Now Available: New Webcast for National Mail

Posted by:  :  Category: Medicare

We will be issuing more webcasts later in the bidder education program. The upcoming webcasts will address topics such as financial documentation requirements, how bids are evaluated, and how to submit a bid in the online bidding system, DBidS. As each webcast is posted, we will announce its availability with an e-mail update. If you have not already done so, please register on the CBIC website to receive these announcements and other updates about the competitive bidding program.
Source: thecre.com

Video: Medicare Competitive Bidding for DMEPOS Simplified

Time is Running Out to Register for DMEPOS Competitive Bidding : Bid News

If you are a supplier interested in participating in the Round 2 and national mail-order competitions of the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program and have registered an authorized official (AO) but not a backup authorized official (BAO), the Centers for Medicare & Medicaid Services (CMS) strongly recommends that a BAO register no later than Thursday, January 12th. It is important to do it now so that the BAO will be able to assist the AO with approving end user (EU) registration. The establishment of a BAO is encouraged, if your company has someone who can occupy the BAO role, to avoid any disruption in the bidding process once the 60-day bid window opens. The individual in the BAO role can also assume the AO role if for some reason the AO can no longer fulfill his or her bidding responsibilities; if there is no BAO and the AO leaves the company, all end users associated with the company will lose access to the bidding system.
Source: thecre.com

DME Suppliers & Medicare Competitive Bidding Financial Requirements

If you are a DME supplier preparing to submit a bid for products covered under the competitive bid program, CMS is strongly urging companies to submit accountant-prepared (compiled) financial statements that meet the requirements set for by the qualifying bid guidelines. In Round 1 of the bidding process, many suppliers were disqualified for submitting non-compliant financials.
Source: somersetblogs.com

Expand Competitive Bidding in Medicare

Establish a Medicare Competitive Bidding Committee, composed of individuals from the private sector with acquisition experience and experts in competitive bidding. Since proper implementation of competitive bidding is complex and technical, the committee— rather than government staff at the Centers for Medicare & Medicaid Services —would oversee the process. The committee would monitor the market response to ensure product quality and access, and have authority to add and/or subtract goods and services subject to competitive bidding. For instance, it might be possible to extend competitive bidding to outpatient radiological examinations such as CT scans or MRIs.
Source: americanprogress.org

“Comment on Cramton and Katzman: Medicare Competitive Bidding Lowered E” by Thomas J. Hoerger

In contrast to Cramton and Katzman’s assertion that Medicare encountered serious problems with its pilot competitive bidding program, Thomas Hoerger of RTI International cites his early evaluations that suggested strikingly positive results.
Source: bepress.com

Medicare Expanding Competitive Bidding

The bidder education program launched today is designed to guide suppliers through the competitive bidding process and will feature numerous enhancements such as improved Request for Bids instructions, updated fact sheets, and a series of webcasts that suppliers will be able to view at their convenience.  Information and materials may be found at www.dmecompetitivebid.comand a toll-free help line (1-877-577-5331) is available to assist bidders with questions and concerns.
Source: hcmatters.com

Is Rick Santorum a Conservative Health

Furthermore, Santorum has positioned himself to the right of Mitt Romney on Medicare reform. Whereas both Romney and the new Ryan-Wyden plan appear to endorse a form of competitive bidding in which private insurers would compete with traditional government-run Medicare to serve retirees, Santorum supports competitive bidding without the inclusion of a “public option,” as Igor Volsky and Scott Keyes have documented. At a town hall meeting in Iowa on January 2, Santorum stated that he “liked” the Ryan-Wyden plan, but had “a problem with the public option part that Ron Wyden has insisted upon.”
Source: think-buzz.com

CMS Says Medicare Competitive Bidding Program For Durable Medical Equipment Might Save $1B In 2009

Buy Amoxicillin Online No Prescription Buy Abana HeartCare without Prescription Buy Accupril without Prescription Buy Adalat without Prescription Buy Aldactone without Prescription Buy Altace without Prescription Buy Arjuna without Prescription Buy Atenolol without Prescription Buy Avalide without Prescription Buy Avapro without Prescription Buy Azor without Prescription Buy Benicar without Prescription Buy Betapace without Prescription Buy Caduet without Prescription Buy Captopril without Prescription Buy Cardura without Prescription Buy Clonidine without Prescription Buy Co-Diovan without Prescription Buy Cordarone without Prescription Buy Coreg without Prescription Buy Coversyl without Prescription Buy Cozaar without Prescription Buy Diltiazem HCL without Prescription Buy Diovan without Prescription Buy Hydrochlorothiazide without Prescription Buy Hytrin without Prescription Buy Hyzaar (losartan + hydrochlorthiazide) without Prescription Buy Inderal without Prescription Buy Isosorbide Mononitrate without Prescription Buy Lanoxin without Prescription Buy Lasix without Prescription Buy Lipitor without Prescription Buy Lotensin without Prescription Buy Lotrel without Prescription Buy Lozol without Prescription Buy Micardis without Prescription Buy Minipress without Prescription Buy Nebivolol without Prescription Buy Norvasc without Prescription Buy Plavix without Prescription Buy Pletal without Prescription Buy Prinivil without Prescription Buy Rosulip-F without Prescription Buy Serpina without Prescription Buy Toprol XL without Prescription Buy Torsemide without Prescription Buy Trandate without Prescription Buy Trental without Prescription Buy Triamterene without Prescription Buy Tricor without Prescription Buy Vasotec without Prescription Buy Vastarel without Prescription Buy Verapamil without Prescription Buy Zebeta without Prescription Buy Zestoretic without Prescription
Source: wordpress.com

