Challenges
Provider/ Independent Practice
- Untimely and incorrect billing
- High insurance and patient accounts receivable
- High claims rejections and part payments
- Lower Healthcare Quality measures/RAF scores
- Missing out on incentives due to compliance issues
- Dropping membership owing to poor member engagement
Insurance Company
- Lower Star ratings affecting new enrollments
- Low RAF / Healthcare Quality measures scores
- Poor compliance with CMS requirements
- Increased plan competition affecting profitability
- Losing CMS incentives because of incomplete encounter submissions
- Ineffective data gathering disturbing population health analysis
- Falling memberships due to plan switching
DME Company
- Decreased margins because of competitive bidding, leading to lower reimbursement rates for medical equipment
- Shortage of DME CSR, resulting in increased waiting time for patients requesting for supplies
- Order backlog generating delay in on-time delivery of critical medical equipment
- High accounts receivable, due to incorrect and untimely filing of bills
HMO/ACO
IPA/MSO
- Ever reducing capitation payments resulting in diminished profit margins
- High administrative and operational expenses
- Difficulty in navigating through the complexities of performance-based payments
- Facing compliance issues due to ever-changing regulations
- Shortage of qualified professionals and effective solutions preventing you from providing effective care
- Falling membership due to poor member engagement
- Lower Healthcare Quality measures /RAF scores affecting your income
