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

Value Based Reimbursement

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...

MIPS Requirements for Clinicians in Small, Rural Hospitals

by Jacqueline LaPointe

In light of the unique challenges eligible clinicians in small and rural hospitals face, CMS developed special Merit-Based Incentive Payment System (MIPS) eligibility and reporting requirements for the clinician group. Through MIPS, CMS...

Value-Based Penalties Target Hospitals With High Risk Patients

by Jacqueline LaPointe

Hospitals that serve greater volumes of African-American patients and those with more severe conditions are more likely to receive a value-based penalty under the Medicare Hospital Readmissions Reduction Program (HRRP), a new JAMA...

CMS Expects to Release MIPS Participation Status By May 2017

by Jacqueline LaPointe

CMS anticipates notifying eligible clinicians about their Merit-Based Incentive Payment System (MIPS) participation status for 2017 via letter between late April through May, a recent email from the federal agency stated. The announcement...

Value-Based Reimbursement Spurs 8% Hospital Merger Growth

by Jacqueline LaPointe

Value-based reimbursement trends drove health system and hospital merger activity to increase 8 percent compared to the first quarter of 2016, Anu Singh, a Managing Director at Kaufman, Hall & Associates, recently told...

NAACOS: Mandatory Bundled Payments Impede ACO Financial Success

by Jacqueline LaPointe

The National Association of ACOs (NAACOS) recently urged CMS to indefinitely suspend upcoming mandatory Medicare bundled payment models until the federal agency resolves financial conflicts between the episodic arrangements and accountable...

AHA Backs Cardiac, Ortho Bundled Payments Delay Until 2018

by Jacqueline LaPointe

The American Hospital Association (AHA) recently supported a CMS proposal to further delay Medicare bundled payments for cardiac and orthopedic care episodes to Jan. 2018. The Advancing Care Coordination through Episode Payment Models...

Oncologists Need Data Reporting, Time for MACRA Implementation

by Jacqueline LaPointe

Although MACRA launched the Quality Payment Program on Jan. 1, 2017, a recent American Society of Clinical Oncology (ASCO) report stated that many oncology practices still need to expand or improve services and data reporting to meet the...

CMS Suggests Hospital Medicare Reimbursement Policy Changes

by Jacqueline LaPointe

CMS recently suggested changes to Medicare reimbursement policies for hospital admissions and long-term care hospital stays as well as several recommendations for other Medicare value-based purchasing programs. The proposed rule released...

Keep Medicare Bundled Payment Models Mandatory, Experts Say

by Jacqueline LaPointe

Switching Medicare bundled payment models that are currently mandatory in select regions to voluntary across the country would impede value-based reimbursement progress through episodic payment, industry experts warned the Trump...

Bundled Payment Models Here to Stay Despite CMS Program Delays

by Jacqueline LaPointe

CMS may have issued three-month delays for several new healthcare bundled payment models, but providers should still anticipate the shift to value-based purchasing through the episodic alternative payment model, said Colin Luke, a partner...

64% of Healthcare Providers Not Ready for MACRA Implementation

by Jacqueline LaPointe

Even though MACRA’s Quality Payment Program started on Jan. 1, approximately 64 percent of healthcare providers stated that they were either unprepared or very unprepared for MACRA implementation in a February 2017 survey by...

How to Prepare for Alternative Payment Model Implementation

by Jacqueline LaPointe

Implementing interoperable health IT infrastructure and a staffing model that aligns with value-based care requirements are key to successfully participating in an alternative payment model, Marjie Harbrecht, MD, a Medical Group...

NAM Advises Leaders to Prioritize Value-Based Purchasing Reform

by Jacqueline LaPointe

In a new report, the National Academy of Medicine (NAM) named value-based purchasing as one of four action priorities for healthcare stakeholders in 2017. To implement more value-based purchasing models, NAM suggested that stakeholders...

MGMA to CMS: Notify Clinicians About MIPS Eligibility ASAP

by Jacqueline LaPointe

The Medical Group Management Association (MGMA) recently called on CMS Administrator Seema Verma to immediately release Merit-Based Incentive Payment System (MIPS) eligibility notifications as well as approved vendor lists and hospital or...

Healthcare Spending Varies More by Provider Than Hospital

by Jacqueline LaPointe

A recent JAMA Internal Medicine study uncovered that healthcare spending varied more across individual providers than across hospitals. Based on Medicare data on hospitalized beneficiaries from 2011 to 2014, researchers from several...

Top 5 Ingredients of a Successful Alternative Payment Model

by Jacqueline LaPointe

Alternative payment models tie provider reimbursement to quality and cost performance. Besides their foundational function, though, each model has its own rules pertaining to financial incentive structures, quality measurements, and...

46% of Providers Unsure About Value-Based Purchasing Impact

by Jacqueline LaPointe

Value-based purchasing is not a new term for many providers, yet 46.4 percent of healthcare providers and leaders are still unsure how the shift away from fee-for-service payments will impact their revenue cycles, a recent Physicians...

Health IT, Care Navigators Most Effective at Lowering Costs

by Jacqueline LaPointe

While countless strategies are out there for making care delivery more efficient, a recent Health Affairs study revealed that interventions that use health IT and community health workers realized the greatest cost savings. Researchers...

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