Potential Consequences of Forgiving Copayments

Back in the day, before health insurance entered the market, patients negotiated directly with healthcare providers and paid what they could afford, often on a sliding scale. Deductibles, copayments, and coinsurance developed as a check against overutilization once insurance companies became responsible for the bill.  These days, many insurance companies are increasingly checking up on the collection of copayments, deductibles and coinsurance by asking for proof of payment collection.  And in certain instances, especially in times of financial hardships, some providers do indeed waive copayments for their patients (yet still bill the insurance companies for services).

With the upcoming changes in the industry, it’s especially important for providers to understand the rules regarding the waiver of copayments.  Providers should be aware that forgiveness or waiver of copayments may violate policies of some insurers, both public and private.  It’s especially important to note that routine waiver of copayments may constitute fraud.  With the ACA rollout expected to be in full swing by the next year, providers should make it a priority to not only update their financial policies, but also to place an emphasis on patient responsibility.

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Tipastic Tuesday: How to Maintain an Excellent Online Reputation

The internet has opened many doors for consumers who are looking to find information about businesses and services.  Information not only spreads faster online, it also has a greater reach.  Therefore, it’s important for healthcare providers to be concerned about the accuracy of information prospective patients are finding out about their practices.  Negative reviews can cost you thousands of dollars by diverting patients from using your services. The following tips will make it easier for you to maintain an excellent online reputation:

  1. Google yourself and your practice: Perform monthly searches to find out what context your practice is being mentioned online.  Pay close attention and make note of whether the information accurately reflects your business and if so, address the specific issue at hand.
  2. Set up Google alerts: Set up alerts at www.google.com/alerts.  Google alerts inform you any time someone mentions your practice.  Simply pick a search query (e.g. Smith Family Practice), select “everything” for type of results you want to receive, decide how often you want to get the results, select how many relevant results you want to receive, and finally enter your email address.  You will start getting emails notifying you each time someone mentions your name.  You could use variations of your practice’s name to get better results.
  3. Update your directory listings: Patients use review sites such as Healthgrades and ZocDoc to find out information about physicians.  If you want patients to easily find you, make sure your information is updated and accurate.
  4. Ask your patients for reviews: Consumers value what other people say and if your practice is lacking reviews, it may be hurting your practice.  Ask existing, loyal patients to post comments about their experiences at your practice.

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Connecticut Medicare Ratings

This year’s Medicare ratings are out and more than two thirds of Connecticut hospitals will face Medicare penalties for not having proper clinical-care measures in the fiscal year that began on October 1.  23 Connecticut hospitals will also lose Medicare funding because of high rates of readmitting patients within 30 days of discharge.  Hospitals can receive penalties and incentives under the value-based program based on how well they perform on a variety of clinical measures like patient satisfaction measures and mortality rates for certain conditions.

Medicare’s penalty formula has proven to be somewhat controversial but many providers and consumers believe a rating system is important for choosing the right provider. Do you believe publicly available information like Medicare ratings make more knowledgeable health care consumers?  We’d love to hear your thoughts.

Click here to read an opinion piece on this matter

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CT Attorney General Wants Hospitals to Disclose ‘Facility Fee’

Many patients have been surprised to see a “facility fee” on top of charges for in-office services and procedures provided to them by practices. Connecticut Attorney General George Jepsen has asked the state’s hospitals for a list of their affiliated providers by December 6 after receiving numerous complaints from consumers who were not informed about the fees. A “facility fee” is what hospitals say they have to charge patients of practices they have acquired because acquiring an independent practice increases their overall costs. Jepsen wants a list for patients so that they have the option of going somewhere else if they don’t want to be charged a fee which is a separate and sometimes expensive fee.

Emerging trends in Connecticut and throughout the country point towards heavy healthcare industry consolidation where hospitals are merging with other hospitals and acquiring medical practices. Jepsen notes that it’s especially important for consumers to understand this shift and the associated costs.

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Connecticut Judge Dismisses Observation Care Lawsuit

On Monday, a federal judge in Hartford, Connecticut dismissed a lawsuit which was filed by 14 Medicare beneficiaries seeking nursing home coverage.  The Medicare beneficiaries, who stayed in nursing homes following a hospital stay, had to pay tens of thousands of dollars in nursing home bills because they stayed in the hospital under observation status.  Under current Medicare rules, patients must be admitted to a hospital for at least three consecutive days to be eligible for follow up coverage in a nursing home.  The primary goal of the lawsuit was to change the observation classification for Medicare beneficiaries.  Medicare beneficiaries staying in hospitals under observation status has increased by almost 70 percent in five years, while admissions under the inpatient status have decreased.

The lawsuit is timely considering CMS finalized the “2-midnight rule” which aims to change Medicare beneficiaries’ status as inpatients.  The new rule, according to CMS, “improves value and quality in hospital care and provides clarification about when a patient should be admitted to the hospital and responds to recent concerns about extended Medicare beneficiary stays in the hospital outpatient department” (click here to read more about the rule).

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Benefits Of Docs, Patients Communicating Via Email

HMS Healthcare Management SolutionsFewer than one-third of physicians surveyed report exchanging email messages with patients last year. One theory is email exchanges between patient and physician appeal more to patients than to time-strapped docs.

But doctors who do use email to communicate with patients describe some impressive benefits to incorporating electronic communication into their practices.

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Tiptastic Tuesday: Keeping Denials At Bay

It can often be difficult to determine exactly what falls under the umbrella of medical necessity for payors.   Medicare define a service as medically necessary if it is needed for the diagnosis or treatment of a medical condition, meets the standards of good medical practice in the local area and is not for the convenience of the patient or doctor.

Though these guidelines were put in place to clarify medical necessity, they are vague enough to cause confusion.  Here are some tips to ensure your claims meet the definition.

1.  Code For Specificity: Using the most specific code available for a diagnosis is essential to establishing medical necessity.  Using a vague code can adversely affect the reimbursement you receive.

2.  Specific Documentation: It’s important to have accurate documentation supporting the patient’s diagnosis and treatment which meets the standard set by your payors.

3.  Record Chronic Conditions: Consistently recording the details of treatment patients receive for chronic conditions is also a significant part of proving medical necessity.  Chronic conditions should be documented and coded as many times as a patient receives treatment for the illness.