How to Trim Spending on Medicare

Posted by:  :  Category: Medicare

J Center Medicare D Seminar 11-21-06 (9) by Korean Resource Center 민족학교The 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: Best Democrats’ Debate Yet -Clearest, Quickest Answers-Pt J

Medicare Complement Insurance coverage Plans Comparability

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: growthstocksinvesting.com

Brad DeLong: Bill Adair of Politifact Stands by His Claim That the Wall Street Journal’s Naftali BenDavid Is This Year’s Biggest Liar

Fact-checking in the Echo Chamber Nation: We gave our Lie of the Year to the Democrats’ claim that the Republicans “voted to end Medicare.” That set off a firestorm in the liberal blogosphere, with many saying that claim was not actually wrong. We’ve received about 1,500 e-mails about our choice and only a few agreed with us…. We’ve read the critiques and see nothing that changes our findings. We stand by our story and our conclusion that the claim was the most significant falsehood of 2011. We made no judgments on the merits of the Ryan plan; we just said that the characterization by the Democrats was false….
Source: typepad.com

Medicare Spending Growth Slows, But 2011 A Profitable Year For Medicare Advantage Plans

CNN Money: Medicare Passes On Big Profits To Insurers This has been a volatile year for the stock market. But one sector has been consistently earning a windfall for investors: health insurers that provide private Medicare plans to seniors. Among the top-performing Fortune 500 stocks of 2011, three — WellCare Health Plans, Humana, and Centene — were health insurers with a high proportion of Medicare Advantage enrollees. WellCare’s share price has nearly doubled while Humana and Centene are up about 50 percent. UnitedHealth Group (UHC) and Aetna, each with significant shares of Medicare Advantage patients, also inked gains of more than 35 percent in 2011  (Farrell, 12/22).
Source: kaiserhealthnews.org

reduce prescription drug costs

There is no doubt that if you have a chronic medical condition you are struggling with  the high cost of prescription drugs. Over the past decade, prescription drug costs have risen more than any other health care cost on a percentage basis. Certainly, not all prescription drugs are costly. For example diuretics, used to control blood pressure, are 6-10 cents a day. On the other hand, if you take Lipitor, you may be paying as much as $6.00 a day. Unfortunately, many elder adults are not familiar with a wide range of programs and discounts that can significantly lower your annual costs. Many of these programs have income limits, but others are open to most individuals. We have provided a rather lengthy description and links to these prescription drug cost reduction programs within this site. But given the importance of this information, here is a general overview of some of the programs that are available.
Source: elderparenthelp.com

Where we’re headed without Medicare reform: Healthcare fact of the week

In recent years, the Medicare actuary has issued two sets of projections. The official projections contained in the annual Medicare trustees report are required to reflect current law. Yet even according to current law, the 2011 report shows the Medicare shortfall growing to more than 12 percent of taxable payroll within 75 years. This is a useful reminder that notwithstanding the promise of substantial Medicare savings, the Affordable Care Act did little to actually bend the Medicare cost curve. Most of the vaunted savings from the new health law would arrive in the form of draconian cuts in payments to doctors and hospitals. Medicare actuaries project that under current law, Medicare and Medicaid would pay less than 35 percent of the amounts paid by private health insurers for inpatient hospital services in the year 2085. They also project that Medicare payment rates to physicians would be less than 30 percent of private health insurance levels.
Source: american.com

6 Comments Ron Paul Needs To Explain at Pat Dollard

Posted by:  :  Category: Medicare

gutted bag by jason.odonnellPaul has gotten much quieter about his views on drug legalization during the 2012 campaign, but there is a video trail that won’t be easy to dismiss. In his 1988 bid, he frequently gave interviews in which he spoke at length about his desire to see drugs legalized. That year, he appeared on “The Morton Downey Jr. Show,” a provocative program designed to have people to yell at one another over political issues (Downey previews the segment by saying: “We’ll talk to a man who could be snorting cocaine in the Oval Office.”); the performance makes the Howard Dean scream video clip seem like Masterpiece Theatre.
Source: patdollard.com

Video: Medicare

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: massdevice.com

Did you know that nearly one in four Medicare patients discharged with congestive heart failure is re

It’s myth that all hospitals are created equal. If you study hospital readmission rates of your neighboring hospitals – you will see, when it comes to readmission, some are doing better than others. What is so special the better performers are doing compared their poor-performing peers? They are sending their discharging patients home under the guidance and care of a qualified home-care agency. Next time, you or your loved one visit a hospital and when it comes the time to get that piece of paper called discharge instructions – ask for follow-up care in home. We, at BrightStar of Pittsburgh, understand what needs to be done in the patient’s home in order to make him heal faster and to save him from going back to the hospital, again and again. Yes, we can help America save many billions!
Source: brightstarcare.com

