Each day, hundreds of thousands of nursing home residents are given antipsychotic drugs, even though, as documented by the Department of Health and Human Services’s Office of Inspector General in May 2011, these drugs are inappropriate and life-threatening for the vast majority of residents to whom they are given. Antipsychotic drugs are also extremely expensive. The Inspector General reported that for the six-month period, January 1-June 30, 2007, erroneous drug claims for atypical antipsychotic drugs for nursing home residents cost $116 million. This report underestimates the costs of antipsychotic drugs because it looked only at atypical antipsychotic drugs (not conventional antipsychotic drugs as well) and because it looked only at nursing home residents (not other care settings, such as hospitals and assisted living).
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Medicare Supplemental Health Insurance Resources Online
When looking into health insurance of any kind the rules, regulations and stipulations often make it so that every word on the policy seems foreign and a bit sketchy. The policy is never laid on it terms that one without industry knowledge would completely understand. Words such as co-payment, deductible, family allowance, preventative vs. routine care often times add confusion in really understanding what is being offered. Health Insurance in general is difficult to understand and often leads us to believe we are being manipulated let alone getting into the next generation of health insurance, Medicare. How is one to determine exactly what is being offered and to finally settle upon a policy that best fits the need with Medicare and Medigap supplemental insurance policies?
Competition cuts down Medicare fraud
In its report, Medicare said it closely monitored the health of beneficiaries likely to use home equipment in the nine areas involved with the competitive bidding experiment. It then compared the results to data for beneficiaries in other similar areas where competitive bidding has not been instituted yet. Using yardsticks such as emergency room visits and nursing home admissions, it found no significant differences.
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Medicare Competitive Bidding Pilot Reduced Costs by 42%, CMS Says
We find it hard to believe that there were only six negative calls about competitive bidding in the whole last quarter and just 151 over the past year. People for Quality Care (www.peopleforqualitycare.org) is an advocacy organization that talks to Medicare beneficiaries and providers across the country every day and we hear the damage competitive bidding has done.
Medicare to Expand Competitive Bidding on Equipment
Medicare’s competitive bidding efforts got off to a rocky start. Many suppliers complained that the government had accepted low bids from companies that had little experience in the industry, while curtailing opportunities for family-owned businesses that had served their communities for many years. In addition, dozen of economists told the Obama administration that its initial plans for competitive bidding were seriously flawed.
CMS Settles Medicare Reimbursement Dispute With Hospitals
Modern Healthcare: CMS’ Hospital Settlements Seen Costing At Least $3 Billion Ongoing CMS settlement negotiations with about 2,200 hospitals are expected to cost the federal government at least $3 billion, according to parties involved in the deal. The payments to hospitals will settle several similar years-long federal lawsuits in which those providers alleged CMS officials erred in calculating pay rate cuts needed to offset an increase for rural hospitals required by a 15-year-old law. The settlement process began when a federal appeals court struck down a lower court ruling that sided with the CMS (Daly, 4/12).
CMS Issues Amended Medicare Physician Fee Schedule for Home Health
Specifically, Section 101 of the MMEA averts the negative update that would otherwise have taken effect on Jan. 1, 2011. The MMEA provides for a zero percent update to the physician fee schedule for claims with dates of service Jan. 1, 2011 through Dec. 31, 2011. While the physician fee schedule update will be zero percent, changes to the relative value units (RVUs) for 2011 require CMS make an adjustment to the conversion factor to make the changes budget neutral. The revised conversion factor to be used for physician payment as of Jan. 1, 2011 is $33.9764.