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October marks the beginning of Medicare’s open enrollment period for the 2022 coverage year. If you already have Railroad Medicare and want to make a change to your Part D coverage or plan, you can do so between October 15 and December 7, 2021. Any changes you make during open enrollment will take effect January 1, 2022.
This period is the time to reflect on any changes that may have occurred this year, as well as the time to do a little research. You can do this on your own online, but also with a friend you didn’t know you had.
The most common change people face each year is a change to their prescription medicines, either the medicines themselves or the dosages. Be sure to check your plan’s drug formulary, which you should receive in the mail prior to October 15. You can compare available Part D drug plans using the “Find a Medicare plan” online tool at https://www.medicare.gov/plan-compare.
Other changes can be in the types of services that you need. Some may not be covered or covered by Medicare at the same rate as in 2021. You can research this when you receive your Medicare & You Handbook (by mail for some, online for those who have chosen to go paperless). Read the handbook carefully. There is a section called “What’s new & important” that will tell you the most critical things you need to know. The book also explains the different parts of Medicare, including what each part covers. Railroad Medicare is Part B (Medical Insurance) for persons covered under the railroad retirement system.
If you would like to see the Medicare & You Handbook now, you can do so by following this web address: https://www.medicare.gov/Pubs/pdf/10050-Medicare-and-You.pdf.
As for the “friend you didn’t know you had” … sometimes it’s hard to know what type of coverage you need or where to go to look and see what options you have. If this is you, then look no further than your state’s health insurance program. Every state has one, and they are manned by volunteers who have no affiliation with any health insurance programs (including Medicare). Visit the State Health Insurance Assistance Program website at https://www.shiphelp.org/ to find the phone number and website for your local SHIP.
As for the 2022 Medicare annual deductible and premium information, it is not available at the time of this publication.
In closing, if you have questions about SHIP or your Part B Railroad Medicare coverage, you can call Palmetto GBA’s toll-free Beneficiary Customer Service Line 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.
We encourage you to visit Palmetto’s Facebook page at https://www.facebook.com/myrrmedicare. Palmetto GBA also invites you to join their email updates list. Just select the ‘Email Update’ link at the top of their main webpage at www.PalmettoGBA.com/RR/Me.

Palmetto GBA is the Railroad Specialty Medicare Administrative Contractor (RRB SMAC) and processes Part B claims for Railroad Retirement beneficiaries nationwide. Palmetto GBA is contracted by the independent federal agency Railroad Retirement Board (RRB), which administers comprehensive retirement-survivor and unemployment-sickness benefit programs for railroad workers and their families under the Railroad Retirement and Railroad Unemployment Insurance Acts.

Do you or a loved one have any of the following symptoms?
It’s easy to forget where you put your car keys once in a while. But if you or a loved one have any of the following problems, please read further:

  • Trouble remembering
  • Difficulty learning new things
  • Feeling overwhelmed making decisions
  • Getting confused easily or frequently
  • Becoming very impulsive or showing poor judgment

You might think your memory has “slipped,” but it might be more than that. Medicare offers a service to test your cognitive functioning. It’s called a cognitive assessment, and it can be performed when you see your provider for a visit. Many times, it is performed when you do your yearly wellness visit, but it can be performed at any time you have a concern.
It’s really helpful if you bring someone with you to that visit, such as a friend, spouse or caregiver, so that they can provide answers to questions you might not know the answers to. During the visit, your doctor will do the following:

  1. Perform a cognitive exam.
  2. Review your medical history and your medication. Sometimes medications can have side effects that may make you appear to have a cognitive impairment.
  3. Develop a plan of care, if one is needed.
  4. Make a referral to a specialist, if one is needed.
  5. Talk to you about community resources (these can include adult daycare, rehabilitation services, and more).

