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

Value Based Reimbursement

Patients Find Medicare Reimbursement to Surgeons Too Low

by Jacqueline Belliveau

Patients may be willing to pay more out-of-pocket expenses for certain medicals services, such as knee surgeries, especially as providers face lower Medicare reimbursement rates, a recent study in Orthopedics contended. The survey of 231 patients...

Rural Hospitals Faced Less Value-Based Reimbursement Penalties

by Jacqueline Belliveau

Rural hospitals outperformed urban hospitals in several Medicare value-based reimbursement programs in 2015, receiving fewer financial penalties, according to a recent report from the Department of Health and Human Services (HHS). Researchers...

GOP Doctors Caucus Suggests MACRA Implementation Changes

by Jacqueline Belliveau

In a recent letter to CMS Acting Administrator Andy Slavitt and Director of the Office of Management and Budget Shaun Donovan, the GOP Congressional Doctors Caucus called for several MACRA implementation changes to make the value-based reimbursement...

AMA Releases New MACRA Implementation Resources for Providers

by Jacqueline Belliveau

With a final ruling on the proposed MACRA implementation rule expected to arrive in early November, the American Medical Association (AMA) recently released three new tools to help healthcare providers prepare for the value-based reimbursement...

How Value-Based Reimbursement Affects Physician Productivity

by Jacqueline Belliveau

As payers push for more value-based reimbursement adoption, many healthcare organizations are wondering how to restructure physician productivity strategies to meet the unique requirements of performance-based payments. But the key to success...

Are Medicare Value-Based Penalties Fair to Safety Net Hospitals?

by Jacqueline Belliveau

Safety-net hospitals have to work harder to avoid value-based penalties than other participants in a Medicare program designed to reduce hospital readmissions, a new study in Health Affairs indicates. While safety-net hospitals have made significant...

Few Docs Familiar with MACRA, Transitioning to Value-Based Care

by Jacqueline Belliveau

Only 20 percent of physicians reported that they are very or somewhat familiar with MACRA, according to a recent survey from the Physicians Foundation and Merritt Hawkins, and the majority of respondents do not currently have a large portion...

Challenges, Successes of First-Year Shared Savings ACOs

by Jacqueline Belliveau

Participants in the Medicare Shared Savings Program (MSSP) already familiar with physician practice transformation were more likely to earn shared savings payments, which should lead the Centers for Medicare & Medicaid Services to focus on...

85% of Orgs Looking to Replace Revenue Cycle Management Systems

by Jacqueline Belliveau

Eighty-five percent of provider organizations, hospitals, and physician practices are currently seeking to replace their healthcare revenue cycle management systems or are deciding if it is time to switch, according to a new survey from Black...

Post-Acute Care Groups Oppose Value-Based Purchasing Program

by Jacqueline Belliveau

Eight healthcare industry groups recently told lawmakers that they oppose the proposed Medicare Post-Acute Care Value-Based Purchasing Program, which is scheduled to start on Oct. 1, 2019. In a letter to the House Committee on Ways and Means,...

Are Federal Value-Based Care Programs Truly Promoting Value?

by Jacqueline Belliveau

In a statement to the House Ways and Means Health Subcommittee, the American Hospital Association (AHA) argued that Medicare value-based reimbursement programs, particularly pay-for-performance initiatives, do not have effective and fair financial...

Four New MACRA Tracks Allow Flexible Attestation for Providers

by Jacqueline Belliveau

Eligible clinicians will be able to select their own pace for MACRA attestation to ensure all participants can succeed under new value-based reimbursement programs, CMS announced. On its official blog, the head of CMS detailed four options for...

CMS Touts Progress of State-Led Alternative Payment Model

by Jacqueline Belliveau

States participating in the first phase of the State Innovation Model Initiative have made significant progress in implementing alternative payment models, CMS officials revealed midweek. Two of six states were able to link more than half of...

How to Plan Out the Transition to Value-Based Reimbursements

by Jacqueline Belliveau

Providers should address the drivers of value-based reimbursements to appropriately pace their transition to alternative payment models without sacrificing crucial fee-for-service revenue, according to  a new guide from Pershing Yoakley...

Industry Groups Call on CMS to Modify MACRA Patient Codes

by Jacqueline Belliveau

Proposed patient relationship codes that will be used under MACRA to measure appropriate resource use and determine value-based reimbursement adjustments may cause more confusion for providers and increase administrative burdens, according to...

CMS Prohibits Creation of Pass-Through Medicaid Reimbursement

by Jacqueline Belliveau

States cannot develop or increase existing pass-through payments, or Medicaid reimbursement arrangements to providers for services that are not related to care delivery or value-based incentives, CMS stated in a recent bulletin. Medicaid pass-through...

CMS Opens Enrollment for Value-Based Primary Care Model

by Jacqueline Belliveau

CMS has opened the application period for the Comprehensive Primary Care Plus (CPC+) model, a value-based reimbursement initiative for primary care physicians in 14 areas of the country. The application period will be open until September 15,...

Is MACRA a True Doc Fix for Value-Based Reimbursement?

by Jacqueline Belliveau

Will MACRA be the answer to tying reimbursements to quality care or will it be just end up as another doc fix, like those under the Sustainable Growth Rate program? A recent National Center for Policy Analysis report is critical of proposed MACRA...

Cerner to Increase Focus on Value-Based Reimbursement

by Kyle Murphy, PhD

Cerner has named Adventist Health System's Jeff Hurst to oversee its revenue cycle management division, the company announced Tuesday. Hurst, who currently serves as Florida Hospital's Senior Vice President of Finance at Florida Hospital...

Would Proposed Value-Based Reimbursements Reduce Drug Costs?

by Jacqueline Belliveau

Spending on prescription drugs has been a major pain point for all stakeholders in the industry. But could value-based reimbursement models for certain drugs under Medicare Part B be the answer to rising drug costs? According to a Health Affairs...

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