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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 7, July 1, 2012 - VIEW THE FULL ISSUE

• Reform, changing ­industry requires changing your approach to contracts

  With all the changes in the healthcare industry, physician practices may need to reassess how they...

• More than $5 billion paid in Medicare, Medicaid EHR ­payments; CMS pleased with progress

  Medicare and Medicaid electronic health record (EHR) payments have surpassed $5 billion to 93,650...

• Dual eligibles represent an opportunity for your practice

  Dual eligibles-patients eligible for both Medicare and Medicaid-could be a good target population...

• Massachusetts first to propose payment model for dual eligibles, suggests patient-centered medical homes

  Massachusetts was the first state to submit a proposal for an integrated service delivery and...

• Report recommends adopting new cancer care payment model to reward physicians for health outcomes

  A new report from UnitedHealthcare in Minnetonka, Minn., examines the current cancer care payment...

• CMS issues final rule for First Choice Option

  CMS has issued a final rule implementing the Community First Choice Option.

Issue 6, June 1, 2012 - VIEW THE FULL ISSUE

• ICD-10 switch is an ­opportunity for improving profit

  The switch to ICD-10 has been looming for some time now and physician practices have mostly looked...

• CMS issues 5010 fact sheet for smooth transitions

  CMS has issued a fact sheet on Version 5010 ­transaction standards to assist with a smooth...

• ICD-10 Summit shows providers moving forward despite delay

  Physician practices are moving forward with their ICD-10 preparation despite the recent delays...

• Poll shows industry is falling behind recommended ICD-10 timelines

  Almost half of healthcare providers don't know when they will complete their impact assessment for...

• Physicians slow to use IT, losing potential benefits

  No more than 20% of doctors are providing online scheduling or test results for their patients and...

• Regular urine drug testing offers cost benefits in chronic pain patients

  Regular urine drug testing (UDT) of chronic pain ­patients can offer economic benefits...

• Ten rights and responsibilities of users of EHRs

  Providing clinicians 10 rights and responsibilities regarding their electronic health record (EHR...

• New MGMA survey details influences on physician compensation in academic settings

  Geographic section and department rank were found to influence compensation in academic settings...

Issue 5, May 1, 2012 - VIEW THE FULL ISSUE

• 5010 logjam delaying ­payments to physicians

  Missing a few payments lately? You're not alone. Physicians across the country report that they're...

• HHS delays ICD-10 past 2013 date

  HHS Secretary Kathleen G. Sebelius announced recently that HHS will initiate a process to postpone...

• Stage 2 requirements set higher standards for CPOE, other electronics

  Standards are higher in the proposed Stage 2 meaningful use requirements, with CMS expecting more...

Issue 4, April 1, 2012 - VIEW THE FULL ISSUE

• Achieving meaningful use not always easy, but worth it

  A large multispecialty group that recently attested for Stage 1 meaningful use tells MCCRA that the...

• Align patient incentives with your goals in move to ACOs

  As physician care moves steadily toward accountable care, revenue enhancement will depend on...

• Cigna and Weill Cornell launch ACO

  Cigna and the Weill Cornell Physicians Organization have launched a collaborative accountable care...

• More physicians opting out of Medicare, but data limited

  The federal government has long been worried about the possibility that large numbers of physicians...

Issue 3, March 1, 2012 - VIEW THE FULL ISSUE

• Understand three-day DRG ­payment window to improve reimbursement

  CMS' rule for billing preadmission nondiagnostic services has long determined how physicians can...

• 5010 enforced this month, so take action now

  Complying with the new 5010 HIPAA transaction standards could require practices to upgrade or even...

• Improve patient billing experience to increase revenue

  Patients today are overwhelmed by the complexity of medical bills. Physicians regret their...

• CMS adds coverage for services to reduce obesity

  CMS announced recently that Medicare is adding ­coverage for preventive services to reduce...

• Legislation aims to ensure prompt payment for Medicaid providers

  U.S. Reps. Brian Bilbray (CA) and Anna G. Eshoo (CA) introduced legislation recently to ensure that...

Issue 2, February 1, 2012 - VIEW THE FULL ISSUE

• You have more leverage than you think when dealing with denials

  Denials can wreck your revenue stream, but physician practices often give up on payment too soon...

• Incident-to billing in OIG's sights this year

  HHS has put physician practices on notice that it will be taking a close look at billing under...

• 5010 deadline extended but MGMA, AMA say threats still exist

  CMS' Office of E-Health Standards and Services (OESS) has announced a 90-day period of...

• Final Physician Payment Rule Factors in GPCI

  The final 2012 Medicare physician payment rule from the Centers for Medicare & Medicaid...

Issue 1, January 1, 2012 - VIEW THE FULL ISSUE

• ACO final rule removes many hurdles, makes option more appealing

  Physicians and practice managers have been trying to decide for months now whether an accountable...

• ACO antitrust fears addressed by FTC, DOJ

  Any consideration of joining an accountable care organization (ACO) quickly leads to concerns about...

• CMS announces primary care initiative, solicits participation from payers

  CMS has announced plans to develop a Comprehensive Primary Care (CPC) initiative in which it is...

• CMS proposes first real revision in Medicare CoP since 1986

  CMS has proposed what would be the first significant revision in the Medicare Conditions of...

• RAC auditors find $92 million in Medicare overpayments

  CMS recently released a report to Congress detailing how RACs found $92 million in...