Health Law

Medicare Issues New Advance Beneficiary Notice (ABN) Form

Posted on March 12, 2008
According to a recent alert on the Centers for Medicare and Medicaid Services (CMS) website, physicians and other providers are required to begin using a new ABN form when services are expected to not be covered by medicare.  According to the alert, beginning Monday, March 3, 2008, physicians may use the revised ABN for all situations where Medicare payment is expected to be denied...

Be On the Lookout for Better Educated Patients

Posted on March 12, 2008
According to an article in the New York Times, Aetna will soon begin offering a new service to help enable patients to research their own specific medical conditions. Specifically, Aetna’s SmartSource Service will allow patients to link online research with their own medical records and claims data...

Medical Society Predicts Doctor Shortage in Pennsylvania

Posted on March 07, 2008
More not-so-good news for Pennsylvania: according to an article in the Times Tribune, Pennsylvania Medical Society officials are predicting a shortage of physicians in Pennsylvania in the foreseeable future.  Citing the Society's recently released demographic report (See The State of Medicine in Pennsylvania), the article suggests that Pennsylvania could be short 10,000 doctors within 10 years...

Supreme Court Decides in Favor of Medtronic

Posted on February 21, 2008
Medtronic (and by default, all medical device manufacturers) scored a huge win on Wednesday when the U.S. Supreme Court held that medical device manufacturers cannot he held liable in tort actions for medical devices that have gone through FDA pre-market approval...

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Physicians Called Upon to Identify Patients with Pre-Existing Conditions

Posted on February 18, 2008
According to an article in the Los Angeles Times, a dispute is brewing in California over what one insurer is calling an “outreach effort” but others are calling an attempt to pit physicians against their patients. Specifically, Blue Cross of California has sent letters to physicians with a copy of patient insurance coverage applications, asking the physicians to identify patients who had pre-existing conditions at the time insurance coverage was extended to them...

Medicare Tracks Provider Inquiries

Posted on February 05, 2008
If you have a question about Medicare coverage or how a particular service is to be billed, who do you call? Many physician practices don’t hesitate to pick up the phone and call their Medicare carrier provider representative for guidance. While this can be an effective way of getting certain kinds of questions answered, practices should be aware that their calls to the carrier are being tracked and can be used by the carrier for a variety of things, including initiating audits...

Diagnostic Imaging Centers Continue to Struggle

Posted on January 24, 2008
As was predicted by many, the Deficit Reduction Act is continuing to cause a major shake-out in the imaging center industry.  According to the Florida Business Journal, a major Florida-based imaging center company has filed for Chapter 11 reorganization and will close 5 of its 17 centers...

CMS Delays Anti-Markup Rules until January 1, 2009

Posted on January 03, 2008
Citing the need for additional clarification of what constitutes the "office of the billing physician" under the final anti-markup regulations issued as part of the 2008 Physician Fee Schedule, the Centers for Medicare and Medicaid Services (CMS) issued another regulation today postponing the effective date of the anti-markup regulations until January 1, 2009...

WHAT PHYSICIANS NEED TO KNOW ABOUT THE HIGHMARK CLASS ACTION SETTLEMENT

Posted on December 27, 2007
(By William H. Maruca, Esq. - Posted with permission of the Allegheny County Medical Society )  A tentative settlement has been reached in a class action brought on behalf of a group of affected physicians against Blue Cross and Blue Shield plans which alleged that the plans engaged in certain misconduct that resulted in the denial or downcoding of physician claims...

Pennsylvania Governor Softens Position on MCare Subsidies

Posted on December 17, 2007
Much to the chagrin of practicing Pennsylvania physicians, the issue of MCare premium subsidies became a political football earlier this month when Governor Ed Rendell said he would not approve the 2008 MCare subsidy until Pennsylvania lawmakers acted on his proposal to expand the state insurance program to uninsured adults...

Major Changes are Afoot at Centers For Medicare and Medicaid Services

Posted on December 11, 2007
The Centers for Medicare and Medicaid Services (CMS) issued a final rule on November 26, 2006 enacting Section 911 of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003. Section 911 of the MMA required the (CMS) to replace the current fiscal intermediary and carrier contracts for the administration of Medicare benefits with new contracts with Medicare Administrative Contractors (MACs) who will administer both Part A and Part B...

Medicare Changes Diagnostic Testing Rules and IDTF Rules

Posted on November 28, 2007
The much awaited 2008 Medicare Physician Fee Schedule has finally been formally published in the Federal Register (click here to read it).  The proposed Fee Schedule published in June of 2007, included a number of proposed changes to the Stark regulations as well as certain regulatory changes to the diagnostic testing rules and IDTF conditions of participation...

Oops! Medical Device Company Identifies Wrong Physician

Posted on November 08, 2007
Earlier this week, a number of major orthopedic medical device companies, as part of an anti-kickback settlement agreement, began posting on their websites the names of physicians to whom the companies have paid consulting fees.  Now, as a perfect example of why this "transparency" is a danger to all physicians, a Michigan newspaper is reporting that one of the companies, Smith and Nephew, incorrectly identified a physician on its website...

