Comments on: Will New York Destroy U&C Method? http://healthcarethoughts.com/2008/02/14/will-new-york-destroy-uc-method/ observations on healthcare, technology and the American way by Brian Sharp Wed, 08 Sep 2010 02:36:59 +0000 http://wordpress.org/?v=2.2.2 By: Dorrence http://healthcarethoughts.com/2008/02/14/will-new-york-destroy-uc-method/#comment-70 Dorrence Tue, 19 Feb 2008 20:01:29 +0000 http://healthcarethoughts.com/2008/02/14/will-new-york-destroy-uc-method/#comment-70 While the case will certainly be interesting to watch, the striking thing to me in this matter is the fact that we have, yet again, another government official with little to no experience in healthcare, healthcare billing, or what may be in the best interest of patient and payor intervening in the operations of the system. Further, as we have seen occur in New York in the past, pursuing such issues is a fast track to getting elected to a higher office (i.e. Eliot Spitzer being elected Governor). It is a shameful day when politicians use issues of concern, like healthcare, to sway public opinion. However, it is of far greater concern when politicians break an operational system in order to "fix" a perceived problem. Attorney General Cuomo will undoubtedly cause serious doubts in the validity of Ingenix data, and may ultimately undo the concept of comparing claims to a usual and customary standard. Like the Presidential candidates who likewise are spouting "solutions" to the healthcare problem, ultimately government intervention will only muddy the waters further. Just as the national Presidential debate is harnessing the perceived fears of the public over healthcare, here we add another doubt to the public perception. One must ask Attorney General Cuomo why he chose this precise moment in time to bring this matter forward. Could the Attorney General for New York be hoping for an appointed position in a newly elected Democrat Administration? Has such a position already been worked out with the Senator from New York? One must wonder. We all should be more concerned with what "backroom deals" may have been cut by the politicians pushing these matters. Ultimately, they may pose a larger threat to America! While the case will certainly be interesting to watch, the striking thing to me in this matter is the fact that we have, yet again, another government official with little to no experience in healthcare, healthcare billing, or what may be in the best interest of patient and payor intervening in the operations of the system. Further, as we have seen occur in New York in the past, pursuing such issues is a fast track to getting elected to a higher office (i.e. Eliot Spitzer being elected Governor).

It is a shameful day when politicians use issues of concern, like healthcare, to sway public opinion. However, it is of far greater concern when politicians break an operational system in order to “fix” a perceived problem. Attorney General Cuomo will undoubtedly cause serious doubts in the validity of Ingenix data, and may ultimately undo the concept of comparing claims to a usual and customary standard. Like the Presidential candidates who likewise are spouting “solutions” to the healthcare problem, ultimately government intervention will only muddy the waters further.

Just as the national Presidential debate is harnessing the perceived fears of the public over healthcare, here we add another doubt to the public perception. One must ask Attorney General Cuomo why he chose this precise moment in time to bring this matter forward. Could the Attorney General for New York be hoping for an appointed position in a newly elected Democrat Administration? Has such a position already been worked out with the Senator from New York? One must wonder. We all should be more concerned with what “backroom deals” may have been cut by the politicians pushing these matters. Ultimately, they may pose a larger threat to America!

]]> By: Brandon http://healthcarethoughts.com/2008/02/14/will-new-york-destroy-uc-method/#comment-69 Brandon Mon, 18 Feb 2008 14:23:52 +0000 http://healthcarethoughts.com/2008/02/14/will-new-york-destroy-uc-method/#comment-69 It should be interesting to see if they focus the investigation of the validity of usual and customary in general or if they make it be more specific to Ingenix and thier practices for obtaining and keeping the data up to date. It should be interesting to see if they focus the investigation of the validity of usual and customary in general or if they make it be more specific to Ingenix and thier practices for obtaining and keeping the data up to date.

]]> By: Kevin http://healthcarethoughts.com/2008/02/14/will-new-york-destroy-uc-method/#comment-68 Kevin Fri, 15 Feb 2008 20:37:20 +0000 http://healthcarethoughts.com/2008/02/14/will-new-york-destroy-uc-method/#comment-68 Certainly builds a case for payors need to utilize objective 3rd party data for determining fair and equitable payments for out-of-network claims. In 2003 the Office of Inspector General issued a mandate that due to increasing fraud and abuse, fair and reasonable payment to providers should be based on REIMBURSEMENT rates, not charges. (Federal Register, Volume 68, No. 178, 09/15/03, p. 53939). While not widely accepted or even known about, if payors were to adopt protocol to adhere with the OIG, the mystery surrounding fees, reimbursement, contracted rates would suddenly be transparent. Consumers and commercial payors would then have the ability to assess providers not only on quality, but also cost benchmarks as well. As more costs are pushed down to the consumer level in healthcare, I believe that we will see this become commonplace. Certainly builds a case for payors need to utilize objective 3rd party data for determining fair and equitable payments for out-of-network claims.
In 2003 the Office of Inspector General issued a mandate that due to increasing fraud and abuse, fair and reasonable payment to providers should be based on REIMBURSEMENT rates, not charges. (Federal Register, Volume 68, No. 178, 09/15/03, p. 53939). While not widely accepted or even known about, if payors were to adopt protocol to adhere with the OIG, the mystery surrounding fees, reimbursement, contracted rates would suddenly be transparent. Consumers and commercial payors would then have the ability to assess providers not only on quality, but also cost benchmarks as well. As more costs are pushed down to the consumer level in healthcare, I believe that we will see this become commonplace.

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