Showing posts with label Medicare. Show all posts
Showing posts with label Medicare. Show all posts
Friday, September 27, 2024
Chevron's Fall: Medicare Set-Asides Face Legal Shake-Up
The recent U.S. Supreme Court decision in Loper Bright Enterprises v. Raimondo (2024), which overturned the Chevron doctrine established in Chevron U.S.A., Inc. v. Natural Resources Defense Council, Inc., is likely to have significant impacts on how the Centers for Medicare & Medicaid Services (CMS) operates regarding the Medicare Secondary Payer (MSP) Act, including conditional payments and Medicare Set-Aside (MSA) agreements.
Monday, September 10, 2018
CMS has scheduled another webinar for Wed., Sept 19, 2018
Commercial Repayment Center Portal (CRCP) Overview Webinar Wednesday, September 19 th, 2018 CMS will be hosting a webinar to present an overview of the Commercial Repayment Center Portal (CRCP) functions.
Friday, July 14, 2017
The Rise and Fall of Workers' Compensation - The Path to Federalization
Every year The Board of Trustees of the Federal Hospital Insurance and Federal Supplemental Medical Supplemental Medical Insurance Trust Funds makes an actuarial guess as to the future financial solvency of Medicare. The report creates an annual news frenzy in the workers’ compensation community since Medicare is both the safety net for injured workers and playground for employers and their insurance companies to use in cost shifting,
Saturday, June 17, 2017
Governor of Nevada Vetoes Single-Payer Legislation
Nevada Governor Brian Sandoval has vetoed legislation that would have established a single-payer Assembly Bill 374 would have expanded a Medicare-type health care insurance plan. coverage to provide health care coverage to all Nevada residents.
Sunday, February 26, 2017
The limits on a total permanent disability award
The New Jersey Supreme Court recently heard oral argument concerning the mathematical limits of a workers’ compensation total disability case. At the heart of the case is the issue of whether an injured worker could have an increase in a pre-existing permanent partial disability [PPT] claim, that existed prior to the last compensable injury which was to another part of the body. The last compensable claim rendered the worker totally and permanently disabled.
Thursday, February 16, 2017
The Consequences of TrumpMedical 2016–25: Price Increases, Aging Push Sector To 20 Percent Of Economy
Workers' Compensation medical expenses mirror some of the national health care projections. An aging workforce and the increased longevity of the population impacts overall all costs. Furthermore as the Affordable Healthcare Act's repeal has been anticipated by the Republican Administration, medical care costs are anticipated to spiral. The draft release of the Republican proposal for a new national medical care system is now being revealed.
Directly and indirectly, workers' compensation coverage will feel the impact. For chronic condition denials, pre-existing condition denials and occupational disease denials, the safety net of Medicaid will be diminished and the workers' compensation system will again be the primary target for payment and litigation will increase logarithmically.
Saturday, February 11, 2017
Chaos in Workers' Compensation - Raising Medicare's Eligibility Age to 67
A new issue for workers' compensation programs is emerging as the Republicans push forward on their legislative agenda to reform Medicare. Uncertainty over the impact of raising the eligibility age for Medicare from 65 to 67 may seriously and adversely impact the nation's network of fragile workers' compensation schemes. Furthermore, looming in the background is also the elimination of The Affordable Care Act and the consequence of a large pool of uninsured again seniors.
Sunday, February 5, 2017
Judge Accepts Medicare’s Plan To Remedy Misunderstanding On Therapy Coverage
Today's post is shared from Kaiser Health News khn.org
"A federal judge has accepted Medicare’s plans to try once more to correct a commonly held misconception that beneficiaries’ are eligible for coverage for physical and occupational therapy and other skilled care only if their health is improving.
"'Confusion over the Improvement Standard persists,' wrote U.S. District Court Chief Judge Christina Reiss in Vermont in a decision released by the court Thursday. Advocates for seniors say coverage is often mistakenly denied simply because the beneficiary reaches “a plateau” and is no longer making progress.
"A federal judge has accepted Medicare’s plans to try once more to correct a commonly held misconception that beneficiaries’ are eligible for coverage for physical and occupational therapy and other skilled care only if their health is improving.
"'Confusion over the Improvement Standard persists,' wrote U.S. District Court Chief Judge Christina Reiss in Vermont in a decision released by the court Thursday. Advocates for seniors say coverage is often mistakenly denied simply because the beneficiary reaches “a plateau” and is no longer making progress.
