Posts Tagged ‘Medicare’

RRB Q&A: Medicare for Railroad Retirement annuitants

The federal Medicare program provides hospital and medical insurance protection for Railroad Retirement annuitants and their families, just as it does for Social Security beneficiaries. Medicare has the following parts:

  • Medicare Part A (hospital insurance) helps pay for inpatient care in hospitals and skilled nursing facilities (following a hospital stay), some home health care services and hospice care. Part A is financed through payroll taxes paid by employees and employers.
  • Medicare Part B (medical insurance) helps pay for medically-necessary services like doctors’ services and outpatient care. Part B also helps cover some preventive services. Part B is financed by premiums paid by participants and by federal general revenue funds.
  • Medicare Part C (Medicare Advantage Plans) is another way to get Medicare benefits. It combines Part A, Part B, and sometimes, Part D (prescription drug) coverage. Medicare Advantage Plans are managed by private insurance companies approved by Medicare.
  • Medicare Part D (Medicare prescription drug coverage) offers voluntary insurance coverage for prescription drugs through Medicare prescription drug plans and other health plan options.

The following questions and answers provide basic information on Medicare eligibility and coverage, as well as other information on the Medicare program.

1. Who is eligible for Medicare?

All Railroad Retirement beneficiaries age 65 or over and other persons who are directly or potentially eligible for Railroad Retirement benefits are covered by the program. Although the age requirements for some unreduced Railroad Retirement benefits have risen just like the Social Security requirements, beneficiaries are still eligible for Medicare at age 65.

Coverage before age 65 is available for disabled employee annuitants who have been entitled to monthly benefits based on total disability for at least 24 months and have a disability insured status under Social Security law. There is no 24-month waiting period for those who have ALS (Amyotrophic Lateral Sclerosis), also known as Lou Gehrig’s disease.

If entitled to monthly benefits based on an occupational disability, and the individual has been granted a disability freeze, he or she is eligible for Medicare starting with the 30th month after the freeze date or, if later, the 25th month after he or she became entitled to monthly benefits. If receiving benefits due to occupational disability and the person has not been granted a disability freeze, he or she is generally eligible for Medicare at age 65. (The standards for a disability freeze determination follow Social Security law and are comparable to the medical criteria a person must meet to be granted a total disability.)

Under certain conditions, spouses, divorced spouses, surviving divorced spouses, widow(er)s, or a dependent parent may be eligible for Medicare hospital insurance based on an employee’s work record when the spouse, etc., turns 65. Also, disabled widow(er)s under 65, disabled surviving divorced spouses under 65, and disabled children may be eligible for Medicare, usually after a 24-month waiting period.

Medicare coverage at any age on the basis of permanent kidney failure requiring hemodialysis or receipt of a kidney transplant is also available to employee annuitants, employees who have not retired but meet certain minimum service requirements, spouses and dependent children. The Social Security Administration has jurisdiction over Medicare in these cases. Therefore, a Social Security office should be contacted for information on coverage for kidney disease.

2. How do persons enroll in Medicare?

If a retired employee or a family member is receiving a Railroad Retirement annuity, enrollment for both Medicare Part A and Part B is generally automatic and coverage begins when the person reaches age 65. For beneficiaries who are totally disabled, both Medicare Part A and Part B start automatically with the 30th month after the beneficiary became disabled or, if later, the 25th month after the beneficiary became entitled to monthly benefits. Even though enrollment is automatic, an individual may decline Part B; this does not prevent him or her from applying for Part B at a later date. However, premiums may be higher if enrollment is delayed. (See question five for more information on delayed enrollment.)

If an individual is eligible for, but not receiving an annuity, he or she should contact the nearest Railroad Retirement Board (RRB) office before attaining age 65 and apply for both Part A and Part B. (This does not mean that the individual must retire, if working.) The best time to apply is during the three months before the month in which the individual reaches age 65. He or she will then have both Part A and Part B protection beginning with the month age 65 is reached. If the individual does not enroll for Part B in the three months before attaining age 65, he or she can enroll in the month age 65 is reached, or during the three months that follow, but there will be a delay of 1 to 3 months before Part B is effective. Individuals who do not enroll during this “initial enrollment period” may sign up in any “general enrollment period” (January 1 – March 31 each year). Coverage for such individuals begins July 1 of the year of enrollment.

