Dresses immunisation facto Medicare offices too

Posted by:  :  Category: Medicare

What's In My Bag... by Amy DiannaWe understand that some practices bill a GP consultation as well as the nurse’s Short Prom Dresses number for these services. Nursing authorities and my division tell me that nurses who have been trained appropriately and are working under standing orders are fully competent to perform these tasks without any medical input. The Medicare rules are that a medical service must be “reasonably necessary” in order for a Medicare benefit to be claimed. In cases where the Cheap Black Prom Dresses bills a GP consultation every time its nurse performs one of these tasks, what is the ‘reasonably necessary’ medical service that is being provided by the GP?
Source: blogdiario.net

Video: CBO Director Douglas Elmendorf on Medicare Advantage

Ohall named speaker at Medicaid, Medicare and Long

Ohall has lectured for the Institute for Paralegal Education on estate planning and probate issues, and for the National Business Institute on asset protection. She is a member of the Brandon and Ohio State bar associations, The Florida Bar (member, Real Property, Probate and Trust Law Section), the National Academy of Elder Law Attorneys, and the Academy of Florida Elder Law Attorneys. Ms. Ohall earned her B.A. degree and her J.D. degree from Stetson University.
Source: ohalllaw.com

As goes the post office, so too Medicare?

That’s because health care is local. Health care is complicated and needs lots of data, systems, and capable facile people to make decisions on data the government wants but knows it doesn’t have. (Remember when the Department of Justice had to "consult" with the Heart Rhythm Society to "understand" defibrillator implant practices by tapping into their NCDR database?) Further, because the government moves slowly, can print money when it runs short, and must work through politics, government rarely works under budget. (In fact, when money runs out in government, they just shut down – not a great idea when working in health care.)
Source: massdevice.com

Saving Money With Private Health Insurance Comparison

This is an initiative introduced by the Federal Government in January 1999. Essentially, the Private Health Insurance Rebate enables anyone with a private health insurance policy to have a certain percentage of their premium reimbursed. It’s the government’s way to encourage people to get private coverage and balance out the public and private sectors of the health care system. The current set private health insurance rebate percentages are 30% for anyone under 65 years old, 35% for those between 65 to 69, and 40% for those 70 years of age and above.
Source: com.au

What do I need to do at the office level with Congress unable to agree on a freeze of Medicare Physician Fee Schedule cuts?

“In 2010 Congress enacted a retroactive 2% increase to the MPFS.  Those providers that were Participating Providers and were billing Medicare their full fee were automatically paid this 2% increase.  Those providers that were not participating or did not bill their full fee to Medicare did not receive the retroactive portion of the increase.  If you are a non-participating provider you have until the end of December to change your participation status.”
Source: moneytreebillingllc.com

Low Medicare, Medicaid Rates Shift Costs To Insurers, Study Finds

An estimated $851 million is added to the cost of commercial health insurance to make up for the lower fees that Medicare and Medicaid pay hospitals in southeastern Wisconsin, according to a study released last week. The study, commissioned by the Greater Milwaukee Business Foundation on Health, supports the long-standing position of the hospital industry that the government health programs don’t cover their share of costs and that the shortfall is passed on to employers and individuals through higher prices for commercial health plans.  (Source: Milwaukee Journal Sentinel)  [Read article]
Source: worh.org

Atlanta abortion doctor charged with Medicare fraud

The Georgia Medicaid program is funded jointly by the state and the U.S. Department of Health and Human Services. Under federal law known as the Hyde Amendment, federal funds cannot be used for elective abortion services; nor are abortions covered by Georgia Medicaid, the indictment states.
Source: wordpress.com

When Does Medicare Pay For Nursing Home Care?

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Source: amexreport.com

Wyden Joins Forces With Ryan On Medicare

A new Medicare overhaul plan touted as a serious bipartisan approach was unveiled today, but it leaves out key details about how it would avoid raising seniors’ premiums. The effort is the latest attempt to curb spending in the giant entitlement program, which is growing faster than general inflation. The key to the plan’s success is getting Congress to step in and make changes to Medicare if spending exceeded Gross Domestic Product plus 1 percent after 2020, Wyden and Ryan said.  (Source: Kaiser Health News)  [Read article]
Source: worh.org

Millions of Seniors Saving Money on Prescription Drugs, Thanks to the Affordable Care Act

Over the weekend, a report by the Associated Press detailed how the Affordable Care Act is dramatically reducing drug costs for seniors who hit the prescription drug coverage gap known as the donut hole. This year, seniors are benefiting from a 50 percent discount on brand-name drugs in the donut hole. And the discount and other provisions in the law are saving money for seniors. As the AP reported:
Source: medicare.gov

Why Get Your Hair Transplant in NYC, Not Abroad

When most people think about the economic advantages of India, they think of tech call centers, but most people are unaware of India’s astonishing growth in medical technology. Training and medical facilities in India are now on par with developed countries when it comes to elective and cosmetic treatments.  In 2007, India had over 1200 trained plastic surgeons, many who have trained abroad in the United States and Europe. Because the costs associated with these types of procedures are often several times lower than in the developed world, India and other developing countries have seen a steady increase in medical tourism.  Today, more than 50 governments actively support medical tourism as a national industry.
Source: hairclinicusa.com

Blue To You by Horizon BCBS

Posted by:  :  Category: Medicare

THE PEOPLES LEADER by SS&SSThe van will aim to give person to person service and health information to individual members, employers and Medicare recipients.  The wheelchair accessible van is equipped with representatives who are courteous and knowledgeable.  They will be able to offer web-based services for insurance information, in addition to completing minor medical screenings and addressing claim processing issues.  This unique program is sure to set the insurer apart since customer service continues to be a crucial part of any quality health insurance plan.
Source: healthinsurancesort.com

Video: Looming Catastrophic Medicare Cuts (Horizon, Ch. 8, AZ PBS- Nov. 17., 2010)

Nursing Strikes On the Horizon

At Mount Sinai, nurses’ base salaries go from $75,000 to $95,000 after 20 years, and average close to $100,000 with overtime and advanced degrees. Jacklynn Price, president of the bargaining unit, said a management negotiator was dismissive of their resistance to reduced health coverage, saying: “We have the money. We just don’t have the will to give it to you.”
Source: ultimatenurse.com

