Medicare Compliance & Reimbursement

Plus:  Seniors not afraid of information overload on important health issues.

As promised, President Bush signed an executive order calling on government agencies to track health care quality and costs. But the order didn't spell out how the government will reimburse providers for the costs of providing this information.

Rather, the order asks the Department of Health and Human Services (HHS) and three other agencies to collect information on the quality and costs of health care they provide. Bush directed that the agencies should share that data with each other, according to the Washington Post.

HHS and the other agencies will work with the private sector and other government agencies to develop programs to measure quality of care. They'll also try to identify practices that lead to high-quality care. In addition, the order calls for the agencies to use interoperable health records wherever possible and to compile information on the prices they pay for common services.

Bush said the order sends a message to providers: "In order to do business with the federal government, you've got to show us your prices." But doctors warned that forcing them to be transparent about prices might not work because the government and health plans set prices for doctors. The agencies must have the programs in place by Jan. 1, 2007.

Seniors Say: We're Not So Worried About Money--But Help Us Beat Alzheimer's

In another sign that baby-boomer thinking is pushing aside earlier-generation thinking, good health is a bigger concern for seniors than financial security, according a recent survey sponsored by SecureHorizons, United HealthCare's new insurance brand for seniors.

Sixty-nine percent of seniors SecureHorizons surveyed were concerned about their health and well-being, while only 52 percent reported being concerned about their finances. Market Strategies, Inc. conducted the survey. They interviewed 750 seniors, ages 63 through 80, in 10 markets and claim a statistical precision of +/- 4.9 percentage points at the 95 percent confidence level.

A high percentage of respondents are hungry for health care information--80 percent reported they keep up-to-date on health news. Seniors still depend primarily on their physicians for information and advice (43 percent), but more seniors, especially younger ones, are going to the Internet for answers. The message here is to provide access to health information in all forms: Internet, TV, magazines, booklets, mailings and person-to-person, through physicians.

The results suggest that you would profit from focusing your education and marketing efforts on wellness programs and preventative care to head off Alzheimer's disease. Fifty-nine percent of those surveyed worried about maintaining mental sharpness, compared with only 32 percent concerned about depression.

In Other News...

• The requirement for physicians to see patients face-to-face before prescribing power mobility devices (PMDs) such as wheelchairs doesn't apply to cases where the doctor is only prescribing wheelchair accessories, the Centers for Medicare & Medicaid Services (CMS) says in Transmittal 156, dated Aug. 18. Also, the doctor doesn't have to see the patient face-to-face before prescribing a replacement wheelchair. The doctor must submit a written prescription for the PMD to the supplier within 45 days after seeing the patient, CMS says.

• Medicare will give physicians some extra leeway in the Competitive Acquisition Program (CAP) for Part B drugs, according to MLN Matters Article SE0657. Some physicians used the "J2" restocking modifier when they faced enrollment delays in the CAP, but faced denials because their situation didn't meet the guidelines for the "J2" modifier. You can resubmit those claims with the "J2" modifier and receive payment prior to Sept. 30, CMS says.

• This year's "Dear Doctor" letter will arrive in the form of a CD-Rom, CMS says in Transmittal 1035, dated Aug. 18. This letter explains the Medicare program, including the process of signing up as a participating provider under Medicare. As usual, the Medicare enrollment period for participating providers runs from Nov. 15 to Dec. 31.

• New York Gov. George Pataki recently signed into law three measures designed to enhance access to home health care for New Yorkers.

The first measure would authorize designated nursing homes to provide medical care to patients in their homes. A second makes permanent the Access to Home Program, which provides financial assistance to homeowners and renters to adapt their homes or apartments to better meet the needs of persons with disabilities. The third initiative would create a comprehensive, at-home hospice program for children.