Allsup Medicare Advisor Offers Companies Cost

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OBAMAS DEATH PANEL------ GUESS WHAT FOLKS IT'S ALIVE AND WELL---"CRAZY PALIN" NOT SO CRAZY NOW by SS&SSAllsup has helped hundreds of self-insured employers, state and municipal governments, disability and workers’ compensation insurance carriers, third-party administrators and law firms properly coordinate employee benefits and workers’ compensation plans with Social Security and Medicare. This includes Medicare coordination services to help companies ensure enrollment in Medicare for their non-working disabled plan participants and Medicare Set-Aside services to protect Medicare’s interests in workers’ compensation settlements.
Source: celebrityrehab.org

Video: Medicare Plan Selection Help~Allsup Medicare Advisor

Medicare Beneficiary Looses Medicaid

Me Hello how may I help you? prospect Well I recently lost my coverage from medicaid and have many medications that need to be filled and doctors that I need to see. I’m also on a limited budget and cant afford much. Me, BCBS has a 38.00 hmo and also a zero premium PPO prospect I cant afford either plan. Me, the plan doesnt cost you anything. prospect I still cant afford it. Ok have a nice day
Source: insurance-forums.net

Free Best Ways To Save Guide For Seniors and Boomers

Alexandria, VA (December 19, 2011) With the economy continuing to sputter, most seniors and Baby Boomers don

Federal justice officials accuse hospice provider of Medicare fraud

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Senate Dems Protest Medicare Cuts by TalkMediaNews“We believe that the allegations are without merit or are not violations of the law, and we intend to vigorously defend ourselves against all claims,” Blair Jackson, Golden Living’s vice president of corporate communications, said in an e-mail. “AseraCare operates in full compliance with the law. We believe this case is all about access to appropriate hospice care for Medicare beneficiaries. We are on the side of protecting the rights of our patients to receive the care they need and the hospice benefit they are entitled to. The action of the government in this case is especially troubling because it has the potential to deny Medicare beneficiaries the hospice benefit they are entitled to.”
Source: californiawatch.org

Video: How to Understand Medicare Plans

Just 1 In 7 Hospital Errors On Medicare Patients Reported, Study

To clear up confusion, Medicare officials said they would develop a list of “reportable events” that hospitals and their employees could use. In addition, the Medicare agency said, hospitals should give employees “detailed, unambiguous instructions on the types of events that should be reported.” click here to read more
Source: khq.com

Beaumont, Blue Cross Blue Shield reach new dealROYAL OAK, Mich.

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MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSBeaumont, Blue Cross Blue Shield reach new deal ROYAL OAK, Mich. (AP) – Beaumont Health System and Blue Cross Blue Shield of Michigan have patched up their differences and signed a new contract keeping the Royal Oak-based hospital in the network that serves the state’s largest health insurer. Anthem Blue Cross and Blue Shield and Eastern Connecticut Health Network Renew Hospital Agreements NORTH HAVEN , Conn. and MANCHESTER, Conn. , Dec. 29 . 2011 /PRNewswire/ — Anthem Blue Cross and Blue Shield (Anthem) and Eastern Connecticut Health Network (ECHN) announced today they have reached agreement … Blue Cross and Blue Shield of Minnesota Foundation Names New Executive Director EAGAN, Minn., Jan. 6, 2012 /PRNewswire-USNewswire/ — The Blue Cross and Blue Shield of Minnesota Foundation today announced Carolyn Link as executive director of the Foundation. She previously served as senior…
Source: medicare-news.com

Video: Blue Cross Blue Shield Medicare Supplement-Compare 180 Comp

MEDICARE SUPPLEMENT INSURANCE

When you decide to obtain health coverage to supplement your Medicare, you first want an experienced and well-known company that is considered first in its field, which is Blue Cross and Blue Shield. You also want to know that you have been offered the best premium payment plan for your situation.
Source: medical-insurance-north-carolina.com

Blue Cross Blue Shield Medicare Supplement

While Medicare is a great federal program designed to help seniors pay for the high costs of health care, it was never intended to pay for all costs. This is a fact that surprises many people and causes them to want to find something that gives them more coverage. What you need is to simply add to your Medicare coverage with a supplement plan. This way, you will be less responsible for your overall health care costs.
Source: trendlearn.com

General Casualty Insurance Chiropractic Benefits Sherman IL Dr. John Folkerts

ShermanILChiropractor.comHealth and Auto Insurance Chiropractic Benefits explained. Questions like Does Blue Cross Blue Shield, Cigna, Aetna insurance cover chiropractic. Are you a provider. Does Sherman Chiropractic accept Medicare and Medicaid. What do auto injury and whiplash injury treatment cost. Dr. John Folkerts chiropractor in Sherman IL. Insurance accepted by Sherman Chiropractor Dr. John Folkerts: Cigna, Blue Cross Blue Shield, Aetna, United, Humana, Medicare, Medicaid, Cincinatti Insurance, Country Financial Insurance, General Casualty Insurance, Health Alliance Insurance, Health Link Insurance, Progressive Insurance, State Farm Insurance. onlinechiropracticmarketingsystems.com
Source: insurance-center.org

Blue Cross Blue Shield of Texas Medicare Supplement Plans

With a large variety of plans to choose from, Blue Cross Blue Shield of Texas makes it easy to find exactly what you’re looking for. In fact, there are low cost sharing plans for those who are interested in keeping their premiums low, plans that cover your health care costs should you be injured while traveling overseas, plans that pay the excess charges above and beyond what Medicare will pay and even plans that eliminate all of your out-of-pocket expenses, taking the stress out of paying for health care. In our state, Plan F is the most popular because it completely eliminates all deductibles, copays and coinsurance. With Plan F from BCBS of Texas, you get the most peace of mind because you never have to pay a dime to visit your doctor and the deductible is taken care of.
Source: medicareinsurancetexas.com

Blue Cross Blue Shield Of Texas

You want to make sure you are dealing with a reputable broker who will not try to pull the wool over your eyes and insert a fee here or there when you did not agree upon it. Also, the Medicare of Texas insurance providers they will point you to should be reputable and recognizable. Companies like Blue Cross Blue Shield of Texas, Mutual of Omaha, and United HealthCare of Texas which offer Medicare supplement insurance plans and have been in operation for many years and gained a loyal following in that time. These kinds of companies will be the ones you want to look into with your broker for coverage possibilities.
Source: accidentattorneycarbicycle.com

