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Medicare Billing Issues- Be Informed

Medicare Billing Issues

 In the August/September issue of Renaissance magazine (http://www.njfoundationforaging.org/Ren_AugSep_WEBa.pdf), NJFA featured an article on observation status at the hospital versus being admitted. The article talked about how this can not only mean that seniors would see a bill for the time spent at the hospital, but that it also affected Medicare’s coverage of post hospital treatment at a rehab facility.

Medicare Part A is your hospital insurance and covers inpatient admissions to the hospital. There have been a few articles and news stories about these instances where a hospital changes a patient to observation status and therefore Medicare A does not cover the stay consequently, the patient is left with a bill. Furthermore, if that patient might benefit from a stay in a Skilled Nursing Facility for rehabilitation, then Medicare will not cover that either as a 3 day inpatient hospital admission is required in order for Medicare to cover an inpatient rehab stay.

Another issue recently cited in a New York Times article is that the Federal Government is concerned with inaccurate billing and coding by hospitals due to the new electronic record system. They feel there may be “upcoding”- increasing the severity of a patient’s condition or treatment as a means of profit. The Federal Government is also concerned about “cloning”- where information about one patient is repeated in other records.

Certainly there are many advantages to electronic medical records, both in cost and efficiency. However there needs to be tight guidelines and monitoring of these practices to make sure that fraud or abuse are not taking place in the system. The Federal Government issued a letter to several National hospital associations indicating that they are concerned about accurate billing in use of the electronic medical records system.

What does this mean for Medicare recipients? Make sure you talk to your doctor and anyone treating you in the hospital. Being an educated patient is your best defense; asking the hospital staff what you are being tested for; having open communication about your status and asking if they’ve communicated with your primary physician. It is also important to review your Medicare statements when they come and if you see anything that you feel  is incorrect to report it.

Know your resources. You can contact the following organizations with assistance understanding or navigating your Medicare coverage, as well as report possible fraud or abuse or other concerns, such as appeals.

Medicare- http://www.medicare.gov or 1-800-MEDICARE

Medicare Rights Center- http://www.medicarerights.org/ or 1-800-333-4114

SHIP (Statewide Health Insurance Assistance Program) 1-800-792-8820

Senior Medicare Patrol- 887-SMP-4359

County Office on Aging- 1-800-222-3737

Reading!

In the Feb/March issue of Renaissance we reviewed the Book Still Alice.  This lead to a discussion with the NJ State Library about other relevant titles to suggest to you, your friends and family. They were very helpful in developing a list that also includes books for young readers. 

We thought we’d suggest a community-wide read focusing on these titles and so we have alerted the County Library Systems and the County Offices on Aging and shared these titles with them.

Let’s read, let’s laugh, let’s talk amongst ourselves. These books will inspire! Enjoy.

I Remember Nothing and Other Reflections by Norah Ephron. Reading these succinct, razor-sharp essays by veteran humorist (I Feel Bad About My Neck), novelist, and screenwriter-director Ephron is to be reminded that she cut her teeth as a New York Post writer in the 1960s, as she recounts in the most substantial selection here, “Journalism: A Love Story.” Forthright, frequently wickedly backhanded, these essays cover the gamut of later-life observations (she is 69), from the dourly hilarious title essay about losing her memory, which asserts that her ubiquitous senior moment has now become the requisite Google moment, to several flimsy lists, such as “Twenty-five Things People Have a Shocking Capacity to Be Surprised by Over and Over Again,” e.g., “Movies have no political effect whatsoever.” Shorts such as the several “I Just Want to Say” pieces feature Ephron’s trademark prickly contrariness and are stylistically digestible for the tabloids. Other essays delve into memories of fascinating people she knew, such as the Lillian Hellman of Pentimento, whom she adored until the older woman’s egomania rubbed her the wrong way. Most winning, however, are her priceless reflections on her early life, such as growing up in Beverly Hills with her movie-people parents, and how being divorced shaped the bulk of her life, in “The D Word.” There’s an elegiac quality to many of these pieces, handled with wit and tenderness. (Nov.) (Publishers Weekly)

