MEDICARE CHANGES

[Guest guest]

......yes Dr. Carpenter.....the wind has changed directions again, and so

have medicare instructions....I no longer am capable of staying up with

them.

I have tried mightily, yet simply can not keep up with their shifting

instructions on HCFA 1500 completion....and since my office is now

'offline' I have no way to comform to their new pronouncement of

'REQUIRED electronic billing'.

Medicare amounts to about 4 patients a MONTH for me yet endless hours

and ever-increasing MONTHS of paperwork....

I am withdrawing as far as possible from such encumbraces.

Perhaps Dr. can shed some light on this noisome subject.

J. Pedersen DC

Sweet Home

[Guest guest]

Dear Marci,I heard that there are going to be other changes to Medicare come 2006,besides this new prescription drug benefit. How will these other changesaffect me? – (Utica, NY) Dear ,You are correct. While most attention has been put on the new Medicareprescription drug benefit, there are a number of other changes beginningto take effect, many of which are a result of the Medicare PrescriptionDrug, Improvement, and Modernization Act of 2003 (MMA). These changesinclude the following:Lock-In. Starting in 2006, if you enroll in a Medicare Advantage plan– mostly HMO's and PPO's – you will be limited in when and how youcan change your Medicare health plan. If you change your plan selectionat any time between November 15 and December 31, 2005, your new coveragewill start January 1, 2006. Then you will only be able to change duringspecified enrollment periods:Once during the Open Enrollment Period—January 1 through June 30 in2006; January 1 through March 31 in 2007 first of the month after youenroll.Once during the Annual Coordinated Election Period—November 15 throughDecember 31 of every year. Your new coverage starts the followingJanuary.During these enrollment periods you can switch fromOriginal Medicare to a Medicare private health plan (like an HMO, PPO orPrivate Fee For Service plan);a Medicare private health plan to Original Medicare; orone Medicare private health plan to another.If your Medicare private health plan leaves your area or you move out ofyour plan's service area, you will be given a Special Enrollment Periodto switch to another private health plan or to Original Medicare nomatter what time of the year it is.Cap on Outpatient Therapy. Currently, Medicare will pay for asmuch outpatient therapy as is medically necessary. Starting in 2006,Medicare will limit the amount of physical, speech-language andoccupational therapy it will cover. The maximum Medicare will pay in2006 for physical and speech-language therapy combined is approximately$1,750. It will cover up to another $1,750 for occupational therapy.These limits apply to outpatient therapy received attherapists' or doctors' offices;outpatient rehabilitation facilities;skilled nursing facilities for outpatients or residents who do not haveMedicare-covered stays; andhome, through therapists connected with home health agencies, when notpart of a Medicare-covered health benefit.The limits will not apply to outpatient therapy received at hospitaloutpatient facilities, unless given by the hospital's Medicare-certifiedskilled nursing facility.Changes to Standardized Medigap Plans. Medigaps (Medicare supplementalinsurance policies you can buy to fill in the gaps in Original Medicare)will change in the following ways:Plans H, I and J, which offered drug coverage, will no longer be soldwith drug coverage after December 31, 2005. If you already have one ofthese plans, you can keep it with the drug coverage. But since thepremiums for these plans are so high and the drug coverage limited, youare probably better off changing to a different Medigap plan andenrolling in a Medicare private drug plan.Two new Medigap plans, K and L, will be created. These plans aredesigned to have lower monthly premiums because they require you to paya portion of your costs for most Medicare-covered services until youhave reached a specified amount out of pocket. Once you reach yourout-of-pocket limit, both plans will pay 100 percent of your Medicarecoinsurance for covered services. These plans may save you money if youcurrently have low medical expenses. However, you may not be able toswitch to another Medigap policy if you later need more medicalservices.Medicare drug discount card enrollment ends December 31, 2005. If youalready have one of these cards, you can continue to use it (and anyleftover assistance money) until your Medicare drug coverage (Part D)begins or until May 15, 2006, whichever comes first.Annual Cost Increases. Some Medicare out-of-pocket costs go up everyyear. In 2006 you will pay the following:Monthly Part B Premium· $88.50Annual Part B