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):

• How bad the illness is or if the patient dies (severity of illness)
• How likely it is that the patient will get better or get worse (prognosis)
• What would happen if the patient does not receive immediate or continuing care (need for intervention)
• How much and what type of service the hospital needed to provide, such as lab work, X-rays or physical therapy (resource intensity)

The payment and volume information is for acute care hospitals. “Critical access hospitals (CAH)”, “Acute Care – VA Medical Centers” and “Children’s Hospitals” are not included because they are paid using another method.

Median Medicare Payments

Median Medicare payments for the same MS-DRG can vary. The median payment refers to the midpoint of all payments to the hospital for a particular MS-DRG, that is, half the payments were lower and half the payments were higher than the median payment. A hospital can get a higher payment for any or all of the following reasons:

• It is classified as a teaching hospital
• It treats a high percentage of low-income patients (disproportionate share)
• It may treat unusually expensive cases (outlier payments)
• It pays its employees more compared to the national average because the hospital is in a high-cost area (wage index). Note: The hospital’s wage index is calculated using the hospital’s payroll records, contracts and other wage related documentation

Range of Payments 25th – 75th Percentile

Hospital Compare lets you compare the hospitals you select with other hospitals in your state and in the nation. The state and national amounts are shown as a range of payments (between the 25th percentile and the 75th percentile). This is the range of payments for the most typical cases treated for the MS-DRG. The information doesn’t include unusually low payments for cases, such as when a patient was transferred to another facility before being fully treated. It also doesn’t include unusually high payments for cases that are more complex and costly to treat. Only one number appears in this field when the 25th and 75th percentiles are the same.

Source : http://www.hospitalcompare.hhs.gov/Hospital/Static/ConsumerInformation_tabset.asp?activeTab=6&language=English&version=default

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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.

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

You may be able to choose up to 12 different standardized Medigap policies (Medigap Plans A through L). Medigap policies must follow Federal and State laws. These laws protect you. A Medigap policy must be clearly identified on the cover as “Medicare Supplement Insurance.” Each plan, A through L, has a different set of basic and extra benefits.

It’s important to compare Medigap policies because costs can vary. The benefits in any Medigap Plan A through L are the same for any insurance company. Each insurance company decides which Medigap policies it wants to sell.

Generally, when you buy a Medigap policy you must have Medicare Part A and Part B. You will have to pay the monthly Medicare Part B premium. In addition, you will have to pay a premium to the Medigap insurance company.

You and your spouse must each buy separate Medigap policies. Your Medigap policy won’t cover any health care costs for your spouse.

For additional information on Medigap policies, including why you would want to buy a Medigap policy and information about what Medigap policies cover, please read our publication, Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare.

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According to Section 1861 (dd) of the Social Security Act, the term “hospice care” means the following items and services provided to a terminally ill individual by, or by others under arrangements made by, a hospice program under a written plan (for providing such care to such individual) established and periodically reviewed by the individual’s attending physician and by the medical director (and by the interdisciplinary group described in paragraph (2)(B)) of the program—

(A) nursing care provided by or under the supervision of a registered professional nurse,

(B) physical or occupational therapy, or speech-language pathology services,

(C) medical social services under the direction of a physician,

(D)(i) services of a home health aide who has successfully completed a training program approved by the Secretary and

(ii) homemaker services,

(E) medical supplies (including drugs and biologicals) and the use of medical appliances, while under such a plan,

(F) physicians’ services,

(G) short-term inpatient care (including both respite care and procedures necessary for pain control and acute and chronic symptom management) in an inpatient facility meeting such conditions as the Secretary determines to be appropriate to provide such care, but such respite care may be provided only on an intermittent, nonroutine, and occasional basis and may not be provided consecutively over longer than five days,

(H) counseling (including dietary counseling) with respect to care of the terminally ill individual and adjustment to his death, and

(I) any other item or service which is specified in the plan and for which payment may otherwise be made under this title.

The care and services described in subparagraphs (A) and (D) may be provided on a 24-hour, continuous basis only during periods of crisis (meeting criteria established by the Secretary) and only as necessary to maintain the terminally ill individual at home.

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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.

When sending ASP data to CMS via first class mail, federal express mail, or overnight delivery, please use the following address:

Centers for Medicare & Medicaid Services
Hospital and Ambulatory Policy Group
Division of Ambulatory Services
ATTN: Medicare ASP Data
Mail Stop No. C4-01-26
7500 Security Boulevard
Baltimore, MD 21244
Phone: 410-786-0548

Please send any questions to: sec303aspdata@cms.hhs.gov.

