St. Cloud Personal Injury Lawyer - Medicare

Medicare Is Delaying My Settlement

Mike Bryant — Sun, 18 Oct 2009 16:08:00 GMT

There have been new and old issues that have come up with recent changes in the Medicare rules. In July of 2009 a number of reporting requirements were added. Basically, in each settlement it must be determined if the plaintiff is Medicare eligible. If they are, then there are additional reporting requirements at the time of settlement. There also is a pay back requirement for money that was expended by the system that was caused by the defendant.

The concern has been if there is a requirement for a future set aside. In workers compensation claims, when there is a settlement that included future medicals, some of the money needs to be set aside so that the Medicare system doesn't pay for those items. The fear that was being pushed by some defendants was that the new rules require a set aside in all cases.

The American Association for Justice followed through on this issue and provided the following information:

... statements from CMS, and other federal entities, make clear that the agency does not require set-asides for liability claims. Since the MMSEA’s passage, CMS has held several Town Hall teleconferences to discuss the Section 111 requirements. During the March 24, 2009 call, Barbara Wright, CMS’ Acting Director of the Division of Medicare Debt Management, made several statements reiterating that Section 111 has no impact on liability MSAs.(2) For example:

In response to a question as to whether liability set-asides will be required under Section 111, she said “the point is the set-aside process is totally separate from the Section 111 reporting process. As we’ve said in more than one call we don’t anticipate changing our routine recovery process.” (Transcript, pg. 24)

When explaining that worker’s compensation agreements use a formal review process which makes set-asides recommended, she said that was in contrast to liability agreements. Liability “does not have the same formal review process although our regional offices will consider review of proposed liability set-aside amounts depending on their particular work load and whether or not they believe significant dollars are at issue.”
(Transcript, pg. 24).

In addition, CMS also has released several Alerts explaining Section 111, which do not indicate any intent to require MSAs for liability claims. For example:

“Unless you are a business entity which qualifies as [a required reporting entity (RRE)] for purposes of Section 111, you do not need to initiate any specific actions in connection with Section 111.” (CMS Alert, 2/23/09).(3)

“The new Section 111 requirements do not change or eliminate any existing obligations under the MSP statutory provisions or regulations.” (CMS Alert, 2/23/09).

Moreover, the Congressional Research Service (CRS) provided Congress with an “objective and non-partisan analysis” analysis of the MMSEA. As there was no legislative history regarding the bill, the CRS research report is the most reliable analysis of the MMSEA, including the Section 111 reporting requirements.

CRS’ analysis of the Section 111 reiterates that it is a reporting requirement, and makes no mention of the need for set-asides in liability cases. The Section 111 analysis states, in part:

This provision requires an insurer or third-party administrator for a group health plan (and in the case of a group health plan that is self-insured and self-administered, a plan administrator or fiduciary) to (1) secure from the plan sponsor and participants information required by the Secretary for the purpose of identifying situations where the group health plan is or has been a primary plan to Medicare, and (2) submit information specified by the Secretary. If an insurer or third-party administrator for a group health plan fails to comply, then a $1,000 per day civil monetary penalty will be imposed for each individual for which information should have been submitted.(4)

If CRS believed that the legislative language implies any Congressional endorsement of liability set-asides, it would have been included in this analysis.

It is still expected that with the reporting requirements many cases will be delayed if an amount needs to be determined for the payback. Early recognition of the claim and making sure all of the reporting is done right will make the biggest difference. Experienced attorneys are getting through the system as fast as possible, and will make a difference to clients who need to know their future Medicare coverage will not be put in jeopardy.

Originally posted at InjuryBoard by Mike Bryant

State And Consumers Will Be Protected Under New False Claims Act

Mike Bryant — Wed, 01 Jul 2009 09:34:00 GMT

Passed the last week of the session and going into law in August, is the False Claims Act (FCA). The FCA imposes civil penalties for persons who make false or fraudulent claims for payments of services to the state or its political subdivisions. "It's the recovery of stolen taxpayer dollars," said Sen. Ron Latz, who championed the bill, along with fellow St. Louis Park DFLer Rep. Steve Simon. "If other states' experiences are comparable, we could be looking at tens of millions of dollars."

The Attorney General is granted the power to enforce the the act which also provides conditions under which a private plaintiff (whistleblowers) may bring actions to enforce provisions. Expenses and fees may be awarded along with the whistleblowers sharing in recoveries under the new law. The FCA provides additional protection as employers are forbidden from discriminating against employees who cooperate with investigations.

