Sunday, June 20, 2010

Weekend update

On Friday afternoon, the Senate approved by unanimous consent a 2.2% increase in Medicare Part B reimbursements to doctors for the period June 1 through November 30, 2010, at which point the sustainable rate of growth (SGR) formula will kick in again absent a longer fix. The Senate bill has to be approved by the House which will return to session on Tuesday evening June 22.  Modern Healthcare reports that CMS nevertheless directed its Part B claims administrators to begin processing the claims with the 21.2% SGR cut that took effect on June 1. If the House approves the Senate action, these claims will have to be reprocessed.

Speaking of bending the health care curve up, Fair Health Inc. which at the direction of the NY State Attorney General will replace as the PHCS and MDR usual reasonable and customary database administrator announced last week that it will be releasing its first set of benchmarking products early next year. The UCR databases are used to price out of network claims. According to its announcement, "FAIR Health’s product modules in 2011 will mirror Ingenix’s existing product modules and our release schedule for each module should be identical to the schedule to which Ingenix has been adhering. With customer input and advance notification, we plan to introduce in late 2011 additional and revised product offerings for distribution in 2012."  It's worth providing a link to the America's Health Insurance Plan's (AHIP) 2009 survey on the role of out of network charges in bending the cost curve up.

The American Medical Association, which pressed hard for this UCR change, released last week its third annual national health insurer report card. Not surprisingly given the AMA's unfriendly attitude toward insurers, the report card finds the health insurers make a processing error in one out of five claims, which strikes me as way too high.  I therefore appreciated the retort from America's Health Insurance Plans:

Health plans and providers share the responsibility of making the innovations and investments needed to improve efficiency in our health care system. A recent AHIP survey found that nearly one-fifth of all provider claims are not submitted to health plans electronically, and more than 1 in 5 claims are submitted by providers at least 30 days after the delivery of care.
"Health plans are investing in cutting-edge technologies to make it easier for providers to submit claims electronically and receive payment quickly. For example, health plans are working with providers in New Jersey and Ohio to implement portals that would simplify administrative processes and enable doctors in these states to spend more time with their patients.
"Government data show that soaring medical costs - not health plan administrative costs - are the key drivers of rising health care costs. In fact, the percentage of premiums going toward health plans' administrative costs has declined for six straight years."

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