Reimbursement Roundup: Discrepancies found in pay times
Reimbursement Roundup
Discrepancies found in pay times
The Office of Inspector General has found what it calls a series of serious discrepancies in records tracking how fast the Health Care Financing Administration (HCFA) pays physician claims.
HCFA’s National Claims History File, for instance, shows the agency paid more than 80% of its Part B claims before expiration of the mandatory 14-day waiting period. But the OIG researchers also found HCFA’s Contractor Reporting of Operational and Workload Data (CROWD) system reported less than 1% of Part B claims were paid before the waiting period closed.
The OIG’s report, "Inconsistent Medicare Data Concerning Carrier Payment Dates (OEI-03-00-00350)," is available on the web at www.dhhs.gov/progorg/oei.
HCFA approves biofeedback pay
The Health Care Financing Administration (HCFA) has announced it will cover biofeedback treatments for Medicare beneficiaries with urinary incontinence. According to an Oct. 6 coverage decision memorandum, biofeedback therapy is for the treatment of stress and urge incontinence in patients who fail to benefit from or are unable to perform pelvic muscle exercises.
"HCFA’s decision is an important victory for physical therapists and their patients with urinary incontinence," says American Physical Therapy Association President Ben Massey.
The coverage decision memorandum is available at www.hcfa.gov/quality/8b3-x.htm.
Basing pay on man-days’
Here’s an interesting approach for paying physician-partners at Rehlen Bartlow & Goodman MDs, a single-specialty dermatology practice in Southern California. This practice’s compensation system is based around days worked by its doctor shareholders, with consideration for individual production. It works like this:
• Add up each partner’s "man-days." In addition to the number of days each physician works each month, the practice uses two adjustments — a larger one for conducting in-office skin cancer surgery; a smaller one for performing hospital consults. A busy physician working 20 days in a month who also performs a lot of surgery can end up with 27 man-days.
• Calculate a dollar value for each man-day. Each quarter, the practice determines its profit without considering the partners’ pay, then divides that by the partners’ total of man-days. to get a man-day dollar value.
• Multiply the man-day dollar value by each partner’s man-days to arrive at an overall pay level.
Cap rates rising, study finds
Nearly 70% of providers and HMOs report their capitation rates have increased this year, and 78% say they are either seeking more capitation or maintaining their current level of risk agreements for global coverage, primary care, hospital services, and ancillary services, finds a National Health Information survey. The study also found:
— On average, 2000 global per member per month rates increased 7.4% compared with the 1999 average, rising from $107.88 pmpm to $115.95 pmpm.
— Average commercial primary care rates increased 8.8% compared with last year, rising from $11.07 pmpm to $12.05 pmpm.
— Twenty-six of 35 specialties saw their commercial cap rates rise this year. Specialties with hikes in the double digits included endocrinology, laboratory, neurology, psychiatry, and radiology.
— Sixty-nine percent of providers said their capitation-related business is more profitable than their discounted fee-for-service business.
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