Reimbursement Roundup

Test project allows GMEs to form coalitions

The Health Care Financing Administration has announced a demonstration project permitting teaching hospitals to form coalitions and share Medicare graduate medical education (GME) payments among themselves. Under current law, GME payments are only paid directly to the teaching hospital.

To qualify, the consortium must contain at least one teaching hospital and at least one of the following: a school of allopathic or osteopathic medicine, another teaching hospital, a federally qualified health center, a medical group practice, a managed care plan, or an outpatient service provider. Applications are due to HCFA by April 4, 2000. For details, see the Jan. 5 Federal Register at /a000105c.html.

NJ expands patients’ rights to retain their physicians

New Jersey has enacted legislation preventing state HMOs from making patients with major illnesses switch physicians during the course of their treatment because their physician’s contract with the HMO has expired or been canceled. The new rules give cancer and surgery patients one year to find a new plan-authorized physician.

Facts to ponder

On-line health care business and insurance claims transactions will reach $348 billion by 2004, finds a survey by Forrester Research in Cambridge, MA. Within four years, 12% of private physician practices will do most of their practice-related purchasing on-line, from drugs to capital equipment, says the survey.

• About 20% of the nation’s physician organizations now generate 100% of their revenues from managed care contracts, according to New Jersey’s Managed Care Information Center.

HCFA putting fraud cops’ in insurer, contractor offices

As part of Medicare’s 2001 budget to be officially released next month, Medicare wants to install teams of federal "fraud fighters" in the offices of health insurance companies and other contractors that process Medicare claims. The administration also wants authority to bring aboard more private sector companies to process claims and police payment activities.

In a related development, word from inside the Health Care Financing Administration is that the agency plans to expand its new hospital payment error prevention program to include nonhospital providers. HCFA auditors will do detailed carrier-by-carrier comprehensive error rate tests to determine what kinds of payment errors are being made and which providers are making them.