Insurer changes policy on endoscopy incentives
Healthcare Auditing Weekly, October 17, 2006
Blue Cross of California has agreed to discontinue its policy of paying physicians a higher fee for performing certain endoscopy procedures in ambulatory surgical centers after a lawsuit was filed challenging the policy, the Hospital Association of Southern California reports.
After reviewing the policy, California's Department of Managed Health Care (DMHC) concluded that Blue Cross should have sought regulatory approval first, as the financial incentive policy constituted a significant change in operations.
DMHC said the program could create an incentive for doctors to treat patients in a manner that financially rewarded them, rather than the one most appropriate for the patient's condition.
The deparment also said the program could violate health code rules that prevent healthcare plans from creating policies that tend to deny, limit, or delay services.
Click here to read the hospital association's news release.
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