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BusinessWeek May 8, 2006 Howard Gleckman	Fighting For The Right Drugs If your Medicare insurer won't cover your medication, here's how to buck the system.
Managed Care July 2000 Michael Levin-Epstein	Congress Asked To Take Action As HMOs Flee Managed Medicare Thanks mainly to the increasing cost of providing a prescription drug benefit, HMOs are exiting Medicare+Choice, the system that was supposed to manage the health of the nation's senior citizens, in droves. Only an act of Congress can save Medicare+Choice, but is seems doubtful that will happen.
Managed Care February 2004 John A. Marcille	The Administration Delivers A Major Gift to Managed Care Which brings me to the announcement that Medicare payments to health plans participating in what was called Medicare+Choice but is now known as MedicareAdvantage will increase by a record 10.6 percent.
Managed Care September 2002	Medicare holds down physician pay Compensation increased at a comparatively small rate from 2000 to 2001 for both primary care physicians and specialists, according to the Medical Group Management Association.
The Motley Fool January 22, 2007 Dan Caplinger	Understanding Medicare: Claims In general, Medicare provides a level of coverage that is fairly similar to what private health insurance plans offer. Here are some tips for getting the most from it.
The Motley Fool August 14, 2006 Tim Beyers	Make Your Insurer Pay Challenging your insurance company will likely require reams of paperwork and more than a little patience, but the potential gains -- both personal and financial -- are worth the effort.
Managed Care February 2001	In Medicare Bill, HMOs Got What They Wanted When the dust cleared over how $35 billion in Medicare "givebacks" would be divided, the Republicans prevailed -- Medicare HMOs got a bigger cut than Democrats wanted to give them. Now, President Bush may be poised to give Medicare managed care plans more...
Managed Care February 2006	Medicare's Efficiency Over-Hyped, Study Claims The belief that Medicare is a more efficient system than employee-sponsored health insurance comes under fire in a study that claims there are hidden costs in the government program.
Managed Care May 2000 Michael Levin-Epstein	Marketing Medicare+Choice? Mind Your Ps and Qs, Says OIG A lot of Medicare HMOs' marketing materials don't cut it, says a report by the Office of the Inspector General. It adds that the Health Care Financing Administration is partly to blame....
Managed Care July 2007	AMA: Patients Will Feel Cuts in Medicare Next year's proposed 10 percent cut in Medicare payments is serving as a rallying point for members of the American Medical Association, which says the cuts will make it difficult for physicians to accept new Medicare patients.
Managed Care July 2002	Memo Clarifies CMS Guidelines on Injectables Injectable drugs should be covered by Medicare if beneficiaries administer them less than 50 percent of the time, according to a clarification on this issue by the Centers for Medicare and Medicaid services that's set to take effect Aug. 1.
Managed Care March 2001 Mark D. Abruzzo	'Final' Stark Regulations Still a Work in Progress The Stark Law generally prohibits physicians from referring Medicare patients for certain designated health services to entities with which the physician (or immediate family members) has a financial relationship...
Managed Care May 2002 Patrick Mullen	Interview: Thomas Scilly In a candid, wide-ranging interview, the Centers for Medicare and Medicaid Services administrator counsels patience in solving the myriad problems of health care. A fix could take 20 years
Managed Care October 2000	Quick Fix May Be in Store for M+C, But Meaningful Change Likely To Wait Whatever diversion prescription drug proposals have provided, Medicare+Choice is back on Congress's radar screen. While sentiment is again running strong among legislators to address the wounded program, Congress is now racing a clock ticking ever closer to the elections...
Managed Care March 2006 Taylor & Eck	It's Time for CMS to Release Physician Medicare Claim Information The Center for Medicare & Medicaid Services is a rich source of price and quality data. Isn't it about time it shared that data?
Managed Care February 2001 Michael Levin-Epstein	Mainstream Media Misinterpret HCFA's Policy on Medical Errors Is the Health Care Financing Administration changing its policy on disclosure of medical errors to Medicare beneficiaries? The issue is causing a tremendous amount of confusion among physicians and health plans. To HCFA, however, the fuss is much ado about nothing...
