“Finally Friday!” Winning 2MN Rule & Other Arguments with Payors

FRIDAY May 8, 2015:

2 Midnight Rule Wrinkles:

Winning Arguments with Payors

Get for the Handouts

Hopefully, your "discussions" with Payors don't look like this, except while daydreaming. We offer some better solutions on this show.

Hopefully, your “discussions” with Payors don’t look like this, except while daydreaming in the shower. We offer some better solutions on this show.

Yes, Virginia, it is possible. Despite the fact that the deck is often unfairly stacked against the providers in contract negotiations with payors, it is possible to sometimes turn the tables on a payor and make them pay a claim, if not in a truly appropriate manner, in at least a manner that coincides with the contract your hospital was coerced into signing agreed to sign, for the high privilege of treating the payor’s insured/beneficiaries, and the even higher privilege of sometimes actually being paid to do so. (Eventually, that is.)

Although we spend quite a bit of time discussing nuances and what I call “wrinkles” in the day-to-day scenarios experienced in hospitals nationwide, our purpose is not to merely find a way to get paid – although that is a valuable talent, even if management is not exactly appreciative of it. The point of our discussions is to USE those scenarios to find a way to avoid audits and denials by identifying and patching, as it were, the potholes in your hospital’s systems, processes, workflow and thought patterns that lead to those audits and denials, which are very often the fault of the whole reimbursement system in the first place.

Whence, this show is no outlier…

We’ll be reviewing the following:

  • How United Healthcare screws up Part C admissions,
  • What you can do to avoid that mess,
  • A Real-World Example of how to Make Your Payor Pay,
  • A recent Federal Court decision on proper judgement of medical necessity.

Joining Sharon Easterling and I on the show will be Dr. Ron Hirsch of Accretive, Chris Baggott of Medlinks Cost Containment, and Dr. Steve Meyerson, now the Blog Meister for the American College of Physician Advisors (ACPA).

Come listen in !

Handouts for This Week's Show

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REPLAY of This Week's Show

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