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With Obamacare How to Make Pay for Performance Program Work for You

May 6, 2014

Pay for performanceFor all the trepidation some physicians view pay for performance (P4P) programs, there are techniques that work well for both provider and payer. There is, indeed, savings that both parties can share, increasing revenue for both physician and insurance carrier.

There is one prerequisite that physicians must master to accomplish this result: Understanding your own data. While P4P remains optional, agreeing to meet specific objectives, if you don’t know where you stand or have a benchmark to measure progress and/or results, you risk losing the potential monetary incentives.

Making P4P Work for You

Since most P4P programs require payer pre-defined goals, it is imperative that you discover where you stand at the beginning, understanding your benchmark. You can then evaluate the revisions, if any, you need to make to reach these goals and objectives.

This is critical knowledge you must have or acquire. Why? Most payers use physicians’ claims information to evaluate their performance. If your performance currently fails payer standards, such as your percentage of prescribing generic versus brand-name drugs, you risk foregoing the bonus payments offered.

Some payers focus on your treatment methods for chronic conditions, believing these may be the most challenging issues physicians and they face in reducing costs, simply because these conditions are long-term and will probably continue into the future. Another typical focus is the increasing use of ER services and your coordinated care efforts.

You may encounter trouble in tracking your performance data. However, there are numerous varieties of “clinical data analytics software” now available to physicians to track and analyze their data. If this is an investment you care not to make, an alternate solution may be even more time and cost effective. The time investment you and your staff need to make if you hope to track your clinical performance manually is typically not a cost savings method. Using this technique may raise costs and actually hurt your performance–or both.

Use the expertise of a top third-party practice management firm, such as M-Scribe Technologies, to track and report your performance data. This approach saves more than money; it saves staff training and data entry time for any analytic or metrics software you might install. This action plan is particularly beneficial to smaller and mid-sized practices that lack the staff numbers and “firepower” of larger practices and hospitals.

You could enjoy another potential benefit by using a top medical billing and management firm to track and improve your performance. Your claims may be processed more rapidly, while consistently earning P4P incentives. Since you’re not pressuring your staff to submit claims quickly with more accuracy, payers who are capturing your claims data may elevate you to their top tier of providers. This increased confidence in the accuracy of your claims submissions, with all documentation and coding correct, can allow payers to reimburse you more quickly, saving them money.

Choosing to participate in P4P incentive programs can work in your favor, if you incorporate the important items you need to succeed.

  • Understand where you stand to establish a performance benchmark.
  • Learn payer criteria and goals to trigger P4P incentive bonuses.
  • Tailor your patient care regimen to meet payer goals.
  • Track and evaluate your performance results.
  • Make changes, improvements and/or modifications in patient care, particularly coordinated care efforts, to earn P4P incentives.
  • Maintain–or improve–the accuracy of your claims submissions.
  • Achieve and maintain HIPAA compliance.

If you follow this brief checklist, you’re ready to participate in P4P incentives. You, your patients and your practice will be rewarded with the increased revenue and cost reductions that are the foundations of P4P programs.You will make P4P a valued friend of your practice.


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