Obamacare Leads University Of Virginia to Drop Spouses’ Health Coverage

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Provisions of the federal Affordable Care Act are projected to add $7.3 million to the cost of the university health plan in 2014 alone. Federal health care reform will create new costs related to the “individual mandate” that requires all Americans to have health care coverage (or pay a penalty).
Source: freebeacon.com

Video: Obama Promises To Lower Health Insurance Premiums by $2,500 Per Year

Daily Kos: Health insurance premium growth staying slow, but customers don’t notice

A soon-to-be-released monthly tracking poll from KFF, previewed for the WonkBlog’s Sarah Kliff, will show that people have no perception of slower health insurance premium growth. A four percent increase in premiums, balanced against a 1.8 percent salary hike, means you’re still paying too much for health insurance. On top of that, the amount you have to pay in deductibles has also been increasing. “We have a very moderate increase this year, but premiums go up each year,” Kaiser Family Foundation president Drew Altman says. “People see what they pay for their premium going up and perhaps more forms of cost-sharing. We’ve been seeing a quiet revolution from more comprehensive coverage to less.”
Source: dailykos.com

Colorado Announces Health Insurance Rates

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Source: webmd.com

Health insurance costs moderate in 2013

WASHINGTON – Health insurance premiums are up 4 percent this year – a moderate rise compared with the double-digit hikes a decade ago, but not one likely to cheer consumers whose wages have gone up by less than that. Healthcare analysts at the Kaiser Family Foundation and the Health Research & Educational Trust said the average family policy cost $16,351 this year, with workers paying $4,565 of that and employers paying the rest. Premiums for individuals getting health insurance at work went up 5 percent. The cost of individual plans averaged $5,884, with workers paying $999 of that amount. Drew Altman, Kaiser’s president and CEO, said the results showed “striking moderation.” “If and when that moderation will end remains a debate in the field. No one knows for sure,” he said. “This is not an environment where companies should be contemplating big cuts in benefits to contain costs.” At the same time, more companies are requiring workers to pay a deductible before their health insurance coverage kicks in. More than three-fourths of American companies offering insurance now require a deductible, with the average for a single worker reaching $1,135 this year.
Source: dallasnews.com

Family Insurance Premiums Rise 4 Percent For 2nd Year In Row, Survey Finds

The increases documented in the report, moderate by historic standards, come amid ongoing debate over the federal health law’s ability to rein in health care costs. In July, the Obama administration granted a one-year delay, until 2015, in the requirement that employers with 50 or more workers offer coverage or face a fine, prompting Republicans to call for a similar delay in the rule requiring most individuals to carry coverage.  Critics and opponents have also sparred over whether the health law will slow premium growth. All sides may find fodder in the report, observers say.
Source: kaiserhealthnews.org

Health Care Costs Are Still Rising Faster Than Workers Can Keep Up

There’s at least one positive side to the report, however. The rate of health care cost growth seemed to stagnate this year, which should help assuage some fears over whether the introduction of the Affordable Care Act (Obamacare) would mean higher premiums across the board. 
Source: businessinsider.com

Rapert, Wren want meetings on school workers’ health insurance costs

Sen. Jason Rapert and Rep. Tommy Wren announced today they want to do something about big health insurance rate increases facing participants in the state’s plan for public school employees. They promise special committee hearings. These won’t come in time to do anything about expected big rate increases, 50 percent or more in many cases, for this school year. The increase could mean costs of an addition $500 a month for family coverage. The state has always provided less support to teachers than to other state employees, but the teacher pool also has had greater expenses in recent years, which depleted reserves. Reserves are sufficient to offset some of the cost of insurance for other state employees. Rapert issued a strong populist message: “In a state where teachers are underpaid compared to other states, it’s unsustainable for them to have to absorb premium increases of up to 50 percent,” Rapert said. “It’s not right for teachers, it’s not right for support staff like cafeteria workers and maintenance personnel, and it’s not right for their families.” The news is unlikely to cost Rapert any friends among school employees heading into an election year. The solution is unlikely to be something that won’t cost money even if, as Rapert says might be necessary, the system might have to be made over “from scratch.” Of course, they could keep costs in check e by making state employees pay a lot more so as to reduce costs for teachers. The full release follows: Senator Jason Rapert of Conway and Representative Tommy Wren of Melbourne said Friday they would schedule a series of special meetings of the Senate and House Committees on Insurance and Commerce to develop a strategy for holding down the spiraling costs of teacher health insurance. “In a state where teachers are underpaid compared to other states, it’s unsustainable for them to have to absorb premium increases of up to 50 percent,” Rapert said. “It’s not right for teachers, it’s not right for support staff like cafeteria workers and maintenance personnel, and it’s not right for their families.” The specific dates for the meetings will be announced soon, Rapert said, adding that there is a need for urgency because many complex issues must be resolved before the 2014 legislative session. “This problem has been getting worse for quite a few years, and now we’re at the tipping point for teachers and other school staff,” Wren said. “They’re staring at increases of $500 a month for the cost of health insurance, and they can’t wait any longer for solutions. “ Teacher health insurance premiums have been increasing steadily for the past several years, but Wednesday teachers learned that next year their health insurance rates would spike even more dramatically than usual. The State and Public School Life and Health Insurance Board approved rate increases of as much as 50 percent. For example, family coverage under the most popular plan will increase from $1,029 to $1,528 per month. A factor in rising health insurance costs for teachers is that they pay a relatively large portion of their premiums. Some elected officials have proposed that the state fund a greater share of the health insurance costs. However, that remedy would take time. The legislature convenes in a fiscal session on February 10, 2014, and a funding increase would take effect at the beginning of the next fiscal year, on July 1, 2014. That would help teachers in the 2014-2015 school year, but not during the current school year. “Something has to be done. It may be that we can adjust the current system, and it may be that we have to explore more drastic alternatives, such as dismantling the system now in place and completely starting from scratch,” Rapert said. “Such drastic increases in health insurance are too much of a sacrifice for the families of school personnel,” Rapert said. “I honestly don’t know how they will be able to handle it, because these increases are devastating to a family budget.” Rapert noted that the state Employee Benefits Division, which administers the teacher and the public employee health insurance programs, reports to the legislature’s Insurance and Commerce Committees. “Costs for state employees have not risen at nearly the same rate as they have for teachers, in spite of the fact they are in the same plan and it’s administered by the same agency,” Rapert said. “I’m really frustrated by the inconsistencies between how teachers and state employees are treated, because if we don’t compensate them more equitably, Arkansas will begin losing our best teachers to other states,” Rapert said. Rep. Wren added, “The time for talking is past. It’s time we did something.”
Source: arktimes.com

