency between you and your team of clinicians. It is understandable as all of us want to be informed about anything to do with our health.

Your doctors have to tell you everything about your care, including

  • Medical procedures they might need to perform
  • Your medical history
  • Your illness(es) or conditions (those that already exist or the ones that might be a side effect)
  • Prescribed medications

You are also free to ask them anything you believe you need to know regarding the treatments you are going through. It empowers patients and allows you to score more via ACO reporting services or a MIPS Qualified Registry.

Cost-Efficient

If you have different doctors for different conditions, there might have been times you had to get the same test done multiple times. Or you were given a medication that the other didn’t think was necessary. It can be troublesome as it increases your overall healthcare costs and makes you spend more money than required.

When you are a part of an ACO, your doctors can contact and communicate with each other. This way, they are updated on all of your medical histories and can work together with you to find the best solution for your health issues.

They know who prescribed what, when, can discuss if there is a better alternative, etc. It prevents you from spending time and money on unnecessary procedures and medications, which is one of the purposes of the ACO 2021 reporting.

Accountability

There is a higher rate of accountability among ACO-affiliated healthcare providers. That is because you can question them at any step, and they are also supposed to communicate with you about everything.

Another thing is that an ACO is required to show that a team is working for your care. They have to show that you are getting everything you need, even the preventative measures such as screenings or shots. They get assessed upon 23 quality measures, and if they are diligent with your care and remain in touch with you, they get rewarded.

Option of Care Coordinator

If you are unsure about the care provided for you, then you can get a care coordinator. It can be someone like a social worker or a nurse who can help with the procedures you are going through and act as a liaison between you and your healthcare team.

They can also monitor, evaluate the care provided, and even supervise or bring together the specialists you might require.

How to Become a Part of ACO?

There are a few ways you can come under the care of ACO, such as,

Joining Through Your Doctor

If your doctor is a part of an ACO, then you can be assigned to their ACO. Also, the ACO itself should inform you if your doctor is a part of one and explain how it will affect your care.

No Changes Required

You do not need to change your primary doctor or even others that are currently working with you. It is perfectly acceptable for you to continue with your preferences, as you are free to go to any healthcare provider, you choose. Moreover, from physicians’ point of view, their quality payment program shifts to ACO reporting services.

to services to require data without using any services as per the environment.

Conclusion

There are advantages to becoming a part of an ACO, as stated in the benefits above. The main thing is that there is communication between you and your healthcare-providing team.

But what you need to remember is that it is not necessary. You can say no when it comes to sharing your information and even change your team of providers if you think they are not the right fit for you. However, as a physician, what’s important is that you gather information accurately and consult ACO reporting services to handle your administrative load for quality data submission.

healthcare services, healthcare system, healthcare standards, healthcare payment model, healthcare providers, ACO, Accountable Care Organizations, Medicare and Medicaid Services, physicians

3 Types Of Payment Models, Physicians Probably Don’t Know!

Value-based healthcare services have not only changed the patients’ healthcare standards but also the physicians’ payment model. Value-based reimbursement models encourage clinicians to adopt methods that make healthcare easy and efficient. Programs like MIPS & MACRA and more depict a value-based care system and allow physicians to achieve rewards and bonuses. The purpose is value-based reimbursement models are too.

  • Straighten up physicians’ revenue cycle management
  • Make patients empower the healthcare system where they choose their desired service

We have heard many of the benefits and the need for value-based healthcare models, but the proper information about the available models is not very common. Let’s review that.

What are the Available Value-Based Care Models?

There are a few types of value-based payment models with a variety of risks attached and benefits.

1. Accountable Care Organizations (ACO)

It is a system of hospitals, clinicians, and other healthcare providers to provide organized and high-quality services to Medicare beneficiaries. This entity helps patients receive up-to-the-mark services at the most appropriate time. So, it means that in case of emergencies or other scenarios, patients don’t have to wait to get to the relevant doctor.

This organization ensures that patient only bears expenses for those services that are absolutely necessary to treat an illness. Moreover, they reduce the redundant medical services by eliminating medical errors that occur while diagnosis or treatment.

Healthcare providers volunteer in this program to get shared savings if the ACO fulfills the standardized healthcare criteria with reduced expenditure.

Risk Factor Involved in ACO

It is not like ACO volunteers always end up adding a bonus to their revenue cycle, but the financial risk is also involved. When able to meet the requirement, physicians have a jackpot, but on the other side, they also have to bear shared losses if any.

For shared loss, healthcare providers have to pay Medicare as compensation for not delivering value-based care to patients.

This value-based reimbursement model is not just about value-based medical procedures but also supports volume-based services. However, the evaluation is based on quality, safety, and experience.

2. Bundled Payment for Rendered Services

This payment model pays physicians not for each service but as a whole series of services. Clinicians receive collective reimbursement for treating a medical condition, including all the charges for physicians and the types of rendered procedures.

For Instance,

If a patient undergoes a surgical procedure, CMS (The Centers for Medicare and Medicaid Services) sets a collective payment for surgeons, an anesthesiologist. It then pays a total amount rather than paying separately to each clinician.

Risks Attached with Bundled Payment Model

This type of payment model same as the ACO also has a certain level of risk involved. Physicians get to fill their pockets when they collectively reduce the incurred cost. Otherwise, they get will have to bear the loss.

Thus, this practice requires standardized procedures so that, all stakeholders get the rightful reimbursements.

3. Patient-Centered Medical Homes (PCMH)

It represents the healthcare payment model in which a primary care physician coordinates the patients’ healthcare. This payment model manages and handles all the needs of the patient in a centralized setting.

Its certification highlights that the physicians are capable of providing healthcare in a patient-centered setting with team-based methods. Moreover, it also ensures consistent care quality for patients.

Patients can develop a one-to-one relationship with their physicians, and it governs the medical and environmental factors.

This payment system has shown great potential in reducing unnecessary cost expenditure. According to a Maryland – based PCMH, via the efficient practice of this reimbursement model, they were able to save up to $98 million and enhance their quality standards by 10%.

Alternative payment methods other than the fee-per-service are not very popular practices. However, physicians are unable to meet their financial requirements. Thus, they are devising ways to incorporate new technologies into their system to speed up the workflow.

Conclusion

Yes! Different payment models allow different facilities against which healthcare service providers can improve their revenue cycle management. However, with flexibility comes various responsibilities and administrative load!

Clinicians can take help from a medical billing services company to optimize their payment in these matters. Of course, the focus of the healthcare industry is on value-based services and it should not be taken lightly at any cost. So, no matter whatever method you choose to associate yourself with, you must comply with all its requirements to survive.