Distributed Healthcare Intelligence
The tool is easy to use and only requires a handful of questions about your institution, including enrollment size, approximate institutional drop-out rate, and approximate per student tuition rate. Based…
This dataset contains the total number of Medi-Cal Managed Care enrollees based on the reported month, plan type, county, and health plan.
Opioid Settlement Distribution: Colorado Regions
The CAQH Index benchmarks adoption, volume, cost savings opportunities and spend for transactions along the administrative workflow. The following metrics help measure progress towards an automated workflow. By tracking progress,…
Eligibility: Contract Language (Payer v Provider) and Sample to Use.
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.
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:
The New Jersey Health Care Quality Act (HCQA), N.J.S.A. 26:2S-1 et seq. and rules establish certain rights AND responsibilities for health care providers that contract with carriers for business that…
Payors use a variety of reimbursement methodologies and reimbursement structures. Several reimbursement methodologies might be combined in a single arrangement with a payor, often as a means of transitioning to…
Patients with multiple (two or more) chronic conditions expected to last at least 12 months or until the death of the patient, and that place the patient at significant risk…
Effective Jan. 1, 2022, Health Plan commercial members will be protected from balance billing after receiving emergency care and nonemergency care from certain out-of-network providers at in-network facilities. The No…
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…
E&M Coding Advice Physicians and Medicare alike have struggled for many years with correct coding, documentation, and payment of evaluation and management (E&M) services. That's because, by their nature, E&M…
Sample Letter (SB 418): Paper Claim in Process over 45 days Dear Payer: Please be advised that this letter is to request final resolution of the claim/services in question. ...…
The Health and Behavior Assessment and Intervention Codes vs. Psychotherapy: How Codes and Reimbursements Differ
BY CARENODES ACADEMY Lines of Business: Medicare, (some private payers) Certain services provided by your employee (or a fellow employee) may also be eligible for Medicare payment, but check your…