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(c) 2010-2024 Jon L Gelman, All Rights Reserved.

Saturday, December 29, 2012

Class Action by Medicare Advantage Beneficiares Dismissed By Federal Court

A federal class action, by a group of plaintiffs who alleged that they were a class of Medicare-eligible individuals enrolled in a Medicare Advantage plan, and received benefits under part C of the Medicare program, was dismissed by a federal court under the preemption doctrine. In an action removed to Federal court, the plaintiffs sought to bring a class action in state court alleging that New York state law applied regarding reimbursement for for monetary settlements from third-party tortfeasors.

The court ruled that the interpretation of the secondary payer provision of Medicare part C, 42 USC section 1395W-22 (a)(4), preempted any state law provisions.

Meek-Horton v. Trover Solutions, Inc., No. 11 CV 6054(RPP), 2012 WL 6699776, (SD-NY 2012) Decided December 26, 2012

Read more about "The Medicare Secondary Payer Act" and workers' compensation


Oct 01, 2012
US Supreme Court Denies CMS-MSP Case - Hadden. 2012 WL 1106757. Supreme Court of the United States. HADDEN, VERNON V. UNITED STATES. No. 11-1197.Oct. 1, 2012. Opinion. The petition for writ of certiorari is ...
Dec 28, 2012
CMS/MSP Requires Deceased Beneficiary Information. CMS has announced that workers' compensation information concerning deceased beneficiaries must be reported by insurance carriers. "We received another question ...
Apr 03, 2009
CMS/MSP Requires Deceased Beneficiary Information. CMS has announced that workers' compensation information concerning deceased beneficiaries must be reported by insurance carriers. "We received another question ...
May 18, 2011
"IT IS FURTHER ORDERED that Defendant's demand for payment of her MSP reimbursement claims, under threat of collection actions before there has been a resolution of an appeal regarding the amount of the Defendant's ...

Friday, December 28, 2012

Legislation Goes to President Obama on CMS Condition Payment Procedures

The US House (H.R. 1845) and US Senate has passed legislation to modify procedures for processing conditional payments under the Medicare (S. 1718) Secondary Payer Act. It establishes parameters for repording, processing and appealing issues concerning conditional payments.

Under the proposed legislation time periods for reporting by parties to CMS (The Center for Medeicare and Medicaid Services) are eased, penalities for insurance carriers are reduced, and a 3 year statute of limitations is established.

The legislation was merged into another pending bill for medical services and was rushed to a favorable vote in both the House and Senate in the last moments before Christmas.

What remains to be determined are the regulations that will be established to implement the legislation. In the past, such regulations usually set boundries for such legislation and may in the end further complicate and even prolong resolution of the issues.

Read more about "The Medicare Secondary Payer Act" and workers' compensation


Oct 01, 2012
US Supreme Court Denies CMS-MSP Case - Hadden. 2012 WL 1106757. Supreme Court of the United States. HADDEN, VERNON V. UNITED STATES. No. 11-1197.Oct. 1, 2012. Opinion. The petition for writ of certiorari is ...
Apr 03, 2009
CMS/MSP Requires Deceased Beneficiary Information. CMS has announced that workers' compensation information concerning deceased beneficiaries must be reported by insurance carriers. "We received another question ...
May 18, 2011
"IT IS FURTHER ORDERED that Defendant's demand for payment of her MSP reimbursement claims, under threat of collection actions before there has been a resolution of an appeal regarding the amount of the Defendant's ...
Dec 23, 2008
A formal process exits to obtain a waiver of an Overpayment Recovery request from The Center for Medicare and Medicaid Services [CMS]. If SSA advises you or your client that it has made an overpayment, ie. Medicare ...


Thursday, December 27, 2012

Who Calls The Shots, Your Employer-Selected Doctor Or The Insurance Company?


Insurance companies sometimes tell doctors that they will not pay for procedures that the doctor says are medically appropriate.

Today's post comes from guest author Nathan Reckman from Paul McAndrew Law Firm.

In Iowa, employers have the right to control an injured worker’s medical care. This means that if you are injured at work, your employer gets to send you to a doctor of their choosing. The doctors chosen by the employer are called “authorized treating physicians.” In theory, after an employer chooses their authorized treating physician, they are required to pay for any care that doctor believes is necessary to treat the work injury. In practice, the employer and their workers’ compensation insurance company often try to interfere with the care the injured worker is entitled to by refusing to pay for procedures or tests recommended by their handpicked doctor.

