Medical Cost Trends
Q: I have a question that I am hoping you can answer. What is medical cost trends for the private sector in 2010? I know that the Costs were expected to grow 9.6% in 2009 compared with 9.9% in 2008. Can you tell me what it will be from 2009 to 2010?
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Payor Provider Manuals and Contracts
Q: Do you know of instances where the provider locks in the payors provider manual as of contract signing or other techniques that keep the payor from unilaterally modifying the contract because the provider manual or medical management policies are incorporated into the contract by reference?
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Robotic Surgery
Q: Are commercial payers paying for additional charges billed by hospitals for robotic surgery? At least one payer that pays on a % of charges basis is not paying the charges for the robotic surgery, additional OR time, etc. and prohibiting a provider from billing the patient under the hold harmless provisions of the contract. It seems that the payer wants it both ways—robotics is a non-covered service but the provider cannot bill the patient, even if the patient agrees to pay. From the payer’s perspective however, the surgery is a covered service but charging more because a robotics device was used is not warranted so those charges are denied and the hospital cannot bill the patient. What's your experience with this?
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Payor Report Card
Q: We are beginning to develop a Payor Report Card and instead of "creating the wheel" do you have a report card that you have already developed that you would be willing to share with us?
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