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

Value Based Incentives

Hospital Readmission Program Penalties Didn’t Raise Mortality Rates

October 12, 2018 - The Hospital Readmission Reduction Program (HRRP) achieved a significant drop in readmission rates for Medicare patients hospitalized for pneumonia, acute myocardial infarction (AMI), and heart failure without bringing an increase of in-hospital and post discharge mortality rates, according to a study published in JAMA. Introduced in 2010, HRRP aims to reduce readmissions after...


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Limited Healthcare Payment Incentives Challenge Care Management

by Jacqueline LaPointe

Misaligned healthcare payment incentives topped the list of challenges providers and payers faced when implementing effective care management programs under Medicare Advantage plans with capitated payments, a recent Robert Graham Center...

How Social Risk Factors Influence Value-Based Reimbursement

by Jacqueline LaPointe

Safety-net providers received more financial penalties under Medicare value-based reimbursement programs because the hospitals treated more beneficiaries with social risk factors, such as dual eligibility, low income, race, ethnicity, and...

Using an Alternative Payment Model to Reduce Hospitalizations

by Jacqueline LaPointe

Are clinical interventions enough to alter provider behavior to align with value-based care? Or are providers more motivated to change because of financial incentives under alternative payment models? CMS recently partnered with the...

Rural Hospitals Faced Less Value-Based Reimbursement Penalties

by Jacqueline LaPointe

Rural hospitals outperformed urban hospitals in several Medicare value-based reimbursement programs in 2015, receiving fewer financial penalties, according to a recent report from the Department of Health and Human Services...

AMGA: New MACRA Flexibilities May Penalize Prepared Providers

by Jacqueline LaPointe

New MACRA flexibilities for the first performance year of the program may help some providers ease into new value-based reimbursement programs, but the American Medical Group Association (AMGA) recently argued that new attestation tracks...

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...

Driven by Specialists, Physician Compensation Rates Rise 3.1%

by Jacqueline LaPointe

Physician compensation has increased by 3.1 percent in 2015, according to a recent survey from the American Medical Group Association (AMGA). The rate represents a 0.3 percent increase from last year. “Once again this year, we see...

Payment Reform Incentives Influence Physician Decision-Making

by Jacqueline LaPointe

Some patients are finding that financial incentives under Medicare payment reform rules have caused their providers to focus more on boosting healthcare revenues rather than improving patient outcomes. According to a recent study in The...

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...

How Does Value-Based Reimbursement Affect Pediatric ACOs?

by Jacqueline DiChiara

Value-based reimbursement and pay-for-performance incentives are positively influencing pediatric accountable care organizations (ACOs), according to research from JAMA Pediatrics. The new future of value-based incentives is perhaps...

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...

CMS Tackles Value-Based Purchasing Pilot Program Questions

by Jacqueline DiChiara

Competition across the nation for value-based payment incentives is underway with the start of a new year. Nine states, each representing a different geographic region, have implemented the home health value based purchasing...

Top 6 Trending Payment Models Demanding New Long-Term Focus

by Jacqueline DiChiara

Time is money, especially when it comes to healthcare. Paying for outcomes gained instead of mere services rendered is the new name of the healthcare game. This means the simple notion of paying for multiple physician visits,...

Cigna-HealthSpring, UPHS Confirm Network Expansion Agreement

by Jacqueline DiChiara

Cigna-HealthSpring and The University of Pennsylvania Health System (UPHS) have announced new collaboration efforts to expand a 2016 network relationship agreement and provide supplementary resources and a series of well-coordinated...

CMS: It’s Quality Over Quantity with Value-Based Purchasing

by Jacqueline DiChiara

The ever familiar “Show me the money!” mentality only rings true in the case of quality over quantity regarding hospital payments, implies the Centers for Medicare & Medicaid Services (CMS). The...

Value-Based Incentives Top Practice in Reimbursement Model

by Sara Heath

Value-based incentives may be gaining momentum as integral parts of physician reimbursement models. A recent survey by Sullivan, Cotter, and Associates confirms that using quality-based incentives and quality metrics are becoming more...

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