Billing & Credentialing Cranberry Twp. (Pittsburgh)
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  • Value-Based Care

Value-Based Care

Value-Based Care Billing: Preparing for the Transition

September 20, 2025 / admin / Articles, RCM, Value Based Care, Value Based System, Value-Based, Value-Based Care, Value-Based Care Adoption, Value-Based Care Integration, Value-Based Care Models, Value-Based Models, Value-Based Reimbursement
Caucasian Red-Headed Male Medical Doctor

The healthcare industry stands at a pivotal moment. After decades of fee-for-service models that prioritized volume over outcomes, we’re witnessing a fundamental shift toward value-based care arrangements that reward quality, efficiency, and patient satisfaction. This transformation is reshaping the entire financial foundation of medical practices. For healthcare providers, this transition represents both tremendous opportunity and […]

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RCM, Value Based Care, Value Based System, Value-Based, Value-Based Care Adoption, Value-Based Care Integration, Value-Based Care Models, Value-Based Models, Value-based Reimbursement

Payer Contract Optimization Strategies

September 16, 2025 / admin / Articles, Healthcare Rate Negotiations, Medical Rate Negotiations, Payer Relationships, Rate Negotiations, Value Based Care, Value-Based, Value-Based Care, Value-Based Care Adoption, Value-Based Care Integration, Value-Based Models
Payer Contracting Negotiation

Managing payer contracts effectively can make the difference between a thriving practice and one that struggles financially. Healthcare organizations face mounting pressure to maximize revenue while delivering quality care, and optimizing payer contracts sits at the heart of this challenge. Smart contract optimization is about creating sustainable partnerships that benefit both providers and payers while […]

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Healthcare Rate Negotiations, Medical Rate Negotiations, Payer Relationships, Rate Negotiations, Value Based Care, Value-Based, Value-Based Care Adoption, Value-Based Care Integration, Value-Based Models

Strategic Payer Negotiations: A Data-Driven Approach

September 11, 2025 / admin / Articles, Contract Negotiations, Data-Driven, Data-Driven Negotiations, Data-Driven Payer Negotiations, Payer Negotiations, Scott Ellsworth, Strategic Payer Negotiations, Value-Based Care, Value-Based Care Models

Healthcare providers today face mounting pressures from multiple directions. Administrative burdens continue to pile up, denial rates are climbing, and reimbursement rates lag behind inflation. Yet many hospitals and health systems approach payer negotiations with the same old playbook, leaving significant money on the table and accepting contract terms that don’t serve their organization’s best […]

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Contract Negotiations, Data-Driven, Data-Driven Negotiations, Data-Driven Payer Negotiations, Payer Negotiations, Scott Ellsworth, Strategic Payer Negotiations, Value Based Care, Value-Based Care Models

Value-Based Care: What It Is and Why You Should Care

August 23, 2025 / admin / Articles, Value Based Care, Value Based System, Value-Based, Value-Based Care, Value-Based Care Adoption, Value-Based Care Models, Value-Based Models, Value-Based Pricing, Value-Based Reimbursement, VBC
Value-Based Care Models

Healthcare in America is undergoing a fundamental transformation. For decades, our medical system operated on a simple premise: the more services provided, the more money earned. This fee-for-service model incentivized volume over value, leading to escalating costs, fragmented care, and outcomes that often failed to match the enormous investment. Enter value-based care, a revolutionary approach […]

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Value Based Care, Value Based System, Value-Based, Value-Based Care Adoption, Value-Based Care Models, Value-Based Models, Value-Based Pricing, Value-based Reimbursement, VBC

Beyond Basic Credentialing: Implementing Competency-Based Provider Assessment Models

January 6, 2025 / admin / Articles, Case Reviews, CBME, Competency-Based Assessment, Competency-Based Provider Assessment, Credentialing, Credentialing AI, Credentialing Automation, Machine Learning, Value-Based Care, Value-Based Models
White Male Credentialer

Let’s talk about something that’s revolutionizing how we evaluate healthcare providers. Gone are the days when a medical degree and a license were all you needed to prove your worth as a healthcare professional. The modern healthcare landscape demands so much more, and that’s where competency-based assessment comes into play. The Limitations of Traditional Credentialing […]

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360-Degree Feedback, AI, Case Reviews, CBME, Competency-Based Assessment, Competency-Based Provider Assessment, Credentialing, Direct Observation, Machine Learning, Medical Credentialing, Outcome Metrics, Simulation Exercises, Value Based Care, Value-Based Care Models

The Impact of Value-Based Care on Credentialing Requirements

November 8, 2024 / admin / Articles, Credentialing, Credentialing Criteria, Recredentialing, Value Based Care, Value Based System, Value-Based, Value-Based Care, Value-Based Care Adoption, Value-Based Care Models, Value-Based Models
Value-Based Care Models

