Checklists help you standardize your inspection process as a health tourism facilitator and care coordinator at the surgical facilities in your provider network. When I inspect a healthcare facility that may be added to my medical tourism provider network, I evaluate the facility from many different angles. The basics include quality, safety, licensing, accreditation,...
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Does your value proposition change over time? Yes. If you don't continually adapt and face the new challenges posed by the disruptors your brand either dies or becomes irrelevant to buyers. (Think adaptive/specific immunity)....
Continue readingOut of Network International insurers / health schemes Denied Workers’ Compensation Third-party liability (slip and fall, etc.) with Attorney Involvement Uninsured Motor Vehicle Accident Claims Lack of Medical Necessity Allegations that you lack proper authorization Coverage Exclusion or Exhaustion Pre-existing conditions on Travel Accident Insurance Denied vs Rejected A denied claim is one that an insurance...
Continue readingUtilization management is a system for reviewing the appropriate and efficient allocation of health care services under a health benefits plan according to specified guidelines, in order to recommend or determine whether, or to what extent, a health care service given or proposed to be given to a covered person should or will be...
Continue readingIn managed care agreements, payers regard rural and urban hospitals as “hospitals”, all uniform in character. But in reality, huge variations in the demography, economics, culture, and environmental characteristics of different rural places make them very different from their urban counterparts and distinctly different from their other rural competitors. Large rural and suburban bedroom...
Continue readingWhy is the process of renewing and renegotiating #managedcare #contracts still such a challenge for providers? Are they not utilizing the tools properly? Are they not adding the contracts into their systems properly? Do the tools have some necessary features missing? Is there some other reason?...
Continue readingBy MARIA TODD Sublease Agreements: Hospitals cannot enter into sublease arrangements with physicians in order to host town hall meetings with Medicare, Medicaid, or otherwise insured beneficiaries in the physicians’ offices. The rental value for these arrangements must be at fair market value and cannot take into consideration the potential volume or value of...
Continue readingInternationally, the healthcare sector is particularly vulnerable to corruption. There are significant amounts of money involved and the complexities of many healthcare systems, their coding, billing, pricing, and even the verification of credentials and privileging of providers and practitioners is implicated. ...more than 85% of the people in the world highly vulnerable to the...
Continue readingBy MARIA K TODD, MHA PhD Know the financial risks associated with these plan participants and prepare in advance to protect your business. What they are Medical Cost Sharing plans claim to be an alternative to health insurance. That confuses healthcare providers and their revenue management team members immediately. Learn what you need to...
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