Medicine & Health articles from May 2006

Medicine & Health archives from May 2006

Affordable short-term coverage eludes legions of uninsured: carriers drop the ball on options awareness for between-job benes.
May 1, 2006... A new survey suggests that insurers should be working a lot harder to attract adult dependents to temporary coverage--by connecting to their parents. After they graduate, nearly 40 percent of young adults are uninsured at some point during...

Insurers get the ok to raise smokers' premiums: benes start paying the price for their poor health habits--so insurers won't have to.(Coverage)
May 1, 2006... For the first time, insurers in Massachusetts can begin to recover smokers' high costs of care by increasing their premiums. In an effort to control medical costs and reduce high-risk behavior associated with Medicaid recipients and the...

Providers warm up to payer-based EHRs: carriers bring more providers on board with clinical quality assurance.(Health IT)
May 1, 2006... President's orders: All insurers, providers and consumers are to adopt and be able to exchange electronic health records by 2014. President Bush's goal is certainly within reach--but the path to achieving it is littered with stones. One of...

DMAC transition delayed until fall in 2 regions: bidding, wheelchair final rule, UPIN information also revealed in forum.
May 1, 2006... Suppliers in Medicare Region C or D can put off worrying about durable medical equipment claims-processing changes for a while. The Centers for Medicare & Medicaid Services has extended its contracts with Region C DME regional carrier...

Nebulizer payment revisions demand proof of medical necessity: providers: don't miss the draft LCD--and a chance to comment.
May 1, 2006... Providers who bill Medicare for nebulizer equipment, related supplies or drugs will need to be ready with proof of medical necessity. The Centers for Medicare & Medicaid Services recently assigned the new durable medical equipment Program...

2 Practices succeed in overturning 'routine' dental denials: medicare will cover dental services when they're medically related.(Dental Services)
May 1, 2006... Providers aren't taking denials of "routine" services as the last word. Two practices found ways to appeal those denials and obtain their rightful reimbursement. Medicare never pays for "routine" services such as dental care. But Medicare...

Congress still struggles to put DRA to bed: plus: HSAs, HDHPs may top new plan growth this year, survey predicts.
May 1, 2006... Congressional representatives are now hopping on the bandwagon to defeat the Deficit Reduction Act. Rep. Henry Waxman (D-CA) is calling on fellow lawmakers to investigate "the White House's knowledge of the constitutional defects" of the...

CMS reduces managed care system glitches.(Brief article)
May 1, 2006... * CMS reduces managed care system glitches. Providers may see a reduction in the number of patients whose switch to a Medicare managed care plan fails to show up in the Common Working File for months on end. CMS identified system problems with...

CMS clarifies policy-making procedures for LCDs.(Centers for Medicare and Medicaid Services)(Brief article)
May 1, 2006... * CMS clarifies policy-making procedures for LCDs. CMS is offering more clarity on how it decides which local coverage determinations will become national policy. The agency has issued two guidance documents that detail steps in the national...

CMS wants to know if OASIS data collection is weighing providers down.(Centers for Medicare and Medicaid Services)(Brief article)
May 1, 2006... * CMS wants to know if OASIS data collection is weighing providers down. Now providers can comment on the burden of OASIS. In the April 14 Federal Register, CMS requests comments on the burden of the Outcome and Assessment Information Set data...

High-tech PMDs don't warrant new benefit category.(.)(Brief article)
May 1, 2006... * High-tech PMDs don't warrant new benefit category. CMS shouldn't create a new benefit category to accommodate high-tech assistive devices, such as the Independence iBOT 4000 Mobility System. At least that's the opinion of Elyria, OH-based...

Unveil the secrets of E/M documentation, AV fistulas.(.)(Brief article)
May 1, 2006... * Unveil the secrets of E/M documentation, AV fistulas. If providers need a refresher course in evaluation and management documentation, help is at hand. CMS has posted an electronic version of its E/M Services Guide. The guide includes a...

Physician groups gripe about MUEs.(.)(Brief article)
May 1, 2006... * Physician groups gripe about MUEs. CMS should totally rethink the Medically Unbelievable Edits; it should also fully explain the reasoning behind the MUEs and allow physician groups to review and comment on the methodology and data it used to...

