UR Reimbursement or Denial of Charges

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If Hospital charges are denied for medical necessity or violation of procedures, then the admitting and all other <Contracting Network> contracted physicians charges must also be denied. If any of the <Contracting Network> contracted physicians are reimbursed for procedures payable by <Contracting Network>, then the Hospital must also be reimbursed according to the payment schedule set forth in this Agreement for the services provided.

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5 practical & achievable ways hospitals can help employers reign in healthcare costs

These days employers are frustrated about healthcare expenditures and what to do about them. Costs continue to escalate, value and quality are measured by the new "yardstick du jour" creating mountains of new data that is often not actionable, employee engagement in money saving behaviors is challenging at best, and there's no way to transfer more of the cost to the employee ledger without serious benefit satisfaction backlash.

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