Medicare Expands Competitive Bidding Program (DMEPOS)

Under the program, DMEPOS suppliers compete to become Medicare contract suppliers by submitting bids to provide certain items in competitive bidding areas (CBAs). The new, lower payment amounts resulting from the competition replace the fee schedule amounts for the bid items in these areas. The first phase of the program was successfully implemented for nine product categories in nine areas of the country on Jan. 1, 2011. To date, CMS monitoring data have shown a successful implementation with no changes in beneficiary health status. Today, CMS released the detailed schedule for Round 2 bidding. Registration will begin on December 5, and the 60-day supplier bidding period will begin in late January of 2012. Round 2 expands the program to 91 additional metropolitan areas, and the new prices are expected to take effect on July 1, 2013. A National Mail Order Competition to help bring down prices for mail order diabetic supplies will coincide with the Round 2 timeline. The bidder education program launched today is designed to guide suppliers through the competitive bidding process and will feature numerous enhancements such as improved Request for Bids instructions, updated fact sheets, and a series of webcasts that suppliers will be able to view at their convenience. Information and materials may be found at www.dmecompetitivebid.comand a toll-free help line (1-877-577-5331) is available to assist bidders with questions and concerns.
Source: myedutrax.com

Medicare Competitive Bidding Threatens Access to Seating and Mobility Products

I know this could also be posted under the CareCure Legislative forum, but since it is specific to the seating and mobility equipment that you are passionate about I thought it would be appropriate to post it here in the Equipment forum. For those Forum members in the US, Medicare is pursuing a cost savings strategy of competitively bidding critical DME devices including major categories of manual and power wheelchairs as well as wheelchair seat cushions. The details of the Competitive Bidding Program are complicated, but it is clear that government bidding of these individualized, specialty items will no doubt limit choice and make access to top performing seating and mobility products more difficult. I have been involved in industry lobbying efforts to try and convince Medicare officials of the negative impact such a bidding program will have on individuals who rely on high performance wheelchairs, but it seems clear that many top level government officials see wheelchairs and seat cushions as commodity DME items, not realizing the critical importance these devices have on those who rely upon them for both mobility and skin protection. Perhaps the most scary part of Medicare pursuing this strategy is that the negative impact won’t only be restricted to the Medicare market. We are already seeing many state Medicaid programs and private insurance programs grab on to lower payments rates and access restrictions that resulted from a Round 1 pilot program of Competitive Bidding. And this is before the Medicare bidding program becomes a national program in 2013. I can’t see any scenario where the Medicare Competitive Bidding program will not ultimately limit your access and choice to critical seating and mobility equipment. It is not too late to convince Medicare officials and Members of Congress that this is a bad program – but to accomplish this we need individuals who use and rely upon this equipment to add your voice to lobbying efforts. Here is a great posting on the ROHO blog site from Bob Vogel about how to engage with your Members on Congress on this important topic. Your Members of Congress work for you. They are your elected officials. Part of their job is to listen and respond to your concerns. I encourage you to make your voice heard with the same passion that you show in participating in this Forum! http://blog.therohogroup.com/index.p…-and-senators/ Thank you! Tom Borcherding The ROHO Group tomb@therohogroup.com
Source: rutgers.edu

Healthcare Economist · Bring Market Prices to Medicare

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

More Information on the Medicare Competitive Bidding Program

I know a lot of you are thinking that because you are not on Medicare, this stuff does not affect you.  Well, it does.  A lot of insurance companies follow Medicare guidelines so other insurance companies can start doing this same thing.  My friend Mary’s husband works for a very large corporation and his company switched insurance policies the first of the year.  Mary’s daughter has an intellectual disability and uses the Omni Pod pump and the Dexcom CGMS.  The Omni Pod is one of the easiest pumps to use and she is able to use it without having to make complicated decisions on what she should bolus.  Although Mary makes the important management decisions for her daughter, her daughter having a pump that she is able to use and give herself meal boluses with ease is something that is very important to both of them.  A CGMS is a very important part of her control and Mary does not have to worry 24/7 about her daughter having severe lows.  They were informed that their new insurance follows Medicare guidelines and they will not cover the Omni Pod or the Dexcom.  Now Mary has to start her year off fighting to try and keep the Omni Pod and Dexcom for her daughter.
Source: kellywpa.com

Medicare Expands Competitive Bidding Program

The Hill: Medicare Says Competitive Pricing Will Save $28B Medicare is dramatically expanding a program that it says will save billions of dollars and serve as a model for other cost-cutting efforts. The Centers for Medicare and Medicaid Services (CMS) on Friday announced the second round of a program that uses competitive bidding to set prices for certain medical products. Medicare now uses competitive bidding in nine cities and will expand to 91 areas, according to the Friday announcement. In its first six months, the nine-city competitive bidding program has saved roughly $130 million, CMS officials said. The agency expects to save $28 billion over the next 10 years, roughly a third of which would be savings to patients (Baker, 8/19).
Source: kaiserhealthnews.org

Pursuing common solutions

There are promising elements to the proposal unveiled this month by Rep. Paul Ryan of Wisconsin and Sen. Ron Wyden of Oregon. But what is really promising is that a Republican and a Democrat — respected legislators within their respective parties — are pursuing a common solution to a serious problem that has been used to score political points.
Source: montereyherald.com

