Topic
Contracting
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Your Billing Problem Started in the Contract: What Revenue Cycle Leaders Need to Know Before a Claim Is Ever Filed
Most revenue cycle management challenges are treated as billing problems. In reality, many are contract problems — upstream issues that billing teams cannot resolve at the claims stage.…
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Academy · Business · Contracting · Leadership · Provider Contracts · Resource · Value Based CareTransforming Healthcare Negotiation: The ‘Getting to Yes’ Approach
Introduction In the intricate dance of healthcare negotiations, achieving a win-win outcome can seem like a daunting task. Whether it’s negotiating agreements between health plans and providers, determining…
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Financial Benefits of Doulas for Hospitals with Capitated Contracts
Doulas, with their specialized training in providing emotional, physical, and educational support during childbirth, are becoming increasingly integral in modern maternity care. For hospitals navigating the intricacies of…
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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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Business · Connected Care · Contracting · Databank · Digital Therapeutics · Funding · HEDIS · Managed Care · Payers · Press · Reimbursement · Startups · Subcontracting · Value Based Care · virtual health · Virtual Specialty CareHealth Insurance Providers’ Actions Concerning Mental Health
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How Are Physicians Paid?
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…
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NEW RULES:Bans on balance billing and out-of-network cost-sharing
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.…
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Provider – Contracting: KPIs
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…
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Subcontracting Opportunities
Carenodes contracts with physicians, facilities and other health care professionals to form our provider networks, which are essential for delivering quality, accessible and cost-effective health care services. In…
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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…