Archive for Insurance News

To Hire or Not To Hire, That is the Question?

With the impending changes on the horizon and the looming Medicare cuts hanging in the balance, it seems that many of our clients are hanging their decision to hire in the balance as well.  What the government has failed(as usual) to realize is that their dithering has done nothing but drive unemployment up and job security down.

We work with hundreds of physicians every year and continued to hear that plans are being put on hold and strategies are being realigned to cope with whatever may happen in Washington.  It is true, there is a problem with some areas of our healthcare system.  The fixes that are being voted on do not really fix anything, they will just create a larger mess to clean up later.



$848 Billion House Bill: Medicare 21.2% Cut Replaced by .5% Increase for 2010

Paying for payment reform

The House-passed Medicare physician payment reform bill would cost the federal government an estimated $210 billion over 10 years. Nearly $260 billion in higher pay would go to physicians and health plans to treat seniors and military members over that time. But beneficiaries would make up roughly $50 billion of that through higher premiums.

Outlays in billions of dollars (fiscal year)
Medicare physician fee schedule Medicare Advantage and Tricare Part B premium receipts Total net changes
2010 $8.0 0 0 $8.0
2011 $13.7 $3.7 -$2.8 $14.7


Filed Under: Insurance News

BYE BYE Consultation Codes

With all of the conversations about Health Care reform many practices have taken their eyes off of the current happenings in Medicare.  2010 will prove to be a year full of changes and could very well have bills signed that transform Medicare/Medicaid like never before.

One of the important changes is beginning January 1, 2010, Medicare will no longer accept consultation codes.  Citing years of billing confusion related to the billing of consultation codes, CMS will require providers to bill all evaluation and management (E/M) services using the appropriate inpatient or outpatient visit codes.  The change is expected to be budget neutral because the money spent on consults will be used to increase payment for new and established E/M services.  However, many specialists who heavily bill consults will likely see a decrease in E/M reimbursement in 2010.



Another Insurance Company Bowing out of Texas Market

UniCare says it couldn’t get enough market share. Members can opt for comparable insurance with Blues plans in both states.

By Emily Berry, amednews staff. Posted Nov. 13.

Indianapolis-based WellPoint is sending about 400,000 of its non-Blue membership to BlueCross BlueShield-affiliated plans owned by another company, citing an inability to win enough market share to serve those members efficiently.

The members belong to WellPoint’s national UniCare subsidiary but are not in one of the 14 states in which it owns Blues plans. The company reported 33.9 million members before the announcement.



Filed Under: Insurance News

Physician Credentialing in a Consumer-Centric World

Physician Credentialing In A Consumer-Centric World

By: Derek van Amerongen

As managed care responds to the rising tide of consumerism in medicine, it is necessary to reexamine the functions that health plans have performed. Chief among the activities that demand resources but return minimal value is the process of physician credentialing. As consumers are asked to assume more control in their health care decisions and to pay more for their care, the credentialing process must be changed if it is to add value for consumers. This paper discusses the role of credentialing and how it might be reconfigured to become more meaningful to consumers.



Filed Under: Insurance News

Insurance Companies Recording Record Profits-Are you?

Interesting artilce was published today covering the significant increase in earnings that many insurance companies enjoyed in the last quarter.  I am perplexed with these numbers because most physicians and households have seen a reduction in revenue and profits.  This just shows that with strong negotiation efforts the insurance companies have the money to pay you what you deserve.  Don’t settle for less than you deserve, use a professional insurance renegotiation company and increase your revenue by 10%-15%.

Article:

Health Plans Need Government Programs-Courtesy of BNET



Filed Under: Insurance News