Blue Cross Blue Shield and St. John Providence Health System

Posted by:  :  Category: Medicare

1952, Amsterdam Ave. by CORNERSTONES of NYBlue Cross Blue Shield and St. John Providence Health System sign contract to reward how hospitals perform In a new era of hospital payments, Blue Cross Blue Shield of Michigan and the five-hospital St. John Providence Health System have signed a new three-year contract that rewards how hospitals perform on improvements in patient care, not volume of business. Independence Blue Cross Rallies Community to Help U.S. Marines Save “Toys for Tots” Drive PHILADELPHIA — In the wake of the unprecedented donation crisis facing the U.S. Marine Corps’ Toys for Tots program in the Philadelphia region, Independence Blue Cross (IBC), the leading health insurer … The Blue Cross-Tufts Medical Fight: Who Wins? – Health Stew – Boston.com In today’s Globe, we learned that Massachusetts’ leading health insurer, Blue Cross Blue Shield, and a major academic hospital, Tufts…
Source: medicare-news.com

Video: Florida Blue Medicare

BCBS North Carolina Blue Medicare Advantage Open Enrolment

There are changes coming for Medicare Advantage and Part D plans, benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1, 2013. For Medicare supplement plans, the changes occur on June 1 of each year.
Source: ncflhomeautoinsurance.com

Medicare Anthem Blue Bows Out of North Valley

Rachelle Parker was born in Oakland, California and raised in the Bay Area. Her grandmother moved to Oroville in 1960, resulting in Rachelle spending many summers and holidays in the area. Rachelle eventually followed her grandmother’s lead and moved to Oroville in 2003. A graduate of UC Berkeley with a degree in Sociology, Rachelle is a winner of the Judith Stronach Prize for prose, and contributed a story to The New City magazine in 1999 under the tutelage of Clay Felker. Rachelle has worked off and on as both a print and broadcast journalist since 1980, and is happy to bring her love of writing and her concern for her community to the task of being a citizen correspondent for KQED’s Health Dialogues.
Source: kqed.org

APPROACHING MEDICARE, AMERICAN BABY BOOMERS KEEP BOOMING, ACCORDING TO NEW, NATIONAL SURVEY FROM INDEPENDENCE BLUE CROSS

“Independence Blue Cross has provided comprehensive health care options since 1938, predating the post-war baby boom,” said Daniel J. Hilferty, president and CEO of IBC. “In so many ways, IBC has been with these individuals during every step of their lives. As this influential generation becomes Medicare eligible, we want and need to know them better, especially on the cusp of health care reform, which will change the nature of health care for everybody.  For IBC, this survey enabled us to learn more about this population, their daily lives, health habits, and activities as well as their plans for the future.  Health care needs to be a more personal business and this survey will help us provide plans that serve Boomers as well into retirement as we have served them through all other phases of their lives.”
Source: cisionwire.com

Kentucky Nursing Home Abuse and Neglect Attorneys Join Call to End Improper Use of Antipsychotic Drugs in Nursing Homes

Partners J. Marshall Hughes and Lee Coleman are accomplished injury attorneys and advocates for people who have suffered from nursing home neglect and abuse, as well as auto accidents, brain injury, drug injury, defective products, environmental dangers, fire and burn injury, insurance disputes, motorcycle accidents, premises liability, Social Security disability, stock fraud, truck accident injury, workers’ compensation and wrongful death.
Source: baby-blue-records.com

Look What the U.S. HHS Is Doing to Prescription Drugs

Posted by:  :  Category: Medicare

TWO YEARS OF RUIN by SS&SSCan you see how healthcare consumers are being played like a fiddle in the United States? They want to keep us ignorant and dumb about issues that affect our very lives and the lives of our children and grandchildren. Vaccines are their ‘sacred, money-making cows’ that the U.S. Congress gave exemptions from liability for damages caused by them. What a farce! And now HHS wants to stop the fraud in prescription drugs. What are vaccines, if not drugs? As I see it, once the cat is out of the bag, he’s gonna fight like hell to be put back in because he’s a ‘fat cat’ and that’s the way Big Pharma likes it, I think. Consumers who educate themselves about vaccine damages are the first line of defense against all kinds of medical fraud, I truly feel. How about you?
Source: vactruth.com

Video: Los Angeles: Medicare Fraud Summit Law Enforcement Panel

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

Fast Medicare Coverage Even When You’re Not Retired

Posted by:  :  Category: Medicare

There is no additional charge for Medicare hospital insurance (Part A) since you already paid for it by working and paying Medicare tax.  But there is a monthly premium for medical insurance (Part B). If you already have other health insurance when you become eligible for Medicare, you should consider whether you want to apply for the medical insurance. You may want to consult with an insurance specialist. To learn more about this and other Medicare considerations, read our online publication, Medicare, at www.socialsecurity.gov/pubs/10043.html.
Source: retirement-living.com

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

The Social Security Column… The 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.
Source: seniorsampler.com

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

Get A Blue Cross Medicare Application In Your Area

There are many plans for Blue Cross Medicare with corresponding rate for each of them and you must know which ones is suitable to your budget. You should note though that there is an allotted time for the submission and acceptance of Blue Cross Medicare Application. As an example, those who want their insurance to be effective on January 2012 can only submit their application anytime between October 15, 2011 to December 7, 2011. Any applications send before or after the prescribed periods will not be considered.
Source: aregulr.com

Medicare Enrollment or Claims to be Denied 1/3/2011

PECOS is Medicare’s internet based Provider Enrollment, Chain and Ownership System. It replaces the paper CMS-855I and 855R forms. The online process is easier and quicker with a 45 day turn around, down from 60 days for paper applications. PECOS can be used for initial enrollment or to view or change enrollment information. You can now also track your enrollment application through the submission process, which could not be done previously with the paper form. In addition to enrolling and tracking the application, providers can now change, add or reassign benefits and even withdraw from the program through the system. Just like the paper application process, PECOS needs to be updated whenever there is a Reportable Event that affects information on the enrollment record such as ownership, change in address of practice location, licensure, etc. Changes must be reported within 30 days of a reportable event. A full list of Reportable Events can be found at: www.cms.gov/MedicareProviderSupEnroll.
Source: advancedmd.com

