Insurance / Payer Archives

Key Takeaways For Physicians From Value-Based Reimbursement

In the rapidly changing healthcare landscape, payers are asking medical providers to shift from volume-based care; the fee for service to a value-based reimbursement structure. This evolution toward value-based reimbursement benefits the patient, the healthcare provider as well as the payers. Value-based reimbursement encourages healthcare providers to deliver the best care at the lowest cost. […]

Patient Payment Balance – When Should You Move Them To Collections?

Providers place patient balances in the hands of a collection agency when the situation grows out of control. However, opting for debt professionals is not always the best option for a medical practice to retrieve payments. There are ways with which seeking help from outside collection agencies can be avoided without causing harm to cash […]

How ‘Malpractice Insurance’ Can Save You From Drowning Financially During Malpractice Law Suits

Physicians, who are generally known for highest professional integrity, often have to live with the tag of ‘malpractice’ despite clinical errors being unintentional. While patients’ have every right to get indemnified for the grievance, physicians’ sole choice of protection against monetary liability – which may vary from few thousand to many thousand dollars depending on […]

Solving the ‘Secondary Insurance’ puzzle at your medical practice

Care providers encounter patients with more than one level of health insurance coverage – a secondary insurance to complement primary insurance. While secondary insurance has considerably reduced patients’ out-of-pocket expenses and facilitated treatment plans outside primary coverage, billing for two-levels of insurance coverage has not been that easy. Even as certain secondaries to Medicare are […]

Negotiating Justifiable Contract with Health Insurance Companies

Care providers operate in an environment characterized by multiple payors – Medicare, Medicaid, and a host of private health plans. The prevalence of such multi-payer is reason enough for differences in rates at which care providers are reimbursed despite the clinical procedures more or less being the same. Adding to this heterogeneous payor-environment is the […]

Navigating Through a Multiple Payer Environment – Providers’ Perspective

Healthcare delivery in the United States of America has come a long way from cash-based to insurance-backed. Currently, over 85% of the nation’s residents have health care plans either through employers’ private pools, private companies, the veterans’ health administration, the children’s health insurance program and Medicare/Medicaid/TRICARE. While insurance payers (whether Federal or private) essentially cover […]

single payer system vermont

Vermont: State with Single payer system “Single-payer health system” which was passed in May 2011 by the Vermont governor, expects to accumulate savings of 24.3% of total health expenditure between 2015 and 2024, according to Harvard economist William Hsiao. Vermont is to be the first state in USA to implement this system, which will move […]

Better Payer Interaction for Physicians

Payer interaction plays a crucial role in ensuring that physicians receive payments in a fair and timely manner. Medical billers and coders who interact with payers need to stay current with major payers (insurance companies, employers, or the government) in order to make sure that errors and delays can be avoided. The changes in the […]

US Physicians’ Administration Costs Four Times Higher Than Single-payer Healthcare Providers

Going by a recent survey by the researchers with Cornell University and University of Toronto – which has unearthed alarming fact about relatively higher administrative costs in the United States: physician practices incurring nearly $83,000 in administrative costs per physician each year, nearly four times the amount spent by their Canadian counterparts – it is […]

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