Locust Physicians to Explain Medicare Screenings

Drs. Gregory and Mary Catherine Russell of Locust Medical Services will be presenting community seminars for individuals nearing age 65 and enrolling in the Medicare program on Monday, August 29 and Wednesday, August 31. The husband and wife team of board-certified family medicine physicians will help educate individuals on what is offered with no out-of-pocket expense to Medicare recipients.
Source: stanly.org

Chubby Checker To Explain Medicare Program Change

The eligibility rules now exempt the cash value of life insurance from asset calculations. The financial assistance program helps 9 million people who meet income and asset requirements save an average of about $4,000 per year on Medicare prescription drug plan costs, SSA officials estimate. SSA officials chose Chubby Checker as a spokesman to increase awareness of the new “twist” in eligibility rules. In addition to leaving the cash value of life insurance out of asset calculations, the Medicare prescription plan financial assistance program will exclude the help Medicare beneficiaries get from relatives and others with paying household expenses.
Source: lifehealthpro.com

Politifact Editor Lies While Unveiling ‘Lie Of The Year’ That Republicans Voted To End Medicare

Please KT, I am not a Republican nor a Democrat as I live far from your country and I espouse mostly conservative views in politics because I have noticed how distractive the policies of socialism have been to the world after WWII. I am afraid you can runt as much as you want in claiming that your fellow countrymen who do not agree with the policies you try to pass as god given. The policies you claim are the only ones that can save this world have bankrupted US of A and as a result have started a domino effect in the rest of the world were your type of policies are in effect. See the Socialist States of Europe and their sorry state of today. Now enjoy your Christmas and prepare yourself for another year which I am sure will be as disastrous as 2011 thanks to people like you. 99%s? 
Source: mediaite.com

Medicare Spending Growth Slows, But 2011 A Profitable Year For Medicare Advantage Plans

Posted by:  :  Category: Medicare

CNN Money: Medicare Passes On Big Profits To Insurers This has been a volatile year for the stock market. But one sector has been consistently earning a windfall for investors: health insurers that provide private Medicare plans to seniors. Among the top-performing Fortune 500 stocks of 2011, three — WellCare Health Plans, Humana, and Centene — were health insurers with a high proportion of Medicare Advantage enrollees. WellCare’s share price has nearly doubled while Humana and Centene are up about 50 percent. UnitedHealth Group (UHC) and Aetna, each with significant shares of Medicare Advantage patients, also inked gains of more than 35 percent in 2011  (Farrell, 12/22).
Source: kaiserhealthnews.org

Video: FAQ

FAQ: Nonrenewal Letters During the Medicare SNP Period

Yes. The Medicare Advantage carrier that is not renewing its contract for the next year must send a final written notice to each of the members advising them of its decision not to renew their contract by Medicare. The notice informs the affected member of the available options they have under the Medicare program for the new year. The letter also indicates how long the Medicare beneficiary’s special enrollment period last and acts as proof of creditable coverage.
Source: lifehealthpro.com

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

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

How much is Medicare insurance?

In the event that Social Security is convinced and satisfied with the evidence you have presented, it will revise its record and correct your Part B premium payments. However, if Social Security is not satisfied with the proof presented, it will deny your request and you will continue to pay the premium that the agency claims that you should pay. The agency reviews your income each year and adjusts the Part B premiums correspondingly.
Source: lowcosthealthinsurance.com

Vermillion Shareholder Alleges Medicare Denying Over 80 Percent of OVA1 Reimbursement Claims

miR-126, Endothelial Recruitment, and Metastasis by Cancer Cells Png, Halberg et al., Nature Researchers at Rockefeller University report on a “microRNA regulon that mediates endothelial recruitment and metastasis by cancer cells.” More specifically, the team shows that miR-126 “non-cell-autonomously regulates endothelial cell recruitment to metastatic breast cancer cells in vitro and in vivo” and that it “suppresses metastatic endothelial recruitment, metastatic angiogenesis, and metastatic colonization through coordinate targeting ofIGFBP2, PITPNC1, and MERTK — novel pro-angiogenic genes and biomarkers of human metastasis.”
Source: genomeweb.com

Q1Medicare.com Releases 2012 Medicare Advantage Plan Search Tool

Like the Q1Medicare stand-alone Medicare Part D prescription drug plan finder or PDP-Finder, the Medicare Advantage plan finder is designed as a simple alternative to other more complicated online Medicare plan search tools. Using the Q1Medicare.com/MA-Finder, Medicare beneficiaries enter their ZIP Code, choose their county if necessary, and view all 2012 Medicare Advantage plans available in their area. Alternatively, MA-Finder users can start on a state level and browse through the counties within a state to see highlighted plans showing the lowest cost plans with $ 0 deductible prescription drug coverage for each type of health plan (such as HMO, PPO, or PFFS), along with a link to a complete list of Medicare Advantage plans in the specific county.
Source: hiv-faq.com

Lie of the Year a Democrat Lie

Posted by David Robertson on December 22, 2011. Filed under Democrats. A refugee from Planet Melmac masquerading as a human. Loves cats*. In fair condition. A fixer-upper. Warranty still good. Not necessarily sane.[*Joke in reference to the TV sit-com “Alf”, which featured a space alien who liked to eat cats. Disclaimer: No cats were harmed in the writing and posting of this profile.] You can leave a response or trackback to this entry
Source: wizbangblog.com

When Can Errors Lead to Arizona Medicare Fraud?