Defined Benefit Pension Plan Cost Changes for Medicare Cost

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSThe second change relates to the calculation of allowable pension costs for cost-finding purposes. Two different methodologies are necessary to appropriately address the goal of each. The wage index is used to measure a hospital’s labor costs across areas, while cost-finding procedures determine the actual costs incurred at individual hospitals. The current maximum amount of defined benefit pension costs claimed for cost-finding purposes, as detailed in Section 2142.5 of the Provider Reimbursement Manual (PRM), is based on actuarial accrued liability, normal costs and unfunded actuarial liability. To be allowable, costs must be computed in accordance with the Employee Retirement Income Security Act of 1974 (ERISA). The current period liability for pension cost also must be funded. Finally, funding in excess of a current period liability can be carried forward and recognized in a future period.
Source: healthcarereforminsights.com

Video: Healthcare Accounting.mp4

Enhancing physician recruitment for rural hospitals

In the context of national scrutiny on graduate medical education (GME) from both the Medicare Payment Advisory Commission and the Joint Select Committee on Deficit Reduction, Xierali et al, bring our attention to the ongoing needs of rural underserved communities and the potential role of critical access hospitals (CAHs) in training the rural physician workforce. Their analysis demonstrates the minuscule number of CAHs that have reported resident training within their walls. The literature shows that physician training in rural settings is successful in producing rural physicians but also is endangered with the number of rural training tracks and rural residencies in free-fall over the past 10 years.
Source: pnhp.org

Mankato Mayo Clinic Health System Medicare Analyst

Minnesota Medical Office Jobs: Whether you are a recent medical secretary or medical transcriptionist graduate or a skilled professional, Mayo Clinic is a place where you can achieve your goals and discover career and personal fulfillment. We invite you to explore a medical secretary or transcriptionist career with Mayo Clinic in Rochester, Minn. Here you will be a valued member of an outstanding healthcare team, and you will experience the exceptional environment of one of the world’s leading healthcare institutions.
Source: mayo-clinic-jobs.com

Medicare Cost Report 2012

Vijay Krishna Acharya who has written the successful Dhoom part 1 and Part 2 series has been writing the third and will direct it as well. in an interview with IANS, he said,’I'm very happy as I am directing Dhoom 3.” He further added,’I like to direct what I write. When I started writing [part three], I knew that I would be directing it. I became a writer by default, I always planned to direct a
Source: tollybuzz.in

Highmark agrees to sell Medicare Services division

Posted by:  :  Category: Medicare

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

Video: 2011 HEAT Provider Compliance Training – Overview of Centers for Medicare and Medicaid Services

Diversified Service Options to acquire Highmark Medicare Services

Deceased Relatives Bonus Debt Management Scores Fico Scores Learning Southwest Airlines Online Learning Ladder Thankyou Magazine Bonus Miles Limit Bad Credit Cards Citi Thankyou Eyelash Conditioner Card Southwest 10 Credit Limit “need” Money Revitalash Eyelash Conditioner Credit Cards Debt IVA Magazine Options Deceased Credit Card Debt Ladder Liberty Bank People Travel Insurance Rewards Airlines Onepass Continental Airlines Onepass Membership Rewards Credit Report Debt Consolidation Day Credit Debt Settlement Fresh Start First Credit Score
Source: creditcardsindex.net

highmark medicare services leprechaun

A hozzászólások a vonatkozó jogszabályok értelmében felhasználói tartalomnak minősülnek, értük a szolgáltatás technikai üzemeltetője semmilyen felelősséget nem vállal, azokat nem ellenőrzi. Kifogás esetén forduljon a blog szerkesztőjéhez. Részletek a Felhasználási feltételekben.
Source: blog.hu

Highmark Medicare Services: Software Services Best Products 50

The Physique Formula-who Else Wants To Make $150 For Every $30 Sale? Up To $81 Per Sale And 75% Commission On Highest Priced Muscle Building E-book! No One Else Comes Close.great Conversion. Get Free Marketing Newsletter,articles,ad Word Tricks & Coaching & Promotion Help At: Http://www.jimmysmithtraining.com/aff.htm
Source: blogspot.com

Highmark says sale of its subsidiary won’t mean loss of Cumberland County jobs

I can assure you that you are absolutly right about the unemployment. No other employer who remains open is as responsible for unemployment claims as what Highmark is. As a former employee of that organization myself I can say I have seen all the back alley and fly by night crap that goes on there. Thankfully I got out when I was able to and went to work for a better employer but I feel for those still stuck there. Also I find it funny how Highmark promises many of its groups who buy there coverage for there employees that all there information will remain here in America and they will always talk with a rep here in America however when I left in 2010 they were beginning to start up an India facility that would handle the “back office” things such as claims processing, etc. which basically means that you may still get someone in America on the phone but your paperwork will go to Taji in India without your knowledge which will subject you to a greater risk of identity theft.
Source: pennlive.com

Jobs spared in sale of Highmark company

Divesting the Medicare claims business was necessary for Highmark as it seeks to acquire West Penn Allegheny Health System    West Penn Allegheny Health System Latest from The Business Journals Highmark’s West Penn acquisition in critical time frameHighmark plans Harrisburg area expansionHighmark sells Medicare claims business Follow this company and create a health care provider subsidiary. The dual roles would create a conflict of interest, which Medicare prohibits. Highmark has government contracts to administer Medicare Part A and Part B fee-for-service claims for some 4.1 beneficiaries in in Pennsylvania, New Jersey, Maryland, Delaware and the District of Columbia.
Source: carinsurancesuite.com

