Medicare News
Primary care boosted in proposed Medicare pay rule
The Centers for Medicare & Medicaid Services has issued a proposed Medicare physician fee schedule rule that it says will expand preventive services for Medicare beneficiaries, improve payments for primary care services and promote access to health care. The proposed rule, announced June 25, would implement provisions in the national health reform law that will eliminate out-of-pocket costs for beneficiaries for most preventive services, including a new annual primary care visit benefit, CMS said.
Medicare Crackdown: "Prosecution Is Not the Solution"
The round up continued Friday night across South Florida and the nation as authorities made nearly 100 arrests relating to some $251 million in Medicare fraud. Officials say it is the largest such bust in history.
The crackdown has so far involved 33 South Floridians who produced $140 million in bogus claims. Arrests were announced in Miami by top Obama administration officials US Attorney Eric Holder and Health and Human Services Secretary Kathleen Sebelius, who spoke of tougher penalties and new ways to find the crooks.
Republicans Demand Hearing On CMS Head Berwick, Block Other Nominees
Senate Republicans are still angry over President Obama's recess appointment of Dr. Donald Berwick to head the Center for Medicare and Medicaid Services. Politico: "Republicans on the Finance Committee, which has jurisdiction over the post, say that not holding a hearing with Berwick would 'result in circumventing the open public review that should take place for a nomination of such importance' and 'casts a shadow over his legitimacy and authority to serve as administrator during a critical time for CMS.'
Second Round of $250 Medicare Checks Sent
Seniors who have recently reached the coverage gap in their Medicare prescription drug plan will soon receive $250 checks from the federal government. Over 300,000 one-time payments are in the mail, the Obama administration announced today. The first round of approximately 80,000 checks was mailed to retirees in June. “Seventy percent of our first round of these $250 rebate checks were cashed within a week of eligible Medicarerecipients receiving them,” says U.S. Department of Health and Human Services Secretary Kathleen Sebelius. “So, we know that folks really need some help.”
CMS proposes 2.15% outpatient update
Hospital outpatient departments will see a 2.15% increase in their Medicare payments under a proposed CMS rule that will set payment rates for outpatient services and ambulatory surgical centers in 2011. The update reflects an inflationary increase of 2.4% minus a 0.25 percentage point reduction required under the new reform law. Overall, the agency estimates that more than 4,000 hospitals and other facilities will get paid a total of $40 billion next year under the outpatient prospective payment system, whereas 5,000 ambulatory surgery centers will receive approximately $4 billion.
Insurers’ Group Skips Endorsement of Medicare Nominee
Dr. Donald M. Berwick’s nomination to head Medicare and Medicaid received a lift on Tuesday when a diverse collection of about 90 employer groups, patient advocates, medical societies and others wrote to Senator Max Baucus, the Montana Democrat who helped oversee the creation of the new health care law, in favor of his selection. Among those signing the letter were the National Business Group on Health, the American Academy of Family Physicians, the A.F.L.-C.I.O. and Families USA.
Congress raises Medicare doctor pay by 2.2% through November
The House on June 24 adopted a Senate-passed Medicare physician pay increase of 2.2% through Nov. 30, temporarily reversing a 21% cut that Medicare contractors began applying to claims a week earlier. The measure headed to President Obama, who signed it June 25. The Senate had approved the bill by unanimous consent on June 18. "I believe we need to permanently reform the Medicare formula in a way that attacks our fiscal problems without punishing our hard-working doctors or endangering the benefits on which so many of our seniors rely," Obama said in a statement after the vote.
Congress grants Medicare reprieve
Physicians got a reprieve from a 21 percent cut in their Medicare reimbursement this week when Congress voted to repeal it and even gave them a 2.2 percent pay raise. But it's only a six-month fix. Congress will have to deal with it again in November. And doctors say it's that instability and uncertainty, along with a payment rate that was until now at the 2001 level, that's forcing some of them to stop taking Medicare patients, or limit the number they take, resulting in access problems for seniors.
Senate Passes Plan to Stop Medicare Pay Cuts to Doctors
With lawmakers worried that older Americans relying on Medicare could begin losing access to health care, the Senate on Friday approved a six-month plan to prevent a steep cut in doctors’ fees paid by the federal health program. The $6.4 billion measure would reverse a 21 percent cut in physician payments that was to kick in Friday, raising the possibility that some doctors might begin to turn away those covered by Medicare. The legislation, known on Capitol Hill as the doc fix, was approved without a roll-call vote after leaders of both parties agreed to pull it out of a stalled package of tax changes and safety-net spending.