Deductible· $124Inpatient Hospital Care· $952 deductible per benefit period· No coinsurance for days 1-60· $238 daily coinsurance for days 61-90· $476 daily coinsurance for 60 lifetime reserve daysSkilled Nursing Facility Care· No coinsurance for days 1-20· $119 daily coinsurance for days 21-100Stay tuned next week to learn more about appeals changes! –Marci Have a question for Marci? Click here to e-mail your questions. Please include your city, county and state of residence. Spotlight on Resources* * * * * * * * * * * *For more information about changes to Medicare private plan enrollment,including those newprescription drug plans, visit MedicareInteractive.To stay up-to-date on the Senate's effort to extend the moratorium onMedicare's outpatient therapy cap, sign up to receive Asclepios, theweekly policy newsletter written by the Medicare Rights Center.For additional information on Medicare therapy caps, including anaudiocast in which Medicare officials explain the new payment policies,visit the American Physical Therapy Association web site.Want a more detailed breakdown of next year's out-of-pocket costs forMedicare and how much each has increased? See the 2006 MedicareCosts chart put together by the Medicare Rights Center. We also have aone-page side-by-side comparison of the benefits provided byeach Medigap plan, including the new K and L plans.Call your State Health Insurance Assistance Program for moreinformation on Medicare benefits, rights and options. Call SocialSecurity (800-772-1213) for questions about enrolling in Medicare.Health Tip of the Week* * * * * * * * * * * *Are you one of the 50 million Americans who provide unpaid, informalcare for a chronically ill, disabled or older loved one? Caregivers'services, valued at $257 billion a year, account for a striking 80percent of home care provided in the U.S. and dramatically reducegeneral spending for these services.That's not to say that these services come without a cost: femalecaregivers average 11.5 years out of the paid labor force, primarily dueto caregiving responsibilities, and all caregivers are more likely tosuffer from mental health problems, sleeplessness and back pain.As you sit down to your turkey and stuffing this Thursday, Marci andthe National Family Caregivers Association (NFCA) want to both givethanks for America's caregivers and urge them to ask for help. If helpis not offered, learn to ask for it—from loved ones or a supportnetwork—or you could end up as the one in the sickbed!For more information about how caregiving can impact yourhealth or to find local services, visit NFCA's web site.Survey Says . . .* * * * * * * * * * Next year's Part B premium increase of 13 percent, while hefty, is stillless than this year's spike of 17.4 percent. 2005 saw the largest dollarpremium increase in the history of the Medicare program. As the cost of health care skyrockets across the country, manyAmericans' primary source of income is dwindling. While Social Securitydoes reflect an annual Cost of Living Adjustment (COLA), the increase istied to general inflation, which is in the low single digits—asignificantly slower rate of growth than that of the health careindustry. Over the past two years, the premium for Part B has risen over25 percent more than the Social Security COLA adjustment (30.4 percentcompared to 4.8 percent) the Medicare Rights Center!MRC's Rx Hotline for Professionals877-RXHELP-0Contents are © 2005 by Medicare Rights Center, 1460 Broadway, NewYork, NY 10036. For reprint rights, please contactAZeno@....

[Guest guest]

Now that ya mention it...I was never very good at algebra. Anyway...A/B, that's Medicare parts A & B; MAC I believe is Medicare Administration r, i.e. the carrier responsible for administering Medicare in a given geographical region, ours being jurisdiction 2. I hope that helps (if you were really that curiious...) J. Holzapfel, DCAlbany, Oregon-- AboWoman@... wrote:

,

this looks more like an algebra equation than a message from medicare. kidding, but I don't know what all the abbrev stand for? A/B MAC ?

Minga

In a message dated 6/12/2008 8:53:45 P.M. Pacific Daylight Time, kjholzdc@... writes:

This may give you some Medicare info on soon to take place changes...

CMS has selected National Heritage Insurance Corporation (NHIC) to be the A/B MAC for Jurisdiction 2 (J2) which is comprised of Alaska, Idaho, Oregon and Washington.

NHIC will assume full responsibility for the J2 A/B MAC work no later than December 31, 2008. NHIC is headquartered in Hingham, MA. However, most of the claims administration work will be performed in ville, CA.

J. Holzapfel, DCAlbany, Oregon____________________________________________________________

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