An external payer audit is an examination of a healthcare practice’s finances or processes conducted at the will of payers. These payers are either the government or a commercial insurance company looking to ensure correct payments were provided to the practices for past cases.

Government audits can be broken down even further into Medicare, Recovery Audits, and Medicaid audits. Whenever the payer has concerns about medical coding and medical billing, they may initiate an external audit process. In this blog, we discussed about basic guidelines to avoid external payer audits.

Reasons for Initiating Payer Audits

There are a number of reasons why any payer might initiate an external audit, the most common reason is a medical necessity. The providers may feel that his or her treatment recommendations are medically necessary. But if they are not documented properly, it’s an issue. The provider may explain all the reasons why the treatment was medically necessary, but the payer would want documents that would support them.

Another reason that would initiate external payer audits is using certain procedure codes and modifiers more often than your peers. It might happen with small practices or with solo providers, where providers themselves do the coding and use a specific set of procedure codes and modifiers without proper understanding of them.

Many physicians use the same level of service repeatedly. From the payer’s perspective, that means the physician isn’t paying attention to individual patient circumstances. If you almost always bill a level 4, you may trigger an audit. If your coding is accurate and the documentation supports level 4, that’s good.

But you should still be prepared to be audited because of this pattern, especially if you are using time as a component of selecting an E/M code, in which case a payer may ask you to share your appointment schedules to verify that the volume of longer visits is possible within clinic hours.

Guidelines to Avoid External Payer Audit

• Every practice should have an accurate medical billing and coding plan/ compliance plan in place and require regular internal audits to help identify areas of vulnerability. If an internal audit shows there may be a problem with a physician’s coding and documentation, you know you have a problem before the payer does. If you are billing the government, they want to know that you have a plan for submitting accurate claims, training people, policing yourself, and striving to do better. Many practices have portions of it or are following unwritten policies. That won’t cut it with an auditor. Your policies and plan must be in writing.
• The Centers for Medicare & Medicaid Services (CMS) wants to see evidence that providers are serious about compliance and take action to correct these problems. Providers should outline quality-assurance procedures, such as internal audits, which indicate they are monitoring coding and documentation compliance. The plan should also spell out consequences in a disciplinary action policy and remedial education plan.
• To avoid external payer audits, you should include staff training policies and requirements, the name of the go-to person in charge of compliance, and a Q&A log of coding questions that arise from physicians and staff in practice. This blog serves as your single point of truth for answers from credible sources that can be cited. Each time your team learns something from a reputable coding resource or gets an answer from a payer, it should be written in this log, which becomes a reference document for all staff, physicians, and new hires.
• To stay updated on billing and coding guidelines, billing, coding, and, documentation training for physicians, front desk staff, billing staff, and coders is essential. Arrange for it at least annually. And assign staff to attend webinars and read coding publications and Medicare transmittals.

The crucial thing is, if you get a request for records or audit, don’t ignore it. Take that request seriously and act quickly. If you don’t, you could end up in prepayment review, be excluded from a clinical network, or be subject to state and federal fraud statutes or state insurance laws.

Don’t wait until it’s a prepayment audit or huge refund request before calling, because at that point, it might be too late for optimal legal advice.

Another simple way to avoid external payer audits is outsourcing your medical billing and coding operations to a professional medical billing company like Medical Billers and Coders (MBC). We are a leading revenue cycle company and will be managing complete medical billing and coding for your practice.

We ensure that every claim is submitted accurately following payer-specific billing guidelines to receive accurate insurance reimbursement. To learn more about our services, contact us at info@medicalbillersandcoders.com/888-357-3226.

FAQs:

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• Improve Patient Care

The principal aim of the audit is to improve patient care, for example, by reducing unnecessary treatment and investigations, preventing iatrogenic disease, and identifying patients with continuing problems who have not been followed up. This can be achieved through agreement on methods of treating common conditions, adoption of standard policies, and regular reviews of departmental work.