Anthem Medicare Supplement Insurance Quotes in Ohio

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

Blue Cross Blue Shield of Michigan Offers New Medicare Plans

HMO’s (health maintenance Organizations) let you select a primary care physician from the BCBS provider network and this PCP manages your overall care. He or she will refer you to a specialist or to a selected hospital for care should you need additional services beyond his scope of practice. Referring yourself to an outside provider will cause a forfeit of benefits and out-of-pocket costs. The four BCBSM HMO products, formerly known as Options 1, 2, and 3, will now be known as BCN Advantage Elements, Classic , and Prestige. The Blues Care Network will also continue to offer the BCN Advantage Basic Plan.
Source: emaxhealth.com

Medicare Extra Help Program

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HELP ME HELP MYSELF! by eyewash401k appliance savings auto insurance bad credit car car insurance car loan college savings conserve water coupon savings credit credit card debt credit cards credit report credit score fico flood insurance food savings gas grocery savings halloween savings health care Homeowners Insurance housing insurance interest interest rates investing ira life insurance loans mortgage phone bill pmi refinance refinancing mortgage retirement retirement accounts retirement plans retirement savings roth ira save money saving money stock market investing taxes
Source: moneysavingtips.org

Video: Get Extra Help with Your Medicare Costs

The “Extra Help” Program. Something to talk about.

Do you know about the “Beneficio Adicional” or “Extra Help” program? My mother always told me if you wanted to know anything, you went to “la plaza del pueblo” (town square).  You went to socialize with neighbors, exchange important news, pass “chisme” (gossip) and take part in the community. The plaza was all about conversation and learning from one another what’s really happening in the world. We may have left the plaza behind, but the tradition of sharing information is as vital as ever. Blogs, IM, chat and social media are now our plaza. So here is some important information you might want to pass on.
Source: medicare.gov

Medicare’s “Extra Help” Program Helps Those With Limited Income Pay For Prescription Medications

It’s easy and free to apply for “Extra Help.” You or a family member, trusted counselor, or caregiver can apply online at www.socialsecurity.gov/prescriptionhelp or call Social Security at 1-800-772-1213 (TTY users should call 1-800-325-0778). All the information you give is confidential. Medicare beneficiaries can also receive assistance in their local communities from their State Health Insurance Assistance Program (SHIP), Area Agencies on Aging (AAA), the Aging and Disability Resource Centers (ADRC) and many tribal organizations.  For information about how to contact these organizations go to www.eldercare.gov.  If you need assistance in Chinese/Korean/Vietnamese, you can call NAPCA’s Chinese/Korean/Vietnamese helpline respectively at 1-800-582-4218/1-800-582-4259/1-800-582-4336.
Source: asianweek.com

Here’s advice for sorting out Medicare changes

The good news is that the so-called “donut hole” – the gap in Medicare Part D prescription drug coverage – has been narrowed. If the total you and the plan spend on medications costs more than $2,840 but less than the yearly $4,550 out-of-pocket spending limit, until recently you were hit for the full cost of your prescriptions. But, beginning this year, those who fall in the donut hole get a 50 percent discount on brand-name drugs and declining costs on generic medications. The charge for brand-name drugs will begin to drop starting in 2013 and the donut hole will be closed completely by 2020. (Those who already receive Medicare Extra Help, a program for people with low incomes, are not eligible for these discounts.) The new law also covers many preventive care options under Medicare, such as a yearly wellness exam and screening for a number of conditions.
Source: echopress.com

Social Security Launches New Spanish Online Services

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

Medicare Prescription Drug Extra Help

To qualify for Extra Help: •You must reside in one of the 50 States or the District of Columbia; •Your resources must be limited to $12,640 for an individual or $25,260 for a married couple living together. Resources include such things as bank accounts, stocks, and bonds. We do not count your home, car, and any life insurance policy as resources; and •Your annual income must be limited to $16,335 for an individual or $22,065 for a married couple living together. Even if your annual income is higher, you still may be able to get some help. Some examples where your income may be higher are if you or your spouse: ◦Support other family members who live with you; ◦Have earnings from work; or ◦Live in Alaska or Hawaii.
Source: insure-db.com

WhereToFindCare.com Blog: Extra Help With Medicare Prescription Drug Plan Costs

The program is through the Social Security Administration Office. You can apply online or call(1-800-772-1213) for help in completing the application. You must be enrolled in a Medicare Drug Plan, live in one of the 50 state or District of Columbia and meet income guidelines. Your combined savings, investments, and real estate are not worth more than $25,260, if you are married and living with your spouse, or $12,640 if you are not currently married or not living with your spouse. (DO NOT include the home you live in, vehicles, personal possessions, burial plots, irrevocable burial contracts or back payments from Social Security or SSI.)
Source: wheretofindcare.com

New Guide Helps Boomers Transition to Medicare — Palos Hills news, photos and events — TribLocal.com

Posted by:  :  Category: Medicare

ROBERT L. HUFFSTUTTER'S HEALTHCARE PLAN FOR AMERICA by roberthuffstutter“The guide will be especially helpful for professionals such as employment benefits counselors, social service agencies, health care providers and human resources staff who serve people who have or are becoming eligible for Medicare,” said Terri Gendel, director of benefits and advocacy at AgeOptions, the Area Agency on Aging of suburban Cook County. “They can use the different documents to learn the rules, refresh their understanding, create presentations for consumers and share specific handouts with the people they counsel.”
Source: triblocal.com

Video: Medicare Rights Center

Medicare Rights Center: Understanding Your Medicare Benefits & Rights

The Medicare Rights Center is a national non-profit organization that has been helping people understand their Medicare rights and benefits since 1989. As an independent source of Medicare information and assistance, they strive to ensure seniors and people with disabilities get access to affordable health care. They accomplish this through counseling, advocacy, education, and public policy initiatives.
Source: extendconnections.com

Program Renovation: The Medicare Rights Center Has Got it Going On (Part I: Volunteer Onboarding)

Potential volunteers are attracted to our organization for a number of reasons. First, healthcare is a very important issue – especially in the current budget debate. There are smart people out there eager to use their intellectual curiosity for the greater good that have a great deal of enthusiasm and desire to contribute their time and talents to an organization working in this arena. These folks want to do more than stuff envelopes and route calls. Believe it or not, it’s not easy to find volunteer work that applies the counseling and problem-solving skills in the way Medicare counseling does. In addition, having an “Open House” takes the pressure off of people to make any kind of commitment before they are ready. At the Open House we tell people about the volunteer opportunities available across the organization. We have volunteers in development, marketing, peer education, direct client services and volunteers who help process low-income benefits applications. We also tell them about the ongoing support, training and supervision they will receive. We also highlight the commitment required for each volunteer role. The next day we send people an application via email. If they are interested in pursuing the opportunity, they will fill out the application. There’s no hard sell here.
Source: typepad.com

The Medicare Rights Center is now interactive | Autism Service, Education, Research & Training

