Updates from your ACE team
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Expand your practice to achieve financial independence
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Revenue leakage is something every FQHC should avoid, as it can significantly impact your cash flow and bottom line over time. If you have a high self-pay balance, aren't using quality measures, or haven't reviewed your 340B pharmacy model lately, you could be missing out on revenue. This month we'll focus on all of these.
We'll also take a look at a recent report by the Kaiser Family Foundation detailing community health center funding sources and how they're used. This is timely, since the Community Health Center Fund (CHCF) is due for extension in September, and the National Association of Community Health Centers (NACHC) has been lobbying for increased funding. To support this effort, NACHC created an infographic highlighting the substantial contribution made by health centers to the economy - we share this below and want to thank you for your service to our communities!
CMS has also been busy, announcing new initiatives focused on primary care, technology, and integrated care - these will change the way FQHCs will be reimbursed in future, and reinforce the importance of transitioning to value-based care. We'll definitely be keeping an eye on this space - to stay updated on the latest, follow us on
LinkedIn!
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Improve patient care and generate revenue!
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Value-based care....the way of the future
Last month we discussed the growing importance of adopting a value-based approach. If you're not already using coding (CPT, DX, HCC, RxHCC) and HEDIS quality measures to quantify the quality of patient care to payers, time is running out
.
Payers across the board are rewarding facilities that provide adequate data on patient conditions - and
those who don't will experience revenue decline
through changes in bonuses, star ratings, and pay-for-performance (P4P)
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CMS has announced that the payment year (PY) 2020 hierarchical condition category (HCC) risk adjustment model will use the Alternative Payment Condition Count (APCC) model for blended risk score calculations. For PY 2020, risk scores will be calculated as follows:
- 50% using diagnoses from encounter data, fee-for-service claims, and Risk Adjustment Processing System (RAPS) inpatient records under the APCC model (Medicare Advantage model)
- 50% calculated from all RAPS records and fee-for-service claims under the 2017 CMS-HCC model (your present model)
Why is this important? The model focuses on the number of conditions that an individual beneficiary may have,
with the model adjusting as the number of conditions increases. It relies
on detailed coding and measures to provide a full picture of patient condition and treatment plan; if these are not accurately recorded in the billing system, there is a financial impact:
- Payer – less funding for patient
- Patient – reduced coverage so greater out of pocket cost
- Facility/provider – no bonus payment, potential loss of insurer-allocated patients or cancellation of contract with insurer
But it goes beyond coding and quality measures...
In a
recent article, RevCycleIntelligence predicted that
most value-based contracts will include risk for providers within 3-5 years. And last week, CMS released its Primary Care First (PCF) initiative, which aims to improve patient care while managing health care costs. The initiative provides new payment models for providers to boost management of patients with chronic illnesses and avert higher hospital costs. In return for a level of financial risk, providers will gain a more predictable revenue stream and reduce health care provider burden.
NACHC is currently reviewing the initiative to determine if/how health centers can get involved.
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Retroactive Medicaid: are you missing a revenue puzzle piece?
Over the past few months, we've discussed how to seek retroactive reimbursement for your self-pay billing claims rather than just writing them off, and we've been seeing great results so far for our clients.
With nothing to lose and unpaid revenues to gain, this is an ideal way to generate additional revenue quickly!
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340B pharmacy training - helping FQHCs maximize program benefits
If your 340B pharmacy isn't a revenue powerhouse,
contact us
!
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Media watch and other useful info
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Sources of health center revenue
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Funding FQHCs helps the economy!
With the CHCF due for extension in September, NACHC has been lobbying for increased funding. Over the past couple of months, they've released several reports and documents highlighting the value that local community health centers provide to the nation's healthcare system. In their latest
infographic, they show a compelling story of how funding brings healthcare where it otherwise wouldn't exist, while at the same time generating economic gains.
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Strategic Plan
HRSA recently released their Strategic Plan f
or FY 2019-2022, with an increased focus on using technology such as telehealth and artificial intelligence to
address critical gaps in health care access and services for underserved populations. Read the entire plan on the HRSA
website.
Stay up to date with HRSA's latest news.
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CMS: Podcast Episode 2
CMS has released the second episode of their
podcast
, CMS: Beyond the Policy. This episode highlights some of the key perspectives from participants at the 2019 CMS Quality Conference in Baltimore, Maryland which had a theme of “Innovating for Value and Results.”
Reference
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