Medicare Premiums and Deductibles For 2012: Medicare Part B

Posted by:  :  Category: Medicare

Racism by elycefeliz What does Medicare Part B cover? This portion of Medicare covers a portion of the cost of physicians’ services, outpatient hospital services, certain home health services, durable medical equipment, and other items. By law, the standard premium is set to cover one-fourth of the average cost of Part B services incurred by beneficiaries aged 65 and over, plus a contingency margin. The contingency margin is an amount to ensure that Part B has sufficient assets and income to cover Part B expenditures during the year, cover incurred-but-unpaid claims costs at the end of the year, provide for possible variation between actual and projected costs, and amortize any surplus assets. Most of the remaining Part B costs are financed by Federal general revenues.  (In 2012, about $2.9 billion in Part B expenditures will be financed by the fees on manufacturers and importers of brand-name prescription drugs under the Affordable Care Act.)
Source: marshagoodmanattorney.com

Video: Getting medicare for low prices

Romney’s Plan to ‘Save’ Medicare: ObamaCare for Seniors

On a policy level, the idea, Romney explains, is to “encourage insurers to lower costs and compete on the quality of their offerings.” But as Ezra Klein has already explained, that was the oft-stated idea behind the liberal proposal to include a government-run “public option” in ObamaCare’s insurance exchanges. What liberal supporters of the public option said less often was that many, including the idea’s designer, hoped it would provide a slow-but-steady path to single-payer, as private insurers slowly dropped out of the market unable to “compete” with a heavily subsidized, artificially low-priced government-run insurance plan. (Read how a public option for property insurance has displaced private offerings in Florida.)
Source: congressarizona.org

Arizona Medicare Advantage Plans or Medicare Supplemental Insurance

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Source: medicaresupplementadvantageplans.com

Medicare Supplemental Insurance plan Arizona

Portion A covers healthcare costs when you are admitted to a hospital. You are responsible for paying out a deductible if this transpires. This expense is not an yearly deductible, it is per advantage time period. This indicates if you are admitted to the hospital then depart for sixty days or far more, that is oen benefit time period. If you return following 60 days you ought to pay the deductible yet again, even if it really is the same year. Based on which Medigap Program you pick, it will probably spend this for you. With no dietary supplement you must pay this cost yourself.
Source: fastoutofdebt.com

Medicare 2012: What you need to know.

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Source: medicarechoicesofarizona.com

Blue Cross Blue Shield of Arizona Offers Medicare Part D Prescription Drug Plan

Blue Cross Blue Shield of Arizona (BCBSAZ), an independent licensee of the Blue Cross and Blue Shield Association, is the largest Arizona-based health insurance company. The not-for-profit company was founded in 1939 and provides health insurance products, services or networks to 1.2 million individuals. With offices in Phoenix, Flagstaff, Tucson and the East Valley, the company employs more than 1,300 Arizonans.
Source: azventurecapital.com

AARP Arizona: “Hands Off” Social Security and Medicare

PHOENIX, Ariz. – AARP state leaders from across the country, including Arizona, met with congressional delegations in Washington, D.C., this week, urging them to keep Medicare and Social Security off the table in the heated talks about raising the federal debt ceiling. Former AARP Arizona state president Ritch Steven says Social Security did not cause the nation’s budget problem, and should not be weakened to fix it. Instead, Steven says, Congress should look at cutting waste and fraud, closing tax loopholes and implementing health care reform. “We need to take the Affordable Care Act that has been passed and let it work as the Congressional Budget Office said it would work. It is projected to save a significant sum of money.” AARP Arizona plans a series of events to hear from seniors on whether cuts to Social Security and Medicare should be considered as part of the debt-ceiling debate. The first event is 9 a.m. this coming Wednesday in Prescott at the Hassayampa Inn. Other events are planned for Tucson and Phoenix. Details are available on the Arizona page at www.aarp.org. Steven predicts grave consequences for many of the 1 million Arizonans who rely on Social Security if benefits are cut as part of a debt-ceiling deal, or if the impasse results in August checks being delayed. “About one-third of these Social Security recipients every month receive a check that is virtually 90 percent or more of their income. If they don’t receive a check, I don’t know how they’re going to pay for their health care and their rent and their food.” Seniors also face a bleak future if the Medicare cuts envisioned in Wisconsin Congressman Paul Ryan’s budget proposal come to pass, Steven warns. The plan would replace the current full medical coverage with a fixed-amount voucher for seniors to buy insurance. “Currently, Medicare recipients pay about 25 percent of their income for health-care services, and under the Ryan proposal, they will pay about 68 percent.” Steven says cutting Social Security and Medicare would also have a strong, negative impact on Arizona’s overall economy. Figures from Families USA show that even a five-percent cut in Medicare would cost Arizona $325 million in health care, $690 million in business activity and more than 5,000 jobs.
Source: publicnewsservice.org

Medicare Supplemental Insurance Arizona

There are two basic parts of original Medicare, Part A and Part B. Medicare Part A was created with the original Medicare package, is an insurance that is bankrolled by the government, and covers costs associated with home health services, hospice, nursing home facilities, hospital stays that are classified as inpatient, and Non medical Health care Institutions with a religious affiliation.There is no premium for Medicare Part A if you paid in Medicare taxes while you were working. There is also no premium if your spouse paid these kind of taxes. Medicare Part A may be available to you for a cost if you are over 65 and meet certain requirements of citizenship. Medicare Part B helps pay for doctors’ visits, outpatient hospital care, and some other medical services that Part A doesn’t cover, such as the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary. If you don’t receive Social Security Benefits you need to apply at the beginning of your seven-month initial enrollment period (90 days prior to your 65th birthday). Please call or visit your Social Security office to sign up.
Source: medicaresupplementadvantageplans.com

Payson Daily Bugle: The Facts about Medicare Premiums

Beginning this year, Plan Finder also rates Medicare Advantage plans according to our Five-Star Rating System. A gold icon indicates plans that received five stars, the highest rating for quality of care and customer service. We encourage people with Medicare to enroll in plans with higher ratings — and we hope lower-rated plans will work hard to improve their care and service.
Source: blogspot.com

Five Levels of Appeal Available for Medicare RAC Overpayment Determinations : Health Care Compliance Watch

Posted by:  :  Category: Medicare

THE PEOPLES LEADER by SS&SSOf particular importance for providers involved in Medicare audits are the new changes in Medicare law that address repayment plans and timeframes for recoupment.  As part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (passed into law on December 8, 2003) (hereinafter referred to as “the MPDIMA”) drastic changes were made to the Medicare recoupment process.  Specifically, for those providers who request a Medicare Hearing of an overpayment determination, the law now in effect prohibits the Medicare Carrier from instituting recoupment on the overpayment demand until after a decision has been rendered by the Medicare Hearing Officer.  Thus, while providers were previously forced to begin the repayment process prior to obtaining any meaningful independent review, the new law does not permit recoupment to take place until after the first level of appeal has occurred.  In cases involving alleged overpayments of high amounts, this provision will prove beneficial for providers by allowing providers to properly work up their cases for the hearing officer level of appeal rather than rushing the process in an attempt to stop a financially devastating withhold process.   Some Medicare Carriers are not aware of the changes in the law and thus providers, with assistance of counsel, may need to seek intervention by the Regional Office and/or the Office of General Counsel that oversees the Medicare Carrier.  Legal counsel should also be aware that with regard to BCBSM audits, the recoupment process cannot begin until after exhaustion of the appeals process. Thus, once the provider timely begins the appeals process, BCBSM cannot begin recoupment until completion of the appeals process. Source: yourhealthydirectory.com
Source: medicaresupplementalco.com

Video: Medicare and Appeals

86% of Providers Drop Appeal After a QIC Denial is Issued

 Despite the fact that ALJ hearings are typically conducted by teleconference, the process can still be quite intimidating.  ALJs almost always place testifying providers and their designated “experts” under oath before taking their testimony.  Additionally, if a provider has introduced new evidence into the record, it will be required to show “good cause” for its admission at this late stage of the proceedings.  Finally, most providers find that the ALJ handling their case is quite knowledgeable and typically has extensive experience analyzing coverage requirements and assessing the adequacy of a provider’s documentation.  Providers who have failed to adequately prepare for the hearing are likely to find that the process can be quite difficult.   
Source: aljappeal.com

Matthews Law Firm, Bartow Health Care Compliance and Criminal Defense

The calendar year 2012 AIC threshold amounts are $130 for ALJ hearings and $1,350 for judicial review. This will be the third straight year that ALJ threshold amounts remain at $130, while the threshold amount for judicial review has increased by $50.00.
Source: matthewspa.com

What You Need To Know To Appeal Medicare Findings

If you are still disputing Medicare’s findings after the Redetermination, you may file a request for reconsideration to be conducted by a qualified independent contractor. This must be filed within 180 calendar days of receiving notice of the redetermination decision with a 60-day processing deadline. This step becomes more resource intensive as you will be required to submit a full and early presentation of evidence and explain the reasons for the disagreement with the initial determination and redetermination. If you fail to produce appropriate information, you will be prohibited from filing additional information at later appeals.
Source: annabellemarsh.com

US District Court Denies an Ambulance Services’ Request for Preliminary Injunction Against a Medicare PSC

As to the first factor, the court held that since success on the merits depended on whether or not Nationwide’s services were covered by the Medicare statute, the court did not have the authority to address this claim. In regards to the second factor, the court held that the harm to Nationwide was not irreparable within the meaning of the statute. Although the court expressed its sympathies regarding Nationwide’s “financial dependence on Medicare payments,” it explained that a preliminary injunction could not be granted based purely on monetary harm because monetary harm may be remedied only by compensatory damages. Finally, the court held that the public interest factor weighed heavily against Nationwide. The court emphasized several times throughout the opinion that Congress intended that discretion to determine Medicare coverage is held by the Secretary of Health and Human Services, and plaintiffs are afforded several ways to challenge claims through the Medicare appeals process. Therefore, the court found that the public interest weighed against its ability to interpret the Medicare statute before the administrative remedies had been exhausted.
Source: wachlerblog.com

