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Tag: Contracting


Also Noted

AAH advocates in several states

February 23, 2021HME News Staff

In Pennsylvania, AAHomecare is working with PAMS and other stakeholders to address concerns about Tomorrow Health. Tomorrow Health is performing double duty as a provider and a third-party administrator for Geisinger Health, raising concerns that the arrangement could impact patient choice and continuity of care for individuals covered under Geisinger’s Medicaid contract, as well as Medicare Advantage and commercial plans in the state. Providers in the state have seen a significant...

aahomecare, Contracting, Pennsylvania Association of Medical Suppliers (PAMS), Tomorrow Health


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Smart Talk

Contracting: Tailor your message

August 12, 2020Armando Cardoso

Q. How do I convey a compelling value proposition to payers? A. There are five critical questions to answer when creating a compelling value proposition to payers.How can I tailor my message to fit a payer's perspective?Like you, insurance is a business and has goals. You want to tailor your message to show how your organization supports their goals. Maybe emphasize if you have been declining their members, have a unique offering, or a geographic/customer service advantage. Do you lower the total...

Armando Cardoso, Contracting, Healthcents


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Smart Talk

Contracting: Know your strategy

July 9, 2020Armando Cardoso

Q. What questions do I need to answer before contracting?A. More contracts do not equal more value. Before you get started, ask the right questions, make a plan and be prepared to follow-up.Who are your patients today and are you expanding your services in the future?There are two key dimensions to consider: geography and your patient's insurance mix (Medicare, Medicaid, commercial, etc.). These factors will be the foundation of your payer strategy.Who else provides the same service(s) in your area?Payers...

Armando Cardoso, Contracting, Healthcents


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Contracting: Understand contract terms

June 10, 2020Armando Cardoso

Q. What do I need to know when it comes to my managed care contracts? A. Unfortunately, there's no Rosetta Stone for payer contracting. You need to understand operational and strategic terms that can have a meaningful implication on your organization and financial performance. We've outlined five critical contract terms that need to be understood for each of your payer contracts.Term & terminationYou want to maintain your options, as this allows you to get out of unfavorable situations or pursue...

Armando Cardoso, Contracting, Healthcents


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Contracting: Consider three key questions

May 13, 2020Armando Cardoso

Q. What should I consider before renegotiating payer contracts?A. Renegotiations don't need to feel like you're facing Goliath—you've got more than a slingshot and it's not one-on-one combat. We've outlined three critical questions that need to be considered for the right contracts to be prioritized.What are your organization's goals and how can you negotiate to support them?More money is a core goal, but it's not the whole story. You should identify how each potential payer negotiation could...

Armando Cardoso, Contracting, Healthcents


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Also Noted

People news: Leadership changes at VGM

December 6, 2017HME News Staff

WATERLOO, Iowa - VGM & Associates has announced that Scott Owen will transition from vice president of sales to vice president of contracting. In his new role, Owen, who has been with VGM for three years, will have oversight of the vendor contract division. Taking Owen's spot as vice president of sales: RJ Meyer, previously with Biotronik Cardiac Rhythm Management. He will lead VGM's regional account managers and member services team. “I'm excited to announce these changes to our team,”...

Contracting, People news, RJ Meyer, sales, Scott Owen, VGM


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News

Legal landscape: M&A, managed care top hot spots

October 6, 2017Liz Beaulieu, Editor

YARMOUTH, Maine - With increased complexity in the HME industry, comes increased legal ground to cover, say healthcare attorneys, particularly in the areas of mergers and acquisitions, and managed care.In M&A, Jeffrey Baird has seen an increasing number of companies selling their stakes in certain geographic markets or certain product categories, or terminating their competitive bidding contracts.In the case of the former, providers must alert the CBIC and make plans to transition their patients...

Competitive Bidding, Contracting, Jeff Baird, M&A, Neil Caesar


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Also Noted

Home infusion providers make gains

December 2, 2016HME News Staff

MedTrakRx, a pharmacy benefit manager, has selected ARJ Infusion Services, a specialty pharmacy, to provide home infusion therapies to patients with complex, rare and chronic conditions. ARJ will be responsible for providing pharmacy and infusion nursing services to MedTrakRx members with hemophilia, immune deficiencies, inflammatory disorders and neurological conditions. The annual cost of therapies to treat these conditions ranges from $35,000 to more than $400,000…Option Care Enterprises, a national...

ARJ Infusion Services, Contracting, Home Infusion, Option Care


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Smart Talk

Contracting: Set your chargemaster

November 30, 2016Steve Selbst

A. One of the most common and often misunderstood potential hazards in payer contracts is the “lesser of billed charges” language found in almost all contracts. This language is usually worded like this: “Health insurance company will pay provider the lesser of its billed charges or its payer contracted rates for each code's reimbursement.” What does this mean exactly?It means that, for example, if your payer-contracted rate at 100%, including patient co-payment, is $110 for...

Contracting, Healthcents, Steve Selbst


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Contracting: Beware these contract pitfalls

October 21, 2016Steve Selbst

A. In addition to contracted rates, there are key items often found in payer contracts that can significantly affect and often reduce reimbursements. Here are a few to look for:• Retrospective review. Watch out for clauses limiting the amount of time the payer can review paid claims for mistakes (and overpayments). A time limit for a retrospective review could prevent you from having to pay for indefinite claims errors on the part of the payer.• Termination for cause. You want to make...

Contracting, Healthcents, Steve Selbst


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