Chaos In Medical Billing … One Mistake Can Affect Your Credit Rating!

Like most everyone I know I don’t look at the EOBs (Explanation of Benefits) I get from Medicare and United Health Care. Do you?

Recently a New York Times article noted “LIKE most people, I am generally vigilant about paying my bills — credit cards, mortgage, cellphone and so on. But medical bills have a different trajectory. I (usually) open the envelopes and peruse the amalgam of codes and charges. I sigh or swear. And set them aside for when I have time to clarify the confusion: An out-of-network charge from a doctor I know is in-network? An un-itemized laboratory bill from a doctor I’ve never heard of? A bill for a huge charge before my insurer has paid its yet unknown portion of a hospital’s unknowable fee?”

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Chronic Disease Management Is Not “Free” Under Obamacare

Here’s a Q&A from Kaiser Health News:

“Q. My doctor added on a charge for a “chronic disease management” appointment on top of my annual physical because I have thyroid disease and arthritis. The doctor’s office explained that my visit was more complicated than a routine physical. I’m not sure I buy that. In my case, it only cost a $20 copay, but I was surprised that it was billed that way, and it could be a surprise for someone without the excellent coverage that I have. Can they do that? ”

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“Consumers Expecting Free ‘Preventive’ Care Sometimes Surprised By Charges”

Recently Kaiser Health News reported “The new health-care law encourages people to get the preventive services they need by requiring that most health plans cover cancer screenings, contraceptives and vaccines, among other things, without charging patients anything out of pocket. Some patients, however, are running up against coverage exceptions and extra costs when they try to get those services.

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“A Visit To The Doctor May Mean Seeing Someone Else Instead.”

New models of clinical practice are being used in the “doctor’s office.”

A recent Wall Street Journal article noted: “An increasing number of practices are scrapping the traditional one-on-one doctor-patient relationship. Instead, patients are receiving care from a group of health professionals who divide up responsibilities that once would have largely been handled by the doctor in charge. While the supervising doctor still directly oversees patient care, other medical professionals—nurse practitioners, physician assistants and clinical pharmacists—are performing more functions. These include adjusting medication dosage, ensuring that patients receive tests and helping them to manage chronic diseases.”

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Many Physicians Do Not Accept Medicare!

Don’t assume your doctor takes Medicare – ask and make sure! Otherwise you may get a surprise – a bill to pay and no reimbursement!

Recently, a WSJ article explained three options physicians have with Medicare claims.

“Fewer American doctors are treating patients enrolled in the Medicare health program for seniors, reflecting frustration with its payment rates and pushback against mounting rules, according to health experts.

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With Hospitals: Does A Great Reputation Mean High-Quality Care?

A conundrum: go to your local community hospital or an academic medical center?

A recent article in Becker’s Hospital Review reported on a study published in Health Affairs which “raised questions about whether hospitals’ reputations match the quality of care they provide. The study examined the differences between high-price and low-price hospitals and found the more costly providers were the clear winners in U.S. News & World Report rankings, which are partly (32.5 percent for the Best Hospitals 2013-14) based on their reputation with specialists. However, low-price hospitals performed better on certain outcomes-based readmissions and patient safety measures, such as postoperative blood clots. If high-price hospitals tend to have better reputations, the study raises the question of whether there’s a disconnect between how hospitals are perceived and how they perform and whether reputation should play a part in lists such as Truven Health Analytics’ 100 Top Hospitals, Becker’s Hospital Review’s “100 Great Hospitals” and U.S. News’ Best Hospitals.”

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