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

Value Based Reimbursement

Employers Play Bigger Role in Value-Based Reimbursement Transition

August 9, 2018 - 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 Foundation. Employers are seeking innovative methods beyond high-deductible health plans and co-payments for controlling rising healthcare costs....


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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...

How Addressing Social Determinants of Health Cuts Healthcare Costs

by Jacqueline LaPointe

Population health management and value-based reimbursement success hinge on reducing healthcare costs not only when a patient is in the exam room, but also when they are beyond the walls of the practice or hospital. Therefore,...

CMS Considers Stark Law Changes to Support Value-Based Care, APMs

by Jacqueline LaPointe

CMS is seeking input on how to potentially modify the physician self-referral law, otherwise known as the Stark Law, to encourage value-based reimbursement and care delivery. In a new Request for Information (RFI), the federal agency is...

Value-Based Care Reduces Costs by 5.6%, Improves Care Quality

by Jacqueline LaPointe

Value-based care strategies are starting to achieve the goals of the Triple Aim, payers reported in a new ORC International study commissioned by Change Healthcare. The analysis of 120 payers across a range of organization size and type...

How Small Health Centers Can Succeed With Value-Based Payments

by Jacqueline LaPointe

Small community health centers should shift to a population-based mindset and deliver care management and coordination to succeed under value-based payment models, uncovered a new analysis from Health Center Partners of Southern California...

HHS Bringing Value-Based Purchasing to SNFs, Post-Acute Care

by Jacqueline LaPointe

HHS Secretary Alex Azar identified value-based purchasing as the key to reducing hospital readmissions and moving skilled nursing facilities and other post-acute care providers to coordinated community care. In a speech to the American...

Value-Based Care Driving Independent Practices to Consultants

by Kyle Murphy, PhD

Independent physicians and practices are turning to consultants to make the transition to value-based care and stay competitive in a shifting market. The latest research from Black Book shows physician-led practices have turned the tide...

CMS OKs Maryland’s All-Payer Alternative Payment Model Expansion

by Jacqueline LaPointe

CMS greenlighted an expansion of an all-payer alternative payment model in Maryland that allows the state to set hospital reimbursement rates, the office of Governor Larry Hogan recently announced. Maryland’s unique alternative...

New Org Aims to Help Independent Practices with Value-Based Care

by Jacqueline LaPointe

The value-based care transition has been a thorn in the side of independent practices, but a group of leading provider organizations is aiming to better support solo practices in the current healthcare landscape through the formation of a...

Only 4 CMMI Alternative Payment Models Met Spending, Quality Goals

by Jacqueline LaPointe

The CMS Innovation Center is on the path to reducing healthcare costs while improving care quality through alternative payment and care delivery models, a recent Government Accountability Office (GAO) report found. But only four...

CMS Targets Value-Based Purchasing, Drug Costs to Reduce Spending

by Jacqueline LaPointe

Healthcare spending is growing at an unstainable rate, and CMS aims to curb spending through initiatives that promote value-based purchasing, reduce administrative burdens, and lower prescription drug costs, CMS Administrator Seema Verma...

AMA Invests $27.2M in Health IT Co to Advance Value-Based Care

by Jacqueline LaPointe

The American Medical Association (AMA) recently invested another $27.2 million in Health2047 Inc., a health IT start-up in Silicon Valley that aims to tackle value-based care, physician productivity, and several other of healthcare’s...

Practices Upping Healthcare C-Suite Bonuses for Value-Based Care

by Jacqueline LaPointe

Bonuses and incentive payments for healthcare C-suite executives are on the rise as medical groups and practices transition to value-based care, according to the most recent AMGA Medical Group Executive and Leadership Compensation...

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