Medicine & Health articles from September 2006

Medicine & Health archives from September 2006

More employees can't afford coverage, Census report confirms: it's time for health plans to step up the pace on offering low-cost plan options.(Uninsured)(Brief article)
September 5, 2006... It's hard to apply the 60's adage that you're either part of the problem or part of the solution when it comes to coveting the nation's uninsured. The U.S. Census Bureau just released their report on the uninsured population and came up with...

U.S. health insurers try to cash in on the growth of offshore surgery alternatives: domestic insurers need to develop strategies now before employers and benes leave them at home.(Global Health Care)
September 5, 2006... When adventurous Americans started going overseas for elective surgeries, the media called it "medical tourism." But now that more employers are contemplating sending employees to foreign hospitals for covered, complex surgeries, "medical value...

Senator praises inhalation-drug pricing plan: industry cites safety concerns.(Prescription Drugs)
September 5, 2006... Suppliers should keep news about inhalation drugs on their radar screens. Sen. Charles Grassley (R-IA) is praising the Centers for Medicare & Medicaid Services' proposal to alter the way Medicare reimburses for compounded inhalation drugs....

Providers look forward to being free of consult confusion: it's not a consult if the requesting physician 'doesn't give a rip.'.(Physicians)
September 5, 2006... Physicians' cries for clarification of what constitutes a consult may have been answered. Some physicians have worried that nothing would count as a consult any longer, ever since the Centers for Medicare & Medicaid Services issued...

SecureHorizons out to gobble up the medicare advantage market: bonding with seniors looking for health care guides is the key to winning them over.(Health Plans)(Company overview)
September 5, 2006... SecureHorizons by United Health Care is the industry leader's new national Medicare Advantage brand. With SecureHorizons, United isn't just out to own the MA market: it also wants to capture its seniors' health care hearts and minds with...

Seniors say: we're not so worried about money--but help us beat alzheimer's: they also say they're not afraid of information overload on important health issues.(Survey)(Brief article)
September 5, 2006... In another sign that baby-boomer thinking is pushing aside earlier-generation thinking, good health is a bigger concern for seniors than financial security, according a recent survey sponsored by Secure Horizons, United HealthCare's new...

Bush calls for info gathering, doesn't cover costs: plus: Feds net half a million for noncovered drugs.(Industry Notes)(health care costs)(Brief article)
September 5, 2006... As promised, President Bush signed an executive order calling on government agencies to track health care quality and costs. But the order didn't spell out how the government will reimburse providers for the costs of providing this information....

Doctors tread carefully when billing for Part B drugs.(Industry Notes)(Brief article)
September 5, 2006... Physicians can't bill Medicare for Part B drugs unless they can prove that they administered them in the office. The U.S. Attorney's Office announced a settlement in which a medical practice agreed to pay just under half a million dollars...

Physicians can write a Part D diagnosis on prescriptions to avoid hassles.(Industry Notes)(medicare coverage)(Brief article)
September 5, 2006... In related news, physicians should have less trouble from now on when a drug could be covered under Part B or Part D of Medicare, the Centers for Medicare & Medicaid Services says in MLN Matters article SE0652. Prescription drug plans...

The requirement for physicians to see patients face-to-face before prescribing power mobility devices such as wheelchairs doesn't apply to cases where the doctor is only prescribing wheelchair accessories.(In Other News ...)(Brief article)
September 5, 2006... The requirement for physicians to see patients face-to-face before prescribing power mobility devices such as wheelchairs doesn't apply to cases where the doctor is only prescribing wheelchair accessories, CMS says in Transmittal 156, dated...

Medicare will give physicians some extra leeway in the Competitive Acquisition Program for Part B drugs, according to MLN Matters Article SE0657.(In Other News ...)
September 5, 2006... Medicare will give physicians some extra leeway in the Competitive Acquisition Program for Part B drugs, according to MLN Matters Article SE0657. Some physicians used the "J2" restocking modifier when they faced enrollment delays in the CAP,...

This year's "Dear Doctor" letter will arrive in the form of a CD-Rom, CMS says in Transmittal 1035, dated Aug. 18.(In Other News ...)
September 5, 2006... This year's "Dear Doctor" letter will arrive in the form of a CD-Rom, CMS says in Transmittal 1035, dated Aug. 18. This letter explains the Medicare program, including the process of signing up as a participating provider under Medicare. As...

