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

Value Based Care

GAO: Quality Measure Misalignment Impedes Provider Improvement

by Jacqueline LaPointe

Healthcare quality measures are integral to determining value-based reimbursement, but misalignment of quality measures across public and private payers has made it more difficult for providers to develop quality improvements for...

Provider Engagement Key to Accountable Care Organization Success

by Jacqueline LaPointe

Accountable care organizations (ACOs) leaders may need to boost healthcare provider engagement to foster value-based care success, a recent study in the American Journal of Accountable Care indicates. In a case study at the Johns Hopkins...

CMS Launches Provider Engagement, Value-Based Care Initiative

by Jacqueline LaPointe

CMS recently announced a new provider engagement initiative designed to improve the clinician experience within the Medicare program, especially as value-based care models are developed under the Affordable Care Act and MACRA. As...

How Value-Based Reimbursement Affects Physician Productivity

by Jacqueline LaPointe

As payers push for more value-based reimbursement adoption, many healthcare organizations are wondering how to restructure physician productivity strategies to meet the unique requirements of performance-based payments. But the key to...

Few Docs Familiar with MACRA, Transitioning to Value-Based Care

by Jacqueline LaPointe

Only 20 percent of physicians reported that they are very or somewhat familiar with MACRA, according to a recent survey from the Physicians Foundation and Merritt Hawkins, and the majority of respondents do not currently have a large...

Value-Based Care Analytics Help Cut Healthcare Costs in Utah

by Jacqueline LaPointe

By implementing a data analytics tool that integrates spending and patient outcome data, a Utah-based healthcare system reduced spending by up to 11 percent on three clinical improvement projects, including joint replacement, laboratory...

Preventable Readmissions Drop Under Value-Based Care Model

by Jacqueline LaPointe

Forty-nine states and Washington DC have decreased preventable hospital readmissions under a Medicare value-based care initiative that financially penalizes hospitals with excess readmissions, reported CMS. “The Hospital...

Value-Based Care Spurs Higher Physician Consolidation Rates

by Jacqueline LaPointe

More healthcare providers are moving to larger group practices in order to gain access to more resources to effectively implement value-based care and risk-based reimbursement models, according to a recent Datawatch report in Health...

CMS Touts Progress of State-Led Alternative Payment Model

by Jacqueline LaPointe

States participating in the first phase of the State Innovation Model Initiative have made significant progress in implementing alternative payment models, CMS officials revealed midweek. Two of six states were able to link more than half...

How to Plan Out the Transition to Value-Based Reimbursements

by Jacqueline LaPointe

Providers should address the drivers of value-based reimbursements to appropriately pace their transition to alternative payment models without sacrificing crucial fee-for-service revenue, according to  a new guide from Pershing...

Is MACRA a Trojan Horse for Small Practices, Value-Based Care?

by Jacqueline LaPointe

While a final rule on MACRA implementation has yet to be issued, some providers are growing concerned that the value-based care models in the legislation could significantly burden small physician practices. Providers in small practices...

AMGA Urges CMS to Release Claims Reimbursement Plan for CPC+

by Jacqueline LaPointe

The American Medical Group Association (AMGA) has called on CMS to release the claims reimbursement formula for the Comprehensive Primary Care + (CPC+) model, according to a letter sent to the federal agency earlier this week. The...

How Emergency Providers Can Adopt Alternative Payment Models

by Jacqueline LaPointe

With many value-based care initiatives aiming to reduce costly emergency room visits, some emergency departments are finding it increasingly difficult to engage with alternative payment models, according to a report in the American Journal...

HHS Awards $100M to Health Centers for Quality Improvement

by Jacqueline LaPointe

The Department of Health and Human Services recently granted over $100 million in awards to 1,304 health centers across the nation to help improve care quality and boost primary care services, according to the federal department’s...

How the Affordable Care Act Impacted Healthcare Revenue Cycle

by Jacqueline LaPointe

From the transition to value-based care to the rise in patient consumerism, the Affordable Care Act has significantly changed the healthcare revenue cycle management landscape since its passage in 2010. Healthcare providers restructured...

AHA: Limiting Low-Value Medical Resource Use Cuts Healthcare Costs

by Jacqueline LaPointe

While it is always reassuring to know that a provider will stop at nothing to diagnosis and treat his patients, limiting some medical resource use may actually help to decrease healthcare costs and improve quality of life for some...

Value-Based Care Penalties Spark Greater Quality Improvements

by Jacqueline LaPointe

Financial penalties may be the key to advancing value-based care goals, such as reducing hospital admissions, according to a recent study in the American Journal of Managed Care. Almost two-thirds of hospital leaders stated that the...

At-Home Service Value-Based Care Model Saves Medicare $10M

by Jacqueline LaPointe

A value-based care model designed to deliver at-home primary care services to patients who suffer from multiple chronic diseases has continued to improve beneficiary outcomes and reduce Medicare spending. Medicare saved $10 million during...

CMS Final Rule Updates Inpatient Claims Reimbursement System

by Jacqueline LaPointe

Providers can expect an array of changes to Medicare claims reimbursement and value-based care programs starting in October, according to a final rule issued by CMS earlier this week. The 2,434-page final rule primarily updated the...

CMS Issues Final Changes for Medicare Reimbursement Programs

by Jacqueline LaPointe

CMS recently announced final rules and payment system updates for four Medicare reimbursement programs affecting a variety of physicians and healthcare professionals, the federal agency reported on its website. Healthcare providers in the...

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