To provider organizations, the Change Healthcare hack in February was a painful reminder of a lesson learned during the first year of the COVID-19 pandemic: A disruption in revenue flow can lead to financial disaster or even closure. Many smaller hospitals and medical offices have struggled to get paid since the ransomware attack shut down…
The answer is ‘yes’ from a paper by Lin et al. (2024). Using 2009-2013 data from the Massachusetts All-Payer Claims Database, the authors measured physician–hospital integration within an accountable care organization (ACO) based on the proportion of primary care physicians (PCPs) in an ACO who billed for outpatient services with a place-of-service code indicating that…
At first glance, CMS’s recently released 2022 QPP Experience Report (PDF) seems reassuring, because the majority of clinicians avoided financial penalties under MIPS. Don’t be fooled! While overall success and failure rates in the report may lead you to conclude that merely participating in the QPP (either in MIPS or as an APM) is enough…
The BCDA (Beneficiary Claims Data API) is a powerful tool made available by CMS (Centers for Medicare and Medicaid Services), allowing providers access to timely insights from Medicare claims data. This helps providers facilitate proactive interventions aimed at preventing potential health problems and optimizing healthcare delivery. As a provider, leveraging BCDA insights is the key…
Operational and financial challenges can make it difficult for nursing homes and other health care facilities to transition to the federal government’s Value-Based Program (VBP), which ties payment to quality and outcomes. An editorial published in JAMA Internal Medicine Monday expresses the need for more data and improved measurement of outcomes, better methods of financial…
Medical billing is a field that is constantly evolving, with new updates and developments. One such development is value-based care, which is currently transforming the medical billing industry. Value-based care is a provider payment model that prioritizes high-quality healthcare over the quantity of services. The goal of this payment model is to provide better care…
Since the introduction of the Triple Aim by the Institute for Healthcare Improvement (IHI) more than15 years ago, efforts to improve the US health care system have been guided by the goals of enhancing patients’ experience of care, improving population health, and reducing per capita health care spending. In 2022, it was proposed that the…
The press release published jointly by the offices of the two senators began thus: “As part of their ongoing work to address primary care challenges and reform physician payment models, U.S. Senators Sheldon Whitehouse (D-RI) and Bill Cassidy, M.D. (R-LA) released a Request for Information (RFI) to accompany the introduction of the senators’ bipartisan Pay…
U.S. Sens. Sheldon Whitehouse and Bill Cassidy, M.D., want to reform how primary care providers get paid through Medicare, and they also want to hear from the healthcare industry about the best way to do it. Whitehouse, a Democrat from Rhode Island, and Cassidy, a physician and Republican from Louisiana, introduced a bipartisan bill, the…
The Centers for Medicare & Medicaid Services’ (CMS) in April released a bundled payment model that is the culmination of the best aspects from such past models, all to align with the agency’s efforts to get all Medicare Fee-for-Service beneficiaries involved in value-based care by 2030. The Transforming Episode Accountability Model, or TEAM, is considered…