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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 12, December 1, 2008 - VIEW THE FULL ISSUE

• Bridges to Excellence pays bonuses to docs for implementing medical home

  Although the medical home concept is moving forward in fits and spurts, many healthcare analysts...

• Use lean cost accounting to examine your cost structure

  Using the RBRVS, physician practices can employ a modified cost accounting methodology to examine...

Issue 11, November 1, 2008 - VIEW THE FULL ISSUE

• Build a defensible fee schedule to challenge lowball payer contracts

  Your fee schedule, or chargemaster, is your most important financial tool, yet the crisis...

• Ensure that contracts cover real-time claims adjudication

  Many payers are jumping on the bandwagon to develop real-time claims adjudication (RTCA), which...

Issue 10, October 1, 2008 - VIEW THE FULL ISSUE

• Use retail clinic referrals to boost your bottom line

  Wal-Mart, CVS, Walgreens, and Kroger now have more than their friendly pharmacists in common. All...

• E-visit payment promising but not ready for prime time

  Payers are recognizing the power of the Internet. In December 2007, Hartford, CT–based Aetna...

Issue 9, September 1, 2008 - VIEW THE FULL ISSUE

• Prepare for contracting challenges during mergers, consolidations

  Increasingly, hospitals are purchasing physician practices and building physician networks. The...

• Think twice before opting out of Medicare

  Despite a last-ditch reprieve by the U.S. Senate in July that halted a 10.6% cut in Medicare...

Issue 8, August 1, 2008 - VIEW THE FULL ISSUE

• Put these provisions on your managed care contracting hot list

  Every managed care contracting director should have a hot list of provisions to check and recheck...

• Watch your contracts in the wake of 'final' Stark rules

  Nearly one year has passed since the final phase of the Stark II law became effective, yet practice...

• E-tool: Payer/MCO contract provision samples

  Use the following sample language when negotiating key managed care provisions:

• E-tool: Sample letter to payer on intention to renegotiate

  Send the following both to the most recent payer/MCO representative with whom you have dealt and to...

Issue 7, July 1, 2008 - VIEW THE FULL ISSUE

• Push the envelope when contracting with highly scrutinized payers

  In recent months, managed care payers have been riddled with lawsuits, investigations, and fines...

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

  An efficient patient financial services (PFS) department is like a well-oiled machine: all of the...

Issue 6, June 1, 2008 - VIEW THE FULL ISSUE

• Organize your contracts to eliminate silent PPOs

  Whether you've just begun working at a healthcare organization or you've served as an administrator...

• Case study: Go electronic on your charge capture process

  Change isn't easy for any healthcare organization, especially one with 16,000 employees and 1,400...

Issue 5, May 1, 2008 - VIEW THE FULL 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...

• 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...

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

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

Issue 4, April 1, 2008 - VIEW THE FULL ISSUE

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

  Editor's note: In the first article of a two-part series, MCCRA talks to coding experts about the...

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

  Although health insurance policies with deductibles aren't new, the policies are multiplying and...

• E-tool: Basic checklist for E/M documentation

  E-tool: Basic checklist for E/M documentation

• E-tool: Sample contract language addresses collection efforts

  Editor's note: You can use the following sample contract language to improve your ability to...

Issue 3, March 1, 2008 - VIEW THE FULL ISSUE

• Focus on the key reasons payers reject your claims

  In February, MCCRA looked at strategies to minimize claims denials from payers by fixing and...

• Prepare for contract clauses defining never events

  A burgeoning number of states and hospital associations are establishing policies to not seek...

Issue 2, February 1, 2008 - VIEW THE FULL ISSUE

• Fix and resubmit rejections to minimize payer denials

  Optimizing denial prevention strategies can help your practice improve cash flow, according to...

• Organize your contracts to improve negotiating clout

  Payers are achieving claims savings today by digging into the pockets of providers and consumers...

• E-tool: Sample ContractMaster

  E-tool: Sample ContractMaster

• E-tool: Sample payer summary

  E-tool: Sample payer summary

Issue 1, January 1, 2008 - VIEW THE FULL ISSUE

• Manage capacity to improve your contracting leverage

  Even small physician groups that feel like guppies in a sea of payer piranhas have more contracting...

• Provider needs strategy to collect out-of-network payments

  Editor's note: This month's question is addressed by healthcare consultant Reed Tinsley, a member...

• Credit ratings raise visibility of managed care contracts

  A major credit rating service has expanded its analytical coverage to include U.S. hospitals and...

• E tool: Getwell Medical Group reimbursement analysis

  E tool: Getwell Medical Group reimbursement analysis