Ask the Experts: Chargemaster Updates
Are members of the group assessing their chargemasters annually? What do they consider when deciding which charges to increase and by how much?
Ask the Experts: Managed Care Contracting Benchmarks
I am trying to find benchmarking information regarding managed care contracting.
Managing and Measuring Payer Performance
Healthcare providers should have a contract management system as the framework for managing the four components of the governance/communication processes―contract analysis and modeling, payment calculations, variance monitoring workflow, and payer scorecard and reporting.
No-Pay Policy for Non-Emergent ED Use Spreading
A growing number of health plans are not paying for non-emergency patient use of the ED.
Bad Debt, Charity Care Contribute To Differences in Patient Revenue
Low margin hospitals may be receiving reduced payments from commercial insurance, which may contribute to their lower net patient revenues.
Ensuring Proper Payments for Substance Abuse Services
Substance abuse treatment providers can maximize payments through contract negotiations and eligibility verification and precertification processes.
Why Horizon BCBSNJ Likes Episode-of-Care Payments
Horizon Blue Cross Blue Shield of New Jersey’s episode-of-care program, believed to be the largest such program in the country, rewards physicians for successes but does not subject them to penalties. Horizon says that this arrangement creates better foundations for payer/provider relationships to move toward shared risk over time.
From Multiple Health Plans Back to “No Plan”
Healthcare reform may have been temporarily sidelined, but the need to reform, repair, or replace the Affordable Care Act remains.
Ask the Experts: Managing Health Plan Overpayments
I have heard there is a rule that health plans cannot recoup overpayments that are more than one year old. Does that stipulation vary by state, or is that a rule that is negotiable per contract?
Ask the Experts: Contracting with Small Health Plans
When negotiating with large and small health plans, what areas of comparison should I look at to be sure I am getting the same levels of service from the various plans?