Posts Tagged ‘2012’

Medicare Billing Issues- Be Informed

Thursday, October 25th, 2012

Medicare Billing Issues

 In the August/September issue of Renaissance magazine (http://www.njfoundationforaging.org/Ren_AugSep_WEBa.pdf), NJFA featured an article on observation status at the hospital versus being admitted. The article talked about how this can not only mean that seniors would see a bill for the time spent at the hospital, but that it also affected Medicare’s coverage of post hospital treatment at a rehab facility.

Medicare Part A is your hospital insurance and covers inpatient admissions to the hospital. There have been a few articles and news stories about these instances where a hospital changes a patient to observation status and therefore Medicare A does not cover the stay consequently, the patient is left with a bill. Furthermore, if that patient might benefit from a stay in a Skilled Nursing Facility for rehabilitation, then Medicare will not cover that either as a 3 day inpatient hospital admission is required in order for Medicare to cover an inpatient rehab stay.

Another issue recently cited in a New York Times article is that the Federal Government is concerned with inaccurate billing and coding by hospitals due to the new electronic record system. They feel there may be “upcoding”- increasing the severity of a patient’s condition or treatment as a means of profit. The Federal Government is also concerned about “cloning”- where information about one patient is repeated in other records.

Certainly there are many advantages to electronic medical records, both in cost and efficiency. However there needs to be tight guidelines and monitoring of these practices to make sure that fraud or abuse are not taking place in the system. The Federal Government issued a letter to several National hospital associations indicating that they are concerned about accurate billing in use of the electronic medical records system.

What does this mean for Medicare recipients? Make sure you talk to your doctor and anyone treating you in the hospital. Being an educated patient is your best defense; asking the hospital staff what you are being tested for; having open communication about your status and asking if they’ve communicated with your primary physician. It is also important to review your Medicare statements when they come and if you see anything that you feel  is incorrect to report it.

Know your resources. You can contact the following organizations with assistance understanding or navigating your Medicare coverage, as well as report possible fraud or abuse or other concerns, such as appeals.

Medicare- http://www.medicare.gov or 1-800-MEDICARE

Medicare Rights Center- http://www.medicarerights.org/ or 1-800-333-4114

SHIP (Statewide Health Insurance Assistance Program) 1-800-792-8820

Senior Medicare Patrol- 887-SMP-4359

County Office on Aging- 1-800-222-3737

Fraud is still out there.

Thursday, September 27th, 2012

Fraud is still out there.

Scammers continue to target seniors.

The Certified Financial Planner Board of Standards, a non-profit organization, conducted a survey of financial planners. In this survey they found that seniors who become victims of financial abuse lose an estimated $140,500.

The financial planners surveyed indicated that seniors who were victims of “unfair, deceptive or abusive practices” were often scammed through misleading marketing schemes. As we have said before, there is no such thing as a free lunch. But often that is just what the scammers do is lure seniors in with a seminar where they get a free lunch. The catch is that is really a sales pitch for misleading or fraudulent investments. 73% of the advisors surveyed said they knew a senior that was invited to this type of “free lunch” seminar.

The financial advisors also stated that they knew of seniors getting unsolicited pitches at home through the mail, e-mail, or the phone. While these type of investment scams, reverse mortgage scams and even sweepstakes scams are prevalent, sometimes seniors are also victims of fraud committed by someone they know. Of the planners surveyed, 35 % of them reported that they knew of at least one case were an elder was the victim of financial abuse by someone they knew. And another 20% said that the perpetrator was the guardian or Power of Attorney for the senior.

And the types of fraud don’t end there either. 83% of the advisors surveyed stated that seniors have been scammed by other financial advisors. Just like the “free lunch” seminars, there are financial advisors out there that have offered inappropriate financial products to seniors, as well as, misrepresented or omitted information about the costs and risks of those products.

Despite the fact that these types of fraud result in big losses for seniors, only 16% actually report the abuse to authorities. Many things can deter seniors from reporting crime, if the perpetrator is a family member they may not want to press charges or they may be afraid to report them. Some seniors may be embarrassed to admit they feel for a scheme, for fear people will think they are feeble. Or, they may be experiencing cognitive impairment or dementia and don’t want to admit that either.

