ECBM Insurance Brokers and Consultants的动态

"The main difference between a healthcare capitation program and a fee-for-service model is in the way that payment is made. In capitated payments, healthcare providers are paid based on how many patients they see over a period of time. In fee-for-service, however, healthcare providers are paid based on the quantity of services, screenings, tests, or procedures carried out during the course of treatment. Historical fee-for-service information provides the basis for defining capitation models." https://lnkd.in/dvMuvDQR. #HealthInsurance #Capitation #FeeForService

?? Healthcare Trends Alert: Payer-Provider Contract Negotiations Heating Up ?? In today's rapidly evolving healthcare landscape, contract negotiations between payers and providers are becoming increasingly contentious. With rising expenses and claim denials, both sides are feeling the pressure to secure favorable terms. But how does this impact patient care, reimbursement models, and the financial sustainability of healthcare systems? ?? Check out this insightful article, "Payer-provider contract negotiations are getting nasty amid rising denials, expenses," to understand the key challenges and strategies involved in navigating this complex dynamic. ?? #Healthcare #PayerProviderRelations #ContractNegotiation #HealthcareCosts #HealthcareBusiness #PatientCare #RevenueCycleManagement #USHealtcare #provider

The healthcare industry utilizes a concept called the 80/20 rule. This rule mandates that insurance companies spend at least 80% of premium dollars they collect on medical care and activities aimed at improving the quality of care. On the surface, this seems like a positive step towards ensuring resources are directed towards patient well-being. However, the remaining 20% allocated for administrative costs and profit can create an unintended consequence. There may be a disincentive for insurers to actively manage healthcare costs since they're already obligated to spend a significant portion on medical care. In some scenarios, insurers might prioritize reaching the 80% spending threshold to maximize their profit margin, potentially leading to increased overall healthcare spending. Moving forward, a deeper understanding of the 80/20 rule's potential drawbacks is crucial. We need further healthcare reform efforts that address these loopholes and establish a system that prioritizes both cost-effectiveness and high-quality care for patients. NGA Healthcare | ngahealthcare.com | (520) 333-2076

"?Rather, the U.S. healthcare system is structured in ways that often can allow for, and sometimes even encourage, questionable billing practices. One example is “upcoding,” where medical charts are coded to reflect a sicker patient or a higher level of service than what actually occurred, resulting in greater reimbursement for the hospital or medical group. It is estimated that in 2019, compared to 2011, upcoding practices were linked to?$14.6 billion?in additional hospital payments, with the largest share, $5.8 billion - coming from private health plans."

Independent healthcare providers face significant challenges due to a lack of payer transparency. Understanding and addressing this issue is crucial for ensuring timely and accurate reimbursements, which support the sustainability of independent practices. Learn more about the importance of payer transparency and how it can improve the financial stability of healthcare providers in our latest blog post. ???Read more: https://bit.ly/3YsNRbI #Healthcare #PayerTransparency #MedicalBilling #HealthcareFinance #IndependentProviders #RCM #HealthCareChallenges #AdvantumHealth

Reminder?? Check Out Our Latest Launch – “Payers Hold the Keys to the Healthcare Kingdom." Have you explored our latest insights that break down the essential role insurance companies, or payers, play in funding the U.S. healthcare system? With $4.8 trillion in healthcare spending last year, there’s more to uncover about the true size of the market and its opportunities. Don’t miss out—read the full article here:

A recent study reveals a dramatic drop in public trust in US healthcare providers—from 71.5% in April 2020 to just 40.1% in January 2024. This trend, unique to the US, points to systemic issues in our healthcare system. Key factors contributing to this erosion of trust: Lack of price transparency; Complex, often incomprehensible hospital bills; Inconsistent insurance reimbursement models. We can do better! What do you think is the most crucial step in rebuilding trust in our healthcare system? #HealthcareReform #PriceTransparency #PatientTrust Erosion in Trust is the Real Healthcare Crisis — Capital Pulse for Medical Receivables Finance https://lnkd.in/eXgFYmXp

Our recent research reveals how healthcare payers can improve member satisfaction with digital features like transparent billing, condition management and Medicaid-specific services. https://cogniz.at/3Ri8oey

Can cash-based healthcare benefit both patients and physicians? Read this latest article where Founder and CEO Satish Srinivasan shares insights about the healthcare industry in America. #Healthcare #DiRxhealth Know more: https://bit.ly/4cXyXxK

Patients deserve care. Providers deserve payment. Insurance shouldn’t stand in the way. Discover how Arrow is bringing transparency to healthcare payments. #HealthcareInnovation #RCM #HealthcareRCM