The healthcare landscape is undergoing a seismic shift. Gone are the days when healthcare providers could simply bill for services rendered and expect payment based on volume alone. Welcome to the era of value-based care (VBC), where compensation is increasingly tied to quality outcomes and patient satisfaction. This transformation isn’t just affecting how care is […]

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Credentialing, Credentialing Criteria, credentialing on-boarding, Recredentialing, Value Based Care, Value Based System, Value-Based, Value-Based Care Adoption, Value-Based Care Models, Value-Based Models

Value-Based Care: Transforming Healthcare Delivery and Outcomes

September 16, 2024 / admin / Articles, Value Based Care, Value Based System, Value-Based, Value-Based Care, Value-Based Care Adoption, Value-Based Care Models, Value-Based Models, Value-Based Pricing
Value-Based Care Billing w/ Smiling Medical Doctors

The healthcare industry is undergoing a significant transformation, shifting from traditional fee-for-service models to a more patient-centric, outcome-focused approach known as Value-Based Care (VBC). This paradigm shift represents a fundamental change in how healthcare is delivered, measured, and reimbursed. Value-Based Care aims to improve patient outcomes while simultaneously reducing healthcare costs, creating a win-win situation […]

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Value Based Care, Value Based System, Value-Based, Value-Based Care Adoption, Value-Based Care Models, Value-Based Models, Value-Based Pricing

Maximizing Healthcare Provider Reimbursement

August 9, 2024 / admin / Articles, Charge Capture, Data Analytics, Denial Management, Fee Schedule, Medical Coding, Payer Contract, Payer Contracting, RCM, Reimbursement, Reimbursement Models, Reimbursement Optimization, Value-Based Care
Elderly White Female Doctor with White Male Residents

Achieving maximum reimbursement is crucial for healthcare providers to maintain financial stability and continue delivering high-quality patient care. We explore key strategies and best practices that healthcare providers in the United States can implement to optimize their reimbursement processes and maximize revenue. Healthcare Reimbursement Before diving into specific strategies, it’s essential to understand reimbursement. The […]

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Charge Capture, Data Analytics, Denial Management, Fee Schedule, Medical Coding, Outsourced Billing, Payer Contract, Payer Contracting, RCM, Reimbursement, Reimbursement Models, Reimbursement Optimization, Value Based Care

What Are the Most Common Value-Based Care Models?

May 28, 2024 / admin / Accountable Care Organization, ACO, Articles, P4P, P4P Model, Patient-Centered Medical Home, Pay-for-Performance, PCMH, Value-Based Care, Value-Based Care Adoption, Value-Based Care Models, Value-Based Models, Value-Based Pricing, Value-Based Reimbursement
Value-Based Care Models

We’re going to cruise into a topic that’s been shaking up the healthcare world, value-based care models. These models are all about shifting the focus from just treating illnesses to actually keeping people healthy and delivering better outcomes for patients. Traditional Fee-for-Service: The Old School Approach But before we get into the nitty-gritty of value-based […]

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Accountable Care Organization, ACO, P4P, P4P Model, Patient-Centered Medical Home, Patient-Centered Medical Home (PCMH), Pay-for-Performance, PCMH, Value Based Care, Value-Based Care Adoption, Value-Based Care Models, Value-Based Models, Value-Based Pricing, Value-based Reimbursement

What is CAQH? A Comprehensive Look

May 26, 2024 / admin / Articles, CAQH, CAQH CORE Certification, CAQH Impact, CAQH Index, CAQH ProView System, CORE, Council for Affordable Quality Healthcare, Value-Based Care, Value-Based Care Models, Value-Based Models, Value-Based Pricing
What is CAQH?

Let’s jump into a topic that might seem a bit dry at first glance, but trust me, it’s super important, especially if you’re in the healthcare industry. We’re going to be talking about CAQH, and by the end of this blog post, you’ll know everything there is to know about this organization and why it […]

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CAQH, CAQH CORE Certification, CAQH Impact, CAQH Index, CAQH ProView System, CORE, Council for Affordable Quality Healthcare, Value Based Care, Value-Based Care Models, Value-Based Models, Value-Based Pricing

Essentials of Revenue Optimization in Healthcare

March 4, 2024 / admin / Articles, Better Payer Contracts, Billing, Clinical Documentation, Patient Collections, Renegotiate Payer Contracts, Revenue, Revenue Cycle, Revenue Cycle Management, Revenue Cycle Optimization, Revenue Integrity, Revenue Leakage, Revenue Optimization, Value Based Care, Value-Based Care, Value-Based Models
Revenue Cycle Management Coins

The healthcare industry is undergoing massive changes. With rising costs, declining reimbursements, and shift towards value-based care, healthcare providers face significant financial pressures. At the same time, patients demand superior access, quality, and lower out-of-pocket costs. To thrive in this environment, healthcare organizations must adopt a strategic approach to revenue optimization. Revenue optimization involves systematically […]

