Reimbursement Roundup
January 1, 2000 3 minutes read
Reimbursement Roundup
Medicare spending drops for first time
During fiscal year 1999, Medicare spending sank 1% to $212 billion, down from $213.6 billion the previous fiscal year, reports the Treasury Department. This is the first time in the Medicare program’s history that spending has dropped. Experts credit congressionally mandated spending cuts, antifraud efforts, and more conservative billing practices by health care providers for most of the savings.
AMA labor negotiating panel announced
Physicians For Responsible Negotiation (PRN), the national negotiating organization created by the American Medical Association, has been formally launched. In turn, PRN is now available to organize and assist eligible physicians and residents in negotiating important issues with their employers involving patient care and physician practice.
Heading PRN will be Susan H. Adelman, MD, a pediatric surgeon from Southfield, MI, who was elected president for the new organization by its board of directors. Other PRN officers named were John C. Nelson, MD, an obstetrician/gynecologist from Salt Lake City, (treasurer) and Andrew M. Thomas, a physician in a fellowship program at the Ohio State University (secretary). Adelman and Nelson also are members of the AMA’s board of trustees.
Initially, PRN will negotiate on behalf of employed physicians, as well as certain resident physicians where state law allows. However, a case pending before the National Labor Relations Board could expand the number of physicians currently eligible to negotiate through PRN.
In addition, PRN will assist self-employed physicians in states such as Texas, where state law allows them to collectively negotiate with insurance plans and other payers.
For additional information, contact: Ross Rubin, acting executive director of Physicians For Responsible Negotiation. Telephone: (312) 464-4776.
Feds crack down on late-paying HMO
Federal authorities have ordered an Arizona HMO owing up to $11.5 million to hospitals in that state to stop signing up Medicare patients until its bill-paying record improves.
Premier Healthcare of Arizona, a Tucson-based health plan with a nearly $4 million operating deficit, is suspended from marketing its services or enrolling new members covered by Medicare until it can show its provider bills are being paid promptly.
Arizona hospitals that Premier owes money include Havasu Regional, $2 million; Western Arizona Regional in Bullhead City, $1.5 million; and Northern Arizona Healthcare’s hospitals in Flagstaff and Sedona, $4 million.
Of the 34 hospitals participating in the Arizona Hospital Association’s DataWatch survey, the statewide average for uncollected accounts receivables (including HMOs and other payers) is 62 days. Reimbursements for care provided to Medicare patients are paid within an average 42 days — 67 days for those covered by Medicaid.
Doctors sue Anthem’s Connecticut Blues
Sixteen orthopedic physicians have filed a class action suit in Waterbury (CT) Superior Court against Anthem Blue Cross and Blue Shield of Connecticut for breach of contract, saying the company arbitrarily changes reimbursement rates.
The doctors’ attorney, William J. Sweeney Jr., alleged that Anthem Blues changes reimbursement rates without notice while paying different rates for the same procedure based on utilization. In turn, a physician who submits more treatment claims is likely to receive a lower payment for each service than a doctor submitting fewer claims, he said. Sweeney also alleged the Blues delay payments and make it hard for practices to get a prompt answer about whether a patient is covered.
HMO may place docs on uncooperative list’
PacifiCare of Colorado has ordered physician members of Millennial: Colorado’s Physician Alliance, to turn over their proprietary contracts with Millennial. Physicians who refused the late November action were told they would be placed on PacifiCare’s "uncooperative list," said Millen nial spokesman David Scott.
Gary Klein, MD, a board member with Physi cian’s Network of Colorado Springs, one of Millennial’s member physician groups, says he received a call from PacifiCare demanding that he send them his Millennial contract. "I refused because the contract contains proprietary information," he explains. "It’s not a contract with Pacifi Care — why should I release it to them? I’m outraged. In 17 years of practicing medicine, I’ve never been threatened by a health plan before. This is a reprehensible way to treat physicians."
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