Senator Bill Frist has launched a new healthcare Blog. MedicalMatter.org: a21st Century Discussion of Health Care Issues. According to the inaugural post, the blog is about "healthcare and the politics of healthcare", and will address issues such as electronic health records (EHR), stem cell research, health savings accounts (HSA), and many other topics.

Physician Care Plan Oversight (CPO) is paid under the Medicare Physician Fee Schedule (MPFS), and due to a provision in the Medicare Claims Processing Manual (Publication 100-04, Chapter 12, Section 180), Non-Physician Practitioners (NPPs) have been prohibited from billing for this service in a home health setting.

The current manual section (Section 180) provides that…

MEDICARE PROGRAM: 5 YEAR REVIEW OF WORK RELATIVE VALUE UNITS UNDER THE PHYSICIAN FEE SCHEDULE

On June 29, 2006, the Centers for Medicare and Medicaid Services (CMS) proposed its 5 year update to the work relative value units (RVUs) used for the physician fee schedule, linked hereto at Physician Fee Schedule. Note, this is…

On June 22, 2006, CMS announced proposed changes for the Medicare Physician Fee Schedule. The proposed changes will appear in the June 29, 2006 Federal Register. The proposed changes include a comprehensive review of the RVU work component for Evaluation and Management Codes, which is projected to increase Medicare expenditures by $4 billion, and a…

The District Court of Appeal of the State of Florida affirmed a lower state court holding that certain aspects of a restricted covenant were not enforceable. In Florida Hematology and Oncology v. Rambabu Tummala, M.D., the Practice had terminated Dr. Tummala allegedly after he began questioning certain billing practices. Although Dr. Tummala was subject to a restrictive covenant prohibiting competition for two years within fifteen (15) miles of any office of the Practice, Dr. Tummala immediately opened a competing practice within the proscribed area. The Practice sought an injunction forcing the restrictive covenant. Continue Reading FLORIDA STATE COURT INVALIDATES RESTRICTIVE COVENANT

In a recent discovery order of The United States District Court, the Southern District of Texas confirms the relevance and discoverability of patient records in credentialing disputes involving comparative peer review, i.e., the peer review disputes where the penalties imposed one physician are dissimilar or unequal to those imposed on others. Continue Reading COMPARATIVE PEER REVIEW RECORDS MADE AVAILABLE BY COURT ORDER

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…

REGARDING SPECIALTY HOSPITALS

The Secretary of Health and Human Services, Michael O. Leavitt, has submitted an interim report to Congress entitled “Development of a Strategic Plan Regarding Physician Investment and Specialty Hospitals,” as required by Deficit Reduction Act of 2005 (DRA). HHS was required to develop and implement a strategic plan concerning whether physician investments…

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