Managing Medicare » General

Medicare billings now reported on federal Web site

jbaker — Wed, 14 Jun 2006 13:30:02 +0000

By KEVIN FREKING
THE ASSOCIATED PRESS

WASHINGTON – To help Americans become smarter health care shoppers, Medicare this month started publishing a range of what it pays for 30 common procedures and report how frequently hospitals perform them.

The release of the information fits with the Bush administration’s strategy of moving more people into health savings accounts and high-deductible insurance policies. Such insurance policies require people to bear more of their initial medical expenses.

As more people buy such policies, the administration maintains, cost increases would slow because people would work harder to look for the best deal or decide they don’t really need a medical service after all.

The Medicare data – released June 1 – covers such procedures as heart operations, the implant of heart defibrillators and back and neck operations.

The most common elective surgery paid for by Medicare is the replacement of a hip or knee. The government information shows that those procedures cost an average of $11,761. Medicare paid between $9,992-$12,173, on average.

The Pueblo Chiefton

Medicare | House Democratic Caucus Asks CMS To Help Low-Income Medicare Beneficiaries Enroll in Prescription Drug Benefit

jbaker — Tue, 30 May 2006 18:18:52 +0000

Nearly 150 members of the House Democratic Caucus have sent a letter to CMS Administrator Mark McClellan urging him to take additional steps to enroll low-income beneficiaries in the Medicare prescription drug benefit, CQ HealthBeat reports. The letter asks CMS to take several steps, including working with the Social Security Administration to identify low-income beneficiaries who might be eligible for assistance with deductibles, premiums and copayments. Rep. Lloyd Doggett (D-Texas), a member of the House Ways and Means Subcommittee on Health, said, “The administration must make an extra effort to notify seniors entitled to extra help.” CMS spokesperson Jeff Nelligan said the agency will review the letter (CQ HealthBeat, 5/26).

Source: Kaisernetwork.org

Senators: Extend Part D Enrollment Deadline…

jbaker — Tue, 11 Apr 2006 17:40:02 +0000

New Jersey’s two U.S. senators on Monday called for the federal government to extend the May 15 deadline for senior citizens to enroll in the new Medicare prescription drug program, commonly called “Part D.”

Sens. Frank R. Lautenberg and Robert Menendez, both Democrat, said many senior citizens remain confused about the program and different prescription plans. In New Jersey, there are 19 providers offering 45 different prescription drug plans, the senators said.

Complete NorthJersey.com Story

Capitol Hill Watch | House Budget Committee Approves FY 2007 Budget Plan Without Medicare, Medicaid Cuts

jbaker — Thu, 30 Mar 2006 17:58:56 +0000

The House Budget Committee on Wednesday voted 22-17 along party lines to approve a $2.8 trillion fiscal year 2007 budget resolution that does not call for mandatory spending reductions to Medicare or Medicaid, CQ Today reports. President Bush in his budget proposal last month outlined $65 billion in spending reductions from Medicare and other mandatory programs over five years. The House resolution includes $6.8 billion in spending reductions to mandatory programs, but it “spar[es] politically sensitive programs such as Medicaid and Medicare,” CQ Today reports (Dennis, CQ Today, 3/29). Budget Committee Chair Jim Nussle (R-Iowa) and other House committee chairs “are still figuring out how to meet the $6.8 billion mandatory spending cut goal,” CongressDaily reports (Cohn, CongressDaily, 3/29). The House resolution adopts Bush’s proposed $873 billion cap on discretionary spending, which would increase 3.6% over last year (Dennis, CQ Today, 3/29). The plan includes a 7% increase in the core defense budget, not including war costs, meaning that domestic programs such as health research and education face tightened budgets (Seattle Times, 3/30). Under the discretionary spending cap, “nonsecurity spending would rise by a negligible amount for a near-freeze over FY06 levels,” CongressDaily reports (CongressDaily, 3/29).

DEADLINE: PDPs, MA-PDs, Cost, and PACE 2007 Applications

jbaker — Mon, 20 Mar 2006 20:35:10 +0000

Today is the deadline for all PDPs, MA-PDs, Cost, and PACE 2007 applications.

Details on the CMS website.

Market Responce: Get the Word Out Tours

jbaker — Mon, 20 Mar 2006 16:12:34 +0000

Private providers are hoping to clear up the confusion over the new Medicare Prescription Drug Plan with road trips to enroll new members and by offering information to consumers about competing plans.

Representatives for Humana, one such provider, will answer questions for the public from its “Let’s Talk” tour bus, which will be at Wal-Mart stores on the East Side today and in Northeast El Paso on Tuesday.

Ross McLerran, spokesman for Humana in San Antonio, said the company’s 10 mobile units began the nationwide tour last year. The tour is set to end on April 1, after stops at 1,187 Wal-Mart stores, and senior and community centers in 408 U.S. cities.

“We had 200,000 visitors as a result of the tour so far,” McLerran said.

MMA 2003 Update

jbaker — Wed, 01 Mar 2006 16:17:43 +0000

The Medicare Modernization Update (MMU) was updated on Wednesday, March 1, 2006.

For your convenience, we offer the following topics and links that this office maintains. Please update your bookmarks and favorites accordingly.

In addition, a summary of changes in this month’s issue follows and is also available at the What’s New page under downloads.

Accomplishments

February 3, 2006: MMA Section 721 Voluntary Chronic Care Improvement Under Traditional Fee-For-Services

CMS announced that more than 100, 000 Medicare beneficiaries are now participating in the voluntary Medicare Health Support programs designed to reduce health risks and improve the quality of life of chronically ill patients. Medicare Health Support connects program participants with specially trained health professionals. The eight pilot programs were announced in December 2005. These programs were required by Section 721 of the MMA.

February 6, 2006: MMA Section 303(d) Payment Reform for Covered Outpatient Drugs and Biologicals

CMS issued a manual instruction (CR 4309) that allows payments beginning in 2005 to be based on 106 percent of the average sales price for drugs and biologicals.

February 15, 2006: MMA Section 923 – Medicare Beneficiary Ombudsman

CMS hosted the first Medicare Beneficiary Ombudsman Open Door forum. This forum provided an opportunity for beneficiaries, caregivers, and advocates to discuss issues and concerns regarding ways to improve the systems within the Medicare program. This is required by Section 923 of the MMA.

February 24, 2006: MMA Section 301- Medicare Secondary Payer

CMS published an interim final rule with comment period (CMS-6272-IFC) that clarifies when CMS may make a conditional Medicare payment when other insurance cannot reasonably be expected to make a prompt payment. This is required by MMA Section 301.

What to Expect

Final Rule: MMA Section 936(b)(1) – Requirements for Establishing and Maintaining Medicare Billing Privileges and Provider Enrollment Process

This final rule (CMS-6002-F) is needed as part of the Administration’s anti-fraud and abuse efforts. It gives CMS the authority to enroll and re-enroll providers, with time frames for re-enrollment. The rule also responds to comments received on the proposed rule and implements section 936 of the MMA, which establishes deadlines for action on enrollments and renewals.