Ask the Experts: Managing Health Plan Overpayments
I have heard there is a rule that health plans cannot recoup overpayments that are more than one year old. Does that stipulation vary by state, or is that a rule that is negotiable per contract?
Optimizing the Preauthorization Process
Senior healthcare provider and health plan leaders examine the difficulties associated with preauthorization and offer strategies for how stakeholders can collaborate to optimize the process.
The Hospital’s Expanding Authority over Authorizations: The Good, the Bad and the Reality
Heather Kawamoto underscores the need for hospitals to improve on the slow manual process of requesting authorizations as they take on this responsibility.
Ask the Experts: Out-of-Network Payments
What are some successful strategies for increasing the amount of charges paid by out-of-network insurance carriers?
Ask the Expert: Payers Linking Cancellations of Separate Contracts
How can providers respond when payers threaten to terminate a Medicare Advantage contract if the provider terminates their separate commercial contract?
Ask the Experts: Non-Contracted Insurer Payment Rates
How can providers respond when non-contracted insurers offer payments limited to some share of Medicare payments for a given service?
HFMA Comments on Interim Final Rule on Third Party Payment of Qualified Health Plan Premiums
HFMA comments on CMS's IFR to codify the guidance related to third party premium payment for individuals enrolling in QHPs. However, the IFR does not resolve the ambiguity created by CMS’s conflicting statements on the issue.
Fact Sheet: Standards for Consumer Assistance Programs for Healthcare Insurance Exchanges
This fact sheet provides details of CMS's rule outlining training requirements applicable to assistance personnel in healthcare insurance exchanges mandated under the Affordable Care Act.
Managed Care Ask the Expert Answer – Robotic Surgery
Q Are commercial payers paying for additional charges billed by hospitals for robotic surgery? At least one payer that pays on a % of charges basis is not paying the charges for the robotic surgery, additional OR time, etc. and
Payment & Reimbursement Forum Articles
An archive of Payment & Reimbursement Forum's articles, featuring our latest content and past articles categorized by topic.