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Payment and Finance >
Health insurance financing
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| 1. |  Hassle Factor Form (2009)
American Academy of Pediatrics
The AAP online hassle factor form may be completed to report insurance administrative and claims processing concerns. The information provided will be used to assist the AAP and Chapters in identifying trends and facilitating public and private sector advocacy related to health plans.
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| 2. | Pediatric Council Start-Up Kit (2005)
American Academy of Pediatrics
Features an overview of AAP Pediatric Councils as well as detailed information on how and why to start one, who to include, the agenda for the Council, antitrust concerns and the 1996 statement issued by the U.S. Department of Justice, information about and samples of the hassle factor form, the executive summary of the managed care pediatric council teleconference from June 25, 2003, sample invitation letters and agendas, and a list of chapter activities with managed care organizations.
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| 3. | Reimbursement Toolkit (2008)
American Academy of Pediatrics
The Reimbursement Toolkit was created to assist American Academy of Pediatrics chapters in their payment-related advocacy work. This resource provides policy considerations, data-supported arguments, and other strategic advice for working toward higher payment as a chapter, most often via Medicaid payment. The toolkit also contains information on private payer advocacy and starting a pediatric council to work toward better insurance plan practices that can affect payment.
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| 5. | What Are Consumer-Driven Health Plans, Health Savings Accounts, and Health Reimbursement Accounts? (2008)
American Academy of Pediatrics
Consumer-driven health plans (CDHPs) are the fastest growing plan design across the county. In an attempt to reduce their health care costs, employers are shifting financial responsibility to their employees by offering health plans that feature high deductibles and coinsurance obligations. This article provides information on CDHPs, health savings accounts, and health reimbursement accounts based on the PediaLink Module "Contract Negotiation With Payers."
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| 7. | Children's Health Insurance Status and Medicaid/SCHIP Eligibility and Enrollment, 2007 (2007)
American Academy of Pediatrics
This report highlights the health insurance status of US children, the health insurance status of US children and Medicaid/State Children’s Health Insurance Program (SCHIP) eligibility of uninsured children, changes in employer-based and Medicaid/SCHIP coverage, uninsured US children, characteristics of US children 18 by health insurance status, parent and child worker status, and more. |
| 10. | 2009 RBRVS: What Is It and How Does It Affect Pediatrics? (2009)
Committee on Coding and Nomenclature
This brochure is a pediatrician's guide to Medicare's Resource-Based Relative Value Scale (RBRVS). It provides simple explanations of its elements (physician work, practice expense, professional liability expense), the Medicare global period, the geographic practice cost indices, and tells you why RBRVS matters to pediatricians.
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| 11. | State-by-State Reports Comparing Medicaid, Medicare, and Commercial Payments (2009)
American Academy of Pediatrics
The AAP has made available a set of state-by-state reports comparing Medicaid and Medicare payments for over 160 commonly reported pediatric services for 2007-2008. These reports support pediatricians in making informed decisions in how they manage their practices management and provide health care services. |
| 12. | Health Savings Account Algorithm (2008)
American Academy of Pediatrics
Do you wonder if you can charge patients who have health savings accounts (HSAs) at the time of their visit? This algorithm will help you determine that answer.
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| 13. | AAP Endorsed Principles on Benefit Plan Coverage and Payment (2009)
AAP Private Payer Advocacy Advisory Committee
The AAP approved a listing of benefit plan coverage and payment principles to serve as an advocacy agenda for discussions with payers by members, chapters and pediatric councils. The principles represent existing AAP policy and strategic plan concepts and the talking points include references to current AAP policies
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| 15. | AAP Letter: AAP Notified National Carriers about the Business Case for Breastfeeding (2008)
American Academy of Pediatrics
Official AAP letter to national payers, dated July 25, 2008, notified national carriers about initiatives to promote employer support of breatfeeding women. It describes two groups that advocate for insurance coverage of and payment for breastfeeding-related services and equipment in support of the recommendation that infants be exclusively breastfed through the first six months.
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| 16. | AAP Letter: UnitedHealthcare Regarding Apnea Monitoring (2008)
AAP Private Payer Advocacy Advisory Committee
Official AAP letter to UnitedHealthcare, dated February 26, 2008, objecting to the carrier's coverage policy for home apnea monitoring for infants and its provisions for terminating monitoring.
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| 17. | Protect Your Practice from Inappropriate Discounts (2008)
American Medical Association
The American Medical Association (AMA) developed the "Read your contracts: Is your practice losing revenue through rental network PPOs?" booklet to educate physicians on how to identify and protect their practices from inappropriate discounts. |
| 20. | Class-Action Compliance and Aetna (2007)
Jill Stoller, MD, FAAP
This Spring 2007 soapmnews article provides one pediatrician's experience and analysis with Aetna related to the class-action settlement process.
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