Part B Insider (Multispecialty) Coding Alert
Don't Let Hospital Talk To Insurers For You
PDF
A group of 192 physicians could get more than they bargained for if they go ahead with a plan to let the hospital that employs them make all their deals with managed care plans.
The Federal Trade Commission said in an advisory opinion that Suburban Health Organization, an Indiana non-profit, would be violating federal anti-trust laws if it required health plans to go through the hospital exclusively to contract with physicians.
The SHO plan would have called for SHO to set prices for physicians' services, and the FTC was concerned this would eliminate price competition. The SHO plan aimed to increase efficiency and improve care, because it included developing practice protocols and disease-specific treatment parameters for some conditions, plus data collection and education.
But the FTC staff said the efficiencies and better outcomes weren't enough to justify fixing prices for physician services. You can read the FTC letter at www.ftc.gov/opa/2006/03/shor31.htm.
Part B Insider (Multispecialty) Coding Alert
- RADIOLOGY:
Learn How To Bill For Pelvic And Transvaginal Ultrasounds On Same Day
Carriers seek documentation that supports both exams on same date
Your carrier may not be up [...] - INJECTIONS:
Watch Out--Carriers Deny E/M Service With 90772
Don't forget the 25 modifier, but separate diagnosis isn't necessary
Medicare is supposed to pay for [...] - Don't Let A DME Supplier Rent Your Closet
A proposed deal in which a durable medical equipment supplier would provide DME to a [...] - DIAGNOSIS CODING:
Keep Track Of Diagnoses That Change During Hospital Stays
Educate your physician to keep you in the loop on patients' development
Just because a patient [...] - Feds May Look Into Podiatrists' Nail Debridement Claims
Medicare could save $285 million per year if it cracked down on chiropractors billing for [...] - CARDIOLOGY:
Are You Billing The Wrong Code For Heart CTAs?
Hint: Get heart CTA claims off your chest
Coders are clinging to CPT code 71275 for heart [...] - Don't Let Hospital Talk To Insurers For You
A group of 192 physicians could get more than they bargained for if they go [...] - CONSULTATIONS:
Prepare For A New Crackdown On Consult Billing
Three out of four consults billed incorrectly, OIG says
Now’s the time [...] - Part B Coding Coach:
Learn 4 Tricks To Code Your Physician's Prolonged Services Correctly
Hint: Face-to-face time in an outpatient setting does not have to be continuous
- PHYSICIAN NOTES:
Electronic Health Records Could Get Boost From Federal Employees
Bill would require EHRs and performance-based funding for feds
You could be seeing wider use of [...]