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Successfully Negotiating Payer Contracts for Value-Based Service

Harold Gibson

The reimbursement landscape is slowly but surely moving from fee-for-service to value-based in response to MACRA’s regulations, with their emphasis on quality of care, and the resulting changes in care delivery, as well as billing and coding. Major players such as Blue Cross and Anthem were reported to have paid close to 60 percent of their 2017 reimbursements through value-based contracts, with other payers moving in the same direction.

With CMS’s goal of fully 50 percent of payments coming through value-based contracts by 2018, its Quality Payment Program also moves this forward through incentive reimbursement based on outcomes. Looking ahead, Medicare payments to practices will either be increased or lowered up to 9 percent depending on value-added merits including outcomes.

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Topics: negotiate payer contracts, Payer Contract Negotiations

Advice for Negotiating with an Insurance Company

Harold Gibson

Unfortunately, there are parts of every job that people would rather leave behind. For many physician practices, this means negotiating with insurance companies. It is no secret that negotiating with different payers can be a major challenge from the time this requires and the revenue implications this entails. For physicians who are looking for ways to either increase reimbursement rates or ensure that bills and claims are paid out as expected, it is important to keep a few negotiating factors in mind.

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Topics: negotiate payer contracts

About this blog

A place for physicians and other healthcare stakeholders to share and discover information about everything related to running efficient medical practices.

Established in 2002 by a group of physicians, we are a national provider of medical billing services to group practices, clinics, and individual physicians. We also specialize in provider credentialing, payer contract reviews, and medical coding for a wide range of clients - from solo practitioners to multi-site, multi-specialty practices.

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