Medicine & Health articles from October 2008

Medicine & Health archives from October 2008

CMS puts more choices in Medicaid beneficiaries' hands: new rule gives Medicaid beneficiaries hiring and firing power.(Medicaid)
October 3, 2008... The Centers for Medicare and Medicaid Services is leaning toward letting individuals make their own healthcare-related decisions. The agency released a rule in the Federal Register that would allow more Medicaid beneficiaries to be in charge of...

OIG puts diagnostic radiology on the spot: utilization and provider relationships--not medical necessity--under scrutiny.(Audits)
October 3, 2008... Hospitals, independent diagnostic testing facilities, and any other provider that's involved in magnetic resonance services, take note. The Office of Inspector General recently released a report on MR services, and it's paying close attention...

CMS reveals 2009 Medicare prescription drug and Medicare advantage plans: agency advises benes to review and compare plan options.(Part D)
October 3, 2008... It's that time of the year when beneficiaries need to reevaluate their existing prescription drug plans and Medicare Advantage prescription drug plans. In general, the Centers for Medicare and Medicaid Services has presented a rosy picture of...

HHS launches initiative to help seniors and veterans: department doles out $36 million in new grant programs.(Older Americans)
October 3, 2008... With the growing population of older Americans, the challenges of their long-term care are growing as well. The Department of Health and Human Services announced on Sept. 29 $36 million in new grant programs to 28 states to try and make a...

Landmark Massachusetts health plan gets federal funding: universal healthcare coverage a step closer to reality in the commonwealth.(State Watch)
October 3, 2008... Many states in recent years have sought to expand eligibility criteria for receiving Medicaid and other health insurance as they try to provide universal healthcare to residents. Massachusetts has been a leader in this regard with a landmark...

Senate wants diagnosis codes linked to DME claims: report finds billions of dollars in questionable DME payments.(Fraud & Abuse)
October 3, 2008... Edits for durable medical equipment claims could get much tougher if the feds listen to a new Senate report. Medicare may be wasting billions of dollars on DME claims that aren't legitimate, says the report from the Senate's Permanent...

OIG nursing home guidance outlines hospice risks: steer clear of reserved bed landmines, OIG warns providers.(Long-Term Care)
October 3, 2008... Hospices shouldn't have to do all the heavy lilting when it comes to compliance for patients in nursing homes. The HHS Office of Inspector General has issued its new voluntary supplemental compliance program guidance for nursing facilities,...

CMS seeks competitive bidding advisers for PAOC: agency reaches out to all types in the healthcare industry.(DMEPOS)
October 3, 2008... Competitive bidding helps rein in costs in many settings. And this fact has really hit home at the Centers for Medicare and Medicaid Services. CMS established the Program Advisory and Oversight Committee in 2004 as mandated by the Medicare...

CMS beefs up MUE program to reduce costs: blatant payment errors will be stopped in their tracks.(Payment Error)
October 3, 2008... Many factors contribute to the ever-increasing Medicare budget which stood at more than 400 billion dollars for FY08--and inaccurate claims payments were part of the reason. But the Centers for Medicare & Medicaid Services is taking steps to...

CMS pulls the plug on Florida MA plan provider: agency assures no interruption in healthcare or Part D coverage for enrollees.(Medicare Advantage)
October 3, 2008... Hurricane Wall Street is proving to be as devastating for some Florida citizens as Hurricane Ike was for many. The Centers for Medicare & Medicaid Services' Medicare Advantage contract with MD Medicare Choice of Florida has been terminated, a...

CMS confirms that docs in ASCs should collect facility rate: in the past, Medicare paid ASCs the higher non-facility rate for non-covered procedures.(ASCs)
October 3, 2008... If providers perform a non-covered service in an ASC, they'd probably expect to be penalized financially for the non-covered nature of the service. But that's just the opposite of how the Centers for Medicare & Medicaid Services was paying...

