Archive for 'General Comments'
Accountable Care Organizations (ACO’S)
19 August 2010The concept of Accountable Care Organizations (ACO’s) was given a prominent place in this year’s reform legislation. In essence, an ACO is a network of healthcare providers that manage the full continuum of care for all patients within the provider network.
The goal of an ACO is to reduce costs and improve quality [...]
Negotiating Managed Care Contracts
19 April 2010Today, most health plans operate with fixed fee schedules. While most are based on a percentage of what Medicare pays, they may be tied to payment levels that are three or more years old. Physicians who question this methodology for paying for professional services are told to take it or leave it.
We are finding, however, [...]
Medicare Eliminates Consultation Codes
11 January 2010CMS (Centers for Medicare and Medicaid Services) announced the elimination of consult codes. Officially released and documented in Change Request “CR 6740″as of January 1, 2010 consult codes will be eliminated from the Medicare fee schedule. Medicare will no longer recognize or pay for services billed with consult codes 99241-99245 or 99251-99255.
CR6470 impacts only [...]
Yet Another Fine
14 August 2008 Yet another payer has been ordered by state regulators to pay restitution of $3.9 million to thousands of members and a $250,000 fine for underpayment of claims related to care in out-of-network hospitals and other medical facilities.
State Insurance Commissioner Mike Geeslin ordered the health insurer to make the payments over the next several [...]
Virtual Office Visits
4 July 2008 The doctor doesn’t have to see you now. Thanks to new technology, patients may not always need a face-to-face visit with their doctor to get the care they need.
And thanks to a growing awareness of this fact on the part of health plans, structured, Internet-facilitated and reimbursable “virtual visits” are on the verge [...]