It is important to make sure the people you’ve selected or hired to help with your finances are trustworthy. It never hurts to obtain a second opinion about any investment advice. If you think you’ve been the victim of financial abuse or fraud, please report it. If you are concerned that a loved one may have been taken advantage of, encourage them to report it or make the call yourself.

You can report financial abuse to the police. You can also reach out to your County Office on Aging to find out about programs or services. To report any elder abuse concern please contact your County Adult Protective service agency.

To find your County Office on Aging phone # visit, www.njfoundationforaging.org/services.html or call 1-877-222-3737.

To find your County’s Adult Protective Service agency visit: http://www.state.nj.us/health/senior/adultpsp.shtml

or call 1-800-792-8820

Medicare Advantage- Beware of scare tactics

Thursday, September 20th, 2012

Medicare Advantage- Beware of scare tactics

What is Medicare Advantage? Medicare Advantage plans are private plans offered by insurance companies to replace your traditional Medicare benefits.

An advantage plan provides all the same benefits as traditional Medicare, such as doctor visits and hospital stays. Some plans may offer extra benefits that are not usually covered by Medicare, such as eyeglasses and hearing aids. Medicare Advantage plans come with a monthly premium that differs depending on the company and type of plan. The Federal Government pays the insurance companies to manage your care under a Medicare Advantage plan, instead of them managing it under traditional Medicare.

There have been some efforts to scare seniors into thinking that the Affordable Care Act (ACA) will change or effect their Medicare Advantage coverage. But you need to know the facts. The Affordable Care Act does not change any benefits guaranteed to Medicare recipients. This includes Medicare Advantage plans. What the ACA does change is the way the Medicare Advantage plans are paid. Starting in 2012, Medicare began reducing the extra government payments to insurance companies for Medicare Advantage plans. The reason for these plans have been made to reduce payments is because there is little evidence that better care was given to anyone on a Medicare Advantage plan. Medicare Advantage plans are eligible to receive bonuses if they provide quality care.

Enrollment in Medicare Advantage plans is low, even here in NJ, leaving some to question, what is the real advantage? Some may think having a commercial insurance company’s name on your card carries more weight than a Medicare card, but just like any commercial insurance plan, there are sometimes more hoops (referrals, prior authorizations) to jump through than there are with traditional Medicare.

What the Affordable Care Act does do for consumers who use Medicare Advantage plans is provide some protections. For example, Medicare Advantage plans are not allowed to charge more for services than traditional Medicare does. The ACA also has provisions to reduce out of pocket costs for patients using high-cost services like cancer treatment or dialysis. Under the ACA, Medicare Advantage plans have also been mandated to limit their administrative costs, as well as their profits. This measure is to ensure that the plans spend 85 % of their money on member benefits (that will start in 2014).

Rumors of Medicare Advantage consumers facing cuts to their benefits due to the ACA are rampant and intended to scare seniors. The truth is, every year the insurance companies are offered the choice to continue operating a Medicare Advantage Plan and to change the services offered under that plan (they are only required to cover what traditional Medicare covers). So, any year, not just this year, Medicare Advantage plans could chose to stop providing optional benefits such as eyeglasses.

So what does this all mean to you, the Medicare recipient? Well, if you are currently in a Medicare Advantage plan, your plan must send you a notice of any changes for 2013 by October 1, 2012. Make sure to read it carefully. Even if you are not currently in a Medicare Advantage plan, all Medicare recipients should go to www.medicare.gov to review both traditional Medicare and Medicare Advantage plans to compare and decide what is best for them. Open Enrollment is October 15 to December 7thand during that period you can decide to stay in the same Medicare Advantage plan you have now, change to a different Medicare Advantage Plan or switch to traditional Medicare. If you chose to switch to traditional Medicare, remember that if you had a Medicare Advantage plan that offered prescription drug coverage you will need to also enroll in a Medicare drug coverage plan and/or buy a Medigap supplemental policy.

