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Transformation toward value-based healthcare is reshaping the delivery of care, patient expectations, and payment structures.
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The Centers for Medicare & Medicaid Services list of hospital acquired conditions for FY10.
One study suggests that success under the Medicare value-based purchasing program may correlate with higher expenditures on routine services that impact patient satisfaction.
CMS is renewing efforts by its contractors to enforce compliance with signature guidelines.
The HHS Office of Inspector General is focusing on readmissions. Hospitals that have excessive readmissions may see reduced payments under the Hospital Readmissions Reduction Program.
New flu, obesity V codes are among the ICD-9-CM changes for FY11.
The long and winding road toward accountable care has not been without bumps, but accountable care organizations constitute a bona fide, inexorable trend that should pick up steam in the years ahead.
If Congress decides to retain an RBRVS type payment system, it will need to consider whether it wants to modify the SGR in some way rather than remove it entirely.
One organization’s long experience as an accountable care organization shows that accountable care can be successful, not only in improving population health, but also financially.
Brent James, MD, chief quality officer at Intermountain Healthcare, says using data-driven performance improvement grounded in shared values is “just good management.”
The Medicare value-based purchasing (VBP) program is an initiative described in the Affordable Care Act whose purpose is to provide a practical means to reduce costs to the nation’s healthcare system while improving quality of care. Hospitals that achieve the highest total performance scores (TPSs) under this program’s scoring methodology can earn incentive payments for performance excellence.
The Issue The Medicare value based purchasing program is an initiative described in the Affordable Care Act whose purpose is to provide a practical means to reduce costs to the nation’s healthcare system while improving quality of care.
Recent pressures from the Medicare RACs and various third-party payers have increased the sense of urgency that hospital leaders feel about getting observation programs established.
The Medicare Shared Savings Program has created the impetus for accountable care organizations. But financial leaders should heed two important lessons from past integration efforts-and six influential forces-before pursuing an accountable care organization.
CMS has an active to-do list under the Affordable Care Act (ACA) for implementing its “Pay for Quality” strategy.
Princeton Healthcare shares the benefits it received from instituting accurate and thorough clinical documentation.
Four strategies can help payers and providers give their customers more value for the dollar as health reforms emerge over the next few years.
States--not CMS--have regulations in place related to timely patient notification of the availability of financial assistance/charity, as well as a statement that includes a summary of charges.
The Conditions of Participation for Critical Access Hospitals have specific requirements that bear careful, periodic review to ensure ongoing compliance.
Providers may be affected by the retroactive increases in payment rates for claims affected by the Affordable Care Act and 2010 Medicare Physician Fee Schedule changes.
Medicare-Medicaid enrollees account for a disproportionately large share of expenditures in both programs, totaling approximately $120 billion in federal and state spending.
A well-written RAC appeal letter can help you win your case and ease the administrative burden of audits.
The average cost per discharge was $9,100 for all payers in 2008. Medicare discharges had the highest average cost per hospital stay ($11,300).
Hospital revenue cycle leaders should prepare for the expansion of the RAC program to include review of Medicaid claims.
All those wanting to be part of the Medicare payment by episode demonstration (aka bundled payment), come on down! And bring your data and signatures.
Glenn Hackbarth, chairman of the Medicare Payment Advisory Commission, shares his thoughts about the cost-effectiveness of preventive care initiatives and other issues related to Medicare.
Tom Myers, chief strategy officer, The SSI Group, discusses the shifting payment environment and how it affects providers' patient access and claims management processes.
Jeff Chester, senior vice president and chief revenue officer at Availity, shares his thoughts on "Revenue Cycle 2.0" and how to best meet its challenges.
Mitch Morris, vice chair and global leader, healthcare, Deloitte, and Michael O'Rourke, senior vice president and chief information officer, Catholic Health Initiatives (CHI), share perspectives on the need for transformational IT in health care today.
Brian Kueppers, founder and CEO, Apex, discusses the importance of a robust patient payment strategy in boosting organization revenue and enhancing patient satisfaction.
Brian Grazzini, CFO, HealthPort, describes the importance of efficient and compliant information exchange and audit management in helping HIM staff spend less time on paperwork and more on mission-critical projects.
Cindy Matthews, executive vice president, Community Hospital Corporation, discusses how rural and community hospitals can use collaborative partnering to position for success through tough market conditions.
Rick Heise, senior vice president, revenue cycle, at Cerner Corporation, discusses the importance of integrating clinical and financial data to excel in health care’s changing payment environment.
Russ Graney, founder and CEO for Aidin, and John Laursen, head of business development for Aidin, share insights on how to improve care transitions between acute and post-acute care settings and incentivize high-quality patient outcomes.
Scott Elston, strategic accounts manager, GE Healthcare Services, describes how substantial cost reduction in health care requires rethinking business strategy and asset use.
Robert Williams, MD, director, Deloitte Consulting LLP, and Arielle Freiberger, product strategist, ConvergeHEALTH by Deloitte, explain how sophisticated retrospective, real-time, and predictive data analytics can inform decision making to reduce costs and improve care.
Stuart Hanson, director of business development (healthcare solutions) at Citi Retail Services, discusses how improving the payment experience can benefit consumers and healthcare providers.
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