HIT Vendor Executives – Part One of Two

McKesson Provider Technology (MPT) division’s Better Health 2020 strategy announced on 12/9/11. MPT has publicly announced what has been rumored for some time – that it will curtail further development of its Horizon software product line and invest heavily in its Paragon product. This decision affects hundreds of hospitals throughout the country. Some long-term McKesson customers have already seen the writing on the wall and have made strategic and financially significant decisions to move away from McKesson’s non-integrated Horizon clinical platform. However, many other customers (medium-sized community hospitals and multi-entity integrated delivery networks) are faced with a critical decision: do we stay the course with McKesson or rethink our EMR strategy and pursue an alternative course?
Source: histalk2.com

Congress in Familiar Territory With Shutdown on the Horizon

The federal government is again facing the threat of a shutdown because of a partisan divide in Congress. The version of the story this time is that Senate Democrats don’t want to pass the House Republican version of the payroll tax cut because it contains policy riders they disagree with. To force a compromise on the payroll tax cut bill, Senate Majority Leader Harry Reid, D-Nev., is delaying a vote on an approximately $1 trillion spending bill that would keep the government running past Friday.
Source: typepad.com

Pharmacies, Medical equipment Suppliers, HENDERSON, NEVADA , (NV) 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,  DM08-HEAT & COLD APPLICATIONS,  DM09-HOSPITAL BEDS (ELECTRIC),  DM10-HOSPITAL BEDS (MANUAL),  DM11-INFRARED HEATING PADS SYSTEMS AND/OR SUPPLIES,  DM12-EXTERNAL INFUSION PUMPS AND/OR SUPPLIES,  DM15-NEGATIVE PRESSURE WOUND THERAPY PUMPS/ SUPPLIES,  DM17-OSTEOGENESIS STIMULATORS,  DM18-PNEUMATIC COMPRESSION DEVICES AND/OR SUPPLIES,  DM19-SPEECH GENERATING DEVICES,  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, PD06-OSTOMY SUPPLIES,  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 ,  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,
Source: usa-hospitals.com

A Note of Reality From the Trenches

This November, I attended the ASHA convention in San Diego and decided to pop in on a few private practice sessions to refresh my spirit and give me some new ideas for marketing and referrals. This fall, I did a large number of screenings for both preschool and elementary-aged children.  While the percentage of referrals for full speech/language evaluations was typical, I found that fewer families chose to pursue one with either myself or another SLP. If, a full evaluation was completed and therapy recommended, more families were opting for a “wait and see” approach or periodic monitoring, especially if it wasn’t covered by health insurance.  This issue of “not covered by insurance” or at percentage rates too high for many families, looks to be a chronic issue for an on-going service such as speech services.
Source: asha.org

Roller Coaster Medicare Gain

Lesson two is if seniors want to drop Medicare Benefit and go again to Medicare, they want to enroll in a Component D to do that, and they must also get a Medicare dietary supplement. And on to lesson three, which would be Medicare supplement applications need to have to be submitted at the beginning of the month to give the bureaucracy time do its point. If you are trapped in a situation in which you require to modify your start off date, be ready to wait around for awhile before nearly anything transpires.
Source: theclimatequilt.com

Wisdom From Wenchypoo’s Old Bat Cave: Academy of Nutrition and Dietetics Wants More Coverage Under Medicare

The Academy of Nutrition and Dietetics wants to include medical nutrition therapy for more chronic conditions. Currently, only renal disease and diabetes are covered. The organization is asking the Centers for Medicare and Medicaid Services to cover cardiovascular disease, hypertension and other chronic conditions. The Academy believes that this type of therapy can actually reduce medical costs because it serves as preventive treatment. This is not the first time that the Centers for Medicare and Medicaid Services have been encouraged to make changes and handle chronic conditions better. A study from 2006 already illustrated how Medicare’s focus on acute illness and neglect of chronic conditions could be dangerous. As the population of the United States continues to age, chronic disease is becoming more prevalent. The CDC reports that 7 out 10 deaths in the United States are caused by chronic disease. It is an epidemic that will get only get worse. The CDC recognizes poor nutrition as one of the main causes of chronic disease in the country. However, Medicare continues to limit the types of conditions that quality for medical nutrition therapy, and no changes to this policy have been planned. Although the Academy of Nutrition and Dietetics plans to pursue this issue, it is difficult to assess the possible success of creating a policy change. The American College of Physicians presented a paper in 2006 that clearly highlighted the growing need to handle chronic conditions, yet the issue has been ignored for years. The Centers for Medicare and Medicaid Services has the opportunity to enact real change and drastically improve the health conditions of an aging population. By expanding the number of conditions that quality for medical nutrition therapy, health costs can actually be cut because preventative treatments can save money.” I see a battle looming on the horizon–The Academy wants to throw a cog into the money-making works of medicine and created sickness by suggesting nutritive therapy. This is a good thing, and if it succeeds, then the cracks in government food policy/medical behavior/social eating behavior will widen, and continue to widen until you can drive trucks through them. I look forward to this day when we finally FINALLY shake off the old much-mistaken hypotheses of old, in favor of the new (with verifiable evidence to back it up). Medicare has been a money-maker for so many companies (through sickness extension), as well as career-enhancers for so many politicians, and now it appears all that may come to an end…I hope. Once Medicare is conquered, maybe the rest of us will also get this access. Maybe one day we’ll all have to see a nutritionist before we see an actual doctor–you think? Obamacare doesn’t think so.
Source: blogspot.com

Ye Olde Journalist: Gov’t Will Share Medicare Patients’ Data With New ‘Accountable Care Organizations’

CMS says it takes its commitment to quality care seriously, and therefore it will guard against ACOs that may try to withhold necessary health care to cut costs. “CMS will routinely analyze data surrounding utilization of services, and will take steps to further investigate any suspect trends, including steps such as beneficiary surveys, audits, and other means.” CMS also said it will compare the health of ACO beneficiaries with Medicare patients who are not part of an ACO.
Source: blogspot.com

Opinion Report: The Deepwater Horizon

In The Loyal Opposition, Andrew Rosenthal offers political commentary on breaking news stories. The Times’s editorial page editor since January 2007, Mr. Rosenthal oversees the editorial board, the letters and Op-Ed departments, and Sunday Review. He has held numerous positions at The Times, including assistant managing editor for news, foreign editor, national editor, Washington editor and Washington correspondent. He has contributed to the paper’s coverage of every presidential election since 1988. Read more »
Source: nytimes.com

Medicare Supplement Insurance coverage

Posted by:  :  Category: Medicare

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Source: nasdaqtradingmarket.com

Video: What Does Medicare Cost?

