Medicare Compliance & Reimbursement

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 45

PHYSICIANS:
Doctors Get Extra Document Postprocessing RVU
Likely pay cut offset by some RVU bumps.Physicians can't count on new CPT codes until Medi... Read more

PHYSICIANS:
CMS Issues E/M Coding Checklist
If three years have passed since his last visit, he's a new patient again.Heads up, physic... Read more

MEDICAID:
'Toolkit' Improves Developmental Delay Care
CHSC resource shows best practices for dealing with poor children.One organization has not... Read more

HOSPITALS:
Facilities Must Consider Post-Merger Provider Numbers
CCR depends on new facility's number.Hospitals that have recently undergone a merger with ... Read more

MEDICARE ADVANTAGE:
Bush Promises To Veto MA-Cutting Bill
White House pressuring Congress on PPO inducement measures.President Bush has vowed to vet... Read more

SPECIAL REPORT:
AVIAN BIRD FLU--Outbreak Of Criticism Follows Flu Plan Announcement
Democratic senator points out 'gaping hole' in Bush flu strategy.On the heels of President... Read more

SPECIAL REPORT:
AVIAN BIRD FLU--One Skeptic Sees Bright Spots In Flu Plan
Leading critic wants more funds to prepare for potential pandemic.For years, many Democrat... Read more

PHARMACEUTICALS:
Inhalation Drug Therapy Fee Falls To CMS Knife
Care management activities not part of Medicare benefit, agency says.In a move that left r... Read more

PHARMACEUTICALS:
Demo On Tap For Inhalation Therapy
CMS says program open to providers, doctors, therapy companies.The Centers for Medicare an... Read more

ENFORCEMENT WATCH:
OIG Has Carriers Sharpening Corrective Action Plans
HHS wants physician-tracking systems up to snuff.Insurance carriers' progressive correctiv... Read more

HOME HEALTH:
PPS Update Not Yet Set For HHAs
Published 2006 rates may not be here to stay.Home health providers should not get too comf... Read more

BILL WATCH
The following bills were introduced in the Senate: S. 1951. A bill to amend the Public He... Read more

News You Can Use:
Circle the ICD-10 Release Date on Your Calendar
Move full steam ahead for the Oct. 1, 2015 deadline for the release of ICD-10, when you ... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 44

PHYSICIANS:
Feds Set To Slash Payments In 2006
CMS final rule also extends glaucoma screening benefit.The Centers for Medicare and Medica... Read more

PHYSICIANS:
Chemo Demo Gets New Life
Feds will create new version of project for 2006.Oncology practices that have been dependi... Read more

PHARMACEUTICALS:
Senator Takes Shot At New CMS Drug Web Site
Agency acknowledges problems with site.Medicare's new Internet-based tool for beneficiarie... Read more

PHARMACEUTICALS:
PAPs Should Not Assist Too Much
Tread carefully when offering PAPs to Medicare Part D benes.Pharmaceutical providers that ... Read more

PHARMACEUTICALS:
Disaster Predicted If 2006 Part D Enrollment Is Low
Too many high-utilizing benes will drive up premiums for everyone.Premiums for Medica... Read more

PAY-FOR-PERFORMANCE:
Medicare Begins Voluntary Reporting Project
CMS phasing in measurements to aid performance improvement.With lackluster Medicare reimbu... Read more

HOSPITALS:
Defibrillator Data Reporting Will Be Different Next Year
ACC has a new national data registry.Facilities must contact the American College of ... Read more

HOME HEALTH:
HHAs Win 1-Year Transition To New Wage Index Areas
CMS announces final 2006 payment levels.Home health agencies will see a 2.8 percent increa... Read more

LONG TERM CARE:
LTC Surveyors Seeking Systemic Sorts Of Problems
Several noncompliance findings may make surveyors suspicious.Heads up, nursing homes: Stat... Read more

ENFORCEMENT WATCH:
Prescription Scheme Busted; 1 Suspect Still At Large
Pharmacist works with feds to catch co-conspirators.Phony prescriptions that fraud scheme ... Read more

DME:
Senate Helps Providers Out On PMD Rule
Regulatory rescue comes as PMD lawsuit fails.After the failure of a last-minute lawsuit to... Read more

BILL WATCH
The following bills were introduced in the Senate: S. 1929. A bill to reduce health care d... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 43

PHYSICIANS:
Savings Plan Spares Physicians From Fee Reductions
Doctors would see 1-percent pay increase under proposal.There is potentially good news for... Read more

PHYSICIANS:
Feds Asking Doctors For Patient Records
CMS using RACs to keep tabs on Medicare payments.In the near future, physicians may notice... Read more

MEDICAID:
Florida Medicaid Getting Experimental
New plan aims at lower costs for benes.Health and Human Services Secretary Mike Leavitt ap... Read more

PHARMACEUTICALS:
Part D Beneficiaries Befuddled By New CMS Tool
Deadline issues mean not all data is in new online plan finder.The Centers for Medicare an... Read more

HOSPITALS:
Self-Referrals To Specialty Hospitals Under Scrutiny
Legislators agree with community hospitals; self-referral abuse is wrecking the system.A n... Read more

LONG-TERM CARE:
Feds Hoping LTC P4P Pilot Will Fly
Project not slated to start for at least a year.Long-term care facilities will soon get a ... Read more

REHAB:
PMD Wars--The Saga Continues For Rehab Providers
LCDs make rules are even more restrictive.Rehab providers that employ physical or occupati... Read more

LABS:
Optometrists Directing Labs Are Under Microscope
Strict federal guidelines must be followed for compliance.Laboratories that perform tests ... Read more

HOME HEALTH:
Feds Grant More Relief To Katrina-Stricken HHAs
CMS to take it easier on RAP recoupments, pending M0175 takebacks.The 91 home health agenc... Read more

ENFORCEMENT WATCH:
Kickback Case Nets More Than $700 Million In Fines
Serono, S.A. out a bundle after fraud surrounding Serostim.Think the era of blockbuster he... Read more

BILL WATCH
The following bills were introduced in the House: H.R. 4131. A bill to amend title 35, Uni... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 42

DME:
Feds Zero In On Unscrupulous DME Suppliers
Audit suggests CMS contractor not up to speed in all fraud-fighting areas.The Senate's top... Read more

REHAB:
CMS Comes Through With More Incident-To Protection
New qualification standards should help facilities get paid.Even though the National Assoc... Read more

PHYSICIANS:
January Pay Freeze Likely Awaits Physicians
Chemotherapy demonstration project peppered with criticism.Doctors, brace yourselves. Next... Read more

HOSPITALS:
October OPPS Updates Change C9255 Reporting Rules
'Pass-through' status granted to pair of C codes.This year's hospital outpatient prospecti... Read more

MEDICAID:
Group--NGA Cost-Cutting Ideas Ungoverned By Sense
Critics point to proposals that endanger many disabled benes.Dismayed by the National Gove... Read more

PHARMACEUTICALS:
Part D Fraud A Priority For CMS
Agency to use innovative techniques to for fraud detection.The Centers for Medicare and Me... Read more

PHARMACEUTICALS:
OIG Trying To Encourage E-Prescription Switch
Office proposal offers anti-kickback safe harbor.A new HHS Office of Inspector General-pro... Read more

LONG-TERM CARE:
Feds Follow Through On LTC Immunization Rule
Document carefully when residents refuse shots.Long-term care providers may want to greet ... Read more

LONG-TERM CARE:
Facilities Should Help, But Not Steer, PDP Selection
Feds offer plan that can help beneficiaries decide on a PDP.Many Medicare beneficiaries ar... Read more

ENFORCEMENT WATCH:
Keep Personal Care Services Rates Honest
One provider found out the hard way: Medicaid won't pay facility ad and marketing co... Read more

BILL WATCH
The following bills were introduced in the Senate: S. 1880. A bill to amend the Public Hea... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 41

PHYSICIANS:
Gainsharing Allows Physician Pay For Cutting Costs
...but there is a fine line between a legit payout and a kickback.Physicians could be rece... Read more

PHYSICIANS:
CMS Launches Demo Directed At FFS Benes
Project covers a wide range of fee-for-service patients.The Centers for Medicare and Medic... Read more

MEDICAID:
Survey--Fixing 'Patchwork' Coverage System A Priority
Respondents say Medicaid, SCHIP have played vital roles in keeping underprivileged covered... Read more

PHARMACEUTICALS:
HHS Reports Drug Payouts Are More Than Adequate
ASP info does not portend higher future pay rates.No matter how providers protest tha... Read more

PHARMACEUTICALS:
Study Supports Medicare Part E Implementation
'Medicare Extra' proponents pushing for $250 per-person deductible.As Medicare beneficiari... Read more

REHAB:
New PMD Rule Could Pose Rehab Provider Problems
Recent reg does not mention rehab providers, but it still affects them.Rehab providers tha... Read more

LABS:
Now See This--Optometrists Can Be Lab Directors
...though there are some restrictions on directors with certain diagnostic specialties.The... Read more

HOSPITALS:
Avoid IPPS Incidents By Asking Questions
Hospitals must know if doctor prescribed aspirin to heart attack patients.August's inpatie... Read more

HOSPITALS:
Facility Incentive Pay May Tie Into Infection Protection
Hospitals that want SCIP money must agree to 20 measures.In September, the Centers for Med... Read more

ENFORECEMENT WATCH:
OIG Keeping A Hawk's Eye on Disaster Funds
Providers that mismanage funding could lose deserved money.Relaxed regulations in Hurrican... Read more

PHYSICIANS:
Feds Moving Toward Reduced Medical Review Period
Want off medical review? Do not argue with auditors.Carriers can still drive physici... Read more

BILL WATCH
The following bills were introduced in the Senate:S. 1808. A bill to amend title XIX of th... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 40

PHARMACEUTICALS:
Legislators Sound FDA Intervention Call On Drug Ads
Officials: DTC tactics are dangerous and misleading.As more revealing data become availabl... Read more

PHYSICIANS:
Battle For Pay Cut Relief Heats Up On The Hill
Conn. Congresswoman still fighting for increase.Physicians may still receive a respite fro... Read more

PHARMACEUTICALS:
New Medicare PDPs Get Final Approval
MA plans also get go-ahead.Medicare took a major step toward its new prescription drug cov... Read more

PHYSICIANS:
HHS Prescription May Stymie Computer Headaches
CMS set to move on several changes.Heads up, physicians that want to prescribe drugs elect... Read more

DME:
Suppliers Should Study Quality Standards Carefully
CMS urges suppliers to submit detailed comments on controversial standards.Suppliers hopin... Read more