Friday, October 7, 2016
US Department of Labor Urges Major Changes in the Nation's Workers' Compensation System
Monday, August 25, 2014
Medicare Star Ratings Allow Nursing Homes to Game the System
CARMICHAEL, Calif. — The lobby of Rosewood Post-Acute Rehab, a nursing home in this Sacramento suburb, bears all the touches of a luxury hotel, including high ceilings, leather club chairs and paintings of bucolic landscapes. What really sets Rosewood apart, however, is its five-star rating from Medicare, which has been assigning hotel-style ratings to nearly every nursing home in the country for the last five years. Rosewood’s five-star status — the best possible — places it in rarefied company: Only one-fifth of more than 15,000 nursing homes nationwide hold such a distinction. But an examination of the rating system by The New York Times has found that Rosewood and many other top-ranked nursing homes have been given a seal of approval that is based on incomplete information and that can seriously mislead consumers, investors and others about conditions at the homes. The Medicare ratings, which have become the gold standard across the industry, are based in large part on self-reported data by the nursing homes that the government does not verify. Only one of the three criteria used to determine the star ratings — the results of annual health inspections — relies on assessments from independent reviewers. The other measures — staff levels and quality statistics — are reported by the nursing homes and accepted by Medicare, with limited exceptions, at face value. The ratings also do not take into account entire sets of... |
Friday, August 22, 2014
Are Your Medical Records Vulnerable To Theft?
| This KHN story also ran in . It can be republished for free. (details) A decade ago almost all doctors kept paper charts on every patient. That is changing quickly as laptops become as common as stethoscopes in exam rooms. Recent hacking attacks have raised questions about how safe that data may be. Here are some frequently asked questions about this evolution underway in American medicine and the government programs sparking the change. Are my medical records stored electronically? At least some of the information you share with your doctor or any hospital or clinic where you’ve been treated is probably stored on a computer. It's pretty common for most hospitals, clinics and doctors’ offices to digitally store your basic information including your name, address and insurance company, the same way many retailers do. It's also likely that at least some information about your specific medical conditions is linked to that data. Health care providers have been using computers to help them get paid for decades. That means many computer-generated bills sent to you and/or your insurance company contain medical details like the conditions you were treated for, prescriptions and referrals to specialists. Where things are really changing quickly is in the use of electronic records for day-to-day patient care. Until recently, most doctors used paper charts to record information generated during patient visits. But the 2009 economic stimulus package offered doctors and... |
Wednesday, August 20, 2014
Questions About Who Should Perform In-Office Surgeries
Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org
One of the hopes embedded in the health law was to expand the role of nurse practitioners and physician assistants in addressing the nation’s shortage of primary care providers. But a new study questions whether that’s actually happening in doctors’ offices.
Of the more than 4 million procedures office-based nurse practitioners and physician assistants independently billed more than 5,000 times in a year to Medicare – a list including radiological exams, setting casts and injecting anesthetic agents – more than half were for dermatological surgeries.
That’s not surprising, according to Ken Miller, president of the American Association of Nurse Practitioners, because when patients are older, skin problems such as “boils, skin tags and warts” are pretty typical.
“I think that’s where you’re going to see the majority of procedures that are occurring both in primary care and in some of the other specialties like geriatric clinics,” he said.
The Aug. 11 study, published in the JAMA Dermatology analyzing 2012 Medicare claims, is suggesting that nurse practitioners and physician assistants should face higher regulation if performing surgical procedures.
The study’s lead author, Dr. Brett Coldiron, a dermatologist and clinical assistant professor at the University of Cincinnati, said while the “intent for...
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Thursday, July 31, 2014
Medicare Experiment Could Signal Sea Change For Hospice
| Diane Meier is the director of the Center to Advance Palliative Care, a national organization that aims to increase the number of palliative care programs in hospitals and elsewhere for patients with serious illnesses. Meier is also a professor of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai in New York City. We spoke about a recently launched pilot program under the health law that allows hospice patients participating in the pilot to continue to receive life-prolonging treatment. This is an edited version of that conversation. Q. There’s a lot of confusion about how hospice care differs from palliative care. Maybe we should start by clearing up what those terms mean. A. The short, quick elevator answer is that all hospice care is palliative care -- but not all palliative care is hospice. Palliative care is a team-based type of care focused on maximizing the quality of life for people and their caregivers at any stage of illness. It focuses on treating the pain, stresses and symptoms of serious illness. The emphasis is on need, not prognosis or how long you might have to live. In contrast, the hospice benefit, which was written into the Medicare statutes about 25 years ago, had a number of limits in it to control spending. Diane Meier (Photo courtesy of Mount Sinai Hospital) ... |
Tuesday, July 22, 2014
CA DWC Issues Notice of Public Hearing on September 3 for Proposed Workers’ Comp Benefit Notice Regulations Amendments
| San Francisco, CA (WorkersCompensation.com) - The Division of Workers' Compensation (DWC) has issued a notice of public hearing on proposed amendments to the Workers’ Compensation Benefit Notice regulations found in California Code of Regulations, title 8, sections 9810, 9811, 9812, 9813, 9814, 9815, 9881.1 and 10139. Formal notice of this rulemaking proceeding will be published in today’s California Regulatory Notice Register. A public hearing on the proposed regulations has been scheduled at 10 a.m., September 3 in the auditorium of the Elihu Harris State Office Building at 1515 Clay Street, Oakland, CA 94612. If public comment concludes before the noon recess, no afternoon session will be held. Members of the public may submit written comments on the proposed regulations until 5 p.m. that day. The rulemaking proposes to amend and update existing regulations requiring employers to serve notice on injured employees that they may be entitled to workers' compensation benefits. These notices deal with: the payment, nonpayment, or delay in payment of temporary disability, permanent disability, and death benefits; any change in the amount or type of benefits being provided; the termination of benefits; the rejection of any liability for compensation; and the requirement to provide an accounting of benefits paid. In addition, changes are also being proposed to the Notice to Employees Poster and the Notice of Potential Eligibility for Benefits and Claim Form. The... |
Saturday, July 19, 2014
California Dreamer: Recent Reform Too Good To Be True
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| California IMR-Source: CA DIR (7-2014) |
This week the California Division of Industrial Relations (CA DIR) published a report of the implementation status of recent workers' compensation reform legislation commonly referred to as SB 863 (2012 enactment).
