Medicare Compliance & Reimbursement

Good news for the nation's seniors: Health reform measures aimed at improving seniors' access to better health insurance services and benefits are starting to take effect. In the six months since President Obama signed the bill into law, much needed help is rolling in.

Of perhaps the greatest interest to senior citizens, the government has already started the process of filling in the Medicare Part D coverage gap, the "doughnut hole." Checks have started going out to around 80,000 people across the nation, and 4 million checks will be mailed over the next year.

In addition to this, starting January 1, 2011, Medicare will provide free preventive care: no co-payments and no deductibles for preventive services such as glaucoma screening and diabetes self-management. Also, the legislation increases reimbursements to doctors who provide primary care to seniors, increasing access to these services for Medicare patients.

Also, retirees in the age bracket 55"64 will shortly be able to avail of a temporary re-insurance program that will offset the cost of expensive health claims for employers that provide health benefits. Scheduled to run from June 21, 2010 through January 1, 2014, the reinsurance program will pay 80 percent of eligible claim expenses incurred between $15,000 and $90,000.

• Quite a few provisions aimed at ending Medicaid's "institutional bias," which forces elderly and disabled individuals in many states to move to nursing homes;

• Provisions that will help protect nursing home residents and other long-term care recipients from abuse, and give families of nursing home residents more information about the facilities their loved ones are living in or considering moving to; and

• The Elder Justice Act, which will establish an "Elder Justice Coordinating Council" and provide federal resources to support state and community efforts to fight elder abuse. (To read the Elder Justice Act, go to: www.elderjusticecoalition.com/index.htm.)

But the new law with its new opportunities has a flip side also. It has created opportunities for scam artists, many of whom have already moved in loaded with bogus policies, operating both through 1-800 numbers and going from door-to-door, according to secretary of Health and Human Services Kathleen Sebelius. (To read more about their modus operandi, please visit: www.seniorjournal.com/NEWS/Alerts/2010/20100407-ScamArtists.htm.)