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Accountable
Care Organizations Series
Part VI of VI
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"I KEEP six honest
serving-men
(They taught me all I
knew);
Their names are What and
Why and When
And How and Where and
Who."1
Under
the Patient Protection and Accountable Care Act, Accountable Care
Organizations (ACOs) were touted as the new redeemer of the
American healthcare industry, promising to lower costs and increase
quality for patients and providers. Within the context of these
challenging expectations, significant questions have arisen among
key industry stakeholders. This final installment of the ACO Series
will explore questions surrounding "How" are ACOs
compliant.
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 Accountable Care Organizations
Series: How Are ACOs Compliant?
Accountable care organizations push the regulatory boundaries as
physicians work to coordinate care across specialties and practices;
changing focus to quality not quantity of care. In the sixth and
final part of the Accountable Care Organizations Series, this article
considers regulatory compliance to address the question: How Are ACOs Compliant? (Read more...)
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CMS
Auditing Series
Part II of IV
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One
of healthcare reform's primary objectives is to reduce the
continued rise in healthcare spending. Enforcement against Medicare
and Medicaid fraud and abuse and other improper payments for
services under the Centers for Medicare and Medicaid Services has
gained traction with the passage of the ACA. This second
installment of the CMS Auditing
Series will examine the
emergence of the Medicaid RAC and subsequent industry response.
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CMS Auditing Series: Establishing Medicaid
RACs
While
the initial Medicare Recovery Audit Contractor (RAC) demonstration
project recovered a staggering $1.03 billion in improper
Medicare payments, providers feel they are unequipped and
ill-prepared to handle the implementation of Medicaid RACs. In part
two of the CMS Audit Series, this article examines CMS's final rule
on Medicaid RAC audits and the industry's response. (Read more...)
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The Sustainable Growth Rate Saga Continues
The
SGR, designed to control growth in Medicare expenditures by linking
physician payment rates to overall spending targets, has called
for cuts in reimbursement each year since 2002. On October 6, 2011,
MedPAC officially endorsed a controversial permanent repeal to the
SGR, funded by $300 billion in cuts to provider reimbursement and
increases in beneficiary costs. (Read more...)
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In the Electronic Age, Is PHR Adoption
Lagging Behind?
In
2010, the market for Personal Health Record (PHR) software generated
revenues of approximately $312.2 million and market researcher, which
comes as a surprise in light of the slow rate at which providers and
consumers have embraced PHRs. (Read more...)
1 "The
Elephant's Child" By Rudyard Kipling, Just So Stories, New York, NY:
Garden City, 1912.
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