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

Healthcare Payment Reform

AHA: Post-Acute Care Medicare Reimbursement Reform Needs Time

April 3, 2017 - Later this month, the Medicare Payment Advisory Commission (MedPAC) plans to vote on a draft recommendation to Congress that would accelerate the development and implementation of a unified Medicare reimbursement system for four post-acute care settings. But the American Hospital Association (AHA) recently called on the commission delay the timeline. Under the Improving Medicare Post-Acute...


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AHA: Post-Acute Care Medicare Reimbursement Reform Needs Time

by Jacqueline Belliveau

Later this month, the Medicare Payment Advisory Commission (MedPAC) plans to vote on a draft recommendation to Congress that would accelerate the development and implementation of a unified Medicare reimbursement system for four post-acute care...

NAM Advises Leaders to Prioritize Value-Based Purchasing Reform

by Jacqueline Belliveau

In a new report, the National Academy of Medicine (NAM) named value-based purchasing as one of four action priorities for healthcare stakeholders in 2017. To implement more value-based purchasing models, NAM suggested that stakeholders focus...

MedPAC Targets Post-Acute Care for Healthcare Payment Reform

by Jacqueline Belliveau

In its March 2017 report to Congress, the Medicare Payment Advisory Commission (MedPAC) pinpointed post-acute care for healthcare payment reform after Congressional and CMS inaction resulted in as much as $11 billion in lost savings since 2009....

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...

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...

Payment Reform, Value-Based Care Top 2017 Medicaid Priorities

by Jacqueline Belliveau

Delivery system and healthcare payment reform, especially through value-based care, topped the list of 2017 Medicaid priorities, according to the annual State Medicaid Operations Survey from the National Association of Medicaid Directors (NAMD)....

AHA Calls for Value-Based Reimbursement Reform Under Trump

by Jacqueline Belliveau

In a recent letter to President-Elect Trump, the American Hospital Association (AHA) urged the upcoming administration to continue the value-based reimbursement transition by developing more effective alternative payment models, promoting telehealth,...

Staffing Shortages, Healthcare Reform Top C-Suite Concerns

by Jacqueline Belliveau

Healthcare C-suite executives identified staffing shortages and healthcare reform as having the largest impact of their organization’s ability to delivery care, a recent Premier survey found. About 41 percent of the 52 C-suite level respondents...

Payment Reform Suggestions to Improve Complex Pediatric Care

by Jacqueline Belliveau

Payment reform for medically complex children is needed to support a more family- and patient-centered care delivery model that requires extensive care coordination and non-face-to-face services, a new study in Pediatrics indicated. Researchers...

AHA Urges Congress to Pass Healthcare Payment Reform Bills

by Jacqueline Belliveau

The American Hospital Association (AHA) recently called on Congress to pass several healthcare payment reform bills, such as the Helping Hospitals Improve Patient Care Act and the Sustaining Healthcare Integrity and Fair Treatment Act of 2016,...

CMS Updates Site-Neutral Payment Reform Implementation Rule

by Jacqueline Belliveau

In a recent ruling on the outpatient prospective payment system, CMS finalized several changes to the site-neutral payment reform policy under which most provider-based hospital outpatient departments will no longer receive outpatient Medicare...

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...

Senate Group Drafts Chronic Disease Management Payment Reform

by Jacqueline Belliveau

The Senate Finance Committee Chronic Care Working Group recently released a draft healthcare payment reform bill targeting chronic disease management programs and services, such as the Independence at Home Model, telehealth consultations, accountable...

House Reps Urge CMMI to Cease Mandatory Payment Reform Models

by Jacqueline Belliveau

In a recent letter to CMS leaders, House representatives urged the federal agency to stop all mandatory payment reform demonstrations through the Center for Medicare and Medicaid Innovation (CMMI), such as the ongoing Comprehensive Care for Joint...

Will Site-Neutral Payment Reform Rule Cause Hospital Closures?

by Jacqueline Belliveau

Many long-term acute care facilities are projected to close over the next few years as Medicare enacts a payment reform rule that will introduce site-neutral payments for certain long-term acute care services, according to a Standard & Poor’s...

CMS Prohibits Creation of Pass-Through Medicaid Reimbursement

by Jacqueline Belliveau

States cannot develop or increase existing pass-through payments, or Medicaid reimbursement arrangements to providers for services that are not related to care delivery or value-based incentives, CMS stated in a recent bulletin. Medicaid pass-through...

New Rules for Bundled Payment Models for Cardiac, Hip Care

by Jacqueline Belliveau

CMS has proposed to develop bundled payment models for cardiac care and hip surgeries that would qualify for financial incentives in the proposed Quality Payment Program in MACRA, according to a recent announcement. “On July 25, 2016, the...

Payment Reform Incentives Influence Physician Decision-Making

by Jacqueline Belliveau

Some patients are finding that financial incentives under Medicare payment reform rules have caused their providers to focus more on boosting healthcare revenues rather than improving patient outcomes. According to a recent study in The American...

Would Proposed Value-Based Reimbursements Reduce Drug Costs?

by Jacqueline Belliveau

Spending on prescription drugs has been a major pain point for all stakeholders in the industry. But could value-based reimbursement models for certain drugs under Medicare Part B be the answer to rising drug costs? According to a Health Affairs...

CMS Proposes Medicare Payment Reform Rule for Primary Care

by Jacqueline Belliveau

In efforts to better support primary care physicians, CMS has announced a proposed Medicare payment reform rule that would improve payment accuracy for providers who treat chronically ill and medically complex patients. The rule would update...

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