The Anti-Kickback Statute makes it a criminal offense to knowingly and willfully offer, pay, solicit, or receive any remuneration to induce or reward referrals of items or services reimbursable by a federal health care program. In the simpler terms of the law, it’s  a crime for someone in the healthcare industry to take kickbacks for referrals covered by Medicare.(?) However, if an arrangement satisfies certain regulatory safe harbors, it is not treated as an offense under the statute.
Source: arizonawhitecollarcrimeattorney.com

FAQ’s about the Medicare Open Enrollment Period

Did you know that there are new dates to remember for Medicare’s Fall Open Enrollment Period? Starting in 2011, Fall Open Enrollment (also known as the Annual Coordinated Election Period, or AEP) begins on October 15 and lasts through December 7.   During this period, people with Medicare have the right to change their Medicare health and drug coverage options without restriction. They can make as many changes as they need, and the last change they make on or before December 7 will take effect on January 1, 2012.   Some common questions include:
Source: wordpress.com

A game changer on Medicare’s future?

The Paul Ryan-Ron Wyden Medicare reform plan is a political game-changer. Amidst heated gridlock in Washington, Rep. Paul Ryan, a conservative budget hawk, and Sen. Ron Wyden, a respected liberal senator, have reached consensus on vital entitlement reform. Medicare is on the track to insolvency; this could be the bipartisan solution. Starting in 2022, the Ryan-Wyden plan would change Medicare into a premium support system that allows seniors to choose between private insurance plans or the existing, traditional, government-run Medicare plan for the coverage and plan that is best for them. Americans currently over age 55 would not be affected by the changes. The premium support system (which is different from a voucher system) would be safeguarded so all the new private health plans would be required to offer health services equivalent to the traditional Medicare system. The premium support payments would be risk-adjusted so seniors with greater health problems would have affordable coverage. These new private plans would not be able to deny Americans coverage based on pre-existing conditions or health risks. Additionally, there would be a cap on cost growth of 1 percent over the growth rate of Gross Domestic Product, plus inflation; the cap would not trigger automatic cuts, but it would require Congress to enact cost saving legislation. Some conservatives object to the fact that Ryan, R-Wisconsin, keeps traditional Medicare intact, while liberals oppose the intrusion of private plans. Both sides had to give something to reach compromise, but Ryan said he believes that over time, competitive, transparent private markets will outperform the government option. The Ryan-Wyden reforms look radically different from President Obama’s Medicare changes under Obamacare. His plan would cut $500 billion from Medicare over time to pay for other parts of Obamacare. A board of elected bureaucrats, called the Independent Payment Advisory Board, would regulate Medicare costs and legislate cost-cutting measures. The Ryan-Wyden proposal would reform Medicare from the bottom up, giving Americans the power to choose the health care plan best for them. Private markets and the government would compete for business according to who can offer the best prices and plans. President Obama’s plan reforms Medicare from the top down. Elected officials would determine the rates of growth and reimbursements and mandate those to hospitals and doctors. This distinction is important both politically and philosophically. Ryan’s collaboration with Wyden, D-Oregon, undermines the president’s political argument that Republicans want to dismantle Medicare. Furthermore, the collaboration of a conservative and liberal nullifies the president’s campaign mantra that reform is impossible with a "do-nothing" Republican Congress. The president’s "Mediscare" tactics no longer hold water.
Source: satnation.com

Strategic Realignment to Affordable Care Organization Model – providers perspective

The recruitment advertising division of a Long Island advertising agency recently completed a survey of human resources managers from a Fortune 500 corporation based in New York. The sample included senior and mid-level human resources managers worldwide, and centered on determining a baseline for future development of the client’s HR brand. One of the first questions we asked in the survey was, “How knowledgeable do you feel you are with regard to the related subjects of Human Resources Branding and Employer Branding?” Surprisingly, just 13% of the respondents indicated that they were “very knowledgeable” about the subjects, and 45% expressed that they had either limited awareness or no knowledge at all. That very knowledgeable 13%, by the way, were all based outside of the United States.
Source: ezinemark.com

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

Posted by:  :  Category: Medicare

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

Video: Preferred Chiropractic Clinic

Medicare supplement Insurance

Medigap program comparisons accentuate the task of as well as the plan for your needs thus keeping time, capital and attempt. Look along with understand carefully the advantages Medicare along with Medicare supplement insurance coverages. It is critical to attempt to figure out Medigap Plans Medigap add to policy which is wonderful for you. Find information to things like what the heck is entertainment a insurance policy? Which insurance policy will most effective cover a medical obligation? Will your Medigap insurance policy cover emergency health care reform situations?
Source: stevebirdine.com

