Payment Reimbursement and Managed Care

If struggles to control healthcare costs continue, more U.S. employers may change their positions in favor of Medicare for All.

Technological innovations can help healthcare organizations improve their managed care programs.

Rolling averages are one way to benchmark patient SSI eligibility percentages.

My organization recently transitioned to its first Ambulatory Payment Classifications (APC)/DRG-based contract with a commercial plan. We are struggling with determining how to monitor the contract’s performance and, in particular, with the primary focus on the APC payment. Are there recommended key performance indicators (KPIs) used to track this performance?  Answer: It is likely that your organization…

The Medicare Discharge Planning Rule, which was sent to the Office of Management and Budget last week, would require hospitals to provide patients with data to help guide their selection of a post-acute care provider.

HFMA’s Chad Mulvany discusses four findings from the latest AMGA Physician Risk Survey about the transition to alternative payment models and risk.

Careful review of medical record sharing costs and responsibilities stated in managed care contracts can reduce providers' expenses and productivity burden during payer reviews and audits.

RAND study says hospitals treating patients with private health insurance were paid 2.4-times the Medicare rates, but Chad Mulvany says Medicare is the wrong measuring stick.

HFMA’s Chad Mulvany says UnitedHealthcare’s move to expand its bundled payment offerings to providers in its Medicare Advantage plans in more than 30 states is a step in the right direction in support of providers’ efforts to transition to value-based payment models.

HFMA’s Chad Mulvany looks at why the transition from acute to post-acute is one of the greatest opportunities to improve clinical outcomes, the patient/caregiver experience of care and reduce the total cost of care for older adults.