3. Are there costs associated with Medicare Part A (hospital insurance)?

Yes. While individuals don’t have to pay a premium to receive Medicare Part A, recipients of Part A benefits are billed by the hospital for a deductible amount ($1,364 in 2019), as well as any coinsurance amount due and any noncovered services. The remainder of the bill from the hospital, as well as bills for services in skilled nursing facilities or home health visits, is sent to Medicare to pay its share.

4. What are the costs associated with Medicare Part B (medical insurance)?

Anyone eligible for Medicare hospital insurance (Part A) can enroll in Medicare medical insurance (Part B) by paying a monthly premium. The standard premium is $135.50 in 2019. However, some Medicare beneficiaries will not pay this amount because of a provision in the law that states Part B premiums for current enrollees cannot increase by more than the amount of the cost-of-living increase for Social Security (Railroad Retirement Tier I) benefits. Since that adjustment was 2.8 percent for 2019, about 2 million Medicare beneficiaries saw an increase in their Part B premiums, but still pay less than $135.50. The standard premium amount applies to new enrollees in the program, and certain beneficiaries who pay higher premiums based on their modified adjusted gross income.

Monthly premiums for some beneficiaries are greater, depending on a beneficiary’s or married couple’s modified adjusted gross income. The income-related Part B premiums for 2019 are $189.60, $270.90, $352.20, $433.40, or $460.50, depending on how much a beneficiary’s modified adjusted gross income exceeds $85,000 ($170,000 for a married couple), with the highest premium rates only paid by beneficiaries whose modified adjusted gross incomes are over $500,000 ($750,000 for a married couple).

There is also an annual deductible ($185 in 2019) for Part B services.

Palmetto GBA, a subsidiary of Blue Cross and Blue Shield, generally processes claims for Part B benefits filed on behalf of Railroad Retirement beneficiaries in the Original Medicare Plan (the traditional fee-for-service Medicare plan). An individual in the Original Medicare Plan should have his or her hospital, doctor, or other health care provider submit Part B claims directly to:

Palmetto GBA
Railroad Medicare Part B Office
P.O. Box 10066
Augusta, GA 30999-0001
1-800-833-4455
www.palmettogba.com/medicare

Persons with questions about Part B claims under the Original Medicare Plan can contact Palmetto GBA as noted above.

5. Can Medicare Part B premiums increase for delayed enrollment?

Yes. Premiums for Part B are increased 10% for each 12-month period the individual could have been, but was not, enrolled. However, individuals age 65 or older who wait to enroll in Part B because they have group health plan coverage based on their own or their spouse’s current employment may not have to pay higher premiums because they may be eligible for “special enrollment periods.” The same special enrollment period rules apply to disabled individuals, except that the group health insurance may be based on the current employment of the individual, his or her spouse or a family member.

Individuals deciding when to enroll in Medicare Part B must consider how this will affect eligibility for health insurance policies which supplement Medicare coverage. These include “Medigap” insurance and prescription drug coverage and are explained in the answers to questions six through eight.

6. What is Medigap insurance?

Many private insurance companies sell insurance, known as “Medigap,” that helps pay for services not covered by the Original Medicare Plan. Policies may cover deductibles, coinsurance, copayments, health care outside the United States and more. Generally, individuals need Medicare Part A and Part B to enroll, and a monthly premium is charged. When someone first enrolls in Medicare Part B at age 65 or older, he or she has a one-time 6-month “Medigap open enrollment period.” During this period, an insurance company cannot deny coverage, place conditions on a policy, or charge more for a policy because of past or present health problems.

7. Do Medicare beneficiaries have choices available for receiving health care services?

Yes. Under the Original Medicare Plan, the fee-for-service Medicare plan that is available nationwide, a beneficiary can see any doctor or provider who accepts Medicare from qualified Railroad Retirement beneficiaries and is accepting new Medicare patients. Those enrolled in the Original Medicare Plan who want prescription drug coverage must join a Medicare prescription drug plan as described in question eight.

However, a beneficiary may opt to choose a Medicare Advantage Plan (Part C) instead. These plans are managed by Medicare-approved private insurance companies. Medicare Advantage Plans combine Medicare Part A and Part B coverage, and are available in most areas of the country. An individual must have Medicare Part A and Part B to join a Medicare Advantage Plan, and must live in the plan’s service area. Medicare Advantage Plan choices include regional preferred provider organizations (PPOs), health maintenance organizations (HMOs), private fee-for-service plans and others. A PPO is a plan under which a beneficiary uses doctors, hospitals and providers belonging to a network; beneficiaries can use doctors, hospitals and providers outside the network for an additional cost. Under a Medicare Advantage Plan, a beneficiary may pay lower copayments and receive extra benefits. Most plans also include Medicare prescription drug coverage (Part D).

