Tag: medicare

Let’s talk Medicare Advantage – NC Health News

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By Thomas Goldsmith

Privately run Medicare Advantage insurers attract more enrollees each year with prominent advertising and enticing perks. But the program, with about 1 million North Carolina enrollees, faces challenges on specifics from federal regulators, the courts and Congress about the profits it makes, its consumer advertising and some of its internal practices. 

As federal regulators are taking aim at aspects of Medicare Advantage, such as allegedly fraudulent billing practices, a report from the U.S. Senate Finance Committee is one of the sources that lists complaints calling its marketing misleading. Those problems have been seen in North Carolina, as well as across the country.

“The North Carolina Department of Insurance shared that its Seniors’ Health Insurance Information Program (SHIIP) had received a number of complaints involving dually eligible beneficiaries who had their enrollment changed to a different [Medicare Advantage] plan even though neither the beneficiary, family member, or power of attorney had been engaged in an enrollment discussion with the plan or an agent,” the August 2022 report reads.

(Dually eligible beneficiaries are eligible for Medicaid, the health insurance that covers low-income people, and for Medicare, which is mostly for people older than 65.) 

Now, federal regulators are proposing new rules to curb such deceptive practices. Regulators say the rules are necessary to make sure potential Medicare Advantage customers can receive accurate information about the plans and their differences from traditional Medicare.

In addition to restricting the advertising that draws millions of enrollees to Medicare Advantage, the federal Centers of Medicare and Medicaid Services is working with the federal Department of Justice to crack down on billing practices that they contend can unnecessarily increase company profits by billions annually.

Recently announced moves by CMS to improve the accuracy of billing by Medicare Advantage companies won praise late last week in a joint letter from a group of more than three dozen leading figures from public health, public policy, health care and clinical care.

“CMS has taken a strong and appropriate approach to improving the accuracy of payment in the MA Program,” said Dr. Don Berwick, a former administrator of the Centers for Medicare and Medicaid Services who signed the letter. 

Additional signers included faculty from Yale, Harvard, Stanford, Southern California, Pennsylvania and New York universities, as well as former officials of CMS, the Center for Medicare and Medicaid Innovation and the Medicare Payment Advisory Commission, known as MedPac,

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Medicare Pay Cuts Will Hurt Seniors’ Care, Doctors Argue

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[UPDATED at 11 a.m. ET for news developments.]

Doctors are urging Congress to call off cuts scheduled to take effect on Jan. 1 in the reimbursements they receive from Medicare.

In what has become an almost yearly ritual, physician groups are arguing that patients will have greater difficulty finding doctors who accept Medicare if lawmakers allow the pay cuts to happen.

A more than 4,000-page draft government spending bill released by lawmakers early Tuesday morning proposed much smaller-than-planned cuts to Medicare payments. But the bill, which Congress hoped to pass by the weekend to keep the government funded and avert a shutdown, would not go as far as doctors wanted.

“Despite overwhelming bipartisan, bicameral support to stop the full Medicare physician payment cut, Congress failed once again to end the cycle of harmful Medicare cuts, showing a disregard for vulnerable seniors,” the Surgical Care Coalition, an organization representing surgeons and anesthesiologists, said in a statement.

The doctors’ lobbying campaign had gained traction on Capitol Hill. A bipartisan group of 115 House lawmakers rallied behind doctors in a letter to congressional leaders and President Joe Biden last week, urging them to prevent cuts that they argued would “only make a bad situation far worse” for Medicare patients.

In recent years, the Centers for Medicare & Medicaid Services scheduled the pay cuts to offset the cost of increasing payments for underpaid services, like primary care. Physicians also stand to see reductions tied to broad cuts implemented by Congress in recent decades to try to control government spending.

Some Republicans have pushed to wait on passing the spending package until their party controls the House of Representatives next year and can have a greater say over what they call out-of-control spending. One priority of the incoming House Republican majority is curbing Social Security and Medicare, a federal health insurance program for people age 65 and older, among others.

“We’re mortgaging our kids’ futures,” Sen. Ron Johnson of Wisconsin, a Republican on the Senate Budget Committee, told reporters, referring to overall spending. “This is killing us from a financial standpoint. It’s got to stop.”

Despite concerns about ballooning government spending, for years doctors have been successful in delaying or softening proposed pay cuts, arguing that there would be dire consequences if the cuts kicked in.

