The Medicare incentive programs with which you and your medical practice are familiar will soon be no more.  As of January 1, 2017, these programs (including the Electronic Health Records
Continue Reading Are You Ready for the New Medicare Quality Payment Program? (Part 2): Basics of the MIPS and How to Qualify in 2017

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,
Continue Reading Expanded Authority for CMS to Deny Enrollment and Revoke Medicare Billing Privileges

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.
 

Continue Reading Take an Active Role in Defining Your Payer Relationships

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.
Continue Reading Court Ruling Broadens Hospital Exposure To Whistleblower Claims For Teaching Physician Medicare Billing