Drug Rebate Is Mailed Out
Some participants in Medicare Part D prescription-drug plans should be on the lookout for a check in the mail. The U.S. Department of Health and Human Services started sending out $250 rebate checks late last week. The one-time rebate, which is part of the health-care reform bill signed into law by President Obama earlier this year, applies to Part D participants who fall into the drug-coverage gap commonly known as the "doughnut hole." The rebate is meant to help alleviate the costs people incur during the gap. The doughnut hole kicks in after a person's annual prescription-drug cost -- covered at 75% -- reaches a set dollar amount. For 2010, it's typically $2,830.
Beneficiary Information About the $250 Part D Rebate
The Centers for Medicare & Medicaid Services (CMS) posted at www.medicare.gov (under "What's New") "Closing the Prescription Drug Coverage Gap" brochure that describes details about the tax-free, one-time check for $250 for people who enter the Part D donut hole and are not eligible for Medicare Extra Help. The first checks are being mailed June 10 and checks will be mailed monthly after people have entered the coverage gap. To help fight fraud and protect beneficiaries from potential scams, Medicare is reminding seniors there are no forms to fill out to receive this benefit. Medicare will automatically send a check. The envelope will have the US Department of Health and Human Services symbol on it and will say "Medicare Part D." Beneficiaries don’t need to provide any personal information.
Doctors' group turns up heat on Medicare payments
The American Medical Association turned up the heat on the U.S. Congress on Thursday for failing to stop a 21 percent Medicare pay cut for doctors treating elderly patients. The doctors group said it launched a multimillion dollar ad campaign criticizing the U.S. Senate for going on a week-long Memorial Day break before acting on a bill that would have postponed the pay cut that went into effect on June 1.
Medicare: Congressional Tax Committees Release Bill with SGR Fix
Congressional leaders on the House Ways and Means and Senate Finance committees have released the purported “tax extenders” bill (HR 4213), which among other things would raise doctors’ Medicare reimbursements 1% to 2% through 2013.
Congress Fails to Act - Medicare Payments Cut 21%
Despite ACEP's plea for Congress to reject the fundamentally flawed payment formula used to reimburse physicians for Medicare services, the U.S. Congress, once again, failed to take the necessary action to avert the 21% cut in payments beginning June 1. The House did approve a 19-month, short-term increase in physician payments on Friday afternoon by a vote of 245 to 171. This measure would provide physicians treating Medicare beneficiaries with a 2.2% update for the remainder of this year and a 1% update in 2011. However, Congress did not alter the underlying payment formula and reimbursement is projected to be cut by around 30% beginning in 2012.
Battle Looms in Senate Over Obama's Pick to Run Medicare and Medicaid
As all eyes watch Elena Kagan make the rounds of Senate office buildings, greeting senators, answering questions and building support, another of President Obama's nominees is taking the same route -- but with much less fanfare. And he very well could wield as much -- or even more -- influence on America's future as the Supreme Court nominee. Dr. Donald M. Berwick, if confirmed by the Senate, will run Medicare and Medicaid, the world’s second largest insurance provider, as the two health care giants transform to meet the requirements of the recently passed health care reform act.
Changes to Medicare Supplement (Medigap) in 2010
Medicare has several gaps and doesn't pay for all of your health care costs. If you have Medicare you may want to buy Medicare supplemental insurance, also called Medigap insurance. This health insurance helps pay for some of your Medicare costs, such as deductibles, coinsurance, and copayments, and for some care Medicare doesn't cover. Medigap insurance is sold by private insurance companies. By law, companies must offer standardized Medigap insurance plans. Each plan has a different set of benefits.
Medicare Fraud Penalties Tougher Under Proposed Bill
Saying that criminal penalties for Medicare fraud must be updated, two Florida lawmakers introduced a bill April 13 that would double fines, increase background checks and even study how biometric technology could help ensure the appropriate use of program services. U.S. Reps. Ileana Ros-Lehtinen (R, Fla.) and Ron Klein (D, Fla.) said the Medicare Fraud Enforcement and Prevention Act is "a tough new bipartisan bill" that will help crack down on Medicare fraud, protecting seniors and taxpayers alike.
