Group Proposes Medicare Changes, While Providers Have Their Own Suggestions for Congress

Posted by:  :  Category: Medicare

Rogue Magazine (October 1964)  Volume 9 Number 5 - Water Balloons ...item 1.. routinely use devious devices -- wears us down like rabid trial lawyers until we give in (August 15, 2011 / 15 Av 5771) ... by marsmet542In the wake of the 2012 election, which has left the balance of power in Washington, D.C. unchanged, certain realities are becoming clearer. For one, implementation of the health reform law enacted over two years ago will continue, with few legislative options open for those who oppose the law. Perhaps more significantly, if Congress does not act before January 1, 2013, automatic 2 percent reductions in Medicare payments to most providers, and an additional 27 percent cut in Medicare payments to physicians will go into effect.
Source: wolterskluwerlb.com

Video: Improving Medicare in 2011

Employee Tax in 2013: Prepare for Changes in Payroll, Income, and Medicare Taxes

“Employers and employees currently each pay a Medicare tax of 1.45% on wages. Beginning in 2013, employers must withhold an additional 0.9% payroll tax as part of the employee portion of the Medicare tax for certain higher income employees. Although the additional tax is imposed on wages in excess of $200,000 for single filers ($125,000 for married individuals filing separately and $250,000 for joint filers), employers must nevertheless withhold the additional tax on behalf of all employees who have annual wages in excess of $200,000, regardless of their marital or tax return filing status.” (Bradley Arant Boult Cummings)
Source: jdsupra.com

Older Americans Have Been Highly Resistant to Medicare Changes

The income gap among Republicans and Republican leaners is about as large as the difference between GOP supporters of the Tea Party and non-supporters. Among Republicans and Republican leaners who agree with the Tea Party, 57% view deficit reduction as more important than preserving Social Security and Medicare benefits as they are. Among Republicans and leaners who do not agree with the Tea Party, just 36% say that reducing the deficit is more important than maintaining benefits.
Source: people-press.org

Avoiding The ‘Fiscal Cliff’ Likely Means Changes In Medicare

REDUCE PAYMENTS TO PROVIDERS: Hospitals, physicians and other health care providers – many who are now facing payment cuts either in the 2010 health care law or from the upcoming “sequestration” reductions (or both) – may take another hit in a deficit deal. Among the options sometimes mentioned are limiting the amount of “bad debt” that hospitals and other providers can write off their taxes,  reducing federal funding for medical education and requiring more prior authorization for some medical services, such as imaging, to help reduce unnecessary care. Lawmakers looking for political cover from angry providers could cite the many deficit-reduction proposals that have advanced provider cuts: Obama’s 2011 deficit reduction proposal, the Simpson-Bowles plan and the Medicare Payment Advisory Commission, or MedPAC, which advises Congress on Medicare payment policy.
Source: kaiserhealthnews.org

Medicare Premium Changes Announced for 2013

Earlier this year CMS projected that the standard premium for Medicare Part B (which covers certain doctors’ services, outpatient care, medical supplies, and preventive services) would rise by more than $9.00 a month in 2013. However, the good news is that the increase will be lower — $5.00 — bringing 2013 Part B premiums to $104.90 a month. By law, the premium must cover a percent of Medicare’s expenses; premium increases are in line with projected cost increases. Medicare Part B premiums have gone up slowly over the past five years – an average of less than 2 percent a year, or $8.50 total.
Source: hcafnews.com

Medicare Choices Begin Early: Enrollment changes due

“It’s wise to assume your plan has changes and read the new materials carefully to compare costs,” says Janet Bowman, Multnomah County SHIBA Coordinator.  “If you’re considering a different health plan, find out if your doctor accepts it, and make sure it will cover what you need. Get the answers before you enroll in a new plan”.
Source: portlandobserver.com

Mutual of Omaha Announces Changes to Medicare Supplement Plan N Underwriting

Mutual of Omaha has announced underwriting changes to their Plan N Medicare Supplements.  This will affect all Mutual of Omaha companies including United World and United of Omaha.  Exceptions will include New York, where health questions may not be asked (per state regulations) and in open enrollment or other guarantee issue situations where health questions normally do not apply.
Source: wordpress.com

What Boomers Need to Know About Medicare Changes. bkhelpnow.com Susan Salehi Bankruptcy Ventura Oxnard Camarillo Santa Barbara Woodland Hills Los Angeles CA.

The Law Office of Susan J. Salehi has helped 1000’s of people like yourself with Chapter 7 and 13 bankruptcies since 1992, both in the Santa Barbara/Ventura and Kern County areas. We offer a free consultation, reasonable rates and payment plans. All of your options will be explained during your free consultation with the attorney at the Law Offices of Susan J. Salehi. We ask that you bring six months’ proof of income (paystubs/rent receipts/profit and loss statement if self-employed), the last two years’ tax return, a credit report – free ones are available at www.annualcreditreport.com, any foreclosure notices, lawsuits, and correspondence from the IRS or FTB if you owe pastdue taxes.Calltoday for a free, no-obligation consultation, contact us through our website at salehilaw@aol.com. Start at only $999 Attorney Fees. Restrictions Apply. Stop Foreclosures with a Chapter 13. Operators 24/7. (805) 654-1467, (818) 880-8305, (661) 631-0252, (805) 202-4688.
Source: bkhelpnow.com

Health Care Reform Brings Major Medicare Changes

In addition, Centers for Medicare and Medicaid Services has begun this month reimbursing hospitals for Medicare services based on how well they follow “best practices” or clinical guidelines and how their patients respond to satisfaction surveys. This is known as “value-based purchasing” or “paying for performance.” Some hospitals will be paid less while higher-performing hospitals will be paid more. Beginning this month, Medicare is reducing payments to hospitals that had higher-than-expected readmission rates over the last three years for patients who returned within 30 days of being discharged after pneumonia, heart attack or heart failure. More conditions will likely be added in the future.
Source: northcarolinahealthnews.org

2013 Part D Medicare Changes

Prescription drug coverage costs are increasing in 2013 again.  Not by a lot, but costs to seniors have been steadily increasing since 2006.  The CMS, Centers for Medicare and Medicaid Services, have created a benefit cost chart from 2006 to 2013.  To name a few of the changes:  Initial deductibles will increase by $5.00 rising from $320.00 in 2012 to $325.00 in 2013.   The initial coverage limit will increase to $2970.00 from $2930.00, and the out-of-pocket threshold (Donut Hole) will increase from $4,700.00 to $4,750.00.
Source: americaninsuranceforexpats.com

NACDS, NCPA Doctors Urge To register now PECOS system to preserve access of Medicare patients’ durable medical equipment

