medicare insurance Archives - Page 26 of 38

CMS To Begin Medicare Audits: What This Means For Providers

In order to ensure that hospitals, clinics, and other healthcare providers are not being overpaid for Medicare services, CMS usually conducts on-going audits. However, CMS suspended most fee-for-service claim audits and medical reviews by Medicare Administrative Contractors (MACs) on March 30th of this year due to the coronavirus pandemic. Suspension continued through most of the summer, but the agency resumed auditing providers’ Medicare claims on August 3rd. CMS stated this summer that the audits will continue “regardless of the status of the public health emergency.”

The Audits That Have Been Resumed

CMS has resumed both prepayment and post-payment medical reviews conducted by:

The Medicare Administrative Contractors
The Supplemental Medical Review Contractors (SMRC)
The Recovery Audit Contractor (RAC)
Any contractors under the Targeted Probe and Educate (TPE) program

What This Means For Healthcare Organizations

As states began to reopen this summer, CMS made it clear that they did not expect to extend the enforcement discretion period for audits any longer. At this point, all organizations should be taking the appropriate steps to be prepared for an audit in case it happens, including notifying all staff involved. If an organization is selected for review and they have any hardships related to the pandemic, they can discuss them with their contractors.

doctors dressed head to toe with protective gear seeing an elderly man with a mask on. — *CMS indicated that hospice care providers will most likely be selected for audits.*

CMS noted that “auditors will be applying any waivers and flexibilities in place during the emergency period, otherwise all reviews will be conducted in accordance with statutory and regulatory provisions, as well as related billing and coding requirements.”

According to CMS, hospices are among the most utilized Medicare services. Because of this, CMS indicated that hospice care providers will most likely be selected for audits. When they are selected, they will have a chance to speak with their contractor about any hardships in replying related to the pandemic.

Many hospice care providers are worried about getting through an audit during this difficult time, especially since being subject to one would redirect focus away from patients, families, and hospice caregivers. “Staff are already being pushed to the limits. We’re operating with constraints in terms of how we can access patients. We’re operating mostly virtually right now, which is cumbersome,” Peter Brunnick, president and CEO of Hospice & Palliative Care Charlotte Region told Hospice News. “To add the audit process, which would require getting staff in-house pulling records and sitting down with auditors, is counter to everything we’re doing now trying to be socially distant and practice safety.”

“We recognize that oversight, even in a pandemic, is important, and we have no patience or tolerance for fraud and abuse. On the other hand, asking a compliant provider to take time out of providing care to their population in the middle of a global pandemic is not the best idea,” said National Hospice & Palliative Care Organization President and CEO Edo Banach. “There is a lot of consternation out there about the possibility that individuals are going to be pulled out of the field into the office and sift through records at a time when really all hands are needed on deck.”

CMS claims that they are taking the pandemic into consideration while doing these audits, so that they will not interfere with healthcare providers providing care to those who really need it.

Medicare’s Expansion Of Telehealth

Over the past few months, many people have gotten used to seeing their doctor virtually, or being able to call them from the comfort of their own home. Access to telemedicine was greatly expanded during the recent pandemic, and this has been especially beneficial for seniors. Having access to telehealth services means that older adults are not forced to jeopardize their health by going to a doctor’s office, and that they can access care even if they live in rural areas or are unable to get to a doctor’s office.

Now, in order to continue to protect older adults, both CMS and Congress are proposing actions to continue the expansion of telehealth. CMS Administrator Seema Verma announced that telehealth and telemedicine will be expanded to Medicare beneficiaries even after the pandemic is over. “I can’t imagine going back,” said Verma of returning to normal doctor’s visits. Now Medicare beneficiaries won’t have to. Congress is also trying to continue the expansion of telehealth services with their bipartisan Helping Ensure Access to Local TeleHealth (HEALTH) Act. If passed, this bill would mean that community health clinics and clinics in rural areas would continue to get reimbursement for telehealth services.

clack and white picture of congress — *CMS and Congress are looking into passing a bill to expand telehealth services for Medicare.*

The Temporary Expansion

CMS has been allowing telehealth services to cover more than 100 medical services since the CARES Act was signed into law in March of this year. This piece of legislation included provisions that removed restrictions on a patient’s location when receiving telehealth services, and permitted CMS to waive any Medicare reimbursement requirements.

Both providers and patients across the country have been taking advantage of the availability of telehealth services since the beginning of the pandemic. Medicare patients have been able to safely access both physical and mental health services throughout these hard times. But as state and federal governments enter their reopening phases, some of the expanded access to telehealth services is beginning to expire.

