Hospitals and other health care providers work hard to eliminate billing and coding errors, but mistakes still happen. When those mistakes occur, health plans sometimes try to capitalize on the error by using it as a basis to...more
Commercial health plans have made numerous policy changes in response to the COVID-1 pandemic, some of which were done in response to mandates issued by state and federal governments, and others in response to pressures being...more
As employers look for new ways to control healthcare costs and provide innovative healthcare offerings to their employees, employers are starting to consider the “direct-to-provider” contracting model as a way to achieve...more
As we approach the end of the year, many providers are in the process of negotiating renewals of their network contracts with health plans. Below are a few “best practices” ideas for providers to consider as they approach...more
California’s Department of Managed Health Care, which licenses and regulates HMOs and certain PPOs in California, is promulgating a new regulation that will require healthcare providers that enter into certain types of risk...more
Payers are increasingly establishing purported “site of service” policies and guidelines that restrict the circumstances under which members may obtain certain services at hospital outpatient departments (HOPDs). In the...more
Many commercial health plans’ template agreements with network providers incorporate a separate “provider manual” into the agreements. These provider manuals address a range of issues that are critical to providers, such as...more