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

Accountable Care Organizations

How to Address Challenges of Alternative Payment Models

by Jacqueline Belliveau

As the healthcare industry moves towards value-based care, more providers are choosing alternative payment models to facilitate the transition. CAPG, a trade association of accountable physician organizations, has published a guide of alternative...

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...

AHA: Commercial ACO Tax Ruling Impedes Value-Based Care Models

by Jacqueline Belliveau

By stripping commercial accountable care organizations (ACOs) of their charitable tax exempt status, the IRS could be threatening the future of value-based care and care coordination, according to the American Hospital Association (AHA). In a...

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...

Mixed Results for MSSP Accountable Care Organization Savings

by Catherine Sampson

According to a report from Leavitt Partners, 42 percent of accountable care organizations (ACO) residing in high-cost markets in the Medicare’s Shared Savings Program (MSSP) earned shared savings, while only 18 percent of organizations...

Post-Acute Care Can Help Accountable Care Organizations Save

by Clay Ackerly, MD

As the Center for Medicare and Medicaid Innovation (CMMI) continues to deploy new programs, evidence of the impact of existing models continues to trickle in. One consistent theme: the importance of, and opportunity presented by, improvements...

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...

Anthem Accountable Care Organizations Save $14.8 Million

by Catherine Sampson

Four medical groups participating in Anthem Blue Cross accountable care organization (ACO) arrangements were able to save a total of $14.8 million from 2013 to 2014 due to improved coordinated care efforts, according to an Anthem press release....

Number of Accountable Care Organizations Continue to Rise

by Catherine Sampson

The number of accountable care organizations (ACOs) continue to increase across the county. Earlier this year, the Centers for Medicare & Medicaid Services (CMS) announced 121 new Medicare Accountable Care Organization (ACO) participants. Between...

IRS: Commercial ACO Can’t Claim Charitable Tax Exemptions

by Catherine Sampson

An unnamed accountable care organization (ACO) will not be able to claim charitable tax exempt status since its role centered on facilitation instead of the provision of care, the IRS said in a determination letter this month. The ACO, which...

MA Medicaid Proposes $1.5B Investment in Accountable Care

by Catherine Sampson

MassHealth, the combine management of Medicaid and Children's Health Insurance Programs by the Commonwealth, is joining the accountable care movement by proposing a major $1.5 billion overhaul of its reimbursement structures. By developing...

NAACOS Comments on Accountable Care Organizations Benchmarks

by Vera Gruessner

Last month, the National Association of ACOs (NAACOS) submitted comments for the Health Care Payment Learning & Action Network (LAN) Financial Benchmarking Draft White Paper. NAACOS takes on the largest portion of accountable care organizations...

Accountable Care Organization Savings Shift After First Year

by Catherine Sampson

More than 700 accountable care organizations (ACO) currently work toward the goal of improving the quality of healthcare while also reducing capital costs of healthcare thanks to the Affordable Care Act. Meanwhile, researchers attempt to figure...

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...

Why Primary Care Matters in Medicare Shared Savings Program

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) is moving forward with updating the rules and programs around accountable care organizations. The American Academy of Family Physicians  (AAFP) is urging for CMS to include key provisions...

Payment Reform Strengthens Patient-Centered Medical Home

by Vera Gruessner

The health payer industry and the federal government including the Centers for Medicare & Medicaid Services (CMS) have positioned hospitals, clinics, and medical practices to adopt necessary healthcare payment reform. Alongside accountable...

What Does the Rise of Bundled Payments Mean For Providers?

by Dr. Richard Wheeler, CMO of Verisk Health

One of the attributes of a sustainable value-based healthcare delivery system is payment based on the value of services delivered, instead of the volume-based fee-for-service model. Bundled payments have been explored for several years as an...

Is the Medicare Shared Savings Program Cutting Costs?

by Vera Gruessner

The Medicare Shared Savings Program has not, as of yet, reduced healthcare spending for the federal government. Along with the lack of cost savings within the Medicare-sponsored program, Kaiser Health News reports that approximately 50 percent...

Medicare Shared Savings Grows Among Burgeoning Payment Models

by Vera Gruessner

Since the healthcare industry has experienced rising costs over the years, providers and federal agencies have focused their energies on implementing new value-based payment models and healthcare delivery systems like accountable care organizations...

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