Re: [QUAD-L] Re-certification for MEDICARE Home Health

[David K. Kelmer]

Hi Lori,

 

My Home Health Care Agency has been re-certifying me every two months for quite a few years now, but this is the FIRST time I've been billed by my Doctor for re-certification by him to MEDICARE.  The RN will come out and we do the vitals, med check, evaluation and the whole re-certification but they don't bill MEDICARE for the visit.  My RN said this was the first year the doctors could bill MEDICARE but I'm still trying to find THAT in PRINT.  This is the first year my Doctor has billed MEDICARE for my re-certification for HHC so it must be allowed now.

 

With Love,

CtrlAltDel aka Dave
C4/5 Complete - 28 Years Post
Texas, USA

Lori Michaelson <[EMAIL PROTECTED]> wrote:

Hi Dave!   At this moment ... the Medicare re-cert info SHOULD be in the MEDICARE and YOU handbook.   I know first-hand because an RN must come out FROM THE AGENCY (Traditional Medicare Guidelines) at the end of the re-cert period ... which is every 2 months.    The RN takes my vitals, documents my current pills, asks about my pain and, of course, makes sure I still have a "skilled nursing need" (in my case my foley catheter) to BE re-certified via MediCARE home health.   My first thought for you, therefore, is WHY isn't your agency doing the actual re-certification that THEY THEN send the paperwork for the Dr to sign?   That, in itself, shows the 2-month re-cert requirement :-).  Cuz they can't continue to provide care and get paid (by traditional MediCARE) UNLESS they do their paperwork on you.???   Lori   -------Original Message-------   From: David K. Kelmer Date: 04/09/05 16:00:57 To: Lori Michaelson; Quad Subject: Re: [QUAD-L] Tell Congress to Pay Doctors What's Reasonable   Hi Lori,   I have Original Medicare (also known as traditional or regular Medicare) and just got a bill for my Doctor to re-certify me for Home Health Care, but I didn't know it was for only two months.  Do you know where the info about Medicare recertification can be found at, Lori?  I'm not sure the doctors will stop billing Medicare for recertification unless Medicare doesn't allow it.  I have taken action on this issue and others, it has to be those of us on Medicare that help shape its rules. With Love, CtrlAltDel aka Dave C4/5 Complete - 28 Years Post Texas, USA Lori Michaelson <[EMAIL PROTECTED]> wrote:  If you recieve (or someone you know) Medicare ... please go ahead below and automatically send your congressmen the pre-written letter to stop the insanity.  I usually add a few personal lines to the pre-written letter but one doesn't have to.   My Dr gets paid 84 dollars every 2 months for HIS SIGNATURE ONLY!  (to re-certify that I need home health help).  THAT'S OUTRAGEOUS!   This is so simple to do (below).  And, again, if you recieve Medicare ... more ugly changes are happening that we, as consumers, must at least TRY (along with the Medicare Rights Center .. below) to prevent something to our detriment.   Lori C4/5 complete quad, 25 yrs post      Your Weekly Medicare Consumer Advocacy Update ACT NOW: Tell Congress to Pay Doctors What’s Reasonable April 7, 2005 • Volume 5, Issue 14   Ouch! Original Medicare is being undermined by those seeking to privatize Medicare.   The headlines this week focused on Congress—stuck between a rock and a hard place—trying to balance adequate doctor payments, affordable Medicare Part B premiums and the overall cost of Medicare.  But key to what is going on is that overpayments to Medicare Advantage plans threaten the foundation of Original Medicare: access to a wide array of doctors with affordable premiums.   Because of provisions in federal law, Medicare will automatically cut payments to doctors by as much as 4 to 5 percent in each of the next six years—totaling a 26 percent cut.  Small reductions in doctor payments have not affected access in the past—for example, a Medicare Payment Advisory Commission (MedPAC) study of Medicare payment policy did not find a significant reduction in access to doctors after a 4.8 percent cut in doctor payments in 2002.  But Medicare has never before cut payments at this level for this length of time.     However, while we don’t have the final numbers, a freeze or a modest increase in physician payments will cause Medicare Part B premiums to be out of reach for more and more Americans.  By law, Medicare Part B premiums are adjusted each year to cover about 25 percent of Medicare spending for doctors and other services.  