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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 2, February 1, 2007 - VIEW THE FULL ISSUE

• Put quality rankings in perspective

  With the growth of transparency initiatives, many health plans have posted not only price...

• Prepare now for patients with limited benefit plans

  As healthcare costs continue to rise, employers are feeling the pressure and are forced to...

• Tackle incorrect payments with a notice to the payer

  Editor's note: The following is an excerpt fromBeyond the Contract: Managing Your Relationship with...

• E tool: Model language: Contract violations

  E tool: Model language: Contract violations

Issue 1, January 1, 2007 - VIEW THE FULL ISSUE

• Don't underestimate the value of a well-defined contract

  Give the definitions section of your contracts some muscle to strengthen your case should you ever...

• Improve your record keeping to reduce underpayments

  If underpayments are an issue bogging down your facility, it would be prudent for you to take a...

Issue 12, December 1, 2007 - VIEW THE FULL ISSUE

• Scrutinize new products as Medicare Advantage continues to expand

  More than 2,750 Medicare Advantage (MA) plans will be available to beneficiaries in 2008-up 25...

• Battle over physician prescribing moves to courtroom, while other states seek to legislate protection of prescribing data

  While the battle over commercial use of physician prescribing information that began earlier this...

• Examine assignment, termination clauses before signing EHR license agreement that could jeopardize your data

  Editor's note: This Q&A is part two of this "Ask the advisor" column, which covers clauses that...

Issue 11, November 1, 2007 - VIEW THE FULL ISSUE

• UnitedHealth settlement may increase provider contracting leverage

  Affiliates of Minneapolis-based UnitedHealthcare (UHC) in 36 states and the District of Columbia...

• Use payer report cards to improve managed care contracts

  Payers often use report cards to rack and stack their providers, but providers can use this tool...

• Evaluate EHR license agreements before you buy

  Editor's note: Part one of this "Ask the advisor" article addresses contracting issues related to...

• UHC Regulatory Settlement Agreement

  UHC Regulatory Settlement Agreement

Issue 10, October 1, 2007 - VIEW THE FULL ISSUE

• Track and manage disputed claims to prevent recurrence

  Managing disputed claims costs provider organizations significant time and expense. Dallas-based...

• Relationships with employers improve contracting leverage

  As reported in the September MCCRA, many employers-especially large, self-insured firms-have shown...

Issue 9, September 1, 2007 - VIEW THE FULL ISSUE

• Employers drive movement to performance-based contracting

  Recent quality initiatives by CMS have pushed performance-based contracting (PBC) to the forefront...

• Use this pay-for-performance readiness template

  A readiness assessment helps a healthcare organization define a joint mission and vision around...

Issue 8, August 1, 2007 - VIEW THE FULL ISSUE

• Use contractual tools to challenge payer collaboration on products

  Payer consolidation is a fact of life for providers throughout the country. For example, some...

• Consider legal remedies for potential antitrust concerns

  Increasingly, competing payers are collaborating on one or more products that could skew the nature...

• Use template to improve negotiations, monitor contracts

  Provider organizations seeking to improve managed care contracting can take a page from The...

• E tool: Sample language addresses selective contracting

  E tool: Sample language addresses selective contracting

• E tool: Model letter

  E tool: Model letter

Issue 7, July 1, 2007 - VIEW THE FULL ISSUE

• PROMETHEUS payment model aims to top P4P

  Providers and payers alike are increasingly frustrated with the limitations of existing healthcare...

• Simple audits help to manage payer contracts

  Here's a remarkably simple contract auditing process you can use to ensure that your organization...

• E tools: Top 10 CPT codes in family practice example

  E tools: Top 10 CPT codes in family practice example

• E tools: Measuring variance between contracted and allowed amounts in CPT codes

  E tools: Measuring variance between contracted and allowed amounts in family practice CPT codes

Issue 6, June 1, 2007 - VIEW THE FULL ISSUE

• Colorado legislature passes landmark managed care bill

  Colorado has enacted sweeping legislation addressing contractual arrangements between healthcare...

• Outpatient imaging on UnitedHealthcare's radar screen

  In January, Minneapolis-based UnitedHealthcare (UHC) placed the imaging community on notice by...

• Hospital outsourcing now part of managed care contracting

  Move over, food and linen services. Outsourcing of diagnostic and clinical services also is...

Issue 5, May 1, 2007 - VIEW THE FULL ISSUE

• Transparency and health information: Who owns your practice data?

  The burgeoning growth of healthcare price and transparency programs is raising a new concern for...

• Use these eight strategies to create reports about your financial performance

  Contracting and financial managers must communicate their practice's performance by presenting data...

• E tool: Sample contract language addresses data disclosure

  E tool: Sample contract language addresses data disclosure

• E tool: Lovely Medical Group

  E tool: Lovely Medical Group

• E tool: Practice Revenue 2005

  E tool: Practice Revenue 2005

• E tool: Metro Area Integrated Clinic, PC

  E tool: Metro Area Integrated Clinic, PC

Issue 4, April 1, 2007 - VIEW THE FULL ISSUE

• Medical Home concept gains ground

  The American College of Physicians (ACP) in Washington, DC, which represents more than 120,000...

• Contracting challenges affect provider-sponsored plans

  Provider-sponsored plans, or health system-owned plans, aren't as prominent in the managed care...

• 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...

Issue 3, March 1, 2007 - VIEW THE FULL ISSUE

• Use utilization data to win an increase in payer rates

  When trying to negotiate a better rate with a payer, many providers often neglect to use an...

• Tips to ensure that payers' audits are fair and equitable

  Payers may insist upon the right to audit providers' books and records in a number of contexts and...

• Alter current procedures to reduce silent PPO activity

  Silent PPOs, as their name indicates, can be difficult to identify. To avoid falling prey to these...

• E tool: Sample contract language to address audit requests

  E tool: Sample contract language to address audit requests

• E tool: Model letter

  E tool: Model letter