Posted by:  :  Category: Medicare

NACDS members also more than 900 pharmacies and front-end providers, and more than 70 international members from 24 countries. Chains operate 37,000 pharmacies, and employ more than 2.5 million employees, including 118,000 full-time pharmacists. They fill more than 2.5 billion prescriptions per year, which is more than 72 % of annual prescriptions in the United States. The total economic impact of all retail stores with pharmacies transcends their $ 815 000 000 000 annual sales. Every $ 1 spent in these stores creates a ripple effect of $ 3.82 in other sectors, for a total economic impact of 3,110 billion dollars, equivalent to 26 per cent of GDP.
Source: redheadappraisals.com

Video: Audio Educator: Medicare Enrollment PECOS And the CMS 855

Important “PECOS” Update…

[…] In 2010, Congress required the use of national provider identifiers for ordering and referring physicians on claims for medical equipment or services from laboratories, imaging providers and suppliers. CMS later issued an interim regulation requiring all physicians who order supplies or refer services, including those from specialists, to be enrolled in PECOS by July 2010, but CMS delayed enforcement of that rule as the agency worked to validate and update enrollment records. Enforcement would have meant that claims for items or services would be rejected unless the ordering or referring physician also was in the enrollment system, not just the physician who provided the care.Source: vgm.com […]
Source: vgm.com

Improvements to the Medicare Internet

Users will soon be able to see if their revalidation application has been received and processed by the Medicare Administrative Contractor (MAC).  In addition to a “Revalidation Notice Sent” date, a “Revalidation Received” date and a “Revalidation Complete” date will be displayed on the My Enrollments page. The “Revalidation Notice Sent” date and the “Revalidation Received” date will display on the My Enrollment page for 120 days. The “Revalidation Complete” date will display on the My Enrollments page indefinitely. There are some problems with this system as it has been reported that some physicians are appearing on the page as having been sent a revalidation notice but there is no record of the notice being sent by the Contractor. CMS is aware of this problem and they are investigating it we will notify you when they have discovered the cause of the problem and possible solutions.
Source: 4dmed.com

Providers Without a PECOS Record Will Receive a Letter From Their Medicare Administrative Contractor (MAC)

There are three important reasons why you should take the necessary action to establish an enrollment record in PECOS as soon as possible. First, updating your Medicare enrollment record will assist us in ensuring payment accuracy for the services you furnish to Medicare beneficiaries. Second, you will need an approved enrollment record in PECOS to continue to order or refer items or services for Medicare beneficiaries. Finally, in accordance with the American Recovery and Reinvestment Act of 2009, Title XIII, known as the HITECH Act, incentive payments may be made by Medicare and Medicaid to enrolled eligible professionals and certain hospitals that meet the HITECH requirements. More information on Medicare HITECH incentive payments can be found at http://www.cms.hhs.gov/Recovery/11_HealthIT.asp under Related Links Outside CMS on the CMS web site. The Centers for Medicare & Medicaid Services (CMS) will use the PECOS enrollment records to verify Medicare enrollment for HITECH incentive payments. Therefore, you will not be eligible to receive incentive payments from Medicare for meaningful use of certified electronic health records if your enrollment information is not maintained in PECOS by CMS.
Source: managemypractice.com

Employee Retirement Health Benefits: Workers Increasingly Do Not Expect Retiree Health Coverage

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSDespite the fact that employees have seen major changes in their current and retirement health plans, a disproportionate number of them still believe their employer will provide health benefits when they retire. A new brief from the Employee Benefit Research Institute (EBRI) found that 32 percent of workers ages 45 to 64 expected to receive retiree health benefits, even though only 17.7 percent of employees worked for organizations that offered early retiree health coverage. Many among that 17.7 percent will not actually get retiree health coverage because they are not full-time employees or have not worked long enough to earn those benefits.
Source: piperreport.com

Video: Can the Government Require Health Coverage?

Medicare and the Fiscal Cliff: Trudy Lieberman's Tips For Your Coverage

The public is confused. One Pennsylvania woman told me last week she didn’t know whom to believe. So learning how to untangle Medicare is important and worth the effort. While you may think Medicare is a national story, it isn’t exclusively the province of Beltway reporters. Like all healthcare, it’s local.
Source: reportingonhealth.org

Adult caregivers and medicare

QUESTION: Why would anyone add, review or possibly change their coverage? Because you want to avoid surprises by checking to see if the current health plan has made any benefit changes for 2013. The  major goal for AEP is to avoid surprises by knowing how benefit changes may affect your loved-ones out of pocket insurance costs.  If you check your loved-ones coverage and know what’s changed for 2013, it’s easier to plan for out of pocket expenses in the upcoming year. During last year’s AEP, switching to the plan with the lowest total out-of-pocket costs could have saved our average customer over $600.
Source: ehealthinsurance.com

Florida Medicare 2013 Open Enrollment

For example, suppose after running a search-providing zip code of your county in a southwestern state and you find that your current plan does not cover any vision or dental coverage, and then plans can be changed. There are other two available plans, which cover both the aspects plus limited hearing coverage. This sort of Medicare plans are of high quality ratings such as 4.5 out 5stars. This also means that Medicare is giving them an extra quality bonus which are use to augment benefits like vision-dental coverage or results in overall cost reduction of the plan, to the members.
Source: medicare-supplement-advisor.org

Recommendations to Medicare: Defined Contribution, No Home Health Co

According to the Partnership, Medicare has been considering re-introducing a co-payment for the home health benefit. Proponents of re-introducing the co-pay believe that requiring beneficiaries to pay for the benefit would put them in “skin in the game.” The Partnership defines “skin in the game” as the full scope of costs that a beneficiary bears as an integral part of receiving Medicare-covered services.  The Partnership contends that Medicare home health beneficiaries have significant out-of-pocket spending on housing and other living expenses, which allow them to receive services in the home rather than in higher-cost institutional settings. Moreover, the Partnership states that although beneficiaries’ living expenses are lower when they receive treatment in an institutional setting instead of in their home, the Medicare program and taxpayer costs are higher when beneficiaries are served in institutional settings instead of in their home. In addition, the authors estimated that the cost of additional hospitalizations exceeded the savings from the decrease in outpatient visits. The Partnership noted that among the copayment related issues that policymakers should consider are:
Source: wolterskluwerlb.com

House Republican budget cuts would have a devastating impact on the elderly and children in Connecticut

Connecticut Medicaid cuts in the outcome of two major changes in the Republican House budget: the conversion of the existing program into a block grant with drastic cuts in the $ 12.7 billion of federal funds provided to the State, and to eliminate the expansion of the program provided coverage uninsured Affordable Care Act by .
Source: yerbabuenainstitute.org

Settlement Proposed for Medicare Coverage of Home Health Care

The changes would apply to the traditional Medicare program and private Medicare Advantage plans. More than 10,000 beneficiaries whose claims were denied before Jan. 18, 2011 — when the lawsuit was filed — are expected to benefit as their claims would be re-examined under the new standards, the Times reports.
Source: californiahealthline.org

