At a Glance: What the Final Health Insurance Exchange Navigator Rule Means for Providers
Can hospitals and health systems serve as navigators or other assisters for the health insurance marketplaces? Here’s what the CMS final rule has to say.
When and How ERISA Can Protect Providers in an Audit Situation
Here are some specifics providers should know about ERISA and commercial audits.
Successfully Negotiating Managed Care Contracts
“The more an organization solidifies its own expectations for contract negotiation and appreciates the needs of the payer, the more likely it is to reach an acceptable agreement,” says Paula Dillon, director of managed care for Rockford Health System.
Ask the Experts Answer: Provider Refunds for Insured Patients
Q: Do you know of any policy/legislation or general practices regarding a provider refunding a payer if the patient was authorized but then later found by the payer to be uncovered because they are secondary?
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
Managed Care Ask the Expert Answer – Payer Report Card
Q We are beginning to develop a Payer Report Card and instead of "creating the wheel" do you have a report card that you have already developed that you would be willing to share with us? A Similar to your
Ask the Expert: PMPM Payments for Case Management
PMPM payments for case management.
Ask the Expert: Adjusting and Automating Self-Pay Accounts
Adjusting and automoating self-pay accounts.
Ask the Expert: Calculating Weighted Averages in Favored Nation Clauses
Calculating weighted averages in favored nation clauses.
Ask the Expert: How Far Can Plans Make Patients Travel?
Can a health plan make a patient travel outside a particular service area (say 40 miles away) to receive care from an exclusively contracted provider?