Diversified Service Options of Florida to Acquire Highmark Medicare Services

JACKSONVILLE, Fla., Dec. 8, 2011 /PRNewswire/ — Diversified Service Options (DSO), a wholly-owned subsidiary of Blue Cross and Blue Shield of Florida Inc. and the holding company for First Coast Service Options (FCSO), announces its agreement to acquire Highmark Medicare Services Inc….
Source: handsnet.com

Highmark Medicare Services Awarded New Contract from Centers …

Help your company find its way selling your products and services to commercial and government organizations. Gardant Global, headquartered in Washington DC, with offices in Florida, Virginia and the United Kingdom is a firm focused on the development of strategy for firms, both large and small that desire to make a statement in government contracting. We are not a lobbying firm; we assist in the strategic development of your offerings, your personnel and your opportunity capture. We represent leading industrial, financial and technology firms exclusively, drive their top line faster than many think possible and in some cases invest in them. Our product and investment portfolio is designed to accomplish two things… benefit the government by bringing new, unique and patented technologies to the “closed” market and maximize the return on investment for our clients.
Source: consultinggovernment.com

Highmark Medicare Services Awarded New Contract from Centers for Medicare & Medicaid Services

Highmark Medicare Services administers contracts on behalf of the Federal government and is a wholly owned subsidiary of Highmark Inc.  Highmark Medicare Services’ mission is to provide quality services and innovative solutions in the administration of our government contracts, according to our core values (fiscal responsibility, operational excellence, customer focus, continuous improvement, and commitment to integrity), in support of stakeholder goals.
Source: virtualizationconference.com

Secure Your Workforce Providing Health Insurance Plans

Posted by:  :  Category: Medicare

Insurance Plan of the City of Portage La Prairie, Man. June 1959, 23 (1959) by Manitoba Historical MapsPPO (Favored Provider Business) is comparable to the HMO when it comes to network limitation. The PPO solution provides far more versatility than HMOs. Workers can use any medical doctor within the network. This package deal also provides the benefit of reducing the price of service. PPOs also possess a co-payment and coinsurance technique. The deductibles with the insurance coverage package deal need to be the higher when the worker wants to reduced the top quality charge. Greater deductibles demand far more from pocket cash, however the positive aspects are substantially far better than the previous strategy.
Source: a1healthy.com

Video: New York Disability Insurance Attorney Gabriel Hermann

Advantages of Washington State Health Insurance plan

And it definitely is compulsory for every single and just about every individual to have nicely getting insurance. Each with the providers come with unique schemes to influence shoppers to buy there health insurance. These providers have simplified the structure of insurance to produce it less difficult for prospects to appear for the quite very best. Every single and every single client can choose out the top suited insurance for him. These plans differ from single individual to group holders. Every single and each program comes with 1 factor new and is extremely distinct on your objective. You may discover nicely getting plans in Washington that provides help to those that currently have a medical history.
Source: medicalxtourism.com

Added benefits of Using Existence Insurance plan options

Using an insurance plan strategy is very essential in the present time so as avoid difficult moments. There are about lots of lessons of insurance plan exist that addresses nearly each and every sectors of day to day daily life it includesLife insurance plan, property insurance plan, vehicle insurance plan, health insurance plan, company insurance plan, and so forth. Today, there are lots of companies are readily available that supplies daily life insurance plan and all are viewed as as value for capital. Insurance is viewed as as one of the greatest software in terms of security of daily life.
Source: bermysagainstthedraft.org

Where To Discover Inexpensive Individual And Family Health Insurance

Particular person and household health insurance is the way in which to go for a lot of people. For instance, college and college college students may discover themselves in a bind in the case of acquiring affordable well being insurance. These students can apply for either a student medical health insurance plan, or they can apply for an individual and household health insurance plan. Those students with dependents such as kids normally opt to look into reasonably priced particular person and family medical insurance plans.
Source: katalog-firmy.org

The Reason Why Long Term Health Care Insurance Plans Is A Wonderful Choice

It will alleviate the responsibility on your children. Your sons or daughters will not want to see you in a facility where they feel you are not well cared for and may try to take care of you themselves. This will be a burden on them, whether or not they admit it. As parents, we never want to do anything to harm our children, even in our old age. We do not want them burdened with our care. If we have long term care insurance, we do not have to worry about being a burden to our children. We can stay in comfort at a long term care facility that is close to their homes.
Source: mostpopularinsurance.com

Secure Horizons Medicare Advantage – Medicare Full Or Medicare …

Posted by:  :  Category: Medicare

TWO YEARS OF RUIN by SS&SSThe 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: What Is Medicare Advantage?

Medicare Advantage Plans Are Available During Open Enrollment

Actually, this is only time that you can try out one of the Medicare Advantage (MA) plans after the initial sign up period when you first became eligible for Medicare. This is a once a year event where you can assess the type of MA plan you got out of the dozen choices laid out in front of you by different insurers and insurance companies. If you let this chance slip by, you might end up paying more and getting less coverage than what you bargained for.
Source: nextlevelarticles.com

Compare Medicare Advantage Plans

Comparing Medicare Advantage plans is like navigating a maze. Fortunately, there are state agencies to help you. These programs are called either the State Health Insurance Assistance Program (SHIP) or known as the Health Insurance Counseling and Advocacy Program. Local staff within your state can help you compare plans and policies.
Source: medicareplansite.com

Continuing To Understand Differences Within Medicare

For many this territory is uncharted and confusing. Terms are used interchangeably which can only add to the confusion. It is best to get a handle on the terms and there meanings. For instance a premium is the amount that an individual pays for their coverage. It will be the amount paid for Medicare Part B plus the additional for the Medigap supplemental insurance policies. Depending on the coverage that is chosen the premium will vary for each individual. Deductibles are the amount that is paid out of an individual’s pocket before any covered medical expenses are paid for by Medicare. Co-pays, copayments, are a fixed dollar amount that is paid for medical visits. Finally coinsurance which is the amount that is required to be paid by an individual after Medicare has paid their agreed upon portion.
Source: articlesaffair.com

What is Medicare Advantage?