Physicians carry a lot of political weight in Washington. The American Medical Association, the professional organization that represents and

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Feds threaten UNC medical center Medicare funds in excess of basic safety challenges

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File photograph

Raleigh

Federal regulators have threatened another North Carolina clinic with the termination of Medicare funding around critical individual safety challenges — this time UNC Health’s flagship campus in Chapel Hill.

In a letter to the UNC hospital’s leaders late very last thirty day period, the Centers for Medicare and Medicaid Companies stated it would terminate UNC Health care Center’s Medicare deal on July 23 except if the facility fixes numerous issues determined as “immediate jeopardy.” An instant jeopardy designation, in accordance to CMS guidelines, usually means a clinic has “placed the well being and basic safety of recipients in its care at threat for major harm, severe hurt, major impairment or demise.” It is the the very least typical and most major result of inspections by wellbeing officials — and it carries the potential for the most significant sanctions.

Prompted by a complaint, condition inspectors surveying UNC Medical Centre on June 17 concluded the facility violated 4 federal wellness rules on clinic oversight and patients’ legal rights, as very well as quality evaluation and an infection regulate.

“During a current criticism study, difficulties had been investigated together with a patient suicide immediately after discharge and an infection prevention difficulties linked to documenting the COVID-19 vaccination status of vendors and the physical spacing of clients and people in our chaotic crisis office ready room,“ UNC Health spokesperson Phil Bridges stated in a statement Monday.

Though likely devastating to a hospital’s funds, professionals say dropping Medicare funding is an not likely end result — presented staff members post a in-depth corrective action plan to federal officers. Bridges mentioned the healthcare facility submitted that prepare by the July 5 deadline, and that a comply with-up survey of the facility is anticipated in the coming weeks “to verify that our motion ideas are in place and efficient.”

“The treatment and security of our people is normally our prime precedence,” Bridges explained. “UNC Hospitals consistently strives to enhance our policies and strategies to ensure we are giving superb treatment to clients.”

The N.C. Office of Health and fitness and Human Solutions, which furnished a copy of the letter in reaction to a community data ask for from The Information & Observer Monday, declined to give particulars about their survey conclusions at UNC Health care Center. They directed a ask for for their in depth report on the hospital to CMS, which has

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1 in 5 Medicare Clients Use Medical Cannabis: Survey | Health and fitness News

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By By Robert Preidt HealthDay Reporter, HealthDay Reporter

(HealthDay)

THURSDAY, April 14, 2022 (HealthDay News) — A person in five Medicare recipients use medical marijuana and two-thirds say it really should be lined by Medicare, a new survey reveals.

The poll of 1,250 Medicare recipients was executed in April and observed that one particular in five use clinical cannabis and 23% have utilized it in the previous. In all, 21% said they use it to deal with a single or far more healthcare problems.

Present use for health explanations was maximum amongst respondents who also used marijuana recreationally (39%). In all, 28% of leisure buyers mentioned they earlier applied health care cannabis.

Respondents use it to treat a wide range of physical and mental overall health problems, which includes 32% for nervousness and 31% for serious agony. Around one particular-quarter said they use it to deal with melancholy, glaucoma, and signs and symptoms associated with HIV/AIDS, together with nausea, urge for food loss and discomfort.

Between respondents, aid was powerful for Medicare coverage of medical cannabis.

Two-thirds claimed they “strongly agree” or “concur” that clinical cannabis need to be protected. 30-four percent stated they “disagree” or “strongly disagree.”

Approximately six in 10 supporters of Medicare coverage said they do so due to the fact health-related marijuana can be powerful when other treatments fail.

Remarkably, support for Medicare coverage was decrease amongst recent health care cannabis consumers (56%), when compared with 63% of former users and 71% of these who mentioned they’ve under no circumstances employed it.

Why the reluctance among the existing people?

Just about four in 10 (38%) claimed they fear Medicare protection would increase the drug price tag.

Pollsters identified that present users’ out-of-pocket prices have been large-ranging. 50 percent described spending up to $200 for each thirty day period 36%, amongst $201 and $500 per month and 14% far more than $500 a thirty day period.

In all, 31% of users who oppose Medicare protection of health-related cannabis cited unidentified lengthy-time period impacts and a deficiency of research into its utilizes and effectiveness.

Fifty percent of buyers said they would like medical marijuana to be lined by Medicare mainly because it can be a multipurpose treatment.

Between earlier people who assistance Medicare protection, the best purpose (48%) is that cannabis is a purely natural cure, not a synthetic pharmaceutical.

