Physicians News Health news for doctors and patients.

Unlike claims for out-of-network services submitted to commercial health plans – which are often paid based on a percentage of charges or some other negotiated process – payment for out-of-network services provided to Medicare Advantage enrollees are dictated by Medicare law and regulations.

IBC pilot project uses physicians instead of nurses to expedite in-home preventive care to the frail eldery.

Many physicians may find the PQRI appealing, as they stand to gain extra reimbursement for reporting data that they may already capture in their patients’ clinical charts, although participation will likely entail workflow changes, and few expect the 1.5 percent bonus to cover a practice’s additional cost for capturing and reporting the data.

The first round of PQRI is underway, and for the majority of physicians who chose not to participate or could not implement its requirements, losing out on the 1.5 percent bonus may not be significant, particularly considering the amount of work required to implement the program.

Confusion results from the need of hospitals and health systems to meet technical and legal requirements to be classified a non-profit, charitable entity.

As the pie shrinks or stays the same, it becomes more important to implement a fair and reasonable net income division formula. While most practices can accomplish that, others cannot, which can lead to practice split-ups, partners leaving and buy-in deals not coming to fruition.

Physicians must take particular care to ensure that the arrangements not only comply with the anti-kickback statute but, wherever possible, do not have the “suspect” attributes identified by the OIG.

What needs to be done to allow physicians to share electronic medical records across Pennsylvania.

Experiences from this project are expected to help shape the nationwide value-based purchasing program authorized under the 2006 Deficit Reduction Act and scheduled to be launched in fiscal year 2009.

Do you realize that you spend 40 to 50 percent of your working hours laboring for the IRS and your state?