Many physicians pay very little attention to their managed care participation agreements. In fact, some simply sign these agreements without ever reading them. I think this apathy stems from the
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Billing & Reimbursement
What Do Your Coding Statistics Say About You?
One of the ways the Medicare program and other payer plans are recovering overpayments and identifying billing fraud is through the regular use of data mining. Simply put, by utilizing…
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OIG Announces 2013 Priorities
OIG has announced its priorities for 2013 and some are of special interest to physicians.
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Take an Active Role in Defining Your Payer Relationships
If you’re not sure what your managed care payers want from you, maybe you need to tell them. Many physicians are (understandably) complacent about taking an active role in defining in their payer relationships. Not surprisingly, managed care payers have had very little incentive or ability to negotiate special arrangements with a diverse and disintegrated physician practice marketplace. However, as the marketplace consolidates, larger independent physician practices may have an opportunity to begin to define in their payer relationships.
Many physicians believe that insurance companies have exclusive access to the data necessary to define the specific cost controls and quality measures they will demand from the physician marketplace. In fact, while payers have historically had access to more utilization and quality data than the physician practices, with the implementation of electronic medical records and sophisticated IT systems, larger practices now have access to key data with which to define their quality, cost and utilization data. Very often when I talk to physicians about negotiating their managed care arrangements, they say that they don’t know what their payers are looking for. Consider, however, that this may be because the payers themselves don’t know what they are looking for.
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Physician Shortage Crisis May Not Be All Bad for Physicians
Physician shortage may have a silver lining for physicians who choose to stay in practice: short supply means higher demand and higher demand is likely to mean increased reimbursement.
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Enforcement Update – Bad Actors Continue to Pay
Recent press releases provide notice of activities that draw the government’s ire — and result in serious criminal consequences. Focusing on these issues is a helpful exercise for any physician trying to stay within the law.
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Court Ruling Broadens Hospital Exposure To Whistleblower Claims For Teaching Physician Medicare Billing
A recent court decision concerns the method of rotating teaching physicians between multiple surgeries and billing Medicare for those services, and “whistleblower” claims when improperly done.
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OIG Alert Encourages Physicians To Use Care When Reassigning Medicare Payments
Physicians who reassign their right to bill the Medicare program can still be liable for false claims…
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Why Should Payers Treat You Any Differently?
My physician clients often ask me for advice on how best to negotiate with managed care payers for improved reimbursement. My advice is typically the same: if you want them…
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According to Recent Study, Future May Not Be Bright for US Physicians
According to a recent study published in the September issue of Health Affairs, one of the key drivers behind the skyrocketing healthcare costs in the United States is the amount…
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