| More and more seniors are finding out that Medicare will not cover their stay at the hospital because they were not officially admitted. Instead, they received ‘observation’ care, which is an outpatient service not covered under Medicare.
Medicare covers the first 100 days of care for skilled nursing, only for patients who were formally admitted into a hospital for three consecutive days.
This is a growing trend that is very costly for senior Medicare recipients. Recent federal data shows a sharp jump in patients receiving ‘observation’ care. In 2011, 1.4 million patients were being labeled under ‘observation,’ compared to the 920,000 in 2006. The trend is apparent with patients who have longer hospital stays lasting more than 48 hours. Observation stays rose from 27,600 in 2006 to 112,000 in 2011.
The increased problem appears to be due to a Medicare effort to control costs through a program that audits hospitals for possible overpayments. Once the program identifies improper errors, the hospital must comply with Medicare and must refund all the Medicare payments it received. This has made hospitals more cautious about the admission process and what they think could be challenged; as well, it allows a hospital to receive a lower reimbursement for observation status patients.
Since 2011, a long time legal battle has prompted a class action lawsuit from the non-profit Center for Medicare Advocacy (Bagnall v. Sebelius), to force the government to change its policy. It has also encouraged other advocacy groups, healthcare providers, and lawmakers the need to change the law.
Momentum to change the law is also (apparent) in Congress, as Senator Sherrod Brown (D-Ohio), is proposing as part of hospital admission process, a legislation that would force Medicare to count all overnight hospital stays; the House of Representatives a similar legislation.
By April Medicare is set to apply a new rule that would require doctors to admit people as patients they expect to stay more than two midnights, and to classify anyone else under observation status. However, there is great resistance to delay the new law from a large coalition of healthcare providers and advocacy groups whom argue that it will be very difficult to comply with the new rule. They argue it would arbitrarily reward patients who happen to arrive at the hospital at certain times of day and that it does not alter the three-day rule.
Traditional Medicare recipients can be affected by the observation status and are the most vulnerable to the rule. Unlike (patients) that uses Medicare Advantage programs, they are subject to their insurance provider’s plans.
Medicare Advantage plans provide comprehensive medical coverage, higher-quality care, better services, and additional benefits, reports The Coalition for Medicare Choices, a national grassroots organization who sole purpose is to protect and improve Medicare Advantage.
Traditional Medicaid program covers 100 percent of the first 20 days of a skilled nursing facility, only when the patient meets Medicare's three-day formal admission hospital rule. Patients are responsible for $152 daily co-pays for the remaining 80 days. Otherwise, patients pay full out-of-pocket cost for the skilled nursing facility if they left the hospital under observation status.
In New York, the daily cost for a skilled private room averaged $230 in 2013, with cost going up to $344 in New York state, according to a survey conducted by Genworth Financial. The survey data illustrates that an observation status patient would pay $34,440 for a 100-day stay in a skilled facility compared to the $12,160 out-of-pocket cost a formally admitted patient; that is $22,280 more.
Hospitals are not required by law to notify patients of their hospital status in many states. The only way seniors may be able to protect themselves from observation status is to constantly ask or have a family member or legal guardian, request to be formally admitted into a hospital.
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Question: Should the government do more to protect seniors by passing a law that makes hospital disclose the patient’s admission status?
Source: Reuters & NBC Nightly News
Medicare Blog | Medicare News | Medicare Information
| Medigap insurance, which reduces consumer out-of-pocket expense, can affect claims at the heart of any plan; says two economists who studied the Medicare Supplement market and analyzed real-world scenarios. The economists believe that simply taxing the Medicare Supplement products could lead to big savings.
Economists Marika Cabral of the University of Texas and Neale Mahoney of the University of Chicago agree that Madigap products encourage extra Medicare spending.
Marika and Neale analyzed Medicare program spending data in hospital service areas across state borders and have also analyzed different Medicare premiums on each side of the border.
The data underwent many variables that could skew comparisons of Medicare Supplement appeals towards the needier elderly, who would also spend heavily even if they only had traditional Medicare.
The findings showed an increase of 22 percent in Medicare spending or about $1400 per year, a 24% increase in hospitalization, with a 34% increase in physician service fee.
