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Recent Prescription Benefits Management Inquiries

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Medicare Advantage Premiums - Cms

We are looking to speak with multiple experts on medicare advantage premiums. We want to understand how the rate notifications by cms are determined and if it has an impact on revenue and medical cost ratios at the individual company level. This would be for a 1-hour paid phone consult. Please respond with a few brief statements of your background and relevance to this space with you short answers to the questions below: 1.Can you share your insights on how the rate notifications are release by cms and the variables affecting the revenue and medical cost on the individual company level? 2.Are you able to discuss base rate determination, bidding, risk adjustment, rebates, and enrollment & payments to plans?

    +undefined Other Responses
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    Medicare Advantage Sales

    Need an expert on the regulation of contacts by insurer with medicare advantage recipients and role of the agent of record. Can insurer directly contact clients who have an agent of record and inform them that they are changing their agent of record? . .

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      Edward |Vice President

      No this should be done by the employer group that is making a change in the agent of record. At tha...

      4 Minutes Later
    +1 Other Responses
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    Medicare Advantage Cpt

    I am looking for an expert for medicare advantage cpt encounter reporting training and superbill development

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      Manu |Certified Professional Coder

      Please contact for your project. I would be interested in rendering expertise towards best possible ...

      1.8 Hours Later
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      Cynthia |Senior Coder

      I am highly experienced in CPR and the Medicare guidelines. I have designed many forms and can adapt...

      3.1 Hours Later
    +3 Other Responses
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    Healthcare Mso

    We are a private equity-backed startup seeking advice regarding the legal hurdles to starting a healthcare mso (managed service organization) from scratch (i.E. Which states are friendly to msos, which are not). We are also seeking advice surrounding corporate practice of medicine laws and friendly-pc managed service agreements. Please respond if you are a c-level executive within an mso, a physician working under a friendly-pc agreement, or a lawyer specializing in mso agreements and cpom regulations. Healthcare managed service organizations (msos). In short, we hope to start a new mso in the primary care space, and are seeking expert advice surrounding this potential investment. Essentially, we are seeking to learn: 1.) what states are the friendliest and least-friendly to new msos 2.) how do mso's set up friendly-pc structures in those states 3.) any differences between state laws concerning msos in primary care (as opposed to speciality care, dentistry, pediatrics, or any related fields) 4.) any legal concerns or pitfalls to avoid when starting an mso

      +undefined Other Responses
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      Hcc Coding For Payers Market

      We are currently working on a diligence on a healthcare bpo asset in india. The focus on the diligence is on hcc coding for payers market ( medicare advantage programs). As a part of the diligence, we will have to build bottom-up view on the market from demand side including – 1) understand the current portfolio mix (in house vs outsource; onshore vs offshore) 2) historical trend of the mix and view forward as well as vendors for the same. 3) vendor portfolio of the buyer – both onshore as well as offshore would appreciate if you can help us identify sme’s in – 1) sr. Director, senior manager in large payers (e.G. Unitedhealthcare group, wellpoint group, kaiser foundation, humana, aetna etc) who manage outsourcing / offshoring of medical coding 2) senior business executives in payers who are managing the medical coding 3) senior account managers in service providers (based out of us) who are managing coding services for payers an ideal expert must be handling the operations business some years/ veteran in operations of risk adjustment, revenue cycle management, health coding services.

        +undefined Other Responses
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        Medicare Advantage Plans

        Looking to start a medicare advantage plan/ part d. We would like to speak to consultants who are knowledgable in this area, someone who has processed such plans in the past and well aware with the compliance requirements.

        1. Profile Picture

          morris |SVP

          A very challenging goal: Besides having enough capital to *****ral and *****irements t...

          49 Minutes Later
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          Michael |Managing Partner

          Here are my *****: I have advised MA plans on *****gement, *****rting...

          1.3 Hours Later
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          Dhun (Dana) |Principal Consultant

          25 years experience with insurance products. Have analyzed financial health of most MAPD plans (AM B...

