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Payer Contract Modeling
Contract modeling, or analyzing potential scenarios of reimbursements to understand financial outcomes, provides a proactive approach to financial management by analyzing the impact of different elements such as methodologies, rate changes, pricing, payor mix shifts and ever changing regulations on margins, rather than net revenue alone.
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Maryland Physicians Care (MPC) Provider Relations Representatives
Maryland Physicians Care (MPC) Provider Relations Representatives Maryland Physicians Care MPC providers have designated Provider Relations Representatives based on the practice/group location. This specialist will be your primary contact with MPC and will keep you updated on any policy changes. To find your Provider Relations Representative, select a territory for the list below. Phone: 1-800-953-8854 (follow prompts…
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Medi-Cal Managed Care Quality Improvement Reports (CA)
Various reports from the State of California regarding the quality of care provided by Medi-Cal managed care health plans. Plan-specific evaluation reports are also prepared for each individual health plan reviewed.
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Eligibility: Contract Language (Payer v Provider) and Sample to Use
Eligibility: Contract Language (Payer v Provider) and Sample to Use.
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Birth Count Query System (Florida)
The Birth Count Query System is a highly useful online tool provided by the Florida Department of Health. It offers a plethora of data on birth counts in Florida, and can be accessed easily through this link: https://www.flhealthcharts.gov/FLQUERY_New/Birth/Count. This comprehensive tool is an excellent resource for researchers and analysts who are interested in delving deeper…
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Physician-Employer Engagement: “Direct-to-Employer” Arrangements
Physician-Employer Engagement has become a popular method for physicians to provide healthcare services to employees of companies. This approach is often referred to as “Direct-to-Employer” arrangements.
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Interpretation of Financial Ratios (Hospitals)
Financial ratio analysis is one critical component of assessing a hospital’s financial condition. The following metrics are examined in CHIA’s quarterly and annual acute hospital financial reports:
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VALUE-BASED PAYMENT MODELS
Medicare Medicaid Alignment Initiative Value-based payment structures are gaining popularity for many reasons. The model can align incentives to encourage disparate providers to collaborate to achieve objectives. Cost savings can be shared with nursing homes, behavioral health providers, specialists, hospitals, home and community-based providers, and others who are creating value for the beneficiary and the…
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Supporting breastfeeding employees is good for business
Business case for breast-feeding
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Alzheimer Care Coordination Payments
Alzheimer’s care coordination payments are financial incentives or compensation provided to healthcare providers or organizations to coordinate the care and support for individuals with Alzheimer’s disease or related dementias. The aim is to improve the quality of care, reduce medical costs and improve patient outcomes by having providers work together and share information. These payments…
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Environmental Scan on Care Coordination in the Context of Alternative Payment Models (APMs) and Physician-Focused Payment Models (PFPMs)
This environmental scan was prepared at the request of the Office of the Assistant Secretary for Planning and Evaluation (ASPE) as background information to assist the Physician-Focused Payment Model Technical Advisory Committee (PTAC) in preparing for a theme-based discussion on the role care coordination can play in optimizing health care delivery and value-based transformation. The…
