Anthem Blue Cross, California's largest for-profit health insurer, has agreed to pay a $1-million fine and offer new coverage to 2,330 people it dropped after they submitted bills for expensive medical care. As part of a deal with the California Department of Insurance, Anthem also will offer to reimburse those people for medical expenses that they paid out of pocket after they were dropped. The company estimated that those reimbursements could reach $14 million. In exchange, California agreed to drop its prosecution of its accusation that the company broke state laws in the way it rescinded members in preferred provider organization policies between 2004 and 2008.
CMS has revised its RAC expansion schedule, according to the new "RAC Phase In Map" posted February 10 to the CMS Web site. The first phase is set to begin March 1, 2009. The second stage will begin August 1, according to the map.
The prior expansion schedule was set to occur in three stages, however, the now-resolved protests by the unsuccessful contract bidders Viant, Inc., and PRG Schultz, USA, Inc. delayed the initial onset of the permanent RAC program.
"For those hospitals who have a couple of weeks to prepare, I believe one of the biggest challenges is to have well established coordination of denials and appeals and an effective tracking tool," says Yvonne Focke, RN, BSN, MBA, revenue cycle director at St. Elizabeth and St. Luke Hospitals in Covington, KY. "For those of us who have until August, we?ll have to continue on course with our RAC preparedness, including assessing our gaps, quantifying our risk and establishing a tracking mechanism."
Editor's note: To view the updated expansion schedule, visit the CMS Web site. For more general information on the Medicare RAC program, visit www.cms.hhs.gov/rac.
This story first appeared as a breaking news item from the editors of The Revenue Cycle Institute, a division of HCPro, Inc. The Revenue Cycle Institute is a multidimensional resource for healthcare professionals offering consulting and on-site education for a range of revenue cycle issues.
Rose Lee Diggs, an 89-year-old woman whose body was found on the roof of University of Pittsburgh-Montefiore, was the victim of a vast, impersonal hospital system that favored profit over patient care, claims a lawsuit. The suit, brought by Diggs' son, accuses the University of Pittsburgh Medical Center of being "recklessly indifferent" in its handling of her treatment. The lawsuit also charges that UPMC created a dangerous healthcare environment with inadequate staffing levels, poor security, a dismal records system, and a patient population bursting at the seams.
Although some physicians who do not accept health insurance could be considered insurance providers, many "boutique" or "concierge" practices can avoid being regulated by state insurance administrators by following market-value guidelines for services they provide and by going over their contracts with the Maryland Insurance Administration, according to findings issued by the agency. The report was prompted by the insurance administration's concerns about some doctors' switching their business models to charge patients an annual, flat fee for services, rather than continue to accept health insurance.
The St. Bernard Parish Council will conduct a special meeting to consider disbanding the five-member hospital board it created more than a year ago and appointing replacements. The measure is the third time since October that the council has proposed a shakeup involving the parish's Hospital Service District Board, tasked by the previous council with building St. Bernard's first post-Hurricane Katrina hospital. Councilman Wayne Landry said the council's proposal comes after a series of problems with the board during the past year, including potential conflicts of interest and issues with properly advertising contracts.
Blue Cross and Blue Shield of Massachusetts said it will eliminate executive bonuses, cut bonuses for other employees, and freeze pay and hiring this year in an effort to save between $10 million and $25 million. The moves come in anticipation of a difficult year because of the economic recession.