Just to let you know, we have become aware of a problem with MediCare which should be ironed out soon.
If you have recently been told that I do not have a contract with MediCare this is not true.
Long story:
MediCare is a Federal program that sub-contracts its billing to big companies.
It has also recently made requirements that doctors accept automated deposits of MediCare payments to their bank accounts, and also that doctors must bill under newly issued unique identifiers (NPI's) which must be flawlessly and seamlessly linked to doctor names, tax ID numbers and legacy MediCare numbers.
These last two requirements became enforceable just in the last month or so.
At the same time, NHIC (the big billing company that has been doing MediCare billing for California, Hawaii, Idaho and Nevada for years) lost the contract to Palmetto GBA (a different big company that has been doing MediCare billing in the Atlantic seaboard states for years), effective now.
So, basically a perfect storm of conditions, changes in business structure and entities and agencies auditing the process and performing due diligence has resulted in 75% of the doctors in these states suddenly not receiving MediCare payments and their patients being told that their doctors are not MediCare contracted doctors.
Short story:
MediCare screwed up again.
Solution:
We and our local billing company (Data Management Services, or DMSCO) are working with MediCare to clearly link my name and practice with all necessary unique identifiers in accordance with instructions from MediCare, and should have this straightened out ASAP.
In other words, sit tight, don't worry, it'll get worked out.
Wednesday, June 18, 2008
Thursday, June 12, 2008
MediCare
Now, those of you who are over 65 should already know this. This posting is mainly for those who are coming up on MediCare eligibility and are having some difficulty sorting it out (the MediCare part, not the becoming 65 part).
Where can I read more about MediCare?
Why, at that fount of all knowledge, the Internet! Or, more specifically, their website.
When do I go on MediCare?
For the most part, when you turn 65, or are found to be permanently disabled. This is usually after you've already consigned yourself to senior discounts, AARP membership, being called Sir/Ma'am, and have long forgotten those unsolicited mail offers of low-cost life insurance.
What is MediCare?
MediCare is a federal entitlement program that was legislated into being in the early 197o's during the Johnson administration. It was intended to provide medical care for seniors then, and still does.
If you get a paycheck, a part of your pay is deducted and goes toward a number of programs including Social Security, state disability and MediCare. This is probably good for everyone including oneself unless you plan to work right up until you die without an injury. If not, these programs protect you from having to do so.
Basically, MediCare covers all procedures and treatments that are proven to be safe and effective and beneficial. This means things that it doesn't cover are either not proved to be so, or have been proved to be more harmful than helpful. So, when you take it on yourself to pay for a medical treatment where the provider or vendor has told you that insurance won't pay for it you are probably spending your money and time on unproven treatment. But hey, it's a free country.
What does MediCare cover?
MediCare has an annual deductible that rolls over every January 1st. It's pretty nominal (about $150), after which Part A picks up hospital care and Part B picks up outpatient care including doctor visits. An overview of benefits gives more detail; you will need Adobe Acrobat to read it.
Specifically, this includes cancer screening and routine monitoring such as diabetes tests. However, when they say every year they mean no more frequently than every 365 days midnight to midnight.
What does MediCare NOT cover?
Aye, there's the rub.
MediCare does cover medicines but as a separate supplemental Part D. This is covered in detail in earlier postings.
It does not cover in-home care or skilled nursing home care after 90 days of rehabilitation (such as following a stroke). You may wish to look at Long Term Care Insurance; this was also addressed in an earlier posting.
What happens to my regular health insurance?
Well, that depends.
If you've been busting hump at a poorly paying McJob just for the insurance or the money to buy it, you may decide to just let it go and go with MediCare Part A and Part B. You may want to get Part D for drug coverage; the average premiums are around $50/month.
If you have medical insurance through your retirement benefits you may want to look at it's coverage and costs and decide whether it's to your advantage to keep it, especially if it becomes your secondary insurance which is usually the case. Some folks find that they're better off letting it go though many don't as they're simply apprehensive about this.
So what's all this about MediCare becoming insolvent?
