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

Value Based Care

Examining the Role of Financial Risk in Value-Based Care

by Jacqueline LaPointe

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...

Non-ACO Hospitals Outperform ACOs in Value-Based Care Programs

by Jacqueline LaPointe

To usher in the age of value-based care, CMS has implemented several value-based care programs and introduced various alternative payment models, such as accountable care organizations (ACO). These programs all have a common goal: raise...

Understanding the Basics of Bundled Payments in Healthcare

by Jacqueline LaPointe

The shift to value-based care has driven public and private payers to redesign reimbursement models that stress accountability for care quality and healthcare costs. As the fee-for-service environment fades away, alternative payment models...

Deloitte: Only Half of Physicians Have Heard of MACRA

by Jacqueline LaPointe

Despite the significance of its provisions, many healthcare providers are still unaware of MACRA and the federal government's plans to eliminate the sustainable growth rate and offer new alternative payment models to eligible...

AHA: Healthcare Fraud Laws Impede Value-Based Care Success

by Jacqueline LaPointe

For alternative payment models under MACRA to succeed, the federal government needs to revise healthcare fraud and abuse prevention laws to work with new value-based care strategies, explained the American Hospital Association (AHA) in a...

House Reps Ask for FFS Waivers for Alternative Payment Models

by Jacqueline LaPointe

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...

CMS Selects 200 Groups for Value-Based Care Oncology Model

by Jacqueline LaPointe

The Centers for Medicare and Medicaid Services (CMS) has announced that almost 200 physician groups and 17 health insurance companies will join the Oncology Care Model, a value-based care program starting in July for providers who furnish...

Characteristics of Successful Accountable Care Organizations

by Jacqueline LaPointe

As the number of accountable care organizations (ACO) continues to grow, many healthcare providers are all too familiar with the alternative payment model’s overarching goals of improving care quality, advancing population health,...

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

by Jacqueline LaPointe

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...

Only One-Third of Physicians Approve of Value-Based Care Models

by Jacqueline LaPointe

Value-based care models represent the future of patient care and reimbursement structures for most healthcare stakeholders, but some providers may not have such positive views on new payment and care arrangements. If a recent survey is...

How to Address Challenges of Alternative Payment Models

by Jacqueline LaPointe

As the healthcare industry moves towards value-based care, more providers are choosing alternative payment models to facilitate the transition. CAPG, a trade association of accountable physician organizations, has published a guide of...

Value-Based Care Implementation Delayed for Most Hospitals

by Jacqueline LaPointe

While the federal government has announced explicit goals for implementing value-based care models in the next few years, some healthcare providers may not be ready to completely do away with traditional fee-for-service reimbursement...

AHA: Commercial ACO Tax Ruling Impedes Value-Based Care Models

by Jacqueline LaPointe

By stripping commercial accountable care organizations (ACOs) of their charitable tax exempt status, the IRS could be threatening the future of value-based care and care coordination, according to the American Hospital Association...

Providers Prioritize Quality Care, Not Lower Healthcare Costs

by Jacqueline LaPointe

By now, many healthcare providers are partaking in some form of value-based care, which aims to foster quality care while reducing healthcare costs. To achieve this, value-based care relies on care coordination to decrease unnecessary...

Value-Based Care Leads to Higher Costs for Surgical Complications

by Catherine Sampson

As a result of recent efforts to bring value-based care to the reimbursement cycle, it’s now more important for both providers and payers to gain an understanding about the link between costs and surgical complications, according to...

For Truly Value-Based Care, Use Outcomes Instead of Processes

by Catherine Sampson

Value-based care is the goal of many of the nation’s healthcare reform efforts, yet basing regulatory changes and provider-facing metrics on checking off processes instead of achieving outcomes could be the wrong approach, states a...

AMA Releases Value-Based Care, MACRA Resources for Providers

by Jacqueline LaPointe

As part of its STEPS Forward program, the American Medical Association (AMA) has released eight new educational modules to support healthcare providers with the transition to value-based care, reported AMA in an official press...

CMS Proposes New Quality Reporting for Skilled Nursing Facilities

by Catherine Sampson

CMS is hoping to bring more value-based care to skilled nursing facilities by issuing a proposed rule that raises the bar on quality reporting programs for these providers. As part of the Improving Medicare Post-Acute Care Transformation...

House Requests CMS Delay Quality, Value-Based Care Ratings

by Jacqueline LaPointe

A group of 225 members of the House of Representatives recently wrote a letter urging CMS it to delay the release of the hospital star rating system because it does not include relevant quality measures for assessing value-based care and...

Bundled Payments Program Extended to Improve Value-Based Care

by Jacqueline LaPointe

The Centers for Medicare & Medicaid Services (CMS) recently announced that some healthcare organizations can extend their participation in the Bundled Payments for Care Improvement (BPCI) initiative, a program that aims to increase...

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