P4P is the newest healthcare reform theory. Many believe the theory developed wide-spread acceptance following the landmark report, To Err is Human, published by the Institute of Medicine (IOM) in 2000, followed by the IOM report, Crossing the Quality Chasm: A New Health System For the Twenty-First Century, issued in 2001. There is almost unanimous agreement that P4P, if implemented correctly, has great potential to improve patient care. The basic premise is to (1) define quality by some measurable standard, (2) provide reimbursement incentives which compensate improved quality and (3) assess performance and pay accordingly.
Continue Reading Pay For Performance (P4P)

In the December 2004 PRN, Highmark stated that concierge medical practices are “not compatible” with its network requirements. Highmark stated that Blue Cross Blue Shield will initiate termination of impacted provider contracts or a without cause basis upon learning of conversion to concierge practice models.

As of Monday, July 25, Medicare will only pay for physical therapy services provided in physician offices “incident to” the physician’s services if the physical therapy services are provided by “qualified personnel” as defined in a June 24 transmittal to Medicare contractors.
Continue Reading “Incident To” Rules Effective July 25, 2005

Highmark will pay for care by more than one physician for treatment of hospital or skilled nursing facility in patients when the physicians are treating two or more separate conditions or the severity of the single condition requires the services of two or more physicians. The medical records should:

– Document the primary physician’s request for the consult(s)
– Document the seriousness of the medical condition
Continue Reading Highmark Defines Concurrent Care Reimbursement Policies