8. How does Medicare Part D (Medicare prescription drug coverage) work?

Medicare contracts with private companies to offer beneficiaries voluntary prescription drug coverage through a variety of options, with different covered prescriptions and different costs. Beneficiaries pay a monthly premium (averaging about $33 in 2019), a yearly deductible (up to $415 in 2019) and part of the cost of prescriptions. Those with limited income and resources may qualify for help in paying some prescription drug costs.

The Affordable Care Act requires some Part D beneficiaries to also pay a monthly adjustment amount, depending on a beneficiary’s or married couple’s modified adjusted gross income. The Part D income-related monthly adjustment amounts in 2019 are $12.40, $31.90, $51.40, $70.90, or $77.40, depending on the extent to which an individual beneficiary’s modified adjusted gross income exceeds $85,000 ($170,000 for a married couple), with the highest amounts only paid by beneficiaries whose incomes are over $500,000 ($750,000 for a married couple).

To enroll, individuals must have Medicare Part A and live in the prescription drug benefit plan’s service area. Beneficiaries can join during the period that starts three months before the month their Medicare coverage starts and ends three months after that month. There may be a higher premium if an individual does not join a Medicare drug plan when first eligible. A beneficiary can generally join or change plans once each year during an enrollment period from October 15 through December 7. Drug coverage would then begin January 1 of the following year. In most cases, there is no automatic enrollment to get a Medicare prescription drug plan. Individuals enrolled in Medicare Advantage Plans will generally get their prescription drug coverage through their plan.

9. Where can I get more information about the Medicare program?

General information on Medicare coverage for Railroad Retirement beneficiaries is available on the RRB’s website, RRB.gov, under the Benefits tab (Medicare) or by contacting an RRB field office toll-free at 1-877-772-5772.

More detailed information on Medicare’s benefits, costs, and health care options are available from the Center for Medicare & Medicaid Services (CMS) publication Medicare & You, which is mailed to Medicare beneficiary households each fall and to new Medicare beneficiaries when they become eligible for coverage. Medicare & You and other publications are also available by visiting Medicare’s website, Medicare.gov, or by calling the Medicare toll-free number, 1-800-MEDICARE (1-800-633-4227).

RRB releases Medicare Part B premiums for 2019

The Centers for Medicare & Medicaid Services has announced that the standard monthly Part B premium will be $135.50 in 2019, a slight increase from $134.00 in 2018. However, some Medicare beneficiaries will pay slightly less than this amount. By law, Part B premiums for current enrollees cannot increase by more than the amount of the cost-of-living adjustment for social security (railroad retirement tier I) benefits.

Since that adjustment is 2.8 percent in 2019, about 2 million Medicare beneficiaries will see an increase in their Part B premiums but still pay less than $135.50. The standard premium amount will also apply to new enrollees in the program, and certain beneficiaries will continue to pay higher premiums based on their modified adjusted gross income.

The monthly premiums that include income-related adjustments for 2019 will range from $189.60 up to $460.50, depending on the extent to which an individual beneficiary’s modified adjusted gross income exceeds $85,000 (or $170,000 for a married couple). The highest rate applies to beneficiaries whose incomes exceed $500,000 (or $750,000 for a married couple). The Centers for Medicare & Medicaid Services estimates that about 5 percent of Medicare beneficiaries pay the larger income-adjusted premiums.

Beneficiaries in Medicare Part D prescription drug coverage plans pay premiums that vary from plan to plan. Part D beneficiaries whose modified adjusted gross income exceeds the same income thresholds that apply to Part B premiums also pay a monthly adjustment amount. In 2019, the adjustment amount ranges from $12.40 to $77.40.

The Railroad Retirement Board withholds Part B premiums from benefit payments it processes. The agency can also withhold Part C and D premiums from benefit payments if an individual submits a request to his or her Part C or D insurance plan.

The following tables show the income-related Part B premium adjustments for 2019. The Social Security Administration (SSA) is responsible for all income-related monthly adjustment amount determinations. To make the determinations, SSA uses the most recent tax return information available from the Internal Revenue Service. For 2019, that will usually be the beneficiary’s 2017 tax return information. If that information is not available, SSA will use information from the 2016 tax return.

