Reimbursement

CMS is adding, dropping, and expanding payment rules

CMS announced changes to how Medicare pays for primary care. Here’s 5 things to consider.

In today’s increasingly consumer-driven environment, personalization is not only expected, but a demanded part of the user experience.

CMS’ Quality Payment Program (QPP) introduced in the Medicare Access and CHIP Reauthorization Act (MACRA) has created a seismic effect across provider organizations.

CMS just released the first Comprehensive Care for Joint Replacement (CJR) data feed. Find out what the preliminary results show.

HHS has announced steps aimed at limiting short-term health plans and strengthening the marketplaces. Here's how you will be affected.

The goal of CMS’ proposal is to reduce costs while rewarding better outcomes for patients. Here are five things healthcare executives need to know.

The transition to value-based payment has accelerated rapidly over the past two years, and payers and providers predict even more dramatic changes.

CMS’ Comprehensive Care for Joint Replacement model will hold hospitals financially responsible for the quality and cost of hip and knee replacements.

Researchers from Leavitt Partners are using a combination of public and proprietary data to report on some early findings about ACOs.

Doug Chaet, senior vice president, Provider Networks and Value-Based Solutions at Independence Blue Cross, shares five strategies that can help providers succeed in value-based reimbursement models.

Hospitalizations represent up to 80 percent of the direct medical costs of heart failure; reducing heart failure hospitalizations can help bring down overall healthcare costs.

Kaveh Safavi, senior managing director for consulting firm Accenture’s global healthcare business, shares how payer mergers will affect provider payments.

In the move to value-based care, there have been surprises and disruptions for payers and providers alike. In this Q&A, an expert shares where we are now.

A diverse group of healthcare stakeholders recently met for CBI's Alternative Payment Models in Healthcare Conference 2016 in Orlando, Florida. Here are five key takeaways from the conference chairman.

Ensuring the appropriate internal investment, addressing key friction points, and taking several steps to increase the likelihood of long-term success is key.

Considering entering into a risk-sharing agreement with another payer or provider? Avoid these top mistakes.

What reimbursement changes can healthcare executives expect in 2016? Three experts weigh in.

Optimism exists for biosimilars in the United States, but questions regarding FDA approval and reimbursement remain.

CMS recently released a proposed draft of its Medicare Reporting Requirements document for 2016 and, for the first time, the guidance includes reporting requirements for Medicare rewards and incentive programs. The new reporting requirement is slated to begin January 1. Are you ready?

Coverage decisions about new technologies, including access and cost considerations, are a major challenge for public and private payers.

We asked healthcare experts and analysts how the move to value-based care will affect prior authorizations. Here's what they said.

Consensus is building on the promise of genetic testing and other technological advances to help individualize testing, prevention and treatment for better outcomes.

Current methods used to measure hospital quality are fraught with problems that have large consequences for how hospitals are reimbursed by Medicare, according to a new study published in the March edition of The American Journal of Accountable Care.

As the Medicare program and the healthcare industry at large begins the transition from fee-for-service to value-based reimbursement models, health plans are responding by ramping up collaboration with providers to improve health outcomes, especially for medically-complex Medicare members.

A new, “next generation” accountable care organization model that encourages greater coordination between providers and beneficiaries has been launched by the U.S. Department of Health and Human Services.

In what is being called a first-of-its-kind joint effort, the Texas Medical Association and Blue Cross and Blue Shield of Texas are launching a resource initiative to assist independent physicians with providing accountable care.

More than 11 million UnitedHealthcare members are enrolled in accountable care organizations (ACOs), and the nation's top insurer plans to contract with 250 more ACOs in 2015.

In a shift from fee-for-service to value-based care, UnitedHealthcare has launched a pilot bundled payment model with the University of Texas MD Anderson Cancer Center for head and neck cancers.

Providers, owners and suppliers who owe Medicare money, have been convicted of felonies or have a history of billing abuse will be excluded from enrollment under new rules adopted by the Centers for Medicare and Medicaid Services (CMS).