This year, Medicare Part B premiums increased by a record $139 dollars, with monthly premiums rising from $66.60 to $78.20.  Next year, Part B premiums will increase again.  The government’s most recent calculation pegged the 2006 premium at $89.20, although this may change—and Part B costs for people with Medicare will rise even higher if d! ! octor payments increase.    Congress is walking a tight rope between ensuring broad access to doctors and keeping Medicare affordable.  While the statutory payment cuts are unacceptable, Congress should not pay doctors more than necessary.   However, Congress should not forget that Congress has the power to eliminate overpayments to Medicare Advantage plans, redefine how doctor’s payments are calculated, and ensure the future of Original Medicare.   Click here  to send a letter to your member of Congress encouraging them to act responsibly by providing reasonable payments to doctors. (We encourage you to personalize your letter.)    Medical Record “A confidential memorandum to Mr. Leavitt describes the situation this way: ‘Keeping Medicare physician fees at the current 2005 level—a 10-year freeze—would cost about $110 billion in federal dollars, increase the federal deficit by the same amount, and increase beneficiary premiums by about $35 billion’” (“Doctors Lobbying to Halt Cuts to Medicare Payments,” New York Times, April 4, 2005)   Eliminating overpayments to Medicare Advantage plans would save Medicare some $68 billion dollars over the next ten years. (“Options to Pay for Physician Payment Rate Freeze,” Congressional Budget Office, April 2005).   For those who have Medicare, its payments are near the middle of the range.  An office visit for a new patient with a "low complexity" problem pays $77.29. A visit for a "high complexity" problem pays $151.92. Setting a dislocated shoulder pays $275.70. Removing a bunion: $492.35. Removing an appendix: $621.31. Removing a lung: $1,662.34 (“Piecework; Medicine's Money Problem,” New Yorker, April 4, 2005).   “The Bush administration projects that, in 2004, the government will pay private plans 19.3 percent in excess of traditional Medicare for providing coverage to their Medicare enrollees” (“Medicare Private Plan Overpayments: An Anti-Competitive Practice That Hurts Medicare,” Medicare Rights Center, October 2003).   PacifiCare Health Systems Inc., the biggest manager of Medicare health plans, and other insurers will get about a 4.8 percent payment increase from the program in 2006, the Centers for Medicare and Medicaid Services said Monday (“Insurers to Get Medicare Increase,” Los Angeles Times, April 5, 2005).   Despite a decrease in doctor payments in 2002, MedPAC did not find “a significant reduction in beneficiaries’ access to physician care during 2002” (“Report to the Congress: Medicare Payment Policy,” MedPAC, March 2004).   MedPAC sponsored a 2003 telephone survey of people with Medicare which found 93 percent of people encountered small or no problems finding a new doctor; 5 percent reported big problems; and 2 percent were unable to find a new doctor (“Report to the Congress: Medicare Payment Policy,” MedPAC, March 2004).   “The high share of charges with accepted assignment (99 percent) is likely due in large part to the additional, valuable benefits physicians receive when accepting assignment and signing Medicare participation agreements.  When physicians accept assignment, they can receive payments directly form Medicare (less the beneficiary cost-sharing portion) rather than collecting from the beneficiary.”  Other benefits include, listing of their name and contact information on Medicare’s web site, and the ability to verify a patient’s Medicare eligibility and Medigap status (“Report to the Congress: Medic! ! are Payment Policy,” MedPAC, March 2004).   Fast Relief: What You Can Do   Write a letter to your representatives and senators encouraging them not to fall to political pressure, but to act responsibly by providing reasonable payments to doctors.   Click here to send a letter today! (We encourage you to personalize your letter.) ***** Don't Let Your Suffering Go Unnoticed Are you struggling to pay for your prescription drugs or get the health care you need? Work with the Medicare Rights Center to bring your story to the ears of policymakers, the press and the public in an effort to expose the shortcomings of the American health care system.  To learn more about how to make your voice heard in the national Medicare debate, visit www.medicarerights.org/hiddenlives.html. 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