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Coding Wars: UHC Escalates Down-coding Assault on ER Claims
Plan Makes a Grab for Prior Claims Payments Many health plans and third party payers have for years been using claims re-coding as a way of reducing plan benefits and payments to physician in order to...
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OIG Targets ED Physicians for Fraudulent E&M Coding Using Incomplete Claims Data
OIG misses the target for claims coding fraud A recent article in the NY Times pointed to the belief that “the move to electronic health records may be contributing to billions of dollars in higher...
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How Health Plans Avoid Paying for Emergency Care
in the health plan counting chamber Emergency care providers (emergency physicians and specialists on-call for the ER) are at a significant disadvantage when it comes to trying to get paid fairly for...
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AHIP Releases Totally Bogus Survey of Physician Billed Charges
Whoa! That AHIP Survey is TOTALLY BOGUS. I use to hear the phrase ‘totally bogus’ all the time in the ‘80s, and when America’s Health Insurance Plans released a ‘Survey of Charges Billed by...
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Will Emergency Physicians be Paid for Performing Ultrasounds ?
Bedside Ultrasound in the ED For many emergency physicians (EPs) the performance and interpretation of ultrasound examinations on patients in the ED has become an incredibly valuable and often...
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What the SCOTUS Decision on Arbitration REALLY Means
Class Action can turn the table Much has recently been published about the Supreme Court decision in Oxford Health Plans LLC v. Sutter, a 9-0 decision in a class action suit that will allow certain...
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CMS Proposes Case Rates for Hospital Outpatient and Observation Services
CMS is Bundling Payments In another effort to discourage up-coding and ‘remove incentives hospitals may have to provide medically unnecessary services and expend additional, unnecessary resources to...
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The Unintended Consequences of Case Rates for ED Services
CMS Proposes Case Rates for ED Services CMS is preparing to pay case rates to hospitals for Emergency Department visits for Medicare patients, changing the current five-level payment structure for...
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The CMS Two Midnight Rule – Impact on Emergency Medicine and the Hospital
The Dark Side of the Two Midnight Rule Perhaps the surest way to drive someone crazy is to expect them to understand the rules and regulations related to coverage and payment by Medicare for hospital...
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Follow-up to Previous Post on CMS Two-Midnight Rule
CMS, you got some ‘splainin’ to do. This post is a follow-up to my previous post on the CMS Two-Midnight Rule. CMS has just released three updated documents that should be helpful for those trying to...
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