Medicare Open Enrollment Ends December 7

advocacy Alpha-1 anxiety asthma awareness bronchiectasis bronchitis caregiver caregiving CDC chronic bronchitis comorbidities COPD COPD awareness COPD education depression education emphysema exacerbation exacerbations exercise family FDA healthcare Healthy Living lung health lung transplant medicare motivation nutrition o2 osteoporosis oxygen pneumonia POCs pulmonary rehab pulmonary rehabilitation research smoking Smoking Cessation spirometry supplemental oxygen support traveling with oxygen world copd day
Source: copdfoundation.org

Navigating Your Medicare Options

Alaska Andrew Schorr Awards BCBSA Blood pressure Corporate Citizenship Cost containment Coverage basics Customer service Diabetes Doctors Federal healthcare reform Fitness tips Food Health screenings Health tips Healthy Eating Holidays Home Visit Program ID theft Immunizations Lean process improvement Medicaid Medical Home Medical Loss Ratio Medication Safety Nursing Nutrition Pharmacy Playmakers Premera Cares Premera Employees Premera in the Community Premera members Preventive Providence Health & Services Recipes Saving money Seahawks Social media State Insurance Exchange Step Out Walk United Way Wellness Women’s health
Source: premeranews.com

Medicare Open Enrollment: What’s your back

Nobody likes to think of back-up plans when it comes to our health, but health can be as unpredictable as the weather. It’s hard to know what you’ll feel like next week, much less what health care you’ll need next year. But that’s exactly what you need to think about when you’re shopping for health coverage during Medicare Open Enrollment – which ends on December 7.
Source: medicare.gov

Preventive & screening services

The page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

What’s not covered in Medicare?

Survey results, put out by Nationwide Financial, show that 38% of respondents nearing retirement have not discussed it (retirement) at all with a financial advisor and only one in five of those who did discuss with a financial advisor included health care costs in the discussion. Yet more than 50% of soon to be retired, high net worth Americans are afraid of what health care costs could do to any retirement plans they’ve made. John Carter, president of Nationwide Financial Distributors, deduced from his personal experience and the results of the survey that “too many [people] assume their employers will continue to pay their premiums during retirement or Medicare will cover all health care expenses.” The same survey responses also indicate that only one in five are confident in their understanding of Medicare coverage but more than half believe it to be important to educate themselves on it.
Source: flavma.com

Medicare, Other Entitlement Programs Key To ‘Fiscal Cliff’ Deal

Posted by:  :  Category: Medicare

Roll Call: Liberals Start To See Entitlement Trim As Inevitable When the Center for American Progress recently pointed to some potential savings from entitlement programs, the political implications were more important than the numbers. The left-of-center group’s entry into the battle over entitlement spending provided some political cover that could allow more Democratic lawmakers to support a deficit reduction compromise including savings from programs they have long defended with their political lives — Medicare, Medicaid and perhaps Social Security. The report said Congress could reduce the cost of health care for seniors by $385 billion over 10 years by picking up some proposals that were either discussed during the 2011 debt limit standoff or included in President Barack Obama’s fiscal 2013 budget proposal — things such as higher premiums for upper-income Medicare beneficiaries and cuts in Medicare payments to hospitals and nursing facilities (Krawzak, 11/28). National Journal: Dems To GOP: Stop Stalling And Name Your Entitlement Cuts Senate Democrats are blaming Republicans for the slow pace of the fiscal cliff negotiations, arguing that Republicans have failed to lay out the entitlement spending cuts they want to see as part of a deal. Instead, Republicans are trying to force Democrats into negotiating with themselves and in the process take on the political burden of proposing both tax increases on the wealthy and spending cuts that could hit the middle class, a Senate Democratic leadership aide said. … Even Democratic Sen. Tom Harkin, who has publicly opposed including Medicare or Medicaid cuts in a deal, refrained from saying that Democrats would reject an Obama-Boehner crafted deal that includes spending cuts. Instead, he urged the president to keep Senate Democrats in the loop so they can work something out (Frates, 11/28).
Source: kaiserhealthnews.org

Video: Company accused of massive Medicare fraud

Elder Lobby Should Back off on Medicare

Several unpleasantries here, in addition to the blatant threat. There’s the return to the nastiness and half-truths that buried productive conversation during the debate over ObamaCare. Unlike Social Security, Medicare is only a partly earned benefit. The average two-earner couple retiring at 65 can expect about $351,000 in benefits after paying $116,000 in lifetime Medicare taxes. Medicare should be subsidized by other taxpayers, but don’t pretend it’s not.
Source: realclearpolitics.com

Daily Kos: We must SAVE MEDICARE, MEDICAID, AND SOCIAL SECURITY!

Consider if one or more of these tags fits your diary: Civil Rights, community, Congress, Culture, Economy, Education, Elections, Energy, Environment, Health Care, International, Labor, Law, media, Meta, National Security, Science, Transportation, or White House. If your diary is specific to a state, consider adding the state (California, Texas, etc). Keep in mind, though, that there are many wonderful and important diaries that don’t fit in any of these tags. Don’t worry if yours doesn’t.
Source: dailykos.com

Saving money on health costs: Extra Help program

monthly premiums, annual deductibles, and prescription copayments in your Medicare drug plan. Did you know that the Extra Help program is estimated to be worth about $4,000 dollars per person, per year? Even if you’re not sure you’d qualify, it’s worth filling out an application to see.
Source: medicare.gov

Capital Gains and Dividend Income Tax Rates Scheduled to Increase in 2013: Added Impact of New Medicare Contribution Tax

Posted by:  :  Category: Medicare

Newsweek Magazine (February 16, 2009) ... Lenders Add Bigger Fannie, Freddie Fee – Thanks to Payroll Tax Cut (January 15, 2012) ...item 2.. Dupuy: GOP trying to sell pyrmaid scheme to voters (September 3, 2012) ... by marsmet526The significant increase in capital gains rates and taxes on dividend income have already resulted in taxpayers attempting to realize gains or accelerating the receipt of dividends from closely held corporations before the end of this year. If the rates do increase, i.e., Congress does not resolve the fiscal tax cliff in a manner that reduces or eliminates the anticipated tax rate hikes, then the new tax rates will certainly have a widespread and dramatic effect on future tax planning for all taxpayers, including closely held businesses and investors. For example, many owners of appreciated real property may prefer to engage in tax-free exchanges instead of having a preference for cash sales. From a merger and acquisition standpoint, privately owned companies looking to sell out may want to either postpone the sale of its business or consider being acquired in a tax-free reorganization or perhaps engage in a joint venture, which could be partially taxed to the extent cash is received. With higher rates also brings along a greater tax benefit from depreciation and other tax deductions, including tax credits. The change in rate structure may also affect the preferred entity form for many businesses particularly if the much talked about reduction in the corporate income tax rate occurs. There could be a wide disparity then in the rate of tax a regular or C corporation pays instead of a flow through entity used by individuals in operating a closely held business or professional service organization causing the entity owners to reassess the best tax form for doing business.
Source: jdsupra.com

Video: Will Higher Tax Rates Balance the Budget?