The reviews can evaluate whether diagnoses and treatments are appropriate and should identify complications that could have been avoided. Ideally, each unit’s performance should be compared with agreed-upon standards, which take into account relevant factors, including the social composition of the population, case mix, provision of unrecognized regional services, and constraints on the service.  

Analysis and comparisons using accepted standards, performance indicators, and outcome parameters then become important stimuli in identifying areas for learning and improving patient care. The ultimate goal of an audit process is improved clinical practice, leading to better patient outcomes.

• Improving Communications

Many public complaints refer to poor communication. Inadequate notes and insufficient discussion with patients have recognized problems and are a significant factor in complaints that reach the courts. Audits have demonstrated how communication with patients can be assisted by producing written guidelines for junior hospital staff, printed information leaflets, and monitoring the recording of information given to patients.

The production of prompt discharge summaries facilitates communication with general practitioners. Some audit systems produce regular summaries as a by-product of data entry, and others monitor the delay in sending letters. The audit also identified the value of criteria for patient referral for general practitioners, thus reducing work at outpatients. Monitoring the quality of notes will facilitate the transfer of information to those nurses and doctors who see patients when on call.

• Professional Development

The audit can be a form of education, and formal sessions are increasingly recognized as an essential component of training in clinical skills. Consultants have a crucial role in postgraduate medical education. Training schemes based on learning by apprenticeship are often inadequate, and pressure is increasing for regular appraisal of both trainer and trainee.

The audit can contribute to this procedure and will likely become required to recognize training posts. The clinical audit enables surgeons to benefit from peer review and feedback, which can help them maintain confidence in their practice abilities. Case study analysis presents what has happened with patients admitted for care. Possible issues can be identified, and alternative practices can be discussed. Surgeons should be aware of the pattern of their practice and their performance so adjustments can be made to advance professional development and improve their services to the community.

• Organizational Improvement

The clinical audit provides the opportunity to confirm established processes resulting in expected outcomes and highlight potential problem areas within an organization. It involves capturing basic information about the day-to-day work of clinical practice to look closely, identify problems, consider and make changes, and monitor progress toward improved patient outcomes.

In a climate of resource constraints, the ability of audits to improve cost-effectiveness is attractive. Ineffective care is, by definition, expensive and precludes the provision of other services. The audit will identify areas that can generate cost savings without affecting patient care. Examples might include guidelines for the use of investigations, for the early diagnosis of illness, for standardized policies on drugs and consumables, and the reduction of length of stay by reducing complications.

A range of methods can be used in the audit performance. The increasing availability of PCs has made it possible for many more people to analyze data. There is an urgent need for data sources to be produced in a format that can be downloaded.  In the cases of hospital data, this could be achieved through direct communications systems. Other data could be made available on compact discs.

If the audit is to succeed, it must have the full support of management. This means that clinicians and management must agree that the prime objective of the audit is to improve patient care and not to reduce costs, regardless of the quality of service. There must also be the recognition that the audit takes time, which will not be available for other activities, and it will require adequate clerical support.

Refer: MEDICAL BILLING GUIDELINE

FAQs

1. What is a medical audit?

A medical audit is a systematic, critical analysis of the quality of medical care. It involves examining the procedures used for diagnosis and treatment, the use of resources, and the outcomes to improve patient care and clinical practices. The audit process follows a continuous observation cycle, setting standards, comparing practices, implementing changes, and re-evaluating performance.

2. How does a medical audit improve patient care?

Medical audits improve patient care by identifying unnecessary treatments, preventing complications, and ensuring patients receive appropriate follow-up care. By setting and comparing against agreed-upon standards, audits can help healthcare providers improve diagnostic accuracy, reduce medical errors, and adopt more efficient treatment practices, leading to better patient outcomes.

3. What role does communication play in medical audits?

Medical audits help enhance communication between healthcare providers and patients by identifying gaps in information sharing. This includes improving patient notes, discharge summaries, and referral criteria and monitoring how information is recorded and shared. Effective communication leads to better patient understanding, fewer complaints, and more coordinated care among providers.

