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 12, December 1, 2006 - VIEW THE FULL ISSUE

• Curb eligibility errors to reduce denials

  Managing denials is a constant struggle. To compound the issue, challenges such as confirming...

• CORE rules could ease eligibility verification headache

  The Coalition for Affordable Quality Healthcare (CAQH), a nonprofit alliance of health plans...

• E tool: Variables to consider when assessing your denials database

  E tool: Variables to consider when assessing your denials database

Issue 11, November 1, 2006 - VIEW THE FULL ISSUE

• Use hard facts to bolster your negotiating position

  Successful negotiations often hinge upon the ability of both parties to agree on the value of a...

• The pressure cooker for pricing transparency intensifies

  Editor's note: This article is the first of a two-part series. ext month, we'll discuss a...

• E tool: Sample baseline costs worksheet

  E tool: Sample baseline costs worksheet

Issue 10, October 1, 2006 - VIEW THE FULL ISSUE

• Claims cleanup: Use technology to verify all insurance

  Although your patients' insurance cards are supposed to facilitate filing correct claims, they...

• Critical steps to implement a managed care exit strategy

  Editor's note: This article is the second of a two-part series. Part one ran in the September...

• Payers may release incomplete data, convince savvy consumers to go elsewhere

  You might think that you are the only one publicizing your rates as a response to the trendy rush...

• E tool: Sample list of pricing questions to consider

  E tool: Sample list of pricing questions to consider

Issue 9, September 1, 2006 - VIEW THE FULL ISSUE

• Insurers expected to abide by more stringent requirements

  The long-term effects of the 2001 Racketeer Influenced and Corrupt Organization Act (RICO) class...

• When it is time to give managed care the boot

  Editor's note: This article is the first in a two-part series. Next month, we'll discuss steps that...

• E tools: Carefully craft communication pieces to retain patients

  E tools: Carefully craft communication pieces to retain patients

Issue 8, August 1, 2006 - VIEW THE FULL ISSUE

• Incorporate due diligence into your contract

  When you contract with an administrative services organization (ASO) or PPO, the ASO or PPO acts as...

• Tips to combat the growing issue of denied stays

  Scenario: A hospital transfers a patient in semiurgent status to a second hospital. The second...

• E tools: Sample contract language to help ensure due diligence

  E tools: Sample contract language to help ensure due diligence

Issue 7, July 1, 2006 - VIEW THE FULL ISSUE

• Tips to achieve success during contract negotiations

  How hard should you push an issue with the payer? Editor's note: This article is the second in a...

• Consumer-directed plans present new patient issues

  Editor's note: This article is the second in a two-part series. Consumer-directed healthcare has...

• E tools: Watch out for vague contract language

  E tools: Watch out for vague contract language

Issue 6, June 1, 2006 - VIEW THE FULL ISSUE

• Tips to achieve success during contract negotiations

  Editor's note: This article is the firstin a two-part series. Next month, we'll discuss tips for...

• Consumer-driven plans present new patient issues

  Editor's note: This article is the first in a two-part series. Next month, we'll discuss...

• Now is the time to review your fee structure

  The times, they are a-changing. But procedure prices-and the methodologies that hospitals use to...

• E tools: Sample contract language to counter an all-products clause

  E tools: Sample contract language to counter an all-products clause

Issue 5, May 1, 2006 - VIEW THE FULL ISSUE

• Maximize high-cost specialty income

  Anticipate common insurer tricks and upcoming costs for new equipment and technology Editor's...

• Don't neglect emergency preparedness in your contracts

  Will you get paid for the services you provide during a state of emergency? Most hospitals have...

• E tool: Contract language to protect yourself in times of crisis

  E tool: Contract language to protect yourself in times of crisis

Issue 4, April 1, 2006 - VIEW THE FULL ISSUE

• The financial effect of coding errors

  Correct mistakes to avoid loss of income Editor’s note: This article is the first part in...

• Reel in healthier contracts, better rates through value plans

  Negotiating payer contracts for your practice without the proper tools is a bit like fishing...

• E tools: 90-day advance notice

  E tools: 90-day advance notice

Issue 3, March 1, 2006 - VIEW THE FULL ISSUE

• Protecting yourself from silent PPOs

  One of the worst problems facing providers is silent yet possibly financially dangerous. As the...

• Consumer-driven plans and their effect on providers

  Despite consumer-driven health plans’ gain in popularity, education regarding the plans and...

• E tools: Model letters: Appeals to silent PPOs

  Following are two letters you can use to request payment from a silent PPO. Both explain why the...

• E tools: Seven tips to tackle high-deductible plans

  The percentage of employers offering high-deductible plans jumped from 5% in 2003 to 20% in 2005...

Issue 2, February 1, 2006 - VIEW THE FULL ISSUE

• Transparency can play a vital role in the success of pay for performance

  Pay-for-performance (P4P) initiatives continue to gain momentum. More hospitals have signed on and...

• Payer report cards put health plans in the spotlight

  Amid the flurry of pay-for-performance activity, a grow ing number of providers hope to develop...

• E tools: Sample payer report card

  E tools: Sample payer report card

Issue 1, January 1, 2006 - VIEW THE FULL ISSUE

• Tracking denial data can help improve your financial performance

  Improving your fiscal future is as easy as examining denial data. By placing such information under...

• Payment challenges for out-of-network providers

  Out-of-network providers often struggle on two levels to collect payment. First, the amount of...

• E tools: Sample problem-fixing tool

  E tools: Sample problem-fixing tool