Table of Contents -- June 2005

Texas Medicine Logo

Vol. 101 No. 6

COVER STORY

D Is for Drugs
What many experts say will be the biggest change in Medicare in its 40-year history will occur Jan. 1 when Medicare Part D takes effect. It's the new prescription drug benefit, and advocates hope it will improve senior citizens' health. But it will be costly and complex, and those following the rollout of Medicare Part D say there is ample potential for confusion among Medicare beneficiaries, physicians, pharmacists, and other health care professionals.

By Ken Ortolon 

LAW

Rejected
The settlement administrator's problems in processing physicians' claims for reimbursement from CIGNA HealthCare as a result of settlement of a federal class-action lawsuit against it and other for-profit HMOs is leaving many doctors and their staff frustrated. They're being told their claims are "defected," but they're not being told how. It's prompted TMA to get more time for physicians to refile claims.

By Erin Prather 

MEDICAL EDUCATION

Take That!
The new clinical skills exam the National Board of Medical Examiners is requiring graduating medical school students to take is less than popular, but the students seem to be doing well on it. Texas and other U.S. graduates are passing the exam at a rate of 96 percent. Still, many students say the exam is unnecessary and too expensive.

By Ken Ortolon 

MEDICAL ECONOMICS

Payback
The rules about coding Medicare claims for consultations are confusing, and it appears many physicians have made errors on their claims. Now, the state's Medicare carrier is asking some 4,000 physicians to check their records and to refund improperly paid claims.

By Ken Ortolon 

TECHNOLOGY

Information Technology
Information technology can be an asset for your practice, but you have to do some planning. Do a little daydreaming about what you want your practice to look like. A good place to start is how you want patients' telephone calls answered. Another big decision you'll have to make is about electronic health records.

By John Lubrano 

MANAGING YOUR PRACTICE

Do you comply with HIPAA?
If your office didn't meet the April 21 deadline for complying with the security standards for protected patient information under the Health Insurance Portability and Accountability Act, then you better get moving.

Medicare and Recalls
A manufacturer's decision to issue recalls or product advisories on medical devices and an announcement that it will pay for monitoring, replacement, and related services (even if it asserts that it will pay "unreimbursed expenses" after Medicare and other insurance pay) constitute a reasonable expectation of payment.

Some Patients Are HIPP
Some of your Medicaid patients may be eligible for the Health Insurance Premium Payment program, which pays for their medical premiums when it is less expensive to pay the insurance premiums than the projected Medicaid cost.

Unlisted TWCC Codes
Two Texas Workers' Compensation Commission-specific services -- outpatient medical rehabilitation programs and chronic pain programs -- use "unlisted" CPT codes. 

TMA ROUNDS

Cancer Survivorship Conference Scheduled Aug. 13 in Austin
iHealthRecord -- Value for Practices and Patients from TMA
Nominations Sought for Health Champion
DSHS Seeks Reports on S. marcescens  Bacteremia
Sharpen Your Coding Skills for Better Reimbursement 

JOURNAL

Culturally Competent Diabetic Education to Lower Hemoglobin A1C Levels of Diabetic Patients: Está Mejor  (abstract)

By Edgar de Peralta, MD; Kaushal Patel, MD; Christine Wan, MD; Bernadette Fuentes, RN; and David Baldwin, PhD 

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