Alternative payment model financial settlements: Preparing for and learning from the process

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By Christine Ferro, Maggie Alston, Pamela M. Pelizzari | 17 September 2018
Alternative payment models (APMs) are often difficult to implement given their operational dependence on payment systems designed for fee-for-service reimbursement. Reconciliation of financial settlements presents challenges requiring parties to be both intimately familiar with both the APM payment specifications and the data on which the calculations are based. While complicated, this process can provide a valuable learning opportunity to improve the management of key targets moving forward. This paper focuses on APM reimbursement methodologies through the lens of the Centers for Medicare and Medicaid Services Oncology Care Model as an illustrative case study.