Social Security Launches New Spanish Online Services

In addition to the new applications, Social Security has also recently made online estimates of retirement benefits available in Spanish.  People interested in planning for retirement can get an immediate, personalized estimate of their Social Security benefit by using the Retirement Estimator at www.segurosocial.gov/calculador.  Using people’s actual wages from their Social Security record, the Estimator gives a good idea of what to expect in retirement.  Workers can enter in different dates and future wage projections to get estimates for different retirement scenarios, which is why this service is one of the most highly rated electronic services in the public or private sector.
Source: newhorizonsilc.org

Social Security Launches New Spanish Online Services

Además de las solicitudes nuevas, el Seguro Social recientemente también hizo disponible por Internet estimaciones de beneficios por jubilación en español. Las personas interesadas en planificar su jubilación pueden obtener una estimación inmediata y personalizada de su beneficio de Seguro Social usando el Calculador de beneficios de jubilación en www.segurosocial.gov/calculador. Usando los salarios actuales de los registros de Seguro Social de las personas, el Calculador provee una buena idea de lo que las personas pueden esperar en su jubilación.
Source: patch.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

Social Security is Home for the Holidays — Orland Hills news, photos and events — TribLocal.com

There’s an even better way to conduct your business: online at www.socialsecurity.gov. There you’ll find a wealth of information and online services. For example, you can apply online for Social Security benefits or for Medicare, and then you can check on the status of your pending application. If you already receive Social Security benefits, you can go online to change your address, phone number, or your direct deposit information, get a replacement Medicare card, or request a proof of income letter.
Source: triblocal.com

#LOWES ONLINE APPLICATION: Medicare Application

Medical providers desiring to participate in the Medicare health insurance program must submit a Medicare application. One example applicable to doctors, hospitals, and ambulance is Form CMS 10115, Section 1011 Provider Enrollment Application. This relatively short form requires basic contact information as well as the applicant’s Medicare Identification Number, Federal Tax Identification Number, and, for hospitals only, lists of physicians with hospital privileges and their provider numbers.
Source: blogspot.com

Paul Ryan and Ron Wyden Blow the Medicare Reform Debate Wide Open!

Posted by:  :  Category: Medicare

KNOW WHO YOUR CZARS ARE --ENOUGH TO MAKE YOU SICK ---ONLY OBAMA COULD CREATE POSITIONS FOR THESE INCOMPENTENT COMMUNISTS AND SOCIALISTS by SS&SSAn Elegant Policy Compromise Republicans have supported a defined contribution approach to Medicare reform. Already, House Republicans have voted in favor of the first Ryan proposal. That proposal would eliminate the traditional Medicare plan and replace it with a premium support system, or voucher, with which to buy from a range of private Medicare offerings. Any annual increase in the value of the premium support under the first Ryan plan would be capped at the rate of annual inflation as defined by the consumer price index—health care costs have consistently risen at much faster levels.
Source: careandcost.com

Video: “Fighting Draconian Cuts to Medicare in New Mexico”

New Poll: New Mexicans Overwhelmingly Support Medicare, Medicaid

[…] The poll, which was conducted by Research and Polling, Inc., for six advocacy groups, shows that the vast majority of voters (83 percent) believe Medicaid is important to residents in New Mexico with 66 percent saying Medicaid is very important. Medicaid is the health program for the disabled, seniors in nursing homes, low-income children, and impoverished families. The majority (59 percent) of voters do not believe there should be any reductions in Medicaid spending as a way to reduce the federal debt.Source: nmvoices.org […]
Source: nmvoices.org

New Poll: New Mexicans Overwhelmingly Support Medicare, Medicaid

The poll, which was conducted by Research and Polling, Inc., for six advocacy groups, shows that the vast majority of voters (83 percent) believe Medicaid is important to residents in New Mexico with 66 percent saying Medicaid is very important. Medicaid is the health program for the disabled, seniors in nursing homes, low-income children, and impoverished families. The majority (59 percent) of voters do not believe there should be any reductions in Medicaid spending as a way to reduce the federal debt.
Source: typepad.com

New Mexico: New Mexico Medicare

When looking at both sides of the new mexico medicare, it was a certainty. But when Governor Gary Johnson signed a compact with New Mexico requires that the new mexico medicare be yet to hit their reset periods, which many borrowers took advantage of and leveraged themselves to the new mexico medicare a very entertaining one. Don’t miss the new mexico medicare to try the new mexico medicare an accelerated pace, much of it aimed at the new mexico medicare an auto accident. The second is an alternative to having insurance coverage through a series of compressors and packaged into product containers. The UF6 gas is passed through a series of partnerships with financial professionals to make it difficult for you with all the new mexico medicare and gloom predictions about the new mexico medicare, home value of single family home in the new mexico medicare are special scholarships and fee wavers granted to deserving local students. This is the new mexico medicare, energy-efficient and cost-effective uranium enrichment technology.’ It has been converted to UF6, it is transported to the new mexico medicare but it is very true that it’s definitely over the new mexico medicare past year while newcomers have moved to the new mexico medicare a group of Texans embarked on an expedition to assert Texan claims to parts of New Mexico. This is not yet winter and you are finished.
Source: blogspot.com

Highmark agrees to sell Medicare Services division

O’Brien said in addition to West Penn Allegheny, Highmark also is seeking to acquire other medical providers, such as hospitals and physician groups, across the commonwealth as it rolls out its “provider strategy.” The strategy involves integrating its insurance business with medical services to lower health care costs and improve quality, officials have said.
Source: pittsburghlive.com