Survey: Health insurance costs outpace wage gains

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Source: sltrib.com

Working for health care in 2013: workers’ health insurance cost burden still grows faster than wages

78% (more than three-quarters) of covered workers have some kind of deductible associated with their health plan, a statistically significant increase from 2012. The average deductible for covered workers in small firms is $1,715, up from $1,596 in 2012; for workers in large firms, the average deductible remained fairly flat at $884. That 58% of workers in small businesses (firms under 200 workers) are enrolled in a high-deductible health plan of $1,000 or more for single coverage is a huge increase from 2012, when 49% of workers in small companies had HDHPs of at least $1,000. Those workers covered by HDHPs in large firms inched up from 26% to 28%, with about 38% of workers across all size firms now enrolled in HDHPs with deductibles of $1,000 or more.
Source: healthpopuli.com

Dallas County Texas Medicare Supplement Quotes

Posted by:  :  Category: Medicare

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Tagged With: Aflac Medicare, Bache, Cigna Medicare, Dallas County Medicare, Dallas County Medicare Supplement Insurance, Dallas County Texas Medicare Supplement Insurance, Medicare, Medicare Quote, MedicareBob, Medigap, Mutual of Omaha Medicare, Robert Bache, Texas Medicare
Source: srhealthcaredirect.com

Video: Medicare Quotes

Medicare Supplement Quotes

Get your Medicare supplement quote by visiting the official website of the Medigap insurance company and apply for the quote. They will contact you by telephone to go over the quote. Don’t worry about your personal information because they won’t share it with others, or the public. Another thing that you should know that this isn’t an application for coverage, which isn’t guaranteed and you will receive only pricing and plan information. They applications must be approved by the carrier before any coverage is purchased. The Medicare supplement quotes will help you a lot if you want to learn more about some particular information and you should do apply it right now. Health insurances can be provided by a lot of insurance companies, but one of the best is Medigap and the Medicare insurance policy, so you should consider this and go right away to their website to find out more about Medigap and their Medicare supplement plans because you will be amazed from the opportunities that you can have if you decide to purchase one of the 10 supplement plans of Medicare. There isn’t better thing than purchasing the right health insurance for the rest of your life and you should do that right now. Start learning about Medicare from their official website where you can find anything you want to know related to the Medicare insurance policy. The website is characterized with every detail that you need to know in order to purchase the Medicare supplement plan that you like and you are lucky that you are reading this article because you would never know about Medigap and the opportunities that provide to their customers. Take care about the rest of your life with the best insurance companies and see their offering on the Medigap website. You don’t have to choose right away because you have a lot of time before you make your decision for the best medicare supplement

Is a Medicare Doc Fix in the Works?

Posted by:  :  Category: Medicare

One proposal, a bill introduced by Reps. Allyson Schwartz (D-Pa.) and Joe Heck (R-Nev.), would offer modest pay raises for four years before basing increases on quality and efficiency of care. The other bill, backed by members of the House Ways & Means and Energy & Commerce committees, would establish a period of predictable, defined payment rates to doctors before similarly offering incentives for better service.
Source: aarp.org

Video: Enzi says Administration rhetoric doesn’t match results on Medicare ‘doc fix’

Democrats praise GOP doc fix effort

Changes in the Medicare provider reimbursement system could have a big effect on commercial health insurance plans, because commercial health plans often come up with the rates they pay the doctors in their networks by using the Medicare rate as a benchmark. For many procedures, carriers may multiply the Medicare benchmark by a percentage, such as 150 percent, or 175 percent, to get the private-pay rate.
Source: lifehealthpro.com

An End to the Doc Fix for Medicare and TRICARE?

Working with the House Committee on Ways and Means, leaders from the House Energy and Commerce Committee have unveiled draft legislation that would repeal the current Sustainable Growth Rate (SGR) system and replace it with a fair and stable system of physician payments in the Medicare program.  Enacted in 1997 as part of the “Balanced Budget Act,” the SGR is a continued concern for physicians who serve Medicare beneficiaries and for the beneficiaries themselves.  Because payments to doctors who treat TRICARE beneficiaries are tied to Medicare, it also affects active duty, reserve, and retired military personnel and their families.  Congress had implemented a temporary “doc fix” to prevent substantial Medicare reimbursement rate cuts, which could result in fewer physicians willing to serve Medicare/TRICARE patients.  This draft legislation would replace the current SGR with an enhanced fee-for-service.  Although the draft legislation provides a clearer picture of the proposed new payment system, it does not address how to pay for the cost of repealing the current payment system.  What’s next:  Health Subcommittee Chairman Joe Pitts, R-Penn., plans to hold a markup of the legislation next month.
Source: ausade.org

What’s being done (and not) to fix Medicare physician payment problems

ACA AcademyHealth accountable care organizations Affordable Care Act announcement antitrust blogging books comic competitive bidding costs cost shifting deficit employer-sponsored health insurance health care costs health insurance health insurance mandates health reform hospital readmissions hospitals insurance exchange market power Massachusetts Medicaid Medicare mortality obesity On The Record physicians politics PPACA premiums premium support prescription drugs prostate cancer quality reading list reflex RWJF single payer spending substance use tax uninsured xkcd
Source: theincidentaleconomist.com

The Poison of Medicare, Medicaid, and Medical Licensure The Future of Freedom Foundation

Posted by:  :  Category: Medicare

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In the first place, licensure is the key to the control that the medical profession can exercise over the number of physicians…. The American Medical Association is in this position. It is a trade union that can limit the number of people who can enter. How can it do this? The essential control is at the stage of admission to medical school. The Council on Medical Education and Hospitals of the American Medical Association approves medical schools. Control over admission to medical school and later licensure enables the profession to limit entry in two ways. The obvious one is simply by turning down many applicants. The less obvious, but probably far more important one, is by establishing standards for admission and licensure that make entry so difficult as to discourage young people from ever trying to get admission.
Source: fff.org

