CBO Medicare Forecast Accuracy

According to a N.Y. Times editorial, the Congressional Budget Office has consistently underestimated costs savings from a variety of institutional changes to Medicare.  For instance: Medicare enacts the prospective payments system (PPS) for reimbursing inpatient hospital stays. The CBO projected total Medicare spending will rise to $60 billion in 1986. Actual Medicare spending in 1986…

Medicare Cost Projections

The Social Security Administration’s Office of the Actuary projects Medicare costs up to 75 years in the future. How much of your taxable income will be going to pay for Medicare in the next 10, 25, or 75 years? Take a look at this chart. By 2085, 12.24% of your taxable income will need to…

Overall Medicare Spending

The largest provider of medical services in the United States is Medicare.  Forty five million Americans receive Medicare.  Out of this total only 85% are elderly (aged 65 or older).  Disabled individuals, individuals with end-stage renal disease or Lou Gehrig’s disease are also eligible for Medicare coverage. Medicare has 4 parts. Part A provides coverage…

Medicare Reimbursement Information VIII

The Medicare Reimbursement series continues with a look at physician reimbursement in more detail. The source of this information is MedPAC’s Payment Basics. Physician Reimbursement Physicians payment is based on 3 factors: RVU, GPCI and the MEI conversion factor. Relative value units (RVUs) measure the relative costliness of three types of resources used to provide…

Medicare Reimbursement Information VII

The Medicare Reimbursement series continues with the big money payments: acute inpatient hospital care, long-term care facilities and critical access hospitals. The sources of this information is MedPAC’s Payment Basics. Hospital Acute Inpatient Services Payments made under the acute inpatient prospective payment system (IPPS) totaled $105 billion and accounted for about 25 percent of Medicare…

Medicare Reimbursement Information VI

The Medicare Reimbursement series continues with today’s focus on outpatient care. The sources of this information is MedPAC’s Payment Basics. Outpatient Hospital Services Outpatient hospital procedures range from injections to complex surgical procedures that require anesthesia. Outpatient hospital care accounted for $19 billion of total Medicare spending in 2007. Currently, outpatient hospital reimbursement is based…

Medicare Reimbursement Information V

Medicare reimburses providers based on the type of service they provide. In the Medicare claims data there are three types of procedure codes: Current Procedural Terminology (CPT): CPT codes are designed by the American Medical Association. They describe medical, surgical, and diagnostic services and are designed to communicate uniform information about medical services and procedures…

Medicare Reimbursement Information IV

The Medicare Reimbursement Series Continues. The sources of this information is MedPAC’s Payment Basics. Clinical Laboratory Services: Under Part B, Medicare covers medically diagnostic and monitoring laboratory services ordered by a physician. Medicare does not cover routine screening tests except for cholesterol and blood lipid tests, fecal occult blood testing, Pap smear tests, prostate-specific antigen…