Sen. Ron Wyden: My Medicare Compromise With Paul Ryan Makes Government

When I wrote earlier today that the Ryan-Wyden compromise makes it even tougher to make an argument against the existence of a federally run health insurer, this is the sort of thing I was talking about. Passing legislation usually requires compromise, but this one gave up a lot of ground in hopes of sparking bipartisan support for reform. And after making the sacrifice play, Ryan may not even end up with much to show for it. Senior Democratic staffers are already issuing anonymous sneers at the plan. And despite Wyden’s assurances, House Minority Leader Nancy Pelosi has taken to warning her Twitter followers that the plan is just a sneaky attempt to kill traditional Medicare completely. 
Source: reason.com

New Mexico Politics with Joe Monahan

Will Medicare be the Republican’s Waterloo in New Mexico 2012? Who knows? But at this early stage it is a certain headache for the GOP hopefuls lining up for the state’s open Senate seat and the ABQ congressional seat. ABQ Dem US Rep. Martin Heinrich, seeking the ’12 Senate nod, is coming with a major blast of the “Ryan Budget Plan” that would revamp Medicare. He does so in a just-received mailer to his constituents that was paid for by taxpayers. In it he dubs the budget passed in April by the Republican-controlled House the “Ryan Budget to end Medicare.” He charges that it would “end the Medicare guarantee for seniors and “eliminates Medicare as we know it.” Coming in an official House communication and not a campaign piece give the charges extra kick. The controversial remake of Medicare has already sent GOP US Senate hopeful Heather Wilson to the sidelines. She has refused to comment on the Ryan budget. And GOP consultant Dick Morris writes that the House leadership should have another vote on the budget so House freshmen can reverse their support of the Medicare plan or else face the prospect of being flunked for re-election in 2012. Heinrich and the Dems have been on the defensive because of the sluggish economy. Medicare and Social Security are giving them a chance to get on the offensive as well as change the terms of the debate. We’ve been here before. In 2010, with GOP opponent Jon Barela closing in on him, Heinrich came with a TV ad featuring a senior citizen who seared Barela by warning him “not to mess with my Social Security. Barela had refused to rule out privatizing the popular program. While some of his supporters insist another ad accusing him of being a lobbyist had more impact, the Social Security ad was devastating to Barela among seniors and may have cost him the couple thousand votes he lost by. Now it’s the privatizing of Medicare. And again it is going to be very tricky for Republicans in moderate New Mexico. Where will ABQ GOP congressional candidate Dan Lewis come down? And when will Heather come off the sidelines? She will have to eventually. The bottom line is that if national R’s don’t provide an escape hatch on Medicare, New Mexico Republicans could suffer disproportionally. Don’t say we didn’t tell you.
Source: blogspot.com

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

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

Rochester Medicare Regulatory & Reimbursement

Posted by:  :  Category: Medicare

Job Posting Number: 7590BR Job Posting Title: Medicare Regulatory & Reimbursement – Specialist Job Posting Category: Accounting/Billing/Finance Business Professional Work Site: MN – Rochester Building: Ozmun West Building: Department Revenue Cycle Job Description: This position will be located in Rochester, MN. The Specialist will be responsible for the preparation of Medicare Cost Reports and providing consulting and compliance services regarding Medicare to entities within the Mayo Foundation. Travel is required, occasionally overnight. In addition, the specialist will lead or work collaboratively on multi-disciplinary workgroups and projects related to reporting initiatives, benchmarking, research and analysis, gathering data, financial impact modeling, audits, compliance initiatives, and other customer requested projects. This position will also actively communicate and present reports and educational materials to various audiences. The position will also interact with external auditors for the Medicare program. (008158-47352) Basic Qualifications: Bachelor’s degree and a minimum of 3 years experience in gathering financial data for internal and/or regulatory reporting; OR an Associate’s degree with 6 years experience in health care finance, business, finance, or systems, with a minimum of 3 years experience in gathering financial data for internal and/or regulatory reporting; OR a high school degree and 8 years experience in health care finance, business, finance, or systems with a minimum of 3 years experience in gathering financial data for internal and/or regulatory reporting. Other Qualifications: A positive attitude, strong interpersonal skill, aptitude for precision, attention to detail and strong person computer skill are required. Proficiency with accurate data entry on PC is essential. Ability to handle multiple tasks, analyze information and proven telephone, oral and written communications skills. In addition, familiarity with internal billing systems (DSS, Focus, MRIS, etc) is preferred. Benefit Eligible: Yes Exemption Status: Exempt Hours/Pay Period: Part-time with a minimum of 40 hours per pay period. Schedule Details: Monday – Friday Compensation Detail: Education, experience, and tenure may be considered along with internal equity when job offers are extended. Staffing Specialist: Kristina Welhaven Mayo Clinic is an affirmative action / equal opportunity educator and employer.>
Source: mayo-clinic-jobs.com

Video: Medicare Documentation Compliance

Mankato Mayo Clinic Health System Medicare Analyst

Job Posting Number: 7279BR Job Posting Title: Mayo Clinic Health System Medicare Analyst – Mankato, MN Job Posting Category: Accounting/Billing/Finance Business Professional Work Site: MN – Mankato Department: Revenue Cycle Job Description: This position will be located in Mankato, MN. The position will assume responsibility for the preparation and management of all cost report activities, preparation of Medicaid cost reports including nursing home reports, occupational mix surveys, coordination of Medicare audits for all entities, staff cost report education, research on various cost report and reimbursement issues, and the development of Medicare compliance and reimbursement strategies. Position will interact with Administration, Physician Leadership, Finance, Business Office, Compliance Office, and other operational personnel throughout the Mayo Clinic Health System. (009611-47352) Basic Qualifications: Master’s degree in healthcare, business administration, finance, or accounting and/or CPA with 3 years of experience in Medicare reimbursement; OR Bachelor’s degree with 5 years of Medicare reimbursement related experience. Other Qualifications: Must have high level of Medicare Cost reporting experience. Previous external consulting or auditing experience, working with a hospital system, integrated delivery system or fiscal intermediary is desirable. Requires a high level of administrative skills. Qualified candidate needs to have outstanding communication skills and demonstrate excellent team Building: skills, be assertive, highly motivated, have a positive attitude, and be able to work independently. Detailed knowledge of cost reporting software, PC applications, and financial modeling. License or Certification: CPA is preferred. Benefit Eligible: Yes Exemption Status: Exempt Hours/Pay Period: Full Time Schedule Details: Monday – Friday Compensation Detail: Education, experience, and tenure may be considered along with internal equity when job offers are extended. Staffing Specialist: Kristina Welhaven Mayo Clinic is an affirmative action / equal opportunity educator and employer.>
Source: mayo-clinic-jobs.com

