Middle Class on Medicaid?

There has been no shortage of controversy surrounding the Obama Administration’s Affordable Care Act. Recent debates have brought up the 10 million additional children and 20 million additional adults Medicaid will be picking up. We’ve also seen dialogue on the 138% poverty level, and access gained by childless adults. Now, a new unforeseen problem in the legislation’s wording will allow early retirees to jump on the Medicaid bandwagon.

Two years from now, many people will begin early retirement, leaving the workforce at 62. During the three years between their retirement and joining Medicare at 65, social security payments will not count toward their annual income mix. This will allow up to 3 million early retirees to gain access to Medicaid in 2014.

Many of the legislators on Capitol Hill are concerned that overloaded state Medicaid programs will further crumble under this flaw. Presently, the administration has addressed the problem, and is seeking a solution, but until something is presented, this is simply another hiccup adding fuel to the anti-ACA flames.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

HIPAA & EHR Security -- Can the Answer Be Found in the Cloud?

On a public website, the Department of Health and Human Services maintains an infamous list known as the “wall of shame.” The site publishes the names of facilities responsible for HIPAA violations affecting 500 or more people. But do we truly understand how the violations occur?  With so many recent news stories about online security and super-hacker group LulzSec, it is easy to blame digital recording. However, after a closer review of the HHS website information, that simply is not the case.

Most often, violations occur due to physical theft and loss. The statistics provided in a recent Software Advice article state that only 6% of the violations are attributed to hacker activities. Of the remaining incidents, 61% are linked to physical theft and loss. Why is there such a difference between public view and reality? Part of it is the media; a story about criminal elements breaking in to secure servers is more interesting than one in which an otherwise skilled employee misplaces a disc. Another part of it is fear. When the public hears about hackers gathering millions of credit card numbers overnight, they assume that all online data is up for grabs.

Whatever the reason, the facts are clear. The vast majority of HIPAA violations and data loss are due to the mishandling of physical files or equipment. With that in mind, EHR security must continue to evolve and work closely in conjunction with newer technologies that show signs of stronger security for our most sensitive personal information.

Cloud technology could allow these medical records to exist in a purely electronic form. Online banking has been commonplace for years, with hardly a second thought and as Michael Koplov, author of this Software Advice article, succinctly points out, “Just a hunch, but I bet more hackers want my credit card information than my HDL/LDL ratio.” In a comment to Merrill Corp, he goes on to say, “I analyzed this data and found that the HHS has no record of cloud-based EHRs being implicated in these large-scale security breaches.”

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Microscopic Science, Big Results

Scientists in the health field have been putting a lot of effort and time into researching the genetics of common health problems, and that energy is starting to pay off. Today, some of the most debilitating common conditions are being explained at a microscopic level. These finds may seem inconsequential now, but within a few short years, the fringes of modern medicine may use this research for cures.

Migraines -- severe headaches that come bundled with hazy vision, nausea, and hyper-sensitivity -- have been traced down to three individual genes. Of those three, one occurs exclusively in women, explaining why women have always been more prone to the debilitating headaches. If scientists can target these genes and shut them off, severe headaches may be a thing of the past.

http://1.usa.gov/k7tPxr

A more universal issue is being solved thanks to breakthroughs made in chromosome research. DNA strands called telomeres cap the ends of chromosomes in living cells. When these caps wear away, due often to physical or mental stress, the cell dies. Faster cell death essentially means faster aging. Though typically linked to those that suffered childhood abuse, any extreme stress can shorten telomeres. Experts recommend the usual dose of increased activity and exercise, as even the most abused individuals were able to divert stress and increase telomere length through activity and exercise.

As science delves deeper and deeper into genetic research, we may see the genetic switches responsible for many causes of human suffering. The things we are accomplishing today were considered fringe medicine a decade ago, and the things we cannot dream of doing today may be commonplace in the near future.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

One-Fifth of Economy to Rely on Health Industry by 2019

Consulting firm PricewaterhouseCoopers has released a somewhat vague statistic stating that by 2019, 20% of the U.S. economy will be occupied by healthcare spending. ComputerWorld’s article breaks down this statistic further, revealing that the number includes money spent on health technologies like mobile apps and even health-related video games. However PWC determined these numbers, the article makes it clear what we all know: That healthcare is a massive part of our country’s spending.

Part of this growth lies in the fact that the health industry has become a major creator of jobs in recent years. ComputerWorld’s article states that “nearly one in three American adults have worked, now work or would like to work in healthcare.” This is a staggering number, considering that the same statistic was 65% lower one decade ago.

The increase in the health industry workforce leads to an increase in the purchase of health technologies, which only makes sense. As sensitive, compliance-controlled data needs to be shared with more and more people, the technology ensuring the security of that data needs to improve. Before long, the market becomes self-sustaining. An increase in health companies leads to an increase in health workers, which in turn leads to an increase in compliance technology, which needs more health workers, and so on.

It is easy to see how these numbers grow, and PWC’s results seem logical, if perhaps somewhat sensational. The healthcare industry is currently running at approximately 17% of the U.S. Gross Domestic Product and grows faster than other sectors of the economy, such as education, transportation, and agriculture. By 2017, CMS, the Centers for Medicare and Medicaid Services, projects healthcare spending will be one fifth of GDP at 19.5%, and as we review new and upcoming regulation, it makes healthcare an attractive marketplace not only for information technology, manufacturing, but all downstream entities tied to healthcare.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

CMS Issues Contract Year 2012 Medicare Model Marketing Materials

CMS has issued the 2012 Medicare Model Marketing Materials. Most materials have seen very few revisions since last year, but the following documents have all been released:

• ANOC EOC
• Provider Directory
• Outbound Education Verification Script
• Outbound Education Verification Letter
• Scope of Appointment Form
• Part D Abridged Formulary
• Comprehensive Formulary
• Excluded Provider Letter
• Pharmacy Directory
• Prescription Transfer Letter
• Transition Letter
• LIS Website Premium Summary Table
• LIS Rider

CMS will release the model Explanation of Benefits (EOB) document separately. The largest changes worth noting are in the ANOC/EOC templates.

All templates, models and applicable instructions are available on the CMS Part C Marketing web page, and the Part D models and summary of changes made to these models are located on the Part D Marketing Models web page.

Merrill Corp will continue to monitor these changes, and will keep you up to date with all of the compliance and marketing issues the industry presents. 

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.