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

Value Based Reimbursement

How Alternative Payment Models Decrease Cancer Care Costs

by Jacqueline Belliveau

As cancer care spending is expected to grow in the next four years, an oncology alternative payment model that incorporates clinical pathways and patient-centered approaches could reduce healthcare spending by 22 percent, or $9.1 million across...

How to Develop a Value-Based Care Implementation Strategy

by Jacqueline Belliveau

When building a value-based care strategy, healthcare organizations should focus on improving care delivery across skilled nursing facilities, at-home services, and end-of-life services, Steven Strongwater, MD, President and CEO of Atrius Health,...

Potential Challenges, Benefits of the Cardiac Bundled Payment

by Jacqueline Belliveau

Earlier this year, CMS proposed a cardiac bundled payment model that would reduce Medicare spending by $170 million on five years, but a new report in the Journal of the American Medical Association identified several potential drawbacks of the...

Only 23% Have Consumer-Centered Healthcare Capabilities

by Jacqueline Belliveau

While approximately two-thirds of healthcare leaders view consumer-centered healthcare as a priority, especially in light of value-based reimbursement, only 23 percent stated that their organization had the capabilities to develop consumer insights,...

Top 5 Facts About the Merit-Based Incentive Payment System

by Jacqueline Belliveau

In October, CMS released the final MACRA implementation rule that will put the Quality Payment Program into action on Jan. 1, 2017. Under the new value-based reimbursement program, the federal agency anticipates 592,000 to 642,000 Medicare providers...

CMS Grants $1.8B to MA Value-Based ACO Implementation Program

by Jacqueline Belliveau

The MassHealth program in Massachusetts will received about $1.8 billion over the next five years to implement value-based reimbursement structures in the statewide accountable care organization (ACO) component of the program, announced CMS....

Large Hospitals Fare Worse in Value-Based Reimbursement Model

by Jacqueline Belliveau

Large hospitals averaging approximately 260 staffed beds were more likely to receive a negative value-based reimbursement adjustment under a hospital-specific Medicare program in 2016, according to a recent report from Definitive Healthcare,...

CMS: Over Half in Value-Based Care Program to Earn Bonuses

by Jacqueline Belliveau

Over 1,600 hospitals in the Hospital Value-Based Purchasing Program, representing over 50 percent of total participants, will receive positive Medicare payment adjustments in 2017 for value-based care performance, CMS reported in a recent fact...

86% Say Provider Compensation Tied to Fee-for-Service, Salary

by Jacqueline Belliveau

About 86 percent of primary care physicians and specialists reported that their provider compensation was still primarily under fee-for-service or salary arrangements, representing a modest increase from 84 percent in 2014, according to a recent...

CMS Launches VT All-Payer Accountable Care Organization Model

by Jacqueline Belliveau

Starting in January 2017, Vermont will implement the first voluntary all-payer accountable care organization (ACO) model that will align ACO design across Medicare, Medicaid, and commercial payers, according to a recent CMS announcement. With...

Benefits, Challenges of Value-Based Health IT Implementation

by Jacqueline Belliveau

From EHR systems to mHealth apps, health IT has the potential to help providers achieve value-based care goals. But with hundreds of new technologies seemingly emerging each day, many providers are struggling to select the most appropriate health...

25% of Healthcare Payments Tied to Alternative Payment Models

by Jacqueline Belliveau

Only one-quarter of healthcare payments in 2016 will be connected to an alternative payment model that has population-based accountability, reported the Healthcare Payment Learning & Action Network (LAN). The survey of over 70 commercial,...

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...

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