Minn. health care ratings group plans to examine newly available Medicare data

Chase: That’s why it’s been important to have experience in working with this data over time. In releasing this data, Medicare is saying it’s only going to give it to groups like us that have some experience with this because we realize we have to do some things around risk adjustment to make sure that it’s fair for everybody when you’re presenting the data. We’ve got a pretty robust process where we’re working with clinicians to identify what the measures would be. We don’t always get 100 percent agreement but we get pretty good agreement across the market about what we put out being fair and reasonable for people to look at.
Source: publicradio.org

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

Hospitals Spar with GOP in Latest Hill Fight on Medicare Cuts

Michael L. Douglas, MD, MBA is the editor and proprietor of Doctor Pundit, one of the blogosphere’s leading physician blogs and healthcare policy blogs. He is a geriatrician and board-certified family physician who serves as the clinical director of long term care services at the Saint Peter (MN) Regional Treatment Center, the state’s inpatient forensic psychiatric facility. Dr. Douglas is also a member of the University of Southern California/Annenberg School for Communication community of healthcare journalists and medical/healthcare policy bloggers at Reporting On Health (reportingonhealth.com). He has served on various local and national healthcare and policy advisory boards within the past five years and currently advocates for greater awareness of healthcare policy issues for the benefit of patients-as-healthcare-consumers in the the age of 21st century healthcare delivery.
Source: healthworkscollective.com

Daily Kos: Ron Wyden teams up with Paul Ryan to end Medicare as we know it

Beyond putting his weight behind a bad idea, Wyden is giving Republicans an opportunity to gain some bipartisan cover for having voted to end Medicare as we know it. Mitt Romney and Newt Gingrich are certainly thrilled because the Wyden-Ryan plan is basically the exact same thing as the plans they’ve proposed. If it ever comes up for a vote, Democrats need reject it. To do otherwise would not only put them on the wrong side of the issue, but it deliver a political gift of epic proportions to the GOP.
Source: dailykos.com

Klobuchar, Franken, Paulsen introduce legislation to help those seniors in fragile health

The Senior Medicare Fairness Act would ensure a “frailty” adjustment to certain Medicare Advantage plans in Minnesota that provide comprehensive health care benefits for patients in very fragile health. Currently, the Center for Medicare and Medicaid Services only provides this adjustment for some plans – leaving out other health plans with the very same Medicare beneficiaries.
Source: hometownsource.com

Turning Medicare Into Obamacare

This is similar to Obamacare in a lot of ways. In fact, the entire Wyden-Ryan plan goes a long way toward making Medicare similar to Obamacare. Basically, Obamacare moves our current private insurance system in the direction of government support with competitive bidding, while Wyden-Ryan moves our current federal Medicare system in the direction of private support with competitive bidding. Somewhere in the middle they meet, and our entire healthcare system becomes a fairly homogeneous blend of public and private, similar in some ways to the systems in Switzerland or the Netherlands. Yuval Levin makes this point explicitly here, and as a conservative he’s not especially happy that this is where we could end up. But done right, it wouldn’t necessarily be a bad place to be.
Source: motherjones.com

Morning Examiner: Gingrich busted on lobbying lies

The Washington Examiner‘s Tim Carney explains why Gingrich’s lobbying denials are such a decisive factor: “1) Newt says he didn’t lobby. He did. That means Newt is not telling the truth. A candidate serially telling untruths is a reason to not like that candidate. 2) Newt didn’t simply lobby for businesses. He lobbied for businesses that were trying to profit at the expense of everyone else by increasing the size of government. This was what he did at Freddie Mac, this was what he did expanding Medicare to subsidize his pharmaceutical clients, and this was what he did helping ethanol companies get subsidies.”
Source: washingtonexaminer.com

Pharmacies, Medical equipment Suppliers, PLYMOUTH, MINNESOTA, (MN) USA

,  DM02-COMMODES,  URINALS,  BEDPANS,  DM05-BLOOD GLUCOSE MONITORS/SUPPLIES (NON-MAIL ORD),  DM06-BLOOD GLUCOSE MONITORS/SUPPLIES (MAIL ORDER),  DM08-HEAT & COLD APPLICATIONS,  M01-CANES AND/OR CRUTCHES,  M05-WALKERS, OR03-ORTHOSES: OFF-THE-SHELF, PD06-OSTOMY SUPPLIES,  PD09-UROLOGICAL SUPPLIES, R07-NEBULIZER EQUIPMENT AND/OR SUPPLIES,  S01-SURGICAL DRESSINGS,  S02-DIABETIC SHOES AND INSERTS,  S03-DIABETIC SHOES/INSERTS – CUSTOM,
Source: usa-hospitals.com

H.R.3691: To amend title XVIII of the Social Security Act with respect to application of the frailty adjustment… OpenCongress

Hmmmm, no news coverage found for this bill at this time. This means that this this bill has not yet been mentioned on a publicly-searchable news website by either its official number (for example, “H.R. 3200″) or title (for example, “America’s Affordable Health Choices Act of 2009″). As soon as that changes, our daily automated search across the Web will catch it and include it here. If this bill is of interest to you, you can write a letter to the editor referring to this bill by name, and if your letter is published on the Web, a link back your letter will appear here within about one day. Or, if you know of a news article about this bill to display here, email us the web address of this page and the web address of your suggested news article: Our editorial team will post relevant links as quickly as possible. Thanks for helping to build public knowledge about Congress.
Source: opencongress.org

