Archive for 'Physicians'
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 [...]
Increasing Revenue
21 May 2010Have you considered your managed care contracts as a source of increased revenue?
Too often, physician practices overlook the opportunities inherent in managed care contracting for improving revenue performance and building their bottom line.
Effective managed care contracting depends on performing three types of analysis:
1. Internal – comparing performance among your current managed care contracts
2. External – comparing [...]
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, [...]
21.2% Medicare Pay Cut Will Take Effect Monday
27 February 2010February 26, 2010 — Unless a minor bipartisan miracle happens in Congress over the next few days, physicians will go over the cliff on Monday. That’s when a scheduled 21.2% reduction in Medicare reimbursement takes effect.
A recent poll conducted by several medical societies representing neurosurgeons, for example, revealed that almost 40% would cut back on [...]
Declining Doctor Reimbursements Continue Closing Offices
10 September 2008For 26 years, Dr. Joseph Lalka has been a family doctor, treating 3,000 patients in his cramped office in Chatham, N.Y., a small town nestled in the rural northern part of the state. But Lalka recently told his patients he is taking down his shingle and closing his practice. He says he no longer [...]
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 [...]
Healthcare Payment Reform
24 July 2008 In many ways, the nation’s current healthcare payment system creates inefficiencies by adding cost and complexity to healthcare administration. Achieving payment system reforms will require a level of cooperation among all stakeholders.
In the current volume-based payment system physicians and others who provide high-quality, efficient care and thereby reduce the volume of patient services, [...]
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 [...]
Physician Costs and Getting Paid Properly
4 July 2008 Administrative complexity and inefficiency are major cost-drivers in a largely fragmented health care delivery system. A typical physician practice contracts with a dozen or more health plans and must contend with each payer’s way of contracting, credentialing, preauthorizing, coding, billing and reimbursing.
Health insurer contracting and billing represent the major sources of administrative burden [...]
Rating Payers
28 June 2008 Some health insurance companies rate doctors on their performance. Now doctors are turning the tables.
The American Medical Association issued its first health insurance report card at the group’s annual meeting Monday. The primary focus is on how quickly and accurately doctors get paid.
“Physicians are spending 14 percent of their total revenue to [...]
