Managed Care Newsletters

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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Managed Care Contracting and Reimbursement Advisor

Issue 10, October 6, 2005 - VIEW THE FULL ISSUE

• Protect yourself from unfair carve-outs with an antisteering clause

  When you contract with a health plan for your services, you base your deal on the reimbursement you...

• Don't let language in consent agreement with licensing board hurt your ability

  No licensed provider expects to be investigated by his or her state licensing board, but a growing...

• Rate filings key to understanding plans' rates

  Rate filings are a valuable resource to help you understand a health plan's financial situation and...

• Rate filings key to understanding plans' rates

  Rate filings are a valuable resource to help you understand a health plan's financial situation and...

Issue 9, September 1, 2005 - VIEW THE FULL ISSUE

• Take five steps to terminate managed care contracts

  If you have a managed care contract that is no longer profitable, you'll need to take several steps...

• Don't agree to overly broad translation services for members

  Many providers must, under guidance issued by the federal government, offer translation services to...

Issue 8, August 1, 2005 - VIEW THE FULL ISSUE

• How to get ERISA plans to pay you more quickly

  Like many providers, you probably find it frustrating to deal with plans governed by the Employee...

• Beware of most favored nations clauses

  Most favored nations clauses say that providers will offer a health plan the best price they give...

• Beware of billing snafus with CRNAs, ER physicians

  Picture this common billing mix-up: A hospital employs certified registered nurse anesthetists...

Issue 7, July 1, 2005 - VIEW THE FULL ISSUE

• Get paid for denials if plan fails to follow medical review procedures

  More plans deny (or reduce payment on) claims based on utilization management/medical necessity...

• Supply all tax ID numbers to a plan to avoid payment problems

  Providers often sign plan contracts in the names of their parent organizations or corporate offices...

• Tips for getting paid correctly based on your contract

  Picture this: A provider discovers one month that his PPO underpays his facility. His contract says...

Issue 6, June 1, 2005 - VIEW THE FULL ISSUE

• Start now, cash in later with pay for performance

  CMS’ pay-for-performance demonstration projects kicked off in January 2005, and experts agree...

• Get the benefit of physicians’ expertise to prevent insurance denials

  To reduce the revenue lost by denials, many organizations involve their physicians in the appeals...

• Clarify contract, train staff to avoid underpayment

  Like many hospitals, yours may sign per diem contracts with plans under which the plan pays a...

Issue 5, May 1, 2005 - VIEW THE FULL ISSUE

• Manage PPO contracts to avoid scam insurers

  The fallout from some multiple employer welfare arrangements (MEWA) are wreaking havoc on the...

• Online postings about plan contracts, compliance could be used against you

  Internet message boards, listservs, and chat rooms are an excellent way for providers to share...

• Beware of restrictions that keep you from filing suit

  There's another emerging trend to keep track of: plans requiring not only total binding arbitration...

Issue 4, April 1, 2005 - VIEW THE FULL ISSUE

• Continuous discount agreements: Consider these three areas before signing on

  If you treat plan members out of network, a repricer (or other agent of a payer) may have already...

• Assess risks before letting your contract negotiator work for another provider

  Providers that employ savvy, experienced managed-care-contract negotiators often want to let them...

Issue 12, December 1, 2005 - VIEW THE FULL ISSUE

• Direct contracting: Seven advantages of dealing directly with employers

  Don’t be surprised if more employers ask you to sign a contract directly with them. Direct...

• Limit obligation to share peer review records with a plan

  Editor’s note: This is part two of a two-part series. By Marla Durben Hirsch, Esq...

• Take a proactive approach when dealing with disputes about bundled charges

  The constant back and forth between providers and payers when disputing bundled charges is an...

Issue 11, November 1, 2005 - VIEW THE FULL ISSUE

• Warn plan members about their financial responsibilities for treatment

  Give plan members early warning about the financial responsibilities they may face for treatment...

• Strategies to avoid refund requests from the start

  Fielding requests for overpayment refunds is unfortunately an all-too-familiar scenario for most...

Issue 7, July 5, 2005

• Etools: July 2005

  Etools: July 2005

Issue 6, June 1, 2005

• Etools: June 2005

  Etools: June 2005

Issue 5, May 1, 2005

• Etools: May 2005

  Etools: May 2005

Issue 4, April 1, 2005

• Etools: April 2005

  Etools: April 2005

Issue 3, March 1, 2005 - VIEW THE FULL ISSUE

• To mediate or not to mediate?

  Many contracts between providers and health insurance companies allow or require the parties to try...

• Three ways to get paid for new providers while they're being credentialed

  Sometime in the near future, you may want new providers to start treating a plan's members, but...

• Managing contracts: Best practices to secure appropriate reimbursement

  Hospitals should book all contractual adjustments as they bill; this will create correct net...

• Etools: March 2005

  Etools: March 2005

Issue 2, February 1, 2005 - VIEW THE FULL ISSUE

• How to respond when plans ask for your chargemaster

  Health plans are asking more hospitals for copies of their chargemasters-the electronic files used...

• Leveraging denial management in contract negotiations helps with denied claims

  Before approaching a managed care company to address a technical denial or a clinical denial, it's...

• Notify your plan that incorrect payments violate the contract

  Like most providers, you probably dread having to cope with the administrative hassle of dealing...

• Etools: February 2005

  Etools: February 2005

Issue 1, January 1, 2005 - VIEW THE FULL ISSUE

• Beware of waiving copays

  The network/nonnetwork and preferred/nonpreferred issues are always top of mind for providers...

• Prove member voluntarily authorized billing auto insurer

  It's a growing trend for providers to bill treatment of a member injured in an auto accident to the...

• Etools: January 2005

  Etools: January 2005