CMS opens up Medicare claims data for provider quality reports

Posted by:  :  Category: Medicare

day 6 365 days Hipstamatic by drivebybiscuits1In a move toward transparency and quality improvement, the Centers for Medicare & Medicaid Services (CMS) yesterday announced a final rule that will allow consumers, insurers, and employers to buy access to an extensive Medicare claims database, the Associated Press reports. The result will be data-rich performance report cards that evaluate providers on quality. “This is a giant step forward in making our health care system more transparent and promoting increased competition, accountability, quality and lower costs,” acting CMS Administrator Marilyn Tavenner said in a press release from the agency. “This provision of the health care law will ensure consumers have the access they deserve to information that will help them receive the highest quality care at the best value for their dollar.” For years, consumer groups and quality advocates have complained that Medicare data has been piecemeal and limited, according to the press release. Performance data, thus far, comes from private insurance companies and focuses on primary care doctors. Critics of the insurer data argue they lack sufficient statistical power to rank specialists. But with the new access, Medicare’s comprehensive claims data can offer a look into specialists’ performance too, the AP notes.
Source: fiercehealthcare.com

Video: Boston: Medicare Fraud Summit Providers Panel

Medicare Coverage And Providers

Choosing the most cost-effective place to receive services can reduce your out-of-pocket expenses. In some cases, services can be provided only at certain facilities. However, there are often several providers from which you can choose. Talk with your physician about your options so you can make informed choices when selecting where you receive health care services.
Source: wellnessarticles4u.com

Medicare health insurance supplement designs: rules to get followed

Footwear seen which the Medicare policy you happen to be hav will never cover for any total payment charged for the medical treatment plan. Now it all sometimes becomes a great problem for a lot of to display that supplemental cost. For of which very reason this can be the Medicare add to, in various other words often called the Medicare supplement policies that can help you get relieved of the extra problem of medical-related cost. It is a fact that while in the original Medicare insurance policies at this time there always continue be several gaps which is why it doesn?t pay for the health attention services that you can need. Therefore for anybody who is the among the many beneficiaries belong to the original Medicare insurance plane, you may well be in the necessity to buy Medicare insurance supplement insurance policies. In various other words it is usually known because the Medigap insurance as a result of reason go without shoes bridges Medicare Supplemental Insurance gap between your policy coverage belong to the original Medicare insurance plans and then the total medical-related bill you have to pay. This can be a type of health insurance coverage policy that can help you pay for a lot of the costs while in the original Medicare insurance program plus for that part go without shoes doesn?t take care of.
Source: worldaims.info

HEALTH REFORM: Medicare Providers and Suppliers Continue in the Spotlight :: Epstein Becker & Green, P.C.

The Program was established by the Medicare Prescription Drug, Improvement, and Modernization Act.[18] The Program involves DMEPOS suppliers submitting bids in order to become Medicare contract suppliers and to provide specific medical equipment and supplies in designated competitive bidding areas (“CBAs”).[19] New payment amounts are determined based on the submitted bids, and subsequently replace the Medicare DMEPOS fee schedule amounts for bid items in the CBAs.[20] Round 1 of the Program was implemented for a brief two-week period in July 2008, before legislation delayed the Program.[21] Ultimately, a Round 1 Rebid was conducted and pricing implemented on January 1, 2011, in nine CBAs: Cincinnati – Middletown (Ohio, Kentucky, and Indiana); Cleveland – Elyria – Mentor (Ohio); Charlotte – Gastonia – Concord (North Carolina and South Carolina); Dallas – Fort Worth – Arlington (Texas); Kansas City (Missouri and Kansas); Miami – Fort Lauderdale – Pompano Beach (Florida); Orlando (Florida); Pittsburgh (Pennsylvania); and Riverside – San Bernardino – Ontario (California).[22] The product categories for the Round 1 Rebid included the following: oxygen supplies and equipment; standard power wheelchairs, scooters, and related accessories; complex rehabilitative power wheelchairs and related accessories (Group 2); mail-order diabetic supplies; enteral nutrients, equipment, and supplies; CPAP, RADs, and related supplies and accessories; hospital beds and related accessories; walkers and related accessories; and support surfaces (Group 2 mattresses and overlays) in Miami.[23]
Source: ebglaw.com

Do I need supplemental health insurance for Medicare?

Part C, or Medicare Advantage plans, are provided by private insurance companies that are approved by Medicare. Part C is for those who want or need further coverage than what part A or part B supplies. Coverage for dental visits, visits to an optician, glasses and hearing services are usually covered. The private insurance plans for Part C vary, and they might also offer other health benefits such as wellness programs.
Source: healthinsuranceproviders.com

MHA’s Executive Briefing: Bill would exempt Medicare providers from sequestration

Rep. Ed Towns (D-NY) on Nov. 30 introduced legislation (H.R. 3519) that would exempt Medicare providers from automatic spending cuts through sequestration under the Budget Control Act. The BCA is set to trigger automatic spending cuts in defense and non-defense programs totaling $1.2 trillion effective January 2013, including reductions in Medicare payments to hospitals and other providers of 2% over nine years (2013 to 2021).
Source: typepad.com

What to Look for In Your Medicare Provider

Information about the Medicare provider: Patients should check the plans of each Medicare provider in detail. The points for comparing the different Medicare providers are:- the amount of premium to be paid, the drugs covered under the drug plans, the procedure for claims and the hospitals and doctors covered under the plans. Although the premium to be paid is an important factor for deciding on a Medicare provider, other factors are equally essential for knowing the quality of their service and how well the service provider can cater to the needs of the patient.
Source: nobledrugstore.com

Things To Consider For Medicare Coverage And Medicare Providers

Choosing the most cost-effective place to receive services can reduce your out-of-pocket expenses. In some cases, services can be provided only at certain facilities. However, there are often several providers from which you can choose. Talk with your physician about your options so you can make informed choices when selecting where you receive health care services.
Source: articlesbacklink.com

CMS Final Medicare Rule Imposes Many Conditions On Access To Medicare Claims Data To Evaluate Providers & Suppliers

A board certified labor and employment attorney widely known for her extensive and creative knowledge and experienced with health and managed care, insurance  and other employment, employee benefit and compensation matters, Ms. Stamer continuously advises and assists employers, employee benefit plans, their sponsoring employers, fiduciaries, insurers, administrators, service providers, insurers and others to monitor and respond to evolving legal and operational requirements and to design, administer, document and defend insured and self-insured medical and other welfare benefit, qualified and non-qualified deferred compensation and retirement, severance and other employee benefit, compensation, and human resources, management and other programs and practices tailored to the client’s human resources, employee benefits or other management goals.  She also has worked extensively with Medicare and Medicaid Advantage, association, employer and other group insurance arrangements, MEWAs, fraternal benefit and mutual aid programs, government programs, and a broad range of other specialized health and other programs and insurers to design and administer arrangements in response to their unique regulatory and operational needs. A primary drafter of the Bolivian Social Security pension privatization law, Ms. Stamer also works extensively with management, service provider and other clients to monitor legislative and regulatory developments and to deal with Congressional and state legislators, regulators, and enforcement officials concerning regulatory, investigatory or enforcement concerns. 
Source: wordpress.com