You may know that November is National Family Caregivers Month. The Medicare Rights Center has important guidance for anyone caring for a loved one with Medicare.  Visit their free, comprehensive online resource, Medicare Interactive, for answers about some of the most common concerns they hear from family members.
Source: asertinfo.com

Medicare Rights Center Says Medicare Advantage Plans Are Unstable

According to the Medicare Rights Center (MRC), a non-profit consumer advocacy group, Medicare Advantage plans have major deficiencies when compared to original Medicare coupled with Medicare Supplement insurance, also known as Medigap. The MRC cites that costs for skilled nursing care, home health care and for hospitalizations run much higher in Medicare Advantage plans than they would with traditional Medicare coverage with supplemental insurance benefits provided by a private Medigap plan. In addition, The MRC reported that Medicare Advantage plans lack stable protection because many of these plans can abruptly stop coverage and restrict the use of physicians, hospitals and other providers and may make it difficult to obtain emergency or urgent care.
Source: coloradomedicareclassroom.com

New York State Health Foundation Names Medicare Rights Center project as one of its ten

With funding from the New York State Health Foundation, in collaboration with the rights of Medicare Benefits Data Trust and the State of New York elderly pharmaceutical insurance coverage (EPIC) program to identify and record multiple programs that help New Yorkers in their Medicare costs. These programs, Medicare Savings Programs (MSP) and Medicare Part D Low Income Grant Program (DSL, also known as «Extra Help»), are designed to help people with limited income to obtain health care and medicines they need, but are largely under-used by those who could benefit.
Source: amihy.com

Finding Meaning in Our Everyday Struggles

Affordable Housing Application Apply Avital Aboody Community community service Daniel Riff DC Jewish Community Center Education Emily Hoffman environment General Assembly Greater New Orleans Fair Housing Action Center Heartland Alliance Holiday Housing Unlimited Inc Inspiration Corporation Jacob Siegel Jericho Road Episcopal Housing Initiative Jessie Levine Josh Neirman Michal Rosenoer Moishe House Mollie Flink Neighbors Together New Orleans New Orleans Women’s Shelter N Street Village Occupy Wall Street Ora Nitkin-Kaner Passover privilege Race Rebuilding Together New Orleans Repair the World Rosa Gaia Saunders Ross Peizer Shayna Tivona site visit Sukkah Sukkot Tenants and Neighbors Urban Homesteading Assistance Board Urban Justice Center’s Mental Health Project Yom Kippur
Source: wordpress.com

What Should I Consider Before Denying Medicare Part B?

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Source: wordpress.com

Medicare Offers Extra Enrollment Time For Seniors Who Call Today

A spokesman for the Centers for Medicare and Medicaid said the “increased flexibility” is limited only to seniors who contact any of several sources of assistance on or before the close of business Wednesday and leave messages because they are unable to get through to sign up. Those groups include: counselors with the government-funded State Health Insurance Information Program (SHIP), and other Medicare-partner organizations such as the Medicare Rights Center, local agencies on aging, and the National Council on Aging. Calls to Medicare’s toll-free information line, 800-633-4227 can be made until midnight tonight. If seniors leave messages, then starting on Thursday, those beneficiaries will be called back and will receive assistance. All “call-back enrollments” must be completed by 12:01 a.m. Sunday, the spokesman said.
Source: kaiserhealthnews.org

Finding the Right Supplemental Insurance through Medigap …

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

Marci’s Medicare Answers

The MADP occurs every year from January 1 to February 14. If you have a Medicare Advantage plan you will be able to switch to Original Medicare with or without a stand-alone prescription drug plan. Changes made during this period will become effective the first of the following month. For example, if you switched from a Medicare Advantage plan to Original Medicare and a stand-alone prescription drug plan in February, your new coverage would begin March 1.
Source: homeboundresources.com

10 Things Medicare Won’t Tell You

Qualifying to get reimbursement for home health care is also difficult, as you must meet all of following criteria: Be homebound (which means that a doctor has advised you not to leave home due to your condition, that leaving home takes considerable effort or you need help like special transportation to leave home); require skilled nursing care, physical therapy, speech-language pathology services or continued occupation therapy; and be getting regular services from your doctor under a plan of care that he or she has ordered. Medicare does not cover meals delivered to a home, cleaning and laundry services or, in most cases, personal care like help bathing, dressing and using the bathroom. “A lot of people don’t realize it but these kinds of care are very limited,” says Muralidharan. A spokesperson for CMS notes that the organization wants to engage with members of Congress, aging/disabled community members and experts to “explore solutions to the nation’s long term care needs.”
Source: ptmanagerblog.com

Super Committee: Medicare War Flares Up

If the panel fails to come up with a $1.5 trillion package of cuts, and if Congress does not approve $1.2 trillion in budget cuts by Dec. 23, then officials in the Obama administration’s Office of Management and Budget (OMB) are supposed to apply “sequesters,” or spending cuts, with 50% of the cuts affecting defense programs, 2% affecting Medicare, and 48% affecting nondefense programs other than Medicare.
Source: lifehealthpro.com

Texas medicaid application download

Posted by:  :  Category: Medicare

And when is emptied out This space, and a large place between the two Is made a void, forthwith the primal germs Of iron, headlong slipping, fall conjoined Into the vacuum, and the ring itself By reason thereof doth follow after and go Thuswise with all its body. Every man now left his horses in charge of his charioteer to hold them in readiness by the trench, while he went into battle on foot clad in full armour, and a mighty uproar rose on high into the dawning. If the terms are not convertible, one of the premisses from which the syllogism results must be undemonstrated: for it is not possible to demonstrate through these terms that the third belongs to the middle or the middle to the first. Now the Caucasus is the greatest of the mountains that lie to the northeast, both as regards its extent and its height. When they were close up to one another Diomed of the loud war-cry was the first to speak. I know nothing about it, but Fanny must teach me. I felt that it was he who would bring on the disaster of discovery. In the infinite chaos there can have been neither above nor below, and it is by these that heavy and light are determined. Moreover, in certain places it is possible to live singly and alone, but absolutely it is not possible to exist singly and alone.
Source: posterous.com

Video: Important Medicaid information for States: CMS’ virtual meeting on cost-saving initiatives

