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

Risk Management News

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...

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...

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...

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...

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...

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...

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...

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...

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...

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,...

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...

Become a member

Complete your profile below to access this resource.

Thanks for subscribing to our newsletter. Please fill out the form below to become a member and gain access to our resources.

Reset your password

Enter your email address to receive a link to reset your password


Join 30,000 of your peers and get free access to all webcasts and exclusive content

Sign up for our free newsletter:

Our privacy policy

no, thanks

Continue to site...