Video: Understanding Healthcare Costs: Medicare Advantage

Medicare Annual Wellness Visits Decrease Healthcare Costs

CMS uses the Medicare Advantage Hierarchical Condition Category (MA-HCC) risk assessment to identify the financial risk of each patient. With the appropriate technology, the provider can easily document the MA-HCC risk score at the time of the AWV. A care coordinator could be contacted at the time of the visit so that care can be provided in real time. Currently, there are third-party providers contracted with MA plans to do risk assessments. In the time between a patient’s AWV with their primary-care provider and notification that the third-party provider has identified that patient as high risk from a HRA, that patient may have been to the ER twice, the physician’s office twice, and have already been hospitalized. Clearly, retrospective risk assessments are of limited value to organizations at financial risk.
Source: physicianspractice.com

Misguided Medicare Recommendation Would Decimate Rural Health Care 53 of Wisconsin’s 58 Small, Rural Hospitals Impacted

In its report, the OIG recommends removing a Medicare payment status known as “Critical Access Hospital” (CAH) for hospitals that do not meet certain distance requirements. The recommendation disregards the fact that each of the impacted hospitals was deemed a necessary provider by their respective states. Nationally, the OIG recommendation would rescind this status for roughly two-thirds of the nation’s CAHs. In Wisconsin, the impact is even worse, resulting in 53 of 58 CAHs losing this status.
Source: wfbf.com

Why Congress Should Pass the Accuracy in Medicare Physician Payment Act

It won’t be easy. In January of this year, a federal appeals court upheld a lower court ruling, rejecting a legal challenge by six Augusta, GA primary care physicians to CMS’ longstanding reliance on the RUC to determine the relative value of medical procedures. The core of the physicians’ argument was that the RUC is a “de facto” federal advisory committee and therefore subject to the common interest rules associated with the Federal Advisory Committee Act (FACA). FACA requires, for example, that a panel’s composition , say of medical specialists, reflects their distribution in the real world. It also requires that applied scientific methods are credible and that proceedings are conducted transparently.
Source: thehealthcareblog.com

Feds Get Tough On Medicare Fraud: Moratorium Bans New Healthcare Agencies In Miami, Chicago, And Houston

In 2012, 662 home health agencies were operating in Miami-Dade county, making its home healthcare agency to Medicare beneficiary ratio 1,960 percent greater than other counties. South Florida is notorious for being a hot-bed for Medicare fraud, in part because of several high-profile cases. In February, owners and operators of 2 Miami home health agencies were found guilty of participating in $48 million Medicare fraud scheme.
Source: medicaldaily.com

Sen. Rand Paul’s Medicare Reform Bill: $1 Trillion in Savings in 10 Years

First of all, medical insurance or medical care in the form of Medicare or anything else (SCHIP, Medicaid, Obamacare), is not the responsibilityof government. These are services that can and should be provided by the free market, just like dining, recreation, entertainment, and automobile repair are services provided by the market. Like all of the other welfare programs of the federal government, Medicare is an unconstitutional and illegitimate function of the federal government. It is socialistic and collectivist, it fosters dependency on the government, it shifts responsibility from the individual and his family to society and the state, it contributes to class warfare, and it crowds out real charity. It doesn’t matter if families and charities don’t pick up the slack (a very unlikely scenario) in the absence of government intervention in the market and someone goes without health insurance or health care. That doesn’t somehow magically make it the responsibility of government to provide someone with medical services. There is no right to health care that it is the duty of governments to provide or enforce.
Source: thenewamerican.com

FAH Submits Letter to Ways & Means Chairman Camp Regarding Medicare Beneficiary Payment Reforms

Hospitals have withstood $95 billion in Medicare cuts in just the past three years alone.  Over the next ten years, hospitals are facing nearly a half trillion in cuts.  These cuts have already resulted in reduced services, reduced access to care, and thousands of job cuts across health care.  Hospitals have done their part and have implemented a number of reforms that contribute to the cost reduction and savings trends occurring now.  As policymakers look for further areas of reform, FAH believes that these cost-sharing proposals are an appropriate area for discussion and, ultimately, modernization.
Source: fahpolicy.org

Why Congress Should Pass The Accuracy In Medicare Physician Payment Act

It won’t be easy. In January of this year, a federal appeals court upheld a lower court ruling, rejecting a legal challenge by six Augusta, GA primary care physicians to CMS’ longstanding reliance on the RUC to determine the relative value of medical procedures. The core of the physicians’ argument was that the RUC is a “de facto” federal advisory committee and therefore subject to the common interest rules associated with the Federal Advisory Committee Act (FACA). FACA requires, for example, that a panel’s composition , say of medical specialists, reflects their distribution in the real world. It also requires that applied scientific methods are credible and that proceedings are conducted transparently.
Source: healthaffairs.org

State Highlights: Fort Worth To Move Retirees Into Medicare Advantage Plans

Los Angeles Times: Patient-Interpreter Bill Aims To Overcome Language Barriers According to a 2012 study prepared for the federal Agency for Healthcare Research and Quality, pediatric patients with limited-English-proficient families who speak Spanish “have a much greater risk for serious medical events during hospitalizations than patients whose families are English-proficient” … [A bill that would make a statewide medical-interpretation program available to Medi-Cal patients] would require the state Department of Health Care Services to apply for federal money that would pay for a certified medical-interpreter program. Such a program is needed, supporters say, to prepare hospitals for the millions of limited-English speakers expected to use healthcare services over the next few years (Kumeh, 8/18).
Source: kaiserhealthnews.org

Optimum HealthCare Medicare Advantage

Optimum Healthcare is one of the nations most popular providers of Medicare health plans. The health maintenance organization (HMO) is based in Tampa, and was established in 2004.  It’s operated by a group of physicians and offers policies to the residents of more than two dozen Florida counties. They offer four different Medicare health plans depending on where you live. There’s also a company office located in Spring Hill. Optimum Health Care Medicare Advantage plans offer more benefits than the original Medicare and include those with Part B premium reductions, prescription drug plans, and special needs plans (SNP), which are designed for those with chronic conditions. All of the plans come with zero deductibles and offer benefits such as dental, vision, and hearing coverage as well as fitness programs.
Source: qooqe.com

