Genetic Testing Scam Targets Medicare Beneficiaries.

Genetic Testing Scam Targets Medicare Beneficiaries.
The U.S. Department of Health and Human Services Office of Inspector General is alerting the public about a fraud scheme involving genetic testing.
Scammers are offering Medicare beneficiaries cheek swabs for genetic testing to obtain their Medicare information for identity theft or fraudulent billing purposes. Fraudsters are targeting beneficiaries through telemarketing calls, booths at public events, health fairs, and door-to-door visits.
If a beneficiary agrees to genetic testing or verifies personal or Medicare information, a testing kit is sent even if it is not ordered by a physician or medically necessary.

Protect Yourself

• If a genetic testing kit is mailed to you, don't accept it unless it was ordered by your physician. Refuse the delivery or return it to the sender. Keep a record of the sender's name and the date you returned the items.
• Be suspicious of anyone who offers you free genetic testing and then requests your Medicare number. If your personal information is compromised, it may be used in other fraud schemes.
• A physician that you know and trust should approve any requests for genetic testing.
• Medicare beneficiaries should be cautious of unsolicited requests for their Medicare numbers. If anyone other than your physician's office requests your Medicare information, do not provide it.
• If you suspect Medicare fraud, contact the HHS OIG Hotline.

Medicare Explained!

Do you know about Medicare and what does it cost? Do you know what medicare cover? Medicare has two parts Medicare Part A and Medicare Part B.
Medicare Part A:  Hospital Insurance and helps to pay for hospital, hospice and home health care.
Medicare Part B:  Medical Insurance and and helps pay for doctors, outpatient care, and other medical services.
Both are very important and depending on ones age, social security status and of course timely application for Medicare.
One retirement planner asked  Charles Schwab's  Ask Carrie the following question;

I'm turning 65 next year. I’m still working and plan to continue for at least a couple more years, so I won't yet file for Social Security. I do, however, want to get Medicare. What do I need to do to make sure I get the right coverage?

I think the answers were great and everyone should read. Take care with Medicare.
Ask Carrie

Rehospitalizations among Medicare beneficiaries are prevalent and costly.

Quantity VS Quality In Medicare Fee-for-Service Program,
According to a study conducted by researchers (Stephen F. Jencks, M.D., M.P.H., Mark V. Williams, M.D., and Eric A. Coleman, M.D., M.P.H.) regarding Reducing rates of rehospitalization has shown that hospitals go for Quantity vs Quality (they prefer quantity) because Medicare pays the same for each hospital stay.
The Researchers went through the medical records from 2003-2004 and the following abstracted results does not give g good picture. (Link to complete publication by New England Journal of Medicine at the end of the post). The cost of unplanned visits was 17.4 Billion in 2004.
"Almost one fifth (19.6%) of the 11,855,702 Medicare beneficiaries who had been discharged from a hospital were rehospitalized within 30 days, and 34.0% were rehospitalized within 90 days; 67.1% of patients who had been discharged with medical conditions and 51.5% of those who had been discharged after surgical procedures were rehospitalized or died within the first year after discharge. In the case of 50.2% of the patients who were rehospitalized within 30 days after a medical discharge to the community, there was no bill for a visit to a physician's office between the time of discharge and rehospitalization. Among patients who were rehospitalized within 30 days after a surgical discharge, 70.5% were rehospitalized for a medical condition. We estimate that about 10% of rehospitalizations were likely to have been planned. The average stay of rehospitalized patients was 0.6 day longer than that of patients in the same diagnosis-related group whose most recent hospitalization had been at least 6 months previously. We estimate that the cost to Medicare of unplanned rehospitalizations in 2004 was $17.4 billion."

New England Journal of Medicine

Tags: New England Journal of Medicine, Medicare beneficiaries, rehospitalization

Personal Health Records (PHRs), Google Health Is One Of The Choices.

