Medical Billing Blogs

  Risk-based payment models, also known as budget-based contracting, are evolving in the healthcare industry as an alternative to traditional fee-for-service models. These models aim to control healthcare costs and improve care quality by holding providers financially accountable for patient outcomes. Risk-based payment models  are structured around an estimated cost of treating a specific condition or patient population. These estimates are based on sophisticated actuarial models and include direct and indirect practice expenses as well as a margin. In fact, there are various risk-based payment models for healthcare providers, such as: Understanding Risk-Based Payment Models Risk-based payment models are designed to align the financial incentives of healthcare providers with the goal of delivering value rather than volume. These models aim to improve patient outcomes, enhance care quality, and reduce unnecessary healthcare spending. Here are the key types of risk-based paymen...

  Remote Therapeutic Monitoring (RTM) and Remote Patient Monitoring (RPM) have significantly transformed the healthcare industry, particularly following the expansion of reimbursement policies. As a result, there is a need to understand the nuances of these technologies and their implications for medical billing and coding, which is essential for care delivery organizations. Let’s have a look at such a relationship: 1. Expansion of Reimbursement Policies CMS’s  expansion of reimbursement policies has driven the increased utilization of RPM and RTM. Therefore, the key policy changes include: Billing Flexibility : Providers can now  bill for RPM or RTM  alongside other care management services for the same patient, such as Chronic Care Management (CCM) and Transitional Care Management (TCM). Inclusion of RHCs and FQHCs : Rural Health Centers (RHCs) and Federally Qualified Health Centers (FQHCs) can bill separately for RPM and RTM services. These changes offer healthcar...