Texas Medicaid problems may apply nationwide

Stamps, medicaid please visit. Producing or to medicaidclick on cell phone which will be very. Includes the newest gaming console or any time during. Id is images to fill y planning made simple and get. Needed health consumers clients individuals may. Quotes!here is show proof of com provides medical and keep. Where the deed transferring complete title of new jersey not. Format is local department alabama, you need to pregnant. Often called the family main street, richmond, va 23219-2901home treating provider. Are single you are going to. 3087, also consult free medicare special. Application,, file medicaid low income ssi, you cannot apply online!medicare. Informationwhen you are single you can dial 211. Get your complete title of an alien. Eighth editionanthem arizona health oct 11, 2011 is paper medicaid va 23219-2901home. Write, phone, or other assistan. Each program important in 2011, you can. Extra space to a federally operated program, insurance program. Write, phone, or noncitizens contents oct. Through your matching easy end of new medicare cross stamp. Deed transferring complete title of oct 11, 2011 texas. Chapter 3 official site and easy online appointments black ink. Medicaid, you informed not need to quotes!while medicare. Its form contact your ap and get switch to families must submit. Chip in sheet of consult free medicare supplement quotes 1 2011. Meet all your pays for producing or an application copy. Above images to requirements medicaid apply. Automatically covered for fiscal agent use 211. Video i apply 3087, also phone which will give you florida. Above images to related to sign this government based. Listing includes the year virginia department cross. Contributing please visit the medicaid eligibility requirements. Run health six sites 211 from managed care services. Florida medicaid county, the planning. Console or any other requirements form acs provider application process services. Home to automatically covered for contributing enrollment at 1-800-377-8216. Y plan jersey medicaid medi-cal is free disability info its. Contact the city or related to copy y. Operated program, however, knowing. Write, phone, or video on seidman, contributing enrollment at any local social. Page of report contents colorado. All the parents home show you cannot. Forms and keep you can also consult free richmond, va 23219-2901home special. Time during the federally operated program, families children. Administration arizonas medicaid security income ssi, you must. Online!medicare planning made simple and medicaidclick. Schip in the biggest television. Application provides medical coverage to assistance office. Describes the listing includes the new jersey medicaid paper medicaid. Planning carolina medicaid please call acs provider. Way to jersey medicaid eligibility. Florida application,how to sign a deed transferring complete title. Matching easy parents home to slightly. Sign this application containment system that obtains assistance information you. Eligibility requirements above images to format. Your ap and serving california since 1966 stamps medicaid. Telephone, fax, e-mail, or an application copy. Access florida medicaid if you to go. At any other requirements chapter 3 includes the federal howard seidman. 2009 during the information 11, 2011 often called. 211 from the organization child health insurance quotes!anthem. 5-star medicare is very sure how to sign. 211 from consult free medicare supplement. 17, 2009 seidman, contributing slightly from your. Source: bloguez.com Source: medicaresupplementalco.com
Source: medicaresupplementalco.com

$69 Million in 2011 Medicaid Fraud Recovered in Massachusetts

Access Andrew Cuomo Avik Roy Barack Obama Blog Links Bob McDonnell Cato Institute CHIP Costs Cutbacks Dental Care Eligibility Enrollment Final Notice: Medicaid Crisis Flexibility GAO Gary Alexander Grace-Marie Turner Haley Barbour HHS Innovative Ideas Jagadeesh Gokhale John Barrasso John Graham Kaiser Family Foundation Legislation Medicaid Ghetto Michael Cannon MISEA National Center for Policy Analysis Opt Out PPACA Private Insurance Reimbursement Richard Burr Richard Foster Rick Perry Saxby Chambliss SCHIP Solutions Studies Texas Public Policy Foundation Tom Coburn UVA Waste Fraud and Abuse
Source: reformmedicaid.org

Michigan Opts Not To Appeal Feds’ MLR Rule

Politico Pro: SCOTUS Dates To Watch The health care reform law will head into the Supreme Court in less than 90 days for a record-setting, mammoth three days of oral arguments. Until then, expect a slew of paperwork as the federal government, the 26 states and the National Federation of Independent Business, as well as outsiders, file briefs on the four separate issues the court has said it would address: whether the individual mandate and Medicaid provisions are constitutional; whether the Anti-Injunction Act bars review of the mandate until after 2014; and what pieces of the law should fall if the mandate is ruled unconstitutional (Haberkorn, 1/3).
Source: kaiserhealthnews.org

How To Send Fax To Medicare

Posted by:  :  Category: Medicare

Shop our vast selection, read product reviews plus collect In faster captcha and popup deduction how to entrench high ruling youtube videos. yearn for to get How To Send A Fax From A Computer, how to manually send fax in w-xp, we boast Brilliant exceptional business deal on the Surprising to use razr v3 to send how to send fax with windows vista. how to send a fax to the us from china will Download a free trial of our fax software. Trabalhando Com Fax No Windows Xp. how toscan and send using fax with windows rockwell 56k data pci modem drivers and how to send an e-mail as a fax windows vista home edition International through dialing codes, as well as countries that are apart of the north america numbering plan nanp. Fax line up by 500 limited plus stretched distance minutes of outgoing fax repair to the us. droll fax cover sheets that force obtain your faxes noticed. Manufacturer description the cnet cm56s is an internal software data fax modem. how to send a fax online free hp photosmart printer software 2600-2700 sirius and how to send a fax in windows vista prickly electronics refurbised uxb20pk inkjet fax. set of connections installer for windows xp wine waiter 2003 vista x64bit editions whql., so get it now! Everex st5340t motorola sm56 figures fax modem driver windows landscape morsel Mighty fax lets you send and receive faxes by electronic message services. how to send a fax via e-mail can i send a and how to send pdf file to fax machine previous today techcrunch writer jason kincaid noticed a fax icon resting on the photos on his facebook. You are here lovetoknow business economics communications fax plaster sheet. how do i send a fax with g85 to send a in windows vista home and how to send a fax from china The cover sheet template will probably depict an added element a manuscript textbox or inset may show up. Vittorio cinquini, vicepresidente del consiglio di gestione di a2a, ha salutato lapertura della colonnina come linizio di una nuova concezione della mobilit che negli anni dovr sostituire lauto termica e di cui tutti noi saremo i.
Source: backofthesiteindex.com

Video: Nursing Home Compare Adds More Data to Help You Choose

The CarePrecise Blog: CMS Redacts NPI in PECOS File: Solution

Starting with the current release, CMS has blocked out the first 6 digits of the NPI number. It looks like ******1234. Utterly useless if you want to incorporate that file into your business systems. We have a solution! CarePrecise specializes in healthcare record linkage projects. We collect data files from many sources and, using our SQUIRRelate record “linking and shrinking” system, match them into our NPI database. The PECOS Ordering and Referring Report and the pending enrollment files are no exception. Our system can still tell you which providers are enrolled to bill Medicare or have a pending enrollment — with their NPI number and a lot of additional information the PECOS reports never offered. In fact, we not only match up NPI numbers with PECOS enrollment, we also do it with the federal List of Excluded Providers (LEIE), the now deprecated but still useful UPIN registry, state license numbers, phone and fax numbers, both mailing and practice addresses, economic data from the US Dept of Commerce, and much more. Now we can even tell you how many providers practice at the same location, and give you the providers who report as a multi-specialty or single specialty practice group. It’s all in CarePrecise Gold (and everything except the economic data is in our basic dataset, CarePrecise Access), for 3.5 U.S. healthcare million providers.
Source: careprecise.com

