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Medical Association of Billers

The Medical Association of Billers (MAB). Founded in 1995, MAB is the premier credentialing.

Medical billing certification, consulting, training, education, networking

01/03/2024

Happy Wednesday Afternoon and Happy 2024!

Health system leaders predict VBC growth in next 3 years.

Healthcare leaders predict that tightening margins and rising costs will push health systems to focus more on value-based care initiatives in the next three years. Greg Poulsen of Intermountain Health thinks organizations will face financial challenges in the next three years and look for ways to boost value while lowering care costs, Nashville General Hospital CEO Joseph Webb says the prevalence of health inequities will likely lead to the growth of "value-based initiatives designed to improve health outcomes, population health management, and reduce costs among statistically indicated at-risk populations."

https://www.beckershospitalreview.com/finance/health-system-execs-see-a-value-based-care-tidal-wave-ahead.html

Healthcare leaders have been talking about the transition to value-based care for years, but without significant movement away from fee for service. In the next

11/29/2023

Good Wednesday Morning!

The Broken Medicare System Is Forcing Physicians Out
November 22, 2023.

Yet another physician pay cut will prevent timely access to care
In any career, 25 years of dedicated work is a lot to let go of. In medicine, it amounts to hundreds of patient relationships, and the blood, sweat, and tears that go into starting and maintaining a practice.
Yet, after all that time, one of my physician colleagues recently had to let go of her beloved private practice -- not by choice and not without tears for her dear, elderly Medicare patients who now face fewer options for care. Her story is unfortunately not unique.

https://www.medpagetoday.com/opinion/second-opinions/107450?xid=nl_secondopinion

Yet another physician pay cut will prevent timely access to care

11/16/2023

Good Thursday Morning!

Humana's ACO saved Medicare over $25M last year.

Humana's accountable care organization that participated in the Global and Professional Direct Contracting model saved Medicare more than $25 million in 2022, according to CMS data. Humana's CenterWell unit, which also joined the model, generated over $2.1 million in net savings for Medicare, while Aetna's ACO saved the program about $307,567.

https://www.beckerspayer.com/payer/how-payers-acos-fared-in-2022.html

Humana's ACO saved $25.6 million for the Medicare program in 2022. Several payers' ACOs participated in the Global and Professional Direct Contracting model, with Humana recording the highest savings.

11/14/2023

Good Tuesday Morning!

HHVBP participants saved Medicare $1.38B in 6 years.

A CMS report showed the nine states that participated in the Home Health Value-Based Purchasing Model achieved $1.38 billion in savings for Medicare during the first six years of the program before the national expansion early this year. The reductions in Medicare spending was mainly driven by decreases in inpatient hospitalization stays, home health spending, and skilled nursing facility services.

https://homehealthcarenews.com/2023/10/home-health-agencies-made-the-hhvbp-model-demonstration-a-resounding-success/

In the first six years of the Home Health Value‐Based Purchasing (HHVBP) Model demonstration, the nine participating states saved Medicare $1.38 billion,

11/02/2023

Good Thursday Morning!

Medicare, MA enrollment period under way.

The Medicare open enrollment period has begun and will continue until December 7, offering older adults the opportunity to select either a traditional Medicare or privately operated Medicare Advantage plan as well as coverage for prescription drugs. A KFF survey indicated that about a third of enrollees tend to compare their coverage choices during enrollment season.

https://apnews.com/article/medicare-advantage-open-enrollment-bec0ef210163d637944d6d81ddbdbd66

Open enrollment for Medicare opens Sunday, and seniors could have dozens of options to choose from. During the enrollment period, which ends Dec. 7, people will have the opportunity to choose between traditional Medicare and privately run Medicare Advantage plans in their area, as well as prescripti

11/01/2023

Good Wednesday Morning!

Health insurers' customer satisfaction scores hit record high.

A report from the American Customer Satisfaction Index found that overall consumer satisfaction scores for health insurers jumped 4% to a record 76 points out of 100 possible points this year. Humana, Aetna, Centene, Kaiser Permanente and Cigna were among the insurers with the highest satisfaction scores. "Despite rising costs, consumers are more impressed with both the quality and value of their health insurance, and the improvement extends across the entire policyholder experience, including mobile apps," according to Forrest Morgeson, director of research emeritus at ACSI.

https://www.beckerspayer.com/payer/top-ranked-insurers-for-customer-satisfaction.html

Customer satisfaction with health insurers is up 4% over 2023, according to the American Customer Satisfaction Index. Humana scored highest with 82, while Cigna had the lowest score.

