One thing that you might notice, is that Medicare and Medicare plans provide a notice that certain information on the care and services that you receive through Medicare or a Medicare Health Plan will be gathered and given to Medicare. In these days of privacy concerns, this might make you hesitate. There is no need to fear. Here is what kind of information the Medicare collects when you get care or use services, and how it is being used.
Use of Services Data
In order to determine the effectiveness of various programs, and track the overall health and direction of Medicare enrollees, the kind of health instances, types of treatment, and days of hospitalization are commonly tracked. Some of this data is used to track the adherence of health plans to the “Two-midnight” rule for hospital stays. Recently some plans were subjected to fines for mischaracterizing hospital treatments to more expensive diagnostic codes. Medicare uses this data to ensure the viability of the program, and prevent abuse by billing providers.
Medicare Status
The reasons for Medicare eligibility include those who are qualified by age, disability, and work history. Payments made by Medicare of Medicare enrollees are broken down by Medicaid status, income (for IRMAA penalties), Extra Help, and PACE/other subsidies. Demographic data is gathered by Medicare and Medicare Health plans to develop a picture of how Medicare recipients’ use and pay for services, and to develop new protections for consumers.
Star Ratings
Health Plan members are polled to determine their level of satisfaction on several areas, and Star Ratings also enable certain bonus payments and privileges to plan sponsors. Members are asked, optionally, to provide contact information, for possible clarification and follow-up. The answers are aggregated, so no personal information is accessible in the final results.
Data gathering is part of the nature of Medicare. Personal information is rarely used and transmitted, and retention of data is highly controlled. The true danger with personal information lies in the actual Medicare and Social Security databases, which do not include personal treatment information. Both the Social Security and the Medicare data bases have been hacked in the past. For help if your information may have been jeopardized in these leaks, refer to the Medicare.gov and ssa.gov websites, or ask your Prime Planners consultant to help.
