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

Value Based Reimbursement

Practices Push for Quicker Value-Based Purchasing Transition

April 12, 2018 - 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 the public’s attention is focused on potential changes to our systems of insurance coverage,” the coalition of multi-specialty medical groups...


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

by Jacqueline Belliveau

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 Belliveau

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 Belliveau

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 Belliveau

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 Belliveau

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 Belliveau

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 Belliveau

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 Belliveau

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...

AMA, Anthem Team Up to Streamline Prior Authorizations

by Jacqueline Belliveau

The American Medical Association (AMA) and Anthem, Inc. recently announced that they will work together over the next year to streamline prior authorization requirements and improve the healthcare experience overall through provider and payer...

Accelerating the Value-Based Payment Transition Top HHS Priority

by Jacqueline Belliveau

Quickening the pace of the value-based payment transition is a major focus for HHS, the department’s new Secretary Alex Azar recently told attendees of the Federation of American Hospitals’ annual Public Policy Conference in Washington...

72% of Medical Groups Oppose Mandatory Alternative Payment Models

by Jacqueline Belliveau

The mandatory versus voluntary alternative payment model debate continues. This time medical group practices are voicing their opinions in a new MGMA Stat poll that found 72 percent of group leaders oppose required participation in Medicare alternative...

Value-Based Purchasing Top Health Reform Priority for Governors

by Jacqueline Belliveau

In a recent healthcare reform proposal, a bipartisan group of governors emphasized that value-based purchasing implementation will be the key to reducing healthcare costs while improving outcomes. “Coverage is important, and coverage reforms...

Slow and Steady Still the Motto for Value-Based Reimbursement

by Jacqueline Belliveau

The healthcare industry has boarded the train to value-based reimbursement. But recent roadblocks have provider organizations pumping the brakes with the shift away from fee-for-service, explained industry experts Doral Jacobsen, MBA, FACMPE,...

Hospital Execs, Payers Face Similar Value-Based Purchasing Barriers

by Jacqueline Belliveau

Payers and hospital finance executives agree that health IT inadequacies and insufficient physician buy-in are top barriers to value-based purchasing adoption, two recent surveys revealed. The Healthcare Financial Management Association’s...

Hospital Cost-Shifting Increases Private Payer Payments by 1.6%

by Jacqueline Belliveau

Healthcare organizations that faced Medicare reimbursement reductions under the Affordable Care Act engaged in hospital cost-shifting that resulted in 1.6 percent higher average payments from private payers, a new working paper from the National...

Doctors to HHS: Level the Playing Field for Independent Practices

by Jacqueline Belliveau

In the face of increased hospital consolidation, HHS should better support independent practices and develop policies that allow solo providers to compete with hospitals and health systems, the Physicians Advocacy Institute (PAI) recently argued....

Doctors, Employers Disagree on Healthcare Payment Reform Strategy

by Jacqueline Belliveau

Healthcare providers and employers are moving to value-based reimbursement models to achieve the Triple Aim, but the stakeholders disagree on how to move healthcare payment reform efforts forward and by what means, a recent Leavitt Partners survey...

Reducing Low-Value Care Key to Value-Based Reimbursement Success

by Jacqueline Belliveau

Value-based reimbursement success hinges on decreasing low-value care across patient populations, explained Scott Weingarten, MD, MPH, Senior Vice President and Chief Clinical Transformation Officer at Cedars-Sinai Medical Center. While hospitals...

AMGA: Link Spending, Quality Performance for True Value-Based Care

by Jacqueline Belliveau

In response to a Request for Information from the Assistant Secretary for Planning and Evaluation (ASPE), AMGA recently called on CMS to “define value in a meaningful way” to ensure value-based care models incentivize providers to...

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