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Archive for the ‘Employment Records’ Category

Patients that have similar clinical characteristics and similar costs are assigned to an MS-DRG. The MS-DRG will be associated with a fixed payment amount based on the average cost of patients in the group. Patients are assigned to a MS-DRG based on diagnosis, surgical procedures, age and other information. Medicare uses this information that is provided by hospitals on their bill to decide how much they should be paid. Hospital Compare shows information for each hospital on selected MS-DRGs from October 2007 through September 2008. If a MS-DRG has “Complications” or “Comorbidities” in its title, it means the hospital may have treated more complicated patients.

Because MS-DRGs are highly technical, patients and other consumers may need to work with a doctor or other healthcare provider to understand these terms as well as the payment and volume information. ‘CC’ refers to complications or comorbidities. MCC refers to major complications or comorbidities. When Medicare pays a hospital based on the MS-DRG, it takes into account the following (case mix): Read the rest of this entry »

NEW JERSEY: In the final days of the 2009 session, the legislature passed a bill requiring managed care organizations to remit direct payments to out-of-network providers. Aetna, along with the business community, trade unions and other health plans, unsuccessfully opposed this legislation. Despite this setback, the chairman and members of the committee found arguments concerning egregious out-of-network reimbursement and network deterioration sufficiently compelling to commit to drafting legislation addressing this issue in the 2010 session. 

The legislation was amended to delay its effective date for 12 months and provide carriers the option of issuing a check requiring dual endorsement. Also, the Assembly took up legislation requiring ambulatory surgical centers to report clinical and financial data to the state. Similar legislation passed unanimously in the Senate.

A Medigap policy is health insurance sold by private insurance companies to fill the “gaps” in Original Medicare Plan coverage. Medigap policies help pay some of the health care costs that the Original Medicare Plan doesn’t cover. If you are in the Original Medicare Plan and have a Medigap policy, then Medicare and your Medigap policy will pay both their shares of covered health care costs.

Insurance companies can only sell you a “standardized” Medigap policy. These Medigap policies must all have specific benefits so you can compare them easily.

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On February 17, 2009, President Obama signed the American Recovery and Reinvestment Act (ARRA), which delayed the phase-out of the hospice wage index budget neutrality adjustment factor (BNAF) for FY 2009. Therefore we are posting a revised copy of the FY 2009 wage index (see Downloads section below), which includes a full (unreduced) BNAF. Please also see CR 6418 (Transmittal 1701, dated March 13, 2009 ) (see Downloads section below) for more information on the revision to the FY 2009 wage index.

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Manufacturer reporting of Average Sales Price (ASP) data: A manufacturer’s ASP must be calculated by the manufacturer every calendar quarter and submitted to CMS within 30 days of the close of the quarter.  Each report must be certified by one of the following: the manufacturer’s Chief Executive Officer (CEO); the manufacturer’s Chief Financial Officer (CFO); an individual who has delegated authority to sign for, and who reports directly to, the manufacturer’s CEO or CFO.

Manufacturers must report the ASP data to us in Microsoft Excel using the template provided in Addendum A, the ASP Data Form.  Both this and the ASP Certification Form (Addendum B), are available in the ‘Downloads’ section below.

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What if my card is lost or stolen?

You can replace your card or your child’s card for free if it is lost or stolen. However, you are limited to three replacement cards in a year and 10 during your lifetime. Legal name changes and other exceptions do not count toward these limits. For example, changes in non citizen status that require card updates may not count toward these limits.

Also, you may not be affected by these limits if you can prove you need the card to prevent a significant hardship.

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What if my immigration status or citizenship changed?

If your immigration status changed or you became a U.S. citizen, you should tell Social Security so your records can be updated. To get your immigration status or citizenship corrected, you need to show documents that prove your new status or citizenship.

Double Check Your Documents

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How do I make sure my records are accurate?

Each year your employer sends a copy of your W-2 (Wage and Tax Statement) to Social Security. They compare your name and Social Security number on the W-2 with the information in their files. They add the earnings shown on the W-2 to your Social Security record.

It is critical that your name and Social Security number on your Social Security card agree with your employer’s payroll records and W-2 so that they can credit your earnings to your record. It is up to you to make sure that both Social Security’s records and your employer’s records are correct. If your Social Security card is incorrect, contact any Social Security office to make changes. Check your W-2 form to make sure your employer’s record is correct and, if it is not, give your employer the accurate information. Read the rest of this entry »

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