Presidential candidates grapple over healthcare choices: free market-driven healthcare and government guaranteed healthcare plans face off.(Politics)
October 10, 2008... With less than a month remaining before Election Day, presidential candidates Barack Obama and John McCain are trying to persuade the remaining undecided voters why their healthcare proposals are the best way to reform American healthcare. Not...

CMS moves forward with RAC program to curb improper payments: agency wages war on fraud, waste, and abuse.(Audits)
October 10, 2008... The Centers for Medicare & Medicaid Services is doing everything possible to bring skyrocketing Medicare expenditures under control, and the agency has high hopes for its new recovery audit contractor program. CMS just awarded contracts to four...

From the experts: a sneak peek into the ICD-10 format: ... and what providers should expect for staff training.(Coding)(international classification of diseases )
October 10, 2008... ICD-10 is a hot topic for policymakers, professional coders and clinicians, and like it or not, the implementation date is less than three years away. While there's still more groundwork to lay, it's not too early to start implementation...

Providers can hire a contractor to process pre-authorizations: as long as arrangement doesn't induce referrals, OIG gives the green light.(Anti-Kickback)
October 10, 2008... Providers who abhor the tedious job of performing insurance preauthorizations may be able to outsource the task--so says a new HHS Office of Inspector General advisory opinion. According to the opinion, posted on Sept. 26, a company asked the...

OIG to focus on incident-to services, ultrasounds, unlisted procedures, and more in 2009: OIG Work Plan puts modifier GY, nonphysician practitioner pay on its radar screen.(Audits)
October 10, 2008... Next year providers will want to make sure they cross all their t's and dot all their i's, because the HHS Office of Inspector General has released its 2009 Work Plan--which includes plans for reviewing Medicare claims for everything from the...

CMS mounts offensive against home health, DME fraud: agency launches a multi-pronged battle against Medicare abusers.(Fraud Prevention)
October 10, 2008... A program as vast and complex as Medicare has a good chance of attracting providers and suppliers who wish to get rich by bilking the government. But the Centers for Medicare & Medicaid Services is on the prowl for these types more than ever....

CMS encourages home-based alternatives to institutional care: agency will fund state efforts to increase awareness about the alternatives.(Long Term Care)
October 10, 2008... The Centers for Medicare & Medicaid Services is advocating community- and home-based care once again. And this time, it's trying to raise awareness through a federal grant program amounting to more than $8 million, according to a Sept. 9 CMS...

California family planning program in Peril: State's Family PACT might lose federal funding.(Stateside)
October 10, 2008... This is not the first time that California's policies have been at odds with those of Washington. This time, California and the feds are having a dispute over a state program called the Family Planning, Access Care and Treatment Program that...

Complementary medicine proves to be a hit at hospitals: patient demand is the primary motivation.(Hospitals)
October 17, 2008... Patients are getting savvy about their healthcare and want to go beyond the traditional forms of Western medicine. Complementary and alternative medicine services are enjoying a spurt as a result, and hospitals across the nation are responding...

U.S. healthcare spending goes under the microscope: MedPAC illuminates the factors contributing to the growth.(Health Expenditure)
October 17, 2008... The aging demography of America ensures that America's healthcare needs will continue to grow for the foreseeable future. So, it's only natural that healthcare expenditures are growing across the board while trying to meet those healthcare...

Are our hospitals ready for a 'dirty bomb' terror attack? AMA study finds there's a long way to go.(Disaster Preparedness)
October 17, 2008... Hospital emergency department physicians and nurses will be the frontline warriors if ever the nation is faced with a terrorist attack involving radioactive 'dirty bombs.' The bad news is that these professionals are concerned about the ability...

CMS reveals new online tools to help medicare beneficiaries: Benes advised to stay on top of changes in health plans for 2009.(Web Tools)
October 17, 2008... One significant challenge that average Medicare users face is the plethora of choices in prescription drug plans offered by the Centers for Medicare & Medicaid Services, It can be quite confusing for the layperson to decide which plan best...

Experts warn consumers to be wary of out-of-pocket expenses: employers offering innovative workplace health benefits.(Enrollment)
October 17, 2008... Employers are driving a hard bargain with their employees on workplace health benefits. This is even more so the case in an economy that is hurtling towards a recession. The cost of health insurance is one of the major factors that is making...