Medicare on Main Street: Obamacare hammers Granite State

“Remember when President Obama said that if his health care ‘reform’ law passed, you’d still get to keep your doctor?  Medicare Advantage participants in the Granite State are finding out what a lie that was. “Medicare Advantage is a subset of Medicare in which the federal government pays private insurers a set monthly rate to provide coverage that is approved and regulated by Medicare. The private insurers can charge different rates and offer a wider variety of services than are offered in traditional Medicare.  Though Medicare Advantage costs more in its startup phase, the idea is to save money in the long run by providing incentives for insurers to reduce costs.  But because the plan is market-based, the Obama administration wants to kill it. Obamacare eventually defunds it. “New Hampshire has a high percentage of Medicare Advantage enrollees. Last month, 7,600 of them received notices that their coverage was being cancelled. Obamacare and another federal law passed in 2008, the Medicare Improvement for Patients and Providers Act, are killing Medicare Advantage to steer senior citizens back into regular Medicare, which offers fewer choices and is more heavily controlled from Washington. “As a result, thousands of Granite State seniors are being forced to switch doctors because they have to switch coverage. “This is just a taste of what is to come if Obamacare takes effect in full force.  Its regulations will so skew the private insurance market that millions will lose the coverage they have and be forced into plans preferred by bureaucrats in Washington.  They will lose access to their doctors, too. It would make a lot more sense to reform the health insurance market by working to give people more control over their own care, not less.”
Source: gop.gov

Some hospitals left out of Medicare Advantage provider's network 

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Source: wvgazette.com

What are Medicare Providers?

1. Medicare Part A offers coverage to individuals concerned with inpatient hospital stays, medical expert service and health care at home. 2. Medicare Part B assists in covering outpatient care, general medical services from doctors and other healthcare facilities like investigations, check-ups, etc. 3. Medicare Part D helps individuals to cover the expenses of prescription medications. 4. Medicare Part C, also called as Medicare Advantage covers all the benefits and services provided under all the 3 parts mentioned above i.e. A, B and D. This all in one plan is offered to individuals by means of private insurance firms approved by Medicare.
Source: easterndrugs.com

Medicare Insurance For Florida’s Residents

Posted by:  :  Category: Medicare

George W. Bush by cliff1066™Like in any many states in United States, the medicare insurance for Florida’s residents are in critical state. Statistics show that one out of five people, or about 18% of residents in Florida, are only able to enroll in the Medicare program. People with their Medicare insurance are mostly seniors and more than half of them are women. There are three Medicare plans that the beneficiaries are entitled with and they are: stand-alone prescription drug, Medicare Advantage, and Medicare Supplement. However, it is a sad thing to know that most of these residents are not able to discern which type of plan they are going to need.
Source: keskuldergisi.com

Video: Leesburg Medicare

Florida Tests New Medicare Payment System

Florida is the lone testing ground in America for a new program for certain types of Medicare hospital payments. As a well known hot bed for Medicare fraud, Florida was chosen by government officials to determine if the new method could reduce the number of improper payments made under the system. The program targets heart operations and a few other specific medical procedures that are commonly used in health care fraud schemes. This particular program requires that all payments for these particular treatments be pre-approved by Medicare contractors.
Source: miamifederalcriminaldefenseattorney.com

UPDATE: The Epidemic of Florida Medicare Fraud (Prison Terms)

Healthcare services is a booming business and one that is often victimized by fraud.  Not only can participants in the healthcare sector perpetrate fraud upon government payors and patients, but such organizations may also be victimized by unscrupulous practices involving demands for kickbacks, bribes, and other frauds.  Hospitals, nursing homes, clinics, and other service providers have come to depend upon a complex inter-relationship among patients, providers, insurers, and government payors.  Healthcare has become big business, with publicly traded companies such as HCA Holdings, Inc.; Tenet Healthcare; Community Health Systems, Medco Health Solutions; Humana, and others combining the provision of healthcare with an eye on the bottom line.  When allegations of fraud circle around such listed companies (be they victims or participants), such news  often highlights the crisis proportion to which healthcare costs have exploded and demand (particularly among the aging Baby Boomer population) is soaring. Clearly, it is in the best interest of both the users and providers of healthcare to ensure that the industry is well policed and fraud rooted out and punished.
Source: financialpress.com

AffordableONE Insurance Wants Local Residents to Start the New Year Right With Florida Medicare Supplemental Insurance

Many people take time during the holiday season to stop and think about the things that are most important to them in life, including their family, friends and personal well-being. In addition, New Year’s resolutions are made in order to establish personal goals for the upcoming year. One common goal among older Americans is to save money whenever possible, and one of the biggest expenses for individuals in this age range is medical care. That’s why the team at AffordableONE Insurance wants local residents to take advantage of this time to purchase Florida Medicare supplemental insurance, which can help them save money on the health care expenses that Medicare Parts A and B do not cover.
Source: bestlongtermcare.org

What Is Medicare Advantage, Exceptionally Florida Medicare

After retiring and contemplating accessible health advantages, many individuals wonder what is Medicare advantage. Medicare is often referred to as the government sponsored health insurance coverage plan for many who have retired or over the age of 65. Nonetheless, most individuals don’t perceive that throughout the Florida Medicare program, there are several several types of Medicare plans and kinds of coverage available. The different types of Florida Medicare plans indicate varying levels of coverage that ranges from hospital visits, emergency services, and different kinds of healthcare insurance. For those who are questioning what is Medicare advantage, it is necessary to first perceive that Medicare is break up into a number of different types of plans and that the total comprehensiveness of Medicare advantage depends upon the plan.
Source: nasdaqreportnews.com

Florida: Medicare Hmos In Florida

Every aspiring business owner will have difficulty focusing on the gheenoe in florida of Ron Jon’s Surf Shop and Daytona Beach, a world away. On 80 acres of land in the taxidermy in florida, with pelicans and gulls flying overhead and dolphins cruising by – you realize that there are some advantages to renting and what locations would be a deterrent to some. Just forty miles north of Miami, lies Boca Raton with five counties increasing by more than seven million tourists yearly, more than seven million tourists yearly, more than your share here. Gatorama is a way of living and can be used primarily for vacationers or for local renters, and whether you intend to do in Florida the medicare hmos in florida a major restaurant chain, club house, lazy river, food court and a robust high-tech manufacturing sector. A big military presence with a cocktail reception and continues throughout the hospice in florida or taking a dramatic jump from $166,000 to $200,000, an appreciation of 27%, making investing near Orlando a great option. Florida ranks 4th in population behind California, Texas and New York. Florida has it!
Source: blogspot.com

Medicare Advantage Health Plan in Florida to be Liquidated

[…] Quality Health Plan of FL has been ordered to be liquidated as of 12/1/2012.  Here is the story from TheLedger.com.  The plan had 10,242 members as of September of 2011 who will be automatically enrolled in a Humana drug plan and Original Medicare as of 12/1/2012.  All of the members will also get a Special Election to choose a new plan and have guarantee issue rights to obtain Medigap coverage, if they so choose.Source: ritterim.com […]
Source: ritterim.com

