decisionhealth Newsletters, Part B News - 2014 Issue 11 (November)
Work with outside practitioners, patients to head off value-modifier cut
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Article Overview
This article explains how CMS quality reporting and cost attribution can affect a practice’s reimbursement, especially when patient care occurs outside the practice. It discusses how providers can review reporting data, identify higher-impact patients, and strengthen coordination with patients and outside practitioners to better align care management efforts. The piece is aimed at physicians, practice managers, and coding/revenue cycle staff who track quality reporting, value-based payment impacts, and care coordination initiatives.
Why This Topic Matters
Because CMS attribution and value-based payment policies can shift financial responsibility based on care delivered across settings, practices need to understand their reporting data and collaborate more effectively with patients and other care partners.
Article Sections
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Quality reporting
Introduces CMS quality and cost attribution concepts and explains why reported performance can affect reimbursement. It also outlines the general context for how patient care outside the office can influence practice-level results.
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Start with your patients
Discusses broad ways practices can focus on patient outreach, care coordination, and use of reporting data to identify patients who may drive higher cost and utilization. It also addresses communication approaches for different patient groups and the role of coordinated care programs.
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Work with outside providers
Covers collaboration with other practitioners and care partners involved in a patient’s treatment. The section emphasizes general coordination, relationship-building, and shared attention to patient care across settings.
What You Will Learn
- How CMS quality reporting can affect practice reimbursement
- Why patient care delivered outside the office matters to attribution and cost measures
- Ways practices can use reporting data to identify patients for outreach
- General approaches to coordinating with outside providers and care partners
- How patient engagement and care coordination fit into value-based care efforts
Who Should Read This
- Physicians
- Practice managers
- Revenue cycle staff
- Quality reporting staff
- Care coordinators
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