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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September 2008 (Volume 5, Issue 9)	view entire issue

Prepare for contracting challenges during mergers, consolidations
Increasingly, hospitals are purchasing physician practices and building physician networks. The integration process poses numerous challenges for managed care contracting, including the recontracting of all payer contracts, physician credentialing, and changes in physician compensation packages. "Physician integration has come back with a vengeance, but hospitals are taking a much more calculated approach in stepping back into this arena," says Anthony G. Mina, MBA, CMPE, executive vice president and chief operating officer at Transylvania Physician Services, Inc., a physician network affiliated with Transylvania Community Hospital in Brevard, NC.

Think twice before opting out of Medicare
Despite a last-ditch reprieve by the U.S. Senate in July that halted a 10.6% cut in Medicare payments to physicians through 2009, many practices are fed up with the payments from CMS. Even with perennial eleventh-hour rescues by the U.S. Congress, Medicare payments to physicians have been declining in real dollars for more than a decade. The Medicare Improvements for Patients and Providers Act of 2008, which became law after both houses of Congress overrode a presidential veto, increases physician payments by a scant 0.5% through the end of this year, followed by a 1.1% boost in payments in 2009.

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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