Those railroad retirement and social security Medicare beneficiaries affected by the 2019 Part B and D income-related premiums will receive a notice from SSA by the end of the year. The notice will include an explanation of the circumstances where a beneficiary may request a new determination. Persons who have questions or would like to request a new determination should contact SSA after receiving their notice.

Additional information about Medicare coverage, including specific benefits and deductibles, can be found at www.medicare.gov.

2019 PART B PREMIUMS 

Beneficiaries who file an individual tax return with income:

Beneficiaries who file a joint tax return with income:

Income-related monthly adjustment amount

Total monthly Part B premium amount

 

Less than or equal to $85,000 

Less than or equal to $170,000

$0.00

$135.50

Greater than $85,000 and less than or equal to $107,000 

Greater than $170,000 and less than or equal to $214,000

$54.10

$189.60

Greater than $107,000 and less than or equal to $133,500 

Greater than $214,000 and less than or equal to $267,000

$135.40

$270.90

Greater than $133,500 and less than or equal to $160,000

Greater than $267,000 and less than or equal to $320,000

$216.70

$352.20

Greater than $160,000 and less than $500,000

Greater than $320,000 and less than $750,000

$297.90

$433.40

$500,000 and above

$750,000 and above

$325.00

$460.50

 

The monthly premium rates paid by beneficiaries who are married, but file a separate return from their spouses and who lived with their spouses at some time during the taxable year, are different.  Those rates are as follows:

 

Beneficiaries who are married, but file a separate tax return, with income:

Income-related monthly adjustment amount

Total monthly Part B premium amount

Less than or equal to $85,000

$0.00

$135.50

Greater than $85,000 and less than $415,000

$297.90

$433.40

$415,000 and above

$325.00

$460.50

 

Railroad Retirement benefits get COLA increase for 2019

Most railroad retirement annuities, like social security benefits, will increase in January 2019 due to a rise in the Consumer Price Index (CPI) from the third quarter of 2017 to the corresponding period of the current year.

Cost-of-living increases are calculated in both the tier I and tier II benefits included in a railroad retirement annuity. Tier I benefits, like social security benefits, will increase by 2.8 percent, which is the percentage of the CPI rise. Tier II benefits will go up by 0.9 percent, which is 32.5 percent of the CPI increase. Vested dual benefit payments and supplemental annuities also paid by the Railroad Retirement Board (RRB) are not adjusted for the CPI change.

In January 2019, the average regular railroad retirement employee annuity will increase $60 a month to $2,808 and the average of combined benefits for an employee and spouse will increase $86 a month to $4,078. For those aged widow(er)s eligible for an increase, the average annuity will increase $34 a month to $1,398. However, widow(er)s whose annuities are being paid under the Railroad Retirement and Survivors’ Improvement Act of 2001 will not receive annual cost-of-living adjustments until their annuity amount is exceeded by the amount that would have been paid under prior law, counting all interim cost-of-living increases otherwise payable. Some 52 percent of the widow(er)s on the RRB’s rolls are being paid under the 2001 law.

If a railroad retirement or survivor annuitant also receives a social security or other government benefit, such as a public service pension, the increased tier I benefit is reduced by the increased government benefit. Tier II cost-of-living increases are not reduced by increases in other government benefits. If a widow(er) whose annuity is being paid under the 2001 law is also entitled to an increased government benefit, her or his railroad retirement survivor annuity may decrease.

However, the total amount of the combined railroad retirement widow(er)’s annuity and other government benefits will not be less than the total payable before the cost-of-living increase and any increase in Medicare premium deductions.

The cost-of-living increase follows a tier 1 increase of 2.0 percent in January 2018, which had been the largest in 6 years. The Centers for Medicare and Medicaid Services recently announced the Medicare Part B premiums for 2019, and this information is available at www.medicare.gov.

In late December the RRB will mail notices to all annuitants providing a breakdown of the annuity rates payable to them in January 2019.

Social Security benefits to get 2.8 percent COLA increase for 2019

Social Security and Supplemental Security Income (SSI) benefits for more than 67 million Americans will increase 2.8 percent in 2019, announced the Social Security Administration (SSA).

The 2.8 percent cost-of-living adjustment (COLA) will begin with benefits payable to more than 62 million Social Security beneficiaries in January 2019. Increased payments to more than 8 million SSI beneficiaries will begin on December 31, 2018. (Note: some people receive both Social Security and SSI benefits). The Social Security Act ties the annual COLA to the increase in the Consumer Price Index as determined by the Department of Labor’s Bureau of Labor Statistics.

