Medicare Compliance & Reimbursement
Currently, Not All Physicians Enamored With P4P Proposal
P4P must be voluntary, docs contend. AMA Unhappy With P4P Tag? Although AMA didn't mention this in its guidelines, the phrase "pay for performance" apparently ticks off many providers, according to a Democratic congressional aide. Physicians and other providers have told Hill aides that they don't like the word "performance," because performing is what monkeys and circus animals do, said the staffer.
The pay-for-performance movement seems well on its way in health care, but it still needs to win more buy-in from the people who receive the pay.
The American Medical Association March 2 issued principles and guidelines that it says should guide all P4P programs. Most problematic for health plans could be this principle: "Physician participation in any [pay-for-performance] program must be completely voluntary."
An increasing number of health plans have instituted P4P programs, and even those who have voluntary programs are hoping to eventually expand them to cover all physicians.
In addition, Medicare will soon launch a P4P demo aimed at determining the viability of a systemwide program. But the AMA guidelines show that physicians would oppose any efforts to institute mandatory P4P.
The AMA also wants health plans to design their P4P programs based on evidence-based guidelines, use "accurate data and fair reporting," provide equitable incentives and continue to foster a strong relationship between patient and provider.
"I think we need to find another name for it, perhaps 'value purchasing' or 'pay for quality'," said the aide.
Medicare Compliance & Reimbursement
- HOSPITALS:
Physician-Owned Hospital Payments Might Fall After DRG Changes
Moratorium likely to last until 2007.
Do physician-owned hospitals that focus on one narrow specialty hurt [...] - HIPAA:
HIPAA Error? You'll Hear From Carriers
Unsuccessful crossover claims will prompt auto notice.
Starting July 5, Medicare contractors will issue special automated [...] - APPEALS:
New Complex Procedures Appeals Rule May Make Physicians Dizzy
Decide in advance what kind of representation to offer.
Appealing claims next year could become simpler [...] - LONG-TERM CARE:
LTC Industry Challenges MedPAC On Recommendations
Stingy inflation policy threatens quality care.
Long-term care industry groups are taking aim at the Medicare [...] - DRUG COVERAGE:
MMA Steps Up Screening Test Coverage
But Medicare wants a V code, not a G code, when reporting a screening.
Physicians now [...] - PHYSICIANS:
Count On Local Carriers For Least Costly Policy Fixes
PPAC: CMS to remove drugs from update formula retroactively.
Least costly alternative policies create an "unlevel [...] - COVERAGE:
CMS Expands Defibrillator Coverage
Transmittal states Medicare HMO patients can get fee-for-service devices.
Patients should be able to receive an [...] - COVERAGE:
Currently, Not All Physicians Enamored With P4P Proposal
P4P must be voluntary, docs contend.
The pay-for-performance movement seems well on its way in health [...] - ENFORCEMENT:
Transport Owner Sidelined 7 Years
Getaway effort by provider no match for law's long arm.
Providers caught in the crosshairs of [...] - HOSPITALS:
Note These OPPS Changes To Avoid Future Trouble
Make sure you're billing correctly for mammographies, observation.
If your facility is receiving denials for services [...] - LABS:
CMS Alters C-Peptide Test Requirement
Lower limit is key.
For services performed on or after Dec. 17, 2004, a positive fasting [...] - BILL WATCH
The following bills were introduced in the House:
HR. 1166. A bill to amend title XVIII [...] - PHYSICIANS:
'Medically Unbelievable' Edits Put On Hold
No explanation for revocation.
The Centers for Medicare and Medicaid Services has rescinded Transmittal 105, which [...]
