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

Value Based Reimbursement

Mixed APM Results Offer Lessons for Healthcare Payment Reform

by Jacqueline Belliveau

The verdict is still out on whether key alternative payment models, such as accountable care organizations (ACOs) and bundled payments, reduce healthcare costs and improve care quality. But the mixed results should not discourage the industry...

Private Sector to Drive Bundled Payments After CMS Cancellations

by Jacqueline Belliveau

CMS recently announced its intention to modify its bundled payments strategy by proposing to eliminate forthcoming mandatory cardiac models and decreasing the scope of the Comprehensive Care for Joint Replacement (CJR) program. The pull away...

Cost Savings Unclear for Medicaid Alternative Payment Models

by Jacqueline Belliveau

Alongside Medicare and private payers, states are making the switch to value-based reimbursement, but states and independent researchers have yet to demonstrate the impact of Medicaid alternative payment models on healthcare costs and patient...

Physician Expert, Clinical Documentation Key to MIPS Success

by Jacqueline Belliveau

Since the Obama administration signed MACRA into law in 2015, healthcare providers have been attempting to understand the Quality Payment Program and its Merit-Based Incentive Payment System (MIPS). But regular updates and tweaks to MACRA have...

Small Health System Achieves ROI with Asthma Management Clinic

by Jacqueline Belliveau

Asthma is one of the most expensive chronic diseases for providers, payers, and patients. But a recent study in the American Journal of Managed Care showed that a stationary pediatric asthma management clinic can achieve a return on investment...

Accountable Care Organizations Grow, But Face New Challenges

by Jacqueline Belliveau

Since the Affordable Care Act paved the way for accountable care organizations (ACOs) in 2010, healthcare providers have increasingly turned to the alternative payment model as a way to engage in value-based care across patient populations. In...

NQF Eyes Adding Social Risk Factors to Value-Based Purchasing

by Jacqueline Belliveau

In response to stakeholder concerns that value-based purchasing programs unfairly penalize providers who treat greater proportions of disadvantaged patients, the National Quality Forum (NQF) recently endorsed 17 quality measures that address...

Do Oncology Bundled Payments Promote Low-Value Drug Use?

by Jacqueline Belliveau

Oncology bundled payments are not the answer to lowering prescription drug costs for cancer care delivery, the American Society of Clinical Oncology recently contended. In a position statement on addressing the affordability of cancer drugs,...

Is a Chief Primary Care Officer Key to Value-Based Purchasing?

by Jacqueline Belliveau

Developing a Chief Primary Care Medical Officer role should help health systems achieve value-based purchasing success by focusing on establishing care coordination systems and improving key quality measures, argued industry experts in a recent...

3 Challenges Providers Face with Healthcare Bundled Payments

by Jacqueline Belliveau

Healthcare bundled payments are becoming one of the most popular alternative payment models available to providers. Providers are drawn to the episode-based structure’s ability to decrease healthcare costs while maintaining or improving...

AMA Backs CMS Diabetes, Legacy Value-Based Purchasing Changes

by Jacqueline Belliveau

The American Medical Association (AMA) recently commended CMS for several recommendations outlined in the recently proposed 2018 Physician Fee Schedule rule. The industry group particularly welcomed a potential Medicare Diabetes Prevention Program...

Understanding the Top 10 Terms of Value-Based Purchasing

by Jacqueline Belliveau

Whether providers favor it or not, the healthcare industry is inevitability moving to value-based purchasing. CMS reported in 2016 that Medicare already linked 30 percent of traditional fee-for-service payments to value-based purchasing models...

Small Hospitals, Systems Grapple with Value-Based Reimbursement

by Jacqueline Belliveau

Approximately 67 percent of small hospitals and health systems do not plan on undertaking value-based reimbursement initiatives in 2017, a recent Ernst & Young LLP Advisory Health survey revealed. The survey of 700 healthcare professionals...

Core Competencies for Accountable Care Organization Development

by Jacqueline Belliveau

The National Business Group on Health (NBGH) recently identified the core competencies accountable care organizations (ACOs) should have at each stage of its development. The two resources from NBGH on ACO competencies are meant to help employers...

Bundled Payments Rely on Robust Networks, Healthcare Markets

by Jacqueline Belliveau

Healthcare providers are finding that it takes a village to succeed in bundled payment models. From primary care to specialists and post-acute care, providers need an integrated network of provider types and to play to their healthcare market...

PCP Patient Attribution Aids Providers in Value-Based Contracts

by Jacqueline Belliveau

Healthcare providers engaging in value-based contracts with shared savings opportunities earn financial bonuses or receive penalties based on the patients linked to them or their provider system. But which patient attribution model provided the...

Long Wait Times Jeopardize Value-Based Purchasing Revenue

by Jacqueline Belliveau

Fee-for-service payment models promote long patient wait times, but providers may want to consider implementing strategies to reduce wait times to increase market share and revenue under value-based purchasing models, argued two Geisinger Health...

GAO: Hospital Value-Based Purchasing Model Rewards Low Quality

by Jacqueline Belliveau

A new Government Accountability Office (GAO) report found that CMS gave financial bonuses to hospitals participating in the Hospital Value-Based Purchasing Program despite the facilities earning composite quality scores below the median. Using...

Accountable Care Organizations Continue to Grow With 11% Boost

by Jacqueline Belliveau

The number of accountable care organizations (ACOs) increased with 92 more organizations operating since the first quarter of 2016, reaching a total of 923 ACOs nationwide by the start of 2017, a recent Health Affairs blogpost stated. The Leavitt...

Payer Collaboration Key to Value-Based Reimbursement Strategy

by Jacqueline Belliveau

Value-based reimbursement arrangements come in a myriad of shapes and sizes much like provider organizations. But successful value-based contracts will align provider and payer goals for care quality and healthcare utilization as well as establish...

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