Study Suggests Extending Medicare to People under 65

"Americans are living longer, so why not lower the eligibility age for Medicare?" asks a Reuters post. "That prescription might sound upside down: rising longevity often is used as an argument for delaying Medicare eligibility past age 65. However, one of the country's top experts on geriatric medicine actually thinks Medicare should start covering preventive healthcare when we turn 50. Dr. Linda Fried, dean of the Mailman School of Public Health at Columbia University in New York, says that could help people not just live longer, but enjoy more healthy years. Meanwhile, Medicare would save money on treatment of chronic illnesses in seniors. Much of Fried's research is focused on promotion of healthy aging, and the latest evidence shows people who get to age 60 in relatively good health are likely to stay healthy." Read more.

Republicans Pass Medicare Bill--Decreasing Fees, Increasing Premiums, Extending Health Insurance for Kids

"The House...approved sweeping changes to the Medicare program on Thursday in the most significant bipartisan policy legislation to pass through that chamber since Republicans regained a majority in 2011," according to a March 26 New York Times post. "The measure, which would establish a new formula for paying doctors, increase premiums for some Medicare beneficiaries and extend a popular health insurance program for children, has already been endorsed by President Obama and awaits a vote in the Senate." Read more.

Opthalmologists Pull in the Big Medicare Bucks

"More than any other specialists, ophthalmologists — not cardiologists, cancer doctors or orthopedic surgeons — were the biggest recipients of Medicare money in 2012," according to the post "Eye Doctors Say Their Profits Are Smaller than the Data Makes Them Look" in the New York Times.  The 17,000 providers, most of whom are concentrated in Florida, Texas, California and New York, accounted for 7 percent — $5.6 billion — of the reimbursements to doctors and other providers. Included in the amount is $929 million for cataract surgery, about $1 billion for an expensive eye drug and $707 million for eye exams." Read more.

The article misses a point, though. The patients of cardiologists and oncologists die from heart disease and cancer, limiting the time the physicians can treat them. AMD, cataracts, and most retinal diseases do not kill patients, so ophthalmologists must treat their patients for longer periods, leading to higher overall billings.

Ophthalmologist Leads in Political Donations

"Two Florida doctors who received the nation’s highest Medicare reimbursements in 2012 are both major contributors to Democratic Party causes, and they have turned to the political system in recent years to defend themselves against suspicions that they may have submitted fraudulent or excessive charges to the federal government," according to the New York Times article entitled "Political Ties of Top Billers for Medicare." "The pattern of large Medicare payments and six-figure political donations shows up among several of the doctors whose payment records were released for the first time this week by the Department of Health and Human Services. For years, the department refused to make the data public, and finally did so only after being sued by The Wall Street Journal. Topping the list is Dr. Salomon E. Melgen, 59, an ophthalmologist from North Palm Beach, Fla., who received $21 million in Medicare reimbursements in 2012 alone." Read more.

Eye Docs Benefit the Most from Medicare

In an article about Medicare payments to physicians, the New York Times reports that "in 2012, 100 doctors received a total of $610 million, ranging from a Florida ophthalmologist who was paid $21 million by Medicare to dozens of doctors, eye and cancer specialists chief among them, who received more than $4 million each that year. While more money by far is spent for routine office visits than any other single expenditure, one of the most heavily reimbursed procedures — costing a total of $1 billion for 143,000 patients — is for a single treatment for an eye disorder common in the elderly."Read more.

Patients Say Cutting-Edge Physician; Feds Say Medicare Fraud

"As a child, Oscar Haza almost lost his left eye in a bike accident in the Dominican Republic. As an adult, he began losing vision in the same eye from retina damage," reports the Miami Herald. "But today, the Miami journalist is able to host TV and radio news shows, thanks to Lucentis, an injectable drug that has helped combat his macular degeneration. Haza considers the ophthalmologist who regularly sticks a needle into his left eye — Salomon Melgen — a miracle worker.'He’s not a conservative eye doctor,' said the 61-year-old Haza. 'He’s always been on the cutting edge.' That’s not exactly how the FBI and the Department of Health and Human Services view the West Palm Beach ophthalmologist. Melgen, 59, has been under a federal grand jury investigation for alleged Medicare fraud for more than a year." Read more.

MDs Say Medicare Cuts Will Hurt Individuals Needing Eye Care

As the federal government assesses an $85 billion reduction in its 2013 budget, an included 2 percent Medicare cut will hurt beneficiaries who need medical eye care, according to ophthalmologists – medical doctors who specialize in the diagnosis, medical and surgical treatment of eye disease. In a survey conducted by the American Academy of Ophthalmology, approximately 72 percent of responding member physicians predicted they would be forced to make decisions that will negatively affect the ability of their Medicare patients to receive the highest quality of medical care.
Specifically, 43 percent of ophthalmologists said they would be forced to close their practice to new Medicare beneficiaries or restrict the number of new program participants they see, while 28 percent predicted they would have to limit access of their current Medicare patients to urgent-care treatment only.  In addition, nearly 11 percent of respondents said they would be forced to consider changing or ending their participation status in the Medicare program. Read more.

Medicare/Medicaid--Five Years to Recoup Overpayments

The U.S. Centers for Medicare & Medicaid Services (CMS) will now have up to five years to recoup Medicare overpayments resulting from coding mistakes or other claims errors, according to the AOA Advocacy Group. A 2012 report found the previous three-year recoupment limit prevented the CMS from collecting more than $300 million dollars annually. Read more.

