Physicians who reassign their right to bill the Medicare program can still be liable for false claims submitted by the entities who obtained that reassignment, as discussed in a recent "Alert" issued by the Office of Inspector General (OIG). [PDF].

OIG also referenced settlements it reached with eight physicians who had reassigned their payments to physical medicine companies … Continue Reading

According to a recent study published in the September issue of Health Affairs, one of the key drivers behind the skyrocketing healthcare costs in the United States is the amount of fees payable to the physicians. According to an article published on MedPage Today, the study found that the United States spends in excess of $7500 per person on … Continue Reading

Hospital-owned practices may take an unexpected hit in revenue under a new Medicare rule that bundles certain physician service fees into hospital payments. The so-called “payment window” rule (sometimes referred to as 3-day/1-day window rule) requires a hospital (or an entity that is wholly owned or wholly operated by the hospital) to include on the claim for a beneficiary’s inpatient stay, … Continue Reading

On November 24, 2009, the U.S. House of Representatives passed the Medicare Physician Payment Reform Act" (H.R. 3961) which would repeal the scheduled 21% fee reduction scheduled for January 2010.  The legislation would also permanently replace the existing Sustainable Growth Rate (SGR) formula with a new formula that, according to the House summary:

  • Removes items such as drugs and laboratory services not paid directly
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Despite efforts by Senator Harry Reid to pass legislation which would have effectively frozen Medicare payment rates for physicians, it looks like Congress will once again look to freeze physician payment rates with a one-year patch. According to an article published by the Wall Street Journal, Senator Reid’s proposed bill would have permanently prevented Medicare payment cuts to doctors. … Continue Reading

According to a recent article published on AIS Health.com, Blues plans are increasingly turning to radiology management firms to help manage costly imaging services.  This is a new twist on the old "managed care" concept and, once adopted by the Blues, other major payors can be expected to follow.   Physicians who provide imaging services are well advised to monitor this trend closely. … Continue Reading

Under what it is calling its Provencare program, Geisinger Health System is now offering patients what amounts to a ninety warranty on surgical care.  Under the program – something like capitation and use of clinical protocols – insurers are charged a flat fee for which patients receive unlimited follow up care after surgery.  Geisinger intends to control costs by developing and applying … Continue Reading

The Medicare incident-to rules permit a physician to bill for the services of auxiliary personnel as if the physician performed those services himself.  You may already know that the incident-to rules require a physician to be present in the office suite and immediately available to assist while auxiliary personnel are performing incident-to services in the office.  But, did you know that you … Continue Reading

Pending PA legislation would limit most insurance refund demands and retroactive payment denials by third party payors to a one-year lookback period except where fraud or miscoding occurs. The full text of the bill can be viewed here:physicianlaw.foxrothschild.com/HB2178P4462(1).pdf . The bill was passed by the House by a vote of 195 to 2 on June 30. It’s still pending before the … Continue Reading