Republicans Will Buckle on High End Tax Rates

The papers this morning are filled with gloomy assessments of the fiscal talks — see the Post’s overview — with predictions mounting that we are going to go over the cliff. A lot of noise has been kicked up by all the finger-pointing, so let me summarize the situation in two sentences:
Source: realclearpolitics.com

Employer rules for withholding the new 0.9% Medicare tax

Beginning in 2013, an additional 0.9% Medicare tax is imposed on individuals who receive wages over $200,000 ($250,000 in the case of a joint return, or $125,000 in the case of a married taxpayer filing separately). When added to the current 1.45% employee portion of the Medicare tax, a high-income taxpayer’s wages will be subject to a 2.35% Medicare tax on wages above the threshold. There is no employer match for the additional Medicare tax – the employer’s Medicare tax rate on wages paid to employees will continue to be 1.45%.
Source: pwc.com

Why The ‘Clinton Tax Rates’ Didn’t Create Prosperity in the 1990′s

Clinton signed his tax hike into law in September 1993, the same year he took office. It included an increase of the top marginal tax rate from 31 percent to 39.6 percent; repeal of the cap on the 2.9 percent Medicare tax, applying it to every dollar of income instead of capping it to levels of income like the Social Security tax; a 4.3 cent increase in the gas tax; an increase in the taxable portion of Social Security benefits; and a hike of the corporate income tax rate from 34 percent to 35 percent, among other tax increases.. (Source: US. Department of the Treasury, Office of Tax Analysis, “Revenue Effects of Major Tax Bills,” September 2006)
Source: varight.com

The Medicare cuts the GOP refuses to identify

Greg Sargent added some additional context that’s worth keeping in mind: “[T]he White House actually has made an opening offer of sorts on entitlements. The Obama budget contained $340 billion in Medicare cuts over 10 years, mostly targeting drugmakers, providers, and high-income beneficiaries. The White House has reiterated that those are on the table. For the left, hitting middle and low income beneficiaries with higher costs will be unacceptable. If Republicans don’t think the White House’s proposed cuts are enough, that’s fine, but it should be on them to say what they want.”
Source: msnbc.com

Raise Medicare Payroll Taxes on Employees

While employers currently match Medicare payroll taxes paid by the employee, these increase in taxes should not be assessed to employers.  Why?  Increasing employer taxes on wages will reduce employment, economic grow, wage growth, and tax revenue; only a vindictive imbecile would support such indirect taxation, which harms workers.  In fact, current Medicare taxes paid by employers should be shifted on to the employees as part of a strategy to reduce the penalty our government puts upon employers for hiring.
Source: wordpress.com

Preparing for the 3.8% Medicare Surtax on Net Investment Income

Effective in 2013, net investment income will be subject to a new 3.8 percent surtax enacted as a part of the Affordable Care Act. Net investment income generally encompasses capital gains, dividends, interest, royalties, rents and passive activity income (such as an investment in a limited partnership). The 3.8 percent surtax will be in addition to any applicable increased capital gain or ordinary income tax highlighted above (bringing the total federal tax on long-term capital gains to 23.8 percent and on dividends and other net investment income to as much as 43.4 percent).
Source: jdsupra.com

Social Security and Medicare Withholdings for 2013 @ TilsonHR Blog Site

401(k) ACA Affordable Care Act Benefits Boom clients communication Compliance Congress Education Emergency Employee Employee Relationships Employment Law Exchange Health Health Care Reform Health Plan Human Resources I-9 Indiana PEO Information Insurance Interviews IRS job satisfaction Life Insurance Lifestyle Management Training Series Open Enrollment Payroll PEO Planning PPACA Professional Employer Organization Recruiting Safety Screening Social Media Taxes Tilson Tilson HR US Department of Labor Wages Workplace
Source: tilsonhr.com

Johnson, Pope, Bokor, Ruppel & Burns, LLP

As the thresholds reveal, the new tax affects wealthier taxpayers and will primarily impact income-generating investments. Accordingly, there are several tax planning techniques individuals and private enterprises should consider for 2013 to eliminate or lessen the impact of the new Medicare tax. Some planning techniques include: (1) deferring capital gains or pairing capital gains with capital losses to offset capital gains being taxed at a higher rate; (2) rebalancing your portfolio to shift income-producing investments into tax-deferred plans such as IRAs and 401(k) accounts; (3) considering tax -exempt bonds instead of taxable bonds; (4) reclassifying passive activity to active activity by evaluating any new factual patterns for each activity that would not lend itself to the tax; and (5) if you have an investment interest expense carryover into 2012, electing not to tax qualified dividends and long-term capital gains at the higher rate to preserve the investment interest expense as a carryover to future years. With January 1, 2013 fast approaching, it is important to not only understand the significance of the new Medicare tax on unearned income, but also consider developing tax planning techniques now to offset its impact on you and your investments.
Source: jpfirm.com

Media enablers of Pete Peterson’s war on social security and Medicare

What has changed? For one thing, the crisis they predicted keeps not happening. Far from fleeing U.S. debt, investors have continued to pile in, driving interest rates to historical lows. Beyond that, suddenly the clear and present danger to the American economy isn’t that we’ll fail to reduce the deficit enough; it is, instead, that we’ll reduce the deficit too much. For that’s what the “fiscal cliff” — better described as the austerity bomb — is all about: the tax hikes and spending cuts scheduled to kick in at the end of this year are precisely not what we want to see happen in a still-depressed economy.
Source: blogforarizona.com

Cutting the clutter – the newly designed Medicare Summary Notice

Posted by:  :  Category: Medicare

gives you faster access to your Medicare claims information—you can check it 24 hours a day, 7 days a week, 365 days a year. Customize your MSN to see procedures broken down by single claim, or by a time period you choose, and print out your own statement anytime. Reviewing your MSN online means a shorter wait to see what you were charged for health care services, medical supplies or equipment, and how much Medicare paid.
Source: medicare.gov

Video: You Can Help Fight Medicare Fraud

Understanding Medicare Statements

You should compare the information on your MSN with bills, statements and receipts from your health care providers and suppliers. Do the dates, billing codes and the descriptions of services you received match? In some instances, your MSN may include valid charges for services or supplies you weren’t aware of having received — such as for medical consultations or tests. But, as a general rule, the dates and codes should match. If you don’t see codes on your provider’s paperwork, ask for copies that include them.
Source: aarp.org