Some other adjustments that take effect in January of each year are based on the increase in average wages. Based on that increase, the maximum amount of earnings subject to the Social Security tax (taxable maximum) will increase to $132,900 from $128,400.

Social Security and SSI beneficiaries are normally notified by mail in early December about their new benefit amount. This year, for the first time, most people who receive Social Security payments will be able to view their COLA notice online through their mySocial Security account. People may create or access their my Social Security account online at www.socialsecurity.gov/myaccount.

Information about Medicare changes for 2019, when announced, will be available at www.medicare.gov. For Social Security beneficiaries receiving Medicare, Social Security will not be able to compute their new benefit amount until after the Medicare premium amounts for 2019 are announced. Final 2019 benefit amounts will be communicated to beneficiaries in December through the mailed COLA notice and my Social SecurityMessage Center.

The Social Security Act provides for how the COLA is calculated. To read more, please visit www.socialsecurity.gov/cola.

Click here for a fact sheet showing the effect of the various automatic adjustments.

How Medicare responds to hurricane-related disasters

When a natural disaster, extreme weather or other emergency occurs that affects providers and the Medicare beneficiaries that they serve, special emergency-related policies and procedures may be implemented.

The process begins when a governor of an affected state requests assistance. This is done if the event is beyond the combined response abilities of the state and local governments. From this request, the President of the United States can declare a Public Health Emergency (PHE), using the Robert T. Stafford Disaster Relief and Emergency Assistance Act.

Under Section 1135 or 1812(f) of the Social Security Act, the Centers for Medicare & Medicaid Services (CMS) can issue ‘blanket waivers’ for providers and suppliers when it comes to services that are provided by skilled nursing facilities, home health agencies and critical access hospitals. Measures are in place to assist with durable medical equipment and supplies, as well as quality reporting, extending the appeals time limit, and getting replacement prescription refills.

As an example in an impacted area, when a waiver is granted for submitting appeal requests (which normally would need to be filed 120 days from the date of the claim denial notification), an appeal may be filed after the 120 days based on CMS guidance.

The following are the most recent hurricane-related PHE’s for which HHS has authorized waivers:

2018 Waivers

  • Hurricane Michael – Florida (at the time of writing this article)
  • Hurricane Florence – North Carolina, South Carolina and Virginia

2017 Waivers

  • Hurricane Maria – Puerto Rico and the U.S. Virgin Islands
  • Hurricane Nate – Louisiana and Mississippi
  • Hurricane Irma – Florida, Georgia and South Carolina
  • Hurricane Harvey – Texas and Louisiana

Medicare has a toll-free helpline you can use if you are in an impacted area. This Disaster Distress Helpline is available 24/7. The toll-free, multilingual and confidential crisis support service can be reached by calling 1-800-985-5990. You can also text TalkWithUs to 66746 (for Spanish, press 2 or text Hablanos to 66746) to connect with a trained crisis counselor.

More information is available to you at the following address: https://www.hhs.gov/about/news/2018/10/09/hhs-secretary-azar-declares-public-health-emergency-florida-due-hurricane-michael.html

Hurricanes don’t discriminate in terms of destruction, and there are times when a person only has the clothes on their back – but no wallet or Medicare card to get assistance. If you lose your Medicare card, you can call our Beneficiary Customer Service Center at 800-833-4455, Monday through Friday, 8:30 a.m. until 7 p.m. ET to order a new one. For the hearing impaired, call TTY/TDD at 877-566-3572. You may also call the Railroad Retirement Board at 877-772-5772.

You are encouraged you to visit Palmetto GBA’s Facebook page at www.Facebook.com/MyRRMedicare, as well as their website at www.PalmettoGBA.com/RR/Me for more information.

“Patients Over Paperwork:” Medicare is reviewing regulations to reduce provider burden

The Centers for Medicare & Medicaid Services (CMS) is reviewing regulations that mandate how doctors and other practitioners document the services they provide. The focus is on the following:

  • Reducing unnecessary burden
  • Increasing process efficiencies
  • Improving the patient’s experience with their provider

CMS is beginning this process with evaluation and management services (office or outpatient visits). The goal is to increase the time providers spend with their patients and decrease the time spent documenting services. At the same time, CMS consistently seeks to reduce provider errors and unnecessary appeals.

CMS Administrator Seema Verma explained: “…we are moving the agency to focus on patients first. To do this, one of our top priorities is to ease the regulatory burden that is destroying the doctor-patient relationship. We want doctors to be able to deliver the best quality care to their patients.”

