Medicare Patient Management: March/April 2006

March/April 2006 • Volume 1, Number 2

Medicare—Another Etiology for Dizziness (PDF, 207K)

Richard G. Stefanacci, DO, MGH, MBA, AGSF, CMD • p. 6

Medicare Rx Coverage: The A, B, C, and Ds (PDF, 251K)

Since Medicare began in 1965, the program has provided medication coverage in acute settings under Medicare Part A and within physicians’ offices under Medicare Part B. Now, with the implementation of Medicare Part D, coverage has been extended to cover prescription drugs in outpatient settings. This article provides information about the various types of coverage, which is essential to ensure improved outcomes and which will affect pay-for-performance measures.

Richard G. Stefanacci, DO, MGH, MBA, AGSF, CMD • p. 8

New Medicare Preventive Services and Screening Tests You Can Perform in the Office (PDF, 183K)

For the first time, beneficiaries have access to a comprehensive set of services designed to identify and treat chronic illness. However, although Medicare coverage for screening tests can provide increased service volume and profits for physician practices, as with any government program, getting paid for these new services depends on knowing the codes and coverage rules that apply, and using that knowledge to produce “clean claims” and minimal denials. This article offers you that knowledge.

Charles B. Root, PhD • p. 18

Unintended Consequences: Generic Competition in the Prescription Drug Market (PDF, 237K)

The Hatch-Waxman (H-W) Act encourages innovation by extending patent terms, but also stimulates imitation and competition by reducing the requirements for generic entry in the drug market. This article examines how the H-W Act has worked by evaluating a number of issues, including the automatic 30-month stay for generic Abbreviated New Drug Applications (ANDAs); the 180-day exclusivity period granted to the generic drug that first challenges a patent with an ANDA; brand name manufacturers’ multiple listings of patents in the Orange Book; settlement agreements between generic companies and brand name manufacturers; and agreements between generic competitors.

Erwin A. Blackstone, PhD and Joseph P. Fuhr, Jr, PhD • p. 25

Reading the Tea Leaves for Medicare Part D (PDF, 274K)

To best understand the direction that Medicare Part D is likely to take, one needs to evaluate the legislative landscape to determine its likely course. This article reviews the early issues that arose involving enrollment and access to medications, as well as several gray areas that have caused considerable confusion and will likely require legislative action for clarification.

Richard G. Stefanacci, DO, MGH, MBA, AGSF, CMD • p. 44

Legal Corner: Medicaid Eligibility Under the Deficit Reduction Act
of 2005 • p. 49

Technology & Information • p. 52

Consultation Corner: Managing Deep Vein Thrombosis in the Medicare Population • p. 54

Q&A: Mark B. McClellan, MD, PhD, on the Progress and Steps that CMS is Taking to Improve Medicare Part D • p. 57

Requests for reprints of Medicare Patient Management articles or permissions to use article content may be sent to Jennifer Kenny at jkenny@healthcommedia.com.