Learn About Medicare Advantage Plans In Wisconsin

Posted by:  :  Category: Medicare

YOU MIGHT WANT TO START PLANNING 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: RANT!!!!! DEBT problem; Wisconsin & Ohio; Social Security, Medicare and Taxes

Learn About Medicare Advantage Plans In Wisconsin

HMO Plans: These plans require members to pick a primary physician, authorized to act as a mediator for your medical services. Primary Care Physicians (PCP) are general practitioners, family doctors or pediatricians. When your primary physician decides you need to visit a specialist her or she will give you a referral. Only specialists that operate in your network are covered by your insurance plan. Their best attribute is that HMOs provide general care at comparatively lower cost. Certain treatment are somewhat less likely to be covered under an HMO because the goal of this type of insurance plan is maintenance.
Source: the-monkey.biz

Better Business Bureau Names Biggest Scams of the Year 

badgercare plus Better Business Bureau charity scams credit card fraud credit card scams election fraud false claims act fraud alert newsletter Frauds healthcare reform identity theft medicaid fraud Medicare medicare fraud medicare overbilling medicare part D medicare reform medicare reimbursement mortgage fraud phishing scams podcasts prevent medicare fraud storm chasers storm scams tax scams telephone scams Training voter fraud wisconsin bbb wisconsin check fraud wisconsin child care fraud wisconsin election fraud wisconsin fraud wisconsin head start fraud wisconsin healthcare wisconsin medicaid fraud wisconsin medicare wisconsin mortgage fraud wisconsin scam wisconsin scams wisconsin smp wisconsin smp training wisconsin unemployment benefits wisconsin unemployment fraud wisconsin voter fraud
Source: wisconsinsmp.org

InsuranceInsuranceInsurance.com

HMO Plans: These plans require members to pick a primary physician, authorized to act as a mediator for your medical services. Primary Care Physicians (PCP) are general practitioners, family doctors or pediatricians. When your primary physician decides you need to visit a specialist her or she will give you a referral. Only specialists that operate in your network are covered by your insurance plan. Their best attribute is that HMOs provide general care at comparatively lower cost. Certain treatment are somewhat less likely to be covered under an HMO because the goal of this type of insurance plan is maintenance.
Source: insuranceinsuranceinsurance.com

Northeast Wisconsin health providers join pilot Medicare program

Bellin Health and ThedaCare have a history of working together. They, along with select independent physicians, launched Touchpoint Health Plan in the 1990s. When the health plan was sold, they continued improving healthcare together through the Northeast Wisconsin Health Value Network (NEWHVN). NEWHVN was formed in 2008, bringing together two healthcare systems and independent physicians with the goal of creating value through quality improvement and the efficiency of care provided. The organization recently renamed itself Bellin Health-ThedaCare Healthcare Partners to better represent the parties involved. Bellin Health-ThedaCare Healthcare Partners covers 12 counties in Northeast Wisconsin. Two major healthcare systems: Bellin Health, based in Green Bay, and ThedaCare, based in Appleton, as well as eight major healthcare facilities, and nearly 700 physicians, make up the network.
Source: insightonbusiness.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: tesarlaw.com

Wisconsin Medicaid, Medicare fraud cases focus on orthotic device sales

According to the U.S. attorney general’s office, Kanter knowingly sold diabetic shoe inserts that failed to conform to Medicare requirements. As part of his plea deal Kanter is barred from participating in any federal healthcare programs for 15 years. Dr. Comfort was sold in March to California-based supplier DJO Global, which paid $254.6 million for the company and agreed to sign a corporate integrity agreement with the Department of Health and Human Services Office of Inspector General.
Source: lowerextremityreview.com

The Different Types Of Medicare Advantage Plans In Wisconsin

Health Maintenance Plans: Plans of this type require patients to pick a PCP, or primary care physician, which is the only doctor which can refer you to other medical services. Primary Care Physicians (PCP) are usually general practitioners, family doctors or pediatricians. When your PCP refers you to a specialist, it is almost always a doctor within your network. This is because only specialists that in your network will be covered by an HMO. HMOs provide general care at comparatively lower cost because certain, more expensive, treatments are less likely to be covered. The goal of this type of insurance plan is exclusively maintenance.
Source: blogmeout.net

Do Gym Memberships Help Medicare Advantage Plans Attract …

Posted by:  :  Category: Medicare

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

Video: Medicare dental coverage Dallas

The Importance of Dental Medicare Plans

Not all insurance plans out there can actually cover for dental expenses. If you want to take care of your oral health, you might want to avail a dental Medicare plan. So what is the importance of this plan and why you should avail it? Well, one thing that you must know about this health insurance plan is that it covers preventive care on oral health. Whether you like it or not, everyone is exposed to different risks that might lead to tooth decay, tooth extraction, infection, and the like. Since dental costs can be surprisingly expensive, availing this plan will help to reduce the overall costs. It can cover regular tooth cleaning and check ups. It also provides discounts on dental surgeries and the like. If you wish to learn more about this, spare some time to visit Medicare Texas today. Since it provides the best coverage and benefits, there are no reasons why you must not avail it.
Source: kurde-francais.com

What is Supplemental Medicare and Who offers it in California?

To be eligible for supplemental Medicare policy, it is required for you to enroll in part A and B of original health insurance policy. Either you can opt for these plans during open enrolling period or you can undergo medical screening and buy the policy individually. The supplemental Medicare plans in California are sold by private insurance companies which are allowed to offer 12 such standard plans. Each plan comes with different benefits though all the benefits cover under part A and B are also found in all these insurance plans (because they are part of basic health insurance plan). Those planning to enroll for supplemental Medicare policies in California should be aware there are some terms and conditions to participate in the same. If you have enrolled in Standalone Part D, you cannot continue to avail drug coverage. Whichever company in California you buy the supplemental Medicare plan from; the plans offer the same benefits though the premium may vary.
Source: projektgenerika.org

www.anthem.com/ca : Get a California Anthem Health Insurance Quote

Anthem provides an online PlanFinder that allows new members as well as prospective members to obtain a free health insurance quote, find plan options and apply for health insurance online. Visitors who want to get a free Anthem health insurance quote need to enter a zip code and answer basic plan preference questions as well as provide general medical history. A quote is provided for immediate review.
Source: guidancepot.com

How to Save Money by Using Medicare Plan?