New York Gov. George Pataki recently signed into law three measures designed to enhance access to home health care for New Yorkers.(In Other News ...)
September 5, 2006... New York Gov. George Pataki recently signed into law three measures designed to enhance access to home health care for New Yorkers. The first measure would authorize designated nursing homes to provide medical care to patients in their...

A South Florida physician was sentenced Aug. 28 to nearly four years in prison for her role in a $2.3 million durable medical equipment-related Medicaid kickback scheme, prosecutors in Florida announced.(In Other News ...)
September 5, 2006... A South Florida physician was sentenced Aug. 28 to nearly four years in prison for her role in a $2.3 million durable medical equipment-related Medicaid kickback scheme, prosecutors in Florida announced. In addition to the 46-month term,...

Individual health insurance market has lots of shoppers, few buyers: HDHPs putting undue strain on low-income families with high OOP costs.(Health Insurance)(High Deductible Health Plan )(Out of Plaster )
September 18, 2006... When Americans lose their health insurance, many turn to the individual insurance market for coverage--only to find that the coverage is unaffordable or unobtainable, a new study reveals. A new report from the Commonwealth Fund finds that...

Providers struggle with secondary claims transition: carriers may grant an extension, vendors may be able to help.(Medicare)(Brief article)
September 18, 2006... Providers have received shocking letters from their Medicare carriers about Medicare secondary claims. Many carriers, including Noridian and Trailblazer, have been telling providers that they have to start billing Medicare secondary claims...

Long shifts for medical interns cause errors, injuries: bonus: P4P initiative doesn't work out as U.K. officials expected.(Research & Studies)(pay-for-performance)
September 18, 2006... Most medical interns are working hours that exceed national standards, leading to needle stick injuries and serious medical errors, according to two new studies. Among several studies on a range of different topics that researchers...

PPAC to CMS: stop the 10-percent RVU cut: conversion factor still faces 5.1-percent cut.(Meetings)(Practicing Physicians Advisory Council)(Centers for Medicare & Medicaid Services)(relative value units)
September 18, 2006... Physicians still have time to stop a steep 10-percent cut to their work relative value units, and they are pressuring the Centers for Medicare & Medicaid Services to help them avoid it. CMS has proposed to cut all work RVUs by l0 percent...

Patient abandonment may equal fraud, OIG warns: 3 abandonment criteria can land HHAs in hot water.(Compliance)(home health agencies)
September 18, 2006... The HHS Office of Inspector General has specifically stated that abandonment of patients may amount to fraud. At the same time, the list of reasons home health agencies might have for terminating a relationship with a client is growing,...

CMS head steps down: plus: stakeholders call for revisions to new price list.(Industry Notes)(Centers for Medicare & Medicaid Services)
September 18, 2006... Say goodbye to Mark McClellan as administrator of the Centers for Medicare & Medicaid Services. McClellan, a physician, lasted just two years in the job but oversaw the introduction of the Part D drug benefit and other sweeping changes in...

HHS Office of Inspector General.(In Other News ...)(Brief article)
September 18, 2006... Medicare spent $275 million on last year's chemotherapy demonstration project, but it collected "incomplete and unreliable data," the HHS Office of Inspector General complained in a new report (OEI-0905-00171). CMS didn't do enough to...

The American Medical Association wasn't idle during the August Congressional recess.(In Other News ...)(Brief article)
September 18, 2006... The American Medical Association wasn't idle during the August Congressional recess. The AMA and the Indiana State Medical Association met with local media and physicians in Indianapolis as part of its National House Call campaign. The AMA...

The Department of Health & Human Services still lacks detailed plans.(In Other News ...)(Brief article)
September 18, 2006... The Department of Health & Human Services still lacks detailed plans, milestones and performance measures for meeting goals of guiding national implementation of interoperable health information technology, the Government Accountability Office...

Home health agencies may succeed in staving off reimbursement cuts.(In Other News ...)(Brief article)
September 18, 2006... Home health agencies may succeed in staving off reimbursement cuts. A letter circulating in the Senate calling for no cuts to home care and hospice now has a solid majority of senators' names on it, reports the National Association for Home...

No A+ for United States on new national health care scorecard: America spends the most but isn't a leader in HIT adoption or care quality.(Health Care Policy)
September 25, 2006... For a long time the world has considered the U.S. health care system to be the best. But a new national "scorecard" has debunked this assumption. Despite spending 16 percent of the gross domestic product on health care (double the median...