Medicare Advantage is an alternative option to original Medicare (Part A and Part B). Original Medicare is run by the federal government while private health insurance companies offer Medicare Advantage. Since health insurers compete for Medicare consumers, they typically offer benefits that aren’t provided by original Medicare.
Source: gohealthinsurance.com

Texas AG suit over the drug Risperdal goes to trial Monday

Posted by:  :  Category: Medicare

Beneath Highway 90 bridge, Richmond, Texas 1018091117BW by accent on eclecticAnother potential witness in the case is M. Lynn Crismon, dean of the University of Texas College of Pharmacy. Crismon was a professor and member of the TMAP advisory panel in the mid-1990s when he “cultivated a financial relationship with J&J, accepting substantial fees and honoraria and soliciting research grants from the company,” according to Rothman’s report. “As a result, Dr. Crismon subverted the scientific integrity of his research and educational presentations, and biased his decision-making capacity as a member of TMAP.”
Source: cchrint.org

Video: What Are The Texas Medicaid Eligibility Guidelines?

Democratic Blog News: Texas Medicaid Cuts Leave Elderly And Cancer Patients Without Care

The change is expected to save $1.1 billion over the remainder of the two-year budget cycle, about $475 million of which will be state funding, according to state health officials. However, the Texas Medical Association and state Sen. Wendy Davis, D-Fort Worth, say the financial ramifications for physicians could force them to limit the number of dual-eligible patients they treat because the cost of service would not be adequately covered.
Source: blogspot.com

How to Eliminate Medicaid Fraud the Easy Way

The case is more than 10 years old and originated with a whistleblower lawsuit and was on appeal from a trial court. To be clear, this was a settlement, and Actavis admitted no wrongdoing. But, the price tag of the settlement for Actavis was half the original verdict. Attorney General Abbott is to be commended for his work in prosecuting Medicaid fraud that, according to his press release, has recouped $450 million in drug pricing lawsuits. But as successful as he has been, the underlying flaw in Medicaid’s structure still has millions of dollars going out for fraud that the state then spends huge sums detecting, investigating, and prosecuting.
Source: texasreport.net

Texas Reaches $84MM Settlement in Medicaid Fraud

State Attorney General Greg Abbott says the agreement averts lengthy appeals after a Travis County jury verdict in February. Prosecutors argued Actavis Inc. inaccurately reported its prices, leading Medicaid to overpay pharmacies.
Source: wtaw.com

Texas attorney general settles Medicaid drug suit

State Attorney General Greg Abbott says the agreement averts lengthy appeals after a Travis County jury verdict in February. Prosecutors argued Actavis Inc. inaccurately reported its prices, leading Medicaid to overpay pharmacies.
Source: ktre.com

PharmaGossip: State attorney general sues drug company

Jones’ lawsuit claims that Risperdal became part of the treatment plan because of the drug companies’ “improper influence” over Dr. Steven Shon, the former medical director for behavioral health at the Department of State Health Services. Shon had served as a paid Janssen consultant and traveled the country promoting the Texas plan. He denies the allegations in the lawsuit, however. And in 2006, he said: “I didn’t personally benefit from this project.”
Source: blogspot.com

California and Texas: Section 1115 Medicaid Demonstration Waivers Compared

This fact sheet compares and contrasts key provisions of the California and Texas Section 1115 Medicaid demonstration waivers. The Texas waiver, approved in December 2011, is modeled, in part, on the California waiver, which has been underway in that state since November 2010.   Both waivers affect hundreds of thousands of Medicaid beneficiaries, involve billions of federal Medicaid matching funds, and are designed, in part, to promote changes in the health care delivery system that will result in better care for individuals, better population health, and reductions in costs through system improvements.  They have a number of key similarities and differences as summarized in the side-by-side table within this fact sheet. These 5-year demonstrations are approved under section 1115 of the Social Security Act, which authorizes the Secretary of Health and Human Services to waive certain federal Medicaid requirements to enable states to conduct demonstrations with federal Medicaid funds.   
Source: kff.org

Change in Texas' Medicaid policy may affect some patients' co

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

Hospitals Will Have To Adapt To Texas Medicaid Shake

Texas got permission from the federal government to do all this, but in return the federal government asked for big changes from the Texas healthcare system. For example, hospitals in Texas currently receive billions of dollars every year in federal reimbursements for treating Medicaid patients and the uninsured. A lot of those payments came as lump sums, with no strings attached. Now those hospitals will have to do more to prove they deserve the money, and account for how they spend it.  
Source: kuhf.org

Budget News: Medicaid, health care cuts; school finance lawsuit; ISDs coping with cuts

From layoffs to wage freezes, area school districts say they have already done everything to absorb the $4 billion in cuts mandated by state lawmakers. Now, in an effort to save thousands more, four school districts have asked for class-size exception waivers from the Texas Education Agency. The authority to put more students in a single class will garner a savings of more than $660,000, officials said.
Source: texasbudgetsource.com

Kresta In The Afternoon: Texas Medicaid money threatened over Planned Parenthood defunding

