Posts Tagged ‘Affordable Care Act’

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

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

Preventive Services

Friday, June 24th, 2011

Preventive Services

The Centers for Medicare and Medicaid Services (CMS) released a new report showing that more than 5 million Americans with traditional Medicare – or nearly one in six people with Medicare – took advantage of one or more of the recommended preventive benefits now available for free because of the Affordable Care Act.   Medicare wants to raise awareness about all of the important preventive benefits now covered at no charge to patients, including the new Annual Wellness Visit benefit created by the Affordable Care Act.  

 “I am committed to ensuring that the Medicare beneficiaries we serve are aware of and take advantage of their Medicare preventive benefits.” Assistant Secretary for Aging Kathy Greenlee.

According to the report, over 5.5 million beneficiaries in traditional Medicare used one or more of the preventive benefits now covered. The covered services do not have co pays and include mammograms, bone density screenings, and screenings for prostate cancer. 

In 2011, Medicare began covering an Annual Wellness Visit at no cost to Medicare beneficiaries.  As part of that visit, beneficiaries and their physicians can review the patient’s health and develop a personalized wellness plan.  Over 780,000 beneficiaries received an Annual Wellness Visit between January 1 and June 10. Additionally, more seniors have used the Welcome to Medicare Exam this year. The Welcome to Medicare is a one-time preventive health exam available to enrollees in the first 12 months they have Part B.  66,302 beneficiaries had taken advantage of the benefit by the end of May 2011, compared to 52,654 beneficiaries at the same point in 2010 – a 26 percent increase.

The new annual wellness visit can help spark the beginning of an ongoing conversation between patients and their doctors on how to prevent disease and disability.  Patients should take advantage of this time by reviewing their histories and making sure their primary care doctor knows about their other providers and prescriptions. They can also talk about the pros and cons of getting an influenza, pneumococcal or hepatitis B vaccination, or find out whether a diabetes test, a bone mass measurement, or any of several cancer screenings would be right for them.  Thanks to the Affordable Care Act, Medicare now covers many of these services without cost to patients.

  You can find additional information on prevention benefits on line at www.Medicare.gov, and at www.healthcare.gov

Affordable Care Act: Fact 4

Thursday, April 7th, 2011

Affordable Care Act (ACA) Facts: Follow this Series

This is part 4 of our ongoing series, so please see Fact # 1 in a post dated, Feb 8, 2011, Fact # 2 in the post dated 2/24/11 and Fact # 3 in a post dated 3/8/11.

There is a lot of speculation and discussion about what affect health care reform legislation, the Affordable Care Act (ACA), will have on seniors and their families.

Fact # 4: The law will improve care for older adults in other ways besides changes to Medicare.

There are improvements beyond Medicare that will help you and your family.  In a previous blog post we discussed the long term care changes that will improve for older adults such as changes to Medicaid that will allow people the choice of home and community based care and regulations that will prevent a spouse from becoming impoverished if their spouse is receiving home and community based care through the Medicaid Program.

There are also measures written in the Affordable Care Act (ACA) that will help early retirees. To help offset the cost of employer-based retiree health plans, the new law creates a program to preserve those plans and help people who retire before age 65 get the affordable care they need. By providing financial relief to businesses that provide health coverage to early retirees, health reform will make it easier for early retirees to obtain health care coverage. Health insurance reform will guarantee that you will always have choices of quality, affordable health insurance even if you retire early and lose access to employer-sponsored insurance. It will create a health insurance exchange so you can compare prices and health plans and decide which quality affordable option is right for you.

The ACA also sets up protections for people with pre-existing conditions. The new law provides affordable health insurance through a transitional high-risk pool program for people without insurance due to a pre-existing condition. The Dept. of Banking and Insurance in NJ as already begun working on the high-risk pool program. Insurance companies will be prohibited from denying coverage due to a pre-existing condition for children starting in September, and for adults in 2014. Insurance companies will be banned from establishing lifetime limits on your coverage, and use of annual limits will be limited starting in September.

And if you are concerned for the young people in your life who may be struggling to find a job in this economy, the ACA didn’t forget them either. According to the Law, young people up to age 26 can remain on their parents’ health insurance policy starting in September of 2011.

Information in this blog was gathered from the Affordable Care Act, Centers for Medicaid and Medicare and the National Council on Aging.

