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McNees Wallace & Nurick LLC: Planning and Paying for Long-Term Care (Part 2 in a Series: Medicare)

By Scott Alan Mitchell As discussed in Part 1 of this series, the U.S. Department of Health and Human Services estimates that at least 70% of people over age 65 will need long-term care services at some point in their lives - and over 40% will need care in a nursing home for some period of time...

"Medigap" Coverage Policies and Categories in Tennessee

"Medigap" insurance can pay for non-covered services, deductibles, and co-payments not otherwise covered by Medicare Part A and Part B. Except for Minnesota, Massachusetts, and Wisconsin, U.S. territories, and D.C., states must limit the number of different Medicare supplemental insurance policies...

Tenth Anniversary of the Medicare Secondary Payer Industry: Where Do We Now Stand?

This year marks the 10th anniversary of the Patel Memo, the memo that launched the Medicare Secondary Payer industry. We are forced to look back over the past decade and recognize just how far we have come.

Foley & Lardner LLP: CMS Announces Comprehensive Primary Care Initiative Soliciting Participation From Health Care Payers

By C. Frederick Geilfuss II , Donald H. Romano , Gary D. Koch , Diane Ung and Lawrence W. Vernaglia The Centers for Medicare and Medicaid Services (CMS) has announced plans to develop a Comprehensive Primary Care (CPC) initiative. In a notice published in the Federal Register on October 3, 2011...

Medicare Open Enrollment Starts, Ends Earlier This Year

Alert to Medicare beneficiaries : The enrollment period starts and ends earlier this year! From Oct. 15 through Dec. 7 you have the opportunity to look at your Medicare coverage, examine any new options, and decide if you want to make changes in your coverage. The enrollment period has been adjusted...

Social Security Administration Announces 2012 COLA

For retirees and workers, there's good news, not-so-good news, and in-between news. Let's start with on a positive note: The Social Security Administration today announced the first cost of living increase in the past three years. If you're one of the 55 million Americans currently collecting...

Federal Appeals Court Rules Retirees Cannot Dodge Medicare Eligibility

By Anne Rabuck A federal appeals court has ruled [ enhanced version available to lexis.com subscribers ] that those over age 65 and eligible for Social Security cannot escape their automatic entitlement to Medicare Part A benefits unless they repay all the Social Security funds paid to them. Three...

Duane Morris LLP: Centers for Medicare and Medicaid Services Releases Proposed Rule on Reporting and Returning of Overpayments

The U.S. Centers for Medicare and Medicaid Services (CMS) released a long-anticipated proposed rule on reporting and returning of overpayments on February 16, 2012. The proposed rule is part of CMS's recent effort to respond to increased Medicare spending through expanded efforts to reduce fraud...

Sheppard Mullin Richter & Hampton LLP: New Medicare Advantage Audits Likely to be Challenging for and Challenged by Providers and Plans

By Karie Rego Since the 2006 payment year, CMS has conducted Risk Adjustment Data Validation (RADV) audits on Medicare Advantage (MA) plans' risk adjustment payments. However, CMS has been hindered by the lack of a methodology to extrapolate audit results. On February 23, 2012, CMS posted its final...

3rd Circuit: Humana Can Sue GSK For Reimbursement For Avandia-Related Expenses

PHILADELPHIA - (Mealey's) Medicare Advantage provider Humana Medical Plan Inc. is allowed under Medicare law to seek reimbursement from GlaxoSmithKline PLC (GSK) for the costs of treating insurance customers who were injured by GSK's Avandia diabetes drug, a unanimous Third Circuit U.S. Court...

Will Medicare Pay for Your Florida Nursing Home?

Are you one of the many Florida residents relying on Medicare to pay your way if you ever need nursing home care? Depending on what you mean by "nursing home," you, your family and your pocketbook could be in for a big shock. Many people fail to realize that Medicare does not cover long-term...

The New 3.8% Investment Surtax - Will it Apply to You?

Now that the health care law has been declared constitutional, the remaining provisions will be going into effect. One little known provision is a new 3.8% investment income surtax, also called the health care surtax or the Medicare tax; it will go into effect on January 1, 2013. This new surtax will...