Typically, when an authorized doctor suggests an expensive course of care (like surgery) the first thing the doctor will do is check with the insurance company to make sure the surgery is going to be paid for. Instead of immediately scheduling the needed surgery, the doctor will wait until the insurance carrier agrees to pay for the procedure. Doctors do this so they don’t have to worry about how they are going to be paid. Asking for this unneeded authorization from the insurance company means the insurance company now has a say in determining what individual procedures are proper for the care of the work injury.

We often see injured workers whose injury was initially accepted by the employer until the doctor requests authorization for an expensive surgery. When faced with the additional cost of surgery, the insurance carrier denies the work injury hoping the injured worker will either forego surgery or try to pay for the surgery through other means, such as their personal health insurance.

This situation may also arise when the authorized doctor recommends expensive diagnostic procedures, like CT scans, or refers the injured worker to a specialist, for example a psychiatrist for depression related to the work injury.

To make sure your rights are protected, it’s often helpful to have an experienced workers’ compensation attorney on your side if you’re facing a situation where your employer is trying to interfere with the decisions of their handpicked doctor. Injured workers should get the care that their doctor, not an insurance company, determines is medically appropriate.

Read more about "medical treatment" and workers' compensation.


Nov 16, 2012
New York Worker's Compensation Board's proposed new medical treatment guidelines that will modify 2010 previously implemented. Adopt the new carpal tunnel syndrome (CTS) medical treatment guidelines (MTG) as the ...
Nov 09, 2012
On Tuesday, the American people expressed its support for a unified medical care program that will embrace all aspects of life, including industrial accidents and diseases. They validated, as did the Supreme Court, the ...
Nov 01, 2012
Planned changes by Mitt Romney to Medicare and Medicaid will have a dire effect on the regulations of the future cost of workers' compensation medical treatment. Proposed changes to the Federal program will indirectly ...
Jan 22, 2011
The court held that the failure of the employer/insurance carrier to provide medical care for out-of-state treatment, even though requested by the employee, was deemed a refusal of the employer to provide adequate medical ...

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Monday, December 24, 2012

Happy and Healthy Holiday Season


Electronic Health Records: Occupational Information and Demographics

Report: IOM
With the widespread adoption of electronic health records (EHRs), the Institute of Medicine has concluded that incorporating patients’ occupational information into EHRs could lead to more informed clinical diagnosis and treatment plans as well as more effective policies, interventions, and prevention strategies to improve the overall health of the working population. However, this potential will only be realized if providers have an incentive to collect and record information on patient occupation and industry.

"Demographics are statistical characteristics of a population. These types of data are used widely in public opinion polling andmarketing. Commonly examined demographics include genderageethnicity, knowledge of languagesdisabilities, mobility, home ownership, employment status, and even location. Demographic trends describe the historical changes in demographics in a population over time (for example, the average age of a population may increase or decrease over time). Both distributions and trends of values within a demographic variable are of interest. Demographics are very essential about the population of a region and the culture of the people there."

Between now and January 14, you have the opportunity to express your support for including occupation and industry codes in the federal rules defining "meaningful use" of EHRs. If you choose to do so, please consider telling the Office of the National Coordinator for Health IT (ONC) that you favor the addition of occupation and industry codes and the retention of demographics as incentivized objectives in the definition of meaningful use.

These changes will not only address the meaningful use goal of improving quality, safety, and reducing health disparities but also serve to improve the goal of improving population and public health by securing the data needed to improve the ongoing, systematic collection, analysis, and interpretation of occupational injury and illness.

Links for submitting your comments and additional background information are included below.

COMMENT

Request for Comment Regarding the Stage 3 Definition of Meaningful Use
http://www.healthit.gov/buzz-blog/meaningful-use/set-stage-meaningful-stage-3/

Stage 3 Definition: Objectives, Recommendations, and Questions/Comments (see Page 6)
http://www.healthit.gov/sites/default/files/hitpc_stage3_rfc_final.pdf

Comment Submission
http://www.regulations.gov/#!docketDetail;D=HHS-OS-2012-0007

BACKGROUND

Included as part of the American Reinvestment & Recovery Act (ARRA), the "Health Information Technology for Economic and Clinical Health" (HITECH) Act promotes the meaningful use of interoperable electronic health records (EHRs) throughout the United States health care delivery system as a critical national goal. This effort is led by the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC).

CMS grants an incentive payment to Eligible Professionals (EPs) or Eligible Hospitals (EHs) who can demonstrate that they have engaged in efforts to adopt, implement or upgrade certified EHR technology. In order to encourage widespread EHR adoption, promote innovation, and avoid imposing excessive burden on healthcare providers, meaningful use has been introduced in stages. Rule making defining meaningful use for stages 1 and 2 has already been finalized. On 11/26/2012, ONC published a notice in the Federal Register requesting comments on the draft recommendations for meaningful use stage 3. The comment period will close on 01/14/2013.