Most employers provide health insurance for their employees. It is this insurance that is greatly used as benefits. Now, it is good to know that you can even have a dental insurance for yourself. You do not need to spend more if your expenses are covered for your dental costs as well. In BCBS medicare, they can help you anytime. It is something really great to have. Imagine the preventative care and other check-ups that you can have whenever you think you have a dental problem. It is very easy to consider this plan because of the coverage you can have. This can help you save your money, and you can also choose the best plan that suits your budget too. The quality is high and plans are reasonably priced. Dental coverage is something you can have as a special coverage. Most of the time, this is neglected. But medicare is committed in helping you meet your dental needs.
Source: nuketema.com

Seniors, Learn The Features About Medicare Supplemental Insurance

All in the years you have been completely working, you (or your business) have was required to pay immense degrees of money for your state of health insurance coverage. These comprise of charges such because deductibles, copayments and coinsurance. Called A through D, there are different examples of coverage along with premium costs according to level of insurance coverage desired. Therefore for anyone who is already a beneficiary of this Original Medicare plan you should get a Treatment Supplement Plan coupled with it to meet any medical costs. If you are required to devote an extended period in a infirmary or requires long-term attention, Medicare will leave them having a huge health treatment bill.
Source: wallacefsc.org

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

Posted by:  :  Category: Medicare

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

Video: Chicago: “Cigna 7″ Arrested – Medicare for All

We thought of Cigna Medicare health needs covered senior

The program replaces a fee for service Medicare Part A and B provides coverage for retirees living in the program of the government Medicare does not demand particular networking or referrals, and works with any vendor that accepts the conditions of Medicare and Cigna. You get complete coverage of this medically following the output level of the pocket is violated, as properly as dental care and a nurse hotline. For much more information visit the CIGNA Medicare who are looking for, answer any questions you could have. Medicare coverage by Cigna is particularly appealing for older folks since it provides 4 distinct possibilities for well being and prescription benefits. It is offered in most states, meaning that practically any person can get it. Plans that cover most drugs can, although a low deductibles are a excellent choice for you retirees. If to retire, if you genuinely feel about it and that is the strategy, and overcome the challenges of this can be exhausting. Cigna Medicare covers all your needs in just a snapshot.
Source: seniordriver.org

Illinois Medicare Part D Plans

Keep in mind that there are two ways to receive Medicare drug benefits. You can enroll in a stand-alone plan or join a Medicare Advantage plan that includes Part D coverage. If you are going to stay with original Medicare or purchase a Medigap policy your only option will be to enroll in a stand-alone Part D plan.
Source: partdplanfinder.com

ACO News: Cigna, Weill Cornell Docs Join Forces

Modern Healthcare: Cigna, Weill Cornell Docs Announce ACO Insurer Cigna announced an accountable care effort with the Weill Cornell Physician Organization, New York, that will employ registered nurses to coordinate patient care. The effort includes 71 Weill Cornell primary-care doctors and their patients, according to a news release announcing the effort (Evans, 1/11). Modern Healthcare: For Pediatric ACOs, Providers Need Not Apply Among the myriad federal healthcare initiatives stemming from the Patient Protection and Affordable Care Act, at least one highly anticipated program has fallen through the cracks. The 2010 law authorized the creation of pediatric accountable care organizations within Medicaid. Such pilot projects were supposed to start on Jan. 1. The planned program would link Medicaid provider pay to patient outcomes and supposedly track the higher-profile version of adult ACOs in Medicare. After a rocky initial start, the adult version of ACOs has gotten under way, but the Medicaid children’s version appears to have stalled (Daly, 1/11).
Source: kaiserhealthnews.org

Medicare Provider Cigna Buys Medicare Carrier Health Spring

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Source: medicareadvantagesupplementplans.com

Deal boosts Cigna share of Medicare Advantage

Cigna’s acquisition is the latest in a series of deals made by health insurers to expand their Medicare Advantage businesses, which are growing at a faster rate than commercial insurance as baby boomers become eligible for them. In addition, big insurers like Cigna have reported strong results in recent quarters, and analysts have speculated that companies would start exploring acquisitions.
Source: kansas.com

Insurer Cigna to buy HealthSpring for $3.8B

healthspring layoffs 2011 cigna laid off when will cigna and heath spring transaction close healthsprings employees out of a job because of cigna healthspring layoff cigna medicare is laying off cigna medicare cuts cigna layoffs december cigna layoffs 2012 cigna layoffs cigna laid off 2011 Cigna Job cuts accounting India cigna health spring layoff cigna employees healthspring cigna accounting layoff 2012 will cigna lay off healthspring employees
Source: ourbusinessnews.com

CIGNA Medicare Part D For 2012

In some States CIGNA is joining Plan One and Plan Two. Members enrolled in certain States in Plan Two for 2011 will be automatically moved to Plan Two for 2012. Members who will be moved to Plan One will recognize substantial savings in premium. But you should keep in mind that the premium is not the most important feature of a Part D Plan.
Source: affordablemedicareplan.com

Business Health Insurance

affordable health insurance best health insurance brain health cost of health insurance department of health family health insurance group health insurance health care health care costs health department health ins health insurance health insurance carriers health insurance company health insurance cost health insurance coverage health insurance nc health insurance plan health insurance quotes health plan individual health individual insurance insurance plans medical insurance medical insurance companies medical insurance coverage private health insurance quality health social security student health insurance
Source: mollywu.org

Five Year Prison Sentences Handed Down In Nnanta Felix Ngari — Unique Medical Solutions Case

Posted by:  :  Category: Medicare

THE PEOPLES LEADER by SS&SSEvidence at trial established that Ngari owned and operated Unique Medical Solution Inc., a Baton Rouge, La.-area DME supply company that specialized in the provision of power wheelchairs to Medicare beneficiaries. Beginning in late 2003, Ngari paid recruiters, including Payne, to locate and solicit prescriptions for medically unnecessary power wheelchairs, which Ngari used as a basis to submit false and fraudulent claims, on behalf of Unique, to Medicare. As part of the scheme, Payne used churches and other Baton Rouge locations to host “health fairs,” at which Medicare beneficiaries would be prescribed medically unnecessary power wheelchairs by doctors, including Lamid. Lamid and the other physicians were paid illegal kickbacks by recruiters based on the number of power wheelchair prescriptions generated at the health fairs. Payne, likewise, was paid kickbacks by Ngari based on the number of prescriptions he brought to Unique.
Source: newsroom-global.com

Video: Medicare Supplements in Texas: What to Look For When Choosing a Plan

Medicare expands savings initiative in Louisiana

“Health Coach” is a law suit waiting to happen. Without one on one in person contact with that patient a nurse “health coach” is begging to lose her or his license. What are they going to do ask them how they’re doing? Did you take your meds? Supposedly they saved 5.2% from readmission. Whoop te do. They are only impressing themselves. Anyone with any medical experience will tell you right off that someone wants to get in on the medicare action in a big way.
Source: nola.com

Owner and Patient Recruiter Heading to Prison for Roles in $4.7m Louisiana Medicare Fraud Scheme

Evidence at trial established that Ngari owned and operated Unique Medical Solution Inc., a Baton Rouge, La.-area DME supply company that specialized in the provision of power wheelchairs to Medicare beneficiaries. Beginning in late 2003, Ngari paid recruiters, including Payne, to locate and solicit prescriptions for medically unnecessary power wheelchairs, which Ngari used as a basis to submit false and fraudulent claims, on behalf of Unique, to Medicare. As part of the scheme, Payne used churches and other Baton Rouge locations to host “health fairs,” at which Medicare beneficiaries would be prescribed medically unnecessary power wheelchairs by doctors, including Lamid. Lamid and the other physicians were paid illegal kickbacks by recruiters based on the number of power wheelchair prescriptions generated at the health fairs. Payne, likewise, was paid kickbacks by Ngari based on the number of prescriptions he brought to Unique.
Source: netnewspublisher.com