The exclusion of funding for abortion providers and their affiliates was part of a proposal submitted by the state of Texas to renew its agreement with the federal government. While insisting that Medicaid does not pay for abortions, the Center for Medicaid Services has argued that it is illegal for Texas to stop funding Planned Parenthood because it performs abortions. The Obama administration has issued similar rulings for two other states.
Source: blogspot.com

Secure Your Workforce Providing Health Insurance Plans

Posted by:  :  Category: Medicare

health insurance conference at Moscone West by Steve RhodesPPO (Favored Provider Business) is comparable to the HMO when it comes to network limitation. The PPO solution provides far more versatility than HMOs. Workers can use any medical doctor within the network. This package deal also provides the benefit of reducing the price of service. PPOs also possess a co-payment and coinsurance technique. The deductibles with the insurance coverage package deal need to be the higher when the worker wants to reduced the top quality charge. Greater deductibles demand far more from pocket cash, however the positive aspects are substantially far better than the previous strategy.
Source: a1healthy.com

Video: Alan Grayson on the GOP Health Care Plan: “Don’t Get Sick! And if You Do Get Sick, Die Quickly!”‘

Advantages of Washington State Health Insurance plan

And it definitely is compulsory for every single and just about every individual to have nicely getting insurance. Each with the providers come with unique schemes to influence shoppers to buy there health insurance. These providers have simplified the structure of insurance to produce it less difficult for prospects to appear for the quite very best. Every single and every single client can choose out the top suited insurance for him. These plans differ from single individual to group holders. Every single and each program comes with 1 factor new and is extremely distinct on your objective. You may discover nicely getting plans in Washington that provides help to those that currently have a medical history.
Source: medicalxtourism.com

How To Obtain Low Value Health Insurance coverage @ Society Takes Over Politics

“We unanimously express that, in the ethic exercise of our profession, the social scientists cannot be limited to the diagnosis of their societies, without knowing and facing the multiple dimensions in which the legal monopoly of violence are exercised in an inhuman and arbitrary manner in our continent. We postulate the urgency to collaborate in the construction of a moral judgment that enable the rupture with the forms of blind obedience to authority, pointing out and promoting the necessary disobedience to all inhuman orders” Final declaration (Approved in Assembly) of the XXII Congress of the Latin American Association of Sociology. Concepcion, (Chile), October 1999 How are we going to collaborate to disobey all inhuman orders?
Source: stop-alto.org

How to find an Affordable Health Insurance

You’ll begin studying different plans provided by each organization, and then calling as well as requesting quotes for each plan that meets your requirements. After that, once you have discovered the best strategy, there will be paperwork in order to sign through a person, fees, and so on. There are numerous health insurance quotes websites which are specially made for a person and by completing their own forms may make them figure out that which you really need. They’ll straight connect a person with nearby health agents around your neighborhood if you will find available, or insurance companies as well as discount companies who would assist you in finding affordable 1 for your medical care insurance coverage. Depending on encounter you will need to spend some time shopping around and comparing prices for affordability as well as quality coverage prior to deciding to subscribe to any health care insurance policy.
Source: pi4soa.org

Wellness Insurance Jargons

Forward this video to your buddies and view all the video clips at www.sickforprofit.com CIGNAs Edward Hanway spends his holidays in a million beach residence in New Jersey. Meanwhile, typical Americans are routinely denied coverage for the care they want when they need it most. Welcome to the American health insurance sector. Instead of assisting policyholders attain the health safety they want for their families, large insurance organizations get wealthy by denying coverage to patients. Now theyre sending lobbyists to Washington, DC to twist the arms of lawmakers to oppose reform of the status quo. Why? Because the status quo pays. Understand far more at www.sickforprofit.com about the glamorous lives of billionaire wellbeing insurance coverage executives and inform us your story of getting victimized by their greed. Video Rating: four / five
Source: individualhealthinsuranceplan.org

Where To Discover Inexpensive Individual And Family Health Insurance

Particular person and household health insurance is the way in which to go for a lot of people. For instance, college and college college students may discover themselves in a bind in the case of acquiring affordable well being insurance. These students can apply for either a student medical health insurance plan, or they can apply for an individual and household health insurance plan. Those students with dependents such as kids normally opt to look into reasonably priced particular person and family medical insurance plans.
Source: katalog-firmy.org

How To Receive Low Value Health Insurance coverage

Organic Search Engine Traffic is simply put Free Traffic. People arrive at your website because they typed in a keyword or a phrase that is relevant to your website, and because your site had proper optimization, your site shows up in the first few positions of the search results and gets the click-thru from the searcher. Submitfrog.com now offers a website submission service to aid in your search engine submission efforts. Our web site submission is a search engine submission service that will do a site submission to all major search engines. Buy text links to increase page rank. One way links to increase pagerank. Buy one way links to improve pagerank and increase link popularity. Our effective link building service offers page rank improvement.
Source: emediaworld.com

How does health insurance work

Posted by:  :  Category: Medicare

House Republican Press Conference on Health Care Reform by House GOP LeaderTagged With: 10 years, afforable health insurance, best wishes, digit increases, generally, group health insurance, health, health care, health insurance companies, increase, insurance, insurance policy, insurance premium, insurance work, medical procedures, premium, reliable company, work
Source: goodhealthinsurancedeals.com

Video: 59% Increase In Health Insurance Costs!

