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4 Ways Healthcare Reforms Will Impact Revenue Cycle Management

With the Supreme Court's decision on the Patient Protection and Affordable Care Act, healthcare providers can properly access how the law will affect their practices, according to Healthcare Finance News.

Here are four ways revenue cycle management may be impacted by the healthcare reforms.

1. Funding cutbacks. The ACA calls for more than $700 billion in reductions from future Medicare spending. States also get the chance to accept or reject federal money for Medicaid expansion. If a state chooses to forgo expansion, the provider could be faced with significant uninsured patient and expand Medicaid payment shortfalls.

2. New quality care programs, reimbursements and incentive models. Many programs will be created or expanded to encourage lower cost care. The Center for Medicare and Medicaid Services' value-based purchasing program will be expanded to provide incentive payments to hospitals that meet or exceed performance benchmarks. Better RCM systems can also help identify areas for cost improvement.

3. Compliance. RCM systems will need to have the capacity to collect and integrate clinical information. The Recovery Audit Contractor program will also be implemented to root out fraud, waste and abuse. Since documentation will closely monitored, RCM systems will need tight controls and audit capabilities.

4. New patients and data. Once coverage expands to the uninsured, healthcare demand will jump, leaving RCM systems to capture a large amount of new information, including eligibility for Medicare, Medicaid and private insurance; coding; medical outcomes; clinical compliance; reimbursement requirements; claims; billing; and collections.

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