CMS Unveils New Medicare Summary Notice

kslaw.com 1 of 1 March 12, 2012 CMS Unveils New Medicare Summary Notice On March 7, 2012, CMS introduced a redesigned claims and benefits notice for Medicare beneficiaries. The new notice, said CMS in a press release, is part of a broader consumer protection effort to make information about the program “clearer, more accessible, and easier for beneficiaries and their caregivers to understand.” Notably, the notice contains a new “How to Report Fraud” section, instructing beneficiaries to report instances of suspected Medicare fraud. The notice lists the receipt of free medical services and billing for services not received as examples of fraud. The notice also explicitly advises beneficiaries that vigilance can pay off—tips that lead to “uncovering fraud” may result in financial rewards. Other new features of the redesigned notice include: • A set of defined terms used throughout the notice. • A clear explanation of where the beneficiary stands with respect to his/her deductible and whether Medicare has approved all services. • “[C]onsumer-friendly descriptions for medical procedures.” CMS will soon make the new notice available to beneficiaries online at www.MyMedicare.gov. Beginning in 2013, CMS will send notices to beneficiaries each quarter. Click here to view the new notice and here to read the corresponding press release. Reporter, Greg Sicilian, Atlanta, +1 404 572 2810, gsicilian@kslaw.com. Health Headlines – Editor: Dennis M. Barry dbarry@kslaw.com +1 202 626 2959 The content of this publication and any attachments are not intended to be and should not be relied upon as legal advice.
Source: jdsupra.com

Medicare Terminology To Know

Medicare summary notice (MSN) deals directly with the beneficiary or the person covered  under Medicare. The MSN replaced the Explanation of Medicare Benefits form in 2001.[1] This is an easy to read document sent to the Medicare holder every month that allows them to see their Part A and Part B claims. The MSN also holds the deductible status. Basically it is an information sheet. Often when a patient receives the MSN they think it is a bill. It is important to understand that this is not a bill but rather an explanation of what has transpired the previous month under their Medicare coverage.
Source: codingcertification.org

CMS announces new Medicare Summary Notice (sometimes referred to as an Explanation of Benefits)

This MSN redesign is part of a new initiative, “Your Medicare Information: Clearer, Simpler, At Your Fingertips,” which aims to make Medicare information clearer, more accessible, and easier for beneficiaries and their caregivers to understand. CMS will take additional actions this year to make information about benefits, providers, and claims more accessible and easier to understand for seniors and people with disabilities who have Medicare. This MSN redesign reflects more than 18 months of research and feedback from beneficiaries to provide enhanced customer service and respond to suggestions and input.
Source: quinnscommentary.com

New Medicare Summary Notice Designed to Help Fight Fraud

“Consumer protection starts with making sure consumers not only get timely and accurate information, but that they understand what services they’re receiving from Medicare,” said Acting Administrator Marilyn Tavenner.  “The new Medicare Summary Notice empowers Medicare’s seniors and people with disabilities.  The statement is easier to understand and navigate, and makes clear what information to check and how to report potential fraud.  The new MSN also makes it easier for people with Medicare to understand their benefits and file appeals if a claim is denied.”
Source: wolterskluwerlb.com

6 Features of CMS’s Redesigned Medicare Summary Notice

In light of ongoing healthcare reform there is a push for clarity, as several of our stories illustrate this week. Medicare claims forms have been redesigned so that beneficiaries and their caregivers can better understand them, check for important facts and potential fraud. The subject of fraud is particularly timely given the story that has been circulating for the last week involving the arrest of a physician, the office manager of his medical practice, and five owners of home health agencies. They’ve been charged with allegedly participating in a nearly $375 million healthcare fraud scheme involving fraudulent claims for home health services.
Source: hin.com

Seniors Pay Too Much for Medicare Part D

Posted by:  :  Category: Medicare

TWO YEARS OF RUIN by SS&SSInsurance companies offering Part D drug insurance are required to mail information about the coming years  premium costs and drug coverage to current members well in advance of the December deadline.  These hefty documents arrive just ahead of the busiest time of year and, after reading the cover letter stating they will be automatically signed up if they do nothing, many do just that: nothing.  Unlike other types of insurance, Medicare Part D drug coverage changes every year because new drugs, manufacturing costs, regulations and effectiveness findings come out literally every day.  As a result, insurance companies must change their formularies, the list of the drugs they cover and the cost, at least every year.
Source: californiahealthplans.com

Video: Medicare Part D and Prescription Drugs

Medicare Part D: It Pays to Shop Around

Politicians often tout the value of the free market, arguing that more choice results in a better deal for consumers. In the case of Medicare Part D coverage, the array of choices don’t always translate into better decision-making and more savings. Perhaps there are too many choices. Plans change from year to year, a drug that may have a high co-pay on one plan may have a tiny co-pay on another. A drug that was covered by a particular plan one year may be dropped from coverage the next.  The researchers conclude that “beneficiaries need more targeted assistance from the government to help them choose plans, such as customized communications about the most cost-effective plans that would cover their medication needs.”
Source: lexisnexis.com

Antidepressant Use Among Seniors: Falling Through Medicare’s Doughnut Hole?

Philadelphia Inquirer/HealthDay News: Medicare Coverage Gap May Cause Seniors To Forgo Antidepressants The Medicare Part D drug plan’s gap in coverage — often referred to as the “donut hole” — has long been a concern, and a new study links it to cutbacks by seniors in the use of antidepressants and other medications. An estimated 13 percent of seniors aged 65 and older suffer from depression, experts say. Antidepressants can stop depression from returning, but the Part D benefit — especially the coverage gap — “imposes a serious risk for discontinuing maintenance antidepressant pharmacotherapy among senior beneficiaries,” the study authors found (Dotinga, 7/2).
Source: kaiserhealthnews.org

Commentary: The case for Medicare Part D

One certain reason enrollees are satisfied is that 2012 premiums are lower on average than 2011 premiums. In 2011, the Centers for Medicare and Medicaid Services (CMS) found that the Medicare Part D program saved enrollees $2.1 billion in 2011 because of the Gap Discount program, which requires drug manufacturers to provide discounts on brand-name and generic drugs to seniors in the gap or “donut hole.” About 3.6 million enrollees nationwide benefitted from these discounts, at an average of $604 each.
Source: northwestopinions.com

Making Sense Of Medicare Part D Open Enrollment

Each year, plan premiums, deductibles, prescription co-payments and annual out-of-pocket expenses can change. When considering what plan works best for you in terms of cost, it is important to consider all these elements (premiums, deductibles and co-payments) in order to calculate the total cost of the plan. Drugs covered under Medicare Part D may also vary from plan to plan and from region to region. It’s important to re-evaluate your plan if your prescriptions have changed, you’re traveling more frequently or have moved. Selecting the right plan can save you money and put you on a path to better health.
Source: sundaynewscape.com

Survey: U.S. Seniors Overwhelmingly Satisfied with Medicare Part D Coverage

Washington, D.C. (October 3, 2012) – With the future of Medicare top of mind for millions of America’s seniors and their families, a national survey released today finds that nine out of 10 seniors are satisfied with their Medicare prescription drug coverage (Part D). The survey also shows that overall satisfaction with Part D has increased from 78 percent to 90 percent since the program was first implemented. Ninety-six percent report that their coverage works well, and nearly 3 in 4 seniors say it works “very well.”
Source: hlc.org

Part III: Medicare Coverage for Parts C and D

Medicare Advantage plans provide a network of clinics, doctors and hospitals where you can obtain healthcare treatment. Once enrolled in a Medicare Advantage Plan, you must obtain your care through its network of providers (there may be additional charges or exclusions of coverage if one obtains care outside the network). Many plans also cover prescription medication and out-of-town emergency services. Part C essentially merges the coverage components from Parts A and B, and some of the coverage aspects of a Medicare Supplemental plan, to cover all needed services. Part C can be a low-cost substitute for Traditional Medicare coverage – private insurance companies can offer additional benefits and may also include Part D coverage.
Source: wordpress.com

After retiring, will medicare provide enough coverage to pay for medical care and prescriptions?

