The Centers for Medicare & Medicaid Services (CMS) has proposed an episodic payment model, the Transforming Episode Accountability Model (TEAM). This is one of CMS’s “innovation” models. If it makes…
COVID-19’s omicron surge is loosening its grip on many of the country’s hospitals, leading several states to relax mask requirements and other restrictions. According to Centers for Disease Control and…
Hospitals support the CMS' proposed changes to medical billing coding and new payments for opioid treatment programs, but they're worried that changes to quality measures could hurt providers. Major medical…
Take a look around any big hospital and you’ll find plenty of imposing technology: surgical robots, artificial organs, wireless brain sensors, three-dimensional imaging visualizations. But you have to look harder…
As momentum builds on Capitol Hill for legislation to curb outsize or surprise medical bills, provider and insurance trade groups have released a consumer guide on balance billing—a sign they…
Physicians often say they feel like the rules, standards and policies regarding the way they practice medicine change all too frequently. In 2016, there are several key issues physicians should…
Medical billing is wrought with errors and overcharges. Here's how to avoid overpaying. The next time you receive a medical bill, read it carefully. It's not uncommon to be charged…
Question: In the CMS DRG datasheet, what is the difference between the column titled “Geometric Mean LOS” and the one labeled “Arithmetic Mean LOS”? Answer: The geometric mean length of stay or (GMLOS) is the national mean length of stay for ea...
Here are the pros and cons to help guide your decision.
Question: Our practice is considering accepting patients with PFFS plans. We’re heard that some patients are starting to have them, but we’re not sure whether we’re going to accept them or not. Are PFFS plans beneficial for us?
Answer: PFFS are Private Fee-for-Service plans, which are non-network plans. These plans let members receive care from any doctor or hospital that accepts the plan’s payment terms and conditions.
If your practice decides to accept these terms, you would become a “deemed” provider. Plan members can receive covered services from any deemed provider in the U.S. However, member patients must confirm that the provider is deemed every time a service is provided.
PFFS plans are different from Medicare Advantage plans because they do not require a doctor or hospital to contract with a health plan to provide services. This means that doctors or hospitals that do not agree to the PFFS plans’ terms and conditions may choose not to provide health care services to a plan member, except in emergencies.
Coming soon: Starting in 2011, PFFS plans will have to measure and report on their providers’ quality of care. But the catch is that they’ll also have to form provider networks with contracts.
In counties where there are two or more non-PFFS plans, PFFS plans will no longer be able to simply “deem” providers into the plan without a contract. Under current law, PFFS plans don’t have to prove they can meet access standards if they allow any willing qualified Medicare provider to participate, and they pay as traditional Medicare would pay.
One argument is that the network requirement would provide better access to care because there would be contracts between the providers of services and the plan. On the...