Medicine & Health articles from March 2006

Medicine & Health archives from March 2006

MedPAC report pins payment system flaws on 'overvalued' services: congress must put the brakes on health care spending, and medicare should lead the way.(Reimbursement)
March 6, 2006... Payment systems for eight different provider types may begin major reconstruction in 2007--if the Medicare Payment Advisory Commission has its way. In MedPAC's March 1 Report to the Congress: Medicare Payment Policy, the commission focuses...

Pharmas work to cover 'doughnut hole' for low-income benes: coalition lacks major players--kickback issues could arise.
March 6, 2006... In an attempt to forestall potential problems with the Medicare Part D benefit, several pharmaceutical companies have joined together to develop a plan to provide discounted prescription drugs to Medicare beneficiaries who reach the doughnut...

The future looks bright for 'mini-medical' plans: escalating health care costs push employers to consider barebones options.
March 6, 2006... Consumer-directed health care coverage isn't the only trend plans should track as companies desperately attempt to find ways to provide coverage for their employees. Employers are not only turning to new developments like CDHC but also...

New CMNs, DIFs Raise questions of medical necessity: physician education is the key to good documentation.(Centers for Medicare & Medicaid Services)
March 6, 2006... Medical necessity documentation remains a thorny issue for durable medical equipment suppliers, and one recent procedural update doesn't offer much help. An updated transmittal from the Centers for Medicare & Medicaid Services reminds...

HHAs brace for an ABN avalanche: reasons to give notices just multiplied.(Home health agencies brace for an advance beneficiary notice)
March 6, 2006... Home health agencies will be taking on an even heavier paperwork burden by May 31. After a long wait, the Centers for Medicare & Medicaid Services has issued the final, revised home health advance beneficiary notice. The agency issued new...

Fast facts: home health ABNs: insufficient notices can land providers in hot water.(Advance beneficiary notices )
March 6, 2006... Providers who don't understand the ins and outs of the new home health advance beneficiary notices could run into trouble with surveyors. Home health agencies must master the new ABN requirements (see related stow), cautions Burtonsville,...

Hospice chains shell out $13 million each in settlements.(Brief article)
March 6, 2006... * Lawsuit, DOJ take bites out of VITAS and Odyssey earnings. The backlash against the booming hospice industry seems evident in two recent settlements. Miami-based VITAS plans to settle a class action Fair Labor Standards Act Wage and...

HSA tax break expansion would increase number of uninsured.(In Other News ...)
March 6, 2006... President Bush's proposal to expand tax subsidies for health savings accounts would cause a net increase in the number of uninsured, according to an analysis by Jonathan Gruber, an economics professor at the Massachusetts Institute of...

4 tricky stark law exceptions just got simpler: flat fees, fair-market payments won't land providers in hot water.
March 13, 2006... Nobody ever accused the Stark law of stark simplicity. That law, named for Rep. Fortney "Pete" Stark (D-CA), says doctors can't refer patients to anyone with whom they have financial relationships, including hospitals. There are myriad...

AMA defends quality improvement deal with congress: association didn't give away the store on P4P, it insists.(P4P)
March 13, 2006... Specialty associations reacted with anger when they heard the American Medical Association had signed a deal with Congress to come up with 140 standard measures of physician quality, covering 34 clinical areas. They voiced their objections...

CDHPs not enough to control health care spending, study argues: insurers need to invest judiciously in IT to cause real change.(Consumer-directed health plans)(Information Technology)(Brief article)
March 13, 2006... Within the managed care arena, health insurers are in the best position to control and even reduce health care spending in the United States--but relying on consumer driven health plans alone won't make a dent, analysts charge. Insurers...

No rural add-ons for many HHAs: CMS promises fix soon.(Health and Human Services)(Centers for Medicare & Medicaid Services)
March 13, 2006... Thanks to a technical glitch, many home health agencies will have to wait a while longer before seeing the 5-percent rural add-on they are entitled to. That's because the Centers for Medicare & Medicaid Services home health payment...

