All Entries in the "Latest News" Category
Medicare pays, even if providers do not
Healthcare providers are allowed to collect millions of dollars in federal Medicare payments each year despite owing the government more than $2 billion in back taxes, according to the Government Accountability Office.
The office found that more than 27,000 providers flouted the tax system while collecting Medicare fees in 2006, the Washington Post reports. That represented 6% of all providers in the Medicare program.
To read the full story in the Washington Post, click here.
Kennedy fights for Massachusetts Medicaid
Despite beginning treatment in his battle with brain cancer, Massachusetts Senator Edward M. Kennedy has placed a flurry of phone calls to top Bush administration officials in a bid to make sure the state continues receiving hundreds of millions of dollars in Medicaid money, the Boston Globe reports.
Kennedy spoke with Health and Human Services Secretary Michael Leavitt and Josh Bolten, the chief of staff to President Bush. He also had a conversation with Governor Deval Patrick, who is meeting this morning with Leavitt to discuss extending a Medicaid waiver that is set to expire June 30. Massachusetts would probably lose at least $600 million if the waiver negotiations fall through.
To read the full story by the Boston Globe, click here.
NEWS: Coventry’s announcment makes impact
Major insurers felt the impact of Coventry Health Care Inc.'s announcement it would reduce its projected earnings because of unforeseen costs and more claims under Medicare Advantage, Bloomberg reports.
Aetna Inc., WellPoint Inc. and other insurers saw shares fall after the announcement.
"In this case, if Coventry has pneumonia, everyone else has at least a cold," said Sheryl Skolnick, an analyst with CRT Capital Group in Stamford, Connecticut, in a telephone interview with Bloomberg. "Now you have to start thinking about what are the implications for bad news in 2009. The 2009 estimates haven't come down as hard or as fast as the 2008 estimates, and they have to start coming down right away."
To read the full story by Bloomberg, click here.
NEWS: Medical mistakes no longer billable in Massachusetts
Hospitals and doctors who make medical mistakes will no longer be able to bill the state of Massachusetts or its largest private health insurer for costs related to fixing the error, according to policies outlined separately by the state government and Blue Cross and Blue Shield of Massachusetts, the Boston Globe reports.
The state and Blue Cross policies apply to 28 types of surgical, medication, and other errors, and the policy changes by the state are part of a national effort to reduce healthcare errors.
Analysts said the move to restrict reimbursements represents the boldest attempt by any state to use payments to reduce life-threatening errors that are considered preventable.
To read the full story by the Boston Globe, click here.
New York Medicaid to deny payment for hospital errors
Beginning in October, New York hospitals won't be able to bill Medicaid for "never events" such as mistakes during surgery, medication errors and other deadly complications caused by preventable hospital blunders, the Associated Press reports.
The goal is to shift the burden to hospitals, practices and doctors if they make a dangerous mistake, and the state health department expects to save $6 million from the change. New York's Medicaid program is among the most expensive in the nation, costing taxpayers $47 billion annually.
To read the full story by the Associated Press, click here.
Millions of Americans still underinsured, study finds
U.S. residents who have health insurance but can't afford quality care continues to be a problem, the New York Times reports.
About 25 million Americans did not have sufficient coverage last year to shield them from financial hardship if they ended up in the emergency room or were seriously ill, according to a study by the Commonwealth Fund.
The continuous rise in medical costs, combined with a growing number of insurance plans that require patients to pay a higher portion of their medical bills, has led to a 60% increase in the number of underinsured adults from 2003 to 2007, according to the study.
To read the full story by the New York Times, click here.
Q. Can you give examples of items or services for which we should give a HINN 11?
Q. From a PARC reader: We have a question after reading the "Administering the new HINNs" article in the June PARC newsletter. Can you give examples of items or services for which we should give a HINN 11? We had a situation recently where a patient asked for her monthly osteoporosis medication. She was an inpatient at the time, but the medication was not related to her stay. Her request was out of convenience.
Would this be a situation where a HINN 11 would be appropriate?
A. Judith L. Kares, JD, CPC, HCPro, Inc.: In answer to your question, HINN 11 is only appropriate to notify a beneficiary of his/her liability for noncovered severable services when all of the following criteria are met:
• The item or service is excluded from coverage as medically unnecessary (under a written Medicare policy)
• The beneficiary requires a continued inpatient stay
• The inpatient stay is covered under Part A
• The item or service is not bundled or integral to payment or treatment for the diagnoses or reasons justifying the inpatient stay.
Here is an example that I use when teaching the HCPro Medicare Boot Camp--Hospital Version course that illustrates when use of the HINN 11 would be appropriate: A patient admitted as an inpatient is being treated for pneumococcal pneumonia (481) with pneumonitis due to toxoplasmosis (130.4).
During the otherwise Part A covered stay, the physician orders a PET scan for breast cancer which does not meet Medicare’s medical necessity guidelines. The PET scan is not bundled into or integral to payment or treatment for the diagnoses/reasons justifying the covered inpatient stay.
In that case, the hospital may notify the patient (and the attending physician), using HINN 11, referencing NCD PET (FDG) for Breast Cancer, 220.6.10. If you have a question as to whether to use HINN 11 for particular services ordered in the inpatient setting, I recommend that you check with your FI or MAC. In particular, the hospital must reference a written Medicare policy to support the hospital's position that the particular item or service is excluded from coverage as medically unnecessary.
Good luck as you apply these rules.
NEWS: CMS clarifies instructions regarding the attending/referring physician NPI for self referred mammograms
On May 30th CMS issued a transmittal clarifying and manualizing instructions to providers to use their own NPI in the place of an attending/referring physician NPI for self referred mammograms.
Effective date: May 23, 2008
Implementation date: June 30, 2008
See related CMS link -- http://www.cms.hhs.gov/transmittals/downloads/R1519CP.pdf
NEWS: One way to collect debt – send it to auction
Hospitals have long searched for ways to collect debt from patients, especially from the uninsured and underinsured. These days, they are turning to online auctions, the Wall Street Journal reports.
The hospitals are sending the debt to the auctions for collections agencies to bid. The winning bidders then turn to the patients to collect the money.
To read the full story by the Wall Street Journal, click here.
If your facility has sent debt to an online auction, we at PARC would love to hear about it. Send an e-mail to Dom Nicastro at dnicastro@hcpro.com.
Thanks!
NEWS: Newly insured outpace available doctors in Massachusetts
Healthcare reform in Massachusetts has increased the number of newly insured patients in the state, and the demand for care has gone up as a result, the Boston Globe reports.
The trend, along with a longstanding shortage of primary-care physicians, is creating a real crunch for community clinics, say advocates of healthcare reform and medical professionals.
Critics have said healthcare reform should not have been attempted without first addressing the workforce shortages, but state officials and healthcare advocates are starting to address the problem of recruitment.
The state Legislature has taken up a bill, for example, which includes a clause aimed at establishing a primary-care recruitment center in the state.
To read the full story in the Boston Globe, click here.