Reimbursement Roundup
June 1, 2000 2 minutes read
Reimbursement Roundup
SGR for 2000 higher than expected
An expected minus becomes a plus
The sustainable growth rate (SGR) for Medicare physician payments in calendar year 2000 has been placed at 5.8%, reports the Health Care Financing Administration (HCFA). Last fall, HCFA was predicting a 2.1% SGR for 2000. The 1999 SGR was -0.3%.
The SGR is used to set a yearly target for payment increases in Medicare spending on physician services. If the target is exceeded, HCFA reduces the next year’s physician reimbursement rate update to compensate.
This year’s 5.8% rate increase reflects estimated changes in physician fees (2.1%), number of Medicare beneficiaries (-0.6%), growth in per capita gross domestic product (2.5%), and impact from changes in laws and regulations (1.7%), according to HCFA.
HMOs expanding into administrative field
Internet project coming
Six of the country largest health maintenance organizations are developing a joint Internet that will process provider claims, patient referrals, and prescriptions, say industry sources.
The consortium is being formed in reaction to HMOs’ fears that unless they act quickly, they will be locked out of the potentially lucrative market for Internet-based health care administrative services by such fast-growing portals as Healtheon/WebMD in Atlanta.
The managed care plans working on the on-line project, tentatively named MedUnited, are Aetna, Cigna, Wellpoint Health Networks, Oxford Health Plans, Foundation Health Systems, and Pacificare Health Systems.
"These HMOs are saying they want to participate in this emerging market offering Internet-based alternatives for providers looking for ways to reduce their practice management hassles," notes Claudine Singer, an analyst with Internet research firm Jupiter Communications in New York City.
However, many experts wonder if such consortia can get off the ground given the hotly competitive nature of the HMO industry and possible reluctance of doctors to do business with a plan they feel is already working overtime to cut their income.
Another potential pitfall is that submitting a claim over the Internet is not as simple as insurers and Internet health companies would lead you to think.
"One challenge for doctors is that they have to figure out how to take the claim from their practice management system and put it on the Internet," notes Michael Mytych, a principal with Health Information Consulting in Menomonee Falls, WI.
"The same challenge applies to doctors whose offices aren’t automated because they still have to produce a claim file from somewhere," he explains.
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