Hospice Care, False Claim?

March 26, 2019

Hospice Care, False Claim

You primary doctor indicated that you have less than six months to live and you qualify for hospice care. A second doctor disagreed. If the second doctor proves correct, did your primary doctor committed fraud?

This is the very issue that the following court case is addressing: United States v. Aseracare, Inc. (16-13004); Court of Appeals for the Eleventh Circuit

Medicare Rule.

If you have Medicare Part A (Hospital Insurance) and meet all of these conditions, your hospice care cost may be covered:

  • Your hospice doctor and your regular doctor (if you have one) certify that you’re terminally ill (with a life expectancy of 6 months or less).
  • You accept palliative care (for comfort) instead of care to cure your illness.
  • You sign a statement choosing hospice care instead of other Medicare-covered benefits to treat your terminal illness and related conditions.

Medicare won’t cover any of these once your hospice benefit starts:

  • Treatment intended to cure your terminal illness and/or related conditions.
  • Prescription drugs to cure your illness.
  • Care from any hospice provider that wasn’t set up by the hospice medical team.
  • Medicare doesn’t cover room and board if you get hospice care in your home or if you live in a nursing home or a hospice inpatient facility.
  • Care you get as a hospital outpatient (like in an emergency room), care you get as a hospital inpatient, or ambulance transportation, unless it’s either arranged by your hospice team or is unrelated to your terminal illness and related conditions.

Leave a Comment » | 7.20 Hospice Care | Permalink
Posted by SSAedge.com

Special Minimum Benefit Tables

January 6, 2019

Special Minimum Benefit

“Special minimum” benefits are payable to certain individuals with long periods of relatively low earnings. To qualify for such benefits, an individual must have at least 11 “years of coverage.”

To earn a year of coverage for purposes of the special minimum, a person must earn at least a certain proportion (25 percent for years before 1991; 15 percent for years after 1990) of the “old-law” contribution and benefit base.

SSA provides tables showing the range minimum primary insurance amounts (PIA) from 1973 to the present. If no benefit increase became effective in the year you select, we will give you the table for the last prior year in which an increase became effective. Go to> http://www.ssa.gov/oact/progdata/tableForm.html

Leave a Comment » | 3.51 Minimum Benefits | Permalink
Posted by SSAedge.com

Computation of Family Maximum (FM)

January 5, 2019

The maximum family benefit is the maximum monthly amount that can be paid on a worker’s earnings record. The following, however, is devoted to the more common family maximum for retirement and survivor benefits.

Special formula for computing the maximum benefits payable to the family of a disabled worker. Benefits are payable to spouses and children of disabled workers, but such benefits are limited. The family maximum for a family of a disabled worker is 85 percent of the worker’s Average Indexed Monthly Earnings (AIME). However, it cannot be less than the worker’s PIA nor more than 150 percent of the PIA. [www.ssa.gov/oact/COLA/dibfamilymax.html]

Steps for computing the Family Maximum Benefit
Step 1. Segregate the Primary Insurance Amount from the bend point table.
Step 2. Compute the family maximum.

Computation of Family Maximum Benefit [www.ssa.gov/oact/COLA/familymax.html]

(4) From To PIA Fam Max
150% 1 1,184 1,184 1,776
272% 1,185 1,708 524 1,425
134% 1,709 2,228 520 697
175% 2,229 633 1,108
Total 2,861 5,006
Fam Max / PIA Percentage 175%

(4) Benefit Formula Bend Points: [www.ssa.gov/oact/COLA/bendpoints.html]
(5) Formula for Family Maximum Benefit [www.ssa.gov/oact/COLA/familymax.html]

Leave a Comment » | 4.02 Family Maximum (FM) | Permalink
Posted by SSAedge.com

Computation of Primary Insurance Amount (PIA)

January 3, 2019

The “primary insurance amount” (PIA) is the benefit a person would receive if he/she elects to begin receiving retirement benefits at his/her normal retirement age. This amount is not reduced for early retirement nor increased for “delayed retirement credit” (DRC).

