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

Risk Management News

Key Issues Impacting Two-Sided Risk Accountable Care Organizations

June 20, 2018 - 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, benchmarks, and other issues to ensure two-sided risk ACOs continue to generate savings, the Medicare Payment Advisory Commission (MedPAC) recently reported. “Medicare...


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 Healthcare...

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 agreement period....

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 these...

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 majority...

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 the Medicare...

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 extend...

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 in...

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 reported that...

ACO, Bundled Payments Alignment Key to Success for Both Models


CMS should align accountable care organizations (ACOs) and bundled payments by creating a blended accountability structure that allows organizations to participate in both alternative payment models without financial conflicts, industry experts...

Industry Orgs Urge CMS to Lower Risk for MACRA’s Advanced APMs


Healthcare stakeholders recently encouraged CMS to reconsider the financial risk requirements for Advanced Alternative Payment Models (Advanced APMs), arguing that the risk criteria limit participation in the models. Industry groups, including...

Home Health Owners Face Charges for Medicare Fraud, Upcoding


The federal government filed a lawsuit against the two owners of Gateway Health Systems in Chicago for their involvement in a Medicare fraud scheme that cost the federal healthcare program millions, the Department of Justice recently announced....

ACOs Plan to Move to Downside Financial Risk, Capitation Contracts


Accountable care organizations (ACOs) are planning to enter downside financial risk arrangements, with 47 percent planning on entering a shared savings and losses contract and 38 percent pursuing capitation, uncovered a recent survey of 240 ACOs...

Bringing Back House Calls to Cut Spending on High-Risk Patients


Before the early 1960s, the majority of healthcare visits were performed in patient homes. But as healthcare evolved, providers could no longer fit their tools in a transportable medical bag and the proportion of visits made by house calls dropped...

Patient-Reported Data Helps Providers Find High-Cost Patients


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....

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...

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