The study also uncovered dissimilarities based mostly

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Frank DeFilippo: Overall health Treatment as Prosperity Care Alternatively of Medicare

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Squeezed by at any time-decreasing govt reimbursements and confused by compensating amplified client-loads, primary care medical professionals are, in rising quantities, coming into a way close to each. It’s termed concierge drugs.

And a key consequence, meant or not, is that they’re abandoning proven clients along the way who will not engage in or pay back, or can’t manage, the large expenses for less patients and additional encounter time with their health professionals.

Concierge, as any person who’s been to France or stayed at a luxe lodge is familiar with, defines a human being who attends to the demands and desires of guests.

Concierge drugs is pretty considerably the exact. But it arrives with a significant price tag, frequently close to $1,800 to $2,000 a calendar year out-of-pocket and on top rated of the prices of a patient’s overall health care program. The yearly price receives a affected individual a doctor’s cell mobile phone selection, 24/7 reaction, and, as obtainable, similar-day appointments.

The up-front payment is not reimbursable or lined by any health treatment approach, which includes Medicare, which is primarily the squeeze element on doctor’s charges by way of recurring cuts. Wellness treatment ideas, together with Medicare, will address only most exams and lab operate requested by a concierge physician.

In other terms, concierge medication is turning out to be a pricey different to crowded waiting rooms, emergency rooms, health and fitness hubs, and all those people Docs “R” Us urgent care pop-ups together properly-traveled roadways. And it is an anodyne to anyone who has the approach and wakes up with, say, a sore toe and desires calming reassurance from a particular medical doctor.

Basically place, wellbeing treatment in The us is headed right back to in which it started out, a two-tier method – all those who can find the money for it and people who simply cannot.

And in the U-turn, primary treatment health professionals are a vanishing breed as they abandon team procedures, or the unusual person follow, for the more valuable and own observe of concierge drugs, which greatly cuts down the amount of clients they see in exchange for the up-front service fees.

In lots of circumstances, individuals medical professionals who continue to follow principal care medicine are declining to settle for new clients because they are at the optimum amount they can fairly treat. The lookup for an satisfactory most important

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CMS: Healthcare workers must get first COVID shot by Dec. 5 to continue Medicare, Medicaid participation

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The Facilities for Medicare & Medicaid Providers (CMS) has issued its promised unexpected emergency regulation necessitating team working at healthcare services be vaccinated for COVID-19 as a affliction of participation in Medicare and Medicaid.

According to an announcement from the company, health care services must have a plan in place that ensures all qualified staff have obtained the first dose of a two-dose COVID-19 vaccine sequence or a a person-dose COVID-19 shot “prior to supplying any care, treatment or other companies” by Dec. 5. Qualified staff will then need to be completely vaccinated by Jan. 4, 2022.

“Ensuring patient safety and protection from COVID-19 has been the concentrate of our efforts in combatting the pandemic and the continuously evolving difficulties we’re observing,” CMS Administrator Chiquita Brooks-LaSure mentioned in a statement. “Today’s action addresses the danger of unvaccinated health and fitness treatment staff to patient basic safety and presents balance and uniformity across the nation’s health and fitness treatment process to strengthen the wellness of individuals and the providers who treatment for them.”

CMS claimed its new regulation necessitates health care services to establish a approach for exemptions based on health-related problems or religious grounds in accordance with federal law. The entire interim rule is 214 internet pages long and is scheduled to be revealed in the federal register Nov. 5.

Connected: Conflicting federal, condition COVID-19 vaccine needs have hospitals trapped in noncompliance

The agency claimed these demands will apply to around 76,000 suppliers and deal with much more than 17 million health care personnel across the U.S.

It plans to guarantee compliance with the COVID-19 vaccination prerequisites by way of a survey and enforcement course of action. Surveyors who decide a service provider or provider does not fulfill the needs will be cited as noncompliant be provided a grace time period to grow to be compliant “before supplemental steps come about,” the company mentioned.

“CMS’ goal is to convey healthcare vendors into compliance.  Nonetheless, the agency will not hesitate to use its total enforcement authority to guard the overall health and safety of clients,” the company wrote in its announcement.

CMS claimed in the announcement that it has by now found an “encouraging” 9% uptick in nursing property workers vaccination costs considering the fact that asserting in excess of the summer season that team in all those services would be demanded to be vaccinated. The company also referenced a report

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