          23.5 Hours Later
        +8 Other Responses
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        Medicare Advantage

        Hello, we are looking for analysts with ma experience.

        1. Profile Picture

          Beth |Director, Consultant, Contractor

          Please clarify what you mean by MA experience. Most of my experience is on the research and marketin...

          1.7 Hours Later
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          Sriram |VP Operations

          Hi - I have a lot of experience in the Medicare Advantage arena, specifically Medicare Risk Adjustme...

          16.2 Hours Later
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          Wise |President/Principal

          I do have 4 years experience selling MA plans in Florida...

          45.2 Days Later
        +4 Other Responses
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        Healthcare Education Services

        We are working on healthcare education market dynamics and need to understand the perception about the various healthcare education products and services among end-users like physicians, nurses, radiologists etc.

        1. Profile Picture

          Csongor |CEO, consultant

          Would you please clarify what do you mean exactly by "Healthcare *****ices"? Thank you ver...

          52 Minutes Later
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          Carol |Principal

          I have extensive experience in identifying perceptions, unmet needs, barriers and opportunities to h...

          1.2 Hours Later
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          Shelly |RN, BSN, MSN

          I would be happy to consult with you regarding the *****et, as I have had nursing education...

          1.7 Hours Later
        +20 Other Responses
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        Hcc Coding For Payer's Market

        We are currently working on a diligence on a healthcare bpo asset in india. The focus on the diligence is on hcc coding for payers market ( medicare advantage programs). As a part of the diligence, we will have to build bottom-up view on the market from demand side including – 1) understand the current portfolio mix (in house vs outsource; onshore vs offshore) 2) historical trend of the mix and view forward as well as vendors for the same. 3) vendor portfolio of the buyer – both onshore as well as offshore would appreciate if you can help us identify sme’s in – 1) sr. Director, senior manager in large payers (e.G. Unitedhealthcare group, wellpoint group, kaiser foundation, humana, aetna etc) who manage outsourcing / offshoring of medical coding 2) senior business executives in payers who are managing the medical coding 3) senior account managers in service providers (based out of us) who are managing coding services for payers

          +undefined Other Responses
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          Healthcare Services Marketing

          Best way to market to healthcare services companies between $50 million to $100 million in revenues

          1. Profile Picture

            Neil |Consultant

            Hewe, A couple of questions before determining if I am the right expert for you. Are you intereste...

            11 Minutes Later
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            Tim |Director

            I would be very interested in learning more about this opportunity and if my skill set can be of val...

            13 Minutes Later
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            Stephanie |Managing Director

            I am a qualified expert in healthcare services marketing. I would do an initial call for $270 per ho...

            18 Minutes Later
          +15 Other Responses
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          Healthcare Services

          We are looking for executives who have built a multi-million dollar health-care services business to serve on advisory council team for a growing healthcare company.

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            Vidushi |Dr Babber - Physician Media and Marketin

            I would be happy to learn more about the project. Please do connect with me through Zintro. Thank ...

            11 Minutes Later
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            Bruce |President, American Health Care Appraisa

            I have served as a consultant and a sub-contractor in setting up several major healthcare facilities...

            1.6 Hours Later
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            Niamh |CEO

            It would be helpful if you would provide *****t the healthcare sector and the role for th...

            1.6 Hours Later
          +24 Other Responses
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          Healthcare Business Development

          We are a medical billing company and supplies located in new hampshire. We tried strategies such as cold-calling, ppc, etc. Without any success. We need an expert to create and implement sales/marketing strategy for us. Experience in healthcare industry is required. Specifically, someone who have experience selling services to medical practices.

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            Joel |Animal Health Consultant

            Would be interested in learning/discussing more. ...

            13.7 Hours Later
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            Ken |President

            I have over 30 years of senior Business Development experience with the leading providers of medical...

            17.4 Hours Later
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            Ed |Dir Business Development

            I have has similar problems and I was able to find a solution. I would love to talk to you about it...

            19.6 Hours Later
          +15 Other Responses
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