Q: How will healthcare reform affect provider reimbursement?

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Answer:

The healthcare reform law does not directly address provider reimbursement, except in the case of Medicare. However, as part of an ongoing effort between insurers and providers to coordinate care and manage overall healthcare expenses, many new reimbursement models are being tested. Their goal is to find one that best aligns the incentives of the providers, insurers, and patients. In addition, many insurers are trying to reduce the rates that they pay providers in order to keep premium prices reasonable for customers. In some cases, this means that insurance companies are building narrower networks—that is, fewer doctors will be in your provider network—in order to obtain bigger discounts from providers.

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Linda V. Tiano

Member of the Firm at Epstein, Becker, and Green in Washington, DC and New York

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David Randall

Senior Vice President of Strategic Planning and Business Development at the University of Alabama at Birmingham Health System.

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Marti Lolli

Director of Health Care Reform at Priority Health in Michigan.

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