Medical Electronic Record "Vulnerable," Says Report

"The conversion to electronic medical records — a critical piece of the Obama administration’s plan for health care reform — is “vulnerable” to fraud and abuse because of the failure of Medicare officials to develop appropriate safeguards, according to a sharply critical report to be issued Thursday by federal investigators," according to a New York Times post. "The use of electronic medical records has been central to the aim of overhauling health care in America. Advocates contend that electronic records systems will improve patient care and lower costs through better coordination of medical services, and the Obama administration is spending billions of dollars to encourage doctors and hospitals to switch to electronic records to track patient care." Read more.

Midwest ODs Getting Paid Again by Medicare

A  Medicare administrative contractor (MAC) reversed course on Monday and announced that it would withdraw a restrictive, anti-optometry coverage directive that wrongly sought to limit the scope of practice of optometrists in nine states, according to the American Optometric Association (AOA). Wisconsin Physician Services (WPS) — the MAC servicing Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska and Wisconsin — had issued an “optometry services” coverage determination whereby the contractor created a list of services it determined optometrists are allowed to provide based on its own interpretation of state law. With backing from a Medicare regional office, WPS then utilized the directive to deny payment for services provided to Medicare beneficiaries. Read more.

Costs for Part B E and M Services Rising Quickly

Medicare Part B costs for evaluation and management (E&M) services are rising more rapidly than other Part B costs, according to a report issued last month by the U.S. Department of Health & Human Services’ Office of the Inspector General (HHS-OIG), according to a press release from the American Optometric Association (AOA). Read more.

Averting a 30% Cut in Medicare Reimbursements

The AOA (American Optometric Assn.) and other physician organizations are increasing pressure on Congress and the Obama administration to find a solution that will avert a nearly 30% cut in Medicare reimbursements set to take effect at the end of this year. Read more.

Medicare Giving EHR Practitioners in HPSA's Additional Bonus

Qualified EHR (Electronic Health Records) practitioners who practiced last year in federally recognized Health Professional Shortage Areas (HPSA) will be getting an additional bonus payment for their participation in the program – if they haven’t received it already, according to the U.S. Centers for Medicare & Medicaid Services (CMS). Read more.

ODs Warned Only 3 Months Left for EHR Incentives

Health care practitioners have just a few months to ensure they earn the maximum possible payments through the Medicare Electronic Health Records (EHR) Incentive Program, according to the AOA Health Information Technology (HIT) Subcommittee. In fact, they must act within the next 90 days, AOA HIT Subcommittee Chair Philip Gross, O.D., noted. Under the Medicare EHR Incentive Program, health care practitioners can earn up to a total of $44,000 ($48,400 in federally designated health professional shortage areas) over the six-year life of the program if they install EHR systems that are certified for use under the program and achieve compliance with the program’s EHR utilization criteria, known as “meaningful use” standards. Read more.

Medicare Reviewing of Outpatient Claims

A Medicare carrier medical review probe may be coming to your area soon.The medical review department at Palmetto GBA, the A/B MAC for North Carolina, South Carolina, Virginia and West Virginia, recently announced it will perform a service-specific prepay probe review on outpatient ophthalmic claims. Read more.

CMS Prepayment Reviews More Common with ECPs

The rapid expansion of a U.S. Centers for Medicare & Medicaid Services (CMS) initiative, launched last year to crack down on improper billing and claim errors, has meant more optometrists across the nation are receiving Medicare prepayment review notices, according to the AOA Third Party Center Executive Committee. The new prepayment review program means health care practitioners, including optometrists, will have to more diligently avoid common claim filing errors – such as coding mistakes or missing signatures – if they wish to ensure prompt payment, according to AOA Third Party Center Executive Committee members. Read more.

ODs Earn Millions in Bonuses from EHR

Optometrists reportedly earned more than $21 million in top-level bonuses during the first year of the Medicare Electronic Health Records (EHR) Incentive Program, according to the latest in a series of monthly reports from the U.S. Centers for Medicare & Medicaid Services (CMS). Read more.

Retirees Not Aware of Vision Care Benefits on Medicare

A number of middle-income retirees misundertand the coverage and costs associated with Medicare programs, according to the latest findings released by the Bankers Life and Casualty Company Center for a Secure Retirement(SM) (CSR). The study, Retirement Healthcare for Middle-Income Americans, which focused on 400 pre-Medicare Boomers (age 47 to 64) and 400 older adults (age 65 to 75) with an annual household income of between $25,000 and $75,000, found that one in three Medicare enrollees still did not know how much the program covers for doctor's visits (33 percent) or hospitalization (31 percent), which are the basic components of the program's health benefits. The CSR study also found nearly half (49 percent) do not understand their benefits for vision care and hearing care, both which are services typically not covered by Medicare. Read more.

Cuts in MD Medicare Payments Postponed for 60 Days

"In an 11th-hour maneuver before adjourning for holiday recess Dec. 23, the U.S. House of Representatives and Senate passed a bill that delays for 2 months a 27.4% Medicare physician payment reduction that would have taken effect Jan. 1," notes OSNSuperSite."The bill passed by voice votes with no debate in both houses; President Barack Obama immediately signed the bill into law. The measure also extends the payroll tax cut and unemployment benefits. Congressional leaders are expected to resume deliberations on long-term extensions after Jan. 1." Read more.  

This is the reason why medical providers in general are being told to delay submitting payment requires to Medicare.

MedPAC Recommendations about Medicare Reimbursement

Last week, the Medicare Payment Advisory Commission (MedPAC) introduced a proposal to fix the formula used to establish Medicare physician pay that includes an 18 percent cut in reimbursement for specialists (5.9 percent for three years), followed by a seven-year freeze at the reduced level. Over the past decade, freezes in Medicare reimbursement have already meant physician fees have lagged inflation by about 16 percent. Read more.