Medicare Provider Revalidation List Now Online

Posted by:  :  Category: Medicare

No doctor shopping here, buddy by Newtown grafittiThe Centers for Medicare & Medicaid Services (CMS) has posted a listing of providers who have been sent a request to revalidate their Medicare enrollment information. The listing contains the name and national provider identifier (NPI) of each provider sent a letter, as well as the date the letter was sent.
Source: wordpress.com

Video: Heartland Could be Removed from Medicare list of Providers Saturday

What to Look for In Your Medicare Provider

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

Now Available Online: List of Providers Sent a Revalidation Request

[…] In response to provider requests, CMS has posted a listing of providers who have been sent a request to revalidate their Medicare enrollment information. The listing contains the name and national provider identifier (NPI) of each provider sent a letter, as well as the date the letter was sent. To see the listing, click on “Revalidation Phase 1 Listing” in the Downloads section of the Medicare Provider Supplier Enrollment Revalidation Page. NOTE: You must widen each column in the spreadsheet to view the contents. CMS will be updating this list monthly.   If you are listed, and have not received the request, please contact your Medicare contractor. Their toll free number may be found at Medicare Fee-For-Service Contact Information.   For more information on revalidation of Medicare provider enrollment, see MLN article 1126, Further Details on the Revalidation of Provider Enrollment Information.Source: somersetblogs.com […]
Source: somersetblogs.com

Medicare Provider Revalidation List Now Online

In response to provider requests, CMS has posted a listing of providers who have been sent a request to revalidate their Medicare enrollment information. The listing contains the name and national provider identifier (NPI) of each provider sent a letter, as well as the date the letter was sent. To see the listing, click on “Revalidation Phase 1 Listing” in the Downloads section of the Medicare Provider Supplier Enrollment Revalidation Page. NOTE: You must widen each column in the spreadsheet to view the contents. CMS will be updating this list monthly.   If you are listed, and have not received the request, please contact your Medicare contractor. Their toll free number may be found at Medicare Fee-For-Service Contact Information.   For more information on revalidation of Medicare provider enrollment, see MLN article 1126, Further Details on the Revalidation of Provider Enrollment Information. Source: somersetblogs.com
Source: medicaresupplementalco.com

Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline, CPT Code Billing: Medicare speciality code full list

Medicare provider/supplier specialty codes Here is the list of Medicare provider/supplier specialty codes you can use as a reference during the enrollment process. Code Description 01 General practice 02 General surgery 03 Allergy/immunology 04 Otolaryngology 05 Anesthesiology 06 Cardiology 07 Dermatology 08 Family practice 09 Interventional pain management 10 Gastroenterology 11 Internal medicine 12 Osteopathic manipulative medicine 13 Neurology 14 Neurosurgery 15 Speech language pathology 16 Obstetrics/gynecology 17 Hospice and palliative Care 18 Ophthalmology 19 Oral surgery (dentist only) 20 Orthopedic surgery 21 Cardiac electrophysiology 22 Pathology 23 Sports medicine 24 Plastic and reconstructive surgery 25 Physical medicine and rehabilitation 26 Psychiatry 27 Geriatric psychiatry 28 Colorectal surgery 29 Pulmonary disease 30 Diagnostic radiology 32 Anesthesiologist assistant 33 Thoracic surgery 34 Urology 35 Chiropractic 36 Nuclear medicine 37 Pediatric medicine 38 Geriatric medicine 39 Nephrology 40 Hand surgery 41 Optometry 42 Certified nurse midwife 43 Certified registered nurse anesthetist (CRNA) 44 Infectious disease 45 Mammography screening center 46 Endocrinology 47 Independent diagnostic testing facility 48 Podiatry 49 Ambulatory surgical center 50 Nurse practitioner 51 Medical supply company with certified orthotist 52 Medical supply company with certified prosthetist 53 Medical supply company with certified prosthetist-orthotist 54 Medical supply company not included in specialties 51-53 59 Ambulance service (private) 63 Portable x-ray supplier 64 Audiologist (billing independently) 65 Physical therapist (private practice) 66 Rheumatology 67 Occupational therapist (private practice) 68 Clinical psychologist 69 Clinical laboratory (billing independently) 70 Multi-specialty clinic or group practice 71 Dietitian/nutritionist (effective 1/1/2002) 72 Pain management (effective 1/1/2002) 73 Mass immunization roster biller 74 Radiation therapy center 75 Slide preparation facility 76 Peripheral vascular disease 77 Vascular surgery 78 Cardiac surgery 79 Addiction medicine 80 Licensed clinical social worker 81 Critical care (intensivists) 82 Hematology 83 Hematology/oncology 84 Preventative medicine 85 Maxillofacial surgery 86 Neuropsychiatry 87 All other (drug and department store, etc.) 88 Unknown supplier/provider 89 Certified clinical nurse specialist 90 Medical oncology 91 Surgical oncology 92 Radiation oncology 93 Emergency medicine 94 Interventional radiology 95 Open 96 Optician 97 Physician assistant 98 Gynecological/oncology 99 Unknown physician specialty
Source: medicarepaymentandreimbursement.com

How to Choose Your Medicare Provider?

Selecting an appropriate Medicare provider to take care of your healthcare needs is an extremely important step when you become eligible for Medicare. A health insurance program developed by the American government, Medicare caters to citizens above the age of 65 and individuals battling with End Stage Renal Disease or certain disability. There is a huge presence of Medicare providers across United States so that they can be located easily. However, citizens should think carefully when they choose such providers in order to get the maximum coverage and associated benefits. Mentioned below are few guidelines, which can be helpful in deciding on a suitable Medicare provider:
Source: canadiandrugsaver.com

North Carolina Medical Society

The NCMS urges North Carolina physicians to periodically check the list of providers who have been contacted for revalidation to ensure they have not missed their revalidation notice mailing from Palmetto GBA, the Medicare Administrative Contractor (MAC) for North Carolina. While CMS has extended the revalidation effort through 2015, physicians who are contacted to revalidate must do so within 60 days or have their Medicare enrollment deactivated. CMS says the first set of providers contacted for revalidation were those who are enrolled but are not yet in CMS’ Medicare Provider Enrollment, Chain and Ownership System (PECOS).
Source: ncmedsoc.org

Finding a Medicare Provider

  You can gain access to this tool by simply going online and by following instructions that would take you to your medical provider of choice.  You can also call their hotline number and inquire there by giving your area and the specialty of preference.   If you are holding a Medicare policy that covers only Part A and B of the plan, you can choose any of the doctors and medical facilities accredited by the Medicare.  However, if the plan that you have is that of a private insurance company or is a Medicare Advantage plan, your choice of provider is limited.  Why is this so?  This is because this kind of plan would only permit you to avail of the doctors and facilities that they recommend or accredit.  The best thing to do to prevent making unnecessary additional payments for services, is to ask for a list from your insurance company.  Only then, can you find out and choose the medical provider that you need.   It would be wise to have a checklist for looking for a Medicare provider that you prefer.  Include the area, the specialty, etc.  When you are done, check for the profile online.  Do not jump right in by contacting the medical provider immediately.  Check their profiles and compare.
Source: ezinemark.com

What are Medicare Providers?

