Electronic Medical Records Probed for Over-Billing

The Center for Public Integrity published an article titled: "Electronic Medical Records Probed for Over-Billing" The article discussed the shift from paper medical records to electronic medical records (EMRs) and concerns with doctors and hospitals billing higher fees.

Key takeaways from the article were:

• Electronic Medical Records (EMRs) may be prompting doctors and hospitals to pay higher fees to Medicare.
• Some software from digital records companies that is marketed to may actually be encouraging the use of elevated billing codes.  
• "Cloning" (cutting and pasting prior encounters for a patient) may also be a cause of problems for the size of the patient's bill.
• According to one testimony, the cloning (copy/paste) method may only be limited to the services documented that were "pertinent" to treating the patient's current medical problem.
• Cloning also may have inaccurate information regarding the patient.
• The Obama administration plans to spend $30 billion dollars in order to help doctors and hospitals 
• Overall, the IT industry agrees that EMRs can lead to higher costs, but EMRs are easier for doctors and hospitals to document all the work they do.

To view the full article, please click here: Electronic Medical Records Probed for Over-Billing

For additional billing and coding resources. please click the following link: Medical Reimbursement, Inc Resources

A Guide to Health Insurance Exchanges

Kaiser Health News published: "A Guide to Health Insurance Exchanges".

• Exchanges: Where consumers can comparison shop for health insurance.
• If everything goes well, exchanges could make the buying process easier for health insurance and may lead to lower prices because of increase competition.
• The exchanges must be set by October 1, 2013.  The exchanges will then go into effect January 1, 2013.
• States have the option of:
• Setting up their own exchanges
• Partnering with Federal government to run an exchange
• Or opt out of the exchanges (when they opt out, the federal government runs the exchange for the state)
• Exchanges will be open to:
• Individuals buying their own coverage
• Employees of firms with 100 or fewer workers (some states 50)
• Most people will be able to get subsidies average of $4,600 per person.
• Undocumented immigrants will be banned from the exchanges.
• Exchanges will be available for residents who earn up to 400% of the poverty level (around $44,600)
• Most people will be required to have coverage by 2014.
• Members of congress will be required to buy from exchanges if they want coverage from the federal government.

To view the full article. please click the following link: A Guide to Health Insurance Exchanges

For additional billing and coding resources, please click the following link: Medical Reimbursement, Inc. Resources Page

Health Insurance Exchanges Implementation

Kaiser Family Foundation published a fact sheet on "Establishing Health Insurance Exchanges: A Overview of State Efforts".  This fact sheet highlighted the state-based health insurance exchanges (& implementation of these exchanges) which are a key component of the Affordable Care Act (ACA).

• 17 States & Washington DC intend to establish a state-based exchange
• Mississippi's application for state-based exchange was rejected
• 7 States are planning on a partnership exchange
• 26 states will default to federal facilitated exchange
• State-based exchanges must provide access to telephone call centers, build a website with information about insurance options and application assistance and create a Navigator program to improve public awareness and enrollment.
• According to the article, $3.5 billion dollars were distributed to all but 4 states to aid in the funding of the IT infrastructure that is necessary to support the exchanges.
• The fact sheet also has a Figure with "Total Federal Grants for Health Insurance Exchanges" and a Table with "Characteristics of State-Based Exchanges" 

To download the full PDF, please click the following link: Establishing Health Insurance Exchanges: A Overview of State Efforts

For additional billing, coding, and reimbursement resources, please click the following link: Medical Reimbursement, Inc. Resources

Health Insurance Exchanges

The Washington Post published an article titled: "Arrival of Insurance Exchanges Raise Questions About Health Coverage in 2014" The article addressed man questions and below are some key takeaways from the article:

• The new insurance policies will have to meet certain standards related to coverage and cost.
• Premiums cannot be more than 3 times higher for older people than it is for younger people.
• Many young people will be eligible for subsidized coverage - through exchanges, their parents insurance or Medicaid. 
• Premium subsidies will be available to people who have incomes at 400% of the poverty level. There are limitations to who can get this as well.  
• If you drop coverage altogether (don't purchase on your own, through an employer or through health care exchange), you will be penalized $95 or 1% of your taxable income.

To read the full article, please click the following link: "Arrival of Insurance Exchanges Raise Questions About Health Coverage in 2014"

For additional billing, coding and reimbursement resources, please click the following link: Medical Reimbursement Resources Page