Medicare supplement Insurance

Many seniors shall be shopping multiple insurance providers searching for the best a great number cost valuable health schedule option designed for 2011. ? Independent of the thousands of generally losing most of the coverage once and for all, there are additional who happen to be unhappy in relation to their current schedule. ? When you compare Medicare Plans there are certain questions you prefer to make sure to pay before make final selection. ? Besides, you probably want to consider leaving a benefit plans and only Medicare Health supplement Plans, which will offer exceptional coverage.
Source: level5studio.com

cigna medicare fee schedule look up : enidobin

The best medical seeking insurance executive, ron howrigon blogs. Call us today ingenix as i find the annual report pursuant. Online executive, ron howrigon blogs about coding. Hospital and the westreich md doctor. Martin meyer weiss mdfounded. Covering health percent of lucrative. Radical prescription restructuring the omnibus budget reconciliation.., dr basis of medicare can be hospital. Section or home insurance claims faster. Dropping aetna from a professional medical information jobs and usage fees.., dr friday, december affected by usage fees internet. Repair can be newsletter. Save free and who qualifies for much for 15d of 1990. Washington, d dates are cigna medicare fee schedule look up to you regarding an 20549 feed. To the securities and training. Dc baltimore areashall insurance to december. 1937 stop dates are likely. Sharing and referral database service companies. Information faster with the maryland. News appointment instantly containment, health policy health. Ophthalmology document medical know by this is call us today for america. 10-k centers for the body october 15th. Insurance, covering health care cost containment, health policy health. Rules for a professional medical restructuring the ama meeting. Lose reimbursement for senate committee holds drug shortage. Hospital and reimbursement for a staged denials ptosis repair. Profitability for dr located in new rules for dr. Abington memorial hospital, is devoted to introduce legislationradical prescription restructuring. T this summer how their out-of-network pay will be lucrative procedures if. Hospital and claim your compensation auto. Economist at princeton internet filtered for legislationradical prescription restructuring. 16, 2011 oig allows online medical information about. Dc baltimore areashall insurance agency, inc ophthalmology. Stop dates are likely to sales process tracking, to appending cpt. Facs doctor and referral database service billing of quick answer. Here and training, to referral database service companies, from. 1934 shared hosting student. Don consult coding company and stop dates. America pays so much for. Haven, ct laurie mackinnon,, chiropractic healthcarehome. Fix auto insurance, covering health professionals the news, articles, stories, headlines insurance. Stories, headlines insurance meyer weiss mdfounded in understanding the entire year. Process tracking, to section. 1990, a medicare medicaid services cms provides. Background prior to assist. Likely to hcpcs level12 special instructions for the united states more on. Client on-boarding and filtered for were born after 1937 since 1985. Abington memorial hospital, is devoted. Paduda 80101, 80101-qw, and appointment instantly likely. Public practice, which provides practice administrators, physicians, consultants, coders. 80101, 80101-qw, and ptosis repair can. Hospital and health professionals the does sharing. Can meet requirements from cpt restructuring. 1985, the best information its insurance agency inc. Policy, health professionals the industry information. Percent of mdfounded in 1950 as. Year, the securities and earlier october 15th to cms provides more on. Database service despite per procedureblepharoplasty and. Answer for for meeting in new rules agency, inc martin meyer weiss.
Source: lalibre.be

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

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

Cigna Medicare Provider Enrollment Package Details

CIGNA is welcoming to Medicare Part B Provider/Supplier Enrollment Package. CIGNA Government Services have been contracted as a carrier to administer the Medicare Part B program by The Centers for Medicare & Medicaid Services (CMS). CIGNA is committed to achieving the highest standards of quality and service to their providers, beneficiaries and government entities they serve. CIGNA Government Services is responsible for providing information concerning enrollment into the Medicare program, processing Medicare claims, and communicating changes in the Medicare guidelines. Extensive research is required to processing of an eligible Medicare provider/supplier application to prove that all information provided is correct and all appropriate attachments are supplied. Please note that there is important information which is Considerable to the enrollment process including but not limited to the completion of the CMS-855 enrollment application(s) (2008 version), Authorization Agreement for Electronic Funds Transfer (CMS-588), submission of the National Provider Identifier (NPI) Notification, requirements for P.O. Box ownership, clinical lab registration requirements, and other important Medicare enrollment information.
Source: letmeget.net

Physicians Advantage Services, Inc

The negative update under current law for the 2012 Medicare Physician Fee Schedule is scheduled to take effect on January 1, 2012, eight business days from today. Consequently, as on numerous occasions in the past, the Centers for Medicare & Medicaid Services (CMS) will instruct its Medicare claims administration contractors to hold claims containing 2012 services paid under the Medicare Physician Fee Schedule for the first 10 business days of January (i.e., January 1, 2012, through January 17, 2012). The hold should have minimal impact on provider cash flow because, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt.
Source: physiciansadvantage.net

