Targeting high-billers: what it means and what you should do when Medicare singles you out

Article Abstract:

Medicare sends Comparative Performance Reports to physicians who have billed Medicare for an unusually large number of procedures or services compared to their peers; the agency delivered 54,000 such evaluations in 1992. Although many physicians discard the reports, the reports could be the first step toward further review or disciplinary action. Physicians who receive a report should take several steps, including carefully reviewing the report and explaining their findings to Medicare in writing. Additional steps for physicians to take in reviewing their evaluation are presented.

Offices & clinics of medical doctors, Evaluation, Reports, Physicians, Medical professions

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Medicaid waiver plan could spur innovations

Article Abstract:

Medicaid waivers can help state health programs implement innovative health care reform plans by using Medicaid funds in the most effective way possible. For example, Virginia obtained a waiver to purchase discounted vaccines with Medicaid money. Alabama sought a waiver to use Medicaid funds to improve home care services. Twenty-eight such projects are being tested in 18 states, and 11 new projects are being developed. The waiver application process is being streamlined after a directive from Pres Bill Clinton.

Laws, regulations and rules, Social policy, Health care reform, Medicaid, State government

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Shots, shoes are new items in Medicare coverage

Article Abstract:

Medicare is expanding its preventive services coverage by adding flu vaccinations and therapeutic shoes to its benefits program. The additions were the result of two demonstration programs conducted by the agency. The effectiveness of these preventive services was not proven. The programs wee approved for coverage under the Omnibus Budget Reconciliation Act of 1987.

Services, Public health

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