Strategic Healthcare Partners, LLC

Why is Managed Care Contracting most essential to your revenue stream? Contract language and reimbursement rates are the driving force behind a payer’s payment structure. Charge levels, charge capture, clinical coding, as well as billing, payment posting, and appeal processes affect overall reimbursement. Additionally, aging managed care contracts may lack mechanisms that allow for appropriate reimbursement for new services, new locations and chargemaster increases. Learn more below!

MGMA Stat for today regarding physician engagement. How often are your providers surveyed on satisfaction? #providersatisfaction

A Summary of Best Practices for Provider Enrollment Provider enrollment is what we often refer to as the offensive lineman of healthcare. No one knows or appreciates the function until there’s an issue. And in this case, a revenue stream issue. Basically, PE is a critical revenue cycle process that must exist in most healthcare settings, that verifies a healthcare professional is authorized to deliver appropriate service. And as a result, receive reimbursement from carriers, including Medicare, and Medicaid. In a proactive manner, igniting an efficient process is essential for maintaining proper healthcare delivery and preventing the providing from any disruption in care. Click the link in the comments to see some PE best practices that healthcare organizations can use to assess or implement to hopefully improve their respective process.

ABC’s of Managed Care Contracting In its most simple form, managed care contracting is a business agreement between insurance companies and other managed care organizations, and healthcare providers where a few items are defined and agreed upon: 1) How providers will get paid for the services provided to their patients by those patients and by their insurance 2) what services will be covered under insurance 3) And requirements like prior authorization, referrals, etc. Click below to learn about a few key elements for a successful negotiation.

What is Clinical Integration(CIN)? In 1996, the DOJ and the FTC defined CI as an active and ongoing program to evaluate and modify practice patterns by the CI network’s physician participants and create a high degree of interdependence and cooperation among the physicians to control costs and ensure quality. Learn more below!

QPP Website Update. https://qpp.cms.gov/ For those participating in the Quality Payment Program, CMS has updated its QPP site, including quality measures, MVP criteria, and other helpful resources for your organization. #QPP

Why should you join an IPA? First off, what is an IPA…? An Independent Physician Association (IPA) is a legal entity that is a collection or network of independent doctors who come together to contract with carriers or employers, exchange best practices to improve overall practice management, group purchasing organizations benefits, all while maintaining full autonomy. No billing practices are altered, while also benefiting from such shared resources. Click on the link below to learn about more benefits of being an IPA member.

Do Your Financial Processes and Respective Toolbox Include Effective Analytics of Your Revenue Cycle? Revenue cycle analytics is vital in improving overall financial outcomes for any provider setting. By harnessing internal systems for furthering your data insights, organizations can reduce inefficiencies and maximize revenue generation while enhancing patient satisfaction streamlining operations. Click below to find out the key components of revenue cycle analytics!

Why is Managed Care Contracting most essential to your revenue stream? Contract language and reimbursement rates are the driving force behind a payer’s payment structure. Charge levels, charge capture, clinical coding, as well as billing, payment posting, and appeal processes affect overall reimbursement. Additionally, aging managed care contracts may lack mechanisms that allow for appropriate reimbursement for new services, new locations and chargemaster increases. Learn more below!

What is your definition of a Team? Well ok, maybe we’re not talking about that Team. But rather, the Medicare TEAM - Transforming the Evaluation and Management of Surgical Care program that is a mandatory initiative by CMS. Its core objective is to improve coordination between hospitals and post-acute care providers for surgical patients. It requires hospitals to communicate and work more closely with post-acute care entities to improve patient outcomes and streamline the transition of care. This will involve the sharing of treatment plans, patient information, and implementing standardized protocols across care settings. Goals from such collaboration include the reduction of readmission rates, prevent complications, and improvement of overall patient satisfaction. Such partnerships encouraged include skilled nursing facilities, home health agencies, and rehabilitation centers. The mandatory language emphasizes the ongoing attempt by CMS to improve quality and efficiency on a national scale. Such requirement also allows CMS to collect data on best practices and effective strategies for care coordination. Through this initiative, CMS seeks to improve patient outcomes, reduce healthcare costs, and promote a more integrated approach to surgical care delivery.