fee for service

How well a provider succeeds in three performance areas is the basic element of eligibility. One is the quality of care provided to Medicare patients. The second area is following clinical best practices.

Securing Maximum Levels of Reimbursement from CMS

The centers for Medicare and Medicaid services (CMS) developed a value-based purchasing program (VBP) in 2013 in an effort to provide hospitals and clinics with incentives. Those organizations that meet all specified criteria and measures for four areas will receive bonuses. Those that fall short will be penalized. The goal is to reduce costs for Medicare and Medicaid reimbursements.

Moving Forward

The process of moving from the traditional fee for service reimbursement program to value-based can be arduous when attempted in-house. If it was simple, hospitals would have achieved improvements in efficiency and quality of care well before the development of the new program. Understanding the three performance areas, four domains, and twenty measures used for eligibility is the key to a successful transformation. A unique approach of products and services has proven to assist large medical centers, small community hospitals, and even physician clinics in the process of moving forward.

Performance Areas

How well a provider succeeds in three performance areas is the basic element of eligibility. One is the quality of care provided to Medicare patients. The second area is following clinical best practices. The degree to which the provider keeps up with and utilizes best practices is an ongoing process as they change often. The last one is steps taken to enhance the experiences of patients requiring hospital stays.

Where to Begin?

The details of eligibility requirements for all criteria are outlined in the CMS program, as are the bonuses and penalties. The difficulty is developing and implementing facility wide changes to meet the criteria. Outcomes improvement is the goal of one approach that combines education, software and platform products, and professional services to assist providers in securing maximum levels of reimbursement from CMS.

An advanced data warehouse is accessed via a platform. Over one-hundred software and analytics applications in a variety of topics and uses are available to clients. Professional services help clients identify and implement changes for increased improvement throughout the facility. Request a free demonstration of the program to see how the total approach works in all departments. Reducing costs, increasing efficiency, and earning CMS bonuses are possible with some outside assistance.