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

Alternative Payment Models

CMS Delays Rollout of Cardiac, Ortho Bundled Payment Programs

March 20, 2017 - 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 the start of the Comprehensive Care for Joint Replacement pilot (CJR), the Cardiac Rehabilitation Incentive Payment Model, and three other Medicare...


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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...

Stakeholders Propose 4 MACRA Physician-Focused Payment Models

by Jacqueline Belliveau

MACRA’s Quality Payment Program offers 5 percent maximum incentive payments if eligible clinicians sufficiently participate in an Advanced Alternative Payment Model (APM) from 2017 to 2022. But many specialists are still waiting for CMS...

MACRA Implementation, Healthcare Consumerism Trends at HIMSS17

by Jacqueline Belliveau

As healthcare stakeholders are packing their bags for the upcoming HIMSS17 conference in sunny Florida, many are expecting to learn about the hottest healthcare revenue cycle management topics from the past year. From MACRA implementation and...

Key Considerations for Bundled Payment Model Adoption, Success

by Jacqueline Belliveau

As the value-based reimbursement transition pushes on, many provider organizations have turned to bundled payment models as a stepping stone to alternative payment model adoption. “Bundled payments can be an organization’s first step...

Did Risk-Based APMs Propel Greater Provider Consolidation?

by Jacqueline Belliveau

A recent Health Affairs study revealed that risk-based alternative payment models, such as accountable care organizations (ACOs), have not spurred greater provider consolidation in the post-Affordable Care Act healthcare environment. Medicare...

How Radiologists Can Join an Advanced Alternative Payment Model

by Jacqueline Belliveau

Radiologists may want to look to the physician-focused payment model path in MACRA to develop specialty-specific Advanced Alternative Payment Models (APM), suggested a recent Journal of the American College of Radiology report. Harvey L. Neiman...

Maryland All-Payer APM Reduces Medicare Hospital Costs by $429M

by Jacqueline Belliveau

As the Maryland All-Payer alternative payment model starts its fourth year, a Health Affairs report shows that the program reduced Medicare hospital costs by $429 million, exceeding CMS requirements that the model save $330 million five years....

Industry Orgs Urge Lawmakers to Continue Value-Based Care Push

by Jacqueline Belliveau

Over 120 healthcare industry groups, including hospitals, healthcare systems, payers, and professional organizations, recently urged the Trump administration and Congress to not discontinue or slow the transition to value-based care. In the letter...

CMS Reopens 2018 Next Generation ACO Model Applications

by Jacqueline Belliveau

Providers interested in participating in the Next Generation Accountable Care Organization (ACO) model in 2018 can now submit a letter of intent to CMS, according to the alternative payment model’s webpage. The Next Generation ACO model...

359K Clinicians to Join CMS Alternative Payment Models in 2017

by Jacqueline Belliveau

CMS recently announced that the federal agency selected over 359,000 clinicians to participate in four of the federal agency’s alternative payment models in 2017. The new participants will be joining the Medicare Shared Savings Program...

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