HOSPITALS:
Hospitals Impatiently Waiting For ICD-10
Critics decry dated ICD-9.Hospitals that are anxious to begin using International Classifi... Read more

LONG-TERM CARE:
CMS Gears Up For Nursing Home P4P
Voluntary program nets bonuses across wide variety of quality measurements.As part of its ... Read more

DME:
Even Non-Members Can Get A Blue Cross Number
...but there must be a prescription for DME. A durable medical equipment company need... Read more

REHAB:
Rehab Providers Must Now Deal With NCCI
Remember to use modifier 59 to unbundled services.The world of National Correct Coding Ini... Read more

ENFORCEMENT WATCH:
Aggressive Audits Often Follow Split Claims
Why it's a good idea to keep a sharp eye on Fls.Bad news for rehab providers that don't ke... Read more

DISASTER RELIEF:
AMA Urges Increased Funding For Hurricane Victims
House hears doctors' concerns about recovery.As victims struggle to recover from recent di... Read more

BILL WATCH
The following bills were introduced in the Senate: S. 1784. A bill to amend the Public Hea... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 39

PHYSICIANS:
Calls To Legislators May Save Physician Payments
Medicare pay cut more likely in the wake of Katrina and Rita.Physicians that don't want ta... Read more

PHYSICIANS:
CMS Stands By Part B Premium Projections
Monthly premium to increase next year, but out-of-pocket costs will drop.The abundance, an... Read more

SPECIAL REPORT:
DISASTER RELIEF--Lawmakers Pass Legislation To Up Katrina Assistance
Most measures enjoy support from both sides of aisles.Despite disaster-budget debates, Con... Read more

HOME HEALTH:
Many HHAs Not Ready For HIT
Care continuity an issue as smaller providers try to get on EHR train.Further insight into... Read more

MEDICARE PART D:
Katrina Relief Not Likely To Stall Part D
Part D delay called 'a non-starter' by opponents.Despite calls by several key fiscal conse... Read more

PHARMACEUTICALS:
Federal Drug Savings May Be Higher Than Thought
PWC estimates of MMA savings could hurt physician pay.Oncology providers may have to dig e... Read more

LONG-TERM CARE:
Therapy Services Set For Billing Changes
NCCI edits could scare up cash-flow woes if providers aren't aware.Long-term care faciliti... Read more

HOSPITALS:
Study Reveals Reductive Effects Of 75-Percent Rule
Report: 30,000 fewer benes got IRF services in first year.A report from two hospital... Read more

LONG-TERM CARE:
Feds Following Through On Immunization Policies
Non-compliance could result in revoked Medicare certification.Long-term care providers nee... Read more

ENFORCEMENT WATCH:
DOJ Chips Away At 'Double Dipping' Schemes
Best advice: Dip once and end it.Providers beware: The Department of Justice is paying eve... Read more

BILL WATCH
The following bills were introduced in the Senate: S. 1750. A bill to provide for the issu... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 38

PHYSICIANS:
CMS Presents A Bundle Of Nerve-Block Edits
...but everyone expected feds to make the move.Physicians performing procedures to destroy... Read more

PHYSICIANS:
EHR Software Now Available For Physicians
Installation will require a vendor's assistance.For once, the Centers for Medicare and Med... Read more

PHYSICIANS:
Feds Sound New PET Edits
Nuclear medicine services now included in PET imaging.All doctors that perform PET tumor i... Read more

HOME HEALTH:
PPS For HHAs Not Set Yet, MedPAC Says
Agency wants CMS to research case-mix data.Home health agencies' 2006 prospective payment ... Read more

MEDICAID:
Special-Needs Children Hurting For Coverage, Access
Budget may dictate postponement of a solution.Federal and state politicians are considerin... Read more

MEDICAID:
Revenue Downturns Lead To Recruiting Woes
Many potential benes caught in economic 'Catch-22.'When it comes to healthcare coverage, m... Read more

LONG-TERM CARE:
Commission Studies Reasons For Long Stays
Study reveals factors common to discharges.The Kaiser Commission on Medicaid and the Unins... Read more

PHARMACEUTICALS:
GAO Outlines Skyrocketing Drug Price Pattern
Feds analyze pair of pharmacy assistance programs for report.As the federal government tak... Read more

LABS:
Prepare For Pay Increase For Flow Cytometry Services
Tech components get RVU increase.Most labs were adversely affected by 2005's almost 50 per... Read more

ENFORCEMENT WATCH:
DOJ Doesn't Back Pay For All Services In Chiro Clinics
Feds unearth massive Medicare fraud scheme.Hiring medical doctors to work in a chiropracti... Read more

BILL WATCH
The following bills were introduced in the Senate: S. 1716. A bill to provide emergency he... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 37

Physicians:
AMA Outlines Possible Upcoming CPT Codes
CMS continues push for disposal of non-physician workpool. Physicians could soo... Read more

Long-Term Care:
Providers Must Document Flu Shot Offer
If nursing home residents aren't offered vaccine, facility may violate new immunization ru... Read more

Physicians:
E-Claim/Paper Attachment Combo Slowly Fading
E-standards may be more opportunity than compliance burden.Tired of sending paper attachme... Read more

DME:
OIG Wants CMS To Help Docs Attend To DME Claims
Will Orange Book revolutionize DME spending?The Centers for Medicare and Medicaid Services... Read more

Medical Supplies:
Feds May Wrap Casts, Splints Into Surgical Codes
Providers hoping CMS increases RVUs to compensate for bundling.Medical offices that provid... Read more

Medicaid:
Medicaid Helps Stave Off Uninsured Increase
Census survey also shows SCHIP's effectiveness.Thanks to government programs, the plight o... Read more

Pharmaceuticals:
CAP Comes Off--CMS Clarifies Part B Timeline
Providers afforded pair of chances to choose vendor next year.The Centers for Medicare and... Read more

Medicaid:
Commission Recommendations May Save Billions
Beneficiaries may pay the price through co-pays on non-preferred drugs.States might start ... Read more

DME:
Wheelchair Rule Not Sitting Well With Suppliers
Providers let CMS have it at Open Door Forum.The power mobility industry may not enter a b... Read more

Enforcement Watch:
Bankruptcy Filing Won't Wash Sins Of Fraud
Providers assets could be confiscated, sold to pay fraud fines.Healthcare providers lookin... Read more

Rehab:
Collect Copays, Or OIG Could Come Knocking
Put policies in place that ensure collection in most scencarios.With health care costs sky... Read more

Bill Watch
The following bills were introduced in the Senate: S. 1637. A bill to provide emergency re... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 36

Special report:
Disaster Relief--Katrina, Aftermath Spur CMS To Loosen Guidelines
Unprecedented beneficiary blight lightens some procedure rules.Many physicians and other m... Read more

Rehab:
'Roadmap' Could Lead To Greater Rehab Riches
Quintet of system strategies highlight federal improvement plan.The Centers for Medicare a... Read more

Physicians:
'Prior Determination' System Premieres
Carriers have 45 days to decide on pricey items, but may respond more quickly.When patient... Read more

Medicare Demonstration:
Providers, Get Ready For Pay System Overhaul
CMS wants your help to develop and test major health care system improvements.The feds hav... Read more

Hospitals:
CMS Wants Hospitals Up To Snuff On Quality Standards
Agency says incentive payments will be harder to qualify for.How well a hospital provides ... Read more

Medigap:
No Money For 'None' Or 'Other' Medigap Claims
C11 denials frequently befuddle physicians.Medicare Remittance Notices are often confusing... Read more

Hospitals:
Don't Forget About Pending OPPS Changes
Pass-through payments possible for certain codes.The bulk of the changes to hospital outpa... Read more

Pharmaceuticals:
Initial Post-Infusion IV Push Needs Subsequent Code
AMA adds category for hormonal agents to drug administration codes.Physicians that are str... Read more

Medicaid:
Commission Recommendations Rile NGA
Proposals affect drug reimbursement, eligibility and tax treatment of MCOs.The controversi... Read more

Enforcement Watch:
States May Be Overcharging For Medical Staff
Enhanced-rate payments not possible on certain overhead costs.Providers in states that cha... Read more

Medicare Part D:
Seniors Slowly Coming Around On PDP
Attitudes shift as PDP enrollment approaches.Do more seniors believe that the upcoming Med... Read more

Bill Watch
The following bills were introduced in the House: H.R. 3654. A bill to amend title XVIII o... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 35

PPO:
PPOs To Fill Gaps Managed Care Plans Create
Incentives will burn a hole in feds' pockets.Medicare will spend as much as $60 billion ov... Read more

Rehab:
75 Percent Rule Wreaking Rehab Havoc
Longer stays are already a reality after joint replacement shakeup.Rehab managers in acute... Read more

DME:
Providers Facing Tough New PMD Requirement
Documentation demands will up reimbursement rate, though.As of Oct. 25, doctors will have ... Read more

DME:
NCA Could Expand Oxygen Concentrator Payout
CMS considers expanding coverage for home use of supplemental oxygen.Durable medical equip... Read more

Physicians:
Docs Don't Want Drug Bidders Dragging Prices Down
PPAC examines impact of Part B CAP.The Centers for Medicare and Medicaid Services hadn't r... Read more

Home Health:
Compensation Adjustments Not So Cut And Dried
CMS has switched nearly all pro-provider decisionsHome health agencies that have filed app... Read more

Long-Term Care:
Medicare To LTC Providers: Vaccinate To Participate
Feds want LTCs' Medicare status tied to flu, pneumonia immunizations. Long-term care provi... Read more

Medicaid:
Co-pay Question Causes Commission Commotion
Plan would save money, but at what cost?A recent federal proposal that would allow Medicai... Read more

Hospitals:
Urban, Suburban Public Hospitals In Peril
The wealthier the community, the better the care access, a study finds.Public hospitals ha... Read more

Enforcement Watch:
OIG Eyeing Deceased Medicaid Patient Payments
Watch out for claims after a patient's date of death.Signs are pointing toward states crac... Read more

Long-Term Care:
Choose Nursing Home Drug Providers Carefully
Carelessness could mean trouble when it comes to Part D plan selection.Long-term care faci... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 34

PHYSICIANS:
GAO Says 'Concierge Care' Not Causing Concern
... but growing trend could lead to crackdown.The government isn't likely to crack down on... Read more

PHYSICIANS:
NPIs And When To Apply-Now Or Later?
Doctors who hold off could be sorry.Should a physician wait to apply for a National Provid... Read more

