June 24th 2025
"We have received numerous complaints about the PA and predetermination process. We all wish we could answer this differently and definitively," write Jonathan Rubenstein, MD, and Mark Painter.
CMS: 'We are trying to reduce physicians' burden'
February 15th 2004Las Vegas--The Centers for Medicare & Medicaid Services istaking steps to lessen the burden that its policies create for physicians,according to two West Coast representatives of the agency. Physicians alsohave more influence on shaping health care policy, including the value ofservices, than they realize, said the officials, both physicians themselves.
CMS adopts identifier for use in transactions under HIPAA
February 5th 2004The Centers for Medicare & Medicaid Services has adopted the National Provider Identifier (NPI) as the standard unique health identifier for health care providers to use in filing and processing health care claims and other transactions.
Use -59 modifier when billing for indwelling stent
February 1st 2004Q I am in a multiple-physician urology practice. One of our physiciansbelieves that billing 52332 with 52352 or 52353 with a 59 modifiershould be paid, and that billing 52005 with 52332 with the 59 modifiershould be paid (ie, 52005-59). When is it appropriate to use the 59modifier?
Reimbursement for cancer drugs drops to 85% of AWP
January 1st 2004Washington--The new Medicare reform bill, which for the first time providesa prescription drug benefit for Medicare recipients, comes with a hiddencost for physicians who administer chemotherapy drugs in their offices-andperhaps their patients.
Urology avoids financial woes of other specialties
January 1st 2004Minneapolis--Surgeons and other physicians across the country continueto deal with the higher costs of practicing medicine in the face of decliningreimbursements. Those factors added up to lower profit margins for U.S.physician groups in 2002 and a continuing awareness of the need to pay attentionto all of the vagaries of the business of practicing medicine. For the mostpart, urologists showed little change in reimbursement.
CMS updates process for making coverage decisions
October 9th 2003The Centers for Medicare & Medicaid Services said it has updatedand improved its process for making Medicare coverage decisions. A noticepublished in the Federal Register on Sept. 26 incorporates lessons learnedover the past 3 years and implements certain requirements of the Medicare,Medicaid, and SCHIP Benefits Improvement and Protection Act (BIPA) of 2000.
Many physician groups are showing losses, survey shows
October 9th 2003Many U.S. physician groups are experiencing losses in the midst of anincreasingly competitive and regulatory environment, according to a recentsurvey by the American Medical Group Association. Results for medical groupfinancial performance on a per-physician basis revealed that the averagegroup lost $3,977 per physician.