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

Value Based Reimbursement

Hospital Execs, Payers Face Similar Value-Based Purchasing Barriers

February 16, 2018 - 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 (HFMA) Value-Based Payment Readiness survey, sponsored by Humana, revealed that poor data access and the inability to collect and manage data were...


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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...

Flexibility, Value-Based Payment Key to Rural Hospital Success

by Jacqueline Belliveau

Health policies should provide rural hospitals with the flexibility to develop healthcare services that meet community needs and the value-based payment and funding structures to support tailored services, the Bipartisan Policy Center (BPC) and...

72% of Clinicians See No Adjustment Under Value Modifier in 2018

by Jacqueline Belliveau

An overwhelming majority of clinicians who participated in the final year of the Value-Based Payment Modifier (Value Modifier) program will receive neutral payment adjustments in 2018, according to new CMS data. Out of over 1.1 million eligible...

AMGA: Align Medicare Advantage, APMs to Promote Value-Based Care

by Jacqueline Belliveau

If CMS moves forward with relaxing Medicare Advantage benefit requirements, then the federal agency should offer the same flexibilities to providers and beneficiaries in Medicare Part B alternative payment models, such as accountable care organizations...

How Mercy Improved Care Transitions for Risk-Based Care Success

by Jacqueline Belliveau

For the thousands of patients released from their 23 acute care hospitals a year, Mercy Health ensures that each patient receives the highest value care. But there is only so much providers can do within the walls of their health system to extend...

Prescription Drug Rates Continue to Challenge Cancer Centers

by Jacqueline Belliveau

Prescription drug rates and the costs of new treatment modalities continued to challenge cancer centers, according to the most recent Trending Now in Cancer Care survey from the Association of Community Cancer Centers (ACCC). For the second year...

Mandatory Bundled Payments Drive Value-Based Care, Docs Argue

by Jacqueline Belliveau

The recent decision from CMS to cancel two mandatory bundled payments programs slated to launch in 2018 was a “step in the wrong direction for pursuing a healthcare system that focuses on value and not volume,” three physicians argued...

AHA: Global Budget Payments Help to Treat Vulnerable Communities

by Jacqueline Belliveau

Global budget payments support providers treating patient populations in vulnerable communities by granting them the flexibility to address the health needs of their community, the American Hospital Association (AHA) recently stated. Millions...

Limited Quality Benefits for Early Pay-For-Performance Adopters

by Jacqueline Belliveau

The impact of hospital pay-for-performance models, such as Medicare’s Hospital Value-Based Purchasing Program (HVBP), have been “limited and disappointing” over the past decade, researchers stated in a new BMJ study. The analysis...

3 Strategies to Reduce Hospital Readmission Rates, Costs

by Jacqueline Belliveau

Providers understand that high hospital readmission rates spell trouble for patient outcomes. But excessive rates may also threaten a hospital's financial health, especially in a value-based reimbursement environment. Readmissions are...

Vermont ACO Receives $620M to Lead Healthcare Reform Efforts

by Jacqueline Belliveau

Vermont’s healthcare reform group, Green Mountain Care Board, recently approved a budget of $620 million for OneCare Vermont, an accountable care organization (ACO) working with Medicare, Medicaid, and private payers, local news sources...

Hospital Discharge Patterns Trouble Skilled Nursing Facilities

by Jacqueline Belliveau

Hospital discharge patterns under value-based reimbursement models are troubling the revenue cycles of skilled nursing facilities, causing operating margins and occupancy rates to significantly decline in 2016, consulting firm CliftonLarsonAllen...

Nearly 71% of Practice Revenue Under Fee-For-Service in 2016

by Jacqueline Belliveau

Fee-for-service was still the dominant source of medical practice revenue in 2016, the American Medical Association (AMA) recently reported. Almost 84 percent of physicians stated that their practice received fee-for-service revenue in 2016....

Top 4 Healthcare Revenue Cycle, Finance Trends to Watch in 2018

by Jacqueline Belliveau

As 2017 comes to an end, hospital and practice leaders are preparing their priority lists and agenda items for next year. The top four healthcare revenue cycle and finance trends that should appear on 2018 agendas include voluntary Medicare alternative...

Key Capabilities for Value-Based Reimbursement Models

by Jacqueline Belliveau

Rising healthcare costs, shrinking reimbursement rates, and federal policies are driving hospitals and health systems to adopt value-based reimbursement, according to a new American Hospital Association (AHA) report. But the models are not one-size-fits-all...

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