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

Value Based Reimbursement

Key Considerations for Bundled Payment Model Adoption, Success

by Jacqueline Belliveau

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 first step...

Healthcare Execs Ponder Financial Impact of Possible ACA Repeal

by Jacqueline Belliveau

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 reimbursement...

Maryland All-Payer APM Reduces Medicare Hospital Costs by $429M

by Jacqueline Belliveau

As the Maryland All-Payer alternative payment model starts its fourth year, a Health Affairs report shows that the program reduced Medicare hospital costs by $429 million, exceeding CMS requirements that the model save $330 million five years....

Industry Orgs Urge Lawmakers to Continue Value-Based Care Push

by Jacqueline Belliveau

Over 120 healthcare industry groups, including hospitals, healthcare systems, payers, and professional organizations, recently urged the Trump administration and Congress to not discontinue or slow the transition to value-based care. In the letter...

Should the Hospital Readmissions Reduction Program Add Sepsis?

by Jacqueline Belliveau

The Medicare Hospital Readmission Reduction Program currently determines value-based penalties on 30-day unplanned readmissions rates for six conditions. But the value-based reimbursement program may be missing a key condition that contributes...

359K Clinicians to Join CMS Alternative Payment Models in 2017

by Jacqueline Belliveau

CMS recently announced that the federal agency selected over 359,000 clinicians to participate in four of the federal agency’s alternative payment models in 2017. The new participants will be joining the Medicare Shared Savings Program...

Avoidable Hospitalizations Drop 31% for Long-Term Care Patients

by Jacqueline Belliveau

Avoidable hospitalizations among dual-eligible long-term care facility residents dropped by 31 percent between 2010 and 2015 largely because of value-based care programs, CMS recently stated in an official blog post. “Family members want...

CMS: Providers Need Data Access for Value-Based Reimbursement

by Jacqueline Belliveau

Value-based reimbursement success rests on providing clinicians with convenient and increased access to meaningful data, the leaders of the Office of the National Coordinator (ONC) and CMS stated in a recent official CMS blog post. “Data...

All-Payer Alternative Payment Model Targets PA Rural Hospitals

by Jacqueline Belliveau

A new six-year all-payer alternative payment model will focus on improving care quality and reducing healthcare costs at rural hospitals in Pennsylvania, CMS announced in a recent fact sheet. The CMS Innovation Center’s latest project,...

Do Pay-for-Performance Programs Improve Patient Outcomes?

by Jacqueline Belliveau

Value-based reimbursement models that pay for performance modestly incentivized providers to stick to clinical guidelines, but they may not be linked to better patient outcomes, a recent Annals of Internal Medicine study indicates. The literature...

Addressing Social Risk in Medicare Value-Based Reimbursement

by Jacqueline Belliveau

Hospitals that disproportionately treat patients with social risk factors, such as low income and race, may be unfairly penalized under some Medicare value-based reimbursement programs. But the National Academies of Science, Engineering, and...

AHA Calls for Medicare Reimbursement Bump for Hospital Services

by Jacqueline Belliveau

The American Hospital Association (AHA) recently urged the Medicare Payment Advisory Commission (MedPAC) to finalize a recommendation that would boost Medicare reimbursement for hospital inpatient and outpatient services in 2018. In a comment...

ACO Incentives, Coordination Improve Complex Pediatric Care

by Jacqueline Belliveau

Children with medical complexities, or children who require the highest level of service and support, are one of the most expensive pediatric patient populations. But provider collaboration and financial incentives through an accountable care...

CMS: Innovation Center Key to APM, MACRA Implementation Success

by Jacqueline Belliveau

In a recent official blog post, CMS Acting Principal Deputy Administrator Patrick Conway, MD, highlighted the federal agency’s Innovation Center’s successes with alternative payment model development, especially as MACRA implementation...

How Social Risk Factors Influence Value-Based Reimbursement

by Jacqueline Belliveau

Safety-net providers received more financial penalties under Medicare value-based reimbursement programs because the hospitals treated more beneficiaries with social risk factors, such as dual eligibility, low income, race, ethnicity, and rural...

Does Hospital Size Impact Value-Based Penalties in CMS Program?

by Jacqueline Belliveau

Value-based penalties in the Medicare Hospital-Acquired Condition Reduction Program are disproportionately affected by a participating hospital’s bed size and number of cases, a recent American Journal of Medical Quality study indicated....

Payment Reform, Value-Based Care Top 2017 Medicaid Priorities

by Jacqueline Belliveau

Delivery system and healthcare payment reform, especially through value-based care, topped the list of 2017 Medicaid priorities, according to the annual State Medicaid Operations Survey from the National Association of Medicaid Directors (NAMD)....

PQRS Medicare Payment Adjustments Waived After ICD-10 Update

by Jacqueline Belliveau

Some eligible professionals and group practices will not receive Physician Quality Reporting System (PQRS) Medicare payment adjustments in 2017 and 2018 because of the recent ICD-10 update, CMS recently announced in an email. The announcement...

2018 Advanced APM Options Added to Quality Payment Program

by Jacqueline Belliveau

Eligible clinicians now have more opportunities to earn value-based incentive payments by participating in the Advanced Alternative Payment Model track of the Quality Payment Program in 2018, according to a recent CMS announcement. Starting in...

Developing Post-Acute Networks for APM Reimbursement Success

by Jacqueline Belliveau

About 85 percent of healthcare C-suite leaders expect to expand post-acute care partnerships over the next three years, especially as their organizations aim to maximize alternative payment model reimbursement, a recent Premier report found....

X

Join 30,000 of your peers and get free access to all webcasts and exclusive content

Sign up for our free newsletter:

Our privacy policy

no, thanks