Day: July 7, 2015
Phia Group – Claim Negotiation & Sign Off – Case Study
“The provider, as is the case with many, initially told us that it was not interested in negotiating at all….”
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The Employer-Led Health Care Revolution
Intel was rigorously managing its equipment suppliers but not its health care suppliers…….Intel decided it could use its purchasing power in markets where it had operations to influence health care players—care providers, health plan administrators or insurers, and other employers—to rise above their competing self-interests and work together to redesign the local health care system….
Assuring Hospital Emergency Care Without Crippling Competition
“Emergency departments are often more profitable than hospitals admit, as they are the source for roughly half of inpatient admissions. Patients admitted in emergency situations are rarely price-conscious, and revenue from ED admissions is often counted as part of subsequent inpatient stays. Furthermore, as non-urgent cases presenting in the ED are often relatively cheap to treat and well-covered by ED reimbursement rates, hospitals lack the incentive to redirect them to cheaper sites of service.”
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Appropriate Use Of Reference Pricing Can Increase Value
“The U.S. Department of Health and Human Services has interpreted reference pricing as consistent with the principles of the Affordable Care Act when implemented by large, self-insured employers, and has adopted a salutary wait-and-see stance.”
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