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

Alternative Payment Models

How CMS Improves Primary Care Payments Through Codes, APMs

December 13, 2017 - New medical billing codes for non-face-to-face encounters and alternative payment models are trying to change the way Medicare reimburses for primary care, according to researchers at the Urban Institute’s Health Policy Center. The report, supported by the Robert Wood Johnson Foundation, showed that CMS aims to find the right payment amount and structure to reimburse providers for treating...


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Key Capabilities for Value-Based Reimbursement Models

by Jacqueline Belliveau

Rising healthcare costs, shrinking reimbursement rates, and federal policies are driving hospitals and health systems to adopt value-based reimbursement, according to a new American Hospital Association (AHA) report. But the models are not one-size-fits-all...

CMS Cancels Mandatory Hip, Cardiac Bundled Payment Models

by Jacqueline Belliveau

CMS recently finalized proposals to eliminate mandatory hip fracture and cardiac bundled payment models slated to launch on Jan. 1, 2018 and decrease the scope of the existing Comprehensive Care for Joint Replacement (CJR) bundled payment initiative....

Industry Orgs Urge CMS to Lower Risk for MACRA’s Advanced APMs

by Jacqueline Belliveau

Healthcare stakeholders recently encouraged CMS to reconsider the financial risk requirements for Advanced Alternative Payment Models (Advanced APMs), arguing that the risk criteria limit participation in the models. Industry groups, including...

AMGA Advises CMS on Including MA Models as Advanced APMs by 2018

by Jacqueline Belliveau

CMS can boost participation in Medicare Advantage alternative payment models in 2018 by creating a submission form that allows providers in the models to apply to participate in MACRA’s Advanced Alternative Payment Model (Advanced APM)...

PTAC Recommends 2 APMs for Potential MACRA Implementation

by Jacqueline Belliveau

The Physician-Focused Payment Model Technical Advisory Committee (PTAC) recently recommended two alternative payment models to HHS for possible MACRA implementation. Stakeholders have submitted 19 alternative payment model proposals since the...

Industry Orgs Concerned with 2018 MACRA Implementation Rule

by Jacqueline Belliveau

Industry groups, including the American Medical Group Association (AMGA) and the Medical Group Management Association (MGMA), are questioning if the new 2018 MACRA implementation rule truly promotes value-based care. In recent comments on the...

29% of Healthcare Payments Under Alternative Payment Models

by Jacqueline Belliveau

About 29 percent of healthcare payments in 2016 were paid through an alternative payment model, such as shared savings/risk arrangements, bundled payments, or population-based reimbursements, the Health Care Payment Learning and Action Network...

Value-Based Reimbursement Shift Slows, But CEOs Still Preparing

by Jacqueline Belliveau

Hospital and health system CEOS are gearing up for alternative payment models and population health management, but the transition to value-based reimbursement is taking more time than expected, a recent survey from Deloitte Center for Health...

382 Hospitals Earn Initial Reconciliation Payments Under CJR Model

by Jacqueline Belliveau

Out of approximately 800 hospitals required to participate in Medicare’s Comprehensive Joint Replacement (CJR) model, 382 facilities will receive a reconciliation payment based on cost savings and care quality, according to preliminary...

Specialists Face 16% MIPS Payment Adjustment Swing Under Proposal

by Jacqueline Belliveau

Specialists could face up to a 16 percent value-based incentive payment or penalty under MACRA’s Merit-Based Incentive Payment System (MIPS) in 2018 if a proposed rule to include Medicare reimbursement for Part B drugs in the program is...

AHA Supports Bundled Payment Cancellation, Voices MACRA Concerns

by Kyle Murphy, PhD

Despite back the decision by CMS to cancel two bundled payment models and modify another, the American Hospital Association contends that the federal agency is moving a bit too quickly in shifting providers to value-based payment. According to...

Do Alternative Payment Models Overcome Fee-for-Service Flaws?

by Jacqueline Belliveau

While alternative payment models, such as pay-for-performance, shared savings and risk, and bundled payments, were designed to improve the flawed fee-for-service system, the models are not addressing volume-based payment issues, according to...

Specialists Lack Medicare Alternative Payment Model, MACRA Options

by Jacqueline Belliveau

Opportunities for specialists to join a Medicare alternative payment model are severely limited, especially for emergency medicine providers and audiologists, a recent Leavitt Partners report showed. As part of its effort to reimburse one-half...

Mixed APM Results Offer Lessons for Healthcare Payment Reform

by Jacqueline Belliveau

The verdict is still out on whether key alternative payment models, such as accountable care organizations (ACOs) and bundled payments, reduce healthcare costs and improve care quality. But the mixed results should not discourage the industry...

Private Sector to Drive Bundled Payments After CMS Cancellations

by Jacqueline Belliveau

CMS recently announced its intention to modify its bundled payments strategy by proposing to eliminate forthcoming mandatory cardiac models and decreasing the scope of the Comprehensive Care for Joint Replacement (CJR) program. The pull away...

Cost Savings Unclear for Medicaid Alternative Payment Models

by Jacqueline Belliveau

Alongside Medicare and private payers, states are making the switch to value-based reimbursement, but states and independent researchers have yet to demonstrate the impact of Medicaid alternative payment models on healthcare costs and patient...

CMS May Cancel Upcoming Cardiac, Ortho Bundled Payment Models

by Jacqueline Belliveau

UPDATE: CMS released the complete proposed rule, which would cancel the Episode Payment Models and the Cardiac Rehabilitation Incentive Payment Model. The proposed rule would also decrease the number of mandatory geographic regions in the Comprehensive...

Quality Payment Program, MIPS Top 2017 Regulatory Burden List

by Jacqueline Belliveau

Medicare’s new value-based reimbursement program has topped the list of most burdensome regulations for healthcare providers, according to a new MGMA survey. About 82 percent of leaders from 750 group practices viewed MACRA’s Quality...

Do Oncology Bundled Payments Promote Low-Value Drug Use?

by Jacqueline Belliveau

Oncology bundled payments are not the answer to lowering prescription drug costs for cancer care delivery, the American Society of Clinical Oncology recently contended. In a position statement on addressing the affordability of cancer drugs,...

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