Reimbursement
20 Sep 2022
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 transitioning to “value-based” payment. Reimbursement methodologies may include the following:
3 Aug 2021
Managed Care Contracts and Health System Operational Alignment
CASE EXAMPLE of how we breakdown contracts and tie the terms to operational alignment Because the...
28 Oct 2020
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 cases, the denial may have been caused by a clerical error such as an incorrect CPT code, a missing signature, or another simple oversight.
15 Oct 2020
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 partnership with providers (medical and non-medical, behavioral, primary, substance abuse, and others), we have developed (and are growing) community-wide coalition efforts geared towards addressing larger systemic health, infrastructure or social determinant issues with a large impact on health.
15 Oct 2020
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 methodologies, rate changes, pricing, payor mix shifts and ever changing regulations on margins, rather than net revenue alone.
30 Sep 2020
Digital Therapeutics and Healthcare Reimbursement
Many digital therapeutics (DTx) providers are working to obtain reimbursement from U.S. payers. The following post...
30 Sep 2020
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 specific benefits.
4 Sep 2020
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 nature, E&M services are a diverse set of cognitive procedu
4 Sep 2020
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 nature, E&M services are a diverse set of cognitive procedu