The Politics of Health Care

Health Insurance for Young Adults: What You Need to Know

Michael LaMagna — Mon, 20 May 2013 18:03:00 GMT

If there is one thing that many of us are guilty of, it's neglecting our own health and focusing on our children and their needs. I am sure that most of us are aware that our health plans are now required to keep young adult children on their parent's health plans until they reach age 26, but many people, including the plan participants, do not know what is covered and what is not.

Currently, there are more than 3 million young adults covered under their parent's plans. Although this group may be covered for comprehensive medical needs, young adults who are covered under their parent's plans find themselves not covered for mental health issues, substance abuse and maternity care, which are common healthcare occurrences in the 26 and under crowd. There may be some hope starting in 2014, health plans will no longer be able to turn people down because they have preexisting medical conditions and with the advent of healthcare exchanges, young people will be free to shop around for individual plans if they don't want to stay on their parent's plan. All non-grandfathered healthcare plans will cover 10 essential health occurrences, including maternity and newborn care, mental health and substance abuse services.

In addition to the comprehensive plans available on the exchanges, young people up to age 30 will have the option of choose a catastrophic plan, which will cover preventive services without any cost sharing and three physician visits after a $6,350 deductible is met.

Of course there are exceptions called grandfathered plans, which you should be aware. Large-group employers are exempt from covering the 10 essential health benefits, which may exempt young people from mental health, substance abuse and maternity care. While Medicaid can be an option for specific care, there are strict income and asset guidelines that must be adhered to, which will make it impossible for most non-disabled working people to qualify.

Even still, many mental health professionals and counselors who provide outpatient services may not take many of the health plans or accept Medicaid. It is vital that you become very familiar with your health plans and know your rights regarding coverage and the appeals process in case you or your children get denied coverage. It is common for bills for these services to be in the tens of thousands of dollars, which many people do not have to pay the hospital bills, especially those 26 and under and their parents.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Plan to attend Attorney LaMagna's free seminar, "Talking Dollars and Sense," at the Kensington Assisted Living, White Plains, NY on May 16, 2013 from 6:00-7:30pm. RSVP by calling The Kensington at 914-220-4259. Michael LaMagna is a Partner at Helwig, Henderson, Ryan, LaMagna and Spinola, practicing Elder Law/Probate/Disability/Wills, Trusts and Estates, Health Care Regulatory, Medicare Appeals, Social Security and General Legal practice in both New York and Connecticut. Email him at Mlamagna@hhrls.com, call him at 914-437-5955 or visit Attorney LaMagna's website at www.HHRLS.com for more information.

The Price of Long-Term Care Keeps Rising

Michael LaMagna — Tue, 07 May 2013 13:57:00 GMT

Long-term care costs continue to rise, many times keeping the costs and more importantly, the needed care out of reach for the individuals who need the services. Genworth Financial, which itself just announced cuts to its long term care insurance portfolio, just released its 10th annual survey of Long Term Care Costs. Here are some highlights:

adult day care costs rose 6.56% to an average daily rate of $65.
nursing home care private room costs increased 3.6% to $230 per day/ $83,950 per year.
nursing home care semi-private room rates increased 3.3% to $207 per day/ $75,555 per year.
home health care costs have remained relatively flat.
Assisted living care costs increased 4.55% to a national median monthly rate of $3,450.

As you can see the high costs are staggering and increasing each year. It is vital that everyone think about long term care early enough to prepare for the unpredictable future. Further, long term care insurance is one of many possible solutions; however, it is important to explore each possibility, which also includes utilizing estate and long term care legal and financial planning. Although, skilled elder lawyers can assist when you are in crisis, i.e. in a facility or hospital, the best plan is to plan early and prepare for the unexpected.