DME MAC transition delay may leave suppliers bewildered: are DMERCs ready for the end of power mobility CMNs? Why some think they're not.(Durable medical equipment Medicare Administrative Contractor)
March 13, 2006... Two durable medical equipment Medicare Administrative Contractor jurisdictions have hit a bump in the road transitioning to the new claims processing environment, and the result could be further confusion for suppliers. DME MACs National...

'Teamwork' helps providers manage therapy under new RUG system: following one facility's lead could help boost outcomes and payments.(Case Study)(Resource Utilization Group)
March 13, 2006... Providers may see their revenue margins suffer this year if their staff isn't acing patient assessment. Sunshine Terrace Foundation Rehabilitation Center, a skilled nursing facility in Logan, UT, works as a team to ensure that both...

Brace for more changes in capped rental regs: still no details on oxygen maintenance and service payments.(Reimbursement)
March 13, 2006... New rules for home medical equipment rentals in the Deficit Reduction Act raise more questions than they answer, some suppliers criticize. The legislation, which President Bush signed into law on Feb. 8, shortens by two months the length...

15 states take part D 'clawbacks' to the Supreme Court: plus: CDHPs have positive effects on medical costs and health behavior, insurer's study shows.(Consumer-directed health plans)(Brief article)
March 13, 2006... States are sharpening their claws in retaliation against so-called "clawback" provisions associated with the Medicare drug benefit. Attorneys General from five states--Texas, Kentucky, Maine, Missouri and New Jersey--requested permission...

CDHPs may change benes' behaviors and reduce costs.(Consumer-directed health plans )(Brief article)
March 13, 2006... In other news, beneficiaries who hold consumer-driven health plans saw an 8-percent reduction in their medical costs as well as positive changes in their health behavior, according to a recent CIGNA HealthCare analysis. The study's findings...

Watch for this crucial ERISA case.(Employee Retirement Income Security Act)(Brief article)
March 13, 2006... The U.S. Supreme Court is set to reconsider the types of remedies the Employee Retirement Income Security Act can use to bring about "equitable relief" for ERISA plan fiduciaries. At stake is the possibility that the law would require...

10 diagnoses could obtain new ICD-9 codes in October.(Industry Notes)(Disease/Disorder overview)
March 13, 2006... The next batch of ICD-9 diagnosis codes don't take effect until Oct. 1, but they're already in the pipeline, so take note. The ICD-9 Coordination and Maintenance Committee will hold its next meeting on March 23, and it will consider adding new...

Hospitals must bare it all under new price transparency initiatives; consumer-driven health care drives more purchasing power into benes' hands.
March 20, 2006... Hospitals' pricing structures and quality data will soon face full exposure under President Bush's new price transparency strategy. In the Bush Administration's ongoing efforts to stem out-of-control health care spending, the nation's...

Medicare 'bounty hunters' to receive payment for reconnaissance: P4P train 'has left the station,' CMS says.
March 20, 2006... Providers who thought they were safe from the Recovery Audit Contractors need to start worrying again. Congress appointed the RACs to investigate claims in Florida, California and New York, and they receive compensation based on how many...

Medicare overpaid $110 million for Part B drugs; OIG report could trigger a future slash in drug payments.(Office of Inspector General)
March 20, 2006... This may be hard to believe, but the HHS Office of Inspector General believes the Centers for Medicare & Medicaid Services is overpaying providers for many Part B drugs. Inconsistent accounting practices have led CMS to overestimate many...

HHAs bristle at 2007 rate freeze proposal: MedPAC pushes freeze at House hearing.(Medicare payment)
March 20, 2006... The final decision on 2007 Medicare payment rates is probably at least half-a-year away, but the battle over home care reimbursement is already escalating into an all-out war. In the Medicare Payment Advisory Commission's annual March...

Class III DME could lose out on payment update: rapid spending growth, pre-marketing costs for high-risk devices concern GAO.(Durable medical equipment)
March 20, 2006... Class III durable medical equipment devices won't have their own distinct annual payment update on the DME fee schedule if the Government Accountability Office gets its way. Congress should establish a uniform payment update to the DME fee...