Louisiana Law Blog: 2011 Medicare RAC Audit Results

CMS released 2011 recovery results for the Recovery Audit Contractor (RAC) Program. The 2011 figures reflect a significant increase over the amounts recovered or returned to providers in 2010. Through four quarters (October, 2010 through September, 2011), RAC contractors recovered a total of $797.4 million in overpayments, with $141.9 million in underpayments returned to providers. The recovery amounts increased with each quarter of the fiscal year, from $82.9 million in the first quarter to $277.1 million in the last quarter.
Source: louisianalawblog.com

Louisiana Medicare Fraud Case Yields 4 Convictions

Ngari owned and operated Unique Medical Solution Inc., a Baton Rouge-area DME supplier that specialized in the provision of power wheelchairs to Medicare beneficiaries.  Evidence at trial established that beginning in late 2003, Ngari paid recruiters, including Jones and Payne, to locate and solicit Medicare beneficiaries to attend “health fairs” hosted by Jones and Payne at churches and other locations.   At the health fairs, doctors, including Dr. Lamid, prescribed the beneficiaries power wheelchairs that were medically unnecessary.   The prescriptions were used by Ngari to submit false and fraudulent claims, on behalf of Unique, to Medicare.  According to information presented at trial, the doctors, including Dr. Lamid, were paid illegal kickbacks by Payne and Jones based on the number of power wheelchair prescriptions generated at the health fairs.   Jones and Payne were also paid kickbacks by Ngari on a per prescription basis.
Source: newsroom-magazine.com

Health News Med: OIG Updates Enforcement Actions

Owner of Westlake Home Health Agency Pleads Guilty to Bilking Medicare out of over $5 Million in Health Care Fraud Scheme http://go.usa.gov/RjV ____________________________________________________________________
Source: blogspot.com

Mississippi has highest rate of obesity in nation; Louisiana holds steady in 8th place

Hello, I am a mother of seven and I have been dealing with weight since I had my daughter in 1980. I would lose the weight, but some how it would always come back. My highest weight now has been 260lbs and I hate it, this is a miserable feeling. It’s like the body you are in is not your own, but for someone else and you want out of it so much that you can scream. I am here to post my weight loss journey and share it with the women of the world that are having the same problems I am having, which is keeping the pounds at bay permanently. My weight consumed my life. There was not a day that passed that I didn’t think about it. But I wasn’t really doing anything about it. Tomorrow, tomorrow, tomorrow I’m going to stop. I told so many lies to myself about what I was going to do tomorrow. I got tired of hearing my own broken promises. I thought I’d try hiring a trainer, but that didn’t work for me. I went to a few gyms. I lost some weight here and there and a few inches, nothing significant. It was a hard thing to get up the next day and say to myself again, you failed. I had decided that I would never go on another diet again, in saying that I didn’t mean I was going to give up on losing the weight. I just meant that I had to find something that worked. In the meantime, I was going to try to figure out how to be happy with where I was. I hear a lot of people saying that they are happy being fat, well I couldn’t just settle for that, I have to give it my best shot and in doing so I have to and will succeed! I purchased a book called, Make The Connection, written by Bob Greene and Oprah Winfrey. After reading her story and what she has had to go through in order to get to the weight she had obtained, I know that I can do this. I not only want to lose weight, but I want to be healthier, and happy in the body that was given to me. Once I get there, I am going to be content with where I am, and I will make sure that I stick to my program that I have put together so that I won’t fall back into the same situation which is hell for me. So ladies let’s work together and help each other to get our sexy bodies back and get healthy!!!! I also want to share this information with the men in the world that are having the same problems as we women are, and that is losing the weight or keeping it under control. The comments or suggestions that the men make on this blog is definitely appreciated, as I said I am here to share what I am going through with my weight loss journey and to help the men as well as the women, so if you know of any body that is in need of information on losing the weight and needs motivation or needs to be inspired share the website with them. Enjoy Life!!!
Source: inspired-weightloss.com

All in One Blog: OIG Updates Enforcement Actions

Owner of Westlake Home Health Agency Pleads Guilty to Bilking Medicare out of over $5 Million in Health Care Fraud Scheme http://go.usa.gov/RjV ____________________________________________________________________
Source: blogspot.com

Ten Louisiana Residents Charged by Medicare Fraud Strike Force

Also indicted are three women with A&A Durable Medical Supply LLC, in Plaquemine. Charged with conspiracy to commit healthcare fraud are: Linda M. Jackson, 49; her mother, Eunice Sparrow, 67; and one of Jackson’s daughters, Uniecesco Smith, 29. Sparrow was assistant manager at A&A. Smith worked for A&A in operations and billing. Between April 2007 and April 2009. The charges allege that the three women used A&A to fraudulently bill Medicare more than $4.8 million for equipment either medically unnecessary or never provided to patients. The total included $2.3 million in power wheelchairs that were never provided according to the indictment.
Source: homecarela.org

Medicaid Cuts won’t affect profits : South Carolina Nursing Home Blog

“Our analysis demonstrates that the rate reductions imposed by the CMS final rule have far exceeded the stated goal of parity with prior Medicare rates, and we remain concerned that these reductions may have serious consequences for our entire industry,” said William A. Mathies, chairman and CEO of Sun Healthcare Group, in a statement. “That said, we are moving expeditiously to mitigate the impact of the rule on our operations while retaining our focus on our primary mission of providing quality care.”
Source: scnursinghomelaw.com

medicare prescription drug plans: a goog thing, louisiana medicare part b

Nobody can be no healthy problem in his life. The uncertain ill conditions leads to uncertain charge. For many reasons ,goverment lines the medical treatment insurance. People can choose the hosptial whatever is expensive,cause they have medical treatment insurance. It is best for society. just imagine the happiness of being security. if you have the medicl insurance. Have health insurance, once you get sick, you can go to insurance company or community organization to submit an expense account some or all of the medical expenses. in some critical moment, such as car accidents, unexpected injuries and serious dieases,mediacl insurance will account for most of medical expenses or even all the expense ,that time ,how important to those people and family. For some of the old man had no children, health insurance is played a decisive role, they can be allowed to get care for free and more serucity. In countless undeveloped countries, the health care insurance plan is charged with by individuals and businesses. In order to get better medical insurace services, we finally choose some of the commercial health insurance companies. Before we should pay more attention and do some research. We should be clear that weather the company has been recognized by Insurance Regulatory Commission or not? It is very important weather the company has enough money to pay for accident insurance or not. We really should uncover out environment the business consists of a higher reputation or not. As well as, both the company’s health insurance products and insurance costs are taken into consideration. According to the survey ,it’s about 90% of Americans are enjoying the new medical insurance that the government adopted in 2010. The introduction of the new medical insurance can make the protection of many Americans’lives well. New Zealand government is planning to introduce new medical insurance program. Good medical insurance is an important indicator of stability and unity for a country’s people.
Source: blogspot.com