Healthcare Economist · Bring Market Prices to Medicare

Authors also propose to eliminate the 25% tax on premiums. According to MedPAC, “Plans that bid below the benchmark also receive payment from Medicare in the form of a “rebate.” The law defines the rebate as 75 percent of the difference between the plan’s actual bid (not standardized) and its case mix-adjusted benchmark. The plan must then return the rebate to its enrollees in the form of supplemental benefits or lower premiums” The rebate structure gives plans a disincentive from lowering their bids since they only recover a share of the cost decreases.
Source: healthcare-economist.com

Medicare Benefit Plans To Cost Much less In 2012

While all information is believed to be reliable, it is not guaranteed by us to be accurate. Individuals should assume that all information contained in our newsletter is not trustworthy unless verified by their own independent research. Also, because events and circumstances frequently do not occur as expected, there will likely be differences between the any predictions and actual results. Always consult a real licensed investment professional before making any investment decision. Be extremely careful, investing in securities carries a high degree of risk; you may likely lose some or all of the investment.
Source: theinvestmentmarket.com

Viewpoints: If Not The Health Law, Then What?; Shifting Medicare Costs Isn’t Enough

San Francisco Chronicle: Reform Medicare Before It’s Too Late With Medicare projected to run out of money in 2024, at least (Sen. Ron Wyden and Rep. Paul Ryan) are talking about changing a system that is unsustainable. Republicans maintain that only market competition can curb rising health care costs that have outpaced inflation. Wyden-Ryan allows that competition, but in a regulated framework that requires private plans to provide benefits on a par with Medicare coverage (12/19). Los Angeles Times: Boehner’s Brinksmanship It’s only fitting that House Speaker John A. Boehner (R-Ohio) would close the year with one more act of brinksmanship. Boehner announced Sunday that he opposed the bipartisan deal in the Senate on a stopgap extension of soon-to-expire payroll tax cuts, unemployment benefits and Medicare payment rates for physicians — a deal that he reportedly urged his caucus to accept, only to have other members of his leadership team oppose it. The Senate proposal was far from perfect, but it gave the House GOP a clear win on what supposedly was its top priority: the Keystone XL pipeline project. By not accepting the deal, House Republicans show again that they’re unable or unwilling to stop moving the goal posts (12/20).
Source: kaiserhealthnews.org

Home Healthcare Accountants Bad Debt Recovery

 Home Health Care Accountants we’re concerned as the economic recession continues and with the rise in unemployment, Home Health Agencies Accountants must deal with accelerated growth in bad debts in addition to the myriad of other financial and operating challenges presented during the downturn. Home Health Agency Accountants understand that while all bad debts cannot be recovered, 70% of allowable Medicare bad debt claims, including Medicaid cross-over balances, can be salvaged through the filing of a Medicare Cost Report.
Source: vieracpa.com

Missed Medicare Dec. 7 deadline? There may still be hope!

If you had health coverage because you or your spouse was working and that employment ends, you have an 8 month SEP.  Remember you have to submit the appropriate paperwork with Social Security (See blog post “Medicare and Working Past 65.”)
Source: retirementeducationplus.com

Medicare and Private Health Insurance

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

The Inherent Flaws in Medicare Premium Support

On December 15 Sen. Ron Wyden (D-OR) and Rep. Ryan released another variation. Their plan is similar to the Rivlin-Domenici plan but removes the cap on the voucher. Instead, if Medicare spending growth exceeds growth in the economy plus 1 percentage point, then Congress must reduce payments to health care providers, reduce program overhead, or increase premiums for higher-income beneficiaries. Importantly, while the Rivlin-Domenici plan would require private plans to cover the same services as traditional Medicare, the Wyden-Ryan plan would only require private plans to cover any package of benefits that provides the same “actuarial value”—pays the same percentage of costs—as traditional Medicare.
Source: americanprogress.org

UHC Announces Changes to its Medicare Advantage Audits …

Posted by:  :  Category: Medicare

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

Video: GBMC Primary Care – Debbie Jones, CRNP

united health care medicare

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Source: cipunce.net

AthletiCo Physical Therapy and Chicago Blackhawks Renew Partnership

AthletiCo president, Mark Kaufman, founded AthletiCo in 1991 by providing athletic coaching coverage and rehabilitation services to sports teams and organization all through Chicagoland, bridging the gap in between on-field medical coverage and rehabilitation services. These days, AthletiCo gives rehabilitation and fitness services to over 160 specialist sports organizations, performing art companies, high schools, colleges and universities, rugby clubs, golf events, endurance events, tournaments, unique events, and industrial and commercial organizations.
Source: usajobsearch.co

Medicare passes on big profits to insurers

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Source: g7finance.com

GOP Issues Part One: Healthcare

I think you summed up the contradictions in Newt’s position quite well. If “social engineering” can ever be benign, he’s been a big supporter of benign social engineering his whole career. Cutting capital gains taxes, for example, is a use of a government function for the purpose of changing individual behavior. Perry’s “bi-national” insurance isn’t governmentally-run or governmentally-mandated, and he hasn’t talked about it in ten years, the nearest I can tell. It was something he mentioned a while back, that’s all. But your phrasing implies that it’s something on the level of international “Obamacare”. I think that Huntsman and Romney both can be viewed as having classical federalist impulses. I don’t think you gave them quite enough credit. You were right to call out Santorum for supporting Medicare Part D, but if you look at your nuggets from Santorum and Paul, they’re basically the same. And that’s my real problem with this analysis. Any one of these people, as president, would sign practically the same legislation (except Paul). They all see some level of government intervention as necessary, but less than the current amount, and far less than the Obama package will entail. But just as .001% of Democrats would actually want government making every health care decision for the consumer, .001% of Republicans are calling for a complete hands-off. (It happens that one of that minority is Ron Paul.) So my problem is with the spirit of your analysis. We can’t guess what specific items are going to be in the probably-inevitable overhaul of “Obamacare”, whoever wins the White House. The only thing we can do is try to gauge where each candidate lies on the private-public spectrum, and even that’s going to be distorted by their positioning. I forget which candidate it was who said that he liked Cain’s 9-9-9. That was probably the truest thing said on stage during the debates. Some advisor is going to have a pet project that’s going to make it into the platform, but his son is entering college next fall and he doesn’t want to have to pay out-of-state tuition, so he’s not going to move to DC. That’s the kind of thing that determines the content of legislation more than what’s being said on stage or probably what’s written on a candidate’s website. And as for my comment #3, it just seemed like you threw in the towel at the end of the article. I may be doing the same thing, but it’s because I don’t believe the analysis can be made, not because I think that the answer is necessarily found in the middle.
Source: blogcritics.org

