Showing posts with label medicare. Show all posts
Showing posts with label medicare. Show all posts

Sunday, December 23, 2012

Medicare Posts List of Top Hospitals


Medicare on Thursday disclosed bonuses and penalties for nearly 3,000 hospitals as it ties almost $1 billion in payments to the quality of care provided to patients.
The revised payments, which will begin in January, mark the federal government's most extensive effort yet to hold hospitals financially accountable for what happens to patients. In what amounts to a nationwide competition, Medicare compared hospitals on how faithfully they followed rudimentary standards of care and how patients rated their experiences.
In many regions, the hospitals that did the best are not the ones with the most outsized reputations, but regional and community hospitals, according to government records. New York-Presbyterian in Manhattan and Massachusetts General Hospital in Boston, both dominant hospitals in their cities, will have their payments reduced. Other leading names in the hospital industry, including the Cleveland Clinic and Intermountain Medical Center in Utah, will receive bonuses, although not the largest in their regions.
In all, Medicare is rewarding 1,557 hospitals with more money and reducing payments to 1,427 others, according to a Kaiser Health News analysis of records released by the Centers for Medicare & Medicaid Services. The maximum amount any hospital could gain or lose was 1% of its regular Medicare payments.
Locally, Robert Packer Hospital, in Sayre, Pennsylvania, faired better than the average hospital.  Here's a link to the RPH's Hospital Profile Page where you can look at many different categories that Medicare rated.  Since many of my workers' compensation clients and personal injury clients have treatment at RPH and Guthrie Clinic, I thought this information was relevant.

Thursday, September 11, 2008

SURPRISING POLICY CHANGE IMMEDIATELY IMPACTING MEDICARE SET-ASIDE ACCOUNTS

On August 25, 2008, the Centers for Medicare & Medicaid Services ("CMS"), issued a Memorandum immediately rescinding a previous policy pertaining to claimants requesting termination of Workers' Compensation Medicare Set-Aside ("WCMSA") funds.

As you may recall, CMS had previously issued a Memorandum date July 11, 2005, establishing guidelines and allowing for requests for the reduction of WCMSAs. If the treating physician concluded that the beneficiary's medical condition had substantially improved, then the beneficiary (or the beneficiary's representative) may submit a new WCMSA proposal covering future expected medical expenses.

That policy has now been eliminated. Pursuant to the recent CMS Memorandum:

Effective immediately, the July 11, 2005 memorandum at Question and Answer 10, entitled "Beneficiaries that Request Termination of a WCMSA Account," is rescinded. Section 1862(b)(2) of the Social Security Act (the Act) (42 USC 1395y(b)(2)) requires that Medicare payment may not be made for any item or service to the extent that payment has been made under a workers' compensation (WC) law or plan. Medicare does not pay for an individual's WC related medical services when that individual received a WC settlement, judgment or award that includes funds for future medical expenses, until all such funds are properly expended.

The ramifications of this Memorandum is that CMS will no longer consider a reduction of the funds required to be "Set-Aside" to protect Medicare's interests, at least in Workers' Compensation cases, once the proposal has been submitted and a determination has been issued, even if the client's condition substantially improves and can be documented by medical records. The funds must remain in the WCMSA account as originally proposed. Time will tell if this policy will also be extended to "liability only" cases, but practitioners should be forewarned of same.

Now, more so than ever, it is critical that Plaintiff's counsel consider the timing of the submission of a WCMSA proposal, based upon not only a client's current medical condition, but also the future prognosis for improvements which may eliminate costly surgical procedures and/or cause the "weaning off" and discontinuance of prescription medications.

This information has been provided by Settlement Professionals, Inc.