Love My Country, Loathe My Government: The Disgrace and Waste That is Medicare Fraud

The Federal government actually manages a website dedicated only to Medicare care fraud examples that occur only in the state of Florida. The site has reported on fraud cases that involved $200 million in claims for unnecessary mental health services, $24 million for a fraud scheme based on AIDS injections, $61 million in taxpayer dollars paid to a man running a network of false health clinics, and the fact that the criminals perpetrating the fraud own fine homes, expensive cars, and a report that one of the criminals had purchased half a million dollars worth of jewelry with Medicare fraud money.
Source: blogspot.com

Physicians Advantage Services, Inc

Files submitted between October 26 and November 11 were received and processed by the payer, but many of the responses were delayed or not returned. Please verify that you have received payment on these claims, and if not, resubmit your claim.
Source: physiciansadvantage.net

Medicare in Florida Spells P

Moreover, new immigrants are not entitled to benefits such as Medicare. Demographics in 2010 shows that around 1.6 million veterans are in Florida comprising more or less 20% of Florida’s population number. This fact justifies the turnout level in the enrolled Medicare recipients. Also, though Medicare Component B can be bought practically by anyone, the monthly costs range from $600 to $1,000 per head. A costly mistake is certainly avoided, unless the necessary Medicare details override the usual indifference. Medicare in Florida, however, must not be confused with Medicaid. Medicaid is a jointly funded health program by the state and federal government which caters families in United States with little incomes. This is the largest health funding source for those with limited amounts of income and is not to be used interchangeably with Medicare. Getting to know Florida’s Medicare system helps much. Medicare in Florida is all about health plans. These health plans are further divided into four major components under the federal government’s health coverage program, Parts A, B, C and D. All of these benefits are based on medical necessity and varies in terms of services covered. Component A is basically hospital insurance. Inpatient stays covering expenses such as semiprivate rooms, food, tests and doctors’ fees fall under this. Component B is medical insurance. This kind pays for services and products excluded from component A and are utilized under an outpatient basis. Among others, physician and nursing services, diagnostic tests, ambulance transportation (with a certain limit though) and x-rays are included under Component B. Component C, forwarded by the Balanced Budget Act of 1997, offers another option through private health insurance companies. Aside from the original Medicare standard list, Medicare advantage plans, as commonly referred to, provide coverage for new items in exchange for additional fees. These new items can come in the form of savings or net extra benefits exclusive to those who enrolled and in add-on services such as a more comprehensive dental and vision coverage. Prescription drug plans are accommodated in Component D and no standard provisions are available. Though the Medicare program explicitly approves and regulates, the choice as to what drugs are covered depends on the providers. It is imperative therefore that interested parties interact closely with providers to get necessary information and make wise investment decisions.
Source: ezinemark.com

Central Florida Republican News: Members of the GOP Doctors Caucus Address Medicare Reimbursement Rates

++++++++++please click on the small envelop at the bottom of this post to email this to others. This blog is not authorized by any official Republican organization. Material presented on this blog is not necessarily considered an endorsement but is included as a political courtesy, and or to help educate our readers.
Source: blogspot.com

Campaign Enlists Seniors to Fight Medicare Fraud

Tips from the patrol delivered. In 2009, a retiree noticed residents of an assisted living facility being bused every day, she said. It turned out they and the facility owners were being paid kickbacks to attend a mental health program that billed Medicare $3 million for phony treatments. Medicare prosecuted and got back $1.3 million, she said.
Source: wordpress.com

Medicare Florida Information

Everyone is getting old. No one can stay healthy forever yet no one can live forever. When you getting older you want to think about getting a social insurance program that covers health program. Aging process is unavoidable and tend to produce disease that related to age. This disease need a proper treatment and we are all know that it is not cheap. We need a proper health plan before it is too late.
Source: medicarewikipedia.com

AffordableONE Insurance Educates Seniors on How Much Money They Could Save with the Affordable Care Act and Florida Medicare Supplemental Insurance : e Yugoslavia

The organization also reports that more than 22.6 million seniors and disabled individuals have taken advantage of at least one free Medicare preventative benefit. These services include things like the Annual Wellness Visit, diabetes screening and smoking cessation assistance, which have all made available at no cost through the Affordable Care Act.
Source: eyugoslavia.com

AARP official traveling state talking about Medicare, Social Security cuts

Posted by:  :  Category: Medicare

Counter demonstration: wingnuts by tswedenHe was in Newton this morning, urging senior citizens to lobby Iowas five congressmen now because the super committees work is almost done. Theyre scheduled to come up with their proposalby November 23, so November 23 is really a magical date, Carroll says. Once that proposals out, that cannot be amended. It has to be taken as an up or down vote in both the senate and the house of representatives, so the chance to impact what is or is not in that proposal is now.
Source: 9tharkansas.org

Video: Arkansas Medicare Supplements

Republicans still want to kill Medicare

Steel, nice try but the fact is that both sides have to give up some of their sacred cows and Medicare is a Democratic concern because they actually care for people like the Bible says. Republicans only care for teh rich and corporations but you know that. The Rethuglicans so far haven’t made any concessions and until they do, the whole issuie is moot and the Defense budget will take another $600,000 hit. If they don’t reach an agreement, the president should veto any plan to stretch out the timimng. They are grown adults and if they won’t work together than take all of the hits where they belong. Defense spending is the Republican stimulus plan with plants located in their favorite states and districts and it is time to bring the defense costs back in line with 2001 + compound interest and if it costs them some votes, well too damn bad. Right now the Defense budget is 62% higher than 2001 and I can tell you, with the current Congress I don’t feel 62, or even 6% safer. Solon is reporting that the committee may come up with an agriculture bill with all of the subsidities still there and cuts to food stamps and almost total elimination of the conservation program and hide it in the budget bill so it can’t be discussed or amended. I don’t think the Rethuglicans can pass up on the chance to make a lot of their plans to further enrich corporations without discussion or the right of the people to have a say. The Tea Pot brains in Congress need to have the opportunity to go back home and sulk. They always have their left over campaign funds to build their retirement.
Source: arktimes.com

Arkansas Medicare Supplements

In the Natural State, which is of course Arkansas, retiring and dealing with Medicare may not be on the top of ones list when turning 65 or coming off of employer coverage. This video goes over some fo the basic points that consumers in The Natural State should know. Medicare Supplement Plan F is the most popular of all the Medicare Supplement Plans because it covers all the expenses left behind by part A and Part B of traditional Medicare. Logon to www.medicaresupplementsmadeeasy.com or call us at 1 800 218 7935 for your free Medicare Supplement Quote.
Source: bestlongtermcare.org

Saving Medicare : South Carolina Nursing Home Blog

Recently, the White House laid out new steps to cut fraud in Medicare and Medicaid.  Many of the moves that support Obama’s “we can’t wait” mantra are modest  including the newest measures being pilot programs intended to further cut waste and fraud in the Medicare and Medicaid entitlement programs. The Health and Human Services Department will oversee the changes, such as testing changes to outdated hospital billing systems to prevent overbilling.
Source: scnursinghomelaw.com

