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

Alternative Payment Models

CMS Expects to Release MIPS Participation Status By May 2017

April 26, 2017 - CMS anticipates notifying eligible clinicians about their Merit-Based Incentive Payment System (MIPS) participation status for 2017 via letter between late April through May, a recent email from the federal agency stated. The announcement (via AHA News Now) said that eligible clinicians should expect a letter from the Medicare Administrative Contractor who processes their Part B claims. The...


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CMS Expects to Release MIPS Participation Status By May 2017

by Jacqueline Belliveau

CMS anticipates notifying eligible clinicians about their Merit-Based Incentive Payment System (MIPS) participation status for 2017 via letter between late April through May, a recent email from the federal agency stated. The announcement (via...

Value-Based Reimbursement Spurs 8% Hospital Merger Growth

by Jacqueline Belliveau

Value-based reimbursement trends drove health system and hospital merger activity to increase 8 percent compared to the first quarter of 2016, Anu Singh, a Managing Director at Kaufman, Hall & Associates, recently told RevCycleIntelligence.com....

NAACOS: Mandatory Bundled Payments Impede ACO Financial Success

by Jacqueline Belliveau

The National Association of ACOs (NAACOS) recently urged CMS to indefinitely suspend upcoming mandatory Medicare bundled payment models until the federal agency resolves financial conflicts between the episodic arrangements and accountable care...

AHA Backs Cardiac, Ortho Bundled Payments Delay Until 2018

by Jacqueline Belliveau

The American Hospital Association (AHA) recently supported a CMS proposal to further delay Medicare bundled payments for cardiac and orthopedic care episodes to Jan. 2018. The Advancing Care Coordination through Episode Payment Models postponement...

2 APMs Take Next Step As MACRA Physician-Focused Payment Models

by Jacqueline Belliveau

Two proposed physician-focused payment models will go to the HHS Secretary for possible limited-scale testing, while one model was stopped from becoming a potential alternative payment model under MACRA, the Physician-Focused Payment Model Technical...

CMS Calls On Rural Hospitals to Join Alternative Payment Model

by Jacqueline Belliveau

CMS is seeking applicants to participate in a new round of the Rural Community Hospital Demonstration Program that tests a cost-based alternative payment model among small rural hospitals. Lawmakers authorized a five-year extension of the demonstration...

Oncologists Need Data Reporting, Time for MACRA Implementation

by Jacqueline Belliveau

Although MACRA launched the Quality Payment Program on Jan. 1, 2017, a recent American Society of Clinical Oncology (ASCO) report stated that many oncology practices still need to expand or improve services and data reporting to meet the program’s...

Keep Medicare Bundled Payment Models Mandatory, Experts Say

by Jacqueline Belliveau

Switching Medicare bundled payment models that are currently mandatory in select regions to voluntary across the country would impede value-based reimbursement progress through episodic payment, industry experts warned the Trump administration...

How to Prepare for Alternative Payment Model Implementation

by Jacqueline Belliveau

Implementing interoperable health IT infrastructure and a staffing model that aligns with value-based care requirements are key to successfully participating in an alternative payment model, Marjie Harbrecht, MD, a Medical Group Management...

CMS Delays Rollout of Cardiac, Ortho Bundled Payment Programs

by Jennifer Bresnick

CMS is pushing back the start date for a number of its bundled payment programs in an effort to provide additional time to review and prepare for the initiatives. In a notice posted in the Federal Register, CMS has issued three-month delays for...

Top 5 Ingredients of a Successful Alternative Payment Model

by Jacqueline Belliveau

Alternative payment models tie provider reimbursement to quality and cost performance. Besides their foundational function, though, each model has its own rules pertaining to financial incentive structures, quality measurements, and patient populations...

274 Orgs Calls on CMS to Add Medicare Advantage Advanced APMs

by Jacqueline Belliveau

CMS should develop financial incentives comparable to those in the Quality Payment Program’s Advanced Alternative Payment Model (APM) track for providers who assume financial risk under Medicare Advantage plans, CAPG and 273 other healthcare...

Premier: Bundled Payment Models Should be Voluntary Nationwide

by Jacqueline Belliveau

Premier Healthcare Alliance recently offered CMS several recommendations for bundled payment model development, including making programs voluntary for providers across the nation. CMS has implemented several mandatory bundled payment models...

65% of Organized Providers Paid Via Alternative Payment Models

by Jacqueline Belliveau

Nearly two-thirds of healthcare providers in some type of integrated employment model, such as integrated health networks, physical hospital organizations, accountable care organizations, and large medical groups, are primarily reimbursed through...

AHA Critiques MedPAC’s Potential MACRA Implementation Changes

by Jacqueline Belliveau

The American Hospital Association (AHA) recently responded to potential MACRA implementation changes discussed at the Medicare Payment Advisory Commission’s (MedPAC) January meeting. The industry group called on MedPAC to “draw upon...

CMS Calls on Stakeholders for Pediatric APM Development Input

by Jacqueline Belliveau

CMS recently put out a request for information for a potential Medicaid and Children’s Health Insurance Program (CHIP) alternative payment model targeting pediatric care, according to an official CMS blog post. “Through the RFI [request...

Transradial, Same Day Discharge Cardiac Care Drops Costs by $3.7K

by Jacqueline Belliveau

From acute myocardial infarctions to coronary artery bypass grafts initiatives, recent Medicare bundled payment models have providers focusing more on reducing healthcare costs and improving care quality for a range of cardiac care episodes....

Coalition Offers CMMI, Alternative Payment Model Improvements

by Jacqueline Belliveau

Thirty-five healthcare industry groups recently banded together to offer the newly-approved Department of Health and Human Services (HHS) Secretary a set of guidelines for CMS Innovation Center (CMMI) and alternative payment model development...

FFS, Risk-Based Medicaid ACO Programs Similarly Reduce Costs

by Jacqueline Belliveau

In a comparison of two state Medicaid Accountable Care Organization (ACO) programs, researchers in a JAMA Internal Medicine study found that Oregon’s global capitation ACO model produced similar healthcare savings and care quality improvements...

MGMA to Price: Simplify MACRA, Reassess Alternative Payment Models

by Thomas Beaton

MGMA would like HHS Secretary Tom Price to reduce the regulatory burdens of HIPAA and MACRA, reassess the development of Alternative Payment Models (APMs), and postpone implementation of the ONC’s 2015 Certified EHR criteria, the organization...

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