Archive for the ‘Diabetes’ Category

As a person with diabetes, it’s essential to keep an eye on your eye health. High blood sugar levels can damage the tiny blood vessels in the retina, leading to diabetic retinopathy. This condition can cause vision loss or even blindness if left untreated. Therefore, regular eye exams are crucial to catch any issues early on and prevent further damage. So, it’s highly recommended to have more frequent eye exams if you have diabetes.

Medicare Part B (Medical Insurance) covers annual eye exams for diabetic retinopathy if you have diabetes. The exam must be conducted by an eye doctor legally authorized to perform the test in your state.

It is important to note that your healthcare provider may suggest that you receive services more frequently than what Medicare covers. Additionally, they may recommend services that are not covered by Medicare, which means you may have to pay some or all of the costs. To better understand why your doctor recommends certain services, you should ask questions and determine how much Medicare will pay for them.

Commissioner of Social Security, today announced that the agency has released its Open Government plan.  The plan, available at, reflects the agency’s commitment to increase transparency, expand opportunities for citizen participation and collaboration, and make open government sustainable at Social Security.  Three flagship initiatives are highlighted in the plan — the Spanish-Language Retirement Estimator, Online Service Enhancement, and an Online Life-Expectancy Calculator.  These initiatives support the agency’s mission, goals, and objectives, as well as showcase the value of open government principles.

“I applaud President Obama’s commitment to opening the federal government to the people it serves and I am especially proud of the three flagship initiatives we have chosen to implement by the end of this year,” said Commissioner Astrue. “These initiatives signify Social Security’s ongoing commitment to transparency, citizen participation, and collaboration as we improve the services we provide to the public.”

Social Security’s Spanish-language Retirement Estimator will be the agency’s and the federal government’s first-ever non-English interactive Internet application — a tool that furthers transparency by offering the Spanish-speaking public an opportunity to get instant, personalized estimates of future retirement benefits.  Last year, over three million people used the English-language version of this popular online service available at

As part of its Online Service Enhancement initiative, Social Security will unveil a new service-channeling tool that will help people more easily find the information and services they seek on the agency’s website  A key feature will be the opportunity to go online to schedule an in-office appointment for those who are unable to use our online services to conduct all of their business.  This idea was submitted by Christie Dickson, an employee of Social Security, and was one of the finalists for the President’s SAVE award.  In developing this tool, the agency will collaborate with members of the public as well as with industry experts.

The agency also is developing an Online Life-Expectancy Calculator — a simple, but important tool to assist the public with retirement planning.  Many people substantially underestimate life expectancy, and this new online service will add a measure of accuracy to retirement planning by providing average life expectancies at different ages based on the person’s gender and date of birth, and drawing on assumptions provided in the annual Social Security Trustees’ report.

“I look forward to continuing to translate the values of open government into lasting improvements in the way the agency makes decisions, solves problems, and addresses its challenges,” said Commissioner Astrue.  “Social Security’s flagship initiatives will improve our services and further break down barriers between the American people and their government.”

Social Security encourages feedback on its Open Government plan.  To view the plan and share your comments and ideas, please visit

Patients that have similar clinical characteristics and similar costs are assigned to an MS-DRG. The MS-DRG will be associated with a fixed payment amount based on the average cost of patients in the group. Patients are assigned to a MS-DRG based on diagnosis, surgical procedures, age and other information. Medicare uses this information that is provided by hospitals on their bill to decide how much they should be paid. Hospital Compare shows information for each hospital on selected MS-DRGs from October 2007 through September 2008. If a MS-DRG has “Complications” or “Comorbidities” in its title, it means the hospital may have treated more complicated patients.

Because MS-DRGs are highly technical, patients and other consumers may need to work with a doctor or other healthcare provider to understand these terms as well as the payment and volume information. ‘CC’ refers to complications or comorbidities. MCC refers to major complications or comorbidities. When Medicare pays a hospital based on the MS-DRG, it takes into account the following (case mix):

  • How bad the illness is or if the patient dies (severity of illness)
  • How likely it is that the patient will get better or get worse (prognosis)
  • What would happen if the patient does not receive immediate or continuing care (need for intervention)
  • How much and what type of service the hospital needed to provide, such as lab work, X-rays or physical therapy (resource intensity)

The payment and volume information is for acute care hospitals. “Critical access hospitals (CAH)”, “Acute Care – VA Medical Centers” and “Children’s Hospitals” are not included because they are paid using another method.

