Provider

Key MACRA timeframes

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• The changing landscape of out-of-network reimbursement

  By David C. Lewis | 19 September 2018

  To avoid unfavorable outcomes, it is important to evaluate the methodology used for setting out-of-network reimbursement levels and to identify savings opportunities.

• Fiscal year 2019 HRRP impact to hospitals

  By James Lucas | 11 September 2018

  This paper describes the changes that are coming with the Hospital Readmission Reduction Program and explores what the likely effects will be.

• Critical Point podcast, Episode 2: Alternative Payment Models 101

  24 July 2018

  A discussion about alternative payment methods, bundled payment, ACOs, and more.

• Is your provider organization maximizing its performance in value-based care programs?

  By Rod Martin, Laurie Lingefelt | 06 March 2018

  As the use of value-based reimbursement programs and the associated financial impact increases, it is important for providers to be educated on the mechanics of the program and to understand the analytical, operational, and clinical requirements to ensure success.

• Insurance risk and its impact on provider shared risk payment models

  By Juliet M. Spector, Cory Gusland, Carol Kim | 12 January 2018

  A challenge facing providers and payers is to design shared risk payment models that incentivize providers to deliver efficient, high-quality care without assuming too much insurance risk from payers.

• ACA risk adjustment management: Going all-out

  By Brandy N. Millen, Jason Petroske | 22 December 2017

  This paper introduces the broader concept of risk management adjustment and highlights actions you can take to maintain its long-term success.

• Risk adjustment in CMS episode-based payment models: A resource guide

  By Samuel Bennett, Thomas D. Snook | 20 December 2017

  This paper provides a high-level guide on risk adjustment within the broader scope of four Centers for Medicare and Medicaid Services episode-based payment models.

• Impacts of hurricanes on health outcomes and health insurance company operations

  By Lynn F. Dong, Scott O. Jones, Michael J. Polakowski | 23 October 2017

  From an operational and financial perspective, natural disasters can have significant effects on healthcare providers, insurers, and payers.

• Provider coding accuracy in commercial value-based contracts

  By Jared Hirsch, Howard Kahn, Rong Yi | 02 October 2017

  This paper explores various aspects of risk sharing as it pertains to value-based contracting for commercial lines of business.

• Regulatory capital strategies in an evolving health insurance landscape

  By David M. Liner | 30 August 2017

  As the relationship between health plans and healthcare providers continues to evolve, this landscape creates new financial opportunities for health plans managing regulatory capital.

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