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

Accountable Care Organizations

What Considerations Do Alternative Payment Models Require?

by Jacqueline DiChiara

As the direction of various payment models evolve, payers are focusing on a variety of focuses and objectives. Effective physician engagement may require a stronger focus on specialist engagement, especially in preparation for 2018’s transition...

CMS Announces Next Generation ACO Model Initiative

by Jacqueline DiChiara

The Department of Health and Human Services (HHS) has announced its latest initiative for the Centers for Medicare & Medicaid Services’ Innovation Center (CMS Innovation Center), the Next Generation Accountable Care Organization (ACO) Model...

History of Value-Based, Accountable Care Models at CMS

by Jacqueline DiChiara

Improving the overall quality and efficiency of medical care via physicians’ active execution of “meaningful and actionable information” is necessary to promote reimbursement rewarding “value rather than volume,”...

Benefits of Forming an Accountable Care Organization

by Ryan Mcaskill

Executives of a newly formed ACO discuss the decision to form, the reasons behind it and the benefits to come from it. At the start of 2015, a three year partnership went into effect between Health Net California and John Muir Health. The organizations...

AHA Reacts to Proposed Rule for Medicare Shared Savings Program

by Stephanie Reardon

CMS’s proposed changes to the Medicare Shared Savings Program would save approximately $280 million more than the median net savings in federal funds from 2016 through 2018. The Medicare Shared Savings Program (MSSP) seeks to save money...

Rural Hospitals Join Forces to Access ACO Incentives

by Ryan Mcaskill

The National Rural Accountable Care Consortium is helping rural hospitals transform the care they provide. With the healthcare landscape in the middle of a major evolution and embracing value-based care, solutions that embrace coordinated care...

Looking Back on 50 Years of Medicare and Medicaid

by Stephanie Reardon

The Medicare and Medicaid system has evolved along with the healthcare industry. It was a warm day on July 30, 1965 in Washington, D.C. when President Lyndon B. Johnson signed the Social Security Amendments bill into law. This would establish...

The Benefits and Challenges to Medication Therapy Management

by Ryan Mcaskill

This is part two of an interview about the impact of medication therapy management on ACOs and coordinated care. Yesterday, we posted part one of an interview with Robert Dubois, MD, PhD and National Pharmaceutical Council (NPC) Executive Vice...

How Medication Therapy Management Helps ACOs Manage Costs

by Ryan Mcaskill

NPC has started a case study series that examined how pharmacists can impact ACOs, cost and quality of care. There are a number of different ways that organizations can try and reduce costs through the use of the Accountable Care Organization...

Examining Private Payer ACO Contracts

by Ryan Mcaskill

A new study asked providers to discuss their risks and rewards experienced with private payer ACO contracts. Recently, the American Journal of Managed Care released a report that examined the ACO model that is currently be used by private insurers...

The Multiple Benefits of Remote Monitoring and Telehealth

by Ryan Mcaskill

By adopting remote monitoring and telehealth technology, clinics can improve patient health and organizational finances. In the healthcare landscape, keeping patients out of the hospital had become just as important as treating them if they arrive....

CMS Issues Proposed ACO Antitrust Regulations

by Ryan Mcaskill

CMS has issued a proposed rule change that clarifies the formation of ACOs and could impact antitrust regulations. This week, the Centers for Medicare and Medicaid Services (CMS) released proposed regulations for Accountable Care Organizations...

CMS Proposes Rule Changes for Accountable Care Organizations

by Ryan Mcaskill

Several potential new rules would strengthen the Medicare Shared Savings Program by altering risk/reward, enrollment and more. Yesterday, the Centers for Medicare and Medicaid Services (CMS) announced several proposed changes that will strengthen...

Hospital Sector Embraces Consolidation Over ‘Mega-Mergers’

by Ryan Mcaskill

A new study found ACO-style agreements are growing in 2014 instead of blockbuster mergers that were seen in 2013. Throughout 2013 in the hospital sector, a theme emerged known as the “mega-merger.” Several major health systems combined forces...

Quality and Financial Performance Study Finds ACO Success

by Ryan Mcaskill

A CMS study found ‘substantial improvement’ to quality and financial performance for accountable care organizations. Earlier this month, the Centers for Medicare & Medicaid Services issued quality and financial performance results that...

Accountable Care is Not a New Concept

by Ryan Mcaskill

The term Accountable Care Organization was coined in 2006 but the history of accountability in healthcare in much longer. One of the hottest trends in the healthcare landscape is accountability. Following the Affordable Care Act, a focus on value-based...

Patient Satisfaction Grows With Accountable Care Organizations

by Ryan Mcaskill

A new study found that beneficiaries are more satisfied with their care following a year with Accountable Care. One of the biggest changes to healthcare in the last few years, has been the growth of Accountable Care Organizations (ACOs). This...

Proper Measures Needed to Close Accountable Care Service Gaps

by Ryan Mcaskill

A new study examined accountable care measures for innovative treatment approaches and specialty forms of care. Recently, the National Pharmaceutical Council and Discern Health examined the accountable care measures for specialty care and innovative...

Big Healthcare Payers Thank Accountable Care for High Revenues

by Jennifer Bresnick

Payers see a bright future for accountable care as pay-for-performance profits begin to roll in. Accountable care arrangements are helping healthcare payers rake in significant revenues, and are predicted to continue to be a driving force in...

Accountable Care Organizations Make News in Massachusetts

by Ryan Mcaskill

$60 million awarded to Mass hospitals to improve participation in accountable care organizations. Over the last few weeks, accountable care organizations have been front and center for a couple announcements out of Massachusetts. The first big...


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