decisionhealth Newsletters, Part B News - 2015 Issue 3 (March)
With 2% sequester cut extended, make sure non-Medicare plans don’t try it on you
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Article Overview
This article covers the extension of the 2% sequestration reduction on provider payments and the implications for Medicare fee-for-service as well as certain private and Medicare Advantage payer contracts. It is intended for practices, billing staff, and contract negotiators who need to review payer notices and contract terms to understand whether a plan is attempting to apply the reduction. The discussion focuses on broad contract-review considerations, payer communication issues, and negotiation awareness rather than detailed coding guidance.
Why This Topic Matters
Providers may see payment reductions carried into non-Medicare contracts through contract language or payer notices. Understanding the issue helps practices review agreements and protect reimbursement terms during renewals or amendments.
What You Will Learn
- How the extended sequestration reduction affects Medicare payment timing
- Why private and Medicare Advantage contracts may be affected by payer language
- What to look for in payer notices and contract amendments
- Why contract renewal is an opportunity to review payment terms
- General considerations for negotiating payment factors and percentages
Who Should Read This
- Physician practices
- Billing and coding staff
- Practice managers
- Contract negotiators
- Revenue cycle professionals
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