Reimbursements

Reimbursement rates are gathered and organized for each third party payer that RowanSOM UD FPP has an agreement for in-network participation.  For more information.

Health care insurance is a large component of how patients cover the medical expenses incurred during the treatment or prevention of illness.  The rates by which the insurances pay for medical care varies from payer (such as Medicare, Medicaid or health insurance through your job) and the type of coverage you may have (HMO,PPO or Healthcare Spending Account).  These rates are collected and analyzed in order to make necessary business decisions.

Before RowanSOM University Doctors Faculty Practice Plan providers enter into any new Managed Care third party payer arrangement, the rates are analyzed and reviewed by a committee.  All considerations for new participation agreements must complete the Prospective Health Plan Questionnaire.

The Managed Care Committee meets on a regular basis to review the status of group contracts at RowanSOM UD FPP.  Please click on the link at the left of the page to view a list of participating health plans.  While our goal is to have every provider participate in every health plan we are required to follow the health plans requirements for participation and may be limited in the services or specialties included in the agreement.

The Managed Care Department also collects and distributes newsletters, provider manuals, bulletins and policies as it relates to doing business with the third party payers. 

The Managed Care Department assists in setting the charge for each service by CPT procedure code or HCPSC code.  All billed charges are categorized and stored in the practice management billing system under the Charge Master.  The charges are reviewed every year by the CM Task Force.  The Task Force includes representatives from Central Billing Office, Clinical Department Administration, Decision Support, Ethics & Compliance, IS&T and Managed Care Departments. 

If your department is starting a new line of business or purchasing/leasing new equipment and need CPT or HCPSC code added to the practice management system; please contact the Central Billing Office to initiate your request.

 

If you have further questions, please feel free to contact:

Joanie Page
Reimbursement/Budget Analyst
(856)566-2795

 

 

 

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