Six Ways the 2014 Fiscal Budget May Change Healthcare

Michael LaMagna — Tue, 23 Apr 2013 12:58:00 GMT

With all of the talk regarding the sequester and budget cuts, I decided to focus on what the fiscal 2014 budget would mean to the 54 million+ Medicare beneficiaries, if the budget was passed in its current state. Currently, the 2014 proposed fiscal budget contains $4 trillion in cost savings, with almost $400 billion in Medicare spending reductions over the next decade. The cost-saving provisions are spread amongst all beneficiaries and providers of care. I highlighted the six provisions that would directly affect Medicare beneficiaries and their providers of care:

Higher Part B deductibles: Medicare Part B, which pays for physician and ancillary services, will have an increase of approximately $75, which is a significant increase over the $147 current deductible. This is true despite more than half of Medicare beneficiaries having an annual income of less than $22,500 in 2012;
Home Health Care Visits: Starting in 2017, new Medicare beneficiaries would be expected to pay $100 for five or more home healthcare visits paid by Medicare if the care was not provided after a hospital or rehabilitation visit;
Surcharge for Medigap premiums: Also starting in 2017, new beneficiaries who purchase the often critical supplemental or Medigap policy, will have a 15% surcharge to discourage over usage;
Medicare Part B and Part D premiums to increase for wealthier individuals: Although individuals with incomes above $80,000 and couples who have incomes over $170,000 already pay a larger share of Medicare premiums, the budget calls for higher premiums for those with higher incomes:
Doughnut Hole Closing: The good news is that the dreaded doughnut hole would be closing as soon as 2015;
Cuts to Healthcare Providers: Hospitals would see the amount of money provided to them because of bad debt slashed by almost two-thirds and the amount paid to teaching hospitals also decreased.

Of course, this is just a snapshot of the proposed budget, but it is vital that all of us take notice of the possible changes and the likelihood that many of these provisions will become enacted and to prepare accordingly.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Plan to attend Attorney LaMagna's free seminar, "Talking Dollars and Sense," at the Kensington Assisted Living, White Plains, NY on May 16, 2013 from 6:00-7:30pm. RSVP by calling The Kensington at 914-220-4259. Michael LaMagna is a Partner at LaMagna & Associates, PC, practicing Elder Law/Probate/Disability/Wills, Trusts and Estates, Health Care Regulatory, Medicare Appeals, Social Security and General Legal practice in both New York and Connecticut. Email him at Mlamagna@nyandctlaw.com, call him at 914-437-5955 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.

Medicare Class Action Suit Settled

Michael LaMagna — Thu, 18 Apr 2013 13:39:00 GMT

There are big changes to your Medicare benefit that will assist you to obtain a longer stay at a rehabilitation center or more outpatient therapy. Medicare just settled a lawsuit, Jimmo v Sebelius, which clarifies when a rehabilitation center, home health care or outpatient therapy provider can discontinue services paid by Medicare.

As most readers know, your Medicare Part A benefit pays for rehabilitation after a 3 day hospital stay for a period up to 100 days, day 1 to 20 at 100%, day 21 to 100 at 80% (you are responsible to pay the 20% co-pay of $148/per day or a supplemental plan will cover the daily fee). Prior to the recent settlement of the Jimmo lawsuit, Medicare providers would discharge beneficiaries, thus denying them more services during the 100 days if there wasn't any "Improvement." This rule of thumb "Improvement Standard" meant that the provider would determine that there wasn't any further rehabilitation or restoration potential, leaving the beneficiary to pay privately (at $400 to $500 per day), be discharged or appeal the decision.

Jimmo, which was a class action lawsuit against Medicare based on this very issue, was just settled. Effective immediately, Medicare can no longer deny a claim because of a lack of rehabilitation potential, but is expanded to pay for rehabilitation which prevents or slows further deterioration in a beneficiaries' clinical condition. This new standard will allow many Medicare beneficiaries to continue on with their therapy, even if they do not show restorative potential, but require more time to prevent further physical deterioration. This should save beneficiaries thousands of dollars and more importantly, allow beneficiaries to obtain the therapy they need to prevent them from further harm after discharge.

