Medical Tourism Facilitator Checklist – Site Inspections

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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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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Sample 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...

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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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Problematic 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...

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Healthcare 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...

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Is 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...

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