Medicare out-of-network payments

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.

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Physician pay-for-reporting launched

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.

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How to divide the practice pie

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.

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