Not all prescription drugs are covered by Medicare. Additionally, if you are prescribed a name brand and a generic equivalent is available, Medicare may only pay for the generic version. Check the available Medicare Part D plans available in your state, and choose a plan that best meets your financial and medical needs. Most states have several different plans available, including Medicare Advantage and low-cost Prescription Drug Plans.
Source: usinsurancenet.com

Adult caregivers and medicare

QUESTION: Why would anyone add, review or possibly change their coverage? Because you want to avoid surprises by checking to see if the current health plan has made any benefit changes for 2013. The  major goal for AEP is to avoid surprises by knowing how benefit changes may affect your loved-ones out of pocket insurance costs.  If you check your loved-ones coverage and know what’s changed for 2013, it’s easier to plan for out of pocket expenses in the upcoming year. During last year’s AEP, switching to the plan with the lowest total out-of-pocket costs could have saved our average customer over $600.
Source: ehealthinsurance.com

Medicare Prescription Drug Coverage, Medicare Part D, Doughnut Hole

Medicare has an optional program — called Medicare Part D — that provides insurance to help you pay for prescription drugs. If you select to have the coverage, you pay a monthly premium. This guide explains how the program works and helps you make decisions in choosing a plan that’s right for you.
Source: aarp.org

Medicare Terminology To Know

Posted by:  :  Category: Medicare

Code Pink R-E-P-P-E-N' ENDS! by eyewashdesign: A. GoldenMedicare summary notice (MSN) deals directly with the beneficiary or the person covered  under Medicare. The MSN replaced the Explanation of Medicare Benefits form in 2001.[1] This is an easy to read document sent to the Medicare holder every month that allows them to see their Part A and Part B claims. The MSN also holds the deductible status. Basically it is an information sheet. Often when a patient receives the MSN they think it is a bill. It is important to understand that this is not a bill but rather an explanation of what has transpired the previous month under their Medicare coverage.
Source: codingcertification.org

Video: Medicare denial code

Medicare code denial MA130 and action

MA 130 – Claims returned as unprocessable as appeal requests There are large volume of appeals have been filed on claims that were returned as unprocessable. An unprocessable claim is one that was filed with incomplete and/or invalid information. Claims that are unprocessable cannot be appealed. Therefore, when a provider files an appeal on an unprocessable claim, the correspondence is returned to the provider with a letter instructing the provider to refile a new claim. Response letters are typically not generated for at least 30-40 business days after the original request was submitted. To avoid delays in payments, providers must resubmit claims returned as unprocessable. Filing an appeal only delays payment on claims and could result in a timely filing denial if the incomplete/invalid claim is not re-filed with the correct information with the timely filing period. Identifying an unprocessable claim Claims returned as unprocessable will typically include the MA130 remittance advice message with a corresponding reason code message to denote why the claim was incomplete or invalid. Communication letters to top providers that file appeals on unprocessable claims CMS will be sending communication letters to providers in the future if appeals are continually filed on unprocessable claims. These letters will provide details on the number of appeals requests received on unprocessable claims by the applicable providers and the impacts that such requests have on regular appeal and inquiry inventories.
Source: insuranceclaimdenialappeal.com

Denied Medicare for Mesothelioma? New Settlement May Provide Relief

The government offered a settlement that, if approved, would alter the current Medicare policy that determines the amount of care a patient is eligible to receive. Under the current system, contractors that process Medicare claims use an “improvement standard” to calculate that patient’s chances of recovering. They would often deny services like speech therapy and inpatient nurse care for people who were unlikely to make a full recovery. The settlement would allow patients to receive these treatments.
Source: asbestoscancerblog.com

AHA sues HHS over Medicare Payment Denials

“What the federal government is doing is wrong, unfair and a clear violation of federal law,” said AHA President and CEO Richard Umbdenstock in a news release (PDF). The AHA stated in the release that although hospitals and auditors may have disagreed about the appropriate settings for care and subsequent reimbursement rates, government officials were not questioning the fact that needed services were delivered to the patients.
Source: quickreadbuzz.com

Lalor and Zampa in Bupa Sheffield Shield squad for Canberra

Posted by:  :  Category: Medicare

BUPA-NHS Reversion by imjustcreativeLeft-arm swing bowler Josh Lalor and leg-spinner Adam Zampa have been added to the NSW SpeedBlitz Blues squad for their Bupa Sheffield Shield match against Queensland at Manuka Oval, Canberra starting on Tuesday (November 27).
Source: com.au

Video: Bupa. Find A Healthier You

Lalor and Zampa in Bupa Sheffield Shield squad for Canberra

Left-arm swing bowler Josh Lalor and leg-spinner Adam Zampa have been added to the NSW SpeedBlitz Blues squad for their Bupa Sheffield Shield match against Queensland at Manuka Oval, Canberra starting on Tuesday (November 27).
Source: internationalcrickethall.com

Bupa and Holler create Facebook Timeline scavenger hunt to ‘Find a Healthier You’

The competition aims to engage the social community, and was designed to be challenging, really rewarding those who were able to complete the journey. We’re trying to convey through the scavenger hunt that no one is perfect when it comes to good health, but it’s easy to get on the right track and find a healthier you. The winner of the Facebook scavenger hunt will receive a trip to a health resort in Thailand worth $8,000, and the first 100 Bupa members to complete the challenge will receive a fruit and veg box from Aussie Farmers Direct. Try it out here. 
Source: campaignbrief.com

