Today’s Hot Topics in Medicare

Medicare billing: Hospital "observation" can cost you

Medicare billing: Hospital “observation” can cost you

BY WALECIA KONRAD: … However, Higgins’ remarkable recovery comes with a big price tag. Because of a common and often misunderstood Medicare billing policy, she must pay the weekly nursing facility bill of $2,340 out of her own pocket, according to Titus, who has power of attorney for Higgins. “She is up to about $50,000 now,” said Titus. “I’m getting so worried about Mary’s funds.”

What’s going on? Although Medicare doesn’t cover general custodial nursing home care — such as help with daily living, administering medicine, etc. — it does pay for prescribed follow-up treatment in a skilled nursing facility with specialized care. To qualify for this benefit, though, Medicare patients must have previously stayed in a hospital for three days, not counting the day of discharge. (read more)

Pressure builds to cut Medicare patients in on prescription deals

BY SARAH JANE TRIBBLE, KAISER HEALTH NEWS: Medicare enrollees, who have watched their out-of-pocket spending on prescription drugs climb in recent years, might be in for a break.

Federal officials are exploring how beneficiaries could get a share of certain behind-the-scenes fees and discounts negotiated by insurers and pharmacy benefit managers, or PBMs, who together administer Medicare’s Part D drug program. Supporters say this could help enrollees by reducing the price tag of their prescription drugs and slow their approach to the coverage gap in the Part D program. (read more)

Fewer return visits to the hospital, but higher rates of death, study finds

BY MELANIE EVANS: The Affordable Care Act required Medicare to penalize hospitals with high numbers of heart failure patients who returned for treatment shortly after discharge. New research shows that penalty was associated with fewer readmissions, but also higher rates of death among that patient group.

The researchers said the study results, being published in JAMA Cardiology, can’t show cause and effect, but “support the possibility that the [penalty] has had the unintended consequence of increased mortality in patients hospitalized with… (read more)

3 reasons seniors can’t count on Medicare to cover health costs

BY CHRISTY BIEBER: If you’re counting on Medicare to cover your healthcare costs after you turn 65, you may be in for a nasty financial surprise that could derail your retirement.

Even for seniors who purchase optional Medicare supplementary plans, healthcare costs could be as high as $350,000 for a couple during their retirement years. And, that scary number doesn’t even factor in long-term care costs and is based on the current benefits system. Costs could be much greater if Congress changes Medicare.

Why does Medicare leave seniors on the hook for so much healthcare spending? Here are three big reasons you can’t count on Medicare to keep you out of the poorhouse if you have costly health issues after age 65. (read more)

Hospital consolidation drives up Medicare costs, study finds

BY JOYCE FRIEDEN: Consolidation of hospitals and their increasing employment of physicians have combined to drive up Medicare costs, researchers found.

For four services — colonoscopy, arthrocentesis, echocardiogram, and diagnostic cardiac catheterization — Medicare paid $2.7 billion more from July 2012 through December 2015 because the services were performed in hospital outpatient settings rather than in independent physician offices, and beneficiary copays were a total of $411 million higher, the analysis found. (read more)

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