Need Help to Appeal Denied/Rejected Claims?

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...

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Why America’s Rural Hospitals Suffer under Shared Risk and Full-Risk Payer Contracts

In 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...

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Managing Managed Care Contract Renewals

Why 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?...

Vertical Integration Returns to U.S. Healthcare: What You Need to Know Now

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...

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#AskMariaTodd: The Proliferation Trajectory of Community-based, Freestanding Emergency Departments

Recently, I've been taking calls from venture capital investment funds and bankers curious about my impression and experience with community-based freestanding emergency departments.  Most of the questions are similar: Why this, why now, what's next, hurdles and obstacles? They also want to know if I can share any proven contracting strategies with third party...

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The 340B reductions

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...

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