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

Value Based Purchasing

55% of Hospitals Earn Incentive in Value-Based Purchasing Program

December 3, 2018 - More hospitals participating in the Hospital Value-Based Purchasing (VBP) Program will see a Medicare payment increase in 2019, CMS recently reported. The Hospital Value-Based Purchasing Program adjusts Medicare reimbursement to hospitals billing under the Inpatient Prospective Payment System (IPPS). CMS adjusts IPPS reimbursement upwards or downwards based on the quality of inpatient...


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Hospitals Seek Value-Based Contracting in Healthcare Supply Chain

by Jacqueline LaPointe

Nearly three-quarters of hospital and health system leaders are interested in value-based contracting in the healthcare supply chain, but opportunities to secure contracts with suppliers are lacking, a new survey from Premier Inc....

OIG: Healthcare Fraud Exceptions for 2 Value-Based Payment Models

by Jacqueline LaPointe

Two recent advisory opinions from the Office of the Inspector General (OIG) at HHS are demonstrating why current healthcare fraud and abuse laws are not aligned with value-based payment and care delivery. The federal watchdog recently...

Aligning Incentives for Providers, Payers Improves Primary Care

by Jacqueline LaPointe

How the healthcare industry delivers and pays for primary care is changing as the country finds their healthcare spending skyrocketing. Healthcare spending across the country is slated to increase at an average annual rate of 5.5 percent...

Value-Based Purchasing, Consumerism Top Healthcare Exec Challenges

by Jacqueline LaPointe

Transitioning to value-based purchasing and responding to healthcare consumerism continue to be among the top challenges, issues, and opportunities healthcare C-suite leaders are facing in 2019, according to a new poll from the Healthcare...

Patient Attribution Key Component to APMs, Value-Based Contracts

by Jacqueline LaPointe

Patient attribution is a critical component of alternative payment models (APMs) that appropriately hold providers accountable for their care performance. “Attribution methodology is at the core of constructing actuarially sound,...

Hospitals Seek Non-Acute, Supplier Partners for Value-Based Care

by Jacqueline LaPointe

Hospitals are looking to strategically expand their footprint in the non-acute care space to succeed in value-based care and alternative payment models, a new study of hospital decisionmakers found. L.E.K.’s ninth annual...

New Alternative Payment Model Tackles Holistic Addiction Recovery

by Jacqueline LaPointe

A national multi-sector alliance of healthcare industry leaders is looking to incentivize providers and payers to deliver coordinated, holistic addiction recovery services to patients through a new alternative payment model. Nearly 21...

CMS Initiative to Create Pediatric APMs to Address Opioid Crisis

by Jacqueline LaPointe

A new CMS Innovation Center initiative will call on local stakeholders and Medicaid agencies to develop alternative payment models that address the impact of the opioid crisis for children, CMS recently announced. Medicaid and local...

Value-Based Experience, Robust EHR Use Key Factors to ACO Success

by Jacqueline LaPointe

A collaborative culture, prior value-based reimbursement experience, and robust EHR use are among the top factors contributing to accountable care organization (ACO) success, according to a new report from the Patient-Centered Primary Care...

After a Slow 2017, ACOs Grow and Expand Their Contracts in 2018

by Jacqueline LaPointe

The number of accountable care organizations (ACOs) continued to grow in 2018, as did the number of contracts the organizations entered, a new report from Leavitt Partners and the Accountable Care Learning Collaborative uncovered. From...

Academic Medical Centers Receive More Value-Based Penalties

by Jacqueline LaPointe

Academic medical centers (AMCs) are key members of the healthcare industry, engaging in medical research, uncovering clinical breakthroughs, and training future providers. However, a new analysis by Navigant shows that the organizations...

Employers Play Bigger Role in Value-Based Reimbursement Transition

by Jacqueline LaPointe

Providers wanting to expand their value-based reimbursement contracts may want to look to the employer-sponsored health plan market, according to a new report from the Duke-Margolis Center for Health Policy and the Robert Wood Johnson...

Post-Acute Care Providers Worry About Patient-Driven Payment Model

by Jacqueline LaPointe

Leading post-acute care associations are expressing concerns with the recently finalized Patient-Driven Payment Model (PDPM), which will tie skilled nursing facility (SNF) reimbursement to value, rather than therapy volume. CMS issued the...

CMS Moves Medicare Payments for Skilled Nursing Facilities to Value

by Jacqueline LaPointe

CMS recently finalized a rule that will shift the Medicare payment system for skilled nursing facilities (SNF) away from fee-for-service and toward value starting in 2019. The federal agency will make the move by implementing the...

Docs, Payer Execs Agree Providers Lack Tools for Value-Based Care

by Jacqueline LaPointe

A lack of technology and patient data may be stalling or even reversing the value-based care transition, a new survey of primary care physicians and health plan executives revealed. “Stalled Progress on the Path to Value-Based...

EHR Costs, Staffing Still Trouble Small, Rural Practices in MIPS

by Jacqueline LaPointe

Financial challenges plaguing small and rural practices under legacy Medicare value-based purchasing programs are likely to persistent under the Merit-Based Incentive Payment System (MIPS), the Government Accountability Office (GAO)...

More Execs Expect Value-Based Reimbursement to Up Profitability

by Jacqueline LaPointe

Approximately 46 percent of healthcare executives and managers expect value-based reimbursement contracts to improve their organization’s profitability, according to a recent KPMG survey. Healthcare leaders are more optimistic about...

Giving Providers Hospital Cost Accounting Data Will Lower Costs

by Jacqueline LaPointe

Engaging physicians with hospital cost accounting data will be key to lowering costs under accountable care organizations (ACOs) and other population-based reimbursement models, Stanford researchers recently explained. Population-based...

ACOs and Other Value-Based Purchasing Models Have Yet to Cut Costs

by Jacqueline LaPointe

Accountable care organizations (ACOs) and other population-based value-based purchasing models have not decreased total cost of care or generated quality improvements at the market level, a new study found. The Healthcare Financial...

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