DME:
Proposed Dispensing Cut Leaves Suppliers Gasping
CMS seeks comments on appropriate fee amount.Respiratory providers should gird for battle ... Read more

DME:
Lawmakers Want Clear Mobility Equipment Guidelines
Senators chide inconsistent documentation requirements.Two U.S. senators want mobility doc... Read more

PHARMACEUTICALS:
Getting Psych Meds May Be Tough For Part D Duals
Move to Medicare drug coverage confusing beneficiaries.Provisions of the Medicare Prescrip... Read more

PHARMACEUTICALS:
Feds Keeping An Eye On PDP Advertising
Physician PDP promotion also under watch.On the heels of the Center for Medicare and Medic... Read more

HOSPITALS:
Now Hear This-Some Cochlear Implants Are Payable
Facilities must check the tests.Facilities that perform cochlear implantation for certain ... Read more

HOSPITALS:
Facilities Could See Part B Pay Boost
CMS may reimburse for more Part Bs.Good news for hospitals that administer biologicals and... Read more

LONG-TERM CARE:
CMS Wants To Up Private LTC Financing
Demo designed to reduce stress on Medicaid.As the federal government scrambles to prepare ... Read more

ENFORCEMENT WATCH:
Medicare May Dictate Medicaid-Allowable Costs
The OIG can involve Medicare FIs identity duplicate claims.Providers should make sure they... Read more

HIPAA GUIDELINES:
E-Claims Must Be HIPPA-Compliant By Oct. 1
Providers can submit non-compliant claims through September.The Centers for Medicare and M... Read more

PHYSICIANS:
Physicians Should Prep For Applying Ultrasound Rules
Doctors may need to restructure payment arrangements soon.If the Centers for Medicare and ... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 33

MEDICARE ADVANTAGE:
A Dream Deferred- Regional PPO Plans Face Obstacles
Many won't be able to comply until 2007.Health plan providers see great possibilities in t... Read more

HOSPITALS:
Ambulance Services Added To Billing Duties
Independent contractors will look to facility for reimbursement.When an ambulance transpor... Read more

PHYSICIANS:
CMS Pushes Self-Referral Ban For PET Scans
Nuclear medicine also on chopping block.Physicians could have a much harder time performin... Read more

PHYSICIANS:
Medicare Offering Exemption Waivers
Burden on provider to prove patient hardship.A new proposal might play a big role in savin... Read more

PHYSICIANS:
Brakes Applied To Drug Bidding Program
Drugs may be available through vendors by July 2006.The Centers for Medicare and Medicaid ... Read more

REHAB:
Live Appeals Hearings Headed Toward Extinction
Expert fret over rule change that may damage appeal chances.Under the new appeals system, ... Read more

REHAB:
Rule Reduces IRF Outlier Thresholds
...but it will also cut standard payments.Good news for inpatient rehab facilities: The Ce... Read more

LONG-TERM CARE:
Providers Get Ready: New Pay System Starting Soon
Feds show no signs of slowing new PPS implementation.Long-term care providers should not l... Read more

LONG-TERM CARE:
Hello QIO? Providers Can Profit From A Call
'8th Scope Of Work' now underway.Providers that are looking for a way to edge ahead of the... Read more

ENFORCEMENT WATCH:
Bad Consultants Are The Clinic's Problem, Too
Physical therapy clinics come under fire for Medicare and Medicaid fraud.Physical therapy ... Read more

PHARMACEUTICALS:
Ad Rules: Drug Makers Doing It For Themselves
Critics question appropriateness of PhRMA making DTC ad guidelines.The trade association t... Read more

BILL WATCH
The following bills were introduced in the House: H.R. 3423. A bill to amend the Federal F... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 32

PHYSICIANS:
House Proposal Could Reduce Sting Of Cuts
...but P4P is part of the package.The Centers for Medicare and Medicaid Services issued a ... Read more

PHYSICIANS:
CMS Puts Temporary Nix On Name/ID Denials
Medicare gives up on edit until further revision.Pressure from thousands of providers has ... Read more

PAY-FOR-PERFORMANCE:
Slow, Deleberate P4P Intro Touted
MedPAC director says P4P may only evaluate IT initially.The steamroller of pay for perform... Read more

HOSPITALS:
Count Pennies To Cope With Proposed IPPS Rates
AHA calls payment increase 'inadequate.'Hospitals, watch out: The Centers for Medica... Read more

HOSPITALS:
Dems Claim Dubious Patient Makeup In Some Facilities
Government likely to extend moratorium on payments for new physician-owned hospitals.Do so... Read more

PHARMACEUTICALS:
States May Ask For More Provider Rebates
OIG finds weak accounting controls on state Medicaid programs.As states try to improve the... Read more

CARE QUALITY IMPROVEMENTS:
Feds Pave Road To Better Care With Incentives
'Roadmap' features 5 improvement 'destinations' for providers.Providers that wanted some e... Read more

HOME HEALTH:
Many Benes To Need Home Care, But Few Can Afford It
Pair of solutions might help fix tight budgets and poor planning.Medicaid and the majority... Read more

LONG-TERM CARE:
Feds Pushing For LTC Financing Reform
Private pay may be the next wave for the industry.Long-term care providers that serve only... Read more

ENFORCEMENT WATCH:
NJ Provider On Hot Seat In Drug-Fraud Case
Rx-dispensation scam could lead to harsh penalties.Pharmaceutical providers should know th... Read more

HOME HEALTH:
Physicians Must Know Home Health CPO
OIG will come down hard on facilities that don't instruct docs.Home health providers shoul... Read more

BILL WATCH
The following bills were introduced in the Senate: S. 1489. A bill to amend the Public He... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 31

MEDICARE PART D:
Part D Sponsors Prep For Advertising 'Blitz'
Medicare plans with strong reps are in best market position.With the new Medicare drug ben... Read more

MEDICARE PART D:
Beneficiaries Confused About Part D Benefit
Lack of knowledge concerns industry insiders.Providers that are having trouble deciphering... Read more

MEDICAID:
Study Finds Elderly Patients Getting Subpar Care
Quality of care tethered to physician training, experience.Few elderly Medicaid patients r... Read more

SKILLED NURSING FACILITIES:
AHCA Doles Out SNF Financing Tips
Organization asks CMS for more level payment differential.The American Health Care Associa... Read more

HOSPITALS:
Cuts Cut Both Ways, Hurt Hospitals And Private Payers
Low Medicare, Medicaid payments force hospitals to overcharge commercial plans.Health plan... Read more

HOSPITALS:
Payment Increases Highlight Proposed OPPS Rule
Medicare patients could enjoy lower coinsurance rates for outpatient services.The Centers ... Read more

PAY-FOR-PERFORMANCE:
Docs Will Likely Have To Bend On P4P
Insiders cannot foresee a future without P4P measures.Washington observers say it's increa... Read more

DME:
Suppliers Now Allowed To Deliver Home Oximetry Tests
CMS reins in self-testing limits. Durable medical equipment suppliers will soon be able to... Read more

HOME HEALTH:
Day Care Demo Project Comes With Strings
Tab for transport, care must be paid by participating HHA.Details about the medical adult ... Read more

ENFORCEMENT WATCH:
Medicaid Patients Must Verify Home Health Claims
State AG pursues civil fraud lawsuit against a home health facility.Filing false home heal... Read more

HOME HEALTH:
CMS Says 2-Sheet Review Notices OK
... but providers better use carbonless paper to garner the required exception.New informa... Read more

BILL WATCH
The following bills were introduced in the Senate: S. 1563. A bill to amend title XIX of ... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 30

Medicaid:
States Under Microscope For Consultant Use
Senator wants states to provide information on contingency-fee payouts.Sen. Charles Grassl... Read more

Medicaid:
Leavitt Announces Who Will Shape Medicaid's Future
Advisory commission members don't represent all viewpoints, Baucus says.The Medicaid progr... Read more

Pay-for-Performance:
New House Bill Would Repeal Update Formula
Republicans, Democrats agree upcoming cuts are unacceptable. Instead of seven lean years s... Read more

Pharmaceuticals:
Rx Drug Guidance Available On Web
Outreach toolkit could make explaining coverage to benes easierPharmaceutical providers ca... Read more

Care Access:
Rural Health Care Not Sparse, According To Researchers
Are urban patients better off? A report says, 'Maybe not.'Any problems patients living in ... Read more

Rehab:
'Concierge Care' Causes Concern
Feds pay heavy scrutiny to claims for concierge services. More and more physicians have be... Read more

Rehab:
75-Percent Rule Not Here Yet
Some in Congress want to keep IRF compliance threshold at 50 percent.Rehab providers that ... Read more

Home Health:
PPS Could Get Boost Ahead Of Implementation
CMS wants 2.5-percent payout increase.There's some good news for home health agencies: The... Read more

Physicians:
'Bounty Hunters' Don't Yet Have Docs On Radar
Physicians must supervise nurse anesthetists in New Jersey.Physicians have been bracing th... Read more

Physicians:
CMS Offers Free IT To Doctors
But some question whether Medicare should push one solution over others. To all physicians... Read more

Enforcement Watch:
Prosecutors Punching Out Kickback Fraudsters
Undercover investigators could expose a prescription-drug fraud scamAny pharmacist who is ... Read more

Home Health:
CMS Backs Down On Expedited Review Certification
QIO can't furnish beneficiary risk certification required for review.The number of work-in... Read more

Bill Watch
The following bills were introduced in the Senate: S.1440. A bill to amen... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 29

PHYSICIANS:
Docs Can Dole Out DMEPOS-With Personal Touch
Beware of satellite offices that don't practice medicine.Physicians who are sending out re... Read more

PHYSICIANS:
Legislators Press CMS On Physician Payments
Nixing certain drugs from formula would help avoid steep cuts.Avoiding an estimated 31 per... Read more

MEDICARE PART D:
Drug Benefit May Harm More Than Help
'Clawback' payments could give states incentives to drop dual eligibles.Many low-income in... Read more

MEDICAID:
Congressional Hearings Examine Medicaid Waste
Grassley wants answers on overspending.The U.S. Senate has turned its attention to waste, ... Read more

PAY FOR PERFORMANCE:
AARP Fancies P4P Bill
...and no one should discount this organization's infulence.The powerful AARP has come out... Read more

PHARMACEUTICALS:
CAP Vendors-Too Much Trouble?
CMS refuses to recognize program's administrative burden.The Centers for Medicare and Medi... Read more

