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

Value Based Reimbursement

How MACRA, MIPS Will Impact Critical Access Hospitals, FQHCs

by Catherine Sampson

MACRA means different things to various types of healthcare providers, such as critical access hospitals, rural health clinics and Federally Qualified Health Centers. Although the new MACRA framework provides multiple paths to success with various...

AMA Releases Value-Based Care, MACRA Resources for Providers

by Jacqueline Belliveau

As part of its STEPS Forward program, the American Medical Association (AMA) has released eight new educational modules to support healthcare providers with the transition to value-based care, reported AMA in an official press release. AMA has...

Five Best Practices to Prepare for Value-Based Reimbursement

by Catherine Sampson

Accountable care organizations (ACO) hold the key to successfully implementing value-based care and receiving value-based reimbursement. However, delivering quality care while also preparing for value-based reimbursement is not a simple task....

Bundled Payments Program Extended to Improve Value-Based Care

by Jacqueline Belliveau

The Centers for Medicare & Medicaid Services (CMS) recently announced that some healthcare organizations can extend their participation in the Bundled Payments for Care Improvement (BPCI) initiative, a program that aims to increase value-based...

41% of Providers, Payers Adopt Value-Based Care Reimbursement

by Vera Gruessner

With the push from private and commercial health payers along with federal agencies to adopt value-based care reimbursement strategies, many more healthcare providers seem to have begun contracting through pay-for-performance arrangements. A...

Top 5 Ingredients of a Successful Accountable Care Organization

by Catherine Sampson

Because of the Affordable Care Act, the healthcare industry continues to move toward value-based care. As a result, Medicare has invested heavily in value-based reimbursement structures, such as accountable care organizations (ACOs), which turn...

Accountable Care Organizations Improve Quality, Cut Spending

by Catherine Sampson

Accountable care organizations (ACO) are beginning to achieve results as they help to move the healthcare system towards a value-based care delivery environment. As the popularity of these arrangements continues to grow, the changing dynamics...

New Primary Care Model Embraces Value-Based Reimbursement

by Jacqueline Belliveau

This week, CMS announced its largest multi-payer initiative to improve primary care and introduce new value-based reimbursement models. The Comprehensive Primary Care Plus (CPC+) model aims to help practices transition from the “one-size-fits-all,...

How Value-Based Care Payment Improves Patient Outcomes

by Vera Gruessner

Last month, the Centers for Medicare and Medicaid Services (CMS) released a new value-based care payment system for Medicare Part B drug prescribing protocols of physicians. Medicare Part B is a program in which decisions are reimbursed for prescribing...

Value-Based Care Final Rule to Implement MACRA Sent to OMB

by Jacqueline Belliveau

The final rule for implementing the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) — and its provisions for value-based care and reimbursement — is now in the hands of the Office of Management and Budget (OMB) according...

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...

Patient-Centric Strategy Key for Value-Based Care Reimbursement

by Vera Gruessner

As is common in today’s healthcare industry, the move toward value-based care reimbursement has put a greater focus on patient satisfaction and engagement. Quality of care is intrinsically tied to superior health outcomes and patient satisfaction....

Lack of Medicaid Expansion Leads to Hospital Revenue Loss

by Vera Gruessner

Ever since a number of states refused to expand their Medicaid programs and receive the majority of funding for this enterprise from the federal government, there has been a division of revenue between states that have broadened Medicaid coverage...

Value-Based Care Reimbursement Needs Greater Customization

by Vera Gruessner

With rising healthcare spending found throughout the US, the federal government has put greater focus on value-based care reimbursement than ever before. Healthcare providers and payers are seeking ways to move beyond fee-for-service payment...

Value-Based Reimbursement May Not Bring Benefits for SNF Care

by Jacqueline Belliveau

CMS has released the Skilled Nursing Facility Utilization and Payment Public Use File, a dataset on the care skilled nursing facilities (SNF) provided to Medicare beneficiaries in 2013.  The data raises questions about the effect of...

CMS Releases 2016 Results for Value-Based Care Program

by Jacqueline Belliveau

The Center for Medicare and Medicaid Services (CMS) released the results for calculating the 2016 Value Modifier, which will come as financial boost to some and hindrance to others. Out of the 8,395 eligible physician groups, which satisfactorily...

HIMSS: Providers Not Ready for Value-Based Care Reimbursement

by Vera Gruessner

In recent years, the healthcare industry and the revenue cycle of providers has had a much greater target of achieving value-based care reimbursement and moving away from fee-for-service payment systems. The Centers for Medicare & Medicaid...

ICD-10 Claim Denial Rate Remains Low among Most Providers

by Vera Gruessner

It seems that the ICD-10 implementation has not had a very negative effect on the ICD-10 claim denial rate, which hasn’t risen much since the October 1 deadline. For example, RelayHealth Financial, a revenue cycle management solutions provider,...

2 Medicare Alternative Payment Models Demanding Future Focus

by Jacqueline DiChiara

Medicare alternative payment models have the ability to make affordable, high quality care a reality. But providers still demand greater levels of care coordination and cleaner streamlining of clinical data to achieve value-based reimbursement...

How EHR Data Analytics Influences Value-Based Reimbursement

by Jacqueline DiChiara

As the transition away from traditional, fee-for-service payment models towards value-based reimbursement continues, the implementation of electronic health records (EHRs) is becoming the rule rather than the exception. The Centers for Medicare...

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