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

Alternative Payment Models

All-Payer Alternative Payment Model Targets PA Rural Hospitals

January 16, 2017 - A new six-year all-payer alternative payment model will focus on improving care quality and reducing healthcare costs at rural hospitals in Pennsylvania, CMS announced in a recent fact sheet. The CMS Innovation Center’s latest project, the Pennsylvania Rural Health model, will explore how all-payer global budgets to rural hospitals will improve care quality, care access, and patient...


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All-Payer Alternative Payment Model Targets PA Rural Hospitals

by Jacqueline Belliveau

A new six-year all-payer alternative payment model will focus on improving care quality and reducing healthcare costs at rural hospitals in Pennsylvania, CMS announced in a recent fact sheet. The CMS Innovation Center’s latest project,...

CMS Releases MSSP Track 1+ Model Risk Structures, Eligibility

by Jacqueline Belliveau

In a new Medicare Shared Savings Program (MSSP) Track 1+ fact sheet, CMS clarified model details for 2018 to 2020 participation, including maximum shared savings and losses rates, risk assignments, and eligibility requirements. CMS announced...

CMS: Innovation Center Key to APM, MACRA Implementation Success

by Jacqueline Belliveau

In a recent official blog post, CMS Acting Principal Deputy Administrator Patrick Conway, MD, highlighted the federal agency’s Innovation Center’s successes with alternative payment model development, especially as MACRA implementation...

What is the Medicare Shared Savings Program Track 1+ Model?

by Jacqueline Belliveau

As the Quality Payment Program links more Medicare payments to value-based reimbursement, a new Medicare Shared Savings Program (MSSP) track will allow eligible clinicians to qualify for additional incentive payments in the program’s Advanced...

CMS Unveils New Medicare APMs for Quality Payment Program

by Jacqueline Belliveau

CMS finalized several new Medicare alternative payment models that will qualify for a five percent value-based incentive payment through the Quality Payment Program. The announcement contained bundled payment initiatives for cardiac and orthopedic...

AMGA: Drop Transition, Add MSSP Track for MACRA Implementation

by Jacqueline Belliveau

With the Quality Payment Program set to launch on Jan. 1, 2017, the American Medical Group Association (AMGA) provided CMS with several MACRA implementation suggestions, including transition year elimination by 2018 and Medicare Shared Savings...

CMS Reveals Medicare-Medicaid Accountable Care Organization

by Jacqueline Belliveau

CMS recently unveiled a Medicare-Medicaid accountable care organization (ACO) model that will allow participating providers in the Medicare Shared Savings Program to take on accountability for Medicaid costs and quality of care for dual-eligible...

2018 Advanced APM Options Added to Quality Payment Program

by Jacqueline Belliveau

Eligible clinicians now have more opportunities to earn value-based incentive payments by participating in the Advanced Alternative Payment Model track of the Quality Payment Program in 2018, according to a recent CMS announcement. Starting in...

Developing Post-Acute Networks for APM Reimbursement Success

by Jacqueline Belliveau

About 85 percent of healthcare C-suite leaders expect to expand post-acute care partnerships over the next three years, especially as their organizations aim to maximize alternative payment model reimbursement, a recent Premier report found....

How Palliative Care Can Maximize Value-Based Reimbursement

by Jacqueline Belliveau

Providers can boost value-based reimbursement success by incorporating early palliative care into routine cancer care delivery, a new study in the American Journal of Managed Care indicated. Researchers at the Center to Advance Palliative Care...

GAO Finds Value-Based Care Issues for Small, Rural Practices

by Jacqueline Belliveau

A recent Government Accountability Office (GAO) report found that small and rural practices faced several challenges with implementing value-based care models, such as limited financial resources, a lack of interoperable health IT, population...

Value-Based Care, Hospital Revenue Cycle Lead Top 2016 Stories

by Jacqueline Belliveau

From the final MACRA implementation rule to new value-based care initiatives, 2016 certainly did not leave healthcare providers bored at their desks. Instead, providers were busy digesting changes to reimbursement structures and researching ways...

How Alternative Payment Models Decrease Cancer Care Costs

by Jacqueline Belliveau

As cancer care spending is expected to grow in the next four years, an oncology alternative payment model that incorporates clinical pathways and patient-centered approaches could reduce healthcare spending by 22 percent, or $9.1 million across...

Using an Alternative Payment Model to Reduce Hospitalizations

by Jacqueline Belliveau

Are clinical interventions enough to alter provider behavior to align with value-based care? Or are providers more motivated to change because of financial incentives under alternative payment models? CMS recently partnered with the University...

Key Ways to Succeed Under MACRA’s Quality Payment Program

by Jacqueline Belliveau

Do not feel overwhelmed by the upcoming Quality Payment Program, a healthcare expert at CAPG, a non-profit trade association for accountable physician organizations, advised the projected 592,000 to 642,000 eligible clinicians participating in...

FQHCs Push for Health Center Medicaid Payment Reform Models

by Jacqueline Belliveau

Federally qualified health centers (FQHCs) in five states voiced strong interest in Medicaid payment reform model participation to improve value-based care delivery and boost healthcare employment strategies, a recent Geiger Gibson RCHN Community...

CMS Launches VT All-Payer Accountable Care Organization Model

by Jacqueline Belliveau

Starting in January 2017, Vermont will implement the first voluntary all-payer accountable care organization (ACO) model that will align ACO design across Medicare, Medicaid, and commercial payers, according to a recent CMS announcement. With...

25% of Healthcare Payments Tied to Alternative Payment Models

by Jacqueline Belliveau

Only one-quarter of healthcare payments in 2016 will be connected to an alternative payment model that has population-based accountability, reported the Healthcare Payment Learning & Action Network (LAN). The survey of over 70 commercial,...

CMS Announces New Advanced Alternative Payment Model Options

by Jacqueline Belliveau

CMS recently announced new opportunities for eligible clinicians to participate in an Advanced Alternative Payment Model (APM) under the Quality Payment Program in 2017 and 2018. The Oncology Care Model’s two-sided financial risk track...

Industry Groups React to Final MACRA Implementation Rule

by Jacqueline Belliveau

In the week that the healthcare industry has had to digest the 2,400-page final MACRA implementation rule, many industry groups have come forward to express support for the rule, especially attestation flexibilities, while others have challenged...

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