Managed Care April 2000 Michael Levin-Epstein	Congressional Anti-Kickback Battle Hinges on HCFA's Regulatory Stance In an election year, the political hot buttons -- the Patients Bill of Rights and a Medicare prescription benefit, and maybe the issue of medical errors -- are sure to get a lot more attention than such mundane things as laws that would address potential kickbacks....
Managed Care August 2000	Medicare+Choice pullouts' deep, deep sting The health plan exodus from Medicare+Choice will affect 934,000 people in 2001 -- more than were affected in 1999 and 2000 combined, according to the Health Care Financing Administration.
Managed Care October 2007 John Carroll	Medicare Coverage Rules Are Not Always Last Word Yes, commercial health insurers often take a cue from the government, but that doesn't mean that they follow blindly.
Managed Care August 2000	Nation's Only Medicare PSO Under Rubble of M+C Pullout There was a time when provider-sponsored organizations were the government's great hope for the spread of managed Medicare. But less than three years later, the nation's only Medicare PSO is cashing it in.
Managed Care April 2002 Frank Diamond	Medicare+Choice: Uncertain Future for Unstable Program While policy makers haggle over President Bush's budget request for the system, an ominous question looms: Can money solve all the problems?
Managed Care February 2005	Medicare's Drug Coverage Seeks To Strike Compromise Health plan officials are still trying to determine just how the final rules for the new Medicare prescription drug benefit will affect them, because it appears that government officials tried their best to address the competing concerns of all players.
Managed Care February 2004 John Carroll	New Medicare Risk Adjustments Bad News for Unprepared HMOs Getting less-than-hale elderly enrolled can finally be a sound business strategy for HMOs that comprehend the new rules and have sufficient IT capability.
Managed Care January 2001 David Ricks & Joe Suminski	Nowhere To Go but Out? Tracking Medicare+Choice Managed Medicare's trouble may have something to do with underfunding or rich benefits, but for health plans, market share has a lot to do with it, too...
Managed Care December 2000 Michael Levin-Epstein	Outpatient PPS Regulations Latest Source of Anti-HCFA Anger The Health Care Financing Administration continues to be one of the most besieged agencies in the federal government. Now, providers are attacking the agency's rules for the prospective payment system (PPS) for hospital outpatient services...
Managed Care October 2001	Washington's Focus on Terrorism Jeopardizes Quick Health Care Reform Though President Bush has pledged to be a faithful steward of the country's business while directing the war against terrorism, nobody is predicting that what had been pressing health care issues before Sept. 11 will now be dispatched swiftly...
Knowledge@Wharton July 30, 2003	Restructuring Medicare Is a Riskier Operation than First Thought Hailed as a bipartisan success when passed in late June, two Medicare reform bills are losing some of their luster as they face closer scrutiny by a conference committee made up of members of both chambers charged with reconciling the legislation this fall.
Managed Care March 2006	Standard Measures In Works For P4P Push Uncle Sam has decided to get behind the pay-for-performance effort in a big way, something some physician associations are less than thrilled about.
Managed Care March 2002	NCQA To Help CMS Monitor Quality of M+C Plans The National Committee for Quality Assurance has been tapped to help the Centers for Medicare and Medicaid Services (formerly HCFA) monitor plans that participate in Medicare+Choice...
Managed Care December 2007 John Carroll	How Doctors Are Paid Now, And Why It Has to Change Everyone knows about the perverse incentive of fee-for-service medicine, but that hasn't had much effect on its use.
Managed Care November 2001	Medicare+Choice Problems Chasing Away 58 Health Plans Medicare+Choice, the program that was supposed to ease the elderly into managed care, is itself suffering from the uneasiness of HMOs dissatisfied with payment rates...
