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

Risk Management News

Patient-Reported Data Helps Providers Find High-Cost Patients

August 4, 2017 - Self-reported patient data on health conditions, status, and utilization may be the key to identifying high-cost patients and guiding them to care management models to reduce their spending, a recent American Journal of Managed Care study indicated. As providers assume financial risk under value-based purchasing models, they should implement processes to identify high-cost patients and prevent...


MSSP ACOs Missed $886M in Potential Revenue By Avoiding Risk


Accountable care organizations (ACOs) in Track 1 of the Medicare Shared Savings Program (MSSP) could have received an additional $886 million in net payments in 2015 if the organizations took on downside financial risk and earned the 5 percent...

PCP Patient Attribution Aids Providers in Value-Based Contracts


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...

AHA Backs Cardiac, Ortho Bundled Payments Delay Until 2018


The American Hospital Association (AHA) recently supported a CMS proposal to further delay Medicare bundled payments for cardiac and orthopedic care episodes to Jan. 2018. The Advancing Care Coordination through Episode Payment Models postponement...

61% of ACO Contracts Only Include Upside Financial Risk


A recent Leavitt Partners study showed that 61 percent of accountable care organization (ACO) contracts are upside risk-only, indicating that ACOs may be risk-adverse or are still in the experimental stage with financial risk. Even though ACOs...

Examining the Role of Financial Risk in Value-Based Care


As the healthcare industry ramps up its efforts to advance value-based care, providers are expected to take on more financial risk. One of the goals of value-based care is to transition financial risk away from taxpayers and healthcare payers...

The Future of Accountable Care Organizations Involves Risk


As many healthcare providers know, participating in a value-based care program, such as an accountable care organization, is about more than just tying payment to quality.  It involves shouldering financial risk as a way to motivate clinicians...

Risk-Based Alternative Payment Models Key to Value-Based Care


Although the Department of Health & Human Services (HHS) recently announced that it had already tied 30 percent of Medicare payments to an alternative payment model nearly a year ahead of schedule, a recent study indicates that further value-based...

Detailing ACO Challenges with Risk, MACRA Implementation


While accountable care organizations (ACOs) are popular and effective ways to implement value-based care, many ACOs are still facing significant challenges with managing risk and healthcare costs as the industry prepares for MACRA implementation....

Why Accountable Care Organizations Need Revenue Cycle Risk


Is the "Accountable" part of accountable care organizations being ignored? Over 100 new Medicare Accountable Care Organizations (ACO) participants will keep quality high and costs low, according to the Centers for Medicare &...

Medicare Spending Up, Medicare Shared Savings Requires Risk


Medicare spending is on the rise as the sizable impact of high-priced drugs on healthcare spending evolves. Accountable Care Organizations (ACOs) appear to be either in, out, or somewhere in between on the financial risk spectrum. Will ACOs take...

Considering Healthcare Providers’ Value-Based Risk Burdens


Value-based reimbursement may not be good for revenue cycle management. Increasing levels of financial risk may be setting healthcare providers back, but to what extent and at what cost? As the payment model landscape changes, can providers...

CMS Reports ACOs Assume High Risk Yet Generate High Savings


Accountable care organizations (ACOs) generated over $411 million in net program savings last year, according to financial and quality performance results from the Centers for Medicare & Medicaid Services (CMS). “The Affordable Care...

Are Accountable Care Organizations Worth Investment Risk?


Do Accountable Care Organizations (ACOs) have longevity in the healthcare industry or will they soon merely be gone with the wind? As reported, the Centers for Medicare & Medicaid Services (CMS) said within its 2014...

Are Medicare Pay-for-Performance Benefits Worth the Risk?


Medicare pay-for-performance (P4P) incentives are inadvertently averting money away from those financially aching hospitals primarily serving minorities and the economically disadvantaged to instead inflate the revenues of those hospitals serving...

12 Value-Based Reimbursement Strategies to Cut Revenue Risk


Value-based reimbursement is a hearty healthcare subject worth diving into as the shift from volume to value continues to evolve. Thirty percent of Medicare payments will be tied to alternative payment models, as per a recent announcement from...

5 Needed Considerations in ICD-10 Enterprise Risk Management


Enterprise risk management – the rather involved process of minimizing financial risk to capital and earnings through effective organization, leadership, and control – is emerging as a central ICD-10 focus. Despite hearty preparation...

How to Mitigate Risk With a Value-Based Strategy


With healthcare solutions adopting a more value-based approach, mitigating risk is key to experiencing the best reward. Value-based payment options have become the trendy buzzword in the healthcare sector. The rise of the Affordable Care Act...

Are Providers Updating Patients on ACA and Financial Risks?


The Affordable Care Act (ACA) not only gives the opportunity for more individuals to find quality health insurance at the right price, it also requires patients to take more financial responsibility in their health. Deductibles and co-pays may...


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