Medicare Report Index-Summary

AARP

– Brand-name drug price increase, 571; widely used brand name drug prices continue to rise, report, 987
– MA and Part D changes, fact sheets, 516
– Physician pay fix bill

See LEGISLATION, FEDERAL, HR 4213

– Sustainable growth rate (SGR) formula repeal urged, 130

ABORTION

– Health care reform and use of federal funds

See LEGISLATION, FEDERAL, HR 3962

ACADEMIC MEDICAL CENTERS (AMCs)

See generally TEACHING HOSPITALS

ACCESS TO CARE

– Disabled beneficiaries, Medicare not working as well as for elderly, report, 961
– Expanding primary care access, no guarantee of better quality, study, 1059
– Medicare Advantage special needs plans for dual eligibles, network adequacy, 883
– MedPAC survey, 1455
– Part A providers, insolvency possible for some, CMS analysis, 465
– Part D drug benefit, access to drugs

See generally PART D DRUG BENEFIT

– Physician pay cut issue

See PHYSICIAN PAYMENT

– Provider access top reason for MA disenrollment, 666
– Rural health care

See RURAL HEALTH CARE

ACCOUNTABLE CARE ORGANIZATIONS (ACOs)

– AHA urges flexibility in implementation, 1411
– All types of providers should be considered, stakeholders tell CMS, 1409
– AMA announces 13 principles for development and implementation, 1346
– Antitrust, anti-kickback, and Stark protections possible, attorney says, 1412
– Begin integrating despite unanswered questions, attorney says, 1169
– Beneficiary opt-out considered by MedPAC, 1177
– Cal. Med. Ass'n recommendations, 1305
– CMS rules expected mid-January, providers must be serious about change, 1450
– Effect on market, CMS should consider, panelists, 1115
– Fraud and abuse challenges, BNA Insights, 1518
– Fundamental changes, report, 1171
– Guidelines will avoid antitrust violations, Justice Dep't official, 1421
– Health information exchange link, PriceWaterhouseCoopers report, 1458
– Impact on other providers, CMS concerns, 1047
– Important to health IT industry, expert, 885
– Industry urged to act now, 744
– Initial rulemaking, CMS seeks comments, 1336
– Limits on integration, attorney, 1207
– NCQA

– – Draft standards released, 1201; comments from providers and patient advocates, 1407
– – Implications of draft criteria, BNA Insights, 1305
– – Proposed standards overlap “meaningful use” standards, PriceWaterhouseCoopers report, 1458

– New relationships between doctors and hospitals, BNA Insights, 1393
– Notice of proposed rulemaking expected this fall, CMS, 639
– Open Door Forum conference call for providers, 666
– Outlook 2010, top health issues, 42
– Patient notification requirements, proposed rules due soon, 1237
– Pilot project in Vt., considerations, report, 590
– Premier health care alliance collaboratives, 589
– Preparedness, BNA Analysis & Perspective, 20
– Promising if properly implemented, attorney says, 547
– Providers should share financial risk with Medicare, MedPAC, 1422
– Questions about function raised at Am. Enterprise Inst. conference, 1231
– Reconciliation bill

See LEGISLATION, FEDERAL, HR 4872

– Regulation and enforcement questions, BNA Insights, 1132
– Response of stakeholders, flexibility and inclusion of small practices, 1449
– Safe harbor

– – Fraud and abuse waivers, options outlined by AHLA, 1271
– – Stakeholders want fraud and anti-kickback guidance, 1145; recordings and transcript, 1206

– Savings

– – Ability to cut spending unclear, CRS report, 1295
– – Costs may not decrease, report on Cal., experience, 1236
– – Shared savings program, misconceptions and questions, BNA Insights, 1251

– Still evolving but promising, conference participants, 954
– Strong performance measurement system key to success, article, 1236
– Structure, additional guidance sought, 1171
– Workshop, FTC and CMS, 1049

ACCOUNTANTS

– Cost reports, qui tam suit against Ernst & Young and hospital dismissed without prejudice (S.D.N.Y.), 268
– State and federal FCA suit against Ernst & Young dismissed (S.D.N.Y.), 1101

