Medicine & Health articles from November 2008

Medicine & Health archives from November 2008

CMS reveals lots of policy updates in 2009 Physician Fee Schedule: physicians see 1.1 percent payment increase, thanks to MIPPA.(Policy Update)
November 7, 2008... The Centers for Medicare & Medicaid Services issued its final rule for the 2009 Medicare Physician Fee Schedule on Oct. 30, according to a CMS press release, and physicians were able to squeak by without cuts to the conversion factor. ...

Medicare lowers 2009 new conversion factor to $36.0666: but budget neutrality adjustment softens the blow, offering 1.1 percent boost.(Fee Schedule)
November 7, 2008... Providers shouldn't lose heart when they see CMS' 2009 conversion factor of $36.066--a drop from this year's $38.0870. CMS attempts to make up for the lower conversion factor by boosting the budget neutrality adjustment by 1.1 percent. ...

Emergency medicine, infectious disease practices benefit from new fee schedule: audiologists, radiation oncologists, diagnostic testing facilities could lose out in 2009.(Specialties)
November 7, 2008... The 2009 Medicare Physician Fee Schedule offers a bleak outlook for audiologists in the form of a 10 percent reimbursement cut. Audiologists may be taking it on the chin as of Jan. 1, but emergency medicine specialists will see a distinct boost...

CMS offers e-prescribing incentive program in 2009 Medicare Physician Fee Schedule: final rule also spruces up PQRI incentives.(Incentives)
November 7, 2008... Times are changing, and physicians need to adjust accordingly. That's perhaps the implicit message behind the Centers for Medicare & Medicaid Services' push for wider adoption of electronic prescribing by physicians. In its 2009 Physician Fee...

OIG on the prowl for faulty HIPAA Security: CMS falls short in its oversight and enforcement, OIG says.(HIPAA)
November 7, 2008... The Health Insurance Portability and Accountability Act has been in existence now for more than a decade, but apparently it needs some more work on the enforcement end. The Office of Inspector General of the Department of Health and Human...

Hospitals get low scores in first major national survey: southern hospitals fare better--patients want 'human touch.'.(Surveys)
November 7, 2008... American consumers spend $2 trillion annually on healthcare, so it might come as a surprise that patient surveys aren't commonplace in the healthcare industry. But that has just changed. Researchers at the Harvard School of Public Health...

Heads up: credit squeeze affects hospitals too: some hospitals are already bankrupt while others are tightening belts.(Finance)
November 7, 2008... The idea that healthcare is recession-proof is perhaps a misnomer. Hospitals are finding it tough and are raising credit to meet their cash flow requirements because of the ongoing liquidity problems in the nation's financial system. Raising...

OIG gives OK to outsourcing pre-authorizations: but beware any compensation that is based on commissions.(Compliance)
November 7, 2008... If providers have significant managed care business and abhor the tedious job of performing insurance preauthorizations, they may be able to unload the task, according to a new OIG advisory opinion. According to Opinion No. 08-12, a company...

Judge shoots down Medicare's plan to pay 'least costly alternative' therapy for COPD.
November 7, 2008... Medicare will have to find another way to save money rather than limiting COPD payments, according to a new court ruling. A Nov. 4 New York Times article indicates that on Oct. 16, a federal judge ruled that Medicare can no longer use the...

Permanent RAC program on hold.(in other news ...)
November 7, 2008... * If providers were biting their nails awaiting the Centers for Medicare & Medicaid Services' permanent RAC program to take effect, they can relax--at least for now. On Nov. 4, CMS announced that it would impose an "automatic stay in the...

CMS issues flu resources.(in other news ...)
November 7, 2008... * With flu season here, providers may want to check out some new resources from the government. One tool is a new compliance checklist offered by the feds. "'Community Pan-Flu Preparedness: A Checklist of Key Legal Issues for Healthcare...

Providers had better make sure their employees are adequately trained, or their bottom line--and their reputation--could suffer.
November 7, 2008... * Providers had better make sure their employees are adequately trained, or their bottom line--and their reputation--could suffer. One Seattle home health agency has learned that lesson the hard way. The city of Seattle and HHA Millennia...

Get ready: CMS is launching its full-blown RAC program: what every provider should know about RAC audits in advance.(Audits)
November 14, 2008... The Centers for Medicare & Medicaid Services is counting on its recovery audit contractor program to rake in masses of overpayments--and every medical practice or facility's claims could soon be under scrutiny. With the demonstration project...

4 things every facility manager can do to prepare for RACs: it's never too late to improve billing and documentation practices.(Practice Pointers)
November 14, 2008... Providers who think there's nothing they can do to prepare for the Centers for Medicare & Medicaid Services' recovery audit contractors--since one can't go back and change claims--are mistaken. Healthcare practices and facilities can take these...

