ACR representatives updated members on recent insurance issues…
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Coverage & Reimbursement Challenges: Updates from the ACR Insurance Subcommittee Chair
The ACR Insurance Subcommittee is working to address specialty pharmacy requirements for in-office treatments, elimination of consultation codes and other coverage and reimbursement challenges.
Even with Insurance, Fewer Americans Seeing Primary Care Providers
(Reuters Health)—Almost half of U.S. adults with private health insurance are not visiting primary care providers for routine care or sick visits, a new study suggests. Between 2008 and 2016, the number of annual primary care visits for every 100 people with private health insurance declined by 22%, from 169.5 to 134.3, the study found….
ACR Insurance Subcommittee Focuses on Coverage & Reimbursement
On behalf of the ACR, I wish you happiness, prosperity and, above all, good health in this new decade. Now that the holidays are behind us and 2020 has launched, the ACR’s dedicated volunteers and staff are working collaboratively to achieve many ambitious initiatives to ensure the College’s dynamic and bright future. A few weeks…
One-Third of U.S. Healthcare Spending Is Administrative Costs
(Reuters Health)—U.S. insurers and providers spent more than $800 billion in 2017 on administration, or nearly $2,500 per person—more than four times the per-capita administrative costs in Canada’s single-payer system, a new study finds. Over one-third of all healthcare costs in the U.S. were due to insurance company overhead and provider time spent on billing,…
Legal Updates: Tips for Protecting Your Patients’ Health Information
In the daily shuffle of evaluating patients and focusing on the delivery of high-quality patient care, the importance of protecting patient information may get overlooked. Human error is just one possible way patient information can be compromised. Cybersecurity attacks are becoming more numerous and sophisticated every day, with the number of patient records compromised increasing….
How to Navigate & Manage Insurance Overpayments
Insurance overpayments can occur in a practice for a variety of reasons. An insurer may simply make a mistake by paying a provider more than the contracted amount for a service or pay for a service that is not covered under the patient’s insurance plan. Whatever the reason, overpayments can and will create headaches for…
Google Signs Healthcare Data & Cloud Computing Deal with Ascension
(Reuters)—Alphabet Inc.’s Google signed its biggest cloud computing customer in healthcare yet, according to an announcement on Monday, gaining with the deal datasets that could help it tune potentially lucrative artificial intelligence tools. The Wall Street Journal earlier reported Google teaming up with Ascension to collect personal health-related information of millions of Americans across 21…
Coding Corner Answer: An Insurance Billing Quiz
Take the challenge. A—The commercial insurance coverage is primary in this situation. Medicare should be billed secondarily because it will not become primary until after the first 30 months of ESRD Medicare entitlement. After that, Medicare will be primary no matter the patient’s employment status. C—Unless the patient has a qualifying condition, such as ESRD,…
UnitedHealthcare Delays Policy Changes Affecting Physician-Administered Treatments
Changes announced at the beginning of October have now been delayed for Actemra, Benlysta, Cimzia, Orencia and Simponi Aria, but changes to the Stelara policy remain in effect.
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