Fight Club (UHC and the Land of Make Believe)

The first rule about Fight Club is not to talk about Fight Club. SOAPM-list members know all about this, but a copy of the most ridiculous and obnoxious confidentiality agreement I have ever, ever seen is making the rounds. It’s so…ludicrous, my heart stops. Sadly, I know there are folks out there who have signed …

Excel 2007 Bugs

In a previous piece, I wrote about small businesses needing to consider using a variety of Open Source (or free) software programs to run their offices – it’s often safer, more secure, more stable, and a lot cheaper. It was reported on Slashdot today and in the on-line newsgroups that a fairly important bug has …

UHC and Synagis

From a few places, including SOAPM: There are rumors floating around that UHC will not approve Synagis this year for any babies 32-35 weeks regardless of their current age or risk factor status (against current AAP recommendations). Surprised? No. UHC will continue to behave this way until it becomes worthwhile for them to stop (and …

Vaccine Showdowns (Go EBP!)

My apologies to the readers of the SOAPM mailing list, as this is a repeat, but there are too many folks who would otherwise miss this piece from the San Francisco Chronicle: Doctor-insurer disputes force parents to pay up front for shots It’s the children who feel the sting of vaccinations, but it’s their parents …

Financial Analysis for the Managing Pediatric Provider

First, the facts: October 11 7-9 p.m. $75/person Doubletree Hotel Boston Downtown Boston, MA What are we covering? PCC’s Pediatric Solutions team will share current pediatric trends that drive bottom line change and show you where to look to evaluate the impact these trends have on your practice. Then, we’ll teach you how to apply …

E-Mail I Love To Get

This arrived in my mailbox last week: By the way……Take a look at my SRS coding numbers from 7/23/06-9/14/06 compared to 7/23/07-9/14/07. I listened at the conference. For the unitiated, “SRS” is the name of our “Smart Support Suite” that our customers use to look at their data. It comes with all kinds of pediatric …

A Recipe For Success

Excerpts from a fun letter one of our clients put together recently. Note the results at the end. …Vaccine reimbursement is always an issue with your company. In our practice, [MCO] has the lowest vaccine reimbursement of all insurance companies. The American Academy of Pediatrics has published recommendations for vaccine reimbursement. You can find the …

-25 Modifier Data

Another scoop for the blog.  Pediatric benchmarks regarding the use of -25 modifers. This is part of the quick examination the AAP asked us to do.  Ultimately, they are trying to determine whether improper payment for -25 modified codes should take priority over immunization admin codes or not.  Tough call, though I lean toward the …

Not Making the Grade

I picked up this tidbit from a message forwarded to PedTalk (thanks, Dr. Gewanter). Family Practice Magazine and the associated AAFP (from whom the AAP is finally starting to learn!) “…decided last year to conduct a Consumer Reports-style survey of physicians’ experiences with third-party payers.” The results are hardly surprising. OK, I was surprised that …

Imms Admin (90465 vs. 90471)

For some time, we have known that our customers who use the “new” imms admin codes tend to get paid better for them. We figure, just as Dr. Bradley stated at the PCC-sponsored Coding event in NYC recently, that many of the MCOs simply entered the new codes with the new values but didn’t update …