The CY23 End-Stage Renal Disease (ESRD) Prospective Payment System Proposed Rule would increase Medicare reimbursement rates, among other policy changes. CMS recently proposed the Calendar Year 2023 End-Stage Renal Disease (ESRD) Prospective...
More InfoMedicare Advantage beneficiaries who received care under value-based payment models, including two-sided risk models, saw lower acute care use than beneficiaries under a fee-for-service model. Medicare Advantage beneficiaries whose primary care...
More InfoNew data from LAN shows modest progress with value-based reimbursement adoption in 2019 and 2020. But some programs, like Medicare Advantage, are moving to financial risk faster than others. Most healthcare payments made in 2020 were tied in some...
More InfoThe volume of Medicare beneficiaries has been slowing growing while the distribution of Medicare plans is quickly changing. Medicare provides federal healthcare coverage for Americans 65 or older, or anyone with end-stage renal disease...
More InfoOver half of health systems also said they plan to advance risk-based payments or some form of capitation in commercial lines of business. The executive survey conducted by the Healthcare Financial Management Association (HFMA) for the Guidehouse...
More InfoProvider-sponsored health plans can be naturally aligned with value-based care goals while also being attuned to providers’ needs. Providence Health Assurance’s Medicare Advantage provider-sponsored health plan received a five-star rating through...
More InfoOrganizations that do strong vendor relationships, invest in the organization, and are willing to take on commercial risk will be poised to take on downside risk financial contracts. Through working with population health management vendors, KLAS...
More InfoThe Government Accountability Office (GAO) analyzed performance data from providers who participated in the Merit-Based Incentive Payment System (MIPS) between 2017 and 2019 and found that some providers experienced MIPS challenges. Under MIPS...
More InfoAMGA expressed some concerns following CMS’ decision to extend its postponement policy regarding ACO financial risk advancement in the Medicare Shared Savings Program. The American Medical Group Association (AMGA) recommended several steps...
More InfoTelehealth, remote monitoring will boost patient outcomes and value-based care results Limited by the slow pace of change in traditional reimbursement models, shifts in the paradigm for patient care have also lagged far behind the possibilities...
More InfoLeveraging technology, auditing for compliance, and providing robust education are key ways providers can improve medical coding quality. While some have said medical coding sits quietly in the middle of the healthcare revenue cycle, it is a key...
More InfoClinicians who served more patients with social risk factors such as low income performed worse in the Merit-Based Incentive Payment System’s inaugural payment year, and therefore, received unfavorable value-based reimbursement, according to a...
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