Topic
Providers
-
Business · Innovations · Leadership · Managed Care · MCO · Medical Loss Ratio · Medicare · Medicare Advantage · Payers · Providers · Startups · Value Based CareThe 2025 Healthcare Perfect Storm: How Rising Costs and Increased Scrutiny Impact Insurers
The blog post examines the health insurance industry’s challenges in 2025, highlighting rising healthcare costs, increased patient demand, and heightened government scrutiny. Insurers, particularly those focused on Medicare…
-
Academy · Administrative Work · Business · Calculators · California · California Advancing and Innovating Medi-Cal (CalAIM) · Care Coordination · Data Tools · Finance & HR · Funding · Health Equity · KPI · Managed Care · MCO · Medicaid · Modeling · Providers · Resource · Return on Investment Calculator · ToolkitsUnlock Financial Success with CalAIM: Budget Estimator Tool for CBOs
The CalAIM Budget Estimator Tool helps CBOs navigate the financial complexities of contracting under CalAIM. It offers an Excel-based template with built-in assumptions, cost input fields, revenue customization,…
-
Care Coordination · Data Tools · Finance & HR · Funding · Managed Care · MCO · Outcomes · Providers · Reimbursement · Resource · Return on Investment Calculator · SDoH · Startups · templates · Toolkits · Value Based Care · Value Based Operations · WorkflowsIntroducing the Care MAP Tool: A Comprehensive Guide
Introducing the Care MAP Tool, designed to support healthcare providers in managing complex care needs. This user-friendly, Excel-based tool offers a structured framework for effective care coordination, resource…
-
Data Tools · Databank · Health Insurance Marketplaces · Healthcare Law · Legislation · National · Policies & Procedures · Provider Bill of Rights · Provider Contracts · Providers · Regulation · Resource · State LawsState Policies on Provider Market Power
The Source is a comprehensive platform that monitors and documents various state-level activities related to healthcare prices and competition. It provides valuable resources in the form of legislation…
-
Alternative Payment Models · Innovations · Providers · Reimbursement · Resource · Value Based Care · Value Based OperationsCMS Bundled Payments for Care Improvement (BPCI) Initiative: A Discussion on Bundled Payments
There is a large disconnect between what occurs after a patient is discharged from a hospital (acute) and what occurs thereafter. The quality of care is entirely unmanaged,…
-
Carenodes Behavioral Health Case Management
ETHOS AND PROGRAM DESIGN The central premise of the Carenodes Behavioral Health Case Management (BHCM) Program is to promote collaboration between all treating providers, ensuring coordination between medical…
-
1-Minute Pro Tip: How to Handle Claim Denials from Private Insurance Companies
Before challenging a claim, examine the reason for your denial. The reason for the payer’s denial can be found on the Explanation of Benefits or EOB. In some…
-
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…
-
E&M Coding Advice: Simplified
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…
-
Don’t Lose Revenue With an Outdated Fee Schedule
If you have not updated your practice’s fee schedule for several years, you may be in for some surprises. Carenodes Advisory recommends that you analyze and update your…
-
Sample Letter (SB 418): Paper Claim in Process Over 45 Days (TEXAS MARKET)
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…
-
Funded by Health Net to Expand Telehealthcare
Carenodes network secures funding from Health Net Health Net has grant funded a proposal by Insight Choices, in partnership with Carenodes, to expand virtual healthcare delivery capacity and accessibility. In response…
-
Health Net, Carenodes, and Insight Choices Expand Access to Telehealthcare
Health Net has grant funded a proposal by Insight Choices, in partnership with Carenodes, to expand virtual healthcare delivery capacity and accessibility. In response to the ongoing COVID-19…
-
The Millennial Manager’s ‘Dilemma’​
I had the distinct opportunity to serve as a judge for CSULB’s College Bowl 2020, side-by-side with top industry leaders from Kaiser, AltaMed, medical informatics field, the VA,…
-
How much lip service can we take?
As a longtime healthcare administrator, from managing 28 safety net clinics across CA and TX, to 14 hospitals, over 50 skilled nursing facilities, and 1 national health plan,…
-
Employer Performance Standards for Behavioral Health: A Guide & Sample Standards to Implement
Sample Employer Performance Standards for Behavioral Health Developed by Catalyst for Payment Reform In 2018, based on input from eight purchasers and a subject matter expert, Catalyst for Payment…
-
Employer Performance Standards for Behavioral Health: A Guide & Sample Standards to Implement
Sample Employer Performance Standards for Behavioral Health Developed by Catalyst for Payment Reform In 2018, based on input from eight purchasers and a subject matter expert, Catalyst for Payment…
-
#IBELIEVE in Maternal Mental Health Access: Payer Guidance & Provider Talking Points to Hold Payer Accountable
#IBELIEVE in Maternal Mental Health Access and I will fight alongside you each and every step of the way. Closing gaps in maternal mental health care seems like…
-
#IBELIEVE in Maternal Mental Health Access: Payer Guidance & Provider Talking Points to Hold Payer Accountable
#IBELIEVE in Maternal Mental Health Access and I will fight alongside you each and every step of the way. Closing gaps in maternal mental health care seems like…
-
I’m out-of-network with the payer requesting an audit. What right does the company have to audit my records?
A LOOK INTO (MANAGED) BEHAVIORAL HEALTHCARE: AUDITS A trending issue has popped up in my inbox and I thought I’d take a quick minute to post this crude…
-
Opioid Crisis Response: Key Opportunities and Challenges for Hospitals and Health Systems
On October 24, 2018, President Trump signed H.R. 6 into law. More formally known as the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for…