Personal Health Records (PHRs)
I read in Google blog today that Google Health is participating with Centers for Medicare and Medicaid Services (CMS), on a pilot program in Arizona and Utah. The program is for Medicare beneficiaries to bring their Medicare claims data into Google Health.
Medicare Claims data is much more complex than they appear in words of our mouths or brains. There are zillions of codes to follow, comparisons and recheck denials, all of these are important to both health care providers and to receivers.
So having these data online accessible from anywhere to people and entities that have rights to access the data is a great benefit.
I do not work with Healthcare itself but I do deal with healthcare data. I see the complexities, I help to resolve bottlenecks. As the author of the blog article I am reffering to explained, Medicare data carries a great wealth of data about health of medicare reciepants. Having access to this data, will be a great benefit to the people involved.
The Utah Arizona Pilot that Google Health is involved is a perfect way to find out the benefis of this information. The participants has a choice among four PHR vendors participating in the Medicare PHR Choice (Links are through CMS):

• PassportMD
• NoMoreClipboard.com
• HealthTrio
• Google Health

Only traditional fee-for-service (FFS) Medicare beneficiaries with a primary residence in Arizona and Utah are eligible to participate in this pilot but there are more than one million eligibale people there.
Medicare will only be sending data to your Account (They will not access the data). Beneficiaries who participate in the pilot will still have access to data imported into their Google Health Accounts after the conclusion of the pilot and with the Google Health sharing feature, any beneficiary enrolled in this pilot can now share this data with family members and doctors in their care network.

Official Google Blog: Getting your Medicare records in Google Health

Tags: Personal Health Records, PHRs, Medicare, Google Health, HealthTrio, NoMoreClipboard.com, PassportMD

2009 Medicare Prescription Drug Plan Options

For Immediate Release:	Thursday, September 25, 2008
Contact:	CMS Office of Public Affairs 202-690-6145

CMS REMINDS MEDICARE BENEFICIARIES TO REVIEW AND COMPARE THEIR CURRENT DRUG COVERAGE

Today, CMS Acting Administrator Kerry Weems announced the 2009 Medicare prescription drug and Medicare Advantage plan options. Approximately 97 percent of beneficiaries enrolled in a stand-alone prescription drug plan (PDP) will have access to Medicare drug and health plans in 2009 whose premiums would be the same or less than their coverage in 2008.

“As we enter the fourth year of the Medicare Part D prescription drug program, we continue to see high satisfaction rates among beneficiaries and high participation among plans,” said Weems. “However, plans do change their offerings from year to year. Some beneficiaries may see significant premium increases or changes, such as reduced coverage in the gap, if they stay in the same prescription drug plan in 2009. We encourage individual beneficiaries to review how their plans are changing and what other options are available to them to determine which plan best meets their needs.”

In every state, beneficiaries will have access to at least one prescription drug plan with premiums of less than $20 a month, except for beneficiaries living in Alaska who will have access to one prescription drug plan at $23 a month. Those who qualify for the full Medicare subsidy will pay no premiums or deductibles in these plans. The national average monthly premium for the basic Medicare drug benefit in 2009 is projected to average approximately $28.

Beneficiaries will continue to have access to prescription drug plans that offer a wide range of design options, including zero deductible plans. Plans with coverage in the gap for generics are available in every state.

In 2009, 100 percent of beneficiaries will have access to a Medicare Advantage plan. Many beneficiaries will continue to have access to Medicare Advantage plans that have prescription drug coverage (MA-PDs) and more than 93 percent of people with Medicare will have access to a MA-PD for a $0 premium and with a $0 drug deductible.

Marketing of 2009 plans will begin October 1 under new marketing requirements. “These new requirements are meant to protect Medicare beneficiaries from deceptive or high-pressure marketing tactics by insurance companies and their agents,” said Weems.

This fall CMS will be conducting numerous outreach events to help new beneficiaries and help those already enrolled understand their plan choices. “We want to make sure that every beneficiary knows where to go for individualized advice and counseling,” said Weems.

Details about the specific plans in each region will be available mid-October at www.medicare.govand 1-800-MEDICARE. Open enrollment for prescription drug coverage begins November 15 and ends December 31. Beneficiaries who want to review their current coverage as well as the other options available to them will have access to information and assistance from many sources including:

• A notice of any coverage changes from their current prescription drug plan, by October 31^st ,
• The enhanced Medicare Drug Plan Finder, available in mid-October;
• Toll free information available 24/7 at 1-800-MEDICARE (1-800-633-4227);
• The annual Medicare & You 2009 handbook that explains Medicare coverage, to be mailed in October; and
• Local organizations such as the State Health Insurance Assistance Programs and thousands of other Medicare partner organizations that will provide personalized assistance throughout the fall.

