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

Value Based Care

CMS Touts Progress of State-Led Alternative Payment Model

by Jacqueline Belliveau

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 of...

How to Plan Out the Transition to Value-Based Reimbursements

by Jacqueline Belliveau

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 Yoakley...

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

by Jacqueline Belliveau

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 will...

AMGA Urges CMS to Release Claims Reimbursement Plan for CPC+

by Jacqueline Belliveau

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 value-based...

How Emergency Providers Can Adopt Alternative Payment Models

by Jacqueline Belliveau

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 of...

HHS Awards $100M to Health Centers for Quality Improvement

by Jacqueline Belliveau

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 website....

How the Affordable Care Act Impacted Healthcare Revenue Cycle

by Jacqueline Belliveau

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 how they...

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

by Jacqueline Belliveau

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 patients, reported...

Value-Based Care Penalties Spark Greater Quality Improvements

by Jacqueline Belliveau

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 Hospital...

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

by Jacqueline Belliveau

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 the...

CMS Final Rule Updates Inpatient Claims Reimbursement System

by Jacqueline Belliveau

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 Medicare Hospital...

CMS Issues Final Changes for Medicare Reimbursement Programs

by Jacqueline Belliveau

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 Medicare...

Examining the Role of Financial Risk in Value-Based Care

by Jacqueline Belliveau

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 payers...

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

by Jacqueline Belliveau

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 care...

Understanding the Basics of Bundled Payments in Healthcare

by Jacqueline Belliveau

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 like...

Deloitte: Only Half of Physicians Have Heard of MACRA

by Jacqueline Belliveau

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 clinicians beginning...

AHA: Healthcare Fraud Laws Impede Value-Based Care Success

by Jacqueline Belliveau

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 recent...

House Reps Ask for FFS Waivers for Alternative Payment Models

by Jacqueline Belliveau

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 waive...

CMS Selects 200 Groups for Value-Based Care Oncology Model

by Jacqueline Belliveau

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 chemotherapy...

Characteristics of Successful Accountable Care Organizations

by Jacqueline Belliveau

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, and reducing...


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