PHARMACEUTICALS:
Providers Frustrated By CMS CAP Get Relief
Now, doctors get a weeklong window to provide drugs.While it is far from a complete cave-i... Read more

REHAB:
Fight For Knee-Replacement Patients Could Start Soon
New rehab rule will set off a scramble among HHAs, SNFs and other facilities.The Centers f... Read more

LONG-TERM CARE:
LTC Providers Must Be Ready To Move On P4P
Pay attention to quality measures, or P4P transition will hurt more.If Medicare links reim... Read more

ENFORCEMENT WATCH:
Want Civil And Crimianl Fines? Commit Rx Drug Fraud
How an undercover MFCU investigator can expose a pharmacy fraud scheme.Providers that bill... Read more

MEDICARE ADVANTAGE:
MA's Mass Appeal Ascends As CMS Makes Adjustment
New out-of-pocket savings to benes makes plan popular in 2005.Medicare Advantage health pl... Read more

BILL WATCH
The following bills were introduced in the Senate: S. 1385. A bill to amend part A of titl... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 28

MEDICARE ADVANTAGE:
Plans May Struggle To Get Some MediGap Benes
Survey reveals seniors reticent to switch providers, even to save money.A new survey ... Read more

HOSPITALS:
There's More Than 1 Way To Get NPI Application
July 1 marked beginning of paper mail option.Providers that prefer the good old U.S. Post ... Read more

PAY-FOR-PERFORMANCE:
'MVP' Bill Could Spur P4P Incentives
New bill would facilitate the spread of quality incentives.A new bill could have a huge im... Read more

REHAB:
Post-Acute Care Payouts Could Be Changing
CMS wants to standardize clinical data collection across different service sites.Providers... Read more

MEDICAID:
Reps Rail Against Medicaid Drug System
Report says newer generics, AWPs are inflating drug costs.Judging by the tone of a recent ... Read more

LONG-TERM CARE:
Get Smart Before Part D Starts
Provider must educate Part D switchovers by autumn.The feds are intent on making waves wit... Read more

LONG-TERM CARE:
Industry Urges Cool-Headed Assessment Of Home Care
Experts recommend a look before the leap to different care settings.A rush to shift elder ... Read more

HOME HEALTH:
CMS Not Playing Hardball With Review Notices...Yet
Delivering the notice at the start of care is OK.The expedited review notice may be a crus... Read more

HOSPITALS:
Expanded Classification Criteria Could Ease Burdens
GAO greenlights IRFs' 75-percent compliance threshold.The government has decided that reha... Read more

ENFORCEMENT WATCH:
Mattress Scam Could Land Fraudster In Prison Bed
Why hiring Medicare and Medicaid beneficiary recruiters or marketers might not be wise.Sub... Read more

HOSPITALS:
AHQA Cries Foul On Latest JAMA Study
Medicare QIOs have no significant impact on quality of care, JAMA says.The American Health... Read more

BILL WATCH
The following bill was introduced in the Senate: S. 1329. A bill to amend the Internal Rev... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 27

MEDICARE DRUG BENEFIT:
CMS Demanding Extensive Formularies From PDPs
Some sponsors say government going back on its word.Could the Part D drug benefit wind up ... Read more

MEDICARE DRUG BENEFIT:
Still Plenty Of Room For Efficient PDPs To Profit
Strong step therapy program puts PDPs on payment path.Not everyone thinks the Centers for ... Read more

PHYSICIANS:
AMA Won't Say 'A-OK' To Any Substandard P4P
Physicians set 'principles' that will guide P4P decisions.Pay-For-Performance anxiety domi... Read more

PHARMACEUTICALS:
Dramatic Payment Drops Set For Common Drugs
New rates could hit hardest in smaller offices.Even though the Centers for Medicare and Me... Read more

SPECIALTY HOSPITALS:
Goodbye, Moratorium...Hello, Prohibitions
New set of restrictions parallel the just-lifted moratorium.Just as specialty hospitals we... Read more

HOME HEALTH:
It's A Mistake To Hold Onto That ABN
Delayed ABNs ignore the NEMB altogether.One of the biggest gray areas regarding the new ex... Read more

HOME HEALTH:
CMS Rolling Out Termination Notice Rule July 1
... but notices don't yet have that prime-time shine, experts protest.Home health agencies... Read more

HOSPITALS:
Start NPI Application Process Early
The new NPI will make life easier, but providers aren't spared the legwork.Hospitals that ... Read more

HOSPITALS:
CMS Extends Electronic Cost-Reporting Period
Transition period still possible for providers.Organ procurement organizations and rural h... Read more

ENFORCEMENT WATCH:
OIG Finds Fertile Fraud Hunting Grounds
HHS watchdog sniffs out 258 criminal actions in the first half of FY 2005.Providers, watch... Read more

HOSPITALS:
QIO Participation May Not Yield Improvements
Study finds no quality differences between participating and non-participating hospitals.A... Read more

BILL WATCH
The following bills were introduced in the Senate: S. 1277. A bill to amend title XVIII of... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 26

Pharmaceuticals:
Senators Want Drugmakers To Grant Them More Info
Baucus, Grassley asking questions about 'educational grants.'For years, major drug compani... Read more

Pharmaceuticals:
Doctors Welcome Competitive Drug Demo
Oncologists most likely to feel negative effects of new program.Some physicians are optimi... Read more

HOME HEALTH:
CMS Giveth, And Taketh Away, HHA Cost Report Victory
Favorable PRRB decision on therapist compensation won't last much longer.Home health agenc... Read more

Rehab:
HHA Therapy Threshold May Not Hold With New PPS
PPS tune-up will likely include big changes for therapists.The first overhaul of the prosp... Read more

Medicaid:
Studies Say Medicaid Shoulders Too Much Burden
Medicaid must ID high-cost benes, say researchers. As a special, presidentially-appointed ... Read more

DME:
Suppliers Moving Closer To Ambulation Standard
Mind the gap between NCD's effective and implementation dates.The Centers for Medicare and... Read more

Medicare Modernization Act:
Undocumented-Alien Treatments Could Land Pay
EMTALA funding available until 2008.Hospitals can receive direct payments from their state... Read more

Long-Term Care:
Long-Term Concerns For Medicaid Long-Term Care
Can Medicaid still fill the LTC coverage gap?With big changes in the government's healthca... Read more

Physicians:
Medicare Cards Must Match Other Patient ID
Don't neglect middle names, or claim may be shunned.Physicians in offices that doesn't alw... Read more

Enforcement Watch:
DOJ Doling Out Stiff Punishment In Deceased-Px Case
PA billing at a physician's rate facing a half-century in the big house. Submitting outpat... Read more

Hospitals:
CMS Looking To Change IPPS Billings
New medical services and technologies could bolster payments.Hospitals should watch for a ... Read more

Bill Watch
The following bills were introduced in the Senate: S. 1225. A bill to expand access t... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 25

Pharmaceuticals:
Medicare May Cut Ad Costs Out Of Drug Prices
Congress looking closer at advertising influence.Two senators want to reduce providers' Me... Read more

Rehab:
CMS To Show IRFs The Money In 2006
Aggregate pay increase could approach 3 percent.The Centers for Medicare and Medicaid Serv... Read more

DME:
New NCD For Mobile Equipment Still Causing Problems
'NCD' stands for 'No Clue what to Do' for many DME providers. The federal polic... Read more

Rehab:
Feds Take Umbrage With IRF Upcoding
CMS hints that IRFs are upcoding on a regular basis.The Centers for Medicare and Medicaid ... Read more

Medicaid:
Results Mixed For Coverage Expansion Proposals
Report: There's no magic wand to wave at all states' uninsured ratesUnder current federal ... Read more

Pharmaceuticals:
Plans, PBMs, Pharmacies Jockey For Part D Positioning
Are pharmacies raising rates for health plans?As the implementation of the prescription dr... Read more

Pharmaceuticals:
Demo Covers Recurrent Breast Cancer Drugs
Officials say there's lots of spots left in demo.Medicare has expanded the coverage ... Read more

Long-Term Care:
Let The Cat Out Of The Bag About CT Scans
How a scan can take money from an LTC provider's kitty when someone else should pony up.Lo... Read more

Long-Term Care:
QIOs Will Target Nursing Home Turnover
CMS wants turnover rate cut 15 percent before 2008.Quality improvement organizations will ... Read more

Enforcement Watch:
Medicaid Mistakes Put Feds In State Of Suspicion
OIG audit deems Illinois payment monitoring inadequate.Providers beware: If your sta... Read more

Home Health:
Expect Termination Notice Deadline To Stick
Short notice on new forms won't lead to leeway, say experts.Home health providers better b... Read more

Bill Watch
The following bill was introduced in the Senate: S. 1179. A bill to amend title SVII... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 24

HIPAA:
Compliance Changes Do Not Equal Relaxed Standards
HHS still expects providers to pay for non-compliant behavior.Providers that base their se... Read more

PHARMACEUTICALS:
E-Benefit Coordinaton To Coincide With New Rx Plan
NDCHealth to construct pharmacy-like electronic system for benes.The Centers for Medicare ... Read more

PHYSICIANS:
PPAC Calls For Physicians To Share In Care Rewards
Organization proposes transferring some Medicare savings to docs.When physicians do a good... Read more

LONG-TERM CARE:
House Subcommittee Checking Into Asset Transfers
Medicaid-sponsered nursing home care could get harder to obtain.Congressional leaders once... Read more

MEDICAID:
Reports-Benes Blighted By Increasing Costs
Out-of-pocket expenses getting out of control, says CBPP.It looks as if Medicaid beneficia... Read more

HOSPITALS:
Overcrowded EDs Could Become All Too Common
Recorded ED numbers may only be starting, ACEP warns.The president of a leading emergency ... Read more

HOSPITALS:
Specialty Hospitals Hearings See AMA, MedPAC Clash
Organizations disagree on specialty moratorium extension.Congress should end the moratoriu... Read more

HOSPITALS:
April OPPS Offers An Array Of Coding, Policy Changes
Use C9723 when reporting blood perfusion imaging to Medicare.Hospitals can anticipate paym... Read more

PHYSICIANS:
Bills Would Replace Cut With 2.7-Percent Boost
... but a permanent solution to physician payment woes may have to wait.Physicians could a... Read more

ENFORCEMENT WATCH:
OIG Eyes Suspicious Therapy Claims
Providers must meet all 10 medical necessity requirements.Make sure your home health thera... Read more

LABS:
Know Diagnostic From Screening For Testing Claims
If a screening is deemed medically unnecessary, Medicare will deny the claim.If labs don't... Read more