Bupa Arabia successfully concludes ‘Walk Your Heart’ campaign

“The incidence of obesity in the Kingdom is on the rise with the latest report from the Saudi Diabetes and Endocrinology Society stating that among the middle-aged population 34% of men and 45% of women in Saudi Arabia are considered obese, a figure that is drastically high and affecting nearly everyone’s lives either directly or indirectly,” said Tal Nazer, CEO of Bupa Arabia. He added that his company’s objective for launching “Walk Your Heart” campaign was to encourage people to have a more active life and make walking a daily part of a change to a healthier lifestyle. Over 4000 participants took part in the “Walk Your Heart” campaign, 2,330 of them completed the 1,400 meter designated route within Red Sea Mall passing by various, educational health tips and environmental reminders. Upon reaching the finish line participants qualified to enter a draw for a free family trip to Dubai along with other valuable prizes. Participants also got a chance to vote for charitable causes that they were walking for, choosing between causes such as, Orphans, Disabled Children’s Association or the National Home Health Care Foundation. The cause receiving the most votes received the allocated fund as a donation from Bupa Arabia. In addition, Bupa Arabia also provided a “Health Lounge,” which received over 600 visitors and consisted of small clinics that offered quick and accurate medical check-ups as well as two specialized clinics devoted to diabetes and smoking cessation sponsored by the Ministry of Health. Nearly 150 volunteers, consisting of Bupa Arabia employees and others worked and collaborated in preparing, organizing and promoting the successful event. Some celebrities and social activist such as the, Saudi Rap Singer, Qusai Khider, Media Presenter, Ahmad Al-Shugairi and the Mizan Corporation Team consisting of Dr. Obai Al-Bashir, Dr. Rayan Karkadan, also Ibrahim Kherallah and Nawaf Al-Thufairi as well as students from Dar Al-Fikr and the King Abdul Aziz University (KAAU) have taken a part in supporting the campaign. To further encourage people to take a more healthier lifestyle Bupa Arabia devised a way for family members and friends to share in the activity by developing a smartphone application that allows each individual participant to count the number of steps they walk in a day, and to make it more fun the application also allows users to share and invite friends through Facebook, Twitter and Instagram. The “Walk your heart” Application is available in both IOS and Android platforms and the competition will still be active for few months to come. Deeply committed to social responsibility, Bupa Arabia is the first specialized medical insurer in Saudi Arabia to proactively work for the public in providing increased health awareness by putting its medical expertise at the service of the community.
Source: ameinfo.com

Bupa Latin America, Biking for Health

With 546 employees in Latin America and Miami, Bupa Latin America and the Cari-bbean has insurance companies in Mexico, Ecuador, the Dominican Republic and Bolivia. It provides health insurance to individuals, families and companies, and allows customers to choose where they want to receive medical treatment. Its services include air ambulance and the option of obtaining a second expert opinion.
Source: latintrade.com

Bupa CEO Pledges to Create UK’s First ‘Teaching’ Dementia Care Home

The Carer is read by thousands of care business owners, suppliers and general readers. It is one of the UK’s leading care industry newspapers and as such boasts a massive readership and advertising clientele. If you are interested in advertising in the off-line publication
Source: thecareruk.com

Bupa Health Challenge Promotes Walking for Wellness

Last year, the Bupa health and wellbeing challenge, titled “Shall We Dance?” encouraged people around the world to get physically and mentally active by dancing. This year’s theme was walking. In September 2012, Bupa started a health initiative that encouraged people across the globe to get on their feet and get going. The Global Challenge, dubbed “Walking to a Well World”, promoted walking, spread information about the health benefits associated with walking and encouraged people to make it a part of their daily lives. During September 2012, Bupa organised more than 450 community walking events in 16 countries around the world.
Source: getholistichealth.com

Bupa Runners Celebration Evening

Thanks to the dedicated Bupa runners and fundraisers, we have managed to raise over £7,300 this year. This money will help us reach out to more homeless people on the streets with blankets, gloves, hot meals and providing them with a listening ear and helping them by sign posting to appropriate organisations.
Source: org.uk

Total climbing for the Bupa Challenge

Just another to throw into the mix: http://app.strava.com/segments/2711197 – the segment seems to suggest a gain of 1900m but the two attempts recorded as of today look like in the order of 1500-1700m.   Roughly speaking, Kersbrook is 200m, Hector Fletcher is 100m, Burkes is 100m, and Snake Gully, Crosshill and Cornishmans combined are another 120m… so there’s only 500m or so in Cat4+ climbs but with countless undulations in between.
Source: adelaidecyclists.com

Forced to Choose: Nursing Home vs. Hospice

Posted by:  :  Category: Medicare

The study, using data from the National Health and Retirement Study from 1994 through 2007, looked at more than 5,000 people who initially lived in the community – that is, not in a facility. About 30 percent used the skilled-nursing facility benefit during the final six months of life; those people were likely to be over 85 and family members said, after their deaths, that they had expected them to die soon. (The benefit is commonly referred to as S.N.F., which people in the field pronounce as “sniff”).
Source: nytimes.com

Video: Medicare Hospice, American Journal Of Palliative Care

Medicare covers hospice & comfort care

, your loved one can get the care and support they need. This can include doctor and nursing services, counseling, medical supplies, pain medications, and other services. And, most importantly, hospice can provide much needed comfort while at home.
Source: medicare.gov

Growing Pains for the Medicare Hospice Benefit

For 30 years, the Medicare hospice benefit has played a key role in shaping end-of-life care in the United States. Authorized by the Tax Equity and Fiscal Responsibility Act of 1982, the benefit was meant to improve the dying experience for terminally ill beneficiaries and to reduce the intensity and cost of health care services at the end of life. After a slow start, hospice became an integral part of Medicare, and nearly half of all people who die while covered by Medicare now use the benefit before death.
Source: globalhealthhub.org

Medicare Part A Hospice Care

This post was written by Jim Blazer, Executive V.P. of Bermel, Inc.  Since joining Bermel, Inc. 18 years ago, Blazer has led the company in its steady expansion. He is recognized for managing one of two major US hospital networks for Medicare Select. Bermel, Inc’s Medicare Select Supplements significantly reduce the premium outlay for policyholders.
Source: medicareecompare.com

Benefits of Medicare Hospice Services

WAXAHACHIE, TX—U.S. Rep. Joe Barton (second from left) meets with area staff members at Odyssey Hospice’s South Dallas office to learn more about the ways that Medicare-supported hospice services can benefit Texans with life-limiting illnesses.  Among those attending the session were (left to right): Seeley Avery, Odyssey’s Regional Vice President-Sales; Rep. Barton; Pamela Bailey, Quality Manager; Jennifer Leggett, Account Executive; Larry Chesney, Clinical Liaison; Doris Barnes, Registered Nurse; Mark Cook, Area Vice President-Sales; and Trivia Spencer, Community Liaison.
Source: countylifeonline.com

Updating the Medicare Hospice Benefit

This also makes the physician’s decision to request hospice more difficult. In its current form, a physician requesting that their patient seek hospice care means that she believes that curative treatments are no longer beneficial.  While this is likely true, the firm line that has to be crossed by patient and physician can likely be misunderstood as the doctor giving up on their patient. The current system creates an artificial distinction between curative treatments and care geared towards the patient’s emotional needs while providing care to ensure their comfort. Even in Medicare Advantage, a program that promotes coordinated, streamlined care through its capitated payment system, the Medicare hospice benefit is excluded. A patient enrolled in Medicare Advantage who elects hospice care reverts back to regular fee-for-service Medicare.
Source: policyinterns.com