 Detailed information about Medicare, Medicare Advantage, Medicare Drug coverage, Medigap plans and Open Enrollment can be found at http://www.medicare.gov/.

 For detailed information about the Affordable Care Act and seniors, visit www.ncoa.org/StraightTalk

For more information about the Affordable Care Act in general, you can visit, http://www.healthcare.gov/law/index.html

Boomer Alert: CDC Recommends Hepatitis C Screenings

Monday, August 27th, 2012

Boomer Alert: CDC Recommends Hepatitis C Screenings

The number of Americans dying from Hepatitis C related diseases nearly doubled from 1999 to 2007. And one in 30 baby boomers have been infected and might not even know it. These statistics come to us from the CDC who is now urging that baby boomers get tested for Hepatitis C. Baby boomers are defined as those born between 1945 and 1965.

It is possible that people were infected by blood transfusions, tattoos, piercing, shared razors, toothbrushes, even manicures. Of course other means of infection with Hepatitis C are sharing drug needles and sexual contact. This blood-borne virus can cause liver damage and it may take years for symptoms to appear. In addition to liver damage, Hepatitis C is linked to liver disease and liver cancer. The CDC estimates that more than 15,000 Americans die each year from Hepatitis C related illnesses.

Screening for Hepatitis C used to just be recommended for those at risk, like drug users. According to CDC, risk-based screening will continue, but is not sufficient alone.  More than 2 million U.S. baby boomers are infected with hepatitis C – accounting for more than 75 percent of all American adults living with the virus.  Studies show that many baby boomers could have been infected with the virus decades ago, did not perceive themselves to be at risk, and have never been screened.

The CDC estimates one-time Hepatitis C testing of baby boomers could identify more than 800,000 additional people with hepatitis C.  And with newly available therapies that can cure up to 75 percent of infections, expanded testing – along with linkage to appropriate care and treatment – would prevent the costly consequences of liver cancer and other chronic liver diseases and save more than 120,000 lives.

The CDC states that without some intervention the statistics will only get worse and the number of infected and the number of deaths will continue to rise. Another reason the CDC is recommending testing now for baby boomers is that there are two new drugs on the market. Treatment for Hepatitis can vary and after receiving results patients should consult with a physician to decide the best treatment plan for them.

More information about Hepatitis C is available at http://www.cdc.gov/knowmorehepatitis/

Foundation’s Annual Fall Event and Honoree Dinner Announced!

Tuesday, August 21st, 2012

Foundation’s Annual Fall Event and Honoree Dinner Announced!

The New Jersey Foundation for Aging (NJFA) will hold its 5th Annual Fall Fundraising event on Sunday, Oct. 21, 2012. The event will begin with a 2 pm Matinee at the George Street Playhouse to see the production, One Slight Hitch. The show is written by The Daily Show’s Lewis Black and is described as “a smart modern farce”.

Following the performance at the George Street Playhouse, guests will be invited to the Honoree Award Dinner at the Heldrich Hotel. This year NJFA is honoring Katherine M. Klotzburger, Ph.D., Founder, President and Executive Director of the Silver Century Foundation (SCF). After nearly four decades of devoting herself to social and political issues affecting women’s lives, Kay created the Silver Century Foundation in 2003. She brings her vast experience in advocacy, academia and consulting to helping others‚Äîwomen and men of all ages‚Äîsucceed in their quests to age well.

Dr. Klotzburger spent nearly 30 years in academic administration, primarily at the City University of New York, and as a management consultant specializing in organizational effectiveness and equal opportunity. She was the director of the CUNY Affirmative Action Office. She served as the coordinator of the American Council on Education’s program in the New York tri-state area, where she guided efforts to help women advance into major positions in academic administration. In addition to her work in the academic field, she founded Change-Agents, Inc., a management consulting practice providing consulting, counseling and training to colleges, small businesses and individuals wishing to make career transitions.