Nothing found for Business Health Medicare

Dedicated to the hard working men and women of Mena, Arkansas this site is focused on promoting all of the local businesses to visitors and residents alike. We offer some of the most beautiful scenery in the country and we invite you to see what sets us apart.
Source: menaarkansasguide.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: Texas Medicare Advantage Plans

New Educational Video about Medicare in ASL

ADA American Sign Language Arlington article asl austin children church club community conference dallas dars deaf Deaf Action Center DFW DVD entertainment family foods fort worth Hard of Hearing harris communications hoh houston interpreter job meeting opportunity prizes registration san antonio school sign language students texas Texas School for the Deaf training TSD video videophone Video relay service volunteer vrs workshop
Source: deafnetwork.com

Texas Medical Association Video: Grandma and the Big Bad SGR

Dear Mr. President I sense that you are struggling with managing the budget and its seems that you and the MEDPAC committee are having trouble finding ways to save money and increase the value to the system of providing medical care. I have good news . It’s really not all that difficult and it can be done without cutting the throat of Doctors who are underpaid for their services by Medicare currently. For many years now many healthcare providers have taken advantage of a loophole in the payment rules and allowed hospitals to bill for their services. These services are identical to services provided by other physicians except that they are reimbursed at rates varying from 20-150% or more than identical services provided to Medicare beneficiaries. Apparently a long time ago, someone convinced the government that services provided in a hospital based clinic were worth more than services provided by private practice physicians and considerations such as regulatory compliance should be an allowable expense to the Medicare system. I personally think this is hogwash and we should have one fee schedule for all physicians. If I have done the math properly, a few hundred billion a year are spent on physician services and if 50% of the physicians in this country now work for hospitals then stopping this horrible overpayment will result in savings of tens of billions of dollars each year and will be more than enough to plug the SGR gap without cutting rates for physicians who more than earn their money. I will admit to being a simple country Doctor and high finance isn’t my forte but I believe this would help fix one of the looming problems in medicine. I am a simple man and I like simple solutions. Another problem with the current Medicare system is the gaming of the observation vs 1 day admission rules. The current system encourages hospitals to over document and stretch the rules that are used to review one day admissions. Outliers on the high end of costs compose about 3% of claims at some hospitals but approximately 12-18% of admission in hospitals are single day admissions. This low end anomaly costs the Medicare system hundreds of billions of dollars of costs each year. The RAC system seems to be having a major impact recovering these overpayments. Since I’m a simple guy , I would propose that we pay all hospitalizations under Medicare and Medicaid at observation rates if they last less than 48 hours. The savings will be large and immediate and again in the billions of dollars range. A similar problem is patients who are readmitted within 30 days. Eliminate the first day charge differentials for all these admissions and require a comprehensive plan for avoiding these admissions at all at each facility providing acute cae hospital services to patients. The personnel who are charged with gaming the observation rules can be refocused on managing patients for a revenue neutral proposal for the hospitals. Again the savings would amount to hundreds of millions of dollars since 20-30% of Medicare beneficiaries admitted to the hospital are readmitted within 30 days. A more reasonable rate of 10% should be easily achievable and create large savings for the Medicare program. As I suggested, it’s not all that hard to create savings for services that are overcompensated and continuing to pay other physicians at fairer rates. I might point out that we have studied and have established that Medical homes provide higher quality and better valued services to Medicare beneficiaries than non medical home practices. Perhaps rather than experimenting with someone’s pipedreams, we should establish criteria for being a medical home and establish a fee schedule with savings from the above suggestions to fund this change and create more savings for the Medicare system. I’m not against experiments but perhaps we should go with tried and proven rather than follow the drug induced whims of policy wonks who have no clue about how to fix the problems in Medicine. Mr. President I hope my suggestions are helpful to you and lead you to better solutions that some of the Alice in Wonderland suggestions that have been provided by other advisors to you. Lastly, I’d like to point out that Medicare as it has been modified and added to is a failed system. We need to reexamine the system in terms of current research and alter the program to correct design flaws to prevent costs of not being able to afford quality primary care services. Instead of a confusing 20% after meeting a deductible after allowable charges scheme, perhaps we should adopt the Federal employees and Medicare Advantage model and move to a no deductable co pay system so patients know how much they owe and offices can easily explain the charges and owed amounts to the patient. By increasing access to quality primary care we should eb able to manage conditions and avoid unnecessary costs to the system such as ED visits and emergency admissions for UTI’s and problems that can be easily managed as an outpatient. This increase in quality primary care costs should lead to a decrease in avoidable medical procedures such as cardiac services and cancer care that are largely avoidable or have the ability to be much less than current incidence rates of these conditions. I realize that we will never eliminate all problems but correcting design problems in our current system would go a long way to fixing the problems. I hope my suggestions have been useful to you. They are a result of a medical career spanning 26 years in a rural area that have exposed me to a number of experiences that have shaped my thoughts. If I can ever help you or provide further information on my thoughts to you, please feel free to contact me.
Source: managemypractice.com

Big Government Brings Big Profits To Texas Health Plans

Image via Wikipedia While Texas Governor Rick Perry rails against the evils of  federal involvement in health care on the GOP presidential campaign trail, businesses back home are busy raking in record profits from government dollars. “By largely exiting the employer market and focusing on Medicare and Medicaid, Texas HMOs have enjoyed […]
Source: financeroom.net

NAMI Texas Voices Concern over Medicare 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 […]
Source: medicare-plans.net

Medicare to cover more costs

Theeagle.com is pleased to offer readers the ability to comment on stories. We expect our readers to engage in lively, yet civil discourse. Theeagle.com cannot promise that readers will not occasionally find offensive or inaccurate comments posted in the comments area. Responsibility for the statements posted lies with the person submitting the comment, not theeagle.com. If you find a comment that is objectionable, please click “report abuse” and we will review it for possible removal. Please be reminded, however, that in accordance with our Terms of Use and federal law, we are under no obligation to remove any third party comments posted on our website. Full terms and conditions can be read here.
Source: theeagle.com

What Every Baby Boomer Should Know About Medicare

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSWith all the talk about the high federal budget costs of Medicare, some may erroneously think the government pays for all Medicare services. Far from it. Beneficiaries have to pay monthly premiums, deductibles and co-payments or coinsurance. Figuring out your coverage and costs can be challenging, especially given Medicare’s different alphabetic parts: A (for inpatient hospital care), B (for outpatient services and doctor visits) and D (an optional drug benefit). There’s also a Part C, usually known as Medicare Advantage. This is an alternative to traditional Medicare and is offered by private insurance companies.
Source: kaiserhealthnews.org

Video: Patty and Richard say, “Apply online for Medicare” (20 seconds) – Social Security

Bill Boushka retires: Many seniors don’t apply for Medicare on time, then go without insurance for extended periods

Since the 1990s I have been very involved with fighting the military “don’t ask don’t tell” policy for gays in the military, and with First Amendment issues. Best contact is 571-334-6107 (legitimate calls; messages can be left; if not picked up retry; I don’t answer when driving) Three other url’s: doaskdotell.com, billboushka.com johnwboushka.com Links to my URLs are provided for legitimate content and user navigation purposes only. My legal name is “John William Boushka” or “John W. Boushka”; my parents gave me the nickname of “Bill” based on my middle name, and this is how I am generally greeted. This is also the name for my book authorship. On the Web, you can find me as both “Bill Boushka” and “John W. Boushka”; this has been the case since the late 1990s. Sometimes I can be located as “John Boushka” without the “W.” That’s the identity my parents dealt me in 1943!
Source: blogspot.com

North Carolina Medical Society

The first step in the application process is to submit your Notice of Intent (NOI) to Apply to the Shared Savings Program. After completing this form, CMS will assign you an ACO identification number. The NOI must be completed by 5 pm EST on January 6, 2012, for the April 1, 2012 program start date and by February 17, 2012, for the July 1, 2012 program start date.
Source: ncmedsoc.org

Is it possible to get health insurance for disabled people?

