In a proposed decision memo, the Centers for Medicare & Medicaid Services (CMS) states that there is little evidence to support open and laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, or open and laparoscopic biliopancreatic diversion with duodenal switch as reasonable and necessary in patients with type 2 diabetes mellitus (T2DM) and a body-mass index (BMI) less than 35. Read more »

The U.S. Food and Drug Administration (FDA) seized 11 lots of contaminated heparin—a blood thinner drug—from Celsus Laboratories Inc. on Nov. 6, according to an FDA news release.

The 11 lots consisted of five lots of Heparin Sodium Active Pharmaceutical Ingredient (API) and six lots of Heparin Lithium. These products were manufactured in China and found to be contaminated with over-sulfated chondroitin sulfate (OSCS)—a substance that mimics heparin’s anticoagulant activity. Read more »

As of Jan. 1, 2009, eligible originating sites for payment of telehealth services will include hospital-based or critical access hospital-based renal dialysis facilities (including satellites), skilled nursing facilities and community mental health centers. This amendment to the Social Security Act is mandated by the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008. Read more »

A federal district court last month found Medicare and some of its contractors had unlawfully limited payments for DuoNeb, an inhalation drug used to treat chronic obstructive pulmonary disease, according to The New York Times. Read more »

Millions of dollars in potential revenue is lost every year due to billing errors, such as under-pricing, missed charges, under-coding, and unreimbursed claims. In essence, this is like offering medical services for free.

“As much as 3 to 5 percent of annual practice revenue is lot because the practice simply did not bill for services and procedures that the physicians performed,” said National Advisory Board President Deborah Grider, CPC, CPC-H, CPC-P, CPC-E/M, CPC-I, CCS, CCS-P (Physicians Practice, November 2008). Read more »

In 2002, less than a year after 9/11, the U.S. Department of Health and Human Services (HHS) made available more than $7 billion in funding to increase state and local public health preparedness and emergency response capabilities. In 2006, the Centers for Disease Control (CDC) allocated $766 million of that to 62 awardees to meet nine out of 11 preparedness requirements for Preparedness Goal 3: Detect and Report through its Public Health Emergency Preparedness Cooperative Agreement (Cooperative Agreement).  Six years later, with the completion goal of 2010 less than two years away, less than 10 percent of states have met two of the nine requirements, concludes the Office of Inspector General (OIG) in an October 2008 report. Read more »

The Centers for Medicare & Medicaid Services (CMS) updated the therapy services chapter of the Medicare Claims Processing manual to reflect the extension of the therapy caps exceptions process to Dec. 31, 2009, mandated by the Medicare Improvements for Patients and Providers Act (MIPAA) of 2008. CMS also added HCPCS Level II coding requirements. Read more »

Hospitals can add to their list of covered services new HCPCS Level II code C9899, Implanted prosthetic device, payable only for inpatients who do not have inpatient coverage, that will be effective for services furnished on or after Jan. 1, 2009. Use form TOB-12X for claims of this nature.

This code was missing from an earlier Centers for Medicare & Medicaid Services (CMS) transmittal. Transmittal 1628, issued Nov. 3, rescinds transmittal 1597, issued Sept. 12. Read more »

The Centers for Medicare & Medicaid Services (CMS) has named four personal health record (PHR) companies to participate in the Medicare PHR Choice Pilot, according to a Nov. 12 press release. The pilot will be conducted in Arizona and Utah, and is slated to begin early 2009.

The four PHR companies are: Google Health, HealthTrio, NoMoreClipboard.com, and PassportMD. Read more »

Let diabetic patients know Tyco Healthcare Group LP (Covidien) recalled one lot of ReliOn 31-gauge, 1cc insulin syringes due to possible mislabeling.

According to a U.S. Food and Drug Administration Nov. 5 news release, there was a mix up during the packaging process and some syringes labeled for use with U-40 insulin were mixed with syringes labeled for use with U-100 insulin. The syringes were then packaged individually and boxed as 100 units for use with U-100 insulin. Read more »