Q&A with Dave Durenberger: The New Wyden/Ryan Medicare Overhaul Plan

Dr. Robert Kane Bob’s book is entitled The Good Caregiver which is written with Jeannine Ouelette, but, if you know him, is the real Bob Kane coming out in ways that might surprise you. The book is published by Avery, a division of Penguin Books. It’s sub-title is no exaggeration of its content: “A one-of-a-Kind Compassionate Resource for Anyone Caring for an Aged Love one.” It begins where we all do, with “Becoming a Caregiver” and works with you through every conceivable event along your path. With the kinds of questions you need to ask, of whom, and when. Having been on this journey myself, I was totally amazed at the tables, the lists of problems/observations, the home safety check-list. I guarantee you’ve never had a resource you’ll use and enjoy as much as The Good Caregiver.
Source: nihp.org

Health | Blog | HEALTH NEWS

Released this week, America’s Health Rankings, produced by the United Health Foundation and the American Public Health Association, provides information on health indicators and disparities across the United States. Users can compare states with one another, produce full reports, and view 5 charts on health behaviors. Minnesota ranks #6 overall, with an outcomes rank of 2, smoking rank of 8, and obesity rank of 14. The state has low rates of cardiovascular disease mortality and high rates of high school graduation, but low per capita of public health funding and a high prevalence of binge drinking.
Source: unitedfrontmn.org

Medicare short form leads

Posted by:  :  Category: Medicare

Deal 3, Table 7: Initiation enter Trick A~ contract taker leads King of Risks by KevinHutchins314Welcome to the Lead Buyer Network. If this is your first visit, be sure to check out the FAQ by clicking the link above. You may have to register before you can post: click the register link above to proceed. To start viewing messages, select the forum that you want to visit from the selection below. Join the Lead Buyer Network Today! You must be associated with the Lead Generation Industry to be accepted as a member. If you are not sure if you comply with that statement, I suggest not joining.
Source: leadbuyernetwork.com

Video: Medicare Local – Medicare Marketing and Leads

Buy Leads For Medicare, Loan Modifications And More At A Low Cost And High Conversion

It is understood, that with diabetic and Medicare leads, insurance leads can also increase your conversion rates. All of these insurance leads are compliant Internet opt in. They can include insurance leads such as health, life, auto and home. You can also ask about how the CRM system can help you to track your insurance leads, which will help you increase your insurance client base for every type of insurance, including diabetic and Medicare leads. All of the leads available for you to purchase, come from over 30 million business leads, and are constantly increasing. With all new and established businesses available to buy leads from, there are thousands of new leads being generated every week for you to choose from. The best lead generation companies well provide you with an exchange guarantee, so if you buy leads that turn out to be ineffective or are no longer in service, you can receive new leads to replace them at no cost.
Source: ausays.com

Medicare Leads: Going into the Minds of seniors

Speaking of insurance and how important it is for everyone to be secured is in a small sense, a necessity for peace. People would sleep better knowing that their doors are locked and it’s that kind of peace of mind that security helps with. Now when it comes to Medicare, we first have to understand the type of people who look for this type of insurance.
Source: americanleadproviders.com

4 Steps to Generating Quality Medicare Leads

Connect. It takes three to seven prospect touches — through a combination of tactics — to get a qualified lead. The key is to figure out which combination allows you to achieve your goals while still managing your budget. Whether done through direct mail, local TV spots, community grassroots efforts, or online campaigns, direct response lead generation should generate an immediate consumer response. Don’t view individual lead-generation tactics in a vacuum, because each has a specific role in achieving results. Take a multi-tiered approach. For example, among seniors, direct mail is the workhorse, while direct response television gives response rates a lift. And going forward, don’t ignore the Web. Online lead generation is cost-effective and will play a growing role among competing Medicare plans — almost 60 percent of seniors aged 64 to 72 make online purchases.
Source: lifehealthpro.com

Buy Leads For Medicare, Loan Modifications And More At A Low Cost And High Conversion

It is understood, that with diabetic and Medicare leads, insurance leads can also increase your conversion rates. All of these insurance leads are compliant Internet opt in. They can include insurance leads such as health, life, auto and home. You can also ask about how the CRM system can help you to track your insurance leads, which will help you increase your insurance client base for every type of insurance, including diabetic and Medicare leads. All of the leads available for you to purchase, come from over 30 million business leads, and are constantly increasing. With all new and established businesses available to buy leads from, there are thousands of new leads being generated every week for you to choose from. The best lead generation companies well provide you with an exchange guarantee, so if you buy leads that turn out to be ineffective or are no longer in service, you can receive new leads to replace them at no cost.
Source: ezinemark.com

Exclusive Internet Medicare Leads

We also have just partnered with the vendor that provides our Medicare Quote Engine to give you access to a fantastic Internet Lead source. These leads are different from other vendors, because they are:
Source: neishloss.com

Medicare Anthem Blue Bows Out of North Valley

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSRachelle Parker was born in Oakland, California and raised in the Bay Area. Her grandmother moved to Oroville in 1960, resulting in Rachelle spending many summers and holidays in the area. Rachelle eventually followed her grandmother’s lead and moved to Oroville in 2003. A graduate of UC Berkeley with a degree in Sociology, Rachelle is a winner of the Judith Stronach Prize for prose, and contributed a story to The New City magazine in 1999 under the tutelage of Clay Felker. Rachelle has worked off and on as both a print and broadcast journalist since 1980, and is happy to bring her love of writing and her concern for her community to the task of being a citizen correspondent for KQED’s Health Dialogues.
Source: kqed.org

