The OIG has previously isled final guidance for hospitals, home health agencies, clinical laboratories, durable medical equipment providers, hospices, and third-party medical billing industries, copies of which are available from HMA by clicking here. While premiums continue to increase, more employees choose PPO s and more HMO s bail out. Employers are becoming frustrated because efforts to manage and control utilization have failed to produce lower costs. Also, Georgia Medicaid s last HMO, Grady Health System, had its contract terminated by the state. Nationwide, HCFA reports that about 100 managed care plans have shut down or cut services to Medicare or Medicaid patients.
Most fingers point to inadequate payment dates.
Blue Cross argues that the hospital had no right to file suit since the termination of any such contract requires 90 days written notice to the state Insurance Department. Please contact us promptly if you have any questions. However, Blue Cross argues that CHOP failed to give the Pennsylvania State s law mandated 90 and 60 day notices and that the Pennsylvania Insurance Department has not approved any termination of the agreement. Another HMA web poll will also be posted to explore how compliance officers would go in investigating coding or billing problems. We encourage our Strategy Advisor readers to participate in both polls and share your comments too.