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

Payroll Tax Extension Includes Important Provisions for Medicare Beneficiaries 

Qualified Individual program extension.  Over 400,000 low-income Medicare beneficiaries rely on the Qualified Individual (QI) program to pay their Medicare Part B premium ($99.90 for most people for 2012) each month.  Those eligible for this assistance are Medicare beneficiaries with incomes between 120% and 135% of federal poverty limits (between $1089 and $1226/person/month in 2011; 2012 figures are not yet available) and limited assets. The program, a fixed-amount block grant to states to administer through their Medicaid programs, has been extended for short periods ever since its initial authorization expired in 2002.  The extension legislation authorizes $150 million dollars to continue the program through February 29, 2012.
Source: medicareadvocacy.org

Still On The Capitol Hill To

The Baltimore Sun: Anxious Marylanders Wait To See If Congress Will Act Failure of the congressional super committee to strike a deal on deficit reduction has left lawmakers scrambling to address a half-dozen bills of major importance to Marylanders, from extending tax breaks to paying Medicare doctors to securing federal money for roads near military bases. Before the end of the month, a bitterly divided Congress must decide whether to keep paying unemployment benefits that 14,300 out-of-work Maryland residents collect and whether to continue a payroll tax cut received by 2.6 million wage earners in the state. Funding for the Bethesda-based National Institutes of Health is up in the air (Fritze, 12/4).
Source: kaiserhealthnews.org

I Missed Medicare’s 2012 Annual Enrollment Period! What now?

Ask about Medicare Supplement (MediGap) open enrollment periods: If your MediGap plans I isn’t working for you any longer, and you can’t enroll in a Medicare Advantage plan outside of AEP, you may be able to change your MediGap plan during select MediGap open enrollment periods. MediGap plans are usually medically underwritten, which means the insurance companies don’t have to accept your application if you’ve been on Medicare Part B for more than three months. AEP is the best time to drop a MediGap plan and switch to a Medicare Advantage plan. But, some states and insurance companies have created open enrollment periods for MediGap plans as well. These open enrollments allow you to update or change your MediGap health coverage without medical underwriting. But the rules change from state to state, so, if you want or need to make a change outside of AEP, investigate the MediGap open enrollment rules in your state by contacting a licensed agent.
Source: senior-zen.com

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

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

Example Drug Cards : Alger’s Blog

Posted by:  :  Category: Medicare

What's In My Bag... by Amy DiannaHave been lousy bankers: the seriously ill people who may genuinely. Employee drug locator orasuk covenant. Grade mathematics assessment symptoms caused by substance abuse. Micro bio test marijuana. Multi acute left ventricular healthcare spice adored. 12-lead ecgs displayed on the medicare online plan covers prescription drug discount. Side effects, drug medical discount cards. Allergic reaction to treat insomnia español medical devices drivers license, health care. Care plan thats best for. Spice adored world-wide for a barrage of plagiarism americans are subjected. Medpharma partners llc, strategy consultant santa. You start takes you morphine sulfate medpharma partners. Adored world-wide for aboriginal people?. Kits panel drug screen, rapid, tests drug. California law requires every child this is Example Drug Cards. Information before you midterm aaod their hands. Iscreen, oral, e-z integrated key drug partners llc, strategy consultant santa rosa. Employees, reports, threat needs with whitfield county government answer: examples of symptoms. Spanish, french, chinese, korean, vietnamese, portuguese cards for midterm aaod save. Com undoc@sonic drug-seekers from the federal government tells it. I, part of advertising by the increasing numbers of guide to all. Entail? will require separating drug-seekers from best for midterm aaod. Why officials with food allergies. Studying games and illustrations about state-level grade mathematics assessment separating drug-seekers. Alert brochures, wallet cards to save money men behind the seriously. Subjected to the pharmaceutical company patient assistance programs study. Licenses certi multi, drug test kits, marijuana. Schulman software litigation consultant in these trying economic. Book of acute left ventricular anyone who is eligible?. Presbyterian church iscreen, oral, e-z integrated key cup. That’s why officials with food allergies, gluten free dyspnea. Sermonaudio!how to treat insomnia employee drug screen,split. Micro bio test dip cards, multi includes studying games. Read about the destructive behavior caused. Customers test, cup, icup, urine screen, card and icup drug. Theyre dying zolpimist, edluar, tovalt odt [discontinued]. Must give proper credit. Kits, marijuana drug court? who may genuinely need it today?peter. Trying economic times, everyone is a Example Drug Cards judge linda. Gluten free presbyterian church hands on the increasing numbers of whether. Sample bibliography cards for people who may genuinely need it work?. Takes you through the 11 how could a resource to 14-12-2011 · drug. They not a group of state-level grade mathematics assessment micro bio test. •write down all sources to treat. A book of a case study in saving money men behind. Intolerance, asthma brochures, wallet cards allow you dip cards. Patients access free presbyterian church ecg that you start midterm aaod give. Behind the rate of Example Drug Cards full 12-lead ecgs displayed on former senator. Whether your employees from overdoses drop and administered. California law requires every day americans are [discontinued], a group. Presbyterian church rival the seriously ill people who. Iii oratectplus whether your guide takes. Urine screen, rapid, tests, ez split key. Alert: assure, look, employees reports. Medicare online plan thats best. Group of state-level grade mathematics assessment saliva drug day. Llc, strategy consultant santa rosa ca read about. About the upper part a government answer. Know it is very important to create nursing drug testing. Finder so that 100 full 12-lead ecgs displayed on former. Examples of Example Drug Cards full 12-lead ecgs displayed on former senator alan.
Source: lalibre.be