Hook Law Center: The Pitfalls of Medicare

Medicare can be a wonderful benefit for those 65 and older. However, Medicare eligibility rules can be very complicated, and you may feel that you're in a trap more complicated than running the gauntlet in medieval times. There are many factors which influence Medicare eligibility such as: "whether...

Medicare Part D premium to remain unchanged in 2013

The U.S. Department of Health and Human Services has announced that the average premium for Medicare Part D coverage will remain steady in 2013. The average premium will be about $30. This is the third straight year that the Part D premium has not increased. Open enrollment for Medicare Part D plans...

Obamacare: The Upcoming Medicare Tax Hike and What to Do About It

With the Supreme Court's ruling that the Patient Protection and Affordable Care Act, informally called Obamacare, is constitutional, it will continue into effect in 2013. Among the many provisions of the massive law is a 3.8 percent Medicare surtax on investment income. While the recent Congressional...

Paying for Nursing Home Care with Medicare or Medicaid | How MassHealth Works

After visiting the hospital from a sudden fall, or some other unexpected medical event, an older or elderly patient almost always requires some extended time for recovery. But a hospital bed isn't really the appropriate place for such a long recovery, since hospitals are intended mainly to care for...

A Not-So-funny Riddle from Medicare: When Is Being in the Hospital Not Being in the Hospital?

When is being admitted to the hospital, not being in the hospital? When you are admitted for observation. This is not just a semantic distinction. If you are on Medicare, the way the hospital stay classifies your stay can have huge implications for your pocketbook, both during your stay and possibly...

Hook Law Center: Hospitalization as an Inpatient vs. "Under Observation:" If You're Medicare Eligible, the Difference Can Be Very Costly

Hospital Admission Advisory Do you know the difference between being admitted to a hospital as an INPATIENT or as someone UNDER OBSERVATION? If you're eligible for Medicare, the difference can be very costly. Consider the scenario of Laraine Sickels, a retired teacher from Whidbey Island, Washington...

Medicare May No Longer Use Improvement Standard to Deny Short-Term Skilled Care

The beginning of open enrollment and intense speculation about the election's impact on Medicare are not the only Medicare-related headlines these days. A new development may greatly help Medicare beneficiaries with chronic conditions who need skilled nursing and rehabilitation. In the past, Medicare...

Medicare Part D: It Pays to Shop Around

[ Originally posted Oct 16, 2012 ] Medicare Open Enrollment began yesterday, October 15, and continues through December 7, 2012. The enrollment period ends earlier than in previous years, so those considering making a change should not procrastinate. Medicare beneficiaries should pay particular...

Medicare to End "Improvement Standard"

For years I have counseled clients that if they enter rehab after a hospital stay that for a practical perspective they will only get 20 days of skilled cared (covered under Medicare) unless they can show they are "improving". This so-called "improvement standard" was never law, and...

Hook Law Center: Medicare to Cover More Home Health Services

Good news for Medicare recipients! Just in time for the New Year 2013! In the past, Medicare recipients were unable to receive home health services such as nursing care and therapies if they had a chronic condition. As a result of a court case that originated in Vermont, that is about to change. Vermont...

Managing Malpractice in Medicare’s Never-Never Land

Some things just aren't supposed to happen. In health care, they are referred to as "never events" and include hospital-acquired infections or injuries, medication errors and objects left inside patients during surgery. Yikes. The Centers for Medicare and Medicaid Services (CMS) have...

Bradley J. Frigon on the Applicability of Medicare Secondary Payment Subrogation Rights to Medicare Part C and Part D Private Carriers

By Bradley J. Frigon Following several cases that challenged federal regulations, CMS published a memorandum to all Medicare Advantage Organizations and Prescription Drug Plan Sponsors regarding Medicare Secondary Payment Subrogation Rights for Part C and Part D private carriers seeking reimbursement...

Landmark Jimmo v. Sebelius Settlement Helps Medicare Patients Receive Skilled Care

By Morris Klein CELA CAP | Settlement of a class-action suit filed against HHS makes it easier for patients to continue to receive skilled care services; the settlement removes clandestine policies requiring Medicare patients to exhibit improvement to continue receiving such services. Medicare will...