I wrote here about a decision by the Texas Medical Board to reject an ALJ's proposal-for-decision.The case involves the Board's rejection of the ALJ's Proposal that the case against the physician be dismissed. The physician had committed a one time error by responding to a patient's request for medical records with a bill based on the amount that hospitals are allowed to charge, rather than in accordance with the Board rule laying out what physicians are allowed to charge. All of the parties … [Read more...] about Update On Texas Medical Board Decision
GAO Says CMS Failed to Properly Audit Private Insurance Companies
According to a new Government Accountability Office (GAO) report, the Centers for Medicare and Medicaid Services (CMS) failed to properly audit private insurance companies for overpayments or to recover the excess payments. (Kaiser Network) Medicare-participating private insurers kept "tens of millions of dollars" that could have been passed on to beneficiaries or returned to the government. Federal law requires CMS to audit financial records of at least one-third of such companies every … [Read more...] about GAO Says CMS Failed to Properly Audit Private Insurance Companies
A Troubling Texas Medical Board Decision–Just My Opinion
See my Update for the Board's side of the story. Administrative Law Judge, Wendy Harvel, of the Texas State Office of Administrative Hearings, personally presented her recommendation that a complaint against Texas Ob/gyn licensee Chris Kuhne MD be dismissed. The meeting was held on August 23 and 24th,2007, A complaint had been filed against Dr. Kuhne because he inadvertently overcharged a patient for medical records. He charged $81 rather than $39 by mistakenly using the guidelines for … [Read more...] about A Troubling Texas Medical Board Decision–Just My Opinion
DADS Letters – August 28-September 1
Last week, the Texas Department of Aging and Disability Services (DADS) issued a series of provider and information letters: Multiple Providers Reimbursement Rates Effective September 1, 2007 Nursing Facilities Amendments to Health and Safety Code (HSC) Chapter 242 Notification of Adverse Change in Financial Condition … [Read more...] about DADS Letters – August 28-September 1
Number of Beneficiaries Caught in Coverage Gap Reduced, Study Says
According to a new study published in the Health Affairs journal, Medicare Part D has "dramatically reduced" the number of beneficiaries caught in the coverage donut hole. The donut hole, also known as the coverage gap, is the period of time during the year when a beneficiary is not covered and is responsible for paying drug costs out-of-pocket. Over 16,000 seniors were surveyed last fall, and a quarter of respondents said they spent $100 or more out-of-pocket on Part D drugs per month, and 8 … [Read more...] about Number of Beneficiaries Caught in Coverage Gap Reduced, Study Says
Texas Register Updates: Response to Alberto N., et al
On behalf of the Texas Department of Aging and Disabilities, the Texas Health and Human Services Commission has adopted an amendment to implement an age requirement for Community Care for Aged and Disabled (CCAD) primary home care services in response to the settlement agreement in Alberto N., et al, vs. Albert Hawkins and James Hine. (Also see CCAD Age Requirement, ICM Program) Persons 21 and younger will be offered personal care services (unskilled attendant care). For more information, see … [Read more...] about Texas Register Updates: Response to Alberto N., et al
Texas Register Updates: Adopted Rules
The Texas Health and Human Services Commission (HHSC) has adopted an amendment to the Medicaid Managed Care section of the rules. The amendment updates the definition of Value-added Services. Pursuant to Senate Bill 10, HHSC is to “actively encourage†HHSC-contracted Medicare managed organizations to offer value-added benefits. HHSC also adopted an amendment regarding the Consumer Directed Services (CDS) Payment Option, Reimbursement Rates Chapter. The U.S. Department of Health and Human … [Read more...] about Texas Register Updates: Adopted Rules
Medicare News: Preventive Services Coverage, Conflict of Interest Referrals, Etc.
The Kaiser Network reports Medicare is spending more on preventive services and screenings, according to the Centers for Medicare and Medicare Services (CMS). This isn’t news, but it’s interesting to note that fewer than 10 percent of beneficiaries receive preventive screenings and immunizations recommended by health care professionals. In other Medicare news, CMS has issued a final rule that prohibit doctors from conflict-of-interest referrals. They can longer refer patients for services … [Read more...] about Medicare News: Preventive Services Coverage, Conflict of Interest Referrals, Etc.
DADS Letters: Individual Cost Limits, New Convictions
The Texas Department of Aging and Disability Services (DADS) informed Community Services Waiver Providers about the increase in individual cost limits for six Medicaid waiver programs operated by DADS. The three-page August 20 letter includes of a breakdown of cost limits for such programs as the Consolidated Waiver Program and the Deaf-Blind with Multiple Disabilities Program. You may download the letter here. In an August 24 provider letter to Assisted Living Facilities, Adult Day Care … [Read more...] about DADS Letters: Individual Cost Limits, New Convictions
Texas Register Updates: Obsolete Rule Deletions, Public Meeting Notices
The Board of Nurse Examiners has proposed amendments to delete obsolete portions of rules pertaining to Practice and Procedure. The proposed amendments were reviewed by the Board's Eligibility and Disciplinary Task Force on July 13, 2007, and the Board and task force recommended approval. For more information, see the relevant section of the August 17 Texas Register. The Board also proposed a new rule pertaining to Licensure, Peer Assistance and Practice. Read more about this proposed new … [Read more...] about Texas Register Updates: Obsolete Rule Deletions, Public Meeting Notices