Median Medicare Payments

Median Medicare payments for the same MS-DRG can vary. The median payment refers to the midpoint of all payments to the hospital for a particular MS-DRG, that is, half the payments were lower and half the payments were higher than the median payment. A hospital can get a higher payment for any or all of the following reasons:

  • It is classified as a teaching hospital
  • It treats a high percentage of low-income patients (disproportionate share)
  • It may treat unusually expensive cases (outlier payments)
  • It pays its employees more compared to the national average because the hospital is in a high-cost area (wage index). Note: The hospital’s wage index is calculated using the hospital’s payroll records, contracts and other wage related documentation

Range of Payments 25th – 75th Percentile

Hospital Compare lets you compare the hospitals you select with other hospitals in your state and in the nation. The state and national amounts are shown as a range of payments (between the 25th percentile and the 75th percentile). This is the range of payments for the most typical cases treated for the MS-DRG. The information doesn’t include unusually low payments for cases, such as when a patient was transferred to another facility before being fully treated. It also doesn’t include unusually high payments for cases that are more complex and costly to treat. Only one number appears in this field when the 25th and 75th percentiles are the same.

Source :

Cartoons of woman walking in sunshine, calcium rich foods and a woman lifting weights.Our bones are alive. We might not think of them that way—but to keep themselves strong and usable, our bones are always changing. “Bone is living, growing tissue,” says Dr. Joan McGowan, a scientist at NIH. “It’s constantly breaking down and building up. It keeps refreshing itself.”

But as you get older, your bones may be at increased risk for osteoporosis (oss-tee-oh-pore-OH-sis), when the bones become weak, fragile and more likely to break. And once they break, they take longer to heal. This can be both painful and expensive. Current estimates suggest that around 10 million people in the U.S. have osteoporosis, and 34 million more have low bone mass, which places them at increased risk. 

Osteoporosis is a “silent” disease. You may not realize you have it until a sudden strain, twist or fall causes a broken bone (also called a “fracture”). With osteoporosis, even a minor tumble can be serious, requiring surgery and hospitalization. If you have osteoporosis, you can get a broken bone even though you haven’t fallen—by shoveling snow, for example.

A spinal fracture, a break in one of the small bones in your back, may be subtle and go unnoticed. Or it may cause back pain, which you shouldn’t ignore. “A large part of osteoporosis and fracture risk is inherited,” says McGowan. “If close relatives have suffered a fracture in their later years, this may be a clue to think carefully about your own risk. But diet and physical activity are major ways to build and maintain the best possible skeleton.”

NIH-funded research shows that childhood is the best time to build up bone tissue. Most bone is built by age 18 in girls and 20 in boys. Start with a well-balanced diet rich in calcium and vitamin D. Most of our bone is made of a rigid protein framework. Calcium (a mineral) adds strength and hardens that framework. Vitamin D helps the intestine absorb calcium.

Calcium is found in many foods, but the most common source for Americans is milk and other dairy products. One 8-ounce glass of milk provides about one-third of the recommended intake for younger children and about one-fourth of the recommended intake for teens. Your body makes vitamin D in the skin when you’re out in the sun. Some people get all they need from sunlight, but others need to take vitamin D pills. Talk to your doctor or see the chart at to find out how much calcium and vitamin D you should get each day.

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Manufacturer reporting of Average Sales Price (ASP) data: A manufacturer’s ASP must be calculated by the manufacturer every calendar quarter and submitted to CMS within 30 days of the close of the quarter.  Each report must be certified by one of the following: the manufacturer’s Chief Executive Officer (CEO); the manufacturer’s Chief Financial Officer (CFO); an individual who has delegated authority to sign for, and who reports directly to, the manufacturer’s CEO or CFO.

Manufacturers must report the ASP data to us in Microsoft Excel using the template provided in Addendum A, the ASP Data Form.  Both this and the ASP Certification Form (Addendum B), are available in the ‘Downloads’ section below.