Therefore, if you are currently obtaining Medicare paid rehabilitation services in a rehabilitation center or at home and you are being discharged because of a lack of improvement, you may be able to stop the discharge by reminding the provider of the new Medicare policy clarification.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a Partner at LaMagna & Associates, PC, practicing Elder Law/Probate/Disability/Wills, Trusts and Estates, Health Care Regulatory, Medicare Appeals, Social Security and General Legal practice in both New York and Connecticut. Michael was just appointed to the ACO Task Force of the American Health Lawyers Association. Email him at Mlamagna@nyandctlaw.com, call him at 914-437-5955 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.

Crisis Medicaid Planning Tool Ruled Valid

Michael LaMagna — Tue, 02 Apr 2013 11:22:00 GMT

For those of you who have placed a family member in a nursing home, you already know the costs are astronomical. In the Westchester, N.Y., area most nursing homes run $14,000-$16,000 per month and it's even more in New York City. To qualify for Medicaid to pay for your nursing home bill, you either spend-down all of your assets or use a Medicaid crisis planning tool called a promissory note, or "note," where in many instances you can gift almost half of your money, which would otherwise go to the nursing home. This method should be explored only by a qualified lawyer skilled in elder law matters.

A promissory note allows a nursing home resident to loan a sum of money to another person with specific written repayment terms detailing the interest rate, the amount of principal and interest to be paid each month and the term of the note. This loan must be made in conjunction with a non-exempt transfer or gift of assets which causes a period of ineligibility ("penalty period") for that person. The end result is that the Medicaid applicant should be eligible to receive institutional Medicaid benefits ("Nursing Home Medicaid") upon the expiration of the term of the note and the penalty period, saving almost half of the money they would otherwise be given to the nursing home.

As you can imagine, there have been challenges to this Medicaid loophole. This week a U.S. District Court in Oklahoma upheld a promissory note as a "valid form of Medicaid planning" and the state cannot penalize the applicant for taking advantage of a lawful loophole that Congress has not foreclosed. The result was that the note was not considered a resource and does not subject the Medicaid applicant to a transfer penalty, Lemmons v. Lake (U.S. Dist. Ct., W.D. Okla., No. CIV-12-1075-C, March 21, 2013). I would be happy to explain more about this strategy in a legal consultation.

A better method of preserving assets is to start the Medicaid planning process several years prior to the entrance into a nursing home, however, if you do not have the opportunity to plan ahead, the promissory note is certainly a valid and acceptable Medicaid planning technique, which can save you hundreds of thousands of dollars that would otherwise go to the nursing home.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a Partner at LaMagna & Associates, PC, practicing Health Care Regulatory, Elder Law/Probate/Disability/Wills, Trusts and Estates, Social Security and General Legal practice in both New York and Connecticut. Michael was just appointed to the ACO Task Force of the American Health Lawyers Association. Email him at Mlamagna@nyandctlaw.com, call him at 914-437-5955 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.

Observations Days: Is It Inpatient or Outpatient?

Michael LaMagna — Tue, 12 Mar 2013 12:14:00 GMT

I want to revisit the topic of Hospital Observation Days. This is a poorly understood concept and one that I receive many questions about.

If you have Medicare, Part A and you are admitted as an inpatient for three overnight stays, on the fourth day your Skilled Nursing Benefit would be active, and if admitted to a nursing facility, Medicare would pay for up to 100 days of rehabilitation and skilled nursing. The benefit period pays 100% of the nursing costs for days 1 to 20 and there is a co-pay of $148 per day from day 21 to 100. This part is relatively uncomplicated; however, this isn't the end of the story.

Whether you are inpatient or outpatient during your stay at the hospital is critical. Although you are staying overnight, that doesn't necessarily mean you are an inpatient, and very often you are considered under Observation, which is outpatient status and not counted toward the three night qualifying stay, thereby costing seniors thousands of dollars for rehabilitation that Medicare would have paid for if the hospital had classified the stay as inpatient. In order to be considered inpatient you must be actually admitted to the hospital with a physician order. You are considered outpatient if your receiving emergency department services, lab tests, x-rays and the physician hasn't written an order to admit.

