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 readingSample Contract Language: Utilization Management
Utilization 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 readingWhy 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...
Continue readingProblematic Arrangements Between U.S. Hospitals and Their Staff Physicians
By 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 readingHealthcare Fraud, Abuse & Waste in Medical Tourism
Internationally, 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 reading“Medical Cost-Sharing” Plans: What Your Hospital or Practice Needs to Know Before You Agree
By 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...
Continue readingIs Your Concierge Membership Practice a Best Kept Secret?
Many concierge physicians contact me because I wrote the book (literally) on Concierge Medical Practice Design. Some have not yet launched their practice while others did it themselves and realize they made some mistakes or that they had hired consultants to help them but things didn't work out as planned or the consultant failed...
Continue readingSingle Case Agreements for Specialty Concierge Physicians
As a specialist in a private concierge medical practice, you’ve chosen to terminate all insurance panel agreements. Patients will pay you directly for services (out-of-pocket). You provide patients with an invoice marked with dates of service, service codes, diagnosis codes and all payments paid by the patient. Patients agree that if they have insurance,...
Continue readingInternational SEO – Standing Broad Jump or Flying Leap?
I find a major gap in healthcare professionals' understanding of the nuances of international marketing and SEO. They have no clue about the nuances of international SEO and how it can impact a medical practitioner's global digital strategy to attract patients from foreign countries. International SEO considerations go much further than website domain structures, such...
Continue readingMedical Tourism Destination Development
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 You may automatically assume that I am...
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