Monthly Archives: June 2015

CMS must do more to stop Medicare Part D fraud, OIG says – Modern Healthcare

Two new federal reports shine a light on questionable billing patterns across the country in regards to Medicare Part D and urge the CMS to do more to protect the program.

The reports, released Tuesday by HHS’ Office of Inspector General, come days after federal officials announced charges against 44 people across the country for fraud in Medicare Part D, which is Medicare’s drug benefit program. Those charges represented the first large-scale, federal effort to focus on Medicare Part D fraud—an effort many say is likely to continue.

One of the reports (PDF) released Tuesday shows that more than 1,400 pharmacies had questionable billings for opioid drugs, and a number of cities had higher than average billings for certain medications last year. The second report (PDF) calls on the CMS to implement more of the OIG’s recommendations for fighting fraud and abuse in Part D.

Source: CMS must do more to stop Medicare Part D fraud, OIG says – Modern Healthcare

The Risk Adjustment Scoring Scam — A Medicare (Dis) Advantage

Medicare Advantage, a managed care program created to save the government money, is losing anywhere from $2 billion to $10 billion a year from overbilling.That’s the staggering conclusion by the National Bureau of Economic Research (NBER), which recently published a report analyzing how private insurance companies that run Medicare Advantage health plans may be gaming the system to inflate so-called “risk adjustment” payments they receive from the government.Medicare Advantage was supposed to realize cost savings by shifting government healthcare spending from a “fee-for-service” model to a capitated managed care approach. More than 17 million people are enrolled in Medicare Advantage plans — about a third of those eligible for Medicare.The capitation payments to private insurers are based, in part, on the enrollees’ health risks. Payments to Medicare Advantage plans are influenced by “risk scores” that take into account differences in patients’ medical diagnoses and health outcomes. The sicker the patient, the higher the “risk score” assigned. For example, a depression diagnosis that is reclassified as a “major” depression would receive a higher risk score. Higher risk scores, in turn, generate increased risk adjustment payments by the federal government to the Medicare Advantage insurance plans.

Source: The Risk Adjustment Scoring Scam — A Medicare (Dis) Advantage

Thompson Medicare Advantage bill passes House

The Increasing Regulatory Fairness Act (H.R. 2507), co-authored by Rep. Kevin Brady (R-Tex.) would expand an annual comment period for proposed payment rates and regulatory changes for Medicare Advantage plans, according to the announcement.

“This legislation will double the time that stakeholders have to provide constructive feedback on Medicare Advantage rates and policy changes,” Thompson said in the announcement. “As more Medicare beneficiaries sign up for Medicare Advantage, it is important that stakeholders have time to provide thoughtful input so that access to Medicare Advantage plans can keep pace with the growing number of enrollees.”

Each year, the Centers for Medicare and Medicaid Services publishes its Medicare Advantage call letter and rate notice, outlining payment rates and changes for the nearly 2,000 such plans.

to read the original article click the link below…

Source: Thompson Medicare Advantage bill passes House

FL Medicare Insurance Agent – V.Reed Speas II – Plan F HDF

V. REED SPEAS II IS A LICENSED MEDICARE INSURANCE AGENT WITH OFFICES LOCATED IN FORT MYERS AND FORT LAUDERDALE, FL.

 

He provides Medicare recipients with a simplified explanation of the 4 parts of Medicare and the insurance options available. Reed will explain how you can protect yourself from medical bills with a Florida Medicare Supplement Plan F and how a healthy individual can save money each year by paying lower monthly premiums on a Medicare Supplement High Deductible Plan F. He also will broker Medicare Part D plans for his clients to insure they do not over pay for prescription drug coverage. Appointments can be scheduled by calling the office, sending an e-mail, or by filling out the form below.Call 239 288 0880 today for an appointment

