Medicine & Health articles from December 2005

Medicine & Health archives from December 2005

15 new developments are already reshaping 2006 Medicare coverage: the new year brings big changes that every plan, physician, supplier and biller should know about.(health insurance)
December 5, 2005... The 2006 Medicare Part D rollout is drawing the focus of the entire Medicare community--but not to the point of distraction, the Centers for Medicare & Medicaid Services hopes. Coverage and compliance changes abound for 2006; these hot-button...

Pharma Group pushes to change Medicare rules: why pharmacists can't advise seniors about drug-plan choices.(Long Term Care Pharmacy Alliance)
December 5, 2005... To help end apparent confusion among seniors about enrolling in the new Medicare prescription benefit, the law should allow nursing home staff and pharmacists to counsel patients about which drug plans would be best for them, one organization...

AstraZeneca backs massive Medicare Part D education initiative: benefit educators to target 27 states.(medicare beneficiaries)
December 5, 2005... A van full of trained educators could cruise into your town over the next few months on a mission to help local Medicare beneficiaries understand the new prescription drug benefit. While Medicare rules prevent long-term care pharmacists...

CMS will limit bariatric surgery benefits to a younger demographic: detailed restrictions surround coverage for weight-loss surgery.(Centers for Medicare and Medicaid Services)
December 5, 2005... In an attempt to cut down on obesity-related health risks, Medicare is proposing a new set of guidelines to govern bariatric surgery. But the altered rules would shift bariatric procedure coverage to a younger set of beneficiaries. The...

Two key factors hold down health benefit cost increases: AHRQ releases new statistics on prescription drug, HIV hospital stay expenditures.(Agency for Healthcare Research and Quality)
December 5, 2005... Employers' health plan design changes and major cost shifts to employees in the past three years has slowed annual health benefit cost increases, a recent survey said. Costs rose just 6.1 percent in 2005, compared to a 15-percent peak only...

Big pharma in the spotlight yet again for drug-pricing schemes: HHA pays out $7 million for improper Medicaid billings.(Boehringer Ingelheim Corp., HHA Americare Certified Special Services Inc.)
December 5, 2005... In the latest in a series of whistleblower lawsuits against several drug companies, Boehringer Ingelheim Corp. of Connecticut and its subsidiaries will pay the Texas Medicaid program $10 million for allegedly falsifying its wholesale prices for...

The growth in Federal funding for medical research during the past 10 years has spurred the need for more oversight.(In Other News ...)
December 5, 2005... The growth in Federal funding for medical research during the past 10 years has spurred the need for more oversight. In the Nov. 28 Federal Register, the HHS Office of the Inspector General asked for public comments on developing compliance...

The OIG is specifically concerned about helping facilities that receive extramural research awards from the National Institutes of Health and other agencies under the U.S. Public Health Service.(Office of Inspector General)(Brief Article)
December 5, 2005... The OIG is specifically concerned about helping facilities that receive extramural research awards from the National Institutes of Health and other agencies under the U.S. Public Health Service. While many recipients of PHS awards for...

Medicare drug plan may not be living up to savings promises: insignificant drug discounts threaten to undermine the legislation's integrity.(Medicare Part D)
December 12, 2005... If competition among private plans is the strategy that's supposed to drive down drug prices, Medicare Part D isn't playing its A-game, a recent report revealed. The complicated drug discount plan has not only stymied seniors with its profusion...

Nationwide solutions could come from Massachusetts' uninsured problem: different approaches amplify debate about states' roles in supplying health care coverage.(Commonwealth Care)
December 12, 2005... Recent discussions among Massachusetts lawmakers will have profound implications not just for uninsured individuals but also for employers and private health insurers. At stake is the very idea of health care coverage: is it a right, a product,...

10 initiatives may ensure uninterrupted drug coverage for dual eligibles: an elaborate safety net attempts to secure claims and payments for low-income and special-needs enrollees.(Centers for Medicare and Medicaid Services)
December 12, 2005... Dual eligibles' special needs and drug regimens require the federal government to handle the drug coverage transition from Medicaid to Medicare Part D with kid gloves to ensure uninterrupted coverage. To facilitate a smooth transition, the...

Cost-to-charge gap could threaten hospital payments: Lewin Group study revealed potential hospital overcharges.(health care costs)
December 12, 2005... Hospitals' charges for services, supplies and drags often don't reflect actual costs, a new study maintains. Further, the gap between charges and costs raise concerns about the accuracy of Medicare's hospital in- and outpatient prospective...

Budget reconciliation proposals shift Medicaid costs to states, NGA says: CMS releases the CY 2006 inflation update for ambulance payments.(Industry Notes)
December 12, 2005... As major budget reconciliation bills make their way through both the House and Senate, the bills' changes to Medicaid have become the center of governors' attention. The National Governors Association is especially concerned that states will...

Prescription drug plan draws meager turnout from low-income seniors: advocacy groups criticize drug plan's complexity and propose new protections for bewildered eligibles.
December 19, 2005... Confusion about the new Medicare prescription drug program could cost millions of non-Medicaid low-income seniors the very subsidies the program affords them. The Congressional Budget Office projects that 5.7 million non-Medicaid...

Insurers leading the health care technology charge: health plans push innovations that improve quality, cost and efficiency, survey finds.
December 19, 2005... For a while now, health care commentators have been noting the role health insurers are playing in stimulating and supporting health information technology. But some experts worry that the fast-growing health IT advances could create serious...

Short-term commitment to retiree drug plans leaves future uncertain: businesses' wait-and-see approach to retiree drug coverage could be the calm before a storm.
December 19, 2005... Most large-scale private employers will continue to offer coverage as good as or better than the new Medicare Part D drug plan--for now. But industry experts and beneficiaries still fear that employers will drop prescription drug coverage for...

SNFs could face hard times without a market basket update: recommendations for 2006 PPS revisions offer big changes but little assistance.(skilled nursing facilities)(Prospective payment systems)
December 19, 2005... The Medicare Payment Advisory Commission's recommendation to freeze inflation adjustments to payment rates for skilled nursing facilities has long-term care providers steaming. Rebuke from the American Health Care Association and the...

Motion to warn could sway budget bill conferees to throw out medicaid benefit cuts: plus: scrutiny of QIOs intensifies.(Industry Notes)
December 19, 2005... Just as the much-debated budget reconciliation bill is under consideration in the Senate, an influential hospital organization and a senator took a last stand against the legislation's provisions for Medicaid "benefit flexibility" and...

Grassley wants to see how far down the QIO 'rabbit hole' goes.
December 19, 2005... Medicare Quality Improvement Organization board of directors' hefty travel expenses and exorbitant paychecks have come under fire. Sen. Grassley's latest inquiry furthers his hard-hitting investigation into QIOs' effectiveness and costs to...

Part D enrollees could save 47 percent annually, consumer group says.(Brief Article)
December 19, 2005... If benes who are eligible for the new Medicare prescription drug benefit manage to overcome complex planselection hurdles, they may realize an average annual savings of $1,741 or 47 percent, a new study claims. Consumer group Copay...