Healthcare Reform information from

The White House:

http://www.whitehouse.gov/assets/documents/Pages_from_Health_Insurance_Reform_PDF-4.pdf

Medicare

http://www.medicare.gov/Publications/Pubs/pdf/11467.pdf

National Council on Aging

http://www.ncoa.org/public-policy/health-care-reform/straight-talk-for-seniors-on.html

Affordable Care Act (ACA) Facts: Fact # 3

Tuesday, March 8th, 2011

Affordable Care Act (ACA) Facts: Follow this Series

There is a lot of speculation and discussion about what affect health care reform legislation, the Affordable Care Act (ACA), will have on seniors and more specifically, Medicare. We decided to do a series of blog posts about the facts; this is part of our ongoing posts, so please see Fact # 1 in a post dated, Feb 8, 2011 and Fact # 2 in the post dated 2/24/11.

Fact: The law will make it easier to receive and pay for long-term care at home.

As we covered in our Medicare Myths post, Medicare does not cover long term care costs. Long term care in a facility or at home is often an out of pocket expense. The Affordable Care Act has some provisions (Section 2401-2403) that allow States to apply for Federal Funding to provide in home services. Some of these programs already exist in NJ and are open to those who have or are eligible for Medicaid. Starting in 2011, the Law allows States to apply for additional funding for these Medicaid programs, often referred to as, Waiver programs.

You may have heard about the new national long-term care insurance program called CLASS (Community Living Assistance Services and Supports). According to the ACA this will become available in 2013. Full and part-time workers with salaries of at least $1,200 per year will be eligible to participate in CLASS and may choose to have the premiums deducted from their paychecks. Non-working retirees are not eligible for the program. After you have participated in CLASS for at least five years and you can no longer perform basic activities (such as eating, dressing, or bathing, or if you have Alzheimer’s disease or other forms of dementia), you are eligible to receive a daily cash benefit. This cash benefit is expected to average $50 per day and can be used to pay for anything that will help you stay at home. Examples of things it will pay for include, home care services and equipment.

Beginning in 2014 the ACA specifies that more regulations be put in place to protect spouses of those who are receiving home care services. Sometimes referred to as, “Spousal Impoverishment” rules, some states, including NJ already have these in place for those who have a spouse living in a nursing home who needs to apply for Medicaid. What the regulations do is protect the money that the other spouse needs to remain living in the community, the ACA states that this should be extended to spouses that have an ill husband or wife at home who is in need of Medicaid services.

Information in this blog was gathered from the Affordable Care Act, Centers for Medicaid and Medicare and the National Council on Aging.

For more information:

A brochure from Medicare:

http://www.medicare.gov/Publications/Pubs/pdf/11467.pdf

Webpage from the National Association of States United for Aging and Disabilities (NASUAD):

http://www.nasuad.org/affordable_care_act/nasuad_materials.html

Answers from the National Association of Area Agencies on Aging (n4a):

http://www.n4a.org/advocacy/health-care-reform/

Straight Talk for Seniors from the National Council on Aging:

http://www.ncoa.org/public-policy/health-care-reform/straight-talk/

Details about the law at Heathcare.gov

http://www.healthcare.gov/law/about/index.html

Affordable Care Act (ACA) Facts: Part 2 in a Series

Thursday, February 24th, 2011

Affordable Care Act (ACA) Facts: Follow this Series

There is a lot of speculation and discussion about what affect health care reform legislation, the Affordable Care Act (ACA), will have on seniors and more specifically, Medicare. We decided to do a series of blog posts about the facts; this is our second post, so please see Fact # 1 in a post dated, Feb 8, 2011.

Fact # 2 The ACA will reduce Medicare spending growth, extend Medicare solvency and is projected to reduce the budget deficit.

While Medicare spending will continue to grow, over the next 10 years the healthcare law will slow the overall rate of growth. Average spending per person will grow at about 2% per year, according to the Congressional Budget Office (CBO) this is compared to the current rate of 4% per person per year. This slight decrease will be a result of reductions in waste, fraud and abuse.  The CBO also projects that the ACA will save Medicare about $400 billion over 10 years and will extend the solvency of the Medicare Trust Fund until 2026.

What you need to know:

In 2011, the ACA will slow payment increases that are made to Medicare providers such as, hospitals, nursing homes and home health agencies. Please note that doctors are not included in that group. The ACA does not reduce payments to your primary care doctor.

