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

Risk Management News

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

July 16, 2018 - 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 Health Plan’s Chief Financial Officer. “It’s important to think about how important hospitals are to local communities. In many...


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...

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...

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,...

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...

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...

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...

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...

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...

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