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!

To view the entire newsletter issue, click the “View Entire Issue” link below

April 2007 (Volume 4, Issue 4)	view entire issue

Medical Home concept gains ground
The American College of Physicians (ACP) in Washington, DC, which represents more than 120,000 internal medicine physicians across the United States, is proposing a new physician payment and delivery model to replace Medicare's current fee-for-service payment system for physicians. In a policy paper released in January, the ACP recommends instituting a multicomponent, bundled payment structure that encourages more effective and efficient care coordination through the Advanced Medical Home (AMH) concept, also known as patient-centered care.

Contracting challenges affect provider-sponsored plans
Provider-sponsored plans, or health system-owned plans, aren't as prominent in the managed care landscape as they were a decade ago. But dozens of these plans remain, from household names such as Health Alliance Plan (an affiliate of the Henry Ford Health System in Detroit) and Tufts Health Plan in Massachusetts, to lesser-known AultCare (affiliated with Aultman Hospital in Canton, OH), which nonetheless boasts nearly as many members as its nationally known peers.

Exert control over a payer's policies using these tactics
Editor's note: Please note that this response is an expression of opinion or informal guidance and is not intended as legal advice. Please consult with an attorney who is familiar with your specific circumstances. Q: How do I get some control over a payer's ability to change its policy manual?

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

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

Push the envelope when contracting with highly scrutinized payers

Case study: Go electronic on your charge capture process

Organize your contracts to eliminate silent PPOs

E-tool: Determining level of service for new patients/consultations in the office/outpatient setting

Use E/M coding audits to train your physicians

Prepare your practice for a visit from the RACs

E-tool: Sample contract language addresses collection efforts

E-tool: Basic checklist for E/M documentation

Target front-desk staff to improve collection of patient deductibles, especially for high-deductible health plans

Conduct E/M coding audit to ensure compliance, enhance practice revenue

Prepare for contract clauses defining never events

Focus on the key reasons payers reject your claims

E-tool: Sample payer summary

E-tool: Sample ContractMaster

ABOUT HCPRO

PRESS

CAREERS @ HCPRO

ADVERTISING OPPORTUNITIES

ONLINE STORE

200 HOODS LANE

P.O. BOX 1168

MARBLEHEAD, MA 01945, USA

PHONE: 800/650-6787

FAX: 781/639-7857

Copyright Statement	Privacy Policy

*MAGNET™, MAGNET RECOGNITION PROGRAM®, and ANCC MAGNET RECOGNITION® are trademarks of the American Nurses Credentialing Center (ANCC). The products and services of HCPro, Inc. and The Greeley Company are neither sponsored nor endorsed by the ANCC