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Presented by: Jim Farley Down To  The Details: Network Contract Provisions And How They  Affect Your Health Plan
Contract: Rates & Discounts ,[object Object]
Rates & Discounts ,[object Object],[object Object]
Sample Reimbursements –  Based on Medicare Discount  80.1% 54,854.56  20,484.65  501.7% 13,656.43 68,510.99 88.5% 100,178.27  19,562.30  868.1% 13,041.53 113,219.80 96.9% 269,639.55  12,742.38  3274.1% 8,494.92 278,134.47 84.4% 154,180.05  42,797.70  640.4% 28,531.80 182,711.85 69.0% 328,911.54  222,110.34  322.1% 148,073.56 476,985.10 63.6% 26,979.42  23,117.18  275.1% 15,411.45 42,390.87 68.0% $345,264.18  $244,071.30  312.2% $162,714.20  $507,978.38  Savings at  %Medicare Savings at %Medicare 150% Medicare 100% Medicare Allowable Total Billed Charges
Rates & Discounts ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Rates & Discounts ,[object Object],[object Object],[object Object],[object Object]
Contract:  Timeframes ,[object Object]
Timeframes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Contract: Financial Incentives ,[object Object],[object Object]
Financial Incentives ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Contract:  Co-pay Requirements ,[object Object]
Co-pay Requirements ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Contract: Exclusivity  ,[object Object]
Exclusivity  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Contract: Refunds  ,[object Object]
Refunds  ,[object Object],[object Object]
Contract: Termination  ,[object Object],[object Object],[object Object]
Termination  ,[object Object],[object Object],[object Object],[object Object],[object Object]
Contract: Liability Limits  ,[object Object]
Liability Limits  ,[object Object],[object Object]
Contract: Provider Directory ,[object Object]
Provider Directory ,[object Object],[object Object],[object Object]
Protecting Your Plan ,[object Object],[object Object]
Recommended Items to Address ,[object Object],[object Object],[object Object],[object Object],[object Object]
Recommended Items to Address ,[object Object],[object Object]
Examples ,[object Object]
Dialysis Savings - Example ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Additional  35% Savings

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JPFarleyppocontract_provision&yourplan

  • 1. Presented by: Jim Farley Down To The Details: Network Contract Provisions And How They Affect Your Health Plan
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  • 4. Sample Reimbursements – Based on Medicare Discount 80.1% 54,854.56 20,484.65 501.7% 13,656.43 68,510.99 88.5% 100,178.27 19,562.30 868.1% 13,041.53 113,219.80 96.9% 269,639.55 12,742.38 3274.1% 8,494.92 278,134.47 84.4% 154,180.05 42,797.70 640.4% 28,531.80 182,711.85 69.0% 328,911.54 222,110.34 322.1% 148,073.56 476,985.10 63.6% 26,979.42 23,117.18 275.1% 15,411.45 42,390.87 68.0% $345,264.18 $244,071.30 312.2% $162,714.20 $507,978.38 Savings at %Medicare Savings at %Medicare 150% Medicare 100% Medicare Allowable Total Billed Charges
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