Did you hear about the surprise bill of an urgent care patient? Well, there are loads to discuss this week. Let’s see one by one.

HEALTH

  • Bryan Keller, a New York resident, met with an accident and was rushed for an emergency, where he had five stitches in a clinic.
  • Later, he got a surprise bill for $1,039.50, to be precise. Keller ensured whether the insurance would be covered for the stitches but didn’t guess about the plastic surgeon who had rendered the service.
  • It was an out-of-network provider who had billed for such an amount with no hint prior to the service.
  • Keller had no clue about the physician’s bill that’s not included in the insurance coverage. “The people at CityMD just said this sort of thing is covered as part of an emergency procedure,” said Keller.
  • “It really irked me that, it’s this classic thing you hear in this country all the time,” Keller said. “When you do all the right things, ask all the right questions and you’re still hit with a large bill because of some weird technicality that there’s absolutely no way for you to understand when you’re in the moment.”
  • Last year, Congress had passed a law that surprise bills will be banned from January.
  • The Biden administration has expressed an interest in prohibiting surprise bills in those clinics, which may treat serious conditions but not life-threatening injuries and illnesses.
  • Lung cancer screening (LCS) rates had remained stable between 2019 and 2020 in the United States and increased in 19 states.
  • Stacey A. Fedewa, Ph.D., from the American Cancer Society in Atlanta, and colleagues had examined annual LCS rates before and during the pandemic nationally and by state.
  • However, the numbers of LCS performed in 2019 and 2020 were obtained from the American College of Radiology Lung Cancer screening public reports. Among the adults, it was compared before and during the pandemic.
  • The researchers found that 564,164 and 557,795 of the 8.51 million eligible adults received LCS in 2019 and 2020, respectively.
  • The national LCS rates were unchanged between 2019 and 2020 (6.6 versus 6.5 percent; screening rate ratio [SRR], 0.99; 95 percent confidence interval, 0.97 to 1.01).
  • “Although national LCS rates remained low and unchanged, 19 states experienced significant improvements despite the pandemic,” the authors write. “Best practices from successful state and local LCS programs could inform ongoing efforts to detect lung cancers early.”

TECHNOLOGY

  • Automation and Software Company Olive has recently announced their new AI software launch.
  • It claimed to focus on enhancing the quality of work and its impact on healthcare professionals.
  • “Olive Helps” is designed to minimize workflow barriers and help eliminate the disruptions associated with using multiple technology systems to complete tasks.
  • It also helps in organizing information and provides real-time assistance and information exchange for employees.
  • This technology’s additional features include Loop Library, which hosts a collection of health systems and effectively creates an ecosystem of information and additional applications developed by Olive partners.
  • Medical technology manufacturer Exo has recently completed a Series C of funding that left the company with $220 million in additional capital gain.
  • Exo has been perfecting the development of an ultrasound device that utilizes artificial intelligence, silicon technology, and medical imaging to conduct low-cost and effective ultrasounds with ease.
  • This particular device is said to be cheaper than the standard $50,000+ ultrasound machine, costing roughly the price of a high-end laptop.
  • But the device is yet waiting for approval from the U.S. Food and Drug Administration but will likely start appearing in U.S. hospitals shortly after getting the green light.

BUSINESS

  • Saum Sutaria is the new CEO of Tenet Healthcare Corporation on Sept. 1, 2021, according to a new announcement.
  • Tenet Healthcare Corporation has announced its new CEO as part of its long-term leadership succession plan.
  • The large healthcare services company headquartered in Dallas announced yesterday that Saum Sutaria, MD will take over as CEO starting September 1, 2021. Sutaria is currently president and chief operating officer at Tenet and will replace Ron Rittenmeyer.
  • “I am honored to serve as CEO and continue our work in building a truly unique and diversified healthcare enterprise,” Sutaria stated in the announcement.
  • “Tenet is a remarkable company with a mission that embraces the many different dimensions of healthcare that we are always striving to improve,” Sutaria continued.
  • The US District Court of New Jersey granted a preliminary injunction against the proposed hospital merger between Hackensack Meridian Health and Englewood Health.
  • The organizations had jointly announced the deal in the year 2019 in order to build an existing clinical and academic affiliation.
  • The Federal Trade Commission had filed an administrative complaint against the hospital merger deal by December 2020.
  • The complaint was about the concerns the combined health system would control half of the six inpatient general acute care hospitals in Bergen County, New Jersey if allowed to close.
  • “This acquisition would give the combined hospital system increased bargaining leverage, likely leading to increased prices,” Ian Conner, Director of the FTC’s Bureau of Competition, said at the time.

MEDICAL BILLING

  • Non-teaching and for-profit hospitals are more likely to use conveners for bundled payment success.
  • They also tend to choose more episodes and those with higher target prices.
  • The use of conveners for bundled payment success has become more common among non-teaching and for-profit hospitals. They tend to select more episodes with higher target prices, according to a recent study.
  • Conveners can encourage participation in voluntary bundled payment models like the BCPI Advanced by allowing hospitals to share the financial risk of selected clinical episodes with another entity.
  • It has proven to be true for non-teaching and for-profit hospitals, which have historically been less likely to participate in voluntary alternative payment models, researchers explained.
  • The study explained that a $1,000 increase in episode target price was linked to a 1.66-percentage-point increase in the probability of episode participation in the model compared to a 0.72-percentage-point increase for participating hospitals without a convener.
  • Surprise billing compliance will definitely have impacts throughout the revenue cycle. Thus, preparation remains the key to meet the January 1 deadline.
  • A prohibition on surprise billing is coming in the first month of next year, and federal agencies have already started to release what surprise billing compliance looks like.
  • “This is a major new regulatory scheme which will have impacts throughout the revenue cycle and will directly impact workflows from admissions to billing,” Harvey L. Rochman, partner at Manatt, recently told RevCycleIntelligence.
  • The law itself will “mean significant changes and new or different workflows for hospitals which they should be working on now given that the law is effective on January 1, 2022,” Rochman says.
  • HHS has jointly released an interim final rule (IFC) with the Office of Personnel Management (OPM), Department of the Treasury, the Internal Revenue Service, and the Department of Labor’s Employee Benefits Security Administration to provide additional information.
  • It’s mentioned that revenue cycle leaders must particularly pay attention to the part of the IFC that prohibits balance billing.

Healthcare companies will have vast areas to research and develop their skills with a positive approach. Healthcare professionals must compete to be successful in their industry.

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