Get creative with technology to drive your managed care programs
Technological innovations can help healthcare organizations improve their managed care programs.
Ask the Experts: Contract performance
My organization recently transitioned to its first Ambulatory Payment Classifications (APC)/DRG-based contract with a commercial plan. We are struggling with determining how to monitor the contract’s performance and, in particular, with the primary focus on the APC payment. Are there recommended key performance indicators (KPIs) used to track this performance? Answer: It is likely that your organization…
Part D savings plan dialed back
Part D plans will have fewer new tools to control drug spending than Medicare initially proposed.
Analysis: How overcoming some hurdles can help providers manage PAC spend
HFMA’s Chad Mulvany discusses how the PAC-spending results of a recent study on older patients with joint replacements could easily apply to any number of common episodes of care experienced by Medicare beneficiaries.
Ask the Experts: Provider Level Adjustments
Is there a best practice for handling provider level adjustments (PLBs) in electronic health record (EHR) systems?
Improving PHI Disclosure Efficiency in the Business Office
With pressure on providers to prove medical necessity and validate code assignments, business office staff must provide more patient information, such as medical records, putting greater demands on their time. Yale New Haven Health addressed this problem by implementing a centralized protected health information (PHI) disclosure management system.
Interoperability and Patient Access to Health Data Proposed Rule Summary
This document summarizes the proposed rule on interoperability and patient access to health data, published by CMS, in the March 4, 2019, Federal Register.
Henry Ford Health System Joins Direct-Contracting Trend
Henry Ford Health System expects to succeed in its direct-contracting initiative with General Motors, thanks in large part to its capabilities in areas such as analytics, case management, and patient engagement.
Value-Based Payment Can Reduce Need for Preauthorizations
BlueCross BlueShield of Western New York has removed prior authorization requirements for more than 500 therapies, services, and procedures in conjunction with its move to value-based payments for primary care providers.
Your To-Do List When Health Plan Contracts Change
Six steps can help revenue cycle leaders manage health plan changes effectively.