When this service is performed, the Part B deductible and coinsurance apply.
Cognitive impairment doesn’t always present in the ways noted above. It can also show up as depression, anxiety, apathy or irritation/aggression. If you see these in yourself or others, please make an appointment with your doctor. Having mild cognitive impairment can increase your risk of developing dementia caused by Alzheimer’s. Per the Mayo Clinic, “some people with mild cognitive impairment never get worse, and a few eventually get better.” Be the one who gets better. Call your doctor today.
If you need help locating a doctor, you can call our Palmetto GBA’s Beneficiary Contact Center at 800-833-4455, Monday through Friday, from 8:30 a.m. to 7 p.m. ET. You are invited to use Palmetto’s free internet portal, MyRRMed, to access claim status, historical Medicare Summary Notices, and review any individuals you have authorized to have access to your private medical information. You can visit MyRRMed at www.PalmettoGBA.com/MyRRMed.
We also encourage you to visit the Mayo Clinic website, which discusses mild cognitive impairment (MCI) here: https://www.mayoclinic.org/diseases-conditions/mild-cognitive-impairment/symptoms-causes/syc-20354578.
You can also access the Alzheimer’s Association website, which discusses cognitive assessment services, by visiting here: https://www.alz.org/professionals/health-systems-clinicians/cognitive-assessment.

Palmetto GBA is the Railroad Specialty Medicare Administrative Contractor (RRB SMAC) and processes Part B claims for Railroad Retirement beneficiaries nationwide. Palmetto GBA is contracted by the independent federal agency Railroad Retirement Board (RRB), which administers comprehensive retirement-survivor and unemployment-sickness benefit programs for railroad workers and their families under the Railroad Retirement and Railroad Unemployment Insurance Acts.

While we are coming up to the one-year anniversary of the coronavirus being present in the United States, we are happy to report that Medicare is taking action with the administration of the coronavirus vaccine across the country.
As the vaccinations roll out, we are receiving questions about the process, and we would like to share them and the answers with you. They are:
What does the vaccine cost?
The vaccine is free. Medicare will pay your provider for administering the vaccine, and you will not be charged in any way. If a provider tries to collect co-pays or any other types of funds specific to the coronavirus vaccine (such as coinsurances or deductibles), please call our office and let us know.
How is the vaccine being distributed?
Every state has its own vaccine distribution plan, and you can access that information from each state’s health department. To find a listing of states and their health departments, their websites and phone numbers, please see the article “What You Don’t Know May Make A Difference” on the Palmetto GBA website at www.PalmettoGBA.com/RR/Me. You can also find a listing on the Centers for Disease Control and Prevention (CDC) website at www.CDC.gov.
Where can I find out more about the individual vaccines?
There are two vaccines being used. They are Pfizer-BioNTech COVID-19 vaccine and Moderna’s COVID-19 vaccine​​. Additionally, per the CDC, there are three large-scale (Phase 3) clinical trials in progress or being planned for three COVID-19 vaccines:

AstraZeneca’s COVID-19 vaccine

Janssen’s COVID-19 vaccine

Novavax’s COVID-19 vaccine​

As each vaccine is approved and authorized, the CDC publishes information on who should or should not receive that particular vaccine based on health profiles. Additionally, the CDC will publish information to include the vaccine’s ingredients, its safety and its effectiveness. This information is located on the CDC website at www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines.html.
Can I get my shot sooner if I pay for that?
The vaccine is available based on each state’s distribution program. If someone contacts you and tells you that you can pay to either have your name put on a list to receive the vaccine (when you were not on the list yet to receive the shot) or tells you that you can pay to receive the vaccine sooner than you are scheduled for, do not believe them. These “opportunities” do not exist. And as always, do not share your personal and financial information with people who call, text or email you with any offer like this. Keep your private information private. The government will never call you and ask you for money.
If you have a question about Medicare’s coverage of the coronavirus vaccine, please 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 are encouraged to visit the Palmetto GBA website at www.PalmettoGBA.com/RR/Me, as well as enrolling to use their free self-service internet portal, MyRRMed. MyRRMed offers you access to your healthcare data. At this time, you can use the portal to access:

  • Status and details of your Railroad Medicare Part B claims
  • Historical Medicare Summary Notices (MSNs) for your Railroad Medicare Part B claims
  • A listing of individuals you have authorized to have access to your private health information.
  • You can also submit a request to add an authorized representative or to edit or remove an existing authorized representative.