To protect yourself, you have a right to ask hospital personnel the status of your hospital stay, and if you don't agree, you have a right to appeal any adverse decision; however the appeal time frames are very short, in some cases 48 hours, so make sure you read all the information provided and take notes when talking to hospital staff.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a Partner at LaMagna & Associates, PC, practicing Health Care Regulatory, Elder /Probate/Disability/Wills, Trusts and Estates, Social Security and General Legal practice in both New York and Connecticut. Michael was just appointed to the ACO Task Force of the American Health Lawyers Association. Email him at Mlamagna@nyandctlaw.com, call him at 914-437-5955 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.

The Alzheimer's Crisis

Michael LaMagna — Tue, 19 Feb 2013 12:40:00 GMT

As many of you already know, caring for someone with Alzheimer's disease is both emotionally and financially draining. Alzheimer's is an incurable disease, which in many cases erodes a person's memory and makes the most basic daily care tasks that we take for granted, such as bathing, dressing and cooking, virtually impossible. Each week families who are struggling with this vicious disease visit my office seeking advice regarding finances, government benefits, housing alternatives and support groups. It's a very long and difficult road, but one that doesn't need to be traveled alone.

Unfortunately, the disease is quickly growing and a recent report noted the expected number of Alzheimer's cases could triple from 5 million currently to nearly 14 million by 2050, costing an estimated $1.1 trillion. Besides the human toll on the families and the patients, it is an overwhelming cost to the Medicare and Medicaid systems, which pay more than 70% of all related costs. It has been shown that patients with Alzheimer's will spend three times more on healthcare than patients with other types of illnesses. Medicare patients with Alzheimer's and other dementias spend $43,847 on healthcare and long-term care services annually, compared to $13,879 spent by patients without those illnesses. However, that leaves 30% of the overwhelming costs to the individuals.

Because the disease is progressive, early detection is crucial. If you see signs of Alzheimer's, which includes memory loss that disrupts daily life, difficulty completing daily tasks and confusion with time or place, see a physician immediately. In addition, it is critical you get your legal affairs in order, such as the power of attorney and healthcare proxy, so you have the peace of mind that other people are appointed to make decisions even when someone no longer has the capacity to make them. In addition, it is critical to have your finances in order and professionals to assist in obtaining benefits to avoid the overwhelming financial and emotional toll.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a partner at The Law Office of LaMagna & Associates, PC, practicing Health Care Regulatory, Elder /Estate Administration/Probate/Disability/Wills, Trusts and Estates, Social Security and General Legal practice in both New York and Connecticut. Email him at Mlamagna@nyandctlaw.com, call him at 914-437-5955 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information. You can also follow Attorney LaMagna on Twitter@michaellamagna1.

Healthcare Law Glitch Will Leave Many Without Insurance

Michael LaMagna — Tue, 05 Feb 2013 22:04:00 GMT

In somewhat unexpected news, there appears to be a serious crack in the healthcare law, one which may "price out" millions of families from healthcare coverage altogether. The issue recently came to light when confusing language in the new law appears to carve out lower income families who do not qualify for Medicaid, requiring them to either pay more for their employee sponsored health insurance or go without insurance.

The problem arises because the law redefined what employers are responsible to pay for insurance. Under the law, an employer will face a penalty if the premiums are so expensive that a worker would qualify for a subsidy. Subsidies are available for unaffordable coverage, deemed as 9.5% of a worker's household income. The problem is that the benchmark used is cost of an individual policy, not a family policy. Anyone who pays for health insurance knows it is often 3-4 time more expensive for a family policy than an individual, so if you base the calculation on an individual policy, not very many people would qualify for the subsidy and the employers are not responsible to make up the difference.

