When the Hospital CEO Questions Test Utilization in the ED
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Benchmarking ED Test Utilization

A client just wrote me to say: “Recently, a hospital administrator brought up the issues of over-utilization. I found some solid stats on CT use and found that we are near, or below, that benchmark, but I am curious to … Continue reading

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CMS Consultant Cites Problems with ACA Protections for ER Patients
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Freedom of Information Act in action

When CMS came out, in 2010, with Interim Final Rules for the Affordable Care Act, these rules were supposed to protect emergency care patients from excessive out-of-pocket costs when they obtained care from out-of-network (OON) hospitals and physicians. ACEP, the … Continue reading

Responding to Surprise Balance Bills for ER Care – Part 3
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Referrals from the ER and balance bills

The title of Part 3 is a little misleading, as it really deals with other aspects of out-of-network ER-related care in circumstances where patients go to in-network and out-of-network hospital ERs.  One of the surprises that are associated with using an … Continue reading

Responding to Surprise Balance Bills for ER Care – Part 2
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Standing up to health plans in claims disputes

As I mentioned in Part 1, if you get a surprise balance bill for ER care after being treated in an in-network hospital ER, you need to understand the terms of your health plan policy before you respond to this … Continue reading

Responding to Surprise Balance Bills for ER Care – Part 1
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balance bills

What is a surprise balance bill for ER services? Say you walk in to an ER that is in a hospital that your health insurance plan tells you is in the plan’s network, or you get taken to this ER … Continue reading