Pennsylvania House Democrats have introduced a plan to roll out state-subsidized health insurance for about 270,000 uninsured Pennsylvania adults over a five-year period. Backers of the plan promoted it as the next logical step after recent state laws that cover children and pay prescription costs for the elderly. Residents ages 19 to 64 who meet income guidelines and who have gone six months without insurance would qualify for what would be known as the Pennsylvania Access to Basic Care program.
The Pennsylvania Department of Public Welfare is proposing taking about $100 million from 33 hospitals in Philadelphia and Allegheny (PA) Counties so that it can increase Medicaid funding in those counties. The department says most hospitals will make money in the deal because Pennsylvania can use the new assessment to leverage more federal funding for Medicaid. Representatives from the hospitals involved, however, remain skeptical.
For many hospitals, the answer to "anesthesia awareness" is to use a brain monitor so doctors can give more drugs to patients who seem to be awaking. A study published in the New England Journal of Medicine, however, found the monitor might not reduce this risk at all. The manufacturer of that brain-monitoring technology has disputed the researchers' interpretation, and anesthesiology chiefs at three Philadelphia-area hospitals said the results would not keep them from using the device.
The Iowa Board of Regents has given approval for planning to move forward on a proposed $700 million expansion at the University of Iowa Hospitals. The project calls for construction of an 800,000 square foot critical care tower and a 600,000 square foot children's hospital tower, with construction to begin in 2010. Despite the approval, the board expressed concerns about patient access and convenience and asked UI hospital leaders to address those issues in their planning.
Las Vegas-based Medical Marts, a company that operated three clinics in suburban Chicago, has shuttered its operations in various retail outlets across the country. Medical Marts staffed its clinics with two full-time primary-care physicians, as well as two full-time medical assistants or licensed practical nurses. Medical Marts had previously announced a goal of 400 clinics in retail outlets across the country by the end of 2009.
Massachusetts health authorities have proposed a campaign to catch prescription drug abusers by alerting doctors when patients visit multiple clinics and pharmacies in pursuit of powerful painkillers and stimulants. The practice has drawn increasing scrutiny from substance abuse specialists and regulators.
To control soaring healthcare costs, Massachusetts must overhaul how doctors and hospitals are paid, according to several state healthcare leaders during legislative testimony. John McDonough, executive director of Health Care for All, said large healthcare providers have driven up costs through secret negotiations with insurers. McDonough proposed that Massachusetts seek federal approval to impose a system in which payments would be made based on the service provided and not on who was shelling out the money or how much clout the provider had.
The federal government has reached a $666 million settlement with 667 hospitals that had sued for back payments stemming from shifts in Medicare reimbursement policies. The deal is among the largest government settlements paid to healthcare providers, and is the result of negotiations under way since April 2006.
The Centers for Medicare and Medicaid Services has reversed an earlier decision and will continue to cover the use of an increasingly popular procedure to detect heart disease. CMS had misgivings about the scanning procedure due a lack of evidence to justify paying for the tests under Medicare. The agency now says that it will continue to leave payments for the scans up to the local insurance carriers it employs to oversee medical claims.
Too often, providers overlook front-desk procedures as a tool for protecting their money. Having fundamental frontdesk procedures in place is a vital component to having a claim paid the first time it is submitted to the insurance carrier. Some areas to watch include:
1. Checking insurance eligibility. The eligibility of the patients may be checked by staff members at the time of the patient's arrival, before the patient arrives, or the day before the patient's appointment. However, an exception to this policy may be when checking the eligibility of Medicaid patients. In some states, the status of a patient's Medicaid eligibility could be changed at any time up to midnight. In this case, the best way to verify the Medicaid patient's eligibility is to check the eligibility on the day of the appointment.
2. Verifying demographic information. Medicare has issued a directive stating that the Medicare patient's name, birth date, the spelling of the patient's name, and the ID number should be verified against the patient's Medicare card to ensure that this information matches the information in your computer system. If any of the information is incorrect, Medicare will deny the claim. These protocols should be in place when validating the demographic and insurance information for all of your patients, regardless of the type of insurance.
3. Collecting copays and outstanding self-pay balances. It is usually best to collect the copay before the provider sees the patient. Also, it is important to check the amount of the patient's copay each time the patient comes into the office. Besides collecting copays, the front desk may also collect outstanding balances.
4. Completing registration forms. Having the patient complete and sign a registration form is essential for the front desk to oversee so that all of the pertinent information is available to be put on the claim.
5. Putting the charges into the computer. Following are some of the questions that should be addressed before the charges are entered:
Is the patient new or established?
If there is more than one diagnosis, are the diagnoses being put into the system in order of importance?
If there is more than one procedure code, does each procedure code have its own diagnosis?
Are the correct age-specific annual codes billed?
Is the claim being submitted to the current insurance carrier?
Are the ID numbers on the claim correct?
6. Answering the telephone. Telephone etiquette is another aspect of protecting practice revenue. Strong telephone skills will create a positive impression. It is important that when front-desk personnel answer the phone, they identify the practice and give their own name.
Shannon Sousa is the editor of The Doctor's Office. She may be reached at Ssousa@hcpro.com. This story was adapted from one that first appeared in the March edition of The Doctor's Office, a monthly newsletter by HealthLeaders Media.
