Revenue at Risk

Capture Revenue and Reduce Program Risks

Since the Affordable Care Act (ACA) was signed into law in 2010, the Centers for Medicare & Medicaid Services (CMS) has initiated several “pay-for-value” quality programs, holding providers accountable for the value and quality of care they provide. The programs also have established an environment in which providers need to exhibit good quality performance or risk takebacks of their Medicare revenue and the possibility of costly penalties.

For organizations to succeed within a challenging financial landscape in which an increasing amount of their Medicare revenue is put at risk, they need to have a thorough understanding of these often-complicated regulations and a set of strategies and approaches for successfully navigating them. Crowe Horwath LLP assists by performing assessments and analyses – applying advanced data analytics combined with expertise gained from consultations with hundreds of hospitals across the U.S.

Our services assist healthcare organizations with developing a quality culture, retaining at risk revenue, earning incentives and decreasing risks. We can also improve the efficacy of the following programs:

Hospital Clinical Management Programs

  • Hospital Value-Based Purchasing
  • Hospital-Acquired Conditions (HAC)
  • Hospital Readmissions Reduction Program (HRRP)

Hospital Clinical Management Models

  • Comprehensive Care Joint Replacement Model
  • Bundled Payments for Care Initiative Advanced (BPCI Advanced) - A new program put forth by the Trump administration in early January. This program is in addition to the existing BPCI.

Physician Quality-Based Programs

  • Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)
    • Alternative Payment Models
    • Advanced Payment Model (APM)
    • The Merit-Based Incentive Payment System (MIPS)
    • Medicare Shared Savings Track 2 & 3
    • Next Generation ACO model
    • Comprehensive Primary Care Plus (CPC+)
Contact Us
Warren Beck
ruiz-ken-150
Ken Ruiz
Principal