Weekend Update

Happy Presidents’ Day. At lunch today, the FEHBlog learned to his great surprise that for official federal government purposes (5 U.S.C. § 6103(a)) today is Washington’s Birthday, not Presidents’s Day. Live and learn. Congress is not in session this week.

The Wall Street Journal, the New York Times, and others are reporting an investment group lead by former AIG CEO Maurice Greenberg is planning to purchase Multiplan from its current investment group owners for around $4.4 billion.  Multiplan is a preferred provider network developer and administrator. In the last decade, another independent PPO network vendor, PHCS, was merged into Multiplan. Several FEHB plans use Multiplan as a secondary network.

Following up on FEHBlog post last week about the ICD-10 code set, EHR Intelligence writes about the American Medical Association’s latest efforts against the code set, including a twitter campaign and another letter to the HHS Secretary. The Washington Post featured a humorous article about the code set yesterday titled “When squirrels attack, there’s a medical code for that.”  The article explains that

Two key factors help explain the explosion in medical codes. First, ICD-10 adds in the ability to differentiate between left and right sides of the body. This can help insurers, for example, to root out fraud. A hip replacement on both the left and right side might not raise any red flags — but two hip replacements on the left side probably would.
Second, the new codes categorize whether a trip to the hospital was the first round of treatment or a subsequent encounter. This is important for reimbursement purposes, as first visits to the doctor tend to require more resources.

That’s a pretty weak justification for this enormous expense. FYI, people do receive replacement hip transplants.

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