Five Levels of Appeal Available for Medicare RAC Overpayment Determinations : Health Care Compliance Watch

If at least $1,300.00 or more is still in controversy following the Appeals Council’s decision, a party to the decision may request judicial review before a U.S. District Court Judge.  The appellant must file the request for review within 60 days of receipt of the Appeals Council’s decision.  The amount in controversy required to request judicial review is increased annually by the percentage increase in the medical care component of the consumer price index for all urban consumers.  The amount in controversy threshold for 2011 is $1,300.
Source: healthcarecompliancewatch.com

Adjustment to the 2012 Amount in Controversy Thresholds for Medicare Appeals : Health Industry Washington Watch

annual adjustment in the amount in controversy (AIC) threshold amounts for Administrative Law Judge (ALJ) hearings and judicial review under the Medicare appeals process, effective for requests filed on or after January 1, 2012. The calendar year 2012 AIC threshold amounts are $130 for ALJ hearings (unchanged from 2011) and $1,350 for judicial review (up from $1,300 in 2011).
Source: healthindustrywashingtonwatch.com

Medicare Sign Up: Why You Should Get One

Posted by:  :  Category: Medicare

TWO YEARS OF RUIN by SS&SSIn Medicare Part A, the majority does not have to pay anything while in Medicare Part B, the majority will have to pay monthly. • Part A, or also called Hospital Insurance. It helps you pay for hospital stays, nursing facility, home health care and end-of-life care. The majority automatically acquire a Part A when they turn 65 years of age. You can verify that you have Part A if you have a red, white and blue Medicare card and printed with “HOSPITAL (PART A)”. • Part B, or also called Medical Insurance, will help you pay for physician services, OPD or out-patient services. This plan mostly covers the services that Part A doesn’t cover such as physical and occupational therapists and other medically-required services. You are also free to add other types of coverages on your chosen plan. For example, you can add Part D or Prescription Drug insurance since the prices of drugs today are getting high. It is up to you on what plan to choose besides, you can assess your health needs each year and change to a different plan. Medicare sign up is easy but there are things to consider first and requirements to pass. Be practical and wise in selecting. Empowering ones health nowadays is very, very important. Choose a way that you know will work out the best for you. You can choose base on where you currently reside or what your health really needs the most. Basically, Medicare sign up are suitable for those who have worked for at least 10 years in a Medicare-approved employment and/or for those who are 65 years or older and a local citizen of the United States. Those who have lifetime disability or with kidney failures are also qualified for a Medicare sign up. For further questions and assistance in applying for a Medicare, you can call or visit your local Social Security Office.  
Source: ezinemark.com

Video: Medicare Local – Medicare Marketing and Leads

Online Medicare Advantage Leads

Another factor that would contribute to rate difference is whether a troupe chooses to offer Medicare Supplement Plans to people that are retiring from a Group Plan. What we are referring to is not offering insurance coverage individually but to the total group. Offering insurance coverage to the whole unit would increment the amount of Guaranteed Issue status cases that would have to be written meaning that there is an exalted chance of health topic and in turn advanced rates.
Source: insuranceinfoconnection.com

NEED LEADS Medicare Advantage Leads

Welcome to the Lead Buyer Network. If this is your first visit, be sure to check out the FAQ by clicking the link above. You may have to register before you can post: click the register link above to proceed. To start viewing messages, select the forum that you want to visit from the selection below. Join the Lead Buyer Network Today! You must be associated with the Lead Generation Industry to be accepted as a member. If you are not sure if you comply with that statement, I suggest not joining.
Source: leadbuyernetwork.com

Douglas Hall Canyon Lake CA

Douglas Hall also offering people, turning 65 Medicare Supplement plans that are not even cover what normal supplement do, I do not even know where he did produce them. Douglas Hall, insurance agent from Canyon Lake CA have been trying to dishonest many insurance and lead generating companies on the internet to get a free ride, but himself he in nothing but a SCAM.
Source: wordpress.com

Medicare vs. Medicaid:Your Own Choice

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Source: apssupplements.com

Medicare Supplement Leads

This allows your agents to cover their desired territory by city or county as well as times and days to call on prospects. The leads are screened for existing conditions that would invalidate any type of insurance contract. Medicare supplement leads are basically set as preset appointments so that you will be talking to those that want more information about the benefits of the package in question and need your information. They will be waiting for an agent to come by to explain benefits of the package. These are not the only types of leads that Senior Marketing will generate as far as the senior market is concerned. Besides the Medicare supplement leads, there are also other insurance policies such as reverse mortgage leads. This can be a big boost to your agency.
Source: medicareadvantageleads.com

Medicare Advantage Leads for Sale

Over the past month we have been mailing for medicare advantage and have received thousands of medicare advantage leads all of them are in upstate new york. Unfortunately the parter in our company that had the NY license is no longer working for us and we are STUCK with leads we can’t sell medicare advantage to. These are real leads – you’ll get a copy of the response card 95% of them have phone numbers on them permitting you to call them to setup an appointment. These leads cost us tens of thousands of dollars and I need to get rid of them. Please PM me if you are interested. I’ll only sell them in blocks: 5 leads as a sample $75 25 = $12/ea 50 = $10/ea 100= $9/ea 250=$8.50/ea 1000+=$6/ea You can pay for the samples with paypal, all others must be via company check. I’ll even credit back the $75 for a bulk order. This isn’t a scam, I’m desperate to get rid of these hot leads. I hate to see them go but I would hate to have the respondents not get anyone sending them information. I’ve called around to lead companies but I keep getting disconnected numbers! So I am only selling them here and will only sell them once.
Source: insurance-forums.net

