How Vermont’s All-Payer ACO Model Paves the Way for Value-Based Care
RevCycleIntelligence As its name states, the Vermont All-Payer Accountable Care Organization (ACO) Model is an arrangement that incorporates patients with both private and public healthcare coverage, but what makes this model so appealing to providers? Is this system finally the solution to moving more healthcare stakeholders away from traditional fee-for-service and toward value-based care? The...
More Features
What the Latest Court Decisions Mean for the Federal IDR Process
The latest court rulings in a series of legal challenges have left the No Surprises Act’s (NSA’s) federal independent dispute resolution (IDR) process in limbo yet again. In an announcement on the CMS website on August 25th, the...
Top 10 Accountable Care Organizations by Medicare Shared Savings
The Medicare Shared Savings Program (MSSP) saved CMS $1.8 billion in 2022, marking the sixth consecutive year of overall savings for the program. This also represents the second-highest yearly savings since the program started in 2012....
Key Ways to Boost Collection of Patient Financial Responsibility
Patient financial responsibility keeps growing, creating challenges for healthcare organizations looking to collect all revenue for services provided to patients. According to the latest “KFF Employer Benefits Survey,” the...
Exploring Front-End Revenue Cycle, How to Optimize Its Performance
The healthcare revenue cycle is broken down into three parts: the front-end, mid-cycle, and back-end. Much focus goes into mid and back-end functions, such as coding and billing, claims management, and denials management. However, what...
Private Equity Acquisitions Come with Growing Antitrust Concerns
In some instances, private equity acquisitions have pro-competitive benefits for physician practices, Diane Hazel, partner at Foley & Lardner, told RevCycleIntelligence. Private equity firms can help practices consolidate operations,...
Healthcare’s Interest in Private Credit, Other Funding Sources Grows
There has been a lot of buzz around private equity's growing reach in healthcare, but providers have other options to fund growth. And one of those funding sources is gaining popularity. "Private credit is filling a void right now,"...
What Technologies Do Providers Need for Value-Based Care Success?
Value-based care models incentivize healthcare providers to improve care delivery by tying reimbursement to care quality. While value-based care holds providers more accountable for patient health outcomes, it also affords them the...
As Patient Financial Responsibility Grows, Technology Key to Collections
You may not want to think about the new year just yet. But if you don’t have a patient payment solution in place now, you might be sorry come January. Patient financial responsibility has hit all-time highs over the last decade, with...
Private Equity in Healthcare Is Under A Microscope, So What’s Next?
Private equity is gaining a foothold in healthcare despite growing evidence that its role has been detrimental to care quality and prices. But new data and even governmental concern aren't slowing private equity investments in provider...
Investments Are Needed to Implement Value-Based Care in Pediatrics
While value-based care adoption has accelerated in the healthcare industry, the alternative care delivery and payment model is still lacking in the pediatric setting. The current healthcare infrastructure does not support the resources...
How Revenue Cycle Automation Keeps A Physician-Owned Practice Open
Every penny counts when you are an independent physician-owned practice, according to Melissa Huff, CIO of the Clinics of North Texas. Founded over 100 years ago, the Clinics of North Texas is a multispecialty network of more than 30...
Key Types of Revenue Cycle Technology That Optimize Operations
The healthcare revenue cycle is a sprawling operation that encompasses patient registration and insurance verification to denials management and patient collections. Provider organizations of all sizes have leveraged revenue cycle...
The Next Step in UnityPoint Health’s Revenue Cycle Technology Journey
Digital transformation is taking UnityPoint Health’s revenue cycle system from automation to machine learning in order to drive efficiencies and capture value. The non-profit health system consisting of 17 regional hospitals, 19...
What Payment Integrity Means for Providers, How to Avoid Claim Issues
Healthcare providers are constantly running into payment integrity tools payers put in place to ensure proper payment. But payment integrity is also crucial for providers if they want accurate, complete, and timely reimbursement. Of the...
Back to the Basics, Other Payment Integrity Strategies Post-PHE
After an unprecedented three years, it’s time to return to the basics, according to Jordan Kearney, partner at Hooper, Lundy, and Bookman and founder of the firm’s Medicare Audits and Appeals Practice Group. By that, she means...
Key Ways the Debt Ceiling Impacts Healthcare Providers, Payments
The US government could run out of money by next month if lawmakers cannot agree on raising or suspending the country’s debt limit. This economic catastrophe could leave the US without funds to pay its bills, and healthcare providers...
What Kaiser’s Acquisition of Geisinger Means for Value-Based Care
Kaiser Permanente’s plans to acquire Geisinger Health have opened the door to new value-based opportunities. Specifically, the proposed acquisition has the potential to create an accelerated path to value-based care and lead to...
How Primary Care Acquisitions Can Advance Value-Based Care
As value-based care becomes the end goal for many healthcare organizations, health systems across the country are acquiring primary care practices to achieve this mission. Critical aspects of these acquisitions include ensuring that...
What Prior Authorization Changes in MA Final Rule Mean for Providers
CMS has released its 2024 Medicare Advantage (MA) and Part D Final Rule, which finalized policies on marketing oversight, prescription drugs, and prior authorization processes. Changes to prior authorization policies are particularly...
