Update: CMS Wraps Up New Medicare Card Program Ahead of Schedule

Update: CMS Wraps Up New Medicare Card Program Ahead of Schedule

The Centers for Medicare and Medicaid Services has completed mailing new cards to the 61 million people covered by Medicare in the U.S., each with their own unique, randomly assigned Medicare Beneficiary Identifier (MBI). The old cards were based on each person’s Social Security number, the widespread access to which left individuals open to identity theft. When the plan was rolled out to the public last April, CMS said it would take a year for …

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Hospitals Slam North Carolina Proposal, but Could it Benefit Urgent Care?

Hospitals Slam North Carolina Proposal, but Could it Benefit Urgent Care?

North Carolina’s state treasurer would like to see his state become the second in the country to align healthcare reimbursements with Medicare rates. The proposal is already being slammed by hospital systems and the North Carolina Healthcare Association on the grounds that any savings realized by the health plan and its members will come at the expense of overall quality of care across the state. However, Dale Folwell claims the plan he’d like to implement …

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Watch Out: Employer Health System Networks Are Getting Tighter

Watch Out: Employer Health System Networks Are Getting Tighter

The pressure to demonstrate the value you provide to employers, compared with telemedicine, on-site clinics, and other venues for on-demand primary care, is increasing as employer health system networks continue to become more exclusive. An article posted recently by HealthLeaders suggests that employers and insurers believe tightening their provider selections will raise quality and cut costs. Regardless of whether that logic proves fruitful in the end, the result today is that provider networks are smaller. …

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Why Are North Carolinians Going to the ED Instead of Urgent Care—at a Cost of $75 Million?

Why Are North Carolinians Going to the ED Instead of Urgent Care—at a Cost of $75 Million?

North Carolina’s Medicaid program has spent at least $75 million for patients to have nonemergency complaints addressed in the emergency room over the past couple of years. According to a new report released by the state, patients have to gone to the ED with primary complaints as mundane as bad breath, sunburn, bunions, and common warts. The report goes on to specify that those concerns—and many more—could be handled much less expensively and just as …

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Anthem Policy Should Direct More Patients to Urgent Cares—if You Seize the Opportunity

Anthem Policy Should Direct More Patients to Urgent Cares—if You Seize the Opportunity

One out of every six patients who visit an emergency room could see denied claims—and a whopping hospital bill—if a retrospective review policy imposed by Anthem not long ago were adopted by other insurers. A study just published in JAMA Network found that 15.7% of ED visits by commercially insured adults could result in denial of the claim on the grounds that presenting symptoms were found to be nonemergent after the fact. The researchers considered …

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CMS’s 2019 Plan Could Even the Playing Field for Nonhospital Urgent Care Centers

CMS’s 2019 Plan Could Even the Playing Field for Nonhospital Urgent Care Centers

The Centers for Medicare & Medicaid Services says it wants to stop paying hospital-based clinics more than they pay physician offices for the same level of care administered to Medicare patients. Calling it a “site-neutral plan for clinic visits,” CMS proposes lowering reimbursements for hospital outpatient departments to match what it pays on the physician fee schedule for clinic visits. According to figures released by CMS, right now Medicare pays roughly $116 for a visit …

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Lawmakers Want to Meet with BCBS Over Claims That It Stifles Urgent Care Competition

Lawmakers Want to Meet with BCBS Over Claims That It Stifles Urgent Care Competition

An urgent care operator has accused Blue Cross Blue Shield of South Carolina of trying to restrict competition among urgent care centers by refusing to allow any new ones into its network in the Palmetto State—possibly due to a conflict of interest, they say. BCBS has called the anticompetition charge “an unfounded attack on the company’s integrity.” Nevertheless, state legislators Mike Burns and Bill Chumley see the urgent care operator’s point and have asked for …

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Medicare Fee Schedule Proposes Urgent Care Specialty Measure Set

Medicare Fee Schedule Proposes Urgent Care Specialty Measure Set

Among the proposed changes in the newly released 2019 Medicare Physician Fee Schedule (PFS) is a new urgent care specialty measure set. The Urgent Care Association and the College of Urgent Care Medicine had asked the Centers for Medicare and Medicaid Services to include 12 specific measures, 11 of which were included in CMS’s proposal. The creation of a proper set is expected to help urgent care providers select measures when fulfilling the quality component …

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ACEP and Georgia Physicians File Suit Over Anthem ED Policy

ACEP and Georgia Physicians File Suit Over Anthem ED Policy

Anthem’s policy of refusing to pay on nonemergent visits to the emergency room (after the fact, at their discretion) has moved the Medical Association of Georgia and the American College of Emergency Physicians to file a lawsuit in U.S. district court. The two groups hope to get the court to compel Anthem and subsidiary Blue Cross Blue Shield of Georgia to abandon the policy, which is intended to discourage patients from going to the emergency …

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Will Rising Out-of-Pocket Costs Drive More Patients to Urgent Care?

Will Rising Out-of-Pocket Costs Drive More Patients to Urgent Care?

Employers and insurers can expect to see a 6% increase in healthcare costs in 2019, according to the Medical Cost Trend report just released by PwC. If that’s the case, rest assured they won’t just be eating the cost, but passing the bump along to employees and plan members. Given that 12% of wages are presumed to go toward healthcare, all concerned parties will be looking to do more with less—which may make urgent care …

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