Filling the Medicare Doughnut Hole

Posted by:  :  Category: Medicare

United We STAND. by eyewashThe so-called "doughnut hole," as many know all-too-well, is the treacherous territory you fall into when you have spent too much of your Medicare Part D benefits to continue receiving full benefits (but not so much of your own money to qualify for "catastrophic coverage").
Source: kylekrull.com

Video: Medicare for All – MoKan demonstration at Blue Cross/Blue Shield offices in Kansas City, Missouri

Soft Selling to Seniors on Medicare (Kansas City)

Medicare/DME Sales — We Will Train Five Star Senior Services is expanding its regional Sales and Service team. . . We are a provider of technologically advanced, heat-therapy bracing equipment and power wheelchairs. We market directly to the senior, Medicare-eligible community and their healthcare partners. This is a low-pressure, commission-based opportunity that requires a professional, service-oriented attitude utilizing a consultative, compassionate approach. You will be calling primarily on senior centers, churches, and retirement communities. Secondary markets would include physicians, physical therapy and pain management practices. Training provided via the platform on the website and on an individual basis. This can be done on a full- or part-time basis and is available throughout the region. First year, realistic full-time earnings should exceed $40,000 and could be as high as $70,000, depending on work ethic and motivation. Please visit our website (***/Opportunity), listen to “Our Story & Strategy” to learn more, and if you are still interested we invite you to complete the brief application online . . . Thank you and God Bless. Come be a Partner in Our Vision. . .
Source: telecommuteanywhere.com

Kansas Treatment Supplement

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Source: cospnyc.com

Pharmacies, Medical equipment Suppliers, KANSAS CITY, MISSOURI, (MO) USA

,  DM02-COMMODES,  URINALS,  BEDPANS,  DM03-CONTINUOUS PASSIVE MOTION (CPM) DEVICES,  DM05-BLOOD GLUCOSE MONITORS/SUPPLIES (NON-MAIL ORD),  DM06-BLOOD GLUCOSE MONITORS/SUPPLIES (MAIL ORDER),  DM07-GASTRIC SUCTION PUMPS,  DM09-HOSPITAL BEDS (ELECTRIC),  DM10-HOSPITAL BEDS (MANUAL), DM20-SUPPORT SURFACES: PRESSURE REDUCING BEDS/MATS/PADS,  DM21-TRACTION EQUIPMENT,  DM22- Transcutaneous Electrical Nerve Stimulation (TENS) AND/OR SUPPLIES,  DM23-ULTRAVIOLET LIGHT DEVICES AND/OR SUPPLIES,  M01-CANES AND/OR CRUTCHES,  M02-PATIENT LIFTS,  M03-POWER OPERATED VEHICLES (SCOOTERS),  M04-SEAT LIFT MECHANISMS,  M05-WALKERS,  M06-WHEELCHAIRS (STANDARD MANUAL & RELATED ACCESSORIES),  M07-WHEELCHAIRS (STANDARD POWER & RELATED ACCESSORIES),  M08-WHEELCHAIRS (COMPLEX REHABILITATIVE MANUAL & RELATED ACCESSORIES),  M09-WHEELCHAIRS (COMPLEX REHABILITATIVE POWER & RELATED ACCESSORIES),  M10-WHEELCHAIR SEATING/CUSHIONS,  PD01-BREAST PROSTHESES AND/OR ACCESSORIES, PD06-OSTOMY SUPPLIES,  PD07-SOMATIC PROSTHESES,  PD08-TRACHEOSTOMY SUPPLIES,  PD09-UROLOGICAL SUPPLIES, R01-CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEVICES & RESPIRATORY ASSIST DEVICES,  R03-INVASIVE MECHANICAL VENTILATION,  R04-INTERMITTENT POSITIVE PRESSURE BREATHING IPPB ( Intermittent positive pressure breathing) device ,  R05-INTRAPULMONARY PERCUSSIVE VENTILATION DEVICES,  R06-MECHANICAL IN-EXSUFFLATION DEVICES,  R07-NEBULIZER EQUIPMENT AND/OR SUPPLIES,  R08-OXYGEN EQUIPMENT AND/OR SUPPLIES,  R10-RESPIRATORY SUCTION PUMPS,  R12-VENTILATORS ACCESSORIES AND/OR SUPPLIES,  S01-SURGICAL DRESSINGS,  S02-DIABETIC SHOES AND INSERTS,  S03-DIABETIC SHOES/INSERTS – CUSTOM,  Oxygen,  Oxygen Equipment and Supplies,  Enteral Nutrients,  Equipment,  and Supplies,  Continuous Positive Airway Pressure (CPAP) Devices and Respiratory Assist Devices (RADs),  and Related Supplies and Accessories,  Hospital Beds and Related Accessories,  Walkers and Related Accessories,
Source: usa-hospitals.com

Q&A: does medicaid or medicare cover dental work in kansas?

Medicare will pay for an opthamologist visit and he can prescribe glasses. They must but be a medical doctor. Dental is another thing altogether. You can get some supplemental policies that offer some dental but sometimes you are just as well off to find a reasonable dentist and pay cash. This works unless you have large dental needs. Go to Medicare.gov and look at the supplemental plot supplies. They are listed from A-M and each company must offer identical services for the letter that you have chosen. The more services included the more expensive they will be. Your state insurance office can give you the names of all the companies that are licensed to sell this type of insurance in your state. Prices and how the rates go up can vary from company to company.
Source: discountdental.info

5 Star Medicare Part D Plans in Kansas

The star ratings are now available on the Medicare website.  This is the source you will use to determine if a plan has a 5 star rating or not, making it a plan you could enroll in at anytime during the year.  The bad news is Kansas does not have any 5 Star Rated Medicare Part D plans.  So for current Kansas Medicare beneficiaries this Special Enrollment Period will not apply to you if you want to enroll in a Stand Alone Drug Plan outside of the Open Enrollment Period.
Source: wordpress.com

Free Medicare counseling at Guadalupe Center

All Medicare beneficiaries are eligible for Part D coverage, but they must enroll first. People enrolled in Part D still pay out-of-pocket costs for their prescriptions, but there is an additional program meant to help those who have trouble doing so. Called Extra Help, this program reduces prescription-drug costs for Medicare patients who meet low-income guidelines. Many Medicare beneficiaries do not know about the program. Thousands of eligible Missourians are missing out on help paying for their prescription drugs, according to the federal government.
Source: kcstar.com

