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

Value Based Reimbursement

CMS Opens Enrollment for Value-Based Primary Care Model

by Jacqueline Belliveau

CMS has opened the application period for the Comprehensive Primary Care Plus (CPC+) model, a value-based reimbursement initiative for primary care physicians in 14 areas of the country. The application period will be open until September 15,...

Is MACRA a True Doc Fix for Value-Based Reimbursement?

by Jacqueline Belliveau

Will MACRA be the answer to tying reimbursements to quality care or will it be just end up as another doc fix, like those under the Sustainable Growth Rate program? A recent National Center for Policy Analysis report is critical of proposed MACRA...

Cerner to Increase Focus on Value-Based Reimbursement

by Kyle Murphy, PhD

Cerner has named Adventist Health System's Jeff Hurst to oversee its revenue cycle management division, the company announced Tuesday. Hurst, who currently serves as Florida Hospital's Senior Vice President of Finance at Florida Hospital...

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...

Survey: Value-Based Reimbursement to Eclipse FFS by 2020

by Jacqueline Belliveau

As federal agencies and commercial payers push to eliminate fee-for-service payment models, value-based reimbursement structures have been on the top of most healthcare provider and payer agendas. The majority of healthcare providers and payers...

Managing the Revenue Cycle while Acquiring Physician Practices

by Jim Denny, Founder and CEO of Navicure

Since 2010, hospital and health systems have been adapting their care delivery models to meet health reform requirements. At the forefront of this effort is physician practice acquisition. An analysis of healthcare provider acquisitions in the...

Value-Based Care Implementation Delayed for Most Hospitals

by Jacqueline Belliveau

While the federal government has announced explicit goals for implementing value-based care models in the next few years, some healthcare providers may not be ready to completely do away with traditional fee-for-service reimbursement structures....

OIG: CMS Lacked Good Management Policies for Pioneer ACO Model

by Jacqueline Belliveau

The Pioneer Accountable Care Organization (ACO) program faced a number of management and leadership challenges during its early days, according to a report from the Office of the Inspector General (OIG).  The report indicates CMS faced several...

Medicare Shared Savings Program Gets New Cost Calculations

by Jacqueline Belliveau

The Centers for Medicare and Medicaid Services (CMS) has recently finalized a rule that will change the methodology for calculating costs under Medicare Shared Saving Program, the federal agency announced. MSSP accountable care organizations...

CMS Allows Some ACOs to Join New Value-Based Care Model

by Jacqueline Belliveau

CMS has expanded the eligibility requirements in the Comprehensive Primary Care Plus (CPC+) model to include primary care physicians in certain Medicare accountable care organizations (ACOs), according to an updated fact sheet. Up to 1,500 primary...

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...

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