Posts tagged 'Medicare Payments'
It is estimated that the number of internists will decline substantially by 2025, and the Medicare Payment Advisory Commission indicates finding a new primary physician is becoming more difficult for seniors—meaning that Medicare recipients should begin as early as possible for the best doctor and get established and comfortable with that doctor.
According to MedicareSupplementPlans.com: Many Medicare recipients, are having a difficult time finding a new primary care physician. A 2008 survey conducted by the Medicare Payment Advisory Commission (MedPAC) found that by 2025 there will not be enough primary care physicians. In addition, an estimate from the American College of Physicians (ACP) that there won’t be enough internists to go around by 2025. Let's add one more issue: the ACP also indicates that current internists are becoming less willing to accept new Medicare patients.
According to Alan Weinstock, an insurance agent at MedicareSupplementPlans.com, many physicians are no longer taking Medicare because reimbursement rates and too much paperwork. With all these trends converging at once, Weinstock believes Medicare recipients need to shop early to find the best doctor—before they turn 65. "It’s traumatic turning 65 and entering an unknown area of new healthcare. So many questions…wondering if you asked the correct ones and were given all the correct facts."
“The impact on seniors of physicians opting out of the Medicare program hasn’t been a serious problem yet,” said Weinstock. “But if large numbers of physicians join the group that is opting out, it may be difficult for seniors to have access to affordable health care.”
This is why it is important for the 40 million Americans who have Medicare insurance or those who will be starting Medicare soon to start early in their hunt for a physician who still accepts Medicare. Many of the physicians who accept Medicare now may not accept new Medicare patients but will still continue to take Medicare as payment for the patients they already have if a good relationship is established. It is equally important that seniors take the time to determine the best Medicare supplement insurance coverage, since Medicare often does not cover all health care costs.
Robert Dowell of Visalia, Calif., understands full well the need to have someone knowledgeable when searching for the best Medicare supplement plan. “It’s traumatic turning 65 and entering an unknown area of new healthcare. So many questions…wondering if you asked the correct ones and were given all the correct facts.” But Dowell found all the answers he needed at MedicareSupplementPlans.com and says that now he “has a clear path on how to control my health needs.”
If you are a Medicare recipient now or will be soon, check with your doctor or a recommended doctor and check with the references in this article so that you will be prepared with a doctor who will accept Medicare benefits as payment for your treatment.
In three western states – California, Hawaii and Nevada – doctors who accept Medicare as payment for patients are stuck between a huge rock and a very, very hard place. They are in a situation where Medicare’s payment backlog has created a multimillion dollar problem. They now have to make some vey difficult choices between their patients and their practice.
This is not a small thing. This is a situation where many doctors have not been paid by Medicare since February. How many of us could go through almost a full year with a large part of our salary unpaid?
It is understandable that there can be backlogs from time to time in a system as large and complex as Medicare, but no payments for almost 10 months is much more than a small backlog. It is a backlog of epic proportions.
The situation has forced some doctors to have to drop some or all of their Medicare patients. Other doctors are on the verge of declaring bankruptcy or have already done so. This has hurt the doctors in many ways – including, of course, financially – but it leaves thousands upon thousands of patients without a personal physician who can provide adequate services to keep their health conditions under control.
What does it say when the doctors who are willing to treat the most needy patients are being forced out of business or forced to drop those very patients because the system that is supposed to care for them is hurting them? How can the system be fixed so that the most vulnerable among us get the care they need from the system that they paid into for year after year?
Medicare says that the reason is that doctors who were to switch to a new identification number for claims (sort of like a social security number) did not do so. The doctors say that the numbers were never given to them until they contacted Medicare time after time over several months to finally get their identification number. In addition, Medicare moved processing to another area and there were “glitches” in the move – many of which are still not fixed.
At present, Medicare says they are fixing the problems, but for many of the doctors who were severely affected, the damage has been done, and for their patients, they are left looking for medical care.
