Are Usual and Customary Charges Reasonable?

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

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

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

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

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