InsureBlog: Meanwhile, back in the Lab (LabCorp, that is)

Of course. I was President of MedPath, which was owned by Corning Glassworks. That was spun off, and I ended up buying the lab, which became Unilab. Eventually, I sold the lab to a private equity firm, which then re-sold it a short time later at a much greater price. I was a bit curious about the difference because, as far as I could tell, the market itself hadn’t changed dramatically in such a short time, and I didn’t understand how the value could have increased so quickly and so greatly.
Source: blogspot.com

The Relationship between Medicare Supplemental Insurance and Health

This paper investigates Medicare supplemental insurance and health-care spending. The empirical models attempt to determine whether seniors who possess certain traits, particularly health- and risk-related factors, choose supplemental coverage based on expectations of health-care needs. Employer-provided supplemental coverage is considered separately from official “Medigap” policies. Results indicate favorable selection into supplemental insurance based on health status, but no selection based on risk attitudes. The models indicate that Medigap and employer-provided enrollees spend approximately $1,000 and $1,500 more annually, respectively, than those without supplemental coverage. Finally, moral hazard induced by Medicare supplemental coverage appears to add $5.5 billion annually to the federal budget, although this estimate lacks statistical significance.
Source: wordpress.com

A.N.O.C Received for UHC Members Today

A SH mb gave me his ANOC today because he desperately wants to get out of it and has no need for it. The changes were mild. They changed the spec copay from $30 to $32- cute. Offices better have lots of single bills for change. They shifted some commonly used currently Tier 2 rx and moved them to a Tier 2 in a 5 tier grid. They will be offered for a ridic low $5 copay for 90-day supply thri Rx Sol. They were currently $50 for a 3 month supply, now down to $5!! Unless it’s a typo? According to this website, many of the basement price drugs that UHC is offering are due to go generic soon anyway: http://seekingalpha.com/article/7137…piration-drugs
Source: insurance-forums.net

Free RBRVS Calculator For Your Medical Practice – Pediatric Inc

Heads up –  I encountered a few minor issues with the Excel sheet that I wanted to warn you about. Sometimes, Excel converts many of the cells into ‘text’ fields. Even though you see a number (ie 99213), Excel thinks it is a word. The sheet has all kinds of fancy formulas. And those formulas are looking for numbers, such as 99213, not letters. So have that in mind when using the tool.  If you don’t know how to change text into numbers in an Excel cell, check out this link.
Source: pediatricinc.com

Medicare Part B Premiums lower than projected for 2012

Posted by:  :  Category: Medicare

OOPS I THINK THE SHINE IS OFF THE PEACH ...........IT'S ABOUT TIME by SS&SSThe U.S. Department of Health and Human Services announced that Medicare Part B Premiums will be lower than projected. The Part B premiums will have a 3.6% increase to coincide with the COLA increase previously decided earlier in the year. For 2012 the Medicare Part B Premium will be $99.90 and the Part B deductible will decrease by $22, however the premiums paid for Medicare’s prescription drug plan will remain virtually unchanged.
Source: paworkinjury.com

Video: State Takeover of Harrisburg, Medicare/Medicaid Funding [Pennsylvania Newsmakers]

Free Legal Question: Personal Injury

Is there a maximum percentage Medicare and Medicaid are legally allowed to take from the money I receive from an insurance company (from a car accident settlement). I would received (from a car accident) to cover the medical bills they paid? For example, can they take all of the money, half or how much can they take? Please let me know if you need additional information.
Source: lawguru.com

Pennsylvania Medicare Help

The truth is, Medicare can be a really great benefit to many seniors that cannot afford their own healthcare insurance. However, some seniors may have more advanced health issues or concerns, and then the best options for them are found in supplemental health insurance plans. You may not know that Pennsylvania has many insurance companies that offer really great supplemental insurance plans tailored towards your Medicare coverage. Meeting with an insurance agent and having all of your questions and concerns resolved can be a great start to getting the coverage you need to accompany your Medicare plan in retirement. Source: writingdepartment.net
Source: medicaresupplementalco.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

Representative Kelly Votes For Higher Taxes and Higher Medicare Premiums, Protects Billionaires

Kelly voted to raise Medicare premiums for seniors. The Associated Press reported that, “Raising taxes on millionaires may be a non-starter for Republicans, but they seem to have no problem hiking Medicare premiums for retirees making a lot less. The House is expected to vote Tuesday on a year-end economic package that includes a provision raising premiums for “high-income” Medicare beneficiaries, now defined as those making $85,000 and above for individuals, or $170,000 for families. Some would pay as much as several hundred dollars a month additional for Medicare outpatient and prescription coverage. Millions who don’t consider themselves wealthy would also end up paying more.” [HR 3630, Vote #923, 12/13/11; Associated Press, 12/13/11]
Source: eriedems.com

Pennsylvania Medicare Help

The truth is, Medicare can be a really great benefit to many seniors that cannot afford their own healthcare insurance. However, some seniors may have more advanced health issues or concerns, and then the best options for them are found in supplemental health insurance plans. You may not know that Pennsylvania has many insurance companies that offer really great supplemental insurance plans tailored towards your Medicare coverage. Meeting with an insurance agent and having all of your questions and concerns resolved can be a great start to getting the coverage you need to accompany your Medicare plan in retirement.
Source: writingdepartment.net