Medicare Contractor Reporting Template for Medicare Part B Drugs – (Located in the “Downloads” section below)

As indicated in CR 4140, dated February 15, 2006, Medicare contractors shall use the Medicare Contractor Reporting Template for Part B drugs to report information on all Medicare Part B drugs not paid on a cost or prospective payment basis when payment limits are not listed in the quarterly drug pricing files, or in the OPPS Pricer. Contractors shall also use the template to report pricing information for the NOC drug billing codes. This information must be sent to CMS on a monthly basis to e-mail address: sec303aspdata@cms.hhs.gov.

New Information Regarding Medicare Payment and Coding for Drugs and Biologics (See Downloads section below for the message)

Section 303(c) of the Medicare Modernization Act of 2003 (MMA) revised the payment methodology for Part B covered drugs that are not paid on a cost or prospective payment basis. In particular, section 303(c) of the MMA amended Title XVIII of the Act by adding section 1847A, which established a new average sales price (ASP) drug payment system.  Beginning January 1, 2005, drugs and biologicals not paid on a cost or prospective payment basis will be paid based on the ASP methodology, and payment to the providers will be 106 percent of the ASP.  There are exceptions to this general rule which are listed in the latest ASP quarterly change request (CR) document.  The ASP methodology uses quarterly drug pricing data submitted to the CMS by drug manufacturers.  CMS will supply contractors with the ASP drug pricing files for Medicare Part B drugs on a quarterly basis.

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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.

To get a replacement card, you will need to:

• Complete an Application For A Social Security Card (Form SS-5);
• Present a recently issued document to show your identity;
• Show evidence of your U.S. citizenship if you were born outside the United States and did not show proof of citizenship when you got your card; and
• Show evidence of your current lawful non-citizen status if you are not a U.S. citizen.

Your replacement card will have the same name and number as your previous card.

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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

Only certain documents can be accepted as proof of citizenship for new and replacement cards. These include your U.S. passport, a Certificate of Naturalization or a Certificate of Citizenship. If you are not a U.S. citizen, Social Security they ask to see your current immigration documents.

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2. Change Name On Medicare Card – How too? If you are a U.S. citizen born outside the United States and their records do not show you are a citizen, you will need to provide proof of your U.S. citizenship. If you are not a U.S. citizen, Social Security will ask to see your current immigration documents....
3. You must provide current, unexpired evidence of identity in your legal name. You must provide current, unexpired evidence of identity in your legal name....
4. What if my social security card is lost or stolen? 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, [...]...
5. Learning About Your Social Security Card Number and Information Social Security – Government Assistance A Social Security number is important because you need it to get a job, collect Social Security benefits and receive some other government services. Many other businesses, such as banks and credit companies, also ask for your number. If you are a non-citizen living in the United States, you also [...]...
6. How do I make sure my social security records are accurate? 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 [...]...
7. Replacing a Lost Social Security Card Because I’m a government employee, I’ve gotten emails from time to time from friends of mine who are trying to figure out something government-related and assume I have all the answers. And because I work in the office that runs USA.gov, I can usually point my friends in the right direction. Last week a friend [...]...
8. Citizenship Applications — Top 5 Mistakes Applying for American citizenship takes time, but you can facilitate the process by avoiding the most common mistakes. Watch our video on the top 5 mistakes....
9. How should I protect my Social Security number? How can I protect my Social Security number? You should treat your Social Security number as confidential information and avoid giving it out unnecessarily. You should keep your Social Security card in a safe place with your other important papers. Do not carry it with you unless you need to show it to an employer [...]...
10. Medicare Eligibility Requirements Medicare is a Health Insurance Program for people age 65 or older, some disabled people under age 65...
11. Who is Eligible for Medicare Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years or older and a citizen or permanent resident of the United States. If you aren’t yet 65, you might also qualify for coverage if you have a disability or with [...]...
12. Family Genealogy: Helping Medicare My mom used to tell her school friends that she was related to the actor, Roy Rogers. She wasn’t. As a kid I used to tell people I was half German, half English, half Irish, and half American. Knowing these two things, you could extrapolate that my family tree contains liars and people that can’t [...]...
13. Vitamin D Status is Not Associated with Risk for Less Common Cancers Despite hopes that higher blood levels of vitamin D might reduce cancer risk, a large study finds no protective effect against non-Hodgkin lymphoma or cancer of the endometrium, esophagus, stomach, kidney, ovary, or pancreas. In this study, carried out by researchers from the National Cancer Institute (NCI), part of the National Institutes of Health, and [...]...
14. Here are the Social Security Office Center Locations If you live or receive mail in Brooklyn, N.Y.; Queens, N.Y.; Orlando, Fla.; Sacramento County, Calif.; Phoenix, Ariz. (Maricopa County and Apache Junction Area); or Las Vegas, Nev., you must visit a Social Security Card Center to apply for an original or replacement Social Security card. If you do not live or receive mail in [...]...
15. Federal Report Details Health and Economic Status of Older Americans Today’s older Americans enjoy longer lives and better health than did previous generations. These and other trends are reported in Older Americans 2010: Key Indicators of Well-Being, a unique, comprehensive look at aging in the United States from the Federal Interagency Forum on Aging-Related Statistics....