Following provides an example of an individual retiring in 2019. Steps in the computation follows:
Step 1. Identify earnings years by year.
Step 2. Apply the indexing factors to annual earnings. [Indexing factors for eligibility year 2015: http://www.ssa.gov/cgi-bin/awiFactors.cgi%5D
Step 3. Identify the highest 35 years of indexed earnings.
Step 4. Sum up the indexed earnings.
Step 5. Compute the averaged indexed monthly earnings by dividing total indexed earnings by 35 years, then divide by 12 month per year.
Step 6. For an individual retiring in 2019, refer to table of bend points. [Benefit Formula Bend Points: http://www.ssa.gov/oact/COLA/bendpoints.html%5D
Step 7. Segregate the averaged indexed monthly earnings by amount from the bend point table.
Step 8. Compute and round the amount to the next lower multiple of $.10 if it is not already a multiple of $.10.

Benefit Examples For Workers With Maximum-Taxable Earnings: http://www.ssa.gov/oact/COLA/examplemax.html

(1) Contribution Base (2) Indexing Factors
Year Earnings age Factor Indexed
Earnings
a b c d e=b*d
1937 3,000
1938 3,000
1939 3,000
1940 3,000
1941 3,000
1942 3,000
1943 3,000
1944 3,000
1945 3,000
1946 3,000
1947 3,000
1948 3,000
1949 3,000
1950 3,000
1951 3,600
1952 3,600
1953 3,600 0
1954 3,600 1 14.224741
1955 4,200 2 13.596540
1956 4,200 3 12.707697
1957 4,200 4 12.326088
1958 4,200 5 12.218455
1959 4,800 6 11.641724
1960 4,800 7 11.202100
1961 4,800 8 10.983801
1962 4,800 9 10.460027
1963 4,800 10 10.209651
1964 4,800 11 9.808790
1965 4,800 12 9.635299
1966 6,600 13 9.089690
1967 6,600 14 8.610085
1968 7,800 15 8.056370
1969 7,800 16 7.616218
1970 7,800 17 7.256130
1971 7,800 18 6.908975
1972 9,000 19 6.292321
1973 10,800 20 5.921796
1974 13,200 21 5.589528
1975 14,100 22 5.200855
1976 15,300 23 4.865145
1977 16,500 24 4.590054
1978 17,700 25 4.252371
1979 22,900 26 3.910302
1980 25,900 27 3.587190
1981 29,700 28 3.259118
1982 32,400 29 3.089059
1983 35,700 30 2.945564
1984 37,800 31 2.782025
1985 39,600 32 2.668339 105,666
1986 42,000 33 2.591423 108,840
1987 43,800 34 2.436064 106,700
1988 45,000 35 2.321717 104,477
1989 48,000 36 2.233292 107,198
1990 51,300 37 2.134687 109,509
1991 53,400 38 2.057995 109,897
1992 55,500 39 1.957155 108,622
1993 57,600 40 1.940466 111,771
1994 60,600 41 1.889747 114,519
1995 61,200 42 1.816918 111,195
1996 62,700 43 1.732204 108,609
1997 65,400 44 1.636701 107,040
1998 68,400 45 1.555299 106,382
1999 72,600 46 1.473200 106,954
2000 76,200 47 1.396001 106,375
2001 80,400 48 1.363473 109,623
2002 84,900 49 1.349935 114,609
2003 87,000 50 1.317723 114,642
2004 87,900 51 1.259186 110,682
2005 90,000 52 1.214739 109,326
2006 94,200 53 1.161359 109,400
2007 97,500 54 1.110942 108,317
2008 102,000 55 1.085961 110,768
2009 106,800 56 1.102589 117,756
2010 106,800 57 1.077131 115,038
2011 106,800 58 1.044406 111,543
2012 110,100 59 1.012781 111,507
2013 113,700 60 1.000000 113,700
2014 117,000 61 1.000000 117,000
2015 118,500 62 1.000000 118,500
2016 118,500 63 1.000000 118,500
2017 127,200 64 1.000000 127,200
2018 128,400 65 1.000000 128,400
2019 132,900 66 1.000000 132,900
Total, 35 years max 3,933,168
Total years 35
Months per year 12
average indexed monthly earnings (AIME) 9,365

 

To determine your PIA, your average indexed monthly earnings are applied to a formula. For 2018, the formula is:

