Navigating Medicare Policy on Physical Therapy and Other Services

For years, some people on Medicare had difficulty getting insurance coverage approved for physical therapy, occupational therapy and other treatments. The prevailing approach was that if the therapy was not helping to improve a patient’s condition, then it was not eligible for coverage. “They’d get denied because they weren’t improving, or because they had plateaued,” […]

Exclusive: Medicare on drugs: 24,000 tests for 145 patients

(Reuters) – Three Connecticut doctors billed Medicare for nearly 24,000 drug tests in 2012 – on just 145 patients. Despite the extraordinary number, Medicare administrators paid the doctors a total of $1.4 million, according to a Reuters analysis of government payments to health providers. The three physicians stand out in the Medicare data released last […]

Report shows $6.7 billion in improper Medicare payments

WASHINGTON — Medicare paid out $6.7 billion in 2010 for health care visits that were improperly coded or lacked documentation, a report released Thursday found. That’s 21% of Medicare’s total budget for diagnostic and assessment visits, according to the Department of Health and Human Services inspector general. They found that 42% of diagnostic and assessment […]

How Medicare covers your eyes

Q: What does Medicare cover when it comes to eye care? I currently have good vision insurance through my employer but will lose it when I retire. A: Many retirees are unclear with what Medicare does and doesn’t cover when it comes to eye care. The good news is that Medicare covers most medical issues […]

Tips for getting on Part A and B of Medicare

BY BETSY VIPOND The Senior Health Advisor Published: May 4, 2014 Getting on Medicare can be confusing so I would like to share some simple tips about ways you can go about it. Part A is hospitalization coverage and Part B is the medical benefits. There is no charge for Part A and the base […]

Medicare Seeks To Stop Overpayments For Hospice Patients’ Drugs

New Medicare guidance taking effect today aims to stop the federal government from paying millions of dollars to hospice organizations and drug insurance plans for the same prescriptions for seniors. But the changes may make it more difficult for dying patients to get some medications, senior advocates and hospice providers say. The new measures direct […]

Letter: Don’t cut federal support for Medicare Advantage

Because of Obamacare, government subsidies for the Medicare Advantage program were reduced. I have an Advantage plan because it provides additional coverage that isn’t available under traditional Medicare. It is important to me to have access to prescription drug coverage, eye care and other benefits that Advantage plans offer. The price of everything is increasing […]

House Passes Payment Fix For Medicare Docs, But At What Cost?

Bipartisan support dissolved this week for compromise legislation that would have fixed a longstanding problem with the way Medicare pays physicians. Though the bill passed the House of Representatives Friday, it now contains a provision almost certain to invite veto unless a Senate version can quickly nudge the ultimate bill back toward compromise. Republican leaders […]

CMS backs off major changes to Medicare Part D

The Obama administration backed away from major changes proposed for the Medicare Part D prescription drug program, providing political cover ahead of the mid-term elections this year—and disappointing community pharmacists, who say the White House also bowed to lobbying from drug companies. A draft policy that the CMS introduced in January was intended to control […]

The ACO Hypothesis: What We’re Learning from the Medicare Shared Savings Program

Last month, the Center for Medicare and Medicaid Services (CMS) reported first-year results from the Medicare Shared Saving Accountable Care Organization Program (MSSP). As noted in a previous post, shifting to an accountable care model is a long-term, multi-year transition that requires major overhauls to care delivery processes, technology systems, operations, and governance, as well […]