Source: FL Medicare Insurance Agent – V.Reed Speas II – Plan F HDF

Study finds high Medicare Advantage copays for hospital, nursing care

Millions of seniors with Medicare Advantage plans, including more than a million with low incomes, were on the hook to have large out-of-pocket costs for a 27-day course of hospital and skilled nursing care, according to a new study.
“Policymakers are very concerned about how much Medicare beneficiaries need to spend for essential medical services,” said Dr. Amal Trivedi, associate professor of public health at Brown University and corresponding author of a new study in the June issue of the journal Health Affairs. “It’s one of the goals of insurance—to protect people from large, catastrophic out-of-pocket expenses.”
Copays, or cost-sharing, can limit health care usage if the high out-of-pocket costs they engender discourage consumers from engaging certain services. In the new study the researchers focused on a sequence of services that is medically important, difficult to predict, expensive, and common.
What the data showed is that on average in 2011, seniors in Medicare Advantage plans that had lower premiums were expected to pay $1,785 for a week in the hospital and 20 days in skilled nursing, which are typical stays in the aftermath of catastrophic incidents such as stroke, congestive heart failure, or a hip fracture, Trivedi said. People in plans with higher premiums faced an average copay of $1,446.
Medicare Advantage copays were just as high for members who receive federal subsidies because their incomes are between the poverty level and 150 percent of poverty, added study lead author and Brown doctoral student Laura Keohane.
“For low-income beneficiaries, these copayments for inpatient and skilled nursing care could be more than a month’s worth of income,” Keohane said.
Seniors with traditional Medicare would pay a $1,132 for a week in the hospital and 20 days in skilled nursing, plus additional copayments for physician services while hospitalized.
“The perception out there is that Medicare Advantage offers more generous benefits than traditional Medicare without supplemental coverage but for long inpatient stays and long stays in a skilled nursing facility, that’s generally not the case, we found,” Trivedi said.
For shorter stays in the hospital and in skilled nursing facilities, Medicare Advantage copays were lower than those of traditional Medicare. Because many Medicare Advantage plan copays rise with the length of hospital or skilled nursing stays, the average costs for only three days in the hospital were $544 for low-premium plans and $511 for those with higher premiums.
Despite policy protections
Keohane, Trivedi, and their co-authors considered the issue in the context of federal policy changes starting in 2011. In that year, federal officials restricted some cost-sharing levels and imposed a cap of $6,700 on total out-of-pocket costs and restrictions on copays in Medicare Advantage plans, with the intention of protecting consumers. Some plans already offered members a cost sharing limit at an allowed level, but others did not. Under the new regulations, Medicare Advantage plans that agreed to a lower cap of $3,400 could gain more leeway regarding how they could revamp their cost-sharing. Traditional Medicare has no cap on out-of-pocket expenses.
To conduct their study, the authors looked at the anonymized records of more than 8 million Medicare Advantage enrollees and the pricing structures of their plans, both before and after the federal policy changes. The seniors were enrolled in 1,841 Medicare Advantage plans, including 333 specialized plans.
The researchers’ analysis calculated what average customers were expected to pay for hospital and skilled nursing care based on their plan terms and whether they received subsidies, for instance for Part D drug coverage, because of low income. One set of findings were the Medicare Advantage costs and how they compared to traditional Medicare. But the researchers also examined the specific impact of the 2011 policy changes.
That analysis showed that among Medicare Advantage members in low premium plans that already had an out-of-pocket limit, fewer than a third of members had increased copays for hospital or skilled nursing care after the policy change and more than a third of members had a reduction in copays. But among those members for whom the out-of-pocket caps were new, 55 percent had increased copayments for hospital stays and 46 percent had greater copays for skilled nursing. Fewer than one in six of members in plans with new out-of-pocket limits had lower cost-sharing.
The study data suggest that imposing an overall cap on out-of-pocket costs may have resulted in many plans increasing copays for hospital and skilled nursing care, but it does not explain why. To finance the expense of adding an out-of-pocket limit, Medicare Advantage plans may have raised copays.
Trivedi and Keohane hypothesize that greater copayments for hospital and skilled nursing care may dissuade people who are more sick (and more expensive to cover) from enrolling in some Medicare Advantage plans or cause those receiving these services to exit their plan. No one can predict a catastrophic need for hospitalization, but a sicker person may be more likely to be deterred from a plan with higher copays for such care.
Ultimately the authors said they hope policymakers will look at whether more needs to be done to protect Medicare Advantage consumers, particularly ones with low incomes, from high out-of-pocket costs for unpredictable catastrophic illnesses such as the ones that result in long hospital and skilled nursing stays.

Source: Study finds high Medicare Advantage copays for hospital, nursing care

Why are Medicare Advantage co-pays so high?

Millions of seniors with Medicare Advantage plans, including those who live just above the poverty line, are on the hook to pay significantly larger out-of-pocket costs for a 27-day course of hospital and skilled nursing care than those with traditional Medicare.

“Policymakers are very concerned about how much Medicare beneficiaries need to spend for essential medical services,” says Amal Trivedi, associate professor of public health at Brown University. “It’s one of the goals of insurance—to protect people from large, catastrophic out-of-pocket expenses.”

Co-pays, or cost-sharing, can limit health care usage if the high out-of-pocket costs they lead to discourage consumers from using certain services. In a new study, researchers focused on a sequence of services that is medically important, difficult to predict, expensive, and common.

MORE THAN A MONTH’S INCOME
What the data showed is that on average in 2011, seniors in Medicare Advantage plans that had lower premiums were expected to pay $1,785 for a week in the hospital and 20 days in skilled nursing, which are typical stays in the aftermath of catastrophic incidents such as stroke, congestive heart failure, or a hip fracture, Trivedi says. People in plans with higher premiums faced an average co-pay of $1,446.