5 plead guilty in fraud scam involving clinics in Jefferson Parish

Two individuals from Metairie have pleaded guilty to conspiracy to commit health care fraud, as well as an individual from Kenner, one from Sherman Oaks California. A third individual from Metairie pleaded guilty to health care fraud. The individual from Kenner reportedly also pleaded guilty to conspiracy to commit money laundering. Several Louisiana-based clinics and one from California have pleaded guilty to involvement in the scam.
Source: batonrouge-criminallawyer.com

Louisiana Medicare Supplemental Plans: The State Has Done Its Research

The federal government must facilitate the widespread adoption of universal standards that will allow healthcare stakeholders to better share electronic health information and maintain patient privacy, according a report from the President’s Council of Advisors on Science and Technology (PCAST). The Office of the National Coordinator for Health Information Technology and the Centers for Medicare and Medicaid Services should develop guidelines to facilitate the adoption of a universal language for assisting the exchange of electronic health information and the transition from paper to electronic health records, PCAST said.
Source: americasnewsonline.com

Dennis Flint Earning His Wings, Again

About Dennis Flint Parker, Colorado resident and retired U.S. Air Force Capt. Dennis Flint earned a bachelor’s degree in Organizational Behavior from the U.S. Air Force Academy in 1977 and has enjoyed a long, varied and successful career in private industry. A former commercial pilot for Northwest Airlines and franchise manager for Snelling Temporary Services, he’s filled various roles – from sales director to VP of education to CEO – during two decades in the medical-practice support and administrative services industry. Dennis Flint currently serves as director of consulting and education for Baton Rouge, Louisiana-based Complete Medical Solutions.
Source: bloginteract.com

Gym benefits help Medicare plans recruit healthy seniors

Posted by:  :  Category: Medicare

Federal Building by midwestnerdOne analysis compared the self-reported health of seniors who enrolled in case plans before the fitness club benefit was offered to the health of those who enrolled after the benefit was offered. While 29.1 percent of the seniors who enrolled before the benefit was available described themselves to be in excellent or very good health, 35.1 percent of the seniors who enrolled after it became available reported that level of health. In the before group, 56.1 percent reported some limitation to their physical activity but only 45.7 percent in the after group did. Also, a third of the before group reported difficulty walking compared to just a quarter in the after group.
Source: sciencecodex.com

Video: Medicare Plan Finder at a Glance

Do Gym Memberships Help Medicare Advantage Plans Attract …

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

Medicare Plans Recruit Healthy Seniors By Offering Gym Benefits

Because healthy enrollees cost them less, Medicare Advantage plans would profit from selecting seniors based on their health, but Medicare strictly forbids practices such as denying coverage based on existing conditions. Another way to build a more profitable membership is to design insurance benefits that attract the healthiest patients…
Source: ewallstreeter.com

Humana dropping Thomas, Saint Francis for Medicare plans 

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Source: wvgazette.com

Medicare Disenrollment Period For 2012

[…] If you are enrolled into a Medicare Advantage Plan, you are allowed to drop your Medicare Advantage Plan and go back to original Medicare.  If you do this, you will also want to enroll into a Medicare Part D Prescription drug plan.  Original Medicare is the Part A and Part B that is on your paper Medicare card that you received when you first joined Medicare.  It does not include drug coverage which is why you would want to enroll into a Part D drug plan.  You have until February 14th to enroll into a Part D drug plan.  The coverage starts the first day of the month after you enroll.  For example, if you enroll into the drug plan on January 20th, your coverage would start on February 1st.  If you wait until February 14th to enroll, then your coverage starts on March 1st.Source: medicare-plans.net […]
Source: medicare-plans.net

Medicaid Cuts won’t affect profits : South Carolina Nursing Home Blog

Posted by:  :  Category: Medicare

319 | Tragedies of Medicine by The Doctr“Our analysis demonstrates that the rate reductions imposed by the CMS final rule have far exceeded the stated goal of parity with prior Medicare rates, and we remain concerned that these reductions may have serious consequences for our entire industry,” said William A. Mathies, chairman and CEO of Sun Healthcare Group, in a statement. “That said, we are moving expeditiously to mitigate the impact of the rule on our operations while retaining our focus on our primary mission of providing quality care.”
Source: scnursinghomelaw.com

Video: Medicaid, Nursing Homes and Asset Protection

So What If the Government Pays for Most LTC?

  ALFs are 90% private pay and they cost an average of $41,724 per year (Source:  2011 MetLife survey at http://www.metlife.com/assets/cao/mmi/publications/studies/2011/mmi-market-survey-nursing-home-assisted-living-adult-day-services-costs.pdf).  Many people who could afford assisted living by spending down their illiquid wealth, especially home equity, choose instead to take advantage of Medicaid nursing home benefits.  Medicaid exempts one home and all contiguous property (up to $525,000 or $786,000 depending on the state), plus one business, and one automobile of unlimited value, plus many other non-countable assets, not to mention sophisticated asset sheltering and divestment techniques marketed by Medicaid planning attorneys.  Income rarely interferes with Medicaid nursing home eligibility unless such income exceeds the cost of private nursing home care. 
Source: honeyleveen.com

What Happens to Current Nursing Home Residents if the House Budget Resolution Becomes Law? 

