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Coordinated Care and its Effects on Physician Billing

Feb 27th 2015 at 3:05 AM

In order to put an end to the duplication of physician care services and inflation of healthcare costs, the Affordable Care Act (ACA) introduced a cost-effective and patient-friendly healthcare model. It is called the ‘Coordinated Care’ or ‘Integrated Care’. From the Providers’ viewpoint, implementing this model would be quite challenging as the medical claims processing for integrated services is complex. To get the best physician billing solutions, outsourcing medical billing and collections could be one of the options to be considered. Let us delve more into the details of coordinated care and its effects on physician billing:

What is coordinated care?

Several models were introduced under the Coordinated Care including Accountable Care Organizations (ACOs) and bundled payment initiative. When a group of healthcare Providers and Facilities work together to provide patients with high-quality care, then it is called coordinated care. In other words, Providers and healthcare Facilities will receive a single payment for rendering a group of services during an episode of care. They are also eligible for incentives and benefits if they excel with outcomes, which would be the patient’s recovery to optimal health. The ultimate goal of this model is to offer patients with the best care when they most need it, by avoiding repetitive diagnostic tests and medical services. It also helps in avoiding unnecessary hospital admissions, emergency room visits and more, which are the causes for healthcare cost inflation.

The Downside:

The medical needs of each patient vary widely. Some patients will barely need any medical assistance, while others suffer from chronic conditions requiring multiple healthcare services. Such patients with complex needs might visit more than 10 Providers with varied specialties. In these cases, not only is the care coordination challenging, but also the medical claims processing part.

Problems Involved:

· With so many changes like 5010 conversion, impending ICD-10 implementation etc in the healthcare industry, performing medical billing and collections in-house has become a herculean task.

· In addition to these revolutionary changes, the coordinated care medical claims processing has made the situation more complex.

· Providers are facing a tough time managing both patient care and in-house medical billing and collections teams.

· Billing the claims of patients with chronic health conditions are even worse, as the error-rate is high due to the complexities.

· Struggling with the in-house medical billing and collection processes has diverted many Providers and healthcare Facilities from focusing on their core job of patient care. This has kept them from enjoying several benefits and incentives offered by bundled payment and ACO models on attaining a certain target.

Thus, the coordinated care has a great impact on physician billing although it has various advantages. To avoid medical errors that are frequent in coordinated care, Providers should outsource medical billing and collections.

About MGSI:

For the best physician billing solutions, look no further than MGSI, a reputed outsourced medical billing company in Florida, US. With more than 21 years of experience in the healthcare space, this national company has been providing end-to-end medical claims processing services. MGSI can take care of all your coordination care services and provide cleaner claims. To learn more details, log on to .

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