Medicare Advantage co-pays were just as high for members who receive federal subsidies because their incomes are between the poverty level and 150 percent of poverty, says doctoral student Laura Keohane, lead author of the study in the journal Health Affairs.

“For low-income beneficiaries, these co-payments for inpatient and skilled nursing care could be more than a month’s worth of income.”

Seniors with traditional Medicare would pay a $1,132 for a week in the hospital and 20 days in skilled nursing, plus additional co-payments for physician services while hospitalized.

“The perception out there is that Medicare Advantage offers more generous benefits than traditional Medicare without supplemental coverage but for long inpatient stays and long stays in a skilled nursing facility, that’s generally not the case, we found,” Trivedi says.

For shorter stays in the hospital and in skilled nursing facilities, Medicare Advantage co-pays were lower than those of traditional Medicare. Because many Medicare Advantage plan co-pays rise with the length of hospital or skilled nursing stays, the average costs for only three days in the hospital were $544 for low-premium plans and $511 for those with higher premiums.

POLICY PROTECTIONS
The researchers considered the issue in the context of federal policy changes starting in 2011, when federal officials restricted some cost-sharing levels and imposed a cap of $6,700 on total out-of-pocket costs and restrictions on co-pays in Medicare Advantage plans, with the intention of protecting consumers.

Some plans already offered members a cost sharing limit at an allowed level, but others did not. Under the new regulations, Medicare Advantage plans that agreed to a lower cap of $3,400 could gain more leeway regarding how they could revamp their cost-sharing. Traditional Medicare has no cap on out-of-pocket expenses.

To conduct the study, the authors looked at the anonymized records of more than 8 million Medicare Advantage enrollees and the pricing structures of their plans, both before and after the federal policy changes. The seniors were enrolled in 1,841 Medicare Advantage plans, including 333 specialized plans.

The analysis calculated what average customers were expected to pay for hospital and skilled nursing care based on their plan terms and whether they received subsidies, for instance for Part D drug coverage, because of low income. One set of findings were the Medicare Advantage costs and how they compared to traditional Medicare.

SICKER PATIENTS
But the researchers also examined the specific impact of the 2011 policy changes.

That analysis showed that among Medicare Advantage members in low premium plans that already had an out-of-pocket limit, fewer than a third of members had increased co-pays for hospital or skilled nursing care after the policy change and more than a third of members had a reduction in co-pays. But among those members for whom the out-of-pocket caps were new, 55 percent had increased co-payments for hospital stays and 46 percent had greater co-pays for skilled nursing. Fewer than one in six of members in plans with new out-of-pocket limits had lower cost-sharing.

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The study data suggest that imposing an overall cap on out-of-pocket costs may have resulted in many plans increasing co-pays for hospital and skilled nursing care, but it does not explain why. To finance the expense of adding an out-of-pocket limit, Medicare Advantage plans may have raised co-pays.

The researchers hypothesize that greater co-payments for hospital and skilled nursing care may dissuade people who are more sick (and more expensive to cover) from enrolling in some Medicare Advantage plans or cause those receiving these services to exit their plan. No one can predict a catastrophic need for hospitalization, but a sicker person may be more likely to be deterred from a plan with higher co-pays for such care.

Ultimately the authors say they hope policymakers will look at whether more needs to be done to protect Medicare Advantage consumers, particularly ones with low incomes, from high out-of-pocket costs for unpredictable catastrophic illnesses such as the ones that result in long hospital and skilled nursing stays

Source: Why are Medicare Advantage co-pays so high? – Futurity

Medicare Supplement Deductible Plan F Agent – Florida

  • REED SPEAS IS A LICENSED INSURANCE AGENT LOCATED IN FORT LAUDERDALE, FL.

    He provides Medicare recipients with a simplified explanation of the 4 parts of Medicare and the insurance options available. Reed will explain how a healthy individual can save money each year by paying lower monthly premiums on a Medicare Supplement Deductible Plan F. He also will broker Medicare Part D plans for his clients to insure they do not over pay for prescription drug coverage. Appointments can be scheduled by calling the office, sending an e-mail, or by filling out the form below.

    Call 239 288 0880 today for an appointment

    CLICK HERE TO GET A MEDICARE HIGH DEDUCTIBLE PLAN F QUOTE

  • REED SPEAS
    MEDICARE INSURANCE AGENT

    Fort Lauderdale, FL
    Florida License # W029777

    239 288 0880Telephone:
    239 275 9967FAX:
    V.Reed.Speas@gmail.comE-mail:

    INSURANCE PRODUCTS

    Medicare Supplements: Plan F, High Deductible Plan F, Plan N
    Medicare Part D plans
    Dental Insurance
    Life Insurance

Source: Medicare Supplement Deductible Plan F Agent – Florida

Medicare Supplement Advisor | Insurance Agent Fort Myers – Cape Coral

Medicare Insurance Agent – V. Reed Speas II

Van “Reed” Speas II

Fort Myers Insurance Agent(239) 288 – 0880
1228 Shadow Lane
Fort Myers, FL 33901
www.FortMyersInsuranceAgent.com
Florida License # W029777

V. Reed Speas II is an Insurance Agent, serving the greater Fort Myers – Cape Coral area, who exclusively sells Medicare Supplemental Insurance. Reed offers a full explanation of the four parts of Medicare and the insurance options available to a Medicare recipient. Reed also offers an expert recommendation on choosing a Medicare Part D plan that is the least expensive for your specific prescription drugs.

