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Author: Valerie Shahriari
Company: Florida Healthcare Law Firm
Website: www.healthcarereimbursementblog.com
Author Comment / Biography:
Attorney Valerie Shahriari has extensive clinical experience from her background as a surgical nurse, risk manager and physician practice management consultant. Valerie spent many years in the managed care industry engaged in such pertinent responsibilities as Director of Compliance and Quality and also Corporate Director of Integration Implementation for Amerihealth. She has an extensive healthcare law background and for the past several years (i) established and implemented payer appeal procedures, (ii) developed a Patient Centered Medical Home model, and (iii) developed an ACO model and program for implementing shared savings, shared risk and full risk. Her extensive hands-on experience with developing and negotiating innovative payer/provider compensation models helps bring our firm and the provider community to the “next level.”
Valerie represents healthcare professionals and businesses in the areas of:
• Value based contracting with payers • Disputes involving rates and reimbursement with commercial payers, Medicare and Medicaid • Employment & Recruitment Contracts • Shareholder & Operating Agreements • ACO Formation • PCMH Accreditation
Valerie graduated from Indiana University School of Law in 2001. She is admitted to practice law in the State of Florida and is a past board member of the Indiana Society for Healthcare Risk Management. She was also an ASHRM member from 2006-2011, ISHRM from 2006-2009 and held membership with both the Indiana and Minnesota State Nurses Associations.
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| Articles by Valerie Shahriari |
1. UnitedHealth Housekeeping Spurs Settlement Trend for Providers
September 15, 2015
This summer brought about insurer merger acquisitions of Cigna by Anthem and Humana by Aetna, which leaves UnitedHealth as the only remaining major insurer not to make such an announcement. However, the UnitedHealth Group Inc. very recent settlement of a suit over 15 years old and another settlement...
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2. Managing Managed Care
August 05, 2015
While your healthcare business may be compliant with billing regulations and coding, this does not mean that your payer is compliant and has paid you correctly per your contract. Providers know that Fraud and Abuse has been one of the largest areas of focus for payers and the government over the...
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3. Is an ACO Right for You? The Complete ACO Checklist for Providers
July 22, 2015
As the movement to value based arrangements continues many providers are considering joining an Accountable Care Organization (ACO). At the same time, regulators from the Federal Trade Commission (FTC) and the HHS Office of Inspector General (OIG) are signaling increased scrutiny of Accountable Car...
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4. How to Get Managed Care Companies to Pay for Your Practice's Improvements
July 03, 2015
Florida’s providers are buzzing with questions about value based care, asking why now? Is it a fad? Will it really ever be a widespread form of payment? Why does Florida seem farther behind the value based curve than other markets? While there are more aggressive markets in other parts of the cou...
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5. CMS is Ahead of Schedule... Are You?
June 16, 2015
It’s only 2015 and CMS has already reached 42% of their 50% goal to tie traditional Medicare payments to quality or value by 2018. Humana has implemented a similar strategy and set a 50% goal by 2018 and Aetna further has upped the ante by striving to tie a whopping 75% of Medicare Advantage members...
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6. Provider Service Volume is No Longer King
June 16, 2015
As the shift from fee for service to value based payment develops, one thing is crystal clear: volume is no longer king. Prior to 2010, medical providers were being paid on the amount of services that they rendered. The more patients that they treated, the more money they made. That certainty has ...
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7. Is the "Managed Care Cartel" Squeezing Your Bottom Line?
June 16, 2015
Providers need to know that managed care contracts usually suffer from two common problems: 1) very important terms are unclear and 2) the cost control provisions are unfair. In addition to the need for clarity, most managed care agreements lack what many consider to be basic procedural fairness. ...
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