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  • Surprise billing summary by Dr Heller

    Posted by Unknown Member on May 11, 2023 at 8:39 am

    [link]https://www.youtube.com/watch?v=q1qFNKqrEcs[/link]
     
    [link]https://www.youtube.com/watch?v=_jakn7HGrrs[/link]
     
    Great work. Insurance companies seem to be winning the game.
     
    Qualifying payment amount- nice ring to it- insurancespeak for a number near Medicare.

    Unknown Member replied 1 year ago 3 Members · 7 Replies
  • 7 Replies
  • Unknown Member

    Deleted User
    May 11, 2023 at 11:32 am

    Does RP have a qualifying payment amount for rads? 
     
    Yes it does, 30 wrvu as of now, but Dr Heller less concerned about that. It’s what RP can get on the front end from commercial insurance that counts.

    • mircea.cg_544

      Member
      May 12, 2023 at 7:01 am

      Interesting video. Why not take the dentist approach to thingsupfront tell the patient their insurance covers $10, but we charge $40. Obviously the patient would be the outside owned imaging center or the hospital?

      • Unknown Member

        Deleted User
        May 12, 2023 at 7:19 am

        Quote from xraygiggles

        Interesting video. Why not take the dentist approach to thingsupfront tell the patient their insurance covers $10, but we charge $40. Obviously the patient would be the outside owned imaging center or the hospital?

        The only RP video with as- Tai Lopez would put it- knowledge. The rest are just intelligent people trying to cheerlead and looking like fools.

        • lisa.kipp_631

          Member
          May 12, 2023 at 12:38 pm

          That was worth the watch for sure.

          • Unknown Member

            Deleted User
            July 5, 2023 at 12:19 pm

            “Urban Institute experts anticipate that decisions over out-of-network payments and dispute resolutions will eventually begin influencing negotiations tied to in-network providers.”

            • Unknown Member

              Deleted User
              July 5, 2023 at 12:20 pm

              A recent analysis from S&P Global Ratings shows thats already happening. Since the roll out of the legislation, commercial insurers started terminating some of their in-network contracts that involved higher-than-average reimbursement rates. The intent, analysts noted, was to use arbitration to lower reimbursement. As one example, UnitedHealthcare knocked multispecialty provider group Envision Healthcare out of its network at the end of [link=https://radiologybusiness.com/topics/healthcare-management/healthcare-economics/unitedhealthcare-envision-radiologists-out?utm_source=related_content&utm_medium=related_content&utm_campaign=related_content]2020[/link] following the NSAs passage, citing egregiously high rates.
               
              Rad Partners has been submitting out-of-network claims to the independent dispute resolution process, and its won about 85% of the resolved cases. Yet, only 15% of the submitted claims have actually been resolved. Thats because the IDR process is running very slow, taking more than 250 days to settle disputes, and leading to a significant postponement in the receipt of payment.
               
              [link=https://radiologybusiness.com/topics/healthcare-management/healthcare-policy/no-surprises-act-urban-institute-radiology-margins-sp?utm_source=related_content&utm_medium=related_content&utm_campaign=related_content]https://radiologybusiness…mpaign=related_content[/link]

              • Unknown Member

                Deleted User
                July 5, 2023 at 12:22 pm

                In response to the growing backlog, CMS upped the administrative fee for the IDR process from $50 to $350 in December. Deval and colleagues said they expect this change will result in a modest reduction in claims submitted to IDR entities, but it may continue to constrain radiology providers margins.
                 
                This will not work for Radiology.