The numbers certainly are staggering. There are as many as 4 million households, including 500,000 children, affected by this glitch. Using 2011 figures, a family making more than $9,700 per year would be ineligible for a subsidy, while the cost of that plan for a family is actually more than $4,000 per year, far more than most families can afford without some assistance from the employer or the government.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a partner at The Law Office of LaMagna & Associates, PC, practicing Health Care Regulatory, Elder /Probate/Disability/Trusts and Estates, Social Security and General Legal practice in both New York and Connecticut. Email him at Mlamagna@nyandctlaw.com, call him at 914-534-1048 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information. You can also follow Attorney LaMagna on Twitter@michaellamagna1.

SMART Act Puts Deadlines on Settlement Money

Michael LaMagna — Tue, 29 Jan 2013 16:56:00 GMT

A little known law is about to have a pretty big impact on Medicare beneficiaries who find themselves victims of negligence and wait for their settlement money. Currently when a Medicare beneficiary has a lawsuit and receives a monetary judgment or settles out of court and Medicare has paid the related medical bills, that person is required to wait until Medicare is reimbursed before receiving the proceeds of that lawsuit. Currently, it can take months or even years just for Medicare to provide you with the amount they are due reimbursement.

The new law, the Strengthening Medicare and Repaying Taxpayers (SMART) Act, sets time frames for CMS and Medicare beneficiaries to provide information in cases where a settlement is expected. Under the SMART law, a beneficiary must notify CMS within 120 days of the lawsuit settlement. CMS then has 65 days to tell the parties how much is owed. The agency can request an additional 30 days if necessary. Moreover, if beneficiaries believe the amount posted is wrong, they can provide documentation to CMS, and the agency has 11 days to respond. The law also limits to 3 years the time CMS has to pursue reimbursement.

The previous system not only would cause delays in the settlement process, but affected whether or not a case would even go forward, as most attorney's want the information regarding the Medicare figure prior to taking a case. Moreover, if a case is expected to go to mediation and the mediator doesn't have accurate numbers, a decision cannot be reached.

In addition, the slow reporting process didn't allow for the famous ever-dwindling Medicare Trust Fund to get promptly repaid. In 2011, more than 480,000 new cases were recorded, and CMS realized more than $860 million in payments and savings related to such cases, many months or years longer than they could have. It is expected that the new law will allow for more timely reimbursement. However, with the new time frames, I could foresee a situation where Medicare foregoes its right to be paid back altogether, if they do not pursue reimbursement within 3 years.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a partner at The Law Office of LaMagna & Associates, PC, practicing Health Care Regulatory, Elder/Probate/Disability/Trusts and Estates, Social Security and General Legal practice in both New York and Connecticut. Email him at Mlamagna@nyandctlaw.com, call him at 914-534-1048 or visit www.nyandctlaw.com for more information. You can also follow Attorney LaMagna on Twitter@michaellamagna1.

Medicare Settles Lawsuit: Many Will Gain Access to Services

Michael LaMagna — Tue, 11 Dec 2012 16:19:00 GMT

If any readers have patients Medicare refused to pay for skilled nursing, home care or other outpatient benefits because their condition was "stable, chronic, not improving or that the necessary services were for maintenance," keep reading because there is some very good news.

In early October, CMS settled a class action lawsuit filed by the Center for Medicare Agency and Vermont Legal Aid. According to the settlement, CMS will reverse course and allow Medicare to pay for services "necessary for the performance of a safe and effective maintenance program." In addition, CMS will no longer deny claims because a Medicare beneficiary wouldn't be able to achieve complete independence or because they can no longer return to their prior functioning level.

Under the agreement, CMS will also set up an appeals process, similar to the process currently in place, in which a beneficiary can appeal a denial for a claim, all the up to an impartial Administrative Law Judge. It is expected the new policy revision will enable thousands to gain access to needed skilled care and allows those Medicare providers to continue needed services, in particular, to those with chronic conditions, including Alzheimer's, Parkinson's and multiple sclerosis.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a partner at The Law Office of Michael LaMagna, LLC, practicing Health Care Regulatory, Elder /Probate/Disability/Trusts and Estates, Social Security and General Legal practice in both New York and Connecticut. Email him at Mlamagna@nyandctlaw.com, call him at 914-534-1048 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information. You can also follow Attorney LaMagna on Twitter@michaellamagna1.

