dynamichealthsys.com Blog

Medicare billings now reported on federal Web site

By KEVIN FREKING
THE ASSOCIATED PRESS

WASHINGTON – To help Americans become smarter health care shoppers, Medicare this month started publishing a range of what it pays for 30 common procedures and report how frequently hospitals perform them.

The release of the information fits with the Bush administration’s strategy of moving more people into health savings accounts and high-deductible insurance policies. Such insurance policies require people to bear more of their initial medical expenses.

As more people buy such policies, the administration maintains, cost increases would slow because people would work harder to look for the best deal or decide they don’t really need a medical service after all.

The Medicare data – released June 1 – covers such procedures as heart operations, the implant of heart defibrillators and back and neck operations.

The most common elective surgery paid for by Medicare is the replacement of a hip or knee. The government information shows that those procedures cost an average of $11,761. Medicare paid between $9,992-$12,173, on average.

The Pueblo Chiefton

Part D Weely Calls to Be Terminared

Since December of 2005 we have been holding weekly Part D Providers conference calls to address issues physicians and other health care providers were having with Part D. We have seen a gradual decline in the participation on those calls and this past week, we only had one question on the call. To that effect, we are going to hold the final weekly Part D Providers call on May 30th at 2pm EST.

We continue to remain committed to fixing your Part D issues and we are confident that between your email access to us

(PRIT@cms.hhs.gov) and our participation in the Open Door Forums (ODF) you will not feel abandoned. We are asking that physicians and other health care providers take their Part D issues to their respective ODF calls. If you do not currently participate in the ODFs, you are encouraged to sign up to receive the ODF announcements by going to: http://www.cms.hhs.gov/apps/mailinglists/default.asp?audience=4 or http://www.cms.hhs.gov/opendoorforums/

Again, the last Weekly Part D Providers call will occur on May 30th at 2PM EST. The next Skilled Nursing Facilities/Long-Term Care ODFs is June 6th (1-800-837-1935, Reference ID: 8266876) and the next Physician ODF is June 27th. Both will start at 2pm EST.

2007 MA/MAPD Call Letter

CMS has released the 2007 MA/MAPD Call letter.  Download it here.

Payment Increases to Medicare Advantage Plans Lower

CMS on Monday said that reimbursement rates for Medicare Advantage plans in 2007 will increase by only about 1.1% on average, rather than 4% as scheduled, because of a technical adjustment of how physicians code beneficiaries for billing, CQ HealthBeat reports. According to CQ HealthBeat, past small increases in reimbursement rates have led to decreases in benefits offered by Medicare Advantage plans.

Medicare Advantage plans in most cases offer more benefits than traditional Medicare because of higher reimbursement rate increases established under the 2003 Medicare law, in addition to separate subsidies from the federal government for plans that provide prescription drug coverage.

Karen Ignagni, president of America’s Health Insurance Plans, said, “No member of Congress will be able to conclude that plans are overpaid next year.”

Health Plans Don’t Fear 2007 Medicare Advantage Rates, See Positive Long Term

CMS is expected to issue final 2007 Medicare Advantage (MA) payment rates April 3. But some established Medicare managed care organizations aren’t holding their breath: They anticipate satisfactory reimbursement for next year’s MA product lines….

Visit AISHealth to read the entire story.

CMS Takes Steps To Clean Up Enrollment

Last week CMS notified Medicare prescription drug plan sponsors of the process for reconciling plan enrollments to ensure that all beneficiaries who have elected to change plans are appropriately disenrolled from their initial plan by April 30, 2006. To ensure that all enrolled beneficiaries would have access to prescription drug coverage in the early days of the new program, particularly for dual-eligible beneficiaries who switched plans later in the month, CMS advised plans in January to delay processing certain disenrollments. By early February, most plans began processing disenrollments. As a result of the January CMS instruction and some plans’ decision to continue delaying disenrollments into February or March, certain beneficiaries have had access to coverage under more than one plan: the initial plan that continued coverage, and a subsequent plan chosen by the beneficiary or an agent acting on their behalf (the Medicare “plan of record”). As the startup of the drug benefit progresses, CMS is now taking steps to ensure that all beneficiaries who changed plans are appropriately disenrolled from their initial plan by April 30, 2006. This process of reconciling plan enrollments will assure consistent coverage, allow appropriate tracking of out-of-pocket costs, permit payments to be fully reconciled between plans, and most importantly, ensure that each beneficiary continues to receive drug coverage smoothly and consistently. Please find attached a one-pager that further describes this process. The standard letters sent to affected beneficiaries on CMS letterhead are also attached for your reference.

DEADLINE: PDPs, MA-PDs, Cost, and PACE 2007 Applications

Today is the deadline for all PDPs, MA-PDs, Cost, and PACE 2007 applications.

Details on the CMS website.

Surprise CMS Move Will Cost Hospitals for Multiple Push Injections of Same Drug

AISHealth and the 3/6/06 Report on Medicare Compliance are reporting Hospitals are about to lose money for intravenous push injections because of a surprise move by CMS, experts say.

CMS said recently that hospitals can’t charge Medicare for more than one IV push injection of the same drug during the same patient encounter (HCPCS code C8952C), according to new guidance on billing for drug administration under the outpatient prospective payment system (OPPS). Only multiple injections of different drugs can be charged separately, according to the guidance, which comes in the form of answers to frequently asked questions (FAQs) and was posted on the CMS Web site in mid-February.

This is the latest in a series of OPPS drug administration changes to cause revenue and/or compliance challenges for hospitals.

MMA 2003 Update

The Medicare Modernization Update (MMU) was updated on Wednesday, March 1, 2006.

For your convenience, we offer the following topics and links that this office maintains. Please update your bookmarks and favorites accordingly.

Subject area on the web site Link
Medicare Modernization Update (MMU) http://www.cms.hhs.gov/MMAUpdate/
Quarterly Provider Update (QPU) http://www.cms.hhs.gov/QuarterlyProviderUpdates/
CMS Manuals http://www.cms.hhs.gov/Manuals/IOM/list.asp
CMS Transmittals http://www.cms.hhs.gov/Transmittals/
Office of the Attorney Advisor http://www.cms.hhs.gov/OfficeAttorneyAdvisor/
FOIA http://www.cms.hhs.gov/AboutWebsite/04_FOIA.asp
Advisory Committees http://www.cms.hhs.gov/FACA/
SBA Ombudsman Liaison http://www.cms.hhs.gov/CMSSmallBusAdminOmbuds/
CMS Rulings http://www.cms.hhs.gov/Rulings/
eComments http://www.cms.hhs.gov/eRulemaking/
Paperwork Reduction Act (PRA) http://www.cms.hhs.gov/PaperworkReductionActof1995/

Continue reading MMA 2003 Update…

Public Comment Period for Draft 2007 MA, MA-PD and PDP Call Letters

We are pleased to issue this notice announcing the release of the DRAFT 2007 Medicare Advantage (MA), Medicare Advantage-Prescription Drug (MA-PD) and Stand Alone Prescription Drug Plan (PDP) Call Letters for public comment. We are sending theseletters out via HPMS and will post them on our website at
http://www.cms.hhs.gov/HealthPlansGenInfo/02_WhatsNew.asp#TopOfPage

and

http://www.cms.hhs.gov/PrescriptionDrugCovContra/01_Overview.asp#TopOfPage