Federal Watch
April 26th, 2013
AGS is tracking developments of interest to geriatrics health professionals in order to provide weekly updates for our readers via our List Serv, americangeriatrics.org, our Facebook page, and our Twitter feed. This week, we update you about the increases in Medicare costs for higher income beneficiaries proposed in the new budget from the Obama Administration. We also report on an upcoming date that may impact doctors who refer or order services for Medicare beneficiaries. In addition, with the confusion surrounding the Affordable Care Act there has been a rise in the number of health care scams targeting Medicare beneficiaries. Lastly, we bring you a new report from the Office of the Inspector General for the Department of Health and Human Services about limiting prior payments to private health insurers.
Increase in Medicare costs for higher income seniors
The Obama Administration revealed in their new budget, a plan that will continue to increase Medicare costs for seniors with incomes over $85,000 as an individual, and $170,000 as a couple. The new plan calls for raising $50 billion over 10 years by increasing monthly premiums based upon income for both outpatient and prescription drug coverage. The Administration’s plan would increase the premiums that these beneficiaries pay and in addition, freeze adjustments for inflation until 1 in 4 Medicare beneficiaries were paying the higher costs. According to the budget beginning in 2017, there would be nine income brackets on which the higher premiums would be charged. Currently, there are only four. To read the entire article, click here.
Medicare Enrollment Referring/ ordering deadline
Today physicians and health care providers who bill Medicare are required to list the name and National Provider Identifier (NPI) of the ordering/referring physician or health care provider in order to be paid for claims. Beginning May 1st 2013, if the ordering/referring physician or health care provider that is listed on the claim is not enrolled in Medicare, or does not have a valid opt-out affidavit on file, then the billing physician’s claims will be denied. This requirement was initially scheduled to go into effect in 2010.The requirement was delayed because the American Medical Association (AMA) and the Medical Group Management Association (MGMA) successfully persuaded the Centers for Medicare & Medicaid Service (CMS) to delay the requirement so that additional time could be given for physicians to opt-out, or enroll into Medicare. For additional information about Medicare enrollment please click here.
Health care scams and Medicare beneficiaries
Recent polls, have found that over half of Americans state they still do not know how the Health care law will affect them. Health care scammers are using this confusion to prey on people such as the elderly. One Medicare beneficiary discussed that the scammer began the phone call by saying he was calling to verify her information in order to send her a new Medicare card. It was once the scammer asked for her bank routing number that she became suspicious and ended the phone call. She expressed her frustration by saying, “There are some seniors who aren’t well and don’t think as well as they used to, and it just made me angry that they would be victimized like this." Sally Hurme, an elder law attorney at AARP states, As the Affordable Care Act ramps up, the country is likely to see more frequent insurance scams, and they’re likely to get more sophisticated. “To read the entire article, visit here.
Recent report about limiting prior payments to private health insurers
According to a government report out last week from the Office of the Inspector General for the Department of Health and Human Services, Medicare could earn over $100 million yearly if it limited private insurers ability to retain investment earnings on the money they are paid through the prescription drug program. Currently, Medicare pays private health insurers approximately 20 days before the insurer pays their pharmacy bills. In addition, they do not require that the insurers return any of the interest they earn while holding the money. This report is advisory and was given to both members of Congress and the Centers for Medicare and Medicaid Services. If the government had such a rule in place in 2009—the year that the auditors studied the Medicare Part D trust fund would have earned over $111 million in interest. CMS did not agree with the auditors. They said that the options presented in the report would cause many insurers to raise their prices to the government, in order to recoup the investment loss. To read the entire report and Kaiser Family Foundation article, visit here.
Should you have any questions, please don’t hesitate to contact Ashley Fletcher, Senior Coordinator of Public Affairs & Advocacy afletcher@americangeriatrics.org.
Modified On: April 26th, 2013
