AMA: Auditors Should Pay For Their Mistakes

The American Medical Association (AMA) is telling lawmakers and regulators that Recovery Audit Contractors (RACs) making incorrect accusations should be penalized. The RAC system, which rewards the government’s contracted investigators based on the volume of improper payments they find, has long been criticized by healthcare providers. The AMA believes there are not enough disincentives for auditors who make false accusations without merit. The AMA is also asking CMS to pay providers interest when they successfully appeal a finding. As of now, there is a two-year RAC appeal backlog which federal regulators are working through. The AMA believes that without any government action, RACs will “continue to operate under their current financial incentives and resist changes that would improve audit accuracy, reduce the number of appeals, and mitigate the burden on physicians.

Click here to read the AMA letter to CMS.

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AMA Wants to Delay ICD-10 Implementation

The American Medical Association (AMA) recently reinforced its position that ICD-10 implementation should be delayed by two years. The AMA was instrumental in helping delay the ICD-10 implementation from October 1, 2013 to October 1, 2014. However, some experts say that this delay is only hurting physicians by giving them the idea that the AMA will be able to delay ICD-10 implementation once again.

So, how can we make physicians start taking ICD-10 implementation seriously? We can start by reminding them that ICD-10 will not change the way they practice medicine, it will only change the way they document it. In fact, ICD-10 is written more in clinical terms and less in coder speak so this may be important to physicians who already document necessary information about their patients. It is crucial that physicians are reminded not what they need to document, but what they are not documenting.

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What’s the Future Payment Model for Healthcare Delivery?

According to the American Medical Association (AMA), physician-led team-based care is the future of healthcare delivery in America.  Recently, AMA members suggested physicians receive payment for services and then make the decisions about how other team members get paid.  These “disbursement decisions” would be based on factors such as volume and intensity of services and care quality. Believing that physicians are crucial to optimal patient care, the AMA has been outspoken about their concerns for nurse-led practices.  Nurse practitioners have fought back stating that have the required skills to help areas where there are primary-care shortages.

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What’s Behind Exorbitant Healthcare Costs?

According to a new study published in the Journal of the American Medical Association, the reason behind high healthcare costs is price increases, not a larger senior population. More recently, it has been theorized that a much larger aging population and their demand for services due to chronic conditions was the culprit behind these costs.  But, researchers who examined publicly available data determined that healthcare costs “exceed any other industry as a share of gross domestic product.”  91% of cost increases can be attributed solely to price increases since hospital charges, professional services, drugs, devices, and administrative costs are much higher than they ever were.

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AMA Urges CMS to Rethink New Method of EFT Payment Method via ACH

Part of a growing trend, insurance companies are issuing plastic and virtual cards to practices rather than depositing funds directly into physician accounts. The American Medical Association (AMA) wants the Centers for Medicare & Medicaid Services (CMS) to rethink these methods of payment since physicians are getting less than the negotiated prices for services. These cards have the potential to cut physician pay by as much as 5% after transaction fees, as insurers casually leave behind traditional practices of EFT’s due to cash-back incentives. For health plans these cards are a revenue generator and for practices—a revenue drainer.

Click here to read, “What do I need to know about payer and patient credit cards?” published by the American Medical Association, 2012

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AMA To Challenge SNF Care Prerequisite

Earlier this week, delegates of the the American Medical Association (AMA) approved plans to change the 72-hour hospitalization requirement for Medicare Part A coverage of skilled nursing facility (SNF) care. The resolution asserts Medicare should immediately cover a SNF stay if a physician determines its the best setting for care.

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