Medicare Expands Competitive Bidding Program for Durable Medical Equipment

You can also get the supplies from a store or pharmacy that accepts "Medicare assignment." This means that the store will accept the Medicare-approved amount as payment in full and that you cannot be charged more than a 20 percent copay (after you meet your annual deductible). A Medicare contract supplier can’t charge you more than that for the equipment or supplies included in the competitive bidding program.
Source: aarp.org

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August 23, 2013

Top 10 Health & Medical Information Websites

Posted by:  :  Category: Medicare

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Note: The Experian Hitwise data featured is based on US market share of visits as defined by the IAB, which is the percentage of online traffic to the domain or category, from the Experian Hitwise sample of 10 million US internet users. Experian Hitwise measures more than 1 million unique websites on a daily basis, including sub-domains of larger websites. Experian Hitwise categorizes websites into industries on the basis of subject matter and content, as well as market orientation and competitive context. The market share of visits percentage does not include traffic for all sub-domains of certain websites that could be reported on separately.
Source: marketingcharts.com

Video: Health Care Apps Streamline Medical Information

Welsh GPs Local Medical Committee (Bro Taf LMC) statement on withholding WCA support information

As doctors on the front line witnessing daily the enormous avoidable suffering of many of our most vulnerable patients caught up in this Kafkaesque system of ‘disability assessment’, we find this failure to meaningfully engage unacceptable. More critically, we fully share in the dismay with which sick and/or disabled people have greeted the failure of the BMA’s leadership to give any meaningful effect to the unanimous wishes of its members: that this dreadful assessment régime should be immediately terminated.  
Source: blacktrianglecampaign.org

Interview with Sameer Badlani, MD, FACP, Chief Medical Information Officer, Assistant Professor, Section of Hospital Medicine, The University of Chicago Medicine and Biological Sciences

, M.D., is the Chief Medical Information Officer for the University of Chicago Medicine. He leads the medical center’s implementation of the Epic EHR and development of a clinical informatics infrastructure in collaboration with the CIO and CMO’s office. His focus is on promoting clinical adoption of the EHR through physician engagement and value generation. Dr. Badlani has conducted national workshops through the American College of Physicians on various topics in clinical informatics. His interests include maximizing the potential of clinical decision support and evidence based information at point of care.
Source: ihealthtran.com

90% of published medical information is flawed: Expert

In India, medical research does not have much value in the eyes of private medical college/hospital managements.The MCI which first said that two research publications with first authorship is required to get promoted as associate professor later changed the rule as first or second author without any publicity.The medical faculty working in some medical college automatically become great and are seen on the dias of every national conference.It is not possible to satisfy the editor of many medical journals about the range of investigations required either to confirm or rule out certain medical conditions.Those who conduct medical research voluntarily may not get even the copyimg facility in most of the private medical colleges of our country.So they can not do certain costly tests just to rule out rare diseases.They are forced to add contents for completion sake just to satisfy the requirement.The bias in decisions with regard to medical research in certain institutes were clearly visible until few years ago.For example,a research paper from a central medical institute gets priority and published quickly and not in case of a research paper from a state medical college.Many editors seem to think that few medical colleges in our country have credibility and trustworthy which is not true.There were instances where a paper from a state medical college was rejected in one journal was published in another indexed journal or no decision is conveyed to the author for more than six months.
Source: indiamedicaltimes.com

Verifying a Dementia Patient’s Medical Information

The training involved in the Alzheimer’s/Dementia Hospital Wristband Project I initiated will be educated by the Gulf Coast Alzheimer’s Association Chapter. This, and many more instructions on dementia care, will be presented to all hospital staff members during the pilot program which is taking place at Brooksville Regional Hospital in Hernando County, Fl. It’s important to note that this type of dementia care should be practiced by all medical professional and first responders when dealing with dementia patients, not just in the hospitals.
Source: alzinfo.org

Firefighters hand out ‘File of Life’ folders to have medical information at hand during emergencies

The folders are to be completed by residents, who will enter their names, medical conditions, medications, allergies, emergency contacts and other vital information. The folders, which have magnetic backs, are made to be attached to a refrigerator for easy viewing by an emergency responder.
Source: oregonlive.com

HIPAA/HITECH Compliance Strategies for Medical Device Manufacturers : FDA Law Update

If data collected by a medical device does not meet the definition of “individually identifiable,” or “health information,” it is not covered under HIPAA and HITECH. For example, a medical device that logs detailed medical diagnostic information about a patient, but includes no means by which that information may be traced to the patient, the data would likely fall outside of HIPAA and HITECH. Alternatively, a medical device, such as a mobile medical app, may request that a user provide detailed medical information about himself or herself. Provided that information is requested outside of the context of a health care provider, health plan, public health authority, employer, life insurer, school or university, HIPAA and HITECH similarly would likely not apply.
Source: fdalawblog.com

CVS pharmacies ‘bribing’ customers to abandon medical privacy protections

(NaturalNews) The CVS/pharmacy corporation recently launched a new pharmaceutical marketing scheme that pushes customers to fill more drug prescriptions at its stores by enticing them with cash prizes and other rewards, an initiative that is now part of the company’s “ExtraCare Rewards Program.” But a recent investigation by the Los Angeles Times (LA Times) reveals that, in order to enroll in the new program, customers must first surrender their medical privacy rights protected under HIPAA by signing them away. Known formally as the Health Insurance Portability and Accountability Act, HIPAA was originally enacted by Congress to guard individuals’ private health information from being sold, shared, or otherwise exploited by the medical industry or third parties. HIPAA’s Privacy Rule specifically governs how private health information can be accessed and used legally, restricting it in such a way as to allow health providers access only to what they actually need in order to provide reasonable care, while protecting the rest. You can read a summary of how HIPAA’s Privacy Rules affect you here: http://www.hhs.gov But CVS has apparently devised a way to bypass these protections by tricking its customers into signing away their HIPAA protections in exchange for store credits. According to the CVS ExtraCare Rewards signup page, all customers must “sign a HIPAA Authorization to join,” a process that CVS fails to explain involves customers completely giving up their right to medical privacy. CVS discreetly admits this later on in the last step of the process, where customers are required to acknowledge that their “health information may potentially be re-disclosed.” “CVS takes the liberty of assuming you know that HIPAA and the ‘federal Privacy Rule’ are one and the same, although it has nowhere made the connection clear,” writes David Lazarus for the LA Times about the final step in the signup process, which explains to customers that they are no longer protected by the federal Privacy Rule. “The company also assumes you are aware of what it means to no longer be protected by HIPAA, although, again, it hasn’t spelled out the implications of giving up your HIPAA rights.”
Source: naturalnews.com