To see more information about the Patients Over Paperwork initiative, please visit the CMS website at https://www.cms.gov/About-CMS/story-page/patients-over-paperwork.html.

If you have questions about your Railroad Medicare coverage, you may call Palmetto GBA’s Beneficiary Contact Center at 800-833-4455, or for the hearing-impaired, call TTY/TDD at 877-566-3572. Customer service representatives are available Monday through Friday, from 8:30 a.m. until 7 p.m. ET. Visit Palmetto’s Facebook page at https://www.facebook.com/myrrmedicare/.

Visit Palmetto GBA’s free online beneficiary portal at www.PalmettoGBA.com/MyRRMed. This tool offers you the ability to access Railroad Medicare Part B claims data, historical Part B Medicare Summary Notices (MSN), and a listing of individuals you have authorized to have access to your personal health information.

RRB to mail new Medicare cards

The U.S. Railroad Retirement Board (RRB) will send out new Medicare cards that do not feature beneficiaries’ Social Security numbers in the coming weeks.

The Medicare Access and CHIP Reauthorization Act of 2015 required the Centers for Medicare and Medicaid Services (CMS) to develop a new card that does not have an individual’s Social Security number on it to cut down on the likelihood of identity theft.

The new Medicare cards instead have a randomly assigned 11-digit combination of numbers and upper-case letters and will no longer indicate the beneficiary’s gender.

When they receive their new Medicare card, beneficiaries should safely and securely destroy their old Medicare card and keep their new Medicare number confidential, the RRB said.

The new card and number will not affect Medicare benefits, and CMS has been working with medical providers to ensure a smooth transition, the RRB said..

A single exception involves people enrolled in a Medicare Advantage Plan, also known as Medicare Part C. These individuals will continue to use their plan’s identification card for access to Medicare benefits as these cards already have a unique identification number.

The RRB said it will mail the new Medicare cards to about 450,000 beneficiaries in early June. A railroad Medicare beneficiary who has a lost or damaged Medicare card can request a new one by calling the RRB at 877-772-5772 or going to the Benefit Online Services section of the agency’s website at www.rrb.gov.

Beneficiaries also can print out a new card at home by setting up an online account at www.mymedicare.gov. This feature will be available after their new card has been mailed.

For additional information, visit www.cms.gov/newcard.

An example of the new Medicare card can be accessed at this link.

Medicare introduces new claim review process

Medicare is always working to fight fraud and abuse. With that, a new type of claim review has recently begun: a process called Targeted Probe and Educate, or ‘TPE’ for short.

How TPE works:

Palmetto GBA/Railroad Medicare will conduct data analysis and find providers whose billing may be very different from their peers. Palmetto will also look at providers who have been identified as having a high error rate (having filed claims that should not be paid, due to medical necessity issues, billing or coding errors, or ones that do not have sufficient documentation to support the service was rendered as billed).

Once a provider is identified, Palmetto will request records for 20 to 40 services, depending on how much the provider has billed to Railroad Medicare.

After the claims are reviewed, one of Palmetto’s clinical staff members will contact the provider by letter and by phone to go over their results and offer education on how to bill and document their services correctly. If the provider has a high error rate in the review, then Palmetto will ask for records for an additional 20-40 claims submitted for payment and follow the process outlined above. If the provider fails to improve again, then a last round of TPE is conducted. If the provider’s error rate is still unacceptable, they will be referred to Palmetto’s Benefit Integrity Unit for investigation. The same is true for providers who refuse to respond to the records requests.

However, if the provider makes an appropriate improvement, they can be removed from the TPE process for a period of time, and then rechecked later to be sure they are still in compliance.

If your provider has questions:

Your provider may have questions about this review process. If they do, please ask them to call our Provider Contact Center at 888-355-9165 and select Option 5. Customer Service Representatives can assist them in understanding the TPE process. All Medicare contractors are using the TPE process to review claims.

If you have any questions about your Railroad Medicare coverage, please call Palmetto’s Beneficiary Contact Center at 800-833-4455, Monday through Friday, from 8:30 a.m. to 7 p.m. ET. For the hearing impaired, call TTY/TDD at 877-566-3572. This line is for the hearing impaired with the appropriate dial-up service and is available during the same hours customer service representatives are available.

Palmetto also invites you to join their listserv/email updates. Just select the ‘Listservs’ link at the top of their main webpage at www.PalmettoGBA.com/RR/Me.

