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

Risk Management News

Home Health Owners Face Charges for Medicare Fraud, Upcoding

October 20, 2017 - 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. The suit alleged that husband-and-wife owners Ajibola Ayeni and Joy H. Turner-Ayeni defrauded Medicare by billing for medically unnecessary or nonexistent...


Articles

ACOs Plan to Move to Downside Financial Risk, Capitation Contracts

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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?

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

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

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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

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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

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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...

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