First Edition: November 16, 2011

The original Medicare program has two parts: Part A (Hospital Insurance), and Part B (Medical Insurance). Only a few special cases exist where prescription drugs are covered by original Medicare, but as of January 2006, Medicare Part D provides more comprehensive drug coverage. Medicare Advantage plans, also known as Medicare Part C, are another way for beneficiaries to receive their Part A, B and D benefits. All Medicare benefits are subject to medical necessity. Part A: Hospital Insurance Part A covers inpatient hospital stays (at least overnight), including semiprivate room, food, tests, and doctor’s fees. Part A covers brief stays for convalescence in a skilled nursing facility if certain criteria are met: 1. A preceding hospital stay must be at least three days, three midnights, not counting the discharge date. 2. The nursing home stay must be for something diagnosed during the hospital stay or for the main cause of hospital stay. 3. If the patient is not receiving rehabilitation but has some other ailment that requires skilled nursing supervision then the nursing home stay would be covered. 4. The care being rendered by the nursing home must be skilled. Medicare part A does not pay for custodial, non-skilled, or long-term care activities, including activities of daily living (ADL) such as personal hygiene, cooking, cleaning, etc. The maximum length of stay that Medicare Part A will cover in a skilled nursing facility per ailment is 100 days. The first 20 days would be paid for in full by Medicare with the remaining 80 days requiring a co-payment (as of 2009, $133.50 per day). Many insurance companies have a provision for skilled nursing care in the policies they sell. If a beneficiary uses some portion of their Part A benefit and then goes at least 60 days without receiving facility-based skilled services, the 100-day clock is reset and the person qualifies for a new 100-day benefit period. Part B: Medical Insurance Part B medical insurance helps pay for some services and products not covered by Part A, generally on an outpatient basis. Part B is optional and may be deferred if the beneficiary or their spouse is still actively working. There is a lifetime penalty (10% per year) imposed for not enrolling in Part B unless actively working. Part B coverage includes physician and nursing services, x-rays, laboratory and diagnostic tests, influenza and pneumonia vaccinations, blood transfusions, renal dialysis, outpatient hospital procedures, limited ambulance transportation, immunosuppressive drugs for organ transplant recipients, chemotherapy, hormonal treatments such as Lupron, and other outpatient medical treatments administered in a doctor’s office. Medication administration is covered under Part B only if it is administered by the physician during an office visit. Part B also helps with durable medical equipment (DME), including canes, walkers, wheelchairs, and mobility scooters for those with mobility impairments. Prosthetic devices such as artificial limbs and breast prosthesis following mastectomy, as well as one pair of eyeglasses following cataract surgery, and oxygen for home use is also covered. Complex rules are used to manage the benefit, and advisories are periodically issued which describe coverage criteria. On the national level these advisories are issued by CMS, and are known as National Coverage Determinations (NCD). Local Coverage Determinations (LCD) only apply within the multi-state area managed by a specific regional Medicare Part B contractor, and Local Medical Review Policies (LMRP) were superseded by LCDs in 2003. Coverage information is also located in the CMS Internet-Only Manuals (IOM), the Code of Federal Regulations (CFR), the Social Security Act, and the Federal Register. Part C: Medicare Advantage plans With the passage of the Balanced Budget Act of 1997, Medicare beneficiaries were given the option to receive their Medicare benefits through private health insurance plans, instead of through the original Medicare plan (Parts A and B). These programs were known as “Medicare+Choice” or “Part C” plans. Pursuant to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, “Medicare+Choice” plans were made more attractive to Medicare beneficiaries by the addition of prescription drug coverage and became known as “Medicare Advantage” (MA) plans. Traditional or “fee-for-service” Medicare has a standard benefit package that covers medically necessary care members can receive from nearly any hospital or doctor in the country. For people who choose to enroll in a Medicare Advantage health plan, Medicare pays the private health plan a capitated rate, or a set amount, every month for each member. Members typically also pay a monthly premium in addition to the Medicare Part B premium to cover items not covered by traditional Medicare (Parts A & B), such as prescription drugs, dental care, vision care and gym or health club memberships. In exchange for these extra benefits, enrollees may be limited in the providers they can receive services from without paying extra. Typically, the plans have a “network” of providers that patients can use. Going outside that network may require permission or extra fees. Medicare Advantage plans are required to offer coverage that meets or exceeds the standards set by the original Medicare program, but they do not have to cover every benefit in the same way. If a plan chooses to pay less than Medicare for some benefits, like skilled nursing facility care, the savings may be passed along to consumers by offering lower copayments for doctor visits. Medicare Advantage plans use a portion of the payments they receive from the government for each enrollee to offer supplemental benefits. Some plans limit their members’ annual out-of-pocket spending on medical care, providing insurance against catastrophic costs over $5,000, for example. Many plans offer dental coverage, vision coverage and other services not covered by Medicare Parts A or B, which makes them a good value for the health care dollar, if you want to use the provider included in the plan’s network or “panel” of providers. Because the 2003 payment formulas overpay plans by 12 percent or more compared to traditional Medicare,[11] in 2006 enrollees in Medicare Advantage Private Fee-for-Service plans were offered a net extra benefit value (the value of the additional benefits minus any additional premium) of $55.92 a month more than the traditional Medicare benefit package; enrollees in other Medicare Advantage plans were offered a net extra benefit value of $71.22 a month more.[12] However, Medicare Advantage members receive additional coverage and medical benefits not enjoyed by traditional Medicare members, and savings generated by Medicare Advantage plans may be passed on to beneficiaries to lower their overall health care costs.[10] Other important distinctions between Medicare Advantage and traditional Medicare are that Medicare Advantage health plans encourage preventive care and wellness and closely coordinate patient care.[13] Medicare Advantage Plans that also include Part D prescription drug benefits are known as a Medicare Advantage Prescription Drug plan or a MA-PD. Enrollment in Medicare Advantage plans grew from 5.4 million in 2005 to 8.2 million in 2007. Enrollment grew by an additional 800,000 during the first four months of 2008. This represents 19% of Medicare beneficiaries. A third of beneficiaries with Part D coverage are enrolled in a Medicare Advantage plan. Medicare Advantage enrollment is higher in urban areas; the enrollment rate in urban counties is twice that in rural counties (22% vs. 10%). Almost all Medicare beneficiaries have access to at least two Medicare Advantage plans; most have access to three or more. Because of the 2003 law’s overpayments, the number of organizations offering Fee-for-Service plans has increased dramatically, from 11 in 2006 to almost 50 in 2008. Eight out of ten beneficiaries (82%) now have access to six or more Private Fee-for-Service plans.[14] Each year many individuals disenroll from MA plans. A recent study noted that about 20 percent of enrollees report that “their most important reason for leaving was due to problems getting care.”[15] There is some evidence that disabled beneficiaries “are more likely to experience multiple problems in managed care.”[16] Some studies have reported that the older, poorer, and sicker persons have been less satisfied with the care they have received in MA plans.[17] On the other hand, an analysis of the Agency for Healthcare Research and Quality data published by America’s Health Insurance Plans found that Medicare Advantage enrollees spent fewer days in the hospital than Fee-for-Service enrollees, were less likely to have “potentially avoidable” admissions, and had fewer re-admissions. These comparisons adjusted for age, sex and health status using the risk score used in the Medicare Advantage risk adjustment mechanism.[18][19] In December 2009 the Kaiser Family Foundation published a report that rated Medicare Advantage organizations on a five star scale. The ratings were based on data from CMS, the Consumer Assessment of Healthcare Providers and Systems (CAHPS), Healthcare Effectiveness Data and Information Set (HEDIS) data, and the Health Outcomes Survey (HOS). New plans did not receive ratings, because data were not available. Almost six out of ten (59%) of MA plans did receive ratings, and these plans represented 85% of the enrollment for 2009. The average rating was 3.29 stars. Twenty-three percent of enrollees were in a plan with four or more stars; 20% were in a plan with fewer than three stars.[20] Twenty percent of African-American and 32 percent of Hispanic Medicare Beneficiaries were enrolled in Medicare Advantage plans in 2006. Almost half (48%) of Medicare Advantage enrollees had incomes below $20,000, including 71% of minority enrollees.[21] Others have reported that minority enrollment is not particularly above average.[22] Another study has raised questions about the quality of care received by minorities in MA plans.[23] The Government Accountability Office reported that in 2006, the plans earned profits of 6.6 percent, had overhead (sales, etc.) of 10.1 percent, and provided 83.3 percent of the revenue dollar in medical benefits. These administrative costs are far higher than traditional fee-for-service Medicare.[24] [edit] Part D: Prescription Drug plans Main articles: Medicare Part D and Medicare Part D coverage gap Medicare Part D went into effect on January 1, 2006. Anyone with Part A or B is eligible for Part D. It was made possible by the passage of the Medicare Prescription Drug, Improvement, and Modernization Act. In order to receive this benefit, a person with Medicare must enroll in a stand-alone Prescription Drug Plan (PDP) or Medicare Advantage plan with prescription drug coverage (MA-PD). These plans are approved and regulated by the Medicare program, but are actually designed and administered by private health insurance companies. Unlike Original Medicare (Part A and B), Part D coverage is not standardized. Plans choose which drugs (or even classes of drugs) they wish to cover, at what level (or tier) they wish to cover it, and are free to choose not to cover some drugs at all. The exception to this is drugs that Medicare specifically excludes from coverage, including but not limited to benzodiazepines, cough suppressant and barbiturates. Plans that cover excluded drugs are not allowed to pass those costs on to Medicare, and plans are required to repay CMS if they are found to have billed Medicare in these cases. It should be noted again for beneficiaries who are dual-eligible (Medicare and Medicaid eligible) Medicaid may pay for drugs not covered by part D of Medicare, such as benzodiazepines, and other restricted controlled substances.
Source: medicare-health.com

Medicare Advantage scam crackdown hits Fresno business

/*Hussein Osman Ali*? is a convicted felon who’s accused of using deceptive practices to sell Medicare Advantage plans and collect big bonuses. Ali told Action News he’s never sold the plans, he just manages people who do, and he says the government hasn’t told him about any sanctions.
Source: ptmanagerblog.com

Too Many Medicare Advantage Choices Can Decrease Enrollment

To examine the effects of multiple plan options on enrollment in Medicare Advantage, the authors looked at 21,815 enrollment decisions from 2004 to 2007 made by 6,672 participants in the Health and Retirement Study, a national longitudinal survey conducted biennially by the University of Michigan. They found that if fifteen or fewer plans were available in a region, more choices usually led to an increase in Medicare Advantage enrollment. When the number of options surpassed thirty, as it did in 25 percent of US counties, more choice was associated with decreased enrollment in the program.
Source: healthaffairs.org

health insurance sales leads: How Can You Get Absolute Allowance Quotes Quickly And Easily?

How abundant advantage do you need? That depends on why you are affairs a policy. Is it to assure your apron or accomplice and admired ones in the accident of your death? You wish to accomplish abiding they can abide to reside calmly and adore the superior of activity you accept formed so harder to accommodate for them. Or conceivably you are gluttonous advantage to armamentarium your children’s academy education? Or maybe you wish a action that can awning the amount of any end of activity analysis not covered by your bloom allowance or Medicare? Or you may wish a action that enables your admired ones to calmly allow the amount of your burying and burying or cremation?
Source: newonlinehealth.com

The Changes and Development with Insurance Sales that You can Take Advantage Of

With the changes that the internet has brought on, you can also ride on the biggest change in the marketing of insurance where senior leads will provide the biggest payoffs today. If you’re concentrating on the individual market, you can do well listening to advice from top producers that the senior market is going to be even bigger than that. It’s true, you’re going to need to make use of a different approach to sell insurance to seniors but you actually have everything that you need with you right now, the internet, tools like quote engines, leads providers and even the advice of seasoned insurance agents.
Source: medicare-insuranceleads.com

Highmark Medicare Services Awarded New Contract from Centers for Medicare & Medicaid Services

Posted by:  :  Category: Medicare

Highmark Medicare Services administers contracts on behalf of the Federal government and is a wholly owned subsidiary of Highmark Inc.  Highmark Medicare Services’ mission is to provide quality services and innovative solutions in the administration of our government contracts, according to our core values (fiscal responsibility, operational excellence, customer focus, continuous improvement, and commitment to integrity), in support of stakeholder goals.
Source: virtualizationconference.com

Video: Pittsburgh Celebrates Medicare’s Anniversary

Highmark lands Medicare contract that could create jobs in the Harrisburg area

The contract involves processing Medicare claims for a region that includes Louisiana, Arkansas, Mississippi, Texas, Oklahoma, Colorado and New Mexico. Highmark already has an identical contact for claims from Pennsylvania, New Jersey, Maryland, Delaware and the District of Columbia.
Source: pennlive.com

Highmark Medicare subsidiary expects to add 500 jobs

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Source: shopexchanges.info

November 1 is the Deadline to Apply for a Medicare E

Some physicians who were not eligible for the e-prescribing incentive program, may not be subject to the 1% penalty. However, those physicians must do the calculations to determine if they fall into these ineligible categories. Ineligible categories include: physicians who had less than 100 claims that fall in the e-prescribing measure specifications; or physicians whose e-prescribing measure specifications represented less than 10% of their allowable part B charges. The time period to calculate these two categories is between January 1, 2011 and June 30, 2011. View an MSNJ tip sheet on how to calculate the 10% eligibility threshold. Physicians will have to review all claims submitted to determine if they have less than 100 cases.) Source: wordpress.com
Source: medicaresupplementalco.com

Trailblazer Loses Medicare Contract ::

The Centers for Medicare & Medicaid Services (CMS) says Highmark Medicare Services  will replace TrailBlazer Healthcare Enterprises in paying Medicare Part A and Part B fee-for-service claims in Texas by late July 2012. Highmark also will handle claims in Arkansas, Colorado, Louisiana, Mississippi, New Mexico, and Oklahoma. It now administers claims in Delaware, New Jersey, Pennsylvania, Maryland, and the District of Columbia. 
Source: solutionsformedicalbilling.net