MedPAC scrutinizes physicians' resource use.(In other news ...)
May 1, 2006... * MedPAC scrutinizes physicians' resource use. The Medicare Payments Advisory Commission is studying a sample of 5 percent of Medicare physician claims to figure out whether commercial episode groupers and clinical quality indicators can help...

CMS is considering adding new diagnoses to the coverage criteria for some diagnostic tests.(.)(Brief article)
May 1, 2006... * CMS is considering adding new diagnoses to the coverage criteria for some diagnostic tests. If a provider performs partial thromboplastin time tests for patients with primary hypercoagulable state (289.81) or prostate-specific antigen tests...

Three red flags could make claims suspicious during an audit.(Brief article)
May 1, 2006... * Three red flags could make claims suspicious during an audit. There are some red flags bound to attract an auditor's attention--providers need to make sure their charts avoid these pitfalls. 1. A laundry list of diagnoses won't wash. If...

Come clean, or we'll fight dirty, OIG warns: physicians' deals with hospitals could be under the lens soon.(Office of Inspector General)
May 8, 2006... The HHS Office of Inspector General is looking into physicians' hospital relationships, but it's offering them a chance to come forward with potential violations before the hammer comes down. In an "Open Letter" to providers on its Web site...

No backup source for providers who rely on CAP vendor for drugs: this CAP only has one feather.(Competitive Acquisition Program)
May 8, 2006... The Competitive Acquisition Program (CAP) for Part B drags looks less and less attractive all the time. CAP was supposed to solve all of providers' drug-stocking woes, by enlisting the aid of private pharmacy companies. Then the Centers for...

Bidding rule prompts trade groups' call to action: bidding, new quality standards confront DMEPOS suppliers.
May 8, 2006... Suppliers of durable medical equipment, prosthetics, orthotics or other supplies need to get ready--and respond fast. The future success of their businesses depends on it. That's the message from trade groups representing DMEPOS suppliers...

Soaring gas prices squeeze HHA, employee budgets: agencies risk losing staff to eroding compensation, hope for IRS to step in.(HHAs)
May 8, 2006... The return of high gas prices is hitting home health agencies where it hurts--square in the wallet. At press time, the average U.S. gas price was $2.92 per gallon, reports Web site gasbuddy.com. The previous month, the average price was...

Continuous care probe hits hospices: rise in utilization sparks scrutiny.
May 8, 2006... Increased utilization of costly continuous home care is drawing unwanted attention to the service--and to hospices that provide it. Regional home health intermediary Palmetto GBA is launching a probe review of continuous home care (CHC),...

Redouble privacy rule efforts--or risk fines, lawsuits: health systems struggle to comply, survey suggests.(Health Insurance Portability and Accountability Act )
May 8, 2006... Many health care providers' policies relating to the Health Insurance Portability and Accountability Act's privacy rule may be sitting on a back burner--and providers could wind up getting scorched. The drop in the number of facilities...

Providers say good-bye to Part B carriers and hello to MAC transition: plus: medicare will cover pancreas transplants--but only in a few cases.(Medicare Administrative Contractors)(Brief article)
May 8, 2006... Part B carriers will soon be a thing of the past. The Centers for Medicare & Medicaid Services is replacing the carriers and intermediaries with Medicare Administrative Contractors (MACs) for both Part A and Part B. There will be just 15...

Physicians must recertify.(In Other News ...)
May 8, 2006... Physicians will have to recertify their enrollment information with Medicare every five years, under a new proposed rule CMS published in the April 21 Federal Register. Physicians must also report enrollment information changes within 90 days,...

Medicare generally doesn't cover the osteoporosis drug Forteo under the home health benefit, Palmetto GBA's April bulletin to providers explains.(Brief article)
May 8, 2006... Medicare generally doesn't cover the osteoporosis drug Forteo under the home health benefit, Palmetto GBA's April bulletin to providers explains. That's because providers are supposed to administer Forteo daily for up to two years, which...

