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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July 2008 (Volume 5, Issue 7)	view entire issue

Push the envelope when contracting with highly scrutinized payers
In recent months, managed care payers have been riddled with lawsuits, investigations, and fines regarding the transparency of physician quality ratings, the criteria used to assign physicians to tiered networks, the mishandling of claims payments, and the violation of the Racketeer Influenced and Corrupt Organizations Act-commonly known as RICO-to deny and delay physician payments. And payers' reputations are reeling.

Audit your patient financial services department to maximize your managed care reimbursement
An efficient patient financial services (PFS) department is like a well-oiled machine: all of the pieces fit perfectly into place and perform the right function at the right time. Auditing the core processes in your PFS function helps to maximize your managed care reimbursement by improving internal controls on billing, collections, cash posting, and valuation of accounts receivable (A/R).

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

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

Organize your contracts to eliminate silent PPOs

E-tool: Determining level of service for new patients/consultations in the office/outpatient setting

Use E/M coding audits to train your physicians

Prepare your practice for a visit from the RACs

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