Payment & Reimbursement Forum Tools

An archive of Payment & Reimbursement Forum tools

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Tool Archive

Managed Care

• Job Description: Manager of High-Cost Drugs (October 2018) 
• Analysis of an ED Claim  (May 2018)
• Progress Measures for IBD Specialty Medical Home (February 2018) 
• A Formula to Determine the Impact of Anthem’s Imaging Policy (November 2017)
• Direct Employer Contracting Checklist (July 2016)
• Checklist: Commercial Utilization Review (November 2015)

Medicare Reimbursement

• Action Steps that Can Help Hospitals Improve Their MSPB Scores (April 2015)

Policies

• How Will Anthem’s Policy Affect Your Hospital Outpatient Imaging Program (November 2017)

Payment Models: Bundled Payment, Shared Savings, P4P, etc.

• Contracting Parameters for Maternity Bundle Pilots (January 2017)
• Checklist for Safety Net Provider Success Under Alternative Payment Models (April 2016)
• Checklist to Avoid a Negative Value-Based Modifier Adjustment (February 2016)
• Checklist for Common Mortality Risk Variables (August 2015)

Pricing

• Checklist for Successful ACO Contracting (January 2016)
• Checklist for Reviewing Lesser-Than Provisions in Payer Contracts (July 2015)