How Value Based Care is Changing Your Revenue Cycle

by: Jennifer A. Geoppinger

Be PreparedA practice’s rejections and denials are a key piece to keep cash flowing swiftly for the practice. So is office workflow. But with the looming change to value based care coming, there are certain key areas that practices should be watching for to ensure minimal impact to their revenue.

None of the items pointed out today are new philosophies in the revenue cycle management industry. They are, however, becoming more than just key points to highlight, but imperatives that need to be implemented now to prevent losses in the future.


As we have written in previous blogs, provider credentialing is a key piece to prevent revenue loss. Not having a new provider fully credentialed before they begin practicing ensures that the practice will be writing off visits. This can be for a particular payor, or payors, if the new provider sees patients with these plans despite not having an effective date. Therefore it is critical to make sure your new providers are credentialed prior to seeing patients. Also, current providers’ credentialing status should be checked to ensure everyone is up to date. When Value Based Care reimbursement begins, regular quarterly check-ins on credentialing status should be established for each provider in your practice. Staying on top of your provider’s effective dates will be key.

Rejections & Denials

Rather than simply working your rejections and denials on a daily basis, you should also be trending which rejections and denials are flowing into the practice. Categorizing both rejections and denials into various batches will help you identify pain points in your practice and get them resolved now.

  • Are you constantly having to correct a provider’s NPI? Go into your EMR system tables and get it updated.
  • Are there consistent denials for medical necessity? Make sure providers are following proper diagnosis and procedure code combination guidelines.
  • Running into patient demographic errors? It’s time to work on your communication between your front and back office.

Us vs. Them

Retire the divide between front and back offices

Speaking of front office vs. back office, it is time to start thinking of them as one in the same. You need to ensure communication between the billing department and the front desk flows seamlessly. Missing authorization numbers? The billing department can show the front desk how to make sure they are entered correctly. Eligibility issues? The front office can update the billing department on a patient’s benefits to help reduce rejections and denials. Now is the time to stop thinking of your office as us vs. them, and start thinking about how everyone can work together to get clean claims out the door daily.

Value based care is changing the way providers are reimbursed for their services. By implementing just these few practices now, you will help avoid payment delays as it goes into effect in the future.

Need help implementing these items? Contact us today for more!

The 5 keys to RCM


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