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

Value Based Reimbursement

HCTTF Helps Providers Find Value-Based Purchasing Partnerships

February 19, 2019 - A new open-sourced tool from the Health Care Transformation Task Force (HCTTF) is helping providers and payers assess value-based purchasing partnerships. The Partnership Evaluation Tool is a new resource that allows healthcare stakeholders to evaluate a potential partner’s core value-based care competencies. The tool, which is available for free download on HCTTF’s...


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HHS Releases Alternative Payment Model for Ambulance Providers

by Jacqueline LaPointe

HHS and the CMS Innovation Center (CMMI) recently announced a new alternative payment model for ambulance providers that aims to improve Medicare emergency transport services. The five-year Emergency Triage, Treat, and Transport (ET3)...

Data Sharing Critical to Value-Based Purchasing, HHS Leaders Say

by Jacqueline LaPointe

To move the industry to value-based purchasing, healthcare leaders are putting healthcare data sharing and interoperability high on their priority lists in 2019. “Technology, and the sharing of data, underpin the entire move to...

Humana Brings Value-Based Care to Independent Practices in 3 States

by Jacqueline LaPointe

Humana is helping bring value-based care to independent practices in Louisiana, Pennsylvania, and West Virginia. The Louisville, Kentucky-based payer announced a new value-based care arrangement with physicians in Aledade’s...

AHA Wants More Alternative Payment Models for Rural Hospitals

by Jacqueline LaPointe

In its 2019 Rural Advocacy Agenda, the American Hospital Association (AHA) called for more opportunities for rural hospitals to successfully participate in bundled payment models, the Quality Payment Program, and other alternative payment...

AMGA: Full MACRA Implementation Needed to Advance Value-Based Care

by Jacqueline LaPointe

AMGA is urging Congress to enforce MACRA implementation as policymakers intended by no longer excluding providers from the Merit-Based Payment Incentive Program (MIPS). “MIPS was designed as a viable transition tool to value-based...

Only 13% of Hospital CFOs Prepared for Value-Based Reimbursement

by Jacqueline LaPointe

Fewer hospital CFOs are prepared to manage the financial impact of evolving business conditions, such as value-based reimbursement and care delivery models, a new survey finds. Consulting firm Kaufman Hall recently surveyed CFOs and other...

Post-Acute, At-Home Care Saves Next Gen ACO Atrius Health $19.9M

by Jacqueline LaPointe

“You can't emphasize enough the right setting and the right care,” stressed Peggy Chou, MD, the Senior Medical Director of Performance Excellence of Atrius Health in Massachusetts. Atrius Health is a non-profit system of...

HHS Sets New Priorities for Physician-Focused Payment Models

by Jacqueline LaPointe

Healthcare stakeholders looking to develop their own alternative payment models for HHS implementation should look to new guidance before submitting their applications to the Physician-Focused Payment Model Technical Advisory Committee...

GAO: Advantages of Voluntary and Mandatory Bundled Payments

by Jacqueline LaPointe

Voluntary and mandatory bundled payment models each have their own pros and cons. But providers like voluntary models because they offer more favorable financial terms, a new Government Accountability Office (GAO) report showed. “In...

Hospitals, Blue Cross NC Share Risk with New Value-Based Contract

by Jacqueline LaPointe

Five major health systems recently entered a value-based contract with Blue Cross and Blue Shield of North Carolina (Blue Cross NC) that will hold them financially accountable for total costs of care and overall quality performance. Cone...

Beta Testing Alternative Payment Models to Advance Value-Based Care

by Jacqueline LaPointe

Forcing providers to participate in alternative payment models (APMs) will do little to incentivize providers to make the care delivery and payment changes needed to reduce costs and improve quality, experts at the Center for Healthcare...

67% of MSSP ACOs May Be High-Revenue Under Pathways to Success

by Jacqueline LaPointe

Over two-thirds of Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) would qualify as high-revenue organizations under the new Pathways to Success initiative, a recent Leavitt Partners analysis...

Congress Wants More on CMMI Alternative Payment Model Development

by Jacqueline LaPointe

The House Committee on Ways and Means is calling on CMS to boost transparency with alternative payment model development in the Center for Medicare and Medicaid Innovation (CMMI), which develops and operates alternative payment and care...

Are Hospital Readmissions Reduction Program Results Overstated?

by Jacqueline LaPointe

CMS, researchers, and other healthcare stakeholders have touted the Hospital Readmissions Reduction Program (HRRP) touted as a success. Under the authority of the Affordable Care Act, CMS launched the HRRP in 2010 to incentivize hospitals...

Social Determinants of Health Key to Value-Based Purchasing Success

by Jacqueline LaPointe

We are quickly heading to the value-based purchasing tipping point, according to the Vice President of Network Management at Health Partners Plans in Pennsylvania. “While adoption rates are still relatively low in some regions of...

ACO Financial Risk Rules for Pathways to Success Raise Concerns

by Jacqueline LaPointe

Leading healthcare industry groups are concerned that the overhaul of the Medicare Shared Savings Program (MSSP) will impede the transition to value-based care. On December 21, 2018, CMS finalized changes to the largest Medicare...

Next Generation Accountable Care Organizations Save $164M

by Jacqueline LaPointe

Accountable care organizations (ACOs) assuming the highest levels of financial risk in Medicare saved $164 million during their second performance year, CMS recently reported. Medicare ACOs bring together groups of physicians, hospitals,...

CMS Overhauls MSSP by Finalizing Pathways to Success for ACOs

by Jacqueline LaPointe

CMS recently finalized an overhaul of the Medicare Shared Savings Program (MSSP), which will require accountable care organizations (ACOs) to assume downside financial risk sooner. The MSSP is the largest Medicare ACO program, boasting...

Key Providers, Payers Tie 47% of Business to Value-Based Payment

by Jacqueline LaPointe

A large group of major healthcare payers and health systems are reporting that nearly half of their business rests in value-based payment arrangements. The Health Care Transformation Task Force (Task Force) is a group of leading...

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