For more than a decade, taxpayer-funded health care programs have seen a steady uptick in higher-paying billing codes. Office visits, outpatient services, and emergency room care have all been billed at progressively higher reimbursement codes, raising fees by billions of dollars. Many providers contend the shift is the result of sicker patients coupled with the
In a recent ruling between Humana vs. Western Heritage Insurance, the courts upheld the rights of Medicare Advantage Organizations (MAOs) to sue for double damages for any costs they incurred that should have been paid by the primary carrier. In a nutshell, MAOs will now have the same protections and rights as the Centers for
This article features a patient that posted their $55K appendectomy surgery bill online, and it makes some very interesting points. The University of California San Francisco researchers set out to find out how much an appendectomy cost in California. The price varied from $1,529 to $182,955. The “recovery room” was over $7K for 2 hours.
Years ago, the Center for Medicare Services (CMS) discovered in an audit $48 million they had paid out for treatment that had already been paid for in a settlement from another payer. Since then, a long process has been started by CMS to control these costs.First, they required money be set aside to cover these
Outpatient surgery in an Ambulatory Surgery Center (ASC) costs much less than in an outpatient hospital setting or ASC owned by a hospital. The gap has been growing due to the need for ASCs to compete and be efficient, and regulations and rates as defined by the largest payer in the country, Medicare.ASC reimbursement rates vs.