Last August, the U.S. District Court for the District of Columbia ruled that the U.S. Department of Health and Human Services (HHS) must release Medicare physicians claims information for Illinois, Maryland, Virginia, Washington state, and the District of Columbia. (Kaiser Network) An organization called Consumers' CHECKBOOK/Center for the Study of Services sued for access to this information apparently "to help the public evaluate the performance of the program and the physicians," and HHS … [Read more...] about HHS Appeals Ruling Requiring Release of Medicare Physicians Claims Data
New Law Revises Medicare ‘Behavioral Offset’ Provision
President George W. Bush signed into law a measure that prevents the Centers for Medicare and Medicaid Services (CMS) from implementing a behavioral offset provision that would have reduced Medicare inpatient hospital reimbursements by $20.3 billion over five years. (Kaiser Network) When the House of Representatives passed the measure in July, Congressman Jerry Weller said CMS sought to preemptively punish hospitals "before they’ve done anything wrong." CMS attempted to reduce … [Read more...] about New Law Revises Medicare ‘Behavioral Offset’ Provision
Provider and Information Letters: New Payment Rates, Life Safety Code
The Texas Department of Aging and Disability Services (DADS) issued a letter to Community Based Alternatives and Assisted Living/Residential Care Providers to inform them about Personal Care 3 Reimbursement Rates. These rates became effective on September 1, 2007. For more details, download the letter here. DADS informed the Medically Dependent Children Program and Home and Community Support Service Agencies about increases in provider rates. New rates and billing codes can be accessed here … [Read more...] about Provider and Information Letters: New Payment Rates, Life Safety Code
Texas Register Updates: Payment Rates Adoption and Notices
The Texas Department of Health and Human Services (HHSC) has notified providers about new per diem payment rates for the nursing facilities program operated by the Texas Department of Aging and Disability Services. The new payment rates were effective on September 1, 2007. For more information, see the relevant section of the August 31 Texas Register. HHSC issued several public notices of its intent to submit amendments to the Texas State Plan for Medical Assistance, under Title XIX of the … [Read more...] about Texas Register Updates: Payment Rates Adoption and Notices
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
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
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.
Medicare Won’t Cover Preventable Errors
Medicare will no longer pay for "treating preventable errors, injuries and infections that occur in hospitals," according to the New York Times. Such preventable errors include leaving a sponge or other object inside a patient during surgery and giving a patient the wrong blood. Such a policy obviously will put pressure on hospitals to get it right the first time (which they should be doing anyway), or they won’t get paid. An excerpt: Hospital executives worry that they will have to … [Read more...] about Medicare Won’t Cover Preventable Errors
Medicare News: Anemia Treatment, Off-Label Use Issue
Earlier this week, the Centers for Medicare and Medicaid Services (CMS) announced that it will limit Medicare coverage for anemia medications in cancer patients. CMS will cover medications to treat anemia caused by chemotherapy but won’t cover medications for anemia caused by cancer. (Kaiser Network) Roger M. Perlmutter, a physician and spokesman for the drug company Amgen said, "The coverage restrictions placed on the FDA-approved indication have no scientific basis and are incompatible … [Read more...] about Medicare News: Anemia Treatment, Off-Label Use Issue
CMS To Increase Medicare Payments for Skilled Nursing Care
The Centers for Medicare and Medicaid Services (CMS) announced an increase in Medicare payments for beneficiaries using skilled nursing facility care for fiscal year 2008. (Source) The 3.3 percent increase translates into about $690 million for beneficiaries recovering from “serious health problems†who need skilled nursing and rehabilitation care. Acting CMS Administrator Herb Kuhn said, "These new payment rates reflect our commitment to improving the quality of care in the long-term … [Read more...] about CMS To Increase Medicare Payments for Skilled Nursing Care
