Cloud & Associates Blog
Check back often for important Health Insurance Information
Medicare
WASHINGTON — A Democratic senator, Ron Wyden of Oregon, and a Republican member of the House, Paul D. Ryan of Wisconsin, unveiled a bipartisan plan on Wednesday to revamp Medicare and make a fixed federal contribution to the cost of coverage for each beneficiary.
The lawmakers aim to reshape the debate over the giant health insurance program by addressing concerns that have provoked fierce opposition to similar ideas in the past.
Just as important as the details of their proposal was the fact that the two were working together on an issue that both parties have exploited for political advantage.
In 2010, many Republicans won House seats — and the support of older voters — by arguing that President Obama’s health care law would damage Medicare. Democrats are hoping to retake the House by arguing that Mr. Ryan and other House Republicans are pushing for the privatization of Medicare, which they say could greatly increase costs for beneficiaries.
The new Wyden-Ryan proposal, by blurring the contrast between the parties on this issue, could make it more difficult for Democrats to win the argument.
The proposal would make major structural changes in Medicare and limit the government’s open-ended financial commitment to the program.
Under the proposal, known as premium support, Medicare would subsidize premiums charged by private insurers that care for beneficiaries under contract with the government.
Congress would establish an insurance exchange for Medicare beneficiaries. Private plans would compete with the traditional Medicare program and would have to provide benefits of the same or greater value. The federal contribution in each region would be based on the cost of the second-cheapest option, whether that was a private plan or traditional Medicare.
In addition, the growth of Medicare would be capped. In general, spending would not be allowed to increase more than the growth of the economy, plus one percentage point — a slower rate of increase than Medicare has historically experienced.
To stay under the limit, Congress could cut payments to providers and suppliers responsible for the overspending and could increase Medicare premiums for high-income beneficiaries, the lawmakers said.
The proposal is sure to come under fire from beneficiaries and Democratic lawmakers who see themselves as the pre-eminent defenders of Medicare.
For his part, Mr. Wyden said: “Medicare is the most important fiber in the social safety net. I would never do anything to shred it, weaken it or harm it in any way. Our proposal places traditional Medicare, long supported by progressives, alongside a menu of private alternatives that provide the choice and competition long supported by conservatives.”
Unlike the Ryan budget blueprint approved by the House in April, Mr. Ryan said, the new proposal would preserve the traditional fee-for-service Medicare program as an option for all beneficiaries. “Our proposal harnesses the power of competition to address the root cause of medical inflation,” said Mr. Ryan, the chairman of the House Budget Committee.
Democrats expressed concerns about the proposal based on policy and politics. A senior Democratic Congressional aide said, “This plan gives bipartisan political cover to Ryan and other Republicans against whom we have been waging a very successful political offensive.”
from BigHealthReport.com
Tags: Untagged
Most of us remember the 1997 Steven Spielberg movie! Richard Dreyfus plays Roy Neary who chases his vision of a spacecraft into a remote area where he and others experience a "close encounter of the third kind" - contact with ET! Well, if this happens to you, you can now rest assured that the Federal regulations will have a code for it in their new release of the ICD-10 medical diagnosis codes.
A new federal law is about to expand the number of medical-insurance codes dramatically. The International Classification of Diseases (ICD) Codes are the classification codes used by hospitals and doctors to diagnose and describe a patient's illness and injuries. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires these codes be used by health plans, health care providers and related services when electronically submitting claims and such. This does of course affect Medicare and Medicade patients and some non-government services. But, it will also undoubtedly affect every one of us and our providers due to the new health care act passed last year.
According to the Centers for Medicare & Medicaid Services (CMS) ICD-10 Website, the old codes ICD-9 are outdated. The 18,000+ codes don't allow them to be specific enough. They are about to be replaced with a new ICD-10 code. The new law will result in about 140,000 codes. This is expect to be the most complex, expansive and expensive code change in history. Industry analysts expect it to exceed Y2K with respect to cost and impact. The governments' own site states, "Every standard has been updated, from claims to eligibility to referral authorizations." www.cms.gov
So, OK where were we? One web company is advertizing that its ICD-10 training can be fun! So how much fun can we have with this one! Think about this:
If you step on a turtle - which causes you to walk (please walk, don't run, don't think they have a code for running) into a lamp post - at the pool behind your neighbors mobile home - while you are distracted by the crash of a spacecraft, which injures the occupant, there are codes for that!
W5922XA - Struck by a Turtle, initial encounter
W2202XA - Walked into lamppost, initial encounter
Y92026 - Swimming-pool of mobile home as the place of occurrence of the external cause
V9541XA - Spacecraft crash injuring occupant, initial encounter
Oh wait, wrong code! we weren't struck by the turtle, we tripped over him/her/it!
W5929XA - Other contact with turtle, initial encounter
So, where does the "Third Kind" come into play? How about these codes?
1.) V9541XA - Spacecraft crash injuring occupant, initial encounter
2.) V9541XD - Spacecraft crash injuring occupant, subsequent encounter
3.) V9541XS - Spacecraft crash injuring occupant, sequela
And heaven forbid you are a "sequela" which a dictionary defines as "A pathological condition resulting from a disease." Yea, second definition defines it as "A secondary consequence or result", but they have a code for "subsequent encounter". Maybe the "Third Kind" can be used for an alien abduction!
Are you ready for new HIPAA X12 5010 & ICD-10 standards? Version 5010 (which is a whole 'nuther update) standards for electronic health transactions start on January 1, 2012. ICD-10 for medical diagnosis and inpatient procedure coding on October 1, 2013. Don't you just love it?
This year you have a longer window of enrollment than the November 15 to December 31 stretch of last year. Open enrollment runs from October 15 to December 7 this year. Someone out there has no sense of history or ironic sense of humor. The health-care overhaul calls for an earlier deadline to ensure that all new coverage begins as planned on January 1.
You should receive an annual notice telling you about any changes in your coverage for next year by September 30. Insurers will begin to market their 2012 plans on October 1. The dates are bound to catch some seniors off guard. Be proactive! If you are interested in enrolling in an Advantage Plan for 2012 start comparing plans as soon as possible. If you are considering changing plans for the first time visit the Medicare.gov to search for plans in your area.
Do not take any coverage for granted. Just because something was covered this year by no means indicates that it will be covered next year. Plans change how they cover expenses from year to year. You may find that a prescription drug that was covered last year is not covered for the new year, or you may face a big bill for a costly treatments like chemotherapy. Any changes will be laid out in the annual notice you receive from your insurer. Read it carefully!
If you miss the deadline things can get complicated. The open enrollment period, which ran from January 1 through March 31, has been eliminated and is no longer available. So, if you fail to do due diligence, the plan you are on may still be offered for 2012, but the details of the plan may change. If the plan is discontinued you may be switched to another plan or dropped into regular Medicare, which does not provide prescription drug coverage. If you enroll in a Medicare Advantage plan and wish to make a change, your only opportunity will be between January 1 and February 14. But, you will only be allowed to dis-enroll and return to original Medicare. You may also purchase a stand-alone Part D plan and a Medicare supplement if you wish. But, you will not be allowed to jump into another Medicare Advantage Plan.
The goal of the new deadline is to prevent coverage problems arising from late December enrollment decisions. But it could be a real headache if you are not on top of your game! You can rest assured, however, that the expert staff at David C. Cloud and Associates is on top of the game for you! We will be glad to assist you with any questions concerning your Medicare options. Just click on the Contact Us link above, or call us to discuss your specific situation and questions. Tags: Untagged