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Healthcare reimbursement questions to ask during a time of uncertainty

Healthcare reimbursement questions to ask According to a March 2016 report by the Department of Health and Human Services, an estimated 20 million more Americans have health insurance coverage as a direct result of changes driven by the Affordable Care Act (ACA).   The influx has payors scrambling to meet coverage demands, while providers and provider organizations simultaneously navigate the murky waters of reimbursement codes.

As the healthcare industry morphs from the traditional fee-for-service to the patient centered model, organizations will be tasked with understanding how to develop workflows that measure financial and quality performance for each patient population and its respective needs.

While data enables providers to set the standards of care and tailor needs to specific patient populations, systems and processes need to evolve to support the business side of the healthcare shift. We know the value of guiding not only the process improvements, but also the necessary IT adjustments as well. Data is only valuable when properly interpreted and put into action; IT solutions must pull together information from disparate sources to account for total care coordination payable under the value-based reimbursement.  AAFCPAs is helps clients identify what their reimbursement future could possibly look like, especially as Medicare and Medicaid changes are set to be reliant on grants to fill in gaps for services.  AAFCPAs works with our clients to determine what the deficiency may be between the costs of providing the services and the expected reimbursements.

This is especially important as Accountable Care Organizations (ACOs) pop up more frequently nationwide. ACOs will enable provider networks to integrate their services – from physical health, to behavioral health and dental – to provide coordinated care that leads to higher quality patient outcomes.  ACOs encourage the consolidation of the healthcare industry, and as such, organizations will be tasked with evaluating unnecessary spending.

While the new Administration in Washington has thrust healthcare into a new spotlight, the exact changes ahead are still difficult to predict. Right now, however, even if the ACA is modified, the model will still likely follow quality vs. quantity when it comes to reimbursements. The fee for patient care will be paid for as a shared responsibility for the patient’s recovery.

Understanding the evolving healthcare regulatory landscape is tricky. What should you be asking as the scene shifts?

  • What are the risks my organization should be prepared for?
  • What will the reimbursements be?
  • How will we support ongoing care?
  • How do we track receivables?
  • How do we address our financial reserves and consider them for reimbursements?

Once answers to these questions are determined, it’s much easier for an organization to ascertain its needs and get a systems structure in place that will put the organization at an advantage as the healthcare landscape transforms.  To learn more about how we may help you, please contact Matthew Hutt at mhutt@nullaafcpa.com or 774.512.4043.

About the Author

Matthew Hutt CPA
Matt leads AAFCPAs’ Healthcare Division, providing assurance, tax and advisory solutions for Federally Qualified Health Centers (FQHCs), behavioral health providers, home care agencies and hospices, nursing homes, and senior care living centers. Matt advises healthcare providers on consolidation and coordination of care, including the integration of behavioral health into the primary care delivery system. He also provides consulting solutions for providers transitioning to new value-based reimbursement models, and data driven patient care, including: developing business process and controls for collecting and advantaging data to provide analysis on: provider activity, delivery of care, and analysis of efficiency & cost effectiveness. Matt is also highly-sought after for his knowledge on issues related to affordable housing developers with requirements related to the US Department of Housing and Urban Development, MassHousing, Low Income Housing Tax Credits, Historical Tax Credits and New Markets Tax Credits. 

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