[1] John Hancock, “John Hancock Announces Results of 2011 National Long-Term Care (LTC) Cost Study” (April 21, 2011), http://www.johnhancock.com/about/news_details.php?fn=apr2011-text&yr=2011. [2] Nursing home residents receiving Medicaid and those receiving Medicaid-financed home and community based services are the only Medicaid beneficiaries who have a second financial determination made after they are found eligible for Medicaid.  In the "post-eligibility" financial determination, the state determines how much of his or her income the Medicaid beneficiary must contribute to the cost of nursing home or community based care.  All income must be contributed, with limited deductions for health insurance premiums, costs of maintaining the home while a spouse or dependent child lives there, and a monthly personal needs allowance of $30 (which some states supplement).  42 C.F.R. §§435.832, 436.832 ("Post-eligibility treatment of income of institutionalized individuals; Application of patient income to the cost of care"). [3] 42 U.S.C. §1396p. [4] AARP Public Policy Institute, "Valuing the Invaluable: A New Look at the Economic Value of Family Caregiving,"  http://assets.aarp.org/rgcenter/il/ib82_caregiving.pdf. [5] Kaiser Family Foundation, "Medicaid and Long-Term Care Services and Supports" (Feb. 2009), http://www.kff.org/medicaid/upload/2186_06.pdf. [6] American Healthcare Association, LTCStats: Nursing Facility Patient Characteristics Report (March 2011), http://www.ahcancal.org/research_data/Pages/default.aspx (click on the report), based on data from the Centers for Medicare & Medicaid Services’s Certification and Survey Provider Enhanced Reporting (CMS-CASPER), formerly OSCAR data. [7] The National Nursing Home Survey reported in November 2010, that in 2004, 543,100 of 1,492,200 residents used Medicare at the time of admission.  At the time of their interview, however, only 189,400 were using Medicare.  Many residents had shifted to Medicaid.  518,700 residents used Medicaid at admission, but by the time of their interview, 890,200 relied on Medicaid.  Table 8, "Number of nursing home residents by selected resident characteristics according to all sources of payment at time of admission and at time of interview: United States, 2004," http://www.cdc.gov/nchs/nnhs/nnhs_products.htm (click on Series 13, No. 167). [8] Medicare Payment Advisory Commission (MedPAC), Report to Congress: Medicare Payment Policy, 154, Table 7-3 (March 2011). [9] Center for Disease Control and Prevention, The National Nursing Home Survey: 2004 Overview page 4, Vital and Health Statistics, Series 13, No. 167 (June 2009), www.cdc.gov/nchs/data/series/sr_13/sr_13_167.pdf.   [10] MedPAC, supra note 3, 149. [11] Id. 165. [12] 42 U.S.C. §1307a(a)(17)(D). [13] 42 C.F.R. §447.15. [14] 42 U.S.C. §1396r-5. [15] 42 U.S.C. 1395i-3(a)-(h), 1396r(a)-(h), Medicare and Medicaid, respectively. [16] More than 90% of nursing facilities participate in both Medicare and Medicaid.  American Healthcare Association, LTCStats: Nursing Facility Operational Characteristics Report, Table 3, page 5 (March 2011), http://www.ahcancal.org/research_data/Pages/default.aspx (click on the report), based on CMS Form 671:F9.  As a result, the repeal of Medicaid would not lead to the immediate loss of the Reform Law’s protections as long as a facility continued to participate in Medicare.  However, with immediate changes to Medicaid and changes to Medicare on the horizon, it seems likely that the federal standards of care would soon be substantially compromised.
Source: medicareadvocacy.org

Paying for Skilled Nursing Care: Medicare & Medicaid

Many seniors on Medicare get understandably confused when trying to determine what long-term care is provided by the program. The short answer is: very little. The Centers for Medicare and Medicaid Services have produced a handbook entitled Medicare Coverage of Skilled Nursing Facility Care which is a good starting point for those hoping to learn more. In general, the takeaway is that Medicare will only pay for certain skilled nursing stays and never for those staying longer than 100 days. The first 20 days of qualifying care are covered completely, while anything more (up to 100 days) often requires some sort of copayment. To even qualify for that care a resident must have a qualifying hospital stay, need the care immediately after the hospital stay, and meet a few other requirements.
Source: medicaidnursinghome.ca

Drug Errors In Care Homes Very Common, UK

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

Medicare Nursing and Home Care Coverage

Do you want the benefits of Medicare home health care fell by almost half in 1997 to $ 18.3 billion $ 9.5 billion in 1999, stimulated demand for more benefits of home care, as Americans get more of the former
Source: blogspot.com

Terms To Better Understand Your Nursing Home : Nursing Homes Abuse Blog : Jonathan Rosenfeld’s Nursing Homes Abuse Blog : Jonathan Rosenfeld’s Nursing Homes Abuse Blog

For families seeking information on a particular nursing home or additional information about a specific event, the need for such information usually comes at a time when external pressures abound.  In order to fully appreciate such information, it is important to have a complete grasp of the terms involved. 
Source: nursinghomesabuseblog.com

Congressional “Super Committee” Meets, THCA Urges Protection From Texas Rep. Hensarling Co

Graves noted that Texas is especially challenged by chronic Medicare and Medicaid underfunding that has put the continued provision of quality nursing home care at risk in many local communities. Recent funding challenges include Medicaid nursing home cuts of $58 million enacted this year and federal Medicare cuts of $1.6 billion over ten years implemented as part of health care reform and other regulatory changes. In addition, the Centers for Medicare and Medicaid Services (CMS) has reduced Medicare nursing home funding in Texas by $234 million – a 10.4% rate reduction for 2012 – at a time when nursing homes are experiencing rising costs of care as residents are requiring additional complex and acute care services.
Source: conservativedailynews.com

Caregiverlist.com Provides Daily Costs of Nursing Homes Nationwide

FOR IMMEDIATE RELEASE / PRURGENT Senior caregiving costs and options vary depending on a senior

The Republicans’ push to end Medicare

Posted by:  :  Category: Medicare

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

Video: Arkansas Medicare Supplements

Golden Living Accused Of Fraudulent Medicare Practices, DOJ Steps In 

Add new tag Alltel Alltel Corp. Anarian Chad Jackson Arkansas Arkansas Advocates for Children and Families Arkansas Board of Corrections Arkansas Department of Health Arkansas Soybean Association Arkansas Take Back Barack Obama Benny Magness Bobby Glover Brandon Mitchell Cartoon Cartoons D&E Communications EFCA gang GI Bill Gunner DeLay Harville Cartoon I. Dodd Wilson Kim Hendren L.T. Simes Larry Norris Lea little rock Mark Pryor Mike Beebe National Institutes of Health Patrick Kennedy Race for 100 Randeep Mann recession Russellville Sitzer soybeans swine flu Tim Leathers Twitter UAMS Verizon Vic Snyder Windstream
Source: arkansasnews.com

Medicare Insurance in Arkansas

There are different Medicare insurance plans in Arkansas then from America. Citizens of Arkansas may qualify for the insurance while less than 65 years. To know more about Medicare insurance you should know about the insurance system first. There are mainly two major headings under which all other Medicare insurances take place. One is original Medicare coverage and other is Medicare advantage insurance. The original Medicare insurance is that which is comprised of Part A and Part B Medicare and for Medicare Advantage insurance this is comprised of Part C. AR Medicare Advantage insurance also comes in Medicare insurance Part C. this allows you to get coverage just like original Medicare insurance and also in supplements in several cases. The main feature of this insurance plan is that prescription drugs are included in this.
Source: firerubenamaro.net

How Do I Apply for an Arkansas Medicare Provider Transaction Access Number?