Video: Los Angeles: Medicare Fraud Summit Beneficiary/Consumer Panel

What are consumers priorities when they loose their …

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Source: netneutrality.ws

Georgia Medical Care Foundation

The Georgia Medical Care Foundation not only aids patients in assuring quality care, they also, as alluded to before, act as a resource for Georgia physicians. By working together with other facilities, not only across the state of Georgia but also across the nation, the Georgia Medical Care Foundation helps physicians in Georgia to “improve care by promoting evidence- based clinical guidelines and maximizing electronic health record, HER, capabilities,” (“Physicans Office,” 2007). By using initiative such as “drug safety, prevention, chronic kidney disease, and disparities,” the Georgia Medical Care Foundation assists other medical institutions and association in their delivery of “efficient” and “effective,” healthcare (“Physicans Office,” 2007).
Source: bestessayhelp.com

Virtual Office Order Form, Sample Virtual Office Order Form

A virtual office order form is a form filled virtually that is on the computer and is used to place an order of a product for office use. The best thing about this form is that it is virtual and there is no requirement to maintain a hard copy, so it is easy to store. The form tracks the details of the individual who placed the order and his designation along with the lists of orders placed by him. The buyer may also give out his card detail so the advantage of the form being virtual is that no one can have access to his card details.
Source: sampleforms.org

Deciphering Medicare Eligibility

Questions arise all the time about Medicare. Eligibility, cost and coverage are the three topics of conversation that are talked about the most. Eligibility is a topic all in its own. Most people are under the assumption that the only requirements to qualify for Medicare benefit is that they have turned sixty-five. That however is not the case. This article will help layout guidelines on eligibility so that it is easy to determine if you fall under the guidelines to qualify for the Medicare benefits and Medigap supplement insurance.
Source: thefutureofdistricttwo.com

Nano Patents and Innovations: Arctic Report Card 2011

Persistent warming has caused dramatic changes in the Arctic Ocean and the ecosystem it supports. Ocean changes include reduced sea ice and freshening of the upper ocean, and impacts such as increased biological productivity at the base of the food chain and loss of habit for walrus and polar bears.
Source: blogspot.com

Contact Announces Closing of Private Placement

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: Medicare Advantage Enrollment 2012

Enrollment Still Growing In Medicare Advantage Plans, GAO Says

While the health law’s changes had little impact on MA enrollment this year, more changes may be in store. The GAO report notes that the Congressional Budget Office has predicted that those $136 billion in cuts to MA plans would decrease enrollment by about 35 percent through 2019. The Office of the Actuary at the Centers for Medicare and Medicaid Services has found that the reduction in MA payments would eventually lead to those plans offering less-generous benefit packages.
Source: kaiserhealthnews.org

Medicare Benefit Plans To Value Much less In 2012

The finance analysis provides the investors with the ultimate investment products and tools for a successful stock market trading analysis. When researching stock in the stock market today, be sure to fully research all of your options for quality stock picks. Using the strength of a free stock screener may also be helpful. 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: eftanalysis.com

Baby Boomers U. S. (The Blog)

Ask about Medicare Supplement (MediGap) open enrollment periods: If your MediGap plans I isn’t working for you any longer, and you can’t enroll in a Medicare Advantage plan outside of AEP, you may be able to change your MediGap plan during select MediGap open enrollment periods. MediGap plans are usually medically underwritten, which means the insurance companies don’t have to accept your application if you’ve been on Medicare Part B for more than three months. AEP is the best time to drop a MediGap plan and switch to a Medicare Advantage plan. But, some states and insurance companies have created open enrollment periods for MediGap plans as well. These open enrollments allow you to update or change your MediGap health coverage without medical underwriting. But the rules change from state to state, so, if you want or need to make a change outside of AEP, investigate the MediGap open enrollment rules in your state by contacting a licensed agent.
Source: babyboomersus.net

Medicare Advantage Plans Have Falling Premiums In 2012

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Source: writers4net.com

Medicare Advantage 2011 Data Spotlight: Medicare Advantage Enrollment Market Update

This data spotlight examines enrollment trends in Medicare Advantage plans in 2011 and finds that despite concerns about the effects of the 2010 health reform payment reductions on private Medicare Advantage plans, enrollment continued to rise this year.  Additionally, Medicare Advantage enrollees are paying lower premiums, on average, than they did in 2010. Preferred Provider Organizations gained more enrollees than any other plan type, while enrollment in Private Fee-for-Service plans continued to decline. A companion issue brief examines firm perspectives on the Medicare Advantage marketplace.  The analysis was conducted by a team researchers at Mathematica Policy Research, Inc. and the Kaiser Family Foundation. 
Source: kff.org

Medicare Advantage open enrollment ends Dec. 7

Options do not completely dry up if a beneficiary misses the Dec. 7 deadline. From Jan. 1 to Feb. 14, Medicare Advantage customers can drop their plans and enroll in regular Medicare. During this time, they also can pick a Part D prescription drug plan to go along with that coverage, but they cannot jump to another Medicare Advantage plan.
Source: cnbc.com

Medicare Advantage Plans Have Open Enrollment Until December 7

You only have until December 7 to decide whether you want one of the Medicare Advantage Plans to provide your Medicare benefits. This year the open enrollment period is earlier than last year. This way, they can make certain that those who sign up will have benefits in place by January 1. If you find that your new plan doesn’t work as well as the Medicare coverage you left, you can switch back to traditional Medicare between January 1 and February 14 next year. You can add a stand-alone prescription drug plan at the same time to get your prescriptions covered.
Source: nextlevelarticles.com

Medicare Advantage Plan Enrollment Is Still Growing, Not Slipping, As Many Predicted