Two New Medigap Companies Driving Price Competition

New Era/Philadelphia American The New Era companies (New Era, New Era of the Midwest, and Philadelphia American) have been in business for over 25 years. However, just in the last couple of years, they have become a major player in the Medicare Supplement marketplace. In many states where the plans are offered, they currently are a price-leader with the most competitive rates available. Some of the states in which the New Era companies are most competitive are: NEW ERA/NEW ERA OF MIDWEST: Georgia, South Carolina, Pennsylvania, Texas, Louisiana PHILADELPHIA AMERICAN: Tennessee, Alabama, Mississippi, Ohio There are of course many other states in which their plans are offered, but the aforementioned states are ones where the plans are very competitively priced at this time.
Source: medicare-supplement.us

Medicare Supplements Pennsylvania

Medigap4seniors provides Medigap plans & Medicare Supplement Plans for Pennsylvania. Pennsylvania Medicare Supplement Insurance Plans, also known as Pennsylvania Medigap Insurance is designed to supplement Standard Medicare Insurance. Apply for Quotes Now
Source: bookmarkslife.com

Medicare’s previously guarded data now open to enhanced access

Until now, that information has been closely guarded and largely off limits to all but academic researcher in limited instances. The American Medical Association has long held that wide dissemination of physician-related data could sometimes lead to the reporting of inaccurate information relating to medical malpractice and doctors’ performance reports.
Source: pittsburghmedicalmalpracticeattorneyblog.com

Federal Funding Available to Reduce Acute Care Hospital Readmissions

According to the U.S. Department of Health and Human Services, nearly 20 percent of Medicare patients discharged from hospitals are readmitted within 30 days, costing $26 billion annually.  In an effort to improve healthcare quality, affordability, and safety,  the Obama Administration announced earlier this year the formation of the  Partnership for Patients, a public-private initiative between the administration and health industry leaders and patient advocates.
Source: wphospitalnews.com

Risk & Insurance Online

Posted by:  :  Category: Medicare

Running Amok Again by elycefelizA second memo pertained to conditional payments. Medicare implemented a $300 threshold for certain liability cases, saying it would not pursue a conditional payment amount in such cases if all Medicare’s criteria are met. What’s not entirely clear is whether litigants would need to send final settlement documents indicating the amount is $300 or less. "My advice to anyone dealing with this provision would be to send the final settlement documents to the Medicare Secondary Payer Recovery Contractor with a cover letter indicating the settlement is for $300 or less and no conditional payment should be assessed," Pocius said.
Source: riskandinsurance.com

Video: Structured Medicare Set Aside

Workers’ Compensation: The Workers’ Compensation Medicare Set

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

The Official Medicare Set Aside Blog And Information Resource: Ametros Financial names “new” CEO

First, regardless of any improved computer technology, of which I am skeptical, the market is not nearly big enough to support a firm with such a singular focus and high fixed expenses. For example, between Tom Ash, Sandra O’Sullivan and Hany Abdelsayd (former PMSI and Rising pitchman) command executive salaries. And given that we see them at every workers compensation conference, large and small, travel and entertainment expenses have to subtract another 100k to 200k from the bottom line (unless of course the three of them are tripling up at the Motel 6 and eating the free food at the conferences). And that is before anyone, other than HAL2000 back in the office, administers a single claim.
Source: medicaresetasideblog.com

When to Use a Liability Medicare Set

42 USC §1395y(b)(8) Allocation bad faith Centers for Medicare & Medicaid Services (CMS) Centers for Medicare and Medicaid Services CMS Franco Signor Franco Signor LLC Gary E. Seger et. al. vs. Tank Collection Hadden Hadden v. U.S. Jeffrey J. Signor Katie Fox Liability Medicare Set-aside Arrangement LMSA Mandatory Insurance Reporting Medicare Medicare & Medicaid Schip Extension Act of 2007 Medicare beneficiary Medicare reimbursement amount Medicare Secondary Payer Medicare Secondary Payer (“MSP”) Medicare Secondary Payer Act Medicare Secondary Payer Compliance Medicare Secondary Payer Compliance: How to Mitigate Exposure in the Medicare Beneficiary Personal Injury Case Medicare Secondary Payer Liability Medicare Secondary Payer Manual Medicare Secondary Payer Statute Medicare Trust Fund MMSEA MSP MSP compliance MSP private cause of action; Geer v. Amex Assuance Co. ORM Responsible Reporting Entity Roy A. Franco RRE SCHIP Extension SCHIP Extension Act Sebelius Section 111 Section 111 Mandatory Insurance Reporting Section 111 reporting User Guide wrongful death
Source: francosignor.com

Medicare Supplemental Ins 101

Posted by:  :  Category: Medicare

Senate Dems Protest Medicare Cuts by TalkMediaNewsMedicare Part A- This is the portion of Medicare that you automatically receive from working 10 years or more at a job in the United States. Medicare Part A covers the hospital portion of any medically necessary situation. Medicare Part A has some large gaps in it however, as of 2011 there is a $1132 deductible associated with Medicare Part A, this deductible is a per benefit period deductible meaning that it needs to be paid for every separate accident or illness that may occur. If you have an accident or illness that you are going back into the hospital for within 60 day of the first occurrence of the accident or illness you will not have to pay the deductible twice, only if you are going outside of that 60 day window. I know that this may sound confusing but think of it like this the great majority of the time that you go into the hospital you will be responsible for a $1132 (2011) deductible. You will also be responsible for co-insurance or co-pays to the hospital that Medicare does not cover. This is one of the main reasons why we see so many people that are starting Medicare choose to have a Medicare Supplemental Ins plan. There is also another large gap in Medicare, this is Medicare Part B.
Source: trendlearn.com

Video: 12/14/11- Keynote by Medicare Ins Specialist Barbara Hogan @ Platinum Coast BNI

When can you enroll in Medicare outside of the Annual Enrollment Period (AEP)?

