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

Value Based Care

Post-Acute Care Payment Reform Threatens Rural Hospitals

August 17, 2017 - 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 care revenue, a recent NC Rural Health Research Program brief stated. “If the number of rural providers of PAC [post-acute care] and hospice...


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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...

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 Association...

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...

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