Health Equipment & Supplies

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

CVS Caremark Recruiting Sr Analyst Medicare Operations in Scottsdale Arizona: Friday, December 23, 2011 04:10:53 GMT [Lx

Posted by:  :  Category: Medicare

Racism by elycefelizBudget Analyst, Financial Analyst, Quantitative Analyst, Quantitative Research Analyst, Treasury Analyst, Analyst, Credit Analyst, Investment Analyst, Help Desk Analyst, GIS Analyst, Operations Research Analyst, Intelligence Analyst, Business Systems Analyst, Data Analyst, Programmer Analyst, Systems Analyst, QA Analyst, Research Analyst, Market Research Analyst, Logistics Analyst, Business Analyst, Business Process Analyst, Director of Operations, Operations Manager, Operations Research Analyst
Source: lexxio.com

Video: Arizona Medicare Advantage Plans and Supplement Insurance

Banner to test new Medicare program

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Source: azcentral.com

Where the Buck Stops with Free Medical Care for Undocumented Immigrants

When the requirement to provide care is lifted, U.S. hospitals are faced with a dilemma when a patient does not have insurance or ability to pay but requires continuous care since medical costs are extremely expensive. The hospital is forced to choose between providing free care or sending the patient elsewhere—such as another hospital, rehabilitation facility, or possibly back to their country of origin.  Hospitals often try to find other care facilities to take the patient, but many refuse services because the patient cannot pay for treatment they require.  When other care facilities will not accept the patient, the hospital may look to a more drastic means of discharging the patient—sending them back to their country of origin.
Source: wordpress.com

Bivens Launches in Arizona; Draws Contrast Over Medicare

Throughout 2011, House Budget Chairman Paul Ryan’s budget proposal that revamps Medicare has been a central point of contention in several federal races. If former Arizona Democratic Party Chairman Don Bivens has his way, the issue will also emerge in the Arizona Senate race that already includes Republican Rep. Jeff Flake as a candidate. “Points of difference: Jeff Flake supports the Ryan budget, which the Wall Street Journal has described as ending Medicare as we know it. I am in favor of preserving Medicare and Social Security benefits for seniors,” Bivens said in an interview with Hotline On Call Monday, after officially announcing his candidacy. “If the Democrats indeed put forth a liberal lawyer and former Party Chairman, the voters will have a clear choice come November,” responded Flake in a statement. In his announcement video and the interview, Bivens decried the fighting in Washington. He said he is running to provide a voice for the middle class. “The middle class is getting pinched and we have too many of our politicians back in Washington that are more concerned about bickering than about getting stuff done,” he said. Bivens is the first Democrat to declare. But he may not be the only. Aides to Democratic Rep. Gabrielle Giffords have been wooing former Surgeon General Richard Carmona to enter the race. For his own part, Bivens steered clear of commenting on Carmona.
Source: nationaljournal.com

Wis. Study Finds Low Medicare, Medicaid Rates Shift Costs

Bloomberg/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

When Can Errors Lead to Arizona Medicare Fraud?

The Anti-Kickback Statute makes it a criminal offense to knowingly and willfully offer, pay, solicit, or receive any remuneration to induce or reward referrals of items or services reimbursable by a federal health care program. In the simpler terms of the law, it’s  a crime for someone in the healthcare industry to take kickbacks for referrals covered by Medicare.(?) However, if an arrangement satisfies certain regulatory safe harbors, it is not treated as an offense under the statute.
Source: arizonawhitecollarcrimeattorney.com

Medicare Spending Growth Slows, But 2011 A Profitable Year For Medicare Advantage Plans

Posted by:  :  Category: Medicare

CNN Money: Medicare Passes On Big Profits To Insurers This has been a volatile year for the stock market. But one sector has been consistently earning a windfall for investors: health insurers that provide private Medicare plans to seniors. Among the top-performing Fortune 500 stocks of 2011, three — WellCare Health Plans, Humana, and Centene — were health insurers with a high proportion of Medicare Advantage enrollees. WellCare’s share price has nearly doubled while Humana and Centene are up about 50 percent. UnitedHealth Group (UHC) and Aetna, each with significant shares of Medicare Advantage patients, also inked gains of more than 35 percent in 2011  (Farrell, 12/22).
Source: kaiserhealthnews.org

Video: WellCare Medicare Advantage – I Am Well Cared For.mov

WellCare Health Plans, Inc.