BILL WATCH
The following bills were introduced in the House: H.R. 2518. A bill to amend title XVIII o... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 23

MEDICAID:
Advisory Commission Causing Controversy
Skeptics scoffing at claims of bipartisanship.The new Medicaid advisory commission has a m... Read more

PHYSICIANS:
Consider The Source On Document Changes
Employees should be handled differently than outside entities.If an entity outside of a ph... Read more

PHYSICIANS:
Bariatric Surgery Benefits From New BMI Codes
... but most doctors don't list body mass index on patient's charts.Physicians' offices ha... Read more

PHYSICIANS:
Medicare Issues New Smoking Cessation Codes
... but acupuncture cannot stick a permanent code.Physicians who are gearing up to provide... Read more

HOSPITALS:
'Ghosting' Trend May Be Grafting Medicare
Outsourcing to other countries raises HIPAA questions, economic concerns.Now the growing o... Read more

MEDICARE ADVANTAGE:
MA Plans Wise To Target MediGap Purchasers
MediGap's rural route can lead to a gold mine of customers.Medicare Advantage plans lookin... Read more

ASC:
CMS Officially OKs Ciliary Destructions In ASCs
Procedure has long been covered, CMS reports.There's good news for ambulatory surgery cent... Read more

HOME HEALTH:
Hospital Transfer Policy Could Choke Off Referrals
CMS proposes reducing DRG payments for patients who go to home care.Home health agencies t... Read more

ACUTE CARE HOSPITALS:
Care-Transfer Payouts May Need Re-Transferring
Why the OIG wants CMS to collect millions in potential overpayments.Warning: Inaccurate di... Read more

ENFORCEMENT WATCH:
The Big Payback: OIG Says OK Owes For Overages
An audit of Medicaid billings proves costly for state.When the feds order hefty paybacks f... Read more

LONG-TERM CARE:
MedPAC Wants To Subtract Add-On Payments
Proposal would also nix inflation adjustment.Medicare revenues for long-term care provider... Read more

BILL WATCH
The following bills were introduced in the Senate: S. 1081. A bill to amend title XVIII of... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 22

ASC:
CMS Expands Procedure List By 60
More procedures will be covered in ASCs, and planned cuts are canceled.Pressure from ambul... Read more

Long-Term Care:
Report: Action Needed To Avert Geriatric Care Crisis
Payment system discourages medical students from geriatric path.While the U.S. population ... Read more

Long-Term Care:
Medicare Payments On Uptick Despite Debate
MedPAC's cautions all but ignored in new rule.The Medicare Payment Advisory Commission sus... Read more

Pharmaceuticals:
CAP Shouldn't Require Exact Date Of Drug Admin
Associations object to 'radical' change in drug-billing window.Now that the Centers for Me... Read more

Hospitals:
Hot Specialty Hospital Issue Just Got Hotter
New bill would prohibit physician investor increases in 'grandfathered' specialty hospital... Read more

Physicians:
RAC Letters May Slip Through The Cracks
CMS will try to contact providers when it sends letters.Given the high non-response rate t... Read more

Physicians:
Know How To Cope With Altered Documentation
Tips for action when someone makes unauthorized revisions.Physicians who suspect that some... Read more

Rehab:
75-Percent Rule Report May Up Admissions Scrutiny
Proposed refining of covered IRF diagnoses 'disappoints' some. The long-awaited repo... Read more

Rehab:
Medicare Clarifies Tricky Therapy Supervision Issue
Physician must certify plan of care each month.Providers confused about how to supervise t... Read more

Enforcement Watch:
Providers Blow It With Ihnalant Overpricing
Giving free samples and rebates to pharmacies? It's not the best idea.Defrauding Medicaid ... Read more

Home Health:
Associations Team Up To Alleviate OT Headaches
If CMS makes OT a qualifying service, scheduling could get a whole lot easier.A pair of tr... Read more

Bill Watch
The following bills were introduced in the House: H.R. 2257. A bill to amend title XVIII o... Read more

Rehab:
Medicare Seeing Vision Demo Through
Project will give rehab pros more equity. Later this year, the Centers for Medicare and M... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 21

HOSPITALS:
E/M Visit Levels Are Safe From RAC Scrutiny
... but CMS may examine medical necessity of the claims.Good news for hospitals: Medicare'... Read more

HOSPITALS:
Project Progressing: CMS Touts P4P Demo
3-year incentive project already improving care, says McClellan.The early word is good on ... Read more

HOME HEALTH:
Patient Discharge Rule Confounding - And Pending
Every discharged patient must be issued notice.A massive new paperwork mandate requiring H... Read more

HOME HEALTH:
Expect Deadline For Termination Notices To Hold
Despite confusion, don't bet on extension of July 1 deadline.In its final rule in the Nov.... Read more

PHYSICIANS:
Extra Scribbles Can Lead To Fines, Jail Time
Make sure doctors date all new entries on patient records.Physicians who suspect that some... Read more

PHARMACEUTICALS:
Rules For Multi-Drug Concurrent Infusion Vary By Area
The answer is hiding in carriers' local coverage decisions.The Centers for Medicare and Me... Read more

MEDICAID:
Budget Socks Medicaid With $10 Billion In Cuts
Clinton leads a group of vocal, displeased Dems. If the hard part was deciding whether to ... Read more

MEDICAID:
States Recommend Ways To Ease Medicaid Cuts
Could higher Medicaid copays be on the horizon?The National Governors Association and the ... Read more

LABS:
Providers Must Stay Posted On MSP Changes
Modifications could severely affect secondary payer rules.The last thing a lab needs is to... Read more

ENFORCEMENT WATCH:
Subsidiaries Cannot Sidestep Fraud Penalties
... Read more

REHAB:
Recent Report Could Mean More Admissions Scrutiny
GAO charges providers with 'sloppy' admissions practices - and fallout is expected.The lon... Read more

BILL WATCH
The following bills were introduced in the House: H.R. 2051. A bill to amend title XVIII o... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 20

HIPAA:
Providers Should Target PHI Mishaps For Extinction
Minor slip-ups can evolve into major legal issues.An employee's honest mistake can expose ... Read more

REHAB:
Meeting IRF Criteria A Must For Facilities
Compliance review periods governed by tricky CMS guidelines.Inpatient rehabilitation facil... Read more

INFUSIONS:
Infusion Confusion Gone, Thanks To CMS
Transmittal states: Use G0350 once per session.Providers who have been trying to squeeze t... Read more

PHYSICIANS:
Medicare Makes It Clear- Consults A 1-Doctor Affair
A consultation is a single physician's opinion, not a consensus.Consults are hard work, an... Read more

PHYSICIANS:
Double-Digit Spending Growth A Bad Omen For 2006
What's behind the skyrocketing payments?Physician spending rose a startling 15.2 percent i... Read more

REIMBURSEMENT:
AMA Revving Up RVU Review Engine
E/M services the focus as AMA looks at reimbursement rates.The AMA's Relative Value Update... Read more

HOSPITALS:
Hospital Organizations Say HSAs, HRAs Thriving
AHA and FAH say consumer-driven plan members will be equal.Participants in so-called consu... Read more

DME:
Inhalation Drug Denials Leave Many Suppliers Gasping
... but CMS pledges to set DMERCs straight on G codes.Durable medical equipment providers ... Read more

PHARMACEUTICALS:
Enzi Treads Cautiously On Rx Importation
HELP will 'do something,' senator promises.Sen. Mike Enzi (R-WY) said April 19 that his He... Read more

ENFORCEMENT WATCH:
DOJ Circles Fraud Ring, Prison Possible For Leader
Massive kickback network offers no safety in numbers.Just because a real physician wrote t... Read more

HOME HEALTH:
CMS Setting Sights On Medical Directors
Going overboard on number of directors raises a red flag. The newest compliance hotspot fo... Read more

BILL WATCH
The following bills were introduced in the Senate: S. 911. A bill to amend title XVIII of ... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 19

COMPLIANCE:
Compliance Statements Sate Hungry HIPAA Auditors
Providers can deal with possible HIPAA violations through 3 retaliatory methods.Preparing ... Read more

LABS:
How To Bounce Back From A CLIA Deficiency
Warning: All talk and no action could land a lab in hot water.A deficiency doesn't have to... Read more

DME:
Analysis Casts Doubt On Competitive Bidding Savings
Economist raises concerns about anti-competitive aspects of CMS initiative.Durable medical... Read more

PHYSICIANS:
Doctor's Scrawl Could Spell Doom For Practice
Trouble lurks when two out of three reviewers can't read handwriting. Illegible handwritin... Read more

APPEALS:
Prepare Now For Quicker 2006 Appeals Turnaround
Providers that don't learn new rules early could be sorry all next year.Starting this Janu... Read more

APPEALS:
Here's One Appeals Change Providers Should Notice
Medicare carriers will send appeal denial notes. Starting in January, when a Medicare carr... Read more

MEDICARE ADVANTAGE:
MedPAC- Remove Medicare Advantage Advantages
Commission wants MA benchmarks to line up with FFS costs.The Medicare Payment Advisory Com... Read more

COMPLIANCE:
Inform Patients Up Front To Avoid Payment Surprises
Denials shouldn't catch anyone off guard.Just because a provider knows that not every proc... Read more

HOSPITALS:
Hospital Association Raises NPI Questions
Many facilities still in dark about subpart IDs, other NPI issues.While physicians have be... Read more

ENFORCEMENT WATCH:
Bogus Diagnosis Scam May Send Physician Up River
Medicare nabs doc who treated nonexistent skin cancer ... repeatedly.Health care fraud goe... Read more

PHYSICIANS:
CMS Increases Physician Scarcity Area Incentives
Docs in critical access hospitals eligible for payout. If you are a physician whose county... Read more

BILL WATCH
The following bills were introduced in the House: HR 1729. A bill to amend title XVIII of ... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 18

PHYSICIANS:
Flu, Bioterror Fears Altering HHS Budget
Funding to fight potential outbreak has docs fretting.Members of a House appropriations su... Read more

MEDICAID:
Medicaid Commission Idea Has GOP Backers In House
Republicans push for removal of cuts, program study.Forty-four of his GOP colleagues are u... Read more

MEDICAID:
Caps? Medicaid Already Wearing Them
Advocates: More cuts could be coming, and the infirm will suffer.If Congress enacts a budg... Read more

HOSPITALS:
TAG May Make EMTALA Easier To Digest
Why EMTALA burdens could get lighter.The Emergency Medical Treatment and Active Labor Act ... Read more

