Physician profiling is used by payers to steer their members to in-network physicians who, by their measures, are the most cost-efficient and provide the highest quality of care. Wonder if you’ve made the grade? Look yourself up in a provider directory: if you see a star or two beside your name, you’ve been profiled.
At least once a week I hear clients complain about difficulties they are having organizing simple work flow processes.
Medicare is getting more aggressive with audits through its Recovery Audit Contractor program. Here’s how to assess your billing procedures to avoid audits, and establish a process for when a RAC does come knocking.
I attended a managed-care business forum in Washington a couple of weeks ago to find out what initiatives payers have been working on recently.
Consultant Susanne Madden offers a step-by-step guide to handling payer take-backs and not getting bullied into writing a check without researching the situation.
Recovery Audit Contractor (RAC) is a term that every Medicare healthcare professional and staff member needs to know.
Where do your patient referrals come from? Do you know?
Pay-for-performance programs, or P4P as they are more commonly known, are designed to improve the quality, effectiveness, and safety of patient care.
Payers have been investing heavily in technology to help manage data and keep their costs to a minimum.
CMS has implemented changes to the rules that cover Medicare's hospital inpatient prospective payment system (IPPS) which will affect physician-hospital referrals and ancillary arrangements.
Congress is still debating healthcare reform. It’s not too late to make sure your voice is heard.
Last week I asked one of our pediatric clients how many plans they participated with.
It’s not too often that physicians can really come together on policy issues and make their voices heard, but there is no better time than now to do so!
Payer requests for refunds for incorrectly processed claims are endemic. But wait! There are some things you can do before you write that check.
Whenever possible, you should negotiate with your payers for better contract terms and payment rates.
Likely, you’ve at least heard of the BCBS-Thomas/Love Settlement.