Carefully Weighing the Effect of Raising the Medicare Age Requirement

Michael LaMagna — Tue, 04 Dec 2012 16:36:00 GMT

Medicare, the primary insurer for those who are over 65 or disabled, is going through some serious challenges at the moment. The Medicare trust, which is the money withheld through the Medicare payroll tax, is slated to become insolvent at some point between 2016 and 2024. This fact, coupled with the upcoming Fiscal Cliff, has politicians scrambling for ideas to save money and keep Medicare solvent. The latest idea is to increase the age of Medicare eligibility from 65 years of age to 67.

The premise is that if you increase the age by 2 years, the 3.3 million individuals who would be disqualified would be required to either: 1) pay for coverage out of pocket; 2) go without insurance and pay a fine; 3) rely on employer sponsored insurance; or 4) rely on Medicaid. The proposed result would be a total savings of $5.7 billion; however it is projected to cost the entire healthcare system $11.4 billion dollars in spending.

The spending costs include the cost of seniors paying for replacement plans, fines and costs to employers. The question remains to be seen whether raising the eligibility age would simply shift the costs from the Federal government, who pays for Medicare, to the individuals and ultimately the states (Medicaid costs).

Now, I am not suggesting that raising the age isn't a viable solution; however, I am calling on Washington to carefully consider all of the ramifications of changing the system and ensuring the states will be able to withstand the impact.

Your comments are always appreciated.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a partner at The Law Office of Michael LaMagna, LLC, practicing Health Care Regulatory, Elder /Probate/Disability/Trusts and Estates, Social Security and General Legal practice in both New York and Connecticut. Email him at Mlamagna@nyandctlaw.com, call him at 914-534-1048 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.

Medicare Premiums to Rise in 2013

Michael LaMagna — Mon, 19 Nov 2012 14:59:00 GMT

The premium for Medicare Part B, which is the voluntary Medical insurance covering medically necessary doctors' services, preventive care, durable medical equipment, laboratory tests, x-rays, limited home health and ambulance services will rise by $5 in 2013. This increase will offset the Social Security cost of living increase for 2013 of 1.7%, or an average of $19 per month.

The new Part B cost for the majority of beneficiaries will be $104.90, up from the current $99.90 per month. However, those "high income" beneficiaries, whose income is more than $85,000 for an individual or $170,000 for couples will see an increase of $42 to $230.80 per month. Most beneficiaries will not realize the change because they pay directly from their Social Security check.

In addition, Medicare's hospitalization deductible will increase by $28, to $1,184. The deductible is the amount a person must pay before health insurance kicks in. It is recommended that seniors have supplemental coverage to offset their Medicare hospital deductible.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a partner at The Law Office of Michael LaMagna, LLC, practicing health care regulatory, elder /probate/disability/trusts and estates, social security and general legal practice in both New York and Connecticut. Email him at Mlamagna@nyandctlaw.com, call him at 914-534-1048 or visit www.nyandctlaw.com for more information.

Two More Provisions of ACA Now in Effect

Michael LaMagna — Tue, 02 Oct 2012 22:21:00 GMT

Starting Oct.1, 2012, two very important provisions of the Affordable Care Act (ACA) went into effect, which will significantly impact hospitals and other healthcare facilities. The two provisions are: 1) penalizing hospitals for readmitting patients within 30 days of discharge and 2) utilizing hospital value-based purchasing, which ties hospital payments to achieving clinical thresholds.

It is anticipated that more than 2,200 hospitals will be fined at least $125,000 this year as a result of readmissions. As expected, the hospitals are outraged for being fined for conditions that may be out of their control, which includes the readmission of chronically ill people. The variables that will be measured in the first year include: heart attacks, heart failure and pneumonia. The penalty is capped at 1% of the hospital's Medicare payments, rising to 3% in the next few years and adding variables, which includes: joint replacements, stenting, heart bypass and stroke.