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Better Payer Contracts, Billing, Clinical Documentation, Healthcare, Healthcare Billing, Medical, Medical Billing, Patient Payments, RCM, Renegotiate Payer Contracts, Revenue Cycle, Revenue Cycle Management, Revenue Cycle Optimization, Revenue Integrity, Revenue Optimization, Value Based Care, Value Based System

The Reimbursement Model Shift in Medical Billing

January 29, 2024 / admin / Accountable Care Organizations, Articles, Billing, Billing Operations, Bundled Payments, Capitation, Fee-for-Service, Fee-for-service Model, Medical Billing, P4P, P4P Model, Pay-for-Performance, Reimbursement Disruption, Reimbursement Models, Value-Based Care, Value-Based Models, Value-Based Reimbursement
White Middle-Aged ER Doctor

The healthcare industry in the United States has undergone massive changes in recent decades. One of the most significant shifts has been in how healthcare providers get reimbursed for services. The traditional fee-for-service model is giving way to value-based models that tie reimbursement to quality of care and patient outcomes. This transformation in reimbursement is […]

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Accountable Care Organizations, Billing Operations, Bundled Payments, Capitation, Fee-for-Service, Fee-for-Service Model, P4P, P4P Model, Pay-for-Performance, Reimbursement, Reimbursement Disruption, Value Based System, Value-Based Models, Value-based Reimbursement

The Benefits and Challenges of Adopting Value-Based Care

March 19, 2023 / admin / Articles, EHR, Healthcare, HIPAA, Medical, Value Based Care, Value Based System, Value-Based, Value-Based Care, Value-Based Care Adoption, Value-Based Care Models, Value-Based Models, Value-Based Pricing, VBC
Doctors Adopting Value-Based Care

Value-based care (VBC) is a healthcare delivery model that aims to achieve better health outcomes and cost-effectiveness by focusing on the value of care provided to patients. This model shifts the focus from the traditional fee-for-service approach, where healthcare providers are paid based on the number of services they provide, to a system where providers […]

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EHR, Healthcare, Healthcare Outcomes, HIPAA, Medical, Value Based Care, Value Based System, Value-Based, Value-Based Care Adoption, Value-Based Care Models, Value-Based Models, Value-Based Pricing, VBC

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Practices Served

  • Behavioral Health
  • DME
  • Urgent Care
  • Speech Therapy
  • Geriatric Medicine
  • Skilled Nursing Facilities (SNF)
  • Substance Abuse
  • Genetic Testing
  • Pharmacogenetic (PGx)
  • Toxicology
  • Allergy Testing
  • Oncology
  • Pathology
  • OBGYN
  • Internal Medicine
  • Biologics and Specialty Drugs
  • Telestroke and Teleneurology
  • Digital Therapeutics (DTx)
  • Remote Patient Monitoring
  • Remote Therapeutic Monitoring
  • Home Infusion Therapy
  • Sleep Study Labs
  • Physical Therapy (PT)
  • Occupational Therapy
  • COVID-19 Testing

Practices Served

  • Behavioral Health
  • DME
  • Urgent Care
  • Speech Therapy
  • Geriatric Medicine
  • Skilled Nursing Facilities (SNF)
  • Substance Abuse
  • Genetic Testing
  • Pharmacogenetic (PGx)
  • Toxicology
  • Allergy Testing
  • Oncology
  • Pathology
  • OBGYN
  • Internal Medicine
  • Biologics and Specialty Drugs
  • Telestroke and Teleneurology
  • Digital Therapeutics (DTx)
  • Remote Patient Monitoring
  • Remote Therapeutic Monitoring
  • Home Infusion Therapy
  • Sleep Study Labs
  • Physical Therapy (PT)
  • Occupational Therapy
  • COVID-19 Testing

Recent Posts

  • Abstract, Punk Rock Female Medical Doctor

    What are Peer and Professional References in Credentialing?

  • Older, Female Medical Doctor Writing a Prescription

    Healthcare Consolidation: How It Affects (Credentialing Timelines)

  • Explanation of Benefits or EOB

    EOBs: A Guide to Explanation of Benefits

  • A White, Male Medical Doctor Signing Paperwork. Sitting at a desk.

    Top 25 Physician Procedures w/ CPT Codes

  • Amazon Healthcare One Medical

    Amazon’s Healthcare Revolution: Transforming Patient Care

  • robotic-process-automation-RPA-example-code

    How RPA Can Save Your Medical Billing

  • Group of Ethnically Diverse Medical Doctors Discussing Charge Capture

    Getting Charge Capture Right

  • Caucasian Red-Headed Male Medical Doctor

    Value-Based Care Billing: Preparing for the Transition

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