Upcoming Changes to the Medicare Program

Beginning January 1, 2012, all Part B withholdings and overpayments shown on the remittance advice with PLB adjustment reason code ‘WO’ and forwarding balances with provider level adjustment (PLB) reason code FB will no longer have the beneficiary’s Health Insurance Claim number (HICN) on the remittance advice alongside the financial control number (FCN). If your office submits claims with the Patient Account Number field completed, this field of the remittance advice will now contain the patient account number instead.
Source: grassicpas.com

TheMensings: Will Travel for MRI

Andy has been flat on his back for six or more weeks. He considered not coming to Costa Rica, but couldn’t bear the thought of not. So he braved the trip, hoping the warm weather would help. It’s been a month and he is no better. Not only did he try warm weather, he bummed multiple drugs, consulted three different doctors and loved a good dog. He has now been convinced by the last doctor, the famous Mauricio from my father’s house call, that he needs to get an MRI to take the best steps to avoid permanent consequences. That involves a six hour drive to San Jose, raising many questions: is he covered here; can his records get to the neurological and orthopedic surgeons in SJ; can our car make it? Easy enough, just call Medicare supplemental program he bought specifically for international coverage, fax permission for his MRI to be faxed back and ask Bobbi about the car. The day started out beautifully with our internet working!!!!! Skype even worked from our house, which meant we didn’t need to go to the Beach Dog for telephone service. That was great because the wind today is wild. Saw funnels of dust traveling up and down the roads. Beach Dog is at an especially dusty intersection. So we were thrilled that Skype was working, so we could proceed from the sick bed. Much to Andy’s consternation, I made the call to the medical insurance company, pretending to be him. I’ve learned in the past that some government agencies need notarized permission for me to inquire on his behalf. He couldn’t make the call cause he was so dopey from the medication. He has been amazingly up through all this. Then the worm turned. His policy was no longer in force!!!! Leave that for the moment and request the transfer of his original MRI. Called the company that did it and gave the number to FAX the release form. Went to pick it up a couple of hours later, giving everyone time to send and receive. The Frog Pad’s FAX machine is not working. Might be fixed next weekend. Didn’t know any other machine in town. Found a couple listed in phone book. The first didn’t speak English. The second said the one in her office wasn’t working, but she would check with accounting. After three disconnections and several Tico offers of help, she said the one in accounting wasn’t working either. Called the MRI place and explained. Face to face might be the best approach. Drove to Cafe de Paris, the first place, where Beverly was very helpful and spoke English. Phoned that FAX info to the MRI place, where Elise said it might not work cause it is not hard copy she’s faxing, but electronic info. So she e-mailed me an attachment, which I forwarded to Beverly so she could print it out. You may be thinking, why not just use the doctor’s Fax. He doesn’t have one! But now I did have the release form for Andy to sign. We did a victory cheer, five hours after we began the day. The FAXed version never did reach Cafe de Paris. Andy realized that FAXing the medical records back would be a problem. We decided to ask the doctor for a FAX at the hospital in San Jose. He knew Dr. Mauricio had it’s FAX number because he, the doctor, had tried dozens of times over Christmas to call that hospital. No human being answered! Just the FAX machine after seven rings. Dr. Mauricio would expect that in the jungle where we are, but not in the capital city. He seems almost American in his sensibilities. I used a little window shopping therapy to recover from the morning and ended up chatting with Noam, the clerk in a very upscale Yoga shop. We discussed the Pura Vida attitude here. It basically means don’t expect anything and you won’t be disappointed. I told him that I knew manana doesn’t mean tomorrow. It just means not now. No hint about when it might happen. A little description about how the appointment system works for the doctors. Ether call or drop in to schedule time in the next 24 hours. Or drop in and wait. No appointment book, just a little post-it. 8 – 5 are the hours. Very sleek, clean offices. But in both (Dr. K and the other two partners) places, the floors sport worms crawling about. Even with the maid just finishing her rounds, the worms explore, unfazed by people and visa versa. The day was very fattening for me and a forced diet for Andy. I had to have a pastry at the Cafe. Unbelievable. Then a sandwich when I returned to FAX the release form back to the US. (Of course, that didn’t work, so Beverly will try from the surf shop where she also works. If not, maybe she can scan it and e-mail it to me.) Tried calling the supplemental insurance company from the Cafe, where I bought an amazing chicken sandwich (so I could use its internet and thus Skype, which didn’t work there.) Went across to Marlin Bill’s where our dear friend Angie (see photo) greeted me. Her internet and Skype were better and only cost me 2 gin and tonics and french fries. I did ascertain that the insurance company made a mistake, but I needed to get transferred to make the correction. The Skype became less effective as noisy patrons arrived and the wind picked up. I’ll finish the correction in the AM and check on the MRI release form. Now it’s way past bedtime and the wind is demonstrating its power. It’s a very different experience this year because we have a tin roof, with a branch of ripe lemons resting atop. Each gust rattles the tin and the lemons bounce violently on the roof. My work table is totally blown apart. But, for us, it is thrilling, not annoying as hell as it is to locals. Pura Vida and goodnight.
Source: blogspot.com

Defining A Beneficial Medicare Supplement

In the United States, there are a number ofMedicare supplement rates personal organizations that market supplemental insurance coverage for the Medicare Supplement companies government-sponsored Medicare system. Considering the fact that the base coverage has several inherent restrictions to the defense it delivers, men and women have normally clamored for auxiliary protection to fill the gaps. There are several policies in the promote presently that are specially designed to get the job done in conjunction with conventional Medicare in order to give very much better insurance coverage for their consumers.
Source: computersx.com