ACCOUNTING

– IG audits

See generally INSPECTOR GENERAL (IG) REPORTS

– Part D tax deduction repeal considered

See LEGISLATION, FEDERAL, HR 3590, HR 3962

– Retiree benefits, company changes to avoid one-time charge, 548

ACCREDITATION AND CERTIFICATION

– EHRs

– – First certifying bodies announced, 1013
– – Meaningful use, temporary certification program, 689; end date set, 690
– – More official certifiers, 1114
– – Standards and certification criteria, 775; public health surveillance and reporting rule error, 1172

– False certifications to Medicare, FCA suit dismissal for insufficient pleading (9th Cir.), 942
– Home health certification by physician, intermittent skilled nursing services (D. Vt.), 345
– Joint Commission

See JOINT COMMISSION

– Recertification for Anaheim Gen. Hosp., 1234
– Telemedicine, credentialing of providers, CMS proposes streamlining rules, 587; comments propose including ambulatory care, 934

ACOs

See ACCOUNTABLE CARE ORGANIZATIONS (ACOs)

ADMINISTRATIVE LAW

– Full-time equivalent (FTE) resident caps dispute, administrative record needed (D.D.C.), 267

ADVERSE EVENTS

– Cost to economy of medical errors $19.5B, 941
– Frequency, 13.5 percent of Medicare beneficiaries, IG report, 1340
– Number of Medicare patient incidents, 390
– Screening methods effectiveness, IG report, 241

ADVERTISING

– HHS use of funds to produce television ads on health care reform, no violation of law, GAO report, 1210

ADVISORY OPINIONS, HHS IG

– Anti-kickback laws

See ANTI-KICKBACK LAWS

ADVISORY PANELS

– IPAB

See INDEPENDENT PAYMENT ADVISORY BOARD (IPAB)

– MedPAC

See MEDICARE PAYMENT ADVISORY COMMISSION (MedPAC)

– PPAC

See PRACTICING PHYSICIANS ADVISORY COUNCIL (PPAC)

AFFORDABLE CARE ACT

See PATIENT PROTECTION AND AFFORDABLE CARE ACT (PPACA)

AHA

See AMERICAN HOSPITAL ASSOCIATION (AHA)

AHLA

See AMERICAN HEALTH LAWYERS ASSOCIATION (AHLA)

AIDS AND HIV

– Facial filler injections coverage proposed, 9; decision to cover immediately, 309

ALFs

See ASSISTED LIVING FACILITIES (ALFs)

AMA

See AMERICAN MEDICAL ASSOCIATION (AMA)

AMBULANCE SERVICES

– Annual dispatch fee part of contract with municipality, advisory opinion, 1175
– City reimbursed for emergency dispatch costs and quality monitoring, advisory opinion, 1341
– Cost-per-trip limits for Ariz. hospital (D. Ariz.), 1018
– CY2011 fee schedule, analysis, BNA Insights, 1315
– Extrapolation in Medicare overpayment assessment challenged (M.D. Tenn.), 289

AMBULATORY CARE

– CY2011

– – Affordable Care Act changes, BNA Insights, 814
– – Detailed analysis of final rule, BNA Insights, 1362
– – Fee schedule, analysis, BNA Insights, 1315
– – Increase of 0.6 percent for ASCs recommended by MedPAC, 109
– – Proposed payment changes, BNA Insights, 794

– CY2012, MedPAC members uncertain about draft recommendation, 1455
– Outpatient and emergency departments, new data on Hospital Compare website, 746
– Ownership, arrangement between physician organization and health system, advisory opinion, 1054
– Patient rights disclosures, proposed rule, 431
– Payment rates for ASCs too low, attorney says, 339
– Physician supervision for therapeutic services

– – Final rule redefines supervision requirement, 1262
– – General rather than direct supervision

See LEGISLATION, FEDERAL, HR 6376

– – Lawmakers urge rule change, 1095

– Primary Care Home Initiative standards, expansion of Joint Commission ambulatory health care organizations accreditation, 1062
– Telemedicine, credentialing of providers, comments, 934

AMCs (ACADEMIC MEDICAL CENTERS)

See generally TEACHING HOSPITALS

AMERICAN HEALTH LAWYERS ASSOCIATION (AHLA)

– ACOs, fraud and abuse waivers, options outlined by AHLA, 1271
– Meetings

See CONFERENCES AND MEETINGS

AMERICAN HOSPITAL ASSOCIATION (AHA)

– ACOs

– – Flexibility in implementation urged, 1411
– – Response of stakeholders, 1449

– Background checks, CMS proposal to enhance procedures for high-risk providers, changes urged, 1339
– Conferences and meetings

