Practice Manager Insider

A First: Higher Earners Pay More for Medicare Part B in 2007

For the first time, higher-income beneficiaries will pay a larger share of their premiums for Medicare Part B in 2007, according to Mary Agnes Carey, associate editor of CQ HealthBeat. Carey discussed this issue in “HealthCast,” a weekly series of audio reports by kaisernetwork.org.

The change to requiring higher-income enrollees to pay more was part of legislation passed in 2003. The Centers for Medicare & Medicaid Services (CMS) recently released 2007 premiums and deductibles for Medicare beneficiaries.

The government typically pays 75% of the premium for Medicare Part B while beneficiaries pay the remainder. In 2007, individuals earning more than $80,000 and married couples earning more than $160,000 will pay a higher proportion – up to 80% of the premium by the end of a 3-year phase-in period. The standard Medicare Part B monthly premium for beneficiaries with incomes below those thresholds will rise by $5 or 5.6% in 2007, to $93.50. The increase in the standard premium is the smallest since 2001, according to CMS. It also is lower than the 11% projected in the July mid-season review of the President’s 2007 budget. The premium for Part B is adjusted annually based on formulas set by statute.

An estimated 4% of Medicare Part B enrollees will pay higher-than-standard Part B premiums in 2007 based on their incomes. Higher premiums will range from $106 to $162.10, depending upon income.

The Part B deductible also will rise to $131 in 2007. This represents a 5.6% rise over the 2006 figure of $124. The deductible is indexed to the increase in the average cost of Part B services for aged beneficiaries.

http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=1917

http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1958

Physicians Unfamiliar with Part D Formularies, Kaiser Survey Says

A national survey about perceptions of and experience with the Medicare Part D formulary reports that 59% of physicians with at least a few patients enrolled in the drug benefit rarely or never check their patients’ formulary when prescribing. This finding comes from an evaluation conducted last spring and early summer by the Kaiser Family Foundation. The organization surveyed 834 randomly selected office-based physicians and separately conducted a similar study of 802 pharmacists. A total of 69% of physician respondents said that they are “not too familiar” or “not at all familiar” with their patients’ drug formularies.

Other findings suggest that Medicare formularies influence prescribing choices. Nearly half (46%) of physician respondents said that they have talked to a patient about switching from a brand to a generic drug in order to save money under a Medicare drug plan.

Pharmacists reported that access problems surface when patients attempt to fill prescriptions. Two-thirds (67%) of responding pharmacists said that customers have left the pharmacy without a medication because the prescribed drug was not on their Medicare drug plan’s formulary. Nearly 6 in 10 (58%) of pharmacists said that customers have paid out-of-pocket for their drugs due to inability to verify whether the customer was enrolled in a Medicare drug plan. Nearly half of pharmacists (49%) reported having customers leave without a prescription because they could not afford the co-pay charged under the Medicare drug plan.

On the whole, Part D received mixed reviews. An overwhelming majority of respondents in both groups said that the Medicare drug benefit is too complicated (91% of pharmacists, 92% of physicians). Among physicians, less than half said that Part D works “very” or “somewhat” well for lowering patients’ out of pocket costs (42%) or for helping patients gain access to needed prescription drugs (43%).

http://www.kff.org/kaiserpolls/pomr090706nr.cfm

http://www.kff.org/kaiserpolls/upload/7554.pdf

OIG to Congress: CMS Oncology Demonstration Data Are Unreliable

A highly critical report from the Department of Health and Human Services Office of Inspector General (OIG) characterizes data from the Medicare 2005 chemotherapy demonstration project as unreliable due to inconsistent data collection methods. The 12-month-long project is on track to cost about $275 million, making it by far the most expensive research program undertaken by the Centers for Medicare & Medicaid Services (CMS). Because CMS did not waive the 20% beneficiary coinsurance, patients paid about $55 million of the project’s cost. The OIG analyzed demonstration project claims that CMS had received through the end of 2005.

Under the 2005 demonstration project, office-based physicians could bill $130 for visits at which a patient received chemotherapy by infusion or push for a cancer diagnosis—if the office reported an assessment of the patient’s nausea and vomiting, pain, and fatigue. Demonstration project codes described on a 4-point scale the degree to which the beneficiary experienced each of these 3 conditions.

A major reason for the unreliability of the data is that CMS did not specify how to collect information. Therefore, oncology practices used varying methods. This limits the usefulness of the data. For example, one nurse told the OIG that if a patient had vomited several times in the past week but was feeling fine on the date of the assessment, then she would report the lowest level of nausea and vomiting. Another practitioner legitimately could choose to report the highest level, based on the patient’s symptom during the prior week.

CMS did not require participants to document demonstration assessments in the patient’s medical record. Therefore, CMS cannot verify the accuracy of the data. CMS provided no list of valid diagnostic codes for the demonstration; lists developed by carriers varied.

The OIG also found that Medicare overpaid $17 million in demonstration claims because of issues such as duplicate billings, reimbursements for demonstration activities not performed concurrent with chemotherapy, and payments for services associated with patients not diagnosed with cancer.

http://oig.hhs.gov/oei/reports/oei-09-05-00171.pdf

Medicare To Beneficiaries: Here’s How to Reimburse Us

The Centers for Medicare & Medicaid Services (CMS) mistakenly issued refund checks to about 230,000 Medicare beneficiaries in August, and is now trying to get the word out about how to repay the government. Refunds occurred due to a computer glitch and totaled $50 million, according to the San Francisco Chronicle. The average individual refund was $215. The checks were erroneously repaying beneficiaries for their drug plan or Medicare Advantage plan premium. Beneficiaries received the refunds along with their Social Security benefit checks or direct deposits. Persons who received the refunds will not lose coverage, according to CMS.

Those affected will receive a letter from Medicare in early September explaining the error and the procedure for returning the money. Beneficiaries can call a toll-free number for information about repayment options (866-292-8080). CMS has asked those who have already returned their overpayment to call this number and let Medicare know that.

For more information about this error, call 1-800-MEDICARE (1-800-633-4227).

http://www.cms.hhs.gov/partnerships/downloads/PremiumWithholdRefundIssue.pdf

http://www.sfgate.com/cgi-bin/article.cgi?f=/n/a/2006/08/28/national/w142209D63.DTL&type=politics