4. Medicare Supplement/Medigap Plans - Medicare Supplement plans do not have a defined annual open enrollment period. Most States, carriers and plans allow for enrollment year round. Beneficiary’s can make changes or adjustments based on the insurance company, plan or state they live in throughout the year. But, some underwriting qualifications may have to be met.
Source: ehealthinsurance.com

The Republicans’ push to end Medicare

I love to cook, too, Doigotta. I like simple food, well prepared. Megan McArdle of the Atlantic has been the butt of endless jokes over at BJ because of her equipment fetish. She has a $1500 Thermonix (or Thermomix?) which she swears makes perfect bechamel and Hollandaise every time. Now, bechamel is just a fancy word for white sauce which I learned to make when I was working on my cooking badge in Girl Scouts. We also did lots of hootin’ and hollerin’ over her gift suggestions for one’s friends who cook. I was gobsmacked when I realized that I had been making do for 40 years without a kitchen twine dispenser—I had no idea there was such a thing. Some of my favorite things in the kitchen are cast iron skillets. One of mine is my grandmothers and is probably a hundred years old. Another is my Mom’s old aluminum roasting pan. It’s great for browning on top of the stove and then popping in the oven. I know the roaster is older than I am, because the story is when my Mom was p.g. with me, her water broke and she told my Dad to bring her something. Instead of bringing a towel, he brought the roasting pan. I finally invested in some Cuisinart pots and pans several years ago and I love them. My kids got me a kitchen-aid stand mixer a few years ago which is so much better than the hand-held mixer. It does lots of stuff and has lots of accessories. Last Christmas they got me the ice cream freezer bowl that goes with it—home made ice cream in 30 minutes! And no need for rock salt, ice, and elbow grease. I’m flying out to L.A. Thursday and have a busy day tomorrow, dropping the dog off at the kennel, stopping the mail, etc. I wish all of you here at ATblog a wonderful Christmas with loved ones. This goes for the trolls and the ones who drive me crazy some times. This is a wonderful community here. I apologize for all the mean things I sometimes write when my mean girl busts loose. Here again is my Christmas gift from Hayden a few years ago. The Christmas story is the best one in the Bible. It doesn’t have to be historically true or factual to be wonderful. Who could imagine a little baby, born to be a prince of peace and bring good will to the world? I love Hayden’s voice, even if she is mine. She could carry a tune before she could talk. http://www.youtube.com/watch?v=hdYJjEYtTlw… http://www.youtube.com/watch?v=EJS31fC9VGc
Source: arktimes.com

Healthcare Economist · Bring Market Prices to Medicare

Authors also propose to eliminate the 25% tax on premiums. According to MedPAC, “Plans that bid below the benchmark also receive payment from Medicare in the form of a “rebate.” The law defines the rebate as 75 percent of the difference between the plan’s actual bid (not standardized) and its case mix-adjusted benchmark. The plan must then return the rebate to its enrollees in the form of supplemental benefits or lower premiums” The rebate structure gives plans a disincentive from lowering their bids since they only recover a share of the cost decreases.
Source: healthcare-economist.com

How Long Does It Take for a Medicare/Medicaid SSD Review for a Section 32 Settlement

Ok….then IMHO, you would be much further ahead for your Dr to get this pre authorized through the WC carrier…before you accept any cash settlement…you won’t be paid enough cash for the medical to cover what you are planning, OR the surgery in the event you need it later on… IC’s don’t pay for anything that isn’t in the treatment guides or a "maybe" later on surgery…that is part of the "compromise" when you "release" them from further liability for this injury. You agree to accept liability for your medical care from now on, out of your pocket. If the laser isn’t something Medicare would normally pay for …you can’t use the money in a setaside either. I would take the cash for PPD indemnity, and leave the medical alone for now… besides, your atty gets a fee based on the entire amount of the settlement, taking more money from your future medical cash. You can always cash out the medical in a couple of years…and there probably wouldn’t be a atty fee then… see just how much medical you will actually need.
Source: workerscompensationinsurance.com

The Interview: Hank Greenberg, AARP Maryland state directorMaryland, like the

Posted by:  :  Category: Medicare

New Online Rx System Makes UM Student 'Top Entrepreneur' Finalist by University of Maryland Press ReleasesThe Interview: Hank Greenberg, AARP Maryland state director Maryland, like the rest of the country, is aging. Plan to raise Medicare premiums for upper-income retirees would affect middle class as well WASHINGTON Republicans may have found a way to squeeze more money out of well-to-do Americans without raising their taxes. A year-end economic package approved by the House on Tuesday prescribes a Medicare premium increase for high-income beneficiaries. Although the bill faces a veto threat from the White House, that specific provision may turn out to have staying power. Read full article >> Medicare HMO plan stirs confusion in north state Some north state doctors want to know why their names show up as network providers for a Medicare Advantage HMO plan being marketed by AARP. AARP president — Protect and strengthen SS, Medicare BY CAROLYN LUCAS-ZENK WEST HAWAII TODAY clucas-zenk@westhawaiitoday.com A big bullet was dodged with the supercommittee’s recent failure to reach an agreement on debt reduction, but the public should remain vigilant in “protecting and strengthening” Social Security, Medicare and Medicaid, AARP National President Lee Hammond said Wednesday. These programs are still “prime targets of many in …
Source: medicare-news.com

Video: Medicare Insurance Baltimore MD — John Basmajian Insurance

The Official Medicare Set Aside Blog And Information Resource: Changes to Maryland Workers’ Compensation Regulations Finalized

You may recall a September 2011 blog article that discussed proposed amendments to COMAR 14.09.01 and COMAR 14.09.19 adding specific requirements for workers’ compensation settlements involving Medicare beneficiaries. These amendments were finalized November 28, 2011 and officially adopted into Maryland Workers’ compensation law. The most noteworthy aspect of the new regulations is that the parties are permitted to forego CMS approval of a proposed settlement that meets CMS review thresholds provided that the settlement documents contain three elements: (1) an acknowledgement that the settlement is within the CMS review thresholds, (2) a statement that the parties voluntarily have elected not to submit the settlement and formal set-aside proposal to CMS for review and approval and (3) a statement that the parties are aware that CMS may refuse to pay for services related to the injury and may assert a recovery claim against any entity, including a claimant, provider, supplier, physician, attorney or private insurer. The previous version attempted to use state law as a means to mandate participation in CMS’ voluntary WCMSA review program, a move that was opposed by both claimant and defense attorneys equally.
Source: medicaresetasideblog.com

Physicians face cut in Medicare reimbursements

Governor Martin O’Malley, Maryland State Senator Jim Mathias, Ocean City Mayor Rick Meehan and Maryland Department of Natural Resources (DNR) Secretary John Griffin today toured a sand dredging and replenishment project at Skimmer Island, which is restoring the Island’s size and safeguarding habitat for endangered wildlife. Governor O’Malley was also joined by Coastal Bays Program Executive Director Dave Wilson, DNR staff and Coastal Stewards, members of a summer youth employment program, for an informational tour of the island’s renovations.
Source: marylandblogs.info

Video: Tapping into Medicare's gold mine?