The economist estimate a simple 15% Med Supp premium tax could generate $13 billion per year in spending cuts and tax revenue, and that a "Pigouvian tax,” could generate $32 billion in yearly savings.
The research did not focus on the Medigaps effects to patients' health, care, or product satisfaction; however, they found no noticeable effect on the likelihood that patients would get genuinely urgent procedures with or without the use of Medigap.
The economists make their research available on a copyrighted working paper on the National Bureau of Economic Research website.
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Question: Do you think a Medigap premium tax will save the government money in the long run and keep the quality and the satisfaction of care seniors receive high?
| A new policy that informs the public how much money Medicare pays individual doctors may be underway and could violate physicians' privacy rights if poorly handled, warns the American Medical Association.
The Department of Health and Human Services (HHS) has announced that it will start responding to Freedom of Information Act requests for physician-payment data. Government officials will be using a ‘balancing test’ to determine who gets access to the information, and not guaranteeing the data to all filed request. This has prompted groups to say the administration needs to do much more in making payment data broadly accessible and transparent.
Under the FOIA's privacy exemption, some of the doctor’s information may be kept from public view if the damage to physician privacy is deemed greater than the public interest. Disclosure of the doctor’s data will exclude patients information; however, the information released will depend on the outcome of the “balancing test”, which varies by circumstance, analysis, facts, and per case. In all cases, the HHS says they “are committed to protecting the privacy of Medicare beneficiaries.”
In addition, the Center for Medicare & Medicaid will begin “aggregating” data sets about Medicare physician services, 60 days after the new policy appears in the Federal Register.
Disclosure of doctor payment data “from government healthcare programs must be balanced against the confidentiality and personal privacy interests of physicians and patients who may be unfairly impacted by disclosures” says Dr. Ardis Dee Hoven, president of the AMA, who has long opposed the release of data.
Over the past 3 decades, Medicare physician-payment data has been highly sought by media groups, government watchdogs and private organizations. They argue that the disclosure of information informs consumers of a doctor’s competence, performance, and highlights any possible abuse or fraud. The release of information should only be done in the efforts of “improving the quality of healthcare services and with appropriate safeguards,” Hoven said.
Critics against disclosure argue that the release of information would reveal proprietary details the general public does not need to know, and that inaccurate data presentation would damage a doctor’s reputation.
In spite of responding to Freedom of Information Act requests for physician-payment data, the government is not planning to put the entire Medicare physician-payment data online in a searchable format. It will require individuals seeking data to submit specific request under the FOIA’s. Any information that gets released will be filtered and judged by its worthiness, and will take physicians privacy concerns into consideration.
On May 2013 a 1979 federal injunction ruling, that barred the release of Medicare payment data and identified doctor’s specifics, was dissolved by U.S. District Judge Marcia Morales Howard in Jacksonville, Fla., ruling on the grounds that physicians' privacy concerns no longer outweighed the public interest.
Following the ruling, CMS followed suit to and decided to release physician-payment data, citing disclosure under the Freedom of Information Act. Disclosure of the data will be determined on the outcome of the “balancing test,” as a result every case will be treated as an individual basis (FR Doc. 2014-00808).
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Question: Will disclosing physician fees help stop Medicare fraud and save money in the long run or will it have an adverse effect and persuade more physicians to stop accepting new Medicare patients?
| Big plans to change the way how the private Medicare sector pays brokers and agents are underway and set to appear in the Federal Register on Friday.
The Centers for Medicare & Medicaid Services (CMS), an arm of the U.S. Department of Health and Human Services (HHS), has included the compensation proposals changes in a batch of regulations that deals with the governing rules of the Medicare wellness program, its incentives and the provisions meant to prevent and attack fraud.
The addendum targets current compensation practices of brokers and agents who sell Medicare Advantage plans -- commercial, CMS-subsidized plans that replace traditional Medicare coverage -- and Medicare Part D prescription drug plans.
A yearly “fair market value” limit for producer compensation is what CMS wants, states the proposed regulations.
In 2014, $400 per year may be considered the fair market value. A plan possibly paying a first year commission that was any amount less than or equal to the fair market value limit, officials say.
