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

Value Based Reimbursement

67% of MSSP ACOs May Be High-Revenue Under Pathways to Success

by Jacqueline LaPointe

Over two-thirds of Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) would qualify as high-revenue organizations under the new Pathways to Success initiative, a recent Leavitt Partners analysis...

Congress Wants More on CMMI Alternative Payment Model Development

by Jacqueline LaPointe

The House Committee on Ways and Means is calling on CMS to boost transparency with alternative payment model development in the Center for Medicare and Medicaid Innovation (CMMI), which develops and operates alternative payment and care...

Are Hospital Readmissions Reduction Program Results Overstated?

by Jacqueline LaPointe

CMS, researchers, and other healthcare stakeholders have touted the Hospital Readmissions Reduction Program (HRRP) touted as a success. Under the authority of the Affordable Care Act, CMS launched the HRRP in 2010 to incentivize hospitals...

Social Determinants of Health Key to Value-Based Purchasing Success

by Jacqueline LaPointe

We are quickly heading to the value-based purchasing tipping point, according to the Vice President of Network Management at Health Partners Plans in Pennsylvania. “While adoption rates are still relatively low in some regions of...

ACO Financial Risk Rules for Pathways to Success Raise Concerns

by Jacqueline LaPointe

Leading healthcare industry groups are concerned that the overhaul of the Medicare Shared Savings Program (MSSP) will impede the transition to value-based care. On December 21, 2018, CMS finalized changes to the largest Medicare...

Next Generation Accountable Care Organizations Save $164M

by Jacqueline LaPointe

Accountable care organizations (ACOs) assuming the highest levels of financial risk in Medicare saved $164 million during their second performance year, CMS recently reported. Medicare ACOs bring together groups of physicians, hospitals,...

CMS Overhauls MSSP by Finalizing Pathways to Success for ACOs

by Jacqueline LaPointe

CMS recently finalized an overhaul of the Medicare Shared Savings Program (MSSP), which will require accountable care organizations (ACOs) to assume downside financial risk sooner. The MSSP is the largest Medicare ACO program, boasting...

Key Providers, Payers Tie 47% of Business to Value-Based Payment

by Jacqueline LaPointe

A large group of major healthcare payers and health systems are reporting that nearly half of their business rests in value-based payment arrangements. The Health Care Transformation Task Force (Task Force) is a group of leading...

MSSP Accountable Care Organizations Saved Medicare Nearly $2.7B

by Jacqueline LaPointe

Accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) saved more than previously thought, according to a new analysis. The updated analysis of MSSP ACO savings from the National Association of ACOs (NACCOS)...

Value-Based Care, Price Transparency Rule Top Stories of 2018

by Jacqueline LaPointe

2018 has kept healthcare revenue cycle management and finance leaders on their toes. The healthcare industry continued its slow, but steady transition to value-based care and purchasing all while navigating the new landscape of healthcare...

Healthcare Interoperability, Rule Reform Key to Value-Based Payment

by Jacqueline LaPointe

Healthcare interoperability is vital to the transition to value-based payments, the second in command at HHS recently stated at the Office of the National Coordinator for Health Information Technology (ONC) annual...

55% of Hospitals Earn Incentive in Value-Based Purchasing Program

by Jacqueline LaPointe

More hospitals participating in the Hospital Value-Based Purchasing (VBP) Program will see a Medicare payment increase in 2019, CMS recently reported. The Hospital Value-Based Purchasing Program adjusts Medicare reimbursement to hospitals...

Clinicians Less Optimistic About Value-Based Care Than Execs

by Jacqueline LaPointe

Clinicians are more skeptical about the benefits or viability of value-based care and reimbursement compared to healthcare executives, a new survey shows. Only about one-third of clinicians (38 percent) in a recent NEJM Catalyst survey...

Investing in Primary Care Delivers Value-Based Care Results

by Jacqueline LaPointe

Supporting primary care will bring value-based care results, asserts Humana’s Chief Medical Officer Roy Beveridge, MD. Value-based arrangements between providers and payers have the lofty, yet admirable goals of improving care...

Value-Based Reimbursement Reduces Costs 15.6%, Improves Quality

by Jacqueline LaPointe

Value-based reimbursement models are moving the needle on quality and cost, a new analysis from Humana shows. In 2017, medical costs for patients attributed to primary care practices (PCPs) in Humana’s value-based reimbursement...

5% of MIPS Eligible Clinicians Earn a Negative Payment Adjustment

by Jacqueline LaPointe

Approximately 93 percent of eligible clinicians participating in MACRA’s Merit-Based Incentive Payment System (MIPS) in 2017 earned a positive payment adjustment, CMS Administrator Seema Verma recently reported. “These results...

CMS Shifting Home Health to Value-Based Payments Under New Model

by Jacqueline LaPointe

CMS recently finalized a new value-based payment system for home health agencies that would move Medicare reimbursement away from the volume of therapy delivered. Medicare will start to reimburse home health agencies under the...

Practices Still Averse to Risk-Based Alternative Payment Models

by Jacqueline LaPointe

Physician practices are less willing to participate in alternative payment models with downside financial risk compared to four years ago, revealed a new study from the RAND Corporation and the American Medical Association (AMA). Several...

OIG: Healthcare Fraud Exceptions for 2 Value-Based Payment Models

by Jacqueline LaPointe

Two recent advisory opinions from the Office of the Inspector General (OIG) at HHS are demonstrating why current healthcare fraud and abuse laws are not aligned with value-based payment and care delivery. The federal watchdog recently...

Putting Both Feet in the Value-Based Care, Reimbursement Boat

by Jacqueline LaPointe

“Do not put each foot in a different boat,” warned Partners HealthCare CFO Peter Markell at Xtelligent Healthcare Media’s third annual Value-Based Care Summit in Boston. But the current reality in healthcare is that...

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