private insurers
MN hospitals won't charge for major errors
Minnesota hospitals have decided to get on the 'no pay' bandwagon. The facilities have announced that they'll stop billing both public and private insurers for 27 preventable adverse events,... Read more...
MN hospitals won't charge for major errors
Minnesota hospitals have decided to get on the 'no pay' bandwagon. The facilities have announced that they'll stop billing both public and private insurers for 27 preventable adverse events,... Read more...
PET scan rates climbing dramatically
While positiron emission tomography (PET) scans weren't used much in clinical medicine 10 years ago, today they've become far more common. The number of PET scans performed has climbed dramatically as Medicare and private insurers have agreed to pay for them. Over the past five years, the number of PET scans performed has climbed 400 percent, with more than a million scans being performed per year, according to consulting firm IMV Limited. This surge tracks with increases in MRI and CT …
... Read more...NJ charity care program faces fraud, waste
According to a new report by state investigators, a New Jersey program designed to help the poor and uninsured get emergency care is being sapped by waste and fraud due to poor oversight by hospitals and state officials. The state currently pays hospitals a portion of the cost of emergency care for some 300,000 poor state residents with no health coverage. This year, the program should spend $583.4 million on charity care, partly drawing on funds from federal sources. The problem is that …
... Read more...Dems pitch 12%cut to Medicare insurers
Democrats looking for ways to expand children's healthcare funding are considering a new option. A commission that advises Congress, the Medicare Payment Advisory Commission, has suggested that CMS stop paying private insurers more than Medicare spends when it pays for patients directly. Right now, Medicare spends about 12 percent more for Medicare managed care plans than it does when it pays providers itself, a difference of about $65 billion. Among other things, Democratic legislators …
... Read more...Critics question Democrats' Part D plans
Under the original Medicare law, the private insurers who offer Medicare Part D coverage negotiated prices with drug companies; the federal government was not allowed to bring its considerable bargaining power to the table in order to push down the cost of prescription drugs. Opponents have strenuously objected to this arrangement, saying that drug companies are reaping billions in profit because the federal government isn't forcing them to lower their prices. Many critics felt that …
... Read more..."Health coaches" guide post-ED care
When chronically ill patients are discharged from the emergency department, chances are they'll be back soon without further help. In response, health plans have increasingly been assigning "health coaches" to such patients, tasked with making sure patients are doing what they can to stay well. The health coaches, typically registered nurses, stay in regular touch with the patients, sometimes with home visits and sometimes over the phone, helping them schedule appointments, decipher …
... Read more...Letter: Pricing Transparency
There are several issues here. First, is the hospital efficiently managed? If its costs are excessive because it is poorly run, it is unreasonable to expect anyone, insured or otherwise, to compensate it for its inefficiency. Second, does it have any idea what its costs are? Many hospital accounting systems aren't very good. If it could credibly quantify its costs and communicate them to both uninsured patients and third party payers, it would be helpful. While Medicare may dictate prices that the hospital feels it must accept due to the high number of patients insured by the program, it should be able to negotiate more reasonable payment terms with private insurers. Again, a robust accounting system would be helpful in negotiations. With respect to the uninsured, I just don't think it is reasonable to charge them more that about 10 to 15 percent above what it accepts from private insurance for the same service or, if less, 25 percent above Medicare for the same set of services even if the patient is wealthy. I suggest that hospital executives might ask themselves how they would feel if they were on the receiving end of bills to the uninsured knowing what the hospital routinely accepts as full payment from insurers, including Medicare. If Medicare is paying mostly on the basis of DRG's and private insurers are paying either on a case rate or per diem basis (depending on the treatment), the same approach should be used for the uninsured.
... Read more...Study ranks TX payer performance
If you're a Medicaid provider in Texas, get ready to have your claims denied and your payments delayed. That's one of the conclusions drawn by a recent study of payers in Texas, conducted by physician practice management technology vendor Athenahealth. Athenahealth's Texas rankings, which analyzed claims performance for providers and medical practices from the second quarter of 2006, included 295,000 charge lines. Among other things, the study found that Texas Medicaid denied physician …
... Read more...IN providers protest Medicaid plan
In Indiana, doctors and hospitals are protesting a plan to transfer the state's Medicaid patients to three private insurers. Providers are vehemently resisting the change because the insurers have proposed a 30 percent cut to physician reimbursement for Medicare patients. Doctors and hospitals say that the steep cuts will force physicians to limit the number of Medicaid patients they treat, leaving a high number of indigent patients to receive expensive emergency care. Insurance company …
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