Workers' Compensation: Medicare

Showing posts with label Medicare. Show all posts

Monday, January 6, 2014

CMS Takes a New Direction in the Proposed MSP Appeal Process

The Centers for Medicare and Medicaid services (CMS) has proposed rules for the Medicare Secondary Payer (MSP) appeals process that will target the “applicable plan” as the primary responsible party for recovery.

Medicare, in pursuing recovery directly from the applicable plan, removes the beneficiary, as well as the provider or supplier, as the responsible party to initial a re-determination and all subsequent levels of the administrative process that could culminate in judicial review.

Docket ID:CMS-2013-0270

Topic(s):Administrative Practices and Procedures, Health Facilities, Health Professions, Kidney Diseases, Medical Devices, Medicare, Reporting and Recordkeeping Requirements, Rural Areas, X-Rays

Document Type:Proposed Rule

Received Date:Dec 27, 2013

Start-End Page:78802 - 78807

Comment Start Date:Dec 27, 2013

Comment Due Date:Feb 25, 2014

Click here to review the proposed rules.

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Sunday, January 5, 2014

Comments Medicare Program: Obtaining Final Medicare Secondary Payer Conditional Payment Amounts via Web Portal

Comments submitted concerning the Medicare Program: Obtaining Final Medicare Secondary Payer Conditional Payment Amounts via Web Portal are now available for review.

Summary

This interim final rule with comment period specifies the process and timeline for expanding CMS' existing Medicare Secondary Payer (MSP) Web portal to conform to section 201 of the Medicare IVIG and Strengthening Medicare and Repaying Taxpayers Act of 2012 (the SMART Act). The interim final rule specifies a timeline for developing a multifactor authentication solution to securely permit authorized users other than the beneficiary to access CMS' MSP conditional payment amounts and claims detail information via the MSP Web portal. It also requires that we add functionality to the existing MSP Web portal that permits users to: notify us that the specified case is approaching settlement; obtain time and date stamped final conditional payment summary forms and amounts before reaching settlement; and ensure that relatedness disputes and any other discrepancies are addressed within 11 business days of receipt of dispute documentation.

Docket ID:CMS-2013-0199

Topic(s):Kidney Diseases, Medicare, Physician Referral, Reporting and Recordkeeping Requirements

Document Type:Rule

Received Date:Sep 20, 2013

Start-End Page:57800 - 57806

Comment Start Date:Sep 20, 2013

Comment Due Date:Nov 19, 2013

Comments submitted included those of:

-Progressive Medical

-AAJ

-Property Casualty Insurers of America

-Crowe Paradis

-Franco Signor

-MARC

-CA State Compensation Fund

-NAMSAP

-DRI

-Allsup

-RIMS

-FCC

-Garretson Resolution Group

-AIA

-UWC

Click here to view all contents individually.

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Tuesday, December 31, 2013

Coordination of Benefits and Non-Group Health Plan Recovery Transition

The Centers for Medicare & Medicaid Services (CMS) is completing its restructuring of the Coordination of Benefits (COB) and Medicare Secondary Payer (MSP) recovery activities.

COB activities for both Group Health Plans and Non-Group Health Plans (that is, liability insurance (including self-insurance), no-fault insurance, and workers' compensation laws or plans) and Recovery activities for Non-Group Health Plans will be transitioned from the COB contractor and the Medicare Secondary Payer Recovery Contractor effective February 1, 2014. The new Benefits Coordination & Recovery Center (BCRC) will assume these activities. As previously announced, this action will provide:

Improved customer service for stakeholders
Consolidated and streamlined data collection and recovery operations
Value-added efficiencies and enhanced resource utilization

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Saturday, December 28, 2013

Senators Press Medicare for Answers on Drug Program

A Senate committee chairman said he is concerned about the “serious vulnerabilities” detailed in a ProPublica report about scams that target Medicare’s popular prescription drug program.

Sen. Tom Carper, D-Del., who chairs the Homeland Security and Governmental Affairs Committee, said in a statement that he plans to ask Medicare officials and the inspector general of the U.S. Department of Health and Human Services “to look into the specifics of these cases, as well as determine the extent of any program-wide vulnerabilities that may have allowed them to occur.” The committee monitors fraud in government programs.

ProPublica reporters, using Medicare’s own data, identified scores of doctors whose prescription patterns within the program bore the hallmarks of fraud. The cost of their prescribing spiked dramatically from one year to the next — in some cases by millions of dollars — as they chose brand-name drugs that scammers can easily resell.

The cost of medications prescribed by one Miami doctor jumped from $282,000 to $4 million in one year, but her lawyer said Medicare never questioned it. A Los Angeles psychiatrist said Medicare didn’t shut off his provider identification number, used to fill prescriptions, even though he claimed someone had forged his name on more than $7 million worth of them.