To sign up for MyRRMed, please visit the site at www.PalmettoGBA.com/MyRRMed.

Palmetto GBA is the Railroad Specialty Medicare Administrative Contractor (RRB SMAC) and processes Part B claims for Railroad Retirement beneficiaries nationwide. Palmetto GBA is contracted by the independent federal agency Railroad Retirement Board (RRB), which administers comprehensive retirement-survivor and unemployment-sickness benefit programs for railroad workers and their families under the Railroad Retirement and Railroad Unemployment Insurance Acts.

When a severe weather event happens (such as a hurricane, typhoon, earthquake or wildfire), the last thing you or your healthcare provider are thinking about is Medicare. Concerns are about staying alive and what kind of home and property damage you will have. Your situation may be the most-stressful event in your life. When a disaster like the California wildfires or Hurricane Dorian hits, your survival is most important.
Medicare understands this.
For some disasters, like a hurricane or wildfires, the Secretary of Health and Human Services may declare a Public Health Emergency (PHE), which provides waivers for 90 days. In Hurricane Dorian, Medicare made accommodations in the states of Florida, Georgia, North Carolina, South Carolina, and the Commonwealth of Puerto Rico. In those states, providers have an extension on the time allowed to enroll providers or request appeals.
As a patient, you may wonder if Medicare will pay if you see another doctor outside of the disaster area or another sate to receive the care you need. Medicare/Railroad Medicare beneficiaries can receive services anywhere in the United States. The services must be medically necessary and a covered Medicare benefit.
Another concern when a disaster hits is what happens if you lose your Medicare card. If you’ve lost your card (and can’t remember the number) but need to see a doctor or other healthcare provider in an affected area before you receive a replacement card, Medicare advises providers to hold their claims until you receive your new card. It is your responsibility to inform the provider of your new Medicare number. If you need emergency care and do not have your Medicare card or know the number, providers should try to obtain your Medicare number from you or your family. If that fails to be successful, your provider can call Railroad Medicare to request the Medicare number. This should be a rare incidence.
If you have questions or need to obtain a replacement 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.
We encourage you to visit our website at www.PalmettoGBA.com/RR/Me and visit our Facebook page at www.Facebook.com/MyRRMedicare.

Last July, the Railroad Retirement Board (RRB) mailed approximately 450,000 new Railroad Medicare cards with new Medicare Numbers. The new Medicare Numbers, which are unique to each person with Railroad Medicare and do not contain Social Security Number (SSNs), replace the former Health Insurance Claim Numbers (HICNs). Providers can bill claims to Medicare with either a HICN or a new Medicare Number through December 31, 2019.
At this time, approximately 70% of the Railroad Medicare claims received are submitted with Medicare Numbers. Beginning January 1, 2020, all providers will be required to file claims with Medicare Numbers only.
When it’s time for a doctor’s appointment or other Medicare service, be sure to take your new card with you. Your provider’s office knows everyone should have a new Medicare Number, and they will need to keep a record of your Medicare Number so they can bill Railroad Medicare correctly.
If your provider does not have a copy of your card, they may be able to look up your information with their local Medicare Administrative Contractor (MAC) or with Palmetto GBA Railroad Medicare through our online provider portals. These portals give authorized providers access to claims history, eligibility and more. The portals also contain a tool that allows providers to look up a Medicare Number with the following patient information:

