Medicare health plan enrollees receive a Notice of Medicare Non-Coverage (NOMNC) prior to termination of Medicare-covered skilled nursing facility (SNF), home health (HH), and comprehensive outpatient rehabilitation facility (CORF) services
Both Medicare Beneficiaries and Providers Have Certain Rights
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.
If you have one of these health conditions — asthma, arthritis or lupus, diabetes, cancer, HIV/AIDS, and heart or kidney disease — and you develop flu-like symptoms, contact your health care provider or seek medical care.
CMS’ mission is to ensure health care security for beneficiaries. A major component in achieving this mission is the successful administration of Original Medicare, or Fee-for-Service (FFS) Medicare. Medicare Contracting Reform (or section 911 of the Medicare Prescription Drug,
Persons with Disabilities: The term “disability” refers to limited physical or cognitive capacity. It includes people with neurological and neuro-developmental conditions, such as disorders of the brain, spinal cord, peripheral nerve, and muscle (e.g., cerebral palsy, epilepsy/seizure disorders, stroke, intellectual disability/mental retardation); moderate to severe developmental delay; muscular dystrophy; and spinal cord injury. These chronic conditions interfere with functional capacity. “Disability” also includes people with other chronic health conditions that interfere with functional capacity.
Most Medicare beneficiaries will not see a Part B monthly premium increase as a result of a “hold harmless” provision in the current law. This allows for 73 percent of beneficiaries to be protected from an increase raising the 2010 Part B monthly premiums from $96.40 to $110.50.
CMS uses five different provider and supplier enrollment applications. In general, Part A providers are required to use the CMS-855A to enroll or update their enrollment information
For 2009, CMS improved how it reviews Medicare claims for inpatient hospital services and eliminated the use of past billing records as part of a complex medical review. As a result of this heightened scrutiny and more complete accounting of Medicare FFS claims, CMS is reporting a 2009 FFS error rate of 7.8 percent, or $24.1 billion, compared to 3.6 percent in 2008. In addition, for 2009:
The Centers for Medicare & Medicaid Services (CMS) today announced its final decision to cover Human Immunodeficiency Virus (HIV) infection screening for Medicare beneficiaries who are at increased risk for the infection, including women who are pregnant and Medicare beneficiaries of any age who voluntarily request the service.
Michael J. Astrue, Commissioner of Social Security, today announced that for the first time since 1999, the agency has ended the year with fewer disability hearings pending than in the prior year. Social Security ended fiscal year (FY) 2009 with 722,822 hearings pending compared to 760,813 hearings pending at the start of the year, a reduction of more than 37,000 cases. Over the same period, the average processing time for these cases improved from 514 days in FY 2008 to 491 in FY 2009.
With consumer prices down over the past year, monthly Social Security and Supplemental Security Income benefits for more than 57 million Americans will not automatically increase in 2010. This will be the first year without an automatic Cost-of-Living Adjustment (COLA) since they went into effect in 1975.
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.
The Centers for Medicare & Medicaid Services (CMS) has ten Regional Offices (ROs) reorganized in a Consortia structure based on the Agency’s key lines of business: Medicare health plans, Medicare financial management, Medicare fee for service operations, Medicaid and children’s health, survey & certification and quality improvement. The intent of this structure is to improve … Read more
Michael J. Astrue, Commissioner of Social Security, today announced that the online Retirement Estimator, available at www.socialsecurity.gov/estimator, now can provide immediate and personalized benefit estimates to people who have enrolled in Medicare but have not yet filed for Social Security benefits. Previously, these “Medicare only” beneficiaries would need to contact a local office in order to obtain an estimate of their benefits. Currently, about a half-million people file for Medicare each year and delay filing for Social Security benefits.
The Centers for Medicare & Medicaid Services (CMS) today announced its final decision to cover Human Immunodeficiency Virus (HIV) infection screening for Medicare beneficiaries who are at increased risk for the infection, including women who are pregnant and Medicare beneficiaries of any age who voluntarily request the service. The decision is effective immediately.
Michael J. Astrue, Commissioner of Social Security, today hosted the agency’s fifth public hearing on Compassionate Allowances. Commissioner Astrue was joined by Philip Wang, M.D., Dr. P.H., National Institute of Mental Health, National Institutes of Health, and Social Security executives. They heard testimony from some of the nation’s leading experts on schizophrenia about possible methods of identifying and implementing Compassionate Allowances for young adults with schizophrenia.