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

Alternative Payment Models

Do Proposed Quality Payment Program Changes Support Specialists?

August 16, 2018 - The American Society of Clinical Oncology (ASCO) recently expressed their concerns with proposed Quality Payment Program changes, arguing the potential implementation policies for the third year of the program do not align with specialty care. “The recently released 2019 Quality Payment Program (QPP) rule in combination with the Medicare Physician Fee Schedule (MPFS) raises...


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Employers Play Bigger Role in Value-Based Reimbursement Transition

by Jacqueline LaPointe

Providers wanting to expand their value-based reimbursement contracts may want to look to the employer-sponsored health plan market, according to a new report from the Duke-Margolis Center for Health Policy and the Robert Wood Johnson...

Giving Providers Hospital Cost Accounting Data Will Lower Costs

by Jacqueline LaPointe

Engaging physicians with hospital cost accounting data will be key to lowering costs under accountable care organizations (ACOs) and other population-based reimbursement models, Stanford researchers recently explained. Population-based...

CMS Considers Stark Law Changes to Support Value-Based Care, APMs

by Jacqueline LaPointe

CMS is seeking input on how to potentially modify the physician self-referral law, otherwise known as the Stark Law, to encourage value-based reimbursement and care delivery. In a new Request for Information (RFI), the federal agency is...

Level the Playing Field for Medicare Advantage in MACRA, Orgs Urge

by Jacqueline LaPointe

Eleven industry groups are urging CMS to include Medicare Advantage (MA) in MACRA as soon as possible to provide the same incentives to eligible clinicians in risk-based MA models as those offered to clinicians in Medicare Advanced...

Hospitalization-Based Bundled Payment Models Key to Lowering Costs

by Jacqueline LaPointe

Bundled payment models should center on acute hospitalizations, rather than outpatient care, because hospitalization-based bundles can more effectively impact post-acute care (PAC) spending, industry experts from the USC-Brookings...

CMS OKs Maryland’s All-Payer Alternative Payment Model Expansion

by Jacqueline LaPointe

CMS greenlighted an expansion of an all-payer alternative payment model in Maryland that allows the state to set hospital reimbursement rates, the office of Governor Larry Hogan recently announced. Maryland’s unique alternative...

Only 4 CMMI Alternative Payment Models Met Spending, Quality Goals

by Jacqueline LaPointe

The CMS Innovation Center is on the path to reducing healthcare costs while improving care quality through alternative payment and care delivery models, a recent Government Accountability Office (GAO) report found. But only four...

CMS Targets Value-Based Purchasing, Drug Costs to Reduce Spending

by Jacqueline LaPointe

Healthcare spending is growing at an unstainable rate, and CMS aims to curb spending through initiatives that promote value-based purchasing, reduce administrative burdens, and lower prescription drug costs, CMS Administrator Seema Verma...

CMS Seeks Info on a Direct Provider Contracting Model for Medicare

by Jacqueline LaPointe

CMS is seeking comments on a potential alternative payment model that would allow primary care providers to directly bill Medicare beneficiaries through a direct provider contracting model. Currently, providers must opt out of Medicare...

AMA, ASAM Create Alternative Payment Model for Opioid Use Disorder

by Jacqueline LaPointe

The American Society of Addiction Medicine (ASAM) and the American Medical Association (AMA) recently unveiled an alternative payment model that aims to improve care and reduce costs associated with opioid use disorder. The new...

Bundled Payments with Drug Costs Threaten Cancer Care Quality

by Jacqueline LaPointe

Oncology bundled payments that include drug costs would negatively impact cancer care, a new report in the Journal of Oncology Practice showed. According to the report done by Milliman, Inc. for the American Society of Clinical Oncology...

Practices Push for Quicker Value-Based Purchasing Transition

by Jacqueline LaPointe

The Council of Accountable Physician Practices (CAPP) recently urged policymakers to prioritize the value-based purchasing transition by accelerating the shift away from fee-for-service. “We recognize that much of...

Orgs Not Living Up to Risk-Based Revenue Goals, C-Suite Says

by Jacqueline LaPointe

Provider organizations failed to achieve their risk-based revenue goals in 2017, according to the most recent State of Population Health survey by Numerof & Associates. The survey of healthcare C-suite executives showed that the...

Uniform Operational System Key to Value-Based Payments, CAQH Says

by Jacqueline LaPointe

The healthcare industry needs an “efficient, uniform operational system” to sustain value-based payment success, the Council for Affordable Quality Healthcare’s (CAQH) Committee on Operating Rules for Information Exchange...

MD All-Payer Alternative Payment Model Met Medicare Spending Goal

by Jacqueline LaPointe

The Maryland All-Payer alternative payment model has already met and exceeded its five-year goal of reducing Medicare spending on hospitals by $330 million and the state is on its way to achieving care quality improvement goals, the...

Orgs Troubled by Post-Acute Care’s Role in New Bundled Payments

by Jacqueline LaPointe

Long-term and post-acute care provider organizations recently voiced their concerns with the new Bundled Payments for Care Improvement (BPCI) Advanced model’s reduced role of post-acute care providers. Eliminating the post-acute...

Large, High-Volume Hospitals Save in CJR Bundled Payments Model

by Jacqueline LaPointe

Larger hospitals with greater knee and hip replacement volumes were more likely to realize cost savings under Medicare’s mandatory lower joint replacement bundled payments model, a new analysis from Penn Medicine showed. The...

AMA, Anthem Team Up to Streamline Prior Authorizations

by Jacqueline LaPointe

The American Medical Association (AMA) and Anthem, Inc. recently announced that they will work together over the next year to streamline prior authorization requirements and improve the healthcare experience overall through provider and...

Accelerating the Value-Based Payment Transition Top HHS Priority

by Jacqueline LaPointe

Quickening the pace of the value-based payment transition is a major focus for HHS, the department’s new Secretary Alex Azar recently told attendees of the Federation of American Hospitals’ annual Public Policy Conference in...

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