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Managed Care Contracting & Reimbursement Advisor April 2010

Thu, 01 Apr 2010 14:01:00 GMT

This month’s edition of MCCRA offers guidance on preparing for contract renewals and dealing with the rising cost of provider/insurer relationships.

Not the enemy: Retail clinics offer opportunities for collaboration, marketing and enhanced revenues

Thu, 01 Apr 2010 14:01:00 GMT

Retail clinics, once viewed as the enemy by some providers, now offer opportunities for hospital systems and physician groups to bolster the bottom line, remove pressure on the emergency departments, and recruit new patients.

Verify, document and close the loop, columnist counsels

Thu, 01 Apr 2010 14:01:00 GMT

Columnist focuses on malpractice, but the issues he raises have important implications for payer relationships – and the bottom line.

Managed Care Contracting & Reimbursement AdvisorMarch 2010

Mon, 01 Mar 2010 14:01:00 GMT

This month’s edition of MCCRA offers guidance on preparing for contract renewals and dealing with the rising cost of provider/insurer relationships.

Don't ignore managed care contracts during mergers, acquisitions

Mon, 01 Mar 2010 14:01:00 GMT

Integration continues to be an important trend in healthcare, and as health systems purchase physician practices (and practices merge) managed care contracting issues emerge. But often, they quickly fall to the bottom of the “to do” list.

Costly documentation and coding woes beset providers

Mon, 01 Mar 2010 14:01:00 GMT

Despite increased scrutiny from CMS and private payers, many practices continue to make costly mistakes in coding, in documentation, and often, in both.

Use these tips and insights to deal with shrinking reimbursements

Mon, 01 Mar 2010 14:01:00 GMT

How is your organization coping with this era of declining—or, at best, stagnant—reimbursements? You could be missing opportunities and making cuts that will ultimately cost more than they save.

Experts share tips for terminating contracts

Mon, 01 Mar 2010 14:01:00 GMT

Reimbursement experts frequently advise terminating unprofitable contracts. But doing it well can be a challenge.

Promote prompt payment from CDHP, HDHP patients

Mon, 01 Feb 2010 13:23:00 GMT

The secret to high-deductible health plans (HDHP) and consumer-driven health plans (CDHP) seems simple enough: Collect the amount due while the patient is in your facility.

Payment issues to contemplate before building a medical home

Mon, 01 Feb 2010 13:22:00 GMT

The patient-centered medical home (PCMH), with support from physician groups and the Obama administration, may be the future of healthcare delivery.

It represents a change not only in care delivery, but also in reimbursement. In some ways, the PCMH resembles both capitation and pay for performance (P4P). But it represents a marked departure from the status quo. Practices considering such a shift need to ensure that they are adequately compensated for their efforts.

Managed Care Contracting & Reimbursement Advisor, February 2010

Mon, 01 Feb 2010 13:20:00 GMT

Inside:

Payment issues to contemplate before building a medical home

Promote prompt payment from CDHP, HDHP patients

MCCRA 2009 index

Fri, 01 Jan 2010 20:22:00 GMT

Index of MCCRA 2009 issues

Think twice before you submit that invoice

Fri, 01 Jan 2010 20:19:00 GMT

Carve out reimbursement for implants and prosthetics, but be wary of providing an invoice.

Regulatory scrutiny: IPAs: Are you in the FTC’s crosshairs?

Fri, 01 Jan 2010 20:16:00 GMT

Is your messenger IPA risking Federal Trade Commission ( action? It could be and you don’t even realize it. Much depends on just how— and how well— the IPA is integrated.

Managed Care Contracting & Reimbursement Advisor, January 2010

Fri, 01 Jan 2010 20:12:00 GMT

This month’s edition of MCCRA offers guidance on preparing for contract renewals and dealing with the rising cost of provider/insurer relationships.

Prepare for cooperation, scrutiny, and declining reimbursements in 2010

Tue, 01 Dec 2009 18:06:00 GMT

MCCRA asked several experts on reimbursement and contracting issues to offer a forecast for 2010.

Managed Care Contracting & Reimbursement Advisor, December 2009

Tue, 01 Dec 2009 18:04:00 GMT

This month’s edition of MCCRA offers guidance on preparing for contract renewals and dealing with the rising cost of provider/insurer relationships.

Silent PPOs, unintended discounts, and your bottom line: Learn how to identify and address leased networks

Sun, 01 Nov 2009 19:01:00 GMT

“Silent PPOs” can access a provider’s discounted rates without the provider’s permission or knowledge. Some managed care organizations lease out their provider lists and associated discounts to third parties, such as small health plans, workers’ compensation plans, TPAs that process claims for self-insured employers, and insurance companies that are too small to afford their own.

Learn how to challenge flawed ratings, tiers

Sun, 01 Nov 2009 18:57:00 GMT

Payers have various rating, tiering, and ranking systems that attempt to assess a physician’s performance against his or her peers. Often, say critics, the criteria on which the ratings are based are not disclosed to physicians in advance—when they could make changes in their practice. Moreover, many providers and consultants say the ratings are often incorrect, or at least imprecise. They also warn that the ratings may have more to do with cost than quality.

Managed Care Contracting & Reimbursement Advisor, November 2009

Sun, 01 Nov 2009 18:53:00 GMT

This month’s edition of MCCRA offers guidance on preparing for contract renewals and dealing with the rising cost of provider/insurer relationships.