 

Medicare Supplemental Insurance policies in Fort Myers – Cape Coral start at$62.00 Monthly.

 

Medicare Supplement Advisor.org

This website is designed to help Americans understand the four parts of traditional Medicare and the insurance options available to Medicare recipients. On the top of this web page you will find tabs to learn about: Traditional Medicare Part A and B, Medicare Advantage Plans, Medicare Part D prescription drug coverage, Local Insurance Agents, and Medicare Q and A section with an on-line form to ask question. On the lower left side of this page you will find the official Medicare and you handbook as well as other helpful informational documents to help you make decisions on Medicare insurance.  The bottom of this page is dedicated to Florida Medicare Supplemental Insurance; this website was started in Florida and still provides services to many Floridians.

Source: Medicare Supplement Advisor | Insurance Agent Fort Myers – Cape Coral

Proposed Medicare Cut Dies on House Floor

A proposal to take a tiny slice out of Medicare payment rates died a complicated death — at least for now — in the House of Representatives today, much to the relief of organized medicine.The rate reduction — 0.25% from October 2024 through March 2025 — was part of the Trade Adjustment Assistance Reauthorization Act (TAA), designed to help American workers who might lose their jobs because of international trade bills passed by Congress. The TAA was one half of a bill called the Trade Act of 2015. The other half would give the Obama administration fast-track authority to negotiate international deals such as the Trans-Pacific Partnership, now under discussion.The Trade Act of 2015 easily passed in the Republican-controlled Senate last month. However, it encountered stronger opposition in the House from Republicans unwilling to give President Barack Obama more executive authority and Democrats standing up for labor unions, which feel threatened by the legislation.Defying both the president and GOP leadership, the House rejected the TAA portion of the bill today in a 126-to-302 vote while passing the trade authority portion 219 to 211. House Republican leaders said they would schedule another vote for the TAA to give the White House more time to rally Democratic support, according to The Hill. Democrat nays had outnumbered yeas 144 to 40.Lawmakers included the Medicare pay cut in the TAA because it would have offset $700 million of its cost. The reduction represented a short-term extension — and shrinkage — of an across-the-board budget cut called sequestration that’s in effect through fiscal 2024. The annual sequestration cut for Medicare stands at 2%.Even if the House were to pass the TAA the second time around, the 0.25% Medicare pay cut probably would never see the light of day. In response to critics who said that Medicare funds should be left alone, the House approved yet another trade bill yesterday — this one focused on Africa — that would have nullified the rate reduction in the TAA and substituted another “pay-for.” Senate Majority Leader Mitch McConnell (R-KY) indicated that his chamber will give this measure speedy consideration.Medical societies such as the American Medical Association and the American Academy of Family Physicians had objected to the proposed Medicare cut. They said that, although it was small, it would set a precedent for raiding Medicare whenever lawmakers needed to balance the budget.

Source: Proposed Medicare Cut Dies on House Floor

Replacement Medicare cards available online

The Social Security Administration introduced the expansion of online services available through its my Social Security portal available at www.socialsecurity.gov/myaccount. Medicare beneficiaries can now get a replacement card if they have lost, damaged or simply need to replace one online using a my Social Security account.

Requesting a replacement card through my Social Security account is a convenient, cost-effective and secure way to ensure Medicare beneficiaries have a critical piece of identification available when required by medical providers as proof of Medicare coverage. Simply access your online my Social Security account atwww.socialsecurity.gov/myaccount and select the “Replacement Documents” tab. Then, select “Mail my replacement Medicare card.” After you request a card, it will arrive in the mail in about 30 days.

My Social Security is a secure, online hub for doing business with Social Security, and more than 19 million people have created an a personal account. Current Social Security beneficiaries can manage their account—change an address, adjust direct deposit, obtain a benefit verification letter, or request a replacement SSA-1099. Account holders still in the workforce can verify their earnings, and obtain estimates of future benefits. In addition to those existing services, Medicare beneficiaries will now be able to request a replacement Medicare card without waiting for a replacement form in the mail.

For more information about my Social Security or to establish an account visit www.socialsecurity.gov/myaccount.

Source: Social Security: Replacement Medicare cards available online – Terre Haute Tribune Star: Business News