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Difficulty in Adopting the Fee-for-value Billing Model

Jan 24th 2014 at 11:01 PM

The alarming inflation of costs in the US healthcare domain is the prime cause for the emergence of the fee-for-value medical billing model. It is a quality-driven model, in which physicians have to render superior-quality healthcare services for proper reimbursement. In recent times, most healthcare providers have started implementing this medical claims processing model in the aim of reducing the rising healthcare costs. However, there are certain difficulties in adopting the fee-for-value billing model in a practice which is used to the traditional fee-for-service (FFS) model. They are as follows,

Impact on Normal Workflow: The transition to the fee-for-value billing model from the fee-for-service model is not a simple task. Although this model is supported by various private health insurance plans and government health insurance plans like Medicare & Medicaid, a lot of challenges are involved in implementing it. Since quality is the prime goal, Providers will be expected to spend more time with their patients. Therefore, medical billing and collection processes will definitely get affected badly. The same thing happens as the number of patients increase due to the reducing healthcare costs and universal coverage.

Increased Documentation: Revenue cycle changes and new operational challenges involved in the fee-for-value medical claims processing model have increased the documentation and medical billing and collection services eventually.

Training and Costs: As a result of increased documentation, Healthcare Providers will be expected to train their medical claims processing staff about the new billing model. Training the in-house billing staff will cost considerable revenue for Providers. Also, time involved in training is more, which eventually affects the normal workflow of physician billing services.

Care Coordination: Sometimes, patients with serious health issues will get treatment from multiple physicians, including anesthetists, Cardiac specialists, and more. In such an instance, coordinating care under the fee-for-value model would be a task that involves considerable time and expertise. Accessing patient information across multiple practices should be made simple and easy.

Reporting: Medical claims processing is equally challenging as coordinating care among multiple Providers. ‘Who to bill?’ and ‘how to bill?’ are a few questions that arise when it comes to processing claims for multiple care providers.

To reduce the inflating healthcare costs and render high-quality patient care services, Providers must overcome the challenges involved in the fee-for-value medical billing model. However, the time involved in implementing this new payment model cannot be compromised for medical billing and collection services. Therefore, the prudent choice would be medical billing outsourcing. Providers can get help from a renowned medical billing company like MGSI.

About MGSI:

MGSI is a highly reliable, national medical claims processing company based in Florida. With more than 22 years of experience in the healthcare domain, MGSI has been providing quality physician billing services to its clients. It takes care of your medical billing and collections while your in-house billing team gets accustomed to the fee-for-value billing model. For more details, log on to

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