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August 23, 2013

Feds Get Tough On Medicare Fraud: Moratorium Bans New Healthcare Agencies In Miami, Chicago, And Houston

Posted by:  :  Category: Medicare

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In 2012, 662 home health agencies were operating in Miami-Dade county, making its home healthcare agency to Medicare beneficiary ratio 1,960 percent greater than other counties. South Florida is notorious for being a hot-bed for Medicare fraud, in part because of several high-profile cases. In February, owners and operators of 2 Miami home health agencies were found guilty of participating in $48 million Medicare fraud scheme.
Source: medicaldaily.com

Video: Medicare Supplement Insurance, Health Insurance Agency in Greencastle IN 46135

San Diego Medicare Agency Comments on Denied Medicare & What to Do

Understand your doctor’s classification. If your doctor “accepts assignment,” you’ll likely have to pay the annual Medicare Part B deductible and a 20% copay per visit. That’s the ideal situation for most Medicare policies. However, if you have a non-participating doctor, he or she may still accept Medicare but not quite under the prescribed reimbursement amounts. A non-participating doctor can charge a patient up to 15% over the Medicare-approved amount. However, a Medigap insurance policy can take care of these extra costs – call us at 619-934-7227 to discuss selecting a Medigap policy in addition to your current Medicare coverage.
Source: pomeradonews.com

Medicare Bad Debts and CMS’s “At a Collection Agency Policy”

In a Memorandum Opinion issued July 19, 2013, another judge of the D.C. district court upheld CMS’s “at a collection agency” policy. Lakeland Regional Health Sys. v. Sebelius, Civ. Case No. 12-600 (RJL)  The court concluded that the policy is supported by substantial evidence, by the language of the regulation at 42 C.F.R. 413.89(a), by the Secretary’s interpretive guidance, and by past administrative practice. The court stated that, where an outside collection agency continues collection efforts on behalf of a provider, it cannot be said that a bad debt is “actually uncollectible when claimed as worthless” or that “sound business judgment” establishes that “there was no likelihood of recovery at any time in the future,” as the regulation requires. Moreover, the court said, the fact that CMS’s policy was not explicitly set forth in writing prior to the bad debt moratorium is not fatal. The Interpretive Guidance in place prior to August 1, 1987, the court ruled, “did not purport to be a comprehensive review of all conditions that might be placed on reimbursement” of Medicare bad debts. The court thus concluded that it cannot logically be inferred that the agency lacked a policy to disallow reimbursement of accounts pending at a collection agency or had a contrary policy.
Source: jdsupra.com

Are Inaccurate OASIS Assessment & ICD

When we are asked to assist a Medicare Home Health agency, we frequently find supervisors at their desks busily reviewing OASIS for integrity and doing the sequencing and coding. Most Medicare Home Health supervisors have training for the coding and review, however, most do not have time to keep up to date with the monthly advisories as new rules and codes are issued. As a result, Medicare Home Health supervisors are using invalid codes. The difference between valid and invalid codes can amount to hundreds of dollars per episode. Additionally, the Home Health agency is adversely impacted by the delay in cash flow as result of late development of the 485 when supervisors are processing the cases.
Source: kenyonhcc.com

Medicare and Health Insurance, What is Covered, Medicare Supplement

Medicare Part D pays for prescription drugs. This plan covers both generic and brand name prescription drugs. The initial enrollment period to join a Medicare drug plan is three months before your 65th birthday to three months after you turn age 65. Each year during the open enrollment period, you have the option to change your drug plan to fit your specific needs. Perhaps when you turned 65 you did not have need for extensive coverage, but as you get older and your needs change, this coverage can be increased as necessary.
Source: bradeninsurance.com

Medicare Timely Filing Denials: How to Avoid Rejection

Retroactive Disenrollment from a MA Plan or PACE Provider Organization It’s similar to the State Medicaid Agencies exception, but involves Medicare Advantage plans and Program of All Inclusive Care of the Elderly organizations. For instance, a patient receives treatment while eligible for one of the said programs, but later receives notification of disenrollment retroactive to the date of the provided service, resulting in a payment recoup.
Source: poweryourpractice.com

USDOJ: Michigan Physical Therapist and Home Health Agency Owner Pleads Guilty for Role in Medicare Fraud Scheme