The Silver Century Foundation (SCF) promotes a positive view of aging. The Foundation challenges entrenched and harmful stereotypes, encourages dialogue between generations, advocates planning for the second half of life, and raises awareness to educate and inspire everyone to live long, healthy, empowered lives. SCF has provided key support for local senior transportation and to promote community dialogue on aging. SCP has partnered with the NJFA on projects related to mobility, public awareness and elder economics.

Dinner will feature an award presentation, a silent auction, a 50/50 raffle and a menu that is sure to please. More information, invitations and sponsorship opportunities are available by visiting our website, www.njfoundationforaging.org/events.html, or by calling the office, 609-421-0206 Or contact us by email: [email protected]foundationforaging.org

Many Considerations Regarding Social Security Benefits, Who Knew?

Monday, August 6th, 2012

Many Considerations Regarding Social Security Benefits, Who Knew?

File and Suspend. Sounds like orders for a top secret spy. But no, it is a term used in the world of Social Security benefits. File and suspend means that someone can apply for their Social Security Retirement benefits but then suspend receiving their payments. Why? Well some people want to delay collecting their Social Security because there is a retirement bonus for putting off collecting your benefits. The reason that some individuals may elect to file and then suspend those benefits is so a husband or wife can collect spousal benefits presently and the individual can still receive the delayed bonus when they unsuspended their benefits at age 70.

Confused? So were we. Upon reading about this in a Social Security advice column in the Trenton Times, we did some research. There is a lot of information online about Social Security benefits and financial advice regarding applying for your benefits. As always, we suggest you start at the source and only trust information from the Social Security Administration website. This page on the Social Security Administration website, http://www.ssa.gov/retire2/suspend.htm tells you about your option to suspend benefits and a few cautions before making your decision.

If you receive Medicare Part B, you will be billed directly by Medicare for that premium which is usually deducted straight from your Social Security payment. If you suspend and are not receiving a Social Security payment but still are enrolled in Medicare Part B you will be billed for your premium for that coverage. The other caution which may affect less people is that if you are an SSI recipient, suspending your Social Security Retirement benefit will make you ineligible for your SSI benefits.

So, if you want to hold off until age 70 to receive your Social Security Retirement benefits and receive  bonus for delaying your benefits, whatever the reason may be, you can do so by using the file and suspend method. If you have questions or need further advice contact the Social Security Administration online at www.ssa.gov, on the phone at  1-800-772-1213, or TTY number, 1-800-325-0778, between 7 a.m. and 7 p.m. Monday through Friday. You can also contact your financial advisor.

Be sure to read the next issue of Renaissance magazine for important information on financial planning, social security and more. Don‚Äôt know how to find it? Ask us at [email protected]

Communication

Wednesday, July 25th, 2012

Communication

¬†I recently read an article from the LA Times, that was run in the Living section of the Trenton Times on July 3rd. It was titled ‚ÄúGrandma, you’ve got mail‚Äù and told the story of seniors taking computer classes. The article was very interesting and there were some great quotes from both the student volunteers teaching the courses and the seniors taking advantage of them.

We’ve known for awhile that there is a “digital divide” among the generations. Certainly there are some more mature users of such technology was email, cell phones and even Facebook, gasp! But there are also those older adults that either fear the computer, or just have no interest. One quote from the LA Times piece that really caught my attention was this, “It scares me”, Edythe Eisenberg said of her iPad. “But when I call my kids and grand kids they don’t call me back, so I have to use e-mail.” This really touched me as a sad aspect of our growing reliance on computer technology and non-verbal communication.

I think technology is great and offering seniors a chance to learn how to use and not fear some of these new technologies is also great, if they want them. However, those of us that are caught up in the fast paced world of communicating with our friends and colleagues through mostly email, text or online chats should not forget the seniors in our lives that want to hear from us. Your mother, father, grandmother or grandfather shouldn’t feel forced to use a technology they don‚Äôt like just because it is the only way to hear from you. Pick up the phone and say, ‚Äúhey, how are you today?‚Äù Don‚Äôt miss that chance to learn something, help out with something or just connect, with an actual voice. It will be good for them and for you.

