Insurance Company, Inc.: Simply The Best Insurance Negotiation

Rather than having the other claims adjusted, the provider insisted that we not look into the matter further because they did not want us to take back any money. Sadly this is just one example of fraud; it is not uncommon to see providers change the coding of claims to get something that they know should not be paid to process for payment. Cracking down on this type of fraud will reduce the amount of money paid out on claims by insurance carriers. Since claims payments directly affect the cost of insurance, this will also help in lowering premiums.

It is essential for an administrator to understand how private and government payers impact actual reimbursement. Government payers have a standardized benefit structure. The one benefit is that registration staff have an easier time calculating payment due (copayments) for service and can set up payment arrangements. Since the most significant proportion of funds coming into a healthcare organization is usually payments from third-party payers, therefore, it is critical to know how each reimbursement affect the others that come in. Healthcare organization may have hundreds of different payer’s relationships in the form of different contracts that have their own rates of payment that are usually different from other payers for an identical

Once the patient comes through the door payment for services should be top of mind. All copayments and deductibles collected and any other non-covered expenses billable to the patient. The correct information is gathered and if all is handled initially properly within in the cycle the claim can go the workflow and payment received with minimum effort by human hands.

The patient is informed about their coverage and the amount of copayment they would have to pay.

You have open access to indemnity insurance. You have the right to choose your PCP and it doesn’t matter what your insurance may like. This makes things very convenient considering many people go to the same doctor for the vast majority of their life and solely rely on them for their treatment or care.

“the contractor shall further insure that all medical, dental, and mental health services are secured from a Medicaid approved provider and that charges for services shall be at the Medicaid approved rates. If no Medicaid provider is available the contractor must make every

|  Re-imbursement for the insurance. If the paper work is not right it will affect billing and can create major problems.

Closing out the meeting was John Connolly who serves as Associate Director of Insure the Uninsured. Connolly detailed the Covered California healthcare exchange as a commercial insurance provider. Connolly spent the majority of his time speaking addressing the improvements to coverage, and eligibility changes to applicable California residents. Making a repeated and substantial effort to state how the commercial insurance exchange would work, Connolly showed the various healthcare providers that would be available to certain individuals, and an estimation of the average cost per provider. The most significant aspect of Connolly’s presentation was his outline of the new health insurance plan tier levels, ranging from “Bronze” to “Platinum”. Bronze tier coverage represented the tier with the smallest amount of payment made by the plan and highest amount of payment made by the consumer, and Platinum tier coverage representing the highest amount of payment made by the plan and lowest amount paid by consumer.

The fee-schedule is the second component of the payment-determination basis, in which fees are pre-negotiated and have no correlation with the provider’s cost. For example, Medicare uses a fee schedule to

1. Should the information pertaining to actual claims incurred as of B/S date that became available after the B/S date be considered in determining management’s best estimate of the medical benefits payable? If so,

After reading over the material in chapter 14, it is my opinion that selective contracting should not be allowed to exist between providers and payers. Utilizing selective contracting puts both the payer and the provider in a position to possibly limit the quality of care actually needed by the patient for their own benefit. This benefit doesn’t necessarily have to be in the form of a financial gain, but could merely be in the form of a financial security. Selective contracting appears to place of great deal of power within the hands of the payer, who now has the power to control fees charged by providers, through controlling which providers make it on their list of in plan providers.

For every healthcare organization, contract negotiating is a very important step in the financial strategy, and both parties go through the negotiation process such as research, preparation, cooperation, and settlement to reach an agreement. They are two fundamental factors in this process: revenues and risks, where all organizations wanting to make a profit and in the mean time protecting themselves from any wrong action that could happen in the future. However, “successfully negotiated contracts cannot only preserve revenue but yield additional dollars through new insurance product and models” (hmfa.org). Also, the strong contract provides easier access to all services and result in an increase in the patients’ satisfaction. In addition, “the more an organization solidifies its own expectations for contract negotiating and appreciates the needs of the payers, the more likely it is to reach an acceptable agreement” (hmfa.org). Personally, as a member of the contract negotiating team working on renegotiating a 3-year contract with the Yellow Patriot Health Insurance Company, we have to pay close attention to all terms and conditions and reshape the contract to perfectly fit our organization needs. First of all, we have to choose the best team for this negotiation. Second, demonstrate why we are the best and why it is a gain for the insurance company to pick us. Third, we should request the highest reimbursement. Fourth, we have

Having quality health insurance correct to meet your needs is vital to ensuring that you may have a healthy body.The following article below with provide you with strategies for obtaining and maintain medical insurance.

Medical malpractice insurance is a type of professional liability insurance purchased by health care professionals (and sometimes by other types of professionals, such as lawyers). This insurance coverage protects health care providers against patients who sue them under the claim that they were harmed by the physician's negligent or intentionally harmful treatment decisions. Premiums are usually based on the physician's specialty and geographic location but not on claims experience. This means that even if a physician has never been sued, he or she can end up paying extremely high premiums. The premiums can become high because of factors such as amount of coverage needed, claims severity, claims frequency, location of practice and laws in

You're right. Normally, if the insurance doesn't pay, the answer is yes, the patient will have to take the full responsibility for it.