The Health Information Technology (HIT) Policy Committee has proposed adding occupation and industry codes and eliminated demographics as incentivized objectives. The addition of occupation and industry codes is welcome, but these data will have little value for computing health statistics if demographics are missing. Occupation and industry codes should be added and demographics should be retained.

IOM: Incorporating Occupational Information in Electronic Health Records: Letter Report http://www.iom.edu/Reports/2011/Incorporating-Occupational-Information-in-Electronic-Health-Records-Letter-Report.aspx

CDC: Introduction to Meaningful Use
http://www.cdc.gov/ehrmeaningfuluse/introduction.html

Health Affairs: 'Meaningful Use' Of Electronic Health Records
http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=24

NEJM: The "Meaningful Use" Regulation for Electronic Health Records
http://www.nejm.org/doi/full/10.1056/NEJMp1006114

Wikipedia: Meaningful Use
http://en.wikipedia.org/wiki/Electronic_health_record#Meaningful_use

Read more about "Electronic Health Records" and Workers' Compensation


Jul 05, 2012
Written comments submitted to the Docket will be used to inform NIOSH with its planning and activities in response to the 2011 letter report “Incorporating Occupational Information in Electronic Health Records” written by the ...
Oct 05, 2011
David H. Wegman, Catharyn T. Liverman, Andrea M. Schultz, and Larisa M. Strawbridge, Editors; Committee on Occupational Information and Electronic Health Records; Institute of Medicine. 84 pages PAPERBACK $35 ...
Oct 04, 2011
The use of electronic health records (EHRs) has increased rapidly since the passage of the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act. Incorporating patients' occupational information ...
Feb 14, 2009
The new economic recovery package includes an appropriation of $19 Billion for the expansion of electronic health records [EHR] by funding intellectual technology. The legislation fails to include an essential prohibition on ...

Saturday, December 22, 2012

Are You Sure Your Hospital is on Santa's List?

Medicare has announced the bonuses and penalties for specific US Hospitals holding them accountable on quality of services rendered to patients. Soon the program will be expanded to doctors.

Thursday, December 20, 2012

SeaWorld Safety Investigation Expanded by OSHA

Safety at SeaWorld continues to be an issue. OSHA has expanded a new investigation concerning the exposure of trainers to struck by and drowning hazards when engaged in performances with killer whales.

The U.S. Department of Labor's Occupational Safety and Health Administration has filed a petition against SeaWorld of Florida LLC to comply with administrative subpoenas that require SeaWorld to provide three managers to be interviewed during OSHA's follow-up abatement inspection. SeaWorld has declined to provide personnel to answer questions regarding abatement or correction of a prior violation related to trainers' exposure to struck-by and drowning hazards when engaged in performances with killer whales.

"The employee testimony for the follow-up abatement inspection, required by a subpoena, allows OSHA inspectors to determine if SeaWorld employees continue to be exposed to unsafe and unhealthy working conditions," said Assistant Secretary of Labor for Occupational Safety and Health Dr. David Michaels. "Abating safety and health hazards in the workplace needs to be as important to an employer as recognizing the hazards in the first place."

The follow-up inspection is being conducted as a result of previous violations that OSHA identified after a February 2010 drowning of a trainer who was grabbed and pulled under the water by a six-ton killer whale during what SeaWorld described as a "relationship session." In August 2010, OSHA issued SeaWorld citations related to the incident. SeaWorld contested OSHA's proposed violations and penalties.

A trial was held by the Occupational Safety and Health Review Commission, and in June an administrative law judge upheld OSHA's citations against SeaWorld. Subsequently, SeaWorld was required to abate cited hazards, including those specifically related to trainers working in proximity to the killer whales. However, since the order went into effect, SeaWorld has filed a petition with the review commission seeking additional time to abate the violation regarding trainers' interaction with killer whales. SeaWorld maintains that the petition, which is pending resolution, should restrict the scope of OSHA's follow-up inspection.

The enforcement action has been filed in the U.S. District Court for the Middle of Florida, Orlando Division by the department's Atlanta Regional Solicitor's Office.


Read more about "SeaWorld" and safety issues:


Sep 25, 2011
This week a trial began in Florida between SeaWorld theme parks and the Occupational Safety and Health Administration(OSHA). The trial is over several citations and a fine stemming from incidents in which killer whales ...
Feb 27, 2010
The terrible and tragic death of Daum Brancheau, the trainer who was attacked at SeaWorld by a killer whale, provides striking evidence that the present system, to make the workplace safer, is not working. The corporate ...