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

Value Based Reimbursement

Providers Lack Tools, Payer Alignment for Value-Based Purchasing

by Jacqueline LaPointe

Healthcare providers still lack the necessary tools for value-based purchasing success with only 43 percent of providers reporting that they have access to the appropriate solutions, a recent Quest Diagnostics and Inovalon survey...

Count Medicare Advantage Patients for Advanced APMs, Orgs Say

by Jacqueline LaPointe

Eligible clinicians participating in appropriate alternative payment models under a Medicare Advantage plan should qualify for Advanced Alternative Payment Model (Advanced APM) incentive payments in 2019, the AMGA and nine other healthcare...

Lab Experts Help Providers Reduce Low-Value Resource Use, Costs

by Jacqueline LaPointe

Collaboration between laboratory medicine experts and clinicians is critical to reducing unnecessary and low-value resource use for value-based purchasing success, the American Association For Clinical Chemistry (AACC) recently...

87% of Practices Not Adding Staff for MACRA Implementation

by Jacqueline LaPointe

About 87 percent of physician practices do not plan on hiring additional healthcare staff to help with MACRA implementation, a recent Physicians Practice survey showed. The survey of over 1,000 practice managers and physicians revealed...

Commitment Key to Successful Value-Based Reimbursement Adoption

by Jacqueline LaPointe

It is time for healthcare providers to move past understanding the concept and start the value-based reimbursement adoption process. Otherwise, they may face profitability decreases from operating both fee-for-service and alternative...

Data Analytics, Collaboration Critical to MACRA Implementation

by Jacqueline LaPointe

Healthcare providers need to restructure many aspects of their organization for successful MACRA implementation, including data analytics capabilities, financial risk assumption, stakeholder partnerships, and patient engagement strategies,...

Medicare Cardiac, Ortho Bundled Payments Delayed Until 2018

by Jacqueline LaPointe

CMS recently delayed the launch date of three mandatory Medicare cardiac and orthopedic bundled payment models and the Cardiac Rehabilitation Incentive Payment program from May 20, 2017, to Jan. 1, 2018. The final ruling from the federal...

Execs To Continue Value-Based Purchasing Despite Uncertainty

by Jacqueline LaPointe

Despite a possible Affordable Care Act repeal, healthcare executives still plan to stay the course with value-based purchasing implementation and healthcare cost reduction initiatives, a recent BDC Advisors survey reported. Although the...

Post-Acute Care Costs by Market Affect Bundled Payment Models

by Jacqueline LaPointe

A recent study in Medical Care found that post-acute care variations by healthcare market significantly impacted total episode costs in 30-day hip and knee replacement bundled payment models, suggesting financial strategies should focus on...

CMS Opens Comprehensive Primary Care Plus Apps in 4 Regions

by Jacqueline LaPointe

CMS recently announced that the second round of the Comprehensive Primary Care Plus (CPC+) alternative payment model will launch in four regions in 2018. The four regions are Louisiana, Nebraska, North Dakota, and the greater Buffalo area...

10 Orgs Call for Medicare Advantage APMs to Qualify for MACRA

by Jacqueline LaPointe

A coalition of ten healthcare industry groups recently urged HHS Secretary Tom Price to weigh risk-based Medicare Advantage alternative payment models the same as Advanced Alternative Payment Models under MACRA. Qualifying participants in...

Key Capabilities for Population-Based Alternative Payment Models

by Jacqueline LaPointe

To succeed in population-based alternative payment models with two-sided financial risk, health systems should embrace assuming the role of the payer and work to get all staff on board with the model, suggested Jackie Selby, a healthcare...

Execs Say Value-Based Purchasing to Hit Tipping Point by 2020

by Jacqueline LaPointe

Over one-half (55 percent) of healthcare executives surveyed after the recent presidential election stated that the industry should reach the value-based purchasing tipping point before 2020, a recent Lazard report revealed. The survey of...

Will Behavioral Economics Improve Alternative Payment Models?

by Jacqueline LaPointe

Alternative payment models may need to account for the behavioral economics behind provider prescribing habits to effectively reduce healthcare costs from expensive medications and treatments, a recent American Journal of Managed Care...

Engaging Providers Key to Value-Based Reimbursement Adoption

by Jacqueline LaPointe

Nearly three-quarters (73 percent) of providers prefer a fee-for-service model over value-based reimbursement structures even though almost one-half acknowledged that the traditional payment model contributed to higher healthcare costs, a...

Creating Alternative Payment Models to Support Health Centers

by Jacqueline LaPointe

Healthcare stakeholders and lawmakers should encourage community health centers to engage in alternative payment models to financially incentivize providers to improve safety-net care, a recent Journal of the American Medical Association...

56% of Top Performing Med Groups Plan Value-Based Purchasing

by Jacqueline LaPointe

About 56 percent of medical groups that were financially high-performing have a plan for a value-based purchasing transition versus just 32 percent of medical groups falling behind with healthcare revenue cycle management, a recent...

Post-Acute Care Network Key to Value-Based Purchasing Success

by Jacqueline LaPointe

Health systems should develop a post-acute care network and strategy to succeed in value-based purchasing models, a recent Deloitte survey indicated. The survey of 36 executives from health systems, payers, post-acute care organizations,...

Bundled Payments, Clinical Pathways Drive Cancer Care Savings

by Jacqueline LaPointe

Early adopters of value-based reimbursement models for oncology realized significant cancer care savings through bundled payments and clinical pathways, a recent Evidence-Based Oncology study revealed. But the financial incentives for the...

AAFP: Drop MIPS APM Pathway to Simplify MACRA Implementation

by Jacqueline LaPointe

The American Academy of Family Physicians (AAFP) recently urged CMS to simplify MACRA implementation to support primary care provider participation in the Quality Payment Program. The industry group called for several Quality Payment...

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