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Biomedical subjects

D S Millman

Publications and source records attributed to D S Millman.

16 recordsLinked to original sources
PubMed1987

Regulatory and legal aspects of outpatient surgery.

This is a brief summary of the regulatory and other legal issues that may be raised by the provision of surgery outside of the hospital environment. Despite these potential problems, however, outpatient surgery embodies significant potential for hospitals, physicians, patients, and third-party payers. Outpatient surgical facilities embody the potential to achieve two of the government's primary goals: the provision of high-quality services and the reduction of health care costs. Third-party payers, similarly, are increasingly recognizing the benefits of outpatient surgery. Some are providing "facility" payments to cover the overhead costs of such facilities, or at least, providing an add-on to physicians' professional fees, for example, UCR (usual and customary rates) plus 20 per cent, if surgery is conducted in an office setting. Health maintenance organizations and other alternative delivery systems are actively seeking to enter into contracts with ambulatory surgical centers to provide outpatient surgical services to their enrollees because HMOs and other alternative delivery systems maximize profits by decreasing inpatient hospital utilization. In the years ahead, certificate of need and other regulatory barriers to the establishment of ambulatory surgical centers may fall as states increasingly begin to reassess the costs and benefits of certificate of need programs. In short, the trend toward outpatient surgical facilities and outpatient care generally is one that is here to stay.

Ambulatory Surgical Procedures↗
PubMedDate not supplied

Reimbursement update: looking toward the 1990s.

Some Medicare carriers have independently decided to treat all billings for echocardiographic services as radiologic, whereas others have decided to treat billings from multispecialty practices that include a radiologist as radiologic services. The result is that the radiology fee schedules are being applied, even though the services were not supplied by radiologists.

Budgets↗
PubMedDate not supplied

Interpretation of echocardiographic data: are physicians and sonographers violating the law?

When a sonographer renders diagnostic interpretations from echocardiographic data, the possibility exists that state statutes concerning the unauthorized practice of medicine may be violated. Problems likely exist in this regard when the sonographer renders such interpretations without proper physician interaction or when the physician delegates such responsibilities to the sonographer. In such situations the physician may be guilty of aiding and abetting the unauthorized practice of medicine. Such practices may also violate various reimbursement rules and policies. Given such a situation, even the rendering of preliminary results by sonographers without appropriate supervision by the physician may be in violation of various state statutes and rules governing reimbursement procedures.

Echocardiography↗
PubMedDate not supplied

Changes in Medicare reimbursement for echocardiographic procedures.

Medicare reimbursement for echocardiographic procedures is clouded by the fact that Medicare defines ultrasound services to be "radiologic." As such, a 40% limitation has been imposed in some states. In addition, as a result of the Omnibus Budget Reconciliation Act of 1987, a new radiology fee structure was negotiated with Medicare, without the input of internists and cardiologists, that may significantly affect reimbursement patterns for echocardiographic services. Those who perform and interpret cardiac ultrasound studies are again urged to use the medicine codes (90,000 series) rather than radiology codes (70,000 series).

Abstracting and Indexing↗