iMAXX Medical Billing Solutions Knowledge Hub

iMAX Medical Billing Knowledge Hub

Trump Administration: Ease Scope of Practice Laws Also takes aim at “certificate of need” regulations


Easing scope-of-practice laws and streamlining graduate medical education (GME) funding would make U.S. healthcare more competitive and efficient, the Trump administration said Monday. “Reduced competition among clinicians leads to higher prices for healthcare services, and reduces choice… Government policies have reduced competition by restricting the available supply of providers and restricting the range of services they offer,” said a senior administration official, speaking on the condition of anonymity, during a call with reporters to discuss a new report called “Reforming America’s Healthcare System Through Choice and Competition.” President Trump called for the report, issued jointly by the departments of Health



Price Not the Only Driver of High Healthcare Costs, Research Shows


The reasons behind total healthcare costs vary by region, so local leaders need reliable data to truly bend the cost curve, a new study shows. November 12, 2018 – Healthcare costs in Colorado are significantly higher compared to other states in the country. A recent analysis by the Network for Regional Healthcare Improvement (NHRI) showed that total cost of care in Colorado was 19 percent higher than the average costs in six other states. Greater utilization and prices drove the higher-than-average healthcare costs in Colorado. The rate of healthcare utilization in the Mountain state was five percent higher than the six-state average, and prices were



NP, PA Office Visits Grow 129%, But Healthcare Costs Still Rising


The overall rate of primary care office visits also fell 18 percent, but the trends did not necessarily result in healthcare cost savings, HCCI reported. Office visits to primary care physicians dropped 18 percent from 2012 to 2016 among non-elderly adults with employer-sponsored healthcare coverage, the Health Care Cost Institute (HCCI) recently reported. “The decline in primary care visits comes at a time when awareness has grown of the role of primary care in prevention and in containing overall medical spending,” Niall Brennan, President and CEO of HCCI, stated in a press release. “We saw these trends in our annual report



Who Should be Held Accountable for Healthcare Costs?


About one-half of healthcare leaders and clinicians said providers are not accountable for total cost of care, but payers and pharmaceutical companies are, a new survey found. While the recent growth in patient financial responsibility has providers thinking about healthcare costs when making care decisions, many still do not think they should be held accountable for the costs of care, a recent survey showed. A new NEJM Catalyst Buzz Survey, sponsored by the University of Utah Health, asked the NEJM Catalyst Insights Council, a qualified group of healthcare executives, clinical leaders, and clinicians, about their views on healthcare costs and patient



Turnkey Approach to Fighting Healthcare Fraud, Waste, Abuse


Collaboration is key to the fight against healthcare fraud, waste, and abuse. Healthcare fraud, waste, and abuse (FWA) investigators have a tough job. Keeping pace with the latest schemes, continuously weeding through hundreds of false-positive leads, and understanding the right time to pursue a case are just a few of the challenges a health plan’s special investigative unit (SIU) face. When armed with the right information to immediately open a solid case, SIUs can quickly take intelligent action to educate providers, recover funds, or even prevent payment before it is made. The path from lead to allegation A turnkey allegation



Playing Santa gets doctors sued: Medical office holiday party liability


The holiday party season traditionally starts next week, right after Thanksgiving. Consider what your medical practice should and should not be doing at the office party to avoid liability. Despite the repeated warnings from myself and others, we inevitably get calls in the early part of next year from clients wanting advice about a problem that occurred and others calling too late to do anything about it. Here are ten simple safety tips. It’s an “office” party, so everyone needs to behave like it.  Standards of professional language, conduct, sexual harassment, and other rules in your employment policy manual  that control possible workplace



NY Health System Settles E&M Upcoding, Healthcare Fraud Case


Other recent healthcare fraud schemes involved a family doctor submitting false claims for unnecessary services and prison time for a healthcare CEO using kickbacks for referrals. A New York-based health system will pay the federal government $14.7 million to settle healthcare fraud allegations that claim the system engaged in evaluation and management (E&M) upcoding. According to the Department of Justice (DoJ), Health Quest Systems, Inc. and some of its subsidiaries allegedly submitted claims for E&M service levels that were not supported in the medical record. The health system billed the E&M services two levels higher than what the medical record indicated. “This



How PAs help practices in rural areas, during holidays


Some of the best providers I saw growing up in McCook, Neb., were physician assistants (PAs). After working in a lab for a few years, I decided that I wanted to be a PA, too. I wanted to diagnose patients on the front lines instead of reporting the lab results to the clinical team. Except for a short stint in Kansas City, Kan., I have chosen to work in rural areas, much like my hometown. Currently, I spend the bulk of my time in a family practice clinic but also work in the local emergency department (ED). The town I



Healthcare Revenue Higher for Practices Employing More NPs, PAs


Primary care practices with a non-physician provider to physician ratio of 0.41 or greater earned over $100,000 more in healthcare revenue, MGMA found. Primary care practices that employ more physician assistants, nurse practitioners, and other non-physician providers have greater healthcare revenue and productivity, the Medical Group Management Association (MGMA) recently reported. In its 2018 MGMA DataDive Cost and Revenue report, the industry group found that practices with a non-physician provider to physician ratio of 0.41 or greater reported higher expenses. However, the practices also had more revenue after operating costs compared to practices with provider ratios of 0.20 or lower. The comparative data



Revenue Cycle Management Outsourcing Market to Grow at 11.9% CAGR


The global healthcare revenue cycle management outsourcing market will see significant growth as providers aim to free up their resources while improving revenue. July 27, 2018 – The global healthcare revenue cycle management outsourcing market is slated to significantly increase, with its valuation rising from just $11.7 billion in 2017 to $23 billion by the end of 2023, a new market report shows. The authors of the report, The Market Reports, project the growth in the global healthcare revenue cycle outsourcing management market to increase at a compound annual growth rate (CAGR) of 11.9 percent from 2017 to 2023. Healthcare revenue cycle management outsourcing should