Archive for June 11th, 2010

Hospital Reimbursement Models

Friday, June 11th, 2010

This article walks you through three hospital reimbursement models; Cost based reimbursement (cost plus), prospective payment and capitation – http://www.itdl.org/Journal/May_09/article03.htm

Top Ten Lies

Friday, June 11th, 2010

1. Hospitals lose money on Medicare patients

2. PPO discounts are meaningful

3. Fee Based Insurance Consultants are Not Biased

4. Health Insurance Companies Make Enormous Profits

5. Physicians are Good Businessmen

6. PBM Contracts are transparent

7. Insurance Agents and Brokers Work in the Best Interest of their Clients

8. Stop Loss Carriers Pay According to ERISA guildlines

9. Most Contracts Do Not Contain Evergreen Clause

10. ObamaCare will Lower Health Care Costs

Daily Quiz

Friday, June 11th, 2010

We have received a confidential memorandum from a Texas hospital that stipulates a major health insurance company operating within the state pays out-of-network hospitals Medicare +20%.  Which health insurance company does this:

_____Aetna _____Blue Cross _____Cigna _____ United Healthcare _____ Humana _____ Shifting Sands Mutual

3 Texas Hospitals Agree to Cost-Plus Reimbursement Methodology

Friday, June 11th, 2010

Three Texas hospitals, independent of each other, have agreed to accept cost-plus reimbursment provided on in-patient and out-patient services for their own employee benefit program. Hospital employees who seek medical treatment at hospitals other than their own, will have their claims priced at cost-plus 12%.

These three hospitals see the value of cost-plus. Most consumers would agree that a 12% profit margin is fair and reasonable.