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

Value Based Reimbursement

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...

Industry Groups Call on CMS to Modify MACRA Patient Codes

by Jacqueline Belliveau

Proposed patient relationship codes that will be used under MACRA to measure appropriate resource use and determine value-based reimbursement adjustments may cause more confusion for providers and increase administrative burdens, according to...

CMS Prohibits Creation of Pass-Through Medicaid Reimbursement

by Jacqueline Belliveau

States cannot develop or increase existing pass-through payments, or Medicaid reimbursement arrangements to providers for services that are not related to care delivery or value-based incentives, CMS stated in a recent bulletin. Medicaid pass-through...

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...


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