Employers are uniquely positioned to positively influence the quality and cost of health care through direct-with-employer contracting. But they aren't sure whom to call and how to proceed. Neither are the providers......
New and significant hospital price transparency rules are proposed for hospitals in the USA. Will you be ready in less than 4 months?...
Are you one of the thousands who compete for medical tourism and medical travel brand awareness posting promotional advertisements on Facebook expecting unrealistic results....
Out 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 reading
CMS Administrator Seema Verma has warned that data blocking will not be tolerated. Healthcare data can be exchanged, but software and applications providers have been accused of hoarding it because for many, their business model has been designed on deriving profits from data hoarding. But if Seema Verma’s admonitions are any indication, them days...Continue reading
We help a limited number of ambitious and extraordinary clients to grow and scale their unique game-changing medical, dental, rehabilitation and wellness businesses Will your business be our next success story? By Maria K Todd, MHA PhD CEO & Founder, The Mercury Healthcare International group of companies As a former hospital administrator, and now...Continue reading
Reference-based pricing in healthcare is an interesting concept. What it is and how it works: Reference-based pricing is a relatively new healthcare reimbursement model where employers contract with a company to negotiate payment rates outside a traditional HMO or PPO contractual relationship and pay hospitals a negotiated amount based on a multiple of Medicare’s...Continue reading
This morning, as I was contemplating what to write about for today's article, I received an email from a client who red lined an offer from a health plan for the new Medicaid Managed Care initiative in Illinois. It seems the payer did not want to accept the proposed...Continue reading
In the 1990s, during the Clinton Administration, the USA saw many attempts to achieve vertical integration in healthcare. Here we are again! New acronyms were initiated and made popular to describe Independent Practice Associations (IPAs), Physician Hospital Organizations (PHOs), which were managed and administered by entities known as Management Services Organizations (MSOs). Physicians felt the...Continue reading
As you may have heard, new 340B guidelines announced in November 1, 2017 and became effective January 1, 2018. Since the announcement I've been working with hospitals on strategies to implement, extend, and optimize participation in the 340B program. The back story On November 1, Centers for Medicare and Medicaid Services (CMS) issued its 2018...Continue reading