The report concludes that it is still too early to determine whether or not the legislation produced a positive impact on the system. If delay and denial of benefits is what was intended, then from what has been heard on The Street, the legislation is a win.
Basically, the latest round of reform, crafted with very little public input and enacted in "the dead of night," was intended to curb and contain costs. The "innovative process" to limit escalating medical costs, probably the largest ticket item in the entire package, was to be limited going forward through a process termed Independent Medical Review (IMR). A theoretically system that removes the medical delivery decision from the adversary system, ie. get rid of the lawyers approach.
While it sounded great on paper, the process turned out to be a constitutionally challenged nightmare that ultimately delayed and denied benefits and added insult to injury for disabled workers. Employers and carriers started to challenge everything. No one wanted to take responsibility for medical care and the system suffered from compounding delay as everything seemed to be tossed in the IMR bucket.
California is particularly important as a model for workers' compensation. It is a national testing ground for innovation. It is a very large and extremely complex system, where even the exceptions to the rule have multiple exceptions. Luckily the California workers' compensation bar is well organized, educated, knowledgeable and skilled. Unfortunately, the numbers of expert workers' compensation lawyers continues to become fewer as firms backout of the system for lack of economic incentive to participate.
The CA DIR report released this week basically answers nothing about whether the system improved since the SB 863 was enacted. A few charts loaded with caveats only reflect a statistical vision of political hope for improvement that is diluted with a conclusion that it is too soon to tell if it is really working as promised.
The "promise" made by Industry to Labor in 1911 for system of remedial social legislation, ie. workers' compensation, seems broken. Recognizably the cycle after cycle in California of repeated efforts to readjust the system through major systemic efforts continue to compound failures.
It is far time that California stopped dreaming about improvements that appear too good to be true and start thinking creatively on how to craft an innovative system that meets the needs of ALL the stakeholders.
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Jon L. Gelman of Wayne NJ is the author of NJ Workers’ Compensation Law (West-Thompson-Reuters) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thompson-Reuters). For over 4 decades the Law Offices of Jon L Gelman 1.973.696.7900 jon@gelmans.com have been representing injured workers and their families who have suffered occupational accidents and illnesses.
Thursday, July 17, 2014
Retiree Health Plans Considered
Today's post was shared by CRR Boston College and comes from squaredawayblog.bc.edu
 Dave Gardner says: The health exchanges are also a help to many retirees losing group coverage. It is also an alternative to COBRA or state benefits continuation. This is especially true for those who can qualify for a premium subsidy (tax credit) based on income. Still, it is hard to tell retirees their loss of benefits has a “silver lining.” Most will not see it that way. Between the availability of the exchanges, premium subsidies and continued “dumping” of group health for Medicare eligible coverages, it is no surprise major corporations favored the ACA. In a number of ways, this is another example of passing the buck to govt. to pay i.e. privatizing profits while socializing losses. Corporate welfare is still welfare. Eventually Elizabeth Warren, Ralph Nader and the Tea Party will realize they share common ground here. |
Monday, June 30, 2014
Medicare Takes Bigger Bite Out California Workers Compensation
Medicare has doubled its reimbursement recover from California workers' compensation claims in a single year according to a report released today. The 100% increase in California from $3Million (2012) to $6Million (2013) illustrates the determinate of CMS (The Centers for Medicare and Medicaid Services) to end cost-shifting through strict enforcement of the Medicare Secondary Payer Act (MSP).
