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

Value-Based Care News

How Social Risk Factors Influence Value-Based Reimbursement

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Safety-net providers received more financial penalties under Medicare value-based reimbursement programs because the hospitals treated more beneficiaries with social risk factors, such as dual eligibility, low income, race, ethnicity, and rural...

OIG: Provider Support, Health IT Needed for MACRA Implementation

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MACRA implementation has been a major priority for CMS in the past year, but the Department of Health and Human Service’s Office of the Inspector General (OIG) recently found several challenges that could impede Quality Payment Program...

URAC Calls for Virtual Group Rules in Quality Payment Program

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URAC, a non-profit healthcare accreditation company, recently called on CMS to implement virtual group standards under the Quality Payment Program in 2018 that promote economies of scale for more activities than just reporting compliance. The...

Does Hospital Size Impact Value-Based Penalties in CMS Program?

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Value-based penalties in the Medicare Hospital-Acquired Condition Reduction Program are disproportionately affected by a participating hospital’s bed size and number of cases, a recent American Journal of Medical Quality study indicated....

Payment Reform, Value-Based Care Top 2017 Medicaid Priorities

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Delivery system and healthcare payment reform, especially through value-based care, topped the list of 2017 Medicaid priorities, according to the annual State Medicaid Operations Survey from the National Association of Medicaid Directors (NAMD)....

CMS Unveils New Medicare APMs for Quality Payment Program

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CMS finalized several new Medicare alternative payment models that will qualify for a five percent value-based incentive payment through the Quality Payment Program. The announcement contained bundled payment initiatives for cardiac and orthopedic...

AMGA: Drop Transition, Add MSSP Track for MACRA Implementation

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With the Quality Payment Program set to launch on Jan. 1, 2017, the American Medical Group Association (AMGA) provided CMS with several MACRA implementation suggestions, including transition year elimination by 2018 and Medicare Shared Savings...

CMS Reveals Medicare-Medicaid Accountable Care Organization

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CMS recently unveiled a Medicare-Medicaid accountable care organization (ACO) model that will allow participating providers in the Medicare Shared Savings Program to take on accountability for Medicaid costs and quality of care for dual-eligible...

PQRS Medicare Payment Adjustments Waived After ICD-10 Update

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Some eligible professionals and group practices will not receive Physician Quality Reporting System (PQRS) Medicare payment adjustments in 2017 and 2018 because of the recent ICD-10 update, CMS recently announced in an email. The announcement...

2018 Advanced APM Options Added to Quality Payment Program

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Eligible clinicians now have more opportunities to earn value-based incentive payments by participating in the Advanced Alternative Payment Model track of the Quality Payment Program in 2018, according to a recent CMS announcement. Starting in...

Developing Post-Acute Networks for APM Reimbursement Success

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About 85 percent of healthcare C-suite leaders expect to expand post-acute care partnerships over the next three years, especially as their organizations aim to maximize alternative payment model reimbursement, a recent Premier report found....

How Palliative Care Can Maximize Value-Based Reimbursement

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Providers can boost value-based reimbursement success by incorporating early palliative care into routine cancer care delivery, a new study in the American Journal of Managed Care indicated. Researchers at the Center to Advance Palliative Care...

HHS Sec. Burwell Shares Vision for Value-Based Care Future

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In a recent Health Affairs blog post, HHS Secretary Sylvia Mathews Burwell called for value-based care progress after the Obama administration ends through more alternative payment models, care delivery transformation, and health data access....

GAO Finds Value-Based Care Issues for Small, Rural Practices

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A recent Government Accountability Office (GAO) report found that small and rural practices faced several challenges with implementing value-based care models, such as limited financial resources, a lack of interoperable health IT, population...

AMGA: Value-Based Reimbursement Transition Slower Than Expected

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Fee-for-service revenue decreased by more than 20 percent as value-based reimbursement payments increased, reported the American Medical Group Association (AMGA). But the transition to value-based reimbursement may be slowing down compared to...

Slavitt Offers Value-Based Care Steps Post MACRA Implementation

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As CMS gets ready for MACRA implementation in the new year, CMS Acting Administrator Andy Slavitt urged healthcare and political leaders to carry on value-based care progress made under the Affordable Care Act. In a statement at the MACRA MIPS/APM...

How Alternative Payment Models Decrease Cancer Care Costs

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As cancer care spending is expected to grow in the next four years, an oncology alternative payment model that incorporates clinical pathways and patient-centered approaches could reduce healthcare spending by 22 percent, or $9.1 million across...

Premier Medicare ACOs Outperform Peers in Cost, Quality By 2:1

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Medicare accountable care organizations (ACOs) that are part of Premier Inc.’s Population Health Management Collaborative (PHMC) outperformed other Medicare Shared Savings Program (MSSP) and Pioneer ACOs in earning shared savings and improving...

Using an Alternative Payment Model to Reduce Hospitalizations

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Are clinical interventions enough to alter provider behavior to align with value-based care? Or are providers more motivated to change because of financial incentives under alternative payment models? CMS recently partnered with the University...

How to Develop a Value-Based Care Implementation Strategy

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When building a value-based care strategy, healthcare organizations should focus on improving care delivery across skilled nursing facilities, at-home services, and end-of-life services, Steven Strongwater, MD, President and CEO of Atrius Health,...

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