November 1 is the Deadline to Apply for a Medicare E

Some physicians who were not eligible for the e-prescribing incentive program, may not be subject to the 1% penalty. However, those physicians must do the calculations to determine if they fall into these ineligible categories. Ineligible categories include: physicians who had less than 100 claims that fall in the e-prescribing measure specifications; or physicians whose e-prescribing measure specifications represented less than 10% of their allowable part B charges. The time period to calculate these two categories is between January 1, 2011 and June 30, 2011. View an MSNJ tip sheet on how to calculate the 10% eligibility threshold. Physicians will have to review all claims submitted to determine if they have less than 100 cases.)
Source: wordpress.com

Medicare contract to boost Highmark hiring

2012 Election Aging Airlines/Airports/Airplanes/Air Travel/Fares/Fees Australia California (CA) Canada China Computer Security Curious News European Debt Crisis Finance & Business Florida (FL) Former Gov Mitt Romney (R-Massachusetts) Gov Rick Perry (R-Texas) Health Illinois (IL) Inflation/Deflation IRAs/401k/Pensions Jigsaw Puzzle Jobs/Employment/Unemployment Kids/Children/Teenagers Medicaid Medicare Medicare Reform Military/Defense/US Armed Forces National Debt/Deficits New York (NY) Obesity/Weight Loss/Gain Organized Labor/Unions/Strikes/Public/Private Pensions Political Opinion Politics Pres Barack Obama (D) Retirement Retirement Savings/Withdrawals Scam Scams/Cons Social Security Social Security Reform Spending Cuts Taxes Travel UK/Britain/England US Debt Ceiling/Debt Limit Wisconsin (WI)
Source: elder-gateway.com

Review of Medicare Payments Exceeding Charges for Outpatient Services Processed by Highmark Medicare Services in Jurisdiction 12 for the Period January 1, 2006, Through June 30, 2009 (A

Our audit found that 1,027 of the 1,507 selected line items for which Highmark Medicare Services (Highmark) made Medicare payments to providers for outpatient services for the period January 1, 2006, through June 30, 2009, were incorrect. The line items included overpayments totaling approximately $6.8 million that the providers had not refunded by the beginning of our audit. Providers refunded overpayments on 71 line items totaling approximately $2.0 million before our fieldwork. The remaining 409 line items were correct.
Source: wordpress.com

Ga Medicare Designs ? Greatest Prescription Narcotic Plans, Identify Who For you to Trust

Posted by:  :  Category: Medicare

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Source: thewallstreetcloner.com

Video: Georgia retirees celebrate Medicare, Social Security Birthday

Bobbie Paul: Cut Missiles, Not Medicare

Bobbie Paul serves as Executive Director of Georgia WAND. She has spent almost 25 years supporting the vision of WAND’s founder – Dr. Helen Caldicott – to gradually rid the world of nuclear weapons. She has helped the Georgia chapter define its three areas of concentration across the state and Southeast region:  Peace in Action, Environmental Justice and Empowering People to Act Politically. Paul has watch-dogged Savannah River Site (SRS) for over fifteen years and led campaigns to successfully restore Department of Energy (DOE) environmental monitoring of SRS in Georgia. Paul is a former theatre professional and the co-founder of a regional theatre company in St. Petersburg, Florida (now known as American Stage Company). She has worked for the US Department of State as a theatre specialist in Egypt and Jordan.
Source: gawand.org

Medicare Supplement Plans GA: Stop Overpaying. Find The Best Plan Value

Medicare Supplement Plans GA, Stop Overpaying, Find the Best Value was written by Bob Vineyard, CLU. We are your number one resource for complete information on Medicare benefits and supplement plans. We serve senior clients on Medicare all over Georgia, and have the lowest priced Medigap plans in the state. Your needs come first, not our own. To assist you best, we tell it like it really is. Visit Georgia Medicare Plans at http://georgia-medicareplans.com
Source: 93705.info

Commonly Used Medicare Modifiers

The analysis of any medical billing or coding question is dependent on numerous specific facts — including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies (as well as coding itself) are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly.
Source: capturebilling.com

Target waste and fraud, not Medicare patients

Although a home health co-pay would be intended to generate Medicare savings, it could actually drive costs up, both for seniors and for the government. Research shows that requiring co-pays could shift costs of care from Medicare to Medicaid, and it could drive up Medicare costs by forcing patients to seek costlier inpatient services. Some beneficiaries, when faced with a high co-pay, might simply try to do without the home health care they need. That, in turn, could cause them to suffer worse medical problems, and they would wind up requiring treatment in a more expensive institutional setting.
Source: georgiahealthnews.com

Medicare Part B premiums for 2012 lower than projected :: Georgia Politico

The majority of people with Medicare have paid $96.40 per month for Part B since 2008, due to a law that freezes Part B premiums in years where beneficiaries do not receive cost-of-living (COLA) increases in their Social Security checks. In 2012, these people with Medicare will pay the standard Part B premium of $99.90, amounting to a monthly change of $3.50 for most people with Medicare. This increase will be offset for almost all seniors and people with disabilities by the additional income they will receive thanks to the Social Security cost-of-living adjustment (COLA). For example, the average COLA for retired workers will be about $43 a month, which is substantially greater than the $3.50 premium increase for affected beneficiaries. Additionally, the Medicare Part B deductible will be $140, a decrease of $22 from 2011.
Source: gapolitico.com

My life…(with a side of Lupus): Response from my GA Senator Saxby Chambliss

Organ transplant recipients must take immunosuppressive drugs daily for the life of the transplant in order to prevent rejection of the organ by the body.  The Medicare End Stage Renal Disease (ESRD) program pays for dialysis, transplantation, and immunosuppressive drugs for kidney disease patients.  However, the program ends its coverage after 36 months for those who do not qualify for Medicare or Medicaid. 
Source: blogspot.com

Atlanta doctor sentenced for Medicare, Medicaid fraud

But law enforcement officials contended that he did not provide all the services for which he was billing. An investigation by the FBI and Georgia’s Medicaid Fraud Control unit allegedly showed that many of the doctor’s reported patients were actually deceased or were not in a nursing home setting. Prosecutors argued that it would have not been possible for the doctor to have actually provided all of the services for which he submitted claims.
Source: atlantafederalcriminaldefenseattorney.com

GA medicare supplemental insurance for disability

There are many supplemental insurance providers who provide discounts throughout begin enrollment. In some cases, the applicant’s achieve reduction can be as broad as 15%. This savings will carry more than into subsequent years helping to have premiums lower as the insured grows older. Additionally, some insurance businesses will require underwriting for common supplements, like concept J, if the applicant is more than 3 months past their 65th birthday. If applying during originate enrollment, health underwriting will not be required for understanding J.
Source: carinsurancesaga.com

Watch for PECOS warning on DMEPOS remittance advice

Posted by:  :  Category: Medicare

Optometrists who provide eyeglasses to Medicare patients using prescriptions that are written by other physicians should watch for the notice “Ordering Provider Not Authorized” on remittance advice forms, the AOA Advocacy Group warns. The advisory indicates that Medicare, in the future, will not cover eyewear ordered by the optometrist or ophthalmologist listed on the prescription because the prescriber does not have a complete enrollment record in Medicare’s Provider Enrollment, Chain, and Ownership System (PECOS).
Source: newsfromaoa.org

Video: Audio Educator: Medicare Enrollment PECOS The CMS 855.mp4

“The Basics” Chiropractic Medicare: No Out

Newsletter November 9, 2011 Chiropractic Medicare Dear Doctors and Staff, 1.  No Out-of-pocket Expense – Medicare 2.  CMS 855i or PECOS 3.  Medicare Fees 1.  It is against the law to practice No Out-Of-Pocket expense in Medicare.  If you are a participating provider, you have signed a contract with the Federal Government that you will “accept assignment” on ALL Medicare patients.  The Medicare reimbursement of 80% always comes to the doctor.  However, the doctor MUST collect the other 20% from either the patient or the patient’s supplemental insurance.  Only accepting the 80% of what Medicare pays is called No Out-Of-Pocket expenses, which is a breach of Medicare law. 2.  CMS 855i Application or PECOS must be completed by All Chiropractors.  If you have not gone on line and completed PECOS or downloaded CMS 855i off the CMS website and completed…DO IT NOW!  If you do not, there will be NO Medicare reimbursement in the near future. 3.  Our Medicare fees have been posted for 2012.  All have been decreased by about 21%.  We again wait on Congress to move on this issue, the same as earlier this year.  With any luck, we may have our fees restored with minimal increases over 2011.
Source: blogspot.com

Clarification of Provider Enrollment Revalidation

It saves you time, therefore, it cuts costs. It is easy to overlook required fields on a Medicare paper application that is 60 pages long. The obvious advantage of this automated system is that it has edits to ensure required fields are completed thus reducing delays due to incomplete information. Simple things like address changes are handled faster. The ability to update, view, and check status gives you more control. You will need an approved enrollment record in PECOS to continue to order or refer items or services for Medicare beneficiaries.  To clarify, if you refer a Medicare patient for services, the provider you referred to will not be paid unless you have your approvedPECOSenrollment in place. Medicare incentive payments require that you are enrolled in PECOS. Medicare and Medicaid providers that use qualified electronic health records systems or e-prescribing and they meet meaningful use requirements, may be eligible to receive stimulus payments in accordance with the American Recovery and Reinvestment Act of 2009 (ARRA), Title XIII, known as the HITECH Act. You can find out more about this at: http://www.cms.hhs.gov/Recovery/11_HealthIT.asp. Source: valeriani.com
Source: medicaresupplementalco.com

Improve Your Medical Billing Efficiency With PECOS

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Source: personalhealthcaretips.com

Musings about meaningful use: Perspectives from the C

Accountable Care Organizations, Clinical integration, Clinical IT, CDS and data analytics, Cloud, Cloud computing, Coding and documentation, Compliance, Data analytics, Data management, Data management and data standards, Data privacy, data privacy and security, Data security, Data storage, Disaster recovery and business continuity, EHR, EHR Adoption, EHR functionality, EHR implementation, EHR incentives, EHR integration, EHR systems, electronic health records, Health care applications and vendor organizations, Health care models and frameworks, Health care reform and federal initiatives, health information exchange, healthcare storage virtualization, HIE, HIMSS 2011, HIPAA, HIPAA Academy, HITECH, ICD-10, iHT2, Industry organizations and associations, Interoperability and health information exchange, Live chat, Meaningful use, mHealth, Mobile devices and telehealth, mobile health, Networking, PHI, PHRs and patient engagement, Privacy and security, REC, virtualization, Virtualization and cloud computing, webcast
Source: techtarget.com

PECOS: Will your Medicare claims be rejected?