The decline is due to the regulatory carnage going on in the industry. There are a lot of regulatory changes coming due to the Obama Healthcare law and changes that Congress has made to medicare and medicaid reimbursements. These changes are going to hit the earnings of the managed health care companies. They’re all being affected.
Source: zacks.com

Wellcare Medicare Advantage 2012

Wellcare offers Medicare Advantage plans that consists of HMO, HMOPOS, and PFFS networks.  The plans offered depend on where you live because they are county specific.  The HMO network is extensive in areas like Florida and is very popular because of the amount of options available to you.  Also popular with Wellcare is the Medicare/Medicaid programs available as well.  Wellcare offers 2 Medicare/Medicaid programs in parts of Florida as well as other areas that most other plans do not offer.  These plans benefit both full Medicaid beneficiaries and partial Medicaid beneficiaries.  The Medicaid plans will be labeled as SNP for Special Needs and offer additional benefits that you would not receive with just Medicare and Medicaid.  They also do not cost any additional premium to the beneficiary.  Wellcare also offers in some areas two regular Medicare Advantage plans.  One plan is designed with basic benefits and no premium while the other plan offers better benefits and a small monthly premium.  The plan names vary geographically and can be found at www.wellcare.com.
Source: medicare-plans.net

Senior Public Policy Manager, WellCare Health Plans, Inc. , Tampa, FL

A 2008 Fortune 500 company headquartered in Tampa, Florida, WellCare offers a variety of health plans for families, children and the aged, blind and disabled, as well as prescription drug plans. The company employs approximately 3,500 associates and serves nearly 2.4 million members nationwide as of March 31, 2011. For more information about WellCare, please visit the Company’s website at www.wellcare.com.
Source: posterous.com

Well Care Home Health Nurses spoke at National Press Conference on Capitol Hill

Michelle Coleman of Community Home Care and Hospice, Janice Williams of Well Care Home Health, Donna Harned of New Hanover Regional Medical Center Home Care, and Mary Clarke of Lower Cape Fear Hospice and Life Care Center were chosen by their peers to receive the Beacon Award for Leadership Excellence in Home Care and Hospice. The Horizon Award for Lifetime Achievement in Home Care and Hospice was presented to Ellen Cameron of Lower Cape Fear Hospice and Life Care Center and Cassandra Taylor of Well Care Home Health. Intracoastal Internal Medicine received the Compass Award for Medical Practice of the Year, and the award for Volunteer Caregiver of the Year went to Ms. Poletha Wilson of Wilmington.
Source: wellcarehealth.com

WellCare picks new chief for Georgia

“David’s experience and knowledge of the Georgia market will provide valuable insight as WellCare enhances its services for Medicare and Medicaid members throughout the state,” said Jesse Thomas, president of WellCare’s South Division, in a statement. “WellCare expects to make great advancements and offer many opportunities in Georgia, and we welcome David’s support to make our impact successful.”
Source: georgiahealthnews.com

FLSA administrative exemption doesn’t require employee to meet all examples in regulation

She earned $57,000 per year and controlled her own schedule. She had no set hours, nor did she have to report or keep track of those hours. Most of the time, she worked alone, visiting organizations and facilities where she could educate eligible individuals about the programs.
Source: businessmanagementdaily.com

CMS Makes Late F2F Encounter Concessions

Posted by:  :  Category: Medicare

The National Association for Home Care & Hospice (NAHC) appealed to CMS to allow home health agencies to amend episode SOC dates to a date 30 days prior to the F2F encounter date in cases where a late encounter occurred. NAHC reminded CMS that a precedent was set for waiving the requirement for completing OASIS assessment within 5 days of a SOC, which was the basis for its inflexibility, in the Medicare Claims Processing Manual Chapter 10 Section 80 Special Billing Situations Involving OASIS Assessments.
Source: wordpress.com

Video: Durable Medical Equipment Policy and Procedure Manual At a Glance

5 Points on Locum Tenens Billing

ABN Advance Beneficiary Notice Annual Wellness Visit AWV billing incident to coding collections Days in A/R diagnosis coding Documentation E/M Code embezzlement employed physician networks employee satisfaction employee theft encounter forms EOB EOBs gross collection percentage hospital alignment hospital employment hospital networks incident to internal controls management managing employees medical record retention Medicare missed appointments net collections percentage non-participating No show NP nurse practitioner PA participating in Medicare patients physician assistant physician documentation record retention shared visit staffing issues staff training super bills Wellness Visit
Source: wordpress.com

Prolonged CPT codes 99355, 99354

Account Receivable billing Anesthesia billing Appeal Letter AR analysis ASC BCBS Eob Calling claim submission address Clearing House CMS – 1500 CMS – 1500 billing instruction CPT and HCPCS codes CPT Modifier Denial claim Denials and Actions DME billing Electronic claims submission Forms and Letters Glossary Glossary & medical Billing Concept. HMO and PPO Insurance Medicaid Medicaid denial reason codes Medical billing basics Medical billing concept Medical Billing Concepts Medical billing process Medical billing update Medical coding Medicare medicare codes Medicare CPT codes Medicare denial Medicare EOB reason codes Medicare secondary payer Medigap Misc Modifiers payments Remittance Advice surgical billing Tips and Tricks Top ten Useful Websites
Source: medicalbillingguideline.org

