The Shifting Out-of-Network Reimbursement Playing Field
Mar 3rd
Recent lawsuits and industry changes have dramatically altered the out-of-network reimbursement ‘playing field.’ Additionally, pending litigation is aimed at further redefining certain aspects of the body of law that governs out-of-network reimbursement.
It’s important that healthcare providers understand the new ‘rules of the game.’ In an effort to shed light on these changes, upcoming blogs will address the following key aspects of these important developments:
- Basics of out-of-network reimbursement
- Key elements of usual, customary and reasonable (UCR) computation
- History of the Ingenix-related UCR litigation
- The emergence of FAIR as a replacement to Ingenix for UCR benchmarking
- Recent litigation against out-of-network providers who allegedly charge unreasonably high fees
- Pending litigation against out-of-network providers who regularly waive patient responsibility amounts
- Pending litigation involving in-network providers who refer subscribers to out-of-network providers
Stay tuned.
Podiatry EHR: An EHR that will Work for You
Mar 2nd
Podiatry is the field of medicine that involves study and diagnoses of foot, ankle and lower leg disorders. The person who specializes in podiatry is called a podiatrist or a doctor of podiatric practice. Within podiatry, there are many other specializations such as surgery, geriatrics, biomechanics and others.
Podiatry is practiced as a specialty in many countries. It is considered as one of the highest paid specialties in health sector. Like other practices, podiatrists in USA are also supposed to have Electronic Health Records software by 2015. US Government is giving incentives to encourage adoption of specialized EHRs. Therefore, adapting the podiatry EHR will enable a podiatry practice to become HIPPA/HITECH compliant.
The podiatric procedures are complex and may result in errors in treatment and processing payments. This exerts negative impact both on profitability and reliability of practice. A podiatry specific EHR caters to the unique needs of podiatrists and helps in better workflow management.
An EHR for podiatry has some essential features such as customized podiatry templates, multiple graphical views of foot, ankle and lower limb, nail evaluation, online patient portal, reports and analysis etc. Podiatry EHR allows podiatrists to efficiently handle all the billing and claims. It leaves them free to concentrate on treatment and improve overall quality of their services.
There are many companies which are offering general EHRs but there are very few health care IT companies which offer podiatric-specific EHR. One such specialized EHR for podiatry is also being launched by Medical Transcription and Billing Company (MTBC) this March, which is already serving practices with its general EHR. The podiatry specialty EHR is being developed in close consultation with doctors. It offers very detailed features that will help podiatrists in giving better treatment, thereby increasing efficiency and revenues. The best part of this podiatry specialty EHR is detailed illustrations using which podiatrists can select and mention the specific area which requires treatment. Moreover, the podiatry specific EHR by MTBC also accompanies Value Added Services without any extra charges. This will help podiatrists to streamline their workflow and ensure better treatment of their patients.
Are House Calls making a Comeback?
Oct 17th
Several factors suggest that the old-fashioned practice is returning, thanks in part to an aging population and the many advances in healthcare technology.
An Aging Population of baby boomers seems to be creating a growing need for physicians who make house calls. According to the Journal of the American Medical association, house calls to Medicare recipients have risen by over 40% since 2004. As patients age, traveling to the doctor’s office can become more difficult. An older patient may be homebound due to a medical condition, may be without transportation or may be a part of a growing trend of families that are keeping aging relatives at home instead of placing them in nursing homes or assisted living facilities. It’s not uncommon for frail and elderly people to simply skip seeing the doctor because it is too difficult to make the trip to the office. For these patients, house calls are essential for quality healthcare.
The Benefits of House Calls are many and extend to the physicians as well. Aside from the obvious convenience they provide to patients, house calls also have the potential to cut patient costs by eliminating unnecessary visits to the ER, and saving money on gas and tolls. House calls also cut down the amount of time an elderly or frail patient spends in an uncomfortable waiting room. House calls also have the potential to enhance the physician-patient relationship. House calls allow physicians to see their patients in their own environment, which can provide valuable insight to the physicians and allow them to learn things about a patient they otherwise would not have. House calls then allow physicians to regain some control of meaningful medicine, while decreasing costs for the patient.
Advances in Technology, specifically the development of Electronic Medical Records software and other digital mobile medical technology are have made the modern medical office easily transportable and are contributing to the make-over of the traditional “black bag.” The modern black bag now includes everything from a Blackberry to an EKG machine to portable lab kits and IV medications. Some physicians have even traded in the traditional black bag for a padded one containing a laptop computer with Electronic Medical Records and digital diagnostic software and devices such as glucose monitors, EKGs installed.
A shift to “mobile medicine” could present a “new” business model for physicians struggling to keep their practices viable in tough economic times. Recent studies have suggested that physicians can create a profitable practice by eliminating the overhead associated with office-based medicine, and focusing entirely on house calls. The emergence and rapid growth of online businesses which use websites to connect patients with doctors who make house calls suggests that many physicians are convinced by these findings. These services are appealing not only to the elderly, but also to those who don’t want to “worry about taking a day off from work, making special arrangements or having to take your child out in bad weather.” One Online Service touts its services by telling patients that before their service, “You would have to wait in a crowded emergency room, urgent care facility, or doctor’s office. Now you can have a skilled physician come to you in the comfort of your home, hotel, or office.”
While these type of concierge services may only be available to patients who can afford to pay thousands of dollars a year for services, insurance companies seem to be embracing the idea of house calls because they realize that paying for a doctor to see a sedentary or shut-in patient who cannot otherwise get out to see a physician, can prevent a more costly hospital admission for that patient down the line. The House Call’s coming full circle is more proof that what’s old is new again.
Christine Salimbene, Vice President & General Counsel
Ms. Salimbene joined MTBC in 2009 as General Counsel, Vice President and Company Secretary. She and her team focus on mitigating business risk and ensuring compliance with all legal requirements.