Ask the Experts: Out-of-Network Payments
What are some successful strategies for increasing the amount of charges paid by out-of-network insurance carriers?
Partnering With Healthcare Purchasers
Mount Sinai Health System partnered with a trade union to develop a bundled-payment program designed to improve patient outcomes and reduce the purchaser’s costs.
Ask the Experts: Bundled Payment Contracts
What are some changes in the way payment and reimbursement professionals should view health plan contracts when moving to bundled payments?
Winning Direct Contracts with Employers
Pacific Business Group on Health, a leader in direct contracting, uses an extensive evaluation process to choose the provider organizations for its Employers Centers of Excellence Network.
Hospitals with PBGH Joint Replacement Contracts
Pacific Business Group on Health (PBGH), a membership organization that includes many of America’s largest healthcare purchasers, has developed direct contracts for joint replacements, spine procedures, and bariatric surgery with hospitals across the country.
Finding Success in the Physician Feedback Program/Value-Based Modifier
By taking certain steps, physician practices can make the most of CMS’s quality outcome feedback and payment program.
Negotiating Tips for ACO Contracting
Successful payer negotiations to launch commercial ACOs will depend on careful preparation and understanding of hospitals’ capabilities, says George Wojtal.
Utilization Review Reduces Inpatient Denials
Covenant Health’s utilization review strategies have helped the health system recoup the difference between inpatient and observation status payments.
HFMA Comments on the HRSA 340B Drug Pricing Program Omnibus Guidance
The 340B program stretches resources for care to indigent and at-risk populations. Without this program, these individuals would find more difficulty in finding ready access to care and medications.
Discerning the Impact of Lesser-Than and Greater-Than Provisions in Payer Contracts
If hospitals do not take these payment provisions into account, a small price adjustment could result in a significant revenue hit, says William O. Cleverley.