See CONFERENCES AND MEETINGS

– Deficit reduction panel recommendations, response, 1345
– Electronic health records incentives

– – Balance between swift and careful implementation, paper, 470
– – CMS proposal criticized, 168
– – Hospital groups urge CMS to abandon “all or nothing” approach, BNA Special Report, 294
– – Implementation guide, AHA and College of Healthcare Information Management Executives, 861
– – “Meaningful use” and hospital definitions position papers, 150
– – Requirements too stringent, hospital official, 469

– Fraud-fighting bills support

See LEGISLATION, FEDERAL, HR 5044, HR 5546, S 3632

– Health care reform concerns

See LEGISLATION, FEDERAL, HR 3590, HR 3962

– Inpatient prospective payment system (IPPS)

– – Coding offset flaws, study, 830
– – Model letter for comments on proposed rule, 618

– Medicare underpayments in 2009, survey, 1458
– Physician supervision for therapeutic services, general rather than direct

See LEGISLATION, FEDERAL, HR 6376

– RACs

– – Auditor overlap and lack of consistency, criticism by AHA official, 1051
– – Reviews, administrative burden, survey, 1051

– Readmissions reduction, guide, 133
– Repeal of Independent Payment Advisory Board support

See LEGISLATION, FEDERAL, S 3653

AMERICAN MEDICAL ASSOCIATION (AMA)

– ACOs, principles for development and implementation, 1346
– Background checks, CMS proposal to enhance procedures for high-risk providers, changes urged, 1339
– Conferences and meetings

See CONFERENCES AND MEETINGS

– E-prescriptions, CMS urged to change penalty calculation policy, 1482
– Elimination of Medicare consultation codes, negative financial impact on physician practices, survey, 834
– “Meaningful use” incentives, proposals, 282
– Penalties for unsuccessful e-prescribers, opposition, 983
– Physician pay cut

– – Action before Thanksgiving urged, 1303
– – Delay bill fails to address access-to-care issue

See LEGISLATION, FEDERAL, HR 4213

– – Media campaign, 622
– – “Outrage” at Congress failure to cancel 21 percent cut, 664
– – Speedy processing of overdue claims urged, 1482
– – “Unconscionable,” official says, 341
– – White House article, response, 985

– Sustainable growth rate (SGR) formula

– – Alternate payment systems study, resolution, 668
– – Repeal urged, 130

AMERICAN RECOVERY AND REINVESTMENT ACT (ARRA)

– Comparative effectiveness

See COMPARATIVE EFFECTIVENESS

– Electronic health records incentives in stimulus law

See ELECTRONIC HEALTH RECORDS

ANESTHESIOLOGY SERVICES

– Physician supervision of nurse anesthetists

– – Certified registered nurse anesthetists without supervision, doctors sue state (Cal. Super. Ct.), 157; state opt-out upheld, 1184
– – Colo., may seek federal waiver of Medicare requirement, 1089; state applies for waiver, 1117
– – Patient death rate of nurse anesthetists without supervision, no increase, study, 889

ANTI-KICKBACK LAWS

– ACOs, protections possible, attorney says, 1412
– Ambulance company

– – Annual dispatch fee part of contract with municipality, advisory opinion, 1175
– – City reimbursed for emergency dispatch and quality monitoring, advisory opinion, 1341

– Ambulatory care center arrangement between physician organization and health system, advisory opinion, 1054
– Charitable donations in return for provider's using software to schedule manufacturer's representative visits, advisory opinion, 886
– Children's health system donations to fund programs at another health system, advisory opinion, 1085
– Cochlear implants, faulty devices, maker reimbursement of providers for services, advisory opinion, 1055
– Continuing care retirement community operator, gift cards for referrals, advisory opinion, 621
– County grants for county emergency operations center, advisory opinion, 691
– Cystic fibrosis drug coverage, modifications in proposal to help needy patients, IG opinion, 1271
– Dietitian and social worker free to Medicare cancer patients at free-standing radiation oncology centers, advisory opinion, 692
– DME, reconsideration of qui tam case dismissal (N.D. Miss.), 392; government motion to compel production of documents on nursing homes denied, 1212
– Free insurance preauthorizations for patients referred to hospital for diagnostic imaging, advisory opinion, 1014
– Medigap

