Hospitals and other providers will see Medicare payment reductions totaling $11.1 billion this upcoming year, due to the Budget Control Act of 2011, unless Congress passes new measures to prevent the cuts, according to a report from the White House’s Office of Management and Budget (pdf). Last summer, the bipartisan Joint Select Committee on Deficit Reduction, more commonly known as the “supercommittee,” was unable to reach an agreement on ways to reduce the national deficit. As such, the Budget Control Act of 2011’s sequestration process became the default plan to reduce the deficit by $1.2 trillion over the next 10 years via across-the-board budget cuts to all government agencies. In the sequestration plan, roughly $109 billion of cuts would be implemented every year from fiscal year 2013 to FY 2021. Defense spending would take the biggest hits with cuts of 9.4 percent. Nondefense spending would be reduced by 8.2 percent, most entitlement programs by 7.6 percent and Medicare by 2 percent. Two percent of Medicare’s budget ($554.3 billion) is roughly $11.08 billion. Medicare providers — ranging from hospitals and physician practices to home health agencies and hospices — would see reductions in their payments, but Medicare beneficiaries would not lose any of their benefits. Over the next 10 years, Medicare providers stand to lose upwards of $120 billion. In addition to the Medicare cuts, the National Institutes of Health would also have to “halt or curtail scientific research, including needed research into cancer and childhood diseases,” according to the OMB’s report. President Barack Obama and the OMB said the sequestration process is a “blunt and indiscriminate instrument,” and the reductions could be “destructive” to the country’s social programs, national security and other governmental functions. President Obama has called on Congress to “act responsibly” and put forward a new proposal. “[Sequestration] is not the responsible way for our nation to achieve deficit reduction,” according to the OMB’s report. “The President has already presented two proposals for balanced and comprehensive deficit reduction. It is time for Congress to act. Members of Congress should work together to produce a balanced plan that achieves at least the level of deficit reduction agreed to in the BCA that the President can sign to avoid sequestration. The administration stands ready to work with Congress to get the job done.”
Video: Medicare Provider Enrollment 3.wmv
How to Speed Up the Medicare Prepayment Review Process
MACs will initiate prepayment reviews of health care providers suspected of improper billing for services. If the MAC detects anything resembling fraud during the process, the prepayment review can extend for up to a year or more. However, MACs will generally terminate the prepayment review when the health care provider demonstrates a pattern of correct billing. Health care providers who are notified of a MAC prepayment review should consult with an experienced health care attorney from the beginning of the process. An experienced health attorney will be able to assist the health care provider to ensure everything is in place for a speedy prepayment review.
Independence Blue Cross Selects Medicare Analytics Provider
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Obama Crows About Private Medicare Provider Success while Bashing GOP Plans
[…] abuse Advance Directives advantage plans affordable care act baby boomers budget Congressional Budget Office Dan Morhaim donut hole election fraud gap coverage healthcare Health Care healthcare reform Health Care Reform health exchange individual mandate provision Living Wills medicaid medicare medicare advantage medicare benefits medicare budget medicare cuts medicare fraud medicare news medicare politics medicare refor medicare reform medicare supplement medigap obama obamacare part d plans paul ryan Politics News romney Sarah Palin seniors supreme couty tax breaks unitedhealth waste wealthySource: medicarewire.com […]
Los Angeles Doctor Convicted of Health Care Fraud for Submitting to Medicare About $1 Million in Bills for Tests Never Performed
The case against Firempong was brought as a part of a nationwide takedown by Medicare Fraud Strike Force in September 2011. The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative between the Department of Justice and the Department of Health and Human Services to focus their efforts to prevent and deter fraud around the country. Since their inception in March 2007, Strike Force operations in nine locations have charged more than 1,330 defendants who collectively have falsely billed the Medicare program for more than $4 billion. In addition, the Centers for Medicare and Medicaid Services, working in conjunction with the HHS’s Office of Inspector General (HHS-OIG), are taking steps to increase accountability and reduce fraudulent billing.
House Cmte. Looks at Status of Medicare Advantage Program
The head of the Medicare Payment Advisory Commission said his organization is trying to craft a new formula for Medicare payments to doctors. Glenn Hackbarth says the goal is to release that recommendation this fall. Since 1998 Congress has passed legislation every year known as the “doc fix” overriding scheduled cuts in Medicare payments. At a Ways and Means Subcommittee hearing, Mr. Hackbarth also presented the recommendations in MedPAC’s latest report. It includes a 1% increase in hospital payments and a 1% increase in physician fees.
Booman Tribune ~ A Progressive Community
You don’t wait until you have been in a car accident to purchase car insurance; you don’t wait until your house has been flooded to buy flood insurance, and you don’t wait until your home is ablaze to buy fire insurance. That is not how insurance works. And it most certainly is not how health insurance should work. That’s why we have Medicare. Medicare is a program designed primarily for people who are 65 years old or older, most of whom are either retired or working part-time. Their income has gone down at the precise time that their health risks are beginning to skyrocket. These people often don’t have the extra money lying around that they need to pay for either insurance or for prescription drugs and other care. The insurance companies are not interested in insuring the health of the elderly, and if they do offer a plan, it’s going to be astronomically expensive. It’s easy to see why. Someone who needs dialysis at 70 may have paid their insurance company for fifty years by the time they need to make a claim. But someone who has only been a customer since they turned 65 will use up all the money they paid in after only a few treatments. It isn’t profitable to insure old people at any reasonably affordable rate.
AMA Urges Congress to Nullify Medicare Cuts
Congress’ failure to agree on a plan to reduce the federal deficit activated automatic budget cuts, including a 2 percent cut in payments to Medicare providers, that will become effective on January 1, 2013, absent new legislation. The AMA warned that this cut would endanger patients’ access to care and lead to a loss of jobs in the health care industry. The American Hospital Association issued a press release discussing the results of a report it commissioned with the AMA and the American Nurses Association. The report concluded that more than 496,000 health care jobs would be lost during 2013 alone, with up to 766,000 lost by 2021.
Budget Sequestration (“Fiscal Cliff”) to Cost Medicare Providers $11 Billion in FY 2013, White House Reports : Health Industry Washington Watch
The Budget Control Act imposes a number of special rules regarding the application of sequestration to the Medicare program. Most notably, Medicare cuts are limited to provider payments, and reductions are capped at 2% of individual provider payments under Medicare Parts A and B, and monthly payments under Part C (Medicare Advantage) and Part D prescription drug plan contracts. Medicare payment reductions must be made at a uniform rate across all programs and activities subject to sequestration. Sequestration reductions will be disregarded for purposes of computing adjustments to Medicare payment rates, including the Part C growth percentage, the Part D annual growth rate, and application of risk corridors to Part D payment rates. Also specifically exempt from sequestration are Part D low-income subsidies, Part D catastrophic subsidies, and payments to states for Qualified Individual premiums.