scoanet

HEAT initiative created to chill purveyors of Medicare fraud.

The U.S. Department of Justice (DOJ) and the U.S. Department of Health and Human Services (HHS) have announced the creation of a joint task force to combat Medicare fraud. The Health Care Fraud Prevention and Enforcement Action Team (HEAT) will include senior officials from DOJ and HHS who will strengthen existing programs to combat fraud and invest in new resources and technology designed to prevent future fraud, waste, and abuse.
Read More...

Majority of Physicians Now Compensated for ER Call

Modern Physician reported on April 1st that according to a report released by the Medical Group Management Association that almost two-thirds (62%) of healthcare providers receive some form of additional compensation for on-call coverage.  The report notes that compensation agreements are in the form of a daily stipend or hourly rate with variations for specialty, group size and region.

See the full story, Most providers receive compensation for on-call duty, MGMA survey finds or go to www.modernphysician.com.

AMA, medical associations file suit over Ingenix database.

The Associated Press reports that the American Medical Association (AMA) and several state medical associations have joined to sue health insurers Aetna Inc. (Hartford, Conn.) and Cigna Corp. (Philadelphia) over a database the associations claim was rigged to underpay out-of-network physicians for more than 10 years. The complaints allege that Aetna deleted valid high charges from figures contributed to the UnitedHealth (Minnetonka, Minn.)-owned Ingenix database, and accuse Cigna of hiding "serious, systemic flaws" in the data. UnitedHealth has already agreed to close the database, and—along with Aetna—fund the creation of a replacement system.
Read More...

Dear SCAOE Members,

Attached is a bulletin distributed by the South Carolina Department of Health & Human Services concerning budget cuts that went into effect as of January 1, 2009.   These reductions in benefits may impact your patients and practice so we wanted to pass them along to you.   It seems at first glance that the changes dealing with DME, Group Therapy, and strict limits on the total number of physician visits per year by adult Medicaid beneficiaries may be those changes that might impact our specialty.

Download MedicaidBulletinDecember30

If you have any questions please let me know.

Sincerely,
Fraser Cobbe

Executive Director

South Carolina

Orthopaedic Association

South Carolina

Association of Orthopaedic Executives

Tel: 813-949-3121

Proposal would "rebase" Medicare SGR.

U.S. Rep. Pete Stark (D-Calif.) has outlined a plan to "rebase" the Medicare sustainable growth rate (SGR) formula. Rep. Stark’s proposal to reform Medicare includes setting a new baseline for reimbursement rates. Physicians currently face a 21 percent reduction in reimbursement when a July 2008 SGR patch expires on Dec. 31, 2009. A new patch would cost an estimated $20 billion. According to Mr. Stark, eliminating the overall rate cuts under the current SGR system over the next 10 years would cost the federal government from $200 billion to $300 billion, so Congress must change the baseline that the SGR uses to set up fee increases.

Delays in Medicaid Payment Drive Physicians Away

Modern Physician is reporting on a study published by the Center for Studying Health System Change that indicates that slow payment to physicians discourages their participation in Medicaid even in those states with higher Medicaid reimbursement.  

For the full story, please click here or go to modernphysician.com.

Reduced reimbursement for DXA may cost government more in the long run.

A report published in the November issue of the journal Osteoporosis International notes that Medicare reimbursement for dual-energy X-ray absorptiometry (DXA)—a key tool in the monitoring of osteoporosis—has been cut to levels substantially below the cost to perform the procedure, and as a result, healthcare providers may consider discontinuing the service. The authors cite a recent study that found that restoring DXA reimbursement to 2006 levels would save the Medicare program $1.14 billion over five years due to the reduced number of osteoporotic fractures.
Read More...

Read the abstract...

The Wall Street Journal reports that some health insurers have hired outside firms to serve as radiology benefits managers (RBMs) to ensure that physicians use high-tech scans such as CTs and MRIs only when patients will clearly benefit from them. According to some physicians, however, the RBMs' review procedures can result in delays or rejections that sometimes pose risks for patients, waste staff time, and force physicians to justify decisions to reviewers who haven't seen the patients.
Read More...

Physicians concerned about delayed Medicare payments.

According to the Los Angeles Times, millions of dollars in Medicare reimbursements remain outstanding, due to a backlog in claims processing. Some providers haven't been paid in months, and the lack of reimbursement is threatening not only patient care but also provider solvency. Observers blame the delays on factors such as the May 2008 switchover to National Provider Identifiers (NPIs), new claims processing contractors, and in some cases, data errors such as not processing a change of address.
Read More...

CMS to host conference calls regarding ICD-10 adoption.

CMS will host two separate calls to discuss issues associated with the adoption of the ICD-10 coding system. The first, for Medicare Part A and Part B providers, will take place Nov. 12. The second, targeted at physicians, will take place Nov. 17. Call details, including registration information and CMS's slide presentation, are available on the CMS Web site.
Read More...