Are you at risk for getting Hepatitis B? If you have hemophilia, End-Stage Renal Disease (ESRD), diabetes, or certain conditions that lower your resistance to infection, you have a higher risk for getting Hepatitis B increases. Additionally, if you have a profession that puts you in frequent contact with blood or bodily fluids, you may be at a higher risk.
Video: Guide to Medicare Part A and Part B
Blended Medicare Plan Could Save $180B Over 10 Years, Study Finds
Both studies — the Commonwealth Fund Medicare reform proposal and the Rand analysis of others’ Medicare reform proposals — are seriously flawed and illustrate no real-world understanding of Medicare. It is good that the Commonwealth Fund includes the catastrophic coverage and annual OOP limits that are not included in Original Medicare. All Part C plans and a few Medigap plans include such protection today. In fact, the Commonwealth Fund looks like a Part C health plan — except that it costs more than the average Part C plan and does not have as many other benefits (other than the OOP limits). The one-size-fits-all drug plan proposed by Commonwealth Fund will lead many low-income seniors back to the two-tier VA-like prescription drug coverage that pre-dated Part D (one inferior tier for low-income seniors, one better plan for the rest of us seniors). Because I cannot take Essential without taking this inferior two-tier drug plan is bad news for we middle-income seniors also
Reducing Subsidies for Higher Income Medicare Beneficiaries
Currently, Medicare beneficiaries with incomes starting at $85,000 (or $170,000 for couples) pay higher Part B and D premiums, which start at 35 percent of program costs and peak at 80 percent of program costs for beneficiaries with incomes over $214,000 (or $428,000 for joint filers). As of now, these higher premiums affect only 1 in 20 Medicare recipients. While the thresholds for higher premiums were originally adjusted annually for inflation, a provision in the ACA froze the income thresholds through 2019, at which point almost 10 percent of beneficiaries are projected to pay income-related premiums. Starting in 2020, however, the thresholds are scheduled to bounce back upward as if they had never been frozen, thereby reducing the proportion of beneficiaries who would be subject to higher premiums.
Medicare RAC Overpayment Collections Hit $4.5B Since 2009
Since the Medicare Recovery Auditor, or RAC, program began in October 2009, hospitals and providers have had $4.5 billion in Medicare overpayment recouped, according to the latest RAC figures from CMS. In the first six months of the federal government’s 2013 fiscal year, Medicare RACs have recouped $1.37 billion and have returned $65.4 million in underpayments. CMS did not identify how much of those recoupments were tied up in the appeals process or had been successfully appealed by providers. In the second quarter, Medicare RACs collected $626.5 million in overpayments — almost equaling what was recouped in fiscal year 2011 alone. Medicare RACs returned $31 million in Medicare underpayments. Medical necessity of cardiovascular procedures continued to be the top overpayment issue for RACs. Minor surgery and other treatments billed as inpatient when they should have been billed as outpatient or observation was another top recoupment reason. CMS again did not disclose the most common issues for underpayments. HealthData Insights and Connolly collected roughly $400 million of all Medicare overpayments in the second quarter ended March 31. HDI and Connolly audit hospitals in 32 states across the West and South, including Florida, Texas and California.
New CMS Website: Medicare Secondary Payer Conditional Payment Information
 Title II of H.R. 1845, entitled "Strengthening Medicare Secondary Payer Rules," amends 42 U.S.C. §1395y(b)(2)(B) of the Medicare Statute, Pub. Law No. 112-242 (January 10, 2013). See http://beta.congress.gov/bill/112th-congress/house-bill/1845/text. The Bill Summary and status report are available at: http://thomas.loc.gov/cgi-bin/bdquery/z?d112:h.r.1845. The current Medicare Secondary Payer Recovery Contractor (MSPRC) website is located at www.msprc.info. Title I, Section 101 of H.R. 1845, sets out a demonstration project under Medicare Part B for the payment of supplies and services related to the administration of Intravenous Immune Globin (IVIG) for the treatment of primary immune deficiency diseases.  The Medicare Secondary Payer program is set out at 42 U.S.C. §1395y(b)(2).  The Center’s work on MSP matters can be accessed at: http://www.medicareadvocacy.org/medicare-info/medicare-secondary-payer-program/. In addition, the Center led a task force of the Public Policy Committee of the National Academy of Elder Law Attorneys (NAELA) (www.naela.org) on the use of set-aside arrangements involving future medical expenses. The task force made recommendations on how attorneys might approach "future medicals" pending guidance from the Medicare agency. See: http://www.naela.org/App_Themes/Public/PDF/Home%20Page/ISSUE%20Medicare%20Set%20Aside%20TF_2%20(2).pdf.  See, for example, the joint findings and recommendations, sent to the Medicare Agency, by the Center for Medicare Advocacy, the Medicare Rights Center, and California Health Advocates, available at http://www.medicareadvocacy.org/2011/05/12/medicare-secondary-payer-practices-that-harm-medicare-beneficiaries/.  See §201of the Act. Note, the term "website" includes any successor technology that might be developed. Id., at subclause (VII).  See §201of the Act, ("VI") Effective date.  See §201of the Act. Id., amending §1862(b)(2)(B) of the Social Security Act, 42 U.S.C. §1395y(b)(2)(B), adding a new clause: (vii) use of website to determine final conditional reimbursement amount.  Id.  See §204, amending §1862(b)(8)(B) of the Social Security Act, 42 U.S.C. §1395y(b)(8)(B).  Id.  Id., at subclause "(III)."  Id., at subclause "(IV)."  Id.  Id.  Id.  Id.  Id., at subclause (V), protected period.  Id.  Id. In addition, the Secretary shall promulgate final regulations to carry out this clause not later than 9 months after the date of the enactment of this clause. Id.  Id., §202(a)(2) of the Act.  Id., §202(b).  Id., subclause "(D)"Report to Congress.  Id.  See §203, amending §1862(b)(8) of the Social Security Act, 42 U.S.C. 1395y(b)(8)( Required submission of information by or on behalf of liability insurance (including self-insurance), no fault insurance, and workers’ compensation laws and plans).  Id.  See §205, amending §1862(b)(2)(8)(iii) of the Social Security Act, 42 U.S.C. §1395y(b)(2)(8)(iii).