Never Say Die: The Myth and Marketing of the New Old Age by Susan Jacoby (February 2011) As the older members of the baby boom generation approach 65, marketers are at the ready with an abundance of ‚Äúage defying‚Äù products and services. But is aging as trouble free as marketers tout and aging consumers would like to believe? For her part, journalist Jacoby, herself in her 60s, admits to rage at the efforts to redefine old age without facing up to the unavoidable realities. For example, after age 65, the prevalence of Alzheimer‚Äôs doubles every five years. She focuses on distinctions between the young old (60s and 70s) and the old old (80s, 90s, and the few 100s) as well as the very different prospects for the elderly who are poor or minorities. Jacoby explores social, cultural, economic, and political changes in the concept of old age, from passage of the Social Security Act to extended life expectancy and retirement, from the activism of the Gray Panthers to the ravages of Alzheimer‚Äôs. Drawing on research, personal experience, and anecdotes, she offers an important reality check for Americans enamored of the images of healthy, active seniors featured in advertisements. –Vanessa Bush (Booklist)

I’m Too Young to Be Seventy and Other Delusions by Judith Viorst. The beloved bestselling author of Forever Fifty and Suddenly Sixty now tackles the ins and outs of becoming a septuagenarian with her usual wry good humor.

Fans of Judith Viorst’s funny, touching, and wise poems about turning thirty, forty, fifty, and sixty will love this new volume for the woman who deeply believes she is too young to be seventy, “too young in my heart and my soul, if not in my thighs.” Viorst explores, among the many other issues of this stage of life, the state of our sex lives and teeth, how we can stay married though thermostatically incompatible, and the joys of grandparenthood and shopping. Readers will nod with rueful recognition when she asks, “Am I required to think of myself as a basically shallow woman because I feel better when my hair looks good?,” when she presses a few helpful suggestions on her kids because “they may be middle aged, but they’re still my children,” and when she graciously — but not too graciously — selects her husband’s next mate in a poem deliciously subtitled “If I Should Die Before I Wake, Here’s the Wife You Next Should Take.” Though Viorst acknowledges she is definitely not a good sport about the fact that she is mortal, her poems are full of the pleasures of life right now, helping us come to terms with the passage of time, encouraging us to keep trying to fix the world, and inviting us to consider “drinking wine, making love, laughing hard, caring hard, and learning a new trick or two as part of our job description at seventy.” (Amazon.com)

Rules of the Road – Joan Bauer. (Teen Fiction) Jenna Boller, 16, has had a lot of practice at being responsible. Her mother is a nurse who works the night shift, and her younger sister yearns for attention. Jenna’s long-divorced, alcoholic father embarrassingly shows up whenever he gets an occasional urge to “make it up” to her. In addition, her wise and beloved grandmother is grappling with Alzheimer’s disease. So the teen’s mother reluctantly agrees to let her accept a summer job driving the elderly Madeline Gladstone, the crusty and demanding president of the shoe chain for which Jenna works, from Chicago to Texas. Jenna is surprised to learn that Mrs. Gladstone has problems, too: an aching hip as well as an aching heart. Her conniving son is maneuvering to take over the company and sell out for a huge short-term gain. Jenna comes to admire and love her boss and eagerly enters into an alliance of loyal employees to save the company. In making this valiant attempt, she finds herself truly transformed.

¬†Granny Torrelli Makes Soup by Sharon Creech, grades 4 to 7¬†¬† “Bailey, who is usually so nice, Bailey, my neighbor, my friend, my buddy, my pal for my whole life, knowing me better than anybody, that Bailey, that Bailey I am so mad at right now, that Bailey, I hate him today. Twelve-year-old Rosie and her best friend, Bailey, don’t always get along, that’s true. But Granny Torrelli seems to know just how to make things right again with her interesting stories and family recipes. It’s easier to remember what’s important about love, life, and friendship while Granny Torrelli makes soup. ”

Now, head to your local library, it is a great place to keep cool on hot, humid summer days!

How Are You Being Creative

How are you being creative?

In the recent issue of Renaissance Magazine (May/June 2011) we featured an article by Mercer County Office on Aging Director, Eileen Doremus. In the article Ms. Doremus talks about creative ways to engage older adults living in residential care settings (assisted livings, nursing facilities, etc). The article also featured some information on how some NJ Activity/Recreation professionals are being creative, as well as, what their challenges are for remaining creative in those settings.

Creativity often grows when you share ideas with others, given that, Ms. Doremus was interested upon completing her article with what others might have to add. So, NJFA gladly welcomes you to share here on our blog and comments, challenges, ideas or feedback on creativity in residential settings for older adults. This has the potential to be a great discussion, so get to it! Creativity is all about sharing!

To see the article please visit: www.njfoundationforaging.org/ren.html