In a move that could lead to significant changes in medical care for older men, a national task force in the United States recommended that doctors stop screening men ages 75 and older for prostate cancer because the search for the disease in this group is causing more harm than good. The new guidelines, issued 4 AUG by the U.S. Preventive Services Task Force, represent an abrupt policy change by an influential panel that had withheld any advice regarding screening for prostate cancer, citing a lack of reliable evidence.

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If it is an emergency Medicare will generally cover ambulance services, as long as an ambulance is the only safe way to transport you (medically necessary); and you are transported to and from certain locations. If covered, Medicare will pay for 80% of its approved amount for the ambulance service. You or your supplemental insurance policy will be responsible for the remaining 20%. All ambulance providers must accept Medicare assignment, meaning they must accept the Medicare-approved amount as payment in full. If it is not an emergency, Medicare coverage of ambulance services is very limited. An emergency is when your health is in serious danger and every second counts to prevent your health from getting worse. If the trip is scheduled as a way to transport you from one location to another when your health is not in immediate danger, it is not considered an emergency. Medicare will never pay for ambulette services (i.e. use of specially equipped motor vehicles for transporting convalescing or handicapped people). Also, lack of access to alternative transportation alone will not justify Medicare coverage. Medicare may cover non-emergency ambulance services if:

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A new report from the House Committee on Oversight and Government Reform found that people who get coverage from both Medicare and Medicaid (a group sometimes called “dual eligible”), pay 30% more for prescription drugs under the Medicare prescription drug benefit (Part D) than they would if Medicaid paid the bill. According to the study released 25 JUL, this discrepancy in pricing accounted for $3.7 billion in revenue for drug manufacturers during the first two years of the Part D program. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003, which established the drug benefit, required that Medicare Part D, not Medicaid, cover the cost of drugs for people with both Medicare and Medicaid. Many nursing-home residents fall into this category. Democrats in the House say this overpayment is an unjustified burden on the taxpayer, and they seek to correct the problem through new legislation. But House Republicans have countered that the new report overlooks important aspects and benefits to dual eligibles contained in the Part D program. Under Part D, for example, dual eligibles have access to a greater variety of prescription drugs. [Source: Medicare Rights Center 12 Aug 08 ++]

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A new report from the House Committee on Oversight and Government Reform found that people who get coverage from both Medicare and Medicaid (a group sometimes called “dual eligible”), pay 30% more for prescription drugs under the Medicare prescription drug benefit (Part D) than they would if Medicaid paid the bill. According to the study released 25 JUL, this discrepancy in pricing accounted for $3.7 billion in revenue for drug manufacturers during the first two years of the Part D program. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003, which established the drug benefit, required that Medicare Part D, not Medicaid, cover the cost of drugs for people with both Medicare and Medicaid. Many nursing-home residents fall into this category. Democrats in the House say this overpayment is an unjustified burden on the taxpayer, and they seek to correct the problem through new legislation. But House Republicans have countered that the new report overlooks important aspects and benefits to dual eligibles contained in the Part D program. Under Part D, for example, dual eligibles have access to a greater variety of prescription drugs. [Source: Medicare Rights Center 12 Aug 08 ++]

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President Bush sought to block a bill 15 JUL aimed at forestalling an 11% cut in payments to doctors taking care of Medicare patients, but Congress quickly overrode his veto. The House voted 383 to 41 to override the veto, while the Senate voted 70 to 26, in both cases far more than the two-thirds necessary to block the president’s action. With organized medicine, other lobbies, and the military community promoting the popular measure in an election year, Republicans broke heavily from the white house. A total of 153 House Republicans voted to defy the White House, 24 more than in a 24 JUN vote that started the momentum toward passage of the Medicare doctors’ bill.

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The National Park Service is an participant in the new Interagency Pass Program which was created by the Federal Lands Recreation Enhancement Act and authorized by Congress in DEC 04. Participating agencies include the National Park Service, U.S. Department of Agriculture - Forest Service, Fish and Wildlife Service, Bureau of Land Management and Bureau of Reclamation. The pass series, referred to collectively as the America the Beautiful Pass, went sale 1 JAN 07. It replaces the former Golden Age, Golden Access, and Golden Eagle pass. The new series consist of the following:

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U.S. health officials said 21 JUL that starting in 2009 doctors can earn additional money from Medicare if they use electronic prescribing systems. The bonus program, which will continue for four years, is designed to streamline the prescription process and cut down on errors. In 2009 and 2010, Medicare will give doctors an additional 2% bonus on top of their fee for “e-prescribing.”

