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

Value Based Reimbursement

Avoidable Hospitalizations Drop 31% for Long-Term Care Patients

by Jacqueline Belliveau

Avoidable hospitalizations among dual-eligible long-term care facility residents dropped by 31 percent between 2010 and 2015 largely because of value-based care programs, CMS recently stated in an official blog post. “Family members want...

CMS: Providers Need Data Access for Value-Based Reimbursement

by Jacqueline Belliveau

Value-based reimbursement success rests on providing clinicians with convenient and increased access to meaningful data, the leaders of the Office of the National Coordinator (ONC) and CMS stated in a recent official CMS blog post. “Data...

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,...

Do Pay-for-Performance Programs Improve Patient Outcomes?

by Jacqueline Belliveau

Value-based reimbursement models that pay for performance modestly incentivized providers to stick to clinical guidelines, but they may not be linked to better patient outcomes, a recent Annals of Internal Medicine study indicates. The literature...

Addressing Social Risk in Medicare Value-Based Reimbursement

by Jacqueline Belliveau

Hospitals that disproportionately treat patients with social risk factors, such as low income and race, may be unfairly penalized under some Medicare value-based reimbursement programs. But the National Academies of Science, Engineering, and...

AHA Calls for Medicare Reimbursement Bump for Hospital Services

by Jacqueline Belliveau

The American Hospital Association (AHA) recently urged the Medicare Payment Advisory Commission (MedPAC) to finalize a recommendation that would boost Medicare reimbursement for hospital inpatient and outpatient services in 2018. In a comment...

ACO Incentives, Coordination Improve Complex Pediatric Care

by Jacqueline Belliveau

Children with medical complexities, or children who require the highest level of service and support, are one of the most expensive pediatric patient populations. But provider collaboration and financial incentives through an accountable care...

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...

How Social Risk Factors Influence Value-Based Reimbursement

by Jacqueline Belliveau

Safety-net providers received more financial penalties under Medicare value-based reimbursement programs because the hospitals treated more beneficiaries with social risk factors, such as dual eligibility, low income, race, ethnicity, and rural...

Does Hospital Size Impact Value-Based Penalties in CMS Program?

by Jacqueline Belliveau

Value-based penalties in the Medicare Hospital-Acquired Condition Reduction Program are disproportionately affected by a participating hospital’s bed size and number of cases, a recent American Journal of Medical Quality study indicated....

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)....

PQRS Medicare Payment Adjustments Waived After ICD-10 Update

by Jacqueline Belliveau

Some eligible professionals and group practices will not receive Physician Quality Reporting System (PQRS) Medicare payment adjustments in 2017 and 2018 because of the recent ICD-10 update, CMS recently announced in an email. The announcement...

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....

Provider Orgs Seek Healthcare Costs Tools for Value-Based Care

by Jacqueline Belliveau

Provider organizations are increasingly looking to implement healthcare costs tools to better manage healthcare supply chain costs under value-based care models, a recent Black Book Market Research survey stated. The survey of 1,158 healthcare...

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...

HHS Sec. Burwell Shares Vision for Value-Based Care Future

by Jacqueline Belliveau

In a recent Health Affairs blog post, HHS Secretary Sylvia Mathews Burwell called for value-based care progress after the Obama administration ends through more alternative payment models, care delivery transformation, and health data access....

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...

AMGA: Value-Based Reimbursement Transition Slower Than Expected

by Jacqueline Belliveau

Fee-for-service revenue decreased by more than 20 percent as value-based reimbursement payments increased, reported the American Medical Group Association (AMGA). But the transition to value-based reimbursement may be slowing down compared to...

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