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

Practice Management News

Value-Based Care, Hospital Revenue Cycle Lead Top 2016 Stories

New value-based care models and hospital revenue cycle management strategies were some of the most popular topics in 2016.

By Jacqueline LaPointe

- 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 to optimize their hospital revenue cycle in a changing industry.

Top stories fo 2016 included news on value-based care, hospital revenue cycle management

As providers and stakeholders enter the new year, they are faced with a new Medicare value-based reimbursement program as well as a myriad of new alternative payment models. Under new payment structures, healthcare leaders and providers need to demonstrate high quality care as well as lower healthcare costs and the top stories of 2016 reflected how stakeholders prepared for this shift.

Here is the annual of list the top ten stories in the past year, counting down to the most popular read article this year.

10. 5 Ways to Cut Costs through Hospital Revenue Cycle Management

A major theme throughout 2016 was how to improve hospital revenue cycle management, including ways to reduce healthcare costs. As hospitals enter more value-based reimbursement arrangements, hospital leaders and providers face the task of reducing healthcare costs while boosting patient satisfaction and improving care quality.

In this article lays out the top five hospital revenue cycle management strategies to cut costs, including overhead cost reduction, patient satisfaction improvement, health IT use, and key performance indicator identification.

9. 4 Value-Based Care Models Demanding New Long-Term Focus

The Department of Health and Human Services intends to link half of fee-for-service Medicare reimbursement to an alternative payment model by the end of 2018. But providers can choose from a long list of different value-based care arrangements.

What are the top value-based care models that providers should be considering? According to, the four models demanding more attention are accountable care organizations (ACOs), patient-centered medical homes, pay-for-performance structures, and bundled payments.

8. Direct Physical Therapy Access Could Reduce Healthcare Costs

The Health Care Cost Institute (HCCI) reported in March that patients with lower back pain who received physical therapy earlier in their treatment decreased healthcare costs more than those who visited another provider first.

Lower healthcare costs for patients who received physical therapy was primarily driven by decreased outpatient spending. Physical therapy access reduced a patient’s odds of experiencing costly or unnecessary healthcare encounters, such as an emergency room visit and imaging services.

With healthcare spending on back pain reaching $90.6 billion, providers were interested in how to lower costs for this patient population.

7. CMS Plans to Reverse Two-Midnight Rule for Medicare Payments

In April, CMS proposed to offset the estimated costs and hospital effects of the Two-Midnight policy by increasing the inpatient Medicare reimbursement rate by 0.8 percent.

The Two-Midnight rule required hospital admissions for observation of fewer than two consecutive midnights to be billed at the lower outpatient services rate. CMS also reduced inpatient reimbursement rates by 0.2 percent to balance new utilization trends.

Many providers and hospitals groups, however, staunchly opposed the policy, claiming the rule was arbitrary, confusing, and deprived them of necessary Medicare reimbursement.

CMS finalized the rule by August and officially reversed the Two-Midnight rule’s negative Medicare payment adjustment.

6. ICD-10 System Codes Will See New Updates by October 1

ICD-10 implementation may have dominated the top stories in 2015, but the only ICD-10 story to grace this year’s list was one on code updates.

CMS announced in March that it would end the freeze on ICD-10 code additions and release 5,500 new codes by October. The federal agency also ended ICD-10 coding flexibilities, meaning providers would have to submit the most specific diagnosis codes in order to get paid. After the update, claims could be denied because of specificity issues.

5. Understanding the Basics of Bundled Payments in Healthcare

From a value-based care model demanding long-term focus to the basics of episodic payments, providers wanted to know more about how bundled payment models work.

Bundled payment models reimburse multiple providers for coordinating the total care required for a single, pre-determined episode of care. The alternative payment model has become a popular method for advancing value-based care without requiring providers to take on downside financial risk.

CMS also included several bundled payment models as Advanced Alternative Payment Models in the Quality Payment Program.

4. Top 5 Facts to Know about MACRA Alternative Payment Models

When MACRA’s Quality Payment Program takes effect on Jan.1, CMS expects about 70,000 to 120,000 eligible clinicians to participate in a qualifying Advanced Alternative Payment model.

For those looking to earn the five percent value-based incentive payment in this reimbursement track, breaks down how the Advanced Alternative Payment Model program works under the Quality Payment Program. How does it differ from the Merit-Based Incentive Payment System? Who can participate? And what models qualify for the financial incentives offered?

3. How MACRA, MIPS Will Impact Critical Access Hospitals, FQHCs

In addition to Advanced Alternative Payment Models, providers were also curious about how MACRA and the Merit-Based Incentive Payment System (MIPS) would affect critical access hospitals and federally qualified health centers (FQHCs).

Many of these healthcare organizations will not participate in MIPS because they meet exclusion requirements, such as low-volume thresholds and new Medicare enrollment status.

However, some critical access hospitals and FQHCs will participate in either MIPS or an Advanced Alternative Payment model. For those facilities, CMS will count some professional services performed at these organizations as points towards the qualifying professional determination.

2. 5 Most Common Hospital Revenue Cycle Management Challenges

How can hospitals overcome the top revenue cycle management issues? From billing and collection errors to claims management inefficiencies, identifies the most common challenges hospital revenue cycles face and provides tips on how to resolve them.

1. Demand for Physician Assistants Led to Increased Pay in 2015

Our top read story veered away from popular buzzwords, like value-based care and healthcare revenue cycle management, but the article still showed how providers are preparing for a changing reimbursement landscape.

At the top of the list was an American Academy of PAs report on how physician assistant compensation grew by 3.4 percent between 2014 and 2015. The report also found rapid growth in the physician assistant workforce between 2010 and 2015 as well as an increase in demand for these providers.

Physician assistants may be the key to driving value-based care, AAPA CEO Jennifer L. Dorn indicated. As the population ages and grows, physician assistants are becoming critical healthcare leaders in the shift to value-based care, which requires more focus on patient engagement and prevention.

Dig Deeper:

Preparing the Healthcare Revenue Cycle for Value-Based Care

What Is Value-Based Care, What It Means for Providers?


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