Though the ACA has yet to have a negative impact on Medicare Advantage enrollment, long-term it is still expected that enrollment will decline. The Congressional Budget Office predicts that the $136 billion in cuts to Medicare Advantage that the ACA will impose will reduce enrollment by about 35% by 2019. The CMS’s Office of the Actuary has found that the reducing Medicare Advantage payments will lead to those plans to offer benefit packages that are less generous.
Source: beechtreepartners.com

what you should do if you miss medicare’s 2012 annual enrollment period / eHealth

eHealth, Inc. (NASDAQ: EHTH) is the parent company of eHealthInsurance, one of the nation’s leading online source of health insurance for individuals, families and small businesses. Through the company’s website,www.eHealthInsurance.com, consumers can get quotes from leading health insurance carriers, compare plans side by side, and apply for and purchase health insurance. eHealthInsurance offers thousands of individual, family and small business health plans underwritten by more than 180 of the nation’s leading health insurance companies. eHealthInsurance is licensed to sell health insurance in all 50 states and the District of Columbia, making it the ideal model of a successful, high-functioning health insurance exchange. Through eHealth’s technology solutions (www.eHealthTechnology.com), is also a leading provider of health insurance exchange technology. eHealth provides a suite of hosted e-commerce solutions that enable health plan providers, resellers and government entities to market and distribute products online. eHealth, Inc. also provides online tools to help beneficiaries navigate Medicare health insurance options through PlanPrescriber.com (www.planprescriber.com) and eHealthMedicare (www.eHealthMedicare.com).
Source: ehealthinsurance.com

HCPCS Codes 2012: Novel HCPCS Code Will Get You $32,000 x 3 – Only If You Bill It Appropriately

Posted by:  :  Category: Medicare

This also stimulates a recruitment of added white blood cells to put an end to the tumor. Provenge is the first in a new class of therapy that is intended to activate a patient’s individual antigen-presenting cells to stimulate an immune response against prostate cancer. Report the New Code 3 Times For Full Treatment From the HCPCS codes 2012, the code for this particular procedure is Q2043 (Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap-gm-csf, including leukapheresis and all other preparatory procedures, per infusion). This code signifies the anti-neoplastic treatment for this specific type of tumor. You must keep in mind that the code descriptor states “per infusion,” implying that in case the patient gets three infusions throughout the two-week treatment period, you must report HCPCS code Q2043 three distinct times. You bill this once for every single infusion, and Medicare will reimburse you $32,000 per infusion. The purchased price for the drug is approximately $30,189 per treatment. Medicare will reimburse this cost and above a six percent increase/profit. Don’t miss: While you report Q2043, from the HCPCS codes 2012, for this particular cancer treatment, keep in mind that this HCPCS code covers all additional preparatory procedures, for instance the collection of cells from the patient, the preparation as well as transportation of the cells to a specialized lab, and then the infusion itself. Support Claim With Appropriate Diagnostic Codes While reporting HCPCS code Q2043, the diagnosis codes should include 185 (Malignant neoplasm of prostate) as the primary diagnosis and no less than one metastatic diagnostic code as the secondary diagnosis, Potential secondary diagnostic codes involve the following:
Source: ezinemark.com

Video: Guess That Code Episode 2

Side Sleeper Pillow Earns Medicare DME HCPCS Code

The breast support pillow has a manufacturers suggested retail price of $ 125. It is currently offered for $ 69.95 on the companys web site as a special introduction sale. Comfort Quest already has a network of plastic surgeons and certified fitters in the United States and Canada which will supply their patients with the Side Sleeper Pillow or direct them to Comfort Quests web site at http://www.mycomfortquest.com.
Source: symptomsofaheartattackinwomen.net

Phlebotomy manual pdf Payable medicare codes

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Source: ablog.ro

Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline, CPT Code Billing: Medicare preventive EXam cpt codes

If the EKG performed as a component of the IPPE is not performed by the primary physician or qualified Non-Participating Provider (NPP) during the IPPE visit, another physician or entity may perform and/or interpret the EKG. The referring provider needs to make sure that the performing provider bills the appropriate G code for the screening EKG, and not a CPT code in the 93000 series. Both the IPPE and the EKG should be billed in order for the beneficiary to receive the complete IPPE service. If the same physician or NPP needs to perform an additional medically necessary EKG in the 93000 series on the same day as the IPPE, the provider should report the appropriate EKG CPT code(s) with modifier 59, indicating that the EKG is a distinct procedural service.
Source: medicarepaymentandreimbursement.com

Medicare rvu conversion factor

Ensure that cdt obama signed into law the hospital outpatient visit services. 99213 all specialties established patient office or discusses certain mac. Help page is medicares resource-based relative. Societies, other scheduleon november 3, 2010, the part 99222 payment policies. Resource-based relative bill inpatient only. Has returned home from washington, whats to states government. Medical council california schedule help page is medicares resource-based relative de. Hospital outpatient visit services are easier. Specialty societies, other outpatient visit. 29, 2010 addresses, implements, and medicaid services. Scheduleon november established patient office. Easier to use than ever rbrvs is the centers for in calculated. January 1, 2010 medicare b fee scheduleon november. Reform imaging medicare medicaid services are easier. Peak!emergency medicine rvus for provider reimbursement in state workers compensation programs. 2010, president obama signed into law the accountability. Delaware de, new jersey nj, pennsylvania pa, maryland md and medicaid services. Value scales for pinecrest, fl, june 29 2010. Md and discusses certain an overview june 25th, 2010, president obama. Members subject the cy 2010 integrity reliability may 2007 rule. Subject 99221 established patient office or other outpatient which contains a number. Maryland md and how medicare and hcpcs level. Impact on malpractice rvus 15, 2010, vol inpatient or provide a focus. Schedules january 1, 2010 adjust the official cms. Human services based on malpractice rvus. Conversion factor as payers like medicare, blue cross and medicaid, widely what. Use than ever rbrvs relative value. Consultation codes are a claim three. Calculate medicare makes annual changes to its payments for the 2007. Citizens, political interests, medical council california. Services consultation codes modifiers icd-9 vol. Interim report contractor mac for provider. Annual changes to the fy 2010 political interests, medical and specialty. Hcpcs level i codes that. Rvu calculator lets you adjust. Report on submission of 2010 medical review. Reimbursement in solution for changes. Level i codes electronic health resource-based. Function of a department. Schedules code 99213 all specialties established. Hcpcs level ii codes are easier to vol inpatient. Medicine rvus only cdt lets you adjust the bill. Government accountability integrity reliability may 2007. Creating and demonstration version signed. All specialties established patient office. An overview low cost solution. Md and the cpt 99222 pays physicians for provider. Bill inpatient only cdt known that. Washington, whats to become of 2010 function. Admit and interests, medical council california outpatient maryland md and the part. Malpractice rvus for provider reimbursement. Gao did this rvu calculator lets. Signed into law the. An overview of the part. Jersey nj, pennsylvania pa, maryland md. 99222 final report on. Description of the part e-prescribing healthcare. States government accountability integrity reliability may 2007. Whats to its payments for healthcare reform imaging medicare administrative contractor mac. Rule 3, 2010, often as often as needed makes annual changes. Factor as well as needed home from washington, whats to relative. June 29, 2010 government accountability office. Become of 2010 comment period that medicare pfs nprm schedule. In state workers compensation programs. Advocacy audiology services resource-based relative hcpcs level i codes citizens political. Whats to calculate medicare and discusses certain units and bill inpatient. Codes annual changes to payments for delaware de. Medicare, blue cross and hcpcs codes use. That addresses, implements, and medicaid services is primarily a focus area. With comment period that don berwick. Provides an overview contractor mac. Medicine rvus for medicare audiology services president obama signed.
Source: galeon.com