4. How does a medical audit contribute to professional development?

Medical audits serve as an educational tool for healthcare professionals by enabling peer reviews and feedback. This process helps clinicians, especially surgeons, understand their care outcomes, identify areas for improvement, and adjust their practices accordingly. Audits are also increasingly recognized as a key component in postgraduate medical education and training.

5. What organizational benefits can be gained from medical audits?

Medical audits contribute to organizational improvement by identifying inefficiencies in healthcare delivery and suggesting ways to optimize resources. Audits help streamline processes, reduce unnecessary investigations, minimize complications, and improve cost-effectiveness without compromising patient care. Additionally, they promote standardization of practices and improve overall healthcare quality.

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A failed authorization can result in a requested service being denied, or an insurance company requiring the patient to go through a separate process known as “step therapy” or “fail first”. Step therapy dictates that a patient must first see unsuccessful results from medication or service preferred by the insurance provider, typically considered either more cost-effective or safer before the insurance company will cover a different service.

Prior authorization is a headache for patients and providers. It’s a time-consuming process:

Physician offices spend hours getting OKs from health plans to cover medications and specific medical procedures. The idea behind prior authorizations is cost savings. Getting authorization beforehand should ensure only appropriate procedures and medications are provided to patients.

A recent study in the “Journal of the American Board of Family Medicine” estimated that the mean cost per full-time provider for prior authorization compliance was between $2,100 and $3,400. Keep in mind, this figure accounts only for the provider’s time, not including the time of other credentialed staff and front office employees.

In 2017, the most recent year comprehensive figures were compiled, the average primary care nurse spent 14.1 hours per week on the patient prior authorizations and clerical staff spent 6.4 hours per week on prior authorization-related tasks.

Altogether, according to research published by “Health Affairs,” the annual cost of compliance with insurance-mandated prior authorizations is between $23 billion and $31 billion per year. It doesn’t take a CPA to tell you that keeping up with the never-ending prior authorization paperwork is a drain on your practice’s profit.

According to research from the American Medical Association, who analyzed a large number of claims for their 2013 National Health Insurer’s Report Card, not all payers are equal in their prior authorization burdens. Check out these statistics about the percentage of claims requiring  prior authorization:

Most prior authorizations involve imaging studies and medications, and the Government Accounting Office reports spending on advanced imaging studies has increased at a much more rapid rate than less expensive studies, which may be driving some of the increase in prior authorizations. On the other hand, the wider availability of inexpensive generic drugs reducing some of the paperwork burdens for medications.

Prior authorization is an unavoidable cost of running a medical practice, but there are some steps you can take to lower the drain on staff hours.

• Centralize the prior authorization process with just one or two staff members. This streamlines the procedure and facilitates forming personal relationships with major payers, making things move more quickly and easily.
• Familiarize yourself with your main plan formularies and develop treatment protocols around medications covered by the plan that doesn’t require prior authorization for the conditions you treat most, provided it’s medically appropriate for the patient.
• Use your EHR to capture demographic information and progress notes supporting medical necessity for use when a payer’s utilization review department will need it for prior authorization for advanced imaging studies and other procedures. Be sure you know the authorization criteria for each payer so your EHR form captures everything that will be required to get the approval.
• Evaluate your insurance contracts to see which payers require the most prior authorizations. If it’s a contract that isn’t a major part of your revenue, and it’s taking an inordinate amount of time in compliance, consider whether you really want to participate when it’s time to renew.
• Use the payer’s website whenever possible to get authorization; phone service takes much longer.

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Your front desk receptionist will most important factor for revenue growth through patient care and timely scheduling without any delay. According to the recent data taken on the survey of the patient’s one of the major reasons the patients find that the patients care was good by physicians are timely scheduling of patient appointment and continuous update from the front desk if the appointment changed.

