WASHINGTON (Reuters)—Aetna Inc.’s plan to buy smaller insurer Humana Inc. for $31 billion will mean seniors will pay higher Medicare Advantage premiums, according to a new report by the think tank Center for American Progress (CAP). Aetna’s proposed deal for Humana would combine Aetna’s 7% of the Medicare Advantage market with Humana’s 19%, and make…
U.S. Government Suspends Enrollment in Cigna Medicare Advantage, Drug Plans
(Reuters)—The U.S. government has suspended new enrollment in Cigna Corp’s Medicare Advantage health plans for seniors and standalone Medicare prescription drug plans, citing noncompliance in its appeals and grievances procedures. The government said Cigna had deficiencies in its appeals and grievances processes in both Medicare Advantage and the Medicare prescription drug program, according to a…
How to Avoid Legal Pitfalls
In busy rheumatology practices, mountains of paperwork for insurance companies and federal healthcare programs make it hard to keep track of what’s legal. Missing documentation is the most common way to spark an investigation. Here are a few considerations to help you avoid legal pitfalls…
Medicare Drug Coverage Plans for Rheumatologic Medications
Different parts of Medicare cover different services. For outpatient prescription drugs, Medicare has two distinct programs with a maze of complex policies. Most physicians along with Medicare patients, retail pharmacies, Medicare drug plans as well as Medicare Advantage health plans continuously struggle with navigating Medicare drug coverage under Part B and Part D. There are…
5 Considerations to Help Jumpstart Your New Rheumatology Practice
Starting your own rheumatology practice is daunting, and it’s easy to focus on the medical side and neglect the business side of a practice. Here are five important considerations that could help a new practice thrive…
Docs & Patients Should Remember to Use Generics
(Reuters Health)—Prescribing generic medicines instead of brand name drugs whenever possible cuts costs, improves patient adherence and improves health outcomes, according to a new recommendation from the American College of Physicians. “Generic medications are cheaper and patients are more likely to get those prescriptions filled,” says Dr. Amir Qaseem of the American College of Physicians,…
Hospital-Owned Physician Practices Linked to Higher Prices
(Reuters Health)—Outpatient care may cost more when hospitals own the medical practices or employ the physicians, a U.S. study suggests. Hospital employment of doctors and ownership of physician practices has grown over the past decade as healthcare providers seek to curb expenses with economies of scale and deliver better coordinated treatment to patients. Research reported…
Unwelcome News about Medicare’s Rising Drug Plan Costs
CHICAGO (Reuters)—Seniors have received some unpleasant news in their mailboxes in recent weeks: premiums for many Medicare prescription drug insurance plans will rise at double-digit rates next year. Premiums for the ten most popular Medicare Part D prescription drug plans (PDPs) will rise an average of 8 percent next year—the fastest clip in five years,…
Complex Patients More Likely to Switch from Medicare Advantage
NEW YORK (Reuters Health)—Medicare Advantage plans might not be meeting the needs of patients requiring the costliest and most complex levels of care, a new study suggests. Between 2010 and 2011, such patients were more likely to switch from Medicare Advantage plans to traditional Medicare, rather than vice versa, researchers found. The results suggest people…
Moving to ICD-10 Has Promises, Challenges
NEW YORK (Reuters Health)—While the new International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes offer greater diagnostic precision, their implementation will require training of clinicians, coders, and other staff to minimize payment denials or delays from both public and private payers. Brian Outland and colleagues from the American College of Physicians in Washington,…
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