Imagine you have received a remittance for patient John Doe for charge 99214 in the amount of $69.89. Your billing staff reconciles the money and updates the account. Would you consider this a successful reimbursement? If so, it may surprise you to know you have just been underpaid by $20 because the correct fee schedule was $89.89.
National HMO Class-Action Case Settled
The latest development in the healthcare class-action settlement will affect approximately 900,000 physicians (and some major state medical societies) who may be eligible to receive compensation from the settlement – as long as they file a claim. The case has been called “historic” by those representing both physicians and insurance companies.
Combine With Medicare Part D to Help Patients Afford Prescriptions
According to the 2003 U.S. Census, 29 million people in the United States make less than 200% of the federal poverty level and have no health insurance. Many persons have difficulty affording prescribed medications. In addition to Medicare Part D, there are more than 350 public and private patient assistance programs, including programs by pharmaceutical companies, that help patients pay for prescriptions.
Zero Stars for Star-based Physician Ranking
Several insurance companies have tried to share quality information with enrollees by developing “star” systems to rank physicians. While star rankings may be a good way to pick a movie or restaurant, the ACR feels this system may be too simple to serve as a tool for identifying quality healthcare. Consumers need quality information, and need to know the true costs of medical services so they can make informed decisions about their healthcare. This idea is reflected in an executive order President Bush signed in August 2006 requiring government agencies to work with the private sector to gather and share data on the quality and cost of healthcare.
Medicare D-lemmas
Rheumatologists and patients report mixed experiences with the new prescription drug benefit
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