HCPro.com: Managed Care Contracting and Reimbursement Advisor

Managed Care Contracting & Reimbursement Advisor tells you exactly what you must know and do to successfully negotiate the best deal with HMOs, PPOs, and other payors - and get bigger and faster reimbursement!

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June 2008 (Volume 5, Issue 6)	view entire issue

Organize your contracts to eliminate silent PPOs
Whether you've just begun working at a healthcare organization or you've served as an administrator for many years, one of the most daunting challenges you're likely to face is the forced reduction in reimbursement that results from silent PPO arrangements. Physician practices are commonly victimized by silent PPOs when they treat patients out-of-network who are traveling, unable to visit their regular physician, or simply prefer a non-network provider.

Case study: Go electronic on your charge capture process
Change isn't easy for any healthcare organization, especially one with 16,000 employees and 1,400 clinical staff members who treat more than 83,000 patients annually, including 28,000 new patients each year. But with its billing department handling 1.2 million annual claims and generating more than 842,000 patient statements annually, The University of Texas M. D. Anderson Cancer Center in Houston decided to move from paper-based to electronic charge capture. Less than two years after adopting the electronic system for its outpatient services, the institution has reaped a $500,000 increase in average daily cash posting.

Other recently-published articles from Managed Care Contracting and Reimbursement Advisor:

Use lean cost accounting to examine your cost structure

Bridges to Excellence pays bonuses to docs for implementing medical home

Ensure that contracts cover real-time claims adjudication

Build a defensible fee schedule to challenge lowball payer contracts

Use retail clinic referrals to boost your bottom line

E-visit payment promising but not ready for prime time

Think twice before opting out of Medicare

Prepare for contracting challenges during mergers, consolidations

E-tool: Sample letter to payer on intention to renegotiate

E-tool: Payer/MCO contract provision samples

Watch your contracts in the wake of ’final’ Stark rules

Put these provisions on your managed care contracting hot list

Audit your patient financial services department to maximize your managed care reimbursement

Push the envelope when contracting with highly scrutinized payers

Case study: Go electronic on your charge capture process

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