Commonsense & Wonder: Obamacare

Under our plan, Americans currently over the age of 55 would see no changes to the Medicare system. For future retirees, starting in 2022, our plan would introduce a “premium support” system that would empower Medicare beneficiaries to choose either a traditional Medicare plan or a Medicare-approved private plan. Unlike Medicare Advantage, these private plans would compete head-to-head with traditional, fee-for-service Medicare on a federally regulated Medicare exchange.
Source: blogspot.com

Tips for Getting the Best Medicare Supplemental Insurance

“Lasik Surgery Kansas City. If you need answers for your eye and vision problem, Lasik surgery is the answer. Visit us more often for additional information and updates. Both LASIK and PRK represent advances over radial keratotomy in the surgical treatment of vision problems, and are thus viable alternatives to wearing corrective eyeglasses or contact lenses for many patients”
Source: lasiksurgerykansascity.org

Kansas Bioscience Authority eyes $600K investment in Spinal Simplicity

Josh Sandberg has been recruiting specifically in the musculoskeletal industry for over 8 years. Throughout this time, he has been able to have a positive impact on his client’s businesses. With an educational background in Business Management, Josh is adept to discern which people will be the best fit for the company he is searching for by understanding how candidates will incorporate with the company’s culture and operational nuances. His experience as an executive in a start-up business has granted him the ability to understand what is takes to thrive in a hands–on environment, where desire and dedication are paramount for success.
Source: orthospinenews.com

How to Apply for Social Security Retirement Benefits and Medicare : Pennsylvania Law Monitor

Posted by:  :  Category: Medicare

DAMN!! -- I THINK WE'RE F*%KED by SS&SSThe earliest age at which you can receive Social Security Retirement Benfits is 62. You can start receiving Medicare Benefits at age 65. Within 4 months of the date you wish to start receiving benefits you should contact Social Security. The application process will require you to answer certain questions and provide some documents. If you have difficulty obtaining all the documents, Social Security will assist you in getting them. The documents required to prove your eligibility for retirement benefits include:
Source: stark-stark.com

Video: How to Apply For Medicaid in Florida Online

Twelve Sites of Social Security

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. Get all your Social Secu­rity ser­vices and infor­ma­tion at www.socialsecurity.gov.
Source: thebellevuegazette.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

DAR File No. 35441 (Rule R414

If the Medicaid eligibility agency receives a signed signature page and the completed application after the application processing period but during the 30 calendar days immediately after the denial notice is mailed, the Medicaid eligibility agency will contact the applicant to ask if the applicant wants to reapply for medical assistance. If the applicant wants to reapply, the Medicaid eligibility agency may use the previous application form it received, but the application date will be the date the Medicaid eligibility agency receives both the signed signature page and completed application form according to the same provisions in Subsection R414-308-3(2).
Source: utah.gov

InsureBlog: Medicare Advantage

Disenrolling in an MA plan may also trigger a GUARANTEED ISSUE situation allowing you to enroll in any Medigap plan without answering health questions. If you enrolled in an Advantage plan for the FIRST TIME, either when you first became eligible for Medicare Part B or you left Medicare to join an Advantage plan. If you leave the Advantage plan during the first 12 months you may have a guaranteed right to return to Medicare and a Medigap plan. You should apply for a new Medigap plan no later than 63 days following the end of your Medicare Advantage coverage. Your new Medigap plan cannot become effective before the date of your application. You may also have other guaranteed rights to purchase a Medicap plan without answering health questions. Call us. We can help. Even if you do not have a guaranteed right to purchase a Medigap plan you may still qualify if you are in reasonably good health. We have helped people age 80 and younger find an affordable Medigap plan once we determine they still qualify.
Source: blogspot.com

Medicaid Application Details

As you complete your Medicaid application, be sure to include accurate information. Additionally, provide any documentation that is requested. This may include: birth certificate; proof of citizenship; recent paystubs; proof of other income; proof of where you live; and an insurance card if you currently have coverage.
Source: retireeasy.com

Apply for Medicaid Online

States have it to where you can apply for medicaid online because it’s simple and easy to do plus it helps the environment. When you go to apply online there are forms you still might have download and then you will have to print out those forms and fill them out. The process is still very fast and easy. If you have any questions about the forms that you do online they will be able to help you in the process. Make sure that you put in all of your current information when you are filling out the forms and check them twice before you send them back in.
Source: medicaidvsmedicare.org

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: hitconsultant.net

Medicare Savings Plan helps eligible seniors save money — Bangor Daily News

Posted by:  :  Category: Medicare

"Every citizen should be a soldier. This was the case with the Greeks and Romans, and must be that of every free state." ` Thomas Jefferson. by eyewashThe site will still be viewable but certain elements might display incorrectly. In order to enjoy all the features of our site, we recommended you upgrade to a newer, more secure browser. Read more ». If you don’t have administrator privileges for your computer, you can still take action. Google has developed a free plugin for Internet Explorer called Google Chrome Frame. You can install it on any computer, even if you can’t install applications, and it will ensure your computer stays secure and that you can still visit our website. Enable Google Chrome Frame now »
Source: bangordailynews.com

Video: Peter Welch discussing Medicare Part D

Common Questions About Medicare Supplement Plans

Enrollment is Not Always Guaranteed: Medicare Supplement insurance is regulated by the states, so there will be eligibility differences based on where you live. For example, in New York, most applicants must be accepted anytime, while in other states all applicants must be accepted only within their first six months of eligibility for Medicare Part B and in a few other situations. Outside of the eligibility periods, carriers are allowed to reject an applicant based on adverse health conditions. This means that if you apply at the wrong time, you may not be eligible for a Medicare Supplement policy.
Source: ehealthinsurance.com

Florida’s 3rd DCA Weighs in on PIP Reimbursement Limits After All : Florida Appellate Review

That question mattered because Geico’s policies stated that it would pay, “in accordance with and subject to the terms, conditions, and exclusions of the Florida Motor Vehicle No-Fault Law, as amended…80% of medical expenses,” with “medical expenses” defined as “reasonable expenses.” So if 80% of 200% of Medicare Part B = reasonable expenses, then the policies could be characterized as stating that this reimbursement formula might be used. Judge Rothenberg agreed with Geico that this was the proper way to understand the statute and the policies, and as such, the policies could not reasonably be read to affirmatively elect to reimburse based on reasonableness rather than taking advantage of the Medicare Part B methodology.
Source: floridaappellatereview.com

Is High Deductible Plan F the Best

Hi, I just turned 65, live in NY and I’m in pretty good health at the moment. I signed up for Original Medicare and I’m researching Medigap plans. It looks like Plan F is the most popular, probably since it covers everything with limited cost. Since I don’t have many doctor or hospital visits high deductible Plan F seems like an even better choice for me. It potentially has the lowest premiums of all the plans (if I don’t need much medical care for the year) and has the benefit of limited maximum costs if I do need a lot of care. The cost in that case would then be about the same in NY (i.e. approx $3,000 in premiums for Plan F and the same for premiums + deductible for the high deductible version). High deductible ssems like a no-brainer for someone in good health. Am I missing something? Thanks in advance, Stan
Source: insurance-forums.net

