tci Medicare Compliance & Reimbursement - 2013 Issue 2

Industry Notes: Prepare for Quality Measure Contract Discussions

Contracts between hospitals and insurers cover virtually every facet of care, so be aware that a greater focus on quality might find its way into your paperwork. Case in point:Blue Cross Blue Shield (BCBS) of Rhode Island and Care New England, a major hospital group in the state, reached a five-year plan that includes BCBS paying the hospital additional amounts based on quality measures. The two entities are reworking their contract to focus more on comprehensive, quality-focused reimbursements. "We want to create incentives to better coordinate care and management of these patients, rather than keep them in silos,"...

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