Follow me
Tag Archives: Medicaid
Obamacare May Hurt Emergency Physicians Financially
Many emergency physicians have expressed support for the provisions in Obamacare that expand Medicaid coverage; though they usually acknowledge that coverage does not necessarily mean access to care. Certainly, moral considerations account for much of this support, but in addition, emergency physicians tend to believe that providing Medicaid coverage to many of the currently uninsured will benefit them as well, by reducing the financial burden that comes with providing care to everyone, including many patients … Continue reading
Inappropriate Use of the ER: Solutions that Make Sense
The perception that many people, in particular uninsured and Medicaid patients, use the ER inappropriately, is one reason why CMS proposed new rules to allow states to increase Medicaid cost-sharing for ER services. Of course, there is some truth to the assertion that a certain percentage of ER patients could, or should, get their care in a clinic, urgent care center, or primary care provider’s office. In many of these cases (though definitely not all), … Continue reading
Analysis of Proposed New CMS Rules on Medicaid Cost-sharing for ER Care
CMS just published some newly proposed rules that enable States to impose increased cost sharing on Medicaid patients for non-emergency care in the ER. These rules open the door even wider for these States to abuse ER providers and hospitals, and discourage Medicaid patients from seeking needed care. Sadly, CMS did not even bother to consult with the American College of Emergency Physicians before drafting these rules, which makes it a lot more difficult to … Continue reading
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
Why is the Government Targeting the Most Charitable Physician Specialty?
I don’t get it. I do not understand why the US government has decided to paint a target on the backs of physicians who, according to the AMA, provide more charity care than any other specialty, in a program that uses so-called hired gun auditors to recoup over-payments in Medicare’s fraud and abuse prevention strategy. These are physicians who give away, on average, more than $140,000 a year in unreimbursed services to the poor and … Continue reading
Posted in Medicaid, Medicare, Rants
Tagged claims audit, CMS, Emergency Care, health care savings, Healthcare claims coding, Medicaid, Medicare payments, RAC, Recovery Audit Contractor
1 Comment