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

Value Based Care

Value-Based Care Reimbursement Needs Greater Customization

by Vera Gruessner

With rising healthcare spending found throughout the US, the federal government has put greater focus on value-based care reimbursement than ever before. Healthcare providers and payers are seeking ways to move beyond fee-for-service payment...

Value-Based Reimbursement May Not Bring Benefits for SNF Care

by Jacqueline Belliveau

CMS has released the Skilled Nursing Facility Utilization and Payment Public Use File, a dataset on the care skilled nursing facilities (SNF) provided to Medicare beneficiaries in 2013.  The data raises questions about the effect of...

CMS Seeks Final Applications for Next Generation ACO Model

by Jacqueline Belliveau

The Centers for Medicare and Medicaid Services Innovation Center announced the opening of its final round of applications for Next Generation Account Care Organization (ACO) Model, which will begin on January 1, 2017. The final round of Next...

CMS Releases 2016 Results for Value-Based Care Program

by Jacqueline Belliveau

The Center for Medicare and Medicaid Services (CMS) released the results for calculating the 2016 Value Modifier, which will come as financial boost to some and hindrance to others. Out of the 8,395 eligible physician groups, which satisfactorily...

4 Healthcare Revenue Cycle Outcomes Make Headway at HIMSS16

by Vera Gruessner

With the HIMSS16 conference in Las Vegas, Nevada coming to an end, it is useful to look back and see which avenues are making an impact on the healthcare revenue cycle among providers. Both health IT solutions and new reports coming out of the...

HIMSS: Providers Not Ready for Value-Based Care Reimbursement

by Vera Gruessner

In recent years, the healthcare industry and the revenue cycle of providers has had a much greater target of achieving value-based care reimbursement and moving away from fee-for-service payment systems. The Centers for Medicare & Medicaid...

Federal Agencies Advance Alternative Payment Models in Medicine

by Vera Gruessner

In recent years, the federal government has positioned the healthcare industry to adopt new reimbursement tactics aimed at strengthening pay-for-performance initiatives. These regulations consist of alternative payment models such as bundled...

Examining the Value-Based Alternative Payment Model Basics

by Jacqueline DiChiara

Alternative payment models like the accountable care organization (ACO) and the bundled payment model have been gaining popularity under the Affordable Care Act’s (ACA) mandates. Figuring out how alternative payment models will evolve under...

Why Patient-Centered Accountable Care Organizations Thrive

by Jacqueline DiChiara

The patient-centered accountable care organization (ACO) is the new future of healthcare. According to Mark Wagar, President of Heritage Medical Systems, when patients' voices are heard, they receive better quality care. Wagar said...

Why Revenue Cycle Management Needs Electronic Data Exchange

by Jacqueline DiChiara

More focus on electronic data exchange can potentially save healthcare organizations, hospitals, and health systems $8 billion annually, according to a report from the American Hospital Association (AHA). Rising healthcare costs may...

How Do High-Deductible Plans Affect Value-Based Care Goals?

by Jacqueline DiChiara

Value-based care outcomes are shaped by a variety of factors – but especially the ever influential high-deductible health plan (HDHP). The recent significant increase of HDHPs across the healthcare industry is apparently tied to their...

Medicare Advantage Value-Based Care Arrangements Up Revenue

by Jacqueline DiChiara

Healthcare providers have yet to recognize the significant yet untapped potential of Medicare Advantage value-based care arrangements to increase revenue, according to a study from Deloitte.  Health plans are apparently stressed,...

4 HIMSS16 Revenue Cycle Management, Value-Based Care Focuses

by Jacqueline DiChiara

The topics of revenue cycle management innovation and value-based care will be of key importance at HIMSS16, one of the largest healthcare information technology (IT) conferences of the year, held next month in Las Vegas. Promoting financial...

Value-Based Incentives Enrich Accountable Care Organizations

by Jacqueline DiChiara

Pay-for-performance incentives positively sway physician behavior when it comes to value-based care advancement, according to a new JAMA Pediatrics study. Financial incentives tied to value-based reimbursement advance basic health measures,...

Value-Based Care Models Still Pose Opportunities, Challenges

by Jacqueline DiChiara

The value-based care model is allegedly winning the claims reimbursement race, leaving its fee-for-service competitor in the dust. How valid is the widespread claim that value-based reimbursement models are tied to higher care quality levels,...

Providers Face Value-Based Care’s Financial Reality, Demand

by Jacqueline DiChiara

The value-based care transition is a sizable endeavor for healthcare providers. Jumping in head first into dark payment water takes bravery, experience, and knowledge. Although healthcare leaders are often hesitant to fully commit to...

4 Value-Based Care Models Demanding New Long-Term Focus

by Jacqueline DiChiara

Value-based care models are taking over the healthcare industry. Providers are struggling to stay ahead of the reimbursement curve, some smiling more than others when they consider where their ROI currently sits. The transition away from...

Why the Value-Based Care Journey Begins with Assessment

by Jacqueline DiChiara

How to find value in the value-based care reimbursement movement is one goal the healthcare industry will likely be striving for in 2016. As Medicare, Medicaid, and commercial health plans continue to press hospitals and physicians to implement...

Physicians List Top 5 Value-Based Payment Success Factors

by Jacqueline DiChiara

Physicians say lack of time is one of the leading obstacles they face regarding value-based care delivery, according to a study from the American Academy of Family Physicians (AAFP). One-third of family physicians are actively pursuing value-based...

CMS Announces Top 3 Volume to Value Medicare Payment Goals

by Jacqueline DiChiara

Patrick Conway, MD, MSc, Chief Medical Officer at the Centers for Medicare & Medicaid Services (CMS), is speaking out about the administration’s overarching goals for Medicare’s future. In yesterday’s blog post,...


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