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Posts Tagged ‘primary care’

What Every Internist Should Know About Health Care Reform

August 20, 2012 Leave a comment

Below is what every Internist should know about health care reform.

The new regulations provisions will have a direct impact on internal medicine. It is imperative that internists take the time to review provisions listed below, as well as any other pertinent new changes.
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Section 1001 Subsection 2713 – Coverage of Preventive Health Care
A group health plan and a health insurance issuer offering group or individual health insurance coverage shall, at a minimum provide coverage for and shall not impose any cost sharing requirements for-evidence-based items or services that have in effect a rating of `A’ or `B’ in the current recommendations of the United States Preventive Services Task Force; immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved; and with respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration.

Section 1201 Subsection 2704 – Prohibition of Preexisting Conditions
A group health plan and a health insurance issuer offering group or individual health insurance coverage may not impose any preexisting condition exclusion with respect to such plan or coverage.

Section 4104 – Elimination of Co-Pay
Elimination of coinsurance (co-pay) on preventive services (ie. physical exams). Elimination of coinsurance (co-pays) in outpatient hospital settings.

Section 4108 – Incentive for Prevention of Chronic Diseases
Incentives for prevention of chronic diseases. A program described in this paragraph is a comprehensive, evidence-based, widely available, and easily accessible program, proposed by the State and approved by the Secretary, that is designed and uniquely suited to address the needs of Medicaid beneficiaries and has demonstrated success in helping individuals achieve one or more of the following: ceasing use of tobacco products, controlling or reducing their weight, lowering their cholesterol, lowering their blood pressure, avoiding the onset of diabetes or, in the case of a diabetic, improving the management of that condition.

Section 5501 – Expanded Access to Primary Care
Expanded access to primary care. In the case of primary care services furnished on or after January 1, 2011, and before January 1, 2016, by a primary care practitioner, in addition to the amount of payment that would otherwise be made for such services under this part, there also shall be paid (on a monthly or quarterly basis) an amount equal to 10 percent of the payment amount for the service under this part.
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Every Internist must take the time to read and understand the above regulations and provisions. For more information and a complete list of new provisions, click  HERE

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What Every Pediatrician Should Know About Health Care Reform

August 15, 2012 1 comment

Below is what every Pediatrician should know about health care reform.  

The provisions listed below will have a direct impact on pediatric care and pediatricians need to take the time to familiarize themselves with the new regulations.
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New Pediatric Regulations

Section 1001 Subsection 2713 – Coverage of Preventive Health Care
A group health plan and a health insurance issuer offering group or individual health insurance coverage shall, at a minimum provide coverage for and shall not impose any cost sharing requirements for-evidence-based items or services that have in effect a rating of `A’ or `B’ in the current recommendations of the United States Preventive Services Task Force; immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved; and with respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration.

Section 1001 Subsection 2714 – Extension of Child Coverage
A group health plan and a health insurance issuer offering group or individual health insurance coverage that provides dependent coverage of children shall continue to make such coverage available for an adult child (who is not married) until the child turns 26 years of age.

Section 1201 Subsection 2704 – Prohibition of Preexisting Conditions
A group health plan and a health insurance issuer offering group or individual health insurance coverage may not impose any preexisting condition exclusion with respect to such plan or coverage.

Section 2004 – Medicaid Coverage for Former Foster Children
Medicaid coverage for former foster children who were in foster care under the responsibility of a State for more than 6 months.

Section 2302 – Concurrent Care for Children
A voluntary election to have payment made for hospice care for a child (as defined by the State) shall not constitute a waiver of any rights of the child to be provided with, or to have payment made under this title for, services that are related to the treatment of the child’s condition for which a diagnosis of terminal illness has been made.

Section 4204 – Immunizations
Funds received under a grant under this subsection shall be used to implement interventions that are recommended by the Task Force on Community Preventive Services (as established by the Secretary, acting through the Director of the Centers for Disease Control and Prevention) or other evidence-based interventions, including–providing immunization reminders or recalls for target populations of clients, patients, and consumers;educating targeted populations and health care providers concerning immunizations in combination with one or more other interventions; reducing out-of-pocket costs for families for vaccines and their administration; carrying out immunization-promoting strategies for participants or clients of public programs, including assessments of immunization status, referrals to health care providers, education, provision of on-site immunizations, or incentives for immunization; providing for home visits that promote immunization through education, assessments of need, referrals, provision of immunizations, or other services; providing reminders or recalls for immunization providers;conducting assessments of, and providing feedback to, immunization providers; any combination of one or more interventions described in this paragraph; or immunization information systems to allow all States to have electronic databases for immunization records.

Section 5203 Subsection 775 – Pediatric Loan Forgiveness Program
The Secretary shall establish and carry out a pediatric specialty loan repayment program under which the eligible individual agrees to be employed full-time for a specified period (which shall not be less than 2 years) in providing pediatric medical subspecialty, pediatric surgical specialty, or child and adolescent mental and behavioral health care, including substance abuse prevention and treatment services.

Section 5501 – Expanded Access to Primary Care
Expanded access to primary care. In the case of primary care services furnished on or after January 1, 2011, and before January 1, 2016, by a primary care practitioner, in addition to the amount of payment that would otherwise be made for such services under this part, there also shall be paid (on a monthly or quarterly basis) an amount equal to 10 percent of the payment amount for the service under this part.
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Every Pediatrician  needs to make sure that they take the time to familiarize themselves with the above regulations. To learn more, please click HERE

2013 Medicare Physician Fee Schedule Released

July 10, 2012 1 comment

CMS has released the Physician Fee Schedule for 2013 has been released. The fee schedule will be officially published July 20th and will become finalized November 1. Primary Care will sill see a 16% increase in reimbursement and specialities will see a 33% decrease in reimbursement.  Here exactly is how it is broken down by specialty.

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Increase
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Family Practice        7%
Internal Medicine    5%
Geriatricians              4%
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Decrease
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Radiation Oncology     -15%
Radiology                       -4%
Anesthesiology            -3%
Cardiology                     -3%
Vascular Surgery        -3%
Pathology                     -2%
Urology                         -2%
Neurosurgery               -1%

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No Effect
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Allergy/Immunology
Gastroenterology
General Surgery
Plastic Surgery
Rheumatology

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Keywords: family medicine, family practice medicine, internal medicine, health care, medicare fee schedule, medicare, reimbursement, health plan, medical practice, U.S. Health and Human Services

Student Loan Forgiveness for Primary Care Physicians Announced

July 2, 2012 Leave a comment

Dr. Tom Price, MD of Georgia has a bill in the U.S. House geared directly at replacing the infamous health care reform bill officially known as the affordable care act. This bill is called HR 3000 “Empowering Patients First Act”. Below are key provisions of the bill. You can read the bill for yourself here: http://www.gpo.gov/fdsys/pkg/BILLS-112hr3000ih/pdf/BILLS-112hr3000ih.pdf

Key Provisions
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Loan forgiveness for Primary Care Providers

Federally Supported Student Loans for Medical Students

Refundable Tax Credit for low-income families

Deduction for health care costs

Credit for small employers adopting auto-enrollment

Improve beneficiary choice in S-CHIP

Financial Incentives for Treatment Compliance

Freedom of Choice, Right of Contract with Providers

Reduction in Medicaid DSH

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Keywords: physician, health care reform, primary care physician, student loan, health policy

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