Category: ACO

This post is part 2 of the Accountable Care series and contains information about how health is managed in ACOs. Recall that these organizations are paid based on the quality of care provided to their patient population. This video describes the unique characteristics of how health is managed in an ACO for Medicare beneficiaries. Click…

The following is a guest post by Barry Haitoff, CEO of Medical Management Corporation of America. It’s not a stretch to say that the healthcare payment system has hit some tumultuous waters. Medical billing hasn’t been easy for a long time, but with things like the Affordable Care Act, Value Based Reimbursement, and the shifting…

Four Florida insurance companies offering Affordable Care Act policies are discriminating against people with HIV or AIDS, according to two health-rights organizations that plan to file a formal complaint with the federal government Thursday. …read more    

Today’s early morning highlights from the major news organizations, including articles on an inspector general’s report on care at VA hospitals and growing pressure from some House Republicans to vote on an alternative to the Affordable Care Act. …read more    

Meanwhile, Democrats are also trying to cope with the issue of health care this election season. Senate Republican leader Mitch McConnell wants to repeal the Affordable Care Act, but he would not say Friday what that would mean for the 413,000 Kentuckians who have health insurance through the state’s health care exchange. …read more    

Top News An MGMA survey of large (median of 10 FTE physicians), mostly independent physician practices finds that 62 percent are struggling to identify patients whose insurance came from an Affordable Care Act exchange and to verify their eligibility or obtain plan details. Most practices also say that patients who got their insurance via an…

How successful has the Affordable Care Act been in leveraging health information technology and payment reform? During a presentation in April at the New York State HIMSS Chapter conference, Frank Winter, partnership manager for the regional office of the Centers for Medicare and Medicaid Services (CMS) in New York, said that healthcare IT is at…

Link: ACOs The Centers for Medicare & Medicaid Services (CMS) established a Medicare Shared Savings Program (Shared Savings Program) to engage providers, hospitals, and suppliers in an Accountable Care Organization (ACO) that improves the quality of care provided to a select population of Medicare beneficiaries. As of 4/2014 there are approximately 366 ACOs across the…

Narrow Networks: Blessing, Curse, Should You Care? By Shawn Wagoner Narrow networks = blessing. In its recommendations to improve the government’s ACO programs, the American Hospital Association is urging CMS to “create some financial incentive on the part of the beneficiary to choose to stay ‘in network’ so that their care can be coordinated.” Narrow…

Bruce Bethancourt, MD is chief medical officer of St. Vincent Medical Group of Indianapolis, IN. What are the biggest challenges for the medical group? The biggest challenge is that with the Affordable Care Act, not so much now but in the near future, so many more people that will have access to care. We really…