Medicare reform is a top priority at this time. With changes that have come to pass recently, Medicare recipients and their doctors can hope that the future goes much better than the present and the past.
We have been hearing a lot about computerized electronic prescriptions lately. The old joke about doctors’ handwriting seems to be true in many cases, and unfortunately, in too many situations, pharmacists can’t decipher the scribble and end up dispensing the wrong medication to patients. This is never a good thing, and though in many cases, the patient catches the mistake or the medication is not harmful to the patient, in a lot of cases the medication is not only harmful but fatal.
The Centers for Medicare and Medicaid Services (CMS) have been trying to get doctors to switch to electronic prescriptions to eliminate the high number of problems with prescription errors due to handwriting, but so far many doctors have been resistant. CMS has offered some bonuses if the doctors will at least give it a try, but there hasn’t been much acceptance of the idea.
Some doctors worry that all the software available to the pharmacies and the physicians will not be compatible, leading to other problems in addition to the handwriting issue. CMS says that Medicare expenses are increasing (as we all know), and that these mistakes due to handwriting issues are increasing expenses even more – especially when the wrong prescription has to be thrown away and a new one has to be filled.
CMS has gotten very serious about making the change to electronic prescriptions. They are offering cash back to the doctors who make the change and are error free. In order to get doctors to switch, which CMS says will make the system better, safer, more effective and efficient and more cost effective, doctors who go electronic will receive a 2% increase in their Medicare payments in 2009 and 2010 and a 1% increase in 2011 and 2012.
Only about 2% of all prescriptions are filled electronically every year. Because this number is so small and most of the rest of the prescriptions are handwritten, over 1.5 million patients – over 530,000 Medicare recipients – are harmed every year due to prescription mistakes. The Pharmacy Board has investigated thousands of prescriptions at random and found that there were high percentages of errors involving the type of medication prescribed, the dosage and wrong or incomplete directions.
At present, the Pharmacy Board is working on 48 different prescription programs. They are working with pharmacies and physicians to work out compatibility issues. In the meantime, if you can get your doctor to at least give you your prescriptions typed into his computer and printed out; there will be less room for error. CMS hopes to begin the electronic program by the end of this year.
Medicare is a system that is supposed to help seniors deal with medical issues by providing coverage for healthcare costs. As an individual works month after month and year after year, they pay into the Medicare system and the payments are taken out of each of their paychecks. The idea is that when they are at the point of retirement, the coverage that they have been paying for all those years that they worked will be there to take care of their health needs.
In theory, this works well, and until recently, Medicare has taken care of millions of seniors. Currently, there are about 44 million people enrolled in Medicare. Most of them have the coverage they need, however, during the past decade or so, Medicare has run into various financial issues, creating a situation in which seniors must pay for some of their coverage.
In addition, though the Medicare system has been overhauled to work better with regard to claims and paperwork, it become more sluggish regarding approvals and claim processing, and it has made it difficult for seniors to get good care and for physicians to give good care. The main reason for this is that many physicians have to wait extremely long periods of time to get paid by Medicare for the patients that they treat.
In fact, some physicians have had to stop treating patients covered only by Medicare or they have at least had to stop taking any new patients covered by Medicare. It is simply too long to wait for payment, and many physicians are experiencing financial trouble as a result.
One such provider is an ophthalmologist in Santa Cruz, California. Dr. Joshua Babad treats many patients covered by Medicare. He cares for his patients and knows they need his help. After all, Santa Cruz is not a large town, and even in large towns, there are not a lot of providers – especially eye doctors – who accept Medicare.
Dr. Babad has tried to do his best for his patients, and in doing so, has ended up over $50,000 in debt. He has had to use retirement money to pay expenses while waiting for Medicare to pay him for legitimate services rendered. In addition, his wife has a brain tumor, so he is struggling with serious family medical and financial issues on top of his long wait for payment. He wonders if Medicare is trying to discourage doctors from treating the elderly or disabled who depend on Medicare for their medical needs.