America spends over $500 billion every year so that elderly Medicare patients can get the care they need. But as health care costs rise, many are taking a closer look at what exactly we’re paying for. Our media partners at the Center for Investigative Reporting have been conducting a yearlong California Watch investigation into a prominent hospital chain that is reporting unusually high rates of serious diseases. Does the chain attract the toughest cases, or are the hospitals exaggerating conditions to pump up revenues from taxpayers? Reporter Lance Williams has the story. 
Source: californiawatch.org

Medicare: Where Do We Draw the Line?

Although there are numerous possible solutions, every one of them carries with it significant disadvantages.  However, perhaps the simplest solution is the “Your Medicare; Your Choice” option introduced by Congressman Tom Price of Georgia.  Simply put, the program allows for the physician to set his own fee schedule and allows him the ability to individually contract with his patient.  The Congress would then be free to set its nonbinding fee schedule.  Regardless of what the figure would be, it would fall upon the physician and his patient to negotiate a price for the rest…or not.  The program would be implemented upon enrollees joining the program ten or fifteen years from now so as to spare the presently-enrolled or soon-to-be-enrolled recipients from the hardship of having to adapt to a suddenly and substantially changed system.  Once implemented, the government would no longer be burdened with paying for a system it clearly cannot afford.  The physician would no longer be dependent on the government for the setting of reimbursement rates and defining his value to society, and the patient would become the key guardian of the cost of medical care.
Source: redstate.com

Wake up America quit listening to the media: There is no tax cut involved Medicare and Social Security are entitlement programs that the government has forced us to pay into in the first place.

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Source: wordpress.com

Viewpoints: If Not The Health Law, Then What?; Shifting Medicare Costs Isn’t Enough

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSSan Francisco Chronicle: Reform Medicare Before It’s Too Late With Medicare projected to run out of money in 2024, at least (Sen. Ron Wyden and Rep. Paul Ryan) are talking about changing a system that is unsustainable. Republicans maintain that only market competition can curb rising health care costs that have outpaced inflation. Wyden-Ryan allows that competition, but in a regulated framework that requires private plans to provide benefits on a par with Medicare coverage (12/19). Los Angeles Times: Boehner’s Brinksmanship It’s only fitting that House Speaker John A. Boehner (R-Ohio) would close the year with one more act of brinksmanship. Boehner announced Sunday that he opposed the bipartisan deal in the Senate on a stopgap extension of soon-to-expire payroll tax cuts, unemployment benefits and Medicare payment rates for physicians — a deal that he reportedly urged his caucus to accept, only to have other members of his leadership team oppose it. The Senate proposal was far from perfect, but it gave the House GOP a clear win on what supposedly was its top priority: the Keystone XL pipeline project. By not accepting the deal, House Republicans show again that they’re unable or unwilling to stop moving the goal posts (12/20).
Source: kaiserhealthnews.org

Video: What Does Medicare Cost?

How Will the condition Reform work on Medicare advantage Plans 2010?

Beneficiaries who determine to remain in their same Medicare benefit plan in 2010 can expect superior increases of, on average 32, percent, although the magnitude of the increase will obviously vary from plan to plan. Therefore, beneficiaries may find it in their interests to divulge and compare coverage their health care plan options, taking into account premiums, benefits, cost-sharing, and victualer networks, to select the selection most likely to meet their individual needs and circumstances.
Source: soilsproject.org

Medicare Supplement Insurance coverage

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Source: nasdaqtradingmarket.com

Free Condoms & Lollipops

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Source: freecondomsandlollipops.com

Social Security Increases, But Medicare Costs Rise, Too

 The COLA news also underscores the critical importance of the Super Committee deficit deliberations on possible cuts to future COLAs now under way in Washington. While medical costs continue to bite hard into seniors’ pocketbooks, the Super Committee is said to be taking a hard look at cutting COLAs by implementing a formula change using the so-called chained CPI. The chief actuary of the Social Security Administration (SSA) estimates that the chained CPI will rise about 0.3 percentage points less per year than the CPI-W.
Source: secondact.com

Bad medicine: Harper's prescription for privatizing Medicare

While ignoring the heightened costs of private medicine, the Tories are using the economic crisis to justify cutting public health care, claiming there’s no money to cover it. According to Finance Minister Jim Flaherty, “We all realize that public finances relate to revenues and we can’t pretend that we can spend money that we don’t have.” This ignores massive tax cuts, bank bailouts and military spending sprees. While the new health plan could cut $21 billion from health, the Tories gave a $69 billion bank bailout, are wasting $220 billion on tax cuts, and have been going on a military spending spree — from $30 billion fighter jets, to $25 billion warships — as part of a $490 billion military plan.
Source: rabble.ca

When Does Medicare Pay For Nursing Dwelling Care?

While all information is believed to be reliable, it is not guaranteed by us to be accurate. Individuals should assume that all information contained in our newsletter is not trustworthy unless verified by their own independent research. Also, because events and circumstances frequently do not occur as expected, there will likely be differences between the any predictions and actual results. Always consult a real licensed investment professional before making any investment decision. Be extremely careful, investing in securities carries a high degree of risk; you may likely lose some or all of the investment.
Source: fastrevenuepicks.com

Biggest Lie of 2011: "Republicans Voted to End Medicare"

… Republicans passed the BIGGEST HEALTH CARE Bill since Medicare: But 400 BILLION to 1 TRILLION on unconstitutional health care is ok? Prescription Drug Benefit. The final version (conference report) of H.R. 1 would create a prescription drug benefit for Medicare recipients. Beginning in 2006, prescription coverage would be available to seniors through private insurers for a monthly premium estimated at $35. There would be a $250 annual deductible, then 75 percent of drug costs up to $2,250 would be reimbursed. Drug costs greater than $2,250 would not be covered until out-of pocket expenses exceeded $3,600, after which 95 percent of drug costs would be reimbursed. Low-income recipients would receive more subsidies than other seniors by paying lower premiums, having smaller deductibles, and making lower co-payments for each prescription. The total cost of the new prescription drug benefit would be limited to the $400 billion that Congress had budgeted earlier this year for the first 10 years of this new entitlement program. The House adopted the conference report on H.R. 1 on November 22, 2003 by a vote of 220 to 215 (Roll Call 669). Marsha Blackburn Voted FOR this bill. Marsha Blackburn is a Hypocrite. Marsha Blackburn is my Congressman See her unconstitutional votes at : http://mickeywhite.blogspot.com/2009/09/tn-congressman-marsha-blackburn-votes.html Mickey
Source: thenewamerican.com