Since July 23, 2001(The date the Patel Memo was issued) a dramatic increase in the elimination of the Federal "subsidy" of future medical care for compensable work-related conditions has also been reported. In California a 40% increase has been also reported in the last year from $92Million to $129Millon for Medicare Set Aside Agreements.
Click here to read the entire report.
Related articles
Since July 23, 2001(The date the Patel Memo was issued) a dramatic increase in the elimination of the Federal "subsidy" of future medical care for compensable work-related conditions has also been reported. In California a 40% increase has been also reported in the last year from $92Million to $129Millon for Medicare Set Aside Agreements.
Click here to read the entire report.
….
Jon L. Gelman of Wayne NJ is the author NJ Workers’ Compensation Law (West-Thompson) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thompson). For over 4 decades the Law Offices of Jon L Gelman 1.973.696.7900 jon@gelmans.com have been representing injured workers and their families who have suffered occupational accidents and illnesses.
Related articles
Wednesday, June 25, 2014
Patient Injuries: Hospitals Most Likely To Be Penalized By Medicare
Medicare has identified 761 hospitals that are in line to be penalized for high rates of infections and complications this fall. Some of these hospitals may avoid the penalties in the fall after federal officials factor into their analysis an additional year of infections.
Below are the 175 hospitals that are most likely to be penalized because their preliminary scores are nine or above on a scale of 1 to 10. You can download the complete list of all hospitals here. You can also read the KHN story, KHN explanation of how the penalty program works, and look at the KHN analysis.
Source: Centers for Medicare & Medicaid Services
[Click here to see the rest of this post]
Related articles
- Medicare To Punish 2,225 Hospitals For Excess Readmissions (workers-compensation.blogspot.com)
- Rehospitalization Rates Fell In First Year Of Medicare Penalties (workers-compensation.blogspot.com)
- Nearly 1,500 Hospitals Penalized Under Medicare Program Rating Quality (workers-compensation.blogspot.com)
- Hospitals May Soon Be Reaching For The Stars (workers-compensation.blogspot.com)
- HHS Inspector General Scrutinizes Medicare Observation Care Policy (workers-compensation.blogspot.com)
- Medicare Seeks To Curb Spending On Post-Hospital Care (workers-compensation.blogspot.com)
Monday, February 10, 2014
‘Aid in Dying’ Sentiment Gathers Momentum
Thanks to the marvels of medical science, our parents are living longer than ever before. Most will spend years dependent on others for the most basic needs. That burden falls to their baby boomer children. In The New Old Age, Paula Span and other contributors explore this unprecedented intergenerational challenge. You can reach the editors at newoldage@nytimes.com.
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Thursday, February 6, 2014
No Judges, No Justice
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| The LHWCA covers claims for longshoremen and shipbuilding and repair workers. |
Some months ago, I reported about a slowdown in the processing of claims under the Longshore and Harbor Workers’ Compensation Act and allied statutes. The LHWCA was enacted in 1927, and through amendments over the years has been broadened to include injury and disease claims for longshoremen and shipbuilding and repair workers. Expansion of the program in 1941 resulted in the Defense Base Act, covering employees of military contractors working abroad. With our ten-year presence in Afghanistan and Iraq, a large cohort of injured workers has fallen under the DBA in recent years.
Underfunding of ALJ positions within the Department of Labor routinely results in long delays for the hearing and decision making in claims, often meaning claimants are without any coverage for years.In another segment of its Breathless and Burdened report (subsequent to the one I recently posted about, concerning how black lung victims are routinely having their claims denied as a result of coal company-sponsored evaluations at Johns Hopkins), the Center for Public integrity has now reported on the extreme reduction of the number of administrative law judges within the US Department of Labor who hear and decide claims under the LHWCA and DBA. The center reports that the number of ALJ’s, nationwide, it has fallen to 35, from 41 earlier in 2013 and 53 a decade ago. This has occurred in the context of a 68% rise of new cases before the office of administrative law judges, and 134% increase in pending cases.
Underfunding of ALJ positions within the Department of Labor routinely results in long delays for the hearing and decision making in claims, often meaning claimants are without any coverage for years. Longshore and military contractor employers and their insurance companies, knowing that the adjudicative process in contested claims has become ridiculously long, are emboldened to sit on monies that are clearly owed to injured workers. In addition to the injustice to entitled injured workers resulting from this administrative chaos, to the extent that an injured workers medical benefits and indemnity payments are pushed to other systems, such as Medicare, Social Security, and state disability systems, the costs of the Longshore system are shifted to the federal tax payer and away from the employers and their carriers who should appropriately bear the burden.
Read about the specifics of particular cases in the Center’s report here.
Photo credit: Markus Brinkmann / Foter.com / CC BY-SA
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