Health and Fitness Articles

Few things are more essential than your health, but few things are much more confusing than finding the right medicare plan. From state laws in order to federal regulations and anything else guiding the health care industry, it is one complicated head ache after another. The information contained in this article is designed to lessen the headaches making it easier for you to understand the character of health insurance coverage and how to place it to work for you.
Source: healthandfitnessarticlesblog.com

2012 Medicare Deductible Amounts

One such Medigap option available for purchase is Plan G.  Plan G covers everything that Plan F does except for the Part B deductible.  If Plan G happened to be $300 less (as can be the case) per year than Plan F and Plan F only covers $140 more in costs, then Plan G is a wise choice.  Plan N might also fall into this category if you live in a state (Ohio for instance) that does not allow for Part B Excess charges.
Source: ohioinsureplan.com

Illinois Medicare Supplement Plan F

Like most Illinois residents, you understand the importance of securing dependable, reliable health insurance. While Medicare helps significantly, it doesn’t cover all of your health care needs. Supplement insurance helps you pay for the gaps in coverage that Original Medicare doesn’t cover. Illinois Medicare Supplement Plan F offers the best coverage by providing comprehensive benefits, affordable premiums and completely eliminates all out-of-pocket expenses. Consider a Medicare Supplement Plan F from the most trusted name in insurance- Blue Cross Blue Shield of Illinois- and get the peace of mind that comes from knowing that you are well taken care of.
Source: ssiinsure.com

Guide to Medicare – CIGNA Plans: Review of CIGNA Medicare, CIGNA Part D, and HMO CIGNA

Posted by:  :  Category: Medicare

Currently, this HMO Cigna plan is only available for Arizona residents. In addition, beneficiaries must be eligible for Original Medicare, and must apply in the open enrollment period between November 15 and December 31. (However, individuals may apply for special enrollment outside of this time frame and still be eligible for CIGNA plans.)
Source: suite101.com

Video: Udall Bennet

Health Equipment & Supplies

HMO (Health Maintenance Organization.) Plans have been a slightest costly option. The outcome of reduce costs is reflected as singular entrance to illness care. Plans have a bound volume per month, covering doctors in a plan. If we see a alloy outward a plan, afterwards we have been obliged for a bill. In a since plane, we have since a right to select a first caring medicine (PCP) who will take caring of yourself. CIGNA Medicare HMO skeleton cover a costs of unchanging caring as well as surety services, referrals to a dilettante network or facility, if necessary, diagnosis of injuries as well as disease. There is no need to compensate a single more charges in HMO skeleton as he is no assign for visits to a doctor. The partial of CIGNA Medicare Plan D is called Rx CIGNA offers coverage to 94% of drug available, entrance to over 58,000 network pharmacies, no deductible for sure crimes, no co-payments for drug as well as usual diseases such as diabetes as well as drug pressure. The CIGNA devise D in spin offers 3 sorts of skeleton namely, 1 Plan, Plan 2 as well as Plan 3.
Source: healthequipmentsupplies.org

Images of fake seiko watches

Greenberg york university north york ontario canada fake richard p. Our electricity is solar generated and images of fake seiko watches internet access and seiko tv programming is provided via satellite. Misuses and watches misunderstandings of boundary images theory in clinical and regulatory settings. Spalding’s introduction is seiko nearly identical to the joseph smith story. 318th fighter-interceptor squadron the 318th fis was fake activated in images of fake seiko watches may 1947 at mitchell images field. Students in watches grades third through eighth who excel in math language arts science and social studies were invited to participate. A few of my blog readers have complained images about images my website not working correctly in explorer but looks watches great in firefox. And perhaps fake recall alpha particles can heat lungs ached. Keystroke object the keystroke that triggers this command. So in these widely differing fake communities vegetarians and carnivores alike can seiko both remain perfectly healthy. In postmarketing experience seiko syncope transient ischemic attacks images of fake seiko watches and watches seizures have been observed. So for six months of the year i travel to images of fake seiko watches florida every weekend. Prior to enrolling in cigna medicare rx please review the cigna medicare rx pre-enrollment disclaimer. I usually get about 4k out of the rear and about double that for the front.
Source: typepad.com

Cigna Medicare Plans: An Overview

The Health Maintenance Organization or the HMO plans are known to be the least expensive. But, they provide restricted health facilities. There is a list of doctors covered under such policies. Should you visit a doctor who is not a part of this family, you need to bear the expenses for the same. Fees for regular visits to the doctors are covered under this plan and you need not pay any extra amount for the same. These Cigna medicare plans cover both regular and preventive care. There is a designated network of specialist doctors who are referred to in the event of injuries and illnesses or related emergencies. For regular medical care, you need to choose a PCP or a Primary Care Physician who would look after your general health-related matters on a regular basis. However, medications for commonplace illnesses like drug pressure or diabetes is not included in these Cigna medicare plans and you would be completely responsible for the bill, should you require them.
Source: giant-space.com

Cigna Medicare Provides medical and prescription Drug Coverage at a Low Cost

Cigna offers supplementary benefits to your medical coverage. You are given a toll free whole to call for recorded condition facts or to discuss your medical concerns with a registered nurse. In addition, you have the choice of receiving home pharmacy delivery of your regular medications. Cigna also provides you with a reduction card that could save you money on fitness memberships, eyewear, vision exams, hearing tests, hearing aids, batteries, and chiropractic care. You are also provided programs and discounts to help you with weight loss, proper nutrition, dental care, laser vision care, and smoking cessation.
Source: hearingaidreviews.org

Advantage Plans Are the Best Alternative to Medicare

There are many changes going on in the health insurance field right now so make certain that you review your options every year. Do not automatically assume that you should get the same health plan from year-to-year. Go through the same steps each year before you need to make your health insurance selection for the year. It takes some research to choose the best medicare advantage plans that will provide you with the most coverage for medical care at the most reasonable cost. Use the tips above to assess health insurance plans available to you. Here are some more tips that can help you get more coverage and the following benefits:
Source: ucommando.com

