Wednesday, October 27, 2010

Employers Can Retroactively Amend FSA Reimbursement Policies for OTC Medicines

Under the Patient Protection and Affordable Care Act, all prescriptions submitted for reimbursement through a health flexible spending account (FSA) will now have to be prescribed by a physician, even if the treatment is available over-the-counter.

Employers have until June 30, 2011 to amend their plans to reflect this change. However, the IRS says that employers will be allowed to apply this change retroactively back to January 1, 2011. That means that even if the policy is not in place by January 1, 2011, employers may still deny reimbursements for over-the-counter purchases made after that date. Purchases made before January 1 may still be eligible for reimbursement.

As the provisions of health reform kick in, this serves as a reminder to all MSPs to keep up with the latest news from your employer on how your medical benefits may change.

Source: BNA

Monday, October 25, 2010

OIG Study Examines Medical School Education on Fraud and Abuse

There is and will continue to be more and more investigation into Medicare and Medicaid fraud and abuse which is costing the US taxpayers billions of dollars each year.

One question being discussed is where and when should medical students be provided with instruction on compliance with Medicare and Medicaid laws to prevent fraud and abuse, or is this better left to residency and fellowship training programs?

In the report from the Office of Inspector General (OIG), Department of Health and Human Services, it is reported that Medicare and Medicaid compliance is being provided in medical schools and graduate medical education programs:

44% of medical schools are providing instruction to students

66+% of graduate medical education programs and fellowship programs

The OIG realized that it is difficult for medical schools to incorporate comprehensive education on Medicare and Medicaid fraud and abuse into the medical curriculum. Therefore, it plans to develop educational materials that can be distributed to medical school programs and to engage in conversations with program directors regarding the usefulness of these materials.

To read the full report, click here:

State Insurance Commissioners Vote to Approve More Stringent Rules

The National Association of Insurance Commissioners voted unanimously to endorse standards requiring that "80 percent of premium revenue be spent on medical care and 'activities that improve health care quality' for patients." This requirement was set in place by health reform legislation.

The standards set limits on what revenue spending is defined as improvements to health care quality, and what is considered to be compensation or administrative spending. The goal of the standards is to make insurance companies function more as providers of healthcare and less as for-profit companies.

Secretary of Health and Human Services Kathleen Sebelius is expected to take the recommended standards and propose them as a new regulation for insurance companies. Opponents of the recommendations argue that they will negatively disrupt the insurance industry by forcing companies out of business and reducing consumer choice.

Source: The New York Times

Friday, October 22, 2010

VA Hospitals Implementing Airline Safety Tips

A study of over 108 Veterans Health Administration Hospitals showed an increased drop in patient deaths in facilities that implemented error prevention strategies created by airlines and NASA. Of the 108 facilities, the 74 that implemented the strategies had an 18 percent drop in deaths, compared to a 7 percent drop in facilities that did not implement them.

The Medical Team Training program was targeted at surgical teams, encouraging communication among members of the team, challenging each other to abide by safety practices, and encouraging the use of checklists in preoperative and postoperative briefings. Miscommunication among team members was identified by the aviation industry as a large factor contributing to errors.

The full study can be found in the October 20 Journal of the American Medical Association.

Source: Bloomberg Businessweek

Monday, October 18, 2010

Arkansas Court Strikes Down Economic Credentialing

The Arkansas Supreme Court upheld a 2009 decision stating that a hospital could not deny staff privileges to physicians with an ownership stake in competing hospital based on financial concerns because this policy violates state laws.

Baptist Health in Little Rock, Arkansas denied staff privileges to 12 physicians stating that its conflict of interest policy permitted the hospital to do so because of the economic interests of the facility.

Organizations such as the American Medical Association joined the physicians as plaintiffs, stating that restricting physician practice through economic credentialing restricts patient choice and that physicians should be evaluated on performance, not financial factors.

This is the highest court decision issued on the subject of economic credentialing. The AMA states that it is an issue that if challenged again, will be determined on a state-by-state basis.


Wednesday, October 13, 2010

Even Hospitals Aren't Immune to Bed Bugs

Nationally, residences, businesses, and even federal offices have been dealing with a resurgence of bed bug infestations. Now it appears that even hospitals are receiving visits from the pests.

Lenoir Memorial Hospital in Kinston, North Carolina recently had to implement a policy to prevent the spread of bedbugs in the facility. After exterminating and treating a room that had become infested, LMH imposed a policy that prohibits patients and visitors from bringing outside bedding into the facility, including blankets and pillows.

Hospitals have had to implement policies to prevent the spread of infections. If the number of reported infestations continues to increase, it may not be long until bed bug policies becoming common in facilities.

To read the full article, click here: