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Congress has overwhelmingly passed a law to overhaul the FDA. The new law will allow the agency to oversee and fine drug companies that are not truthful in their direct to consumer advertising. It would allow the FDA to order post approval testing on drugs. There would also be restrictions on who could serve on advisory panels requiring that 5% of those with conflicts of interest be removed per year. The Democrats wanted but did not get a three month decrease in protection from the drug companies who test their product on children. The Dems did get a decrease in drug company protection from being sued. An important step ordered by their masters, the trial attorneys. This was specifically promised by Pelosi, the trial attorney lackey. Top
CMS published its final rule on revisit fees for Medicare survey and certification. The provider may request a refund in fees only if the provider believes an error of fact was made. The CMS doubled the time to 14 days where a provider could request the refund. The refund would be applied to future revisits or immediately if there would be a great delay in the revisit.
CMS has put out a two page chart as to what is allowed in the "Welcome to Medicare" initial physical exam. There must be a history including past history, meds, family history, history of hearing impairment, fall risk, daily living and home activities. The physical must include visual acuity, ht., wt., and blood pressure. An EKG is also required and must be done prior to submitting the bill to Medicare. The initial exam would also contain counseling and completing a brief written plan to get the other Medicare screening tests. Medicare will pay for this screening only once and the enrollee must have it done within six months of enrolling in Medicare. Routine exams are otherwise not covered.
It looks like the proposed 10% physician Medicare cut will be overturned by Congress. The Senate Finance Committee is planning to pay the physicians with money originally earmarked for Medicare Advantage plans.
CMS is not doing well. They had a "behavioral offset" for hospitals in the inpatient prospective payment system that would have decreased by $20 Billion over five years the payments to the hospitals. The Congress voted to overrule CMS and to reduce by 1/2 the proposed cuts.
The CMS rule to start today has been delayed. The Congress has passed a bill to delay for six months the controversial bill mandating Medicaid patients get prescriptions with certain types of prescription pads ala narcotics. Top
In an unusual ruling the FTC is allowing an IPA to negotiate price for its members. The kicker is the IPA is also selling along with the member services activities designed to improve clinical outcomes. The IPA members were also free to contract outside of the IPA individually with those payors that did not want to contract via the IPA. Top
The independent veteran's commission has recommended and President Bush has asked Congress for a law to allow all vets since 2001 with a discharge as "unfit" due to a service related physical or mental condition be placed on lifetime Tricare coverage. Top
The Indiana Attorney General has asked the Indiana Board of Pharmacy to discipline 14 Indianapolis pharmacists who threw away documents with HIPAA protected information into their backdoor dumpsters. Top
Maryland has fined Blue Cross Blue Shield $125,000 for failure to pay for legitimate claims and for untimely properly denying claims. The law states that claims that are denied must be denied within thirty days. The insurer did not do so. The state believes that the insurer did so with intent. There is no penalty for a late denial but there are interest payments due for late payments. The fine is a pittance for the insurer and will be no deterrent to their future arrogance. The thing that will hurt is the order to pay all the claims that they improperly denied. Top
The OIG has issued an advisory opinion on September 27, 2007, that sets out a way to pay for physician on call without worrying about fed interference. The hospital was in need of on call physicians as the physicians had refused to take call. The physicians are being paid a per diem rate depending on weekday versus weekend and how often they are expected to come to the ED. The physicians in each specialty were to take cal equally so that the high referrers would not be paid more. The hospital also had a rule that each physician would take call 18 times a year gratis. The physicians would also have to care for the patient while in the hospital. Therefore if the deal is structured correctly the hospital may pay for call. 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
information presented.