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

Value Based Reimbursement

Payer Collaboration Key to Value-Based Reimbursement Strategy

June 28, 2017 - Value-based reimbursement arrangements come in a myriad of shapes and sizes much like provider organizations. But successful value-based contracts will align provider and payer goals for care quality and healthcare utilization as well as establish provider incentives within the healthcare organization, attendees learned at Xtelligent Media’s 2017 Value-Based Care Summit in Chicago. “There...


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Industry Orgs Back 2018 MACRA Implementation Flexibilities

by Jacqueline Belliveau

Healthcare industry organizations largely applauded the recently-released 2018 MACRA implementation proposal from CMS. The medical organizations commended the federal agency’s continuation of the transition year into 2018 as well as the...

Implementing Value-Based Healthcare Revenue Cycle Management

by Jacqueline Belliveau

To align healthcare revenue cycle with value-based reimbursement, healthcare organizations should start by breaking down clinical and financial siloes established by fee-for-service payment models, agreed presenters at Xtelligent Media’s...

Exploring Quality Measures Under Value-Based Purchasing Models

by Jacqueline Belliveau

CHICAGO – Jason Goldwater, MPA, MA, Senior Director of the National Quality Forum, recently likened the value-based purchasing transition to the evolution of music at Xtelligent Media’s Value-Based Care Summit in Chicago. Music started...

Targeting Skilled Nursing Facility, ESRD Care Saves ACO $15M

by Jacqueline Belliveau

A Medicare Shared Savings Program (MSSP) accountable care organization (ACO) realized over $15 million in healthcare savings between 2014 and 2015 by improving skilled nursing facility utilization and targeting end-stage renal disease care, a...

Optimizing RCM During Value-Based Reimbursement Transition

by Jacqueline Belliveau

Value-based reimbursement revolutionized how providers get paid for care delivery. However, the slow push away from fee-for-service payments has challenged providers looking to optimize healthcare revenue cycle management. To advance healthcare...

AHA to IRS: Foster Hospital Participation in Commercial ACOs

by Jacqueline Belliveau

The American Hospital Association (AHA) recently called on leaders from the Department of Treasury and IRS to issue formal guidance that would permit non-profit hospitals to participate in commercial accountable care organizations (ACOs) without...

Providers Lack Tools, Payer Alignment for Value-Based Purchasing

by Jacqueline Belliveau

Healthcare providers still lack the necessary tools for value-based purchasing success with only 43 percent of providers reporting that they have access to the appropriate solutions, a recent Quest Diagnostics and Inovalon survey uncovered. However,...

Count Medicare Advantage Patients for Advanced APMs, Orgs Say

by Jacqueline Belliveau

Eligible clinicians participating in appropriate alternative payment models under a Medicare Advantage plan should qualify for Advanced Alternative Payment Model (Advanced APM) incentive payments in 2019, the AMGA and nine other healthcare industry...

Lab Experts Help Providers Reduce Low-Value Resource Use, Costs

by Jacqueline Belliveau

Collaboration between laboratory medicine experts and clinicians is critical to reducing unnecessary and low-value resource use for value-based purchasing success, the American Association For Clinical Chemistry (AACC) recently stated. “The...

87% of Practices Not Adding Staff for MACRA Implementation

by Jacqueline Belliveau

About 87 percent of physician practices do not plan on hiring additional healthcare staff to help with MACRA implementation, a recent Physicians Practice survey showed. The survey of over 1,000 practice managers and physicians revealed that most...

Commitment Key to Successful Value-Based Reimbursement Adoption

by Jacqueline Belliveau

It is time for healthcare providers to move past understanding the concept and start the value-based reimbursement adoption process. Otherwise, they may face profitability decreases from operating both fee-for-service and alternative payment...

Data Analytics, Collaboration Critical to MACRA Implementation

by Jacqueline Belliveau

Healthcare providers need to restructure many aspects of their organization for successful MACRA implementation, including data analytics capabilities, financial risk assumption, stakeholder partnerships, and patient engagement strategies, according...

Medicare Cardiac, Ortho Bundled Payments Delayed Until 2018

by Jacqueline Belliveau

CMS recently delayed the launch date of three mandatory Medicare cardiac and orthopedic bundled payment models and the Cardiac Rehabilitation Incentive Payment program from May 20, 2017, to Jan. 1, 2018. The final ruling from the federal agency...

Execs To Continue Value-Based Purchasing Despite Uncertainty

by Jacqueline Belliveau

Despite a possible Affordable Care Act repeal, healthcare executives still plan to stay the course with value-based purchasing implementation and healthcare cost reduction initiatives, a recent BDC Advisors survey reported. Although the C-suite...

Post-Acute Care Costs by Market Affect Bundled Payment Models

by Jacqueline Belliveau

A recent study in Medical Care found that post-acute care variations by healthcare market significantly impacted total episode costs in 30-day hip and knee replacement bundled payment models, suggesting financial strategies should focus on high-utilizers...

CMS Opens Comprehensive Primary Care Plus Apps in 4 Regions

by Jacqueline Belliveau

CMS recently announced that the second round of the Comprehensive Primary Care Plus (CPC+) alternative payment model will launch in four regions in 2018. The four regions are Louisiana, Nebraska, North Dakota, and the greater Buffalo area of...

10 Orgs Call for Medicare Advantage APMs to Qualify for MACRA

by Jacqueline Belliveau

A coalition of ten healthcare industry groups recently urged HHS Secretary Tom Price to weigh risk-based Medicare Advantage alternative payment models the same as Advanced Alternative Payment Models under MACRA. Qualifying participants in MACRA’s...

Key Capabilities for Population-Based Alternative Payment Models

by Jacqueline Belliveau

To succeed in population-based alternative payment models with two-sided financial risk, health systems should embrace assuming the role of the payer and work to get all staff on board with the model, suggested Jackie Selby, a healthcare and...

Execs Say Value-Based Purchasing to Hit Tipping Point by 2020

by Jacqueline Belliveau

Over one-half (55 percent) of healthcare executives surveyed after the recent presidential election stated that the industry should reach the value-based purchasing tipping point before 2020, a recent Lazard report revealed. The survey of 203...

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