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The Merit-Based Incentive Payment System

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Independent health care providers are facing more challenges than ever before. With changes in payment models and reimbursement methods, competition with a large group of employed physician practices, and changes in patients’ insurance coverage, a practice can be at risk for decreased revenue and increased financial instability. Fortunately, having an efficient Revenue Cycle Management (RCM) process and integrated electronic health records (EHRs) can help mitigate financial risk.

Whether we like it or not, reimbursement policies for physicians and their practices are changing. To stay relevant, independent healthcare providers must keep up or get left behind.

A recent article in Healthcare Dive touches upon today's ever-changing regulations …show more content…
Healthcare professionals and physicians alike must now focus their efforts on understanding the end of the SGR formula and the beginning of the Merit Based Incentive Payment System and Alternative Payment Models.

The Merit-Based Incentive Payment System (MIPS) combines parts of PQRS, the value-based payment model, and Meaningful Use while also adding a new performance category for eligible providers. MIPS is intended to simplify the scoring process for eligible providers but is also adding significant pressure on providers to meet higher standards in order to get reimbursed.

In addition to adjusting to new regulations like MIPS, practices are also facing an increase number of insured patients with high deductible health plans resulting in a growing number of self-pay patients. Independent practices must continue to provide the highest level of care while also adjusting to these changes and reinventing revenue cycle management strategies to effectively collect …show more content…
Clinical integration is not a one time activity or having the technology in place but is instead an ongoing process that should ultimately improve quality of care, improve access to care, and reduce the cost of care.

Unfortunately, care coordination is the biggest challenge for health systems to achieve population health management according to a healthcare leadership survey by Philips.

Having access to an EHR that can assist with care coordination initiatives and data exchange can kick start your practice's clinical integration efforts while also resulting in better patient outcomes. According to the Robert Wood Johnson Foundation, patients who are actively involved in their own healthcare manage their conditions better and tend to stay

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