Commission increase could reach up to 35 percent of the fair market value limit in the following calendar year and the subsequent years. For instance, if in 2014, a producer sold a plan and collected in commission equal to $400, or collected 100% of fair market value, and if the fair market value for 2015 rose to $500, the 2015 year commission would be $175 or 35% of $500 and not 35% of $400 fair market value of previous year, officials say.
Many current plans pay 50% in renewal commission for the first-year commission during policy years two through seven, followed by a 25% of the first-year commission in the later years
CMS goal is to simplify the commission calculations and level out the playing field. The way to do this is by setting all renewal commission to 35% of the fair market value limit, officials say.
To further even out the field, official want to cap out referrals fees at $100 for producers; which, CMS recommended a $100 cap in a memo in 2011.
This recommendation is due to the different ways carriers handle referrals, officials say.
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Question: Will overhauling the Medicare broker compensation even out the playing field, or will it hurt the industry and discourage top producers from reaching or exceeding their goals?
| Happy New Years from Precision Senior Marketing; It is that time of year to start off with a clean slate.
If you have not already done so, take the time to reflect on 2013 and take note of the hurdles and successes that made the business year memorable.
Make this the perfect time set new goals. Look at the BIG picture, be considerate and write down what is important to you, what you want to achieve, and the timeframe you want to achieve the goal(s).
Most importantly, if you want to succeed, focus and follow through.
Below are Five Golden Rules to Set Yourself Up for Success:
1. Set Goals as Motivators
Motivation is key to the success of reaching your goals. The goals you set should be important and in high value to you. If you set goals that are irrelevant to or of little interest, chances are there will be little or no devotion to achieving your goals.
To maximize your success for goal setting, make sure you write the reason why it's valuable and important to you.
2. Set SMART Goals
"SMART goals" are powerful goals; these goals designed to be Specific, Measurable, Attainable, Relevant, and Time Bound.
3. Write down your Goals.
Physically write down your goals. The simple act of writing makes your goals more real and it subconsciously makes it a high priority job that needs attention and tending. When writing use words that express, empowerment, desire, willingness and gives you no room for slacking or derailing from your ultimate goals. For example, “I will increase and convert my leads to sales by 40% this year,” rather then, “I would like to” or “I may.”
Once you have the goals written, post them in a visible place where you can be constantly reminded of what is intended to do. Keep the visual on a wall, desk, a screensaver, anywhere it can be a constant reminder.
4. Create an Action Plan.
Actions plans are your smaller steps or smaller goals the lead to the ultimate goal. Think of them as the steps of a ladder. By writing down a series of steps and crossing those out as you reach your action goals; you’ll get a better visual progression of your hard work and efforts.
5. Follow through!
It can’t be over emphasized, follow through the entire course. Set reminders and check periodically to see where you stand in relation to your goals. Review your goals and make the necessary adjustments to stay on course. Don’t get stressed burning your energy on the outcome. Instead focus on the smaller steps (action plan) that will get you to all the way to your final goal.
Remember, without goals, there is no plan…there is no focus...there is no purpose to succeed.
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Question:Do you feel the SMART Goal steps may help your organization layout a better goal plan for 2014, if so, let us know if the full list or partial section will be utilize?
| Seven in ten pre-retirees plan to work past the median age of 65; while 37% of retirees’ decision who opted for this approach was based to address post-retirement health care risks and financial management needs in retirement.
In a report by the Society of Actuaries (SOA), “2013 Risks and Process of Retirement Survey,” provides insights on how Americans decide to retire and how they manage resources in retirement.
The survey's findings include:
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Question: Will pro-longing retirement help seniors save money for post-retirement health care risks and financial management needs?
| Efforts to replace the Medicare physician payment formula for this year have all but been scrapped. Lawmakers have refocused their efforts and the new deadline for the doctors’ payment formula is 2014.
In a rare bipartisan, bicameral approach the Senate Finance and the House Ways and Means committees are to vote next week on a proposal that would repeal the Sustainable Growth Rate and formulate a new payment method for doctors and hospitals that treat Medicare patients.
The committee votes comes at the heels before Congress leaves town for the year and Capitol Hill is in a rush for a “quick patch” to prevent a 20.1 percent cut due in January to the current payment formula. I a short-term patch is not passed, Medicare could be put on hold until an quick fix is reached.