(4) From To AIME PIA
90% 1 895 895 806
32% 896 5,397 4,502 1,441
15% 5,398 3,968 595
Total (3) 9,365 2,841
Differences 20
Workers With Maximum-Taxable Earnings 2,861

(1) Contribution and Benefit Base: http://www.ssa.gov/oact/cola/cbb.html
(2) Indexing factors for eligibility year 2015: http://www.ssa.gov/cgi-bin/awiFactors.cgi
(3) Benefit Examples For Workers With Maximum-Taxable Earnings: http://www.ssa.gov/oact/COLA/examplemax.html
(4) Benefit Formula Bend Points: http://www.ssa.gov/oact/COLA/bendpoints.html

Leave a Comment » | 4.01 Primary Insurance Amount (PIA) | Permalink
Posted by SSAedge.com

Covered Earnings; Non-covered Earnings

October 31, 2018

Covered Earnings

Covered earnings refers to the total amount of an employee’s pay that counts toward the calculation of social security retirement benefits.

Non-covered earnings

Certain individuals who work for a federal, state, or local government agency, a nonprofit organization or in another country, you may be eligible for a pension based on earnings not covered by Social Security.

Leave a Comment » | C | Permalink
Posted by SSAedge.com

Totalization Agreement

October 30, 2018

Totalization agreement

The totalization agreement affects workers who divide their working career between two or more countries. The agreement also address situations where workers or employers are required to pay Social Security taxes on the same earnings to multiple countries.

Leave a Comment » | T, U, V | Permalink
Posted by SSAedge.com

Business Services Online

October 30, 2018

Business Services Online

The Business Services Online Suite of Services allows organizations, businesses, individuals, employers, attorneys, non-attorneys representing Social Security claimants, and third-parties to exchange information with Social Security securely over the internet. You must register and create your own password to access Business Services Online.

Leave a Comment » | B | Permalink
Posted by SSAedge.com

Office of Quality Review (OQR)

October 29, 2018

The Office of Quality Review (OQR) selects cases for Federal QR during the Disability Determination Services (DDS) case closure process and prior to effectuation of the DDS’s determinations.

Leave a Comment » | M, N, O | Permalink
Posted by SSAedge.com

Offset: Windfall Elimination Provision (WEP)

October 9, 2018

There is a number of offsets which could reduce social security payments, including:
(1) Windfall Elimination Provision (WEP), (2) Government Pension Offset (GPO), (3) Workers’ Compensation and Public Disability Benefit and (4) Treasury Offset Program (TOP).

 

Leave a Comment » | M, N, O | Permalink
Posted by SSAedge.com

Offset: Government pension offset (GPO)

October 7, 2018

There is a number of offsets which could reduce social security payments, including:
(1) Windfall Elimination Provision (WEP), (2) Government Pension Offset (GPO), (3) Workers’ Compensation and Public Disability Benefit and (4) Treasury Offset Program (TOP).

Government pension offset (GPO).

A provision that reduces Social Security spousal and widow/widower’s benefits, if they’re based on the earnings record of a worker who spent part of his or her career in government employment not covered by Social Security.

The GPO is a reduction to spousal or survivor benefits if you have a pension where you did not pay Social Security taxes. The reduction is 2/3 of your pension amount! For example, if your pension is $3,000, the SSA will subtract nearly $2,000 from any spousal or survivor benefits before you are paid. This large reduction often completely wipes out any benefit for which you are eligible.

If you have a pension from ‘mixed’ earnings, the entire pension amount should not be used in calculating the 2/3 reduction! Only the amount that came from the months where you did not pay Social Security taxes should be used.

The Social Security rules make this clear: “Some entities may pay a pension based on both government employment and private employment. For pensions based on a combination of federal, state, or local government employment and private employment (i.e., non-government employment), GPO applies only to the portion of the pension based on government employment. [emphasis added]

Example. John receives SSA of $1600/mo. Mary had worked as an educator for the Austin, TX unified school district and receives pension of $1000/mo. If John passed away, what is the net SSA benefit that Mary would receive? $1,600 less (2/3 x $1,000) = $1,600 – 667 = $933

Further readings: https://secure.ssa.gov/poms.nsf/lnx/0202608400

 

 

 

Leave a Comment » | M, N, O | Permalink
Posted by SSAedge.com

« Previous Entries