According to a recent study by the Journal of the American Medical Association, the increased adoption of EHR did not lead to reduced medical billing costs. Although EHRs has proven to show efficiency in some organizations, the complexity and inefficiency of payor contract variations, rules and pricing structures is still a barrier.
According to a TransUnion Healthcare analysis, the average out-of-pocket cost for patients increased from $1630 in 2016 to $1813 in 2017. This is leading to an increased need in third-party billing solutions to assist in automation of patient billing.
Congressional leaders last night released a spending bill that includes a $3 billion increase in funding for the National Institutes of Health, bringing the agency's fiscal year 2018 budget to $37.1 billion.
Growing numbers of hospitals are being asked to enter into a “hospital outpatient department” billing arrangement involving lab testing. One common attribute of these HOPD schemes is that the organizers want the hospital, as an in-network provider, to bill for all the lab tests performed in the organizers’ labs. The hospital and the HOPD organizers then split the payments from payers.
The Pathologists Quality Registry is a qualified clinical data registry (QCDR) launched by the College of American Pathologists (CAP) in 2017. The registry can improve practice performance, through benchmarking against other pathology practices, and make it easier for pathologists to qualify for bonuses under Medicare's Merit-based Incentive Payment System (MIPS) and Quality Payment Program (QPP).
The CAP recommended revising the 2018 Medicare Hospital Outpatient Prospective Payment System (HOPPS) proposed rule to ensure that the laboratory date of service (DOS) for all molecular testing is the date of performance rather than the date of collection, to improve the consistency with Medicare payment policy.
A coalition of physician groups, led by the CAP, is urging the National Conference of Insurance Legislators (NCOIL) to make significant changes to its draft Out-of-Network Balance Billing Transparency Act to ensure network adequacy and fair payment for out-of-network services. The National Conference of Insurance Legislators (NCOIL) is an organization of state legislators whose main area of public policy concern is insurance legislation and regulation. The proposed legislation is a "model bill" that could be enacted by states.
The College of American Pathologists (CAP's) Local Coverage Determination Clarification Act of 2017 bill gained support in both the Senate and also in the House of Representatives this summer by adding additional members of congress who support LCD reform. The CAP continues to work and advocate for its members by helping to improve transparency and accountability when Medicare contractors set local coverage determination (LCD) policies for physician services provided to Medicare beneficiaries.
PMC recognizes the need for a change to CMS' "laboratory date of service policy," which requires hospitals to manage the complex billing processes for many laboratory tests performed within 14 days after a patient's discharge from the hospital even if the test is performed at an outside laboratory. As PMC notes in the letter, the administrative challenges caused by this policy can lead to delayed diagnostic testing that can guide the most appropriate
On June 28th, by a vote of 218-210, the House of Representatives passed H.R.1215, the Protecting Access to Care Act of 2017 which adds limitations to medical malpractice cases. The bill was opposed by all Democrats and a handful of Republicans. The expressed goal of the legislation is to improve access to, and the quality of, medical care.