Is it time for another lawsuit? Advocating to change the Medicare Hospice Benefit eligibility requirements

I have decided that there is compelling evidence that the Medicare Hospice eligibility requirements are outdated and need to be re-written.  These policies are not driven by patient need and the evidence is mounting that limiting access to hospice and palliative services actually increases the cost of health care at the end of life.  Those with concerns about the rise in the cost of the Medicare Hospice Benefit appear to put undue focus on the increasing length of stay of a number of hospice patients without considering that hospice and palliative care can be more cost effective than usual care.  This cost reduction does not come from “irrationally rationing” health care but by facilitating conversations that allow patients and families to understand prognosis and verbalize preferences and goals about end-of-life care.  These conversations enable health care providers to guide patients away from costly treatments and interventions that do not facilitate attainment of patients’ goals or add to the quality or length of their lives. If you agree that it is time for a change to the eligibility requirements, what can we do as hospice and palliative medicine providers to advocate for our patients to receive high-quality palliative and end-of-life care in a manner that makes sense? Do we wait until the results of the concurrent care demonstration project are in? Do we ask AAHPM, NHPCO, and HPNA’s Public Policy and Advocacy Committees to weigh in on the matter?  Or do we wait until the lawyers file another class-action lawsuit against Medicare? by: Shaida Talebreza Brandon (all opinions expressed are my own)
Source: geripal.org

S.C. Hospice Firm Busted for Alleged Medicare Fraud

“As budget pressures increase it is more important than ever to protect Medicare dollars and vigilantly guard against needless health spending,” Daniel R. Levinson, Inspector General of the U.S. Department of Health and Human Services, said in a statement. “The company and its owner have agreed to federal monitoring and reporting requirements designed to avoid such problems in the future.”  The investigation was jointly handled by the U.S. Attorney’s Office for the District of South Carolina, the Justice Department’s Civil Division and the Office of the Inspector General of the Department of Health and Human Services. The claims resolved by this settlement are allegations only, and there has been no determination of liability, the Justice Department noted.
Source: patch.com

Appeal Rights Confirmed for Medicare Hospice Beneficiaries in Case Brought By Center for Medicare Advocacy 

Circuit Court of Appeals today also confirmed that Medicare hospice patients have the right to appeal denials of services. The defendant, Secretary of Health and Human Services Kathleen Sebelius, acknowledged after this lawsuit was filed, that Medicare hospice beneficiaries have a right to appeal coverage denials. However, the plaintiff, Howard Back could not know that, or access the appeal system, since he was told otherwise at every attempt to appeal. The 9
Source: medicareadvocacy.org

Safe Medication Dispensing: Current Issues in Hospice Care

The recent rise of hospices in the United States indeed proves staggering. According to recent reports, “since 1990, approximately 1,500 new hospice agencies have emerged, a 125 percent increase from 1992. Medicare spending under the Medicare Hospice Benefit increased from $445 million in 1991 to $3.6 billion in 2001, and the number of Medicare hospice beneficiaries increased more than sixfold during the same period.” (Carlson, et al., 2011). Indeed, these increases prove to be a logical outgrowth of changing demographic trends here in the country, resulting from the nascent elevation of baby boomers to post-65 ages. Consequently, “with the aging of the population and decrease in the length of hospitalizations, greater numbers of older adults are managing multiple chronic conditions in the community with increasing levels of disability. They are particularly vulnerable because of strained caregiver systems, limited decisional capacity, and financial resources.” (Carlson, et al., 2011). The latter point of this quote denotes the specific problem that families face when facing the problem that will be the focus of the remainder of this blog post: safe prescription medication management.
Source: automatedsecurityalert.com

Medicare as insurance innovator: the case of hospice

Interestingly, hospice is the only part of the Medicare benefit package that is carved out of the Medicare Advantage program. I am unsure of why this is the case. I believe it is likely related to the fact that hospice was created as a demonstration in Medicare as part of TEFRA 1982, as was what I think was the first private insurance option in Medicare. After both parts were later mainstreamed into Medicare, I think they were just never joined. However, it is also possible that it is related to the politics of hospice and end of life care generally. Those politics have only gotten worse (more hysteria, less reasoned discussion) in the last few years. I will be writing more about this and you have thoughts about why someone who elects hospice while in a Medicare Advantage plan reverts to FFS Medicare for hospice, let me know.
Source: wordpress.com

Hospice and Caregiving Blog: Medicare Open Enrollment Extension for Hurricane Sandy Victims

The Centers for Medicare & Medicaid Services annouced an extension of the open enrollment period for Medicare for those effected by Hurricane Sandy. Individuals affected by Hurricane Sandy who are unable to make a plan selection by December 7 can still enroll in health and prescription drug coverage for 2013 by calling 1-800-MEDICARE (1-800-633-4227) anytime, 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048. Representatives at 1-800 MEDICARE have information available to help beneficiaries review their plan options and make a choice, and can complete an enrollment even after December 7.
Source: hospicefoundation.org

Dixon Healthcare Solutions Inc.: Hospice Quality Measures Reporting included in Final Medicare Home Health PPS Update for 2013

CMS is in the process of developing required measures to include NQF 1634, 1637, 1638, 1639, and 0208.  They are also working on a standardized assessment instrument to be utilized to capture all the data for each patient.  This would be similar to OASIS data set utilized in the home health industry.  This standard data set could be implemented as soon as 2014.  They are also considering future implementation of measures based on an experience of care survey such as the Family Evaluation of Hospice Care Survey (FEHC).  This could be implemented in the year prior to the standard data set or the year after the standard data set.  They specifically stated they would not implement both in the same year.
Source: blogspot.com

Can hospice function under Medicare premium support?

How common is it for MA patients to elect hospice as compared to traditional Medicare? MA patients are more likely to choose hospice than are beneficiaries in traditional Medicare, though the gap has been shrinking (47.8% of MA decedents v. 43% FFS in 2010; 30.9% MA v. 20.5% FFS in 2000 p. 288; longstanding p.141-143). MA plans have a financial incentive to encourage hospice selection because it pushes end-of-life costs to traditional Medicare, though a study testing whether making hospice a part of the capitation payment for MA* concluded that it would only save traditional Medicare a modest amount of money. However, this study focused on enrollment in hospice during the last month of life, which covers around two-thirds of users, using data from the 1990s. Since then, the expansion of hospice in Medicare has grown steadily, primarily through increased use of hospice by older beneficiaries, and via an increase in the use of hospice by persons with non-Cancer terminal diagnoses (like CHF and dementia). This means the tails of one side of the distribution (long users) have gotten a lot longer (90th percentile 150 days in 2000, 250 days in 2010 while the 25th percentile stay has been 5-6 days for 20 years. There is a literature on the correlates of hospice choice that partially line up with the correlates of MA advantage selection that I will post on later (urban, white, higher education and higher income are all more likely to choose MA, and hospice, even within traditional Medicare).
Source: samefacts.com