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

Value-Based Care News

Challenges, Successes of First-Year Shared Savings ACOs


Participants in the Medicare Shared Savings Program (MSSP) already familiar with physician practice transformation were more likely to earn shared savings payments, which should lead the Centers for Medicare & Medicaid Services to focus on...

How Pioneer ACOs Earn Shared Savings, Improve Care Quality


Massachusetts-based Atrius Health successfully managed several care quality improvements over the previous year and earned both the recognition of CMS and a portion of shared savings as a participant in the Pioneer ACO Model program. In August,...

Post-Acute Care Groups Oppose Value-Based Purchasing Program


Eight healthcare industry groups recently told lawmakers that they oppose the proposed Medicare Post-Acute Care Value-Based Purchasing Program, which is scheduled to start on Oct. 1, 2019. In a letter to the House Committee on Ways and Means,...

CMS: Bundled Payments Model Will Decrease Medicare Spending


The Bundled Payments for Care Improvement initiative has the potential to significantly reduce Medicare spending on 11 of 15 clinical episode groups that were analyzed in the program’s second annual evaluation report. In an official CMS...

Next Generation Model Methodology May Boost MSSP ACO Success


CMS should use a modified Next Generation model benchmark methodology to calculate healthcare cost thresholds to ensure all accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) have an equal opportunity to earn...

Value-Based Care Analytics Help Cut Healthcare Costs in Utah


By implementing a data analytics tool that integrates spending and patient outcome data, a Utah-based healthcare system reduced spending by up to 11 percent on three clinical improvement projects, including joint replacement, laboratory utilization,...

Preventable Readmissions Drop Under Value-Based Care Model


Forty-nine states and Washington DC have decreased preventable hospital readmissions under a Medicare value-based care initiative that financially penalizes hospitals with excess readmissions, reported CMS. “The Hospital Readmissions Reduction...

AMGA: New MACRA Flexibilities May Penalize Prepared Providers


New MACRA flexibilities for the first performance year of the program may help some providers ease into new value-based reimbursement programs, but the American Medical Group Association (AMGA) recently argued that new attestation tracks may...

Are Federal Value-Based Care Programs Truly Promoting Value?


In a statement to the House Ways and Means Health Subcommittee, the American Hospital Association (AHA) argued that Medicare value-based reimbursement programs, particularly pay-for-performance initiatives, do not have effective and fair financial...

Four New MACRA Tracks Allow Flexible Attestation for Providers


Eligible clinicians will be able to select their own pace for MACRA attestation to ensure all participants can succeed under new value-based reimbursement programs, CMS announced. On its official blog, the head of CMS detailed four options for...

House Reps Ask CMS for MACRA Implementation Flexibilities


Representatives from the House Ways and Means Committee and the House Energy and Commerce Committee have penned a letter to HHS Secretary Sylvia Mathews Burwell calling for more flexibilities with MACRA implementation. With the value-based care...

CMS Touts Progress of State-Led Alternative Payment Model


States participating in the first phase of the State Innovation Model Initiative have made significant progress in implementing alternative payment models, CMS officials revealed midweek. Two of six states were able to link more than half of...

How to Plan Out the Transition to Value-Based Reimbursements


Providers should address the drivers of value-based reimbursements to appropriately pace their transition to alternative payment models without sacrificing crucial fee-for-service revenue, according to  a new guide from Pershing Yoakley...

Industry Groups Call on CMS to Modify MACRA Patient Codes


Proposed patient relationship codes that will be used under MACRA to measure appropriate resource use and determine value-based reimbursement adjustments may cause more confusion for providers and increase administrative burdens, according to...

Is MACRA a Trojan Horse for Small Practices, Value-Based Care?


While a final rule on MACRA implementation has yet to be issued, some providers are growing concerned that the value-based care models in the legislation could significantly burden small physician practices. Providers in small practices will...

Medical Device Reps in OR Sway Healthcare Supply Chain Costs


Medical device sales representatives may act as key resources for surgeons on the latest technological advances and how to properly use specific devices, but the close relationship may actually be driving up healthcare supply chain costs, according...

HHS Awards $100M to Health Centers for Quality Improvement


The Department of Health and Human Services recently granted over $100 million in awards to 1,304 health centers across the nation to help improve care quality and boost primary care services, according to the federal department’s website....

How the Affordable Care Act Impacted Healthcare Revenue Cycle


From the transition to value-based care to the rise in patient consumerism, the Affordable Care Act has significantly changed the healthcare revenue cycle management landscape since its passage in 2010. Healthcare providers restructured how they...

AHA: Limiting Low-Value Medical Resource Use Cuts Healthcare Costs


While it is always reassuring to know that a provider will stop at nothing to diagnosis and treat his patients, limiting some medical resource use may actually help to decrease healthcare costs and improve quality of life for some patients, reported...

Physician Shortages Drive Increases in Provider Compensation


The nationwide physician shortage continues to put pressure on healthcare organizations to retain quality employees by boosting employee compensation and providing incentives to stay at the organization, according to Health eCareers annual salary...


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