4 Key Ways the OPPS Final Rule Affects the Revenue Cycle
Clinic visits in hospital settings and 340B payments are among the changes to be aware of in 2019.
Engaging Physicians in Value-Based Compensation Models
The University of Maryland St. Joseph Medical Center model layers a 50/50 share of any incentive payments on top of a work RVU-based component to account for revenue that is still generated by the number of patients that providers see.
CJR Program Achieves Savings over 2 Years
Jan. 14—Medicare’s first mandatory bundled payment program succeeded in obtaining some savings in its first two years, according to new research.
Value-Based Payment Can Reduce Need for Preauthorizations
BlueCross BlueShield of Western New York has removed prior authorization requirements for more than 500 therapies, services, and procedures in conjunction with its move to value-based payments for primary care providers.
Strategies for Crafting Stop-Loss Contracts
Chris Williams explains how to craft stop-loss contracts for employee health plans.
Medical Bundles Get Another Look
Jan. 8—Despite concerns that savings and quality improvements are elusive in bundled payment episodes for chronic medical conditions, one of the largest health systems aims to expand its use of such payment models.
Q&A: ACO Executive Expects Impacts from New Rules
Jan. 7—HFMA recently talked with the leader of one of the largest accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) about impacts she and other ACO leaders expect from the recently issued 2019 final rules for the program. Early industry reaction to the changes was mixed.
Medicare Shared Savings Program 2019 Final Rule Summary
This document provides a comprehensive summary of December 2018 Medicare Shared Savings Program final rule, published by CMS.
Jan. 7-11: Providers Mull ACO Regulatory Changes Ahead of Deadlines
Jan. 3—An overhaul of Medicare’s main accountable care organization (ACO) program was finalized in mid-December, and many providers looking to join or continue participating will be required to begin the process this month.
Using Ambulatory Pricing Strategically to Protect and Grow Market Share
An increasing regulatory focus on price transparency also is an impetus for hospitals and health systems to pursue ambulatory care pricing strategies aimed at growing market share.