21st Century Care Providers specializes in opening New Home Care Agencies. We will help you establish a well organized senior home care business that gives the highest level of service to your deserving senior population.Their new agency start-up program has NO FRANCHISE FEES – NO ROYALTY FEES or NO TERRITORY RESTRICTIONS. They can be reached at 888-850-6932 or visit them on the web. www.1stproviders.com.21st Century Care Providers specializes in opening New Home Care Agencies. We will help you establish a well organized senior home care business that gives the highest level of service to your deserving senior population.Their new agency start-up program has NO FRANCHISE FEES – NO ROYALTY FEES or NO TERRITORY RESTRICTIONS. They can be reached at 888-850-6932 or visit them on the web. www.1stproviders.com.
Source: 1stproviders.com

DownWithTyranny!: Arkansas

right-wing Republicans and a disgusting, corrupt Blue Dog reactionary, Mike Ross, who is, thankfully, finally retiring. So what is the Democratic Party doing to fight back? Nothin’ much. They have a horrid Blue Dog, Clark Hall, running in the First CD against Rick Crawford in a race that will leave voters wondering if the subtle differences between the two are enough to bother turning out for. In the Second District– the Little Rock-based one, which should be a Democratic stronghold– there isn’t even a candidate against Rove protégé Tim Griffin; there are just unsubstantiated rumors that Bill Halter or Wes Clark “might” run. And in the 4th, Ross is making sure the Democratic nominee will be as far to the right as he is. Keep in mind that according to ProgressivePunch, Ross voted with the Republicans 82% of the time this year (on crucial roll call votes), more frequently than all but one other Democrat, Blue Dog Dan Boren, also retiring, and more than seven Republicans! That leaves one district, so far at least, where Democrats have reason to hope– the Third, usually Arkansas’s most hopeless of all. Even when Democrats were real Democrats and served the interests of ordinary working families, the Third, in the northwest part of the state, was a GOP bastion, under the near-feudal control of the Walton family. The district has been under Republican control back to Civil War times, and in 1974 a right-wing fanatic, John Paul Hammerschmidt, beat Bill Clinton, then 28, in his first try for office. Although the district did vote for favorite son Clinton in 1992, it was back voting GOP in 1996 and gave Bush 60% in 2000 and 62% in 2004. McCain did even better in 2008 (something that happened in only the most racist and/or fascist-oriented districts in the country), with 64% against Obama. In 2010, with Congressman John Boozman pulverizing the despised Lincoln on his way to the Senate, the district elected one-percenter Steve Womack with a startling 72%, winning all 12 counties with over 60% of the vote. And yet… even in the darkest of situations, the brightest of lights can shine through. Of all the unlikely places, home to Walmart and Tyson Chickens, a genuine blue-collar New Deal fighting Democrat is running a real race against one of the most vile Republicans in Congress. Ken Aden is taking on self-entitled would-be plutocrat Steve Womack in a race that is finally starting to get national attention. Oh, I don’t mean from “ex”-Blue Dog Steve Israel and his discredited DCCC, which, of course, is only backing guaranteed loser Blue Dog Clark Hall. But more and more national groups are starting to take a look at the brilliant and inspirational campaign that Aden is running against the bungling, arrogant Womack. Last week he was endorsed by Congressional Progressive Caucus co-chair Raúl Grijalva. For one of the most dogged and effective champions of working families to take note of Ken’s race must be startling to voters in Arkansas, where politicians usually serve the special interests of big corporations. Here’s what Grijalva has to say in his endorsement: The next Congress must protect Social Security, Medicare and Medicaid, and rebuild our crumbling infrastructure. In the face of such weighty issues that have the potential to affect millions of Americans, we need more members of Congress with a true, progressive vision for the future, a representative who will put the interests of American families first. We need people like Ken Aden in Congress. After serving his country in Iraq and Afghanistan as a staff sergeant in the U.S. Army, Ken returned home to Arkansas and helped found a nonprofit organization dedicated to the belief that people from every economic background and walk of life can come together in some small way to create for themselves a better community and neighborhood. Ken will bring this same vision, understanding and energy to the United States Congress and fight on the behalf of the people northwestern Arkansas. Womack’s biggest single source of contributions is Walmart, his second a bank that thrives on foreclosures, and the third Tyson Foods. You get the picture? Another major donor: Koch Industries. So far this year 60% of his campaign cash has come from corporate and far right PACs, less than a third from real people. Every dime Ken has gotten has come from individual donors, all of it in small amounts. If you can, please step up and consider helping get his message out in the sprawling Arkansas district where he means to make history. You can do it here at the Blue America ActBlue page.
Source: blogspot.com

Arkansas Medicare Part D Plans

When researching Arkansas Medicare Part D plans, take the time to visit plan websites for any plan that you are interested in and explore the formulary. Not only will you determine if your drugs are covered but which tiers your drugs are listed in as well. The drug tier will determine how much you will pay for copays and coinsurance. Follow these simple steps and you should have no problem finding the right Arkansas part D plan for 2012.
Source: partdplanfinder.com

Republicans still want to kill Medicare

Steel, nice try but the fact is that both sides have to give up some of their sacred cows and Medicare is a Democratic concern because they actually care for people like the Bible says. Republicans only care for teh rich and corporations but you know that. The Rethuglicans so far haven’t made any concessions and until they do, the whole issuie is moot and the Defense budget will take another $600,000 hit. If they don’t reach an agreement, the president should veto any plan to stretch out the timimng. They are grown adults and if they won’t work together than take all of the hits where they belong. Defense spending is the Republican stimulus plan with plants located in their favorite states and districts and it is time to bring the defense costs back in line with 2001 + compound interest and if it costs them some votes, well too damn bad. Right now the Defense budget is 62% higher than 2001 and I can tell you, with the current Congress I don’t feel 62, or even 6% safer. Solon is reporting that the committee may come up with an agriculture bill with all of the subsidities still there and cuts to food stamps and almost total elimination of the conservation program and hide it in the budget bill so it can’t be discussed or amended. I don’t think the Rethuglicans can pass up on the chance to make a lot of their plans to further enrich corporations without discussion or the right of the people to have a say. The Tea Pot brains in Congress need to have the opportunity to go back home and sulk. They always have their left over campaign funds to build their retirement.
Source: arktimes.com

Medicaid Cuts won’t affect profits : South Carolina Nursing Home Blog

“Our analysis demonstrates that the rate reductions imposed by the CMS final rule have far exceeded the stated goal of parity with prior Medicare rates, and we remain concerned that these reductions may have serious consequences for our entire industry,” said William A. Mathies, chairman and CEO of Sun Healthcare Group, in a statement. “That said, we are moving expeditiously to mitigate the impact of the rule on our operations while retaining our focus on our primary mission of providing quality care.”
Source: scnursinghomelaw.com

Medicare Advantage Plan Provides Model for Improving Care for Patients with Diabetes

The new study, “Medicare Advantage Chronic Special Needs Plan Boosted Primary Care, Reduced Hospital Use Among Diabetes Patients,” examines the model of care used by the largest Medicare Advantage chronic special-needs plan, Care Improvement Plus, and compares utilization rates among its members with diabetes in Arkansas, Georgia, Missouri, South Carolina and Texas with those of similar beneficiaries enrolled in fee-for-service Medicare in the same five states.  Care Improvement Plus’ Model of Care emphasizes direct contacts with patients to help identify gaps in care and promote primary and preventive health care, including periodic home visits with plan clinicians.
Source: ahipcoverage.com

Do Gym Memberships Help Medicare Advantage Plans Attract …

Posted by:  :  Category: Medicare

What's In My Bag... by Amy DiannaThe 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: Using a Medicare card, Australia