Cigna Medicare Plans And Blue Cross Medicare Plans An Overview

The CIGNA plan D in turn offers three types of plans namely, Plan 1, Plan 2 and Plan 3. Medicare CIGNA offers several Advantage plans, one of which is its private fee-for-service (PFFS) option. The PFFS plan offered by this company called CIGNA Medicare Access offers full coverage for Original Medicare (Parts A and B), additional dental, hearing, and vision benefits, the right to choose any health care provider, with no network restrictions, emergency coverage across the world, limited prescription drug coverage for some plans. This plan also offers four different plan options called Plan 1, Plan 2, Plan 3 and Plan 4. Blue Cross medicare plans are often the combination of single medicare plan and HMO plan. The benefits include low or no, monthly premiums, low copayments for doctor office visits, and coverage for vision, dental and routine care. This plan, however, is only available to only certain geographic locals and also the names of the plans are not standardized. For example in California the Blue Cross Medicare HMO is offered by Anthem and is called; Blue Cross Senior Secure. In Florida, plans are available from BlueCross BlueShield of Florida, and the Medicare HMO is specifically called BlueMedicare HMO. The Plan benefits will also vary from plan to plan. The most important beneficiaries offered by Blue Cross medicare plans are Advantage plans, Medigap and Part D drug coverage (PDP). Though Blue Care medicare plans offer standardized beneficiaries, standardized coverage, they vary according to the geographical locations. BlueMedicare HMO, BlueMedicare PPO, BlueMedicare Regional PPO and Blue Medicare PFFS are some of the examples for Blue Cross Advantage plans that are available for 2010.
Source: ezinemark.com

Breaking News: U.S. Senate Investigating United Healthcare, Cigna, Aetna for Medicare/Medicaid Fraud!

In addition, FierceHealthcare is reporting that United Healthcare, Cigna, and Aetna have also been caught in a multi-billion dollar pull-through scheme involving Quest Diagnostics and LabCorp. This scheme specifically involves Quest and LabCorp offering contracts for discounted or below-cost pricing in exchange for in-network physician referrals for lab testing business. The companies have clearly violated the U.S. federal anti-kickback law which protects patients and Medicare/Medicaid beneficiaries from potential influence of financial arrangements on care decisions. (Source: http://www.fiercehealthcare.com/story/senate-probe-aetna-cigna-united-healthcare-quest-lab-corp-alleged-billion-d/2011-11-09?utm_medium=nl&utm_source=internal)
Source: wordpress.com

Cigna Medicare Plans – Advantage Access Renewal

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

Health Policy Issues Draw Headlines For Romney And Gingrich

Posted by:  :  Category: Medicare

HERES YOUR TOP TEN by SS&SSThe 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

Video: AARP Member Mark Walker of North Andover, MA

Health Care Spending: Behind the Numbers

) for per-capita health care spending at $6,921.  This may seem surprisingly high, but it makes sense because Iowa is well insured (10 percent uninsured – only three states do better) and has a relatively large population of senior citizens (15 percent of Iowans are 65 years or older, the fifth highest rate in the nation).  Massachusetts provides the perfect storm for pushing up health care costs: nearly everyone is insured (4.4 percent uninsured) and the median age is high (39).  But most important is Massachusetts’ unrivaled density of medical providers; the state has one physician for every 189 people; in Iowa, there is one physician for every 479 people.  No wonder Massachusetts’ per capita health care spending is $9,277 (the highest of all states and 30 percent more than Iowa).
Source: iowahospital.org

Viewpoints: Wyden And Ryan On Their Medicare Plan; Frist On The Need For International Health Aid

Health Policy Solutions (a Colorado news service): Nurses Lead Program To Change Delivery Of Health Care As health care reform seeks to improve quality of care, achieve better health outcomes and reduce costs, nurses should be at the forefront to change the delivery of care for high-risk clients. Nurses lead a prevention-based health care program through the Nurse-Family Partnership (NFP), a national organization based in Denver that pairs low-income women having their first baby with registered nurses to offer guidance  during pregnancy and  until the child’s second birthday. Randomized, controlled trials showed that if you invest early in a child’s health through NFP, you can improve the child’s development and school readiness and reduce injuries and emergency room visits (Elly Yost, 12/14).
Source: kaiserhealthnews.org

Gilman Law LLP is Investigating Potential Employment Complaints Against Massachusetts Companies that have Misclassified Workers as Independent Contractors

Recently, Massachusetts workers in a number of fields have been able to win back wages and other damages by filing independent contractor misclassification complaints against their employer. Massachusetts has some of the strictest laws in the country governing the classification of workers as independent contractors, and provides for the payment of treble damages and attorneys fees in civil suits. Gilman Law LLP is offering free complaint consultations to any Massachusetts worker who may have been misclassified as an independent contractor. If you or someone you know is being wrongly classified as an independent contractor in Massachusetts, it is important that you contact Gilman Law today to discuss your misclassification complaint with one of our experienced employment lawyers. nytimes.com/2010/02/18/business/18workers.html?pagewanted=all
Source: bestlongtermcare.org

Massachusetts Liberal: There they go again

have a message for Americans this holiday season: let them eat cake. Doing their best impression of Marie Antoinette, House Republicans loaded down a bill to cut payroll taxes and extend long-term unemployment benefits for the 99 percent by adding a Christmas tree of ideological special interest goodies for the 1 percent they know will doom the measure. What exactly will the Keystone XL pipeline or dirtier air do to help people struggling to work their way out of the Bush Recession? At the root of the problem, as always, is the
Source: blogspot.com

Spending on Health Care Varies by State, Age, Income and Gender

The national average of Medicare personal health care spending per enrollee was heavily influenced by a small group of states with higher-than-average spending per enrollee. Just fourteen states had per enrollee Medicare spending levels greater than the national average in 2009 while 36 states had Medicare spending per enrollee below the national average.  The states with higher than average Medicare spending tended to be in the Eastern United States in areas with higher population densities and the states with lower than average Medicare spending per enrollee tended to be less densely populates areas with younger populations and lower ratios of physicians and specialists as a proportion of the population.
Source: wolterskluwerlb.com

Frank lobbies against cuts to Social Security, Medicare

If the automatic cuts kick in, he said he will fight lawmakers who want to change the law to exempt defense spending from those cuts. And he thinks he would find allies among tea party lawmakers in battling any attempts to change the deficit reduction.
Source: gsmlaborcouncil.org

Feds to allow use of Medicare data to rate doctors, hospitals and other health care providers

“There is tremendous variation in how well doctors do, and most of us as patients don’t know that. We make our choices blind,” said David Lansky, president of the Pacific Business Group on Health. “This is the beginning of a process to give us the information to make informed decisions.” His nonprofit represents 50 large employers that provide coverage for more than 3 million people.
Source: profrisk.com

