Unfortunately, those best prepared to provide obesity counseling will not be able to bill directly to do so. CMS has limited who is able to bill for those services to primary care physicians and practitioners, including nurse practitioners, clinical nurse specialists and physician assistants. Those with expertise in the field, such as registered dietitians, are not eligible to bill directly. Medicare will cover services from “auxiliary” providers only if the service is provided in a physician’s office suite and the physician is immediately available to provide assistance and direction.
Video: Medicare Australia and Seeing a Doctor: nib Health Insurance Explained
CMS Announces 2013 Medicare Premiums and Deductibles
When making its calculations, CMS maintained a contingency margin in the event that actual costs surpass anticipated costs. This year, CMS found that the two most important factors affecting its calculation of the contingency margin were the impending changes to the physician fee schedule that are scheduled to result in a nearly 30 percent reduction in physician fees; and anticipated sequestration, mandated by the Budget Control Act of 2011 (P.L. 112-125), that could decrease benefit payments by up to 2 percent and result in a $4.3 billion reduction in expenditures. CMS explicitly stated that the Secretary of HHS directed the agency, when calculating the contingency margin, to assume that Congress would change the physician fee decrease to 0 percent. In making its calculation, CMS also assumed that the sequestration requirements would be either reduced or postponed. Although far from controlling, the agency’s assumptions could be cause for cautious optimism among providers and beneficiaries who anxious about the potential cuts.
Medicare Plan Finder for Health, Prescription Drug and Medigap plans
Doctors billing Medicare for patients’ unneeded, expensive tests
(NaturalNews) With all the outcry by politicians and the public over skyrocketing healthcare costs, maybe it’s time to take a look at how some doctors are running up patients’ bills for unneeded tests. A new study just published in Online First by Archives of Internal Medicine, a JAMA Network publication, concludes that diagnostic tests are frequently repeated on Medicare beneficiaries when there’s absolutely no compelling medical reason. It seems obvious the only other explanation is for physicians to make more money by billing Medicare numerous times for repeated tests for the same patients. H. Gilbert Welch, M.D., M.P.H., of Dartmouth College in Hanover, New Hampshire, and colleagues looked at patterns of repeat testing in a longitudinal study of Medicare beneficiaries. In all, they picked five percent of patients’ records at random from the 50 largest metropolitan statistical areas. “We examined repetitive testing for six commonly performed diagnostic tests in which repeat testing is not routinely anticipated. Although we expected a certain fraction of examinations to be repeated, we were struck by the magnitude of that fraction: one-third to one-half of these tests are repeated within a three-year period. This finding raises the question whether some physicians are routinely repeating diagnostic tests,” the authors noted in their paper. For example, among Medicare beneficiaries undergoing an echocardiography to examine their hearts, over half — 55 percent — had a second test within three years. Nearly half of imaging stress tests were also repeated in fewer than three years and so were about 50 percent of pulmonary function tests. About 46 percent of those having CT scans of the chest were repeated, 41 percent of bladder examinations by cystoscopy. About 35 percent of the beneficiaries were subjected to repeat upper endoscopies (exams of the digestive tract with a tube) within three years, too. So what’s so bad about this? Frequently repeating these high tech, expensive diagnosis tests in situations when there is no medical need, drives up Medicare costs (although, of course, it can put more money in the pockets of doctors.) But there’s also a health risk to patients subjected to over-done testing. “This has important implications not only for the capacity to serve new patients and the ability to contain costs but also for the health of the population,” the authors of the paper concluded. “Although the tests themselves pose little risk, repeat testing is a major risk factor for incidental detection and over-diagnosis.” That means people with no health problems can end up being subjected to anxiety over a diagnosis they should never have been given — to say nothing of potentially dangerous side effects from treatment for a “condition” that is harmless or non-existent. In an accompanying commentary, Jerome P. Kassirer, M.D., of Tufts University School of Medicine, Boston, and Arnold Milstein, M.D., M.P.H., of Stanford University School of Medicine stated: “After decades of attention to unsustainable growth in health spending and its degradation of worker wages, employer economic vitality, state educational funding and fiscal integrity, it is discouraging to contemplate the fresh evidence by Welch et al of our failure to curb waste of health care resources.” The new report is more evidence of a phenomenon Natural News has reported on in the past — doctors subjecting patients to inappropriate and downright unnecessary tests, apparently for money. For example, a study by University of California at San Francisco (UCSF) researchers found unneeded, expensive mammograms are being pushed on elderly women who are incapacitated from Alzheimer’s disease or other forms of dementia, especially if the women have savings or assets of $100,000 or more. Sources: http://archinte.jamanetwork.com/article.aspx?articleid=1392496 http://archinte.jamanetwork.com/article.aspx?articleid=1392495 http://www.naturalnews.com/028095_mammograms_Alzheimers.html
Open Enrollment 2013: Medicare Part D Benefits Improve but Premiums an…
While Medicare Part D prescription drug plan premiums are generally expected to remain steady in 2013, this PPI Fact Sheet by Leigh Purvis and Lee Rucker finds that premiums for many popular plans will actually be considerably higher than they were in 2012. Many plans are also increasing cost-sharing and their reliance on utilization management tools for covered prescription drugs. Medicare beneficiaries should closely examine their 2013 prescription drug plan choices during open enrollment for Part D.
Eagle Pass Business Journal
We hear a lot of back and forth about the Affordable Care Act — the federal health care law — but not much about how it affects people with Medicare. When you sort through all the rhetoric, one thing is clear: The 2-year-old law contains some real benefits for those who get their health insurance through Medicare. Take the “doughnut hole” in Medicare’s prescription drug program. During the first few years of the drug benefit, many seniors had to bear the full cost of their prescriptions once they reached this gap in coverage. It was a burden for most. But under the Affordable Care Act, seniors who fall into the hole are getting bigger and bigger price breaks on their drugs each year. By 2020, the gap will disappear. This year, for instance, you get a 50 percent discount on your brand-name drugs and a 14 percent discount on your generics while you’re in the doughnut hole. Those savings have added up to $197 million for almost 300,000 Texans with Medicare over the last year. That’s an average savings of $661 per person.