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Fair payment issues in healthcareAn open dialog on fair payment issues in healthcare
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An open dialog on fair payment issues in healthcare
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An open dialog on fair payment issues in healthcare
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Fair payment issues in healthcare: April 2008
http://nhxs.blogspot.com/2008_04_01_archive.html
Fair payment issues in healthcare. An open dialog on the economics of audit and appeal for physicians. Tuesday, April 01, 2008. Which AWP did you mean exactly? Now that ASP is into its third year as a method for pricing Medicare Part B drugs, below is a graph showing the relative difference between Red Book AWP and Medicare ASP for the first quarter of 2008. Consistent with the OIG report in 2005, ASP remains significantly lower (with a few notable exceptions for ‘Low AWP’) overall. According to the Marc...
Fair payment issues in healthcare: Tipping Point
http://nhxs.blogspot.com/2005/02/tipping-point.html
Fair payment issues in healthcare. An open dialog on the economics of audit and appeal for physicians. Wednesday, February 09, 2005. Until recently, the economics of revenue recovery. For most physician groups has not been favorable. High volume, low dollar transactions with small variances. Claim payment advice, 2) recent state statutes. And class action settlements. The typical physician practice will establish an appeal threshold. Are less than $10 essentially creating a negative ROI. If you’re a heal...
Fair payment issues in healthcare: February 2008
http://nhxs.blogspot.com/2008_02_01_archive.html
Fair payment issues in healthcare. An open dialog on the economics of audit and appeal for physicians. Wednesday, February 20, 2008. There is no such thing as RBRVS. Sure, we all know the history of the Resource Based Relative Value Scale (RBRVS). Passed into law by Congress in 1989 it has been the payment method for professional services. But it is NOT the payment method used for all services paid to physicians under the Medicare program. MPFS - Medicare Physician Fee Schedule. PFS Relative Value Files.
Fair payment issues in healthcare: April 2005
http://nhxs.blogspot.com/2005_04_01_archive.html
Fair payment issues in healthcare. An open dialog on the economics of audit and appeal for physicians. Thursday, April 28, 2005. Analysis of a health plan. We previously discussed the development and use of clinical edits by government and commercial health plans (see ‘ Claim pricing complexity. The table below shows an analysis of a major US health plan’s re-pricing. Rules Re-pricing is a combination of fee schedule. Adjustments and clinical edits. 8,763,469.65. Contract Allowance by Type. The applicati...
Fair payment issues in healthcare: March 2005
http://nhxs.blogspot.com/2005_03_01_archive.html
Fair payment issues in healthcare. An open dialog on the economics of audit and appeal for physicians. Tuesday, March 29, 2005. As was discussed previously (see ‘ Making audits affordable. Physician practice management systems. PMS) are designed principally around accounts receivable architecture. More recently, integrated electronic medical records, eligibility, and claim ‘scrubber’ functions have been bolted on to the AR function to improve the physician’s business operations. In a candid moment all co...
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Fair payment issues in healthcare
Fair payment issues in healthcare. An open dialog on the economics of audit and appeal for physicians. Tuesday, April 01, 2008. Which AWP did you mean exactly? Now that ASP is into its third year as a method for pricing Medicare Part B drugs, below is a graph showing the relative difference between Red Book AWP and Medicare ASP for the first quarter of 2008. Consistent with the OIG report in 2005, ASP remains significantly lower (with a few notable exceptions for ‘Low AWP’) overall. According to the Marc...
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