Posts Tagged ‘out-of-network charges’

Infographic: U.S. Statistics on Surprise Medical Billing

February 21st, 2020 by Melanie Matthews

Out-of-network charges typically expose patients to higher cost-sharing when they use services and may lead to balance billing—in which healthcare providers bill patients directly, often at an unexpectedly higher rate. In the past two years, one in five insured adults had an unexpected medical bill from an out-of-network provider, according to a new infographic by Kaiser Family Foundation.

The infographic examines unexpected and “surprise” medical billing trends across the United States.

Profiting from Population Health Revenue in an ACO: Framework for Medicare Shared Savings and MIPS SuccessA laser focus on population health interventions and processes can generate immediate revenue streams for fledgling accountable care organizations that support the hard work of creating a sustainable ACO business model. This population health priority has proven a lucrative strategy for Caravan Health, whose 23 ACO clients saved more than $26 million across approximately 250,000 covered lives in 2016 under the Medicare Shared Savings Program (MSSP).

Profiting from Population Health Revenue in an ACO: Framework for Medicare Shared Savings and MIPS Success examines Caravan Health’s population health-focused approach for ACOs and its potential for positioning ACOs for success under MSSP and MACRA’s Merit-based Incentive Payment System (MIPS).

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

Infographic: Patient Out-of-Network Fees

October 28th, 2015 by Melanie Matthews

Patients who seek care from out-of-network providers or specialists, see, on average, potential excess charges of 300 percent compared to Medicare’s fee for the same treatment or procedure, according to a new infographic by AHIP.

The infographic compares the out-of-network charge for 10 healthcare encounters compared with the Medicare payment for that service.

Patient Out-of-Network Fees

Narrow networks—for both medical and pharmacy providers—are gradually becoming more accepted by carriers, plan sponsors and patients. Smaller provider networks allow payers to manage overall healthcare costs while still maintaining access to benefits—an important consideration as plan designs become more commoditized in the age of public and private health insurance exchanges.

Narrow Network Strategies and Trends for Health Plans and PBMs outlines the tactics health plans are using to restrict medical and pharmacy networks while still maintaining adequate access to care and positive relationships with providers. It also summarizes case studies of health plans and PBMs that have formed narrow networks and the results they’ve seen.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

Infographic: Physician Out-of-Network Charges

February 11th, 2013 by Melanie Matthews

Some physicians who choose not to participate in health insurance networks are charging patients fees that are 10 times – and in some cases, nearly 100 times – Medicare reimbursement for the same service in the same geographic area, according to a new report from America’s Health Insurance Plans (AHIP) highlighting data collected by Dyckman & Associates.

Looking at the 30 largest states, the report found that some physicians who do not take insurance are charging patients startling fees for a wide variety of medical treatments and services illustrated in this new infographic by AHIP.

Physician Out-of-Network Charges

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

You may also be interested in this related resource: Practice Management STATS Quick Reference – 10 Specialties Edition.