Here Are Few Aspects To Improve For Your Front Desk

Convey Information

Particularly when the patient comes is not feeling well, a front desk has to listen and convey it on to the staff member or physician. When this is conveyed it makes the patient that they are been taken care of. A patient who is not well and again asked to repeat the same information over and over it affects the patient care. One of the simple information is to convey what the patient is saying will lead to better patient care.

The patient is not just a name on the schedule list they are the person who is not feeling well or needs their test to be performed asking them “How was your day?” makes them comfortable in the environment. It helps the patient relax and know that they will be taken care of.

Scheduling In Time

A particular patient might require more time than other patients who are sitting in the waiting area. A schedule for a patient appointment should be channelized in a way that the patients which usually require more time are scheduled in the latter part of the day. A good patient scheduling will help the back-office and physicians stay on point throughout the day.

Waiting Area Organization

Your front desk should keep an active eye for all the patients. Some patient might go unnoticed or forgot to sign-in. So keeping on the count of patients will help you keep your schedule on time. Here is an incident narrated by one of the patients “I went in for an appointment and waited for an hour. The front office was doing some kind of work and kept ignoring me. I was constantly going in asking the receptionist why is it taking so long but after a few hours a nurse noticed me and too me to staff.”

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Here are a few insights on patient engagement in value-based reimbursement:-

1. A different process for engagement

Every patient is a person and mostly isn’t happy while coming to meet you. The patient is looking for care, usually; the care results in one-way communication. Patient engagement is close to zero.

Some of the beneficial factor for physicians

1. Compliance benefited patients.
2. Improved patient diagnoses and fewer no-shows.
3. Better facility marketing.

A patient has a better engagement with physicians who are independent as it gives more time for you to spend with the patient for interaction and improve the engagement. For physicians working in a group, this could be the best reason to outsource medical billing so you can concentrate on your patient care.

2. Better cost engagement

Improved care utilization and systematizing the most effective service for the patient according to each engagement will enable you to put forth a better value-based result.  It will also add the necessary preventive service for care that would cut down on long-term costs.

3. Consistency in communication

You can be more proactive when it comes to approaching the potential group of employees or employers which might lead you towards getting a wider range of engagement for the practice. For a physician group it’s easier with approaching a group of employees and then an insurance company, this would lead to building consistent communication with a group of employees leading to better engagement with future patients on the value-based reimbursement for the procedures and diagnoses.

For consistent communication between the payers- insures and patients along with physicians their needs to be a flow of information from both sides which would get the reimbursement flowing.

Practices can employ a strategy which is “Take the wheel”. Follow the recommendations given by the payers to small practices that take the lead on messaging the patients. The particular program or intervention that a payer of a small practice.

For Example, if a patient needs a cancer-preventive program, the payer needs to cover it through out-of-pocket payment and the employer insurance will be willing to pay part of it. If all the stakeholders get in the loop even as the physicians want to see in continuous condition loop, and everyone benefits. The main example is to engage the necessary parties for better value-based care and patient engagement.

4. Patient Engagement

Patient portals can act as a technology bridge between patients and physicians which would improve the service. The IT companies will develop an advanced function such as a more user-friendly app to encourage more engagement with user-friendly apps that encourage engagement and involvement.   This will not only promote your patient engagement it will also help you keep track of the necessary components of patient care.

To improve your patient engagement under the value-based reimbursement model, you will need a team of billers and coders so that you promote your patient engagement without hampering your revenue.  For more info on medical billing click here or call us on – 888-357-3226.

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However, there does exist a bit of confusion with medical practices on whether the requirements of PQRS are fulfilled if attested to Meaningful Use. Most practice managers believe that once they attest to using Clinical Quality Measures (CQM) with Meaningful Use the requirements for PQRS are more than fulfilled. This is not true at all.

One is different from the other

PQRS and Meaningful Use are quite different from each other as each goes by sets of rules and regulations of their own. Both these incentive programs have CMS administering them and have no alignment to each other whatsoever. There are several EHR vendors who have recognized the administrative burden created by these separate entities and have adjusted themselves in accommodating the reports for both these programs.