“Through the temporary telehealth changes thus far, community health center patients have been able to access primary care and behavioral health services while physically distancing to limit spread of coronavirus. However, patients and providers alike will benefit from permanent telehealth access even once the virus is under control,” Chris Shank, CEO and president of the North Carolina Community Health Center Association said in a statement.

Possible Changes Ahead

As state and federal governments enter their reopening phases, some of the expanded access to telehealth services is beginning to expire. CMS is seeking to stop this expiration and to:

Allow telehealth services to be covered under Medicare permanently
Remove “originating site facility and location requirements for distant site telehealth services.” In other words, community health centers and clinics would be able to service anyone in any location.
Reimburse community health centers and rural clinics for telehealth services

Congress is also trying to make sure that telehealth is accessible to seniors who could have trouble reaching a provider, as well as to those who receive care through federally qualified health centers. If passed, the HEALTH Act would mean that these community health centers and rural health clinics will continue to be reimbursed by Medicare for telehealth services. The HEALTH Act would provide “permanent cost-related payments for telehealth services furnished by federally qualified health centers [FQHC] and rural health clinics under the Medicare program.”

“The changes that we can make through the standard rule-making process, actions such as adding services to the telehealth list and making those permanent, those will appear in the physician fee rule,” said Emily Yoder, an analyst in CMS’ Division of Practitioner Services, while speaking during the American Telemedicine Association’s virtual conference.

Telehealth has become the new normal, and many Medicare beneficiaries have become dependent on it, especially those who have trouble accessing in-person care. The proposal to expand some telehealth services even after the pandemic is over is a welcome one for seniors who rely on telemedicine to get the care they need.

Trump Cuts The Cost Of Insulin For Medicare Beneficiaries

One in three Medicare beneficiaries has diabetes, which is more than 3 million people nationwide. Unfortunately, Medicare does not provide coverage for insulin. In May, President Trump announced that his administration is going to cut the price of insulin for Medicare beneficiaries to $35 for a one month supply. This would be a drastic reduction in price of about 66%. For older adults struggling to pay for their necessary supply of insulin, this could be a life-saving development.

Insulin Costs Skyrocket Every Year

The cost of insulin therapy tripled between 2002 and 2013, and it has increased another 55% since 2014. Diabetics have been expressing concerns over the out-of-control cost of insulin for many years. In fact, insulin has become so unaffordable that some people have either opted to get their insulin abroad from Canada, or go without it.

To make insulin more attainable, some manufacturers offer copay cards and assistance programs to help lower the out-of-pocket costs. These measures do help, but the costs of insulin copays and coinsurance for those on a Part D plan are still astronomical.

“Having more predictable out-of-pocket costs will help seniors adhere to their doctor’s orders,” White House counselor Kellyanne Conway said.

The Long Battle

This step toward addressing the crisis of rising insulin costs is long overdue. Diabetics, who are dependent on insulin to control their glucose levels and to prevent stroke or even death, have understandably been voicing their concerns about this issue for years. Their voices carried, reaching lawmakers who ended up taking pharmaceutical companies to court over the soaring costs of insulin. The House Committee on Energy and Commerce Oversight and Investigations Subcommittee held a total of 4 congressional hearings on this subject in 2019. In response to the hearings, pharmaceutical companies offered to lower prices and make generic brands available, but their promises were not enough.

Finally Being Heard

The Trump administration realized just how much insulin costs were affecting seniors and decided to take action. On Tuesday, May 26, the president stated, “Today I’m proud to announce that we have reached a breakthrough agreement to dramatically slash the out-of-pocket cost of insulin.”

CMS Administrator Seema Verma added, “President Trump has forged partnerships with pharmaceutical manufacturers and plans to deliver lower priced insulin to our nation’s seniors. This market-based solution, in which insulin manufacturers and Part D sponsors compete to provide lower costs and higher quality for patients, will allow seniors to choose a Part D plan that covers their insulin at an average 66 percent lower out-of-pocket cost throughout the year.”

She continued, “Trump’s Part D seniors savings model plan will go effective January 2021 and will save seniors about 66%, or an average of $446 each year, on insulin copays.” Verma also noted that if this model for lowering costs is successful, then they will try to expand the program to include other expensive prescription drugs.

Does Medicare Cover Ambulance Rides?

Ambulance rides are not cheap, they can range anywhere from hundreds to thousands of dollars. During a medical emergency, the last thing you want to worry about is if Medicare will cover the large ambulance bill. Thankfully, Medicare does cover ambulance rides so you don’t have to worry about anything but receiving the care you need. In fact, Medicare pays over $5 billion for ambulance service claims every year. However, to receive these benefits, there are stipulations you should be aware of first.