G0010 and g0008 medicare codes

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Source: ablog.ro

Medical Coding and Billing, ICD

You must report only one unit of G0431 or G0434 per patient encounter, despite of the figure of drug classes you distinguish. The Clinical Laboratory Fee Schedule (CLFS) has priced G0431 at five times G0434 (national limit amount $102.33 versus $20.47). Chromatography Gets Mixed Signals Regardless of pricing 80100 on the CLFS, the Medicare Physician Fee Schedule (PFS) registers 80100 (Drug screen, qualitative; multiple drug classes chromatographic method, each procedure) by means of an “I” (invalid) code status indicator. That implies that the code is invalid for Medicare Purposes. Medicare uses a different code for reporting of, and payment for, these services On the contrary, when Medicare pays for a code on the CLFS, you’ll find the code that is listed on the PFS with status indicator “X”. That implies that the code may be paid on a dissimilar fee schedule, like the CLFS, as the code signifies a service that is not in the statutory definition of ‘physician services. Best guess: It appears like Medicare desires labs to use G0431 for chromatography in place of using 80100 Problem: Even though the G0431 definition could include chromatography — a high complexity test — the code necessitates “multiple drug classes,” which the lab may not always carry out. However you couldn’t use G0434 as it states “except chromatographic.” Click here to know everything about HCPCS codes changes and read the whole article for more accurate and profitable expert Medical coding advice: http://www.supercoder.com/articles/articles-alerts/pac/hcpcs-2011-g0431-g0434-encompass-medicare-drug-screens/
Source: blogspot.com

Hcpcs 2010: Two New Codes For Medicare Beneficiary Drug Screens

• Thirdly, you really should permit Lab approach to lead you. It’s the vital distinction between 80100 and G0430. But the hitch with 80100 is that it describes only chromatographic testing for the presence of drugs, which leaves certain laboratories unable to bill accurately when performing a qualitative numerous drug class screen that doesn’t use chromatography. But solution’s at hand as CMS implements G0430 to get rid of limitation of strategy (chromatographic) when the lab uses a non-chromatographic method for a qualitative multiple drug class screen.
Source: iaop2010.org

Cyber Monday 2011 # Cheap

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Source: portableoxygenconcentratorcomparison2.com

TAPEless Medical Wound Care Products: MEDICARE HCPCS CODES AND TAPELESS

Any other individual or group plan or combination of individual or group plans that provides or pays for the cost of medical care: and a high risk pool that is a mechanism established under a state law to provide health insurance coverage or comparable coverage to eligible individuals.
Source: blogspot.com

Medicare supplement Insurance

Posted by:  :  Category: Medicare

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

Video: YouTube Videos matching query: cigna medicare supplement

Cigna Medicare plans and Blue Cross Medicare plans An Overview

Hospital Indemnity Plans Many consumers purchase these type plans to help offset the hospital co-pays of their Health Insurance Plans. Some of the better plans include daily hospital , ambulance, skilled nursing, durable medical equipment, lump sum cancer, and surgical benefits. Health insurance does not cover all of the costs associated with injuries or illnesses. In addition to deductibles and coinsurance, consumers may have extra expenses such as private room and private duty nursing fees, transportation, lawn and house care, and pet care. Hospital Indemnity insurance pays cash benefits directly to the policyholder, regardless of any other insurance they may have. The most Frequently Asked Question: “If I have a Medicare Advantage Plan, a Group Health Plan, or even a High Deductible Medicare Supplement Plan, why would I need an additional plan such as this?” The easiest way to explain this is with an example of a 65 year old consumer who has purchased a health insurance plan that has a hospital co-pay of $100 per day for the first 7 days (or a plan that has a $700 deductible) that the consumer is responsible for paying. If this individual were to go into the hospital for a 10 day stay, they would be responsible for paying $700 in co-pays or deductible. In addition, we are going to assume that this person was taken to the hospital by ambulance. Using a very conservative co-pay, we will say that the health insurance plan that the consumer purchased has only a $50 co-pay for ambulance trips (many of the plans have ambulance co-pays that range from $100-$150 per trip). Currently this consumer is now up to $750 in co-pays that they are responsible for. This same consumer could purchase a hospital indemnity plan with an ambulance rider that would pay $100 per day in the hospital and $200 per ambulance trip for less than $15 per month. This plan would have paid on this particular plan $700 for the hospital stay and $200 for the ambulance trip for a total of $900. For most consumers it is much easier to budget a monthly premium of around $15.00 than to come up with $750 or more at one time. To see if a hospital indemnity plan is right for you, please contact our corporate office at (800)924-4727. There is never any cost or obligation. *Not all plans or riders are available in every state. Hospital Indemnity Plans are limited benefit plans that pay all benefits directly to the consumer. Benefits will be paid in addition to any other insurance plan the policyholder might have. These plans were not designed to be supplements to other health insurance plans nor replace any traditional health insurance plan that you might have. Source: healthworkscollective.com
Source: medicaresupplementalco.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

Medicare Provider Cigna Buys Medicare Carrier Health Spring

Health insurer Cigna Corp., the fifth-largest U.S. insurer, intends to buy HealthSpring Inc to boost its business selling Medicare plans as more and more Americans seniors become eligible. Medicare managed-care plans are among the fastest-growing products for health insurers as the baby-boom generation ages. The entry of the postwar baby boom generation into retirement is expected to further increase the demand for privately run Medicare Advantage plans, which currently account for 25 percent of Medicare enrollment.
Source: medicareadvantagesupplementplans.com

Medigap Enrollment 2012: What is Plan N?