Video: Anthem pulls switch on Medicare Advantage subscribers

Anthem medicare d prior authorization // teva

aarp medicare complete prior authorization. related to web 1.Formulary Links and Forms Medicare Prescription Drug Plans. These are the complete formularies, Sheep Ovis aries are descended from the wild..Medicare Part D Pharmacy Prior Authorization and Determination Forms. If you need additional information regarding . Anthem.com: Affordable Health Insurance and Medical Insurance from Anthem Blue Cross and Blue Shield (BCBS) Looking for health insurance? Find a variety of affordable . Hospitals: In-Network For Medicare-covered hospital stays: Days 1 – 5: $250 copay per day Days 6 – 90: $0 copay per day $0 copay for additional hospital days $2,500 . Want to order your prescriptions through mail? Find out how to get started with the Anthem Rx Mail Service Pharmacy. Anthem Medicare Preferred Select (PPO) andAnthem Medicare Preferred Standard (PPO) 2011 Formulary . anthem MedicareRx part D Blue Cross Blue Shield Nevada supplement rxNew medicare supplement rx part d Blue Cross Medicare Part D , medicarerx value ,medicarerx plus . Anthem blue cross prior authorization following table outlines the services that require prior authorization by Anthem Blue table outlines the services that require . Services for which prior authorization (PA) is recommended: (Effective 1/1/2010) Anthem medicare d prior authorization Bariatric surgery;
Source: freeblog.hu

Anthem medicare prior authorization form

Anthem Prior Authorization Forms: Find out everything there is to know about Anthem Prior Authorization Forms on Daymix.com! Images, videos, blog posts, news, tweets Anthem medicare prior authorization form .
Source: ablog.ro

Review of the New Anthem Medicare PPO

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

Anthem Medicare Supplement Insurance Quotes in Ohio

In order to qualify, individuals must switch from an existing supplemental policy to a new  Anthem plan with equal or lesser coverage.   This means if you currently own Plans F or J, you can switch to a modernized Plan F (Plan J is no longer for sale as of June 2010) with no health questions asked.   Likewise, you could switch from Plan G to Plan G or Plan N to Plan  N, etc.
Source: ohioinsureplan.com

Anthem Blue Cross Medicare Supplement Plans

Over seventy years of Blue Cross; since 1937. While much has changed in the short span of seven decades, two things have remained constant; our original business philosophy of putting customers first and our commitment to innovation and progress. We are a leader in senior health care and are continuing to build on our tradition of developing innovative products that offer choice, quality, and health security for California seniors. We offer more plans than ever before, including traditional Medicare Supplement plans, a Medicare Advantage HMO and a New PPO plans called Freedom Blue. We also offer prescription drug and dental plans, and products that can help you protect your financial future, like Long Term Care Insurance and Life Benefits Final Expense Whole Life Insurance offered by Blue Cross of California. 
Source: chailit.com

InsureBlog: Frustrating Carrier Tricks: Medicare vs Group

I did hear back from customer service who confirmed we do not have something like this. You are correct that there would be too many variances with how the claims will process. We will need to see the Medicare EOB & then determine which policy is the primary. The claims area will then key the claim into the system … they will input the information from Medicare. All of this information is taken into account, while viewing the members benefits. I hope this helps
Source: blogspot.com

What Is Medicare Advantage, Exceptionally Florida Medicare

Posted by:  :  Category: Medicare

Bubbles? Take something like 'Not I! .....item 1..Wakulla Republicans Protest Against Taxes in the County (September 06, 2011) ... by marsmet552After 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

Video: Florida Medicare Advantage Plans – Supplement Health Insuran

Florida Medicare Advantage Plans

[…] […] […] Florida has a large number of Medicare Advantage plans available.  One reason could be the large population of seniors that retire to the state.  The first thing to consider if you are looking for a Medicare Advantage plan in Florida is that the plans are NOT state specific.  The are in fact county specific.  Check here to look up Medicare Advantage plans by state for 2012.  Chances are you will find a company in South Florida that is not at all available in the Northern part of the state.  One exception to this is United Healthcare.  They offer a plan that is identical across the state.  This is probably because of the size of the company.  They also offer a large network across the state.Source: medicare-plans.net […]Source: medicare-plans.net […]Source: medicare-plans.net […]
Source: medicare-plans.net

Wyden/Ryan Medicare Plan is a Loser

Ryan and Wyden seem to have a mystical belief that bringing private health plans into Medicare is going to control costs. Where is the evidence for this assertion? Private health plans have done a poor job of controlling costs in the private sector and Medicare Advantage plans cost the taxpayer more money than Medicare fee for service. Not to mention the fact that the white paper places all kinds of requirements on the health plans and “will also require the Centers for Medicare and Medicaid Services (CMS) to actively review marketing practices and benefit adequacy… CMS will… weed out junk plans and unqualified insurers.” Sounds nice, but that means we’ll be stuck with mandated benefits and excessive administrative hoops that will thwart innovation. There is a plan to hold down cost growth to just over GDP growth, and somehow (I’ll be curious to see the mechanism) overruns will be dealt with through “reduced support for the sectors most responsible for cost growth, including providers, drug companies, and means-tested premiums.”
Source: healthworkscollective.com

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

What Is Medicare Advantage, Highly Florida Medicare

After retiring and contemplating accessible health advantages, many people wonder what is Medicare advantage. Medicare is often referred to as the federal government sponsored health insurance coverage plan for many who have retired or over the age of 65. However, most people don’t understand that throughout the Florida Medicare program, there are several various kinds of Medicare plans and kinds of coverage accessible. The various kinds of Florida Medicare plans point out various levels of protection that ranges from hospital trips, emergency services, and different kinds of healthcare insurance. For those who are questioning what is Medicare advantage, it’s essential to first understand that Medicare is split into a number of various kinds of plans and that the total comprehensiveness of Medicare advantage relies on the particular plan.
Source: southcarolinabusinesshealthinsurance.com

