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If the 5 percent bonus payment in the Advanced Alternative Payment Model (APMs) track was available in 2015, accountable care organizations (ACOs) would’ve earned additional net payments of $886 million if they had assumed downside risk under the Medicare Shared Savings Program (MSSP).

Most doctors saw a similar increase in compensation last year as they had in 2015, with an average raise of 2.9 percent across all specialties reported in the American Medical Group Association’s (AMGA) annual medical group compensation and productivity survey. Productivity, however, remained flat, and the move to value-based incentives in compensation continues to be slower than anticipated.

CMS has released its proposed rules for the 2018 Physician Fee Schedule (PFS), Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System, with the biggest change being halving the Medicare reimbursement for off-campus services.

President Donald Trump had proposed a 16 percent cut across HHS in his budget blueprint for fiscal year 2018, but the Republican majority on the House Appropriations Committee added $14.5 billion over his request in its own budget proposal released on July 12.

Jason Considine, senior vice president of patient collections and engagement at Experian Health, argued at the Healthcare Financial Management Association (HFMA) conference in Orlando that providers should first rely on leveraging data and crafting flexible payment options before paying any contingency fees to collectors. He spoke with HealthExec about mistakes providers are making with their collection practices and what data they need to improve the process.

 

Recent Headlines

$54 billion Anthem-Cigna merger blocked by federal judge

The $54 billion acquisition of Cigna by Anthem has met the same fate as the $37 billion merger of Aetna and Humana: blocked by a federal judge on antitrust grounds. 

Lowered reimbursements are C-suite’s top fear with ACA repeal

In a survey of healthcare executives, many said they want several provisions of the Affordable Care Act (ACA) to stay in place if the law is repealed, while expressing concerns over how its elimination could affect their reimbursements from Medicare and Medicaid.

TeamHealth to pay $60 million to settle overbilling allegations

Physician staffing company TeamHealth has agreed to pay a $60 million penalty to settle allegations that one of its subsidiaries told hospitalists to “up-code” and overbill Medicare, Medicaid and other federal programs.

Healthcare consolidation isn’t driven by ACO participation

While the consolidation trend across healthcare accelerated after the Affordable Care Act (ACA) was passed, there's little evidence connecting consolidation to providers wanting to succeed under accountable care organization (ACO) programs created after the ACA, according to a study published in the February issue of Health Affairs.

Coding intensity could lead to $200 billion spending jump in Medicare Advantage

CMS will likely overpay Medicare Advantage plans by hundreds of billions of dollars over the next 10 years if the agency doesn’t account for coding intensity in its risk scores.

Group purchasing cuts costs, optimizes supply chain

A report from the Healthcare Supply Chain Association (HSCA) said the group purchasing organizations (GPOs) it represents help cut supply chain costs by an average of 15 percent and reduce drug spending by 25 percent.

3 ways to proactively identify underpayments before CMS audits

A Recovery Audit Contractor (RAC) review from CMS isn’t cause for celebration for most healthcare organizations, but it can be beneficial if those facilities take proactive steps to identify underpayments.

CMS proposes 0.25% increase in Medicare Advantage payments for 2018

CMS is offering a more modest 0.25 percent increase in payment rates for Medicare Advantage (MA) insurers, one year after a 0.85 percent hike, in its proposed MA update for 2018. 

Former Tenet exec indicted in $400 million Medicaid fraud case

John Holland, a former senior vice president for Tenet Healthcare’s southern region, has been charged with allegedly taking part in a scheme to pay bribes in exchange for patient referrals and resulting in $400 million in fraudulent Medicaid billings. 

Aetna CEO: ‘No intention’ of being in ACA market for 2018

Aetna CEO Mark Bertolini said the uncertainty surrounding the Affordable Care Act (ACA) and its insurance marketplace is too big of a risk for his company, saying it has “no intention of being in the market for 2018.”

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