The EXIT of Fee-For Service Medicine

Posted on March 3, 2016 by Dr. David Edward Marcinko MBA MEd CMP™

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By staff reporters http://www.CertifiedMedicalPlanner.org

EXIT FEE-FOR SERVICE MEDICINE

[Some Pundits say … Bye-Bye]

Continuing the health insurance industry’s march further away from fee-for-service medicine, UnitedHealth Group UNH +0.81% (UNH) will increase value-based payments to doctors and hospitals by 20 percent in 2015 to “north of $43 billion.”

UnitedHealth, considered a barometer for the health insurance industry given its size, is rapidly departing from the traditional fee-for-service approach that can lead to overtreatment and unnecessary medical tests and procedures.

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http://www.BusinessofMedicalPractice.com

Value-based pay is tied to health outcomes, performance and quality of care provided. UnitedHealth’s pronouncements are in keeping with its previously stated commitment to increase payments that are tied to value-based arrangements to $65 billion by the end of 2018. Value-based payments come in a variety of forms.

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They include: pay-for-performance programs, patient-centered medical homes and accountable care organizations [ACOs], a rapidly emerging care delivery system that rewards doctors and hospitals for working together to improve quality and rein in costs.

Source: Bruce Japsen, Forbes

Conclusion

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How to Handle Incurred But Not Reported Health Insurance Claims [Webinar]

Posted on April 2, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

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Event Information
[Live Audio Conference – Webinar]
Dr. David E. Marcinko MBA
Presenter: Dr. David Edward Marcinko; MBA CMP™
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Conference Date: Tue, Apr 02, 2013
Aired Time: 1 pm ET | 12 pm CT | 11 am MT | 10 am PT
Length: 60 Minutes
Product Description
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Here’s How to Augment Bottom-Line Revenues by Understanding IBNR Healthcare Claims

One of most relevant financial issues of the PP-ACA and contemporary healthcare and medical reimbursement is known as Incurred But Not Reported (IBNR) healthcare claims. IBNR claims are an indirect result of prospective payments systems, the insurance industry and commercial risk contracts, and to some extent fee-for-service medicine. IBNR claims represent a risk and an opportunity for managed care companies, healthcare organizations, clinics, physicians and related medical providers alike.

Join this enlightening event presented by expert speaker Dr. David Edward Marcinko MBA CMP™ who will provide you detailed insights on IBNR claims so that you do not face any compliance risk and optimize your organization’s bottom line.

Here is a brief sample of some details you may learn:

  • Historical Review
  • What Is an IBNR Claim?
  • IBNR Problems for Healthcare Organizations
  • IBNR Claims — Management Volume and Consequences
  • Inadequate Cash Flows
  • Reserve Shortfalls and Fiscal Instability
  • Inaccurate Pricing
  • Administrative Cost Increases
  • Regulatory Sanctions
  • Managed Care Organization Exacerbation of IBNR Claims
  • IBNR from a Net Present Value Perspective
  • Tax Strategies for IBNRs
  1. IRS Rules and Regulations
  2. IBNR Tax Qualifications for Managed Care Organizations
  3. How Managed Care Organizations Intensify IBNRs
  4. How Does IBNR Affect Net Present Value?
  • IBNR Challenges and Solutions

1. Tax and Court Penalties

  • IRC Section 4958
  • Excess Benefit Definition
  • Taxes under Section 4958

2.  Tax Deductibility

  • Potential Solutions to the IBNR Challenge
  • IBNR Calculations and Methodology
  1. Actuarial Data Analysis
  2. Open Referral Analysis
  3. Historic Cost Analysis

Ask a question at the Q&A session following the live event and get advice unique to your situation, directly from our expert speaker.

Who should attend? All charge-master coordinators, coding personnel, billing and claims transaction personnel, internal auditing personnel; and financial and compliance personnel! And, all administrators, accountants, comptrollers, office managers, billing clerks and physician-executives, CFOs, CXOs and other interested parties.

IBNRs

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http://www.audioeducator.com/medical-coding-billing/ibnr_problems-040213.html

ORDER HERE FOR WEBINAR

Filed under: Accounting, Health Insurance, Practice Management, Videos | Tagged: , , , , , , , , , | 1 Comment »