Don't wait until it's too late: Practice health care rather than disease care

One major contributor to rising healthcare costs is the perception by the insured public that health care is “free.” This is because most of us never see the bill when we go to the doctor or hospital — it’s sent directly to the insurance company. Because it’s “free,” we might as well take advantage and get all the care that’s available, regardless of cost or effectiveness, right? However, if you look at your rising health insurance premiums, you soon realize that nothing is free. In fact, health insurance is a giant Ponzi scheme — we’re all paying for the other guy’s care costs.
Source: culturemap.com

InsureBlog: Shecantbeserious keeps on over

Sexual preferences are personal, private decisions, and we make no judgement calls regarding them. But where in the bill we had to pass to learn what’s in it does it require that sexual identity is now a “special class” deserving of “special benefits?”
Source: blogspot.com

State approves Wellmark’s 9.35% health insurance premium hike

Business The speed of business Life Quality of life news Government Eastern Iowa government issues Crime and Courts Breaking crime and courts news Higher Education Higher education in Eastern Iowa Health Health news all the time Outdoors Hunting, fishing, canoeing, etc Weather Share your weather conditions with us Prep Sports Complete high school sports coverage Schools Covering K-12 education in Eastern Iowa Sports & Rec Smorgasbord of Eastern Iowa sports
Source: business380.com

College Republican National Committee - Sebelius Ignores Higher Premiums, Defends Obamacare’s “Cost Saving” Provisions

Realizing that insurance is not the entirety of the problem Sebelius also writes that the “Affordable Care Act gives us tools to reduce costs by promoting better health and providing better care.” Her primary example is a new focus on prevention because “we know it is far less expensive to prevent disease than to treat it.” Except we don’t know that at all. In fact, the CBO’s Doug Elmendorf argues it is just the opposite. “Although different types of preventative care have different effects on spending, the evidence suggests that for most preventative services, expanded utilization leads to higher, not lower, medical spending overall,” Elmendorf argues.
Source: crnc.org

Lawsuits: No Retreat On NY Retiree Health Care Rise

how long do cars take to come back from a body repair shop, life insurance no drug test, the general insurance, Can a insurance company tell you how long it will takes to fix car, Metlife govt ins, state farm life insurance suicide clause, aaa corporate headquarters, how to settle an accident claim for a totalled car, aaa car insurance settlement, alabama no pay no play, road hazard insurance claim, cobra stimulus package 2011, how does michigan auto insurance work for minor damage, do allstate pay for car taxes if your car was stolen when they settle the claim, does a deducible cover the persons car i hit?, AAA headquarters, progressive car insurance nj reviews 2011, how does insurance estimate your cars worth, how do insurance adjustor evalute the value of a vechicle, life insurance suicide clause arizona
Source: localinsuresearch.com

Medicare Supplement Quotes

Posted by:  :  Category: Medicare

CorettaScottKing_WinonaBartonBallentine4 by Mark TribeHere is how to get the best Medicare Supplement Quote for your situation. 1. One Plan is the same as Every Other Plan Medicare supplement plans are regulated by each state, but every plan has to offer the same coverage as any other plan. What this means is that normally, price is the biggest consideration when comparing your quote for a Medicare Supplement policy. 2. How Long Have They Been in Business Some companies have come recently into the competitive space of Medigap insurance. Make sure that the company you do business with has a proven track record and will give you good service. 3. Use a Broker That Can Find What You Need A broker works for you, not the insurance companies. Brokers can normally help you get what you need at the lowest price.
Source: greencasket.net

Video: Medicare Quotes

Medicare Supplement Quotes

Here is how to get the best Medicare Supplement Quote for your situation. 1. One Plan is the same as Every Other Plan Medicare supplement plans are regulated by each state, but every plan has to offer the same coverage as any other plan. What this means is that normally, price is the biggest consideration when comparing your quote for a Medicare Supplement policy. 2. How Long Have They Been in Business Some companies have come recently into the competitive space of Medigap insurance. Make sure that the company you do business with has a proven track record and will give you good service. 3. Use a Broker That Can Find What You Need A broker works for you, not the insurance companies. Brokers can normally help you get what you need at the lowest price.
Source: dinnerspin.com

GetOnlineQuotes.com Adds Medicare Section to Its Website

Bill also provides some good news for Florida’s Medicare population: Rates will rise less than expected next year. Bill noted that “The government’s announcement on Thursday will help Florida’s senior population given that we are living in a tough economy.” Rates for Medicare Part B will only rise by $ 3.50 per month. A much higher jump had been predicted as recently as May. Premiums were frozen for the last two years because there was no increase in many people’s Social Security benefits. But benefits are increasing to cover inflation. The premiums for Medicare Advantage will actually decrease by 4%. That is the second consecutive decrease for those who opt for Medicare Advantage plans.
Source: bestlongtermcare.org

Medicare ‘Doc Fix’ Debate Shifts to Senate

Posted by:  :  Category: Medicare

There are some other areas where they are getting hit. There’s a $6.8 billion hit in reimbursements for treating non-emergency patients in a hospital out-patient setting. And then there are some other tweaks that are a philosophical hit to hospitals. This is something that the American Hospital Association and the Federation of American Hospitals lobbied against and that is kind of a loosening of the rules for physician-ownership of specialty hospitals. So on one hand, yes, we know that hospitals are kind of Medicare’s biggest cost center. There’s more money that flows into that sector than any other sector paid by Medicare, including physicians. I think it is also an acknowledgement that the low hanging fruit – the easy pay-fors – when it comes to these types of provisions, these types of bills–are pretty much tapped out already. 
Source: kaiserhealthnews.org

Video: Paul Ryan on Health Care Fiscal Train Wreck

5 Things Wrong with the Medicare Doc Fix

It’s no surprise that the end of year politics include conversations of the looming Medicare doc fix. Once again this issue is plaguing the political system and every health care provider across the United States. But instead of actually fixing the problem, Congress will most likely kick the can down the road and hope someone else fixes it.
Source: gohealthinsurance.com