Earlier this year there was a major push to send the proposal to the president’s desk before year-end and eliminate the massive budget cuts that followed. Current goals have changed in both political parties and are working in an effort to pass the legislation in the committees this year and the Senate and the House in 2014.
In spite the effort to move the payment proposal forward, it is running into some resistance over policy and payment. Lawmakers and aids are in turmoil on how to approach Sustainable Growth Rate (SGR), said Rep. Jim McDermott, top Democrat on the Ways and Means Health Subcommittee and a physician. Pessimism on getting the formula repealed due to dispute over how to pay for it is also high.
“I don’t think they’re going to get a permanent fix,” he said. Republicans “won’t talk real revenues. They’re talking about taking it out of the hides of old people, and that’s not going to happen.”
Adding into the challenge of policy making, The House Republican Doctors Caucus is coming up with their plan, similar to other proposals. The House leaders know that gaining broader support and approval for the SGR replacement plan could be harder if it is not accepted by the GOP Doctors, said Rep. Phil Roe (R-Tenn.), co-chairman of the caucus. “The other members are going to say if the doctors aren’t for it; I’m not for it,” he said.
For years, Members of the Senate Finance, Ways and Means and House Energy and Commerce committees have wanted to repeal the Medicare formula, but there was no real support for the change. That’s because there was no real alternative system in place and repeal was estimated to cost $300 billion or more.
This year the effort got revitalized when the Congressional Budget Office scored repeal at $139 billion and consensus began to form around a replacement plan.
A repeal bill was unanimously passed this summer by The Energy and Commerce Committee and in October, the top Republicans and Democrats on the Finance and Ways and Means committees released a joint proposal will go before Finance on Dec. 12 and is estimated around the $200 billion.
But all focus remains on the “quick patch” for the impending cut and long-term goal of repealing the formula once and for all.
A three-month patch is sought by several leaders on Finance and Ways and Means and physicians. This would force lawmaker to vote for a new SGR bill, keep the cost down and finalize permanent repeal instead of repeat the entire cycle again.
Others would like to prolong the patch as long as they can afford it giving them time to fix the most controversial element of the patch, the payment method, including House Republican leaders, Roe said.
Providers wouldn’t be given too much stability with a short-term patch. The worst that can happen is after Congress did a quick fix, they would fail to reform the payment method.
In either case, this is a very important time, this opportunity for permanent reform should not be left to pass or “let it slip away,” said Bob Doherty, American College of Physicians lobbyist.
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Question: Should the Senate Finance and the House Ways and Means committees’ vote for “quick patch” to prevent a 20.1 percent cut due in January, or should go past 2013 and focus on getting the current payment formula reformed?
| Medicare, the U.S. health care insurance that provides benefits to seniors over 65, and to certain individuals who qualify for the program at an earlier age, has been on the cross hairs of the Congressional Budget Office (CBO), who have been questioning whether it is time to phase in and raise the eligibility age to 67.
With millions of baby boomers retiring and enrolling into Medicare program, and the recent Medicare spending explosion, is threatening the stability of the U.S. economy.
Projection of Medicare spending in the coming decades is expected to continue to exceed domestic per capita growth. Further adding to the growth is increase of life expectancy, translating to; the cost of Medicare has increased along with the life span of the people covered since the program began in 1965.
Currently, there is a two prong camps for and against rising the eligibility age of Medicare. One side says that raising the age would save around 3 million a year or about $19 billion, between 2016 and 2023. This would reduce our current deficit to about 1% (our current deficit is $680 billion). Others argue that it is not fair for people to wait two extra years to qualify for Medicare. And that increasing the age would shift the cost to those ages 65 to 66. Seniors would incur an increased out-of-pocket expense of $3.7 billion, and employers tab would increase to 4.5 billion and states would face increased Medicare cost, estimates the Kaiser Family Foundation.
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Question: What’s your stance on rising the eligibility age to 67? By rising the age and saving 1% on the deficit, will this help our economy or will it dig the U.S. economy deeper into a hole?
