Posted by
Dennis Murray on January 17th, 2008. Filed under:
health plans,
reimbursement,
aetna,
health plans,
hospitals,
insurers,
medicare,
preventable injuries,
reimbursement,
wellpoint.
Aetna, WellPoint, and other big insurers are moving to ban payments for care resulting from serious errors, including operating on the wrong limb or giving a patient incompatible blood. The companies are following the lead of Medicare, which announced last summer that starting this October, it will no longer pay the extra cost of treating bed sores, falls, and six other preventable injuries and infections that occur while a patient is in a hospital. continues…
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From Medical Economics magazine, more on health plans ...
Posted by
Wayne Guglielmo on December 21st, 2007. Filed under:
health plans,
aetna,
Cigna,
claims,
health insurance executives,
healthcare costs,
kaiser permanente,
managed care,
opinion,
patients,
physicians,
reimbursement,
United Healthcare,
wellpoint.
In the debate over rising healthcare costs, some see managed care as part of the solution, and some see it as part of the problem. Industry representatives, to no one’s surprise, place themselves squarely in the first camp. They blame rising costs on a gaggle of factors not of their own doing—overconsumption by consumers, physician overutilization, and poor-quality care, to name a few. To bring high-quality, cost-effective healthcare to all Americans, the industry has sought to tame these runaway drivers. The industry isn’t alone in seeing managed care as part of the solution. In an editorial late last month, The New York Times included managed care among the solutions to the cost crisis. Properly employed so as not to trigger another backlash, the Times editors suggested, it still has a role to play in keeping a lid on things.
But not everyone sees things that way. continues…
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From Medical Economics magazine, more on health plans ...
Late last month, New York Attorney General Andrew M. Cuomo announced that his office had reached an agreement with Cigna HealthCare on major revisions to its physician-ranking programs in the Empire State, and beyond. Under the new pact, Cigna promises, among other things, to broaden its ranking criteria beyond cost, use generally accepted national standards to measure quality, disclose program design elements to consumers and physicians, and hire an independent watchdog (subject to AG approval) to monitor its compliance.
The agreement grows out of Cuomo’s industry-wide investigation of physician-ranking programs. In separate letters to six plans, Cuomo and his staff raised a laundry list of concerns. continues…
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From Medical Economics magazine, more on health plans ...
The Fairfield County Medical Association, a 1,800 member physicians’ association based in Connecticut, is suing Cigna Corp. and UnitedHealth Group for steering patients to doctors who score well on the insurers’ quality and cost efficiency measures. continues…
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From Medical Economics magazine, more on health plans ...
Dr. Mehdi Ansarinia, a solo-practice neurologist in Las Vegas, opened his books for a Las Vegas Sun reporter to give an example of how various payers wrongly return about a third of the claims he submits.
The article gives this list of bogus rejections: continues…
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From Medical Economics magazine, more on claims ...
IBM, the ACP, and the AAFP are joining forces on a project that will test how an IBM-designed system can help physicians create a fully functioning “medical home” for patients. Medical society officials say that the pilot, expected to begin in Austin, TX, later this year, will look at new reimbursement models such as care coordination payments to primary care doctors. IBM will offer incentives, and Aetna will also be involved in the test, according to FP Terry McGeeney, president and CEO of TransforMED, the AAFP’s practice redesign project.
TransforMED and the ACP’s Center for Practice Innovation are already looking at whether doctors in small and medium-sized practices can adopt the medical home approach, which seeks to improve preventive and chronic care through practice re-engineering and the use of health IT.
Update: Professional and financial news you can use [Via Medical Economics]
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From Medical Economics magazine, more on reimbursement ...
The Associated Press reports that the New Jersey Department of Banking and Insurance fined Aetna Health Inc. almost $9.5 million for underpaying some out-of-network doctors, such as ER doctors. New Jersey regulators also ordered the insurer to pay the doctors’ fees in full. continues…
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From Medical Economics magazine, more on health plans ...
An estimated 900,000 physicians nationwide will share $128 million in compensation in a settlement with the Blue Cross and Blue Shield Association and 23 Blue Cross and Blue Shield plans. continues…
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From Medical Economics magazine, more on health plans ...
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