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

Risk Management News

Healthcare Disruption Spurs Hospitals to Alter Business Operations

November 21, 2018 - Eighty-five percent of hospital and health system executives believe the industry is at significant risk for healthcare disruption, and their organizations are preparing their business operations for potential changes to how healthcare operates, a new survey shows. The healthcare industry has recently faced an onslaught of disruption. Amazon, JP Morgan, and Berkshire Hathaway announced...


Practices Still Averse to Risk-Based Alternative Payment Models


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...

36% of ACOs Consider Quitting MSSP Under New Proposed Rules


Over one-third of accountable care organizations (36 percent) said they are unlikely to continue with the Medicare Shared Savings Program (MSSP) if the proposed overhaul is finalized, a recent survey showed. Only 48 percent of ACO leaders...

AMA, AHIP, and Others Oppose Upside-Only ACO Changes for MSSP


The American Medical Association (AMA), Medical Group Management Association (MGMA), and Health Care Transformation Task Force (HCTTF) are among nine industry groups calling on CMS to reconsider proposed changes to the Medicare Shared...

Patient Attribution Key Component to APMs, Value-Based Contracts


Patient attribution is a critical component of alternative payment models (APMs) that appropriately hold providers accountable for their care performance. “Attribution methodology is at the core of constructing actuarially sound,...

CMS to Offer More Flexibility to Risk-Bearing ACOs, Verma Says


Federal regulations and rules are commonly cited as barriers to implementing value-based reimbursement models. The rules can prevent care coordination and appropriate transitions of care, which negatively impact an accountable care...

Next Generation ACOs Save Medicare $62M, Maintain Care Quality


Accountable care organizations (ACOs) in the Next Generation ACO program produced nearly $62 million in net savings to Medicare while maintaining care quality in 2016, CMS recently reported in the newly released evaluation of the...

A Provider-Sponsored Health Plan Is A Hospital’s Natural Next Step


Many hospitals and health systems are bypassing the ultimate opportunity to gain greater control of the outcomes and costs of their patients. That opportunity is developing their own provider-sponsored health plan, according to Geisinger...

Giving Providers Hospital Cost Accounting Data Will Lower Costs


Engaging physicians with hospital cost accounting data will be key to lowering costs under accountable care organizations (ACOs) and other population-based reimbursement models, Stanford researchers recently explained. Population-based...

CMS to Waive MIPS for Providers in At-Risk Medicare Advantage Plans


CMS recently announced that it advanced a demonstration that would waive Merit-Based Incentive Payment System (MIPS) requirements for eligible clinicians participating in at-risk Medicare Advantage plans. If approved, the Medicare...

Key Issues Impacting Two-Sided Risk Accountable Care Organizations


Medicare accountable care organizations (ACOs) operating under two-sided financial risk arrangements save the federal healthcare program more than one-sided risk organizations. But policymakers must address financial incentives,...

Medicare Spending Greater on Patients in Downside Risk MSSP ACOs


Moving accountable care organizations (ACOs) to Medicare Shared Savings Program (MSSP) tracks with downside financial risk may not help the accountable care initiative generate savings, according to a new analysis from the Center for...

House Reps Want to Extend MSSP Track 1 ACO Participation


Seven House Representatives are calling on CMS to allow successful accountable care organizations (ACOs) in the Medicare Shared Savings Program’s (MSSP) Track 1 to continue in the upside-only financial risk track for a third...

71% of MSSP ACOs Likely to Quit Rather Than Assume Downside Risk


The Medicare Shared Savings Program (MSSP) is requiring the 82 accountable care organizations (ACOs) that started in upside-only financial risk tracks in 2012 or 2013 to take on downside financial risk by 2019. However, the majority of...

Orgs Not Living Up to Risk-Based Revenue Goals, C-Suite Says


Provider organizations failed to achieve their risk-based revenue goals in 2017, according to the most recent State of Population Health survey by Numerof & Associates. The survey of healthcare C-suite executives showed that the...

A Holistic View of the Patient Enables Risk-Based ACO Success


Giving providers a holistic view of the patient resulted in accountable care organization (ACO) success for a risk-based organization in southern Florida, which earned a place on the list of ACOs achieving the greatest shared savings in...

How Mercy Improved Care Transitions for Risk-Based Care Success


For the thousands of patients released from their 23 acute care hospitals a year, Mercy Health ensures that each patient receives the highest value care. But there is only so much providers can do within the walls of their health system to...

Risk-Averse MSSP ACOs Missed $966M By Not Assuming Downside Risk


Accountable care organizations (ACOs) in the non-risk bearing track of the Medicare Shared Savings Program (MSSP) could have boosted their bottom lines by an additional $966 million in net payments in 2016 if they had assumed downside risk...

MSSP Accountable Care Organizations Moving to Risk in 2018


According to a new fact sheet from CMS, the Medicare Shared Savings Program (MSSP) will see some fresh faces in 2018, as well as more accountable care organizations (ACOs) entering downside financial risk tracks. The federal agency...

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