• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

Wiki Pay For Performance: What can we expect?

Create Wiki
Pam Warren

Pam Warren

True Blue
Messages
2,653
Location
Springvale, ME
Best answers
1
Recently, my organization is taking steps to move towards becoming an ACO (Accountable Care Organization), to provide healthcare through the Intsitute for Healthcare Improvement's "Triple Aim":
  • Improving the patient experience of care (including quality and satisfaction);
  • Improving the health of populations; and
  • Reducing the per capita cost of health care.
Since I've been practicing this billing/coding gig for the past 20+ years utilizing an RVU and productivity model, I'm left wondering what this change will mean for coders. Since we won't necessarily be instructing physicians to improve documentation for reimbursement, I'm thinking that our role will be to provide instruction on documentation improvement for medical necessity, to support disease management, to report patient non-compliance (which is typically left out of the equation these days), and to report appropriate surgical services. I'm wondering if I need to brush up on disease process and pathophysiology? It appears that we maybe moving back to a reimbursement model similar to capitation.

I'm curious....is anyone else moving towards this model? Have you thought about where coding fits into this scenario? What are you doing to prepare yourself or your staff?
 
You must log in or register to reply here.
Top