Court Finds Medicare Policy Unlawful

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.

The Bush administration argued in the Oct. 16 test case that Medicare officials had the right to decide whether the expense incurred for a given item, not just the item itself, was “reasonable and necessary.”

U.S. District Court Judge Henry H. Kennedy Jr. said the policy of paying for only “the least costly alternative” was not permitted under the Medicare law. Congress set Medicare payment rates and never intended to give officials broad discretion to alter them, the court said.

“We are disappointed with the ruling and continue to believe that our policy is supported by the statute,” Peter L. Ashkenaz, a Centers for Medicare & Medicaid Services (CMS) spokesman said. “We are still considering our options and next steps.”


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3 Responses to “Court Finds Medicare Policy Unlawful”

  1. Shannon Patrick says:

    Duoneb is a combination drug of albuterol and ipratropium which are covered seperately. It makes it much easier for our Elders to use 1 ampule of premixed solution than to increase the chance of error by giving them 2 ampules to mix in their nebulizer. It has had a generic for some time. So, why not give our Elders a break and make this part of their life a little easier?

  2. erlinda says:

    Questions if you can e-mail the answers

    Where might a medical coder find job?
    What duties are performed by the medical coder?
    What career paths might one take after mastering coding?
    What would you do to keep current in your coding profession?
    What professional organizations would you investigate for this profession?
    As you master the profession what cerification/comntinuing education would you pursue?


    As you master the profession, what certifications/continuing education would you pursue?

  3. Mechelle Gutierrez says:

    As for the answer to the above question(s) regarding medical coding, I am a CPC, CCP-P and have been in the profession for a very long time. I started out in the billing department of the institution that I was employed at way back when. From there, I began coding and have advanced to auditing as well.

    You can find a coding position on the AAPC Website/ practices/hospitals.

    The duties that are performed by a coder can vary based on the knowledge and level of expertise that the coder has.

    Careers path are many from Consultants/Auditors for Medicare/OIG. You can also teach those that are willing to learn at colleges to help prep them to take the CPC exam.

    To remain current, you must have the desire to read a great deal and network with your fellow coders.

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