The list of national stand-alone prescription drug plans and state specific fact sheets can be found at: http://www.cms.hhs.gov/center/openenrollment.asp

The Link to the 2009 Landscape Data: http://www.cms.hhs.gov/PrescriptionDrugCovGenIn/

“Beneficiaries should expect to hear from the health and prescription drug plans in their communities and should be assured that CMS has new oversight tools available to ensure they have a positive experience,” said Weems.

Tags: MEDICARE, Medicare Prescription Drug Plan

Physicians With Small Practices Will Be Hurt In the Event Of Medicare Cuts

(Washington) – Noting that many physicians across the country who lead small practices are at a business breaking point, David M. Dale, MD, FACP, president of the American College of Physicians (ACP) testified today before the House Small Business Committee. Dr. Dale emphasized that practices are medicine’s small businesses, where much of their revenue is tied directly to Medicare’s flawed reimbursement rates and formulas.

Approximately 20 percent of ACP members who are involved in direct patient care are in solo physician practices. And, about 50 percent are in practices of five or fewer physicians.

On July 1, physicians face a 10.6 percent cut in Medicare reimbursements. Another 5 percent cut is anticipated on January 1, 2009. The Sustainable Growth Rate (SGR) formula that is used to calculate Medicare payments to physicians was created in 1997 and ties physician payments to growth in the overall economy. When growth in physician expenditures exceeds growth in the economy, the difference is subtracted from physician payments. The SGR formula has led to scheduled annual cuts for six consecutive years.

Earlier this year, ACP surveyed its members to measure the impact of pending Medicare payment cuts on their practices and on their patients. The questionnaire asked internists to report on the changes they would be forced to make if Congress does not act. Although the survey was not designed as a scientific sample, almost 2,000 internists responded, providing ACP with first-hand accounts of how the SGR cuts are affecting millions of Medicare beneficiaries.

Dr Dale cited the story of one respondent, a Texas internist, who said:

“The practice of medicine is a calling and as such, my colleagues and I have endured more unfair revenue cuts than most businesses would have endured. Yet, a medical practice is also a small business, and there are limits to how much we can endure. We are now at the point where further cuts are not survivable. Just like any small business, our revenue has to exceed costs in order to survive. Despite everything that I have been able to do to cut costs, the margin of profit is now thin, and the proposed greater than 10 percent cut will put us out of business. The only option will be to downsize the practice and stop seeing all Medicare patients. I would hate this, but it will be the only option I have if Congress does not reverse the proposed cuts.”

ACP is asking Congress to avert the immediate SGR cut, but also go a step beyond. The College is asking Congress to set a timeline for completely eliminating the use of the SGR formula. ACP also wants Congress to direct Medicare, as part of replacing the SGR formula, to change payment policies to support patient-centered, physician-guided care management based on the patient-centered medical home model of care.

“Medicare patients deserve the best possible care,” concluded Dr. Dale. They also deserve a physician payment system that will help physicians deliver the best care possible, his testimony said.

Contact: David Kinsman
dkinsman@acponline.org
202-261-4554
American College of Physicians

Tags: Medicare, medical insurance, ACP

NURSING HOME COMPARE WEB SITE UPDATED

CRITICAL NEW INFORMATION ADDED TO NURSING HOME COMPARE WEB SITE
MULTI-YEAR PLAN FOR IMPROVED NURSING HOME QUALITY ALSO RELEASED

Medicaid beneficiaries and families searching for top quality long-term care services can find critical new information added today to the Centers for Medicare & Medicaid Services’ (CMS) Web site “Nursing Home Compare.”

For the first time, information about nursing homes on the Compare Web site will list whether a home is or has been on CMS’ special focus facility (SFF) list. The agency’s SFF initiative gives heightened scrutiny to nursing homes that have a history of poor performance or repeated violations of state and federal health and safety rules.