It is not too late to enroll in PECOS and avoid possible denials. The Centers for Medicare & Medicare Services (CMS) had previously announced that, beginning January 3, 2011, it would automatically deny claims for services ordered by physicians not yet enrolled in PECOS.  However, due to enrollment backlogs and other systems issues, CMS decided to delay the start of these automatic claims edits.
Source: wordpress.com

Do you understand the Revalidation of Provider Enrollment Information Process?

CMS has extended the revalidation period for another two years which means the notices will be sent on a regular basis through March of 2015.  When you receive your revalidation notice, you must respond either through internet-based PECOS, which is the most efficient way, or by completing the appropriate 855 application form.  The first set of revalidation letters were sent Medicare providers who are actively billing and who were not in PECOS.  The letter will go to the primary practice or special payment address if you are not listed in PECOS.  If you are listed in PECOS, the letter will be sent to the special payments and correspondence addresses simultaneously.  If those addresses are the same, CMS will send one to the primary practice address as well. 
Source: askccg.com

Update to Scope of DMEPOS Claims Editing for Referring/Ordering Provider

Change Request (CR) 6421 was recently revised to remove chiropractors from the list of providers who may order or refer for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS).  All other information in the CR remained the same.  As you will recall, in CR 6421, the Centers for Medicare & Medicaid Services (CMS) started the expansion of claim editing to meet the Social Security Act requirements for ordering and referring providers.    The claim editing is being expanded to verify that the ordering/referring provider on a claim is eligible to order/refer and is enrolled in Medicare and the Provider Enrollment, Chain and Ownership System (PECOS).
Source: hallrender.com

Codingahead: BASICS OF MEDICARE PROVIDER

This fact sheet is designed to provide education on how physicians and non-physician practitioners should enroll in the Medicare Program and maintain their enrollment information using Internet-based PECOS. It includes information on how to complete an enrollment application using Internet-based PECOS and a list of frequently asked questions and resources.
Source: blogspot.com

Bergen County Medical Society: CMS Pushes Back Medicare Revalidation Deadline to 2015

Responding to pressure from physician organizations, the agency administering the Medicare program will extend by two years the deadline to re-enroll more than 750,000 physicians. The move will provide the Centers for Medicare & Medicaid Services with more time as it embarks on the massive enrollment revalidation effort. The latest change to the timeline would allow for a smoother re-enrollment process, CMS said. The Medicare agency had planned to re-enroll 1.4 million physicians, nonphysician practitioners and other health care professionals by March 2013. Physicians revalidating their enrollment records would be subjected to new screening controls required by the health system reform law. The new standards are designed to prevent fraud in the Medicare system. But physicians are considered to be low fraud risks and would be subject only to license and identification verifications instead of the more stringent screenings required for device suppliers and home health firms. The American Medical Association had requested the delay in September. In doing so, the Association asked CMS to re-examine the statute requiring the revalidation and to consider other changes to enrollment. “We are very pleased that CMS has agreed to the two-year extension on the deadline to revalidate physicians’ Medicare status,” said AMA President Peter W. Carmel, MD. “This extension, recommended by the AMA, allows physicians to be one of the last groups who will have to face this time-consuming process.” The AMA and other health professional organizations said Medicare contractors would have been hard-pressed to revalidate 1.4 million enrollment records within an 18-month window. Contractors already process about 27,000 new enrollments and more than 30,000 billing reassignments each month. The organizations worried that the new revalidation effort would have led to application backlogs or other unintended consequences, such as doctors being inadvertently banned from the program. The health system reform law says that by March 23, 2013, no physician or other health professional may be enrolled or re-enrolled in Medicare without going through the enhanced screening procedures. A Sept. 23 letter from the AMA to CMS referenced the law and noted that the section did not require the agency to complete the effort by the 2013 date. The law provided flexibility to implement the new screening methods from that date onward, the Association said. However, the extra time given to physicians will not affect those doctors and practices who already have received a revalidation notice, CMS said. The physician still must meet the deadlines outlined in the revalidation letter he or she received. Failing to revalidate within the designated timeframe will cause a physician’s enrollment record to be deactivated. The first set of revalidation notices were sent to those who bill for Medicare services but are not in CMS’ electronic enrollment record, the agency said. Typically, these recipients are doctors who have not updated their enrollment in several years. Medicare contractors searched enrollment databases to determine which physicians are not in the electronic system. The Association had recommended that CMS exempt physicians from the revalidation effort altogether because they are low fraud risks to Medicare. The Medicare agency also should allow physicians to revalidate at any time, and not require doctors to print, sign and mail enrollment certification statements when applications are submitted online, the AMA said. CMS declined to exempt physicians from the process, but it was willing to make other changes. A Nov. 4 CMS email on the revalidation states that physicians who believe they are not in Medicare’s Provider, Enrollment, Chain, and Ownership system, or PECOS, can call their administrative contractors about revalidating. The agency also has told the AMA that it will make improvements to the online enrollment system. New features will include electronic signatures, document upload capabilities, seamless password resets, enhancements for authorized officials, reassignment reports, new “My enrollments page” and “Fast track view” screens, and fewer duplicative document submission requirements. CMS has said it will introduce these changes by the end of 2012.
Source: blogspot.com

An Exhaustive (and Exhausting) Medicare Roundup for November 18, 2011 Including the Revalidation Call Transcript, 5010 Enforcement Delay, Medicare Sends Less Collection Letters and ICD

Today the Centers for Medicare & Medicaid Services Office of E-Health Standards and Services (OESS) announced that it would not initiate enforcement action until March 31, 2012, with respect to any HIPAA covered entity that is not in compliance with the ASC X12 Version 5010 (Version 5010), NCPDP Telecom D.0 (NCPDP D.0) and NCPDP Medicaid Subrogation 3.0 (NCPDP 3.0) standards. Notwithstanding OESS discretionary application of its enforcement authority, the compliance date for use of these new standards remains January 1, 2012 (small health plans have until January 1, 2013 to comply with NCPDP 3.0).
Source: managemypractice.com

CMS Announces $523 Medicare, Medicaid, & CHIP Enrollment Application Fee for 2012 : Health Industry Washington Watch

2012 application fee for institutional providers (excluding physicians and nonphysician practitioners) enrolling in Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP) will be $523 – up from $505 in 2011. CMS uses a broad definition of institutional entities subject to the application fee; it applies to “any provider or supplier that submits a paper Medicare enrollment application using the CMS-855A, CMS-855B (not including physician and non-physician practitioner organizations), CMS-855S or associated Internet-based PECOS enrollment application.” As authorized under CMS’s February 2011 final Medicare/Medicaid/CHIP provider screening rule, institutional providers must pay the application fee when initially enrolling in the Medicare or Medicaid programs or CHIP; revalidating their Medicare, Medicaid or CHIP enrollment; or adding a new Medicare practice location (unless a hardship exemption applies).
Source: healthindustrywashingtonwatch.com

CMS Posts Medicare Learning Network Enrollment Fact Sheet to Help Educate Ordering Physicians

The Centers for Medicare & Medicaid Services has issued new educational materials for physicians and other ordering and referring practitioners. This fact sheet provides education on the enrollment requirements for eligible ordering/referring providers. In the fact sheet CMS spells out who the requirements apply to as follows:
Source: wordpress.com

MiraVista: Medicare News Blog

wait to submit important change of information updates to the NSC, such as a change in the types of products supplied or the opening of a new location, you must wait until you have been contacted by the NSC to submit a formal revalidation package (either via PECOS or a paper CMS-855S). Initially, CMS gave contractors until March 23, 2013 to send revalidation request letters to all currently enrolled suppliers and providers. However, after performing an assessment of the task at hand, CMS has extended that timeline to March 23, 2015.
Source: miravistallc.com

Texas Lawsuit Identifies Problems In Medicare Hospice Provisions

Posted by:  :  Category: Medicare

i don't need your rockin' chair... by jmtimagesRehfeldt claims he discovered that the medical director for Vitas’ local office, Justo Cisneros, simultaneously worked as a medical director and doctor for the two HMOs, WellMed Medical Management Group, based in San Antonio, and Care Level Management, run by Inspiris, a Tennessee company. There, Cisneros was in a position to refer the chronically ill HMO patients to Vitas — and to then certify them as meeting Medicare’s hospice rules, the lawsuit alleges. The lawsuit says Cisneros executed the plan with Keith Becker, a former general manager of Vitas’ San Antonio office who is now an executive at Inspiris.
Source: kaiserhealthnews.org

Video: Medicare Supplements in Texas: What to Look For When Choosing a Plan

NAMI Texas Voices Concern over Medicaid Part D Cuts

Increasing cost-sharing or raising co-insurance may cause many – particularly those with chronic conditions that require high-cost drugs or biologics – to face severe financial hardship and/or forego necessary treatment, which will ultimately drive up costs in other parts of the Medicare program.  We ask that you carefully consider the impact on beneficiaries of any changes to the Part D program.  As additional people enter the Medicare program over time, Part D will become even more essential in maintaining health and reducing costs.  Making significant changes that create obstacles to beneficiaries’ access to prescription drugs will render the program less effective.  This would be unfortunate – and unnecessary – for the Medicare population, the entire Medicare program, and the entire nation.  NAMI Texas urges you and your colleagues on the Joint Committee to resist proposals to erode beneficiary protections in Part D that ensure broad and accessible prescription drug formularies.
Source: wordpress.com

