Are Usual and Customary Charges Reasonable?
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U&C Charges and Out of Network Services

In State legislative offices throughout the country where the issue of out-of-network physician charges, balance billing, and plan benefits are being debated, the constant refrain from health plan representatives is that usual and customary charges are an ‘unacceptable standard’ for … Continue reading

Emergency Medicine Practice: What We Don’t Know
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The EM emperor has insufficient data

Whether you are advocating for emergency physician reimbursement or better emergency department patient care, or just trying to build a better practice environment or find a better practice site; what you don’t know about emergency medicine practice may completely undermine … Continue reading

Reconciling Patient Satisfaction, Drug Seeking Behavior, and Cost-effective Care in the ED
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Reconciling Seemingly Conflicting Goals in the ED

  The first step to reconciling the seeming conflicting objectives of improving patient satisfaction, restricting the inappropriate prescribing of abused drugs, and providing cost-effective care in the face of rising patient expectations regarding testing and treatment in the ED, is … Continue reading

CMA Stumbles Over Balance Billing Legislation in California
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CMA Stumbles Over Balance Billing Legislation

AB 72, a bill that is currently on the verge of being approved by the California State Legislature, represents a serious strategic loss for physicians in California around the issue of out-of-network services (OON) and the practice of balance billing. … Continue reading

BCBS GA Walks Back Forced Contracting Policy
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BCBS GA walks back
 Forced Contacting Policy

Back in May of 2016 I put a post up in The Fickle Finger on ‘Forced Contracting, BCBS’s Answer to Balance Billing’, citing a policy in the policy manual that Blue Cross Blue Shield of Georgia had put out some … Continue reading