Dr. Babad has practiced in the same location for over 30 years. He has contacted Medicare, as well as his state representatives to try to deal with the situation. He has stated that if he had to depend on only Medicare, he would have gone bankrupt a long time ago. There are other providers in the general area who are experiencing similar issues with Medicare. Medicare’s response to recent contact is that they have communicated with Dr. Babad and his situation will be corrected soon.
In the meantime, many seniors and their providers continue to struggle with delays and hope that they can continue working together toward good health care while Medicare gets its act together.
It is no secret that there are some serious issues that need to be addressed regarding Medicare. Lawmakers are looking for financial solutions, auditing solutions, quality control solutions and other changes to make sure that the Medicare system becomes sound again and is there to support seniors when they need it.
There have been problems with fraudulent and erroneous claims front and center in the news lately. On top of Medicare paying out billions of dollars that should not have been paid out for claims from phony doctors and patients for phony equipment and services, the Centers for Medicare and Medicaid Services (CMS) has been using their own Medicare officials to do the audits to figure out what types and amounts of fraud were actually perpetrated.
The lawmakers and oversight commissions have come back and stated that the Medicare auditors actually were not the right auditors for the job, were not following the strict guidelines regarding audits and, in the end, needed to be audited themselves because their figures were not accurate. Without following the correct guidelines, much of the fraud was missed. In addition, sending someone from their own agency to audit themselves isn’t a real effective or efficient way to find errors or fraud.
Currently, there are more issues that have arisen. One issue that has created problems for years is the sluggishness of the claims process and the payment process. Medicare beneficiaries and their medical providers are frustrated as they wait month after month for claims to be paid while expenses pile up, making it hard for everyone involved.
The latest situation – which has cost Medicare more money that it doesn’t have to spare and didn’t need to spend – involves overpayments for medication. Because the Medicare system is so slow, Medicare missed the opportunity to pay for less expensive generic drugs rather than brand names. Medicare was so far behind that they did not enter the generic alternatives into their computer systems when they became available, thus paying the higher prices.
One of the main medications, a cancer drug, was paid for at double the generic price because of a two-month delay in entering the new information into the system. The system had no idea that generics were even available for this particular medication, according to the inspector general’s office. There are also overpayments for other drugs that have generic counterparts.
With Medicare’s financial woes, they should be at least working faster to save themselves money. When confronted with the information about the overpayment, Medicare acknowledged that they should input information in a timelier manner so that it will reflect current market prices.
With lawmakers and others trying to save Medicare, it’s time for Medicare to help save itself.
In an effort to control quality and costs Medicare is now watching for a number of specific mistakes and other preventable conditions that will not be paid for if claims are submitted for them. This is the latest set of safeguards that Medicare is using to ensure safety and eliminate erroneous claims and payments on those claims.
A “Do Not Pay” list may sound quite harsh, however, items on the list are not just lightweight mistakes. These items are serious, such as giving a blood transfusions using the wrong type of blood. Basically Medicare will not pay for transfusions gone wrong due to human error, and they will not pay for other services that are botched or that should not have been rendered to begin with.
The bottom line is that Medicare will not pay for complications that are preventable. Some of these complications that will not be paid are extra care costs for breaking up blood clots that are created as a result of knee or hip replacement surgery. Poor control of blood sugar levels will not be paid for.
Some individual insurance companies have begun using these strategies as well. Medicare’s move to keep these situations under control will likely bolster insurance companies in taking steps to do the same. In addition some of the states are considering having Medicaid adopt a do not pay list, as well.
There are opponents to this line of thinking including the American Medical Association (AMA). They have stated that there are better ways to contain costs and that they fear that quality of services rendered will actually decrease by enforcing a strict no-pay list because it does not address all circumstances and sometimes situations arise that are not necessarily the hospital’s clear and actual fault. In addition, it could lead to not attempting to provide treatment or services that could help a patient because of the fear of a complication.
It is clear that the do not pay list will have to be researched and addressed further, but for now it is another tool in trying to keep medical care safe and the costs of the care from skyrocketing further.