Technology is good for those who like it, but let’s remember to communicate to each other in the best way possible, which sometimes may be using the old fashioned telephone or dropping by for a face to face. But by all means if you grandma wants to be on Facebook, teach her how to get online! Who knows, maybe she’ll log on to match.com!

APPROVED CREDITS AVAILABLE FOR CPAs AND LAWYERS!

Wednesday, June 6th, 2012

APPROVED CREDITS AVAILABLE FOR CPAs AND LAWYERS!

The New Jersey Foundation for Aging (NJFA) is pleased to announce the upcoming session on recognizing cognitive impairments and their impacts when considering financial and estate planning needs. This session will be presented by national experts covering both the medical realities and the legal imperatives on June 19th at Baltusrol Golf Club.

The speakers include John Heath, MD, AGSF, clinician, researcher, and author of more than 60 articles. He will provide examples of conditions that may compromise clients: brain injury, stroke, Alzheimer’s, COPD, MS, Parkinson disease. These are just some of the many risk factors that may impact your client’s cognitive capacity.  Martin Shenkman, CPA, MBA, AEP, PFS, JD, who is legal practitioner and award winning author of more than 40 books on tax and estate planning will present practical steps to assess the client’s estate and financial planning needs, drafting steps, financial tools and legal safeguards to create to mitigate the risks clients with health challenges face.

Five million Americans are living with Alzheimer’s disease; 400,000 are living with Multiple Sclerosis; Parkinson’s disease affects 1% of those over age 65; 130 million Americans live with some type of chronic disease. Clearly, these health issues and others affect Estate Planning.

3 CPE hours approved for CPAs; 3 CEs approved for CFPs; 3 CLEs have been approved for attorneys.

The session is being held at the Baltusrol Golf Club, 201 Shunpike Road, Springfield, NJ 07081 on June 19th. To Register go to www.njfoundationforaging.org/events.html

As Senior Population Swells, State Needs to Lift Moratorium on Adult Day Care

Thursday, May 31st, 2012

As Senior Population Swells, State Needs to Lift Moratorium on Adult Day Care

¬†By Roberto Mu?±iz, President and CEO, The Francis E. Parker Memorial Home Inc.

 The NJ Department of Health and Human Services has documented the many financial abuses in the adult day care system, reporting numerous providers who have scammed Medicaid to reap small fortunes off the backs of taxpayers.

Negative stories abound in the media:   Day care providers telling the elderly to lie to state investigators about their needs, people with disabilities placed in wheelchairs when they are able to walk, and even one case where a client with alleged heart failure and severe asthma was spotted cutting the center’s grass.  All these examples illustrate the extent that unscrupulous providers will go to collect Medicaid payments.  

With investigators suspecting that nearly one-third of the state’s adult day care centers committed some form of Medicaid fraud, according to published reports, it was no surprise that the state stopped issuing new licenses for adult day care centers in 2008. And, in an April 16th decision, that moratorium will be in place until at least November 1st of this year.

But while the NJ Department of Health and Human Services remains hesitant to allow any new centers to open, the demand in New Jersey for home and community-based long term care services is growing and adult day care is a cost effective option.

 Adult day care centers, if operated honestly and ethically, are enormously beneficial.  They make life easier for older New Jerseyans, giving them a safe and supportive place to receive quality care throughout the day.  Services vary among centers, but include medical care, stimulating activities and exercise, and nutritious meals and snacks.  They also provide transportation within a designated service area, making care and support accessible, and give caregivers, such as a spouse or child, a break from 24-hour-a-day care.

 Center staff is trained to monitor medical issues and communicate changes in health to caregivers.  For example, a scratchy throat or a fever could ultimately become a costly stay in a hospital if left untreated. Having a hot, fresh, nutritious lunch supports a daily balanced diet minimizing risk of dehydration or malnourishment.  An engaging walk with friends around the grounds can replace another inactive hour in front of a television.

Adult care centers, which receive $78.50 a day from Medicaid for each person served, are saving taxpayers a small fortune. Consider this: if not for these adult day care centers, many more seniors would be placed in skilled nursing homes, where the government would be spending significantly more to care for them, 24 hours a day, seven days a week.  Aside from cost, adult day centers honor every senior’s wish to remain home for as long as possible.

