Medicine & Health articles from April 2006

Medicine & Health archives from April 2006

Payers need to streamline Part D turnaround time to head off potential regulatory changes: pharmacists' payment complaints could also put insurers' co-branding deals on the chopping block.(Claims Processing)
April 10, 2006... Lagging Medicare Part D drug reimbursements have pharmacists seeing red--and they're pointing the finger at private insurers. Payers will need to speed up their reimbursements, or the Centers for Medicare & Medicaid Services might do it...

Home Care not an exception for P4P shift: CMS plans to launch a P4P demo for the home care industry--soon.(Centers for Medicare & Medicaid Services )
April 10, 2006... Providers can't just ignore pay for performance--the mechanism is gaining speed and could become a chief determining factor for Medicare payments sooner than providers think. That was the message of multiple presenters at the National...

CMS mulling pharmacist payment adjustment to shore up drug benefit: industry consolidation may narrow Medicare drug benefit to fewer plans in 2007.(Centers for Medicaid & Medicaid Services)(Brief article)
April 10, 2006... News reports have highlighted some pharmacists' financial problems stemming from the Medicare prescription drug benefit, purportedly relating to health plans' slower reimbursement for dual eligibles' claims. (See related story in this issue.)...

OIG initiates a new crackdown on consult billing: three out of four consults billed incorrectly, OIG says.(Office of Inspector General )
April 10, 2006... Consults look like a juicy target to fraud-busters in the wake of a new HHS Office of Inspector General report that found 75 percent of consults didn't meet Medicare requirements. Only one third of the dollars providers billed in 2001--$1.1...

Bidding rule coming out 'very soon,' CMS promises: bid items may vary for different bid areas.(Competitive Bidding)(Centers for Medicare & Medicaid Services)(Medicare Modernization Act )(Brief article)
April 10, 2006... Durable medical equipment suppliers soon will see the shape of things to come under competitive bidding. The Centers for Medicare & Medicaid Services will issue its proposed rule on competitive bidding "very soon," promised Laurence...

HHAs should hold off on expedited determination notices for Part B therapy: they can't reach for HHABNs either.(Home Health Advance Beneficiary Notices)(Home Health Agency)
April 10, 2006... Home health providers can avoid unnecessary extra work if they furnish outpatient therapy to patients in the home--but they must heed new guidance from the feds. Patients who exceed the new $1,740 annual cap for either occupational therapy...

Senate, house budget committees pass budget resolutions: plus: Fraud fighters target chiropractors once again to save Medicare millions.(Industry Notes)
April 10, 2006... On March 16, the Senate passed the budget resolution that includes no cuts to Medicare, Medicaid or other entitlement spending programs. The Senate Budget Committee approved the budget blueprint March 9. The Senate narrowly rejected an...

RUG software could be costing LTC facilities thousands: software snag may drag down nursing homes' per diems.(Long Term Care)(Brief article)
April 10, 2006... Without naming names, the Centers for Medicare & Medicaid Services confirmed at a March 16 Open Door Forum that not all software vendors serving nursing homes are accurately assigning Resource Utilization Groups for Medicare payment. Some...

Get ready: CMS could slash physician payments to the bone next year: a 4.6-percent cut awaits providers in 2007, CMS estimates.(Centers For Medicare & Medicaid Services)
April 21, 2006... The Centers For Medicare & Medicaid Services says the conversion factor for physician payments in 2007 will be 36.1542--4.6 percent lower than this year's rate--unless Congress steps in again. Writing this off as another false alarm would...

4 reasons to love AHPs--and 4 reasons to leave them: love them or hate them, association health plans are acquiring a growing wave of bipartisan support.
April 21, 2006... The Ides of March sparked a new beginning for association health plans--and the turning point in an uphill battle on health reform that has lasted nearly a decade. AHP legislation would preempt state benefit mandates and allow insurers to offer...

5 ways Part D plans are positioning for new business: new studies reveal what worked for PDP frontrunners in 2006.
April 21, 2006... Whether they offer a standalone prescription drug plan or a Medicare Advantage plan, the steps carriers take now to attract and keep hold of their Medicare Part D enrollees will be critical to their success in 2006 and beyond. Although...

Physicians can give P4P a test run--with no pay at stake: physicians who start now can receive a confidential report by December.
April 21, 2006... Medicare's Physician Voluntary Reporting Program got off to a slow start thanks to a healthy dose of skepticism amongst physicians. A few days after the PVRP's official April 1 start date, officials from the Centers for Medicare & Medicaid...

How HHAs are preparing for P4P: payment mechanism could take HHAs by surprise.
April 21, 2006... Pay-for-performance could determine home health agencies' Medicare payments soon, if policy- and lawmakers get their way. The Centers for Medicare & Medicaid Services is readying a P4P demonstration for HHAs. Congress is requiring HHAs to...

PMD suppliers say 'proceed with caution' under final rule: plus: MA plans could earn a pay raise.(Power mobility devices )
April 21, 2006... Federal regulators have spoken, but suppliers of power mobility devices say they need more specifics on what to document if they are to expect Medicare to reimburse them for their wares. The Centers for Medicare & Medicaid Services' final...