Recently, with all the wrangling back and forth between Congress and the White House regarding the new Medicare legislation that was approved, then vetoed and then approved again over the veto, we have heard a lot of the negatives of this legislation. It’s time that we focus on the positive aspects of the legislation.
This legislation helps seniors where it is most important. For one thing, it will maintain and reinforce the relationship between seniors on Medicare and their physicians. The legislation has blocked a 10.6% cut in pay to doctors who treat patients on Medicare. This is essential, since many of these doctors are treating patients on Medicare at a loss in revenue at current rates, so lowering the amount that we pay to them would make things much more difficult. In fact, not allowing that pay cut to doctors has ensured that millions of Medicare recipients will be able to keep seeing the doctors that they feel comfortable with, the doctors that know them and know how to treat their medical needs, therefore, helping them to stay healthier longer.
Other positive benefits that this legislation will provide include assistance for low income individuals who need help with co-payments and other related expenses. It is essential that our most vulnerable population – seniors, especially those with very little means – do not miss out on receiving ongoing medical care and treatment because they cannot afford a few dollars for a copy to a doctor or pharmacy.
There are more positive benefits of the legislations, as well. There is some coverage for preventative medicine. Each new enrollee to Medicare will receive a comprehensive physical. In determining the health of each individual right at the beginning of their enrollment, there is a better chance for ongoing healthcare that will help maintain and individual’s health and identify any conditions or issues that need to be addressed.
Positive benefits also include stronger Mental Health benefits by equalizing benefits. In the past, Mental Health benefits have been paid at 50% vs. medical benefits that are paid at 80%. The new legislation pays both medical and mental health services at the same rate, making it much easier for seniors to afford and access mental health services that are so essential.
Time will tell how well the new legislation works and how much it helps those individuals who depend on Medicare for their health care needs. In the meantime, there is at least tangible help available that should protect some of the most vulnerable among us.
It is now mid-July and Congress has been going back and forth with President Bush over Medicare cuts to doctors for what seems like forever. In a strong show of bipartisanship, Congress, last week, after the July 4th break, voted to block the 10.6% cuts to doctors who accept patients on Medicare. This was a relief to thousands of doctors and millions of patients who depend on Medicare to help keep their ailments and illnesses under control. If these cuts were to go into effect, many doctors – who are struggling to keep treating Medicare patients even at the current payment rates – would have to cut the number of patients that they could continue to treat, if any. As a result, these patients would end up without a personal physician, likely escalating their diseases and costing the system even more money. So it was a relief all around when Congress voted to maintain these benefits.
That relief was short-lived, though, since President Bush, of course, who has been threatening for months to veto this vote if it went through, did just so. It is unfortunate that this president is “so out of touch,” was an observation by Barbara Boxer.
Congress, however reacted how it promised it would react by overriding the veto. Democrats and Republicans who saw the urgency and the value of the vote, stood firm and saw to it that the President’s veto did not stand.
The AMA’s reaction to Congress overriding the veto was to say in support of Congress, “Today we celebrate that Congress heard the voices of millions of patients and physicians and voted to override President Bush’s veto and protect the health of America.
For now, patients and physicians can breathe a sigh of relief, however, during the next year, Congress will have to work on a permanent solution to this issue and other issues that are cause for concern and debate regarding Medicare, and they will have to come up with a balance that will suit as many people as possible. This will not be an easy task, but for the time being, today has been a good day for Congress, physicians and their patients.
We have all been hearing about he Bush Administration’s idea to cut payments to doctors seeing patients covered by Medicare. The issue on the table has been to cut payments to doctors by 10%. This would create a huge problem for Medicare recipients because many doctors would not be able to afford to continue seeing these most vulnerable patients. As a result, more and more individuals on Medicare would be without a personal physician, leaving them in a situation where they would be open to the increase of health problems – especially if they had chronic health issues such as diabetes or high blood pressure.
