Commercial payors are actively looking for ways to reduce payments to out-of-network providers. One area of focus is discounts and waivers of patient copayments and deductibles by out-of-network providers. In
Continue Reading Offering Discounts (or Waivers) of Coinsurance/Copayments to Patients as an Out-of-Network Provider
Billing & Reimbursement
New Study Suggests Defensive Medicine May Be Effective in Reducing Malpractice Liability
By Edward J. Cyran on
A new study in the BMJ suggests that the more services a physician provides to his or her patients, the less likely the physician is to be sued for malpractice. …
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The Switch to ICD-10
By Edward J. Cyran on
The long-anticipated implementation of ICD-10 coding finally began this past Thursday, October 1, 2015. As of that date, government and commercial payors ceased to accept claims under the old coding…
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First Court Decision on the Medicare/Medicaid 60-day Overpayment Rule
By Edward J. Cyran on
You may have heard some years ago that the Affordable Care Act established a “60-day overpayment rule” that requires a provider to report and return any overpayment from a federal…
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Expanded Authority for CMS to Deny Enrollment and Revoke Medicare Billing Privileges
By Edward J. Cyran on
You may have heard that CMS recently expanded its authority to deny enrollment and revoke the Medicare billing privileges of providers and suppliers. The new changes could affect any physician,…
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CMS Prepares for Physician Fee Schedule Cut
By Todd Rodriguez on
As of today’s date, Congress has not yet fixed or even patched the expected 21% cut to the Medicare Physician Fee Schedule. A eNews alert sent out today by the…
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Pennsylvania Senate Bill would Limit Retroactive Denials
By Todd Rodriguez on
These days, more often than not, physicians and up on the short end of the stick when it comes to new health care legislation. However, last month a bill was…
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HHS to Shift 90% of Fee-For Service Payments to Performance-Based Payments by 2018
By Todd Rodriguez on
Yesterday the Secretary of the Department of Health and Human Services (HHS) formally announced HHS’ intention to shift 90% of all traditional Medicare payments from fee-for-service (FFS) to quality or…
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CMS Issues FY2015 Medicare Physician Fee Schedule
By Todd Rodriguez on
Last week, the Centers for Medicare and Medicaid Services (CMS) issued the final Physician Fee Schedule for Fiscal Year 2015. The annual Physician Fee Schedule includes various policy and…
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Tips for Evaluating Provider Network Arrangements
By Todd Rodriguez on
In response to the development of alternative payment systems, provider networks are forming at a frenetic pace. If you are like most of my physician clients, you have been or…
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