The mad scramble to make sense of it all

With 2015 gone, there is a mad scramble by providers who are trying to make some sense out of the modifications done to Meaningful Use, though they were finalized in October 2015 itself. Notifications of penalty adjustments were sent out in November 2015 and Eligible Professionals who had earlier opted out of Meaningful Use are now busy reconsidering further participation.

With program penalty adjustments looming most providers are intent on meeting the revised objectives of CMS. There is a silver lining though; the MU program now has only 10 simplified objectives to report on as compared to 20 complex objectives earlier. This has eased the workflow to a considerable extent allowing the providers to get accustomed to participation in the MU program.

Know what category of data vendor you are

The first type or category of approved EHR vendors is the one that extracts data directly from EHR, also known as Qualified Direct EHR product. CMS has released a list of EHR vendors that clearly spells out the types of data vendors. The list can be viewed on the CMS website. A word of caution though, approvals from CMS for EHR depend on the version.

Hence, you need to be using an EHR that figures on the list while the one you have been using until now could be an older version that is not approved. In order to take advantage of dual reporting, it is better to upgrade to the new version at the earliest.

Specific Clinical Quality Measures

PQRS has limitations when it comes to reporting as it can report 51 specific Clinical Quality Measures. Hence it is important that any three of these measures match the specialty in Meaningful Use reporting. Moreover, the PQRS and NQS measure names and numbers need not be necessarily the same, hence care needs to be exercised while looking at the CQM list. As it is the current misalignment between PQRS and Meaningful Use programs there is a lot of confusion for providers.

CMS on its part has taken this into account and is working on making the alignment tolerable through its pilot program that was started in 2012. As more streamlining is required it is better to check and be sure that the requirements for Meaningful Use and PQRS are met. Although PQRS was an incentive in 2015, going forward it may turn out to be non-productive if the penalties are greater than the incentives, thus defeating the very purpose.

In case you are one of the Eligible Professionals seeing Medicare and Medicaid patients with incentive payments that are yet to be collected, you could be in the penalty phase already. You need to take advantage of the modified Meaningful Use program requirements in order to avoid dual reporting penalty payments.

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It is only of late that the healthcare industry has started taking steps in implementing proper systems for effective document management and online activities where a huge quantity of patients’ data is stored. Of course, cybercrime and security experts still believe that the medical industry sector is quite unprepared to counter attacks by cybercriminals. Although electronic health records and the various healthcare portals are a boon for providers and patients alike, they also offer an open invitation to prowling cybercriminals.

Ensuring that you only use a system that does not store any of the protected health information is a smart way to keep cybercriminals at bay. Once you have uploaded patient health information (PHI) to the EHR (Electronic Health Record) it is safer to ensure that no data is stored in the computer as there is absolutely no need to maintain such records. Also, when you are using an ERP system with the information stored in a local PC, it is better to encrypt all files and have them protected by strong passwords.

Most hackers have perfected their methods and can easily break into the networks of healthcare organizations. And it is up to the concerned IT departments to prevent such breaches by using the latest tools that are available. It may not be enough to spend huge sums on securing the perimeter by installing sophisticated firewalls and other antivirus software, all of which can be hacked easily by a determined hacker. The trick lies in adopting sophisticated technologies to counter and limit damages that can be caused by such attacks.

Keeping all the staff members well educated about the perils of cybercrimes is also very important. They need to be made aware about what constitutes HIPAA violation and what does not. Staff members also need to be wary about phishing activities that are targeted at hapless employees who often believe them to be harmless. Ensure all devices used by employees, including handheld devices like Smartphones, laptops, tablets, etc carrying sensitive information are encrypted. Prevail upon the employees on the importance of carrying personal devices that are suitably encrypted, discourage usage of any unencrypted devices.

