No one questions the right of any payor to audit its payments to detect fraud, patterns of abuse or patterns of error. Around $5.4 billion were returned to the Medicare coffers as a result of audits by the contractors to Medicare for these audits. But let’s dig a little deeper into this. What if I…
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‘Those Guidelines Don’t Apply to Me’
I was taking a peer review call from a pediatrician. For those of you who don’t know, a request for “peer review” means a physician-to-physician conversation about something that was denied by an insurance company. In this case, I had denied payment to a hospital (as a medical director for an insurer) for a readmission…
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Does Becoming Emotionally Attached to Patients Impact Physicians’ Judgement?
He was a young man, struck head-on by a drunk driver. He arrived conscious and breathing, always good signs in major trauma, but the rapid progression of a complete white-out on his chest x-ray in the ER spoke to a bad prognosis. I knew he would die. My next patient was a small obviously well…
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