Medically Complex Medicare Part B
My personal opinion for the increase in medically complex part B patients is due to the hospital observation status issues. If only I had a nickel for every time a colleague told me stories about their local hospitals keeping patients for several days through observation status. Or the situation where the patient is at the hospital for three midnights, re-admits to your facility, begins Part A benefits, and a few days later it’s discovered they were kept for observation. The Medicare Part A changes to Part B, but our plan of care and treatment approaches and therapy minutes should not change based on insurance issues.
Obama’s $3.7T Spending Plan Would Cut $370B From Medicare
The Wall Street Journal: Obama Reaches For Middle Ground With New Budget Plan Mr. Obama’s budget proposal will call for $3.77 trillion in spending for the fiscal year that begins in October, a senior administration official said, up 6% from projected spending levels in the current fiscal year. The higher spending would come from a combination of canceling the across-the-board spending cuts, known as the sequester, that began in March and pumping more money into education, infrastructure and mental-health treatment, among other things. … The deficit would fall more sharply later in the decade under the president’s plan, senior administration officials said, as a number of changes would kick in, affecting programs like Social Security, Medicare and military spending (Paletta, 4/9).
Medicare Essential – Is this the future of Medicare?
The combined deductible idea is echoed in a recent article in Health Affairs that proposes unification of Parts A and B, and Part D drug benefits. The Health Affairs article also proposes reducing beneficiary cost sharing to levels comparable to Medicare Advantage plans, eliminating the need for Medicare Supplemental coverage. The new Medicare plan, called Medicare Essential, would become the default for people who qualify for Medicare for the first time. New Medicare beneficiaries could opt out and take old traditional Medicare, and go buy their own Part D and Medicare Supplement plans, or they could buy Medicare Advantage plans. Medicare Essential would have a much higher premium than Medicare Part B, but the authors of the article claim that the overall cost would be less than Part B plus Part D plus the full-coverage Medicare Supplement Plan F that most seniors select. So proponents could argue that the added cost of the increased premium is a bargain and that people could always opt out and avoid the higher cost if they wanted to. Medicare Essentials could show significant savings by avoiding the broker commissions that add to the cost of Medicare Supplemental and Medicare Advantage plans. Whether the new program would be able to achieve the supposed 2% administrative cost ratio sometimes claimed for Medicare is highly suspect, but elimination of the need to re-process claims to pay Supplement benefits, along with simplification of coverage rules overall, would probably yield some further efficiencies.
OIG hospital probes may extend to Medicare Part B
Hospitals could face compliance reviews over Medicare Part B, according to a Bloomberg BNA healthcare blog. Speaking at a conference, Daniel R. Levinson, Inspector General of the U.S. Department of Health & Human Services, Office of Inspector General (OIG), said the agency might be interested in performing compliance reviews on Medicare Part B providers.
Medicare latest news, medicare advantage plans
Another aspect up for debate is if changes are made, at what age would these changes begin to affect? Some proposals would not touch anyone who is at least 55 years of age. Others are arguing the age should be 59 and others think 56 is the magic age. One of the more critically proposed issues is the use of a voucher system. The voucher would be issued when the beneficiary turns 65 in lieu of coverage for healthcare expenses. Basically, the voucher allows a check to be issued to the beneficiary to purchase insurance. The voucher amount would be tied to the amount required to purchase Medicare. Additionally, beneficiaries would be able to choose private insurance instead of Medicare. If the private insurance costs more, the beneficiary would have to pay the difference. If insurance costs less, they could bank the difference.
Mental Health and Medicare
After meeting your yearly Medicare Part B deductible ($147.00), the amount you pay for mental health services depends on whether the purpose of your visit is to diagnose your condition or to get treatment. For visits to diagnose your condition, you would pay 20% of the Medicare-approved amount. For outpatient treatment of your condition, like psychotherapy, you would pay 35% of the Medicare-approved amount in 2013. If you have a Medicare Supplement Insurance policy or Medicare Advantage, contact your plan for information on your out of pocket responsibilities.
The Medicare Maze: Observation Stays, Nursing Home Costs, and “Invisible Patients”
We have all been traveling and have found ourselves party to a conversation because of proximity or bad cell phone etiquette. Some of these conversations are irritating, but I was looped into an interesting one the other day. Sitting in the Charlotte airport, two older men who looked like they were returning from a golf vacation started talking about enrolling in Medicare. One had just done it and the other had lots of questions. The recent enrollee said that he had registered through the Social Security web site; it took only ten minutes and was very easy. He told the other man that he only needed to sign up for part A, not for part B.