Medicare policies

Both pharmacists and pharmacies use Health Care Finance Administration (HCFA) Form 855, Provider/ Supplier Enrollment Application, to request a provider number. This form may be obtained from medicare part B carriers or provided by the previously mentioned training programs. This is a cursory review of medicare policies. Training programs will provide additional details, or contact your local medicare part B carrier, HCFA regional office, or other pharmacy reimbursement publications. 

Medicare program revisions to pa3mient policies under the physician fee schedule for calendar year 2003 and inclusion of registered nurses in the personnel provision of the critical access hospital emergency services requirement for frontier areas and remote locations. Final rule with comment period. Fed Regist 2002 67 79965-80184. 

A few studies have examined the impacts of Medicaid and non-Medicaid copayments on drug utilization and health care costs. In a 1993 study, Reeder et al. noted an 11% decrease in prescription use after South Carolina established a 50-cent per prescription copayment. This increase was significantly greater than in Tennessee, a comparison state with no copayments (Reeder et al., 1993). Another study using survey data from the 1992 Medicare Beneficiary Survey found that elderly and disabled Medicaid beneficiaries who live in states with prescription drug copayments have lower prescription drug utilization than their counterparts in states without copayment, and three-fourths of the difference was directly attributed to copayment policies. The study predicted that Medicaid copayments... 

In the near future, government policies may be less supportive of the pharmaceutical industry than in the past. In the Bush administration, Secretary of Health and Human Services Michael Leavitt and FDA Commissioner Andrew von Eschenbach opposed federal efforts to negotiate lower prices for Medicare prescription drugs and to allow reimportation of prescription drugs at lower prices. In the Obama administration, Secretary of Health and Human Services Kathleen Sebelius, FDA Commissioner Margaret Hamburg, and FDA chief deputy Joshua Sharfstein will likely change these policies. New laws and policies may do more to favor consumers. 

Accrediting organizations emphasize patient safety as a fxmdamental issue. The federal Centers for Medicare and Medicaid Services includes monitoring of medication errors as part of their conditions of participation, noting that the medical staff is responsible for developing policies and procedures that minimize drug errors. This fxmction may be delegated to the hospital s... 

The second major change in the nation s health policy during this fourth phase in the evolution of pharmacy practice was the establishment of fhe Medicare and Medicaid programs in 1965, as amendmenfs fo fhe Social Security Act. 

These cases also provoked an investigation into FDA policies by the Institute of Medicine (IOM), a division of the National Academy of Sciences. Criticizing the absence of national reporting requirements, the IOM report suggested that hospitals receiving federal Medicare and Medicaid funds should be required to report to the FDA.54 IOM members also proposed a National Center for Patient Safety that would review drugs on the market and distribute information to physicians and the public. 

There are some Medicare Health Plans that cover prescription drugs. You can also check into getting a Medigap or supplemental insurance policy for prescription drug coverage. Medicaid may also help pay for prescription drugs for people who are eligible. ... 

Centers for Medicare Medicaid Services. Obesity as an Illness ( CAG-00108N). Medicare Coverage Policy, National Coverage Determinations Tracking Sheet and Coverage Issues Manual, sections 35— 26, 35-33. http //www.cms.hhs.gov/mcd/viewtrackingsheet.asp id=57. Accessed May, 2004. 

Since 1983, Medicare has paid hospitals a fixed amount per admission for a package of services based on a patient s primary diagnosis and major treatments. Medicare will now cover attendant hospital costs for patients receiving an experimental drug if the admission was not solely for the experiment. Some observers have suggested that adjustments to hospital payments allowed by Medicare to cover costs associated with medical education also underwrite some of the patient and faculty costs associated with clinical research. Medicare contractors, the companies that administer the Medicare program under contract with HCFA, interpret these policies differently in different parts of the country (395). 

When Medicare does pay for outpatient prescription drugs, the carriers determine pricing policies. There is no official Medicare cost control strategy pertaining to the few outpatient drugs covered by Medicare. 

Many consumers, in a variety of countries, are unclear why identical drugs from the same manufacturer are cheaper to buy abroad, and are tired of the rhetoric. In the main, the FDA will drive the reimbursement policy through Medicare and Medicaid, while private payers will take their lead from the FDA. With regard to reimbursement in Europe, the same may hold true if the government, consumers and payers line up together and challenge the major manufacturers of biopharmaceuticals. If this example can be taken to its final conclusion, it becomes clear that healthcare, business and poHtics - from a global perspective - have become a uniform planetary phenomenon. 

Medicare supplement policy a policy guaranteeing that a health plan will pay a policyholder s coinsurance, deductible and copayments and will provide additional health plan or non-Medicare coverage for services up to a predefined benefit limit. In essence, the product pays for the portion of the cost of services not covered by Medicare. Also called Medigap or Medicare wrap. 

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. 

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