Baseball style arbitration on any OON provider billl at in network hospital starts 2022.
Are U ready ?
Are U ready ?
Surprise billing is over. No surprise ACT in the COVID Bill
- Thread starter AZpath
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deleted314957
I can assure you that there will be zero incentive to be non-par. Insurers are going to pay what the par folks get. You’re not going to “arbitrate” anything with bc/bs, etc.
If this version of the billing gets signed it should be pretty good.
I would have liked payment based on the 80% of FAIR or 150% MC.
Many physician group lobbied for this plan.
The insurance companies are so pissed that this got passed.
They are praying Trump does not sign it.
In this bill, they can pay what they want. You don't have to take it.
You have to negotiate in 30 days with the insurer. After that you go to arbitration.
There is no minimum amount to arbitrate but It remains to be seen if you bundle claims.
The arbitrator can't look at government programs as a payment basis.
They try to send OON payments to patient to patients in my state.
BC/ BS has to send the payments direct to you under this law.
I would have liked payment based on the 80% of FAIR or 150% MC.
Many physician group lobbied for this plan.
The insurance companies are so pissed that this got passed.
They are praying Trump does not sign it.
In this bill, they can pay what they want. You don't have to take it.
You have to negotiate in 30 days with the insurer. After that you go to arbitration.
There is no minimum amount to arbitrate but It remains to be seen if you bundle claims.
The arbitrator can't look at government programs as a payment basis.
They try to send OON payments to patient to patients in my state.
BC/ BS has to send the payments direct to you under this law.
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deleted314957
Your last paragraph is going to put a lot of well deserved money back in the pathologist’s pocket where it belongs.
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deleted314957
By all accounts, the veto should be over-ridden.
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Will this change help pathology groups?
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deleted314957
AZpath’s last comment in his longer post could be a very significant positive.
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We avoided not only the 11% cut and 3% overall Medicare decrease in last minute negotiations, but we actually got a surprise 3.75% increase.
massive win. Massive.
Everyone get drunk 🥴 tonight.
massive win. Massive.
Everyone get drunk 🥴 tonight.
You are right!!
www.medscape.com
All good IMO.
We will see on how the OON portion works out.
I think that there is leverage for better payments for those that understand the system.
Look for a cottage industry to spring up to to seek negotiate better pricing. I am sure Vachette will be all over this.
But If you are path group that always cow tows to the insurance company it may be worse.
Physicians Find Perks in COVID-19 Relief Bill
A compromise surprise billing measure, partial reversal of E/M overhaul cuts, and new PPP loans are all part of the package approved by Congress.
www.medscape.com
All good IMO.
We will see on how the OON portion works out.
I think that there is leverage for better payments for those that understand the system.
Look for a cottage industry to spring up to to seek negotiate better pricing. I am sure Vachette will be all over this.
But If you are path group that always cow tows to the insurance company it may be worse.
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But was it actually a 3.75 % increase on payments, or rather they decreased the impact of cuts by 3.75% (i.e. still a sizeable cut)?
You might be correct, at least according to the plain text of the article. Do not pop the champagne just yet. 11%-3.75% would be approximately 6% cut.
The devil is in details. Somebody already read the legislation and summarize it for the rest of us.
Our mileage may vary ....
PT said they were still looking at 3.6% cut
Cardiologists link bellow. They think they might go up.
Everyone is waiting on the update final rule.
PT said they were still looking at 3.6% cut
Cardiologists link bellow. They think they might go up.
Everyone is waiting on the update final rule.
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I have to say if Medicare is trying to pay specialties which are “using their brain/more cognitive” and pay “procedures less” it makes absolutely zero sense to cut pathology. Zero. Someone really should knock that sense into these people.
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deleted314957
Your comment makes me doubt that you ever practiced any clinical medicine (med school does not count). I have. E&M codes are vastly underpaid compared to most any of the 88305’s you look at. 90+% of the 302’s - 305’s we look at take about , what, 10 seconds more or less to look at after you’ve done this for a few years on your own. Our charges aren’t terrible, it’s just that most of y’all only get a small piece of the money from the codes you bill.
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Maybe we should lobby to make it illegal not to collect all your professional component fees and have it go to a third party.
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Your comment makes me doubt you've ever actually seen a patient. I'm a senior derm resident. I've see far more patients than any path trained person ever will already (path doesn't do an internship).
You'll be surprised how little thinking happens on day to day REAL clinical work (when you take care of patients face to face). Most things are rapidly algorithmic. That is precisely why mid levels are taking over all these fields. Actual use of deep thinking is minimal.