How To Tell Medicare Fraud

Posted by:  :  Category: Medicare

By watching informational auto ins videos, an individual will get information on different matters. First and foremost, one will be informed about the most basic facts. Understanding such builds a strong foundation that will facilitate easy understanding of all complex issues. Actually, it is quite impossible to decipher the nature of a certain difficult variable if one does not know the meaning of indemnity and what is meant by the term insurable interest. In some video presentations, relationship between one particular key aspect and another is presented.
Source: ianslive.com

Video: Maryland Senator Ben Cardin Goes On Record On Medicare Fraud

13 Indicted For Medicare Fraud In Puerto Rico; Federal Officials Use Hotline To Find Medicaid Fraud

This is part of Kaiser Health News’ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.
Source: kaiserhealthnews.org

Dwayne's Give Heed To

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Source: giveheedto.com

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Source: giveheedto.com

Nothing found for Uncategorized Reasons

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Source: exerciseequipmentforhome.net

How To Detect Medicare Fraud

Abuse happens when doctors or suppliers dont follow the appropriate medical practice that can result to unnecessary costs to Medicare. This is quite expensive for the government so they really have to deal with this problem. the truth is, you can combat medicare fraud by reporting suspicious acts via the medicare fraud hotline . Medicare fraud can take many forms. A health provider may charge certain bills to Medicare even if the person has not availed of services or tests. By doing this, health providers can take advantage of the reimbursement that the government gives to them.
Source: the-monkey.biz

Understanding Medicare and Medigap

Posted by:  :  Category: Medicare

Gang of Six - Cartoon by DonkeyHoteyMedigap insurance supplements are each unique and will want to be picked based upon the need of the individual. For instance, clients who need help with copayment and deductibles for basic benefits will want to choose Medigap plan A for those are the items that it helps cover. This plan is attractive for it is the least expensive plan available and is accepted by all doctors who accept Medicare. Drawbacks come with each and every plan available. The major drawback to plan A is that it covers basic necessities and not items such as long term care, skilled nursing, vision care amongst several other major areas of expense.
Source: chantler411.com

Video: Rick Perry Hates Social Security, Medicare & Rules For Wall Street

InsureBlog: Medicare Advantage

Disenrolling in an MA plan may also trigger a GUARANTEED ISSUE situation allowing you to enroll in any Medigap plan without answering health questions. If you enrolled in an Advantage plan for the FIRST TIME, either when you first became eligible for Medicare Part B or you left Medicare to join an Advantage plan. If you leave the Advantage plan during the first 12 months you may have a guaranteed right to return to Medicare and a Medigap plan. You should apply for a new Medigap plan no later than 63 days following the end of your Medicare Advantage coverage. Your new Medigap plan cannot become effective before the date of your application. You may also have other guaranteed rights to purchase a Medicap plan without answering health questions. Call us. We can help. Even if you do not have a guaranteed right to purchase a Medigap plan you may still qualify if you are in reasonably good health. We have helped people age 80 and younger find an affordable Medigap plan once we determine they still qualify.
Source: blogspot.com

Transcript: Donald Berwick on Medicare, Medicaid, ‘Rationing’ and Who Decides

DONALD BERWICK:  Congress sort of answered that question in setting up the Federal Coordinated Care Office under the Affordable Care Act.  They said that it isn’t a sustainable plan.  The dual eligible population – people who have both Medicare and Medicaid – they need the best of coordinated services.  Medicare and Medicaid have to work well together, states and the federal government have to work well together, and caregivers have to work well together in order for these people to get a fair shake.  And Congress was absolutely right.  I think the dual eligible population, they’re the test case for the integrity of American health care; its ability to really help people.  … Now getting them into the right care system where they’re absolutely going to have the benefit of firm, really superb world-class care coordination — they’re going to be at the center of everyone’s concerns, their needs will be met – that’s a big challenge.  That’s where some of those capacity issues arise.  For duals it’s actually a bigger issue, because a lot of the people who are dual eligibles, their needs go outside the health care system.  Their asthma may get worse because they have bad housing.  They may fall because they’re not in a safe nursing home.  And so being able to think about health care even more broadly than we do for duals, that’s pretty important.
Source: kaiserhealthnews.org

Medicare and You! Important information from EUTF and ERS

 Those who are soon to be receiving Medicare, the State/EUTF will reimburse you and your spouse (or domestic partner) for your Medicare Part B premiums.  The EUTF must receive the following documents from you to begin the Part B reimbursement:  1) a copy of your Medicare card, 2) a completed Direct Deposit Agreement Form along with a voided check, and 3) a copy of the letter you receive from the Social Security Administration informing you what your monthly Medicare Part B premium will cost.  
Source: wordpress.com

How to Apply for Social Security Retirement Benefits and Medicare : Pennsylvania Law Monitor

The earliest age at which you can receive Social Security Retirement Benfits is 62. You can start receiving Medicare Benefits at age 65. Within 4 months of the date you wish to start receiving benefits you should contact Social Security. The application process will require you to answer certain questions and provide some documents. If you have difficulty obtaining all the documents, Social Security will assist you in getting them. The documents required to prove your eligibility for retirement benefits include:
Source: stark-stark.com

Senate Doctors Dissect CMS’s “Medicare and You”

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Source: ncpa.org

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

Seniors In Oklahoma, Nationwide Face Important Medicare Deadline

Posted by:  :  Category: Medicare

Gang of Six - Cartoon by DonkeyHoteyCindy Loftin with LIFE Senior Services has been educating Tulsa seniors about their options, and making sure they know about the deadline. Instead of having until the end of the year, seniors have until December 7 to sign up for a new plan or change their current plan.
Source: newson6.com

Video: Oklahoma Medicare Advantage Plans and Supplemental Insurance

Registration Began for Medicare EHR Incentive Program

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Source: articleplusx.com

Oklahoma Medicare Fraud Continues to Rise

Over the last three years, Oklahoma fraud lawyers have seen a significant increase in the number of Medicare fraud cases.  One recent news report claims that in Oklahoma, Medicare fraud has increased by 350% in the last three years, resulting in seven criminal cases and thirty eight civil suits totaling more than $22 million in settlements.  According to the Coalition Against Insurance Fraud, nearly $24 billion dollars are spent on improper, inaccurate, or fraudulent Medicare and Medicaid claims annually in the United States.  With such a heavy financial toll on the government and taxpayers, fraud cases are investigated and prosecuted vigorously.  The United States Department of Health and Human Services reports that the federal government saves $1.55 for every $1 invested in fighting fraud.
Source: oklahoma-criminal-defense.com

Watch This: Making ends meet

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Source: okpolicy.org

A.C.T. Home Health on helping patients while saving billions for Medicare – LIVING WELL Magazine