Medicare Disenrollment Period For 2012

[…] If you are enrolled into a Medicare Advantage Plan, you are allowed to drop your Medicare Advantage Plan and go back to original Medicare.  If you do this, you will also want to enroll into a Medicare Part D Prescription drug plan.  Original Medicare is the Part A and Part B that is on your paper Medicare card that you received when you first joined Medicare.  It does not include drug coverage which is why you would want to enroll into a Part D drug plan.  You have until February 14th to enroll into a Part D drug plan.  The coverage starts the first day of the month after you enroll.  For example, if you enroll into the drug plan on January 20th, your coverage would start on February 1st.  If you wait until February 14th to enroll, then your coverage starts on March 1st.Source: medicare-plans.net […]
Source: medicare-plans.net

Rx Discount Drug Card from Medicare Card

arizona california medi-cal dental Drug Plan electronic health record Health HIV How Social Security Works How to File a Claim for Medicare How to get a new medicare replacement card HUD M.D. Medicaid medicaid card Medicaid Services Medicare medicare card MedicareCard.com MedicareCard Replacement medicare card replacement Medicare claims process medicare coverage Medicare has Two Parts Medicare Help Medicare Part A Hospital Insurance Coverage Medicare Premium Amounts for 2010 Medicare Prescription Drug Coverage Meeting Announcement MyMedicare.gov National Institutes of Health Need a Replacement Card? Order a Medicare Card by Phone or Online NIH NIMH Obama Part A (Hospital Insurance) Part B (Medical Insurance) part of the National Institutes of Health protecting my social security number replacement social security card Social Security social security card some disabled people under age 65 ssa.gov Supplier Enrolled in Medicare VA
Source: medicarecard.com

Five new personal accounts Medicare card payments

Municipal Human Resources and Social Council in the "city of Yinchuan on further improving the urban basic medical insurance, personal account management system view" provides that: personal accounts funds can be used to pay costs of insured health checks; can be used as a home health care accounts for other family members insufficient funds to pay personal accounts when the supplement; discharge settlement costs, start with the insured individual account funds to pay medical expenses to be paid by individuals, personal account of insufficient funds to pay, they may pay cash medical institutions; outpatient medical treatment when ill require the payment of the cost should be personal, available funds to pay for personal accounts; in designated retail pharmacies to buy health insurance drugs, pharmaceuticals and personal need non-Medicare medical equipment, disinfectants and Drug Administration to allow operation of health care products, the funds to pay for personal accounts are available.
Source: cebodoors.com

Medicare expands savings initiative in Louisiana

Posted by:  :  Category: Medicare

THE PEOPLES LEADER by SS&SS“Health Coach” is a law suit waiting to happen. Without one on one in person contact with that patient a nurse “health coach” is begging to lose her or his license. What are they going to do ask them how they’re doing? Did you take your meds? Supposedly they saved 5.2% from readmission. Whoop te do. They are only impressing themselves. Anyone with any medical experience will tell you right off that someone wants to get in on the medicare action in a big way.
Source: nola.com

Video: Medicaid Louisiana Part 2

Five Year Prison Sentences Handed Down In Nnanta Felix Ngari — Unique Medical Solutions Case

Evidence at trial established that Ngari owned and operated Unique Medical Solution Inc., a Baton Rouge, La.-area DME supply company that specialized in the provision of power wheelchairs to Medicare beneficiaries. Beginning in late 2003, Ngari paid recruiters, including Payne, to locate and solicit prescriptions for medically unnecessary power wheelchairs, which Ngari used as a basis to submit false and fraudulent claims, on behalf of Unique, to Medicare. As part of the scheme, Payne used churches and other Baton Rouge locations to host “health fairs,” at which Medicare beneficiaries would be prescribed medically unnecessary power wheelchairs by doctors, including Lamid. Lamid and the other physicians were paid illegal kickbacks by recruiters based on the number of power wheelchair prescriptions generated at the health fairs. Payne, likewise, was paid kickbacks by Ngari based on the number of prescriptions he brought to Unique.
Source: newsroom-magazine.com

Louisiana Health Care Company Owner and Recruiter Plead Guilty to Medicare Fraud Scheme

Abogada Abogado Administrator of Competition Ana Teresa Carrión Antitrust Antonio Robles Anwalt ArnoLampmann Attorney avocat Barreau canadien Brian Inkster CDCINCAM Comision Federal de Competencia Competition Competition Law curia Derecho Dimitris Temperis droit eu Fachanwalt Google Inksters Solicitors Jan Weber Jarod Bona Jorge Kargl José Luis Cárdenas Jose M Delgado Cobos Kunstrecht law Law Library Lawyer legal LL.M. loi Maurice Stucke Miguel Flores Bernés Nacol Law Firm PC PhD. Recht Rechtsschutz SHUNASHI ALTAMIRANO USDOJ WSJ Law
Source: circleoflaw.com

Owner and Patient Recruiter Heading to Prison for Roles in $4.7m Louisiana Medicare Fraud Scheme

Evidence at trial established that Ngari owned and operated Unique Medical Solution Inc., a Baton Rouge, La.-area DME supply company that specialized in the provision of power wheelchairs to Medicare beneficiaries. Beginning in late 2003, Ngari paid recruiters, including Payne, to locate and solicit prescriptions for medically unnecessary power wheelchairs, which Ngari used as a basis to submit false and fraudulent claims, on behalf of Unique, to Medicare. As part of the scheme, Payne used churches and other Baton Rouge locations to host “health fairs,” at which Medicare beneficiaries would be prescribed medically unnecessary power wheelchairs by doctors, including Lamid. Lamid and the other physicians were paid illegal kickbacks by recruiters based on the number of power wheelchair prescriptions generated at the health fairs. Payne, likewise, was paid kickbacks by Ngari based on the number of prescriptions he brought to Unique.
Source: netnewspublisher.com

Louisiana Law Blog: 2011 Medicare RAC Audit Results

CMS released 2011 recovery results for the Recovery Audit Contractor (RAC) Program. The 2011 figures reflect a significant increase over the amounts recovered or returned to providers in 2010. Through four quarters (October, 2010 through September, 2011), RAC contractors recovered a total of $797.4 million in overpayments, with $141.9 million in underpayments returned to providers. The recovery amounts increased with each quarter of the fiscal year, from $82.9 million in the first quarter to $277.1 million in the last quarter.
Source: louisianalawblog.com

Medicaid Cuts won’t affect profits : South Carolina Nursing Home Blog

“Our analysis demonstrates that the rate reductions imposed by the CMS final rule have far exceeded the stated goal of parity with prior Medicare rates, and we remain concerned that these reductions may have serious consequences for our entire industry,” said William A. Mathies, chairman and CEO of Sun Healthcare Group, in a statement. “That said, we are moving expeditiously to mitigate the impact of the rule on our operations while retaining our focus on our primary mission of providing quality care.”
Source: scnursinghomelaw.com