– – Financial arrangements between policy providers and contracted hospital networks, advisory opinion, 217
– – Insurer proposes contracts for hospital discounts, advisory opinion, 1120

– Mutual emergency response arrangement between municipalities, limited cost-sharing waiver, advisory opinion, 691
– Nonprofit charitable foundation created to help people with coagulation disorders, advisory opinion, 1119
– Patient assistance programs

– – Donor-funded program to assist underinsured with drug copays, advisory opinion, 620
– – Financially needy brain tumor patients, foundation program, advisory opinion, 1013
– – Nonprofit organization grants shield beneficiaries from donors, advisory opinion, 643

– Pediatric tonsillectomy patients, one free night, advisory opinion, 1118
– Pa. hospital and physicians, material fact questions (W.D. Pa.), 1352
– Preauthorization service for free, advisory opinion, 1119
– Sleep-testing

– – Administrative sanctions possible under arrangement with hospital, advisory opinion, 1299
– – Provider arrangement with hospital, advisory opinion, 1054

– Waiver of retroactive beneficiary liability due to retroactive payment rate increase, 712

ANTITRUST

– ACOs

– – Guidelines will avoid violations, Justice Dep't official, 1421
– – Limits on integration, attorney, 1207
– – Protections possible, attorney says, 1412
– – Stakeholders want guidance, 1145; recordings and transcript of meeting, 1206

– GPOs, code of conduct changes, concerns linger, GAO report, 1122
– Mergers and acquisitions

See MERGERS AND ACQUISITIONS

APPEALS

– Dismissal

– – Failure to appear at hearing (D.D.C.), 289
– – Hospital missed filing deadline (D.D.C.), 200

– DSH

– – Equitable tolling argument fails in claims for payments (D.D.C.), 249
– – Payment adjustments, CMS rule, BNA Special Report, 526

– FCA

– – Qui tam actions, retroactive application of ruling that 30-day filing notice applies when U.S. does not intervene (9th Cir.), 173
– – Time for appeal, retroactive application of decision (U.S., rev den), 1152

– HHS cannot reopen SNF reimbursement claim to divest federal court of jurisdiction (7th Cir.), 844; remanded to reopen administrative proceedings (C.D. Ill.), 1428
– RACs

– – Consistent interpretation, reopening payment decision proper (M.D. Fla.), 963
– – Decision to reopen payment decision (S.D. Cal.), 891
– – Denials, providers win 64 percent, 692

– Untimely, hospice repayment demand (S.D. Tex.), 701

ARIZONA

– DSH calculations

– – Exclusion of low-income patients from adjustments upheld (9th Cir.), 1099
– – Medically needy/medically indigent patients properly excluded (D.D.C.), 649

– Mayo Clinic stops accepting Medicare patients, 34
– Personal health records pilot, beneficiary satisfaction survey, 216; notice of consumer satisfaction survey, 544; blue button system recommendation, 1009

ARKANSAS

– SNFs, immediate jeopardy finding vacated (8th Cir.), 16

ASCs (AMBULATORY SURGICAL CENTERS)

See AMBULATORY CARE

ASSISTED LIVING FACILITIES (ALFs)

– Continuing care retirement community operator, gift cards for referrals, kickbacks advisory opinion, 621

ATTORNEY-CLIENT PRIVILEGE

– Under arrangements pharmacy goods provider suit against SNFs that failed to pay, discovery order (D. Utah), 942

ATTORNEYS

– False certification, former Tenet general counsel, dismissal as time-barred (S.D. Fla.), 476
– Fees

See ATTORNEYS' FEES

– MSP, U.S. sues plaintiffs' lawyers over pollution liability settlement (N.D. Ala.), 200
– RAC reviews, strategies, BNA Special Report, 967

ATTORNEYS' FEES

– Award to physician after fraud acquittal (9th Cir.), 113
– SNF denied fees in bad debt case (D.D.C.), 90

AUDITS

– Accountants sued

See generally ACCOUNTANTS

– IG audits

See generally INSPECTOR GENERAL (IG) REPORTS

– MA validation audits, OMB reviewing data review process, 432
– Outpatient therapy research project participants, deferrals possible, 981
– Part D oversight

– – Testimony on need for improvement, 245
– – Validation audits, OMB reviewing data review process, 432

– Recovery audit contractors (RACs)

See RECOVERY AUDIT CONTRACTORS (RACs)