As for path, i've read countless dermpath slides. Sure the BCCs/Sks/AKs could take seconds, but the field is immensely broad, and the level of thinking is many levels of magnitude higher for tougher cases (specially tricky inflammatory cases or rare neoplastic cases). Yes this is more cognitively harder than repetitive sepsis protocols, HF, etc. Anyone who disagrees with the above has a knowledge which is outdated and does not reflect the massive strides in diagnosis made in Derm/dermpath within the last decade.
Finally, "time" doesnt correlate with "skilled thought process." I practice, read, and train for years to do things quickly because I become the expert. The fact that a task took me little time, reflects a high level of expertise and thus, confidence, in my ability to do a task quickly.
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If you want to continue underselling yourselves (and insult mine along the way) in pathology go right ahead.
To think I was going out of my way to support a field that is not mine and I thought deserved more recognition from the broader community...
To think I was going out of my way to support a field that is not mine and I thought deserved more recognition from the broader community...
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Pathologists with decades of experience are not looking for the expert advice of some derm resident. We also don’t need your pity. Please go back to your own forum.
Can't we all just get along and focus on the real problem? Instead of fighting against fellow physicians the real problem is the system and market forces. Too much supply with increased efficiency of pathologist kills demand and your ability to capture revenue that you bill for. If CAP and others with power in the field of pathology did what was best for the practicing pathologists we wouldn't need to argue with colleagues about everyone's piece of the pie. If you look at an organization like the American Academy of Dermatology you will see why dermatology is thriving and pathology is not.
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You need to learn to face opposing opinions with more grace, and respond coherently, rather than "we have decades of experience" blah blah and "go back to your forum." Childish. Resident today yes, but attending tomorrow.
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Well that's what i was trying to do. I liked pathology a lot as a med student, and considered going into it.
For some reason, some of you can't even take a vote of support from "some derm resident"
Well anyways, this clearly isn't constructive for anyone, so I'm out!
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Come on don't be hating. I have to side with PhillyMed on this one. Besides let's not get sidetracked from the main subject of this thread.
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LOL, I had to read the above posts several times to make sure I wasn’t tripping...
Derm resident: hey guys, pathology is really intellectual and should get paid more
pathologists on sdn: stfu derm resident, you know nothing! Gtfo. Oh, and your field is stupid.
Ladies and gentlemen, this is why the entire field of medicine has been conquered by the barbarians.
Derm resident: hey guys, pathology is really intellectual and should get paid more
pathologists on sdn: stfu derm resident, you know nothing! Gtfo. Oh, and your field is stupid.
Ladies and gentlemen, this is why the entire field of medicine has been conquered by the barbarians.
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Indeed. Play nice boys and girls
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I still cannot fathom why this is something that is tolerated. If you do the work, you should collect the remuneration in full. It's your name going on the report, after all.
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deleted314957
I did a rotating internship and then 2 1/2 yrs as a GP. I am an old timer from the 70’s-80’s. I’m retired as of 2013. Don’t tell me about ANY aspect of path kid.
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I think because a huge majority of physicians are employed by others, whether by someone of their own field or another field. If we mandated that only the physician doing the work got paid the full amount for that work, then all of academia, corporate labs, small private practices etc would likely become illegal overnight. The law sees no difference in a dermatologist/gastroenterologist employing a pathologist and taking a cut of the billed pathology revenue than it does a hospital employing a pathologist and taking a cut of the billed pathology revenue. Same goes for a hospital employing a hospitalist, radiologist, etc etc. Would be very hard to change the laws just to fit our wants for our field.
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I know. And for some like academics, their professional fees may even be less than their salary. That would require them to be subsidized by somebody else in the department who does higher volume. I don’t know the answer. Still, It’s not good business sense to give up your professional component to someone else.
That whole chain is surreal. Any time an admin sees or overhears stuff like this, they must salivate. "Never interrupt your enemy while he is making a mistake".
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Scuba you do realize pathology is ultimate "Get off my lawn" specialty right?
You can never win and never make happy an old crusty pathologist. Even talking to them arouses intense suspicion and general distrust.
It's a lose-lose situation.
You can never win and never make happy an old crusty pathologist. Even talking to them arouses intense suspicion and general distrust.
It's a lose-lose situation.
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deleted314957
The troll ( path doesn’t do an internship) is gone!
I guess I've been lucky? enough to not run into a true old cruster. In residency, I had one attending who was probably a legit super genius who definitely gave off "I can't deal with this ****" vibes, but was always cordial to us residents and seemed way more relaxed at a couple outside of work functions.
Still looks very bad.
The impact table Vachette sent this morning show a 8% overall cut on PC.
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Vachette wrote that article BEFORE the Congress passed the budget though correct?
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deleted314957
But, if insurance checks have to be sent directly to the doctor rather than the patient, there should be some significant bucks there.
