Medicare Compliance & Reimbursement
DEDUCTIBLE DEALS LEGAL BETWEEN HOSPITALS, MEDIGAP PLANS
Medigap insurers may be able to work deals with hospitals for cut rates on inpatient deductibles. That's the upshot of the HHS Office of Inspector General's most recent advisory opinion (No. 03-10). In the opinion, the OIG takes the measure of an insurer's proposal to contract with preferred provider organizations for inclusion of its policyholders in the PPOs' hospital networks. The insurer would get a discount of up to 100 percent on Medicare inpatient deductibles it would otherwise have to pay under its Medigap policies. Under the plan, the insurer also would reward policyholders who used network hospitals with a discount on their next premium payment. The OIG points out that waivers of deductibles have long been a big kickback concern. But the problem doesn't end there - the premium discount for policyholders could also run afoul of rules barring inducements to beneficiaries. Nevertheless, the OIG said it wouldn't penalize the insurer, pointing out that not only does its proposal present "a low risk of fraud or abuse," it also could end up lowering costs for policyholders. Lesson Learned: PPOs may have more freedom in the way they do business with Medigap plans than they realize.
Medicare Compliance & Reimbursement
- Budget:
HELP FOR STATES, RURAL AREAS IN SENATE BILL
The tax bill passed by the Senate May 15 includes $20 billion in fiscal relief [...] - Hospitals:
INPATIENT RULE LOWERS HIGH-TECH THRESHOLD
The Centers for Medicare and Medicaid Services says hospitals would get a 3.5-percent pay raise [...] - Medicare:
GAO: DEATH TO LOCAL COVERAGE PROCESS
The Centers for Medicare and Medicaid Services should strip Medicare contractors of their authority to [...] - Rehab:
75-PERCENT RULE ENFORCEMENT LOOMS FOR IRFs
Rehab hospitals are in line for a 3.3-percent increase in their Medicare payments - but [...] - Medicaid:
MEDICAID REVISIONS STILL UP IN AIR ON HILL, AMONG GOVERNORS
The National Governors Association task force on Medicaid is a long way from consensus on [...] - Pharmaceuticals:
PRIVATE LABELING LEADS TO CRIMINAL FINES
The feds mean business when it comes to drug pricing improprieties. Case in point: A [...] - Hospitals:
19 DRGs ON PER-DIEM CHOPPING BLOCK
Hospitals have long grumbled over the Centers for Medicare & Medicaid Services' post-acute transfer policy. [...] - Managed Care:
2004 M+C RATES LOW-BALL PLANS
Health plans aren't happy with the Centers for Medicare & Medicaid Services' 2004 Medicare+Choice payment [...] - Overpayments:
CONTRACTORS TOUT PAYMENT SAFEGUARD HAULS
Medicare contractors are boasting once again about the financial fallout from their medical review, fraud-fighting [...] - Kickbacks:
DEDUCTIBLE DEALS LEGAL BETWEEN HOSPITALS, MEDIGAP PLANS
Medigap insurers may be able to work deals with hospitals for cut rates on inpatient [...] - Help With HIPAA:
4 STEPS FOR HANDLING PRIVACY COMPLAINTS WITHOUT GETTING BURNED
Even if you have a top-notch privacy compliance program in place, you're bound to be [...] - HIPAA:
PART A PROVIDERS OPTIMISTIC ON HIPAA TRANSACTION STANDARDS
Medicare Part A providers are generally confident that they'll be ready for the Oct. 16 [...] - PROGRAM MEMO ROUNDUP
Skilled nursing facilities puzzled over Medicare policy for bill types 22x and 23x can take [...] - REGISTER WATCH
Skilled nursing facilities will see a 2.9 percent increase in their Medicare payments next year [...] - BILL WATCH
The following House bill was introduced: H.R. 2070. A bill to amend title XVIII of [...]
