Government Rules and Regulations Archives

How Can Payers Motivate Providers to Adapt a Value-Based Care Model?

2 Comments / Government / By Kelsey Oliveira

In 2017, the Healthcare Financial Management Association (HFMA) presented a success story for implementing a value-based compensation model for primary care. It revealed that “The medical group of one large health system realized significant improvements in the quality of care delivered to patients from implementing a quality-based bonus program for its providers.” The medical group …

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Is It Time to Lift the Ban on Patient Identifiers?

3 Comments / Government / By Kelsey Oliveira

In theory, a nationwide patient health identifier number makes sense. Just like a Social Security number is used for government and financial purposes, a health identifier number is used for patient’s health information. The thought is that these numbers can help achieve interoperability goals, while reducing patient identification mistakes. The COVID-19 pandemic highlighted the need for a cohesive identification system, as …

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What Is Fee For Service In Healthcare?

Government, MACRA & MIPS Articles / By Andrew Fearnley

Fee for service (FFS) is the most traditional payment model of healthcare. In this model, the healthcare providers and physicians are reimbursed based on the number of services they provide or their procedures. Payments in an FFS model are not bundled. This means that the insurance companies or the government agencies are billed for every …

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What Is Capitation Fee In Healthcare

Government, MACRA & MIPS Articles / By Andrew Fearnley

US healthcare is researching ways to tackle the challenges of lowering costs and improving the quality and the outcome. The traditional, age-old Fee for Service model is under scrutiny for being expensive and for focussing on rewarding medical providers for volume and quantity of services rather than the results. Within the current fee-for-service system there are incentives …

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Capitation vs. Fee-for-Service Healthcare Payment Models

Government, MACRA & MIPS Articles / By Andrew Fearnley

Capitation vs. Fee-for-Service Healthcare Payment Models Key Points Comparing Fee-for-service vs. Capitation The Fee-For-Service (FFS) payment model has increasingly been seen as costly and cumbersome overall to providers. Medicare programs highlighted the need to transition to a quality-based payment model, which is Capitation. Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) legislation improves Medicare …

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