National Defense July 2012 D'Agostino & Bradel	Pitfalls Abound in Contract Disputes Act Claims Preparing and filing a certified claim under the Contract Disputes Act for payment from the government for performance of a contract generally is straightforward work for contractors and their legal counsel. Yet certified claims are not without ethical pitfalls.
Managed Care January 2005 Leary & Farley	Health Plans Slow To Adopt Outpatient Prospective Payment The private sector drags its feet over Ambulatory Payment Classifications. Here are some suggestions to move acceptance along.
Managed Care June 2002 John Carroll	DM and Medicare: A Marriage Made in Heaven? With a budget of about $230 billion for 40 million patients, many with chronic ailments, is it any wonder that disease management and Medicare are courting?
Managed Care March 2008	CMS Hybrid Payment System Shows Promise Combining Medicare fee-for-service payments with new incentive programs could help physician groups save money for Medicare and reach quality-of-care targets.
Managed Care March 2007 John Carroll	Democratic Agenda Places Medicare Advantage at Risk Battle lines are drawn over proposals to raid the Medicare managed care program of funds to be applied to other health care needs. Democrats themselves are split.
Managed Care November 1999 Uwe Reinhardt, Ph.D.	Defined Contributions Will Point Employees Toward 'Health Marts' Companies will want to distance themselves from insurance entanglements, giving employees little option but to become more involved....
Managed Care June 2004 John Carroll	Some Plans Take Advantage of Managed Medicare Redux There's more federal money for Medicare plans, but is it enough to reverse the grim five-year drought of managed care offerings? In Florida, it seems so.
Managed Care April 2002 John A. Marcille	Nobody Wants M+C To Die, So Why Can't We Make It Work? Money alone can't solve all of Medicare+Choice's woes, and structural problems will need to be addressed...
Registered Rep. November 5, 2012 Mark Miller	Lawsuit Settlement Is a Game-Changer for Long-Term Care Coverage Medicare recipients will find it easier to get coverage.
Managed Care December 2004	Headlines On Deadline ... Preferred Provider Organizations participating in Medicare Advantage can satisfy federal oversight requirements if they've already received accreditation from the National Committee for Quality Assurance.
Managed Care April 2005 Frank Diamond	Starting Medicare Advantage Plan Brings Special Set of Problems The feds will help you launch a health plan for the elderly, but just what does it take to get something like this operating in so short a time?
Managed Care January 2008 Marcia Naveh	Lax Coding by Physicians Hurts Medicare Advantage Plans By assisting doctors, insurers can get all the payment that they are due, but that too often is lost.
Managed Care May 2005	Medicare PPOs Face Challenge to Funding All the excitement in the industry about Medicare PPOs died in a hurry last month as the Medicare Payment Advisory Committee (MedPAC) moved closer to recommending that the $10 billion fund for the program be eliminated.
Pharmaceutical Executive February 1, 2007 Jill Wechsler	Washington Report: Bundled Together Democrats and Republicans are making waves over whether government drug-pricing policies also raise concerns about drug safety and treatment practices.
Managed Care January 2004 John Carroll	Do the Medicare Math, Then Make Quick Decision Congress frees up billions for plans that choose to participate in a new program for enrollees. This may be opportunity knocking.
Knowledge@Wharton	Prescription Drug Coverage for Seniors Faces Uncertain Future The discussion about adding a prescription drug benefit to Medicare will be put on hold...
BusinessWeek October 10, 2005 Howard Gleckman	Medicare's Big Experiment The coming changes to Medicare aim to cut costs while improving care. Sound familiar?
Managed Care January 2001	Study: Elderly Exit When They Exceed Rx Benefit Cap In a study that confirms what has long been assumed, Medicare HMO enrollees become more likely to drop their carriers when they exceed annual pharmacy-benefit caps...
Managed Care October 2004	Headlines On Deadline ... Good news for government workers... PPO demonstration projects for Medicare in 2001 and 2002 ... A class-action lawsuit filed by 900,000 physicians... Seventy-eight percent of the country wants universal health care... etc.