Retirees: Palmetto GBA introduces beneficiary portal

Palmetto GBA has introduced a new beneficiary portal, MyRRMed, where users will have access to claims data, historical Medicare Summary Notices and data on who they have authorized to have access to their private health information.

Portal Functions:

At this time, you can use the portal to access:

  • Status and details of your last 22 Railroad Medicare claims on file
  • Historical Medicare Summary Notices (MSNs)

You also can view a list of individuals with whom you have authorized Railroad Medicare to grant access to your healthcare information.

Creating an Account:

Accessing MyRRMed information is easy. Just click here to follow the link and enter the following information:

  • Your Medicare number (as printed on your Medicare card)
  • Your last name
  • Your first name
  • Your date of birth
  • The effective date for Part B (as printed on your Medicare card)

Once you have entered this information and it is verified within our files, you will create a user name and password.

Logging Into the Portal:

To enhance the security of Medicare data, the Centers for Medicare & Medicaid services (CMS) requires Palmetto GBA to adhere to several security requirements. Some of these security features require the user to verify their identity using their email address.

This is done through what’s called ‘Multi-Factor Authentication’, or ‘MFA’. MFA has the user log partially in, and then the system sends a ‘passcode’ (a unique and random set of numbers) to either your telephone by text or your email for you to enter on the portal access page. Upon each log in, users are required to enter an MFA code in addition to their password to access MyRRMed. CMS requires that Medicare contractors use MFA as a secondary level of security to protect beneficiary data.

When is the Portal Available?

MyRRMed is generally available 24 hours a day, seven days a week. However, certain functions are only available from 8 a.m. to 7 p.m. Eastern Time (ET). These include accessing claims data and MSNs.

Questions?

If you have questions about using the tool, please call Palmetto’s Beneficiary Contact Center at 800-833-4455, or for the hearing-impaired, call TTY/TDD at 877-566-3572. Customer Service Representatives are available Monday through Friday, from 8:30 a.m. until 7 p.m. EST.

Medicare open enrollment: now thru Dec. 7

Beginning Oct. 15 and running through Dec. 7, 2017, the open enrollment period allows Medicare-eligible patients the option of changing their coverage for 2018. Your 2018 Medicare & You Handbook should have arrived via the postal mail, and it’s important that you read this guide as you are making your decision. Every year, open enrollment is the chance to decide if you want to keep your current plan, or change to a Medicare Advantage Plan, or other health plans. If you were eligible for but not enrolled in Medicare Part B last year, you can sign up for coverage with Original Medicare or a Medicare Advantage Plan. Open enrollment is also the time to sign up for or change your prescription drug coverage, if you need to.

While the Part B premium and deductible have not yet been published, Part B (which includes Railroad Medicare) works as the following:

  • You pay a Part B premium each month (most people will pay a standard amount).
  • You may pay more if your adjusted gross income on your income tax return from two years ago is above a certain level.
  • For most services, you have a 20 percent copay.

If you need help determining the best plan for you, we encourage you to contact your State Health Insurance Program, also called ‘SHIP’. SHIP is available in all 50 states and U.S. territories. It may be called something slightly different in your state (California’s SHIP is called the ‘California Health Insurance Counseling & Advocacy Program’ (HICAP)). However, they function the same way. You can find the contact information for the SHIP in your state by visiting Palmetto GBA’s website at www.PalmettoGBA.com/RR/Me/SHIP.

If you have questions about SHIP, you can call Palmetto’s toll-free Beneficiary Customer Service Line at 800-833-4455, Monday through Friday, from 8:30 a.m. to 7 p.m. EST. For the hearing impaired, call TTY/TDD at 877-566-3572. This line is for the hearing impaired with the appropriate dial-up service and is available during the same hours customer service representatives are available.

Palmetto GBA invites you to join their listserv/email updates. Just select the ‘listservs’ link at the top of their main webpage at www.PalmettoGBA.com/RR/Me.

Medicare to issue new cards in 2018 to protect identities of retirees

Whether a person is receiving Medicare through Social Security or through the Railroad Retirement Board (RRB), the patient may be vulnerable to identity theft due to the SSN/RRB Claim number being present on their Medicare card.

Soon, you won’t need to worry about someone obtaining your personal information from your Medicare card. Starting in April 2018, the Centers for Medicare & Medicaid Services (CMS), in conjunction with the RRB, will begin issuing new cards with a ‘Medicare Beneficiary Identifier’ or MBI. These cards will be sent in phases to existing Medicare beneficiaries, and by April 2019, all Medicare/Railroad Medicare cards will be free of personally identifiable information. This includes the removal of the gender and signature line.

