Reimbursement Archive

Doctors versus Payers: Round Two

Increasingly, payers throughout the country have been issuing “report cards” on participating physicians. While payers argue that these report cards provide valuable information to “consumers” (i.e., patients), physician groups have loudly opposed these report cards asserting that the grades are based on faulty assumptions and are presented in a misleading manner. This frustration regarding the

CMS Offers EMR Users Sizable Bonuses

Your primary care practice could earn up to $290,000, over a five year period, if you adopt and actively use an EMR in coordination with the new Medicare Demonstration Project, which is designed to measure and showcase the quality care improvements that can result from the widespread use of interoperable EMRs/EHRs. Since this program has

Physicians Brace for Summer Reimbursement Cuts

Medicare reimbursements for healthcare providers will be cut by an average of 10.6% on July 1st and Congress may not be capable of rolling back these planned reductions in time to beat the deadline. As many physicians recall, the Centers for Medicare & Medicaid Services CMS”) final 2008 Medicare physician fee schedule included average cuts

OIG Streamlines Provider Self-Disclosure Protocol

In its recent Open Letter to Providers (“Letter”), the Department of Health and Human Services Office of the Inspector General (“OIG”) further refined and streamlined its Provider Self-Disclosure Protocol (“SDP”). SDP Overview OIG created SDP in 1998 to encourage providers to voluntarily disclose Medicare billing fraud and abuse. It provides such encouragement by creating a

Medicare Reimbursement Cuts of 10.6% Scheduled to Take Effect on July 1, 2008

As July approaches, the healthcare community is once again bracing itself for significant, scheduled Medicare reimbursement cuts.  Those who have been following the news or reading this blog for more than one year will agree with Yogi Berra that “it’s like déjà vu all over again.” Unless congress is able to intervene, Medicare physician reimbursements

Florida Moves Closer to Requiring Healthcare Providers and Facilities to Provide Cost Estimates to Uninsured Patients

The Florida House of Representatives’ Healthcare Council recently voted unanimously to recommend the approval of landmark legislation that would require healthcare providers to provide each uninsured patient with a good faith estimate of charges for non-emergency treatment. The “Health Care Consumer’s Right to Information Act”, if adopted, would impose a monetary fine upon any healthcare

CMS Proposes Doubling the Number of Non-reimbursable Hospital-Acquired Conditions

My August 13, 2007 blog discussed CMS’ then-groundbreaking move to deny reimbursement for seven hospital-acquired conditions including pressure ulcers, hospital falls, certain catheter-associated infections, air embolism as a result of surgery, leaving an object in during surgery, providing incompatible blood or blood products and mediastinitis following coronary bypass surgery. CMS has now announced that it

MTBC to CA Regulators: Make Payers Play by the Rules

As I explained in my April 1st blog, California regulators have proposed new rules that would allow payers to continue to underpay non-participating providers, while penalizing the providers who seek customary and reasonable reimbursement. The proposed rules are now open for public comment and we have supplied the following comments to California’s regulators: “The underlying

The Terminator Declares War on Balance Billing

Earlier this week, California Governor Arnold Schwarzenegger’s administration followed the lead of a handful of other states by moving to ban certain balance billing practices. This latest lost hardware debacle is instructive for New Jersey health care providers and payers. Likewise, since most states have laws similar to New Jersey’s data breach law, providers and

Medicare Authorizes Missed Appointment Charges

It is increasingly common for physicians to charge their patients a fee for missed appointments. For example, approximately 31% of MTBC’s clients routinely charge a missed appointment fee. Most of these providers charge approximately $25, while others charge as little as $15 or as much as $100 per missed appointment1. Until recently, there has been