Tag: Rate negotiation

Single Case Agreements 101

Single case agreements are contracts between an insurance company and an out-of-network health care provider for specific patients for billing in particular cases. They allow out-network patients to benefits. from in-network billing benefits. There are two ways for billing after the approval of SCA. First, the insurance company provides the allowed amount, finalized as per […]

Current Trend in the Behavioral Healthcare Industry of Going In-Network

Currently, many behavioral healthcare providers are turning toward the option of going in-network rather than away from it. For those who don’t know, the term in- network refers to the option of connecting with certain health programs and/or insurance companies at a negotiated rate in order to provide care to individuals who are covered by […]

What Behavioral Health Providers Need to Know about Value-Based Reimbursements

Value-Based Reimbursements change the game by offering outcome-based incentives to In-Network providers. Learn more about this important trend.Value-Based Reimbursements give In-Network providers an incentive to remain in a payer’s network, while tying a portion of their payments to patient outcomes. In doing so, the Value-Based system could help bring the cost of healthcare under control.And that’s not the only reason providers should embrace outcomes-based reimbursements. As of 2018 The Joint Commission will require outcomes-based data as a conditioned for accreditation. Other accreditation bodies are sure to follow suit.In this report, we look at how Value-Based Reimbursements, AKA “outcome-based reimbursements,” work and how providers can adapt to get out in front of this massive industry change.Insurer reimbursements are changing once again. This time, payments are being tied to outcomes. We see this as not a “trend” but a long-term solution to the issues that have long plagued payer-provider relations, the biggest being the disparity between In-Network and Out-of-Network payments.Traditionally, In-Network providers received a reduced rate for services, with the trade-off being that insurers funneled more patients to their practices. Out-of-Network providers, however, could charge whatever they deemed appropriate. This meant a huge gap between what In-Network and Out-of-Network providers were being paid for the same service, and led to In-Network providers crying foul.In theory, Value-Based Reimbursements change the game by offering outcome-based incentives to In-Network providers.In this report, we look at how Value-Based Reimbursements, AKA “outcome based reimbursements,” work and how providers can adapt to get out in front of this massive industry change.