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

Value Based Care

Provider Data Integrity Key to Directory Accuracy, Value-Based Care

October 16, 2017 - Providers and their payers oftentimes have a love-hate relationship. Payers boost the number of patients walking through physician office doors using provider directories as well as reimburse providers for treating those patients. But navigating how to join a plan’s network just to see those patients and get paid for providing healthcare services involves extensive communication between...


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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...

CO’s Pediatric Care Network Brings Value-Based Care to Children

by Jacqueline Belliveau

Medicare has led the healthcare industry as it shifts from fee-for-service to value-based care, with 30 percent of traditional Medicare reimbursements already paid under an alternative payment model. The federal government plans to further transition...

Prioritizing Value-Based Care, Affordability in Medicaid

by Jacqueline Belliveau

WASHINGTON DC - The future of Medicaid involves providing value-based care at an affordable price for all beneficiaries in the program, Kaiser Permanente’s CEO Bernard J. Tyson told attendees at AHIP’s National Conference on Medicaid....

Payer, Provider Collab, Home Health Key to Integrated Care

by Jacqueline Belliveau

WASHINGTON DC - The move to integrated care models that treat the whole individual, not just his medical needs, rests on payer and provider collaboration as well as linking healthcare and lifestyle, Humana’s CEO and President Bruce D. Broussard...

How Healthcare Reform, Value-Based Care Define High-Performance

by Jacqueline Belliveau

Whether through the Triple Aim or Institute of Medicine’s six aims, healthcare reform efforts and value-based care models intend to transform health systems and hospitals into high-performing entities. But what exactly does it mean to be...

Orgs Offer Regulatory Relief to Boost Value-Based Purchasing

by Jacqueline Belliveau

In response to the recent CMS call for stakeholder feedback on how to provide regulatory relief, industry groups detailed ways to reduce red tape associated with value-based purchasing implementation. Hospitals and individual providers have recently...

How Palomar Health Created a High-Value Post-Acute Care Network

by Jacqueline Belliveau

Ensuring patients receive high-value care delivery during their hospital stay or office visit is a top priority for healthcare providers. But value-based purchasing models are pressuring doctors to extend that same cost-efficient, high-quality...

AMGA: MIPS Exclusion Rules Inhibit Value-Based Care Under MACRA

by Jacqueline Belliveau

The American Medical Group Association (AMGA) recently opposed several proposed changes to the Quality Payment Program and its Merit-Based Incentive Payment System (MIPS) for the 2018 performance period. The group particularly expressed concerns...

Post-Acute Care Payment Reform Threatens Rural Hospitals

by Jacqueline Belliveau

A proposed unified Medicare reimbursement for post-acute care services and value-based care payment models, such as accountable care organizations (ACOs) and bundled payments, may propel rural hospital closures as the reforms lower their post-acute...

Small Health System Achieves ROI with Asthma Management Clinic

by Jacqueline Belliveau

Asthma is one of the most expensive chronic diseases for providers, payers, and patients. But a recent study in the American Journal of Managed Care showed that a stationary pediatric asthma management clinic can achieve a return on investment...

Health Center Work Conditions Drop After Practice Transformation

by Jacqueline Belliveau

Improving work conditions for clinicians and staff members may be key to implementing practice transformations for value-based care in federally qualified health centers (FQHCs), a new Health Affairs study suggested. Recent survey results showed...

Accountable Care Organizations Grow, But Face New Challenges

by Jacqueline Belliveau

Since the Affordable Care Act paved the way for accountable care organizations (ACOs) in 2010, healthcare providers have increasingly turned to the alternative payment model as a way to engage in value-based care across patient populations. In...

AMA Backs CMS Diabetes, Legacy Value-Based Purchasing Changes

by Jacqueline Belliveau

The American Medical Association (AMA) recently commended CMS for several recommendations outlined in the recently proposed 2018 Physician Fee Schedule rule. The industry group particularly welcomed a potential Medicare Diabetes Prevention Program...

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...

Small Hospitals, Systems Grapple with Value-Based Reimbursement

by Jacqueline Belliveau

Approximately 67 percent of small hospitals and health systems do not plan on undertaking value-based reimbursement initiatives in 2017, a recent Ernst & Young LLP Advisory Health survey revealed. The survey of 700 healthcare professionals...

Core Competencies for Accountable Care Organization Development

by Jacqueline Belliveau

The National Business Group on Health (NBGH) recently identified the core competencies accountable care organizations (ACOs) should have at each stage of its development. The two resources from NBGH on ACO competencies are meant to help employers...

GAO: Hospital Value-Based Purchasing Model Rewards Low Quality

by Jacqueline Belliveau

A new Government Accountability Office (GAO) report found that CMS gave financial bonuses to hospitals participating in the Hospital Value-Based Purchasing Program despite the facilities earning composite quality scores below the median. Using...

Payer Collaboration Key to Value-Based Reimbursement Strategy

by Jacqueline Belliveau

Value-based reimbursement arrangements come in a myriad of shapes and sizes much like provider organizations. But successful value-based contracts will align provider and payer goals for care quality and healthcare utilization as well as establish...

Implementing Value-Based Healthcare Revenue Cycle Management

by Jacqueline Belliveau

To align healthcare revenue cycle with value-based reimbursement, healthcare organizations should start by breaking down clinical and financial siloes established by fee-for-service payment models, agreed presenters at Xtelligent Media’s...

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