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Medicare Drug Program News
CMS and Social Security Crossing Swords over
Glitches in Medicare Drug Program Billing
CMS complains about computer system used by SSA
 September 25, 2006 – The criticism by senior
advocacy groups and members of Congress about the billing problems
swirling around the Medicare drug program appears to have opened a
conflict between the Centers for Medicare & Medicaid Services and the
Social Security Administration. CMS Administrator Mark McClellan has
written a letter to SSA Commissioner Jo Anne Barnhart complaining about
the SSA computer system that processes billing for Medicare.
 Medicare Beneficiary Data Exchange Glitches Between
CMS, SSA Ongoing Problem
A
glitch
last month that caused the government to erroneously reimburse about
230,000 Medicare beneficiaries for their prescription drug benefit
premiums is the latest of several mistakes in the "strained, often
dysfunctional relationship" between
CMS,
which administers the drug benefit, and the
Social Security
Administration, which deducts some beneficiaries' premiums
from Social Security checks, the
New York Times
reports.
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Related Stories |
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Lawsuit Halts Medicare Collection of $50 Million
Mistakenly Refunded to Senior Citizens
Center for Medicare Advocacy sues for two senior
citizen groups
 September 19, 2006 – in response to a lawsuit by
senior advocacy groups, the Centers for Medicare & Medicaid Services
yesterday halted its efforts to recover $50 million dollars in Medicare
Part D drug program premiums it mistakenly returned to senior citizens.
The wheels seem to be coming off at CMS as complaints from Congress and
lawsuits are pounding the agency over billing and other financial errors
that have impacted as many as three-quarters of a million senior
citizens in the drug program.
Read
more...
Detailed Explanation on Correcting Newest Medicare
Billing Errors Due Tomorrow
Two Senators want to know how Medicare and Social
Security are going to correct latest snafu impacting up to 500,000
senior citizens
September
18, 2006 – While Medicare and Social Security are still wrestling to
recover $50 million that was mistakenly paid to senior citizens as
refunds of their Part D drug program premiums, the agencies have been
hit with another controversy over additional errors that have been made
in billing seniors for their premiums. Two powerful Senators have asked
for a detailed explanation by tomorrow.
Read
more...
Read more
on
Medicare
or
Medicare Drug Program |
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According to the Times, CMS and SSA officials for
"more than a year ... have struggled to mesh their computer systems so
that Medicare premiums are correctly withheld from Social Security
checks and low-income people get the extra help to which they are
entitled."
The task of transferring data between the two
agencies is further complicated because the information also is gathered
and used by private insurers who sponsor Medicare drug plans, "each with
its own procedures and computer systems," the Times reports. The Times
reports that federal officials have identified four categories of
problems:
● Beneficiaries who requested that their premiums
be deducted from their Social Security checks, but the government has
not fulfilled their requests, so they owe several months of premiums;
● Beneficiaries who told the government to stop
deducting the premium, but the deductions have continued;
● Beneficiaries whose premiums were correctly
deducted, but their insurers have not received the payments from the
government; and
● Beneficiaries who changed drug plans but are
still having premiums deducted for the original plan.
McClellan Letter
CMS Administrator Mark McClellan in a recent letter to SSA Commissioner
Jo Anne Barnhart wrote about "the unnecessary complexity" of SSA's
computer system, which he said performs "more than 40 edits" each time a
Medicare beneficiary requests a transaction.
McClellan wrote, "In the past, my staff has felt
that significant concerns they have expressed have not been taken into
account by Social Security."
For example, he said, SSA officials in 2004
established the "technical details of the data exchange" between the
agencies without fully taking into account the mandates of the 2003
Medicare law or concerns raised by Medicare officials.
He added, "We have only been allowed to submit data
to your system for about 10 business days out of each month. Because of
your system design, SSA will not process transactions outside of that
window."
Beatrice Disman, chair of the Medicare Planning and
Implementation Task Force at SSA, said, "What the public has to
understand is that Social Security is at the end of the trail. We rely
on information provided by Medicare."
In reference to the number of "edits" on
beneficiary requests, Disman said, "We may have information that a
person is in the ABC [drug] plan. Now Medicare tells us to withhold
premiums for the XYZ plan. We have to verify that" (Pear, New York
Times, 9/25).
Doughnut Hole
In related news, the
Washington Post
on Monday examined how "millions" of Medicare beneficiaries are facing
increases in their prescription drug costs under the so-called "doughnut
hole" of the Medicare drug benefit.
Under the doughnut hole provision, beneficiaries
are responsible for 100% of annual prescription drug costs between
$2,250 and $5,100. Medicare covers 95% of drug costs beyond $5,100.
Medicare officials estimate than about three
million beneficiaries enrolled in the drug benefit will reach the
doughnut hole this year. McClellan said beneficiaries who reach the
doughnut hole should continue to use their Medicare drug cards so that
they get the prices negotiated by their drug plans.
Beneficiaries also can apply for prescription drug
assistance programs offered by states and pharmaceutical companies or
call Medicare for help, he said. "There are lots of places to go to get
lower-priced drugs, to get additional help with you drug costs,"
McClellan said.
Chris DeYoung, community outreach coordinator for
Iona Senior
Services in Washington, D.C., said, "I don't think everyone
really appreciates the doughnut hole, or they thought it'd be narrower
than it is."
Robert Hayes, president of the
Medicare Rights
Center, said, "Virtually everyone who calls to say they've
been denied coverage, they're shocked. Trying to explain that this is
the way the program was created by Congress angers folks who think it
makes no sense" (Lee/Levine, Washington Post, 9/25).
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