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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Vermonters Have a Choice to Make: Get Insurance or Face Legal Consequences

Vermonters Have a Choice to Make: Get Insurance or Face Legal Consequences

Vermont Gov. Phil Scott just signed a new law into effect that requires residents of the state to carry health insurance. Details of the law, which will take effect January 1, 2020, are still being worked out by a special commission. One such detail is the nature of the penalty for those who don’t comply with the law. Advocates say it won’t necessarily be a financial one, yet no other possible consequences have been disclosed …

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Be Vigilant for ‘Small’ Changes in Reimbursement Contracts—They Can Add Up

Be Vigilant for ‘Small’ Changes in Reimbursement Contracts—They Can Add Up

The fact that reimbursement rates decline while the cost of running a practice goes up is hardly a news flash. Relatively minor details in reimbursement contracts that can ultimately add up to big bucks should not go unnoticed amid all the macrodata, however, according to a recent post on Doctor Discourse. Many changes that may seem to be random moves that your staff just has to get used to may also bring new opportunities to …

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TRICARE Offers Nonfinancial Incentives to Push Patients to Urgent Care

TRICARE Offers Nonfinancial Incentives to Push Patients to Urgent Care

Due to its oversight by the federal government, TRICARE is challenged with limitations that don’t apply to most insurers—one being that they’re not able to offer some of the economic incentives commonly used to push patients to lower-cost care settings. At the same time, the military insurer is held to the same (or higher) standard for keeping costs under control. One strategy its administrators have come up with is a familiar one: Get patients to …

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Ready or Not, Here Come the New Medicare Cards

Ready or Not, Here Come the New Medicare Cards

It’s going to take a year for the whole batch to be in place, but your front desk staff will start seeing new Medicare cards this month. As we told you when the Centers for Medicare and Medicaid Services first announced its plans, every Medicare member will be issued a unique ID number to replace their Social Security number on the cards to better protect all manner of personal information tied to the SSN. Patients’ …

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Hospitals Wave Red Flags as UnitedHealthcare ED Policy Takes Effect

Hospitals Wave Red Flags as UnitedHealthcare ED Policy Takes Effect

UnitedHealthcare (UHC) just launched a new protocol for evaluating emergency room claims that it says will encourage accurate coding by providers and ultimately bring down healthcare costs. Some hospitals view it as just another way to deny claims, however—and one that could actually end up costing patients more money, at that. Under the policy that took effect on March 1, UHC reviews and maintains the right to adjust or deny claims for ED visits coded …

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Anthem ED Policy is Starting to Rankle Patients

Anthem ED Policy is Starting to Rankle Patients

When Anthem announced some months ago it would not cover bills for “unnecessary” (in their retrospective view) trips to the emergency room in some states, we noted objections from physician groups. Now that the policy is in place and claims for 2018 have started to be filed, we’re seeing media reports on angry patients who are getting stuck with bills they presumed would be covered. Consumer Reports, for one, recounts the case of a patient …

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Anthem Faces Charges Its Already-Unpopular ED Policy is Harder on Low-Income Patients

Anthem Faces Charges Its Already-Unpopular ED Policy is Harder on Low-Income Patients

Physicians and patients alike have been vocal in their disapproval of Anthem’s policy of denying claims for emergency room visits that are ultimately declared nonemergent—the main criticisms being that it forces patients to self-diagnosis to some extent and that it ultimately may discourage patients from getting emergency care when they really do need it. Now the Indianapolis Recorder newspaper charges the policy is going to have the greatest negative impact on low-income patients, based on …

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