Once your child is born, you will need to purchase an individual health insurance policy to cover immunizations and regular office visits. While rare, single policies are issued on newborn children if the parent has special circumstances, like being disabled. There is a common myth if you have children they are automatically covered by Medicare. The reality is Medicare will not cover your child simply because you are insured.
Source: healthinsuranceproviders.com

Medicare Enrollment Deadline Is Tomorrow

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

How to Apply for Medicare Part B

There are also circumstances sometimes where people do not apply for Part B. . . Usually, it’s because they are still covered by their employers’ health insurance. If this is the case, you have different options. You can apply while still employed or wait and apply after your employment ends. You must do this during the special enrollment period. If you sign up at this time, you will not have to pay any extra fees on top of the premium like those who apply during the general enrollment period.
Source: waysandhow.com

The Urban Politico: GOP TO OBAMA "It’s our way or the highway!"

Basically, President Obama and the Democrats want to not only extend the payroll tax but also they want to reduce the rate to 3.1% for employees and 3.1% for employers up to the first 5 million of payroll income.  The Democrats argue that the tax break would benefit over 160 million people and that a family making $70,000 per year would save $2,170.  Of course, increased taxes on those with income of 1 million dollars and more would have to finance this package.   Oh yeah, AND NO DAMN KEYSTONE XL PIPELINE APPROVAL!!! Democrats presented this package to the American people like it was Freestyle Friday and then dropped the mic on the floor, saying “what what,” as they walked away. Republicans could have still represented and argued that Americans, albeit the wealthy, should’t have to shoulder a 187 billion dollar tax break.  They could have changed the momentum if they challenged Dems by stating that tax payers would be essentially borrowing money to pay for another tax extension.  The GOP could have argued that if the Democrats really wanted to help the middle class, they should phase out the payroll tax break to those with income over $80,000 v. $110,000. The GOP could have had hands waving to the rhythm of their beat if they had argued for a second “Making Work Pay” tax break.  That tax break, which was part of the 2009 stimulus package, gave $400 to singles and $800 to couples but was phased out for singles making $75,000 and for couples making $150,000.  They could have made the argument that a similar tax break would truly help the middle class.  But did the GOP make these common sense arguments?  Nooooooo, instead they offered their own payroll tax extension to a chorus of boos.  Below is a snapshot of what they offered the American People:
Source: theurbanpolitico.com

Social Security FAQ: How to Apply for Medicare Only? : Pennsylvania Law Monitor

Health Insurance Coverage Most people age 65 or older are eligible for free Medicare Hospital Insurance (Part A) if they have worked and paid Medicare taxes long enough. You should sign up for Medicare Hospital Insurance (Part A) within 4 months of your 65th birthday, whether or not you want to begin receiving retirement benefits. When you sign up for Medicare, you will be asked if you want to enroll in Medical Insurance (Part B). Anyone who is eligible for free Medicare hospital insurance (Part A) can enroll in Medicare medical insurance (Part B) by paying a monthly premium. Some beneficiaries with higher incomes will pay a higher monthly Part B premium. Social Security has a booklet which you can request, or read on their website, www.ssa.gov, which will assist you in figuring out the premium amount you will pay should you be considering enrolling for Medicare Part B coverage. This booklet is titled: "Medicare Premiums: Rules For Higher Income Beneficiaries" (Publication No. 05-10536). If you do not choose to enroll in Medicare Part B and then decide to do so later, your coverage may be delayed and you may have to pay a higher monthly premium unless you qualify for a "Special Enrollment Period (SEP)”. An SEP will generally apply if you are age 65 or older and your medical insurance coverage is under a group health plan based on your, or your spouse’s, current employment. In this case, you may not need to apply for Medicare Supplementary Medical Insurance (Part B) at age 65. An SEP exception will let you sign up for Part B during any month you remain covered under the group health plan and your, or your spouse’s employment continues; or within the 8-month period that begins with the month after your group health plan coverage or the employment it is based on ends, whichever comes first. If you are working at age 65 and your business has a personnel or human resources department, you should discuss your health coverage with a representative of that department before you apply for your Medicare Part A benefit. 
Source: stark-stark.com

The GOP Payroll Tax Cut/UI Extension Proposal

While all these ideas are meritorious, I would point out that most of the $200 billion shortfall from the extension package (roughly $120 from the payroll tax cut, $35 from UI [that number is probably low], and the rest from doc fix and small business tax expensing) will be incurred next year (or over two years, in the case of doc fix), while the overwhelming majority of the savings ($173 billion, according to CBO) will occur during subsequent years.  If Republicans fail to conjure up some more mettle over the next few years, it is likely that these measures will continue to be extended at a cost of well over $2 trillion. Moreover, I’m a bit skeptical of optimistic predictions of reduction in federal employees, and by extension, deficit reduction, when those predictions are born out of random hiring freezes, as opposed to actual elimination of programs or agencies.  As long as the program or agency exists, it will somehow find a way perpetuate a need to retain its employees.
Source: redstate.com

How to Sign Up for Medicare 

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Source: kxpc.com

Apply for Medicare Part A

This is the essential information that is all about how you should apply for medicare part a and what might be covered in this which includes the home health care, hospice care visits, plus the hospital stay. Medicare is the government designed program to help with providing insurance to people who meet the criteria that is provided. The program was done so people can get relief with medical bills and much more. Medicare Part A was actually created with as the first Medicare package,  with insurance that happens to be bankrolled in the actual government, and therefore, it can cover the costs that comes associated with the home health services, nursing home facilities, hospice services, plus hospital stays that the patient might have, and it also includes other Non medical Health care Institutions with the religious association.
Source: howdoesmedicarework.net

November 8 New Deadline to Apply for Medicare eRx Exemption

After reaching the hardship extension website, select Tools, then Internet Options, then Advanced in your internet browser. Scroll down toward the bottom and locate the “Use TLS 1.0” option. Place a checkmark next to “Use TLS 1.0.” Click OK. Attempt to access the site again.
Source: wordpress.com

The Twelve Sites of Social Security — Tinley Park news, photos and events — TribLocal.com

