Top Banner


Accountable Care Organizations Series

Part VI of VI 

"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. 


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...) 


CMS Auditing Series

Part II of IV 

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.



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...) 


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...) 


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.