Last month I blogged about an artificial spinal disk called Charite by (Johnson & Johnson). The Centers for Medicare and Medicaid Services proposed to deny coverage for the surgery, citing lack of evidence that it is "reasonable and necessary." The 30-day period for comments ended last Friday, and it appears Medicare will not cover the procedure. The final ruling is due in May. From the New York Times: The Medicare decision was based on several well-known criticisms of Charité. The … [Read more...] about Update Medicare Coverage for Spinal Disk
Market Forces Lower Prescription Drug Prices
According to Mike Leavitt, secretary of the Department of Health and Human Services, prescription drug prices have dropped, thanks to "market forces." (Medical News Today) So capitalism works? Excellent news! President Bush must have had the right idea by injecting competition into Medicare's prescription drug program, the same one that people say is confusing. According to a survey conducted by America's Health Insurance Plans, however, the plan is not so confusing after all. From the … [Read more...] about Market Forces Lower Prescription Drug Prices
Medicare Part D Scams
CMS is warning people against scams regarding the Medicare prescription plan, This scheme is called the "$299 Ring" for the typical amount of money Medicare beneficiaries are talked into withdrawing from their checking accounts to pay for a nonexistent prescription drug plan. Consumers can report these cases to their local law enforcement agencies or call 1-877-7SAFERX (1-877-772-3379). Beware of those asking for personal information, No Medicare drug plan can ask a person with … [Read more...] about Medicare Part D Scams
Hospital Quality Report; New Provider Letter
The Government Accountability Office (GAO) has released a report titled, Hospital Quality Data (PDF). According to the report, hospitals that don't submit clinical data for patients lose 0.4 percent of Medicare payment updates. This information is necessary to calculate a hospital's quality measure. To ensure that publicly released data are reliable, the Centers for Medicare and Medicaid Services needs more rigorous methods, the GAO concluded. In other news, the Texas Department of Aging and … [Read more...] about Hospital Quality Report; New Provider Letter
Texas Pharmacists Lobby White House
A group of pharmacists in Texas is lobbying the White House, demanding to be reimbursed for giving away prescription drugs to Medicare beneficiaries. From CNNMoney.com: "If pharmacists don't receive immediate relief, some will go broke," Bill Pittman, a former president of the Texas State Board of Pharmacy who is chairman of Pharmacists for Bush, a political fund-raising group, was quoted by the Times as saying he told Rove. "Others are hurting so bad that they will choose not to … [Read more...] about Texas Pharmacists Lobby White House
States to be Reimbursed for ‘Dual Eligibles’ Payments
Mark McClellan, administrator for the Centers for Medicare and Medicare, has assured states that they will be reimbursed for payments for "dual eligibles," beneficiaries who qualified for Medicare and Medicaid coverage. Medicare's prescription drug program has caused much confusion, and some beneficiaries had trouble getting prescriptions filled because they missed the January 1 deadline to change plans. More than 40 states have spent millions to make sure dual eligibles received … [Read more...] about States to be Reimbursed for ‘Dual Eligibles’ Payments
Medicare Will Cover Obesity Surgery
According to the Centers for Medicare and Medicaid Services, Medicare is expanding coverage for bariatric surgery. From the press release: CMS reviewed new data and analyses which demonstrate that surgeons with more experience have similar outcomes for patients of all ages. After reviewing the evidence and considering recommendations of professional societies and other experts in the field, the Agency determined that of the various bariatric surgeries currently available, the evidence … [Read more...] about Medicare Will Cover Obesity Surgery
CQ Editor Discusses Medicare; Millions Missing Out on Coverage
Mary Agnes Carey, associate editor of CQ [Congressional Quarterly] HealthBeat spoke about the FY 2007 budget, the FY 2006 budget reconciliation, and Medicare's prescription drug program. (Medical News Today) Under the FY 2007, Medicare spending would be cut by $36 billion. Medicare payments would be reduced for certain long term care providers, including home health agencies. Carey also discussed a clerical error found in the FY 2006 budget reconciliation bill after it was passed in the House … [Read more...] about CQ Editor Discusses Medicare; Millions Missing Out on Coverage
Medicare News: No Coverage for Artificial Spinal Disks
The Centers for Medicare and Medicaid Services seeks to deny coverage for an artificial spinal disk called Charite. Lack of evidence that the surgery required to implant the disk is "reasonable and necessary" is the reason, says CMS. From Kaiser Network's report: The proposal to deny Medicare coverage for Charite could prompt private health insurers to take similar actions. According to the Journal, such actions would represent a "rare setback" for J&J, which has "excelled at persuading … [Read more...] about Medicare News: No Coverage for Artificial Spinal Disks
Medicare News: Ultrasound Coverage
Here is some important news for providers and good news for abdominal aneurysm sufferers: next year Medicare will begin coverage for ultrasound screening for abdominal aortic aneurysms for high-risk beneficiaries, according to the Kaiser Network. "High-risk" groups include: • Beneficiaries with a history of aneurysms in their family • Males who've smoked more than 100 cigarettes in their lifetimes Beneficiaries currently in the Medicare program will not receive coverage for … [Read more...] about Medicare News: Ultrasound Coverage
