Medicaid reimbursement

With worsening of the economy, both the federal and state governments may cut back on Medicare and Medicaid reimbursement to nursing homes. Thus these facilities may go out of business or have insufficient funds to reimburse us for the services of the program. 

Ford, M., Medicaid Reimbursement for Outpatient Prescription Drugs, Congressional Research Service Report to the U.S. Congress, No. 91-235 EPW (Washington, DC U.S. Government Printing Office, March 7, 1991). 

Physician Payment Review Commission (PPRC) a bipartisan congressional advisory group established in 1986 to advise Congress on setting Medicare and Medicaid reimbursement. In 1990, PPRC s responsibilities were expanded to include other payment policy issues. 

National Assembly on School-Based Health Care (2000). Medicaid reimbursement in school-based health centers State association and provider perspectives. Washington, DC Author. 

Soumerai, S., et al., "Effects of Limiting Medicaid Drug Reimbursement Benefits on the Use of Psychotropic Agents and Acute Mental Health Services by Patients with Schizophrenia," N. Engl. ]. Med., 331, 650-655 (1994). 

The Centers for Medicare and Medicaid Services reimbursement criteria for ICDs (http //www.cms.hhs. gov/mcd/viewimplementation.asp id= 148) include patients with either ischemic or nonischemic... 

The medication costs in this study are for branded Lovastatin and generic niacin. For niacin, the cost was taken to be Medicaid s reimbursement for multiple-source drugs. The actual measure was slightly below the average wholesale price but was above the lowest wholesale prices quoted. For Lovastatin, costs were estimated using the 1994 average wholesale price. 

In recent years, numerous studies have evaluated the use of [ F]-FDG-PET for staging and restaging of tumor patients. Based on this data, the Centers for Medicare and Medicaid Services (CMS) have approved Medicare reimbursement for [ F]-FDG-PET imaging in 10 oncological conditions so far (Table 2). 

A significant concern in pharmacy is the level of reimbursement specified in these contracts. In 2000, the average third-party reimbursement for a prescription was 15 percent lower than what a patient would pay for the prescription without third-party reimbursement (USDHHS, 2000). This difference may have increased in recent years because third-party payers have continued to decrease their reimbursement rates. There also are substantial differences in reimbursement rates across third-party payers. For example, many state Medicaid programs reimburse at far better rates than private third-party payers. 

Soumerai SB, McLaughlin TJ, Ross-Degnan D, et al. 1994. Effects of limiting Medicaid drug-reimbursement benefits on the use of psychotropic agents and acute mental health services by patients with schizophrenia. NEnglJ Med 331 650... 

The Medicare and Medicaid programs have had a significant impact on the prachce of pharmacy. The Medicare program stimulated the growth of the hospital pharmacy profession. Only those hospitals with a pharmacy department that was directed by a pharmacist and met a minimum set of federal sfandards could receive federal funding for Medicare reimbursement. °... 

For communify pharmacists, the new Medicaid program had a tremendous impact on the pharmacy profession, which is still seen in today s community pharmacies. The establishment of Medicaid created millions of new prescriphons fhaf needed to be filled in a beneficiary s local pharmacy and for which fhe pharmacy would be reimbursed. With the increased number of prescriphons, however, came many addihonal administrahve fasks. These fasks included negohating pharmacisf reimbursement levels staying... 

The anti-kickback statutes are intended to prevent overuse of and overcharging for medical products that are subject to government reimbursement either under Medicaid or Medicare (or other government-reimbursed health care programs). They prohibit any activity in which a medical products company may try to persuade, other than with sound therapeutic arguments, a physician or another health care provider or facility to use a particular product. 

Specifically, the law prohibits a company from offering any remuneration (including any kickback, bribe or rebate) directly or indirectly, overtly or covertly, in cash or in kind to anyone to induce them to purchase a product or service for which reimbursement may be sought under Medicaid or Medicare. Regulations provide for safe harbors. ... 

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