The average cost of a home health episode, which is measured on a 60-day cycle, cost less than only one and a half days in a short-term acute-care hospital based on Medicare data from 2008. So, one would think Congress would encourage more Medicare beneficiaries to utilize home health services and avoid a very expensive hospital visit. A study by Avalere Health, LLC that began in October 2008, found that early use of home health services following a hospital stay by patients with at least one chronic disease saved Medicare $1.7 billion over a two-year period from 2005–2006. And, could have possibly saved an additional $1.77 billion if those using other post-acute care facilities had, instead, utilized home health services. The Alliance for Home Health Quality and Innovation (AHHQI), a sponsor of the Avalere study, believes Medicare could realize more than $30 billion in savings for chronic disease patients over 10 years by expanding access to home health.
Source: livingwellmag.com

Medicare fraud sweep nets 91; help us keep Oklahoma clean

Earlier this month, Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius announced a nationwide operation by the Medicare Fraud Strike Force with special focus on eight cities had resulted in charges against 91 defendants, including doctors, nurses and other medical professionals. All were accused of participating in Medicare fraud schemes that totaled some $295 million in false billing.
Source: wordpress.com

Soft Selling to Seniors on Medicare (Oklahoma City)

Medicare/DME Sales — We Will Train Five Star Senior Services is expanding its regional Sales and Service team. . . We are a provider of technologically advanced, heat-therapy bracing equipment and power wheelchairs. We market directly to the senior, Medicare-eligible community and their healthcare partners. This is a low-pressure, commission-based opportunity that requires a professional, service-oriented attitude utilizing a consultative, compassionate approach. You will be calling primarily on senior centers, churches, and retirement communities. Secondary markets would include physicians, physical therapy and pain management practices. Training provided via the platform on the website and on an individual basis. This can be done on a full- or part-time basis and is available throughout the region. First year, realistic full-time earnings should exceed $40,000 and could be as high as $70,000, depending on work ethic and motivation. Please visit our website (***/Opportunity), listen to “Our Story & Strategy” to learn more, and if you are still interested we invite you to complete the brief application online . . . Thank you and God Bless. Come be a Partner in Our Vision. . .
Source: telecommuteanywhere.com

Dorchester Pharmacist Sentenced to 12 months for Medicare and Medicaid Fraud

Dorchester pharmacist Ernest M. McGee was sentenced to 12 months in prison by U.S. District Judge Nathaniel M Gorton, the DOJ reports. The judge also ordered McGee to pay restitution to Medicaid and to Medicare, in the amounts of $292,635 and $60,037 respectively. McGee worked at Codman Square Pharmacy in Dorchester, which was owned by Amadiegwu Onujiogu, who was also convicted separately of the same crime. According to the claims, McGee paid customers to bring prescriptions to the pharmacy, but would not then dispense medications to them. McGee would then submit claims to Medicaid and Medicare for the prescriptions and their refills.
Source: whistleblowerlaws.com

universal health care hmo soho centre for health and care

If your doctor refers you out of the network, the plan pays all or most of the bill Some treatments and procedures require a second opinion If you go outside the network, you’ll be responsible for filing insurance claims Prior approval is required for hospitalization (except for an emergency) and some outpatient services Does the plan pay for any special services you need? Your doctors and hospitals are paid for services provided Emergency care doesn’t require approval if you determine you need it You do not have to file claim forms with the insurance company What is the plan’s policy on pre-existing conditions? Health maintenance organizations (HMOs) are considered the most restrictive because they offer you the least amount of choices. However, they tend to have both the lowest out-of-pocket costs and the least paperwork, and they promote general wellness programs to keep you healthy. To increase the overall quality of care and reduce costs, many managed care plans require that you see a primary care doctor (family practitioner, internist, or pediatrician) before visiting a specialist. Your primary care doctor has the responsibility of knowing your complete medical history, making the initial diagnosis, and advising on further treatment. Does it matter that you might be limited to your choice of doctors and hospitals? Ask to see a network directory. Are your current doctors in it? Would getting referrals to specialists be a problem? You must use specific health-care providers and facilities to be fully covered There are financial incentives, such as lower out-of-pocket costs, to use network providers Whatever plan you choose, you will become a partner with your doctor and insurance company. Keep in mind that managed care plans make more money when they keep you healthy and out of hospitals, reduce the amount of care you receive, and stay within the budget set for each member’s total medical care. It will be your responsibility to schedule physical exams and take advantage of other preventive care programs. Make sure there is a good match between what you think you need and what is provided. The goal of managed care is to provide health care that is: Are the doctors close to you accepting new patients? Most preferred provider organizations (PPOs) do not require a referral from your primary care doctor to visit a specialist There is no perfect plan-you’ll have to do some give-and-take. Some questions to consider: After you decide what benefits are important, you will be in a better position to compare individual plans. Plans differ with regard to out-of-pocket costs, services provided, and how easy it is to get those services. Although no plan will pay for everything, some plans cover more than others. You can go for emergency care wherever and whenever you determine you need it, without prior approval Preventive care programs are available to keep you well PPOs are less restrictive than HMOs in your choice of health-care provider, but your out-of-pocket costs may be higher. The coverage provided for treatment and care is similar to an HMO. Point of service (POS) plans are less restrictive than HMOs. They combine some features of HMOs and PPOs and have the highest out-of-pocket costs. So even though POS plans allow greater choice at the time the service is delivered, you’ll pay more for your health care. If it’s been a while since you’ve shopped around for health insurance, you may find that things have changed since the last time you tackled this chore. Not long ago, you could go to any doctor or hospital, and you and your insurance company would each pay part of the bill. Now, most health insurance policies are some form of managed care, with controls to contain costs. Some treatments and procedures require a second opinion Today, more than half of insured Americans are covered by a managed care plan-a plan that gives financial incentives to encourage you to use doctors who are part of the plan network. The better you understand managed care, the better you will be able to select the plan that best meets your needs and budget. Insurance companies negotiate discounts with medical providers who sign up to be part of the managed care plan’s network. In exchange, the providers get an instant pool of patients. The plans generally limit your out-of-pocket expenses for covered care. They usually require (or encourage) that you seek care from a specific list of contracting doctors, hospitals, and other providers. If you go out of the plan’s network for medical treatment, you have to pay higher out-of-pocket expenses. Are therapies such as acupuncture or chiropractic services covered? What is the plan’s rating on quality of care and member satisfaction? Screening tests for cancer and other chronic diseases are usually covered You can receive care from providers outside the network without prior approval Doctors are paid based on a capped or fixed-fee arrangement rather than payment for services given Nonemergency and elective admissions to the hospital require prior approval You can go outside the network only if prior approval is given or for an emergency Your primary care doctor is the gatekeeper who coordinates your health care and refers you to specialists You will have higher out-of-pocket costs if you use providers outside the network
Source: humanhealths.info

