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

Value Based Care

Payer Collaboration Key to Value-Based Reimbursement Strategy

June 28, 2017 - 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 provider incentives within the healthcare organization, attendees learned at Xtelligent Media’s 2017 Value-Based Care Summit in Chicago. “There...


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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...

Engaging Providers Key to Value-Based Reimbursement Adoption

by Jacqueline Belliveau

Nearly three-quarters (73 percent) of providers prefer a fee-for-service model over value-based reimbursement structures even though almost one-half acknowledged that the traditional payment model contributed to higher healthcare costs, a recent...

AMGA President, CEO Donald W. Fisher, PhD, Passes at 71

by Jacqueline Belliveau

AMGA President and CEO, Donald W. Fisher, PhD, CAE, passed earlier this week after battling cancer, the healthcare industry group reported. Fisher, who was 71 years old, had led the organization since 1980. “Don leaves a professional and...

How to Prepare for Alternative Payment Model Implementation

by Jacqueline Belliveau

Implementing interoperable health IT infrastructure and a staffing model that aligns with value-based care requirements are key to successfully participating in an alternative payment model, Marjie Harbrecht, MD, a Medical Group Management...

NAM Advises Leaders to Prioritize Value-Based Purchasing Reform

by Jacqueline Belliveau

In a new report, the National Academy of Medicine (NAM) named value-based purchasing as one of four action priorities for healthcare stakeholders in 2017. To implement more value-based purchasing models, NAM suggested that stakeholders focus...

46% of Providers Unsure About Value-Based Purchasing Impact

by Jacqueline Belliveau

Value-based purchasing is not a new term for many providers, yet 46.4 percent of healthcare providers and leaders are still unsure how the shift away from fee-for-service payments will impact their revenue cycles, a recent Physicians Practice...

Higher Hospital Costs Stem from ICU Overuse for Some Conditions

by Jacqueline Belliveau

Healthcare providers may be able to decrease hospital costs by avoiding ICU admissions for some patients with chronic obstructive pulmonary disease (COPD), exacerbation of heart failure (HF), and acute myocardial infarction (AMI), a recent American...

65% of Organized Providers Paid Via Alternative Payment Models

by Jacqueline Belliveau

Nearly two-thirds of healthcare providers in some type of integrated employment model, such as integrated health networks, physical hospital organizations, accountable care organizations, and large medical groups, are primarily reimbursed through...

Coalition Offers CMMI, Alternative Payment Model Improvements

by Jacqueline Belliveau

Thirty-five healthcare industry groups recently banded together to offer the newly-approved Department of Health and Human Services (HHS) Secretary a set of guidelines for CMS Innovation Center (CMMI) and alternative payment model development...

HHS: Physician Self-Referral Law Hinders Value-Based Care

by Jacqueline Belliveau

Some healthcare fraud prevention regulations many impede value-based care models that use financial incentives to encourage providers to improve care quality and reduce healthcare costs, the Department of Health and Human Services (HHS) recently...

Industry Orgs Urge Lawmakers to Continue Value-Based Care Push

by Jacqueline Belliveau

Over 120 healthcare industry groups, including hospitals, healthcare systems, payers, and professional organizations, recently urged the Trump administration and Congress to not discontinue or slow the transition to value-based care. In the letter...

359K Clinicians to Join CMS Alternative Payment Models in 2017

by Jacqueline Belliveau

CMS recently announced that the federal agency selected over 359,000 clinicians to participate in four of the federal agency’s alternative payment models in 2017. The new participants will be joining the Medicare Shared Savings Program...

Avoidable Hospitalizations Drop 31% for Long-Term Care Patients

by Jacqueline Belliveau

Avoidable hospitalizations among dual-eligible long-term care facility residents dropped by 31 percent between 2010 and 2015 largely because of value-based care programs, CMS recently stated in an official blog post. “Family members want...

Do Pay-for-Performance Programs Improve Patient Outcomes?

by Jacqueline Belliveau

Value-based reimbursement models that pay for performance modestly incentivized providers to stick to clinical guidelines, but they may not be linked to better patient outcomes, a recent Annals of Internal Medicine study indicates. The literature...

Addressing Social Risk in Medicare Value-Based Reimbursement

by Jacqueline Belliveau

Hospitals that disproportionately treat patients with social risk factors, such as low income and race, may be unfairly penalized under some Medicare value-based reimbursement programs. But the National Academies of Science, Engineering, and...

Payment Reform, Value-Based Care Top 2017 Medicaid Priorities

by Jacqueline Belliveau

Delivery system and healthcare payment reform, especially through value-based care, topped the list of 2017 Medicaid priorities, according to the annual State Medicaid Operations Survey from the National Association of Medicaid Directors (NAMD)....

CMS Adds 2 Compare Websites to Boost Healthcare Transparency

by Jacqueline Belliveau

In effort to increase healthcare transparency, CMS recently added two new healthcare organization Compare websites and updated performance data for existing hospice care, hospital, and physician Compare websites. “At CMS, one of our top...

Developing Post-Acute Networks for APM Reimbursement Success

by Jacqueline Belliveau

About 85 percent of healthcare C-suite leaders expect to expand post-acute care partnerships over the next three years, especially as their organizations aim to maximize alternative payment model reimbursement, a recent Premier report found....

Provider Orgs Seek Healthcare Costs Tools for Value-Based Care

by Jacqueline Belliveau

Provider organizations are increasingly looking to implement healthcare costs tools to better manage healthcare supply chain costs under value-based care models, a recent Black Book Market Research survey stated. The survey of 1,158 healthcare...

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