Practice Management
Alabama says it’s just trying to protect its coffers from being pilfered by criminals, but the Centers for Medicare & Medicaid Services is taking a hard look at how the state is handling cases of alleged fraud by Medicaid enrollees. The state acknowledges that it rejects people who would otherwise be eligible for Medicaid funding if those individuals “have been found” to have engaged in fraud—even if they were never convicted of a crime, which …
Read MoreUrgent care in a shifting healthcare delivery environment brings to mind Shel Silverstein’s children’s classic, The Missing Piece Meets the Big O. In that tale, the missing piece stands alone, waiting for someone to come along and take it somewhere. Various shapes come by, but none are quite right. Some could not roll. Some had too many missing pieces. Finally, a shape comes along that fits just right and they roll along until the missing …
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Markets where there are higher concentrations of urgent care centers have lower emergency room visit rates, according to a new survey from the Deloitte Center for Health Solutions. Not unexpectedly, the inverse relationship was also shown; areas where urgent care centers are less concentrated tend to have higher ED visit rates, as well as larger uninsured and Medicaid populations. Industry watchers are eager to see how the numbers trend, as urgent care continues to emerge …
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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 …
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Patients have options for getting to many care settings even if they’re unable to drive themselves or get a ride from a loved one. Some Medicaid patients arrive in the emergency room in an ambulance—even if they’re complaints don’t warrant such urgency. A couple of major health plans in Miami send vans around to collect Medicare members who need to see their primary care, and employers often provide transportation to workers who need to see …
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Urgent care operators—and all healthcare providers who receive federal funds (eg, reimbursement under government programs like Medicaid or plans that take part in the Affordable Care Act)—are required by federal law to post nondiscrimination notices in public view by October 17. The U.S. Department of Health and Human Services (HHS) Office of Civil Rights says physicians must take “appropriate initial and continuing steps” to notify patients of certain information/services related to nondiscrimination. HHS has posted …
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The case of a Canton, MI urgent care provider charged with 22 counts of medical fraud should serve as a cautionary tale and a reminder that unethical (or even just plain sloppy) billing practices can land operators, office staff, and physicians in hot water—or even jail. The physician in the Michigan case stands accused of billing Medicaid and Blue Cross Blue Shield for services he didn’t provide, resulting in nine counts of Medicaid fraud, 12 …
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Payers, politicians, and practitioners don’t often line up on the same side of issues, but in Colorado they’re united in their distaste for a proposed single-payer system that would increase health coverage in the state—at the cost of a $25 billion tax increase that could drive employers out, some fear. Proponents counter that “ColoradoCare” would end up saving more than $6 billion annually by 2019. Under the program, residents would choose among private health insurance …
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Major changes are afoot for urgent care centers that treat patients under Medicaid and the Children’s Health Insurance Program (CHIP), thanks to a new rule the Centers for Medicare and Medicaid Services (CMS) is imposing. In addition to new requirements for insurers, the rule also creates new compliance and administrative burdens that could affect revenue for medical practices (eg, requiring care coordination between different settings and institution of quality-rating systems and allowing states to encourage …
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Physicians and nurses were charged along with business owners after the Department of Justice moved in on scores of clinics that were allegedly involved in fraudulently collecting fees from Medicare and Medicaid. The DOJ says more than 300 people were charged in healthcare fraud schemes involving $900 million in false billings. Sixty suspects were allegedly linked to schemes involving Medicare Part D, which is the fastest-growing component of Medicare, overall. According to court documents, the …
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