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

Alternative Payment Models

382 Hospitals Earn Initial Reconciliation Payments Under CJR Model

October 18, 2017 - 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 data on the program’s first performance year. CMS noted that initial reconciliation payments and the list of hospitals earning them may change since...


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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,...

CMS Considers Behavioral Health Alternative Payment Model

by Jacqueline Belliveau

CMS recently announced its intention to develop an alternative payment model targeting behavioral health services. The federal agency is seeking stakeholder feedback on model development in a public meeting on Sept. 8, 2017, in Baltimore. The...

3 Challenges Providers Face with Healthcare Bundled Payments

by Jacqueline Belliveau

Healthcare bundled payments are becoming one of the most popular alternative payment models available to providers. Providers are drawn to the episode-based structure’s ability to decrease healthcare costs while maintaining or improving...

Understanding the Top 10 Terms of Value-Based Purchasing

by Jacqueline Belliveau

Whether providers favor it or not, the healthcare industry is inevitability moving to value-based purchasing. CMS reported in 2016 that Medicare already linked 30 percent of traditional fee-for-service payments to value-based purchasing models...

Bundled Payments Rely on Robust Networks, Healthcare Markets

by Jacqueline Belliveau

Healthcare providers are finding that it takes a village to succeed in bundled payment models. From primary care to specialists and post-acute care, providers need an integrated network of provider types and to play to their healthcare market...

Accountable Care Organizations Continue to Grow With 11% Boost

by Jacqueline Belliveau

The number of accountable care organizations (ACOs) increased with 92 more organizations operating since the first quarter of 2016, reaching a total of 923 ACOs nationwide by the start of 2017, a recent Health Affairs blogpost stated. The Leavitt...

Surveys Reveal MACRA Implementation, QPP Knowledge Lacking

by Jacqueline Belliveau

Two recent surveys indicated that healthcare provider and executive knowledge of and readiness for MACRA implementation and the Quality Payment Program are lacking despite the value-based reimbursement program launching in January 2017. A new...

Industry Orgs Back 2018 MACRA Implementation Flexibilities

by Jacqueline Belliveau

Healthcare industry organizations largely applauded the recently-released 2018 MACRA implementation proposal from CMS. The medical organizations commended the federal agency’s continuation of the transition year into 2018 as well as the...

CMS Proposes 2018 Quality Payment Program Changes

by Jacqueline Belliveau

CMS recently announced a proposed rule that would modify MACRA’s Quality Payment Program during its second performance year to ease provider burdens and continue to ramp up full participation in the program. A major proposed change would...

MedPAC Eyes Merit-Based Incentive Payment System Redesign

by Jacqueline Belliveau

The Medicare Payment Advisory Commission (MedPAC) recently advised Congress to redesign MACRA’s newly-launched Merit-Based Incentive Payment System (MIPS) by eliminating MIPS measures, replacing them with population health measures, and...

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