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PubMed1981

Department of Health and Human Services--Medicare program; inpatient hospital deductible for 1982. General notice.

This notice announces Medicare's inpatient hospital deductible and coinsurance amounts for calendar year 1982. The Medicare statute specifies the formula the Secretary uses to determine these amounts. The inpatient hospital deductible will be $260. The daily coinsurance amounts will be: (a) $65 for the 61st through 90th days of hospitalization; (b) $130 for lifetime reserve days; and (c) $32.50 for the 21st-through the 100th days of post-hospital extended care services in a skilled nursing facility. Each figure represents an increase of approximately 27 percent over the corresponding 1981 figure. This notice also applies two new rules from sections 2131 and 2132 of the Omnibus Reconciliation Act of 1981, Public Law 97-35, concerning the inpatient hospital deductible and coinsurance amounts.

Deductibles and Coinsurance↗
PubMed1987

Changes to Medicare secondary payer provisions; Omnibus Budget Reconciliation Act of 1986--HCFA. General notice.

This notice describes how section 9319 of the Omnibus Reconciliation Act of 1986 (Pub. L. 99-509) affects the Medicare Program. Section 9319---Makes Medicare secondary for services furnished to disabled beneficiaries who are "active" individuals and are covered under large group health plans; Provides that the Federal Government may recover double damages from group health plans that fail to make primary payments as required by the law; Creates a private cause of action which provides double damages from primary payers that fail to make primary payments as required by the law; Provides special enrollment periods so that Medicare coverage can be restored promptly when group health plan coverage terminates; and Provides that in computing premium increases for late enrollment, periods of large group health plan coverage be excluded. The statutory changes made by section 9319 do not require regulations to implement because they are clear on their face as to what the Congress intended. Thus, we can put them into effect without first issuing regulations. Moreover, we have already had to apply these provisions because the congress made these changes applicable to services furnished on or after January 1, 1987. This notice will help to ensure that all affected parties are aware of the new provisions. This notice is not intended to be an exhaustive list of the changes, nor is it intended to represent the complete text of section 9319.(ABSTRACT TRUNCATED AT 250 WORDS)

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1988

Medicaid: reviewing the program.

This is the final article in a series reviewing the Medicaid program. This article will review the various payment methods used by individual state Medicaid programs and will discuss the current status of litigation initiated on a state-by-state basis in response to inadequate Medicaid payment levels to hospitals and other healthcare providers. A Medicaid information resource listing is provided as a source of reference for patient account managers to obtain additional, specific information concerning administration of the Medicaid program by the various state Medicaid plans.

Deductibles and Coinsurance↗
PubMed1989

Medicare as secondary payer and Medicare recovery against third parties--HCFA. Final rule.

These rules-- 1. Update and revise policies dealing with Medicare as secondary payer; 2. Revise policy on the exclusion of services of immediate relatives of the beneficiary or members of the beneficiary's household; 3. Revise policy on the exclusion of services furnished outside the United States; 4. Clarify policy on the "no legal obligation to pay" exclusion as it applies to services furnished to prisoners; and 5. Reflect a recent statutory amendment that provides an additional exception to the exclusion of services that are "not reasonable and necessary". The changes in the Medicare secondary payer provisions reflect amendments made to section 1862(b) of the Social Security Act (the Act) by section 2344 of the Deficit Reduction Act of 1984 (Pub. L. 98-369), section 9201 of the Consolidated Omnibus Budget Reconciliation Act of 1985 (Pub. L. 99-272), and section 4036(a) of the Omnibus Budget Reconciliation Act of 1987 (Pub. L. 100-203). Separate regulations will be issued to implement section 9319 of the Omnibus Budget Reconciliation Act of 1986 (Pub. L. 99-509), which made Medicare secondary payer for certain disabled Medicare beneficiaries under age 65 who are covered under a large group health plan.

Centers for Medicare and Medicaid Services, U.S.↗
PubMedDate not supplied

A rational solution to billing problems.

For many practices, billing is a back-office task to be completed when the patient leaves the office. Historically, medical offices have placed their least experienced personnel at the front desk while the experienced staff remain hidden behind the scenes handling claims. Today's emphasis on customer service, however, has pushed the pendulum so that seasoned personnel are among the first with whom patients interact. Billing is a process that begins at the front desk when the appointment is made. Understanding the billing pipeline and how every action in a practice can contribute to the successful submission of "clean" claims and improved cash flow can encourage the physician and staff to think "billing" during each step of a patient's visit. This article will take you through the steps involved in the billing pipeline from patient registration to final payment or collection agency referral. For each step, we will point out how the actions of the staff affect billing and what can be done to assure accurate, clean claims are submitted promptly.

Deductibles and Coinsurance↗