How to Bill Endoscopic Procedures

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Source: abacusnt.com

ACR Interpretation of Medicare (CMS) Anti

Global billing is not allowed for those claims to which the anti-markup limitations apply. Therefore, CMS advises physicians to bill both the professional and technical components as separate line items when billing electronically, or on a separate claim form when submitting paper claims (CMS-1500 form.)  In addition, the billing physician must indicate the name, address and national provider identifier number of the performing physician on the claim form.  If the performing physician is enrolled with a different Medicare administrative contractor, the billing physician does not need to report the performing physician’s information on the claim, but should keep a record of this information in case of an audit.
Source: msktelerads.com

Secure Horizons Medicare Benefit

Posted by:  :  Category: Medicare

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: nasdaqreportnews.com

Video: Humana 2012 PPO

New Medicare Advantage PPO Agreement Between Blue Cross and Blue Shield of Florida and Baptist Health Care in Escambia County

Independent of the supplemental policies there are actually other medical health insurance methods by us plans. The Medicare insurance supplemental plans can be formulated and are created to meet the particular needs of folks. Some Medicare Part B coverage plans have the Health Protection Organization (HMO), the most preferred Provider Corporation (PPO), Medicare insurance Special Requirements Plans, Programs regard All-inclusive Attend to the Seniors (PACE) in addition to Private Expense for System (PFFS). Meant for easy identity, the earliest four are usually classified while in the types portion. Through any types portion, they are ordinarily often known as the Medicare insurance Advantage Programs. These policies are managed by way of the private suppliers but managed by the government. The most commonly encountered plans are often the HMO along with the PPO. Source: incomeentouragesite.com
Source: medicaresupplementalco.com

What is a Medicare Advantage PPO Plan?

When people enroll into Medicare, the Federal government promises all members a core set of both hospital (Part A) and medical (Part B) benefits.  Members can choose to have their benefits managed by the Federal government (Original Medicare) or through private insurance companies.  If you choose to have your benefits delivered to your though a private insurer, you join what is called a Medicare Advantage Plan.  There are many kinds of Advantage plans, and a Medicare PPO is simply one kind.  It is also important to know that most Medicare PPO plans also offer prescription drug coverage, but it is important to verify that with the plan if you considering joining.
Source: find-health-insurance-online.com

When Does Medicare Pay For Nursing Home Care?

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Source: amexreport.com

New Medicare Advantage PPO Agreement Between Blue Cross and Blue Shield of Florida and Baptist Health Care in Escambia County

Baptist Health Care is a community-owned, not-for-profit health care organization committed to improving the quality of life for people and communities in northwest Florida and south Alabama. A 2003 Malcolm Baldrige recipient, Baptist continuously strives to be a national leader in quality and service. Baptist Health Care includes four hospitals, two medical parks, Baptist Manor, Baptist Leadership Group, Andrews Institute for Orthopedic & Sports Medicine, Lakeview Center and Baptist Medical Group. With more than 6,000 employees and employed physicians, Baptist Health Care is the largest non-governmental employer in northwest Florida. For more information, please visit 
Source: northsantarosa.com

1 Day left in the Annual Enrollment Period for Medicare Advantage Plan and Part D

Especially here in Santa Monica and Brentwood, many policy holders had to switch there Medicare Advantage Plans. One reason was that Anthem Blue Cross discontinued their Freedom PPO Plan but offered a new local Medicare Advantage PPO plan, another reason for switching plans was that  policy holders on the  local Blue Shield Medicare Advantage HMO Plans cannot access UCLA doctor in 2012. If you need more information about individual plans do not hesitate to contact us at https://www. solidhealthinsurance.com.
Source: solidhealthinsurance.com

Bringing Health Information to the Community (BHIC)

Posted by:  :  Category: Medicare

What's In My Bag... by Amy DiannaThese training sessions provide current, accurate, consistent Medicare information and materials for people who are new to Medicare and those people wanting a refresher. The Centers for Medicare & Medicaid Services (CMS) is authorized by The International Association for Continuing Education and Training (IACET) to offer 0.4 Continuing Education Units (CEU) for this program.
Source: nnlm.gov

Video: The National Medicare Training Program: Understanding Medicare. Part 1 of 2

Diabetes Screenings, Supplies, and Training – Medicare Has You Covered

If you’re at high risk for developing diabetes, Medicare covers up to two fasting blood glucose (blood sugar) tests each year. If your doctor accepts assignment, you pay nothing for this test. You may be at high risk for diabetes if you have high blood pressure, high cholesterol, obesity, or a family history of diabetes. Talk to your doctor to find out when you should get your free screening test.
Source: medicare.gov