Dunno. It's a bit like the way the health care system has been on the verge of collapse for over 40 years without just flat-out collapsing.
Seriously, the issues are that first of all, the MediCare program was signed into legislation when the average life expectancy in the US was about 67-68 years and not 80 years which it is at present. Doh!
Also, the distribution of ages in our population means that where there used to be 5-6 workers contributing part of their paychecks for each senior, now its about 2-3.
Personally and IMHO, I think at some point the US Congress is simply going to have to grab the third rail and decide to increase the age of MediCare eligibility or come up with a way to extend a MediCare like insurance to all citizens with an income tax hike to leverage it.
I hope it doesn't turn into a Catch-22 situation where you get to be 67, and then the age for eligibility gets bumped to 69, and so on and so on. (Yossarian, you still have to fly 5 more missions...)
Where can I read more about MediCare?
Why, at that fount of all knowledge, the Internet! Or, more specifically, their website.
When do I go on MediCare?
For the most part, when you turn 65, or are found to be permanently disabled. This is usually after you've already consigned yourself to senior discounts, AARP membership, being called Sir/Ma'am, and have long forgotten those unsolicited mail offers of low-cost life insurance.
What is MediCare?
MediCare is a federal entitlement program that was legislated into being in the early 197o's during the Johnson administration. It was intended to provide medical care for seniors then, and still does.
If you get a paycheck, a part of your pay is deducted and goes toward a number of programs including Social Security, state disability and MediCare. This is probably good for everyone including oneself unless you plan to work right up until you die without an injury. If not, these programs protect you from having to do so.
Basically, MediCare covers all procedures and treatments that are proven to be safe and effective and beneficial. This means things that it doesn't cover are either not proved to be so, or have been proved to be more harmful than helpful. So, when you take it on yourself to pay for a medical treatment where the provider or vendor has told you that insurance won't pay for it you are probably spending your money and time on unproven treatment. But hey, it's a free country.
What does MediCare cover?
MediCare has an annual deductible that rolls over every January 1st. It's pretty nominal (about $150), after which Part A picks up hospital care and Part B picks up outpatient care including doctor visits. An overview of benefits gives more detail; you will need Adobe Acrobat to read it.
Specifically, this includes cancer screening and routine monitoring such as diabetes tests. However, when they say every year they mean no more frequently than every 365 days midnight to midnight.
What does MediCare NOT cover?
Aye, there's the rub.
MediCare does cover medicines but as a separate supplemental Part D. This is covered in detail in earlier postings.
It does not cover in-home care or skilled nursing home care after 90 days of rehabilitation (such as following a stroke). You may wish to look at Long Term Care Insurance; this was also addressed in an earlier posting.
What happens to my regular health insurance?
Well, that depends.
If you've been busting hump at a poorly paying McJob just for the insurance or the money to buy it, you may decide to just let it go and go with MediCare Part A and Part B. You may want to get Part D for drug coverage; the average premiums are around $50/month.
If you have medical insurance through your retirement benefits you may want to look at it's coverage and costs and decide whether it's to your advantage to keep it, especially if it becomes your secondary insurance which is usually the case. Some folks find that they're better off letting it go though many don't as they're simply apprehensive about this.
So what's all this about MediCare becoming insolvent?
Dunno. It's a bit like the way the health care system has been on the verge of collapse for over 40 years without just flat-out collapsing.
Seriously, the issues are that first of all, the MediCare program was signed into legislation when the average life expectancy in the US was about 67-68 years and not 80 years which it is at present. Doh!
Also, the distribution of ages in our population means that where there used to be 5-6 workers contributing part of their paychecks for each senior, now its about 2-3.
Personally and IMHO, I think at some point the US Congress is simply going to have to grab the third rail and decide to increase the age of MediCare eligibility or come up with a way to extend a MediCare like insurance to all citizens with an income tax hike to leverage it.
I hope it doesn't turn into a Catch-22 situation where you get to be 67, and then the age for eligibility gets bumped to 69, and so on and so on. (Yossarian, you still have to fly 5 more missions...)