Medicare Supplemental Insurance Comparison: Necessary to Find A Medicare Supplement Plan at the Best Price

Posted by:  :  Category: Medicare

"Citizenship is a tough occupation which obliges the citizen to make his own informed opinion and stand by it." ~ Martha Gellhorn  by eyewashWhen performing Medicare Supplemental plans comparison, price quoted by different providers is the single most important factor that needs to be considered. The reason being that all supplement plans and benefits are standardized by the Center for the Medicare services that mean that all carriers offer the same supplement plan options. These options are classified as Plan A-N and carriers cannot alter these supplements nor can they provide additional benefits, but the prices at which they offer these plans do differ. Therefore, people prefer doing a Medicare Supplemental insurance comparison to browse for a carrier who provides the supplemental plan of their preference at the lowest possible price. Since Medicare supplement plan is collateral to Standard Medicare plan, you can visit any doctor or hospital that accepts standard Medicare.
Source: articlegoes.com

Video: Switching To Medicare Supplement Plan F

Why Medigap Plans are Crucial to Seniors

The importance of a good Medicare Plancan not be overstated. Depending upon the plan, Medigap plans make your healthcare costs completely affordable and predictable. Medicare by itself has no limits. If you have no gap coverage and you get really sick, your costs could be unlimited and it could ruin you financially. The Medigap Plan F is the most comprehensive. Sure, the rates go up every year, but compared to the cost of unlimited bills, the premiums will always be affordable. Medigap is not the same thing as Medicare Advantage plans. Those plans work instead of medicare, rather than alongside of Medicare as do the Medigap plans.
Source: thailandbeach.info

Common Questions About Medicare Supplement Plans

Enrollment is Not Always Guaranteed: Medicare Supplement insurance is regulated by the states, so there will be eligibility differences based on where you live. For example, in New York, most applicants must be accepted anytime, while in other states all applicants must be accepted only within their first six months of eligibility for Medicare Part B and in a few other situations. Outside of the eligibility periods, carriers are allowed to reject an applicant based on adverse health conditions. This means that if you apply at the wrong time, you may not be eligible for a Medicare Supplement policy.
Source: ehealthinsurance.com

Is High Deductible Plan F the Best

Hi, I just turned 65, live in NY and I’m in pretty good health at the moment. I signed up for Original Medicare and I’m researching Medigap plans. It looks like Plan F is the most popular, probably since it covers everything with limited cost. Since I don’t have many doctor or hospital visits high deductible Plan F seems like an even better choice for me. It potentially has the lowest premiums of all the plans (if I don’t need much medical care for the year) and has the benefit of limited maximum costs if I do need a lot of care. The cost in that case would then be about the same in NY (i.e. approx $3,000 in premiums for Plan F and the same for premiums + deductible for the high deductible version). High deductible ssems like a no-brainer for someone in good health. Am I missing something? Thanks in advance, Stan
Source: insurance-forums.net

Understanding Medicare Plan F

However, Plan F does not offer coverage to at Home recovery care and any preventive care services. Therefore, those who specifically need such services should seek more information from other plans that sits their needs. Plan J also offers more and a little cheaper in premium. Patients should take time and compare these Plans, especially from different insurance companies to find the cheaper option because the ultimate target from all is to get a guaranteed coverage.
Source: wpa2007seoul.org

Plan F High Deductible Medicare Supplement Quotes

Someone who was once in good health, but later finds that the $2,000 + deductible must be met each year as his or her health has changed might not prefer the coverage any longer. The issue then would be that it is can be difficult to change plans if the insured is in poor health. Medicare beneficiaries cannot change coverages without undergoing medical underwriting with most providers in most states.
Source: ohioinsureplan.com

Medicare Supplement Strategy F

Amongst the most extremely-sought of all Medigap plans is  Medicare Supplement Strategy F. Not only is this strategy favorable because of to its substantial quantity of coverage but also for its inexpensive Medicare supplement insurance average monthly premiums. Seniors who are enrolled in conventional Medicare frequently look to Medicare Dietary supplement Strategy F and other people to fulfill the gap in their Medicare protection. Simply paying the remaining Medicare supplements amount out-of-pocket is just not possible for most senior citizens residing in present day economy. The most optimum time to use for secondary well being protection is throughout your open enrollment time period which begins on the initial day that you are enrolled in traditional Medicare. The open up enrollment period ends six months from that day.
Source: photoeditorv.com