Medicare pay cut stopped again; doctors decry lack of permanent fix
Congress may have stemmed most of the damage from the latest 21% Medicare payment reduction by reversing the cut before any physicians actually could feel it. Still, physician organizations say the harm caused by lawmakers once again bringing doctors to the brink before pulling them back is another major reason why the next solution must be a permanent one. Legislation to reverse the cut and postpone it until June 1 was signed into law by President Obama late on April 15. The cut technically had gone into effect April 1 as lawmakers fought over how to pay for the bill, which also extends various unemployment and health assistance programs.
Seniors fear hit to Medicare
Seniors aren't breaking out the champagne for President Obama's health care law, and for good reason. While Democrats hail the overhaul as their greatest health care achievement since Medicare, seniors fear it's a raid on that same giant health care program - a bedrock of retirement security - in order to pay for covering younger, uninsured workers and their families
CMS sends $41.6 million to Medicare counseling programs
The CMS has announced that nearly $41.6 million has been distributed to state health insurance assistance programs to help beneficiaries get more information about their Medicare health and prescription-drug plan choices.
The grants are the first of two rounds of funding to be distributed to these types of counseling programs in fiscal 2010. Approximately $1.5 million in performance grants will be distributed to the insurance assistance programs in September.
MedPAC urges performance-based GME payments
The Medicare Payment Advisory Commission in a series of recommendations is calling on Congress to overhaul Medicare's graduate medical education, or GME, payments so that institutions are paid based on performance standards. The purpose of these recommendations is to support workforce skills that would reduce cost growth while improving quality, the commission stated. HHS should establish standards for distributing funds to GME institutions that specify “ambitious goals” for practice-based learning and improvement, using overpayments made to the indirect medical education pool to fund the new performance-based program
Obama to name new Medicare/Medicaid chief: official
President Barack Obama has picked a top health policy expert to run Medicare and Medicaid, an administration official said on Saturday, filling a role at the heart of his historic healthcare reform. Obama plans to nominate Dr. Donald Berwick as administrator of the Centers for Medicare and Medicaid Services, a unit of the Department of Health and Human Services, the official said
Medicare audits to be expanded
The use of auditors who pore over physician Medicare claims -- as well as bills from other government contractors -- to identify and recover past overpayments will be expanded under the Obama administration's latest crackdown on fraud, waste and abuse. The president on March 10 announced a new effort to improve federal payment accountability through the use of payment recapture audits. An executive memorandum directs the White House Office of Management and Budget to develop guidance within 90 days on actions agencies across the government should take to expand the use of these reviews.
Obama budget freezes physicians' Medicare pay for 10 years
President Obama promised spending freezes during his first State of the Union address, but his $3.8 trillion fiscal 2011 budget request still would protect physicians from Medicare pay cuts and extend enhanced federal support for state Medicaid programs. Obama's proposal, unveiled Feb. 1, sets aside $371 billion over a decade to pay for the cost of preventing Medicare pay cuts under the sustainable growth rate formula. But the funding would only be enough to turn annual reductions into rate freezes, not to fund pay raises.
Medicare cost plans face uncertain future
Under federal law, the more than 20 Medicare cost plans operating in areas deemed to have sufficient competing Medicare Advantage options for beneficiaries must shut down by 2011 or else convert to Medicare Advantage plans themselves. But a December 2009 report from the Government Accountability Office said some insurers are worried about the effects those conversions would have on the program.
Appeals court rejects effort to sell Medicare physician claims data
A federal appeals court cited an injunctive order from three decades ago when it said a private company does not have a right to sell physicians' Medicare claims data to hospitals. The decision is the latest in a series of court actions protecting doctors' privacy against the release of such information for various purposes.In a ruling on Dec. 18, 2009, the 11th U.S. Circuit Court of Appeals said the government was not required to turn over physician claims information to Real Time Medical Data.
Help for Medicare beneficiaries expands
The Centers for Medicare & Medicaid Services will award new grant money to states in 2010 to support community outreach for Medicare beneficiaries. A total of $45 million in grants will be available to the 54 State Health Insurance Assistance Programs, or SHIPs, CMS announced Dec. 16, 2009. States must apply by Feb. 16, and funds will be awarded in April. The agency said the SHIP grants will help states provide more one-on-one counseling to assist beneficiaries with Medicare prescription drug and plan enrollment information.