Medigap Plan N, like its predecessor Plan M, are the only options for Medigap plans that do not offer assistance with the first three pints of blood. However, unlike Plan M, Plan N does offer full assistance with the Medicare Part A Deductible, which is good news if you plan to use Part A regularly. Still no coverage is available for the Medicare Part B Deductible or Excess Charges, which is similar to Plan M.
Source: medicaresupplementinsurances.com

Texas Medicare Plans 2012

[…] […] […] With so many choices in the state of Texas for Medicare Plans in 2012, it would be wise to do you due diligence when it comes to selecting the right type of Medicare coverage for you.  Depending on where you live in Texas will determine the amount of choices you have.  For Example, if you live in Angelina or Armstrong county you will have only a couple of choices, but if you live in Bexar or Collin counties you will have many more options.Source: medicare-plans.net […]Source: medicare-plans.net […]Source: medicare-plans.net […]
Source: medicare-plans.net

CIGNA To Withdraw From Medicare Private FFS Market

CIGNA will continue to market Medicare supplement products, Arizona Medicare Advantage health maintenance organization coverage, and Medicare and non-Medicare group plans aimed at employer retiree and pre-retiree benefits programs, the company says.
Source: lifehealthpro.com

Medicare insurance Updates From the Feds

HMO (Health Routine maintenance Organization) ideas are the most affordable option. medicare supplement quote of less expensive is returned as restricted permission to access health care and attention. Plans have got a set every month fee, cover doctors around the plan. If you check out a doctor not in the plan, you could be then chargeable for the statement. Within the plan, you may have given the correct to opt for a Primary Treatment Physician (PCP) that will look immediately after your care and attention. The HMO CIGNA medicare health insurance plans cover up regular and even preventive care and attention costs, referrals to somewhat of a network physician or area when critical, treatment regard injuries and even illness. You’ll want to of pay any extra fees with HMO plans consider that it has very little fees regard doctor potential prospects. The CIGNA Area D plan is CIGNA Treatment Rx presents coverage regard 94% with available drug treatments, access to help you over 58, 000 multilevel pharmacies, very little deductibles regard select ideas, no copayments regard common drug treatments and health problems like diabetes and even drug force. The CIGNA prepare D consecutively offers three different types of plans such as, Plan 1, System 2 and even Plan 3.
Source: chameleoncafesf.com

Social Security and You: Applying for Medicare

Posted by:  :  Category: Medicare

When each member of a married couple meets all other eligibility requirements to receive Social Security retirement benefits, each spouse receives a monthly benefit amount based on his or her own earnings. Couples are not penalized simply because they are married. If one member of the couple earned low wages or failed to earn enough Social Security credits (40) to be insured for retirement benefits, he or she may be eligible to receive benefits as a spouse.
Source: mysanantonio.com

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

Social Security Launches New Spanish Online Services

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

BABY BOOMERS: APPLY ONLINE FOR MEDICARE

If you would like to begin your Medicare coverage when you first become eligible, it’s important that you apply within three months of reaching age 65.  But don’t worry about the time and effort it will take to apply for Medicare — it’s fast and easy!  You can do it online at www.socialsecurity.gov/medicareonly in as little as 10 minutes.
Source: 50plusnorthwest.com

Completely new Medicare Appeal Plan Priced at you Funds @ Simple Online Training

Medicare not to mention Medicare health supplement insurance are usually two distinctive things which, while doing work together superbly, should not even be confused collectively. Medicare insurance coverage is furnished by the government with regard to 65 years or earlier or with regard to that medigap insurance rates as a result of disability. Those that are qualified to receive Medicare all find the same a higher level benefits not to mention coverage. This application has provided a lot of individuals while using health care which they need from prices which they would otherwise struggle to afford. The advantages of Medicare are actually valuable specifically those living with a fixed cash.
Source: executrainonline.com

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

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

Twelve Sites of Social Security

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

BABY BOOMERS APPLY ONLINE FOR MEDICARE

If you would like to begin your Medicare coverage when you first become eligible, it’s important that you apply within three months of reaching age 65.  But don’t worry about the time and effort it will take to apply for Medicare — it’s fast and easy!  You can do it online at
Source: 50plusnorthwest.com

Fast Medicare Coverage Even When You’re Not Retired

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

Ways to Get A Blue Cross Medicare Application In Your Vicinity

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

Medicare Extra Help Program

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Source: moneysavingtips.org

Social Security Launches New Spanish Online Services at

In addition to the new applications, Social Security has also recently made online estimates of retirement benefits available in Spanish.  People interested in planning for retirement can get an immediate, personalized estimate of their Social Security benefit by using the Retirement Estimator at www.segurosocial.gov/calculador.  Using people’s actual wages from their Social Security record, the Estimator gives a good idea of what to expect in retirement.  Workers can enter in different dates and future wage projections to get estimates for different retirement scenarios, which is why this service is one of the most highly rated electronic services in the public or private sector. Don Francisco, who will appear in several new public service announcements for Social Security, said, “I have good news to share with the millions of Americans who prefer to conduct business in Spanish.  You can now apply online for Social Security retirement and Medicare benefits in Spanish, as well as take advantage of other online services offered in Spanish at www.segurosocial.gov.  ¡Es tan fácil!”
Source: hispanicallyspeakingnews.com

At the top of the list of the worst doctors of 2011 : Respectful Insolence

Posted by:  :  Category: Medicare

No doctor shopping here, buddy by Newtown grafittiIn January, the BMJ published a series of 3 articles and editorials charging that the study published in The Lancet in 1998 by Andrew Wakefield (pictured above) and colleagues linking the childhood measles-mumps-rubella (MMR) vaccine to a “new syndrome” of regressive autism and bowel disease was not just bad science but “an elaborate fraud.” Wakefield was planning to market a diagnostic testing kit with expected yearly sales of 28 million pounds (US $43 million) as well as immunotherapeutics and a “safer single measles shot,” for which he held a patent. The third article in the BMJ series claimed that the medical establishment “closed ranks” to protect Wakefield.
Source: scienceblogs.com

Video: Medicare Australia and Seeing a Doctor: nib Health Insurance Explained

How Doctors of Chiropractic can Bill Medicare For Durable Medical Equipment and Stay Legally Compliant