PPS inaccuracy should preclude freeze: underpaid services could take a painful and inappropriate hit.(prospective payment system)(Brief article)
March 20, 2006... One big reason not to pass a home health agency rate freeze in 2007 is structural problems with the prospective payment system, industry representatives argue. The Medicare Payment Advisory Commission acknowledges in its report to Congress...

CMS reverses course on oncology demonstration project: gyn-oncs win opportunity to resubmit denied demonstration claims.(Centers for Medicare & Medicaid Services)
March 20, 2006... Reversal of a Centers for Medicare & Medicaid Services oversight that prevented gynecologic oncologists taking part in this year's oncology demonstration project will now afford gyn-oncs new reimbursements. Oncologists are using "G" codes...

Court rules in favor of ER 'balance billing': plus: staff changes in House Ways and Means Committee could spell disaster for home care.(Emergency room)(Brief article)
March 20, 2006... Emergency room physicians who "balance bill" patients who belong to managed-care organizations are not breaking the law, a court ruled. When a managed-care patient comes into the ER, sometimes an emergency physician who belongs to that...

Providers can't play the percentages with overdue copays and deductibles.(Industry Notes)(Brief article)
March 20, 2006... Patients who drag their feet on paying bills can be nuisances to providers--but providers will complicate their lives by trying to hassle them. Some billing experts have been advising practices to charge a "statement fee" for late...

Bill proposes EHRs for all federal employees, ties funding to performance: but to allow carriers to create files automatically or benes to opt-in--that is the question.(EHRs)
March 27, 2006... A new bill that would require "carrier-based" electronic health records for all Federal Employee Health Benefits Plan participants might pave the way for broader use of EHRs among providers. The House Committee on Government Reform recently...

A la carte coverage turns benes into bargain hunters: choice breeds responsibility--just as long as plans don't offer too much.(Health Plans)(consumer-driven health plans)
March 27, 2006... Web-based consumer benefits management and a user-friendly shopping experience could buy insurers' consumer-driven health plans greater enrollment. CIGNA has joined the race to develop compelling and cost-efficient CDHP offerings with its...

Hospices may get higher payments at beginning, end of stays: MedPAC looks to shake up hospice pay--but don't count on a case mix adjuster.(Medicare)
March 27, 2006... After more than 20 years, the Medicare hospice payment system could see some big changes. The Medicare Payment Advisory Commission is considering recommending changes to the hospice payment system in its June report to Congress. And...

Fast facts: medicare hospice payments: non-cancer diagnoses growing for hospice patients, along with lengths of stay.(Hospices)(Brief article)
March 27, 2006... Providers shouldn't be surprised if new Medicare hospice payment policies are soon afoot. The Medicare Payment Advisory Commission is eyeing the hospice payment system for possible changes (see "Hospices May Get Higher Payments At...

Senate proposes to preserve home care spending: but physician fix threatens home care reimbursement anyway.(Budget)
March 27, 2006... After a double whammy from President Bush and the Medicare Payment Advisory Commission for 2007 payments, home care providers are finally seeing a positive legislative development. The Senate Budget Committee recently passed a budget...

Lacking audit trails could render EHRs moot in court: most EHR systems fail to track revisions' sources, study shows.(Electronic health records)
March 27, 2006... Electronic health records need more work--the most common EHR systems still fail to provide a good audit trail that indicates who changed what. Many EHR systems allow "canned" documentation that a provider cuts and pastes from a previous...

'Shelter in place' emergency management plans may be insufficient: upcoming GAO report could make a push for emergency SNF evacuations.
March 27, 2006... Skilled nursing facilities that assume "shelter in place" is the way to go in most emergencies could be endangering residents and inviting the wrath of federal regulators. In a preliminary report the Government Accountability Office...

Medicare needs more up-to-date data on practice expenses: plus: new medicare edits dig deep.
March 27, 2006... The Centers for Medicare & Medicaid Services could make the tangled process of figuring out practice expenses a lot easier, according to the Medicare Payment Advisory Commission. CMS could set a schedule to review clinical staff wages and...