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Tag Archives: Healthcare claims coding
Will Emergency Physicians be Paid for Performing Ultrasounds ?
For many emergency physicians (EPs) the performance and interpretation of ultrasound examinations on patients in the ED has become an incredibly valuable and often life-saving tool, but until recently most health plans and government payers have balked at paying EPs for these services. Even though the F.A.S.T. ultrasound exam has become a widely used diagnostic modality in the evaluation of major trauma patients in the ED, and ultrasound training has now been incorporated into the … Continue reading
AHIP Releases Totally Bogus Survey of Physician Billed Charges
I use to hear the phrase ‘totally bogus’ all the time in the ‘80s, and when America’s Health Insurance Plans released a ‘Survey of Charges Billed by Out-of-Network Providers’; I knew I had come across the perfect example of a totally bogus piece of deliberately misleading health insurance industry propaganda. According to the survey summary: “for consumers who choose to seek care out-of-network, our latest survey shows that the charges billed by some out-of network … Continue reading
How Health Plans Avoid Paying for Emergency Care
Emergency care providers (emergency physicians and specialists on-call for the ER) are at a significant disadvantage when it comes to trying to get paid fairly for services rendered to enrollees of commercial health plans. Most other health care providers are able to: 1) screen prospective patients to make sure they will get paid appropriately for the care, 2) elect not to care for a plan’s enrollees, or participate in a health plan’s network, if the … Continue reading
Posted in Health Care Reform, Managed Care Contracting, Payment Reform
Tagged balance billing, Capitation, deferral of ED care, Emergency Care, emergency medicine, EMTALA, health plan contracts, Healthcare claims coding, Managed Care Contracting, medical screening evaluation, politics of health care
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OIG Targets ED Physicians for Fraudulent E&M Coding Using Incomplete Claims Data
A recent article in the NY Times pointed to the belief that “the move to electronic health records may be contributing to billions of dollars in higher costs for Medicare, private insurers and patients by making it easier for hospitals and physicians to bill more for their services, whether or not they provide additional care”. This and a related article pointed to a recent report, by the DHHS and the Office of the Inspector General … Continue reading
Coding Wars: UHC Escalates Down-coding Assault on ER Claims
Many health plans and third party payers have for years been using claims re-coding as a way of reducing plan benefits and payments to physician in order to add to plan profitability. Recently, United HealthCare (UHC) launched an escalation of this practice in an attempt to recoup millions of dollars paid to emergency physicians over several years, and it is about to boil over into a full-scale shooting war. The practice of down-coding or re-coding … Continue reading