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Archive for the 'Medicare' Category


Posted by Service Officer on 31st July 2008

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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Posted by Service Officer on 31st July 2008

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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Posted by Service Officer on 3rd July 2008

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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Posted by Service Officer on 3rd July 2008

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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Posted by Service Officer on 2nd July 2008

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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Posted by Service Officer on 17th May 2008

Medicare alone will not meet your long-term care (LTC) needs. While Medicare covers some home health, skilled nursing and hospice care, it generally does not cover custodial care, such as cleaning or cooking, at home or in a nursing home. Medicare will help pay for your home care if:

• Your doctor certifies that you are homebound, meaning it takes a considerable and taxing effort to leave your home; and

• You need skilled physical, speech or occupational therapy services, or skilled nursing on an intermittent (less than seven days a week) or part-time (less than eight hours a day) basis. If you only require skilled nursing, you must either need it fewer than seven days a week (even as little as once every 60 to 90 days) or daily (seven days a week) for a short period of time (usually two to three weeks); and

• Your doctor certifies your need for home care, and

• You receive your care from a Medicare-certified home health agency (HHA).

If you qualify for the home health benefit, Medicare covers the following types of care:

1.) Skilled nursing services. Medicare pays in full for skilled nursing, which includes services and care that can only be performed safely and effectively by a licensed nurse. Administration of medications, tube feedings, catheter changes, observation and assessment of a patient’s condition, management and evaluation of a patient’s care plan, and wound care are examples of skilled nursing. Any service that could be safely performed by a nonmedical person (or one’s self) without the direct supervision of a licensed nurse is not covered.

2.) Skilled therapy services. Medicare pays in full for physical, speech and occupational therapy. Physical therapy includes exercises to regain movement and strength to a body area and training on how to use special equipment. Speech-language pathology services include exercises to regain and strengthen speech and language skills. Occupational therapy helps you become able to do usual daily activities by yourself, such as eating and putting on clothes. Medicare will pay for therapy services to maintain your condition and prevent you from getting worse; you do not need to have the potential to improve.

3.) Home health aide services. Medicare pays in full for a home health aide if you require skilled services. A home health aide provides personal care services including help with bathing, using the toilet, and dressing. If you ONLY require personal care, you do NOT qualify for the Medicare home care benefit.

4.) Medical social services. Medicare pays in full for services to help you with social and emotional concerns you have related to your illness. This might include counseling or help finding resources in your community.

5.) Medical supplies. Medicare pays in full for medical supplies provided by the Medicare-certified home health agency, such as wound dressings and catheters needed for your care.

6.) Evaluation services. Medicare pays for evaluation services if performed by a skilled nurse or therapist.

7.) Durable medical equipment. Medicare pays 80% of its approved amount for certain pieces of medical equipment, such as a wheelchair or walker.

The Medicare home health benefit covers a wide range of skilled nursing services as long as you need them fewer than seven days a week, or daily for a finite and predictable period of time (usually no more than 21 days in a row). Skilled nursing care includes services that can only be performed safely and correctly by a licensed nurse (either a registered nurse or a licensed practical nurse) and is under the general direction of a doctor. For example: intravenous injections; tube feeding; oxygen to help you breathe; changing sterile dressings on a wound; training you to perform required tasks, maintenance and evaluation. Any service that could be safely performed by a nonmedical person (or one’s self) without the direct supervision of a licensed nurse is not covered. Regional Home Health Intermediaries (RHHIs) handle home health and hospice claims. You can call your intermediary for claim issues, and questions about coverage, complaints or denials. For additional info and a complete glossary of medical terms refer to http://www.medicareinteractive.org/page2.php?topic=counselor&page=glossary. [Source: Medicare Rights Center www.medicareinteractive.org May 08 ++]

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Posted by Service Officer on 17th May 2008

Everyone in Congress wants to stop a 10.6% cut in Medicare and TRICARE payments to doctors scheduled to take place on July 1. Medicare administrators don’t want the cut to happen either, but they’re worried about how to administer the program if Congress waits until the end of June — or worse yet, until sometime in July or later — to change the law. In early MAY Medicare officials told Congress that the law needs to be changed by 16 JUN in order to allow Medicare computers to be reprogrammed by 1 JUL. If they don’t get updated guidance by that date, Medicare will have to implement the cut on 1 JUL and undo all the erroneous payments later if and when Congress changes the law. The same thing happened a couple of years ago, when Congress had to make a retroactive payment fix. But it’s a nightmare for Medicare (and TRICARE) administrators, and even more so for the doctors who have to suffer the income and book-keeping consequences. Veteran organizations worry that such frustration may cause some doctors to stop seeing elderly and military beneficiaries. The American Medical Association released a survey of nearly 9,000 doctors showing that if the payment cut went into effect:

• 60% of doctors would limit the number of new Medicare patients they accept;

• More than two-thirds would defer the purchase of needed information technology in 2008;

• 50% would reduce their staff; and

• 14% would stop treating patients entirely.

Congressional leaders would love nothing better than to meet the 16 JUN deadline, but they’re struggling to find ways to pay for the $15-$18 billion cost of the fix that a majority of legislators are willing to accept. Like it or not, that’s turned into a political football, with Republicans and Democrats preferring different options. And many on the Hill seem in no mood to compromise in this election year. MOAA said, it’s unacceptable to hold TRICARE and Medicare-eligibles’ access to care hostage to these kinds of political considerations. Congressional leaders need to work out a compromise — and fast — to stop that from happening. Veterans can help by visiting the MOAA or USDR websites http://capwiz.com/moaa/issues/alert/?alertid=10534466 & http://capwiz.com/usdr/issues/alert/?alertid=11354701&queueid=[capwiz:queue_id] to send a suggested message to urge their legislators to act fast. [Source: MOAA Legislative Update 11 May 08 ++]

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Posted by Service Officer on 30th April 2008

President Bush recently submitted a bill to Congress that would raise Medicare Part D premiums for seniors. The proposal would increase prescription drug premiums for individuals with incomes exceeding $82,000 and for couples with incomes greater than $164,000. Premiums would more than triple for individuals with incomes over $205,000 and couples with incomes over $410,000. Although fewer than 5% of people with Medicare drug coverage would be affected at first, increasing numbers of middle-income seniors and the disabled would pay higher premiums in the future. The President’s proposal also would freeze the income thresholds, with no annual adjustment. This would cause a problem similar to one currently affecting the taxation of Social Security benefits. When the tax was first enacted in 1983, the public was told that only higher income seniors would be affected. But because the income thresholds are not adjusted, and have remained at $25,000 for individuals and $32,000 for couples, middle-income seniors pay taxes on their benefits today.

The proposal comes in response to a forecast by Medicare Trustees that by 2013 more than 45% of Medicare’s spending will come from general tax revenue, as opposed to dedicated payroll taxes and premiums paid by beneficiaries. Under the 2003 Medicare drug law, the President must propose legislation to limit the government portion of Medicare spending and Congress is required to give the proposals expedited consideration. The law, however, does not force Congress to vote. The President’s Medicare bill does not include proposals to cut payments to hospitals or other health care providers. He did, however, submit an annual budget that would cut an estimated $481 billion from Medicare over the next ten years, according to the Congressional Budget Office. Despite the deep and widespread cuts, President Bush did not cut subsidies for private Medicare Advantage plans. The plans cost the government about 12% more than it pays for seniors enrolled in traditional Medicare. Since 2000, Social Security benefits have increased 22%, but Part B premiums have increased 111%.” [Source: New York Times article 16 Feb & CBO report 3 Mar 08 ++]

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