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

Value Based Reimbursement

Higher Hospital Costs Stem from ICU Overuse for Some Conditions

by Jacqueline LaPointe

Healthcare providers may be able to decrease hospital costs by avoiding ICU admissions for some patients with chronic obstructive pulmonary disease (COPD), exacerbation of heart failure (HF), and acute myocardial infarction (AMI), a recent...

274 Orgs Calls on CMS to Add Medicare Advantage Advanced APMs

by Jacqueline LaPointe

CMS should develop financial incentives comparable to those in the Quality Payment Program’s Advanced Alternative Payment Model (APM) track for providers who assume financial risk under Medicare Advantage plans, CAPG and 273 other...

Premier: Bundled Payment Models Should be Voluntary Nationwide

by Jacqueline LaPointe

Premier Healthcare Alliance recently offered CMS several recommendations for bundled payment model development, including making programs voluntary for providers across the nation. CMS has implemented several mandatory bundled payment...

CMS Reopens Next Generation ACO Application Request Portal

by Jacqueline LaPointe

Providers interested in joining the Next Generation Accountable Care Organization (ACO) model in 2018 can now access the Request for Applications and Letter of Intent on the program’s portal, according to a recent CMS...

FFS Compensation Linked to More Stroke Prevention Surgeries

by Jacqueline LaPointe

A new study in JAMA Surgery found that providers with fee-for-service compensation performed more carotid stenosis interventions on symptomatic and asymptomatic patients compared to providers reimbursed by a salary. Using data from the...

65% of Organized Providers Paid Via Alternative Payment Models

by Jacqueline LaPointe

Nearly two-thirds of healthcare providers in some type of integrated employment model, such as integrated health networks, physical hospital organizations, accountable care organizations, and large medical groups, are primarily reimbursed...

AHA Critiques MedPAC’s Potential MACRA Implementation Changes

by Jacqueline LaPointe

The American Hospital Association (AHA) recently responded to potential MACRA implementation changes discussed at the Medicare Payment Advisory Commission’s (MedPAC) January meeting. The industry group called on MedPAC to “draw...

Exploring MIPS Advancing Care Info, Improvement Activities

by Jacqueline LaPointe

At HIMSS17, CMS leaders took the stage to ease provider concerns about the newly launched Quality Payment Program and its more popular value-based reimbursement track, the Merit-Based Incentive Payment System (MIPS). Following up on their...

CMS Calls on Stakeholders for Pediatric APM Development Input

by Jacqueline LaPointe

CMS recently put out a request for information for a potential Medicaid and Children’s Health Insurance Program (CHIP) alternative payment model targeting pediatric care, according to an official CMS blog post. “Through the...

Transradial, Same Day Discharge Cardiac Care Drops Costs by $3.7K

by Jacqueline LaPointe

From acute myocardial infarctions to coronary artery bypass grafts initiatives, recent Medicare bundled payment models have providers focusing more on reducing healthcare costs and improving care quality for a range of cardiac care...

Provider Profitability Tops Healthcare Revenue Cycle Concerns

by Jacqueline LaPointe

One of the top healthcare revenue cycle concerns with 40 percent of providers is maintaining profitability while remaining independent, a recent RemitDATA survey revealed. The survey of healthcare providers, billing companies, and vendors...

Creating a Population Health Management Operating Model

by Jacqueline LaPointe

ORLANDO - “Collaboration is a critical piece,” Steven Merahn, MD, emphasized during his HIMSS17 session on developing an operating model for population health management that functions regardless of payment model...

Healthcare C-Suite, Earned Incentive Compensation Down in 2016

by Jacqueline LaPointe

Median healthcare CEO compensation in terms of total cash value remained relatively the same for non-physician executives in 2016, while physician CEOs faced a 3.9 percent reduction, a recent AMGA Consulting survey found. The survey of 78...

Coalition Offers CMMI, Alternative Payment Model Improvements

by Jacqueline LaPointe

Thirty-five healthcare industry groups recently banded together to offer the newly-approved Department of Health and Human Services (HHS) Secretary a set of guidelines for CMS Innovation Center (CMMI) and alternative payment model...

One-Third of Healthcare Execs Ready for MACRA Implementation

by Jacqueline LaPointe

Only 35 percent of healthcare executives said that their organization has a MACRA implementation strategy and feels prepared for the new value-based reimbursement program, according to a recent Health Catalyst and peer60 survey. The...

2012 MSSP ACOs Decreased Post-Acute Care Spending by 9%

by Jacqueline LaPointe

A new JAMA Internal Medicine study showed that Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) established in 2012 decreased post-acute care spending by a 9 percent differential reduction by 2014 without...

Stakeholders Propose 4 MACRA Physician-Focused Payment Models

by Jacqueline LaPointe

MACRA’s Quality Payment Program offers 5 percent maximum incentive payments if eligible clinicians sufficiently participate in an Advanced Alternative Payment Model (APM) from 2017 to 2022. But many specialists are still waiting for...

52-47 Senate Vote Confirms Tom Price as New HHS Secretary

by Jacqueline LaPointe

Early this morning, the Senate approved Tom Price as the new Department of Health and Human Services (HHS) Secretary by a 52 to 47 vote, according to multiple sources. Price, a Republican representative from Georgia, will be the first...

Key Considerations for Bundled Payment Model Adoption, Success

by Jacqueline LaPointe

As the value-based reimbursement transition pushes on, many provider organizations have turned to bundled payment models as a stepping stone to alternative payment model adoption. “Bundled payments can be an organization’s...

Healthcare Execs Ponder Financial Impact of Possible ACA Repeal

by Jacqueline LaPointe

With a possible full or partial Affordable Care Act repeal in the near future, healthcare executives called for some of the healthcare reform law’s provisions to continue, such as increased insurance coverage and the value-based...

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