Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Accountable Care Organizations

Why Primary Care Matters in Medicare Shared Savings Program

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) is moving forward with updating the rules and programs around accountable care organizations. The American Academy of Family Physicians  (AAFP) is urging for CMS to include key provisions...

Payment Reform Strengthens Patient-Centered Medical Home

by Vera Gruessner

The health payer industry and the federal government including the Centers for Medicare & Medicaid Services (CMS) have positioned hospitals, clinics, and medical practices to adopt necessary healthcare payment reform. Alongside accountable...

What Does the Rise of Bundled Payments Mean For Providers?

by Dr. Richard Wheeler, CMO of Verisk Health

One of the attributes of a sustainable value-based healthcare delivery system is payment based on the value of services delivered, instead of the volume-based fee-for-service model. Bundled payments have been explored for several years as an...

Is the Medicare Shared Savings Program Cutting Costs?

by Vera Gruessner

The Medicare Shared Savings Program has not, as of yet, reduced healthcare spending for the federal government. Along with the lack of cost savings within the Medicare-sponsored program, Kaiser Health News reports that approximately 50 percent...

Medicare Shared Savings Grows Among Burgeoning Payment Models

by Vera Gruessner

Since the healthcare industry has experienced rising costs over the years, providers and federal agencies have focused their energies on implementing new value-based payment models and healthcare delivery systems like accountable care organizations...

CMS Proposes New Healthcare Payment Models for Medicare Part B

by Vera Gruessner

New healthcare payment models are being advised by the Centers for Medicare & Medicaid Services (CMS). From alternative payment models to the Medicare Shared Savings Program and the Comprehensive Care for Joint Replacement program, the federal...

Physician-Sponsored Accountable Care Organizations Succeed

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) is constantly attempting to reform and modify current programs in order to achieve the Triple Aim of Healthcare – reduced medical costs, better health outcomes, and improved patient...

CMS Seeks Final Applications for Next Generation ACO Model

by Jacqueline Belliveau

The Centers for Medicare and Medicaid Services Innovation Center announced the opening of its final round of applications for Next Generation Account Care Organization (ACO) Model, which will begin on January 1, 2017. The final round of Next...

Accountable Care Organizations Responsible for Drug Spending

by Vera Gruessner

Accountable care organizations consist of a network in which payers, primary care physicians, and specialists work together to improve the health of a population. To dive deeper into one of the type of specialists seeking to enhance care within...

Examining the Value-Based Alternative Payment Model Basics

by Jacqueline DiChiara

Alternative payment models like the accountable care organization (ACO) and the bundled payment model have been gaining popularity under the Affordable Care Act’s (ACA) mandates. Figuring out how alternative payment models will evolve under...

Why Patient-Centered Accountable Care Organizations Thrive

by Jacqueline DiChiara

The patient-centered accountable care organization (ACO) is the new future of healthcare. According to Mark Wagar, President of Heritage Medical Systems, when patients' voices are heard, they receive better quality care. Wagar said...

Shared-Decision Making Advances Value-Based Care Outcomes

by Jacqueline DiChiara

Shared-decision making promotes strong dialogue between healthcare providers and healthcare consumers and builds stronger value-based care outcomes. At its core, shared-decision making gives beneficiaries more choice about their care and treatment...

How Medicare Accountable Care Organizations Keep CAHs Afloat

by Jacqueline DiChiara

Medicare accountable care organizations (ACOs) are finally smoothing out regional hospitals' revenue cycle wrinkles. But successful ACOs still need to adopt tighter standards to remain financially viable. Critical access hospitals...

How Does Value-Based Reimbursement Affect Pediatric ACOs?

by Jacqueline DiChiara

Value-based reimbursement and pay-for-performance incentives are positively influencing pediatric accountable care organizations (ACOs), according to research from JAMA Pediatrics. The new future of value-based incentives is perhaps all...

CMS Proposes Changes to ACO Medicare Shared Savings Program

by Jacqueline DiChiara

The Centers for Medicare & Medicaid Services (CMS) has released a proposed rule to improve performance incentives for accountable care organizations (ACOs) under the Medicare Shared Savings Program. This proposal builds upon the growth of...

Why Did Experienced Accountable Care Organizations Fail?

by Jacqueline DiChiara

The Medicare Pioneer Accountable Care Organization (ACO) has proven it is able to manage larger performance-based financial risk levels. But some Pioneer ACOs dropped out when quality benchmarks were too hard to reach.

Value-Based Incentives Enrich Accountable Care Organizations

by Jacqueline DiChiara

Pay-for-performance incentives positively sway physician behavior when it comes to value-based care advancement, according to a new JAMA Pediatrics study. Financial incentives tied to value-based reimbursement advance basic health measures,...

Value-Based Care Models Still Pose Opportunities, Challenges

by Jacqueline DiChiara

The value-based care model is allegedly winning the claims reimbursement race, leaving its fee-for-service competitor in the dust. How valid is the widespread claim that value-based reimbursement models are tied to higher care quality levels,...

Why Accountable Care Organizations Need Revenue Cycle Risk

by Jacqueline DiChiara

Is the "Accountable" part of accountable care organizations being ignored? Over 100 new Medicare Accountable Care Organizations (ACO) participants will keep quality high and costs low, according to the Centers for Medicare &...

Do Accountable Care Organizations Save Claims Reimbursement?

by Jacqueline DiChiara

Accountable care organizations (ACOs) are reportedly being penalized for high revenue cycle management performance. Healthcare providers looking to manage their claims reimbursement strategies remain focused on value-based care initiatives while...


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