Most Popular Stories
- The Ring of Fire - 5 YouTube Healthcare Videos Worth Watching
- Top Gunner - 5 YouTube Healthcare Videos Worth Watching
- Electronic Medical Records Kill! - 5 YouTube Healthcare Videos Worth Watching
- I wear a coat - 5 YouTube Healthcare Videos Worth Watching
- Laws to consider in hospital-physician co-management agreements
- How hospitals prepare for health IT in an ACO world
Featured Jobs
- Epic Technical Application Specialist
Kaiser Permanente - California
Events
- Advance your Healthcare Career with a Top Rated Online Degree
- iHT2 Health IT Summit
November 2-3 — Beverly Hills - The 7th Annual World Healthcare Innovation & Technology Congress (WHIT)
November 7-8 — Washington, DC - MHCC - San Diego
Dec 5 - 8, 2011 — Paradise Point, San Diego, CA
Paid Research Reports
-
Electronic health records: getting it right first time
-
Cloud Computing Adoption In The APAC Life Sciences Industry
-
Stakeholder Opinions: Ophthalmology - Leading brands under threat
-
Genomics, Proteomics and Metabolomics in Diagnostics: Market landscape, innovative technologies and future outlook
-
Healthcare Regulatory Update: The United Arab Emirates
-
Point of Care Testing: Evaluating the return to evidence based medicine, novel technologies and the competitive landscape
Free Newsletter
FierceHealthPayer provides the latest news about the fast-changing and heavily regulated area of healthcare reimbursement. Join thousands of healthcare plan executives who get FierceHealthPayer via weekly email. Sign up today!
Top Tags
Delaware Blues - $325K
Payer: Blue Cross Blue Shield of Delaware
Penalty: $325,000
Why: The insurer was recently hit with a large fine for denying cardiac tests. More specifically, the insurer was found to have "deficiencies" in its nuclear cardiac exam pre-authorization process, according to the Insurance and Financial Advisor.
Those deficiencies led Blue Cross to wrongly deny 73 physician orders for cardiac nuclear imaging studies for reasons such as insufficient information and a scan ordered without a doctor having seen the patient in more than 30 days, according to state and federal investigations.
What now: The insurer has agreed to underwrite a pilot program, developed by the American College of Cardiology (ACC), that aims to reduce inappropriate testing. As part of the agreement, Blue Cross will pay an annual fee of up to $100,000 toward the ACC's FOCUS program.
However, if Blue Cross doesn't commit to the program for at least three years, it faces an additional $300,000 fine.
Following the Delaware Blues' failed attempt to impose prior authorization on patients, the Medical Imaging & Technology Alliance (MITA) and the Access to Medical Imaging Coalition (AMIC) have called on Congress to reject the Blue Cross Blue Shield Association's (BCBSA) proposal for Medicare to use prior authorization for advanced imaging services, reports HealthcareIT News.
"It's ironic that Blue Cross Blue Shield of Delaware was taken to task by the state insurance commissioner for denying patient care as a result of using prior authorization for imaging services, yet their national association chooses to advocate that Medicare adopt a similar scheme," said Tim Trysla, executive director of AMIC. "The Delaware Insurance Commissioner's decision underscores the ineffectiveness and negative consequences of prior authorization and it would be irresponsible to enact these tools more broadly."
Lesson learned: Thanks to the Delaware Blues' fine--and potential future penalties, should it violate it's agreement--insurers might reexamine their testing and imaging policies. Despite associated cost savings, payers ought to make sure that prior authorization requirements won't reduce access to necessary diagnostic and screening services, and therefore, compromise care.
Home | Subscribe | Advertise | Mobile Edition | RSS | Privacy | Site Map | EditorsTHE FIERCEMARKETS NETWORKFierceEnergy | FierceSmartGrid | FierceFinance | FierceFinanceIT | FierceComplianceIT | FierceHealthcare | FierceHealthFinance | FierceHealthIT | Hospital Impact | FierceMobileHealthcare | FierceHealthPayer | FiercePracticeManagement | FierceEMR | FierceCIO | FierceCIO:TechWatch | FierceContentManagement | FierceMobileIT | FierceGovernmentIT | FierceGovernment | FierceHomelandSecurity | FierceBiotech | FierceBiotech Research | FiercePharma | FierceVaccines | FierceBiotechIT | FiercePharma Manufacturing | FierceMedicalDevices | FierceDrugDelivery | FierceIPTV | FierceOnlineVideo | FierceTelecom | FierceEnterpriseCommunications | FierceBroadbandWireless | FierceDeveloper | FierceMobileContent | FierceWireless | FierceWireless:Europe | FierceCable© 2011 FierceMarkets. All rights reserved. |