On the twelfth site of Social Security, we present to you: services for people who are currently receiving benefits, like the ability to replace your Medicare card, get or change a password, request a proof of income letter, or check your Social Security information or benefits. You can do these and other things at www.socialsecurity.gov/pgm/getservices-change.htm.
Source: triblocal.com

Things to Consider When Applying For Medicare

Depending n the parts availed of Medicare costs can increase and decrease. Take into consideration your finances, health, other insurance coverage and job environment then decide which parts to include. For example, if you already have a comparative or higher HMO coverage then there is no need to take out a Part C Medicare plan. However if the Part C coverage that can be availed of is higher then decide if the additional costs is worth it for you.
Source: blogspot.com

North Carolina Medical Society

Posted by:  :  Category: Medicare

Jessica Sundheim by On BeingThe first step in the application process is to submit your Notice of Intent (NOI) to Apply to the Shared Savings Program. After completing this form, CMS will assign you an ACO identification number. The NOI must be completed by 5 pm EST on January 6, 2012, for the April 1, 2012 program start date and by February 17, 2012, for the July 1, 2012 program start date.
Source: ncmedsoc.org

Video: How to Apply For Medicaid in Florida Online

HIT Consultant: CMS releases Medicare Shared Savings application

Medicare Shared Savings Program Application 2012 Appendix A-Electronic Funds Transfer (EFT) Authorization Agreement (CMS Form 588) Appendix B-Participant List Appendix C-Data Use Agreement (DUA) Appendix D-Application Reference Guide Refer to the Appendix D-Application Reference Guide document in the Downloads section of this page for further details on how to complete the application.
Source: blogspot.com

CMS releases Medicare Shared Savings application

Following its announcement of the Oct. 20 final rule, the Centers for Medicare & Medicaid Services (CMS) yesterday released the 2012 application for its Medicare Shared Savings Program. Interested accountable care organizations (ACO) have the option for two start dates of April 1, 2012 and July 1, 2012. Before generally cheering for the final rule’s revisions, providers had blasted CMS for the short timeline in its proposed draft in the spring. Under the application guidelines, CMS now will accept applications for the two start dates. It will take applications from Dec. 1. to Jan. 20, 2012 for the April 1, 2012 start date and from March 1 to March 30, 2012 for the later July 1, 2012 start date, according to the CMS website.
Source: fiercehealthcare.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

InsureBlog: Medicare Annual Election Period (AEP)

Advantage plans have a lot of moving parts. At any time you may be expected to pay a deductible or copay if you plan on using the services of a doctor or lab. That may not be bad as long as you are healthy but when your health takes a turn for the worse the copay’s and deductibles add up. You can easily find yourself spending $3000 – $6000 or more out of pocket compared to less than $200 with most Medigap plans.
Source: blogspot.com

CMS Issues Last Minute Guidance on End of Annual Enrollment Period Medicare Advantage and Part D Application Submissions

Last night CMS issued some guidance for Medicare Advantage and Part D enrollments.  This guidance relates to this plan year only.  CMS told the plans that they can accept PAPER enrollments with a POSTMARK of December 8, 2011 or earlier, regardless when they are received by the plan.
Source: ritterim.com

MEDICARE APPLICATION FORM

Specific MEDICARE APPLICATION FORM for groups is also available from the CMS. The difference is in few of the fields, while the rest are still the same as on any other forms. As a group provider, you must be able to fill in the fields 855I and 855B. Each of the providers from your group should individually fill in this field. There is another field 855R which requires the whole group to fill it in. If you have been previously providing Medicare as a solo provider, but you now own a company with different providers, you must fill out the group application form for your company.
Source: medicareapplicationform.net

Ways to Get A Blue Cross Medicare Application In Your Vicinity

There are many plans for Blue Cross Medicare with corresponding rate for each of them and you should know which of them is suitable to your budget. However, you need to keep in mind that there is a specified time for the submission and acceptance of Blue Cross Medicare Application. For instance, if you would like your insurance to become effective on January 2012, your application can only be accepted anytime between October 15, 2011 to December 7, 2011. Any applications send before or after the prescribed periods will not be considered.
Source: smartwomanshearthealth.com

California Wellness Insurance plan How Will Healthcare Reform Have an affect on You

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Source: transplantplaza.com

Workers’ Compensation: The Workers’ Compensation Medicare Set

This site provides an interface for entry of Workers’ Compensation Medicare Set-Aside Arrangements (WCMSA) proposals. Attorneys, Medicare beneficiaries, claimants, insurance carriers and WCMSA vendors may use this site to enter the case information directly. The site also provides attorneys, Medicare beneficiaries, claimants, insurance carriers, and WCMSA vendors with the ability to track their submitted cases and the statuses without inquiry to the Coordination of Benefits Contractor (COBC) or the Centers for Medicare & Medicaid Services (CMS).
Source: blogspot.com

Medicare extends coverage for obesity

Posted by:  :  Category: Medicare

Denied coverage because of a pap smear by Paul SchreiberWhile research finds that physician counseling can be a powerful prod to weight loss for those who need it, many physicians have been reluctant to offer it. While some of that reluctance has stemmed from an absence of insurance reimbursement for such services, many also cite patient pushback and a lack of effective tools as reasons for shrinking from the task of identifying obesity, counseling patients about its health hazards and getting them started on a weight-loss program.
Source: nwsource.com

Video: United Healthcare Oxford Medicare Advantage Denies Coverage

Medicare Coverage for Obesity to Include Intensive Behavioral Therapy

The U.S. Preventive Services Task Force (USPSTF) found that there was fair to good evidence that high-intensity counseling about diet and exercise, with behavioral interventions aimed at skill development, motivation, and support strategies produces modest, sustained weight loss (typically 3-5 kg for 1 year or more) in adults who are obese. Although the USPSTF did not find direct evidence that behavioral interventions lower mortality or morbidity from obesity, the USPSTF concluded that changes in intermediate outcomes, such as improved glucose metabolism, lipid levels, and blood pressure, from modest weight loss provide indirect evidence of health benefits.
Source: wolterskluwerlb.com

Ryan Plan would triple the share of Medicare coverage paid for by Americans

Earlier this week, Romney added one innovation to the Ryan plan that would make it significantly worse. He proposed ending the guaranteed, mandatory nature of Medicare and would instead make Congress vote each year on the value of the vouchers he wants to give seniors — subjecting seniors’ basic health care needs to the whims of an increasingly dysfunctional body. This would be nothing short of a disaster for seniors.
Source: wordpress.com

The main advantages of Medicare Eligibility

At the outset look on some significant th s to remember prior to you apply designed for Medicare unique plan. Original Medicare health insurance policies really are run by the government. It offers your Piece A plus Part N coverage. You can get a Medicare supplemental health insurance (Medicare Dietary supplement Insurance) protection (sold from private insurance coverage companies) to assist you to fill this gaps simply A plus Part N coverage (like coinsurance, copayments, plus deductibles). You re able to join a new Medicare Recommended Drug Decide to add tablet coverage. The standard benefits of obtain Medicare insurance policies is beginn with policies useful on or simply after August 1, 2010, Hospice Piece A coinsurance (outpatient treatment plan drug plus inpatient respite consideration coinsurance) is go to be covered be basic gain. Plan K handles 50%, and Method L handles 75% of such costs. Designs D plus G obtained on or simply after August 1, 2010 need different features than VE HAD or H plans obtained before August 1, 2010. Though, if you purchased Plan VE HAD or H before August 1, 2010, it is possible to keep which will plan along with the benefits will not change.
Source: brix-orlando.com

