News
The Renal Physician Association (RPA) will hold it’s annual meeting March 15-17, 2008 in Austin, Texas where health care attorney Heather Cook Skelton will conduct a workshop on Managed Care contracting. Heather’s session includes tips and tools designed to help physicians and practice managers prepare for negotiating with MCO representatives as well as how to maximize their practice’s bottom line by identifying hidden payments and bonus terms that may not be discussed unless requested. For more information and registration information visit http://www.renalmd.org/meeting/index.cfm.
February 26th, 2008
In a case that could have national ramifications, New York Attorney General Andrew M. Cuomo announced this week that he is conducting an investigation into health insurers regarding the use of data to manipulate reimbursement rates to providers.
Continue Reading February 23rd, 2008
The National 2008 Managed Care Contracting Symposium sponsored by the American Institute of Healthcare Compliance (AIHP) will feature Heather Skelton, healthcare attorney and Joanne Byron, CEO of Health Care Consulting Services, Inc.
Continue Reading February 17th, 2008
Heather Skelton has been invited to speak at the 2008 meeting of the Neurosurgery Executives’ Resource Value and Education Society (NERVES) in Chicago, IL. Heather will be presenting information and strategies for Managed Care contract negotiations to members attending the annual meeting of neurosurgery practice managers and administrators. Managed care contract negotiations are an important element in every medical practice’s business operation and with proper planning and a decisive negotiating strategy can make a positive difference to the bottom line.
The NERVES 2008 Annual Meeting is taking place April 24-26 at the Intercontinental Chicago, 505 North Michigan Ave., Chicago, IL 60611. For meeting schedule and registration information, visit http://www.nervesadmin.com/info.html.
February 4th, 2008
Physician practices have been surprised by a special CD sent out by CIGNA Government Services in Nashville, a CD-ROM containing music files rather than data files. Some CDs did not contain the expected Medicare regulatory content. CIGNA Government services confirmed that the CD was sent out in error, and that new CDs would be sent out this week. They advised that the first CD should be destroyed.
January 30th, 2008
Blue Cross Blue Shield of North Carolina has published “average” prices for numerous services online. The “health care cost estimator” has been described as a method for “triggering discussions” between patients and doctors about health care costs, especially for those patients who pay their own bills or have health savings accounts.
The website, which is accessible only to Blue Cross members, permits members to obtain cost estimates for office visits, certain diseases and conditions, diagnostic studies and procedures and medications.
January 30th, 2008
Physicians billing Nationwide Mutual Health Insurance (also know by Allied and numerous other names) between December 1, 1992 and November 8, 2007 should have received notice of a proposed class action settlement and fairness hearing and may be eligible to receive compensation. These claims were primarily related to personal injury, workers’ compensation and similar coverage.
To obtain compensation, physician offices must submit claim forms with necessary documentation by June 20, 2008.
To opt out, provide notice by February 21, 2008.
More information: http://www.nationwidealliedsettlement.com or 1-877-625-9426.
January 30th, 2008
The New Portable Medical Orders For Scope of Treatment (MOST) form is available to physicians and other health care providers through the Office of Emergency Medical Services, North Carolina Department of Health and Human Services webpage at: http://www.ncdhhs.gov/dhsr/EMS/dnrmost.html.
The yellow portable Do Not Resuscitate forms also will be available via this webpage. The cost per form is 4 cents. To view a sample MOST form and for additional information regarding the new MOST form, go to the NCMS End of Life Resources webpage at: http://www.ncmedsoc.org/pages/public_health_info/end_of_life.html#most.
January 20th, 2008
After Medicare providers have submitted claims containing both NPIs and legacy identifiers and those claims have been paid, Medicare urges these providers to send a small batch of claims now with only the NPI in the primary provider fields. If the results are positive, begin increasing the number of claims in the batch.
(Reminder: For institutional claims, the primary provider fields are the Billing and Pay-to Provider fields. For professional claims, the primary provider fields are the Billing, Pay-to, and Rendering Provider fields. If the Pay-to Provider is the same as the Billing Provider, the Pay-to Provider does not need to be identified.)
January 20th, 2008
The NC Department of Insurance (NCDOI) has responded unfavorably to a complaint filed jointly by the North Carolina Medical Society (NCMS), the North Carolina College of Emergency Physicians and Wake Emergency Physicians.
The complaint, filed on October 30, 2007, asserted that Aetna had violated North Carolina’s prudent layperson statute (NCMS Section 58-3-190) by imposing greater cost sharing on patients treated by emergency non-participating physicians than would have been imposed had the patient visited a participating emergency physician.
Continue Reading January 20th, 2008
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