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

Value Based Reimbursement

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

June 22, 2018 - 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 calling on stakeholders to describe how the Stark Law hinders care coordination and, therefore, participation in alternative payment and care delivery models....


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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 revealed...

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 (HCP...

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 Health...

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 that...

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 payment...

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 new...

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 alternative payment...

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 told...

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 biggest...

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 Survey. The...

Practices Push for Quicker Value-Based Purchasing Transition

by Jacqueline LaPointe

The Council of Accountable Physician Practices (CAPP) recently urged policymakers to prioritize the value-based purchasing transition by accelerating the shift away from fee-for-service. “We recognize that much of policymakers’ and...

Orgs Not Living Up to Risk-Based Revenue Goals, C-Suite Says

by Jacqueline LaPointe

Provider organizations failed to achieve their risk-based revenue goals in 2017, according to the most recent State of Population Health survey by Numerof & Associates. The survey of healthcare C-suite executives showed that the majority...

3 Strategies to Decrease Low-Value Care, Healthcare Costs

by Jacqueline LaPointe

Low-value care, or care for which the potential harm outweighs the possible benefits or there are little to no benefits, is unnecessarily driving up already high healthcare costs and putting providers at risk under value-based reimbursement models....

Uniform Operational System Key to Value-Based Payments, CAQH Says

by Jacqueline LaPointe

The healthcare industry needs an “efficient, uniform operational system” to sustain value-based payment success, the Council for Affordable Quality Healthcare’s (CAQH) Committee on Operating Rules for Information Exchange (CORE)...

MD All-Payer Alternative Payment Model Met Medicare Spending Goal

by Jacqueline LaPointe

The Maryland All-Payer alternative payment model has already met and exceeded its five-year goal of reducing Medicare spending on hospitals by $330 million and the state is on its way to achieving care quality improvement goals, the state’s...

House Reps Create Caucus for Value-Based Reimbursement, Health IT

by Jacqueline LaPointe

Four House Representatives recently announced the creation of a new bipartisan group dedicated to supporting and promoting healthcare innovation through value-based reimbursement. Representatives Mike Kelly (R-PA), Ron Kind (D-WI), Markwayne...

MIPS Will Impede Value-Based Purchasing Transition, MedPAC Argues

by Jacqueline LaPointe

The Medicare Payment Advisory Commission (MedPAC) recently suggested that Congress repeal the Merit-Based Incentive Payment System (MIPS), arguing the new value-based purchasing program “impedes the movement toward high-value care.”...

Fewer Hospitalizations Reduced Skilled Nursing Facility Use by 15%

by Jacqueline LaPointe

Skilled nursing facility (SNF) utilization has declined 15 percent from 2009 to 2016, a new Avalere analysis revealed. The analysis of Medicare fee-for-service claims revealed that SNF utilization dropped from 1,808 SNF days per 1,000 Medicare...

Hospital Readmissions With Value-Based Penalties Vary by Provider

by Jacqueline LaPointe

Hospital readmission rates for conditions that carry value-based penalties under the Hospital Readmissions Reduction Program (HRRP) varied by admitting physician attending type, with geriatricians having the lowest 30-day readmissions rates for...

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