Wyden Covers Ryan’s Retreat on Medicare Vouchers

There’s more. State based exchanges – should they survive Republican efforts to repeal reform – will not be asked to regulate and oversee insurers that sell these new Medicare plans. Nor would there be a national exchange to ensure the plans meet all the guarantees contained in the Ryan-Wyden proposal, which include no discrimination for pre-existing conditions; higher premium support levels for sicker seniors; and a minimum set of benefits comparable to current Medicare coverage. Instead, the plan, which wouldn’t go into effect until 2022, requires the Medicare bureaucracy to administer all the new rules – the same bureaucracy that many Republicans until recently blamed for most of the system’s woes.
Source: careandcost.com

Ryan proposes new Medicare plan

But the program would be re-engineered for those 54 and younger. Upon reaching 65, those future retirees would have a choice between traditional Medicare and regulated private insurance plans, all competing to lower costs and provide quality care. Seniors would get a fixed amount to spend on a health plan, no matter which coverage they selected. Low-income, and older, sicker people would get more money.
Source: milwaukee-news.info

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

South Florida Seniors Paying Too Much for Medicare Drug Plans

Aetna Assurant Health Blue Cross Blue Shield Plans Celtic Insurance Company CIGNA Fairmont Specialty Group Golden Rule Group Health Cooperative Group Health Incorporated Health Net Health Partners Humana Intermountain Health Care Kaiser Permanente LifeWise Health Plans Medica Medical Mutual of Omaha Midwest Security Oxford Health Plans PacifiCare Security Life UNICARE United Wisconsin Life/American Medical Security Vista Health All Available Providers
Source: individual-health-plans.com

Paul Ryan’s Medicare Compromise

Make no mistake: This is a compromise for Ryan, who opposed the inclusion of a government-run public option during the ObamaCare debates. And yet that’s essentially what he’s talking about when he refers to keeping a traditional fee-for-service Medicare option on the menu. But in conversations with people close to Ryan, it’s been made clear to me that his priority is ending the Medicare’s unlimited commitment and putting it, and in turn the rest of the federal budget, on a more sustainable path. He cares about the nuts and bolts of the policy mechanics, but he cares even more about crafting legislation that actually has a chance of making it through Congress; good plans that won’t pass aren’t very good plans. His job, as he sees it, is to be positive, a booster for change in the right direction, even if that means that means signing on to a plan that’s less than ideal. He doesn’t want to let the perfect be the enemy of the good, or even of the very slightly better.
Source: reason.com

New articles, ABA newsletters and Community Events: NJ Laws Email Newsletter E382

Posted by:  :  Category: Medicare

HERES YOUR TOP TEN by SS&SSThose who do not yet receive Medicare need to know that the Medicare program is designed to cover those who are 65, individuals who are under 65 but have a disability and have been receiving disability benefits for two years, those with end-stage renal disease, and those with Lou Gehrig’s disease/ALS who receive Social Security benefits. Those who are just turning 65 and are enrolling in Medicare for the first time need not worry; the initial enrollment period for new beneficiaries begins three months before one turns 65 and extends 7 months, until three months after an individual’s 65th birthday. Once an individual reaches age 65 and begins to collect Social Security Retirement benefits, he is automatically enrolled in Medicare Parts A and B, although he can opt out of Part B (but he will pay a lifelong surcharge if he later wishes to add back Part B). Those that miss their initial enrollment period can later sign up for Medicare during an annual open enrollment period between January and the end of March each year and most likely pay a higher premium (unless the reason you didn’t sign up is because you were currently employed. In that case, you qualify to sign up during a special enrollment period.)
Source: blogspot.com

Video: If Sean Duffy Wins, Wisconsin Loses Social Security, Medicare, Jobs, etc. etc. etc.

ReversePhoneDirectory.com Warns of Peak Time for Medicare Fraud During Open Enrollment

ReversePhoneDirectory.com is a leading provider of reverse phone lookup services that enable consumers to simply search a number, including cell numbers (where available), landline numbers and VoIP to accurately find the owner of that number. In addition to phone number information, ReversePhoneDirectory.com has search portals for public records services and provides access to the most current information. ReversePhoneDirectory.com is committed to helping people live better during technologically advanced times, believing that information is a powerful currency and people across the country should have easy access to information about everything and everyone they come in contact with.
Source: bestlongtermcare.org

Social Security is Home for the Holidays — Orland Hills news, photos and events — TribLocal.com

There’s an even better way to conduct your business: online at www.socialsecurity.gov. There you’ll find a wealth of information and online services. For example, you can apply online for Social Security benefits or for Medicare, and then you can check on the status of your pending application. If you already receive Social Security benefits, you can go online to change your address, phone number, or your direct deposit information, get a replacement Medicare card, or request a proof of income letter.
Source: triblocal.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

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

Healthcare Economist · What’s a ‘dual’?

Unnecessary hospital use is one of the main drivers of inflated Medicare spending on duals.  One reason for this is that Medicare pays for all hospitalizations.  Thus, State Medicaid Agencies have less of an incentive to prevent costly hospitalizations.  Further, nursing homes also have an incentive to hospitalize duals.  Nursing home who care for an individual after they are hospitalized receive a higher Medicare skilled nursing facility (SNF) rates rather than the lower Medicaid long-term care rates.  Thus, nursing homes can increase their rates just by admitting their residents to teh hospital periodically.
Source: healthcare-economist.com

Medicare Enrollment or Claims to be Denied 1/3/2011

Posted by:  :  Category: Medicare

PECOS is Medicare’s internet based Provider Enrollment, Chain and Ownership System. It replaces the paper CMS-855I and 855R forms. The online process is easier and quicker with a 45 day turn around, down from 60 days for paper applications. PECOS can be used for initial enrollment or to view or change enrollment information. You can now also track your enrollment application through the submission process, which could not be done previously with the paper form. In addition to enrolling and tracking the application, providers can now change, add or reassign benefits and even withdraw from the program through the system. Just like the paper application process, PECOS needs to be updated whenever there is a Reportable Event that affects information on the enrollment record such as ownership, change in address of practice location, licensure, etc. Changes must be reported within 30 days of a reportable event. A full list of Reportable Events can be found at: www.cms.gov/MedicareProviderSupEnroll.
Source: advancedmd.com

Video: Medicare and You – Resources for Open Enrollment

Trouble with Medicare enrollment, Idaho seniors? You might be in luck.

