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

May 2008 (Volume 5, Issue 5)	view entire issue

Prepare your practice for a visit from the RACs
As if hospitals and physician practices don't have to jump through enough government-mandated hoops, CMS is throwing yet another obstacle into their path by expanding the use of recovery audit contractors (RAC)-private firms that audit the claims of providers that participate in FFS Medicare, including hospitals, skilled nursing facilities (SNF), physicians, durable medical equipment suppliers, and labs.

Use E/M coding audits to train your physicians
As discussed in the April MCCRA, a coding audit is an excellent tool for physician practices to determine what, if any, problems exist in their claims submissions, particularly for E/M codes. Part II of this coding spotlight illustrates how to use the findings of your audits to help your physicians improve their coding practices. E/M codes affect not just outpatient or office consultations but home, skilled and unskilled nursing facilities, and ED visits, says Jennifer Swindle, RHIT, CCS-P, CPC-EM-FP, CCP, senior coding consultant at PivotHealth in Lafayette, IN.

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

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

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