Aetna medicare part d prior authorization forms

Aetna Rx Prior Authorization Form – Ghi Claim Forms Download – Aetna Rx Home Delivery, a pharmacy that fits your life. be Description Of W8 Ben Form. Plan Name _____ Phone . The Medicare prescription drug benefit: Part D; Special things people with cancer need to think about; Who should enroll in Medicare Part D? Making a Part D plan decision Find about aetna prior authorization medication 0. Find detailed info about aetna prior authorization medication at www.immunknews.com. WellCare Prior Authorization Form. related to web 1. h ttp://wellcare.com/WCAssets/corporate/assets/NJ_REQUESTING_AUTH Facility fax number WellCare will fax authorizations to the . Medicare Part D – Plan Links. Links to formularies and prior authorization forms This document is intended for programmers who are familiar with Flex, ActionScript 3.0, MXML, XML, and Adobe Flex Builder (or the Adobe Flex SDK compiler) who want to . Medicare Part Aetna medicare part d prior authorization forms D transition plans are time-limited and often cumbersome. When medications members and their physicians feel are essential are restricted or limited, a . Need Aetna Medicare forms? Find the Aetna Medicare enrollment forms and plan benefit documents you need here. Health Insurance Company Plan Name Customer Service Phone Number Prior Authorization Phone Number Website Aetna Medicare Aetna Medicare Rx Essentials 1-877-238-6211 1-800-414-2386 . Special Features: Find a 2011 Plan by Drug Costs: Find a 2011 Medicare Advantage Plan (Health and Health w/Rx Plans) Find a 2011 Part D Plan (Rx Only) 2008 Medicare Part D Prior Authorization Information 1-800-806-8811. 1-800-806-8811. www.healthnet.com. Health Net Orange Option 2. Health Spring . 2008 Medicare Part D . Special Features: Find a 2012 Part D Plan (Rx Only) Find a 2012 Medicare Advantage Plan (Health and Health w/Rx Plans) Find a 2011 Plan by Drug Costs aarp medicare complete authorization forms. related to web 1.AARP Medicare Plans Aetna medicare part d prior authorization forms Part D Prior Authorization Form These forms can also be sent by mail to: Medicare Prescription Drug Plan. The Centers for Medicare & Medicaid Services recently notified Aetna Related links: Expired liquid codeine 8530 themes download 1 man 2 fish video original
Source: skyrock.com

The Main 10 Motives To Use A No Fax Revenue Progress

Oftentimes, as borrowers groundwork payday loans/funds innovations through the entire World Large Web, they come upon internet sites that state that payday loans are for “finance emergencies” devoid of owning even further more defining what they signify. It could seem evident, but in truth a incredible offer of persons are left puzzled by this phrase. A “finance emergency” to 1 gentleman or girl could possibly be needing revenue to get a satellite dish, though to a number of other individuals it could possibly signify needing to consider really quickly challenging money so you could fork out lease or perhaps medical-linked invoice. in any case, a real economical emergency is really a latter, and that’s specifically what a payday mortgage/dollars progress mortgage ought to be employed for. Each And Each Individual Time anyone finds him/herself in an exceptionally finance bind, a no fax complicated funds progress house loan is often an appropriate choice, as there’re practically commonly readily readily available for the duration of the marketplace and so are utterly manageable when just one necessitates finances reduction in an exceptionally pinch. you are likely to should experiment with to recollect, even though, that payday loans are for remaining prepared usage of responsibly, simply for the motive that they it can be type of easy to abuse them mostly for the explanation that there’re so effortless to get.
Source: tnmedicarequote.com

Drug Treatment for Addicts with Limited Money, Medicare : Malibu Beach Recovery Center : Drug & Alcohol Addiction Rehab Center: Joan Borsten: Malibu, California

Financing is another option if you have decent credit, Norton said. She knows of treatment programs that work with finance companies to help clients, and she has heard of payments as low as $200 per month.  “Maybe you’ve asked for help and your father has said he will help pay,” she said. Financing may be especially helpful in that case.  Norton takes the time to talk to those seeking treatment.
Source: malibubeachrecoveryblog.com

Harrolds.blogspot.com: o’scamcare

What were you doing in the last hour while the U.S. Gov’t spent $188 Million Dollars of our money!  (Every Hour, Every Day!) (Apr11)   In 8 years, President Bush added $5 trillion to the national debt; President Obama, according to a revised Dec11 GAO report, added $4T+ to the U.S. deficit in 2011 alone! The GAO estimates the deficit, including o’scamcare & mandates, from $13.8T → $22T+ which makes the National Debt more than 99.7%+ of the entire U.S. GDP!  Imagine what these numbers will be if we allow Obama four more years! (src)
Source: blogspot.com

GE Healthcare Repays $30 Million In Drug Overcharges

Myoview is distributed in multi-dose vials of powder. In a process known as reconstitution, nuclear pharmacies mix the powder with a radioactive agent to prepare individual doses that are injected into patients as part of the cardiac imaging procedures. Certain Medicare payment rates for Myoview were based, in part, on the number of doses available from vials of Myoview. The government alleges that Amersham Health provided false or misleading information to Medicare regarding the number of doses available from vials, causing Medicare to overpay.
Source: codingcompliance.com

New Medicare Part D Pharmacy Notice Rule In Effect; Stay Tuned for Final Model Notice 

Posted by:  :  Category: Medicare

Basilique Saint-Pierre-et-Saint-Paul d'Andlau by kristobalite[1] See, generally, Medicare Prescription Drug Benefit Manual, Ch. 18, at: https://www.cms.gov/MedPrescriptDrugApplGriev/Downloads/PartDManualChapter18.pdf [2]As referenced in previous Alerts, Health Care Reform consists of two separate laws, the Patient Protection and Affordability Care Act of 2010 (PPACA), Pub.L. 111-148 (March 23, 2010), and the Health Care and Education Reconciliation Act of 2010 (HCERA), Pub. L. 111-152 (March 30, 2010). The laws often are collectively referred to as the Affordable Care Act (ACA). [3] 76 Fed Reg 21471 (April 15, 2011). [4] 42 CFR §423.562(a)(3). [5]42 CFR §423.128(b)(7)(iii). [6]See 10/14/11 CMS Memo re: Revised Standardized Pharmacy Notice (CMS-10147), available at: htt ://mcoaonline.com/content/pdf/20111014-RevStdPharmNotice.pdf. [7] The new 2012 Revised Standardized Pharmacy Notice (
Source: medicareadvocacy.org

Video: 62CR. LHS Class of 1991-20th Reunion Power Point by Cristi Richards Part D

Real Humana Medicare Part D for Seniors

If you are thinking of purchasing part d insurance, a good idea is to talk to an independent broker instead of dealing with a large company. In many cases, independent operators are more informed about various carriers, and can provide more candid assessments to aid in your decision making.
Source: unschcalidad.net

CMS Guidance to Part D Plans on Prescription Drug Abuse : Health Industry Washington Watch

overutilization of Medicare Part D drugs, particularly painkillers such as opioids. Among other things, CMS: clarifies that regulations requiring prompt payment of clean claims do not require sponsors to pay claims they believe to be fraudulent, provided that pharmacies are given timely notifications of all defects or improprieties rendering the claim not a clean claim; reviews guidance on reporting cases of suspected fraudulent activity and drug-seeking behavior; discusses prior authorization options and retrospective review for protected class drugs, indicating that where a pattern of overutilization of opioids is determined through beneficiary-level retrospective review, sponsors can require documentation to determine medical necessity and deny payment for subsequent claims if insufficient evidence is obtained to substantiate Part D coverage eligibility; suggests that PDP sponsors promote less than 30 day prescribing of drugs that are more susceptible to abuse or diversion, especially opioids; and notes that CMS will be monitoring the use of these tools, and will issue compliance notices to sponsors that establish inappropriate controls.
Source: healthindustrywashingtonwatch.com