PHARMACEUTICALS:
SPAPs That Want Preferred Drug Plans Out Of Luck
CMS nixes notion in March memo.State pharmacy assistance programs may not steer their low-... Read more

LABS:
Stay Atop MSP Rules, Avoid Medicare's Doghouse
MSP modifications could bring big changes.The last thing a lab needs is to be singled out ... Read more

COVERAGE:
X-Rays By A Chiro? CMS May Soon Have Your Back
How a new chiropractic demo could help labs.Getting paid for x-rays, MRIs and CT scans ord... Read more

APPEALS:
Medicare System Still On Schedule For Update
Here's how to catch up with the new appeals process.The Centers For Medicare and Medicaid ... Read more

HOME HEALTH:
Suck It Up- Lower Oxygen Rates A Reality
Previously paid claims will not be retro-adjusted.Oxygen suppliers who were holding their ... Read more

ENFORCEMENT WATCH:
High Admin Costs Will Atrract Curious Auditors
The feds don't limit billing investigations to medical procedure claims. Medicare say... Read more

POLICY REFORM:
Calling All NCD Critics- Medicare Wants Your Input
CMS seeking feedback in effort to fine-tune NCD process.Providers interested in being hear... Read more

BILL WATCH
The following bills were introduced in the House: HR. 1572. A bill to amend title XVIII of... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 17

Appeals:
Medicare Appeals Changes Coming
Strict new protocols highlight alterations.If you're a provider who has gotten used to fle... Read more

Compliance:
Prove Consults With A Written Request
Safety first: Get some kind of documentation on consult request for patient record.Last Se... Read more

Compliance:
In-House Consult Forms Make Good Sense
Docs can protect practices with standard consult sheet.Some consultants do recommend that ... Read more

Physicians:
Incident-to Rule- To Be Or Not To Be?
CMS decides something's rotten in state of Transmittal 20. Physicians who have been relyin... Read more

Disease Management:
Disease Management Demo Projects In Effect
One provider set to sign up 30,000 beneficiaries.If you are a provider frustrated by deali... Read more

Coverage:
Listen To This Good News About Cochlear Implants
Also, triple-threat drug combo will target nausea and vomiting.Medicare expanded its cover... Read more

Hospitals:
Survey- Hospitals Pay Better Than ASCs
Could Medicare save a billion by utilizing ASCs more?Medicare pays much less for the same ... Read more

Medicare Advantage:
2006 MA Pay Hike Not As Steep As Past Years
... but MA plans will still get a bumpMedicare Advantage private health plans will get a 4... Read more

Medicaid:
New York Plan Could Set National Trend
State passes very fashionable Medicaid proposal.An influential Medicaid reform plan in the... Read more

Enforcement Watch:
A Few Bad Apples Ruining It For All DME Providers
DME dealer got wheelchair money - but didn't give her customers wheelchairs. Despite the c... Read more

Rehab:
Therapists Cheer Physician Self-Referral Scrutiny
Congressional proposals could mean more business for therapists.Therapy providers who've b... Read more

Bill Watch
The following bills were introduced in the Senate: S. 708. A bill to amend title XVIII of ... Read more

Physicians:
AMA Sounds Alarm Bells Concerning Senior Access
Organization says if Congress cuts payout, docs will cut Medicare patient loads.Senior cit... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 16

PHARMACEUTICALS:
Medicare Slashes Drugs By Up To 60 Percent
But some drugs may actually get a payment bump.Any providers pining for Medicare payments ... Read more

PHYSICIANS:
Show Septis, Then Bill For Septic Shock
Clarifications, not new codes, highlight ICD-9 changes.If you're a physician treating a pa... Read more

MEDICARE:
CMS Studying Increase In Physician Spending On Part B Premiums
Intense office visits a cause for increase.Unfortunately for beneficiaries, it appears the... Read more

COVERAGE:
LOCM Get New Code Set
CMS unveiled Q codes in March.Providers who routinely bill for low osmolar contrast materi... Read more

HOME HEALTH:
CPO Change Provides Good Marketing Ammo
Contact docs now to let them in on a new way to make money.It's final: Physician practices... Read more

MEDICARE:
Rising Costs Will Eventually Price Beneficiaries Out
It's unavoidable, as health-care costs rise faster than U.S. earnings.Over the long term, ... Read more

MEDICAID:
What's Up For Medicaid When Congress Returns?
Good question: Here's what a couple insiders had to say.As Congress adjourned for its spri... Read more

COVERAGE:
Big Change Coming In Medicare Payments
... Read more

COMPLIANCE:
CMS Issues Its First Draft Of NCD
Increased access to CMS staff a priority.The Centers for Medicare and Medicaid Services ha... Read more

ENFORCEMENT WATCH:
DOJ Says WV Hospitals Too Close For Comfort
Why being bosom buddies with another facility is unlikely to result in good times.Hospital... Read more

MEDICARE MODERNIZATION ACT:
SPAPs Can Still Coordinate Aid With Medicare Benefit
But the SPAP must be 'qualified' to be kosher.Those unanswered questions on the Medicare M... Read more

PHYSICIANS:
CoP Out Or Compassion? CMS Wants To Rein In Regs
Proposed rule will allow docs to focus more time on patients.If you're a physician who fee... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 15

MEDICARE ADVANTAGE:
Who Gets To Keep Medicare Savings: Health Plans Or The Government
Money still headed to MAs, says Prez.President Bush's fiscal year 2005 budget proposal wou... Read more

PHYSICIANS:
What Reimbursement Will Look Like In The Future
Johnson still pushing for SGR repeal.At a March 15 hearing, Rep. Nancy Johnson (R-CT) cont... Read more

DRUG BENEFIT:
PDP Sponsors Face Pricing Challenges
Projected enrollment tied to national average.According to information presented by Medica... Read more

LONG-TERM CARE:
SNFs, HHAs May Need System Upgrades
CMS says long-term care industry not ready for new reporting software. Alert to all nursin... Read more

DRUG BENEFIT:
Rx Plans May Target Dual Eligibles
Plans, PBMs looking at automatic enrollees first.Uncertainty surrounds many facets of Medi... Read more

PHYSICIANS:
Patients Regained Lost Ground In Medicare Physician Access Struggle
But patients may be getting used to long waits for treatment.Medicare patients lost the ab... Read more

PHYSICIANS:
To Avoid Audits, Show MDM Thought Process
Physicians can improve documentation by following these tips.A physician's operative notes... Read more

HOME HEALTH:
Outpatient Therapy Loses Home Health Payment Battles
Before treatment begins, ask the patient if he is under HHA care already.Therapists who tr... Read more

COMPLIANCE:
These Expert Compliance Tips Lead To Peace of Mind
Compliance plans can make all the difference - here's how to get started.In its 2005 work ... Read more

ENFORCEMENT WATCH:
Avoid These Disastrous Supplier Pitfalls
This fraudster's plight shines big and bright ... deep in the heart of Texas.Durable medic... Read more

LABS:
Labs Should Ramp Up Diabetes Screening Tests
Billing at least once per year for all patients now allowed.The Medicare Modernization Act... Read more

BILL WATCH
The following bills were introduced in the House: HR. 1410. A bill to provide for cov... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 14

MEDICARE:
For AMA, McClellan Puts Some Pills In Sugar
CMS administrator hopes docs come around on P4P.Speaking to the American Medical Associati... Read more

HIPAA:
HIPAA Hopping Up Its Security Rules Soon
Providers unprepared by deadline may pass muster with a compliance plan.The April 20 deadl... Read more

MEDICAL IMAGING:
Johnson On Imaging: Who Says More Is Bad?
More use might not mean overuse, some say.The Medicare Payment Advisory Commission says Me... Read more

REHAB:
Sound PAI Practices Can Make OIG Happy
Avoid these widespread FIM scoring errors.The word is out that the Office of the Inspector... Read more

REHAB:
OIG Set For PAI Crackdown In 2005
The feds are focusing on PAI documentation.The patient assessment instrument (PAI) may see... Read more

COVERAGE:
Don't Stick Patients For Services Medicare May Pay For
Watch for gray areas of services Medicare may or may not cover.Medical practices that char... Read more

PHYSICIANS:
OIG Tracking ICD Patients
Implantable defibrillators must be registered.Medicare patients who receive an ICD or repl... Read more

COVERAGE:
Part A-Part B Union Memo Forthcoming
Many existing contractors could be replaced.CMS issued a fact sheet on its reform to repla... Read more

ENFORCEMENT:
Quality-Of-Care Lapses Cost Wisconsin Home
Relaxed staffing requirements lead to record settlement.A resident's death can put a nursi... Read more

PHYSICIANS:
GAO- Expense Indices Don't Always Reflect Real Costs
Old wage data throws off calculations.If you are a physician frustrated by the geographic ... Read more

BILL WATCH
Bills introduced in the House:HR. 1280. A bill to amend Part C of the Title XVIII of the S... Read more

LEGISLATION:
Senate Subs Medicaid Commission For Cuts
Dems all vote 'yea' for resolution.In a 52-48 March 17 vote, the Senate stripped $14 billi... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 13

HOSPITALS:
Physician-Owned Hospital Payments Might Fall After DRG Changes
Moratorium likely to last until 2007.Do physician-owned hospitals that focus on one narrow... Read more

HIPAA:
HIPAA Error? You'll Hear From Carriers
Unsuccessful crossover claims will prompt auto notice.Starting July 5, Medicare contractor... Read more

APPEALS:
New Complex Procedures Appeals Rule May Make Physicians Dizzy
Decide in advance what kind of representation to offer.Appealing claims next year could be... Read more

LONG-TERM CARE:
LTC Industry Challenges MedPAC On Recommendations
Stingy inflation policy threatens quality care.Long-term care industry groups are taking a... Read more

DRUG COVERAGE:
MMA Steps Up Screening Test Coverage
But Medicare wants a V code, not a G code, when reporting a screening.Physicians now have ... Read more

PHYSICIANS:
Count On Local Carriers For Least Costly Policy Fixes
PPAC: CMS to remove drugs from update formula retroactively.Least costly alternative polic... Read more

COVERAGE:
CMS Expands Defibrillator Coverage
Transmittal states Medicare HMO patients can get fee-for-service devices.Patients should b... Read more

COVERAGE:
Currently, Not All Physicians Enamored With P4P Proposal
P4P must be voluntary, docs contend.The pay-for-performance movement seems well on its way... Read more

ENFORCEMENT:
Transport Owner Sidelined 7 Years
Getaway effort by provider no match for law's long arm.Providers caught in the crosshairs ... Read more