The government wants to help with direct-care worker shortages.
May 8, 2006... CMS has created the National Direct Service Workforce Resource Center "to respond to the large and growing shortage of workers who provide direct care and personal assistance to individuals who need long-term supports and services in the United...

Imaging reimbursement could be in for a third hit soon.(medicare )
May 8, 2006... Imaging reimbursement could be in for a third hit soon. Physicians' practice expenses for MRIs and CT scans may come under the knife soon, if the Medicare Payment Advisory Commission has its way. Imaging scans are already slated for tough...

Providers need to get the facts before they write off low-income copays: states may cover copays, even for non-Medicaid patients.
May 15, 2006... If a physician practice sees a lot of low-income Medicare patients, it may be able to get a helping hand from your state. The 1997 Balanced Budget Act gave the states the choice of whether to pay coinsurances and deductibles for...

4 ways to lower the long-term cost of chronic illness: new innovations in DM are lowering costs by improving outcomes.(Disease Management)
May 15, 2006... Individuals with chronic illnesses are living longer--making their cost of care grow even larger. Approximately 70 percent of medical costs result from 7 percent of chronically ill individuals, according to UnitedHealth Group. In addition, the...

Massachusetts mandate bound to shake up health insurance regs: bay State's attempt to help the uninsured could end up helping health plans, too.(Policy)
May 15, 2006... States are getting tired of waiting for heath care reform to work its way from the top down--which means that health plans could be in for major changes if more states follow Massachusetts' lead. Here's a quick breakdown of key measures in...

Consult confusion just got more tangled.(Brief article)
May 15, 2006... * Physicians don't have to verify documentation, but it should be there. Physicians have been tearing out their hair over the confusing consult documentation rules--and the rules just got even more complicated. The Centers for...

OIG to CMS: 51 drugs may be overpriced: CMS disputes OIG's calculations, however.(Office of Inspector General to Centers for Medicare & Medicaid Services)(Brief article)
May 15, 2006... A few dozen Part B drugs could be facing steep drops to their already-low reimbursements soon. The law gives the Centers for Medicare & Medicaid Services the authority to slash drug payments if the average sales price (ASP) is at least 5...

HH PPS revamp details due in November: COPs, hospice-nursing home guidance also slated for this year.(Home health prospective payment system)(Brief article)
May 15, 2006... Home health agencies may have to wait until almost the end of the year to see the changes coming to the prospective payment system, including the much-anticipated therapy threshold change. A Centers for Medicare & Medicaid Services official...

Strategic planning tips help DME players stay in the game: clues in proposed bidding rule can help them prepare.
May 15, 2006... As the feds continue to wrestle with the "what" and "where" of competitive bidding for durable medical equipment, the companies that survive under bidding will revamp their strategic plans in advance to accommodate the new realities under...

CMS may be just going through the CAP motions: plus: organizations release new studies to celebrate 'Cover The Uninsured Week.'.(Centers for Medicare & Medicaid Services)(Competitive Acquisition Program )(Brief article)
May 15, 2006... The Centers for Medicare & Medicaid Services finally issued instructions on how to enroll in the Competitive Acquisition Program for Part B drugs, which promised to take the headache of stocking and billing for drugs away from providers. ...

Affordability issues eroding insurance market, studies reveal.(Industry Notes)(Brief article)
May 15, 2006... May 1 through May 7 marked the Robert Wood Johnson Foundation's (RW JF) "Cover The Uninsured Week," and several organizations released the following studies to coincide with the national awareness program: * Shifting Ground: Changes in...

Doctor can never use that title again, judge orders.(Callie Hall Herpiu to ten years in prison for health care fraud)(Brief article)
May 15, 2006... A defrauder of Medicare gets stripped of her freedom, her medical license--and her title. After U.S. District Judge David Hittner sentenced Callie Hall Herpiu to ten years in prison for health care fraud, he ordered her never to call...

OIG gives thumbs down to DME-physician deal.(Durable medical equipment)(Office of Inspector General)(Brief article)
May 15, 2006... Suppliers and docs can say goodbye to another potential business arrangement. A proposed deal in which a durable medical equipment supplier would provide equipment to a physician would potentially violate the federal anti-kickback statute,...

