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Video: Centers for Medicare & Medicaid Services’ (CMS) Hospital Acquired Conditions
The DD News Blog: Important Medicare case settlement awaits final approval
An agreement has been reached in a class action lawsuit that is especially important to people covered by Medicare who have chronic or debilitating medical conditions from which they may not recover or improve. In the final stage of the settlement process, a Fairness Hearing will be held on January 24, 2013 to determine whether the agreement is “fair, reasonable, and adequate”, after which a final judgment may be issued to approve the settlement. In Jimmo v. Sebelius, No. 11-cv-17 (D.Vt.), the plaintiffs contend that Medicare has for years illegally restricted coverage of skilled nursing and therapy services only to beneficiaries who showed improvement. Beneficiaries who needed services to maintain their status or to slow deterioration were denied services on the basis that they would not improve. A settlement that was signed by the Chief Judge for the District of Vermont on November 20, 2012 would overturn the “improvement standard” and require that skilled nursing and therapy services necessary to maintain a person’s condition can be covered by Medicare. [Visit the Web site for Center for Medicare Advocacy, Inc. for the most complete information on the case that includes Frequently Asked Questions, personal stories, and links to important documents.] The federal Centers for Medicare and Medicaid Services (CMS) has agreed to revise the Medicare Benefit Policy Manual to include new policy provisions. Skilled Nursing Facilities, Home Health Services, and Outpatient Therapy Services, including outpatient physical and occupational therapy and speech pathology services, will be covered “to perform a maintenance program [that] does not turn on the presence or absence of a beneficiary’s potential for improvement from the therapy, but rather on the beneficiary’s need for skilled care.”
Centers for Medicare & Medicaid Services to launch ‘medical neighborhood’
In the wake of the Supreme Court’s ruling to uphold the Affordable Care Act, approximately 30 million uninsured Americans, under age 65, stand to gain coverage under the law. As decisions are made and plans put in place, one thing is certain: When the exchange population is combined with the new Medicaid beneficiaries, the result will be a distinctly different customer base for the health sector, bringing with it many new challenges and opportunities. Register now!
Cops: Fugitive behind $1 million Medicare fraud nabbed in Canada
I personally know of 9 cases here in just one small area of Michigan that total almost 2 million, one defendant sentenced to 10 years and others have fled the country. Does anyone else thinks it time to stop screaming about cuts, and see what it would actually cost if it was administered correctly. Here its mostly Pakistani, Indian, and African doctors that operate for about three to five years before being indighted and then flee before trial. (these are just what I have seen and not a judgement on other well meaning doctors) My mother, for example, has retired from two jobs and has health care coverage for the rest of her life. She is the kind of person that looks at the bill, even if it is not hers. She had a little bit of a health scare and had to go to the hospital. When it was all said and done she found 5 different times that a service was double billed, billed without it being performed, or billed incorrectly. Most of those losses would have been to medicare, because private insurance denies first and pays second.
Medicare preventive services: What’s free, what’s not
Medicare also offers several other preventive services that require some out-of-pocket cost-sharing. With these tests, you’ll have to pay 20 percent of the cost of the service (Medicare picks up the other 80 percent), after you’ve met your $147 Part B yearly deductible. The services that fall under this category include digital rectal exams for prostate cancer, glaucoma tests, and diabetes self-management training services.
Medicare Changes for 2013 and Beyond
Most notable for 2013 is Medicare’s new policy for Transitional Care Management services. Medicare will pay a patient’s physician or practitioner to coordinate their care, 30 days following a hospital or skilled nursing stay. Compensation to Medicare providers will be more directly tied to patient outcomes, which can include a reduced reimbursement for your doctor and hospital if you return to the hospital within 30 days for the same issue.
Center for Medicare & Medicaid Services: 106 Additional Medicare ACOs Announced
The Centers for Medicare and Medicaid Services (CMS) has announced the approval of an additional 106 accountable care organizations (ACOs) through the Medicare Shared Savings Program. These newly approved ACOs bring the total number of ACOs approved by CMS to over 250 organizations. In total, Medicare’s ACO partners will serve more than 4 million beneficiaries nationwide. Federal savings from this initiative could be up to $940 million over four years.
Medicare to Cover More Home Health Services
Just in time for the New Year 2013! In the past, Medicare recipients were unable to receive home health services such as nursing care and therapies if they had a chronic condition. As a result of a court case that originated in Vermont, that is about to change. Vermont Chief Judge Christina Reiss will sign off on the settlement after a hearing on January 24, 2013. The settlement will apply nationally, and it will mean a big change from the current practice. At present, the Medicare recipients had to have had a reasonable chance of recovering from the condition before they could receive rehabilitative services in the home. Of course, sometimes it is difficult to make that prediction, so this ruling represents a giant step forward for patients. Now, they will be able to receive skilled nursing services as well as speech therapy and occupational therapy in the home, despite the fact that the patient may not fully recover. Those enrolled in both fee-for-service Medicare and private Medicare Advantage plans will also have this option.
Are you ready for 2013? 4 questions to ask yourself
Don’t forget, if you have Medicare Part B and are in Original Medicare, you’ll have to meet your deductible before your Medicare coverage pays for services and supplies. Next year, the Medicare Part B deductible will be $147. Make sure to plan your health care budget to account for the increased cost of doctor visits for the time that it will take to cover your deductible.
Proposed Settlement May Expand Medicare Coverage for Important Services
According to a story in the New York Times, “Federal officials agreed to rewrite the Medicare manual to make clear that Medicare coverage of nursing had therapy services does not turn on the presence or absence of an individual’s potential for improvement, but is based on the beneficiary’s need for skilled care.”
Volunteer Medicare Counselor: HICAP Services of Northern California Opportunity
Assist Senior Citizens in your community by helping them to navigate the Medicare maze. Become a Registered Volunteer HICAP Counselor and join a group of energetic, well-trained, computer-literate retirees who counsel individuals, on a one-to-one basis, about Medicare. HICAP provides extensive training & mentorship. Our next training session begins in February, 2013. Opportunities in these counties: Nevada, Yuba/Sutter, San Joaquin, Yolo, Sacramento, El Dorado, Placer.
Despite Potential Benefits, Medicare Slow to Utilize Telehealth
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