Thursday, May 22, 2014

Medicare to save $100 to $740 million over the next ten years

The following is from a CMS bulletin received May 22, 2014---
The Centers for Medicare & Medicaid Services today announced plans to expand a successful demonstration for prior authorization for power mobility devices, test prior authorization in additional services in two new demonstration programs, and propose regulation for prior authorization for certain durable medical equipment, prosthetics, orthotics, and supplies. Prior authorization supports the administration’s ongoing efforts to safeguard beneficiaries’ access to medically necessary items and services, while reducing improper Medicare billing and payments. The proposed rule is estimated to reduce Medicare spending by $100 to $740 million over the next ten years.

“With prior authorization, Medicare beneficiaries will have greater confidence that their medical items and services are covered before services and supplies are rendered. This will improve access to services and quality of care,” said CMS Administrator Marilyn Tavenner.

The announcement builds upon lessons learned from the Medicare Prior Authorization of Power Mobility Device Demonstration. Launched in 2012, the demonstration established a prior authorization process for certain power mobility devices. Based on September 2013 claims data, monthly expenditures for certain power mobility devices decreased from $12 million in September 2012 to $4 million in August 2013 across the seven demonstration states (California, Florida, Illinois, Michigan, New York, North Carolina, and Texas) with no reduction in beneficiary access to medically necessary items.

CMS seeks to leverage this success by extending the demonstration to an additional 12 states. These states include Arizona, Georgia, Indiana, Kentucky, Louisiana, Maryland, Missouri, New Jersey, Ohio, Pennsylvania, Tennessee, and Washington. This will bring the total number of states participating in the demonstration to 19.

CMS also proposes to establish a prior authorization process for certain durable medical equipment, prosthetics, orthotics, and supplies items that are frequently subject to unnecessary utilization. Through a proposed rule, CMS will solicit public comments on this prior authorization process, as well as criteria for establishing a list of durable medical items that are frequently subject to unnecessary utilization that may be subject to the new prior authorization process. The proposed rule is currently on display at and will be published in the Federal Register on May 28, 2014. The deadline to submit comments is July 28, 2014.

CMS will launch two payment model demonstrations to test prior authorization for certain non-emergent services under Medicare. These services include hyperbaric oxygen therapy and repetitive scheduled non-emergent ambulance transport. Information from these models will inform future policy decisions on the use of prior authorization.  

Prior authorization does not create additional documentation requirements or delay medical service. It requires the same information that is currently necessary to support Medicare payment, but earlier in the process. CMS believe prior authorization is an effective way to ensure compliance with Medicare rules for some items and services.  

Additioanl Fact Sheets Links:

Wednesday, May 14, 2014

Are IRAs and 401(k)s the best you can do?

If you are using a qualified plan like an IRA or 401(k) it may be the worst thing you can do because you will be taxed out of your gourd when you retire and actually need your money.

There is a better way that is approved by the IRS and beats IRAs and 401(k)s by 25%-40%.

It’s been around for years. Your money grows tax-free, has no taxes at retirement, no taxes when you die and no taxes when passed on to your heirs.

And there is no risk to your principal. If the market tanks like it did in 2008 you lose nothing.

And there is more. This IRS sanctioned retirement plan can be arranged to provide long term care benefits if you become disabled and that money is also tax-free. 

You can find out more about this guaranteed retirement plan by contacting me at 425-338-1000 or

Saturday, May 3, 2014

Know a good attorney?

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