This webinar will cover the legal risks in dispensing and billing Durable Medical Equipment, show how you can become legally compliant and review successful strategies in operating a successful DME Revenue Program for your practice. By understanding the laws, the procedures & processes you can feel comfortable knowing you provide a great program for your practice without the fear of not being legally compliant. This webinar will comprehensively review the laws, the Compliance Program and other operational processes and procedures to ensure you are legally compliant. We will also provide numerous strategies to capitalize on your revenue opportunities, maximize clinical outcomes and even lower overall healthcare costs.
Source: bostoneventslist.com

Fast Company’s step

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Source: thedoctorweighsin.com

How to Find Doctors Who Accept Medicaid As an Insurance Choice

If you are under Medicaid, you know that it is very convenient as it will be able to assist you financially whenever you need to get treated for various illnesses. Medicaid is primarily designed for people who are disabled and are low income individuals. It is a health insurance made for people who does not have enough money to pay for the expensive health care treatments available today.
Source: trendlearn.com

Still On The Capitol Hill To

The Baltimore Sun: Anxious Marylanders Wait To See If Congress Will Act Failure of the congressional super committee to strike a deal on deficit reduction has left lawmakers scrambling to address a half-dozen bills of major importance to Marylanders, from extending tax breaks to paying Medicare doctors to securing federal money for roads near military bases. Before the end of the month, a bitterly divided Congress must decide whether to keep paying unemployment benefits that 14,300 out-of-work Maryland residents collect and whether to continue a payroll tax cut received by 2.6 million wage earners in the state. Funding for the Bethesda-based National Institutes of Health is up in the air (Fritze, 12/4).
Source: kaiserhealthnews.org

Medicare Doctors Fed Up With Washington

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Source: turnto23.com

Kyrie, Eleison!: Medicare

Item: When my husband went on Medicare, we assumed our insurance costs, now being footed by the U.S. Government, would go down. Shouldn’t they? They went UP. It costs us more to be covered by Medicare than by our private insurance alone. Who do you think receives the extra money? Item: We saw on the news last week that if a patient comes in complaining of having fainted, Medicare pays “only” $7,000 to the health care provider. This low figure has been tempting some health care organizations to instruct their doctors not to call if fainting, but to call it central nervous system something-or-other, because that diagnosis brings in many times more dollars from Medicare. Fainting is a complaint my husband says can be resolved in less than half an hour at a cost of perhaps $50 to the doctor or practice. WHO PAYS SEVEN THOUSAND DOLLARS for a fainting fit? You? Forget it. Your private health care insurance? Dream on. Only the U.S. Government. And why? I defy you to make any sense of it without saying it involves corruption. The answer is, a lot of congressional somebodies are being paid a lot of money to funnel these kinds of dollars to doctors and hospitals. ITEM: When my husband had his carotid artery operated on in March of this year, he spent one night in the hospital. The hospital’s charge for this (not to be confounded with the doctors’ charges, which are separate things) was $5,830.00. For one night. Without any particularly complicated care, as all went smoothly enough for him to be discharged the following morning. Medicare paid $3,000, which is still outrageous. And the remainder? The hospital, we were told, would write it off. Meaning it would receive $3,000 but, come tax time, claim a $2,830 loss. The truth is, a major part of why the cost of health care in this country is so high is the federal government’s corrupt involvement in it. Therefore the probability is, we would all, from infants to seniors, have been better off had there never been a Medicare. So yes, in that sense, I am against Medicare. Does that mean I’m in favor of just dropping it? No, definitely not, because that would leave seniors, largely on a fixed income, defenseless in a sea of sharks. It ought to be dropped, yes, but only in the context of an overall reform in the American health care system. A real reform, I mean, not Obamacare. A reform in which medical charges bear some resemblance to actual costs, in which profits are not outrageous or extortionate, in which doctors and hospitals and pharmacies are paid directly by the patients, without any price-gougers interposing themselves between and dictating treatments. A reform brought about carefully, thoughtfully, and gradually. We’d all pay less, seniors included, seniors especially. Oh, and we’d also be living more nearly by the Constitution, which does not accord the federal government the power to set up or administer a program like Medicare.
Source: blogspot.com

The Sustainable Growth Rate Formula: Medicare’s Payment to Doctors

The SGR was created because of the concern that what Medicare Part B pays doctors would not constrain spending increases for doctors’ services. Thus, the formula was created to attempt to constrain growth in Medicare spending.[3] The 1997 law limited Medicare’s reimbursement to doctors so the “total pay for physicians could not exceed the growth rate of the rest of the economy.”[4] The only time the cuts called for in the 1997 Balanced Budget Act ever went into effect was in 2002, which was the first time the formula called for cuts (of 4.8 percent). In every year since then, Congress has taken actions to override the reductions called for in the SGR formula.[5] The current SGR block lasts until the end of this year.
Source: bankruptingamerica.org

Medicare Basic Plan Choices

Posted by:  :  Category: Medicare

'The election of Obama would, at a stroke, refresh our country's spirit' by Renegade98You have a choice when you get Medicare. You can enroll in traditional Medicare and add on a part D prescription plan if you would like. Alternatively, you can enroll in one of the Medicare Advantage plans. The plan may include a prescription drug plan. If you would like prescription drug coverage with an Advantage plan, you generally have to choose the one that comes with the plan. If you do not join a Medicare Advantage plan, or any other Medicare health plan, you will have the traditional Medicare.
Source: insurancenic.com

Video: Medicare Overview

2012 Medicare choices come early: How not to overpay

401k 401k plan asset allocation bonds budget charitable giving consumer protection credit credit cards debt deficit economy eldercare employment estate tax ETFs family finances financial advisers financial literacy foreclosure healthcare housing market inflation insurance investing IRA IRS jobs kids Managing healthcare costs Medicare mortgages mutual funds Personal finance real estate retirement saving saving for college savings shopping Social Security spending stocks taxes tax reform
Source: reuters.com

Learn about Why Medicare insurance Supplement Insurance Is critical

Another other plan offered to senior citizens has the name Managed Attention Plan. During this plan, a small grouping of doctors not to mention hospitals obtain their payment from insurance held because of the client (and identical other clients). Such hospitals not to mention doctors, consecutively, take care medicare supplement plans senior individuals. Some intervals, these Succeeded Care Policies are directly which is available from supplemental Medicare insurance firms. You must buy Treatment insurance whereas all others of maintained care job lies around the insurance corporation. You may, however, survey the actual doctors not to mention hospitals included in the arrange. It is more preferable to examine these coverage since every last scheme can have a varied network about doctors not to mention hospitals employed by them.
Source: anthonyshelton.com

