Tag: value-based care

Real-World Perspective on Value-Based Care: Q&A With Dawn Edwards

By: Enrique Bakemeyer
Date: March 24, 2020
Category: Cost & Quality
Filed under: clinical integration, clinically integrated network, population health, value-based care

Dawn Edwards is the Consultant of Clinical Care and Quality for Healthcare Business Insights, Part of Clarivate. Dawn has expertise in population health management, value-based contracting, clinical integration, and payer-provider networks. In the following Q&A, Edwards shares some key insights about value-based care and clinical integration by addressing common questions from HBI members.  What advice […]

How the Revenue Cycle Will Need to Adapt to Value-Based Reimbursement

By: Courtney Zott
Date: March 13, 2019
Category: Revenue Cycle
Filed under: ACOs, value-based care, value-based reimbursement

Value-based payment models are undoubtedly the future of health care. The number of commercial and governmental ACO contracts alone increased by an average of 63% annually from Q1 2011 to Q1 2018, according to a Muhlestein et al. analysis of Leavitt Partners’ data. Though commercial payers have been slower to adopt other models that are […]

Reimbursement & Regulations: ADR Guidelines, Stark Law and OIG Updates

By: Andrew Minten JD
Date: July 6, 2018
Category: Custom Services
Filed under: Additional Documentation Requests, ADR, CERT, Comprehensive Error Rate Testing, documentation request, Error Code 99, ESRD Medicare Part B, MAC, Medicare Administrative Contractor, Medicare Dialysis, Medicare Part B Dialysis, OIG Work Plan, Reimbursement & Regulations, Stark Law, value-based care

The CMS is requesting more information! This time, it is looking to reduce “undue regulatory impact and burden” created by the Stark Law. The Stark Law was created to reduce physician self-referrals and other financial conflicts of interest, but organizations have been arguing for years that the Stark Law has made it difficult to comply […]

Reimbursement and Regulations: Value-Based Reimbursement, Price Transparency, and OIG Updates

By: Andrew Minten JD
Date: June 1, 2018
Category: Custom Services
Filed under: 2019 IPPS, chargemaster, CMS, Humana, IPPS, noninvasive home ventilators, OIG, OIG Work Plan, outpatient cardiac and pulmonary rehabilitation services, Price Transparency, reimbursement, Reimbursement & Regulations, respiratory assist devices, value-based care, value-based reimbursement

Though the transition from fee-for-service to value-based care is dreadfully slow (which makes sense with how many factors there are to juggle), commercial payers have been stepping up to the plate. Aetna and United Healthcare have stated that more than 45% of their total annual medical spend is in value-based contracts. As a recent highlight, […]

Trends in Physician Revenue Cycle Integration

By: Jerica Hopkins
Date: February 20, 2018
Category: Revenue Cycle
Filed under: centralizing revenue cycle, physician compensation, physician revenue cycle, revenue cycle integration, value-based care

As the healthcare industry consolidates, hospitals and health systems have been increasingly acquiring physician practices and medical groups. While these acquisitions are anticipated to increase referrals and better position organizations to improve clinical quality, they are placing a strain on revenue cycle operations in the short term. With this in mind, HBI gathered physician revenue […]