Physicians expecting a pay hike from medicare might be in for a shock: States struggle with rising Medicaid spending, enrollment and large holes in their budgets.(Medicaid)
October 17, 2008... Physicians have gotten used to annual pay hikes from Medicaid in the last few years. But this year, things are going to be different--with the economy in a recession and states struggling to balance their budgets. Half of the 50 states--26...

Good news: not-for-profit hospitals hit a purple patch: these hospitals are moving from cities to affluent suburbs--and making profits.(Hospitals)
October 17, 2008... Uninsured city residents will find it tougher to just rush to the nearest hospital emergency room when faced with the smallest health-related issue. Not-for-profit hospitals in low-income areas of cities are getting savvy--or getting...

Industry Responds to Medicare's HHA, DME Fraud crackdown: agencies, suppliers can expect more hoops to jump through.(Fraud & Abuse)
October 17, 2008... Last week, Medicine & Health noted the Centers for Medicare & Medicaid Services' heightened scrutiny on durable medical equipment and home health fraud. Here's a closer look at the industries' reactions. Home health agencies are relieved...

What practices should do when waiting for physician credentials: remember: Medicare credentialing can take 90 days--or longer.
October 17, 2008... Healthcare practices expanding their services should consider these delays if their new physicians aren't yet credentialed with the practice's Medicare carriers. Whether the practice can allow the physician to bill Medicare is up to the...

Upcoding ophthalmologist faces $460,000 settlement, integrity agreement.
October 17, 2008... Upcoding service levels just bit one physician right in the wallet. Kentucky-based ophthalmologist Harry Stephenson, MD, and his wife Catherine Stephenson agreed to pay $461,893 back to the government after being accused of submitting false...

CMS takes a long, hard look at Medicaid spending: Medicaid bill spiraling--outpacing economic growth.(Medicaid)
October 24, 2008... Whoever is the next White House occupant will have a pretty hard time reducing the federal budget deficit, thanks to the economic situation. And that's not good news for Medicaid beneficiaries, who are growing rapidly in number--and adding...

Surprise: public pays scant attention to comparative quality information: survey points to the need to educate the public.(Survey)
October 24, 2008... When it comes to choosing a healthcare provider, the majority of American people still go about it in traditional ways, rather than looking at available comparative data about the quality of various service providers. At least that's what a...

Medicare prescription drug plans under attack on different fronts: doughnut hole forces seniors to skip on prescription drugs.(Part D)
October 24, 2008... One of the major problems facing Medicare is a twofold issue with the Part D prescription drug plan: the rising premiums and the increasing numbers of beneficiaries who are falling in the so-called "doughnut hole." The Centers for Medicare...

Are not-for-profit hospitals getting a free ride? Senator thinks more scrutiny is called for with "community benefits.".(Hospitals)
October 24, 2008... A majority of hospitals in the United States are not-for-profit hospitals, and the benefits are many, namely that they qualify for federal tax exemption. In tact, nonprofit hospitals received tax benefits of $12.6 billion at the federal, state,...

Medicaid spending proves to be massive burden: Part D and managed care the only bright spots of savings.(Expenditure)
October 24, 2008... No question about it, Medicaid spending has ever increased and will continue to do so. But the last 15 years have seen variances in the year-on-year increase in Medicaid expenditures, according to an Oct. 7 press release from the Centers for...

Drug innovation may suffer in future: imposing cost controls will damage drug research, experts say.(Opinion Piece)
October 24, 2008... There's a fine line between protecting the public from unreasonably high-priced medications and hurting medical innovation. And some people fear that a potential Obama presidency might hurt pharmaceutical research. "There is a shift...

Suppliers hold out for more information on oxygen cap policy.
October 24, 2008... The 36-month oxygen cap from the Centers for Medicare and Medicaid Services that's been on the books since 2005 will start hitting Jan. 1--and suppliers still have few details about the new policy, industry representatives complain. ...