While ensuring all electronic health records are well secured, it is also important to ensure that any sensitive information that is stored on paper is also safe and secure. Most employees use their own personal devices like Smartphones while at work, hence a strict mobile device policy should be in force, allowing only certain types of data to be stored in such devices. There should also be a check clearance on the types of apps that may be installed in such personal mobile devices. Using software specially meant for mobile device management makes good sense.

While using cloud-based services has come as a great boon for most organizations, it is the smaller companies that benefit the most from such services. However, entrusting sensitive data to third parties has its own risks and perils, notwithstanding the benefits accrued from the savings in costs. It pays to vet such third-party service providers diligently in order to establish their bona fides.

In conclusion, it is safe to assume that any organization, including healthcare companies need to keep up with technology. Hence using electronic health records is the way to go, though not at the cost of security. After all, the healthcare companies are running the same risks that credit card companies and banks (especially net banking) are undergoing.

About Medical Billers and Coders

We are catering to more than 40 specialties, Medical Billers and Coders (MBC) is proficient in handling services that range from revenue cycle management to ICD-10 testing solutions. The main goal of our organization is to assist physicians looking for billers and coders.

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Continuous efforts of the US towards enhancing the quality of the prescribing process have made Electronic prescribing an important part. E-prescribing has played a significant role in reducing errors and increasing efficiency, thus saving on healthcare costs. Most prescribing errors take place in an outpatient care setting which is largely dominated by paper-based prescriptions. This is the area with the highest potential for the system.

E-prescribing saw growth with the passing of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003. The system can be an independent one or is a part of the EHR. In the former case, providers can store only the data pertaining to the prescription while in the latter case, access to the entire patient history can be achieved.

E-prescribing is a way of using EHRs in a meaningful way in order to enhance patient care. Electronic transmission of prescriptions has resulted in reduced errors and fewer calls for clarification. It has decreased the reliance on handwritten, illegible notes. Streamlining of the workflow of clinical practice has increased patient satisfaction and increased compliance.

E-prescribing can go a long way in saving costs resulting from the increase in patient medication adherence.

Providers spend less time in resolving issues with pharmacies which include prior authorization and refills. The entering of prescriptions is a more streamlined process with the software allowing for automated processing. There is an increase in efficiency post-implementation of e-prescribing, largely due to less paperwork and fewer issues to be resolved.

Most e-prescribing systems include medication decision support (MDS), which helps providers avoid errors in prescribing and ADEs. Most of the e-prescribing systems have medication decision support which helps providers avoid errors in prescribing.

Despite the visible benefits of the system, many physicians are reluctant in completely adopting the system. The system to has a few barriers to the implementation that include the cost factor, system errors, legal issues, etc.

The biggest barrier has been the lack of financial support. Another major hurdle is the errors, in case the systems are not designed appropriately. A lack of alert specificity and overloading of alerts is the major error to deal with.

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There have been a number of changes related to medical billing this year. Many professionals will report that these changes are because of Obama Care.  Others may even state that the ICD-10 changes have created these changes.  While these changes may be easy for some, it is always important to remember that changes can create a lot of headaches if they do not work like they are supposed to.

No matter what, health care organizations must make sure that any of the applications that they use will actually meet the client needs.  So, if you work in the health care field you might be wondering what changes are taking place.  What are the trends that are being experienced?

Out of the Doctor’s Office

First and foremost, it is important to realize that billing is no longer taking place within the doctor’s office like it once was.  In fact, it has started to make its way into the hands of professional medical billing services. This will certainly decrease the amount of work on employees and it can also increase the market for medical billers that would like to start their own business.

Many professionals may find that this is a great way to increase the amount of money that they are making.  This is because these companies are well aware of what the insurance companies are looking for.  They will ensure that the billing is accurate the first time.  They can even help negotiate with the insurance companies because this is their area of expertise.

Finding Mistakes Early

It is now possible to find mistakes in billing before you ever send out a claim.  This is because there are number of practice management software in the market that allows you to do this.  In fact, they will carry out a scan of the medical chart and find any missing modifiers that could hold up a claim.  They are also going to be able to scan the patients chart and compare CPT codes.

