Tag Archives: providers

What Is Cost in Health Care?

Although cost is a common topic in health care, it is not commonly understood. As one man’s trash is another man’s treasure, similarly, in health care, one man’s cost is another man’s gain. Costs to a payer become revenue for a care provider, as do the co-payments and other shared costs paid by consumers. The perception of “cost” depends entirely on who is paying. Not only that, the definition of cost depends on who is measuring. And everyone measures it differently. Continue reading

Four Mistakes My Doctors Make with High Deductible Plans

A year ago my family changed to a high deductible health plan and started using a health savings account. Because we expect to pay higher upfront out-of-pocket expenses, we pay careful attention to the network requirements and out-of-pocket thresholds. Our local providers, though, seem to manage patients with high-deductible plans as if they were no different from traditional PPO plans.

There are several things I wish my providers would do differently, and not just to make it easier for me to manage my family’s health care. My providers inadvertently increased administrative time, delayed payment, and resulted in denials and write-offs. They would do better if they adapted their processes in light of the different plan requirements. Here are four suggestions for avoiding the mistakes my doctors made with my high-deductible plan: Continue reading

Delivering on the Promise of an “E-Health” Revolution

As more and more hospitals and healthcare organizations convert more and more of their paper medical records to electronic health records (EHRs), an interesting dynamic has begun to emerge, as well as an interesting challenge.

The dynamic is that while the conversion from paper to electronic records was promised to provide time and cost savings for healthcare, the adoption of EHR systems by physicians has led to a number of perhaps unforeseen consequences. One of the chief consequences, which could also be considered a chief complaint, is that physicians who document on their patients electronically make less eye contact with their patients and have lower patient satisfaction ratings, vs. physicians who document on paper. Continue reading

CMS: It’s All About Compliance Actually

I’ve spent years reading healthcare rules, regulations, and laws (I know what you are thinking – better you than me!). Often, it’s necessary to connect the dots with the regulations to clearly see their purpose. Lately, everyone in the industry is talking about ‘documentation compliance.’ Actually it’s nothing new – some providers have struggled with documentation for years. I admit, when I worked in the hospital, charting was not the favorite part of my day either. But CMS has been dogged in its documentation improvement efforts which have routinely been ignored by some.

Recalcitrant Providers

On 12/13/13 CMS released Transmittal 495, CR 8394, which became effective 1/15/14. According to CMS, “Any provider referred (to OIG) as a potential recalcitrant provider case should be an ‘outlier,’ meaning a provider who has been the least receptive to changing and has a significant history of non-compliance. Continue reading