But something unusual happened just before Congress left for its summer break. The House Energy and Commerce Committee voted 51-0 for a bill that would overhaul the way Medicare pays doctors. The bill would, among other things, repeal something called the sustainable growth rate formula (SGR) and eventually replace it with a system that would pay doctors based on how healthy they keep their patients. The current formula has threatened to cut physician pay, often by double-digit rates, for each of the past dozen years. "Since its passage in 1997, SGR has bred uncertainty and frustration," said Energy and Commerce…
The government estimates that it loses some $60 billion a year to Medicare fraud and waste, and as it gears up to launch its giant health care reform program to provide affordable coverage for every American, putting a stop to this is at the top of the agenda. One of the ways Medicare officials hope to do this is by turning the 50 million beneficiaries of the senior health insurance program into fraud fighters. This summer, Medicare redoubled its efforts to get them involved by redesigning a claims statement, known as the Medicare Summary Notice, with larger print and a…
Former Medicare chief Dr. Donald Berwick said Obama administration officials should abandon a rule that is leaving many older Americans without coverage for expensive rehabilitation care after they leave the hospital. The Medicare rule requires recipients to be admitted as a hospital inpatient for at least three days before the federal health insurance program for seniors and the disabled will pay for follow-up nursing home care. The problem is that an increasing number of patients are spending days in the hospital under “observation’’ status, often without realizing they were never officially admitted. “The patient ends up holding the bag and…
The U.S. Department of the Treasury and the Internal Revenue Service (IRS) has ruled that same-sex couples, legally married in jurisdictions that recognize their marriages, will be treated as married for federal tax purposes. The ruling applies regardless of whether the couple lives in a jurisdiction that recognizes same-sex marriage or a jurisdiction that does not recognize same-sex marriage. A press release by the Treasury Department says that the Department and the IRS will use a “place of celebration” rule in recognizing same-sex unions (recognition that was illegal before the Supreme Court struck down part of the Defense of Marriage…
Continuing Education Seminar A certificate for 3 Free Category 1 CEU's for Social Workers will be provided with the completion October 2013 9:30 A.M. Registration and Lunch 10 A.M.-1 P.M. Program 1420 Spring Street, Silver Spring, MD 20910 Reuben Rosenfeld Center Director 301.920.9765 Medicare 2014 Part A, Part B, Part C, Part D, Medigap/Supplement The Patient Protection and Affordable Care Act Purpose: To help attendees better understand the Medicare Benefits changes of 2014 Exchanges, Penalties, Waiting Periods, Pre-existing Conditions, Speakers: Jack Davidson CHC; CPDSP AQC Health Networking and Consulting LLC David Wingate, Elder Care Attorney Elder Law Office…
Facing major budget and staff cuts, federal officials are scaling back several high-profile health care fraud and abuse investigations, including an audit of the state insurance exchanges that are set to open later this year as a key provision of the Affordable Care Act. The Department of Health and Human Services’ Office of Inspector General, which investigates Medicare and Medicaid waste, fraud, and abuse, is in the process of losing 400 staff members, about 20 percent of its workforce from its peak strength of 1,800 last year. About 200 will have departed by the end of the year, and the…
When President Lyndon B. Johnson signed Medicare and Medicaid into law on July 30, 1965, he stated, “No longer will older Americans be denied the healing miracle of modern medicine. No longer will illness crush and destroy the savings they have so carefully put away over a lifetime so they might enjoy dignity in their later years. No longer will young families see their own incomes, and their own hopes, eaten away simply because they are carrying out their deep moral obligations.” As a result of these two programs, millions of Americans have been able to gain access to the…
A federal advisory panel said that Congress should move immediately to cut payments to hospitals for many services that can be provided at much lower cost in doctors’ offices. The Medicare Payment Advisory Commission said the current payment disparities had created incentives for hospitals to buy physician practices, driving up costs for the Medicare program and for beneficiaries. Hospital buyouts of doctors, turning independent practitioners into hospital employees, have also led to higher spending by private insurers and higher co-payments for their policyholders, the commission said. Congress often adopts ideas suggested by the commission, and hospital executives fear that could…
As part of the annual update to inpatient hospital reimbursement under the Medicare program, CMS is again considering observation status. This time, CMS is proposing "a time-based presumption of medical necessity for hospital inpatient services based on the beneficiary's length of stay" (78 Fed. Reg. 27486, 47644 (May 10, 2013)). Under the proposed rules, Medicare would presume that an individual is an inpatient if the physician documents that the patient requires more than two midnights in the hospital following an inpatient admission. The "starting point for this time-based instruction would be when the beneficiary is moved from any outpatient area…
For the first time, the federal government has publicly announced what hospitals bill Medicare for the 100 most common diagnoses and treatments. The information shows hospitals across the country — and across Alaska — bill dramatically different prices for the same things. Hospital veteran Rick Davis, the CEO of Central Peninsula General Hospital in Soldotna, was eager to review the on hospital charges as soon as it was out. "It's going to create ripples across the nation, really, on pricing," he says. "It does show some pretty big disparities between hospitals." For example, Alaska Regional in Anchorage charges Medicare $46,252…
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