The American Health Lawyers listserv has an posting by Louise Joy of Texas who discusses the CMS revalidation process. The agency is looking to revalidate physicians who have not revalidated since March 2011. She states that if you get a revalidation notice you must respond within 60 days or run the risk of being cut from the Medicare rolls. This means no money and not being able to order or refer for patients. If you are deactivated you should be reactivated when you submit your papers not when it is completed. Call the CMS to let them know you have done the submission. Patients who receive bills because their physician has been delisted should ask for reconsideration.
The Senate has passed a bill that will reduce the pay in "over priced" procedures. This was approved by the House a week earlier. This bill will virtually kill the AMA that gets millions of dollars for its RVS book on which dollars are attached to each point (unit). The bill also directs that CMS look at the dollars assigned per unit for the "over priced" procedures.
Medicare released the data on what physicians did, where they did it and how much they were paid for it. This will allow the public to check for the low price spread. The physicians will not have the opportunity to correct the usual mistakes prior to publication. Top
HHS has bowed to the GOP and the Dems who are up for re-election. The party has been fighting the administration on their lowering of the amount of money to be paid to Medicare Advantage insurers. The HHS has decided to raise the amount paid by 0.4% which translates into a 3% decrease. This is opposed to the 7% decrease that was supposed to happen. In the past year the amount of people on the Advantage program has raised from 9% of the seniors to 30%.
The House Democrats have defeated a bipartisan Obamacare fix. One of the problems is the companies that insure expatriate workers are at a disadvantage against those from overseas. The foreign companies do not have to comply with the dumb Obamacare mandates so can charge much lower fees. The top Dems do not want any possibility of an Obamacare change prior to the mid-term election.
Wisconsin now has a law that mandates oral chemotherapy be paid for by insurance companies just as they do for IV meds. There is a co-pay of $100 per month for the oral meds. This co-pay will increase yearly by the level of inflation. The law takes effect in January, 2015.
New York has become the 13th state to enact a law prohibiting balance billing for out of network providers. The New Yorker were already protected from balance billing for ambulance providers and ED visits for HMO members. This law goes into effect in January, 2015 and requires all providers to tell patients before treatment if they do not take their insurance. If the provider does not tell the patient then the provider is required to only take the insurance payment without balance billing.
New York continues to show its disregard for patients. They have passed a law allowing nurse practitioners with more than 3600 hours of experience to practice independently. No physician supervision is required. Fortunately it does not expand their scope of service so neurosurgical patients in the Empire State are safe, for now. The rationale for the law was to increase the access to patients in underserved areas. There has been no data that NPs are any more likely to practice in underserved areas than MDs are.
After stating she would be the Secretary of HHS until the next enrollment period for Obamacare, Sebelius "resigned". She could not even do that right. During her "resignation" prepared speech a page went missing. The new Obama appointee may be more attuned to the people and not into lying to save her boss. Top
Nevada has fined Summerlin Hospital of Las Vegas $39,000. This stems from six serious violations found by OSHA in 2013 after a TB outbreak that killed a mother and her twin babies. Two patients with undiagnosed TB were admitted to the hospital and treated in the Neonatal ICU. About 20 workers were exposed to TB and contracted it. The hospital is being sued for this by the husband of the person who died and also by a group of employees. The hospital contests the fines. Top
DISCLAIMER: Although this
article is updated periodically, it reflects the author's point of view at the
time of publication. Nothing in this article constitutes legal advice. Readers
should consult with their own legal counsel before acting on any of the