HOSPITALS:
Note These OPPS Changes To Avoid Future Trouble
Make sure you're billing correctly for mammographies, observation.If your facility is rece... Read more

LABS:
CMS Alters C-Peptide Test Requirement
Lower limit is key.For services performed on or after Dec. 17, 2004, a positive fasting be... Read more

BILL WATCH
The following bills were introduced in the House:HR. 1166. A bill to amend title XVIII of ... Read more

PHYSICIANS:
'Medically Unbelievable' Edits Put On Hold
No explanation for revocation.The Centers for Medicare and Medicaid Services has rescinded... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 12

Coverage:
MedPAC Wants Congress to Act on P4P
... but don't expect a Congressional rush to judgement on issue.Whether or not Congress fo... Read more

Coverage:
Providers Still Wary of P4P System
Most payers feel system must be mandatory to work.MedPAC, private insurers, CMS, many heal... Read more

LEGISLATION:
MedPAC Pictures Payment Increase For Imaging
Some claim radiology will be lone beneficiary of plan.The Medicare Payment Advisory Commis... Read more

Drug Coverage:
Dual Eligibles Facing Potential Coverage Lapses
McClellan: Coverage continuity for duals a priority during switch. Without a transition pe... Read more

Physicians:
CMS Proposes Admin-Only Drug Billing
Vendor would bill for drugs, collect deductibles.If a new proposal from Medicare is approv... Read more

Compliance:
Opinions Don't Mean Gainsharing's Got The Go-Ahead
OIG says gainsharing still a compliance concern.The HHS Office of Inspector General has no... Read more

Medicaid:
Politicians Primed For Medicaid Reduction Talks
State, federal lawmakers want to rein in Medicaid spending.Usually, one good way to clear ... Read more

Enforcement Watch:
Get MDM Descriptors From Providers Before Audit
Physician practices' MDM levels will be in auditor's crosshairs.When Medicare sends audito... Read more

Radiology:
Providers Celebrate CPT Codes For PET Scans
Getting paid for PET scans about to get easier. Providers are cheering the Centers fo... Read more

BILL WATCH
The following bills were introduced in the House: HR. 1016. A bill to amend title XVIII of... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 11

Health Plans:
CMS Happy With Local Medicare Plan Applications
But are regional plan numbers a bad omen for rural patients?The Centers for Medicare and M... Read more

Health Spending:
Expect Scrutiny Of Health Prices As Spending Continues Upward
Growth rate is considerably higher than projected growth for the U.S. economy overall On a... Read more

Long-Term Care:
Providers May Have To Swallow Costlier Meds In 2006
Upside: New HEDIS standards say drugs shouldn't have been included in the first place The ... Read more

Legislation:
States Struggling For Ways To Cover Working Uninsured
Medicaid threatened by decline in employer coverage for lower-income workers Even as state... Read more

Physicians:
Chemotherapy Reimbursement Not Covering $144 Million Cost
If oncology practices feel short-changed, it may be for a reasonChemotherapy administratio... Read more

Laboratories:
Its Time To Ramp Up Diabetes Screening Tests
Now labs can bill at least once per year for all patientsThe Medicare Modernization Act (M... Read more

DME:
Share Power Mobility Denial Pain With CMS
Region B represents a particular problem, some suppliers sayFrustrated over inexplicable d... Read more

Home Health:
CMS Whittles Home Health Compare Measures To 10
Risk adjustment problems keep 5 NQF-endorsed standards on the sidelines.Home health provid... Read more

Enforcement:
Don't Let Networking Weave A Tangled Web
Watch for tactics that build provider alliances-but sabotage complianceThe owner of severa... Read more

Long-Term Care:
How CMS Plans To Make Staffing Choices Safer
OIG: Nurse aid registries are coming up short on the factsFacilities that rely on state nu... Read more

BILL WATCH
The following bills were introduced in the Senate: S. 437. A bill to amend titles XVIII of... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 10

REIMBURSEMENT - MedPAC:
Set Medicare Doc Pay Updates Based On Pay Adequacy
Find out what's on deck if SGR formula gets scrappedThe Medicare Payment Advisory Commissi... Read more

LONG TERM CARE:
These Common PPS Oversights Could Cost Thousands
Clear communication is vital to keeping per diem costs in line Don't wait to l... Read more

LEGISLATION:
On Medicaid, Finance Crowd Is Tough For Leavitt
States not likely to take cuts lying downAt a Feb. 16 Senate Finance Committee hearing, se... Read more

PHARMACEUTICALS:
Medco Says It Will Apply To Be A Nationwide PDP
No word on how much risk PBM is willing to shoulder Presenting a valentine to the Bush adm... Read more

PHYSICIANS:
Waiving Copays Too Much Could Wave A Red Flag
11 tips for avoiding indigent patient woesWith health care costs skyrocketing, demanding 2... Read more

LEGISLATION:
Senate Budget Committee Wishes It Were Senate Finance Committee.
Lawmakers' hopes to spare Medicaid may be too little, too lateAt a Senate Budget Com... Read more

HOSPITALS:
A Fail-Safe Way To Reward Docs Who Save You Money
Caution: You'll need careful planning and plenty of oversightArrangements that allow hospi... Read more

REHAB:
New Resource Illuminates 75 Percent Rule Enforcement
Take heart: If FIs sell you short, the decision can be appealedMany providers are still sc... Read more

ENFORCEMENT:
Your Trading Partners' Help Could Backfire
Alleged deals to win business cost two companies more than $45 millionThe feds' unde... Read more

BILL WATCH
The following bills were introduced in the House: H.R. 712. A bill to require the establis... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 9

COVERAGE:
Get Ready For $142 Billion In Coverage, $82 Billion New
What CMS plans to do once Medicaid savings come rolling inPresident Bush's fiscal year 200... Read more

LEGISLATION:
Bush Budget Mum On Medicare Cuts
But new figures from White House may fan the flames of ongoing struggleWith Congress in se... Read more

REIMBURSEMENT:
House Will Wade Into Doc Pay Issue, But Next Steps Are Unclear
SGR system may be broken, but will pay for performance solve the problem?House health lead... Read more

REIMBURSEMENT:
Rollbacks In Doctor Pay No Barrier To Patients
One more reason why access concerns won't sway CMSWhile payments under the physician fee s... Read more

LONG-TERM CARE:
Future May Brighten For Blood Glucose Monitoring Claims
Review of related policy could boost funding for careWish Medicare Part B was more generou... Read more

PHYSICIANS:
Ordering DME Becomes Easier - But More Fraught With Danger
Why doctors need to know who has control over the office's certificate stampCMS has decide... Read more

HEALTH PLANS:
How To Find The Best Medicaid Markets
Every state has its own rules, so chances for success will differ widelyAny health plan th... Read more

LEGISLATION:
Say Goodbye to FIs, And Hello To MACs
Congress inspects blueprints for new claims payment contractorsThe days of doing business ... Read more

PHYSICIANS:
4 Ways Medicare Could Make Doctors' Jobs Easier
ACP says current restructuring won't do enough to breach 'quality chasm'Despite talk of bi... Read more

HOME HEALTH:
President's Budget Proposal Leaves HHAs Alone
Big Medicaid cuts on the horizon, but Administration pushes home carePresident Bush's budg... Read more

BILL WATCH
The following bills were introduced in the House: H.R. 655. A bill to amend Part D of titl... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 8

Medicaid:
Leavitt Calls For $60 Billion In Medicaid Savings
But the Bush administration wants to rein in even more, insiders say The time for major ch... Read more

Medicaid:
To Cap, Or Not To Cap - Or Have Congress Do It
To fulfill promise of $60 billion, there may be no other waySpeaking to reporters Feb. 2 a... Read more

Health Plans:
Managed Care Faces New Opportunities In Medicaid
Market heats up as more states look to private plans for help.The economy is still sour, m... Read more

Health Plans:
3 Biggest Challenges To Winning At Medicaid
Plan for these hurdles in advance to assure successA growing number of governors - such as... Read more

Physicians:
Don't Let 'Welcome To Medicare' Exam Wear Out Its Welcome
3 tips guard against glitches when providing this new service Medicare's new initial exam ... Read more

Home Health:
How To Make The Most Of Managed Care Rise
Medicare issues final regulations on 'Medicare Advantage' MCOsTo industry veterans, the ri... Read more

Pharmaceuticals:
NLRC Opposes Medicare Rx Bargaining
Right-to-Life Agenda may be broader than you might think.At a Jan. 24 press conference mar... Read more

Physicians:
Will The Federal Government Offer States P4P For Medicaid?
New standards may already be underwayWho's next in the barrel for pay for performance? It ... Read more

HOSPITALS:
Congress Gets Ready to Pat Down Financial Arrangements
Hospitals, IGT schemes are lightening states' load - but forcing government to pay moreOng... Read more

LEGISLATION:
Broad Assault Coming On Health Costs - Or Else
Find out what budget-saving tricks are up CMS' sleeve Neither Medicare nor the American he... Read more

BILL WATCH
The following bills were introduced in the House: H.R. 467. A bill to amend title XVIII of... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 7

REIMBURSEMENT:
For Rural Docs, They Really Are Green Acres
But is CMS' geographic adjustment hurting more than it helps?Taking into account geographi... Read more

MEDICAID:
Leavett, Senators Debate Merits Of Medicaid
Democrats weigh on benefits of 'flawed' programDuring lengthy appearances before the Senat... Read more

LEGISLATION:
With Little Room On Congress' Agenda, Is 2005 The Year Of I.T.?
Leaders on both sides of the aisle get ready to hammer out details of shared goalWhen Sena... Read more

PHARMACEUTICALS:
Leavett Gets HHS Post, Dorgan Gets Reimportation Hearing
Confirmation carries small consolation prize for someIn a Jan. 26 voice vote, the Senate c... Read more

PHYSICIANS:
Brace For A New Layer Of Audits
New contractors will have docs in their crosshairsFor doctors who didn't think they were b... Read more

PHYSICIANS:
CMS Puts E-Prescribing On The Fast Track
McClellan says agency wants widespread use 'as soon as possible'To make good on the Bush a... Read more

LEGISLATION:
Congress Won't Have Time To Fix Physician Payment Mess
Why another year of better pay could signal bad news for the long haulTo avoid a looming 5... Read more

RADIOLOGY:
Imagine New Red Tape Around Imaging Services
New standards, self-referral rules could stymie non-radiologistsIn its March report to Con... Read more