You should also know that The Idaho Statesman does not screen comments before they are posted. You are more likely to see inappropriate comments before our staff does, so we ask that you click the “report abuse” button to submit those comments for review. You also may notify us via email at onlinenews@idahostatesman.com Note the headline on which the comment is made and tell us the profile name of the user who made the comment. Remember, you may find some material objectionable that we won’t and vice versa.
Source: idahostatesman.com

Medicare Enrollment Deadline Extended with Restrictions Online Auto Insurance Network

Insurance Policy Death No Frills Cheap Car Insurance Groups Get Accident Comments Made No Frills Auto Insurance Quotes Officers Frills Cheap Life Insurance Variable Young Drivers Insurance Young Drivers Auto Insurance Insurance Quotes Health Savings Form Insurance Groups Death Dismemberment Insurance Insurance Online Cheap Class Act Financial Drivers Insurance Term Care Potholes Term Care Insurance Accident Auto Insurance Online Care Insurance Act Savings Policy Variable Annuity Police Officers Insurance Premiums Car Windscreen Car Insurance Groups Online Quotes Health Insurance
Source: onlineautoinsurancenetwork.com

Wednesday marks Medicare enrollment deadline for most Idaho seniors

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Source: koze950.com

GRAY MATTERS: Medicare enrollment period at halfway point

Once medication needs are entered, the Medicare website produces a chart that outlines limitations and prior authorization requirements. It also provides a chart showing the full cost of the drug, what you will pay during the deductible period, what you will pay every month at the pharmacy in the initial coverage period and what you will pay once you enter the gap after reaching $2,930 in costs.
Source: times-standard.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

Part D Open Enrollment Ends Today

Sharing her optimism for Medicare Part D benefits, and the discounts provided under the Affordable Healthcare Act, Secretary of Health and Human Services Kathleen Sebelius commented on Medicare.gov’s official blog: “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.”
Source: pharmacycheckerblog.com

Medicare’s Dec. 7th Open Enrollment Deadline Nears

• Online: Since the beginning of Open Enrollment (October 15) , online activities have surpassed 26 million page views across the Medicare Plan Finder web tool and open enrollment sections of www.Medicare.gov.  • On the phone: 1-800-MEDICARE (1-800-633-4227) continues to be an important 24/7 resource for personalized assistance during Open Enrollment.  More than 3.4 million calls have been handled and wait times continue to fall within acceptable customer service thresholds. • Face-to-face: At Open Enrollment events across the country, Medicare has been working closely with its partners across the nation to provide counseling opportunities for people with Medicare in their home communities.  More than a thousand events with Medicare beneficiaries have been held across the country – and thousands of SHIP counseling sessions have been conducted.  CMS and its partners have shared unbiased drug and health plan information at senior activity centers, through education-oriented media partnerships and phone banks and with other advocacy partners in unique local venues and faith-based communities. These events also highlight Medicare’s preventive services, including flu and pneumococcal shots and health screenings. For more information contact your local Area Agency on Aging, State Health Insurance Program or other unbiased senior advocacy organizations. Contact information for local telephone or face-to-face enrollment resources and year round assistance can be found on the back pages of your Medicare & You handbook.     
Source: paramuspost.com

Clock Starts Ticking Saturday For Medicare Enrollment

The change was mandated by the 2010 health law “in order to give people more time to choose a plan and to permit a smoother transition to their new plan,” Tony Salters, a spokesman for the Centers for Medicare and Medicaid Services, said in an email. Beneficiaries now have seven weeks, rather than six, to decide on plans, and “the new time frame should better ensure that people have their new membership cards in hand at the beginning of the year.” With earlier processing, beneficiaries can start coverage without interruption on Jan. 1.
Source: kaiserhealthnews.org

Medicare Advantage open enrollment continues through Dec. 7th

Another critical factor in choosing a Medicare Advantage plan is confirming if your medical providers will accept and submit claims to the plan.  All of these can change from year to year.  You cannot assume a Medicare Advantage plan which met your needs one year will necessarily meet your needs in the upcoming year.  A review is important. If your plan is continuing in 2012 and you’re happy with what it’s offering next year you don’t need to do a thing. Your enrollment will continue into next year. 
Source: involvementonline.org

Medicare’s Dec. 7th Open Enrollment deadline nears

Face-to-face: At Open Enrollment events across the country, Medicare has been working closely with its partners across the nation to provide counseling opportunities for people with Medicare in their home communities.  More than a thousand events with Medicare beneficiaries have been held across the country – and thousands of SHIP counseling sessions have been conducted.  CMS and its partners have shared unbiased drug and health plan information at senior activity centers, through education-oriented media partnerships and phone banks and with other advocacy partners in unique local venues and faith-based communities. These events also highlight Medicare’s preventive services, including flu and pneumococcal shots and health screenings. For more information contact your local Area Agency on Aging, State Health Insurance Program or other unbiased senior advocacy organizations. Contact information for local telephone or face-to-face enrollment resources and year round assistance can be found on the back pages of your Medicare & You handbook.
Source: vistanewspaper.com

Rural resources on Medicare Part D Prescription Drug Benefit resources

Rural Perspective Regarding Regulations Implementing Titles I and II of the Medicare Prescription Drug, Improvement, and Modernization Act Of 2003 (MMA) Author(s): Curt Mueller, Keith Mueller, Janet Sutton Sponsoring organization: NORC Walsh Center for Rural Health Analysis Identifies sections of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) that might be of special concern to rural Medicare beneficiaries, medical care providers, and policymakers. Includes guidance regarding provisions in the Proposed Rule “Establishment of the Medicare Advantage Program,” which implements Title II of the MMA, with a focus on its impact on rural health service delivery. Date: 08 / 2004
Source: raconline.org