HCPro.com: Managed Care Contracting and Reimbursement Advisor

Managed Care Contracting & Reimbursement Advisor tells you exactly what you must know and do to successfully negotiate the best deal with HMOs, PPOs, and other payors - and get bigger and faster reimbursement!

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December 2008 (Volume 5, Issue 12)	view entire issue

Bridges to Excellence pays bonuses to docs for implementing medical home
Although the medical home concept is moving forward in fits and spurts, many healthcare analysts still question whether the concept is delivering on its promise to improve patient care or whether the approach is just the latest medical fad. Genuine progress toward integrating the medical home model into the U.S. healthcare system would have enormous implications for provider organizations because payers and purchasers likely would link payments with the achievement of improved patient outcomes.

Use lean cost accounting to examine your cost structure
Using the RBRVS, physician practices can employ a modified cost accounting methodology to examine their cost structure, enabling them to assess the sufficiency of their managed care reimbursement, says Frank D. Cohen, CMPA, senior analyst at MIT Solutions, Inc., in Clearwater, FL, and a speaker at the Medical Group Management Association’s 2008 annual conference, held in October in San Diego.

Other recently-published articles from Managed Care Contracting and Reimbursement Advisor:

Cash in on Medicare bonus for e-prescribing

Involve physicians in your managed care contract negotiations

Use lean cost accounting to examine your cost structure

Bridges to Excellence pays bonuses to docs for implementing medical home

Ensure that contracts cover real-time claims adjudication

Build a defensible fee schedule to challenge lowball payer contracts

Use retail clinic referrals to boost your bottom line

E-visit payment promising but not ready for prime time

Think twice before opting out of Medicare

Prepare for contracting challenges during mergers, consolidations

E-tool: Sample letter to payer on intention to renegotiate

E-tool: Payer/MCO contract provision samples

Watch your contracts in the wake of ’final’ Stark rules

Put these provisions on your managed care contracting hot list

Audit your patient financial services department to maximize your managed care reimbursement

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