A study, published 4/15/08 by the Kaiser Family Foundation showed that those uninsured whom the proponents
of high deductible health plans (“HDHPs”) hoped would buy HDHPs, don’t have the
assets necessary to pay the deductible. According
to the report-
Continue reading "HDHP and Underinsurance" »
I sometimes participate on a list serve of attorneys who work in
managed care - whether from the provider or payor “side of the table”. An attorney representing a group of
specialty physicians recently posted asking how he could get information about
the rates insurers paid to other area physicians practicing in the same
specialty. His suspicion was that his client's insurance contracts were outdated and their payment rates were
significantly below the market.
Continue reading "Another (Questionable) Approach to Transparency" »
On
April 1st, a consortium of physician organizations, quality
advocates and health plans announced that they had agreed on a set of principles
for health plans to adopt to their programs to evaluate and rate physicians. The purpose of the principles was to
recognize the need for consistency and standardization in measures.
Continue reading "Patient's Charter – A Push for Greater Transparency and Consistency in Physician Evaluations" »
Two Georgia physicians sued Private Health Care Systems, a PPO provider
network, claiming that PHCS injured them by inappropriately sharing their names
and practice information with a company selling medical discount cards to the
uninsured (“Capella”). The physicians
claimed that their agreements with PHCS limited their participation to those PHCS
plans or products whose members had insurance and PHCS misappropriated their
identities for commercial gain when it made their names available to Capella
for use by Capella card holders.
Continue reading "Potential Remedy for Silent PPO Activity? Court Allows Damages to Georgia Physicians whose Discount Inappropriately Used" »
This column has frequently discussed steps a provider or
practitioner can take to speed up its collection of Member payments. See for example:
- Maximizing
Collection of Deductibles – 10 Thoughts
- Can
you Collect that Consumer Directed Health Plan Deductible Up Front?
Can you use prompt pay discounts to encourage payment at the
time of service? What if the patient is enrolled
in Medicare or Medicaid? Would that
violate the prohibition on accepting kick backs? Last month, the Office of the Inspector
General issued an Advisory Opinion describing a health system that wanted to
offer prompt pay discounts. Although the
opinion contains a disclaimer that it cannot be relied on by anyone other than the
party for whom it was written, it does offer some guidance.
Continue reading "Improving Up Front Collections – Collecting from Medicare Beneficiaries" »
I’m once again asking for information from you –
In November, 2006, the National Quality Forum released a
list of 28 medical events that it called “serious reportable events.” Shortly after, the Leapfrog Group, an
association of employers working to improve health care
quality, issued a position statement on what it termed “Never Events”. The Leapfrog Group encouraged hospitals to: (i)
apologize to the patient and family affected by the “Never Event”; (ii) report
the event to an accrediting reporting agency for medical errors; (iii) analyze
the root cause of the error and (iv) waive all costs related to the event.
Continue reading "Is Your Organization Implementing a Policy for “Never Events”?" »
The theme for the latest round of private insurance payment
disputes seems to be payment hassles that physicians and other health care providers
experience when dealing with private insurers, particularly managed care
companies. Here are a few cross
references to issues that I hope to cover in greater detail within the next day
or so:
Continue reading "Getting Paid When the Provider is Out-of-Network: How Much, How Soon, What Hassles?" »