Also in 2011, payments to Medicare Advantage (MA) will be reduced. Approximately 25% of seniors are enrolled in MA plans, HMOs or PPOs offered by private insurance companies, the other 75% have traditional Medicare. The ACA will gradually lower payments made to MA plans, which on average cost 13% more than original Medicare. Another change that ACA makes to Medicare Advantage (MA) plans is that those plans will not be able to charge you more than what you would pay if you were on original Medicare for services such as kidney dialysis, chemotherapy, or skilled nursing home care.

Because of these laid out in the Law, MA plans may cut some of the extra benefits they offer that are not covered by traditional Medicare and some may increase their premiums. Please note that MA plans cannot cut any basic benefits under Medicare, such as doctor visits and hospital care. You will also have the same right to switch out of your MA plan to original Medicare, the new law will not affect your right to Medicare benefits.

Another way that Medicare savings will occur according to statements in the Affordable Care Act, is for higher income individuals to pay higher prescription drug premiums. This will affect about 5% of Medicare recipients in 2011, single people with incomes above $85,000 and couples with adjusted gross incomes above $170,000.

The ACA states that in 2014 a Payment Advisory Board will be created. This board of experts will recommend specific ways to reduce Medicare costs without cutting benefits or increasing out-of-pocket costs.

Information in this blog was gathered from the Affordable Care Act,  Congressional Budget Office, Centers for Medicaid and Medicare and the National Council on Aging.

For more information check out the following links:

A brochure from Medicare:

http://www.medicare.gov/Publications/Pubs/pdf/11467.pdf

Webpage from the National Association of States United for Aging and Disabilities (NASUAD):

http://www.nasuad.org/affordable_care_act/nasuad_materials.html

Answers from the National Association of Area Agencies on Aging (n4a):

http://www.n4a.org/advocacy/health-care-reform/

Straight Talk for Seniors from the National Council on Aging:

http://www.ncoa.org/public-policy/health-care-reform/straight-talk/

Affordable Care Act (ACA) Facts: Follow this Series

Tuesday, February 8th, 2011

There is a lot of speculation and discussion about what affect health care reform legislation, the Affordable Care Act (ACA), will have on seniors and more specifically, Medicare.

Fact # 1 ACA will not cut your basic Medicare benefits.

There are actually some improvements to Medicare benefits as a result of ACA. One immediate improvement, according¬†to the Law,¬†is more help with prescription drug coverage. In Medicare prescription drug coverage there is something commonly referred to as ‚Äúthe donut hole‚Äù which refers to a coverage gap where seniors end up paying 100% of prescription drug costs. The new law helps you pay these costs right away. If you enter the donut hole this year, Medicare will send you a check for $250. You don’t have to do anything to get the check. It will arrive around 45 days after you reach the gap. In 2011, if you enter the donut hole, you’ll pay only half of what your plan charges for brand-name drugs‚Äîa 50% discount. By 2020, the donut hole will be slowly phased out and completely eliminated because of the Affordable Care Act.

Also as a result of ACA, a free annual well visit is now available in 2011. The free annual wellness checkup will allow you and your doctor to develop a prevention plan to keep you healthy. And a range of prevention services, such as cancer and diabetes screenings, will be provided free, no more cost sharing.

Another improvement related to the ACA, better care when you get sick! 80% of older Americans, have at least one chronic medical condition such as heart disease, high blood pressure, or diabetes. If you are one of them, you probably see several doctors, who may not always work together. The law will invest in testing new models of care for people with chronic conditions in order to provide better care, better coordination, and more patient-centered services. If you must be hospitalized, the law also will help you return home successfully, and avoid going re-hospitalization, by providing incentives for hospitals to make sure that you get the services you need in your community and by teaching you ways to take good care of yourself.

There are more facts that seniors need to know about how the new healthcare legislation will impact you and your Medicare coverage, stay tuned for more information from NJFA.

The information in this blog was gathered from language in the Affordable Care Act, the Center for Medicare and Medicaid and the National Council on Aging.

For more information check out the following links:

A brochure from Medicare:

http://www.medicare.gov/Publications/Pubs/pdf/11467.pdf

Webpage from the National Association of States United for Aging and Disabilities (NASUAD):

http://www.nasuad.org/affordable_care_act/nasuad_materials.html

Answers from the National Association of Area Agencies on Aging (n4a):

http://www.n4a.org/advocacy/health-care-reform/

Straight Talk for Seniors from the National Council on Aging:

http://www.ncoa.org/public-policy/health-care-reform/straight-talk/