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Frontline nurses may face additional pressure to document and justify skilled care that is reimbursable under Medicare, once changes to the Patient-Driven Payment Model (PDPM) for Skilled Nursing Facilities (SNFs) are fully in place. Changes to PDPM will take effect later this year, on October 1. The purpose of the change is to reduce mistakes […]

By Jason McCormick Vice President, Partner Services at Fusion5 As we continue our series on the critical elements of a successful bundled payment program, we begin to focus on the normal day-in and day-out processes that can prevent any case from becoming a “bundle-buster.” The first few elements of a successful bundled payment program helped […]

CMS Administrator Seema Verma gave her first update on major changes to the Stark Law, which is currently being overhauled to reflect the shift from fee-for-service to value-based care. “Some changes include clarifying regulatory definition of volume or value, commercial reasonableness and fair-market value,” Verma said. Revised regulations will likely be released before the end […]

By Jason McCormick Vice President, Partner Services at Fusion5 The OrthoForum 2019 Annual Conference was held in San Antonio this past week. Orthopaedic surgeons and practice executives from across America came together to discuss issues facing orthopaedic practices and, overwhelmingly, one theme was consistently heard – bundled payments are on everyone’s mind. Conversations regarding BPCI-Advanced […]

By Matthew DeHart, MPH Research, Statistics & Design Engineer Fusion5 Executive Summary Through analysis of Medicare claims data derived from the Centers for Medicare and Medicaid Services (CMS) Limited Data Set (LDS) Standard Analytical Files from 2012-2016 in concert with iterative analysis of Fusion5 risk assessment data we are able to conclude with high confidence […]

By Jason McCormick Vice President, Partner Services at Fusion5 At the core of any bundled payment program is the ability to control costs generated by the services that patients receive during the bundle episode period. The provider, or the “episode initiator”, is in control of many of the costs associated with the patient’s surgical intervention, but not necessarily […]

By Jason McCormick Vice President, Partner Services at Fusion5 The truth is that, until a few years ago, medical practices were not usually considered the ideal environment for statisticians or anyone who knew what pivot or V-Lookup tables were used for. You were usually hard-pressed to find anyone outside of the accounting department that had […]

by Jason McCormick Vice President, Partner Services at Fusion5 One of the first lessons I learned regarding bundled payments was that everyone had a different definition of the term. To some, bundled payments refer to the proactive payment for a set of services that are provided to a patient, while others may be more in […]

Managed Care Contracts – The Basics Providers of health care services establish relationships with managed care organizations (MCOs) to participate in provider networks, health maintenance organizations, integrated delivery systems, value-based care programs and other health plan initiatives via contract. The contract defines and governs the relationship between the parties and sets forth rights and responsibilities. […]

This article was originally published in Inc. This is not the type of startup story you typically read about in Inc. This is not a group of computer science majors living three-to-a-mattress and surviving on Ramen until their app suddenly becomes worth billions of dollars. This is not another subscription box service. This is a […]