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

Value Based Reimbursement

Value-Based Reimbursement May Not Bring Benefits for SNF Care

by Jacqueline Belliveau

CMS has released the Skilled Nursing Facility Utilization and Payment Public Use File, a dataset on the care skilled nursing facilities (SNF) provided to Medicare beneficiaries in 2013.  The data raises questions about the effect of...

CMS Releases 2016 Results for Value-Based Care Program

by Jacqueline Belliveau

The Center for Medicare and Medicaid Services (CMS) released the results for calculating the 2016 Value Modifier, which will come as financial boost to some and hindrance to others. Out of the 8,395 eligible physician groups, which satisfactorily...

HIMSS: Providers Not Ready for Value-Based Care Reimbursement

by Vera Gruessner

In recent years, the healthcare industry and the revenue cycle of providers has had a much greater target of achieving value-based care reimbursement and moving away from fee-for-service payment systems. The Centers for Medicare & Medicaid...

ICD-10 Claim Denial Rate Remains Low among Most Providers

by Vera Gruessner

It seems that the ICD-10 implementation has not had a very negative effect on the ICD-10 claim denial rate, which hasn’t risen much since the October 1 deadline. For example, RelayHealth Financial, a revenue cycle management solutions provider,...

2 Medicare Alternative Payment Models Demanding Future Focus

by Jacqueline DiChiara

Medicare alternative payment models have the ability to make affordable, high quality care a reality. But providers still demand greater levels of care coordination and cleaner streamlining of clinical data to achieve value-based reimbursement...

How EHR Data Analytics Influences Value-Based Reimbursement

by Jacqueline DiChiara

As the transition away from traditional, fee-for-service payment models towards value-based reimbursement continues, the implementation of electronic health records (EHRs) is becoming the rule rather than the exception. The Centers for Medicare...

CMS Says Alternative Payment Models Still Have a Way to Go

by Jacqueline DiChiara

Leading healthcare experts are speaking out about whether or not the healthcare industry is making progress in regard to alternative payment models. The healthcare industry is apparently on the right track thus far. Thirty percent of all Medicare...

How Does Value-Based Reimbursement Affect Pediatric ACOs?

by Jacqueline DiChiara

Value-based reimbursement and pay-for-performance incentives are positively influencing pediatric accountable care organizations (ACOs), according to research from JAMA Pediatrics. The new future of value-based incentives is perhaps all...

Providers Face Value-Based Care’s Financial Reality, Demand

by Jacqueline DiChiara

The value-based care transition is a sizable endeavor for healthcare providers. Jumping in head first into dark payment water takes bravery, experience, and knowledge. Although healthcare leaders are often hesitant to fully commit to...

HHS, CMS Speak Out on CMS’s Innovation Center Pilot Project

by Jacqueline DiChiara

Medicare reimbursements are preparing to emerge from a fee-for-service caterpillar’s cocoon to a value-based butterfly. The newly announced Accountable Health Communities [AHC] model – a CMS Innovation Center Pilot...

Why the Value-Based Care Journey Begins with Assessment

by Jacqueline DiChiara

How to find value in the value-based care reimbursement movement is one goal the healthcare industry will likely be striving for in 2016. As Medicare, Medicaid, and commercial health plans continue to press hospitals and physicians to implement...

Considering Healthcare Providers’ Value-Based Risk Burdens

by Jacqueline DiChiara

Value-based reimbursement may not be good for revenue cycle management. Increasing levels of financial risk may be setting healthcare providers back, but to what extent and at what cost? As the payment model landscape changes, can providers...

Physicians List Top 5 Value-Based Payment Success Factors

by Jacqueline DiChiara

Physicians say lack of time is one of the leading obstacles they face regarding value-based care delivery, according to a study from the American Academy of Family Physicians (AAFP). One-third of family physicians are actively pursuing value-based...

Physicians Report 4 Factors of Value-Based Payment Success

by Jacqueline DiChiara

Are value-based payment models garnering favorable reviews or mere disdain from physicians? A new Value-Based Payment (VBP) Humana-funded study aims to answer this perhaps simultaneously simple yet heavy-handed question. Survey data...

Top 6 Trending Payment Models Demanding New Long-Term Focus

by Jacqueline DiChiara

Time is money, especially when it comes to healthcare. Paying for outcomes gained instead of mere services rendered is the new name of the healthcare game. This means the simple notion of paying for multiple physician visits, medical...

Top 4 Strategies to Achieve Affordable Value-Based Care

by Jacqueline DiChiara

Value over volume is the name of the revenue cycle game, with the reimbursement concept of “less is more” taking precedence. With the transition to value-based care underway, here are some top collected strategies for healthcare providers...

Humana Pays Physician Groups $77M for Value-Based Outcomes

by Jacqueline DiChiara

As the fee-for-service realm dissipates and the value-based reimbursement model nears its completed transition in coming years, Humana is granting sizable financial rewards for those physician groups yielding quality care outcomes....

Considering MACRA’s Effect on Future Meaningful Use Changes

by Jacqueline DiChiara

The Department of Health and Human Services (HHS) has confirmed a 60-day period of public commentary regarding the Stage 3 Electronic Health Record (EHR) incentive program and the Medicare Access and CHIP Reauthorization Act of 2015...

How to Achieve Value Within the Value-Based Care Transition

by Jacqueline DiChiara

The Department of Health and Human Services (HHS) is on a mission to associate 90 percent of Medicare payments to value within the next three years and Congressional passage of the Medicare Access and CHIP Reauthorization Act of 2015...

Black Book: CFOs Focused on ROI, Revenue Cycle Outsourcing

by Jacqueline DiChiara

Outsourcing may save the healthcare industry, according to Black Book’s yearly survey released today about high performing revenue cycle management (RCM) vendors, as reported by PR Newswire. With its research focusing primarily on RCM outsourcing...


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