“Today’s expansion of information on Nursing Home Compare will give beneficiaries a more complete picture of a nursing home’s history of providing quality care,” CMS Acting Administrator Kerry Weems said.

The SFF initiative was created because a number of facilities were consistently providing poor quality of care, yet were periodically instituting enough improvement that they would pass one survey only to fail the next (for many of the same problems as before). Such facilities with a “yo-yo” compliance history rarely addressed underlying systemic problems that were giving rise to repeated cycles of serious deficiencies.

In November 2007, the agency began publishing a list of Medicare and Medicaid participating nursing homes that have a history of serious quality of care problems and had failed to show significant improvement. In February 2008, CMS took the next step and published an updated, expanded list of nursing homes in the SFF initiative and included the category they fell within such as new additions, not improved, improving, recently graduated or no longer in the Medicare and Medicaid programs.

As of April 2008, there are 134 SFFs, out of about 16,000 active nursing homes. CMS works closely with states to select participants and as homes improve their quality of care and “graduate” from the program, or fail to improve and are terminated from Medicare and Medicaid, new homes are added to the list. This movement of homes off the list allows more facilities with problems to be added as the program continues.

Once a facility is selected as an SFF, the state survey agency conducts twice the number of standard surveys and will apply progressive enforcement until the nursing home either (a) significantly improves and graduates from the SFF initiative, (b) is granted additional time due to promising developments, or (c) is terminated from Medicare and/or Medicaid. CMS and the state can more quickly terminate a facility that is placing residents in immediate jeopardy.

Nursing homes that have the SFF designation, including information about that designation, will now be noted on Nursing Home Compare, which can be accessed at www.medicare.gov. The site helps families find nursing homes in their area. Information about the homes includes performance scores on quality measures, staffing information and a three-year history of the home’s health, safety and fire inspection reports. The Web site will be updated with new information quarterly.

“Today’s action is the next step in our commitment to bring transparency and accountability to the process families must go through to find the care that is best for them and their family member,” Weems said.

tag: CMS, Medicare, NURSING HOME COMPARE,

Sleep Apnea Home Testing Approved by Medicare

The Centers for Medicare & Medicaid Services (CMS) today expanded Medicare coverage for continuous positive airway pressure (CPAP) devices to include beneficiaries who have been diagnosed, using a home sleep test, with obstructive sleep apnea. CMS also announced changes to simplify certain test requirements.

Obstructive Sleep Apnea (OSA) is a condition in which periods of temporary suspension in breathing (apnea) occur during sleep. In most instances, OSA is diagnosed by counting the number of sleep disturbances that occur during a specific time interval. Up to four million Medicare beneficiaries may suffer from some form of OSA.

The CPAP devices provide air pressure through a face mask to help keep breathing passages open during sleep. Medicare’s current policy provides CPAP coverage only for beneficiaries who have OSA diagnosed using a specific type of sleep test called polysomnography in an attended sleep laboratory setting. CMS’ new policy will add coverage for CPAP following a positive at-home sleep test.

In the home tests, the patient wears a device during sleep that collects and records data about airflow and other measurements. The patient takes the device to the physician, who uses the data collected by the device to determine whether the patient has obstructive sleep apnea or needs further sleep studies or assessment.

Some patients with OSA do not continue with CPAP treatment or do not improve on treatment. Thus, CMS is limiting initial coverage of CPAP for OSA to twelve weeks to determine if the beneficiary will respond to the CPAP treatment. Long term CPAP is covered for those beneficiaries who continue and respond to treatment.

“Our revised policy provides more options for Medicare beneficiaries and their treating physicians,” said CMS Acting Administrator Kerry Weems. “At the same time, we remain vigilant to ensure that Medicare payments for these services do not create incentives for inappropriate use.”

CMS will continue to monitor the use of the CPAP home testing services, examining the potential for fraud and abuse as well as making recommendations to implement appropriate safeguards to mitigate potential risk.

The final national coverage determination announced today is available on the CMS web site at www.cms.hhs.gov/center/coverage.asp.

tag: medicare, , obstructive sleep apnea, home sleep test, continuous positive airway pressure, Centers for Medicare & Medicaid Services