All told, just the schemes identified by ProPublica totaled tens of millions of dollars.

While credit card...

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Saturday, December 14, 2013

Congress Moves Closer To Changing How Medicare Pays Doctors

Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org

Key House and Senate committees approved legislation Thursday to repeal the Sustainable Growth Rate, the formula officials use to pay doctors who treat Medicare patients. KHN’s Mary Agnes Carey and Politico Pro’s Jennifer Haberkorn discuss.

>> Click here to download audio of the conversation.

MARY AGNES CAREY: Congress is one step closer to repealing the Sustainable Growth Rate, or SGR, Medicare's physician payment formula. Today key House and Senate committees approved legislation to repeal the formula and replace it with a different way to pay doctors who treat Medicare beneficiaries.
Politico Pro's Jennifer Haberkorn is covering that story and joins us now. Thanks for being with us.
JENNIFER HABERKORN, POLITICO PRO: Thanks so much for having me.
Today the Senate Finance Committee and, in the House, the Ways and Means Committee voted on a bipartisan basis to repeal the Medicare physician payment formula, also known as the SGR. How are those aproaches the same, and how do they differ?
JENNIFER HABERKORN: These bills are very similar. Both of them change the way that doctors are paid under Medicare and eliminate the Sustainable Growth Rate. That's the old formula under which Medicare pays doctors. Neither of them are paid for, which is going to be a significant issue, particularly for Republicans. And one of the big differences in the bills is that there's a permanent fix to a series of provisions that come up...

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New York Data Show Hospital Charges All Over The Map

Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org

New York State has pulled back the curtain on hospital charges with a new database showing what each hospital charges for 1,400 different procedures.

The differences can be dramatic: At Bellevue Hospital, the median charge for an uncomplicated birth is $6,330, and at NYU Langone Medical Center next door, the median charge is $12,222.

Lutheran Medical Center in Sunset Park, Brooklyn, typically charges $5,686 and Maimonides Medical Center, a dozen miles away, $14,763.

Patterns can be difficult to discern, and can vary from procedure to procedure. Overall, academic medical centers are more costly because of the additional staff needed for medical training, the greater use of technology, and the severity and complexity of patients.

But those factors do not account for why at Westchester Medical Center, the median charge for a vaginal delivery is $22,143, and at New York Presbyterian Weill Cornell Medical Center, it is $11,900.

The Greater New Hospital Association said the information is “complex and can be confusing,” because “hospital charges do not reflect the far lower payments hospitals actually receive for the services they provide.” Medicare and Medicaid reimburse much less than what hospitals charge, and insurers and managed care companies also negotiate rates that have little to do with what hospitals ask to be paid.

People without insurance, however, are subject to these sticker prices. In practice, hospitals typically...

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When Life Goes On, and On ...

The debate over a longer lifespan confronts many issued including medical costs, insurance coverage and quality of life. Workers' Compensation programs pay for lifetime care also in most instances. Today's post is shared from the NYTimes.org .

To the Editor:

Re “On Dying After Your Time,” by Daniel Callahan (Sunday Review, Dec. 1): Mainstream aging research neither promises radical immortality nor seeks to keep old people sick longer. Aging is a driving factor in the most prevalent and costly chronic diseases. Research indicates that interventions slowing aging delay the onset of these diseases. Therefore, they extend not only life span but also health span, the disease-free and functional period of life.
Fundamentally, the goals of aging research are not dissimilar from efforts to prevent or treat Alzheimer’s or other chronic diseases in that they both seek to improve quality of life in the elderly. The difference is that interventions in aging may prevent not just one but a range of debilitating diseases simultaneously.
The reality is that the world is rapidly getting older. With baby boomers leaving the work force, there won’t be enough workers to pay the ever-increasing Medicare costs of the retired. Extending health span will lower Medicare costs and allow aging people to stay engaged.
Interventions that slow human aging will provide a powerful modality of preventive medicine: improving quality of life by keeping people...

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Tuesday, December 10, 2013

Rehospitalization Rates Fell In First Year Of Medicare Penalties

Today's post was shared by Kaiser Health News and comes from capsules.kaiserhealthnews.org

During the first eight months of this year, fewer than 18 percent of Medicare patients ended up back in the hospital within a month of discharge, the lowest rate in years, the government reported Friday. This drop occurred during the first year that Medicare financially penalized hospitals for their readmission rates, and the government seized on the decrease as evidence the incentives are having an effect.

revolving door300

The government is targeting rehospitalizations as a significant indicator of gaps in medical quality in the nation’s hospitals. While some elderly patients inevitably return to the hospital, the government and some researchers believe many of those returns are avoidable if hospitals monitor patients after their release to ensure they get appropriate medications and follow-up visits with doctors.
In the first year of the program, which began in August 2012, Medicare fined 2,213 hospitals—about two-thirds of those it evaluated— for higher than anticipated readmission rates. Last August, Medicare issued a second year of penalties against 2,225 hospitals. The maximum penalties created by the health law have risen from 1 percent of regular Medicare payments to 2 percent, and they will increase for a third and final time next August to 3 percent.
The new data reported by Medicare show that readmission rates for the first eight months of 2013 dropped below 18 percent, half a percentage point below 2012’s rate of 18.5 percent. From 2007 to...

