Topic
Reimbursement
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From HMOs to Homerooms: What Managed Care 101 Teaches Us About California’s Youth Behavioral Health Reform
HMO, PPO, EPO, capitation, value-based care — see how these managed care basics play out in real life through California’s CYBHI Fee Schedule program and its Evaluation Hub…
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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…
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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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Managed Care Contracts and Health System Operational Alignment
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,…
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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,…
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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…
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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…
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Digital Therapeutics and Healthcare Reimbursement
Many digital therapeutics (DTx) providers are working to obtain reimbursement from U.S. payers. The following post discusses stategy for reaching patients and partnerships. A reputable DTx company will…
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Physical Therapy Referrals: Not Needed
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…
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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…
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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…
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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…
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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…
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Health and Behavior Assessment and Intervention Codes vs. Psychotherapy
The Health and Behavior Assessment and Intervention Codes vs. Psychotherapy: How Codes and Reimbursements Differ
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Health Behavior Assessment and Intervention Reimbursement Guidance: both Money and Preventive Care Opportunities on the Table
Health Behavior Assessment and/or Intervention (HBAI) “Health and Behavior Assessment procedures are used to identify the psychological, behavioral, emotional, cognitive, and social factors important to the prevention, treatment or…
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Documentation and Billing of Mental Health Services: Incident – to Billing
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…
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Rates: Health Behavior Assessment Services Assessment or Reassessment Reimbursement Table
Health Behavior Assessment Services Assessment or Reassessment Reimbursement Table
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Physical Therapy Incident-to Billing Guidance
Evaluation and Management Coding for Physical Medicine and Rehabilitation Incident-to services are services performed that are integral to and an incidental component of the physician’s professional services in…