Practice Management
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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Three gigantic—and extremely wealthy—corporations are joining forces to try to lower what their leadership considers to be exorbitant healthcare costs. Amazon, Berkshire Hathaway, and JPMorgan Chase say they’re forming an “independent healthcare company” specifically for their employees—more than a million people, though not all are in the U.S. The new entity will focus on technological solutions to lower costs, simplify coverage, and increase transparency in employee healthcare. Berkshire Hathaway’s Warren Buffet says the triumvirate “does …
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A new report published in the Journal of Pediatrics reveals traits common to pediatric Medicaid patients who visit urgent care centers. Roughly 8% of the 2.7 million children under age 19 in the 2013 Marketscan Medicaid database had at least one urgent care visit. More common attributes among those included age 1-2 years and presence of a complex chronic condition. “High” urgent care utilization was associated with five or more primary care visits for acute …
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If you read this newsletter and JUCM, you know the Merit-based Incentive Payment Systems (MIPS) offers a few options in an attempt to encourage participation and allow providers, essentially, to customize their participation to suit their practice. That includes when they start participating, within some limits. And if you read any news sources at all, you know there are more than a few wrinkles in the rollout. With that in mind, here are a few …
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The Centers for Medicare and Medicaid Services says providers have been clamoring for an update of the 1995 and 1997 guidelines for evaluation-and-management (E/M) codes—and it may be ready to oblige them. If it goes forward, the plan would take years to implement and focus mainly on revising the history and physical exam portion of a patient encounter. The aim, according to CMS, would be to simplify and better align E/M coding and documentation, presuming …
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Hospital-owned urgent care centers—many of which became “hospital-owned” thanks to a relatively generous 50% reimbursement rate for off-campus patient visits—may be taking a substantial hit if the Centers for Medicare and Medicaid Services follows through on a plan to cut that rate by half. Hospital administrators say even though running off-campus clinics increases their operating budgets, they enable health systems to offer more patients access to cost-effective care. On the other hand, the Trump administration …
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Urgent care has taken root, among other reasons, based on its capability to treat patients who otherwise would be sitting (and waiting) in local hospital emergency rooms with nonemergent illness and injury. This benefits not only our industry and the patients who need urgent care, but also those patients who will find a less-crowded ED than they might find in a world without urgent care. And some of them—particularly those covered by Medicare and Medicaid, …
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Illinois is not unique in wrestling with Medicaid managed care plan problems, but the situation there seems to have reached a boiling point and can serve as a cautionary tale for urgent care stakeholders across the country. Health system officials there complain that getting providers approved by Medicaid managed care plans has taken anywhere from 6 months up to a whole year. Prior authorizations and reimbursements have been similarly slow in coming, making it so …
Read MoreOf the survey participants, most (78%) manage billing with in-house staff, while the rest contract for their billing services or use other methods. Such billing efforts cost an average amount of $215.91 per patient—about $3,336,967 per site and $8,876,333 per urgent care center. Small wonder, then, that 14% of respondents cannot yet call their business “profitable.”
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Alabama says it’s just trying to protect its coffers from being pilfered by criminals, but the Centers for Medicare & Medicaid Services is taking a hard look at how the state is handling cases of alleged fraud by Medicaid enrollees. The state acknowledges that it rejects people who would otherwise be eligible for Medicaid funding if those individuals “have been found” to have engaged in fraud—even if they were never convicted of a crime, which …
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