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Lowering Medicare Bills

Lowering Medicare Bills | Heart and Vascular Health | Scoop.it
Are you paying higher Medicare premiums because of your income? Now is the time to try to reduce next year's bill.

The federal health-benefits program for older adults and the disabled has started its annual open-enrollment period, which runs through Dec. 7.

Re-evaluating Medicare coverage is as important as rebalancing an investment portfolio. As your needs change, make adjustments—while ensuring you get the same services at the best price.

But very few people do it. Only 15% of 1,000 Medicare beneficiaries who are 65 or older said they had changed their Medicare plans in the past year or plan to do so in the next 12 months, a recent Allsup survey found. Each year, people who use Medicare have to choose at least a few areas of their coverage. In traditional Medicare—comprising parts A (mainly hospitalization), B (outpatient care, including doctor visits) and D (prescription drugs)—you have to choose a drug plan. You also can buy a separate Medigap policy to help insure costs that otherwise aren't covered. Instead of using parts B and D, you can choose a Medicare Advantage plan—technically Part C—which has a set group of providers and might also cover drugs, dental work and eye appointments.

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Hospitals to Congress: Drop Payment Cap Proposal

Hospitals to Congress: Drop Payment Cap Proposal | Heart and Vascular Health | Scoop.it

My comment: Unfortunately this is the way things are going from the Medicare adminstrator CMS.  Fees for important services like Echocardiograms and Nuclear stress tests have been dramatically cut when done in physician offices to rates that cannot be sustained.  Many physicians have merged with hospitals because the EXACT same service billed by the hospital is reimbursed 4 times higher.  (Echocardiogram $1,605 vs. $373)

See Same Doctor Visit, Double the Cost

http://professional.wsj.com/article/SB10000872396390443713704577601113671007448.html?mg=reno64-wsj

So now CMS intends to cut the reimbursement to the outpatient physician level.  Common sense & fairness would lead to a fair payment regardless of where the service is provided but these are the capricious aspects of our reimbursement system.  Physician groups should not be paid so little and hospitals should not be paid so much.

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The nation’s four largest hospital associations and their allies are urging Congress to oppose a cap on payments for outpatient services.

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Medicare Prepayment audits to start Aug. 27 in 7 states

Medicare Prepayment audits to start Aug. 27 in 7 states | Heart and Vascular Health | Scoop.it

Take Home Message - Prepayment review has not been done before by CMS.  Previously this was reported to be for cardiac procedures such as angioplasty and defibrillators.

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The Centers for Medicare & Medicaid Services finally gave the official word on when hospitals should brace themselves for prepayment audits--Aug. 27, the agency quietly announced on its website.

The official launch date of Aug. 27 provides the timeline as to when CMS will target hospitals in states with high volumes of fraud or error-prone providers (Florida, California, Michigan, Texas, New York, Louisiana, Illinois) or many short inpatient stays (Pennsylvania, Ohio, North Carolina, Missouri).

The goal is to cut improper payments before they even happen. Shifting away from the pay-and-chase method, Medicare Recovery Auditors (RAC) will review claims before payment to ensure that providers comply with all Medicare payment rules.

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Dodging Medicare's Hidden Traps: Know the basics

Dodging Medicare's Hidden Traps: Know the basics | Heart and Vascular Health | Scoop.it

The Medicare website https://www.medicare.gov/default.aspx

provides the details, but it contains so much information that it can be difficult to navigate. Here is the very least you need to know.

 

Medicare Basics

Part A,  =>  no premium, is hospital insurance. has a deductible of $1,156 that covers hospital stays up to 60 days, copayments of $289/ day for days 61-90, and copayments of $578 a day for days 91-150 days.

 

Part B => optional insurance that covers doctors' bills, labs & outpatient care. The basic premium is $99.90/ month (can be as high as $319.70 for an individual earning > $214,000 annually), and deductible is $140/ year. Copays are 20% of Medicare-approved amounts.

 

Part D,  => covers prescription drugs, has a monthly base premium of $32.34 (high-income consumers pay more), in addition to a premium which varies by a plan. Copayments and deductibles also vary by plan.

 

If you receive Social Security, you will be enrolled automatically in parts A & B when you turn 65. If you aren't yet receiving Social Security, you have to apply for Medicare, (can do online)

 

The enrollment period for Part B and D begins three months before you turn 65 and lasts seven months. If you miss this enrollment window, your coverage will be delayed and your premiums will be higher.

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How to Appeal Denied Medicare Claims

How to Appeal Denied Medicare Claims | Heart and Vascular Health | Scoop.it

There are several things Medicare beneficiaries can do to reduce their costs. One of the most prominent started last week: the annual open-enrollment period (which runs through Dec. 7), where people can add, drop or switch medical and prescription-drug plans.

But an equally important strategy—and one that most beneficiaries don't pursue—is appealing denied medical claims.

Appeals of denied claims have high success rates. Here are the steps you need to follow.

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Medicare Premiums Holding Steady

Medicare Premiums Holding Steady | Heart and Vascular Health | Scoop.it

A morsel of good news about Medicare drug coverage for the coming year: 2013 premiums will remain basically level for the fourth year in a row.

As it has since 2010, the average monthly premium is projected to hover around $30, the federal Department of Health and Human Services has announced. Last year, the actual amount came in a few cents lower, at $29.67. And the dread doughnut hole, which this year suspends coverage once spending hits $2,930, will kick in a few dollars later, at $2,970.

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CMS to cut 2nd cardio test pay by 25%? Why in the world?

CMS to cut 2nd cardio test pay by 25%? Why in the world? | Heart and Vascular Health | Scoop.it

The plan by CMS - the Medicare payer, to reduce  technical fees because the procedures are performed on the same day FOR NO OTHER REASON THAN CONVENIENCE TO THE PATIENT is irresponsible and detrimental to the goal of an expedient cardiac work-up.

I couldn't agree more.

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Declining Payments for Seniors: drug costs in "donut hole" set to decline

Declining Payments for Seniors: drug costs in "donut hole" set to decline | Heart and Vascular Health | Scoop.it

The court's ruling preserves discounts consumers get on the Medicare drug plan doughnut hole. Drug makers worry Medicare might be able to lower prices it pays the companies even more. The closing of the coverage gap has been a tangible selling point for the health overhaul.

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