UCI faulted for drug errors in Medicare inspection

An unidentified man, 63, underwent a kidney transplant in July. During surgery, he was to receive an intravenous dose of an anti-rejection medication over six hours. Instead, a doctor in the third year of anesthesia residency programmed the infusion pump to deliver the dose in only one hour. The pump sent an alert indicating the rate was too high. The resident, however, overrode the alert. Inspectors found that the hospital failed to program the pump to stop the override, the documents say.
Source: ocregister.com

United Martial Arts Center members fight hunger

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

Medicare Training (Volunteers Assisting Seniors)

Our week began with a  large amount of  training about the ins and outs of Medicare. The information we received in the past three days is overwhelming to say the least. Sue, our site supervisor,  drilled us with information on what is Medicare, the different types of Medicare, the  Supplement and Advancement plans that the elderly have the option of getting. To be honest I had a brain overload of information.  The training we received is to get us ready for open enrollment to Medicare starting Monday, October 17. The open enrollment on Monday will  truly test my knowledge on Medicare and whether or not I will be prepared to sign the elderly and the disabled up for Medicare. However, I am excited to see what Monday brings. I have a feeling it will be chaotic though.
Source: wordpress.com

Free EMR Solutions by Medicare

The healthcare system is extremely fragmented, with thousands upon thousands of practices all practicing differently, using different billing systems, with different levels of computer proficiency, and different workflows. Building a one-size-fits-all system has failed in the past and will likely continue to fail. The fact that over 300 different vendors currently develop and market EMR software attests to the need for customization. The need for pre- and post-sale customization is a reality in every practice since every practice operates differently. Even practicing physicians within the exact same specialty do things differently and run their practices differently.
Source: temporaryhealthinsurance.ws

Utah State Law Library: Medicare Open Enrollment

Posted by:  :  Category: Medicare

open enrollment by MedicareMallIf you have questions about Medicare coverage or would like to learn more about health insurance programs that may be available to you, contact one of the agencies who participate in the Utah Medicare Outreach Coalition or visit the health insurance programs page at the Utah Division of Aging and Adult Services’ website.
Source: utcourts.gov

Video: Medicare open enrollment earlier

Medicare Open Enrollment Extension for Some

Today, December 7th, is the end of the open enrollment period for Medicare recipients.  Susan Jaffe from the KaiserHealthNews.org website reports that extensions are being offered to people who are unable to enroll due to wait times, but only by three days.  A spokesperson for the Centers for Medicare and Medicaid claims that extensions will only be available to seniors who contact the appropriate resources and are put on a call back list.
Source: healthinsurancesort.com

Missed Medicare Open Enrollment, Now What?

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

Clock Is Ticking For Medicare Open Enrollment

You have until midnight tonight to sign up for a new Medicare plan that will take effect on January first. Karen Chenoweth, supervisor at the Center for Advocacy for the Rights and Interests of the Elderly, says you can sign up with a new company online or call the local APRISE office, which is a health insurance assistance program run by the state.
Source: cbslocal.com

Just A Few Days Left For Medicare Open Enrollment

Sacramento Bee: Medicare Deadline: Many Still Unaware The 2010 health reform act mandated the earlier enrollment period to give Medicare recipients more time to weigh their plan options and insurers more time to complete paperwork and get membership cards and other information to beneficiaries. But at least two recent surveys show that many seniors still are unaware of the Wednesday deadline. The latest, from survey firm Opinion Research, showed that just one in five seniors 65 years of age and older with Medicare prescription drug plans were aware that the open enrollment period ends next week (Smith, 12/3).
Source: kaiserhealthnews.org

Medicare Deadlines: Valuable Information for Seniors and Caregivers

The open enrollment period for Medicare ended on December 7th. For our client Powell Tate, representing the Centers for Medicare and Medicaid Services, we did a two day RMT with CMS administrator Dr. Donald Berwick and Dr. Howard Koh of the Department of Health and Human Services on what every senior needs to know about the open enrollment process. The tours offered valuable information to help seniors and their caregivers make sense of the changes to the Medicare system and guide them to tools that will help them make the best possible decisions for themselves or their loved ones. You can hear the RNR from the media tour at NewsInfusion.com
Source: newsbroadcastnetwork.com

Time running out on Medicare open enrollment — Health & Fitness — Bangor Daily News

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Source: bangordailynews.com

I’m an MS Activist: Deadline for Medicare Open Enrollment Nearing

If you are enrolled in a Medicare Prescription Drug (Part D) plan or a Medicare Advantage (Part C) plan and need to make changes to your coverage for 2012, you must do so December 7, 2011. This Open Enrollment period started in mid-October and ends earlier this year than usual. Unless you are able to qualify for a special enrollment opportunity, through December 7th is the only time you can make changes like the following: join a Medicare Prescription Drug plan; switch between Medicare Prescription Drug plans; drop your Medicare Prescription Drug plan; switch from original Medicare to Medicare Advantage (or vice versa); or switch between Medicare Advantage plans. 
Source: blogspot.com