Hospitals have been looking to after-hospital care, including: rehab centers, hospices, home health agencies and nursing homes to decrease the incidences of readmissions. The major emphasis has been on effective discharge planning and wellness programs.

Regarding the Hospital Value-Based Purchasing Program, Medicare will look at a set of standard clinical quality measures and on surveys of patients' experience, to determine reimbursement. Medicare has been sharing data with the hospitals to assist with diminishing their impact and the public can view the information on Hospital Compare, located at http://www.medicare.gov/ starting later this month.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a partner at Timins & LaMagna, LLP, practicing Health Care Regulatory, Elder /Probate/Disability/Trusts and Estates, Social Security and General Legal practice in both New York and Connecticut. Michael was just appointed to the ACO Task Force of the American Health Lawyers Association. Email him at Mlamagna@nyandctlaw.com, call him at 914-819-0663 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.

Projected Costs of Health Care Law Changing

Michael LaMagna — Mon, 24 Sep 2012 13:19:00 GMT

The Congressional Business Office (CBO) reports that in 2016, which is when the 2010 health care law becomes fully in effect, 2% of Americans, or roughly 6 million individuals, will be subject to the health care penalty tax. This is significantly higher than the estimated 4 million, in large part due to higher than anticipated unemployment, lower wages and salaries as well as changes to the law since its passage in 2010.

The new penalty is the infamous individual mandate upheld by the Supreme Court as a tax, which requires that you either obtain health insurance or pay a penalty, amounting to $695 or 2.5% of your annual household income. The tax is expected to bring in more than $7 billion in 2016 and $8 billion thereafter.

In addition, the CBO projected that the total amount of individuals who will remain uninsured with be 30 million, up from the projected 21 million. The reason why it is projected that 6 million will be subject to the tax is because the other 24 million include: undocumented aliens, Indian tribe members and those with lower incomes.

The CBO has projected that the total cost for the new law will be upward of $2.6 trillion dollars in the next 10 years, which is significantly higher than the first estimates of $900 billion and covers fewer individuals than first thought.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a partner at Timins & LaMagna, LLP, practicing Health Care Regulatory, Elder /Probate/Disability/Trusts and Estates, Social Security and General Legal practice in both New York and Connecticut. Michael was just appointed to the ACO Task Force of the American Health Lawyers Association. Email him at Mlamagna@nyandctlaw.com, call him at 914-819-0663 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.

Physician Medicare Upcoding Costs $11 Billion Over Past 10 Years

Michael LaMagna — Mon, 17 Sep 2012 22:10:00 GMT

The Center for Public Integrity recently reported that physician upcoding will cost an addition $11 billion for the past 10 years. When a Medicare beneficiary visits their physician, that service or services gets a billing code. That code is then submitted to Medicare for payment. Upcoding is the practice of billing more expensive services than were performed by the physician. Codes range as low as $20 for a few minutes of a physician's time to more than $140 for more extensive services performed.

Medical groups have quickly defended the physicians' usage of higher codes, stating that the population has grown older and sicker, thereby necessitating the higher codes and ultimately higher reimbursement. However, reports have shown very little shift in cumulative age or infirmity.

Medicare spending is a hot button issue right now as both campaigns are focused on the $500 billion paid out for services in 2011. Upcoding contributes significantly to the costs of Medicare, upwards of $43 per claim, with more than half of the upcoding charges from physician visits and the rest from nursing homes and hospitals.

One explanation for the prevalence of upcoding is the move to electronic medical records and billing systems. The new technology makes it very easy to make the changes and document the justification for the higher codes. In addition, Medicare hasn't kept up with the technology and lacks a uniform standard for coding, leaving it up to the providers to set their own standards, which is a prescription for error.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a partner at Timins & LaMagna, LLP, practicing Health Care Regulatory, Elder /disability/veteran's law, trusts and estates, Social Security and general legal practice in both New York and Connecticut. Michael was just appointed to the ACO Task Force of the American Health Lawyers Association. Email him at Mlamagna@nyandctlaw.com, call him at 914-819-0663 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.