  • Last Name
  • First Name
  • Date of Birth
  • Social Security Number

Please note that in order to use the tool to look up your Medicare Number, a provider must have your Social Security Number. If you do not want to give a provider your SSN, allow them to have a copy of your card or verbally give them your Medicare Number. If you have not used your card yet, you are making it much more difficult for your providers to file claims timely. One of the reasons for having the new cards was to give protection from identity theft. One way to do that is to be very selective when giving your personal information to a trusted entity (your doctor, insurers, etc.).
When verbally giving your Medicare Number to a provider, or to a Customer Service Advocate when you call Railroad Medicare, make sure to read it correctly. Medicare Numbers have 11 characters and contain numbers and uppercase letters only. They do not contain the letters S, L, O, I, B or Z. Characters one, four, seven, 10 and 11 will always be a number. The second, fifth, eighth and ninth characters will always be a letter. The third and sixth characters will be a letter or a number.
Sample RRB Medicare Card:

If you are enrolled in a Medicare Advantage Plan, your new Medicare card does not replace your plan’s identification card. You will continue to use your plan’s ID card to receive your Medicare benefits.
If you did not receive your new Medicare Card with your new Medicare Number, you can call Palmetto’s Beneficiary Contact Center at 800-833-4455 or the Railroad Retirement Board at 877-772-5772.
Have questions?
If you have questions about new Medicare cards or Medicare Numbers, please call Palmetto GBA’s Beneficiary Contact Center at 800-833-4455, Monday through Friday, from 8:30 a.m. to 7 p.m. ET. You are encouraged to sign up for email updates. To do so, click ‘Listservs’ on the top banner on the Palmetto website at www.PalmettoGBA.com/RR/Me. You are also encouraged to use the beneficiary portal, MyRRMed, which is located at www.PalmettoGBA.com/MyRRMed.

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.

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.

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.

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.

Palmetto_rgb_webFor many years, the Centers for Medicare & Medicaid (CMS) has funded programs to reduce claims payment errors (either paying too much, paying too little or payments being made when none should be).  Some of these programs are handled through systematic checks that look for anomalies and mismatched services, and some are handled through clinical reviews of specific claims. 

The program integrity initiatives pertaining to Railroad Medicare include:

Medically Unlikely Edits (MUEs) – These are systematic checks that look for claims that exceed the maximum number of services expected to be reported, in most cases, for a single patient by the same provider on a single day.

National Correct Coding Initiative (NCCI) Edits – These are also systematic checks, and they look for combinations of codes that should not be reported together in all or most situations.  Either we would not expect both services to occur in one treatment, or Medicare does not reimburse both services when performed together.  This could be two codes that represent different methods of performing the same service, such as a laparoscopic gallbladder removal and an open incision gallbladder removal.  It could also be two codes that are components of each other, such as a rhythm electrocardiograph (ECG) and a cardiovascular stress test, which by definition includes an ECG.

Medical Review Program – This initiative involves complex reviews by Medicare (including Railroad Medicare) in which documentation is requested, and then the reviews determine if the claim was correctly billed and properly documented, and that the services meet Medicare coverage criteria. 

Comprehensive Error Rate Testing (CERT) Program – This initiative involves complex reviews in the same manner as the Medical Review program.  External entities include the CERT Review Contractor, the CERT Documentation Contractor, and the CERT Statistical Contractor, and they work together to review a random sample of claims and determine an error rate for local Medicare, as well as Railroad Medicare.  They do this by:

  • Requesting medical records from providers who submitted claims
  • Reviewing claims and medical records for compliance with Medicare coverage, coding and billing rules

The CERT program calculates an improper payment rate, and it also develops an improper payment rate by claim type, to measure Medicare (and Railroad Medicare’s) performance processing claims correctly. 

Working together, these initiatives reduce the number of claims that are underpaid, overpaid or should never have been paid. 

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. Members can sign up for email updates. To do so, visit Palmetto’s website at www.PalmettoGBA.com/RR/Me and click ‘Email Updates’ on the top of the webpage to start the process. 

Visit Palmetto’s Facebook page at www.Facebook.com/MyRRMedicare.