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

Fee For Service

Nearly 71% of Practice Revenue Under Fee-For-Service in 2016

December 27, 2017 - Fee-for-service was still the dominant source of medical practice revenue in 2016, the American Medical Association (AMA) recently reported. Almost 84 percent of physicians stated that their practice received fee-for-service revenue in 2016. The percentage of physicians reporting fee-for-service revenue is down from 89.4 percent of doctors in 2012, revealed data from the AMA’s...


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

by Jacqueline LaPointe

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...

Driven by Fee-For-Service, Docs Say Up to 30% of Care Unnecessary

by Jacqueline LaPointe

At least 15 percent to 30 percent of medical care is unnecessary, contributing to low-value resource use and wasteful healthcare spending, stated the majority of physicians surveyed in a recent PLOS ONE study. While the survey of...

CPC Initiative Improves Care Delivery But Not Medicare Spending

by Catherine Sampson

Although the Comprehensive Primary Care (CPC) initiative lead to progress in primary care delivery, it has not caused improvements in Medicare spending, patient experience or quality of care, researchers from The New England Journal of...

HIMSS: Providers Not Ready for Value-Based Care Reimbursement

by Vera Gruessner

In recent years, the healthcare industry and the revenue cycle of providers has had a much greater target of achieving value-based care reimbursement and moving away from fee-for-service payment systems. The Centers for Medicare &...

ACO Expansion: A Costly but Vital Sustainability Investment

by Jacqueline DiChiara

The number of accountable care organizations (ACOs) is on the rise, albeit a tad slowly, confirms new research from Niyum Ghandi, Partner at Oliver Wyman. There has been active ACO expansion activity with the healthcare...

Hospitals’ Value-Based Revenue Increasing Significantly

by Jacqueline DiChiara

As the healthcare pendulum swings in the direction of value-based care, recent data suggests it may be swinging more quickly than anticipated away from fee-for-service initiatives, according to a pair of hospital surveys from...

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...

Affordable Care Act Means Lower Reimbursement for Physicians

by Jacqueline DiChiara

One year after The Affordable Care Act’s (ACA) implementation, most physicians urge Congress to overturn the legislation after experiencing lower reimbursement, as reported in a recent physician survey. Although 44 percent of surveyed...

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...

Telehealth Reimbursement Needed for its Growth, Advancement

by Jacqueline DiChiara

An increasingly digitalized healthcare system has experienced significant telehealth reimbursement changes — even within the past five years — as it becomes more routinely integrated. The snowballing demand for telehealth...

Why Recent Attempts at Healthcare Reform Regulation Matter

by Jacqueline DiChiara

One notable trending topic — value-based care — is buzzing among healthcare organizations in recent weeks, especially with more federal healthcare reform going into effect. And recent developments at The Department of Health...

UnitedHealth Takes Steps to Embrace Value-Based Reimbursement

by Ryan Mcaskill

More healthcare providers and payers are embracing value-based reimbursement instead of fee-for-service. One of the biggest trends in the healthcare industry is the adoption of value-based reimbursement instead of the traditional...

New York Faces $1M in Inappropriate Medicaid Claims

by Stephanie Reardon

Nearly $1 million paid in Medicaid claims for beneficiaries who already had these services paid for through managed care plans. The New York State Office of the State Comptroller has released an audit on the Medicaid program department of...

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...

Examining the Fee-for-Service v. Value-Based Payment Models

by Ryan Mcaskill

Over the last few years there has been a significant shift in health care payment models. More patients are looking for ways to save on their bills and providers are adjusting operations to meet the demands. Traditionally, the...

Experts Respond to Healthcare Payment Reform Scorecard

by Ryan Mcaskill

Earlier this month, this website examined the Catalyst for Payment Reform’s (CPR) 2014 national Scorecard for Payment Reform. It studied commercial health plans, specifically focusing on value-based payments versus the traditional...

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