Samaritan docs push beyond prudent layperson limits
Samaritan docs push beyond prudent layperson limits
Tempe, AZEmergency physicians at Phoenix-based Samaritan Health System have adopted what may turn out to be a costly new policy regarding the treatment of walk-in cases.
The physicians have agreed to begin treating all patients with "whatever service is deemed necessary to rule out an unstable condition," according to Todd Taylor, MD, a spokesperson for the physicians who work at Samaritan’s four Phoenix-area hospitals. The agreement with the hospitals will be honored regardless of whether or not the procedure is covered or ultimately paid for by a health plan, Taylor says.
In the past, patients would routinely be transferred to a local contracted urgent care center following screening if the patient’s health plan refused to cover the subsequent services.
Since August, "physicians have begun to ignore those considerations," Taylor says. The health plan will still be contacted for pre-authorization. "But the physicians will do whatever is necessary regardless," Taylor adds.
The additional cost to the hospital and physicians is uncertain but likely to be insignificant because most non-urgent cases represent a small amount of marginal cost to hospitals, Taylor indicated. "The only place we may get into trouble is with expensive, non-routine diagnostics" such as special, high-tech imaging, Taylor believes.
HCFA wants to stop ambulance payment abuses
Baltimore, MDHospital EDs that bill Medicare for certain ambulance services without considering whether their actions comply with existing regulations are being put on notice.
The Health Care Financing Administration (HCFA) is taking a close look at the way Medicare has been paying for a range of routine and emergency ambulance transportation.
Among its priorities, HCFA, based in Baltimore, MD, wants to halt a common practice by some hospitals of billing separately for the service despite rules that bar them from unbundling the ambulance portion of certain claims.
Thanks to ambiguities in current law, some providers have been able to skirt pre-conditions for payment that have enabled them to charge separately and sometimes twice for the service, which is illegal under federal law. The agency has proposed a rule to clarify the existing regulation.
The rule would specifically cover situations in which hospitals routinely transport patients to nearby facilities for special diagnostic testing or when patients cannot get there under their own power.
The proposal would make clear that Medicare will not pay separately for ambulance transportation when those services are already covered under Part A of the Medicare program. One exception would apply when the patient’s Part A benefits have been exhausted but the patient is entitled to Part B coverage.1
Reference
1. 62 Fed Reg 32715 (1997)
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