A greater Detroit-area physical therapist who was also an owner of a home health agency pleaded guilty yesterday for his role in a $22 million home health care fraud scheme.   Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division, United States Attorney for the Eastern District of Michigan Barbara L. McQuade, Special Agent in Charge Robert D. Foley III of the FBI’s Detroit Field Office, Special Agent in Charge Lamont Pugh III of the United States Department of Health and Human Services Office of Inspector General (HHS-OIG) Chicago Regional Office, and Special Agent in Charge Erick Martinez of Internal Revenue Service Criminal Investigation made the announcement. Hemal Bhagat, 32, of Troy, Mich ., pleaded guilty on August 14, 2013, before United States District Judge Bernard A. Friedman in the Eastern District of Michigan to one count of conspiracy to commit health care fraud.  At sentencing, scheduled for November 12, 2013, Bhagat faces a maximum penalty of 10 years in prison and a $250,000 fine.   According to information contained in plea documents, Bhagat admitted that from approximately May 2009 through October 2011, he conspired with others to commit health care fraud through billing Medicare for home health care services that were not actually rendered and/or not medically necessary.  A licensed physical therapist, Bhagat began working in June 2009 for Troy-based Prestige Home Health Services Inc ., a home health agency owned by alleged co-conspirators.   In approximately August 2009, he and other co-conspirators became owners of Royal Home Health Care Inc ., a home health agency also located in Troy.     Bhagat admitted that his co-conspirators at Prestige and Royal paid kickbacks to patient recruiters to obtain the information of Medicare beneficiaries, which the co-conspirators then used to bill Medicare for services that were not provided to these beneficiaries and/or were not medically necessary.   He and his co-conspirators then created fictitious therapy files appearing to document physical therapy services provided to Medicare beneficiaries, when in fact no such services had been provided and/or were not medically necessary.   Bhagat’s role in creating the fictitious therapy files was to sign documents – including physical therapy evaluations, supervisory patient visits, and patient discharge forms – indicating that he and others had provided physical therapy services to particular Medicare beneficiaries, when in fact they had not.   Bhagat admitted to knowing that the documents he falsified would be used to support false claims to Medicare by his co-conspirators at Prestige and Royal.   He submitted or caused the submission of claims to Medicare for services that were not medically necessary and/or not provided, which in turn caused Medicare to pay approximately $4,767,359.03. This case was investigated by the FBI, HHS-OIG and IRS Criminal Investigation and was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the United States Attorney’s Office for the Eastern District of Michigan.  This case is being prosecuted by Trial Attorney Niall M. O’Donnell, Deputy Chief Charles E. Duross, and Trial Attorney James McDonald of the Criminal Division’s Fraud Section.   Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,500 defendants who have collectively billed the Medicare program for more than $5 billion.  In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers. To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov. Contact: Department of Justice Main Switchboard – 202-514-2000 Reported by: US Department of Justice
Source: 7thspace.com

Medicare homebound criteria for home care

Signed home health certification from a doctor: Patients must have their doctor sign a home health certification stating that they qualify for Medicare home care. In order for a doctor to sign this certification, the patient must be homebound and need intermittent skilled care. The certification must state that a plan of care has been created for the patient and regularly reviewed by a doctor. A face-to-face meeting or a meeting through telecommunications with the doctor and patient is also required.
Source: homehealthcareconnection.org

CMS Proposes Medicare Payment Adjustment For Home Health Agencies

Modern Healthcare: CMS Adjustments Plan Would Cut Medicare Pay Rates A series of rebasing and coding adjustments from the CMS would cause home health agencies to see a 1.5% reduction in their Medicare payments for 2014, which the CMS estimates could lower total payments to these facilities by $290 million next year. In a proposed rule Thursday, the CMS said the decrease reflects a 2.4% home health payment update amounting to a $460 million increase in overall payments, combined with a host of adjustments that would decrease payments by $750 million (Zigmond, 6/27).
Source: kaiserhealthnews.org

Everything You Need To Know About Medicare

Medicare is stronger than ever and we’re working hard to make sure you havereliable, high-quality health care at a cost you can afford. We’re excited to continue implementing the new Medicare benefits provided to you under the 2010 Affordable Care Act. There’s a lot of information about this law in the news including many new opportunities for all Americans to compare plans and get affordable health care coverage. Be assured that you’ll still have access to all of your guaranteed Medicare benefits. In fact, this important piece of legislation extends the life of the Medicare program and offers you real benefits. Here are some improvements people with Medicare have seen so far because of this law:
Source: kmiagency.net

The Oakland Press: Michigan health agency owner pleads guilty in Medicare fraud scheme

Shah, a licensed physical therapist assistant, admitted that beginning in or around October 2008 and continuing through approximately September 2012, he conspired with others to commit healthcare fraud by billing Medicare for home healthcare services that were not actually rendered and/or not medically necessary, according to information contained in plea documents.
Source: properpayments.org

Medicare fraud outrunning enforcement efforts

The Department of Health and Human Services Office of Inspector General is set to lose a total of 400 staffers that are deployed nationwide as a primary defense against health care fraud and abuse. Though agency officials have yet to decide which investigations will be shelved as staff dwindles, the existing staff is already stretched so thin that the agency has failed to act on 1,200 complaints over the past year alleging wrongdoing — and expects that number to rise. The OIG began shedding staff at the beginning of the year.
Source: publicintegrity.org

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August 23, 2013

Medicare Open Enrollment in NJ and PA

Posted by:  :  Category: Medicare

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David brings over 12 years of experience in health insurance advocacy and coordination. David previously served in a supervisory capacity including acting director with the Camden County Department of Health and Human Services, Division of Senior and Disabled Services. David also was the coordinator of the State Health Insurance Assistance Program (S.H.I.P.) and a certified counselor assisting in the education and implementation of Medicare, supplemental health insurance and prescription drug coverage to the senior and disabled population.
Source: rothkofflaw.com

Video: Medicare Open Enrollment Preparations

Seniors' Knowledge and Experience With Medicare's Open Enrollment Period and Choosing a Plan: Key Findings from the Kaiser Family Foundation 2012 National Survey of Seniors

The survey finds one in four seniors say they are unaware of this annual opportunity to review and change their Medicare coverage, with even larger shares who say they are unaware of Medicare’s open enrollment period among blacks and Hispanics and those seniors in fair or poor health, with low incomes, and without a high-school diploma.
Source: kff.org

Understanding Medicare Advantage and Medicare Prescription Drug Plans Open Enrollment Period

During Open Enrollment you can change from Traditional Medicare to a Medicare Advantage Plan, change from a Medicare Advantage Plan back to Traditional Medicare, switch from your current Medicare Advantage Plan to another Medicare Advantage Plan, make the leap from an Advantage plan that does not offer prescription drug coverage to one that does or vice-versa, join a Medicare Prescription Drug Plan, or drop your Medicare Prescription Drug coverage completely.
Source: themhnews.org

Projecting Medicare Advantage Enrollment: Expect the Unexpected?

