Practice Management
Blue Cross Blue Shield of Georgia and Empire Blue Cross Blue Shield in New York are the latest insurers to require that urgent care centers become accredited before contracting, or as a requirement to maintain in-network status. As noted in a recent posting by Becker’s Hospital Review, such policies highlight growing demand for healthcare providers in all settings to demonstrate both value and quality care—both of which have long been touted as attributes of well-run …
Read More
Urgent care doctors, physician assistants, and nurse practitioners who did not demonstrate that they met requirements for meaningful use of electronic health record systems as mandated by the Centers for Medicare & Medicaid Services (CMS) will see a 3% decrease in Medicare payments starting January 1, 2017. As you read here, CMS first announced its plans to require clinicians to show meaningful use during a finite 90-day period that year. That finite period was later …
Read More
The Centers for Medicare and Medicaid Services (CMS) will ask Medicare beneficiaries how their healthcare providers are doing under the new Merit-based Incentive Payment System (MIPS), which was supposed to help improve the quality of care while lowering cost. No revelations are expected, however, because the survey is voluntary and CMS has taken a relaxed approach to getting providers on board with the new system. In addition, survey results—which, presumably, will be made public to …
Read More
Urgent care operators are watching with interest as Anthem and Cigna Corp. prepare to fight for their proposed $53 billion merger. The U.S. Justice Department has already expressed concerns about the deal moving forward, claiming that federal and state regulators complain consummation would reduce competition, leading to higher prices and lower levels of service. For their part, Anthem insists the proposed massive new company would be in a better bargaining position to negotiate deals with …
Read More
The Affordable Care Act (ACA, or “Obamacare”) has given millions of citizens access to healthcare they didn’t have before, driving up volume in some urgent care centers and emergency rooms. It’s also put sometimes unbearable pressure on insurers to find a way to stay profitable in the state-run exchanges; most that originally participated have bowed out because they were losing too much money, in fact. With the election of Donald Trump as our next president, …
Read More
Changes in the way the Centers for Medicare & Medicaid Services (CMS) pays for primary care will push roughly $140 million to providers next year—with provisions in a new rule bringing another $60 million for a total of $200 million above 2016 payments. There may be even more coming down the road, as CMS says several coding and payment changes could eventually lead to as much as $4 billion or more being funneled into care …
Read More
Like many insurers, Anthem says it’s had a hard time operating profitably in exchanges under the Affordable Care Act (ACA, or “Obamacare”). Unlike many insurers, it has stuck with its participation despite those woes. If the situation doesn’t improve, though, Anthem says it will probably switch gears and reconsider its offerings for 2018. The company, whose proposed merger with Cigna faces an antitrust challenge by the Justice Department, also says it would issue a request …
Read More
Blue Cross and Blue Shield of North Carolinas (BCBSNC) says the federal government is trying to run out on a bill that amounts to $147.5 million in overdue risk-corridor payments. The Justice Department counters that the suit—along with several others that revolve around the 3-year-old program—is premature because any payments wouldn’t be due until next year at the earliest. BCBSNC is eager to have its day in court though, and says the government’s defense is …
Read More
Patients whose health is insured under marketplaces created via the Affordable Care Act (ACA, aka “Obamacare”) have become acutely cost conscious when it comes to their own care—to the extent that they may not be getting the care they need, according to a new survey. While that paints a picture of a dysfunctional system, urgent care may be reaping some rewards as patients seek out quality care that won’t cost them as much as a …
Read More
A new study of the Oregon Health Insurance Experiment shows the program has fallen short on one of the key benefits promised—namely, that emergency room traffic would be reduced if state Medicaid rolls were opened up to low-income adults through a lottery system. Nearly 90,000 residents signed up for the lottery, but EDs are as crowded as ever. It’s beyond question that urgent care could reduce the congestion, but most Medicaid programs don’t offer urgent …
Read More