Surprise Balance Billing Study Raises Serious Questions
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Intro: Cooper paper sets organized EM back a pace This summer Zack Cooper et al gave a kick in the teeth to efforts by ACEP, EDPMA, and Physicians for Fair Coverage to try to reframe the message about balance billing … Continue reading

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Caring for Veterans: A Claims Challenge
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For some time now, the Veterans’ Administration has been making it very difficult for emergency physicians (EPs) to get paid for providing non-service connected emergency care to veterans covered under the Mill Bill when the veteran is admitted from the … Continue reading

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Why Healthcare Regulators Fail to Regulate
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Why do healthcare regulators so often fail to enforce their own regulations?  Let’s look at some examples for an answer.  In 2015, the Department of Managed Health Care in California did a survey of plans and risk bearing organizations (RBOs) … Continue reading

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Anthem Declares War on Emergency Medicine in California
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Anthem Blue Cross (BC) in California announced in its December Professional Network Update that, beginning in January of 2016, the plan will begin a pre-payment review of all ED visits billed with CPT 99285 (professional service) or HCPCS code G0384 … Continue reading

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Does New York Have the Answer to Balance Billing?
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New York State has enacted legislation that purports to solve the issue of patients being caught in the middle of disputes between commercial health plans and physicians over the reasonable value of out-of-network services. Several other states, including most recently … Continue reading

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