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Tuesday, December 3, 2013

Medicare Seeks To Curb Spending On Post-Hospital Care

Long term care is a huge part of medical care benefits. What Medicare ultimately does will control workers' compensation costs. Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org

After years of trying to clamp down on hospital spending, the federal government wants to get control over what Medicare spends on nursing homes, home health services and other medical care typically provided to patients after they have left the hospital.
Researchers have discovered huge discrepancies in how much is spent on these services in different areas around the country. In Connecticut, Medicare beneficiaries are more than twice as likely to end up in a nursing home as they are in Arizona. Medicare spends $8,800 on each Louisiana patient getting home health care, $5,000 more than it spends on the average New Jersey senior. In Chicago, one out of four Medicare beneficiaries receives additional services after leaving the hospital—three times the rate in Phoenix.

Medicare per capita spending on these services, collectively known as post-acute or post-hospital care, has grown at 5 percent a year or faster in 34 of the nation’s 50 most populous hospital markets in recent years, according to an analysis health care economist Chapin White conducted for Kaiser Health News.
Last year $62 billion — one out of every six dollars Medicare spent in the traditional fee-for-service program — went to nursing and therapy for patients in rehabilitation facilities, nursing homes, long-term care hospitals and in their own homes, according to a congressional advisory panel.
Most of them got those services after coming out of the hospital. Some of these...

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Friday, November 22, 2013

California Doctors Prescribe More Name-Brand Drugs Than Any Other State

Today's post was shared by Huffington Post and comes from www.huffingtonpost.com

The only thing that perhaps matched the vastness of the spread or the depth of the traction of the "death panel" lie was the predictability that such a lie would come to be told in the first place.

After all, this was a Democratic president trying to sell a new health care reform plan with the intention of opening access and reducing cost to millions of Americans who had gone without for so long. What's the best way to counter it?

Tell everyone that millions of Americans would have increased access ... to Death! The best account of how the "death panel" myth was born into this world and spread like garbage across the landscape has been penned by Brendan Nyhan, who in 2010 wrote "Why the "Death Panel" Myth Wouldn't Die: Misinformation in the Health Care Reform Debate."

Medicare’s Failure to Track Doctors Wastes Billions on Name-Brand Drugs

Versions of this story were co-published with Digital First Media websites and newspapers, with public radio station WNYC in New York and with American Public Media’s Marketplace.

Medicare is wasting hundreds of millions of dollars a year by failing to rein in doctors who routinely give patients pricey name-brand drugs when cheaper generic alternatives are available.
ProPublica analyzed the prescribing habits of 1.6 million practitioners nationwide and found that a tiny fraction of them are having an outsized impact on spending in Medicare’s massive drug program.
Just 913 internists, family medicine and general practice physicians cost taxpayers an extra $300 million in 2011 alone by disproportionately choosing name-brand drugs. These doctors each wrote at least 5,000 prescriptions that year, including refills, and ranked among the program’s most prolific prescribers.
Many of these physicians also have accepted thousands of dollars in promotional or consulting fees from drug companies, records show.
While lawmakers bitterly disagree about the Affordable Care Act, Medicare’s drug program has been held up as a success for government health care. It has come in below cost estimates while providing access to needed medicines for 36 million seniors and the disabled.
But this seeming fiscal success has hidden billions of dollars lost to unnecessarily expensive prescribing over the program’s eight-year history.
The waste is exacerbated by a ...

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Thursday, November 7, 2013

For Many Workers, It’s Time To Consider Insurance Options

Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org

It’s annual enrollment time, the autumn period when many people with job-based health insurance ante up for another year.

Although news reports have fixated on the problems with the online health marketplaces that launched Oct. 1, for the vast majority of people that’s a nonissue. If they get insurance through a job at a company that has at least 50 employees, they probably won’t be using the marketplaces, also called exchanges.

That doesn’t mean people with employer-based plans are unaffected by the health law. As employers adjust plans to meet new requirements and try to reduce their costs, people can expect to see changes next year.

Overall, premium increases will be moderate in 2014, averaging 5.2 percent,according to a 2013 employer survey about planned health care changes by the human resources consultant Towers Watson. Last year, the increase was projected to be 5.9 percent in 2013.