Mayo Clinic in Arizona to Stop Treating Some Medicare Patients
The Mayo Clinic, praised by President Barack Obama as a national model for efficient health care, will stop accepting Medicare patients as of tomorrow at one of its primary-care clinics in Arizona, saying the U.S. government pays too little. More than 3,000 patients eligible for Medicare, the government’s largest health-insurance program, will be forced to pay cash if they want to continue seeing their doctors at a Mayo family clinic in Glendale, northwest of Phoenix, said Michael Yardley, a Mayo spokesman.
Retirees Snared by Medicare
Rules for enrolling in Medicare are complex. But when people postpone retirement past age 65, as many people are doing these days, it's easy to get caught up in red tape. Older adults can't get into Medicare any time they want. The easiest time to sign up is when you turn 65, and, if you're already collecting Social Security, enrollment is automatic.
The not-so-sweet side of closing 'doughnut hole'
Six years after Congress added a prescription drug benefit to Medicare, Democrats in the House and Senate are poised to make a central change that they and most older Americans have wanted all along: getting rid of a quirk that forces millions of elderly patients with especially high expenses for medicine to pay for much of it on their own. The closing of an unusual gap in Medicare drug coverage -- a gap that Republicans had, when they controlled Capitol Hill and the White House, insisted was needed for the government to be able to afford the program
Medicare physician pay cut delayed until March
President Obama has signed legislation that would prevent a 21.2% Medicare payment cut from taking place Jan. 1 by freezing physician rates for two months. The temporary patch, which expires after Feb. 28, 2010, is intended to give Congress additional time to craft a more lasting solution to the doctor pay problem. It piggybacked on the fiscal 2010 appropriations bill for the Defense Dept., which helps fund the wars in Afghanistan and Iraq. The White House announced Dec. 21 that the president had signed the legislation.
Medicare use, spending found to vary across country
Regional variations in the use of Medicare services across the U.S. do not directly translate to regional variations in spending, the Medicare Payment Advisory Commission noted in a Dec. 1 study. "The two should not be confused," MedPAC stated in the report compiled for Congress, which has been focused on reining in Medicare spending as it attempts to pass comprehensive health system reform.
Senate debates health reform bill with 1-year Medicare pay patch
Senators opened debate on national health system reform legislation on Nov. 30 in partisan fashion. Democrats talked up the bill's coverage expansions and health insurance reforms, and Republicans highlighted the measure's potential to increase both health insurance premiums and the federal deficit.The bill aims to improve the affordability of health insurance and expand government regulation of health plans. It also would implement Medicare cuts to help pay for it.
Should Doctors’ Pay Be Linked to Hospital Readmissions?
One in five Medicare patients winds up back in the hospital within a month of being discharged. At least some of these readmissions could be prevented with proper follow-up care; as part of the big health-care overhaul, Congress is likely to create financial incentives to push hospitals to lower readmission rates. But, as an M.D. points out in an essay in this morning’s New York Times, practicing docs — not hospital execs — decide whether to admit patients to the hospital.
Medicare, Medicaid spent $54 billion too much in 2009, White House says
Improper payments for health care made up a large portion of the $98 billion the federal government spent inappropriately in fiscal 2009. This total was an increase of $26 billion over the previous year, according to a report issued by the White House Office of Management and Budget. The Nov. 17 report concluded that Medicare fee for service improperly spent $24 billion in fiscal 2009, a rate equivalent to 7.8% of total outlays, and Medicaid improperly spent $18 billion, a rate of 9.6%. Medicare Advantage improperly spent $12 billion in 2009, a rate of 15.4% of total outlays on the private plans.
Should Doctors’ Pay Be Linked to Hospital Readmissions?
One in five Medicare patients winds up back in the hospital within a month of being discharged. At least some of these readmissions could be prevented with proper follow-up care; as part of the big health-care overhaul, Congress is likely to create financial incentives to push hospitals to lower readmission rates. But, as an M.D. points out in an essay in this morning’s New York Times, practicing docs — not hospital execs — decide whether to admit patients to the hospital.
House passes major Medicare payment reform; what will the Senate do?