HEALTH PLANS:
How To Stay In The Program In 2006
Interested plans need to jump several administrative hurdles, and time is running out.The ... Read more

REIMBURSEMENT:
Get Up To Speed On CMS' Improved Appeals Procedures
Surprise: New changes could actually make life easier for providersGetting in the loop on ... Read more

DME:
Coming Oxygen Cuts Could Hurt Industry
But DME suppliers are no stranger to fiscal painOxygen cuts to Federal Employee Health Ben... Read more

BILL WATCH
The following bills were introduced in the House: HR. 376. A bill to amend title XVIII of... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 6

Drug Coverage:
Employer Participation Facilitated In Final Rule
CMS tries to smooth out wrinkles in retiree drug benefitsThe final edition of Medicare's r... Read more

Drug Coverage:
Auto-Enrollment May Ease Transition For Dual Eligibles
But no such luck for the lowest-income patients Beneficiaries dually eligible for both Med... Read more

Medicaid:
Leavitt Dodges Questions On Medicaid Caps
Pressure from Congressional leaders turns up few hints about administration's plansWill th... Read more

Health Plans:
Formulary Regs Open The Playing Field For Health Plans
New guidelines should be easier to swallow as plans gear up for Medicare Part DIf health p... Read more

Physicians:
Doctors Are Managing More Complex Patients, But E/M Payments Remain Stingy
Old-school E/M levels short-change docs in today's worldMedicare is doling out 1992-... Read more

Pharmaceuticals:
Leavitt: Let Market, Not HHS, Set Medicare Rx Prices
Congressional leaders press for answers on who should wrangle with big pharmaMichael Leavi... Read more

Long-Term Care:
3 Ways To Keep Unplanned Bills From Sinking The Ship
Batten down the consolidated billing hatches to secure profits, improved patient careFaili... Read more

Enforcement Watch:
Billing Practices That Could Disable Rehab Facilities
Why one company will end up doling out hundreds of millions to the fedsAttention, hospital... Read more

Oncology:
Should You Be Wary Of Proposed Clinical Trial?
ACCC Warning: NCD process is not the right way to address need for more dataClinical trial... Read more

Physicians:
Faulty Consultant Advice Can Cost Doctors Thousands
7 ways practices can stay protectedMany health care providers enlist the help of consultan... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 5

Reimbursement:
MedPAC To Recommend Skimpy Or No 2006 Updates For Providers
Over the past several years, numerous congressional Republicans have grumbled that the Med... Read more

Hospitals:
Specialty Hospital Moratorium May Continue
MedPAC: DRG scheme still riddled with financial incentives The Medicare Payment Advi... Read more

Hospitals:
How To Keep Your Charitable Gifts From Backfiring
Could your good intentions get misconstrued as kickbacks? Find outDonating to tax-exempt o... Read more

Drug Coverage:
Big Risks Await Those Who Offer Medicare PDPs
Prescription drug plans will be unlike anything health plans or PBMs have offered beforeMe... Read more

Reimbursement:
Don't Bill Unless Patient Info Is Correct - And Complete
Some carriers are asking for middle initials, other dataFrequently, physicians may perform... Read more

Drug Coverage:
Voters Still Unconvinced About Medicare Drug Benefit
CMS could face serious shortfall of enrolleesA new survey reveals that Americans know next... Read more

Labs:
Competitive Bidding On The Horizon: Labs Get Ready
As CMS's demonstration project ramps up, every lab should be calling WashingtonMedicare is... Read more

Enforcement Watch:
The Road To Compliance Is Paved With Good Intentions
Why federal appeals court allowed office manager some distance from doctor's crimeHo... Read more

Labs:
Demonstration Project For Lab Services: Just The Facts
The lowdown on how it started, and what to expectOn December 8, 2003, President Bush signe... Read more

Physicians:
Malpractice Insurance Subsidy Passes OIG Muster
Skyrocketing malpractice costs require drastic measuresA hospital facing a severe shortage... Read more

Pharmaceuticals:
Pharmas Offer Version of Together Rx To Younger Folks
Ten major drug companies are collaborating on a new card they say will provide discounts r... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 4

Physicians:
Docs Kissed Nearly $1 Billion Goodbye In 2004
But the AMA doesn't want to tinker with E/M coding againPhysicians are losing thousands of... Read more

Physicians:
Docs Could Be Selling Themselves Short
14.4 percent of claims could have supported higher-paying codes.For 14.4 percent of claims... Read more

Legislation:
Reductions Could Hit Medicare & Medicaid, Staffers Warn
Times are tight for the federal government, and that will affect providers of all stripes.... Read more

Rehab:
Sharpened Medical Necessity Focus Could Cripple IRFs
Newly enforced requirement comes as a surprise to many.Medicare's fiscal intermediaries ha... Read more

Coverage:
Medicare Pumps Up Insulin Coverage
Older patients can now benefit from stem cell transplants.The Centers for Medicare & M... Read more

Drug Coverage:
Plans And PBMs Cheer, Big Pharma Jeers Guidelines
CMS chooses a compromise for the new Part D formulary.On Jan. 3, the United States Pharmac... Read more

Enforcement Watch:
Feds Crack Down On Vaccine Billing Errors
Investigation turns costly for two CT pediatric practices.Practices that regularly submit ... Read more

Medicaid:
Governors Wary Of Too Much Change On Medicaid
But the federal government is searching for ways to cut budgets.President Bush's choice of... Read more

Bill Watch
The following bills were introduced in the House: HR 5393. A bill to amend title XVIII of ... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 3

Surgery:
ASCs Win Some, Lose Many Covered Procedures
100 procedures will be kosher in offices, but no longer in ASCs, if CMS gets its way.The A... Read more

Hospitals:
Hospitals Due For Some Pay Hikes
Revamps to requirements for diagnostic tests mean more reimbursement.Hospitals can ring in... Read more

Rehab:
OIG Increasing Scrutiny Of Wound Care
PPOs can hold the key to rehab programs' success.Providers interested in opening an outpat... Read more

Compliance:
Flat-Fee Billing Contracts Could Reduce Risk
Learn to recognize these danger signs in your billing company contracts.If you're paying y... Read more

Oncology:
Drug Admin Codes Hit With Thousands Of Edits
Prepare to justify using E/M codes with hydration or chemotherapy.The new drug administrat... Read more

Coverage:
Wheelchair Coverage Rolls Out Of Dark Ages
Change would dump bed- or chair-confined standard in favor of functional ambulation. A ray... Read more

Physicians:
Has The Sustainable Growth Rate Outlived Its Usefulness?
You could be paying the price for federal accountants' errorsAccording to the Government A... Read more

Rehab:
Interrupted Stays, Transfers Foiling Rehab Audits
CMS' three-day 'window' can make or break rehab facilities' billing.The HHS Office of Insp... Read more

Oncology:
Accountability Office Can't Count, Docs Charge
Oncologists should be able to afford the new, reduced payments for medications that take e... Read more

Hospice:
Docs Can't Double-Counsel On Hospice Care
A physician who wants to perform an initial consultation with a patient who is going into ... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 2

PHYSICIANS:
Goodies In Fee Schedule Could Make Docs An OIG Target
Physicians should watch out for pitfalls in new demo project, PT provision. The 2005 Phys... Read more

PHYSICIANS:
Medicare Should Raise Prices Retroactively For Pricey Drugs, Physician Group Says
Docs don't understand differences between observation, inpatient admission The Centers for... Read more

REHAB:
Therapists Haven't Won Direct Access - Yet
Here's why therapists still have hope for the future. Therapists hoping for direct access ... Read more

HEALTH PLANS:
New Region Regs Create Winners And Losers, Depending On Location
But the real test will come when CMS releases payment information next month. Health plans... Read more

PEOPLE:
Will Changes At The Top Hinder Medicare Reform?
Unfinished business with the MMA casts a shadow over appointments. Health and Human Servic... Read more

HOSPITALS:
The Right Way To Report Wage Data
Target these problem areas to keep the OIG-and other facilities-off your back. If a facili... Read more

HOSPITALS:
Payments Are Iffy For Residents In Nonhospital Settings
Here's which reimbursement rules are still up for consideration. Good news, hospitals... Read more

PHYSICIANS:
Least Costly Alternative' Could Cost Docs A Bundle
And 'pool leakage' soaks surgeons for $60 million. Some carriers are going haywire with ov... Read more

COMPLIANCE:
Give Your Input On Kickback Regs
It's that time of year again - to voice your ideas on anti-kickback safe harbors and new s... Read more

PROGRAM TRANSMITTAL ROUNDUP
The Centers for Medicare & Medicaid Services said in an Oct. 29 transmittal (CR 3551) ... Read more

ENFORCEMENT WATCH:
Teaching Hospitals Need To Brush Up On Supervision Rules
Feds bring $2.2 million lesson to California university. Services provided by residents an... Read more

Medicare Compliance & Reimbursement - 2005; Volume 31, Number 1

REHAB:
Final Fee Schedule Offers Two Boons For Therapists
Find out what the rehab industry can expect in 2005. Sometimes CMS gives with one hand wh... Read more

PRESCRIPTION DRUGS:
More Drugs? Fewer Drugs? Formulary Debate Rages On
Health plans and pharmaceutical companies in high-stakes, big-dollar clash As the countdow... Read more

QUALITY:
Medicare Inching Towards Paying Incentives
Talk continues of including pay-for-performance measures. Everybody wants to reward physic... Read more

LONG-TERM CARE:
When Can SNFs Get Paid For Glucose Monitoring?
CMS' latest guidance answers questions on when to expect payment- or denials. The most fre... Read more

PHYSICIANS:
New Codes Split Components Of Flow Cytometry
CMS slashes roughly $200 from interpretation code. Changes to the physician fee schedule c... Read more

HOSPTIALS:
List Of Covered Procedures Just Got Shorter
Find out what the two-year review of the ASC list means for hospitals. The Centers for Med... Read more

ENFORCEMENT WATCH:
Feds Are Cracking Down On Transfer Coding Errors
Relatively small settlements not deterring investigations. The Department of Health and Hu... Read more

LABS:
Could Dialysis Arrangements Put Labs At Risk?
Providing services and supplies on the house invites kickback troubles. If you want to hel... Read more

REHAB:
Ensure Co-Treatment Doesn't Lead To Double-Billing
Warning: CMS is on the lookout for providers who team up and game the system. If you prov... Read more

DME:
Feds Going Undercover To Catch DME Fraudsters
Companies that take pains to abide by Medicare regulations may have already averted a disa... Read more

Available Years: 2005 2004 2003