When sending ASP data to CMS via first class mail, federal express mail, or overnight delivery, please use the following address:

Centers for Medicare & Medicaid Services
Hospital and Ambulatory Policy Group
Division of Ambulatory Services
ATTN: Medicare ASP Data
Mail Stop No. C4-01-26
7500 Security Boulevard
Baltimore, MD 21244
Phone: 410-786-0548

Please send any questions to:

Medicare Contractor Reporting Template for Medicare Part B Drugs – (Located in the “Downloads” section below)

As indicated in CR 4140, dated February 15, 2006, Medicare contractors shall use the Medicare Contractor Reporting Template for Part B drugs to report information on all Medicare Part B drugs not paid on a cost or prospective payment basis when payment limits are not listed in the quarterly drug pricing files, or in the OPPS Pricer. Contractors shall also use the template to report pricing information for the NOC drug billing codes. This information must be sent to CMS on a monthly basis to e-mail address:

New Information Regarding Medicare Payment and Coding for Drugs and Biologics (See Downloads section below for the message)

Section 303(c) of the Medicare Modernization Act of 2003 (MMA) revised the payment methodology for Part B covered drugs that are not paid on a cost or prospective payment basis. In particular, section 303(c) of the MMA amended Title XVIII of the Act by adding section 1847A, which established a new average sales price (ASP) drug payment system.  Beginning January 1, 2005, drugs and biologicals not paid on a cost or prospective payment basis will be paid based on the ASP methodology, and payment to the providers will be 106 percent of the ASP.  There are exceptions to this general rule which are listed in the latest ASP quarterly change request (CR) document.  The ASP methodology uses quarterly drug pricing data submitted to the CMS by drug manufacturers.  CMS will supply contractors with the ASP drug pricing files for Medicare Part B drugs on a quarterly basis.


Most Medicare beneficiaries will not see a Part B monthly premium increase as a result of a “hold harmless” provision in the current law.  This allows for 73 percent of beneficiaries to be protected from an increase raising the 2010 Part B monthly premiums from $96.40 to $110.50.  The Administration continues to urge Congressional action that would protect all beneficiaries from higher Part B premiums and eliminate the inequity of a high premium for the remaining 27 percent of beneficiaries.

By law, the Centers for Medicare & Medicaid Services (CMS) is required to announce the Part A deductibles and Part B premium amount – a notice that is published annually in the Federal Register.

Under the Medicare law, the standard premium is set to cover approximately one-fourth of the average cost of Part B services incurred by beneficiaries aged 65 and over.   The remaining Part B costs are financed by Federal general revenues. This monthly premium paid by beneficiaries enrolled in Medicare Part B covers a portion of the cost of physicians’ services, outpatient hospital services, certain home health services, durable medical equipment, and other items.

In calculating the monthly Part B premium each year, the CMS Office of the Actuary includes a contingency margin to provide for possible variation between actual and projected costs.  The size of the contingency margin estimated to be needed for 2010 is affected by two main factors.

First, the current law formula for physician fees, which will result in a reduction in physician fees of approximately 21 percent in 2010 and is projected to cause additional reductions in subsequent years, is one factor affecting the 2010 contingency margin.  For each year from 2003 through 2009, Congress has acted to prevent physician fee reductions from occurring.

In recognition of the strong possibility of increases in Part B expenditures that would result from similar legislation to override the decreases in physician fees in 2010 or later years, it is appropriate to maintain a significantly larger Part B contingency reserve than would otherwise be necessary.  The asset level projected for the end of 2009 is not adequate to accommodate this contingency.

Second, the Social Security Administration announced there would be no increase in Social Security benefits for 2010.   As a result of the hold-harmless provision, the increase in the Part B premium for 2010 will be paid by only a small percentage of Part B enrollees. Most Part B enrollees will pay the same monthly premium that they paid in 2009 ($96.40 was the 2009 standard monthly premium).

Approximately 27 percent of beneficiaries are not subject to the hold-harmless provision because they are new enrollees during the year (3 percent), they are subject to the income-related additional premium amount (5 percent), they do not have their Part B premiums withheld from social security benefit payments (19 percent), including those who qualify for both Medicare and Medicaid and have their Part B premiums paid on their behalf by Medicaid (17 percent).