Nationally and in other states, claims have recovered large sums of money for the government and also straightened out numerous examples of fraud upon the government. Hopefully the act won't be needed very often, but if it is, the new law gives the state another weapon against fraud.

Originally posted at InjuryBoard by Mike Bryant

Potential Options When You Lose Your Health Insurance

Mike Bryant — Sun, 31 May 2009 09:50:00 GMT

Reviews of people without insurance, but have applied for coverage, find that what happens in most cases is:

Denial
Very high rates
Coverage with exclusions

The last two options can get people coverage, but often are unrealistic or don't help with the preexisting issues that the person has. CNN provided a list of other ideas that have to be considered:

1) Look at the possibility of creating a company that could qualify for a group policy-

To find out whether your state will allow you to become a group of one, see this list from the Kaiser Family Foundation (look at the column headed "Definition of Small Group," and look for "1-50").

For more information on becoming a group of one, see this advice from the American Diabetes Association.

In states where you can't become a group of one, you can become a group of two.

2) Apply for Cobra if you are laid off

3) Apply for State coverages within 63 days of losing coverages.

In all states, a designated insurance company -- charmingly called "the insurer of last resort" -- has to take "all comers" in insurance lingo. You have to apply for this insurance within 63 days of losing your group insurance. For all the rules, read this explanation from Families USA (scroll down and look for the "HIPAA eligible" heading).

4) Look for State high risk pools.

Thirty states have high-risk pools, insuring 175,000 people, according to the American Diabetes Association, which lists the states on its Web site.

5) See if any of the groups you are in have coverage.

Originally posted at InjuryBoard by Mike Bryant

New York Times Looks At Low Primary Doctor Numbers

Mike Bryant — Wed, 13 May 2009 09:19:00 GMT

Interesting article in this week's New York Times. The issue was the reduced number of primary care providers. Basically, the issue is that the heath care insurance companies aren't paying enough. The focus of the article was on the Obama Administration's need to look at increasing the amounts of Medicare payments.

Basically, while specialists receive more, the payment for simple visits isn't enough for the doctors to find it worth owing the work. The response has been retirements, transfers to specialties and simply not taking the patients.

The article solutions included upping the payments (with a discussion of cutting the pay to specialists), increasing the incentives to go to medical school, encourage greater use of nurse practitioners and physician assistants, and expand the National Health Service Corps, which deploys doctors and nurses in rural areas and poor neighborhoods.

What's interesting is that there was no talk at all about medical malpractice rates. Maybe the articles of my fellow Injuryboard members:

Wayne Parsons- Tort Reform Myth: AMA Statistics Refute 'Doctors Flee' Myth

Steve Lombardi- Tort Reform Protocol: Oops! Sorry! The Apology, a new Gold Standard of Practice

are really sinking in. The knee jerk reaction of "blame the lawyers", is not only inaccurate, but is also a great example of what a frivolous claim looks like. It's important, as with any profession, that consumers have the medical care they need. It's through truthful and realistic looks at the issue that we will find solutions.

Originally posted at InjuryBoard by Mike Bryant

Stimulus To Include Good News For Cobra Issues

Mike Bryant — Fri, 08 May 2009 12:10:00 GMT

Having to use the protections of COBRA when a person loses their health insurance with their job comes at a scary time for many people. More people have been joining that group with this years changes in the economy. Thankfully, this is one of the things that was addressed in the latest stimulus package.

COBRA is the protection that allows for a person to extend their health coverage by paying for it after they lose their job. The law required that it be offered for 18 months. The new change will double the prescribed time to 36 months.

The costs of maintaining the coverage was also addressed. Terminated employees can also get a subsidy set at 35 percent of your COBRA payment, for up to nine months. Employers will pay the remaining 65 percent and recoup that money by applying for a credit on their quarterly federal employment tax return. .

To qualify for the reduced COBRA payment, the termination had to have taken place between Sept. 1, 2008, and Dec. 31, 2009. Those who are eligible or become eligible for other group health coverage (such as a spouse’s plan) or Medicare are not eligible for the premium reduction. There are income limits and beginning for payments is on or after Feb. 17, when the law was enacted. If your company closed or went bankrupt and there is no longer a group health plan, there is no COBRA subsidy available.

If you were involuntarily terminated between Sept. 1, 2008, and Feb. 16, 2009, but you didn’t sign up for COBRA , you may have another opportunity to elect COBRA coverage, as the plans are now required to notify you of a second election period.

