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Tag: Healthcents


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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Smart Talk

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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Smart Talk

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

Osceola Capital acquires Healthcents

January 9, 2020HME News Staff

TAMPA, Fla. - Osceola Capital, a private equity firm focused on services businesses, has acquired Healthcents, Inc., a provider of medical reimbursement and related services. Founded in 1994, Austin, Texas-based Healthcents consults small and medium healthcare providers across the United States on payer portfolio and growth strategies by strengthening or entirely outsourcing traditional managed care departments. “Healthcents has successfully positioned itself as a leader in the highly complex...

Healthcents, Osceola Capital


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Editorial

Five ways to break down bureaucracies to get payer contracts

July 25, 2019Guest Commentary

It is important to remember that payers are large companies, with protocols, policies and business practices. As with any large company, there are bureaucracies, and they are necessary to maintain the order and success of these organizations.   Therefore, the first tip is to understand that to get contracted you need to identify the right department and right person to send your request to get contracted. This is usually the payer contracting department and payer contracts' manager. Generally,...

Healthcents, payer contracts, Steve Selbst


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Editorial

Three key items to negotiating successful payer contracts

June 26, 2018Guest Commentary

The purpose of this article is to help you, as a provider, to hone in on three key items to look for in payer contracts that will help you to get profitable contracts in place. The three key areas that we will examine are fee schedule amendments, lesser of billed charges vs. contracted rates; term and termination without cause; and claims' payments.Fee ScheduleFee schedules sometimes are RVU based or based upon a percentage of Medicare or based on a percentage of a payer's proprietary fee schedule....

Healthcents, insurance, payer contracts, Steve Selbst


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Smart Talk

Contracting: Understand different programs

January 3, 2017Steve Selbst

A. Most HME providers understand that the Department of Veterans Affairs provides healthcare services nationwide for America's veterans and that in addition to having facilities across the country, the VA has additional methods to provide timely, high quality care to veterans.What providers may not understand is that there are three contracting options available to them. First is Patient-Centered Community Care (PC3), a program for active duty, retirees and their families, that increases access to...

Healthcents, Steve Selbst, VA contracting


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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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Smart Talk

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:ē 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.ē Termination for cause. You want to make...

contracting, Healthcents, Steve Selbst


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