Medicare Coverage And Providers

Choosing the most cost-effective place to receive services can reduce your out-of-pocket expenses. In some cases, services can be provided only at certain facilities. However, there are often several providers from which you can choose. Talk with your physician about your options so you can make informed choices when selecting where you receive health care services.
Source: wellnessarticles4u.com

As Open Enrollment Ends, People with Medicare save $1.5 billion on prescriptions

Thanks to the Affordable Care Act, the Medicare prescription drug coverage gap known as the donut hole is starting to close. Through the end of October, 2.65 million people with Medicare have received discounts on brand name drugs in the donut hole.  These discounts have saved seniors and people with disabilities a total of $1.5 billion on prescriptions – averaging about $569 per person.  For State-by-State information on the number of people who are benefiting from this discount in 2011, visit this page.
Source: medicare.gov

Medicare to Cover Screening and Counseling for Obesity

Thirty-day readmission rates have become a publicly reported quality performance measure for congestive heart failure, acute myocardial infarction, and percutaneous coronary intervention (PCI.) However, little has been known regarding the factors associated with 30-day readmissions after PCI. Researchers from Saint Marys Hospital, which is part of Mayo Clinic, identified nearly 16,000 PCI hospitalizations (elective or for acute coronary syndromes) from January 1998 through June 2008 and found that, within 30 days after discharge, about 10 percent of patients were readmitted, and nearly 1 percent resulted in death within days after discharge.
Source: hin.com

Medicare To Cover Obesity Screening, ‘Intensive Behavioral Therapy’

Kaiser Health News: Capsules: Medicare Offers Expanded Coverage To Battle Expanding Waistlines Keeping off the pounds is tough at any age. Now seniors are getting a helping hand from the Centers for Medicare and Medicaid Services (CMS), which has announced that it will cover screening and counseling for obesity as a free preventive service for Medicare beneficiaries. Coverage is effective immediately (Andrews, 12/1).
Source: kaiserhealthnews.org

National Medicare Coverage Policies For Genetic Tests Suggested By Insurers :: “The Pink Sheet” :: Elsevier Business Intelligence

In response to a CMS call for input on revising its list of potential candidates for national coverage determinations in Medicare, AHIP suggests the agency stop relying on local carriers to determine payment for genetic tests. Biopharmaceutical groups raise concerns that CMS may be signaling a move toward a new standard for Medicare coverage.
Source: elsevierbi.com

Ohio Medicare Beneficiaries In Coverage Gap Saving $64,954,039 This Year As Time To Select 2012 Plans Draws To A Close

And, as of the end of November, more than 24.2 million people with Medicare have taken advantage of at least one free preventive benefit – including the new Annual Wellness Visit – made possible by the Affordable Care Act.  In Ohio, 864,243 people with Medicare have taken advantage of the free preventive coverage. Building on savings in 2011, Medicare also recently announced that the Part B deductible will be $22 lower in 2012 and average Medicare Advantage premiums are projected to drop four percent in 2012.  Part B premiums, which cover outpatient services including doctor visits, are estimated to increase by only $3.50 per month for most beneficiaries in 2012, and some will see a decrease.  These changes will be more than offset by the average Social Security cost of living increase ($43 per month for retired workers). People with Medicare can now review their drug and health plan coverage options for 2012 as part of the annual Medicare Open Enrollment Period.  CMS is highlighting plans that have achieved an overall quality rating of five stars with a high performer or “gold star” icon on Medicare’s Plan Finder – www.medicare.gov/find-a-plan. For more information about how the Affordable Care Act closes the donut hole over time, go to http://www.medicare.gov/Publications/Pubs/pdf/11493.pdf
Source: progressohio.org

Daily Kos: Mitt Romney says he’d sign Paul Ryan’s Medicare repeal plan into law … but wouldn’t propose it

Posted by:  :  Category: Medicare

J Center Medicare D Seminar 11-21-06 (8) by Korean Resource Center 민족학교Consider if one or more of these tags fits your diary: Civil Rights, community, Congress, Culture, Economy, Education, Elections, Energy, Environment, Health Care, International, Labor, Law, media, Meta, National Security, Science, Transportation, or White House. If your diary is specific to a state, consider adding the state (California, Texas, etc). Keep in mind, though, that there are many wonderful and important diaries that don’t fit in any of these tags. Don’t worry if yours doesn’t.
Source: dailykos.com

Video: Medicare Part D and Prescription Drugs

How to encounter the Finest Medicare Product Insurance strategy

Fortuitously, the method is not so complex if the senior wishes out a specialist within the Medicare Supplemental Insurance policy discipline. Accord ly, the first step is almost always to locate a skilled brokerage whom focuses primarily on the Medicare Health supplement Insurance strategy market. While us advent with the internet this is considerably less difficult. By merely go to Google as well as Yahoo and stepp into medigap quote Medicare Health supplement Insurance protection or Medicare supplemental health insurance, you could effortlessly learn about numerous causes of specialist material.
Source: pl-news.us

Early Medicare Part D deadline a concern for state agency

Meeks says the volume of calls to her office has been less than in previous years and she’s concerned that some participants will miss this year’s deadline.  “People that don’t make changes, they may find out in January that their plan may have raised the premium or they may have removed drugs from their formulary, the deductible may have rise.”
Source: wvpubcast.org

beSpacific: Spending Patterns for Prescription Drugs Under Medicare Part D

CBO – Spending Patterns for Prescription Drugs Under Medicare Part D, December 2011: “The centerpiece of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Medicare Modernization Act) was the creation of Medicare Part D, a subsidized pharmaceutical benefit that went into effect in 2006. That additional coverage

Baby Boomers and their Mental Health Care Needs: Can Medicare Rise to the Challenge?

Posted by:  :  Category: Medicare

Press Conference on Benefits of Health Insurance Reform to Seniors by Leader Nancy PelosiThe burdened health care system, combined with a scarcity of psychiatric nurses, has resulted in insufficient care to fulfill the mental health needs of the baby boomer generation, as Robinson points out. In recent years, two changes to the U.S. health system were passed that could potentially help to address this insufficiency. Robinson explains that the first of these acts, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, reduced limits on outpatient visits, thus decreasing costs for those who are in therapy. This act could prove to be quite significant, as therapy visits may decrease the number of hospital visits. Perhaps more importantly, Robinson points out that the act has also allotted financial protection to severely ill patients who face high costs from intensive mental health treatments or inpatient care. The Medicare Improvements for Patients and Providers Act was also enacted. Robinson explains that, as a result, copayments for mental health care will gradually be reduced from 50% to 20%, which is the Medicare copay for other outpatient healthcare. More prescription mental health medications will also be covered under this act, according to Robinson.
Source: yalemedlaw.com

Video: How to Buy Good, Affordable Health insurance

How to encounter the Finest Medicare Product Insurance strategy

Fortuitously, the method is not so complex if the senior wishes out a specialist within the Medicare Supplemental Insurance policy discipline. Accord ly, the first step is almost always to locate a skilled brokerage whom focuses primarily on the Medicare Health supplement Insurance strategy market. While us advent with the internet this is considerably less difficult. By merely go to Google as well as Yahoo and stepp into medigap quote Medicare Health supplement Insurance protection or Medicare supplemental health insurance, you could effortlessly learn about numerous causes of specialist material.
Source: pl-news.us

Do I need supplemental health insurance for Medicare?

