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

Payment Reform Models

CMS Calls on Stakeholders for Pediatric APM Development Input

February 28, 2017 - CMS recently put out a request for information for a potential Medicaid and Children’s Health Insurance Program (CHIP) alternative payment model targeting pediatric care, according to an official CMS blog post. “Through the RFI [request for information], we are seeking input on approaches to improve the quality and reduce the cost of care for children and youth enrolled in Medicaid...


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House Reps Urge CMMI to Cease Mandatory Payment Reform Models

by Jacqueline Belliveau

In a recent letter to CMS leaders, House representatives urged the federal agency to stop all mandatory payment reform demonstrations through the Center for Medicare and Medicaid Innovation (CMMI), such as the ongoing Comprehensive Care for Joint...

For Truly Value-Based Care, Use Outcomes Instead of Processes

by Catherine Sampson

Value-based care is the goal of many of the nation’s healthcare reform efforts, yet basing regulatory changes and provider-facing metrics on checking off processes instead of achieving outcomes could be the wrong approach, states a new...

How to Scale Healthcare Bundled Payments throughout Hospitals

by Vera Gruessner

Healthcare bundled payments are a key strategy across the industry aimed at boosting patient health outcomes, improving the quality of care, and bringing reimbursement toward a value-based payment model. While the Centers for Medicare & Medicaid...

Examining the Value-Based Alternative Payment Model Basics

by Jacqueline DiChiara

Alternative payment models like the accountable care organization (ACO) and the bundled payment model have been gaining popularity under the Affordable Care Act’s (ACA) mandates. Figuring out how alternative payment models will evolve under...

2 Medicare Alternative Payment Models Demanding Future Focus

by Jacqueline DiChiara

Medicare alternative payment models have the ability to make affordable, high quality care a reality. But providers still demand greater levels of care coordination and cleaner streamlining of clinical data to achieve value-based reimbursement...

AHA: Stark Law Exception Advances Alternative Payment Models

by Jacqueline DiChiara

Congress should focus on improving federal fraud and abuse laws, said the American Hospital Association (AHA) to the Senate Finance and House Ways and Means Committee last week. The AHA advocated for an exception to be created under the anti-kickback...

Why Flawed Alternative Payment Model Design Holds MACRA Back

by Jacqueline DiChiara

Alternative Payment Models (APMs) do not adequately address payment system problems, according to a new report from the Center for Healthcare Quality and Payment Reform (CHQPR). Healthcare payment reform is apparently progressing at a snail’s...

Top 6 Accountable Care Organization Questions Explained

by Jacqueline DiChiara

Sometimes questions are more important than answers. Accountable care organizations (ACOs) — groups of doctors, hospitals, and healthcare providers helping provide Medicare beneficiaries with top-notch coordinated fee-for-service care –...

Top 6 Trending Payment Models Demanding New Long-Term Focus

by Jacqueline DiChiara

Time is money, especially when it comes to healthcare. Paying for outcomes gained instead of mere services rendered is the new name of the healthcare game. This means the simple notion of paying for multiple physician visits, medical...

CMS Announces Two-Midnight Payment Cut Commentary Period

by Jacqueline DiChiara

A notice and accompanying commentary period released yesterday from The Centers for Medicare & Medicaid Services (CMS) examines the core issue behind slashing hospital inpatient payments by 0.2 percent. This financial cut is tied to a “two-midnight...

CMS Adds Pilot Project Participants to Reduce Medicare Costs

by Jacqueline DiChiara

The Centers for Medicare & Medicaid Services (CMS) has announced over 2,100 acute care hospitals, skilled nursing facilities, physician group practices, long-term care hospitals, inpatient rehabilitation facilities, and home health agencies...

AMA Inaugurates Stack, Youngest President in 160 Year History

by Jacqueline DiChiara

Steven J. Stack, MD, has been sworn in as the youngest president of the American Medical Association (AMA) within the past 160 years. Stack is the 170th president of the AMA, the nation’s largest physician organization. "I am...

Integrated Community Oncology Practices Need Cost Efficiency

by Jacqueline DiChiara

Integrated community oncology practices represent a core foundation of cancer care by promoting a rewarding patient experience and helping cancer patients successfully battle complex social and health issues. Unfortunately, financial obstacles...

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 fee-for-service...

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 fee-for-service...

Can Primary Care End the Pay-for-Service Model?

by Ryan Mcaskill

According to a new report, the role primary care physicians play in the payment side of the health care landscape is becoming more important. The Affordable Care Act is expected to add 25 million primary care appointments annually, all of which...

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