Contracts, manuals & fee schedules, where are they (Oh, my!) Determine payor contract contact Determine if reimbursement is based on RBRVS or compare to Medicare Determination of any billing concerns Analysis of reimbursement data, including full data review vs. top # of CPT codes … [Read more...]
Free Webinar – Helping Physician Practices Negotiate and Deal with Managed Care Plans – Tips and Strategies
Most medical practices do not negotiate their managed care contracts. However, many practices have successfully increased practice revenues by developing a sound negotiation strategy and then going out and implementing the strategy. Using a process format, this presentation will provide … [Read more...]
How special are you in a payer’s eye?
My physician clients often ask me for advice on how best to negotiate with managed care payers for improved reimbursement. My advice is typically the same: if you want them to pay you more than your competitors, you have to offer them something more than your competitors do. Simply being good at … [Read more...]
Texas allows Blue Cross Blue Shield to deny payments for some out-of-network ER visits
Blue Cross and Blue Shield of Texas will begin a controversial new program today in which it will not pay any expenses for an out-of-network emergency room visit if it is later determined the patient should have gone elsewhere for treatment. Under the new policy, which was announced in April, a … [Read more...]
Proposed North Dakota Physician Group Merger Runs in to FTC Roadblock
A North Dakota federal judge issued a preliminary injunction on Wednesday blocking a proposed merger between a pair of health care providers in the state until the matter could be reviewed at a scheduled Federal Trade Commission administrative hearing in January. The order grants a request made by … [Read more...]
How Clinically Healthy Is Your Practice?
Many medical practices make the mistake of tracking only financial performance. To be sure, a medical practice will not be able to continue its important clinical work without assuring financial health. But focusing on finances alone only gives you a singular snapshot of your practice's performance. … [Read more...]