Eligibility Under Medicare Part B

Medicare Part B covers emergency ambulance services, and in some cases will also cover non-emergency services. An emergency is considered any situation in which your health is in serious danger. If you schedule your ambulance ride, then it is not considered an emergency. To receive coverage from Medicare:

The ambulance service must be medically necessary, and the only way to safely transport you to the hospital.
The transportation supplier (meaning nursing care facility or any provider asking for ambulance services) must meet Medicare ambulance requirements.
The reason for the trip must be to receive a Medicare-covered service during transportation or to return from receiving Medicare-covered care.
if it is not an emergency, then your doctor must provide a written order ahead of your scheduled trip.

If the situation is not an emergency, then ambulance services will only be covered if:

You are confined to your bed and unable to get up.
You need medical services during the trip that are only available in an ambulance.
You live in a skilled nursing facility and your doctor has written an order for an ambulance. You might be required to produce the order within 48 hours of the transport.
Your doctor deems that ambulance transport is medically necessary and provides a written order ahead of your scheduled trip.

Be aware that if you ask first-responders to take you to a hospital or facility other than the one that is closest to you, Medicare will only cover the cost of a ride to the nearest hospital or facility. You will be responsible for paying the rest of the bill out-of-pocket.

Ambulance Flights

Medicare will also cover other modes of emergency transportation, including ambulance flights. In order for Medicare to cover an ambulance flight, a ground ambulance must be unable to make it to your location. Medicare will also approve a flight if a ground ambulance can make it to the location but the situation is unsafe for the crew.

Your Costs

As with many services, Medicare Part B covers 80% of ambulance services, leaving you to pay 20% coinsurance out-of-pocket after you meet your Part B deductible ( $198 in 2020). It is illegal for ambulance companies to apply excess charges to your bill.

Some Medicare Supplement Plans will cover your coinsurance payments, so if you have certain letter plans, then ambulance rides will be covered 100%.

Ambulance rides are mostly covered by Medicare, but if you are worried about coinsurance payments, then consider a Medicare Supplement Plan. These plans mean that you won’t have to face Medicare bills alone, allowing you peace of mind, while at the same time putting money back in your wallet. There are different types of plans to choose from, with different coverage options at different price points. If you’re unsure where to begin, EZ can give you free quotes and a breakdown of all the plans. One of our agents will compare all of your options and find the perfect plan for your budget and needs. To get your free Medicare Supplement Plan quotes, simply enter your zip code in the bar above, or to speak to an agent, call 888-753-7207.

Is The Medicare Annual Wellness Visit Mandatory?

When you sign up for Medicare, you will receive several preventive care services at no cost to you. The exams and screenings offered to you are meant to assess your overall health and your risk for developing certain illnesses. One of these free preventive care services is the Medicare Annual Wellness visit. Many wonder if this visit is a mandatory part of maintaining Medicare Part B coverage. While it is not mandatory, it is beneficial.

What’s Included In the Medicare Annual Wellness Visit

older caucasian man with a nurse — *Your doctor will check your family history, check your weight, blood pressure and more, while offering personalized heal advice/plan.*

The purpose of a Medicare Annual Wellness Visit is to check your overall health, assess your risk factors, and create a wellness plan to help prevent any illnesses you may be at risk for. Your doctor will briefly examine you, but this visit is not to be confused with a physical. A physical is a more comprehensive visit, at which your doctor checks you from head to toe and asks for lab work to be completed. Medicare does not cover physicals, but a Medicare Annual Wellness Visit is the next best thing.

At these visits your doctor will:

Review your medical and family history.
Check your height, weight, blood pressure, and other routine measurements.
Develop or update a list of providers and prescriptions.
Offer personalized health advice.
Create a list of risk factors and treatment options for you.
Discuss a plan for care in the event that you are unable to take care of yourself.
Screen you for conditions such as dementia and depression.

Eligibility For the Medicare Annual Wellness Visit

In order to be eligible for a Medicare Annual Wellness Visit, you need to have been enrolled in Medicare Part B for at least 12 months. When you first sign up for Part B, you will have an initial Welcome to Medicare Exam within the first 12 months of your enrollment. Once you have had this exam, then you are eligible to begin having an Annual Wellness Visit every year.