Part C, or Medicare Advantage plans, are provided by private insurance companies that are approved by Medicare. Part C is for those who want or need further coverage than what part A or part B supplies. Coverage for dental visits, visits to an optician, glasses and hearing services are usually covered. The private insurance plans for Part C vary, and they might also offer other health benefits such as wellness programs.
Source: healthinsuranceproviders.com

Medicare and Private Health Insurance

Turning more of the Medicare system over to private insurers would divert still more money into the pockets of this industry, taking it away from the direct provision of health care. Isn’t it time to consider how best to reduce — rather than increase — the role of this unneeded middleman industry, with its unnecessary and huge overhead?
Source: insurance4cheap.us

Medicare health insurance Appeals

100 % of 12 standard medicare supplemental health insurance plans each work with a different type a benefit in an effort to help the individuals avail this. The programs are alphabetically prepared from words A to help you L. An important indicate be noted in that respect might be that these th s plans beneath same correspondence cover requires the comparable benefits in spite of the corporation sell these folks. This gives a kind of guarantee for the beneficiaries from the plan when they grab the plan from any business they will receive the possession skin color benefits that had been provided just by that corporation under that one plan. No discrimination based on the plan you happen to be choos or the agency that the master plan is to be purchased from created from no matter what. However in spite of all ailments, it must always be remembered that a premium charges range from one company to a new one. The many primary criteria from the enrollment policy from the Medicare Additional Plans is any particular one who might be avail this treatment plan must end up be covered beneath original Medicare insurance plan aspect A plus B. This qualify measure serves as an important points from the coverage in supplement programs because without the presense of original coverage no person can get the advantages of the Extra Plan. Medigap Insurance refore gett in touch with an insurance pro in this unique respect can be an intelligent matter. He will be the one whom could provide right advice in the right instance.
Source: shahbazi2.org

Medicare and Private Health Insurance

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Source: americanhealthoptions.com

Missed Medicare Open Enrollment, Now What?

Sign up for a new Medicare Advantage or Part D plan after open enrollment. You’ll have to pay more for the coverage but depending on your health and cost of monthly prescriptions, it may be worth the extra cost. Talk to a licensed agent about available plans to see how much it would cost for monthly premiums versus the cost of not having additional coverage.
Source: gohealthinsurance.com

Mitt Romney Uses Semantic Shifts To Conceal His Medicare Killing Agenda

It is no wonder Romney is paranoid about calling his plan a cut to Medicare, because as it is now, Medicare is a dependable, popular, and life-saving program for a majority of seniors who exist on a fixed income. He says that no Republican is talking about cutting Medicare, but his own plan to “fundamentally transform Medicare into Medicare 2.0,” automatically cuts benefits depending on the whims of Congress and the cap on its growth every year. His plan, like the Ryan-Heritage plan will issue vouchers to seniors to buy private health coverage and if Congress decides on an amount lower than the cost of a private plan, seniors are left to fend for themselves. Medicare is a wildly popular program that guarantees affordable health care for millions of seniors regardless of private insurer’s premium increases, and Republicans cannot wait to transfer taxpayer contributions directly to the insurance industry that is notorious for raising premiums without cause.
Source: politicususa.com

VIVA MEDICARE Plus Earns Highest Quality Rating Score in Alabama for Second Year in a Row : e Yugoslavia

Posted by:  :  Category: Medicare

CMS established the star rating system to give Medicare patients a single summary score for each health plan to make it easier to compare different plans based on quality and overall performance. Plans are ranked on a scale of one to five stars. The overall score is based on more than 50 separate measures that rank member satisfaction, access to appropriate care, and managing chronic conditions.
Source: eyugoslavia.com

Video: Alabama Medicare Supplements

VIVA MEDICARE Plus Earns Highest Quality Rating Score in Alabama for Second Year in a Row

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Source: insurancepressrelease.com

Medicare, Medicaid Dodge Budget Bullets (For Now)

As Reuters reports, in the event the Super Committee should fail—as it has—then automatic and sweeping cuts go into effect. For Medicare, that means a 2% cut across the board (or about $123 billion over the next decade). Of course, it could have been between $500 billion to $700 billion in cuts if various Super Committee arguments had prevailed.
Source: alabamaestatelaw.com

Seniors May Be Overwhelmed By Complex Choices In Medicare Advantage Program

The researchers found that, on average, an increase in the number of plans was associated with increased Medicare Advantage enrollment, provided the number of available plan options was fewer than 15. When the number of options surpassed 30, as it did in 25 percent of U.S. counties, such increases were actually associated with decreased enrollment. More importantly, beneficiaries with low cognitive function were substantially less likely than their peers with high cognitive function to appreciate the advantages offered by these plans, choosing to remain in the traditional Medicare program instead.
Source: sweethomealabama.info

HealthSpring to offer Medicare Advantage plans in Madison, Limestone counties

According to the Kaiser Family Foundation, 11.1 million Americans were enrolled in Medicare Advantage plans in 2010. Medicare payments to private health plans last year totaled $116 billion, accounting for 22 percent of Medicare spending.
Source: al.com

VIVA MEDICARE Plus Earns Highest Quality Rating Score in Alabama for Second Year in a Row : e Yugoslavia

[…] • Visiting medicare.gov, where they can get a personalized comparison of costs and coverage of the plans available in their area. The popular Medicare Plan Finder tool has been enhanced for an efficient review of plan choices. Spanish Open Enrollment information is available. • Calling 1-800-MEDICARE (1-800-633-4227) for around-the-clock assistance to find out more about coverage options. TTY users should call 1-877-486-2048. Multilingual counseling is available. • Reviewing the 2012 Medicare and You handbook. It is also accessible online at: medicare.gov/publications/pubs/pdf/10050.pdf —  and it has been mailed to the homes of people with Medicare. • Getting one-on-one counseling assistance from the local State Health Insurance Assistance Program (SHIP). Local SHIP contact information can be found at medicare.gov/contacts/organization-search-criteria.aspx, on the back of the 2011 Medicare and You handbook, by calling Medicare or through a listing of national stand-alone prescription drug plans and state specific fact sheets that can be found at cms.hhs.gov/center/openenrollment.asp.Source: mtdemocrat.com […] Source: mtdemocrat.com Source: medicaresupplementalco.com
Source: medicaresupplementalco.com