With too few doctors accepting Medicare at current rates, a cut in their payments would be devastating. This would be a case of saving pennies to spend dollars. A lot of dollars. If individuals who had their ongoing health issues monitored and under control and care by a personal physician, lost that relationship, they would very likely end up doing their best to take care of themselves, however, they would probably end up at the emergency room due to lack of proper ongoing care.
Which makes more sense – paying for a doctor’s visit and some generic medicine or paying for an emergency room visit, hospital visit or hospital stay? Most of us – including Congress – understand the answer to this. Congress is trying to find a solution to help doctors and Medicare recipients continue caring for their ongoing needs.
The Bush Administration has given Congress some extra time after the 4th of July break to process this information further and work toward a solution. At the same time, however, the administration has halted all Medicare payments of claims for the first 10 days of the month, which will only add to the back log of claims that already exists.
We will all have to wait and tune in after the 4th of July to see how the rest of the situation develops. Hopefully the extra time will make it possible for Congress to continue working toward a workable solution to this complex problem.
The Senate and House have been grappling with the budget for months now. There have been many different viewpoints included some pointed and heated debates with the President, with promises of vetoes.
Yesterday, the Senate passed a $3.1 Trillion budget which will pass the burden of balancing the budget and dealing with tax issues that will likely affect Medicare and other important benefits. As the candidates for President assess their plans and responsibilities, as well as their priorities, they will need to be thinking about how to balance the budget while saving essential programs and services such as Medicare.
The annual budget debate in Congress provides for a non-binding resolution that opens the way for later bills that will affect taxes and, of course, Medicare and other programs. For now, though, the budget offered by Congress will extend some tax breaks for businesses, and will prevent doctors from having to absorb the proposed cuts in their Medicare payments.
Though this is a band aid for now, it is not a way to solve the issues in the long term. Medicare recipients could be hit with less reimbursement to doctors, less procedures that are covered and stricter guidelines and oversight as to what is actually “medically necessary.” Of course, services and procedures must be considered “medically necessary” in order to have Medicare pay for them.
The other issue regarding cutting repayment to doctors is also an issue that will need to be addressed when the next President grapples with the budget. Though there is a delay for now, the issue will be right back on the table and needs to be dealt with as efficiently as possible so that the issue is resolved quickly and fairly and everyone involved in the Medicare system – especially patients and doctors – can move forward with more certainty.
It will be important to watch and see what happens during and after the election and see how things pan out. Though the picture does not look rosy, there are a number of ways to help the Medicare system and a number of ideas that are being considered.
For now, at least, benefits are staying as is, and will be dealt with, most likely in 2009, after the political hoopla settles down and Washington get back to the real nuts and bolts business of running the government.
After taking a long look at the way payments to Medicare in many Florida counties are paid, there seem to be a number of inequities. Payments in Miami-Dade counties are 38% higher than in a number of counties and 50% higher than in 24 other counties. In addition, the other counties receive fewer benefits than plans in Miami-Dade.
Somehow this has a lot to do with the way that the counties are districted. To help adjust the situation, next year Miami-Dade will receive a 13% payment increase, while other counties only receive 3% to 4% increases. This will be the beginning of trying to make the Medicare situation more equitable throughout the state.
Florida is not the only state that struggles with some of these issues, however, they are, at present, addressing the issues and tackling them to make the financial ramifications of premiums and payments much more fair and equitable.
Representative Robert D. Wexler, a Democrat, is expected to legislation next week that will change the way that Medicare calculates payments to private health plans in various counties. To this point, has mandated that payments are calculated on a county basis. Miami-Dade has been billed more on a per person basis, leading to the difference in the rates for Miami-Dade, vs. the other counties in question.
Wexler’s proposal would require HHS to close the payment gap until Palm Beach County’s rates are within 3% of Miami-Dade’s by 2012. The bill would lower the Miami-Dade payments and use that money to raise payments in Palm Beach County.
Some of this may sound complicated, but the main issue – especially for the people of Florida – is that there will be a fair and equal distribution of benefits for everyone. This is actually important and trendsetting, because Los Angeles may be the next place they look.
