As a recent announcement by GlaxoSmithKline highlighted – the pharma giant will stop paying doctors to promote its products – the relationship between physicians and pharma reps is a complex and sometimes twisted one. At my first job in healthcare as a receptionist in the 1980s, I remember being puzzled when I was told one of the physicians was being “detailed”. Detailed? What the heck was that?
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Physicians have been extending credit to patients almost since the beginning of time. Any time a patient receives healthcare services, has a financial responsibility and does not pay their portion at time of service, they are in essence receiving credit from the physician. Typically, medical practices have extended credit to patients without interest added, and usually on a schedule that patients can handle. Physicians have created payment plans for patients, or allowed them to carry a balance as long as the patient made a payment every month.
Exchanges and employer-sponsored plans carry higher deductibles in 2014.
Flublok, a influenza vaccine manufactured without live influenza virus or chicken eggs, was approved by the Food and Drug Administration (FDA) in early 2013 for adults ages 18 to 49. Flublok is not only free of egg protein, it has no other ingredients not essential to the vaccine itself including antibiotics, latex, formaldehyde and the mercury preservative thimerosal.
Protein Sciences, the Meriden, Connecticut company that manufactures Flublok, anticipates selling 5 million doses in 2014 and expects to receive additional FDA approval for use in adults ages 50 and older. As reported on HartfordBusiness.com, “…the vaccine’s target market includes the more than 600,000 Americans who are allergic to eggs. They also want to target the “Whole Foods” crowd, or people who prefer organic products that don’t contain chemicals or antibiotics.”
Today the Centers for Medicare and Medicaid Services, announced payment for Flublok for dates of service beginning January 1, 2014, although claims will not be processed until April 1, 2014.
The local Medicare contractors will add influenza virus vaccine CPT code 90673 to existing influenza virus vaccine edits and will determine payment rates. Note that the cost of this vaccine is higher than that of other influenza vaccines.
You may have heard the news last week that CMS will be collapsing the five levels of service for outpatient visit into a single flat rate.
What you may not have realized, though, is that this news relates only to HOSPITAL outpatient visits, and not to the professional (physician fee) component, but only to the facility (hospital) component. Let’s unpack this announcement and understand exactly what it means.
First, some clarifying terminology:
For anyone who tried to register after we were full, or couldn’t attend, there will be a Webinar Replay here: http://bit.ly/1cnb8dn as well as replays on the webinars from previous months and an Action Pack of resources – all free!
Please join us Tuesday, November 12, 2013 for our free monthly HIPAA Webinar. The topics we will be discussing this month are based on the following questions you’ve asked:
We are now in the Medicare Enrollment Period (October 15 through December 7) and Medicare-aged patients are making decisions about which type of Medicare coverage they want. See a description of the different types of Medicare coverage here. Currently-enrolled patients should have already received a “Plan Annual Notice of Change” (ANOC) that describes any changes in their coverage, costs, or service area that will be effective in January.
Starting today, October 1st, 2013 – physician offices and hospitals will probably start fielding calls about the Insurance Exchanges and Obamacare.
October 1st is a big day for heathcare reform in the United States because Open Enrollment is beginning in the health insurance marketplaces created by the Affordable Care Act. Today is the first day patients can see what their options are for health insurance on the state exchanges, and purchase insurance if they decide to.
For your viewing pleasure, we’ve placed this year’s flu vaccine information in a slide format as well as in the post. We hope you enjoy it!
As someone actively engaged in the conversation around health reform, I get a lot of questions about the Affordable Care Act from clients, readers and relatives. With the approaching open enrollment in state healthcare marketplaces (exchanges), and all the recent news stories about employers paring back benefits in the wake of reform, one of the most popular questions recently has been about the possibility that rising insurance costs and regulations will force companies to reduce or abandon health benefits for employees.