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Outpatient Surgery E-Weekly

Contact Congress Over Drug Shortage Issues

A Kentucky congressman is urging surgical facilities to contact their members of Congress and request that they sign his letter demanding changes to...

N.J. Posts ASC Inspection Reports Online

State and federal inspection reports of New Jersey's ASCs are now available online, giving patients an opportunity to make more informed choices abo...

Are Opioids Necessary?

While it's not always practical, or even possible, to eliminate opioids from your post-op pain management regiment, reducing their use in favor of n...

Archive >  Surgical Construction 2006

Speaking the Language of Managed Care

A review of the terms and hidden meanings you need to know to analyze and negotiate payer contracts.

I. Naya Kehayes, MPH

Here's a rundown of some key concepts you'll need to understand in order to effectively negotiate payer contracts for your surgery center. Over the next few pages, we'll cover contract language, reimbursement methodology, contract valuation, payer relationships and negotiating strategy.

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Categories: Code/Bill/Reimburse, Business Management, Legal/Regulatory
Keywords:
Contract language; Assessing the Value of the Contract; Reimbursement rates and methodologies; Negotiating fundamentals; Average; CPT; Check; Claims; Compare; Contract There's; Define; Educate; Eliminate; Favored; I. Naya Kehayes, MPH Reimbursement; Kehayes, MPH Reimbursement; MPH Reimbursement; Medicare; Naya Kehayes, MPH Reimbursement; Negotiating; On-site; Payers; Seek; Success; Termination; Total; access; accessing; accounting; acquainted; address; adequate; administer; advantageous; afraid; ambulatory; amenable; anniversary; annual; appeal; assess; assigned; attain; avenue; average; based... show all keywords
Contract language; Assessing the Value of the Contract; Reimbursement rates and methodologies; Negotiating fundamentals; Average; CPT; Check; Claims; Compare; Contract There's; Define; Educate; Eliminate; Favored; I. Naya Kehayes, MPH Reimbursement; Kehayes, MPH Reimbursement; MPH Reimbursement; Medicare; Naya Kehayes, MPH Reimbursement; Negotiating; On-site; Payers; Seek; Success; Termination; Total; access; accessing; accounting; acquainted; address; adequate; administer; advantageous; afraid; ambulatory; amenable; anniversary; annual; appeal; assess; assigned; attain; avenue; average; based; biggest; billed; business; calculating; care; carve; carve-out; carving; case; center; change; claim; clause; clauses; clean; codes; commercial; compared; compensate; compensation; concepts; contained; contract; contracting; contracts; contractual; cost; counter; cover; coverage; critical; data; dates; days; defined; demonstrate; derive; developing; disallowed; distribution; divided; dominated; drugs; effectively; ensure; environment; equal; essentially; exhibit; expenditures; expenses; exposure; extension; facility; factor; favorable; feasible; financial; find; forfeit; found; greatly; grouper; grouper-type; groups; guarantee; hard; high; high-cost; higher; impact; implants; include; increases; incremental; information; interest; key; language; legal; level; likewise; limited; low; make; managed; managers; map; maturation; meaningful; medical; meet; members; methodologies; methodology; modify; multiple; nations; negotiate; negotiating; negotiation; net; network; non-coverage; non-grouped; notice; occur; offer; operating; opportunity; order; orthopedic; out-of-network; out-of-pocket; outline; overlook; parameters; patient; patterns; payer; payer-defined; payment; payments; percent; percentage; performing; period; person; physician; policy; power; present; prevent; primary; problematic; procedure; procedures; professional; projected; prompt; proposal; proposed; prosthetics; provide; provider; providing; purchased; rate; rates; reasonable; receive; recover; reduces; reductions; referenced; reimburse; reimbursement; relationship; relies; relinquish; rent; require; requiring; revenue; review; rights; room; rules; rundown; salaries; seek; seeking; select; separate; services; short; significantly; specialty; strategies; subject; submission; submitting; success; surgery; surgical; system; targeted; targeting; term; terminate; termination; terms; time; total; tours; typically; understand; understanding; usage; utilization; versus; visualize; volume; walking; written

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