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

Value Based Reimbursement

Large Hospitals Fare Worse in Value-Based Reimbursement Model

by Jacqueline Belliveau

Large hospitals averaging approximately 260 staffed beds were more likely to receive a negative value-based reimbursement adjustment under a hospital-specific Medicare program in 2016, according to a recent report from Definitive Healthcare,...

CMS: Over Half in Value-Based Care Program to Earn Bonuses

by Jacqueline Belliveau

Over 1,600 hospitals in the Hospital Value-Based Purchasing Program, representing over 50 percent of total participants, will receive positive Medicare payment adjustments in 2017 for value-based care performance, CMS reported in a recent fact...

86% Say Provider Compensation Tied to Fee-for-Service, Salary

by Jacqueline Belliveau

About 86 percent of primary care physicians and specialists reported that their provider compensation was still primarily under fee-for-service or salary arrangements, representing a modest increase from 84 percent in 2014, according to a recent...

CMS Launches VT All-Payer Accountable Care Organization Model

by Jacqueline Belliveau

Starting in January 2017, Vermont will implement the first voluntary all-payer accountable care organization (ACO) model that will align ACO design across Medicare, Medicaid, and commercial payers, according to a recent CMS announcement. With...

Benefits, Challenges of Value-Based Health IT Implementation

by Jacqueline Belliveau

From EHR systems to mHealth apps, health IT has the potential to help providers achieve value-based care goals. But with hundreds of new technologies seemingly emerging each day, many providers are struggling to select the most appropriate health...

25% of Healthcare Payments Tied to Alternative Payment Models

by Jacqueline Belliveau

Only one-quarter of healthcare payments in 2016 will be connected to an alternative payment model that has population-based accountability, reported the Healthcare Payment Learning & Action Network (LAN). The survey of over 70 commercial,...

Patients Find Medicare Reimbursement to Surgeons Too Low

by Jacqueline Belliveau

Patients may be willing to pay more out-of-pocket expenses for certain medicals services, such as knee surgeries, especially as providers face lower Medicare reimbursement rates, a recent study in Orthopedics contended. The survey of 231 patients...

Rural Hospitals Faced Less Value-Based Reimbursement Penalties

by Jacqueline Belliveau

Rural hospitals outperformed urban hospitals in several Medicare value-based reimbursement programs in 2015, receiving fewer financial penalties, according to a recent report from the Department of Health and Human Services (HHS). Researchers...

GOP Doctors Caucus Suggests MACRA Implementation Changes

by Jacqueline Belliveau

In a recent letter to CMS Acting Administrator Andy Slavitt and Director of the Office of Management and Budget Shaun Donovan, the GOP Congressional Doctors Caucus called for several MACRA implementation changes to make the value-based reimbursement...

AMA Releases New MACRA Implementation Resources for Providers

by Jacqueline Belliveau

With a final ruling on the proposed MACRA implementation rule expected to arrive in early November, the American Medical Association (AMA) recently released three new tools to help healthcare providers prepare for the value-based reimbursement...

How Value-Based Reimbursement Affects Physician Productivity

by Jacqueline Belliveau

As payers push for more value-based reimbursement adoption, many healthcare organizations are wondering how to restructure physician productivity strategies to meet the unique requirements of performance-based payments. But the key to success...

Are Medicare Value-Based Penalties Fair to Safety Net Hospitals?

by Jacqueline Belliveau

Safety-net hospitals have to work harder to avoid value-based penalties than other participants in a Medicare program designed to reduce hospital readmissions, a new study in Health Affairs indicates. While safety-net hospitals have made significant...

Few Docs Familiar with MACRA, Transitioning to Value-Based Care

by Jacqueline Belliveau

Only 20 percent of physicians reported that they are very or somewhat familiar with MACRA, according to a recent survey from the Physicians Foundation and Merritt Hawkins, and the majority of respondents do not currently have a large portion...

Challenges, Successes of First-Year Shared Savings ACOs

by Jacqueline Belliveau

Participants in the Medicare Shared Savings Program (MSSP) already familiar with physician practice transformation were more likely to earn shared savings payments, which should lead the Centers for Medicare & Medicaid Services to focus on...

85% of Orgs Looking to Replace Revenue Cycle Management Systems

by Jacqueline Belliveau

Eighty-five percent of provider organizations, hospitals, and physician practices are currently seeking to replace their healthcare revenue cycle management systems or are deciding if it is time to switch, according to a new survey from Black...

Post-Acute Care Groups Oppose Value-Based Purchasing Program

by Jacqueline Belliveau

Eight healthcare industry groups recently told lawmakers that they oppose the proposed Medicare Post-Acute Care Value-Based Purchasing Program, which is scheduled to start on Oct. 1, 2019. In a letter to the House Committee on Ways and Means,...

Are Federal Value-Based Care Programs Truly Promoting Value?

by Jacqueline Belliveau

In a statement to the House Ways and Means Health Subcommittee, the American Hospital Association (AHA) argued that Medicare value-based reimbursement programs, particularly pay-for-performance initiatives, do not have effective and fair financial...

Four New MACRA Tracks Allow Flexible Attestation for Providers

by Jacqueline Belliveau

Eligible clinicians will be able to select their own pace for MACRA attestation to ensure all participants can succeed under new value-based reimbursement programs, CMS announced. On its official blog, the head of CMS detailed four options for...

CMS Touts Progress of State-Led Alternative Payment Model

by Jacqueline Belliveau

States participating in the first phase of the State Innovation Model Initiative have made significant progress in implementing alternative payment models, CMS officials revealed midweek. Two of six states were able to link more than half of...

How to Plan Out the Transition to Value-Based Reimbursements

by Jacqueline Belliveau

Providers should address the drivers of value-based reimbursements to appropriately pace their transition to alternative payment models without sacrificing crucial fee-for-service revenue, according to  a new guide from Pershing Yoakley...

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