News in brief - Jan. 3/10, 2000

Law extending disability benefits signed - Prickly Medicare co-pay issue resurfaces

Law extending disability benefits signed

Washington -- President Clinton last month signed legislation that allows people with disabilities to enter the work force without fear of losing their federal health benefits.

The president pledged swift implementation of the Ticket to Work and Work Incentives Improvement Act of 1999. The law creates two options for states to offer a Medicaid buy-in for workers with disabilities; offers grant money to help states to implement one of the options; creates a $250 million Medicaid buy-in demonstration to help people whose disability is not yet so severe that they cannot work; and extends Medicare coverage 4½ years for people who return to work.

Prickly Medicare co-pay issue resurfaces

Washington -- A long-simmering issue over whether physicians can recoup co-payments when Medicare's fee schedule is lower than the fee schedule of a secondary payer is percolating to the surface.

Under the current scenario, Blue Cross of California, as the secondary payer, has refused to pay the co-payment when Medicare's fee schedule is higher than the one it uses. That leaves physicians unable to seek reimbursement for the 20% co-payment, leading them to turn to the Practicing Physicians Advisory Council for help.

A recent Dept. of Health and Human Services Office of Inspector General advisory opinion states that physicians can seek the 20% co-payment from the secondary payer, but only if Medicare's reimbursement is reduced by the same amount.