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

Revenue Cycle Risk

71% of MSSP ACOs Likely to Quit Rather Than Assume Downside Risk

May 4, 2018 - The Medicare Shared Savings Program (MSSP) is requiring the 82 accountable care organizations (ACOs) that started in upside-only financial risk tracks in 2012 or 2013 to take on downside financial risk by 2019. However, the majority of these organizations are likely to leave instead of assuming more risk, a new survey from the National Association of ACOs (NAACOS) indicated. Seventy-one percent...


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

by Jacqueline Belliveau

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 majority...

A Holistic View of the Patient Enables Risk-Based ACO Success

by Jacqueline Belliveau

Giving providers a holistic view of the patient resulted in accountable care organization (ACO) success for a risk-based organization in southern Florida, which earned a place on the list of ACOs achieving the greatest shared savings in the Medicare...

Risk-Averse MSSP ACOs Missed $966M By Not Assuming Downside Risk

by Jacqueline Belliveau

Accountable care organizations (ACOs) in the non-risk bearing track of the Medicare Shared Savings Program (MSSP) could have boosted their bottom lines by an additional $966 million in net payments in 2016 if they had assumed downside risk in...

ACO, Bundled Payments Alignment Key to Success for Both Models

by Jacqueline Belliveau

CMS should align accountable care organizations (ACOs) and bundled payments by creating a blended accountability structure that allows organizations to participate in both alternative payment models without financial conflicts, industry experts...

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...

Full Risk Value-Based Care Key to Treating Vulnerable Patients

by Jacqueline Belliveau

Oak Street Health, a 24-primary care network headquartered in Chicago, aims to rebuild healthcare as it should be using value-based care contracts with full financial risk. The health system’s mission is to deliver personal, equitable,...

ACOs Plan to Move to Downside Financial Risk, Capitation Contracts

by Jacqueline Belliveau

Accountable care organizations (ACOs) are planning to enter downside financial risk arrangements, with 47 percent planning on entering a shared savings and losses contract and 38 percent pursuing capitation, uncovered a recent survey of 240 ACOs...

Creating Alternative Payment Models to Support Health Centers

by Jacqueline Belliveau

Healthcare stakeholders and lawmakers should encourage community health centers to engage in alternative payment models to financially incentivize providers to improve safety-net care, a recent Journal of the American Medical Association report...

61% of ACO Contracts Only Include Upside Financial Risk

by Jacqueline Belliveau

A recent Leavitt Partners study showed that 61 percent of accountable care organization (ACO) contracts are upside risk-only, indicating that ACOs may be risk-adverse or are still in the experimental stage with financial risk. Even though ACOs...

Examining the Role of Financial Risk in Value-Based Care

by Jacqueline Belliveau

As the healthcare industry ramps up its efforts to advance value-based care, providers are expected to take on more financial risk. One of the goals of value-based care is to transition financial risk away from taxpayers and healthcare payers...

The Future of Accountable Care Organizations Involves Risk

by Jacqueline Belliveau

As many healthcare providers know, participating in a value-based care program, such as an accountable care organization, is about more than just tying payment to quality.  It involves shouldering financial risk as a way to motivate clinicians...

House Reps Ask for FFS Waivers for Alternative Payment Models

by Jacqueline Belliveau

CMS should make it easier for fee-for-service providers to get involved in risk-based alternative payment models by reducing regulatory barriers, House representatives said in a letter this week. The seventy representatives asked CMS to waive...

Risk-Based Alternative Payment Models Key to Value-Based Care

by Jacqueline Belliveau

Although the Department of Health & Human Services (HHS) recently announced that it had already tied 30 percent of Medicare payments to an alternative payment model nearly a year ahead of schedule, a recent study indicates that further value-based...

Why Accountable Care Organizations Need Revenue Cycle Risk

by Jacqueline DiChiara

Is the "Accountable" part of accountable care organizations being ignored? Over 100 new Medicare Accountable Care Organizations (ACO) participants will keep quality high and costs low, according to the Centers for Medicare &...

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