Although the news was overshadowed by the dramatic return of Sen. Ted Kennedy, the Senate's veto-proof approval today of a complex Medicare bill represents a striking political victory by doctors over health plans -- one that could bode badly for insurers if healthcare reform becomes a priority after the presidential...
Private auditors hired by Medicare have been scouring hospital and doctor records for the last few years in search of overbilling, waste and fraud. Paid on a contingency basis, which gives them a natural incentive to be aggressive, such "recovery audit contractors" identified more than $1 billion in improper Medicare...
Congress overruled President Bush's veto of the latest Medicare bill, sealing a big victory for doctors over insurance companies. As we noted last week, the bill puts off an automatic cut in physician fees by limiting subsidies to insurance companies. (Paul Krugman, I should note, offered a take similar to...
(Note: This is a post submitted by BNET member Peter Lucash, whose bio appears below. To submit your own post, click here.) It looks like physicians have gotten a last minute reprieve from a 10.6 percent fee cut that really would have sent physicians away from Medicare....
Does your local hospital, nursing home or doctor's office collect Medicare reimbursements while skating by on federal taxes? If so, it's far from alone -- the Government Accountability Office notes that more than 27,000 healthcare providers, or almost six percent of all who take Medicare, collectively owed more than $2...
Although elderly Medicare beneficiaries account for more than a third of the nation's pharmaceutical expenditures, the Medicare program currently offers no prescription drug coverage. While the federal government considers various ways to make prescription drugs more affordable for this population, a number of states, including California, have passed laws creating...
Patients for whom the cost of drugs is a barrier to treatment for chronic conditions have a variety of optionsų from discount card plans tied to Medicare eligibility soon to be replaced by the Medicare Part D prescription program to drug-company-sponsored prescription assistance plans. Knowing the way these plans work...
This paper elaborates and gives information about the health care future. Monetary incentives shape the kind of health care Americans get. Free-spending fee-for-service brought us bountiful, patient-centered medicine and runaway inflation. In a well-designed captivated payment system, health plans would be perfect agents that match the use of health care...
Medicare is the only large health insurance carrier that does not include an outpatient prescription drug benefit. This exclusion is particularly important because the elderly are among the biggest consumers of pharmaceuticals. Medicare beneficiaries comprise 13 percent of the U.S. population, yet account for over 36 percent of total outpatient...
Social security and Medicare taxes pay for benefits that workers and families receive under the Federal Insurance Contributions Act FICA. Social security tax pays for benefits for the retired, survivors, and disability insurance distribution provisions of FICA. Medicare tax pays for benefits under the medical care provisions of FICA. As...
While marking a major turning point in Medicare's history, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 MMA also signals the beginning of new challenges, risks, and opportunities for providers?the key organizations delivering the latest pharmaceutical innovations to consumers. The article outlines that for the first time since...
This paper illustrates the improper use of footwear and remedial given to them by the Hospitals. It also describe the action plan for the same. In May 1993, Congress amended Medicare statutes to provide partial reimbursement for depth shoes, custom molded shoes, and shoe inserts or modifications to qualifying Medicare...
For much of the past two decades, a war has been brewing between traditional community hospitals and a new breed of doctor-owned specialty hospitals that focus on specific treatments such as cardiac angioplasty, outpatient surgery or knee and hip replacements. Although often cast in loftier terms, in reality the fight...
Two weeks after health plans like Wellpoint announced they would follow Medicare's lead in refusing to pay for eight preventable medical problems in hospitals, Medicare has upped the ante by proposing nine more conditions for which it won't fully reimburse hospitals, including surgical infections, wild swings...
Good deeds rarely go unpunished in the field of healthcare reform. And punishment is exactly what's befallen a Medicare demonstration project intended to save money by creating a competitive-bidding system for diagnostic laboratory tests. A federal judge yesterday issued a preliminary junction that stalls the effort,...
Estimate your medicare prescription drug savings enter using this tool. Your annual drug costs in the box below and click the "submit" button to see approximately how much you'd pay when medicare's prescription drug benefits take effect.
Everyone has learned a lot since Medicare Part D was started on Jan. 1. Pharmacists learned new processes, people on Medicare learned new terms and options. Insurers and the Centers for Medicaid & Medicare Services learned to respond quickly to misunderstandings, technical glitches, and personnel shortages. Experience with these early...
Pay-for-Performance (P4P), the practice of paying health care providers differentially based on their quality performance, emerged in the late 1990s as the strategy for driving improvements in health care quality. The Centers for Medicare & Medicaid Services CMS, the largest purchaser of health care services in the United States, is...
Pay-for-performance programs have the potential to increase clinical quality and save lives, according to the first year of official data from the Premier/CMS Hospital Quality Incentive Demonstration Project, which is summarized in this report. The Centers for Medicare and Medicaid Services CMS announced on November 14, 2005 that it would...
Among the sources of confusion accompanying the implementation of Medicare Part D is the distinction between drugs covered under Part B and Part D. CMS officials held a teleconference late in January to listen to provider concerns, answer questions, and correct misinterpretation. The original Medicare program was similar to employer...
