On Demand Webinar | Intermediate | Payment, Reimbursement, and Managed Care
Payment uncertainty in the U.S. healthcare system has become an exhaustive burden for all stakeholders - and further amplified by COVID-19. Healthcare costs and inconsistent volumes demand a holistic, long-term strategy for financial viabil...
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Course | Intermediate | Payment, Reimbursement, and Managed Care
This course describes the regulatory agencies that have authority over healthcare organizations, including the Centers for Medicare and Medicaid Services. It also explains how Medicare and Medicaid function as payers, and how different kind...
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Course | Basic | Payment, Reimbursement, and Managed Care
This course explains how to complete FL 1-41 of the UB-04 billing form. This course covers the use of this form for all payers, including Medicare, Medicaid, and commercial payers. The course describes each form locator and provides detaile...
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Course | Basic | Payment, Reimbursement, and Managed Care
This course explains how to complete FL 42-81 of the UB-04 billing form. The codes needed to fill in these data areas are described. The course covers the use of this form for all payers, including Medicare, Medicaid, and commercial payers....
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Live Webinar | Payment, Reimbursement, and Managed Care
This Spring, Medicare is offering a final enrollment opportunity in the Bundled Payments for Care Improvement Advanced ("BPCI-A") model for new participants. Hundreds of hospitals and physician groups are actively participating in BPCI-A, a...
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Fact Sheet | Payment, Reimbursement, and Managed Care

Health Plan Price Transparency Requirements Final Rule Summary

Fact Sheet | Payment, Reimbursement, and Managed Care

Health Plan Price Transparency Requirements Final Rule Summary

On November 12, 2020, the Internal Revenue Service of the Department of the Treasury, the Department of Labor, and the Department of Health and Human Services (hereinafter referred to as “the Departments”) will publish in the Federal Register final rules requiring group health plans and health insurance issuers in the individual and group markets: 1) to disclose, upon request, cost-sharing liability including in-network provider negotiated rates, and out-of-network allowed amounts to a participant, beneficiary or enrollee (hereinafter referred to as an “enrollee”) through an internet self-service tool and in paper form; 2) to publicly disclose in-network provider negotiated rates, historical out-of-network allowed amounts, and drug pricing information in machine readable data files; and 3) to permit insurers to claim credit towards their medical loss ratios (MLR) for “shared savings” when an enrollee selects a lower- cost, higher-value provider.

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