Texas Medicare Plans 2012

[…] With so many choices in the state of Texas for Medicare Plans in 2012, it would be wise to do you due diligence when it comes to selecting the right type of Medicare coverage for you.  Depending on where you live in Texas will determine the amount of choices you have.  For Example, if you live in Angelina or Armstrong county you will have only a couple of choices, but if you live in Bexar or Collin counties you will have many more options.Source: medicare-plans.net […]
Source: medicare-plans.net

Medical Malpractice Tort Reform in Texas : Day On Torts

These findings are no big surprise to anyone who has ever thought through the issue, Whether tort reform targets malpractice victims in particular or tort victims as a whole, its only goal is to protect wrongdoers and increase the profits of those that insure them. Twenty-five years ago, the insurance companies were on the front-line of this fight. They quickly figured out (they are pretty smart – there is a reason that they own all the big buildings) that they were not the best advocates for the cause, so they funded doctors and "small businesses" to fight the fight. Legislators, always eager to help doctors and small businesses, bought toe tort reform line and limited the rights of their constituents. 
Source: dayontorts.com

Houston nightclub investor accused of Medicare fraud

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Source: emsnetwork.org

Medicare Announces Prepayment Review And Prior Authorization Demonstration Project For Power Mobility Devices

The prior authorization demonstration does not create new documentation requirements for providers and suppliers – it simply requires them to provide the information earlier in the claims process. After receiving the prior authorization request, Medicare will conduct a medical review and communicate the coverage decision (based on Medicare policies such as National Coverage Determinations (NCD) and Local Coverage Determination (LCD) to the patient, provider and supplier within 10 business days of receiving the request. Under rare, emergency circumstances, Medicare must complete this process in 48 hours. Physicians or treating practitioners can make unlimited requests, but Medicare has 30 days to consider any resubmitted requests. Claims with approved prior authorization requests will be paid if all other Medicare coverage and documentation requirements are met.
Source: myedutrax.com

Half Of Texas Doctors May Quit Medicare If It’s Cut

pay more. get less. be happy. while government employees we pay have the best medical and retirement program in the country maybe the world the people who pay for it are abused, ignored and deprived basic services they have earned and payed for. our government has become to big, too self empowered and too corrupt to deserve to exist as it is today. its time for change.
Source: cbslocal.com

CMS Issues Final Medicare Physician Fee Schedule Rule for 2012 : Health Industry Washington Watch

Posted by:  :  Category: Medicare

Congressman Kendrick B. Meek by cliff1066™has adopted a controversial policy to expand its multiple procedure payment reduction (MPPR) policy for advanced imaging services (computed tomography scans, magnetic resonance imaging, and ultrasound), which now applies to only the technical component (TC) of the service, to the professional component (PC) of the service. Effective January 1, 2012, the advance imaging procedures with the highest PC and TC payments will be paid in full, but the PC payment will be reduced by 25% for subsequent procedures furnished to the same patient, by the same physician — including physicians in the same group practice — in the same session on the same day (CMS initially had proposed reducing the PC by 50%). The TC payment will continue to be reduced by 50%.
Source: healthindustrywashingtonwatch.com

Video: How Can Medicare Physicians Get MIPPA e-Prescribing Incentive Payments?

Medicare Physician Revalidation Extended Two Years to March 2015 and a Sample Revalidation Letter

In accordance with the Patient Protection and Affordable Care Act, Section 6401 (a), all new and existing providers must be reevaluated under the new screening guidelines in Section 6028. Medicare requires all enrolled providers & suppliers to revalidate enrollment information every five years (reference 42 CFR 424.57(e)). To ensure compliance with these requirements, existing regulations at 42 CFR 424.515(d) provide that CMS is permitted to conduct off-cycle revalidations for certain program integrity purposes. Upon the CMS request to revalidate its enrollment, the provider/supplier has 60 days from the date of this letter to submit complete enrollment information using one of the following methods: Providers and suppliers can enroll in the Medicare program using either the:
Source: managemypractice.com

Physician Advice Through RUC On Valuing Services Helps Medicare, Primary Care

The need to fix the overall Medicare physician payment system. While the work of the RUC is focused on providing recommendations to the government on how to divide the set Medicare budget, the size of that budget itself is of far greater concern to patients and physicians. Because of the continuing threat of across-the-board Medicare physician payment cuts, access to care for everyone who relies on Medicare – or who will some day – is in jeopardy. All physicians who serve Medicare patients are facing a 27.4 percent cut on January 1 because of the broken Medicare physician payment formula. Medicare payment rates are already low, leaving a 20 percent gap between payments updates and the growing cost of caring for patients.
Source: healthaffairs.org

American College of Physicians supports framework to repeal the SGR formula

The MEDICARE PHYSICIAN PAYMENT INNOVATION ACT proposal prevents devastating cuts in payments for physician services, including a cut of more than 27 percent scheduled to go into effect on January 1, 2012. If Congress allows this cut to go into effect, physicians will have to consider a range of painful options, including closing their practices; limiting how many Medicare patients that they can see; laying off staff; and postponing purchase of electronic health records and other investments to improve patient care.
Source: book4doc.com

AMA President: “Medicare physician pay cut must be stopped now.”

ARTICLE DATA: Reviewer: Mian, Burhan Ahmed MBBS Electrocardiography is a graphical recording of electrical potentials generated due to transmission of depolarization wave through heart and due to its spread into surrounding tissues and body surfaces. Electrocardiogram is the graph obtained after performing the electrocardiography procedure. MECHANISM OF SPREAD OF DEPOLARIZATION WAVE: The ECG device detects and then amplifies the electrical changes occurring in the surrounding tissues and skin as the heart muscle depolarizes and repolarizes with each beat. At rest, the […]
Source: medicalopedia.org

Medical Billing Update: Further Reduction in Reimbursement Proposed for Imaging

The Stark legislation prohibits self-referrals by physicians to facilities in which they have ownership. Later, a series of common sense ‘exceptions’ were granted to allow for legitimate business transactions including the ‘in-office’ ancillary services exception. This exception allows rapid diagnosis and initiation of treatment during the patients office visit resulting inpatient convenience and better coordination of care. However, imaging must be personally supervised by the referring physician, a physician who is a member of the group practice, or an individual who is supervised by the referring physician or another physician in the group (the supervision requirement). There are also specific building/billing requirements in place by Medicare. Now, CMS is proposing that physicians who perform MRI, CT and PET services in their offices relying on this exception to Stark disclose certain information to patients. Patients must be notified in writing at the time of referral that they have the right to receive these services from an entity other than the physician or his/her group practice and practices must also provide a list of alternative “suppliers” in the area. With some exceptions, the list of alternative suppliers would have to include 10 alternative suppliers within 25 miles of the physician’s office at the time of the referral. The documentation required for audit purposes must include the patient’s signature and the record must be placed in the patient’s chart.
Source: kareo.com

Medicare physicians face steep cuts to reimbursement

The Balanced Budget Act of 1997 enacted changes to the formula that computes doctor payments for Medicare services as a means to control spending.  The Sustainable Growth Rate (SGR) uses factors such as the estimated percentage change in doctor fees, changes in expenditures, and average number of beneficiaries to ensure that yearly increases in expenses do not exceed the growth in GDP.  In order to meet the target SGR, a conversion factor is applied to the doctor fee schedule for the coming year.  If the conversion factor exceeds target expenditures, the conversion factor decreases payments; if expenditures are lower than expected, the conversion factor will increase payments to physicians.  For the past ten years, the SGR calculation has resulted in drastic cuts to doctor payments; however, Congress has consistently delayed those cuts to the point that creating a permanent fix to the problem would cost the government almost $300 billion over 10 years (Washington Post, 11/1).
Source: theinsurancepress.com

UPDATE OF SUSTAINABLE GROWTH RATE : New Jersey Healthcare Blog

Physicians need to be considering their options in regard to their Medicare patients.  The American Medical Association has issued a “Medicare Participation Kit, advising physicians of the steps to take to change their status with Medicare.  Physicians, as well as other healthcare providers, also need to be aware of the various state requirements for terminating the relationship with a patient.  The regulations of the New Jersey Board of Medical Examiners contain requirements regarding notice to patients of the termination of the physician-patient relationship.  In contrast, hospitals have a clear obligation to continue to provide the services to all patients, irrespective of the payment received (or not received) from the Medicare program.
Source: njhealthcareblog.com

Utah Accident Attorneys Need to Consider Medicare Interests During Settlement

Posted by:  :  Category: Medicare

OBAMA: THE SOCIALIST/MARXIST/COMMUNIST -- UNMASKED FOR ALL TO SEE by SS&SSSettlements following a Utah accident can sometimes be complicated and involved. This is especially true if Medicare has paid any of the bills in the case. If they have paid bills related to treatment, the attorney must be very careful to make sure that Medicare’s interests are adequately protected. This involves not only reaching resolution on amounts that Medicare has paid in the past but also determining if Medicare is likely to pay for medical expenses in the future. If future payments by Medicare is likely, then the attorney needs to consider setting up a Medicare set aside fund to protect Medicare’s interests moving forward.
Source: ronkramerlaw.com

Video: Utah Medicare Advantage Plans

Medicare Supplemental Insurance Utah

There are two basic parts of original Medicare, Part A and Part B. Medicare Part A was created with the original Medicare package, is an insurance that is bankrolled by the government, and covers costs associated with home health services, hospice, nursing home facilities, hospital stays that are classified as inpatient, and Non medical Health care Institutions with a religious affiliation.There is no premium for Medicare Part A if you paid in Medicare taxes while you were working. There is also no premium if your spouse paid these kind of taxes. Medicare Part A may be available to you for a cost if you are over 65 and meet certain requirements of citizenship. Medicare Part B helps pay for doctors’ visits, outpatient hospital care, and some other medical services that Part A doesn’t cover, such as the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary. If you don’t receive Social Security Benefits you need to apply at the beginning of your seven-month initial enrollment period (90 days prior to your 65th birthday). Please call or visit your Social Security office to sign up.
Source: medicaresupplementadvantageplans.com