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When Medicare processes a claim for health care services you received, the claim is detailed in a Medicare Summary Notice (MSN). It is a summary of claims for health care services Medicare processed for you during the previous three months. They are mailed four times a year and contain information about submitted charges, the amount that Medicare paid, and the amount you are responsible for. The most important fields on your MSN explain:

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Even though it is commonly said that an ounce of prevention is worth a pound of cure, Medicare has not traditionally covered preventive care. However, coverage for many preventive care services has been added in the past few years. Doctors may not realize that Medicare now covers these services, so it is important to ask your doctor about them. As long as you meet basic eligibility standards, you have the right to receive these services no matter which Medicare health plan you are enrolled in. Your costs for these services may be different if you are in a Medicare private health plan (HMO or PPO). However, private plans cannot charge you anything for the flu or pneumonia vaccine. In addition, private plans cannot require that you get a referral in order to get a screening mammogram or a flu shot. Be sure to follow the Medicare guidelines for receiving preventive care services in order to ensure that Medicare will cover them since some are covered only once every few years and others are only covered if you meet specific criteria. The following coverage guidelines are only for preventive screenings. Medicare may cover these tests more frequently if they are needed to diagnose or treat an illness or condition.

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MEDICARE REIMBURSEMENT RATES 2008 UPDATE 10: On 24 JUN, the House overwhelmingly passed H.R.6331, Medicare Improvements for Patients and Providers Act, which would have stopped the payment cuts, substituted a small increase for doctors seeing Medicare and TRICARE patients, and prevented the therapy cutoff. The vote was a solid veto-proof 355-59 with 20 not voting. This bill was almost identical to one rejected by the Senate two weeks ago. But Senate Republicans and President Bush didn’t approve of the funding source for that fix (cutbacks in some Medicare Advantage programs that pay doctors up to 17% more than regular Medicare does), and pushed an alternative bill. Medicare Advantage is but a small portion of those dependent upon Medicare. After the overwhelming House vote, Senate leaders tried to bring the bill up for a vote anyway. But when Republicans objected, they needed 60 votes to overcome the objection. On 26 JUN at 8:20PM, they got 58 with 40 nays and two not voting. Not enough to even get a vote, let alone override a threatened presidential veto. Republicans then proposed extending the current rates for 30 days to allow more time for a fix. But that was a non-starter, since the House had already left town for recess, and the Senate can’t approve a new fix by itself.

Congress took a week’s vacation over Independence Day and promised to fix things when they return. Now Medicare payments to doctors will be cut 10.6% starting 1 JUL. Also as of July 1, speech, physical or occupational therapy patients for whom Medicare has already paid at least $1,810 for therapy in 2008 will have further Medicare payments for that care stopped. (NOTE: Tricare doesn’t have a therapy payment cap like Medicare does, so Tricare therapy patients should be okay. For Tricare For Life patients, Tricare will pick up payments when Medicare stops, BUT only after the $150 annual Tricare deductible has been satisfied, along with applicable copays.) Tricare patients have a little more breathing room. Although Tricare doctor payments are tied to Medicare’s, there’s usually about a month’s delay in updating Tricare payment files when Medicare makes a change.

This isn’t the first time Congress has failed to stop a Medicare payment cut. In 2006, Congress missed the deadline, but approved a fix within a few weeks and made it retroactive. That caused doctors and Medicare administrators lots of headaches in the interim, but in the end, the lost payments were made up. And Tricare patients were never affected, because Congress fixed the rates before TRICARE got around to implementing the cuts. That’s the best-case scenario now - if Congress can act quickly after 4 JUL to approve a fix the president will sign. But the risk remains that some number of fed-up doctors will decide not to accept any more Medicare or Tricare patients and some may even turn away current Medicare/Tricare patients. Whatever Congress does after 4 JUL, they could have done before 1 JUL and prevented this mess. Actually, they have had since 2002 to fix the problem but have only applied a band-aid fix each year. If the President, the House, the Senate, Republicans, and Democrats had been willing to compromise — just a little — health care access for our seniors and military beneficiaries need not have been put at risk in this irresponsible way. All active duty and retire personnel with Tricare are encouraged to go to http://capwiz.com/usdr/issues/alert/?alertid=11554371&queueid=[capwiz:queue_id] , enter your zip code, and send a message to both of your Senators to work out their differences on this issue.

Note: The Bush Administration announced 27 JUN 08, that it will hold all Medicare claims from doctors for the first 10 business days of July and that it will make no payments at the 10% reduced reimbursement rate until 15 JUL at the earliest. This positive step by the administration gives Congress a window of time to come together on a reasonable, bipartisan Medicare bill to eliminate the 10% cut in Medicare payments to doctors. [Source: USDR Action Alert 27 Jun 08 ++]

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