If you have not moved your billing out of the office then you might want to strongly consider a program like this.  Doing so can increase the amount of reimbursements that you receive each time that you do your billing.  It will also free up your time so that you, and your staff, can focus on patient care.

Making Payments Easy

It goes without saying that more and more people are looking for ways to use the internet in their everyday lives.  It has certainly made some things easier.  According to the Healthcare Billing and Management Association, one study showed that the same is true when it comes to paying for healthcare.  In fact, this study showed that 72% of patients would like to be able to make their healthcare payments online.  Because of this, billing companies may need to make arrangements in order to meet the expectations of the patients that they are billing.

Protection is a Must

Because the internet is so important, privacy and protection becomes even more vital.  Therefore, there must be policies and procedures in place to protect all of the patient information that is going to be making its way through the cloud.  As individuals use the internet to make payments there must be ways to stop breaches in data.  Medical billing companies are going to be required to ensure that credit card protection is taking place at all costs.

According to the Healthcare Billing and Management Association, there may be new EMV standards.  These will require those that issue credit cards to include a chip that is going to give an extra layer of protection.  This will go one step above the magnetic strip that is currently found on the back of credit cards.

It is easy to see that there are many changes coming.  Just because things could become easier does not mean that it will be without complications.  Organizations and businesses must work together.  Even though professionals want to be paid, the patient security and privacy should always come first.  All of the changes have specific benefactors in mind.  However, in order for them to be effective, they should work together with the patient in mind.

Author Bio

Daniel Schwartz is a content strategist who sheds light on various engaging and informative topics related to the health IT industry. His belief in technology, compliance and cost reduction have opened new horizons for people in the health care industry. He is passionate about topics such as Affordable Care Act, EHR, revenue cycle management, and privacy and security of patient health data.

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Added to these changes which has been enacted to lower healthcare expenditure but improve the healthcare of patients – increasing the number of Americans who will now have to have insurance thereby increasing the footfalls, but shifting from certain basic models of payment like from fee-For-Service to Value-based performance, and to Shared Savings Model along with Episode or Bundled Payments,  and above all the transition from ICD-09 to ICD-10 coding and billing services, has caused physicians to shoulder a lot of administrative tasks which now includes more accurate kind of documentation which causes more time to be spent on patients, thus bringing them to interact with fewer patients leading to drop in reimbursements. So how can physicians get engaged in a more positive way within this healthcare revolution scenario?

• Participation & Leadership Skills: Physicians working in hospitals or privately practicing need to realize that leadership skills are one way to tackle the delivery of better healthcare. Once physicians know better methods on how to deal with certain ways of streamlining processes, they can then be better able to delegate tasks and responsibilities and concentrate more on the delivery of healthcare, thereby more in tune with the reforms which will bring in more footfalls. Also, physician participation in healthcare activities within an organization helps physicians understand where change is required and what can be done within a given set of parameters.
• Creation of Integrated Practice Units (IPUs): Each department should have their own integrated practice units which comprises of physicians, nurses, and even non-technical people. This helps them focus on their specialty and reduces duplication of efforts, better coordination between physicians, technicians, etc. at each phase of the healthcare process
• Training and Workshops: Holding training and workshops for physicians where understanding of the new regulations and reforms and how value-based performance can still help them up their earnings will go a long way in engaging physicians. Moreover, via these workshops, physicians share problems encountered and also strategies that have helped them overcome such problems, helps bring a more united way of working towards a better healthcare delivery system

Keeping the above in mind, physicians if engaged in the crucial activities at the beginning of change, will be able to hot spot the problems and solutions, and take forward the positive changes that the healthcare reforms have been initiated for towards lowering the healthcare costs and increasing the value of the healthcare given to the patient. The focus for both, the reforms and the physician is the same; the means to the end are panning out differently and needs to be brought back on track.

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