Alternative Payment Model Valuation for Compliance, Success Under APMs

valapm-headerPYA has released a new white paper that demonstrates the appraiser’s key role in determining fair market value for financial arrangements under alternative payment models, allowing providers to pursue new financial relationships without risk under fraud and abuse laws.

A new white paper from PYA, “Valuation of Alternative Payment Models,” addresses the challenges involved in determining fair market value for financial arrangements between and among alternative payment model (APM) participants.  It explores the intersection of APMs with fraud and abuse laws and sets forth the key principles for valuing APMs.

With improved care and reduced costs in mind, payers have developed APMs to compensate providers based not on the volume of services they provide, but the quality of care provided.  While most guidance related to these new reimbursement models has focused solely on the nuances of APMs, PYA’s white paper addresses challenges for appraisers as well as providers in valuing such arrangements.   As the paper points out, overcoming fraud and abuse concerns by demonstrating fair market value will be critical in the transition from volume-based to value-based reimbursement.

According to the paper, “The health of our economy is tied directly to the success of the transition from volume-based to value-based reimbursement, given these APMs’ potential for driving down healthcare spending. . . .  Although valuation of APMs is less straightforward than valuation of productivity-based compensation models, appraisers can identify and employ reliable standards by which to evaluate fair market value.”

PYA’s professionals have the expertise and experience necessary to assist with the transition to, and valuation of, alternative payment arrangements.  We provide fair market value and commercial reasonableness assessments of provider network revenue distributions to ensure confidence with compliance.  And, through appropriately designed plans that incentivize behavior change, we can help providers reach their population health goals.

Related Posts
PYA has added 2018 reimbursement updates to a white paper that provides valuation guidance to hospitals considering telemedicine arrangements for providing much-needed healthcare services at lower costs. As patient demand...
Read More

PYA White Paper “An Introduction to Valuing Telemedicine” Gets 2018 Updates

Compliance Today magazine recently published an article, “Regulatory Compliance: Physician Needs Assessments Are an Integral Step,” authored by PYA Principal Tynan O. Kugler. It highlights the critical role physician needs...
Read More

Regulatory Compliance: Physician Needs Assessments Are an Integral Step

Medicare cards are getting a much-needed facelift.  The Centers for Medicare & Medicaid Services has announced its intention to remove Social Security numbers from the cards in an effort to...
Read More
Medicare card scam

New Medicare Cards in the Mail—Don’t Fall Prey to Scammers

PYA has released an updated white paper offering a succinct list of changes and updated instructions for providing and billing Medicare for chronic care management. PYA, a national professional services...
Read More

Updated White Paper Addresses Changes in Providing and Billing Medicare for Chronic Care Management Services

PYA Consulting Manager Kathryn Culver was recently published in Becker’s Hospital Review. Culver’s article, “Trump’s Tax Act: What It Means for a Physician’s Bottom Line,” examines the impact the Qualified...
Read More

Trump’s Tax Act: What It Means for a Physician’s Bottom Line

The Association of Community Cancer Centers will hold its 44th Annual Meeting & Cancer Center Business Summit (CCBS) March 14-16, 2018, at the Renaissance Washington, DC, Downtown Hotel. PYA will...
Read More

PYA Joins Convergence of Thought Leaders at Cancer Center Business Summit

Leaders in the long-term care industry will convene in New Orleans, LA, to participate in the American Health Lawyers Association (AHLA) Long-Term Care and the Law program February 28-March 2,...
Read More

Long-Term Care Compliance on AHLA Program Agenda

PYA is pleased to announce the promotions of Michael Ramey, Matt Stuart, and Jeff Pate to the level of Equity Principal. PYA has announced the promotion of Senior Manager Michael...
Read More

PYA Announces Three New Equity Principals

Share This Insight

If you received value from this article, please share it with your network (e.g., Facebook, Twitter, LinkedIn). Icons below for your convenience.

Stay Current

* indicates required
Monthly eNewsletters
See more newsletter and alert options.

PYA Population Health Ascend

PYA Healthcare Blog

PYA Thought Leadership Services

The Healthcare Loop