Medicare News

Current news for Medicare beneficiaries and the community that serves them.

New Medicare Web Guides

heidi General Info, Resources for Physicians Comments Off on New Medicare Web Guides
Fast facts provide resources related to certain CMS initiatives.

Fast facts provide resources related to certain CMS initiatives.

A new fast fact is now available at MLN Educational Web Guides. This resource provides information on Evaluation and Management services; Guided Pathways that contain resources and topics of interest; lists of health care management products; and easy-to-understand billing and coding educational products. It is designed to provide educational and informational resources related to certain CMS initiatives. Please bookmark this page and check back often as a new fast fact is added each month.


CMS Releases “2 Midnights” Rule

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New provision is aimed to decrease the number of extended observation stays, while decreasing the number of short inpatient stays billed under Part A that should be billed under Part B as outpatient services.

New provision is aimed to decrease the number of extended observation stays, while decreasing the number of short inpatient stays billed under Part A that should be billed under Part B as outpatient services.

Question: Why does CMS want to decrease the number of extended observation stays?
Answer: Extended observation stays have a negative impact on beneficiaries since they require a 20 percent co-pay for the service and do not count towards the 3 inpatient day stay required for Medicare coverage skilled nursing facility (SNF) admissions.

The Centers for Medicare & Medicaid Services released its controversial “2 midnights” rule in the 2014 Medicare Inpatient Prospective Payment System (IPPS) final rule.

Under the “2 midnights” rule CMS has set both a benchmark and a presumption for when an inpatient satay would be considered appropriate.  If the inpatient stays spans two midnights, CMS will presume that the stay is reasonable and necessary. In addition, admitting clinicians can use the “2 midnight stay” as a benchmark in determining when it is appropriate to admit a patient as an inpatient rather than keeping the patient in an outpatient status in an observation unit. Read more


Beware of Scammers Trying to Sell Health Insurance Marketplace Plans to Seniors

heidi General Info, Resources for Seniors Comments Off on Beware of Scammers Trying to Sell Health Insurance Marketplace Plans to Seniors
Scammers are calling and emailing people with Medicare and telling them Obamacare requires them to change their insurance and buy a marketplace plan.

Scammers are calling and emailing people with Medicare and telling them Obamacare requires them to change their insurance and buy a marketplace plan.

The Health Care Reform Marketplace is NOT for people with Medicare, cautions The Center for Medicare Advocacy and issued this alert:  Beware of scammers trying to sell health insurance marketplace plans to people with Medicare.

The Health Insurance Marketplace, created by the Affordable Care Act (ACA), opened for business on October 1, 2013. Uninsured people can shop for and purchase health insurance on the Marketplace. They can also apply for public programs on the Marketplace like Medicaid and tax credits to help pay for the costs of private insurance.

People with Medicare DO NOT need to visit the new Health Insurance Marketplace. According to the Department of Health and Human Services, it is illegal for a broker, agent or health insurance company to sell someone with Medicare an ACA marketplace plan.

Remember, the Marketplace does not offer Part D prescription drug plans, Medicare Advantage Plans or Medigap plans. If a Medicare beneficiary has questions about Medicare or would like to change their Part D or Medicare Advantage plan during the Annual Election Period (Oct 15 through Dec 7), they should visit www.medicare.gov or call 1-800-MEDICARE.

Scam Alert: The Federal Trade Commission has reported several recent scams targeted at older people. Scammers are calling and emailing people with Medicare and telling them Obamacare requires them to change their insurance and buy a marketplace plan. Oftentimes, these scammers will ask for personal information like Social Security numbers or bank accounts. Do not give them this information!

The Center for Medicare Advocacy encourages beneficiaries and their advocates to report all attempts at scams like this to the Federal Trade Commission.