It is not entirely clear why enrollment has continued to climb since 2010, or if the trend will continue at the current clip. Analysts believe that the bonus payments have certainly helped to mitigate the effects of payment reductions, and that plans appear to be doing more to reduce their costs. Some speculate that Medicare Advantage plans are benefitting from the slowdown in medical spending, enabling them to keep premiums low. Others ascribe the growth in enrollment to the influx of baby boomers who may have greater comfort with managed care plans than previous generations. As additional payment reductions are phased in over the next few years, the growth in enrollment could stall or even reverse, if plans pull out of the market because they feel they cannot operate profitably. Even if enrollment continues to increase, there is some speculation that plans may scale back benefits and/or increase cost-sharing in response to reductions in Medicare payments and the soon-to-be implemented annual fee on health insurance that was enacted in the ACA, which also applies to Medicare Advantage.
Source: kff.org

Oklahoma Insurance Department: Medicare Open Enrollment

Mark was born not in Enid, America but rather Okeene. At a very young age, his family transplanted to Enid and he has lived his entire life here except for a 4 year stint in the Kansas City area. Mark was brought up listening to the jets roar overhead and sight of wheat trucks hauling in the harvest to some of the world’s largest grain elevators. Mark strongly believes in Enid’s potential and is currently raising his family here based on that belief. He also still believes in Santa Claus so take that for what it’s worth
Source: route60sentinel.com

Three Things Every Senior Should Know About Medicare Open Enrollment

Open enrollment is a six month period during which you can buy Medigap insurance. Medigap providers cannot deny coverage during this period. They must cover your pre-existing conditions and they may not charge you a higher premium because of your medical history. Someone looking to enroll who is a diabetic and has smoked their entire life can enroll in Medigap Plan F, and they will pay the exact same premium as an individual who has never smoked and is not a diabetic.
Source: skepticwiki.org

Medicare Open Enrollment Is Coming

Private insurance companies provide Medigap policies. Medigap plans are standardized to meet government requirements for consumer protection. The offering must be identified as a supplement to Medicare. All Medigap policies are similar. The government requires that they offer plans A and B. Beyond this, providers choose which Medigap plans they want to sell. It is important to note that Medigap policies only cover coinsurance after the deductible is met. The exception is when the Medigap plan also provides deductible coverage.
Source: gii-exchange.org

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August 23, 2013

PeonInChief: Medicare Card Fraud

Posted by:  :  Category: Medicare

J will turn 65 in a few months and, in a rite of passage sort of like high school graduation, he received his Medicare card.  (He has also been receiving Medicare supplement advertising by mail, and now follow-up phone calls.  We expect to receive the ads for durable medical equipment soon, as well.)  But back to the card.  There,  front and slightly-below-center, is his full Social Security number.  The number we’re admonished never to give to anyone.  That one.  The one that identity thieves spend lots of time trying to get.  The one that enables them to get credit cards in your name and make purchases you would make if you could afford them.
Source: blogspot.com

Video: Iranian Social Work, USCIS Help Center, SSI, Disability, Medical, Medicare Application

Turning 65: Another milestone known as Medicare

Somehow the whole world has received notice that you are soon turning 65. Every insurance company you’ve heard of and those you haven’t will start sending you information and calling you about Medicare supplemental insurance plans. Military retirees, their spouses, and survivors shouldn’t need those policies because they qualify for Tricare for Life, which picks up the cost shares not paid by Medicare. But, remember—to be eligible for TRICARE for Life, you MUST sign up for Medicare Part B!
Source: militaryfamily.org

How Do I Renew My Medicare Card?

Most of the time, it is easy to get a Medicare card renewed. The process can become frustrating, however, if the person needing to renew their Medicare card does not have the proper forms and identification. Some methods of renewing the Medicare card are: In person at the outlet store that offers this service, online renewal available by some states, or by phone. Some have said that a person cannot renew their card over the phone, but there have been a large number of Medicare card holders who have.
Source: seniorcorps.org

Code Key for Medicare Card Explained

A: Social Security pays benefits to some 56 million people. They include retirees, widows and widowers, families who’ve lost their breadwinners, divorced spouses and people with disabilities. In order to keep track of such huge numbers, Social Security uses a series of codes to identify which individuals are receiving what types of benefits. The codes are assigned to people when they apply for benefits.
Source: aarp.org

Apply RRV: Are aussie bank account & medicare card helps ?

Hi If i have a Australia bank account, a medicare card, will these be considered as "substantial (business, cultural, employment) and beneficial ties" for me to qualify to get a RRV? I have my Australia VISA approved (under Skilled migrant) but due to some personal issues, i won’t be able to migrate them in the coming 5 years and i won’t be able to fulfill the 2 out of 5 years requirement too so i definitely need to apply a RRV when it reaches the 5 years limit. Besides bank account and medicare card, if I buy a house there and rent it out , will that boost up my chance to get the RRV approved ? As someone mentioned if i buy a house there for investment purpose, it won’t be considered, is that true ? Also, if i invest a house for renting purpose there, will i be taxed by Australia government ? If i buy a house there just to qualify for RRV and leave it vacant for 5 years , it sounds like i don’t have any ROI there , that is the reason why i am thinking to rent it out please advice thanks
Source: australiaforum.com

How to Prevent Medicare Card Identity Theft

Note: You’ll notice that your Medicare ID has one or two additional letters or numbers following the digits of the SSN. These identify what kind of beneficiary you are, according to the Social Security Administration. For example, the letter T mainly indicates that you are entitled to Medicare, but are not yet filed for Social Security retirement benefits; whereas W1 indicates that you are a widower who is eligible for Medicare through disability. For the purposes of your photocopy, it doesn’t matter whether you delete these final letters (or letter-number combinations) or leave them in. Also of interest: You can help fight health care fraud. 
Source: aarp.org

Medicare Enrollment Frequently Asked Questions (FAQ)

You may register for Medicare Part A and Part B during what’s known as the Initial Enrollment Period (IEP), which varies by individual. Your IEP begins three months before your 65th birthday, and lasts through your birthday month and the three months that follow it. You can apply online at SocialSecurity.gov or by visiting your local Social Security office. If you wish to register over the phone, you may call the Social Security office at 1-800-772-1213. If you worked for a railroad, then you can register over the phone by calling the Railroad Retirement Board at 1-877-772-5772.
Source: planprescriber.com

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August 23, 2013

Ohio Panel To Hear Testimony On Medicaid Analysis

Posted by:  :  Category: Medicare

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State lawmakers have been trying to find common ground on Medicaid since Republican Gov. John Kasich proposed an extension of the federal-state program in February. GOP leaders pulled it from the state budget, and the issue has yet to gain traction in the Legislature.
Source: 10tv.com