For more details on the COBRA subsidy, go to the Department of Labor’s Web site at www.dol.gov/COBRA. You can also call the Employee Benefits Security Administration at 1-866-444-3272. There is also a helpful question-and-answer section on the COBRA provision for employers at IRS.gov.

Originally posted at InjuryBoard by Mike Bryant

Electronic Medical Records Does it Make Sense?

Mike Bryant — Wed, 08 Apr 2009 09:25:00 GMT

In our practice we are dealing with medical records all the time. Often, it's their procurement which makes up a large part of the costs in a client's case, so we watch the legislative issues that come up with reducing those costs. One help might be if the records all become electronic. If that happened, we would be able to quickly get them on a disk or emailed. This should reduce the cost in time and paper needed to retrieve them.

But, with some systems electronic and others still being by paper, we are seeing the problems that arise. It is not easy for everyone to read the records and they aren't on paper. There in nothing like the frustration that arises when you have a meeting with a doctor and they can't get into the records because they didn't bring a laptop or the system is down. At that point you miss the paper pile. There is also the concern that arises when information like peoples personal records are transferred as part of an email attachment.

Many are also looking at the governments past failures and questioning if the money to change is worth it. The FBI spent $170 million in four years trying to modernize its paper-based case system. They abandoned the idea in 2005. The Federal Aviation Administration spent $1 billion in a failed attempt to get paper out of their the air traffic control system. Is it going to work better with medical records? Can we afford even taking the risk?

The New England Journal of Medicine, found that 4 percent of physicians had extensive, fully functional electronic records systems, while 13 percent had more basic systems. That is a very small part of the overall system. The stimulus bill specifies that $17 billion is to be spent in Medicare and Medicaid incentives for doctors and hospitals to begin keeping electronic records by 2011. In 2015, financial penalties will start being imposed.

Will the money be there to make this work? Many people have concerns, although a better system of providing information as a part of our health care needs to be looked at closely.

Originally posted at InjuryBoard by Mike Bryant

Health Insurance Lost? - Looking At Options

Mike Bryant — Sat, 14 Mar 2009 09:14:00 GMT

Every day we read about more jobs being lost across the country. Recent stories suggest that many of these jobs may be gone forever as the economy "re-corrects". For the person out of work, the issue is the lose of income, trying to find something else, and often the loss benefits that go with the layoff. For the majority of American's who receive their family's health insurance from their job, these loses can be a nightmare.

National News compiled a helpful list of tips for those who have lost their health insurance:

1. Use COBRA if You Are Laid Off - If you get laid off from your job and need health insurance you can Use COBRA (Consolidated Omnibus Budget Reconciliation). COBRA is available for 18 months after loosing your employer health coverage. COBRA allows you to keep the health plan that your employer used to provide as long as that plan still exists. If your employer is still in business and offering some health insurance to current employees you can usually qualify. COBRA will be more expensive than the premiums deducted from your paycheck but this is sometimes necessary if you are unable to get health care elsewhere. COBRA is often cheaper than private and individual health insurance plans.

2. Continue Preventative Measures - Without health insurance it is now more important than ever to live a natural and healthy lifestyle. Use preventative measures such as regulating weight, exercising, eating healthy, lowering your cholesterol (http://www.naturalnews.com/025715.html), and reducing stress from your life. When possible you can resume other preventative measures such as regular checkups and diabetes & cancer screenings.

3. Ask Your Doctor for Help - Ask your doctor about reduced fees or treatment and drug options for those with lower income or no health insurance. Your doctor may also be able to recommend a health care discount card that they accept.

4. Decrease Stress - Stress has a terrible effect on your body and your health. Make sure to get enough sleep, exercise regularly, eat natural and healthy foods, and actively use relaxation techniques such as yoga or breathing exercises.

5. Not Smoking - By not smoking you increase your chances of being approved for another health insurance plan including private and individual health insurance plans. Non-smokers receive much lower health insurance premiums and have less risk of overall health problems.

6. Apply for Medicaid - Almost every state has a local Medicaid office and toll-free numbers. Visit the Centers for Medicare & Medicaid Services web site for information on how to apply: http://www.cms.hhs.gov/home/medicai.... Each state is different but Medicaid allows low-income and eligible people to qualify to have their medical bills paid directly. Some still require co-payments.

7. Apply for Medicare - Medicare is available only for those 65 years of age or older who meet special criteria. You can contact your local Social Security office or the main office at 1-800-772-1213. You are allowed to apply 3 months before reaching 65.

