Distributed Healthcare Intelligence
Get in-network, get paid correctly, and know what changed.
Plain-language analysis of payer contracting, credentialing, managed care and reimbursement, linked to the primary sources.
Latest analysis
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Alzheimer Care Coordination Payments
Alzheimer’s care coordination payments are financial incentives or compensation provided to healthcare providers or organizations to coordinate the care and support for individuals with Alzheimer’s disease or related…
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Environmental Scan on Care Coordination in the Context of Alternative Payment Models (APMs) and Physician-Focused Payment Models (PFPMs)
This environmental scan was prepared at the request of the Office of the Assistant Secretary for Planning and Evaluation (ASPE) as background information to assist the Physician-Focused Payment…
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Business ยท Connected Care ยท Contracting ยท Databank ยท Digital Therapeutics ยท Funding ยท HEDIS ยท Managed Care ยท Payers ยท Press ยท Reimbursement ยท Startups ยท Subcontracting ยท Value Based Care ยท virtual health ยท Virtual Specialty CareHealth Insurance Providers’ Actions Concerning Mental Health
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New Jersey Health Care Quality Act (HCQA) and Provider Bill of Rights
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…
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Toolkit Managed Care Resource
The Managed Care Legal Database is a resource identifying how state and federal statutes and regulations address many issues that may occur between private payers and physicians, such…
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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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Alzheimer disease and related dementias (ADRD), ยท Cardiovascular ยท ccm ยท Chronic Care ยท Depression ยท Diabetes ยท HypertensionWho Qualifies for Chronic Care Management Services
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…
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Medicare Advantage Is Close to Becoming the Predominant Way That Medicare Beneficiaries Get Their Health Coverage and Care
As Medicare Advantage continues to grow, a gradual but significant reshaping of the Medicare program is taking place. A new KFF analysis finds that nearly half of eligible…
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Thoughts from Alex Yarijanian and Carenodes outcomes
Healthcare Startups take too long to go to market hence innovations do not get to the American people in a form and fashion conducive to the aims of…
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Changing Demographics & Value Based Care
The United States is going through a fundamental shift in its demographics. By 2035, there will be more seniors than children under the age of 18.
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CARES Act ยท Digital Therapeutics ยท Hospital Readmissions Reduction Program ยท Post-Discharge Follow-Up
CARES Act Telehealth Expansion: Trends in Post-Discharge Follow-Up and Association with 30-Day Readmissions for Hospital Readmissions Reduction Program Health Conditions
CARES Act Telehealth Expansion: Trends in Post-Discharge Follow-Up and Association with 30-Day Readmissions for Hospital Readmissions Reduction Program Health Conditions
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Healt Plan Leaders’ Statements About VBC
โThe patient-centered medical home has served as a catalyst and organizing philosophy to refineย our state care delivery system. It has brought stakeholders from both the public and privateย sector…
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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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Changing Demographics & Value-Based Care
Changing Demographics & Value Based Care The U.S. is stuck in a system of volume-based (fee-for-service) care that continues to drive up costs without providing better outcomes…
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Improving Payment Accuracy In Health Insurance Marketplaces๏ฟผ
In all three countries studied, risk adjustment leaves some enrollees highly underpaid and others highly overpaid. In the U.S. exchanges, for example, one in a thousand enrollees were…
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Biofourmis Launches Its Chronic Condition Management Platform
The Biofourmis Care platform currently supports five virtual care programs: heart failure, hypertension, diabetes, lipid management, and atrial fibrillation. The technology platform facilitates care coordination across care settings…
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No Surprises Act
On January 1st, 2022, the No Surprises Act went into effect and it provides federal protections for patients from surprise medical bills.
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Prescription digital therapeutics (PDTs)
Prescription digital therapeutics (PDTs) are software applications that are prescribed by a licensed healthcare provider.
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Digital therapeutics (DTx)
Digital therapeutics (DTx): Deliver therapeutic, evidenced-based interventions driven by software to treat, manage, and prevent a broad spectrum of behavioral, mental, and physical diseases and disorders.
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Talking about Mental Health at Work
Tools and Partnerships to help your organization raise awareness, reduce stigma surrounding mental illness, and facilitate help-seeking behavior. MENTAL HEALTH @ WORK Treatment can help people feel better…
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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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Nurse Practitioners Sentenced to Prison for Health Care Fraud
GREATย FALLS โ Two Montana nurse practitioners have been sentenced for conspiring to defraud Medicare of millions of dollars.ย Chief U.S. District Judge Brian Morris sentenced Janae Nichole…
Browse by topic
Payer contracting
Fee schedules, assignment clauses, termination terms and negotiation.
Reimbursement & billing
Underpayments, denials, appeals and the contract terms behind them.
Managed care
HMOs, MCOs, capitation, Medicaid and Medicare Advantage.
Value-based care
Alternative payment models, ACOs and VBCA Podcast recaps.