  Around New Jersey there are a variety of adult day programs.  At Parker, we offer two types, supporting both the social and medical needs of seniors.   The social program available five hours each weekday is for socially isolated elderly, who need motivation and support to maintain an active lifestyle while managing aging issues. Participants benefit from the wellness center, take in a movie, use the hair salon, attend rehabilitation therapy and engage in a host of other stimulating activities. 

 We also offer a medical program, available eight hours each weekday that provides health services, such as monitoring glucose levels, managing medications and providing clinical support for elderly with functional or cognitive challenges. Additionally, the program provides many activities that support the social and emotional needs of participants. 

 In addition to the much needed respite from the challenges of daily caregiving, Parker offers supportive education to caregiver families and assistance with long-term care options as participant needs grow.   

 The time is now for New Jersey officials to plot a future for adult day care, as statistics show there are now 1.13 million seniors living in the state and the numbers are quickly growing. As the Baby Boomers age and hundreds of thousands of New Jerseyans require care, there will be an enormous burden placed on the system.

  We are grateful that the state identified the unethical sources of fraud in adult day health services, and put corrective actions in place.  Now it’s time for state officials to lift the moratorium on new adult day centers, so that more high quality adult day programs can become available. 

 As the state is encouraging long-term care funding to move to home-and-community based services, supporting the growth of adult day programs makes fiscal sense andis the right thing to do for a growing demographic of New Jerseyans who want to remain at home with the support of affordable community resources.  

Roberto Mu?±iz, MPA, LNHA, FACHCA

President and CEO, The Francis E. Parker Memorial Home, Inc.

¬†Roberto Mu?±iz has more than 20 years of senior executive experience with health care and long-term care service providers.¬†¬† In addition to his current role as Present and CEO of Parker, Mr. Mu?±iz is extensively engaged in leadership positions with several New Jersey state and national associations that foster the availability and quality of aging services.¬† Mr. Mu?±iz holds a bachelor‚Äôs degree in public health administration and master‚Äôs degree in public administration from Rutgers University. He is a licensed nursing home administrator (LNHA) in both New Jersey and New York states.

Roberto Mu?±iz is the Chair of the Board of Trustees of the New Jersey Foundation for Aging, Inc.¬†

NJFA’s 14th Annual Conference aims to bring you evidence based and successful community outreach models.

Friday, May 18th, 2012

NJFA’s 14th Annual Conference aims to bring you evidence based and successful community outreach models. One topic being covered on June 14th is community health and wellness.

Exercise can decrease bone loss, increase bone density, and reduce your risk of fractures. Exercise is not only good for the bones but also for your heart health, prevention of diabetes and many more positive outcomes.

 A complete exercise program should include weight-bearing, resistance, postural, and balance exercises, according to Margie Bissinger, Physical Therapist and presenter at this year’s conference.  The NJ Department of Health and Senior Services offers safe, peer led exercise programs such as, “MoveToday” that contain all of these elements.

Move Today is a 30-45 minute non-aerobic exercise class designed to improve flexibility, balance and stamina. Participants assess their health, physical well-being and intent to make behavior changes before and upon completion of the program. The exercises and guidelines are based on current nationally recognized standards and science.

Exercises can be done while sitting or standing. Classes are led by trained peer leaders and meet weekly or bi-weekly for twelve sessions. Program features include:

  • A brief education component focusing on an exercise-related topic.
  • Inexpensive exercise bands to gain maximum effect from resistance exercises.
  • A major focus on good posture and falls prevention.
  • An exercise intensity scale and a weekly exercise log to track participant activity.
  • A self-assessment process for participants to assess their health, physical well-being and intent for behavior change given both before and upon completion of the program.

At NJFA’s Annual conference on June 14th, you can hear from, Margie Bissinger the physical therapist who helping NJ develop these programs, as well as two practitioners, Lois Yuhasz and Susan Galatz who are involved in coordinating Move Today programs.

For more information about the conference and how to register visit: www.njfoundationforaging.org/events.html or call 609-421-0206.