Physician Orthopedic Consulting Fees Made Public

Posted on November 06, 2007
Several weeks ago I posted an entry on this blog about a major federal anti-kickback settlement agreement entered into by the five largest orthopedic device companies: Zimmer Inc., Depuy Orthopaedics, Inc., Smith & Nephew Inc., Biomet Orthopedics, Inc...

CIGNA Reaches Settlement on Doctor Ranking

Posted on October 30, 2007
Several month ago I posted an entry on this Blog about a lawsuit the New York Attorney General was threatening to file to prevent United Healthcare from ranking its participating physicians.  Well, according to an article on USAToday...

CMS Issues Advisory Opinion on Physician Recruitment Arrangement

Posted on October 09, 2007
In a recent Stark law Advisory Opinion (CMS-AO-2007-01), the Centers for Medicare and Medicaid Services (CMS) found that a hospital could not change the terms of an existing physician recruitment assistance agreement where that change would effectively result in additional compensation to the recruited physician...

Medical Device Companies Enter into Major Settlement Agreement

Posted on October 05, 2007
According to a recent DOJ Press Release, five medical device companies (comprising approximately 95% of the hip and knee joint implant market) have settled kickback allegations relating to payments to surgeons by agreeing to pay a total of $311 million and entering into five-year Corporate Integrity Agreements...

Microsoft Launches "HealthVault"

Posted on October 05, 2007
Just when physicians thought it was safe to start investing in electronic medical records systems, Microsoft may be changing the ground rules altogether.  On October 4, 2007, Microsoft took a giant leap into the health information arena by announcing the launch of it's new web site "HealthVault"...

Medicare Audit Program Could Be Costly

Posted on September 17, 2007
According to a recent article in the Seattle Times, the Medicare contractor audit program which was launched in three states on a trial basis in 2005 and is expected to expand to all 50 states by 2010 could end up costing the public dearly, with potentially very little to show for the efforts...

Payors Looking to Better Manage Imaging Services

Posted on August 22, 2007
According to a recent article published on AIS Health.com, Blues plans are increasingly turning to radiology management firms to help manage costly imaging services.  This is a new twist on the old "managed care" concept and, once adopted by the Blues, other major payors can be expected to follow...

Forbes Identifies Top Paying Jobs

Posted on July 30, 2007
So it's stressful, expensive and the hours stink -- accordingly to an article on Forbes.com, medicine is still a pretty good gig.  In what will undoubtedly add fuel to the already raging debate over who is responsible for the high cost of health care, health care-related occupations fill the top 15 slots on Forbes' list of the top 25 best paying jobs in the nation...

Dems' Medicare Bill Would Prohibit Physician Investment in Hospitals

Posted on July 27, 2007
Much has been in the news lately about the Children's Health and Medicare Protection (CHAMP) Act of 2007 recently introduced by the House democrats.   The Bill's proponents claim that if enacted it will provide insurance coverage for millions of children and improve and strengthen Medicare for America's seniors and people with disabilities...

New Jersey Department of Insurance Fines Aetna

Posted on July 25, 2007
The New Jersey Department of Banking & Insurance has issued an order stopping Aetna's practice of limiting non-participating physician reimbursement to 125% of Medicare.  The Department has also fined Aetna almost $10,000 for violations of state insurance laws...

CMS Terminates Florida HMO Plans

Posted on July 25, 2007
According to a recent article in the Florida Sentinal, the Centers for Medicare and Medicaid Services has taken the unprecedented step of terminating the Medicare HMO plans run by America's Health Choice in Florida due to quality of care issues.  According to the article, termination of the plan was the result of patient complaints about delays in and denials of authorizations of care...

Pennsylvania Dept. of Insurance Elects not to Raise Malpractice Insurance Requirements

Posted on July 22, 2007
You may recall from a July 2 posting on this blog that the Insurance Department was considering changing the required level of malpractice coverage Pennsylvania physicians must maintain (before MCARE coverage) from $500,000 to $750,000.  Pennsylvania doctors can breath a sigh of relief, at least for now...

Physician Alert! CMS to Require Hospitals to Disclose Physician Compensation Arrangements

Posted on July 18, 2007
In accordance with the Deficit Reduction Act, the Department of Health and Human Services (“HHS”) is undertaking an initiative to require all hospitals participating in a Medicare program to provide information to HHS on a periodic basis concerning their investment and compensation relationships with physicians...

Watch Out for Physician Rating Systems

Posted on July 17, 2007
More and more payors are instituting rating systems for their participating physicians and at least one state attorney general has taken issue with the practice.  According to a recent article on CNNMoney.com, the New York Attorney General has threatened an injunction against United Healthcare if it implements a physician rating system in New York...

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