The Last Thing Medicare Needs is More Privatization

Americans United for Change said it best in a recent e-mail: “You can’t put lipstick on a pig,” even if a Republican and Democrat are applying the red gloss together. The big hype in federal health care politics last week was the announcement of a joint proposal to mostly-privatize Medicare from Republican House Budget Committee Chair Paul Ryan and Democratic Senator Ron Wyden. But all the hubbub about bipartisanship won’t mask the truth: the plan takes Medicare in the wrong direction, building on the program’s failures and undercutting its most promising reforms.
Source: womenborntranssexual.com

Medicare Fraud in the U.S.: The Castro Connection

It began like this: In 2005, Huarte and his co-conspirators formed or acquired control of six medical clinics in Florida, each with its own office. Patients were then recruited and paid kickbacks to periodically appear at the clinics or allow use of their Medicare numbers, according to a plea agreement signed by Huarte in October 2009. The clinics were shams – patients weren’t receiving legitimate treatment there. Later, when authorities caught on, Huarte created shell companies consisting of entirely fictional clinics — those that corresponded with mailbox stores, for instance.
Source: babalublog.com

Wis. Study Finds Low Medicare, Medicaid Rates Shift Costs

Posted by:  :  Category: Medicare

Sign at Occupy St Pete: "Hands Off Social Security, Medicaid Medicare"  "www.SayNoCuts.org" by Fifth World ArtBloomberg/Stateline: Million-Dollar Nurses Show California’s Struggle to Cut Payroll California has paid Lina Manglicmot $1.5 million since 2005, an average of $253,530 a year, to work as a prison nurse in the agricultural town of Soledad. Manglicmot is one of 42 state nurses who each made more than $1 million in those six years, mostly by tapping overtime, according to payroll data compiled by Bloomberg News. … The extra pay that allows some nurses to triple their regular compensation underscores a broader trend in California, where government workers are paid more than in other states for similar duties and civil-service job protections hamper efforts to close budget gaps. Governor Jerry Brown said this week that revenue will fall short of expectations, triggering $1 billion in cuts to school busing, libraries and care for children, the elderly and the disabled, among other programs (Marois, 12/16).
Source: kaiserhealthnews.org

Video: Medicare and Medicaid: What’s it all mean?

Medicaid cuts to N.J. nursing homes could mean staff layoffs

NorthJersey.com reported that back in July the state planned to move to a system that would reimburse nursing homes with patients who required greater care at a higher rate. But state officials realized that homes containing healthier patients would lose significant revenue from the move. So the new rules changed again, to prevent any home’s rates from moving up or down by more than $10 a day.
Source: newjerseynewsroom.com

Reverse Mortgage and Medicaid and Medicare Benefits

Reverse mortgage is a very safe program which offers great financial security to seniors. They can use the cash to provide for a number of financial needs. Such needs might include consolidation of debts, social security supplement, to make improvements in the home, pay property tax or meet urgent medical expenses. Those who are eligible for this kind of loan are those who are 62 years and above. They should also own the homes outright and must live in them as the primary residence. Alternatively, their mortgage balance should be low enough that it can be easily paid off during the closing using some proceeds from the loan. For the home to qualify, it should either be 1-4 units or a single family home. Condominiums and manufactured residences approved by HUD can also qualify as long as the FHA requirements are met.
Source: reversemortgagebase.com

Proposed Medicaid and Medicare cuts may lead to significant losses

Maine:  On December 6, Governor Paul LePage announced proposed cuts that would lead to more than $30 million in losses at hospitals.  The Maine Hospital Association spoke out against the proposal, claiming that hospitals “won’t be able to absorb” the cuts.  [Portland Press-Herald]
Source: methodcare.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

Will Baby Boomers bankrupt Medicare and Medicaid? (No.)

This paper uses the latest data from the Organization for Economic Cooperation and Development (OECD) to compare the health systems of the thirty member countries in 2000. Total health spending—the distribution of public and private health spending in the OECD countries—is presented and discussed. U.S. public spending as a percentage of GDP (5.8 percent) is virtually identical to public spending in the United Kingdom, Italy, and Japan (5.9 percent each) and not much smaller than in Canada (6.5 percent). The paper also compares pharmaceutical spending, health system capacity, and use of medical services. The data show that the United States spends more on health care than any other country. However, on most measures of health services use, the United States is below the OECD median. These facts suggest that the difference in spending is caused mostly by higher prices for health care goods and services in the United States.
Source: dean2016.com

H.R. 3735: To provide for enhanced penalties to combat Medicare and Medicaid fraud, a Medicare data

When you sign up, your trackers are stored permanently and you can access them from any computer. Otherwise they are stored in a “cookie” on your computer and could get erased. When you are signed in, your personal tracked events RSS feed will update with your tracker settings, and you can get email updates on tracked events sent to you automatically.
Source: govtrack.us

H.R.3735: To provide for enhanced penalties to combat Medicare and Medicaid fraud, a Medicare data

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

CENTRAL La. POLITICS: MEDICARE AND MEDICAID FRAUD

A federal grand jury has indicted on Friday several people, including two elderly doctors, who allegedly netted more than $21 million in a phony Medicaid and Medicare billing scam. (See: “Doctors accused of scam”). “Prosecutors say unneeded neurology tests, pulmonary tests, echocardiograms and other exams were rampant in the scheme, which ran in 2009 and 2010, according to the 44-count, 78-page superseding indictment” and an “earlier indictment in April named nine defendants and placed the cost of the alleged scam at about $12 million”. id. “The defendants allegedly schemed to bill the government for thousands of tests that were never performed, and for others done unnecessarily, the indictment alleges.” id. Last year, CBS News reported that “Medicare fraud – estimated now to total about $60 billion a year – has become one of, if not the most profitable, crimes in America”. (See: “Medicare Fraud: A $60 Billion Crime”).
Source: blogspot.com