As required in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), beginning in 2007 the Part B premium a beneficiary pays each month is based on his or her annual income.  Specifically, if a beneficiary’s “modified adjusted gross income” is greater than the legislated threshold amounts ($85,000 in 2010 for a beneficiary filing an individual income tax return or married and filing a separate return, and $170,000 for a beneficiary filing a joint tax return) the beneficiary is responsible for a larger portion of the estimated total cost of Part B benefit coverage.  In addition to the standard 25 percent premium, such beneficiaries now pay an income-related monthly adjustment amount.  These income-related Part B premiums were phased-in over three years, beginning in 2007.  About 5 percent of current Part B enrollees are expected to be subject to the higher premium amounts

The 2010 Part B monthly premium rates to be paid by beneficiaries who file an individual tax return (including those who are single, head of household, qualifying widow(er) with dependent child, or married filing separately who lived apart from their spouse for the entire taxable year), or who file a joint tax return are:

Beneficiaries who file an individual tax return with income: Beneficiaries who file a joint tax return with income:

Income-related monthly adjustment amount

Total monthly premium amount

Less than  or equal to $85,000 Less than or equal to $170,000



Greater than $85,000 and less than or equal to $107,000 Greater than $170,000 and less than or equal to $214,000



Greater than $107,000 and less than or equal to $160,000 Greater than $214,000 and less than or equal to $320,000



Greater than $160,000 and less than or equal to $214,000 Greater than $320,000 and less than or equal to $428,000



Greater than $214,000 Greater than $428,000



In addition, the monthly premium rates to be paid by beneficiaries who are married, but file a separate return from their spouse and lived with their spouse at any time during the taxable year are:

Beneficiaries who are married but file a separate tax return from their spouse:

Income-related monthly adjustment amount

Total monthly premium amount

Less than or equal to $85,000



Greater than $85,000 and less than or equal to $129,000



Greater than $129,000



Part B Deductible

The Part B deductible was increased to $110 in 2005 and, as a result of the Medicare Modernization Act, is currently indexed to the annual percentage increase in the Part B actuarial rate for aged beneficiaries.  In 2010, the Part B deductible will be $155.

Part A Premium and Deductible

Today, CMS is also announcing the Part A deductible and premium for 2010.  Medicare Part A pays for inpatient hospital, skilled nursing facility, hospice, and certain home health care services. The $1,100 deductible for 2010, paid by the beneficiary when admitted as a hospital inpatient, is an increase of $32 from $1,068 in 2009.  Beneficiaries must pay an additional $275 per day for days 61 through 90 in 2010, and $550 for lifetime reserve days.  The corresponding amounts in 2009 are $267 and $534, respectively. Daily coinsurance for the 21st through 100th day in a skilled nursing facility will be $137.50 in 2010, up from $133.50 in 2009.

Approximately 99 percent of Medicare beneficiaries do not have to pay a premium for Part A services because they have at least 40 quarters of Medicare-covered employment (or are the spouse or widow(er) of such a person).  However, other seniors and certain people under age 65 with disabilities who have fewer than 30 quarters of coverage may obtain Part A coverage by paying a monthly premium set according to a statutory formula.  This premium will be $461 per month for 2010, an increase of $18 from 2009.  A reduced premium applies in the case of individuals with 30 to 39 quarters of coverage, who will pay a premium of $254 in 2010, compared to $244 in 2009.

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For 2009, CMS improved how it reviews Medicare claims for inpatient hospital services and eliminated the use of past billing records as part of a complex medical review.  As a result of this heightened scrutiny and more complete accounting of Medicare FFS claims, CMS is reporting a 2009 FFS error rate of 7.8 percent, or $24.1 billion, compared to 3.6 percent in 2008.  In addition, for 2009:

  • The baseline composite Medicare Advantage, or Part C, error rate, based on payment year 2007, is 15.4 percent, or $12.0 billion.
  • The Medicare Part D composite error rate is under development, and three components are being reported this year: the payment system error of 0.59 percent, the low-income subsidy payment error of 0.25 percent, and payment error related to Medicaid status for dual eligible Part D enrollees 1.06 percent.
  • The composite Medicaid error rate is 8.7 percent, compared to 10.5 percent for states measured in 2007.