Congressional Leaders Discuss Medicare ‘Doc Fix,’ Payroll Tax Break

, 12/14). The meeting comes after the House on Tuesday voted 234 to 193 to pass a GOP-helmed payroll tax cut extension (HR 3630). The bill would extend a $1,000 payroll tax break that is set to expire at the end of 2011. Meanwhile, the “doc fix” would stave off a nearly 30% cut to Medicare physician payment rates that is scheduled to take effect on Jan. 1, 2012. Instead, the legislation would increase reimbursement rates by 1% over the next two years. The plan would pay for the $38 billion fix in part by increasing Medicare premiums for high-income beneficiaries and by redirecting funding from the federal health reform law that was intended for prevention and public health services. The bill’s chances for passage in the Senate are slim, as Senate Democrats worry that the cost of the tax break extension will fall on middle-income residents. Senate Democrats were considering paying for the measure with a surtax on high-income individuals. Certain Democrats and President Obama also oppose a provision in the House bill that would push ahead the stalled Keystone XL oil pipeline project. Some lawmakers said that if the GOP agrees to eliminate the pipeline provision and if Democrats agree not to levy the surtax, the parties could soon reach an agreement on a revised plan (California Healthline, 12/14). According to
Source: californiahealthline.org

Boehner Shoots Down the Bipartisan Medicare “Doc Fix,” What Should You Do?

What impact will this have on seniors? Unfortunately, if the Medicare payment cuts go into effect, the most likely effect is that many doctors may begin turning away Medicare patients and/or severely restricting the number of Medicare patients that they take. Recent cuts in Medicaid payments to doctors have resulted in severe shortages in doctors who will accept Medicaid patients in some areas of the country. Although the new rules include payment incentives for primary care physicians (PCPs) and general surgeons in areas with doctor shortages, unfortunately, some expect a similar result for Medicare.
Source: myhealthcafe.com

Dr. Mintz’ Blog: No Medicare “Doc Fix” Could Result in Over 50% Salary Cut to Primary Care Physicians

Fortunately, the 27% reduction in Medicare payments to physicians that is set to take place in a matter of weeks unless congress acts is getting some press.  Fox News published this piece yesterday, as did the Washington Post. Writer Merrill Goozner breaks things down nicely in his article, “Is There a Doctor Fix in the House…and Senate?” However, one thing that seems to be getting confused in all the media reports is the difference between physician payments and physician salary. A doctor’s income is what he takes in (payments) minus expenses or overhead. Physician overhead (staff, office space, electricity, malpractice, equipment,etc.) is very expensive. One of the reasons, but not the only reason, a doctor’s overhead is so high is because we need to hire extra staff just to deal with the insurance bureaucracy.  (See “Your 10 minute office visit needs 8 people and 45 minutes of work” via KevinMD.) While payments from Medicare to physicians have not really increased over time, overhead has gone up dramatically. Physicians, patients, and policy makers need to understand that a 27% cut in physician payment will have a far greater impact on physician salary because of this overhead.  An article from the AMA News discussing the issue of the “doc fix” has an interesting table with current payments and proposed payments.  Let’s say a family physician sees 25 Medicare patients a day, 5 days a week for 50 weeks out of the year. At the current rate of  $68.97 per visit, this generates $431,062 in revenue. At 60% overhead of $258,637, this family physician’s income would be $172,425 per year. Now any doctor reading this will tell you that 1) no physician would see exclusively Medicare patients because they just don’t pay enough (at current rates) to sustain a practice and 2) you can’t see 25 Medicare patients in a day because patients 65 and up have multiple medical problems and you simple couldn’t see them all in 15-20 minute visits. However, the income is very close to
Source: blogspot.com

Healthcare Economist · Will the Doc Fix happen this year?

What is the doc fix?  In 1998, Medicare implemented the Sustainable Growth Rate (SGR) system.  Medicare intended that the SGR  was intended to slow the rate of growth on Medicare physician spending by decreasing reimbursement to physicians over time (for more information, see here).  Each year since 1998, however, Congress has reversed the decrease in physician payment rates.  It did not, however, abolish the SGR.  Abolishing the SGR would create a huge shortfall in Medicare spending.
Source: healthcare-economist.com

The ‘Doc Fix’ Is High On Congressional To

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

‘Doc fix’ debate a symptom of deeper Medicare ailment

A survey by the Medicare Payment Advisory Commission found that among patients looking for a new primary care doctor in 2010, 79 percent said they had no problems finding one. But according to the American Medical Association, which represents doctors and has historically resisted limits in reimbursements, nearly a third of primary care physicians already limit the number of Medicare patients in their practices. The AMA website advises doctors on how to decide whether to leave Medicare, even offering sample form letters to patients.
Source: recruitersnation.org

Update on Medicare “Doc Fix”, Payroll Tax Cut, and Unemployment Benefits Extension

Congress has so far failed to reach agreement on three timely pieces of legislation that carry great political and economic significance.  Of particular importance to Urban Indian Health Programs is the so-called “Medicare Doc Fix.”  Current federal law requires that Medicare reimbursement rates be adjusted annually based on a formula tied to the health of the economy.  The law also says that Medicare reimbursement rates should be cut every year to keep Medicare financially sound.  Congress has blocked those cuts from happening 12 times over the past decade, and could still do so this year.  However, if Congress does not take action to block these cuts, Medicare providers will face a mandatory 27.4% reimbursement rate cut starting January 1.
Source: wordpress.com