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Accountable Care Organizations (ACO) Development

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Accountable Care Organizations (ACOs) are still in their formative stages but are likely here to stay. And it can be expected that governmental regulations and incentives related to developing the concept of accountable care and the challenges involved in making that concept a reality will evolve and change over time. Sitting on the sidelines will not be an option for very long. The networking and coordination of ambulatory providers in the ACO context will be very important to all hospitals in the near future. Yet the complexity and uncertainty involving ACO development and management is currently daunting.

What is certain is that attention to Part B revenue cycle management is paramount as ACO development is undertaken. Accountable care as a concept is focused on providing better clinical care at lower cost, and so attention to optimizing provider reimbursements is paramount. No allowable reimbursement can remain unrealized, or else the ACO becomes unprofitable and fails from a financial perspective. At the same time, ACOs require the sharing of reimbursements among healthcare providers, and the accounting for such sharing is critical to ACO success. It can expected that software systems will be upgraded and change substantially over time, in order to support ACO-type functionality that does not currently exist, or that must and will change over time. And these software enhancements and corresponding workflow changes associated with those enhancements will create challenges from both a clinical and revenue cycle perspective.

Especially since many hospitals are taking the lead in ACO development, there needs to be directed resources to revenue cycle management for the ACO, and those resources need to be skilled and experienced in core revenue cycle management, electronic health records software and systems and in programming and data management and reporting. In that regard, Precision Practice Management has all the requisite, broad-based talent necessary to partner with its hospital clients on ACO development from the standpoint of revenue cycle services and support.