Ask the Experts Answer: Legislative Requirements for Refunds
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?
Ask the Experts Answer: Medicare Crossovers to Medicaid Bad Debt
If Medicaid contractualizes all or some of the amount deemed as coinsurance by Medicare, can the contractual amount be claimed as part of the bad debt on the cost report? Or, are we only able to claim the amount that Medicaid notes as being the copay or deductible on the cost report?
Ask the Expert: PMPM Payments for Case Management
PMPM payments for case management.
Ask the Expert: Achieving Transparency
Q Are there any best practices that you can recommend for transparency?
Ask the Expert: Medicare Payment for Home Health
Medicare does not distinguish payment by hospital-based or stand-alone home health agencies.
Ask the Expert: Small Claims Court Proceedings
In developing a policy for small claims court proceedings, there are a few homework and research items you will need to complete before proceeding.
Ask the Expert: Adjusting and Automating Self-Pay Accounts
Adjusting and automoating self-pay accounts.
Ask the Expert: When Physicians Terminate Medicare Part B Contracts
When physicians terminate Medicare Part B contracts.
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?