Medical coding and billing: The inside story of how the sausage is made

Medical coding and billing: The inside story of how the sausage is made

Medical coding and billing seems impenetrable — those strings of numbers on  a bill that purport to show what was done, and what was spent. Sometimes it looks as if chimpanzees are typing in random strings of numbers. The bills and explanations arrive months if not years after the event. The numbers are unfamiliar. Memories […]

The transparency conversation over hospital price lists: Scorn and more scorn

The transparency conversation over hospital price lists: Scorn and more scorn

The newly released hospital price lists have been kicking up a lot of commentary on Twitter, Facebook and LinkedIn. The lists, as we’ve been discussing, are being made public in compliance with a new Centers for Medicare and Medicaid Services rule that hospitals have to post all their list prices online as of Jan. 1. […]

Hospitals now have to post price lists. Does that mean instant transparency? Uh, no.

Filed Under: Costs, Health plans, Patients

Hospitals now have to post price lists. Does that mean instant transparency? Uh, no.

(Updated Feb. 9) Of course we support price transparency in health costs. We think all prices should be public all the time. So let’s examine the new Centers for Medicare and Medicaid Services (CMS) rule that hospitals should post their charges online in “machine-readable format” as of Jan. 1. This policy is a tiny step […]

Medicare requests information about physician self-referral law or ‘Stark law’

Medicare  requests information about physician self-referral law or ‘Stark law’

The Center for Medicare and Medicaid Services has issued a request for information on the Stark law, also known as physician self-referral law. The RFI in the Federal Register suggests that the intent is to loosen restrictions on this practice. From the request: “When enacted in 1989, the physician self-referral law (section 1877 of the […]

A doctor’s view on payments: Cherry-picking and lemon-dropping

Guest post summary: “The dirty little secret of current medical payment changes is doctors and hospitals now have a financial incentive to not provide care for some patients, those who put the providers at higher risk of financial penalties. We call this phenomenon cherry-picking and lemon dropping,” writes Mary O’Connor, M.D., Yale School of Medicine and Yale-New Haven Hospital, […]

The new Medicare payment data release: 2 experts set the stage

Filed Under: Costs, Regulators

SUMMARY: A big release of data from Medicare, on what doctors got paid what for doing what, is coming in hours. There’s a lot of debate about it — the American Medical Association resisted, and then stopped resisting — and the mystery about what’s in the data has been building for months. For a sneak […]

How much do prescriptions cost? Here’s the Medicare price info for 2014

Filed Under: Costs, Patients, Regulators

SUMMARY: Curious about drug pricing? Here’s the link to Medicare drug pricing files for 2014. This is important because prescription prices can vary widely. The price Medicare reimburses is the closest thing in this marketplace to a fixed or benchmark price. Read more on the next page…    

Facility fee change proposed for hospital bills, CPI explains

Filed Under: Costs, Patients, Providers

High emergency-room bill? Blame that mysterious facility fee. Well, now the Government is trying to hold down fees by imposing a flat rate, a change that will apply only to Medicare patients. “Federal officials for more than a decade have let hospitals decide on their own how much to charge Medicare for certain emergency room […]