Medicare will cover your Annual Wellness Visits 100% as long as you see a participating Medicare provider. However, if your doctor prescribes any additional treatments or lab work in the course of this visit, then Medicare will cover 80% of the costs of these extras.

illustration of pill bottle with 2 bills beside it — *When going to your doctor, bring your medication with you.*

What To Bring To The Visit

Before you go to your first Medicare Annual Wellness Visit, you will need to fill out a long health risk assessment questionnaire. To avoid sitting at the doctor’s office filling out this form, you can request that it be mailed to you. That way, you can fill it out at home and have it ready when you go to your appointment. In addition to this form, bring any medications you are taking and a list of questions/concerns you may have.

When scheduling your appointment, make sure you let your doctor’s office know that you are scheduling an Annual Wellness Visit and not a regular checkup or wellness visit. If you are not clear about this, you could be charged for a regular wellness visit.

Medicare offers you free preventive care visits so that you can stay on top of your health. So while it is not mandatory to go to these appointments, it is definitely a good idea – you’ll be able to assess your risks and come up with a proactive plan to stay healthy. Your doctor will go over all of your medications, address any concerns, and come up with a new health plan and treatments for you to follow. These visits will keep you feeling your best; they could even end up saving your life.

Get A Plan From One of The Best Rated Medicare Supplement Companies Through EZ

There are a lot of choices when it comes to Medicare Supplement Plans. You not only have the choice between 10 different letter plans, but you also have the choice of multiple companies to buy your plan from. There’s Aetna, Cigna, Humana, Mutual of Omaha, and so many more. But which one in this sea of companies should you go for? First you need to determine which companies service your area. Next, you need to check each company’s ratings. At EZ, we have agents who can find the company that best fits your needs, so you can get the best possible plan and service.

How Companies Are Rated

yellow trophy with a star in the middle of the cup part. — *Organizations like the Better Business Bureau will sometimes evaluate multiple companies and give awards based on certain factors.*

Ratings for insurance companies that offer Medicare Supplement Plans are not based on the coverage that their plans offer. This is because Medicare Supplement Plans are standardized by Medicare, so each insurance company has to offer the same benefits for each letter plan across the board. Insurance companies can, however, set the premiums for their plans, so those vary from one company to another. Ratings aren’t generally determined by price alone, though. Insurance company ratings are based on:

The variety of plans offered. Many companies only offer a limited number of policies out of the 10 different letter plan types.
Their customer service. This is determined by customer reviews.
Awards received. Organizations like the Better Business Bureau will sometimes evaluate multiple companies and give awards based on certain factors.
How many states they offer plans in. Some companies only offer plans in a handful of states, while others serve more areas.

The Top Rated Companies

After evaluating all of the criteria above, we have determined that the top 5 Medicare Supplement insurance companies are:

Humana– Covers all 50 states, offers plans A,B,C,K,L,N, and has the best additional member benefits. This company generally uses attained-age pricing, meaning premiums increase as you age, and premiums depend on your location, age, tobacco use, and gender. They offer small discounts to those who are living with another senior member who has one of their Medicare Supplement Plans.
Aetna- Covers 42 states, offers plans A,B,G,N, and is rated best for customer service. Aetna generally uses attained-age pricing, so premiums increase as customers age. They also offer a 12-month rate lock, which guarantees that your premiums will not go up in the first year. They offer a 12% discount for customers who live with another senior who has one of their Medicare Supplement Plans.
Cigna– Covers 50 states, offers plans A,B,C,D,G,N, and has been rated the best overall value for the plans they offer. They do not require customers to use an in-network doctor, and they offer competitive premiums and some of the most affordable options. They offer a 7% discount for customers living with one other person that is enrolled in one of their Medicare Supplement Plans.
AARP– Covers 50 states, offers plans A,B,C,G,K,L,N, and is rated the most experienced in working with seniors. To qualify for a plan, you must be an AARP member. Their plan prices are community-rated. They offer an enrollment discount in most states of up to 30% for seniors aged 65, and they offer a 5% discount when more than one person in the household is enrolled in one of their plans.
Mutual of Omaha– Covers 50 states, offers plans A,G,N, and is rated the most experienced in working with the Medicare system; they have been offering Medicare Supplement Plans since 1966. Their plans usually use attained-age pricing, so premiums increase as customers age. They offer a 12% discount if you live with one other person (over 60 years old) that is also covered by one of their plans.

If you are interested in getting a plan from a top-rated Medicare Supplement company, EZ can help. We work with all of these companies, and more, and we will provide you with a highly trained licensed agent who works with these companies. Your agent will compare all available Medicare Supplement Plans to find the best one for you. You deserve the best, so we’ll make sure you get the best. To get free Medicare Supplement Plan quotes, enter your zip code in the bar above, or if you prefer to speak to an agent directly, call 888-753-7207. Our agents are ready to help!

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