Recent Articles

May 2013

Trinity Health Is Proactively Preparing for the Health Insurance Marketplaces

Ask the Expert: Chemotherapy Carve Outs

Ask the Expert: Mobile Technology for POS

Tool: Bon Secour's Value-Oriented Payment Performance Dashboard

April 2013

Successfully Negotiating Managed Care Contracts

Checklist: Essential Contract Elements in Managed Care Contracts

Ask the Expert: Dis-enrolling a Patient from a Group Plan While on FMLA

Article Archive

Billings and Collections

• Payer Performance Data Guides Improvement (November 2012)
• Tool: Sample Payer Report Card  
• Retro Termination and Insurance Overpayments (January 2013)
• Saint Francis Halves Days in A/R with a Payer-Focused Strategy (May 2012)

Coding & Documentation

• CCI Edits at the Department Level (January 2013)
• Two Tools for Improving Clinical Documentation (January 2011)

Health Insurance Marketplaces

• Health Insurance Exchanges: Benefits and Challenges for Hospitals (November 2011) 
• Tool: Questions to Ask as Hospitals Prepare for Health Insurance Exchanges (November 2011)
• Lessons from the First Health Insurance Marketplace (March 2013)
• Preparing for Increased Churn in 2014 (November 2011) 

Managed Care

• Balancing IP & OP Reimbursement Increases to Maximize Margin Opportunity (September 2011)
• Data Mining Payments and Contracts (September 2011)
• Effective Negotiation Preparation to Maximize Rate Increases (February 2011)  

• Tool: Presenting Your Hospital's Value Story to Payers (February 2011)

• How Commercial Payers Rate on Rates (June 2011)
• MedStar Health Builds Strong Payer Relationships—Through Communication (March 2012)
• Montefiore's Take on Successful Risk-Based Contracts for Population Management (June 2011)
• Navigating Your ERISA Contracts  (October 2012)
• Payer-Provider Parity: Beyond Just Being Fair (April 2011)
• PR Campaigns May Improve Payer Negotiations, Enhance Market Value (January 2012)

Medicaid Reimbursement

• A Primer on Medicare Managed Care (October 2011)
• Another Form of Medicaid Fraud (October 2011)
• DSHing About DSH Cuts: Preparing for Dramatic Change (January 2013)
• Lee Memorial's Approach to Partnering with Medicaid ACOs (October 2011)
• MetroHealth Seeks Medicaid Waiver to Improve Safety Net, Reduce Charity Rolls (September 2012) 
• NICU Maximizes Revenue by Navigating Complex Medicaid Payment Requirements (November 2011)
• Tool: A Checklist to Determine Why a Unit’s Charges Are Below Average (November 2011)

Medicare Reimbursement 

• Bracing for a Wage Index Cat Fight (July 2011) 
• Key Dates on the Wage Index Timeline (July 2011)
• Cost Report Forms 2552-10: Identifying Opportunities and Threats for CAHs (July 2012)
• Critical Strategies to Ensure Readmission Appropriateness (April 2011)
• DSHing About DSH Cuts: Preparing for Dramatic Change (January 2013)
• How Much Could Medicare Be Cut Under the Debt Deal? (September 2011)
• The New CMS Report Form: Highlights of the Changes by Worksheet  (March 2011)

Payment Models: Bundled Payment, Shared Savings, P4P, etc.

• Breaking Even Under Medicare Bundled Payments (February 2012)
• Changing Payment Structures Require IT Changes(October 2012)
• Cleveland Clinic and Loew's Arrange Bundled Price for Heart Surgery (February 2011)
• Hawaii Launches First-Ever Statewide VBP Program with Private Payers (July 2011)
• Health Plans Pay MDPractices Incentive Bonuses for Converting to Medical Homes (May 2011)
• HFMA Presentation: Medicare Shared Savings Program Summary of Proposed ACO Regulations (April 2011)
• How Exempla St. Joseph Got Physicians Involved in Bundled Payment (January 2011)
• How the Allina vs. HHS Case Could Increase Your DSH Payments (January 2013)
• Tool: Recalculating DSH Payments to Account for Medicare Advantage Change
• IME Payments and Terminated Residency Programs (November 2012)
• Laying the Groundwork for Bundled Payment (June 2012)
• Maryland's Rate Setting Agency Pilots P4P, Bundled Payment (January 2011)
• The Pioneer ACO: A Template for Shared Savings (February 2013)
• A Positive ROI for Most Physician Group Practice Demonstration Participants (May 2011)
• P4P Contract Tips from a Seasoned Negotiator (April 2011)
• Post-Acute Partnerships to Support Bundled Payments: Risk or Opportunity? (July 2012)
• Six Target Markets for ACO-Type Partnerships (April 2011)
• Top 10 Cited Risks Under Bundled Payment (February 2012)
• VBID Offers Unique Opportunities for Provider-Payer Partnerships (April 2012)\
• Wisconsin Systems Launch Accountable Care Network—and Begin Working With Payers (March 2011)

Quality and Cost Reporting

• Nichols on Advanced Medicare Cost Reporting (February 2010)

Supply and Technology Reimbursement

• Medical Technology Reimbursement: Finding the Value Proposition (May 2011)  
• Tool: Checklist for Evaluating the Value-Based ROI of Medical Technology (May 2011)