Providers billing Florida payers should say 'no' to refunds after a year: a new law will change one state's Z overpayment rules.(Billing)
November 14, 2008... Healthcare providers may know that they should take refund requests from payers seriously. But what if a payer requests a refund on a claim it paid out 29 months ago? The obligation to repay that money may vary by state. Providers Should...

CMS stresses quality of care in HOPD and ASC final rule: 2009 final rule brings 4 new quality measures, creates 5 imaging composite APCs.(Hospitals)
November 14, 2008... The Centers for Medicare & Medicaid Services continues to hammer away at implementing Value Based Purchasing initiatives, according to an Oct. 30 press release from the agency announcing its final 2009 payment rule for hospital outpatient...

PPS correction adjustments are finally on deck: HHAs will have to do some work to recover their rightful reimbursement.(Home Health)
November 14, 2008... A nice Christmas present may be on the way for some home health agencies. The Centers for Medicare & Medicaid Services has directed its regional home health intermediaries to adjust HHA claims to correct errors associated with the prospective...

OIG wants tougher reinstatement appeals for ousted suppliers: more than 90 percent of revoked suppliers were reinstated upon appeal.(Fraud & Abuse)
November 14, 2008... Medicare may be doing a better job of chasing fraudulent suppliers out of the program, but it has not been as good at keeping them out. The HHS Office of Inspector General wants the Centers for Medicare & Medicaid Services to toughen appeals by...

Experts predict a medical tourism explosion in the next 2 years: discover what's pushing citizens to seek offshore treatment alternatives.(Trends)
November 14, 2008... The winds of globalization are blowing through the healthcare sector in the United States like never before. The high cost of medical treatment in the United States is persuading some Americans to seek treatment in diverse foreign...

CMS unveils its algorithm for selecting special focus facilities: questions and inconsistencies remain--here's what facilities need to know.(Long-Term Care)
November 21, 2008... Ending up on the government's published "Special Focus Facility" list is definitely on nursing home providers' worry list these days. Yet the Centers for Medicare & Medicaid Services' selection process for the SFF program for chronic poor...

CMS sets the ICD-10 record straight in conference call: agency urges providers to begin preparations now; experts address rumors.(Diagnosis Coding)
November 21, 2008... With all eyes on the proposed Oct. 2011 deadline for ICD-10 implementation, the Centers for Medicare & Medicaid Services is encouraging providers to prepare now in case that proposed rule becomes final. During a CMS-sponsored ICD-10...

FTC: healthcare providers could be considered 'creditors': Federal Trade Commission pulls in health care entities but extends rule deadline.(Security)
November 21, 2008... Healthcare organizations that think compliance enforcement for their businesses is under the purview of their carriers/FIs, CMS, and the OIG should think again. Now it looks like the Federal Trade Commission (FTC) also wants to lay down the law...

Hospices tighten belts in response to BNAF cut: start-ups are vulnerable to closures.(Hospice)
November 21, 2008... The reduced Medicare rate update for hospices that took effect Oct. 1 is hurting, but the pain is going to get a lot worse. The Centers for Medicare & Medicaid Services finalized a 25 percent reduction to the budget neutrality adjustment...

MAC transitions prove rocky for California therapists: all healthcare providers should be aware of these potential pitfalls.(Claims Processing)
November 21, 2008... The Centers for Medicare & Medicaid Services is currently consolidating its contractors (carriers and fiscal intermediaries) to Medicare Administrative Contractors that'll process both Medicare Part A and Part B claims. And problems from the...

Healthcare providers should gear up for CMS' new MACs: carriers and FIs will soon be a thing of the past if they aren't already.(Billing)
November 21, 2008... The Centers for Medicare & Medicaid Services has been steadily announcing newly awarded AB MAC contracts for the past few years, and the transition from carriers and FIs to MACs is now in full swing. Background: The Medicare Prescription...

OIG has its eye on rehab for 2009: plus: Medicare owes physicians big in several states.
November 21, 2008... The HHS Office of Inspector General has once again released its annual laundry list of audit hot spots. This year, rehab providers in all settings should be on their toes. Items in the OIG's 2009 Work Plan included: * Inpatient hospital...

Medicare owes millions to physicians in California, Hawaii, and Nevada.(In other news ...)
November 21, 2008... Medicare owes millions to physicians in California, Hawaii, and Nevada. Physicians in these three states continue to tap their fingers waiting for payment from Medicare, thanks to a recent UPIN number snafu that one carrier appears to have...

Medicaid programs are paying more than their share.(In other news ...)
November 21, 2008... Medicaid programs are paying more than their share. State Medicaid programs are paying for more than 24 hours of personal care services--and that's bad news. In four of the five states studied, the programs in 2005 paid for more than 24 hours...

Medicare will have to find another way to save money rather than limiting COPD drug payments, according to a new court ruling.(In other news ...)
November 21, 2008... Medicare will have to find another way to save money rather than limiting COPD drug payments, according to a new court ruling Last month, a federal judge ruled that Medicare can no longer use the "least costly alternative" to set payment...