8. Alternative Natural Treatments - Alternative Medicine is currently used by thirty eight percent of adults in the United States. http://www.naturalnews.com/News_000... Acupuncture and herbal remedies are often cheaper than expensive prescriptions or medical treatments and can provide similar results.

9. Get Health Insurance through Spouse or Partner - Your spouse or partner may have a health insurance plan where you can qualify as a dependent. Although the cost can be high this typically results in fewer coverage rejections than applying for private or independent health insurance coverage.

10. Take a Lower Paying Job For Better Health Insurance - Consider taking a lower paying job for better health benefits. How important is your health? What is money without your health? It may mean taking a large pay cut, extra searching for a job with good health benefits, or asking more questions during a job interview. There are some employers out there that pay very little but offer a good health insurance plan. Make sure to ask about waiting periods and how coverage begins.

Federally, other options are being looked at for the many displaced workers. Extending the time for coverage and national health care are two of the many options being looked at. These tough times require all options to be considered.

Originally posted at InjuryBoard by Mike Bryant

Medicare Is Not Going To Pay For Medical Errors

Mike Bryant — Sun, 30 Nov 2008 08:26:00 GMT

In a plan to create better care by doctors and safer stays in hospitals, Medicare is not going to pay the bills for problems created by medical errors. The hope is to improve the quality of overall care.

One of the areas that Medicare will be looking at specifically is infections that arise from hospital visits. The Centers for Disease Control and Prevention has found that each year 2 million patients incur health care-associated infections in U.S. hospitals. Those infections contribute annually to more than 90,000 deaths. It is estimated that those same infections have added 30 million dollars to health care costs each year. A survey of 1,256 hospitals last year found that 87% did not have all of the recommended policies in place to prevent many of the most common infections, according to the Leapfrog Group, an organization that includes large corporations and public agencies.

There is also a "never events" category, where Medicare will never pay for the procedure. These are cases where procedures leave items in individuals or do the procedure on the wrong body part. It is estimated that these changes will save 21 million dollars each year.

Many state run programs are looking at following suit and putting limits on what they each will pay for. Wisconsin with BadgerCare Plus, passed their own identical program right after Medicare did. It will be interesting to see if other Health Insurance or ERISA policies do anything to follow suit. Also, if any of the unpaid bills will end up at the doors of the patents. Some doctors and and hospitals are fighting the changes. Hopefully, these changes won't lead to the hiding of medical results in order to ensure payments.

Originally posted at InjuryBoard by Mike Bryant

Medicare Wows Continue

Michael Bryant — Sat, 04 Oct 2008 09:18:00 GMT

The Medicare changed have been well documented for the inside deals that were made with the pharmaceutical companies. As legislators just off well financed campaigns took care of their contributors. Key bill leaders and their staffs even turned up as pharmaceutical executives a short time after they got the bill into law.

It was announced this week that the Part D bargain is now going away. The latest example of what a horrid bill this was. Rates are going to increase and coverages are going to drop. Everyone is being told it's a budget issue. It's sad that at a time when bailouts are being negotiated that the oldest and weakest among us are being told there just isn't any money.

This was a bad bill and it was put through in an outrageous manner. Like a number of the other decisions that have been made by gone or leaving political leaders, those who get elected in 2008 will be left with fixing the problem. It's important that all voters take this into consideration at all levels of the process. Ask who's financing the campaign and why.

Originally posted at InjuryBoard by Michael Bryant

National Attention To Medical Bills Not Owed After Insurance Payments

Mike Bryant — Sun, 31 Aug 2008 20:49:19 GMT

Recently there has been some helpful national attention to the issue of balance billing by medical providers. The issue being medical bills patients are receiving after their insurance company has reduced the bill to a fee schedule. The providers should be fighting the issue out with the insurance company. Instead bills are sent to the patent. It is suspected that patients may have wrongfully paid as much as a billion dollars in bills they don't owe.

The issue was covered in a recent Business Weekly article and also covered in recent television news stories on CBS. The CBS story found that in 2007, 1.7 million people in California had been balanced billed 528 million. Each story had significant human interest examples of people that were chased by collection agencies in States were it simple shouldn't have happened.

There are federal laws that prevent this billing when Medicare is the Insurance company. In Minnesota there are laws that cover Medical Assistance payments and other laws that prevent abusive or fradualent billing practices. There are exceptions for consmetic surgery and out of network non-referal non emergancy care.

The key is that beyond your co pays , make sure that any additional bills are actually legally due and payable. If you have a question you can contact the Attorney General, The Department of Commerse or Call an attorney that practices in this area.

Originally posted at InjuryBoard by Mike Bryant