Nebraska Department of Insurance
THE NEBRASKA HEALTH INSURANCE INFORMATION, COUNSELING, AND ASSISTANCE (NICA) PROGRAM
SEPTEMBER 2001 NICA NEWS
QUESTIONS AND ANSWERS
Q. Can I use the Medicare home health benefit even without an acute illness or a prior hospitalization?A. Yes, you must be homebound and need SKILLED care. Here are two examples.
- If you have Multiple Sclerosis and are homebound with a need for skilled maintenance therapy to maximize function, you qualify for the home health benefit.
- If you have advanced cancer and are homebound with a need for daily skilled nursing for pain and symptom control, you also qualify for the home health benefit.
You DO NOT qualify if you need custodial care alone. For example, if you have Alzheimer's disease and need home health aide services but do not need skilled nursing or skilled therapy, you do not qualify for the home health benefit.
Q. Does Medicare pay for prostate cancer screening?
A. Yes. Medicare began paying for the digital rectal examinations and the prostate specific antigen (PSA) blood test as of January 1, 2000 for all men with Medicare Part B who are age 50 and older. These Medicare preventive benefits can be a key to long lasting good health.
Medicare beneficiaries enrolled in original fee-for-service Medicare Part B will generally only pay 20% of the Medicare-approved amount after they meet the annual $100 Part B deductible for the digital rectal exam. There is no coinsurance or Part B deductible owed for the PSA test.
The common digital rectal exam is a direct examination of the prostate gland to check for unusual growth or tumors. The prostate specific antigen test measures the amount of a protein secreted in the blood. Higher than normal levels can also indicate cancer. However, higher than normal levels may not be cancer and further testing may be required.
If a person is of African descent or has a family history of prostate cancer, it is a good idea to begin screening early.
Prostate cancer is now the second leading cause of cancer death in men, exceeded only by lung cancer. It accounts for 32% of all male cancers and 14% of male cancer-related deaths. Age-adjusted incidence rates increased as well.
Q. Have any of CMS's Medicare systems been broken into by computer hackers?
A. According to CMS, they have never had a report of an actual penetration to one of their Medicare claims processing payment systems. Penetration tests conducted by the Agency or as part of the Office of the Inspector General's Chief Financial Officer audits have disclosed potential vulnerabilities that they have taken action to alleviate. During their Y2K preparations, a hacker did penetrate www.medicare.gov which does not contain patient or provider identified data. The problem was identified and quickly fixed. It's important to remember that Medicare.gov is hosted at a completely different location and uses a separate server system than their Medicare claims processing functions.
Q. Should a beneficiary be worried about personal information being inappropriately released or accessed?
A.No. Personal information that is collected as part of the Medicare Claim is submitted to us over a private network (not the internet) and is processed on systems that are not linked to the internet. CMS has established procedures for releasing identifiable data that ensures the protection of the data. CMS also has safeguards in place to guard against inappropriate or unauthorized release or disclosure of the information.
Just for Laughs
The quotes in this humorous piece were taken from actual medical records as dictated by physicians.- "By the time he was admitted, his rapid heart had stopped, and he was feeling better."
- "She is numb from her toes down."
- "The skin was moist and dry."
- "When she fainted, her eyes rolled around the room."
- "Patient has left his white blood cells at another hospital."
- "The patient refused an autopsy."
- "The patient has no past history of suicides."
- "Patient has chest pain if she lies on her left side for over a year."
- "The patient has been depressed ever since she began seeing me in 1983."
- "Discharge status: alive but without permission."