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|As seniors reach 65 many are faced with a lot of questions about their health, health coverage, and the many plans accessible to them. Currently there has been a tremendous enrollment increase for Medicare Advantage (MA) plans or Medicare Plan C as they are known. This growth has been on the rise since 2004, and it currently makes up about 25 percent of traditional Medicare enrollee opting for MA plans, reports the Kaiser Family Foundation. This trend has more the doubled beneficiaries’ enrollment from 5.3 million to 13.1 million in 2012.
According to the Congressional Budget Office, Medicare Advantage enrollment is expected to grow from 14 million, in 2013, to 21 million by fiscal year 2023.
What it means to seniors?
More and more seniors choose to enroll in Medicare Advantage plans because these plans provide comprehensive medical coverage which are of higher-quality care, with better services, and provide additional benefits. These plans are also used by elderly and people with disabilities to cover additional medical expenses that Medicare does not already cover. Additionally, MA plans are more likely to be purchased by healthy seniors than other supplemental insurance options because these policies are more affordable on a monthly basis.
Cost savings is the driving force behind the increased enrollment of Medicare Advantage plans. With Medicare’s Part A, the insured is provided with inpatient hospital care; however, the enrollees are stuck to cover fluctuating deductibles associated with this plan yearly. Part B covers doctor’s expenses and preventive services, such as, flu. Medicare Part C is the Med Advantage plan that covers the additional expenses not covered by both Part A and B plans, excluding End-Stage Renal.
Further savings can be seen with MA premiums. The Kaiser Family Foundation reports that 50% of seniors enrolled in Medicare Advantage plans have no extra premiums, and two-thirds enrolled in the HMO Advantage plans pay nothing extra.
What does this growth mean to private insurers?
Earlier this year the House mandated a proposal that would make payment cuts to MA plans beginning 2014. By law, Medicare Advantage plans are required by law, to lower cost as much as 7 to 8%, and use 85 percent of their revenue on medical care and quality improvement efforts. Those who fail to meet the requirements will be prohibited from accepting new enrollees, and their plans will be terminated after five years of noncompliance.
However, that proposal changed when the Centers for Medicare and Medicaid Services (CMS) decided to increase payments by 3.3 percent. The proposed change could average $50 or more per month for a Med Advantage enrollee. According to the CMS, the change was made to improve program stability and payment accuracy.
Selling Medicare Advantage plans is not as simple as having a basic health insurance license. By law, CMS requires agents, brokers and all licensed sales representatives to complete a CMS certification program before any marketing and selling can be done.
Additionally, with the certification comes responsibility. It is very important for agents to educate enrollees to what exactly the products they are buying.
Another factor private insurer’s face is the CMS Complaint Tracking Module. The CTM is a complaint tracking module used to track the accuracy of incidents and complaints, responses to those complaints and to ensure compliance.
With the advancement in technology, private insurers should embrace the latest technologies to facilitate the response time to any compliance needs. And with the help of their well-trained CMS certified representatives and producers, they should be able to quickly address any concerns or request their clients may have.
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Question: Do you feel that the CMS abrupt change to increase MA payments by 3.3% will further encourage the quality of care seniors receive? Will this help insurers improve CTM compliance?
| The Centers for Medicare & Medicaid Services (CMS) have decided to keep Medicare Part B monthly premiums at bay.
Medicare Part B helps pay for physician services, medical supplies, and other outpatient services not covered by Medicare Part A service plan.
In 2014, the monthly base actuarial rate for seniors’ participants will be $209.80 per month, while those low to moderate-income enrollees will pay premiums at $104.90.
2013 monthly premium levels remain unchanged and the $147 deductible will continue for Part B plans per year.
Less relevant to participants are the Medicare Part A hospitalization premiums, this is highly due to about 99% of Medicare enrollees qualify for Part A coverage without having to pay a premium, says CMS.
In a notice published at the Federal Register, October 30, CMS notice, CMS-8055-N, enrollees that do pay monthly premiums will range between $15 $426 in 2014.
An income-related monthly adjustments amount has been imposed by the Medicare program on beneficiaries with an annual taxable income less than or equal to $85,000 or joint annual taxable income less than or equal to $170,000, is $104.90.
The most a Medicaid enrollee can pay in monthly premium is $335.70, with an annual taxable income greater than $214,000 or joint annual taxable income greater than $428,000.
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Question: Do you think the government will keep Medicare Part B premiums at bay in 2015 or will there be a premium hike?