Based on recommendations from the HHS Office of the Inspector General (OIG), Members of Congress and CMS clinical experts, the Agency modified the FFS medical review process used to identify improper payments this year.  In addition, CMS is taking further steps to ensure:

  • providers are submitting all required clinical and medical documents to support a claim,
  • providers’ signatures on medical documents are legible,
  • a provider’s claims history can no longer be used to fill in missing treatment documentation, and
  • a requirement that medical information from a health care provider be included to support durable medical equipment claims, in addition to the records from suppliers.

In addition to more complete accounting in the FFS rate, fiscal year 2009 is the baseline year for reporting the Part C composite error estimate because, by law, calendar year 2007 was the first year in which payments to MA plans were 100 percent risk-adjusted. In prior years, MA payments were a blend of risk-adjusted and demographic-only payments.

The Part C composite payment error rate combines two component error rates into a single composite measure for total Part C payments: (1) the Medicare Advantage and Prescription Drug System (MARx) payment error (MPE) rate for Part C; and (2) the Part C risk adjustment error (RAE) rate.

The Part C payment error rate primarily reflects health plan errors in documenting members’ diagnoses.  Improper payments due to incorrect calculations in the Medicare Advantage payment system are routinely resolved and payment adjustments are made.  Program experience indicates that documentation will improve over time.

CMS has also made significant strides in developing an error rate measurement program for the Part D Prescription Drug program.  For 2009, CMS is reporting three components of calendar year 2007 payment error: (1) a Part D payment system error (0.59 percent); (2) a low-income subsidy payment error (0.25 percent); and (3) payment error related to Medicaid status for dual eligible Part D enrollees (1.06 percent).

For the Payment Error Rate Measure (PERM) program, fiscal year 2008 is the second year that CMS has calculated an error rate for all components of Medicaid (fee-for-service, managed care, and eligibility).  The Medicaid composite error rate is 8.7 percent.  CMS uses a 17–state sample to calculate the national PERM error rate.  Each state is reviewed once every three years.

Improper payment rates in Medicaid include those payments that may have been paid incorrectly and, as in Medicare, do not necessarily reflect fraud.   The vast majority of Medicaid errors are due to inadequate documentation, for example, providers either not submitting information to support their FFS or managed care claims or not submitting additional data when requested.  Other errors are due to services provided under Medicaid to beneficiaries who were not eligible for Medicaid coverage or for the services received.

CMS continues to work with states to ensure that payments for treating Medicaid beneficiaries are accurate and reflect updated policies.  In addition, CMS continues to work with states to educate and inform providers about how to avoid errors in areas with high improper payment rates.

Finally, the reporting of a CHIP error rate has been temporarily suspended while CMS develops a new final rule for the PERM program, as required by the Children’s Health Insurance Program Reauthorization Act of 2009.

For Immediate Release: Wednesday, November 18, 2009
Contact: CMS Office of Public Affairs

Mars Snackfood US ISSUES ALLERGY ALERT ON UNDECLARED PEANUTS In Dove Caramel Pecan Perfection Ice Cream
Mon, 26 Oct 2009 15:54:00 -0500

Today, Mars Snackfood US announced a voluntary recall of its Dove Caramel Pecan Perfection ice cream with the lot number 931AB5YN07 because it may contain undeclared peanuts. People who have an allergy or severe sensitivity to peanuts run the risk of serious or life-threatening allergic reaction if they consume these products. No related illnesses have been reported to date.

Accusure Insulin Syringes (Qualitest Pharmaceuticals) – Recall

Audience: Diabetes healthcare professionals and patients

Qualitest Pharmaceuticals and FDA notified healthcare professionals of a nationwide recall of Accusure Insulin Syringes. All syringes, regardless of lot number, are subject to this recall. These syringes were distributed between January 2002 and October 2009 to wholesale and retail pharmacies nationwide (including Puerto Rico). The syringes in these lots may have needles which detach from the syringe. If the needle becomes detached from the syringe during use, it can become stuck in the insulin vial, push back into to the syringe, or remain in the skin after injection. Consumers who have any Accusure insulin syringes should stop using them and contact Qualitest at 1-800-444-4011 for reimbursement.

Read the complete MedWatch 2009 Safety summary, including a link to the firm’s press release and previous August 2009 recall, at:

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