10/31/2023

Good Tuesday Morning!

Affordability is the greatest concern in paying medical bills.

Research from patient financial engagement company Cedar shows that about three-quarters of consumers consider affordability to be the most significant challenge in handling their large medical bills, while 58% say paying their bills is stressful and 18% have trouble understanding their benefits and costs. The company suggests solutions such as offering consumers payment flexibility and boosting collaboration between payers and providers.

https://www.benefitspro.com/2023/10/18/consumers-cite-affordability-as-biggest-issue-when-paying-health-care-bills/?slreturn=20230931091130

58% of people find paying a health care bill to be stressful.

10/25/2023

Good Wednesday Morning!

Some Doc Bonuses From Employers Safe From Anti-Kickback Violation.

If your employer pays you a bonus based on the volume of certain procedures performed, could you be at risk for an Anti-Kickback law violation? As long as you're an employee, you're likely safe, according to the Department of Health and Human Services Office of Inspector General (OIG).
In an advisory opinion posted October 13, the OIG said receiving a physician bonus based on the profits of certain outpatient procedures performed does not violate the federal Anti-Kickback statute (AKS).

https://www.medscape.com/viewarticle/997457?ecd=wnl_dne10_231018_MSCPEDIT_etid5966304&uac=439796PG&impID=5966304

In a new advisory opinion, the Office of Inspector General clarifies when a physician bonus based on certain procedures performed could be considered an Anti-Kickback law violation.

10/20/2023

Good Friday Morning!

Prior Authorization Software: Saves Time but Hurdles Remain.

New England Baptist Hospital has been grappling with a serious problem facing healthcare today — insurers demanding prior authorizations for services ordered by physicians. Meeting payers' requirements eats up time, delays treatment, and can be a costly drain on doctors' practices.
To deal with this problem, the Boston Orthopedic Hospital has opted to automate submission of prior authorization requests on behalf of more than 100 mostly orthopedic surgeons on staff.

https://www.medscape.com/viewarticle/997446?ecd=wnl_dne1_231018_MSCPEDIT_etid5966304&uac=439796PG&impID=5966304

Many organizations have started to automate prior authorization requests. They save physicians time, but the software still has a way to go.

10/16/2023

It is Monday, October 16, 2023! Good Afternoon!

CMS: Medicare Part B premiums to increase next year.

CMS announced that the standard Medicare Part B monthly premium will increase from $164.90 this year to $174.70 in 2024, primarily due to expected growth in healthcare spending. The annual deductible will increase by $14 to $240 for Part B and by $32 to $1,632 for Part A inpatient hospitalization, and the standard premium for elective Part B coverage of immunosuppressive drugs will be set at $103.

https://www.healthcarefinancenews.com/news/cms-releases-2024-medicare-parts-and-b-premiums-and-deductibles

Premiums and deductibles for Part B physician and outpatient care are both increasing next year.

10/11/2023

Good Wednesday Morning!

Should 'Site Neutrality' Be Used to Set Payments?

"I don't think 'site-neutral' is neutral," one commissioner says.
Should "site neutrality" -- the idea of paying the same rate for the same service no matter where it is provided -- be applied when it comes to setting Medicare payment rates? Nope, says Medicare Payment Advisory Commission (MedPAC) member Lynn Barr, MPH.

https://www.medpagetoday.com/medical-journeys/heart-failure/105959

Treatment across the heart failure spectrum

10/10/2023

Good Tuesday Morning!

Survey explores consumer issues with claims denials.

About 60% of adults have issues with denied claims, prior authorization delays and denials, and network adequacy, according to a KFF survey. People with employer-sponsored or marketplace insurance were more likely to have claims denied than those with Medicare or Medicaid, and people who have more than 10 visits per year had a higher likelihood of experiencing a denied claim than those who have fewer than 10 visits annually.

https://www.kff.org/health-reform/issue-brief/consumer-survey-highlights-problems-with-denied-health-insurance-claims/

This Data Note includes major findings from the KFF Consumer Survey on consumer experiences with claim denials. Among those who used the most health care over the past year, 27% experienced a denied claim. More consumers with private insurance experienced denied claims compared to Medicaid or Medica...

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