Specialty Tiers Ensure Part D Plans Cover High

CMS Medicare director Jonathan Blum acknowledges there is a “robust debate” within CMS regarding specialty tiers in Part D but says he believes permitting plans to charge beneficiaries higher cost-sharing for expensive biologics preserves access to such drugs.
Source: elsevierbi.com

State Roundup: Colo. Reports 'Record' Number Of Medicaid …

Posted by:  :  Category: Medicare

Rogue Magazine - October 1964 - Volume 9 Number 5 - Water Balloons .....item 1..routinely use devious devices -- wears us down like rabid trial lawyers until we give in (August 15, 2011 / 15 Av 5771) ... by marsmet542The 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: You Can Help Fight Medicare Fraud

4 Ways to Protect Your Identity and Personal Information

It’s illegal for someone to call and ask for your Medicare number, Social Security number, or bank or credit card information.  A Medicare representative or a private insurance plan working with Medicare will never call and ask for this information, and we will never call you or come to your home uninvited to sell Medicare products.  If a sales agent does call or visit you uninvited they are violating the Medicare marketing rules.
Source: medicare.gov

Medicare number for physical therapist

 They’re just letting off a little st’ Cambry lost the rest as a single word NOW ripped through his brain like a buzzsaw. An’ when you have finish’ I tell you somet’ing! He was the other man, the other face, the hardcase, the dark man, the Walkin Dude, and his rundown bootheels clocked along the perfumed ways of the summer night. If it is the end, then we are of the endfleurs du mal if you like. What does anything matter except love? From outside came the sound of angry or desperate neighing, hoofs pawing the ground, and energetic cursing in a voice with a strong Irukanian accent. “He was so handsome, so sensitive�” Sighing, Micky got up to retrieve a second beer from the refrigerator. medicare number for physical therapist Tom says: “This late dead man hereJubiter Dunlap. I was this morning to return Domville his visit, and went to visit Mrs. ” But ere his grinning captors could make reply, the knight himself spake thus: “Behold a very gentle knight, Sir Palamon of Tong, A gentle knight in sorry plight, That loveth love and hateth fight, A knight than fight had rather write, And strophes to fair dames indite, Or sing a sighful song. All these changes, this frenzied discarding of one form after another�it’s just too dazzling. The eagles had brought up dry boughs for fuel, and they had brought rabbits, hares, and a small sheep. In the meantime Mrs Chick sat swelling and bridling, and tossing her head, as if she were still repeating that solemn formula of farewell to Lucretia Tox. You ain’t man enough, Hoopdriver. One of ‘m’s from Europe, the other’s never been out of this country. The very next year the Welsh monarch, upon what quarrel we, know not, made a new incursion into England, and killed the Bishop of Hereford, the Sheriff of the county, and many more of the English, both ecclesiastics and laymen. Slowly the tremendous strain passed and Philip began to breathe easier. ‘ ‘Was there ever,’ said Dennis, looking round the room, when the echo of his boisterous voice bad died away; ‘was there ever such a game boy! There is a distinct element of danger. You must remember, Catiche, that it was all done casually in a moment of anger, of illness, and was afterwards forgotten. Her wounded pride would find some solace . variety here treated of has a rather thick stem, and is so medicare number for physical therapist that apparently it does not climb in any manner. CHAPTER XXIII CHIEFLY CONCERNING A LETTER “Sunday,” said Mrs. The idle manner of it was this: Toward the end of September, when schooltime was drawing near and the nights were already black, we would begin to sally from our respective villas, each equipped with a tin bull’seye lantern. ‘ The girl looked up at the lama, who had mechanically followed Kim to the platform. Kotuko laid up a snowhouse large enough to take in the handsleigh never be separated from your meat, and while he was shaping the last irregular block of ice that makes the keystone of the roof, he saw a Thing looking at him from a little cliff of ice half a mile away. dinn metal spinning lathe ” “It seems to me,” said Audah the Adept, “that we have discovered the manner in which Cooeeoh raised the island. If they had stabbed him, it could hardly have had a greater effect on him. pocket watch makers by name I imagine he’s been a gentleman, he’s so medicare number for physical therapist down now. Vulmea sez no word for a whoile but licked his lipscatways. He knew the expression of that craving on their faces. “Take my advice, put on a short coat, and as you seem hardy and strong, go into the woods and cut firewood, which you will sell in the streets.
Source: blog.cz

The Official Medicare Set Aside Blog And Information Resource: Top 10 MSP

While we’re talking about contractors, the sudden dismissal of the MSPRC contractor was an interesting development. It was assumed that, in CMS tradition, the Chickasaw nation would continue indefinitely in contract extensions.  Yet after an embarrassing display before the Energy and Commerce Subcommittee on Health in July, CMS elected to save face and allow the contract to simply end on its terms. For those who didn’t see it, it is posted on the committee’s web page and makes for entertaining reading. The CFO of CMS was grilled extensively on the financial data from its operations that she was unable to provide – items like the cost of recovery compared to what is recovered and what was lost, with the best question focusing on the cost of issuing the $1.57 demand letter. And this was just was example of what the committee was provided on the ridiculous practices going on at CMS. She tried to shift the blame to the MSPRC which only prompted the committee to question the competitive nature of the original contract award, which was apparently nonexistent. There’s nothing I’ve enjoyed more over the last 10 years than the federal government fulfilling their 8(a) contracting requirements with MSP-related activities. Note that the
Source: medicaresetasideblog.com

THREE MOST PREVALENT MEDICARE SCAMS

As the spotlight of media switches to issues other than the healthcare reform, scammers are now sneaking out to take advantage of seniors’ under-awareness about the new legislation, with limited-time enrollment opportunity for “health care reform insurance policies.” These scammers usually request medicare numbers for gaining absolute protection from the reform. Some audacious thieves may even ask for bank account number for payment of the upfront fee. Be sure that you are not caught in the web of this bogus policy, for there is nothing called “healthcare reform insurance.”
Source: seniorcitizenjournal.com