Huntsman’s conservative credentials

This is just the beginning. One proposal in Washington that has seemingly become too radical for even many leading Republicans to fully sign on to is the “Ryan plan,” which would rein in unsustainable entitlements, most notably Medicare. Newt Gingrich has criticized the Ryan plan, and has vacillated considerably on the proposal — at best, he seems to think it’s too big, too soon, although at one point he said he would vote for it. Romney supports a weaker version of the Ryan plan, which would not phase out Medicare, but keep it as an option, allowing private carriers to compete with it — we might call it the “competitive option,” a Democratic euphemism for the “public option.” Michele Bachmann supports the Ryan plan, but also voiced reservations regarding potential changes to Medicare. Huntsman, on the other hand, wrote an op-ed in the Wall Street Journal commending the Ryan plan, and has said he would vote for it. He has re-iterated, unequivocally, his support on multiple occasions. This puts Huntsman in the same camp as Herman Cain and, to some extent, Rick Perry, who wants states to be able to opt out of entitlements and believes they’re “Ponzi schemes.” Mitt Romney later criticized this very accurate characterization of entitlements, saying Perry’s rhetoric was over the top and frightening.
Source: geneveith.com

Utah Office of Health Disparities Reduction: Medicare Advantage Premiums To Drop Next Year

Premiums for seniors enrolled in private Medicare health plans will drop 4 percent in 2012 while benefits remain stable, administration officials said today. In 2011 premiums fell by 1 percent.  The plans, called Medicare Advantage, are offered by health insurance companies as an alternative to traditional, government fee-for-service Medicare. Nearly 12 million seniors are in private Medicare health plans, about 25 percent of all Medicare beneficiaries. Enrollment in the plans is expected to grow by 10 percent in 2012, said Jonathan Blum, deputy administrator for the Centers for Medicare and Medicaid Services. Open enrollment in the Medicare health plans starts Oct. 15, a month earlier than in past years. It will run though Dec. 7. Lower premiums and enrollment growth in the plans is the exact opposite of what health insurers predicted would happen after the federal health law was enacted. It reduces payments to the plans by $145 billion over a decade. Many critics had raised fears that Medicare benefits would shrink and premiums would rise. Instead we are seeing just the opposite,” said Health and Human Services Secretary Kathleen Sebelius. “Medicare plans are stronger than ever and beneficiaries continue to have access to affordable options.” Last month, the administration said premiums for private Medicare prescription drug plans would fall slightly, too.
Source: blogspot.com

IN UTAH MEDICARE ONLINE,WITHOUT PRESCRIPTION!Fedex … by Best pills for male erection problems

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Source: shoppharmacy.org

IN UTAH MEDICARE ONLINE,WITHOUT PRESCRIPTION!Fedex … by Free male birth control pills

Fedex Delivery Overnight FREE Pills smiley reply/g postmessage HYDROCHLOROTHIAZIDE PURCHASE HYDROCHLOROTHIAZIDE. Submitted by Bogdanow on Sat, 11/12/2011 – 19:00. IN UTAH MEDICARE ONLINE,WITHOUT PRESCRIPTION!Fedex Delivery … Osteoporosis,Menopause – Cheap Online HYDROCHLOROTHIAZIDE PURCHASE HYDROCHLOROTHIAZIDE IN Newcastle How to buy HYDROCHLOROTHIAZIDE PURCHASE HYDROCHLOROTHIAZIDE IN Gosford …
Source: shoppharmacy.org

RegenceMedicare.com Compare Regence Medicare

About Regence Medicare: Regence Blue Shield (regencemedicare.com) is an independent licensee of Blue Cross and Blue Shield Association. Regence Blue Sheild covers all counties of Oregon, Idaho and Utah as well as select counties in Washington State. Regence Blue Shield provides individual, family and group medical plans. The Regence Medicare division provides a variety of medicare plans for Seniors in the Pacific Northwest and Utah. Medicare Enrollment: Each year medicare insurance plans change what they cost and what they cover. The general open enrollment begins on October 15, 2011 and ends Dec 7th, 2011. During this time, people with Medicare can add, drop or change their prescription drug coverage. They can also select a medicare advantage or supplement plan for their 2011-2012 coverage. The general open medicare enrollment season ends Dec 7,2011 so be sure to get a medicare quote started today.
Source: trinitymedcare.com

Utah senior alert: Medicare enrollment earlier this year

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Source: healthinsurancecoverage.biz

Rep. Jim Matheson Endorses Plan to Double the Unemployment Rate

It’s hard to overestimate the negative effects such an amendment would have on the country’s economy. In addition to destroying millions of jobs, it would force such massive spending cuts that House Republicans’ own budget would be unconstitutional. According to a recent study by Macroeconomic Advisers, enacting a BBA now would double the nation’s unemployment rate and cause the economy to shrink by 17 percent — a far cry from the 2 percent projected growth that would occur with no such amendment.
Source: oneutah.org

Medicare Supplement Options In Nevada, Colorado, and Utah

Usually the healthier the state the reduce the charges. All of these states boast a extremely very good wellness rating. When a Medicare Complement Organization has decrease well being claims they also have lower expenses which they generally pass alongside to the buyer as lower charges for there ideas. Truly these organizations are capable to search in decades previous to try to decide there potential costs for claims, when they see that in a long time past statements charges have been comparably lower than other states they are capable to keep prices reduce due to the fact of that. These rocky mountain region states hence are benefiting from a healthful lifestyle fashion, All of these states have a lot of outside activities which aide in preserving a excellent health rating.
Source: seenauru.com

Medicare Complement Ideas In Nevada, Colorado, and Utah

Typically the more healthy the state the reduce the premiums. All of these states boast a extremely excellent health rating. When a Medicare Dietary supplement Company has decrease wellbeing claims they also have reduce fees which they generally pass along to the client as lower charges for there plans. In fact these organizations are able to seem in years previous to try out to establish there future expenses for statements, when they see that in many years past claims costs have been comparably decrease than other states they are able to retain charges reduce simply because of that. These rocky mountain place states as a result are benefiting from a wholesome existence design, All of these states have plenty of out of doors pursuits which aide in preserving a wonderful wellbeing rating.
Source: twitterboat.com

Medicare Supplement Ideas In Nevada, Colorado, and Utah

Usually the healthier the state the reduced the charges. All of these states boast a extremely excellent wellbeing rating. When a Medicare Supplement Business has decrease wellbeing statements they also have decrease expenses which they normally pass along to the buyer as reduce prices for there programs. Actually these companies are ready to look in a long time earlier to try to determine there potential fees for claims, when they see that in a long time prior claims expenses have been comparably lower than other states they are able to preserve rates reduce simply because of that. These rocky mountain place states thus are benefiting from a healthy life design, All of these states have plenty of out of doors routines which aide in preserving a excellent wellness rating.
Source: watchmygear.com

Access Healthcare Awarded an Additional Medicare Advantage Contract

Posted by:  :  Category: Medicare

'The election of Obama would, at a stroke, refresh our country's spirit' by Renegade98Spring Hill, Florida (November 2011) – Access Healthcare announces that it was recently awarded a Medicare Advantage contract from Optimum Health. The awarding of this contract enables Access Healthcare providers to accept those who choose Optimum Health during the current open enrollment period.
Source: madduxpress.com

Video: Desert Oasis Medicare Advantage – FOX National News

Taking Advantage of Medicare Advantage : Senior Housing News

To aid in that pursuit, the PPACA law included a provision that changes the special Medicare Advantage open enrollment period that occurs each year in January. Previously, Medicare beneficiaries were allowed to either change from one Medicare Advantage plan to another Medicare Advantage plan or to change from Medicare Advantage to traditional fee-for-service Medicare. Beginning in January of 2012, seniors will only be allowed to opt out of the Medicare Advantage plan they chose in 2011 to enroll in traditional fee-for-service Medicare.
Source: seniorhousingnews.com

Bonuses Tied To Medicare Advantage’s Star System Reward Plans For Quality

The Hill: Survey: Medicare Patients Clueless About Health Plan Ratings Most Medicare beneficiaries have no idea how the federal program’s rating system works, according to a new Kaiser Permanente survey. The survey comes as the annual enrollment period for seniors starts Saturday. The Department of Health and Human Services has been touting its new Medicare Star Quality Ratings program as a way for seniors to pick the best plan, but the survey found that only 18 percent of beneficiaries are familiar with it — and only 2 percent actually knew their current plan’s rating. “Evaluating a Medicare plan can be challenging. There are many things to consider, but quality should be at the top of any consumer’s list,” Kaiser Permanente’s senior vice president for quality, Jed Weissberg, said in a statement. “Educating consumers about and encouraging them to use the Medicare Star Quality Ratings helps to ensure that Medicare beneficiaries are receiving only the best available care” (Pecquet, 10/12).
Source: kaiserhealthnews.org

United Healthcare Oxford Medicare Advantage Denies Coverage of Official Medical Health

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Source: officialmedical.com

Maine health group receives five

The rating identifies Martin’s Point Health Care as the only Medicare Advantage carrier in Maine, and one of just two in New England, to win the top-ranking five-star designation. The designation grants Martin’s Point significant benefits, including higher reimbursement levels than other Medicare Advantage plans as well as the ability to enroll new members year-round rather than only during the annual open enrollment period to which other plans are limited. That period runs from Oct. 15 to Dec. 7 this year and also is the window for enrolling in or changing Medicare Part D prescription coverage plans.
Source: bangordailynews.com

The Truth about Medicare Advantage plans

The advantage: The Medicare Advantage plans by law to provide coverage at least as good in original Medicare, and do everything, and I would say that most of the benefits of offering beyond what Original Medicare cover. For example, Medicare has a deductible on a hospital stay, most Medicare Advantage plans do not, most preventive controls in MA plans have a zero copayment, and Medicare does not offer that. And a lot of Medicare Advantage plans offer some type of drug coverage built into them. This means you do not have to go out and buy a separate plan for that. Oh, and did I mention that most of all Medicare Advantage plans have a cousin who is from zero to 150 per month? Obviously, the more you pay the strongest of the benefits. And pre-existing conditions are covered, except for end-stage kidney disease that prevents you from enrolling in these policies.
Source: maranathabbc.org