Passage of a major Medicare physician pay overhaul in the House on Nov. 19 means attention on the issue turns back to the Senate, which in October rejected a similar measure due to its projected cost. The House bill, the Medicare Physician Payment Reform Act of 2009, passed by a vote of 243-183. The measure would repeal a 21.2% fee reduction scheduled for Jan. 1, 2010, and replace the sustainable growth rate formula
21.2% Medicare pay cut for doctors unless Congress acts
The final 2010 Medicare physician fee schedule confirms that physicians face a 21.2% pay cut starting Jan. 1, 2010, unless Congress adopts legislation to avert it. The official figure is only slightly lower than the 21.5% reduction the Centers for Medicare & Medicaid Services was predicting earlier this year. The Obama administration supports a permanent repeal of the current physician payment formula and has called on Congress to pass legislation to that effect.
House Health Bill Would Lower Medicare Payments, Report Finds
A fresh analysis of the House health care reform plan has sounded a warning about the impact proposed Medicare cuts would have on seniors and could spell trouble for Senate Majority Leader Harry Reid's effort to pull a unified Senate bill to the floor by the end of the week. The House and would-be Senate bills rely on hundreds of billions of dollars in cuts to Medicare to keep reform deficit-neutral.
Some specialists will see extra cuts in Medicare pay
Some specialty groups are loudly protesting new Medicare payment policies that will boost some primary care rates starting next year at the expense of rates for certain specialty services. In the 2010 physician fee schedule, the Centers for Medicare & Medicaid Services adopted several major changes to the practice-expense portion of the relative value unit system that determines pay for individual services
Medicare relaunches DME competitive bidding
The Centers for Medicare & Medicaid Services on Oct. 21 began accepting bids from accredited durable medical equipment, prosthetics, orthotics and supply companies in nine metropolitan areas to decide whether they can participate in the Medicare program. The round one rebid for the DMEPOS competitive bidding program will be open for 60 days.
Failed Senate vote clouds future of SGR reform
Advocates of Medicare physician payment reform turned their attention to the House after the late October procedural defeat of a Senate bill that would have repealed the current system and effectively frozen pay rates for the next 10 years. House Democratic leaders restated a commitment to permanent pay reform soon after Senate Democrats failed on Oct. 21 to secure 60 votes to force floor consideration of the Medicare Physician Fairness Act.
Medicare doctor pay plan hits Senate snag
A proposal to boost Medicare payments to doctors ran into trouble in the U.S. Senate on Tuesday as Republicans and some Democrats balked at adding $250 billion to skyrocketing U.S. deficits over the next decade. Senator Richard Durbin said Democratic leaders lack the votes needed to overcome procedural hurdles in the 100 member Senate.
Medicare Backs Off On Order About Lobbying Seniors
The Obama administration is backing away from a ban on insurance company mailings to seniors warning of dire Medicare cuts if health care overhaul legislation is approved. Medicare said Friday it's OK for insurance companies to lobby seniors, provided the Medicare beneficiaries have given advance approval and no federal funds or data are used. Last month, Medicare had ordered a halt to such mailings after a Democratic lawmaker complained about a misleading flyer.
Senate panel's health reform bill OK'd with 0.5% Medicare pay hike
The Senate Finance Committee's approval of a health system reform bill on Oct. 13 set the final stage for a historic Senate floor debate in which lawmakers are expected to revisit the public health insurance option along with some of the other more controversial items proposed so far.
Accountable care organizations: A new idea for managing Medicare
Many physicians who are tuned into the health system reform debate have already heard of several of the methods being discussed for changing the way the federal government delivers care. But one Medicare delivery reform term that has recently caught the attention of Congress may be a new one to most.
Senators span over Medicare
Slogging through a second day of work on legislation intended to overhaul the nation's health-care system, the Senate Finance Committee wrestled Wednesday with politically volatile proposals to squeeze money out of Medicare.
Obama Defends Medicare Advantage Cuts
In his Joint Session speech President Obama promised that no one on Medicare would be forced to lose the coverage they have now. But others, like Florida Democrat Senator Bill Nelson, worry that Obama's reforms will deny seniors coverage they now rely on. When I asked him about Nelson's fear, Obama disagreed, but he didn't rule out endorsing Nelson's effort to shield current Medicare beneficiaries from the cuts.
Half of large practices net bonuses from Medicare P4P demo
The Obama White House has indicated it will continue the move toward more pay-for-performance in Medicare, despite mixed results for physicians in the P4P demonstrations it inherited from the previous administration. On Aug. 17, the Centers for Medicare & Medicaid Services disclosed findings from three ongoing programs --
