The Managed Care Legal Database is a resource identifying how state and federal statutes and regulations address many issues that may occur between private payers and physicians, such as prior authorization, credentialing, network adequacy, out-of-network payment, and contract termination. The Database also contains relevant AMA policy, issue briefs, advocacy resources, model legislation, and a State Laws Map.
CASE EXAMPLE of how we breakdown contracts and tie the terms to operational alignment Because the business of healthcare is to deliver the highest quality care to patients, improving clinical performance is the driving focus. However, understanding and responding to financial pressures through increased efficiency and enhanced revenue capture is what makes high-quality clinical delivery
Healthcare flow of funds explained. Managed Care 101 for healthcare entrepreneurs seeking to do business in the California market. Session led by Alex Yarijanian, CEO Carenodes. The aim: providing healthcare entrepreneurs with a framework within which they will find their place in the business value chain.
Learn to speak the Managed Care Language (101)
KPI / Metric Formula or Definition Target Business Purpose Gross Revenue Gross Revenue or “Top Line Revenue” is synonymous with gross charges associated with the provision of services This is Facility Specific. GR is budgeted at the Financial Class Level based upon historical payer mixes, demographic studies, material managed care contracting changes and other forecasting
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.
Physical therapist services are generally covered as a basic benefit by all major health insurance companies. Ask your physical therapist to contact your insurance company to determine your specific benefits.
Antisocial Personality Disorders and Implications on Business Operations: Corporate Psychopathology as a Human Resources Agenda Item Publication description The ability of a leader to understand, and level with, employees’ emotions can be a vital determinant in business performance and employee morale. Emotional intelligence, as a construct, is a dynamic mitigating element in buffering the myriad
Agenda Managed Care 101 for healthcare entrepreneurs seeking to do business in the California market.