Fee-for-Service Payment Models
Expert articles and analysis related to fee-for-service payment models.
AI Summary — Last 30 Days
Over the past month, significant developments have emerged in the transition from fee-for-service (FFS) to value-based care models, particularly in light of the ongoing challenges posed by policies like the Stark law, which some physician leaders argue is becoming a liability in promoting innovation amidst this shift. CMS continues to refine its approach to managing FFS claims, leveraging predictive analytics through its Fraud Prevention System to curb improper billing practices as emphasized in recent reports on Medicare's improper payment rates for 2025. The implications of these changes are critical for ACOs and healthcare stakeholders as they navigate the complexities of care delivery transformation and strive to optimize cost-effectiveness while ensuring quality care, as highlighted in discussions about the 2026 Physician Fee Schedule.
Related Articles
The economic shift from fee-for-service to direct primary care
According to the Primary Care Collaborative, primary care accounts for roughly 5 percent of health care spending, yet it influences nearly 90 percent of downstream costs. That statistic is not a compl...
Colorado Made at Least $77.8 Million in Improper Fee-for-Service Medicaid Payments for Applied Behavior Analysis Provided to Children - Office of Inspector General (.gov)
Colorado Made at Least $77.8 Million in Improper Fee-for-Service Medicaid Payments for Applied Behavior Analysis Provided to Children  Office of Inspector General (.gov)
The Algorithm Coded Claim: Who Owns the Liability?
The Centers for Medicare & Medicaid Services (CMS) operates a surveillance platform called the Fraud Prevention System (FPS) that analyzes Medicare claims across the full fee-for-service stream — befo...
The Stark law dilemma facing physicians
Stark law was built to guard against financial conflicts in a fee-for-service world, but as healthcare shifts toward value-based care, many physicians say the decades-old framework is creating new fri...
HHS Releases Medicare Fee-for-Service Improper Payment Rates for 2025
Unpacking the 2026 Physician Fee Schedule
Unpacking the 2026 Physician Fee Schedule  AMGA.org