Medicare qualifications for mobility scooter

Posted by:  :  Category: Medicare

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I am sorry that any local disputes of Sir Leicester’sthey are not of his seeking, however, I believeshould render it a matter of some absurd difficulty to show you any attention here. And when she had anointed his eyes and was about to depart, it chanced she saw in the mirror that her beauty had been restored to her. Some criticism was made of the way I worked instead of rested in vacation time. The good old medicare qualifications for mobility scooter read the sixteenth chapter of Samuel, and then proceeded to preach a long and somewhat dull sermon. It is like tumbling down through an empty steeple, feet first. Leaving it like that would be like leaving one piece out of the jigsaw puzzle or a picture hanging crooked on the wall. ‘ He trotted off to the open shop of a kunjri, a lowcaste vegetableseller, which lay opposite the belttramway line down the Motee Bazar. ” “She would no doubt be grateful for your sympathy,” the young woman answered, flinging a queer little look of irony at him. I thought to myself, in the end does it make any difference who is elected a Democrat or a Republican�and maybe my daughter might get a job. Jonesy could have sworn that what he had taken for a middleaged potbelly was almost gone. JONATHAN HARKER’S JOURNAL 30 October. I can hear cheerful shouts: medicare qualifications for mobility scooter Janka, Andryushka’s monster was scarier! The Hype is a medicare qualifications for mobility scooter change con. He was in a mood to shoot her, but this weapon was not fitted with a soundsuppressor. Aristophanes did not, as expected, come running, his tail curled up slightly, eager for his dinner. [16] But on the way he bought two gallons of wine. ” “Thou art a great man, Palitlum,” I said, “and I honor thee. Confident at last, Lena Feldt went down the rocky slope toward the lake, and as she walked through the camp, one or two blankeyed soldiers glanced up briefly, but found what they saw too hard to remember, and looked away again. This playing with tweezers medicare qualifications for mobility scooter knives and scissors is too little. There came a hiss of breath from behind his right ear. “It is medicare qualifications for mobility scooter a night’s journeyat full speed,” said Bagheera, and Baloo looked very serious. ” and presently we were all lined up in a row facing a greensward which had suddenly been revealed to the left and on which, and before a small plumber’s stove standing outside some gentleman’s stable, was stretched a plumber and his helper. Tell you about it later, honey. And she shall touch and remit After the use of kings Orderly, ancient, fit My deepsea plunderings, And purchase in all lands. ‘ ‘But surely you aren’t going to embarrass him by asking? The guy was as pale as a risen corpse but dressed for a Margarita party. Hooker medicare qualifications for mobility scooter at this time attending to polymorphism, variability, etc. The fairies have abandoned their moonlight turf; the witch no longer holds her black orgies in the hemlock dell; and Even the last lingering phantom of the brain, The churchyard ghost, is now at rest again. An almost funereal gloom seemed medicare qualifications for mobility scooter have descended upon the Ghost. The first thing that struck her was the deathlike stillness of the room. Sound of her footsteps crossing the kitchen again she was going to the counter where she had set the pie down. No drink in the pilots’ lounge, no dinner, not even a bath when he got back to Westwood. The anal wowimpulse induces the cell to eliminate money in order to experience pleasure from the coincidence of the abovementioned images. Even her damaged eye managed to emit a holiday gleam. A voice older than his first fathers seemed saying in his ear: “Keep out of the monstrous garden where grows the tree with double fruit. Still you are safer going medicare qualifications for mobility scooter even though you seem to be going back nearer to their strongholds; for that is what they will least expect, and they will have the longer ride to catch you. Is there any carriage to be had? medicare qualifications for mobility scooter Minister, is a single and final communication. Clarendon discovered that he had an unexpected repugnance to doing this. Maybe a little cleaner, but the same stuff. ” “I’ll tell auntie how you feel about it, and I’m medicare qualifications for mobility scooter she won’t forget you. Will saw him reach for the phone, medicare qualifications for mobility scooter left the building quickly. There probably came a time, in due course, when her students began to think there was something deeper in her teachings than they had been suspectinga mystery beyond mentalhealing, and higher. “Come, now, let’s see if I can guess. commentaries on mark 16 please dont walk away baby
Source: blog.cz

Video: American Sign Language (ASL) – Medicare Basics

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

NAOMBAKAZI.COM: Pakistan OTI Deputy Country Representative

The work of the Deputy Country Representative requires teamwork, the exercise of discretion, judgment, and personal responsibility. As a member of a highly visible and rapid response office, the Deputy Country Representative requires a willingness and ability to perform a wide range of administrative functions to help ensure programmatic success. The Deputy Country Representative is highly flexible and the working conditions are subject to ongoing change(s), while maintaining a professional and respectful conduct towards colleagues and authority in a diverse workforce. S/he places a premium on the building positive relationships with his/her respective team, with the rest of OTI and with key stakeholders both in and outside of USAID. The Deputy Country Representative is a team player, able to prioritize and follow up on their own actions without prompting, while also assisting a busy supervisor and fellow colleagues to track and respond to incoming requests and routine tasks, filling in gaps as needed to ensure the responsiveness of the team. The Deputy Country Representative has a strong sense of responsibility, service-oriented, highly organized, pays close attention to detail, is able to complete administrative tasks with minimal guidance, and is able to receive and respond to constructive criticism in a professional manner. The Deputy Country Representative is a strategic thinker, articulates innovative ideas, presents solutions, and is a positive role model for colleagues both in and outside of OTI.
Source: blogspot.com

Health care Billing and Html coding Training

Examination and Qualification. Productive realization an approved method and test affords the headline of Authorized Wellbeing Information and facts Technical assistant (RHIT). There are various other assessments given by the AHIMA for health and fitness information and facts specialist such as the Qualified Programming Affiliate (CCA), and Qualified Programming Expert (CCS), and also certification in Health Security and privacy. The AHIMA also supplies test for any leading-edge winrar location of Authorized Wellbeing Information and facts Manager (RHIA). Most organisations opt to retain the services of accredited personnel instead of no-accredited.
Source: theimempires.com

Items to consider In Scouting for NJ Nursing Homes

Do not forget that you’ll be entrusting to them the well being of your family member. Make certain they are licensed and have enough education in emergency care, critical care, and elder care. Find out as well how many staff in the center to ascertain if the home is capable of providing sufficient care and attention to each senior resident. They must also be pleasing, attentive, and completely understand the requirements of the folks they are looking after. Inspections Records Evaluate the facility’s previous safety and health inspections particularly the “Care Quality Commission” reports. Check if they have any kind of violation and assess the compliance of your chosen NJ nursing homes to the rules set by government bodies. Also, check if they have got smoke alarms, fire exit, handrails on pathways, and specially fitted toilets for impaired patients. Scouting for a good nursing home usually takes time and effort from your part. You have to remember, nonetheless, that you’ll be accomplishing this to guarantee your aged family will have the needed care. Your peace of mind is part of what you are paying for, after all. Nothing beats the thought that your family member is taken good care of in a safe and comfortable nursing home.  
Source: ezinemark.com

sleepdoctor: Medicare qualifications for a Sleep Technician

CMS document 410.33 (2)(c) states “Nonphysician personnel. Any non-physician personnel used by the IDTF to perform tests must demonstrate the basic qualifications to perform the tests in question and have training and proficiency as evidenced by licensure or certification by the appropiate State health or education department. In the absence of a State licensing board, the technician must be certified by an appropiate national credentialing body. The IDTF must maintain documentation available for review that these requirements are met.”
Source: blogspot.com

Basic Notion of Physical Therapy Assistants

Other than performing the task which is allotted to the helpers in this field, they will be carrying out several other responsibilities under the control and direction of the physical specialists. The physical therapy assistants will be making the care sittings very productive. People who wish to work under this medicare sector should hold at least high school diploma degree. Most often, the bosses will be providing on-the-work coaching. The treatment procedures which are executed by the therapy aides may include exercises, massages, electric stimulation, cold and hot packs and paraffin baths.
Source: eva-news.com

Do you know what is in Obama/Pelosi care reforms proposals?

On Nov. 2, the Congressional Budget Office estimated what the plans will likely cost. An individual earning $ 44,000 before taxes who purchases his own insurance will have to pay a $ 5,300 premium and an estimated $ 2,000 in out-of-pocket expenses, for a total of $ 7,300 a year, which is 17% of his pre-tax income. A family earning $ 102,100 a year before taxes will have to pay a $ 15,000 premium plus an estimated $ 5,300 out-of-pocket, for a $ 20,300 total, or 20% of its pre-tax income. Individuals and families earning less than these amounts will be eligible for subsidies paid directly to their insurer.
Source: striveguide.com