Senators soon will urge their leaders to reject an HHA Medicare rate freeze for 2007.(.)(Brief article)
May 15, 2006... Senators soon will urge their leaders to reject an HHA Medicare rate freeze for 2007. Both President Bush and the Medicare Payment Advisory Commission have recommended the freeze, notes the American Association for Homecare. Sen. Susan...

A federal rule will target health care fraud by standardizing existing Medicare enrollment requirements.(.)(Brief article)
May 15, 2006... A federal rule will target health care fraud by standardizing existing Medicare enrollment requirements used by the various Medicare contractors that process and pay Medicare claims. "By standardizing the information that a health care...

Medical malpractice reform bills die on the table; dems write off reform bills as a GOP 'political stunt'--but Republicans aren't giving up just yet.(Malpractice Reform)
May 22, 2006... A recent Senate vote on two versions of a medical malpractice reform bill put the kibosh on one approach to stabilizing doctors' liability insurance premiums. Both bills attempted to cap non-economic damages--defendants' punitive damages...

More providers reject managed care contracts--but is there reason to worry? The media buzz is giving insurers a bad rap.(Contracts)
May 22, 2006... The number of doctors opting not to contract with managed care plans is rising--and so could the time and money insurers spend deciphering claims that inexperienced beneficiaries have to file on their own. The number of physicians without...

PT claims not OK, warns OIG; Medicare spends $136 million on improper therapy claims.(Physical Therapy)(Brief article)
May 22, 2006... Providers' physical therapy claims could be a legal nightmare waiting to happen if their documentation isn't up to snuff. The HHS Office of Inspector General found that 91 percent of physical therapy that physicians billed in 2002 had...

New Medicare certification rule weeds out past variances; prompt payment is one goal, feds say.(Certification)(Brief article)
May 22, 2006... A rose is a rose--and now Medicare certification is Medicare certification. At least that's the intended effect of a new final rule standardizing the certification process. The rule aims to eradicate past variances from Medicare contractors...

Partnerships and premiums propel leading Part D plans; standouts dominate individual PDP and MA-PDP markets.(Health Plans)
May 22, 2006... Only two insurers have managed to capture double-digit market shares of this year's Medicare Part D drug plan enrollees. UnitedHealth Group bagged the lion's share of the Part D enrollee market, according to a recent announcement from the...

Part D policy shift brings new drugs on board; plans can cover prescription niacin, feds allow.(Part D)(Brief article)
May 22, 2006... Medicare beneficiaries with high cholesterol now have a fighting chance of coverage for a prescription drug they may need. Physicians often prescribe the vitamin niacin to fight high cholesterol. But Medicare Part D's prescription drug...

SNFs come up short in consolidated billing arrangements; SNFs struggle with unexpected 'under arrangement' bills from suppliers.(skilled nursing facilities)
May 22, 2006... Skilled nursing facilities struggling with consolidated billing can protect their Medicare profit margins with this simple mantra: "Get it in writing." Officials speaking at a recent SNF/Long-Term Care Open Door Forum touched on issues...

Common MDS problems could be no match for 'DAVE 2'; plus: ER medical records pilot may lower care cost and improve delivery.(minimum data set)(data assessment and verification)(emergency rooms)(Brief article)
May 22, 2006... What are nursing homes' most common mistakes on the Minimum Data Set? A federal initiative that aims to find out should give providers feedback in the coming months. Officials announced at the recent SNF/Long-Term Care Open Door forum...

ER physicians get a jump on care with electronic patient data.(Emergency room)(Brief article)
May 22, 2006... Emergency room physicians will soon be helping Blue Cross Blue Shield of Missouri to reduce health care costs while improving care delivery and patient outcomes. BCBSMo recently announced the new Medical Records For Emergency Department...

Microsoft steps into the ring with affordable technology for health plans.
May 22, 2006... Microsoft is en route to securing its foothold in the health information technology market--which could make insurers' health IT solutions more efficient and affordable. Twenty-two major companies recently announced support for Microsoft's...