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

Value Based Care

Value-Based Reimbursement Shift Slows, But CEOs Still Preparing

by Jacqueline LaPointe

Hospital and health system CEOS are gearing up for alternative payment models and population health management, but the transition to value-based reimbursement is taking more time than expected, a recent survey from Deloitte Center for...

AMA Pres: Align MIPS Improvement Activities with APM Demands

by Jacqueline LaPointe

Providers can ensure their investments in the Merit-Based Incentive Payment System (MIPS) are worth it by engaging in Improvement Activities and other practice transformations that enhance overall Medicare performance and lead them to the...

Provider Data Integrity Key to Directory Accuracy, Value-Based Care

by Jacqueline LaPointe

Providers and their payers oftentimes have a love-hate relationship. Payers boost the number of patients walking through physician office doors using provider directories as well as reimburse providers for treating those patients. But...

Do Alternative Payment Models Overcome Fee-for-Service Flaws?

by Jacqueline LaPointe

While alternative payment models, such as pay-for-performance, shared savings and risk, and bundled payments, were designed to improve the flawed fee-for-service system, the models are not addressing volume-based payment issues, according...

CO’s Pediatric Care Network Brings Value-Based Care to Children

by Jacqueline LaPointe

Medicare has led the healthcare industry as it shifts from fee-for-service to value-based care, with 30 percent of traditional Medicare reimbursements already paid under an alternative payment model. The federal government plans to...

Prioritizing Value-Based Care, Affordability in Medicaid

by Jacqueline LaPointe

WASHINGTON DC - The future of Medicaid involves providing value-based care at an affordable price for all beneficiaries in the program, Kaiser Permanente’s CEO Bernard J. Tyson told attendees at AHIP’s National Conference on...

Payer, Provider Collab, Home Health Key to Integrated Care

by Jacqueline LaPointe

WASHINGTON DC - The move to integrated care models that treat the whole individual, not just his medical needs, rests on payer and provider collaboration as well as linking healthcare and lifestyle, Humana’s CEO and President Bruce...

How Healthcare Reform, Value-Based Care Define High-Performance

by Jacqueline LaPointe

Whether through the Triple Aim or Institute of Medicine’s six aims, healthcare reform efforts and value-based care models intend to transform health systems and hospitals into high-performing entities. But what exactly does it mean...

Orgs Offer Regulatory Relief to Boost Value-Based Purchasing

by Jacqueline LaPointe

In response to the recent CMS call for stakeholder feedback on how to provide regulatory relief, industry groups detailed ways to reduce red tape associated with value-based purchasing implementation. Hospitals and individual providers...

How Palomar Health Created a High-Value Post-Acute Care Network

by Jacqueline LaPointe

Ensuring patients receive high-value care delivery during their hospital stay or office visit is a top priority for healthcare providers. But value-based purchasing models are pressuring doctors to extend that same cost-efficient,...

AMGA: MIPS Exclusion Rules Inhibit Value-Based Care Under MACRA

by Jacqueline LaPointe

The American Medical Group Association (AMGA) recently opposed several proposed changes to the Quality Payment Program and its Merit-Based Incentive Payment System (MIPS) for the 2018 performance period. The group particularly expressed...

Post-Acute Care Payment Reform Threatens Rural Hospitals

by Jacqueline LaPointe

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...

Small Health System Achieves ROI with Asthma Management Clinic

by Jacqueline LaPointe

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...

Health Center Work Conditions Drop After Practice Transformation

by Jacqueline LaPointe

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...

Accountable Care Organizations Grow, But Face New Challenges

by Jacqueline LaPointe

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...

AMA Backs CMS Diabetes, Legacy Value-Based Purchasing Changes

by Jacqueline LaPointe

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...

Understanding the Top 10 Terms of Value-Based Purchasing

by Jacqueline LaPointe

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...

Small Hospitals, Systems Grapple with Value-Based Reimbursement

by Jacqueline LaPointe

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...

Core Competencies for Accountable Care Organization Development

by Jacqueline LaPointe

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...

GAO: Hospital Value-Based Purchasing Model Rewards Low Quality

by Jacqueline LaPointe

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...

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