Here is another checklist from Reed Tinsley, CPA of things to consider when preparing to amend / renew a payor contract. It is an excellent complementary list to some earlier posts: Part 1 and Part 2.
Thanks, Reed!
See checklist Reed Tinsley Negotiation checklist.
At a recent talk about “Never Events” a member of the audience, in house counsel to skilled nursing facilities, asked whether Medicare planned to introduce similar screening and financial penalties for “SNF – acquired conditions”. On Friday, CMS issued its final rule for Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2009 and provided an answer.
The American Health Lawyers Association's 5th Edition Health Plans Contracting Handbook was just published. The book contains chapters written by prominent health care attorneys and... well ... me. The book covers the key elements of a health plan - provider contract, along with the the issues behind many of the terms discussed from both provider and health plan perspectives. It includes sample language for may clauses: both provider-friendly and payor-friendly versions.
Thank you Cynthia Reaves and Will Harvey for your work pulling together all the pieces!
To find out more about this newest release on the subject, click here: AHLA Health Plans Contracting Handbook: A Guide For Payors And Providers, Fifth Edition with CD-ROM
I was talking to Marla Durben Hirsch the other day, and she mentioned a warning issued by the California Medical Association to California physicians about a Network Access Agreement. Apparently this national network is recontracting, so this is an issue that physicians in other states might want to watch.
This past spring, New Hampshire passed a law creating HealthFirst, a health insurance program offering a standardized set of benefits intended to emphasize wellness. The law is intended to create an affordable form of health insurance for employers with between 1 and 50 employees. HealthFirst will focus on wellness and the role of the primary care physician in effectively managing care. The product, which is designed to launch on October 1, 2009 is said to resemble a product offered in Rhode Island, which has saved small employers 15% of premiums.
Here is a link to an interesting commercial - I learned about it from Brian King's ERISA law blog. Yes, it is overblown, but it made me laugh. Insurance Company Rules Happy viewing!
Continuing the trend of state
medical societies to restrict the transfer of physicians’ discounts, Indiana
has passed legislation restricting the activities of Silent PPOs.
Continue reading "Still more on Silent PPO Legislation: Indiana" »
Connecticut
joins approximately 12 other states restricting the selling of a physician’s
discount. The law requires any entity
contracting with a physician, group, physician network, IPA organization or PHO
to disclose the contracting entity’s intent to sell or lease contract rates,
including providing a list of potential “customers” on request. It requires all ID cards to provide a web
address or toll free number access to the discount can be verified at the time
of service. It also requires the contracting
entity’s right to sell that discount to terminate when the provider contract
ends.
Thank you to Marla Hirsh for passing
this information along!
For a link to the bill, Click Pub.
L. 08-126
I have been
writing for a while about approaches to collect deductibles from patients. See for example, earlier Post.
Yesterday, InsureBlog pointed out another tool that may be of interest when attempting to collect from a patient enrolled in a high deductible plan. I remember speaking about this at an association of specialty hospitals and seeing the CFOs sit up and start taking notes.
Continue reading "Another Useful Tool to Collect Deductibles" »
Yesterday, the Chicago Tribune ran a story describing the AMA's new insurer report card aimed at "hold[ing] health insurance companies accountable for making claims processing more cost effective and transparent and to educate and empower physicians so they are no longer at the mercy of a chaotic payment system that takes countless hours away from patient care."
Link to Chicago Tribune Article: Here
Link to AMA "Cure for Claims" press release: Here
The American Association of Health Insurance Plans has issued a statement noting the improvements in claim payments brought on by electronic claim processing.
AHIP Statement: Here
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