Berkeley and Associates

09/14/2021

What is happening with Medicaid and Managed Care in other states?

Georgia is among more than 40 states that have turned to managed-care companies to control Medicaid costs. These contracts are typically among the biggest in these states, with billions of government dollars going to insurance companies.

03/13/2021

Interesting article that highlights the new Medicaid plans in Oklahoma.

Insurers are seizing on growth opportunities in Medicaid managed care and Medicare Advantage to boost their bottom lines.

08/17/2020

Surgeons and anesthesiologists are not happy with the 2021 CMS Fee Schedule, according to the recently-founded Surgical Care Coalition. Here's why: http://ow.ly/nWia50AZCe6

05/10/2020

It seems many people are breathing some relief, and I’m not sure why. An epidemic curve has a relatively predictable upslope and once the peak is reached, the back slope is also predictable. Assuming we have just crested in deaths at 70k, that would mean that if we stay locked down, we lose anothe...

11/17/2014

Do you think this was not part of the plan? Shared risk is now the responsibility of the patient and the providers.

Cost-sharing mechanisms such as deductibles, copays and coinsurance are intended to slow rising healthcare costs by discouraging people from seeking unneeded medical care. But as out-of-pocket cost

11/17/2014

How would you rate them?

Here are the top seven insurers that were rated best overall by physicians, according to the Medscape Insurer Ratings Report 2014.

11/16/2014

I recently experienced Uber for the first time on a trip to New York, loved it because we could control our schedule. This is definitely in the line with Pay for Performance but it may come at the mercy of the providers who are already feeling negative affects of the changing healthcare.

Uber's foray into healthcare, on the heels of its rapid ascension in the taxi industry, should cause healthcare executives to question the very nature of a healthcare organization and what makes it successful.

11/04/2014

This is a requirement for all health care providers:
The Centers for Medicare & Medicaid Services (CMS) requires MedicareAdvantage Organizations and Part D Plan Sponsors to communicate with and provide training and education to their “first tier, downstream, and related entities.”
This includes employees (including temporary workers and volunteers), the CEO, senior administrators or managers, governing body members, sub delegates, contracted physicians,
health care professionals, facilities and ancillaryproviders. The required training, education andscreening requirements to which we – and you –are subject include the following:
• Standards of conduct awareness
• Fraud, waste, and abuse and general
compliance training
• Federal and state (if applicable)

11/04/2014

Just trying to keep up with the growing changes in out healthcare system.

11/04/2014

Did someone say "invest".

Publicly traded health insurers have been reporting higher figures in their individual markets as they offer insurance to people though exchanges built under the Patient Protection and Affordable Care Act. They're also benefiting from another provision of the law: Medicaid expansion.

11/01/2014

(Reuters) - U.S. insurers planning to sell 2015 Obamacare health plans expect at least 20 percent growth in customers and in some states anticipate more than doubling sign-ups.In interviews with Reuters,

02/13/2011

Consultant Tip
If a payor is takes a discount and they do not identify themselves as the network at the time of service they are not authorized to take a discount. Tip: always have a copy of the ID card on file, the network on then EOB should also be on the card.