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

Value Based Reimbursement

Humana Pays Physician Groups $77M for Value-Based Outcomes

by Jacqueline DiChiara

As the fee-for-service realm dissipates and the value-based reimbursement model nears its completed transition in coming years, Humana is granting sizable financial rewards for those physician groups yielding quality care outcomes....

Considering MACRA’s Effect on Future Meaningful Use Changes

by Jacqueline DiChiara

The Department of Health and Human Services (HHS) has confirmed a 60-day period of public commentary regarding the Stage 3 Electronic Health Record (EHR) incentive program and the Medicare Access and CHIP Reauthorization Act of 2015...

How to Achieve Value Within the Value-Based Care Transition

by Jacqueline DiChiara

The Department of Health and Human Services (HHS) is on a mission to associate 90 percent of Medicare payments to value within the next three years and Congressional passage of the Medicare Access and CHIP Reauthorization Act of 2015...

Black Book: CFOs Focused on ROI, Revenue Cycle Outsourcing

by Jacqueline DiChiara

Outsourcing may save the healthcare industry, according to Black Book’s yearly survey released today about high performing revenue cycle management (RCM) vendors, as reported by PR Newswire. With its research focusing primarily on RCM outsourcing...

Value-Based Incentives Top Practice in Reimbursement Model

by Sara Heath

Value-based incentives may be gaining momentum as integral parts of physician reimbursement models. A recent survey by Sullivan, Cotter, and Associates confirms that using quality-based incentives and quality metrics are becoming more prevalent...

Are the Cheapest Provider-Owned Health Plans More Expensive?

by Jacqueline DiChiara

The demise of the fee-for-service model may be unsuccessful in producing the most economically efficient health plans, confirms a new study from HealthPocket. Demonstrating significant findings that are simply “contrary to expectations,”...

How to Address Bundled Payment Cost Reduction Challenges

by Jacqueline DiChiara

As per the Affordable Care Act (ACA), the Centers for Medicare & Medicaid Services (CMS) will begin applying a value-based payment program under the physician fee schedule within the year in association with budget neutrality. This November,...

12 Value-Based Reimbursement Strategies to Cut Revenue Risk

by Jacqueline DiChiara

Value-based reimbursement is a hearty healthcare subject worth diving into as the shift from volume to value continues to evolve. Thirty percent of Medicare payments will be tied to alternative payment models, as per a recent announcement from...

What is the New Future of Value-Based Payment Programs?

by Jacqueline DiChiara

Medicare’s value-based payment programs provide physicians with purposeful information that can be intelligently acted upon to resultantly strengthen care quality. As the shift from physician reimbursement moves from...

Risk-Value-Based Payment Programs a Return on Investment?

by Jacqueline DiChiara

Value-based payment readiness is apparently an area of weakness for senior financial executives, reports an executive survey from the Healthcare Financial Management Association (HFMA) and Humana. An analysis of return on investment (ROI), readiness...

ACOs Fighting Revenue Cycle Setbacks, Says Black Book Survey

by Jacqueline DiChiara

The fastidious partnership of financial incentive and risk is a delicate balancing act the healthcare industry is now increasingly pressured to perfect. As the healthcare system expediently swings away from fee-for-service and into the realm...

Next Generation Analytics Demand Actionable Results

by Jacqueline DiChiara

The value-based reimbursement movement has a leader. That leader is the Centers for Medicare & Medicaid Services (CMS). Indeed, there has been a great deal of hustle and bustle regarding many recent initiatives from CMS,...

Value-Based Reimbursement: Humana CEO’s Payer Perspective

by Jacqueline DiChiara

In a Tuesday morning keynote speech at the Healthcare Information and Management Systems Society’s (HIMSS’) annual HIMSS15 conference and exhibition conducted this week in Chicago, Bruce D. Broussard, CEO and President of Humana,...

New WEDI Focus on Bundled Payments, Value-Based Initiatives

by Jacqueline DiChiara

The Workgroup for Electronic Data Interchange (WEDI) recently announced its Payment Models Workgroup is forming a new project team committee – the Bundled Payments Taskforce – to more closely examine bundled payments and various value-based...

SGR Repeal Requires New Focus on Quality Measurement

by Jacqueline DiChiara

In a landslide vote of 392 to 37, the House of Representatives passed legislation last week to permanently repeal the Sustainable Growth Rate (SGR) designed to limit the increase of Medicare physician payments that has proven highly problematic...

Examining a Holistic Approach to Revenue Cycle Management

by Jacqueline DiChiara

As healthcare continues to shift more of its focus on to the customer, a holistic approach to revenue cycle management requires addressing changing consumer behaviors. Providers experiencing an increasing array of reimbursement challenges seek...

Cost Management Effectively Optimizes Revenue Cycle Activity

by Jacqueline DiChiara

Effective means for managing revenue cycle activity and optimization continue to evolve amidst the upcoming effects of ICD-10 implementation, the urgent push for mainstream mobile data processing, and a vigorous demand for bundled and capitated...

Physician Compensation Models Need Value-Based Reimbursement

by Jacqueline DiChiara

As the healthcare reimbursement shifts from volume to value progresses, many practices are actively reviewing their current compensation plans in connection to accountable care and similar models. Although physician employment was once convolutely...

What Considerations Do Alternative Payment Models Require?

by Jacqueline DiChiara

As the direction of various payment models evolve, payers are focusing on a variety of focuses and objectives. Effective physician engagement may require a stronger focus on specialist engagement, especially in preparation for 2018’s transition...

Adapting the Healthcare Revenue Cycle to Changing Regulation

by Jacqueline DiChiara

Providers continue to evaluate healthcare revenue cycle and volume in relation to the Affordable Care Act (ACA). ACA’s underlying elements — Medicaid expansion and reform — are under close examination. Derek Bang, CPA, CGMA,...

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