Video: What Are The Ohio Medicaid Eligibility Guidelines

Ohio Lawmaker Introduces Medicaid Expansion Bill

Detroit Free Press: Medicaid Expansion Vote In State Senate Committee Could Come Wednesday A committee vote on expanding Medicaid to 470,000 additional Michiganders could happen as soon as Wednesday. The Senate Government Operations Committee heard three hours of testimony Tuesday, mostly from supporters of the plan to expand Medicaid to people who fall between 100 percent and 133 percent of the federal poverty level. … But opponents of the expansion will get their turn Wednesday, when Republican Sens. Patrick Colbeck of Canton and Bruce Caswell of Hillsdale offer their bills that would provide health care for low-income residents, but without any federal money (Gray, 7/30).
Source: kaiserhealthnews.org

Ohio panel hears details on Medicaid projections

Roughly 366,000 Ohioans would be newly eligible for coverage beginning in 2014 by expanding Medicaid. The federal-state health program for the poor already provides care for one of every five residents in the state. Washington would pay the entire cost of the expansion for the first three years, gradually phasing down to 90 percent — still well above Ohio’s current level of almost 64 percent.
Source: lifehealthpro.com

Medicaid Expansion: Beating a Trojan Horse

Fast forward to the August legislative recess, after “flint-hearted,” “off-the-chart right” House Republicans dashed the hopes of Gov. Kasich, progressive activists, the hospital lobby, the Chamber of Commerce, and the media by stripping the Obamacare Medicaid expansion from Kasich’s biennial budget.
Source: freedomworks.org

New BLS Data Shows Why Medicaid Expansion is Terrible Idea for Jobs

…In the early 1950s, practically all men in this age group (25-54) were either working or looking for work—fewer than 3 men out of every 100 were out of the labor force. By contrast, over 11 out of every 100 men of prime working age are completely out of the labor force today—one in nine, fully four times the fraction back in the early postwar era. This flight from work at prime working ages accounts for the vast majority of the 13 percentage point drop in employment ratios reported for this key demographic group over the past sixty years (i.e., 1953-2013)’
Source: buckeyeinstitute.org

Ohio Health Policy Review: Ohio moves forward with designing new Medicaid eligibility system

Ohio’s current eligibility system, known as CRIS-E, was launched more than 30 years ago. The state estimates that 60 percent of CRIS-E’s eligibility determinations for Medicaid are inaccurate and must be manually overridden to prevent eligible applicants from being denied coverage or to remove those who weren’t eligible from receiving benefits.
Source: healthpolicyreview.org

OPINION: On Medicaid, GOP lawmakers out for themselves in Ohio

The legislative redistricting plan that Governor Kasich and other GOP leaders bulled through for last year’s election is designed to create so many safe seats as to place incumbents beyond voter accountability in general elections. (Not to say I told you so, but Ohioans could have voted last November to throw out the rotten Republican gerrymander and replace it with a nonpartisan reapportionment system — and opted for the status quo.)
Source: medcitynews.com

Ohio GOP guv gives pasionate defense of Medicaid expansion

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Source: ncpolicywatch.org

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August 23, 2013

Health Data Intelligence, A New Healthcare Business Intelligence and Data Analytics Company, Formally Launches to Serve Hospitals, Health Systems, and Media Organizations

Posted by:  :  Category: Medicare

Decent Hill Publishers, LLC is pleased to formally announce the launch of a new subsidiary, Health Data Intelligence (HDI). HDI is a healthcare business intelligence and data analytics company providing a fresh new approach to the way hospitals and providers make sense of their clinical and financial data. HDI seeks to simplify and, in the process, revolutionize the way healthcare organizations understand and use their publicly reported clinical and financial metrics as well as data sets stored in their siloed internal systems. HDI is led by seasoned healthcare veterans with well over three decades of combined direct, hands-on experience in healthcare data analytics and clinical decision support systems. Clients of HDI will be able to immediately benefit from the expert support and experience that stand behind the company.
Source: virtual-strategy.com

Video: Data.Medicare.Gov: Get Started!

CMS Call on New Medicare Data Portal (May 16) : Health Industry Washington Watch

Beginning in July 2013, CMS will be posting downloadable data on from various Medicare.gov Compare websites (Dialysis Facility Compare, Home Health Compare, Hospital Compare, and Nursing Home Compare) at Data.Medicare.Gov. On May 16, 2013, CMS is hosting a webinar to provide an introduction to Data.Medicare.Gov and to demonstrate options for accessing the data. CMS notes that the webinar is aimed at both technical and non-technical users of Compare website data, such as researchers, health care administrators, and quality improvement professionals.
Source: healthindustrywashingtonwatch.com

100 Patient Safety Benchmarks

For hospitals, benchmarking data can be incredibly valuable. It allows individual institutions to identify areas of excellence and assess opportunities for improvement, ultimately resulting in more efficient operations and better care. Becker’s Hospital Review has compiled a list of 100 patient safety benchmarks from various sources for hospital comparison.
Source: beckershospitalreview.com

Sources and Methodology: A Guide To Medicare’s Readmissions Data And KHN’s Analysis

CMS expressed the penalty as an “adjustment factor” that will be applied to Medicare reimbursements for care for patients admitted for any reason. The lowest adjustment factor, 0.9800, is the maximum penalty; it means that a hospital would be reimbursed only 98 percent of the amount Medicare usually pays. The highest adjustment factor, 1.000, means that a hospital would receive the full Medicare reimbursement. The penalty does not apply to additional Medicare payments paid to compensate for hospitals’ general operating expenses, their training of medical residents or their treatment of larger than normal numbers of low-income patients. For our stories, charts and graphics, Kaiser Health News expressed the adjustment factor as a penalty, for the purposes of clarity. The penalties were calculated by subtracting each adjustment factor from 1 and turning it into a percentage. Thus, a hospital losing the most money because of its high readmission rate (which CMS gave an adjustment factor of 0.9800) is listed by KHN as receiving a 2 percent penalty. Hospitals receiving a 0 percent penalty are not losing any money.
Source: kaiserhealthnews.org

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