Physician spending grew much less quickly than industry leaders expected: fight against 5.1-percent cut begins with time already running out.(Physicians)
September 25, 2006... There's no time to lose for physicians to save Medicare reimbursement from the 5.1-percent cut slated for next January. Congress has returned from its August recess--but plans to adjourn at the end of September for the election season. ...

Congress considers plan that would keep payment cuts for some doctors: can a lame duck save physicians from the chopping block?(Reimbursement)
September 25, 2006... Forget pay-for-performance. One new plan in Congress would give physicians a choice between deep cuts or intrusive utilization review. The House Energy and Commerce Committee is considering a few options for replacing the next few years'...

Providers are happy with their contractors, new survey reveals: rural health centers, SNFs most pleased with their FI contractors.(Medicare FFS)(Skilled nursing facilities)(fee-for-service)
September 25, 2006... Providers are content with their Medicare fee-for-service contractors' claims processing, customer service and educational activities, according to a new survey. More than 25,000 randomly selected physicians, health care practitioners,...

HHS spends a bundle on state-based programs for the disabled, chronically ill: industry leaders steering away from institutional programs.(Medicaid)
September 25, 2006... The federal government is spending $20 million on grants for states to develop community living programs for individuals with disabilities and chronic illnesses. As part of the Bush Administration's "New Freedom Initiative," which promotes...

Continuity of care threatened by court ruling, industry reps claim: federal court delivers blow to labor law exemption.(Legal News)
September 25, 2006... On Sept. 1, the U.S. Court of Appeals for the Second Circuit reaffirmed its July 2004 decision holding that home health agencies cannot use what's known as the "companionship exemption" to the Fair Labor Standards Act, which lays out...

PE-RVU changes could cut major procedures by 10 percent.(Industry Notes)
September 25, 2006... If the Centers for Medicare & Medicaid Services goes ahead with plans to change how it calculates practice expense relative value units, it could create winners and losers among physicians, the Medicare Payment Advisory Commission said Sept. 9....

CMS is looking out for double billings from radiologists.(Industry Notes)(Brief article)
September 25, 2006... Radiology providers billed Medicare inappropriately for a staggering 100,034 radiology services in 2001-2003, the HHS Office of Inspector General warned in a new report (A-01-04-00528). Medicare overpaid $20 million during that period for...

Home oxygen stakeholders challenge OIG report.(Industry Notes)(Office of the Inspector General)(Brief article)
September 25, 2006... A separate OIG report fuels claims that Medicare overpays providers of home oxygen equipment. The report from the OIG, released Sept. 13, sent the stocks of companies including Lincare Holdings down and garnered quick reaction from...

CMS to correct OASIS manual mix-ups.(Industry Notes)(Centers for Medicare & Medicaid Services)(Outcome and Assessment Information Set)(Brief article)
September 25, 2006... "We identified and reported at least 25 errors to the Centers for Medicare & Medicaid Services," Linda Krulish of Redmond, WA-based OASIS Answers tells Eli. The federal agency has indicated that they will issue a revised version of Chapter 8...

The Tenth U.S. Circuit Court of Appeals ruled Sept. 6 that managed health care company Intermountain Health Care didn't violate the Sherman Antitrust Act when it refused to open its provider panel to optometrists.(In Other News ...)(Brief article)
September 25, 2006... The Tenth U.S. Circuit Court of Appeals ruled Sept. 6 that managed health care company Intermountain Health Care didn't violate the Sherman Antitrust Act when it refused to open its provider panel to optometrists. IHC excluded optometrists...

Starting Oct. 1, Medicare will only send electronic remittance advice notices that comply with the Health Insurance Portability and Accountability Act.(In Other News ...)
September 25, 2006... Starting Oct. 1, Medicare will only send electronic remittance advice notices that comply with the Health Insurance Portability and Accountability Act, CMS said in MLN Matters Article SE0646.

Zabdy Westerburger.(In Other News ...)
September 25, 2006... Miami physician Zahdy Westerhurger received a 46-month prison sentence for her part in a scheme to write prescriptions for fake patients in return for kickbacks, the Sun Sentinel reported.

Health care providers now have an at-a-glance guide for how to make decisions related to the HIPAA privacy rule in an emergency situation.(In Other News ...)(Health Insurance Portability and Accountability Act)(Brief article)
September 25, 2006... Health care providers now have an at-a-glance guide for how to make decisions related to the HIPAA privacy rule in an emergency situation. Created by the U.S. Department of Health & Human Services, the tool takes HIPAA-covered entities...