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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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