Articles

Pharma – What payments do physicians receive?

As we continually look for ways to help our clients control and identify expenditures, we came across a website that was created by CMS that you may find useful. It is called Open Payments and is located on the CMS website. It is a federal program, required by the...

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Capitation vs Fee-for-Service

Capitation and fee-for-service (FFS) are different modes of payment for healthcare providers. In capitation, doctors are paid a set amount per member per month, FFS pays providers based on the service provided to a patient. Both systems are in widespread use in the...

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6 Tips to Avoid Pitfalls in HMO Reinsurance

1.    The first step is a thorough assessment of risk. If risk is underestimated, your policy will be of absolutely no use (or will be a complete liability) in a bad or worst-case scenario. If overestimated, you're paying good money for coverage you don't need. Work...

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Biggest Misconceptions about Cyber and Data Breaches

  With the recent ransomware attack that happened across Europe and England last week, we thought it wise to publish some misconceptions that are common in the medical community regarding cyber security and data breaches. Data Privacy and Network Security is only a...

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New Trend in Managed Care

As leading brokers in Capitation Provider Stop-Loss for 34 years, we at McPhee & Associates regularly stay in touch with medical groups, hospitals, and health systems.  We are always interested in the trends in managed care as it relates to capitation.  This year...

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Managed Care Errors & Omissions vs. Medical Malpractice

Managed Care Errors & Omissions vs. Medical Malpractice There have been confusions about medical malpractice and managed care errors & omissions coverage. We have often heard from medical organizations that they do not need managed care errors & omissions...

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CMS Ruling—A Problem for Providers

CMS is enforcing the stop-loss deductible limits. Therefore this means higher premiums for providers. We have been following this issue in the industry and directly with our clients.  Because of this we recommend you check the CMS ruling.  We helped our clients by...

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How to Choose a Provider Excess Loss/Stop-Loss Broker

HMOs began capitating medical groups and physician groups in the 1980s. Due to this, that is when Capitated Provider Excess Loss or Provider Stop-Loss coverage came into being. The coverage offered was limited and overpriced and it was provided to the providers ONLY...

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Provider Excess Loss—How to get your claims paid

The key point in getting your claims paid is understanding the wording in your policy. Why is it important to understand the wording in your policy?  For the simple reason that, it can affect how, if, or how much reimbursement you receive from your stop-loss claims....

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