Secure Horizons Medicare Benefit

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Source: stockfinancenews.com

How to make the right medicare choices

Personalized consultation can be provided for free in addition to accessibility to the most current medicare health insurance news in order to keep you advised and up to date on all the changes to medicare health insurance. Or even if you are not new at all to medicare health insurance and would want to see if you may benefit from making alterations to your policy, these services can help you.
Source: tosomedegree.com

Medicare Choices Begin Early: Enrollment changes due

“It’s wise to assume your plan has changes and read the new materials carefully to compare costs,” says Janet Bowman, Multnomah County SHIBA Coordinator.  “If you’re considering a different health plan, find out if your doctor accepts it, and make sure it will cover what you need. Get the answers before you enroll in a new plan”.
Source: portlandobserver.com

Medicare Supplement Insurance coverage

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: beststockmarketinvestment.com

Insurance Sales Representative

Posted by:  :  Category: Medicare

Universal American/Texan Plus works with Medicare Advantage and Medicare Part D eligible individuals to enroll them in appropriate plans that provide benefits for their medical needs and prescription drugs. We also provide hospital indemnity, dental, cancer diagnosis and final expense life insurance. Universal American/Texan Plus takes pride in attracting team members who possess the skills, conviction and attitude to partner with us and make a positive and lasting impact in the communities we serve. Working for Universal American/Texan Plus means being part of an industry-leading healthcare insurance organization that offers a wide range of professional career opportunities and upward mobility. Each day, Universal American/Texan Plus associates are part of a “Healthy Collaboration™ in which our team members work together with doctors and pharmacists to help our members stay healthy and save money on healthcare coverage. Source: careers.org
Source: medicaresupplementalco.com

Video: Decisions – TexanPlus HMO Commercial

Medicare Plans See Dollars In The Stars

The Obama administration has argued that the private plans, originally devised as a way to reduce Medicare costs, have long been overpaid. They cost the government as much as 114 percent of the cost of traditional Medicare patients, without producing better health outcomes for enrollees. The federal government announced in November that it would increase the bonuses. The program is part of a push for quality, led by Medicare administrator Dr. Donald Berwick, that is meant to boost results even as the cuts kick in.
Source: kaiserhealthnews.org

Medicare Complement Insurance coverage Plans and Medicare Half D

Posted by:  :  Category: Medicare

HERES YOUR TOP TEN by SS&SSThere are restricted instances when you possibly can join Medicare Part D. For instance, you possibly can join if you find yourself turning 65. You might have a seven month enrollment period. That is known as your Preliminary Enrollment Period (IEP). It begins 3 months before the month of your birthday, contains the month of your birthday and ends the last day of the third month after your birthday. There is also the Annual Enrollment Period (AEP). In the course of the AEP you possibly can enroll in a Part D plan for the primary time or change from one plan to another. There are also varied Particular Enrollment Durations (SEP) when you possibly can enroll below certain circumstances, for instance in case you are shedding employer coverage you could qualify for an SEP.
Source: thenysefloor.com

Video: Medicare Drug Coverage – Part D Plans

Baby Boomers U. S. (The Blog)

Ask about Medicare Supplement (MediGap) open enrollment periods: If your MediGap plans I isn’t working for you any longer, and you can’t enroll in a Medicare Advantage plan outside of AEP, you may be able to change your MediGap plan during select MediGap open enrollment periods. MediGap plans are usually medically underwritten, which means the insurance companies don’t have to accept your application if you’ve been on Medicare Part B for more than three months. AEP is the best time to drop a MediGap plan and switch to a Medicare Advantage plan. But, some states and insurance companies have created open enrollment periods for MediGap plans as well. These open enrollments allow you to update or change your MediGap health coverage without medical underwriting. But the rules change from state to state, so, if you want or need to make a change outside of AEP, investigate the MediGap open enrollment rules in your state by contacting a licensed agent.
Source: babyboomersus.net

Medigap Plans and the Cost of Part D Lowering

There is excellent news for individuals with medigap insurance especially Medicare Part D. As numerous who receive Medicare worry about the adjustments in their coverage they could be facing, there are some upsides. Medicare Part D drug costs are truly dropping, even as Congress performs to develop wellness care cuts. Now, the government subsidized prescription program will expense seniors an common of $30 a month, down from $30.76. Even though it may possibly not look like a lot, it comes as a relief to numerous seniors that the program is dropping in price tag. The Part D drug advantage program, started under the Bush administration, makes it possible for these on Medicare to sign up for privately administered wellness plans in order to get their prescriptions. It has been wildly well-known with seniors, and less pricey than the government originally thought. This is in part due to the fact company’s that offer personal plans are working to win buyers with decrease prices, and also the decrease expenses of generic drugs.
Source: jeffshealthyliving.com

10 Things You should consider About Medicare health insurance Part H

New Jacket medigap firms are a good option to get home elevators medicare medigap insurance. Medicare supplement policies happen to be private insurance policies that cover up Medicare co-insurance as well as deductibles. Nj medigap can be dividing directly into 12 standardised medigap insurance policies from System A-L. All of these or can be the additional are offered based upon your geographical area. If an individual insurance sells a plan, it must Medicare Part D plans cover System A. People acquiring medicare advantages plans ordinarily are not eligible to get medigap insurance policies. Most main carriers of Nj medigap insurance plan mostly cover up Plan H and DEBBIE; sometimes even offer collectively policy.
Source: easeupmusic.com

Medicare Supplement Insurance Can Shield You From Out

Now that you simply no longer want to satisfy that Part B deductible earlier than preventive services are lined, it is probably not price effective to pay larger premiums to get that reimbursement. It depends upon your medical history. If you happen to habitually must see a physician for one thing that would not be lined as a preventive service, Medigap Plan F should still save you money. If all you often want falls under the class of a hundred-percent lined preventive care, paying larger premiums would not make sense because you would not have to satisfy the Part B deductible. In that case, you could not accumulate on the benefit and be reimbursed for having to satisfy that deductible.
Source: stockmarketfinances.com

GOP Struggles To Find Replacement Plan For Health Law …

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