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Q&A: Discounting charges

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Q. How does a hospital go about discounting charges to patients with large medical bills?

A. In the same way that a hospital can waive collection of charges for individuals under its indigency policy, a hospital may also offer discounts to those who have large medical bills. Hospitals have flexibility in establishing their own indigency policies.

The Office of Inspector General (OIG) advises that discounts to underinsured patients can raise concerns under the Federal anti-kickback statute, but only where the discounts are linked in any way to business payable by Medicare or other Federal health care programs. In addition, depending on the circumstances, discounts to underinsured patients may trigger liability under the provision of the civil monetary penalties statute that prohibits inducements offered to Medicare or Medicaid beneficiaries.

But again, if no inducement is being offered, neither statute is implicated. Further information on these fraud and abuse issues are available on the OIG Web site.

Source: Center for Medicare & Medicaid Services.

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Dartmouth researchers have found Medicare spending differs across the country, with some areas seeing much faster growth than others, The New York Times reported February 26.

The analysis was to be published February 27 in The New England Journal of Medicine. It found doctors who often order tests and admit patients to hospitals drive up costs.

“The incentives are there for growth,” Elliott S. Fisher, MD, the director of the Center of Health Policy Research at the Dartmouth Institute for Health Policy and Clinical Practice and one of the work’s authors, told The Times.

“As long as Medicare pays for volume and intensity, that’s what you’re going to get,” Mark B. McClellan, MD, a health policy specialist at the Brookings Institution who oversaw the Medicare program during part of the previous administration, told The Times.

Read the full story in The New York Times.

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U.S. President Barack Obama aims to squeeze payments to insurers, hospitals, doctors and drug manufacturers in order to help fund a $634 billion reserve fund targeted for an overhaul of the country’s healthcare system, The Washington Post reported February 26.

Obama’s plan is to extend health insurance to more Americans and control medical bills.

"We aim to get to universal coverage," administration budget aide Keith Fontenot said in The Washington Post. Obama is "open to any ideas people want to put forward. He wants to work openly with the Congress in a very inclusive process."

Read the full story in The Washington Post.

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It does not pay enough money.

That is the contention of Wellcare, Florida’s largest Medicaid insurer, which announced it is leaving the state’s Medicaid Reform program, The Miami Herald reported this week. Government reimbursement rates are just too low, the insurer said.

”WellCare’s action is a result of recent state budget cuts that make it economically unfeasible to continue offering members sufficient access to quality health services in those programs,” the company said in a written statement.

”It’s fair to say that the rate cuts are substantial enough that some plans will soon have to decide whether to stay,” said Michael Garner, president of the Florida Association of Health Plans, in The Herald.

Read the full story in The Miami Herald.

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Iowa hospital leaders say increasing numbers of uninsured patients are seeking free care in their emergency rooms, the Des Moines Register reported January 21.

Fort Dodge-based Trinity Regional Medical Center’s charity care, for example, jumped from $3.3 million in 2007 to $5.9 million in 2008.

Read the full report in the Des Moines Register.

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Medicaid enrollments are surging in some states because workers are losing their health insurance along with their jobs, The New York Times reported January 22.

Some states saw surges between 5% and 10% in the last 12 months. Growth rates doubled from the prior year in some states.

Read the full story in The New York Times.

Categories : e-Newsletters, Medicaid
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UnitedHealth Group Inc. will pay $350 million to resolve class action lawsuits over reimbursement for its out-of-network medical services. The settlement resolves litigation filed on behalf of the American Medical Association, health plan members, healthcare providers, and state medical societies.

The settlement comes two days after UnitedHealth struck an agreement with the New York state attorney general following a probe into the independence of its database used to set reimbursement rates for patients’ medical bills.

Read the full story by Reuters.

Categories : e-Newsletters
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CMS released specific information about the 2009 Physician Quality Reporting Program (PQRI) on its Web site, including the 2009 PQRI measure groups and the following downloads:

  • 2009 PQRI Quality Measure Specifications Manual and Release Notes
  • 2009 PQRI Implementation Guide
  • 2009 PQRI Measures Group Specifications Manual and Release Notes
  • Getting Started with 2009 PQRI Reporting of Measures Groups

PQRI reporting began yesterday. There is no need to preregister to participate in the program.

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