Medicare Reimbursement Information V

Medicare reimburses providers based on the type of service they provide. In the Medicare claims data there are three types of procedure codes: Current Procedural Terminology (CPT): CPT codes are designed by the American Medical Association. They describe medical, surgical, and diagnostic services and are designed to communicate uniform information about medical services and procedures…

Medicare Reimbursement Information IV

The Medicare Reimbursement Series Continues. The sources of this information is MedPAC’s Payment Basics. Clinical Laboratory Services: Under Part B, Medicare covers medically diagnostic and monitoring laboratory services ordered by a physician. Medicare does not cover routine screening tests except for cholesterol and blood lipid tests, fecal occult blood testing, Pap smear tests, prostate-specific antigen…

Pfizer to pay $2.3 billion in Medicare/Medicaid Fraud

This past February, I wrote about the spread of physician learning concerning harmful side-effects of Cox-2 inhibitors, including Bextra.  Today, The New York Times reports that Pfizer has agreed to pay a $2.3 billion settlement with CMS over the company’s illegal promotion of its now-withdrawn painkiller, Bextra. “Marketing fraud cases against pharmaceutical companies have become…

Medicare Reimbursement Information III

Today, we will focus on hospital care outside of the traditional Inpatient hospital care setting. Again, this information is culled from MedPAC reports. Outpatient Hospital Services Outpatient hospital care, from injections to complex procedures, accounted for $19 billion of total Medicare spending in 2007 Originally, outpatient reimbursement was cost based and copayments amounted to about…

Medicare Reimbursement Information II

I will continue reviewing some Medicare reimbursement information as described in a variety of MedPAC reports. Medicare Advantage Medicare Advantage is a program where Medicare beneficiaries can receive private heath insurance, partially or fully funded by CMS.  The health insurance must provide coverage at least as generous as Medicare Parts A and B. Private health…