Medicare & Reimbursement

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FOR HIGH VOLUME PROCEDURES

In an effort to facilitate consumer directed healthcare, CMS has begun posting the payments that Medicare will make for certain high volume procedures. At this point, the approved Medicare Payments are included in the segment of the CMS website constructed to provide consumer information. Although informative, reports of the action express…

Under Medicare Part D Regulations, employers who sponsor health plans must: (1) determine whether the plan’s prescription drug coverage is equivalent to Medicare Part D (“Creditable”); (2) send notice of the status at least to Medicare-eligible participants and dependents’ and; (3) must report the status to CMS. These reporting requirements help Medicare-eligible individuals decide whether to enroll in or to delay enrollment in Medicare Part D.
Continue Reading Better Late than Never- Health Plan Sponsors’ Obligations under Medicare Part D Regulations

PROGRAM (CAP)
FOR PART B DRUGS ENROLLMENT DEADLINE IS JUNE 2, 2006

This is just a reminder that the Competitive Acquisition Program for Part B drugs for Medicare physicians will be open for enrollment only until June 2, 2006. Participating physicians will be given the opportunity to obtain and bill for Medicare Part B covered…

FOR CARDIAC REHABILITATION PROGRAMS

Effective for services performed on or after March 22, 2006, the Centers for Medicare and Medicaid Services (CMS) is updating Section 20.10 of the Medicare National Coverage Determinations Manual (NCD Manual) to include additional clinical indications for which cardiac rehabilitation services are covered. The NCD Manual now includes a comprehensive description…

CMS PUBLISHES FINAL ENROLLMENT REQUIREMENTS FOR MEDICARE PARTICIPATION

The Centers for Medicare and Medicaid Services (CMS) have published the final rule establishing the enrollment requirements for participation in Medicare. The proposed rule was published on April 25, 2003. There are no significant surprises in the final rule, which does the following:
Continue Reading CMS PUBLISHES FINAL ENROLLMENT REQUIREMENTS

The Medicare Modernization Act of 2003 required the Secretary of Health and Human Services to make the national coverage determination (NCD) process a public and transparent process, with the intent of making the NCD process one that would be better serve Medicare providers and beneficiaries. On April 11, 2006, CMS issued two documents related to “Guidance for The Public, Industry and CMS Staff,” i.e.:
Continue Reading National Coverage Determination Process – CMS Issues Final Guidance Documents

The American Medical Association has signed pact with Congress “agreeing” as follows:

*The parties will develop a total of 140 quality measures covering 34 clinical areas.

*Doctors will voluntarily report on at least 3 to 5 quality measures per physician by 2007.

*Doctors should receive additional reimbursement to cover administrative costs.
Continue Reading AMA AND CONGRESS SIGN P4P AGREEMENT

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