Alliance: Sudden Medicare Cuts Reduce Staff and Quality of Skilled Nursing Care

The original Medicare program has two parts: Part A (Hospital Insurance), and Part B (Medical Insurance). Only a few special cases exist where prescription drugs are covered by original Medicare, but as of January 2006, Medicare Part D provides more comprehensive drug coverage. Medicare Advantage plans, also known as Medicare Part C, are another way for beneficiaries to receive their Part A, B and D benefits. All Medicare benefits are subject to medical necessity. Part A: Hospital Insurance Part A covers inpatient hospital stays (at least overnight), including semiprivate room, food, tests, and doctor’s fees. Part A covers brief stays for convalescence in a skilled nursing facility if certain criteria are met: 1. A preceding hospital stay must be at least three days, three midnights, not counting the discharge date. 2. The nursing home stay must be for something diagnosed during the hospital stay or for the main cause of hospital stay. 3. If the patient is not receiving rehabilitation but has some other ailment that requires skilled nursing supervision then the nursing home stay would be covered. 4. The care being rendered by the nursing home must be skilled. Medicare part A does not pay for custodial, non-skilled, or long-term care activities, including activities of daily living (ADL) such as personal hygiene, cooking, cleaning, etc. The maximum length of stay that Medicare Part A will cover in a skilled nursing facility per ailment is 100 days. The first 20 days would be paid for in full by Medicare with the remaining 80 days requiring a co-payment (as of 2009, $133.50 per day). Many insurance companies have a provision for skilled nursing care in the policies they sell. If a beneficiary uses some portion of their Part A benefit and then goes at least 60 days without receiving facility-based skilled services, the 100-day clock is reset and the person qualifies for a new 100-day benefit period. Part B: Medical Insurance Part B medical insurance helps pay for some services and products not covered by Part A, generally on an outpatient basis. Part B is optional and may be deferred if the beneficiary or their spouse is still actively working. There is a lifetime penalty (10% per year) imposed for not enrolling in Part B unless actively working. Part B coverage includes physician and nursing services, x-rays, laboratory and diagnostic tests, influenza and pneumonia vaccinations, blood transfusions, renal dialysis, outpatient hospital procedures, limited ambulance transportation, immunosuppressive drugs for organ transplant recipients, chemotherapy, hormonal treatments such as Lupron, and other outpatient medical treatments administered in a doctor’s office. Medication administration is covered under Part B only if it is administered by the physician during an office visit. Part B also helps with durable medical equipment (DME), including canes, walkers, wheelchairs, and mobility scooters for those with mobility impairments. Prosthetic devices such as artificial limbs and breast prosthesis following mastectomy, as well as one pair of eyeglasses following cataract surgery, and oxygen for home use is also covered. Complex rules are used to manage the benefit, and advisories are periodically issued which describe coverage criteria. On the national level these advisories are issued by CMS, and are known as National Coverage Determinations (NCD). Local Coverage Determinations (LCD) only apply within the multi-state area managed by a specific regional Medicare Part B contractor, and Local Medical Review Policies (LMRP) were superseded by LCDs in 2003. Coverage information is also located in the CMS Internet-Only Manuals (IOM), the Code of Federal Regulations (CFR), the Social Security Act, and the Federal Register. Part C: Medicare Advantage plans With the passage of the Balanced Budget Act of 1997, Medicare beneficiaries were given the option to receive their Medicare benefits through private health insurance plans, instead of through the original Medicare plan (Parts A and B). These programs were known as “Medicare+Choice” or “Part C” plans. Pursuant to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, “Medicare+Choice” plans were made more attractive to Medicare beneficiaries by the addition of prescription drug coverage and became known as “Medicare Advantage” (MA) plans. Traditional or “fee-for-service” Medicare has a standard benefit package that covers medically necessary care members can receive from nearly any hospital or doctor in the country. For people who choose to enroll in a Medicare Advantage health plan, Medicare pays the private health plan a capitated rate, or a set amount, every month for each member. Members typically also pay a monthly premium in addition to the Medicare Part B premium to cover items not covered by traditional Medicare (Parts A & B), such as prescription drugs, dental care, vision care and gym or health club memberships. In exchange for these extra benefits, enrollees may be limited in the providers they can receive services from without paying extra. Typically, the plans have a “network” of providers that patients can use. Going outside that network may require permission or extra fees. Medicare Advantage plans are required to offer coverage that meets or exceeds the standards set by the original Medicare program, but they do not have to cover every benefit in the same way. If a plan chooses to pay less than Medicare for some benefits, like skilled nursing facility care, the savings may be passed along to consumers by offering lower copayments for doctor visits. Medicare Advantage plans use a portion of the payments they receive from the government for each enrollee to offer supplemental benefits. Some plans limit their members’ annual out-of-pocket spending on medical care, providing insurance against catastrophic costs over $5,000, for example. Many plans offer dental coverage, vision coverage and other services not covered by Medicare Parts A or B, which makes them a good value for the health care dollar, if you want to use the provider included in the plan’s network or “panel” of providers. Because the 2003 payment formulas overpay plans by 12 percent or more compared to traditional Medicare,[11] in 2006 enrollees in Medicare Advantage Private Fee-for-Service plans were offered a net extra benefit value (the value of the additional benefits minus any additional premium) of $55.92 a month more than the traditional Medicare benefit package; enrollees in other Medicare Advantage plans were offered a net extra benefit value of $71.22 a month more.[12] However, Medicare Advantage members receive additional coverage and medical benefits not enjoyed by traditional Medicare members, and savings generated by Medicare Advantage plans may be passed on to beneficiaries to lower their overall health care costs.[10] Other important distinctions between Medicare Advantage and traditional Medicare are that Medicare Advantage health plans encourage preventive care and wellness and closely coordinate patient care.[13] Medicare Advantage Plans that also include Part D prescription drug benefits are known as a Medicare Advantage Prescription Drug plan or a MA-PD. Enrollment in Medicare Advantage plans grew from 5.4 million in 2005 to 8.2 million in 2007. Enrollment grew by an additional 800,000 during the first four months of 2008. This represents 19% of Medicare beneficiaries. A third of beneficiaries with Part D coverage are enrolled in a Medicare Advantage plan. Medicare Advantage enrollment is higher in urban areas; the enrollment rate in urban counties is twice that in rural counties (22% vs. 10%). Almost all Medicare beneficiaries have access to at least two Medicare Advantage plans; most have access to three or more. Because of the 2003 law’s overpayments, the number of organizations offering Fee-for-Service plans has increased dramatically, from 11 in 2006 to almost 50 in 2008. Eight out of ten beneficiaries (82%) now have access to six or more Private Fee-for-Service plans.[14] Each year many individuals disenroll from MA plans. A recent study noted that about 20 percent of enrollees report that “their most important reason for leaving was due to problems getting care.”[15] There is some evidence that disabled beneficiaries “are more likely to experience multiple problems in managed care.”[16] Some studies have reported that the older, poorer, and sicker persons have been less satisfied with the care they have received in MA plans.[17] On the other hand, an analysis of the Agency for Healthcare Research and Quality data published by America’s Health Insurance Plans found that Medicare Advantage enrollees spent fewer days in the hospital than Fee-for-Service enrollees, were less likely to have “potentially avoidable” admissions, and had fewer re-admissions. These comparisons adjusted for age, sex and health status using the risk score used in the Medicare Advantage risk adjustment mechanism.[18][19] In December 2009 the Kaiser Family Foundation published a report that rated Medicare Advantage organizations on a five star scale. The ratings were based on data from CMS, the Consumer Assessment of Healthcare Providers and Systems (CAHPS), Healthcare Effectiveness Data and Information Set (HEDIS) data, and the Health Outcomes Survey (HOS). New plans did not receive ratings, because data were not available. Almost six out of ten (59%) of MA plans did receive ratings, and these plans represented 85% of the enrollment for 2009. The average rating was 3.29 stars. Twenty-three percent of enrollees were in a plan with four or more stars; 20% were in a plan with fewer than three stars.[20] Twenty percent of African-American and 32 percent of Hispanic Medicare Beneficiaries were enrolled in Medicare Advantage plans in 2006. Almost half (48%) of Medicare Advantage enrollees had incomes below $20,000, including 71% of minority enrollees.[21] Others have reported that minority enrollment is not particularly above average.[22] Another study has raised questions about the quality of care received by minorities in MA plans.[23] The Government Accountability Office reported that in 2006, the plans earned profits of 6.6 percent, had overhead (sales, etc.) of 10.1 percent, and provided 83.3 percent of the revenue dollar in medical benefits. These administrative costs are far higher than traditional fee-for-service Medicare.[24] [edit] Part D: Prescription Drug plans Main articles: Medicare Part D and Medicare Part D coverage gap Medicare Part D went into effect on January 1, 2006. Anyone with Part A or B is eligible for Part D. It was made possible by the passage of the Medicare Prescription Drug, Improvement, and Modernization Act. In order to receive this benefit, a person with Medicare must enroll in a stand-alone Prescription Drug Plan (PDP) or Medicare Advantage plan with prescription drug coverage (MA-PD). These plans are approved and regulated by the Medicare program, but are actually designed and administered by private health insurance companies. Unlike Original Medicare (Part A and B), Part D coverage is not standardized. Plans choose which drugs (or even classes of drugs) they wish to cover, at what level (or tier) they wish to cover it, and are free to choose not to cover some drugs at all. The exception to this is drugs that Medicare specifically excludes from coverage, including but not limited to benzodiazepines, cough suppressant and barbiturates. Plans that cover excluded drugs are not allowed to pass those costs on to Medicare, and plans are required to repay CMS if they are found to have billed Medicare in these cases. It should be noted again for beneficiaries who are dual-eligible (Medicare and Medicaid eligible) Medicaid may pay for drugs not covered by part D of Medicare, such as benzodiazepines, and other restricted controlled substances.
Source: medicare-health.com