While health care was not central to the 2016 Presidential campaign, the election’s outcome will be a major determining factor in the country’s future health care policy. A number of issues have garnered media attention, including the future of the Affordable Care Act (ACA), rising prescription drug costs, and the opioid epidemic.
Financial Security of Elderly Americans at Risk: Proposed changes to Social Security and Medicare could make a majority of seniors ‘economically vulnerable’
To better measure the economic vulnerability of older adults, they suggest using the Elder Economic Security Standard Index (Elder Index) developed by Wider Opportunities for Women (WOW). The Elder Index estimates how much it costs seniors to live in different communities across the country, accounting for an elder household’s housing type, transportation type, health status, and geography-specific cost of living. The index is more comprehensive than the SPM in its appraisal of costs, including food, housing, healthcare, and transportation costs, as well as miscellaneous expenses such as telephone, clothing, and personal care costs and relevant sales taxes. At the time we began our analysis, the measure had only been produced for 17 states, and therefore could not be used to assess elderly vulnerability nationwide. However, when we compared the index’s state-level thresholds to SPM thresholds for those same areas, we found a measurable pattern: The Elder Economic Security Standard Index threshold (the line below which the elderly are considered economically insecure) is roughly 200 percent of, or twice, the SPM threshold, on average. (Note that WOW has since released Elder Index values for states, counties, and cities throughout the United States; the data are available at www.basiceconomicsecurity.org/EI)
Medicare Advantage 2015 Data Spotlight: Overview of Plan Changes
When SNPs were authorized, there were few requirements beyond those otherwise required of other Medicare Advantage plans. The Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 established additional requirements for SNPs, including requiring all SNPs to provide a care management plan to document how care would be provided for enrollees and requiring C-SNPs to limit enrollment to beneficiaries with specific diagnoses or conditions. As a result of the new MIPPA requirements, the number of SNPs declined in 2010. The ACA required D-SNPs to have a contract with the Medicaid agency for every state in which the plan operates, beginning in 2013. Additionally, in 2013, joint federal-state financial alignment demonstrations to improve the coordination of Medicare and Medicaid for dually eligible beneficiaries began to enroll beneficiaries. Today, financial alignment demonstrations are underway in 12 states: California, Colorado, Illinois, Massachusetts, Michigan, Minnesota, New York, Ohio, South Carolina, Texas, Virginia, and Washington. The financial alignment demonstrations could influence the availability of D-SNPs in these states, either increasing or decreasing the availability of SNPs, depending on the design of the demonstration.
Medicare Fee, Payment, Procedure code, ICD, Denial: June 2011
Do you want to avoid the 1% Medicare Part B payment adjustment on claims in 2012? * Send at least 10 e-prescriptions for Medicare Part B patient visits which include one of the e-prescribing denominator codes* AND * Send your 10 claims to Medicare Part B with the denominator code* and code G8553 before 6/30/2011 OR * Send one (1) claim to Medicare Part B with the denominator code and one of the Hardship codes before 6/30/2011 G8642: The eligible professional practices in a rural area without sufficient high speed internet access and requests a hardship exemption from the application of the payment adjustment under section 1848(a)(5)(A) of the Social Security Act G8643: The eligible professional practices in an area without sufficient available pharmacies for electronic prescribing and requests a hardship exemption from the application of the payment adjustment under section 1848(a)(5)(A) of the Social Security Act G8644: the eligible professional does not have prescribing privileges
Medicare Flu Shot Codes: Q2035, Q2036, Q2037, Q2038
The Centers for Medicare & Medicaid Services (CMS) no longer recognizes and does not reimburse CPT Code 90658 Influenza Virus Vaccine, Split Virus for flu shots. CMS has established six separate influenza vaccine HCPCS codes to distinguish between the brand-names of influenza vaccines for governmental tracking purposes. Make sure to use these new codes in your medical billing.