But employers may raise rates disproportionately for spouses and dependents, the survey found. The health law requires plans to cover dependent children up to age 26, and most plans cover spouses too. But employers continue to try to minimize those costs by making it financially less attractive to employees to cover their family members. They may charge separately for each child on a plan, for example, or add a surcharge for covering a spouse who is also offered insurance through his or her own job. Some, such as UPS,have moved to cut off coverage...

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New WCMSA Reference Guide is Now Available

An updated Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide is now available in the Downloads section found at the bottom of this page. This version documents the current WCMSA review process and provides more detailed information on the actions performed by the Workers’ Compensation Recovery Contractor (WCRC).

CMS is currently working on additional enhancements to the WCMSA process. Stakeholders will be notified of these proposed changes prior to implementation. Please continue to monitor the WCMSA website for updates.

The following sections of the Guide have been enhanced or added:

9.4.1.1 – Most Frequent Reasons for Development Requests: The five most common omissions as provided by the WCRC.
9.4.2 – WCRC Team Background and Resources Used: The expertise of the WCRC reviewers as well as the resources used when reviewing a WCMSA.
9.4.3 – WCRC Review Considerations: Examples of the questions and factors that guide the WCRC’s review of WCMSA proposals. The overarching guidelines used in treatment allocations and pricing is also provided.
9.4.4 – Medical Review: A diagram and steps the WCRC follows in its medical review process with a general explanation of documentation requirements.
9.4.5 – Medical Review Guidelines: Considerations and examples in specific medical cases and topics.
9.4.6.1 – Prescription Drug Review: Details the process the WCRC follows in reviewing prescription medication allocations and the resources that may be used.
9.4.6.2 – Pharmacy Guidelines and Conditions: Discusses specific drug usage and pricing considerations.
10.1.8 – Pay history added to list of information needed for WCMSA submission.

Click here to read the guide.

Friday, November 1, 2013

Two Kinds of Hospital Patients: Admitted, and Not

Today's post was shared by The New Old Age and comes from newoldage.blogs.nytimes.com

Judith Stein got a call from her mother recently, reporting that a friend was in the hospital. “Be sure she’s admitted,” Ms. Stein said.
As executive director of the Center for Medicare Advocacy, she has gotten all too savvy about this stuff.
“Of course she’s admitted,” her mother said. “Didn’t I just tell you she was in the hospital?”
But like a sharply growing number of Medicare beneficiaries, her mother’s friend would soon learn that she could spend a day or three in a hospital bed, could be monitored and treated by doctors and nurses — and never be formally admitted to the hospital. She was on observation status and therefore an outpatient. As I wrote last year, the distinction can have serious consequences.
The federal Centers for Medicare and Medicaid Services tried to clarify this confusing situation in the spring with a policy popularly known as the “two-midnight rule.” When a physician expects a patient’s stay to include at least two midnights, that person is an inpatient whose care is covered under Medicare Part A, which pays for hospitals. If it doesn’t last two midnights, Medicare expects the person to be an outpatient, and Part B, which pays for doctors, takes over.
It’s rare to have hospital and nursing home administrators, physicians and patient advocates all agreeing about a Medicare policy, but in this case “there’s unanimity of dislike,” said ...

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Copyright

Monday, January 6, 2014

CMS Takes a New Direction in the Proposed MSP Appeal Process

Sunday, January 5, 2014

Comments Medicare Program: Obtaining Final Medicare Secondary Payer Conditional Payment Amounts via Web Portal

Tuesday, December 31, 2013

Coordination of Benefits and Non-Group Health Plan Recovery Transition

The Centers for Medicare & Medicaid Services (CMS) is completing its restructuring of the Coordination of Benefits (COB) and Medicare Secondary Payer (MSP) recovery activities.

Saturday, December 28, 2013

Senators Press Medicare for Answers on Drug Program

Saturday, December 14, 2013

Congress Moves Closer To Changing How Medicare Pays Doctors

New York Data Show Hospital Charges All Over The Map

When Life Goes On, and On ...

Tuesday, December 10, 2013

Rehospitalization Rates Fell In First Year Of Medicare Penalties

Tuesday, December 3, 2013

Medicare Seeks To Curb Spending On Post-Hospital Care

Friday, November 22, 2013

California Doctors Prescribe More Name-Brand Drugs Than Any Other State

Wednesday, November 20, 2013

Medicare’s Failure to Track Doctors Wastes Billions on Name-Brand Drugs

Thursday, November 7, 2013

For Many Workers, It’s Time To Consider Insurance Options

New WCMSA Reference Guide is Now Available

Friday, November 1, 2013

Two Kinds of Hospital Patients: Admitted, and Not

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Monday, January 6, 2014

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Tuesday, December 31, 2013

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