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

Value Based Reimbursement

Uniform Operational System Key to Value-Based Payments, CAQH Says

by Jacqueline LaPointe

The healthcare industry needs an “efficient, uniform operational system” to sustain value-based payment success, the Council for Affordable Quality Healthcare’s (CAQH) Committee on Operating Rules for Information Exchange...

MD All-Payer Alternative Payment Model Met Medicare Spending Goal

by Jacqueline LaPointe

The Maryland All-Payer alternative payment model has already met and exceeded its five-year goal of reducing Medicare spending on hospitals by $330 million and the state is on its way to achieving care quality improvement goals, the...

House Reps Create Caucus for Value-Based Reimbursement, Health IT

by Jacqueline LaPointe

Four House Representatives recently announced the creation of a new bipartisan group dedicated to supporting and promoting healthcare innovation through value-based reimbursement. Representatives Mike Kelly (R-PA), Ron Kind (D-WI),...

MIPS Will Impede Value-Based Purchasing Transition, MedPAC Argues

by Jacqueline LaPointe

The Medicare Payment Advisory Commission (MedPAC) recently suggested that Congress repeal the Merit-Based Incentive Payment System (MIPS), arguing the new value-based purchasing program “impedes the movement toward high-value...

Fewer Hospitalizations Reduced Skilled Nursing Facility Use by 15%

by Jacqueline LaPointe

Skilled nursing facility (SNF) utilization has declined 15 percent from 2009 to 2016, a new Avalere analysis revealed. The analysis of Medicare fee-for-service claims revealed that SNF utilization dropped from 1,808 SNF days per 1,000...

Hospital Readmissions With Value-Based Penalties Vary by Provider

by Jacqueline LaPointe

Hospital readmission rates for conditions that carry value-based penalties under the Hospital Readmissions Reduction Program (HRRP) varied by admitting physician attending type, with geriatricians having the lowest 30-day readmissions...

AMA, Anthem Team Up to Streamline Prior Authorizations

by Jacqueline LaPointe

The American Medical Association (AMA) and Anthem, Inc. recently announced that they will work together over the next year to streamline prior authorization requirements and improve the healthcare experience overall through provider and...

Accelerating the Value-Based Payment Transition Top HHS Priority

by Jacqueline LaPointe

Quickening the pace of the value-based payment transition is a major focus for HHS, the department’s new Secretary Alex Azar recently told attendees of the Federation of American Hospitals’ annual Public Policy Conference in...

72% of Medical Groups Oppose Mandatory Alternative Payment Models

by Jacqueline LaPointe

The mandatory versus voluntary alternative payment model debate continues. This time medical group practices are voicing their opinions in a new MGMA Stat poll that found 72 percent of group leaders oppose required participation in...

Value-Based Purchasing Top Health Reform Priority for Governors

by Jacqueline LaPointe

In a recent healthcare reform proposal, a bipartisan group of governors emphasized that value-based purchasing implementation will be the key to reducing healthcare costs while improving outcomes. “Coverage is important, and...

Slow and Steady Still the Motto for Value-Based Reimbursement

by Jacqueline LaPointe

The healthcare industry has boarded the train to value-based reimbursement. But recent roadblocks have provider organizations pumping the brakes with the shift away from fee-for-service, explained industry experts Doral Jacobsen, MBA,...

Hospital Execs, Payers Face Similar Value-Based Purchasing Barriers

by Jacqueline LaPointe

Payers and hospital finance executives agree that health IT inadequacies and insufficient physician buy-in are top barriers to value-based purchasing adoption, two recent surveys revealed. The Healthcare Financial Management...

Hospital Cost-Shifting Increases Private Payer Payments by 1.6%

by Jacqueline LaPointe

Healthcare organizations that faced Medicare reimbursement reductions under the Affordable Care Act engaged in hospital cost-shifting that resulted in 1.6 percent higher average payments from private payers, a new working paper from the...

Doctors to HHS: Level the Playing Field for Independent Practices

by Jacqueline LaPointe

In the face of increased hospital consolidation, HHS should better support independent practices and develop policies that allow solo providers to compete with hospitals and health systems, the Physicians Advocacy Institute (PAI) recently...

Doctors, Employers Disagree on Healthcare Payment Reform Strategy

by Jacqueline LaPointe

Healthcare providers and employers are moving to value-based reimbursement models to achieve the Triple Aim, but the stakeholders disagree on how to move healthcare payment reform efforts forward and by what means, a recent Leavitt...

Reducing Low-Value Care Key to Value-Based Reimbursement Success

by Jacqueline LaPointe

Value-based reimbursement success hinges on decreasing low-value care across patient populations, explained Scott Weingarten, MD, MPH, Senior Vice President and Chief Clinical Transformation Officer at Cedars-Sinai Medical Center. While...

AMGA: Link Spending, Quality Performance for True Value-Based Care

by Jacqueline LaPointe

In response to a Request for Information from the Assistant Secretary for Planning and Evaluation (ASPE), AMGA recently called on CMS to “define value in a meaningful way” to ensure value-based care models incentivize providers...

Flexibility, Value-Based Payment Key to Rural Hospital Success

by Jacqueline LaPointe

Health policies should provide rural hospitals with the flexibility to develop healthcare services that meet community needs and the value-based payment and funding structures to support tailored services, the Bipartisan Policy Center...

72% of Clinicians See No Adjustment Under Value Modifier in 2018

by Jacqueline LaPointe

An overwhelming majority of clinicians who participated in the final year of the Value-Based Payment Modifier (Value Modifier) program will receive neutral payment adjustments in 2018, according to new CMS data. Out of over 1.1 million...

AMGA: Align Medicare Advantage, APMs to Promote Value-Based Care

by Jacqueline LaPointe

If CMS moves forward with relaxing Medicare Advantage benefit requirements, then the federal agency should offer the same flexibilities to providers and beneficiaries in Medicare Part B alternative payment models, such as accountable care...

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