Question: I terminated employment and elected COBRA continuation coverage. I have gone to work for another employer, can I keep my COBRA if I enroll in my new employer's plan?
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Answer: It depends. If under the new plan you will be subject to any exclusion or limitation with respect to any preexisting condition, you may enroll in the new plan and keep your COBRA coverage. However, if you will not be subject to any exclusion or limitation with respect to any preexisting condition, COBRA coverage may be terminated--including prescription drug coverage--on the date on which you become covered under your new employer's group health plan. (42 U.S.C. 300bb-2(2)(D)(i).)
Tuesday, December 8, 2009
If I sign up for Medicare Part B, can my COBRA coverage be terminated?
Question: If I sign up for Medicare Part B, can my COBRA coverage be terminated?
Answer : Not on the basis of Medicare entitlement. This issue also was clarified by the U.S. Supreme Court's decision in Geissal v. Moore Medical Corporation, 118 S. Ct. 1869 (1998). (See Q&A ID 6343). In general, an individual who first becomes entitled to Medicare benefits on or before the date that COBRA continuation coverage is elected, is entitled to elect and maintain continuation coverage without regard to his or her Medicare entitlement. (42 U.S.C. 300bb-2(2)(D)(ii).) A qualified beneficiary first becomes entitled to Medicare benefits upon the effective date of enrollment in either Part A or Part B, whichever occurs earlier. (26 CFR Sec. 54.4980B-7, Q&A-3.) Because you first became entitled to Medicare (Part A) before electing COBRA continuation coverage, your enrollment in Medicare Part B will not be your first Medicare entitlement. Therefore, it will not be a basis for termination of your COBRA continuation coverage even if you enroll in Medicare Part B after the election of COBRA coverage.
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Answer : Not on the basis of Medicare entitlement. This issue also was clarified by the U.S. Supreme Court's decision in Geissal v. Moore Medical Corporation, 118 S. Ct. 1869 (1998). (See Q&A ID 6343). In general, an individual who first becomes entitled to Medicare benefits on or before the date that COBRA continuation coverage is elected, is entitled to elect and maintain continuation coverage without regard to his or her Medicare entitlement. (42 U.S.C. 300bb-2(2)(D)(ii).) A qualified beneficiary first becomes entitled to Medicare benefits upon the effective date of enrollment in either Part A or Part B, whichever occurs earlier. (26 CFR Sec. 54.4980B-7, Q&A-3.) Because you first became entitled to Medicare (Part A) before electing COBRA continuation coverage, your enrollment in Medicare Part B will not be your first Medicare entitlement. Therefore, it will not be a basis for termination of your COBRA continuation coverage even if you enroll in Medicare Part B after the election of COBRA coverage.
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Monday, December 7, 2009
Does CMS have any plans for combining the current claims processing systems?
Question: Does CMS have any plans for combining the current claims processing systems?
Answer :
The MediSAM initiative replaces the Medicare Claims Processing Redesign (MCPR) effort. MediSAM is a long-range initiative that will incrementally transform and modernize the independent contractor systems, Shared Systems, and the Common Working File (CWF).
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For Medicare FFS claims processing systems, the new approach will combine newer technologies with existing system components to make incremental improvements rather than completely replacing the existing systems all at once. A unified, modernized FFS claims processing system will evolve from this incremental modernization approach. Key characteristics of the approach include:
· Eliminating duplicate functions and data among the current systems.
· Modernizing and renovating existing system components and data.
· Strategically injecting new technology to allow for greater flexibility and interoperability.
· Modernizing auxiliary systems and utilities that support claims adjudication (e.g., back end print).
The long-term MediSAM vision and concept of operations calls for Medicare FFS operations to be hosted in a geographically-dispersed EDC environment. A unified claim processing system, operating at multiple EDCs, will replace the existing Shared Systems and CWF; and interact with front-end and back-end services as well as related CMS systems (e.g., Health Integrated General Ledger Accounting System (HIGLAS)).
Answer :
The MediSAM initiative replaces the Medicare Claims Processing Redesign (MCPR) effort. MediSAM is a long-range initiative that will incrementally transform and modernize the independent contractor systems, Shared Systems, and the Common Working File (CWF).
4396710
Aprilaire Humidifier
Business Process Automation
For Medicare FFS claims processing systems, the new approach will combine newer technologies with existing system components to make incremental improvements rather than completely replacing the existing systems all at once. A unified, modernized FFS claims processing system will evolve from this incremental modernization approach. Key characteristics of the approach include:
· Eliminating duplicate functions and data among the current systems.
· Modernizing and renovating existing system components and data.
· Strategically injecting new technology to allow for greater flexibility and interoperability.
· Modernizing auxiliary systems and utilities that support claims adjudication (e.g., back end print).
The long-term MediSAM vision and concept of operations calls for Medicare FFS operations to be hosted in a geographically-dispersed EDC environment. A unified claim processing system, operating at multiple EDCs, will replace the existing Shared Systems and CWF; and interact with front-end and back-end services as well as related CMS systems (e.g., Health Integrated General Ledger Accounting System (HIGLAS)).
Medicare Part A and Part B
Question: Why is the administration of the Medicare Part A and Part B programs being combined?
Answer : Medicare Part A and Part B claims are processed by separate contractors using different claims processing systems, with few exceptions. Having to deal with more than one contractor can increase the frustration for beneficiaries and providers and can make it difficult to get answers on coverage questions quickly. Providers also face increased expenses due to separate processing, and can have difficulty coordinating services on behalf of their patients.
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By combining the administration of Part A and Part B, Medicare will be able to deliver more efficient and effective services to beneficiaries and healthcare providers and better meet future programmatic challenges. CMS will achieve comprehensive care for beneficiaries by integrating claims processing for Medicare Part A and Part B, and creating a modernized administrative IT platform that incorporates the latest technological advances and standardization practices.
Answer : Medicare Part A and Part B claims are processed by separate contractors using different claims processing systems, with few exceptions. Having to deal with more than one contractor can increase the frustration for beneficiaries and providers and can make it difficult to get answers on coverage questions quickly. Providers also face increased expenses due to separate processing, and can have difficulty coordinating services on behalf of their patients.
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By combining the administration of Part A and Part B, Medicare will be able to deliver more efficient and effective services to beneficiaries and healthcare providers and better meet future programmatic challenges. CMS will achieve comprehensive care for beneficiaries by integrating claims processing for Medicare Part A and Part B, and creating a modernized administrative IT platform that incorporates the latest technological advances and standardization practices.
How is rural area defined?
Question: How is rural area defined?
Answer : Since comprehensive care is provided to PACE participants, those participants who need end-of-life care will receive the appropriate medical, pharmaceutical, and psychosocial services through the PACE organization. If the participant specifically wants to elect the hospice benefit from a certified hospice organization, then the participant must voluntarily disenroll from the PACE organization. The PACE organization would work with the State administering agency and CMS to facilitate the election of the hospice benefit.
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Answer : Since comprehensive care is provided to PACE participants, those participants who need end-of-life care will receive the appropriate medical, pharmaceutical, and psychosocial services through the PACE organization. If the participant specifically wants to elect the hospice benefit from a certified hospice organization, then the participant must voluntarily disenroll from the PACE organization. The PACE organization would work with the State administering agency and CMS to facilitate the election of the hospice benefit.
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