Tag: Alternative Payment Models

Medicaid payment model

CMS Unveils Medicaid Payment Model for Improved Behavioral Health

CMS’s Medicaid Payment Model show can be seen as a healthcare bridge, giving fundamental behavioral wellbeing administrations to both Medicaid and Medicare beneficiaries over a period of eight years. As portion of a unused Medicaid Payment Model demonstrate reported by CMS, physical, behavioral, and community suppliers will be required to arrange care in arrange to […]
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CPT® codes play a pivotal role in the transition to value-based care

In order for value-based healthcare to succeed, it is imperative that physician practices effectively articulate the medical services and procedures they provide. This underscores the vital role of the Current Procedural Terminology (CPT®) code set in driving the shift towards value-based care. According to the chair of the AMA/Specialty Society Relative Value Scale Update Committee (RUC), […]
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Value-Based Payment Models Can Limit Healthcare Spending

Value-based payment models, including accountable care organizations, bundled payment models, and capitation models, can generate savings for providers and limit healthcare spending. As healthcare spending escalates in the US, stakeholders have started looking at value-based payment models to address rising costs, but many payments are still tied to fee-for-service models, according to a Health Affairs […]
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Value-Based Care Catching up to Fee-For-Service

Outcomes-based models are spreading, but fee-for-service still dominates payment landscape. Is value-based care having a moment? Health care policy experts and institutions have long agreed that fee-for-service (FFS) medicine is wasteful, outmoded and at least partially responsible for the U.S. spending far more than peer nations on health care, but with outcomes that are no […]
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Value-Based Payment Models Associated with Lower Acute Care Use

Medicare Advantage beneficiaries who received care under value-based payment models, including two-sided risk models, saw lower acute care use than beneficiaries under a fee-for-service model. Medicare Advantage beneficiaries whose primary care organization participated in a value-based payment model saw lower rates of hospitalizations, observation stays, and emergency department visits, according to a study published in […]
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CMS Updates End-Stage Renal Disease APM, PPS to Address Health Equity

. The End-Stage Renal Disease (ESRD) Treatment Choices Model is the first to undergo changes to directly address health equity—a new goal for CMS-run alternative payment models. The ESRD Treatment Choices (ETC) Model is a mandatory alternative payment model (APM) that encourages greater utilization of home dialysis and kidney transplants for Medicare beneficiaries with the […]
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Rethink ACO Financial Risk Advancement in MSSP

AMGA expressed some concerns following CMS’ decision to extend its postponement policy regarding ACO financial risk advancement in the Medicare Shared Savings Program. The American Medical Group Association (AMGA) recommended several steps regarding accountable care organization (ACO) financial risk advancement in the Medicare Shared Savings Program (MSSP) in a letter to CMS. CMS’ decision to […]
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Top 3 Concerns with the 2021 Medicare Physician Fee Schedule Rule

Comments on the 2021 Medicare Physician Fee Schedule proposed rule centered on potential payment cuts, telehealth reimbursement, and quality reporting changes. Provider groups are concerned that some proposals in the Medicare Physician Fee Schedule rule for 2021 would exacerbate the financial challenges physicians are already facing during the COVID-19 pandemic, including lack of adequate telehealth […]
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