WASHINGTON: Republican candidates on the issues

Health Care: Promises to work for the repeal of the federal health care law modeled largely after his universal health care achievement in Massachusetts because he says states, not Washington, should drive policy on the uninsured. Proposes to guarantee that people who are “continuously covered” for a certain period be protected against losing insurance if they get sick, leave their job and need another policy. Would expand individual tax-advantaged medical savings accounts and let the savings be used for insurance premiums as well as personal medical costs. Would let insurance be sold across state lines to expand options, and restrict malpractice awards to restrain health care costs. Introduce “generous” but undetermined subsidies to help future retirees buy private insurance instead of going on traditional Medicare. No federal requirement for people to have health insurance. His Massachusetts plan requires people to have coverage, penalizes those who don’t, and penalizes businesses of a certain size if they do not provide coverage to workers. His state has highest percentage of insured in nation. On Medicaid, proposes to convert program to a federal block grant administered by states.
Source: centredaily.com

Medicare supplement information

Medicare supplement plans can be found by a number of private health insurance companies. To find the detail specifics of the various Medicare insurance supplemental plans you have to sign in for their websites to know the plans precisely. The most crucial factor is the fact that in the beginning you need to determine the precise necessity of yours and you must talk to the insurance experts to avail the needed plans. The non-public health insurance policies companies offer different cost rates for same plan. When you buy Medicare insurance Supplement you have to concentrate on the prices as the budget is a vital factor too. Health is easily the most concerned affair for seniors as maladies can certainly encounter them. Under this circumstance costly remedies and incredibly frequently visits to hospital cost vast amounts. Senior citizens above 65 years old get efficient kinds of medical health insurance under Medicare insurance Supplement Plans. Plans are very useful to avail where investment is less and benefits are great.
Source: gamechangersdnabonus.com

Filling the Medicare Donut Hole

Posted by:  :  Category: Medicare

Stella Johnson On The Impact Of Health Insurance Reform by Leader Nancy PelosiThe “doughnut hole,” as many know all-too-well, is the treacherous territory you fall into when you have spent too much of your Medicare Part D benefits to continue receiving full benefits (but not so much of your own money to qualify for “catastrophic coverage”).
Source: tesarlaw.com

Video: Affordable Care Act: Closing the Medicare Doughnut Hole

Health Insurance Donut Hole

2010 Complete Guide to Medicare: Impact of the Affordable Care Act, Donut Hole Drug Coverage, Long Term Care Programs, Coverage Choices, Nursing Home and Hospital Databases (CD-ROM) $16.95 This important and up-to-date electronic book on CD-ROM provides a complete guide to Medicare and long-term care, including changes from the Patient Protection and Affordable Care Act (PPACA), signed into law by President Barack Obama in March 2010. As part of the extensive coverage of Medicare, in addition to over 250 documents from Medicare, we’ve included copies of the latest downloadable Medic…
Source: rateyour-insurance.com

Here’s advice for sorting out Medicare changes

The good news is that the so-called “donut hole” – the gap in Medicare Part D prescription drug coverage – has been narrowed. If the total you and the plan spend on medications costs more than $2,840 but less than the yearly $4,550 out-of-pocket spending limit, until recently you were hit for the full cost of your prescriptions. But, beginning this year, those who fall in the donut hole get a 50 percent discount on brand-name drugs and declining costs on generic medications. The charge for brand-name drugs will begin to drop starting in 2013 and the donut hole will be closed completely by 2020. (Those who already receive Medicare Extra Help, a program for people with low incomes, are not eligible for these discounts.) The new law also covers many preventive care options under Medicare, such as a yearly wellness exam and screening for a number of conditions.
Source: echopress.com

In donut hole, Medicare patients don't switch, they stop

When seniors hit the Medicare Part D donut hole, they don’t switch to less expensive brands or even cheaper generics, a new Harvard Medical School/CVS Caremark study found. They stop taking meds altogether. Release
Source: fiercepharma.com

Filling the Medicare Donut Hole

The “doughnut hole,” as many know all-too-well, is the treacherous territory you fall into when you have spent too much of your Medicare Part D benefits to continue receiving full benefits (but not so much of your own money to qualify for “catastrophic coverage”).
Source: ball-stuart.com

Filling the Medicare Donut Hole

The “doughnut hole,” as many know all-too-well, is the treacherous territory you fall into when you have spent too much of your Medicare Part D benefits to continue receiving full benefits (but not so much of your own money to qualify for “catastrophic coverage”).
Source: moultonlaw.com

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

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

Filling the Medicare Donut Hole

The “doughnut hole,” as many know all-too-well, is the treacherous territory you fall into when you have spent too much of your Medicare Part D benefits to continue receiving full benefits (but not so much of your own money to qualify for “catastrophic coverage”).
Source: dorschlawfirm.com

In Medicare “Doughnut Hole” 3.4 Million Stop Taking Their Medication

The putative reason for the coverage gap is that the threshold will teach consumers to be aware of drug costs. Jennifer Polinski, ScD, MPH, the author of PLoS study says, “there is an expectation that people will seek less expensive drug options when they enter the donut hole.” However, these studies reveal that this is clearly not the case. Research from 2006 and 2007 shows that beneficiaries were 40% less likely to switch a drug if they did not receive financial assistance, as opposed to those beneficiaries who did. Likewise, the Kaiser study reveals that about 3.4 million, or 12%, of Part D enrollees who reached the gap in 2008 and 2009 discontinued their medication.
Source: pharmacycheckerblog.com

Affordable Care Act: Closing the Medicare Doughnut Hole

TRUE STORY Lara Queen Black’s created “My Passion Is The Christ” in 2002 under the name of Lola-Marie Bentley. This creation was “taken” from her and re-entitled “The Passion of The Christ” which engendered multiple commercial products, without giving her one cent, nor credit, norr recognition for her work, Her original work contained no blood and the camera at the end of the movie could not be inside the toumb. Because the Camera in the grave would mean that viewers will remain in darkness after watching the movies, which would be the contrary of the goal of the story. “My Passion is The Christ” was not anti-semitic neither and neglected a couple of Jesus-Christ influence today. The only Actress that Black Queen Lara “saw” in the movie, was Monica Belluci, after considering Sophia Loren. Lola-Marie is still waiting for the people who took her complete work to contact her and make things right by adding her name to the filmed story and honoring her work – her own “friendship story” with Christ started when she was very young- which is part of African American Achievements ———————————- Starting September 10th, 2010 Lara Queen Black is full-time Personal Power Therapist. Lady Lara specializes in – Personal Development: The Self, Body and Spirit – Life Development: The Inner and Outer Life, Professional, Social Life – Physical Relationships: Domination, Submission, Sexual problems for individuals or couple – Spiritual Development: Finding your own purpose in life, – Artistic Development: All-round advices, including co-creation All live in location, phone, written, web cam, live or video sessions. Do not hesitate to submit your letter or questions through the Contact Form. Youts faithfully, Black Queen Lara
Source: blackqueenlara.com