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.

Over Age 25 and Not Receiving Benefits

If you are a worker age 25 and older and not receiving benefits, you receive a Social Security Statement every year that summarizes your earnings. Review this Statement to make sure that all your earnings are included. If your Statement does not include all your earnings, let your employer and your Social Security office know about any incorrect information.

Related posts:

1. Social Security Medical Express Records You can submit evidence directly to your client's case file by using your office fax or through the Social Security secure Electronic Records Express website...
2. How should I protect my Social Security number? How can I protect my Social Security number? You should treat your Social Security number as confidential information and avoid giving it out unnecessarily. You should keep your Social Security card in a safe place with your other important papers. Do not carry it with you unless you need to show it to an employer [...]...
3. Name changed and now I need to tell the Social Security. Where do I start? What if my name changed? If you legally change your name because of marriage, divorce, court order or any other reason, you need to tell Social Security so that you can get a replacement card. If you are working, also tell your employer. If you do not tell them when your name changes, it may: [...]...
4. Often employers ask to see an employee’s Social Security card Often employers ask to see an employee’s Social Security card. But, do you really need to see the card? Since 1936, Social Security has issued over 30 different versions of the Social Security number (SSN) card which makes it difficult to recognize a valid card....
5. Information and Instructions to Verify Social Security Numbers Online There are two Internet verification options you can use to verify that your employee names and Social Security numbers match Social Security's records. You can: Verify up to 10 names and SSNs (per screen) online and receive immediate results. This option is ideal to verify new hires....
6. Learning About Your Social Security Card Number and Information Social Security – Government Assistance A Social Security number is important because you need it to get a job, collect Social Security benefits and receive some other government services. Many other businesses, such as banks and credit companies, also ask for your number. If you are a non-citizen living in the United States, you also [...]...
7. Will Medicare, Medicaid, and Social Security Survive Understanding the Largest Federal Assistance Program Social Security is the federal government’s largest single program. Created in 1935, the program now consists of two parts: Old-Age and Survivors Insurance pays benefits to retired workers and to their dependents and survivors. Disability Insurance (DI) makes payments to disabled workers who are younger than the normal retirement [...]...
8. Replacing a Lost Social Security Card Because I’m a government employee, I’ve gotten emails from time to time from friends of mine who are trying to figure out something government-related and assume I have all the answers. And because I work in the office that runs USA.gov, I can usually point my friends in the right direction. Last week a friend [...]...
9. Facts About Social Security Facts About Social Security...
10. The Privacy Act of 1974, as amended at 5 U.S.C. 552a, protects records The Privacy Act of 1974, as amended at 5 U.S.C. 552a, protects records ...
11. SOCIAL SECURITY BENEFITS PLANNER – www.ssa.gov/planners SOCIAL SECURITY BENEFITS PLANNER - www.ssa.gov/planners...
12. Social Security E-News Social Security E-News...
13. How to Find the Nearest Social Security Office Near You If you live in the United States and you want information and directions to the Social Security office that serves your area, just enter your U.S. Postal Service five-digit ZIP code below and select Locate. You’ll get information about your local Social Security office and other agencies in your area that may be able to [...]...
14. Social Security Files Statement of Interest Michael J. Astrue, Commissioner of Social Security, today announced that the Department of Justice, on behalf of the Social Security Administration, has filed a “Statement of Interest” inUnion of American Physicians and Dentists v. Arnold Schwarzenegger, Governor of California , which is currently pending in a state trial court in California. The Union of American Physicians and Dentists includes employees of the California Disability Determination Services Division (DDSD), Department of Social Services, who evaluate Social Security Disability and Supplemental Security Income claims. The Federal government fully pays for the salaries and overhead costs for these employees....
15. Here are the Social Security Office Center Locations If you live or receive mail in Brooklyn, N.Y.; Queens, N.Y.; Orlando, Fla.; Sacramento County, Calif.; Phoenix, Ariz. (Maricopa County and Apache Junction Area); or Las Vegas, Nev., you must visit a Social Security Card Center to apply for an original or replacement Social Security card. If you do not live or receive mail in [...]...