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Non Fee-for-Service Revenue Cycle Management: Managing Patient Service and Clinical Performance to Maximize Healthcare Practice Profit

Non Fee-for-Service Revenue Cycle Management: Managing Patient Service and Clinical Performance to Maximize Healthcare Practice Profit


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Ron Sterling

As the healthcare system migrates from the fee for service (FFS) model to a variety of non-fee for service (non-FFS) payment systems, practices/HCOs will be seeking strategies and tactics to fill the care gaps that exist because of the fee for service model.

From more active patient engagement to establishing and maintaining collaborative patient and provider relations, practices/HCOs need to rethink their own added value strategies and how to best serve healthcare stakeholders including patients, patient caregivers, physicians and other providers.

Consequentially, practices/HCOs will need to modify a variety of processes, strategies, and tools. Using existing FFS focused tactics could inhibit the ability to analyze clinical and/or financial performance. From managing services that generate revenue to the billing process and tracking clinical and business performance, the non-FFS models present resource, patient service, billing, and reporting challenges.

In today's high-stakes healthcare practice business climate, physician leaders and healthcare organization will need to answer the following questions:

  • What are the clinical and operational requirements to earn the non-FFS revenue?
  • How will the practice/HCO track clinical performance and patient service that could impact non-FFS revenue?
  • What are the costs incurred in producing the non-FFS revenue?
  • How will the practice/HCO verify that the non-FFS payment is correct?
  • How will non-FFS revenue be credited to physicians in calculating their compensation?
  • What are the analytical tools needed to evaluate the financial performance of the non-FFS arrangement?

The Non-Fee for Service reimbursement changes for healthcare practices are a business challenge that you cannot afford to ignore. These transformative challenges must be addressed for health care organizations to succeed in the coming years. Leveraging his extensive knowledge of healthcare information technology and accounting, Ron Sterling provides a complete view on how to track and manage Non-FFS reimbursement and how to capitalize on the financial opportunities of Non-FFS arrangements.

TABLE OF CONTENTS

  • Chapter 1: Introduction – Presents the key issues that practices/HCOs need to address to succeed in the non-FFS environment.
  • Chapter 2: Why Non-FFS is a Challenge – Provides strategic context to the differences between the FFS and non-FFS arrangements.
  • Chapter 3: Physician Compensation – Examines the impact of non-FFS models on physician compensation plans.
  • Chapter 4: Tools of the Trade – Practice Management System – Reviews the key features of FFS focused PMS tools and how PMS features can be repurposed to support the more varied and complex aspects of non-FFS billing and payments.
  • Chapter 5: Tools of the Trade – Electronic Health Record (CEHRT) – Examines how CEHRT features can be used to support and track non-FFS oriented patient care and services. Includes sections on remote patient monitoring, telemedicine and patient portals.
  • Chapter 6: Tools of the Trade – Orders – Focuses on the use of treatment plans to reinforce and document patient care and practice/HCO due diligence. Reviews the importance and significance of treatment order status and review features.
  • Chapter 7: Tools of the Trade – Clinical Call Center – Assesses the significance of clinical call centers for non-FFS arrangements as well as transition issues from current patient service strategies.
  • Chapters 8 through 13: A chapter is included for each non-FFS model to explain how the model operates and the performance and payment posting challenges of each situation. Each chapter includes sections on managerial accounting and policy issues as well as patient service, practice management system, electronic health record, and reporting considerations.
  • Chapter 8: MIPS Adjustments
  • Chapter 9: Performance and Quality Incentives
  • Chapter 10: Care Management
  • Chapter 11: Shared Savings
  • Chapter 12: Episode of Care
  • Chapter 13: Capitation Payments
  • Chapter 14: Monitoring Operations and Patient Information - Non-FFS situations require close attention to monitoring clinical performance and patient services.
  • Chapter 15: Go Forward Strategy – Concludes with strategic context for your continuing efforts.
Ron Sterling

Ronald B. Sterling, CPA, MBA, president of Sterling Solutions, Ltd. is a nationally recognized thought leader on healthcare information technology. He has worked with a wide array of healthcare organizations on using technology to improve patient service, clinical operations, and financial performance. A HIMSS “Book of the Year” winning Author, Ron Sterling has written eight books on healthcare IT, including Keys to EHR Success. Ron frequently speaks on a variety of healthcare technology and management issues. He serves on the Medscape Business of Medicine Advisory Board.