Learn how Maria Todd can help with surgical cost containment for hospitals ASCs so you can maintain margin integrity under bundled price reimbursement....
Continue readingLooking Back Ten Years: Managed Care, Medical Tourism, and more
Looking Back at the Past Ten Years: Managed Care, Medical Tourism, Concierge Medicine and Bundled-priced Surgery Case Rates...
Continue readingNeed 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...
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 readingData Blocking and its Effect on Physician Integration and Alignment
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 readingReference-based Pricing Gets Put to the Test in Virginia
Make no assumptions about reference-based pricing! Not yet, anyway… 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...
Continue readingVertical 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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