Managed Care Contracting & Provider Payment

Dollars Make Sense: Proven Strategies to Increase Medical Practice Revenue

Marla Durben Hirsch is a health lawyer, editor of the American Bar Association's Health Lawyer publication and an author in her own right.  Fierce Practice Management just published an e-book that she helped author entitled "Dollars Make Sense: Proven Strategies to Increase Medical Practice Revenue".  In writing this book, she has called on a few folks for input, including yours truly.  It has some great ideas and advice, but as always, some ideas will comply with the laws in one state, but not in another so please discuss them with your attorney before implementing them.

You can download the e-book free from FiercePracticeManagement.com here: Dollars Make Sense

Thank you Marla!

New Model Law Requires Cost Estimates & Disclosure of Facility Based Provider Balance Billing

On March 6, 2011, the National Conference of Insurance Legislators (“NCOIL”) finalized model legislation intended to provide consumers with information about balance billing practices of facility-based providers.  More significantly, the law would require health plans to provide enrollees with information about out-of-pocket costs of elective procedures.  The law, if adopted by any state will impose requirements on facilities, facility-based providers and health benefit plans (including health insurers, managed care plans, multiple employer welfare arrangements, an entity that direct-contracts with providers on a risk-sharing basis) to inform patients about balance billing practices by facility-based providers who are out-of-network  with the patient’s health plan.

Some Thoughts About Financial Hardship Waivers

Providers have maintained financial hardship policies for decades.  Typically, a provider establishes a process for determining which patients qualify for its charity care program.  What’s new about this?

This process used to be primarily for uninsured patients.  However, in light of the increased enrollment in high deductible health plans and reductions in insurance benefits (i.e., capped and limited services, increased co-payments), more and more underinsured patients are asking for financial hardship waivers.  See earlier posts on HDHP and Underinsurance HERE and HERE.  What had been a process exclusively between patient and provider now can have ramifications with the payor.  Can you grant a patient’s request for a hardship waiver without jeopardizing your payment from the insurer or self insured payor? 

Quick Post: NPR Reports on Increased Medical Identity Theft

This morning, National Public Radio aired a segment about the growing incidence of medical identity theft and red flags.  The segment stressed the risks to the patient from medical identity theft, noting that ID thieves are “becoming bolder and more sophisticated”.  The report also noted that insurers are paying more attention. 

A link to the audio is: Here

See prior posts: Here and Here

Bill Passed by House that Would Exempt Small Business from Red Flag Rules– Including Health Care Practices with 20 or Fewer Employees

On October 20^th, the House of Representatives passed a bill to amend the provisions of the Fair Credit Reporting Act to exempt small businesses including medical practices with 20 or fewer employees. 

Quick Post: FTC Delays Enforcement of Red Flag Rules Until August 1st

The FTC announced yesterday that it will once again delay enforcement of its controversial Red Flag Rules ... this time until August 1st.  They also plan to provide additional guidance for "low risk" creditors in the form of a template.

Provider Readiness for May 1st Red Flag Rule Enforcement Deadline

According to a study conducted by IdentityForce and published last week:

Only 17.5% of hospitals surveyed reported they were in compliance with the Red Flag Rules.

Approximately 53% were in the process of designing and implementing their compliance programs.

Approximately 24% were still evaluating their options.

IdentityForce is a company that offers Red Flag, identity theft and Identity misuse prevention and compliance tools.

A link to the report is: Here

Link to post noting delayed enforcement date: Here

The Red Flag Compliance Train is coming down the Track and Payors are Asleep at the Switch.

Now, as we all know, the deadline for enforcement of the Red Flag Rules is looming … May 1^st.  Providers are struggling to implement red flag compliance policies.  It’s another big PROVIDER compliance panic.

In Face of Physician Protest over Red Flag Rules FTC Stresses Flexibility

Quick post:  Here is a link to an article in today's AMA News on the continued controversy over including physicians in the definition of "creditors" under the red flag rules.  The AMA promises guidance on compliance with the Red Flag Rules by April 10th.  Medicine slams FTC over forcing physicians to police identity theft

Price Estimates and Informed Consumers

I received a call from a hospital describing an increasingly common scenario:  a potential patient calls asking for the price of an outpatient CT scan; either because he is uninsured or is covered by insurance with a deductible.  The caller had already called several other providers and this hospital’s price was higher.  Even if the caller was covered by a high deductible plan (and was therefore entitled to pay the insurer’s negotiated rate) the hospital’s charge for the scan was still higher than the competitors’ prices – especially outpatient scanning sites.

The hospital wanted to know whether it could match their “competitor’s” price for the MRI.