Here is what an MBI will look like:

  • It will have 11 characters
  • The numbers will be generated randomly. Medicare considers them ‘non-intelligent’ numbers that don’t have any hidden or special meaning
  • It will be unique to each patient
  • It will contain capital letters (all letters with the exception of S, L, O, I, B and Z) and numbers (0-9)
  • The 2nd, 5th, 8th, and 9th characters will always be a letter, while
  • Characters 1, 4, 7, 10, and 11 will always be a number, and
  • The 3rd and 6th characters will be a letter or a number
  • There will be no dashes in the numbers on the card

To learn more about the layout of an MBI, please visit this CMS webpage: https://www.cms.gov/Medicare/New-Medicare-Card/Understanding-the-MBI-with-Format.pdf.

As you may have experienced, providers can’t always tell the difference between an SSN patient and a RRB patient. They may submit your claims to regular Medicare, instead of Railroad Medicare. To help providers know what patient they have, the new cards will have the RRB logo on them when applicable, so your doctor’s office will know where to submit claims.

This October, you will receive your 2018 Medicare & You handbook, which will contain additional information about the MBI change.

If you have a question about a claim, you may call Palmetto GBA’s Beneficiary Contact Center at 800-833-4455, or for the hearing-impaired, call TTY/TDD at 877-566-3572. Customer Service Representatives are available Monday through Friday, from 8:30 a.m. until 7 p.m. ET. You’re also encouraged to visit Palmetto’s website at www.PalmettoGBA.com/RR/Me.

Attention retirees: significant delays in Medicare appeals

Palmetto_rgb_webIt’s been on the news, and you may have heard about it: the Medicare appeals process is taking longer, specifically, at the Administrative Law Judge (ALJ) level. This article explains the five levels of appeals and provides information about the wait times for an ALJ hearing.

 

To begin, let’s look at the Medicare appeals process. The five levels are:

  1. Redetermination (first-level, performed at Railroad Medicare or your local Medicare Administrative Contractor for part A or durable medical products claims)
  2. Reconsideration (second-level, performed by a Qualified Independent Contractor/QIC)
  3. Hearing before an Administrative Law Judge or ALJ (which are independent from Medicare and are governed by the US Department of Health & Human Services (HHS))
  4. Review by the Medicare Appeals Council
  5. Judicial review in the U.S. District Court

Each level of appeal has certain timeliness standards. For a redetermination and reconsideration, contractors have 60 days to process an appeal request. For a third-level appeal, the guideline is the ALJ will generally conduct a hearing and render a decision within 90 days of the receipt of the hearing request. However, backlogs at the ALJ level are causing appeals to be processed, on average, in 819.4 days for Fiscal Year 2016 (from October 2015 to the present).

This problem with the untimely processing of appeals at the ALJ level is not new; however, the growing wait time has risen greatly since Fiscal Year (FY) 2012. The following trends show the average wait times by day at the ALJ level:

  • FY 2019 = 94.9 days
  • FY 2010 = 109.6 days
  • FY 2011 = 121.3 days
  • FY 2102 = 134.5 days
  • FY 2013 = 220.7 days
  • FY 2014 = 414.8 days
  • FY 2015 = 661.1 days
  • FY 2016 Average = 819.4 days

While the wait times average more than two years, HHS has been making beneficiary-submitted appeals a priority, “given that they often present emergent circumstances that must be promptly addressed,” as written on the Office of Medicare Hearings and Appeals (OMHA) Adjudication Timeframes webpage at http://www.hhs.gov/omha/important_notice_regarding_adjudication_timeframes.html.

It’s important to note that Medicare contractors, such as Palmetto GBA Railroad Medicare, do not have any connection to the ALJs and cannot assist in fast-tracking any appeals at the ALJ level.

For more information on this issue, you can visit the OMHA website at http://www.hhs.gov/omha.

If you have questions about your Medicare coverage, you may call Palmetto’s toll-free Beneficiary Customer Service Center at 800-833-4455, Monday through Friday, from 8:30 a.m. until 7 p.m. ET. For the hearing impaired, call TTY/TDD at 877-566-3572. You are also encouraged to visit the Palmetto GBA Railroad Medicare website at www.PalmettoGBA.com/RR/ME and their beneficiary Facebook page at www.Facebook.com/MyRRMedicare.