Louisiana economy will be affected by Medicaid cuts

Despite these positive events which have increased Louisiana’s economic output, there are proposed cuts to Medicaid funding that would negatively impact the State’s economy by reducing hospital revenue. According to a report from the Louisiana Hospital Association (LHA); hospitals throughout Louisiana State employ a combined total of over 99,350 people and contributes 4.4 billion in payroll throughout the year. The report goes into detailed numbers explaining how the economic contributions of hospitals to the state would be negatively affected by proposed Medicaid budget cuts. According to their analysis budget cuts would terminate approximately 6,764 jobs and result in a reduction of $258 million in earnings throughout the state.
Source: debtplan.org

Performance Bonus Accorded for Louisiana and Connecticut

This was the first time Connecticut was able to receive a performance bonus from HHS. For the previous years, the state was not able to meet the criteria needed for qualification.  This year, Connecticut made an extra effort in adding a fifth program feature which they “presumptive equality.” The new program is called Children’s Health Insurance Program (HUSKY B) which was implemented last April.  The policy was the main reason that prompted the good news.
Source: childrenhealthwizard.com

Mississippi has highest rate of obesity in nation; Louisiana holds steady in 8th place

Hello, I am a mother of seven and I have been dealing with weight since I had my daughter in 1980. I would lose the weight, but some how it would always come back. My highest weight now has been 260lbs and I hate it, this is a miserable feeling. It’s like the body you are in is not your own, but for someone else and you want out of it so much that you can scream. I am here to post my weight loss journey and share it with the women of the world that are having the same problems I am having, which is keeping the pounds at bay permanently. My weight consumed my life. There was not a day that passed that I didn’t think about it. But I wasn’t really doing anything about it. Tomorrow, tomorrow, tomorrow I’m going to stop. I told so many lies to myself about what I was going to do tomorrow. I got tired of hearing my own broken promises. I thought I’d try hiring a trainer, but that didn’t work for me. I went to a few gyms. I lost some weight here and there and a few inches, nothing significant. It was a hard thing to get up the next day and say to myself again, you failed. I had decided that I would never go on another diet again, in saying that I didn’t mean I was going to give up on losing the weight. I just meant that I had to find something that worked. In the meantime, I was going to try to figure out how to be happy with where I was. I hear a lot of people saying that they are happy being fat, well I couldn’t just settle for that, I have to give it my best shot and in doing so I have to and will succeed! I purchased a book called, Make The Connection, written by Bob Greene and Oprah Winfrey. After reading her story and what she has had to go through in order to get to the weight she had obtained, I know that I can do this. I not only want to lose weight, but I want to be healthier, and happy in the body that was given to me. Once I get there, I am going to be content with where I am, and I will make sure that I stick to my program that I have put together so that I won’t fall back into the same situation which is hell for me. So ladies let’s work together and help each other to get our sexy bodies back and get healthy!!!! I also want to share this information with the men in the world that are having the same problems as we women are, and that is losing the weight or keeping it under control. The comments or suggestions that the men make on this blog is definitely appreciated, as I said I am here to share what I am going through with my weight loss journey and to help the men as well as the women, so if you know of any body that is in need of information on losing the weight and needs motivation or needs to be inspired share the website with them. Enjoy Life!!!
Source: inspired-weightloss.com

5 plead guilty in fraud scam involving clinics in Jefferson Parish

Two individuals from Metairie have pleaded guilty to conspiracy to commit health care fraud, as well as an individual from Kenner, one from Sherman Oaks California. A third individual from Metairie pleaded guilty to health care fraud. The individual from Kenner reportedly also pleaded guilty to conspiracy to commit money laundering. Several Louisiana-based clinics and one from California have pleaded guilty to involvement in the scam.
Source: batonrouge-criminallawyer.com

Dennis Flint: A GEM in the Rough

The Center for Medicare & Medicaid Studies’ planned update from ICD-9 to ICD-10 in October 2013 – the first update of the diagnosis coding system in 25 years – represents a massive upheaval for national medical practitioners. Even to laymen, the change appears daunting: from about 14,000 codes, each three to five characters long, to over 68,000 codes, some as long as seven characters. For doctors, there will be rough seas indeed; according to some studies, it will cost the average five-doctor practice about $160,000 over three years to implement the coding change, while that same firm can expect a 20-percent revenue drop – if it perfectly implements the changes.
Source: bloginteract.com

Q&A: Can a person in Louisiana who has cancer get Medicare at the beginning of disability?

About Advantage affordable article Benefits best Business Care Companies compare comparison costs Coverage dental drug financial find from Good great Guide Health Healthcare home Insurance Joint Life Medicaid Medical Medicare News Nursing online Part Plan Plans Private Quotes Reform Report Security Small Social Student Supplemental
Source: healthinsuranceandmedicareupdate.com

Important Information Surrounding Medicare Plans and Coverage

Posted by:  :  Category: Medicare

ILGWU senior female members and retirees holding placards urging "fair play for the aged", "hands off social security", "don't mess with medicare", "keep your promises Mr. President", and more. by Kheel Center, Cornell UniversityMany insurance companies offer to explain the different Medigap policies but it is best to find assistance from a company that looks into each situation and explores the options and costs associated through many different insurance agencies. The coverage is completely regulated by the government so the plans consist of the same coverage the differences will come in service and cost from different insurance agencies. A company such as Senior Health Direct which is web based can offer assistance and free information on Medicare and Medigap Supplemental Insurance Plans. Another source of information that can be easily accessed through Internet is the Medicare government’s site.
Source: articlesaffair.com

Video: Medicare Advantage Information Session with Q&A

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

With regard to the reasons against, it is important to understand a few basic facts about the MSP to understand why reliance upon CMS memos was shaky at best. First, the CMS policy memoranda are merely agency interpretations of the governing statutes and regulations and do not carry the force or effect of law. While generally granted deference by the courts, CMS policy is not infallible nor is it the only means by which to comply with the underlying legal obligations. It is simply the agency’s recommendation in light of what it believes it can do to pursue recovery under the MSP. The WCMSA review program is not governed specifically by any law or regulations and is voluntary, a fact finally openly admitted by CMS itself in its May 2011 memo. Those who have followed the issue since the beginning will recall CMS’ liberal use of the word “must” in the early memos, and the idea that an MSA must be approved by CMS when the settlement meets the established thresholds continues to erroneously linger today. The reason we have not had any detailed memos for liability is that tort law is not as uniform as workers’ compensation, thus it would be impossible to render unilateral policies across all jurisdictions as was possible for workers’ compensation which is fundamentally the same throughout the country. I am not saying that all states are exactly the same, only that the differences are more the exception, whereas in liability, the only common thread is generally the common law elements of negligence. Pretty much everything after that will be determined on a case by case basis due to a unique limiting feature specific to state law or governed by an insurance contract. To even expect such policies to be issued by CMS is unreasonable in and of itself, but to rely upon the absence as a means to avoid a statutory obligation borders upon negligence.
Source: medicaresetasideblog.com

Medicare Open Enrollment: 4 Places to Look for Medicare Information

Your mailbox Look through your mail carefully — you may get important notices from your current plan, Medicare, or Social Security about changes to your coverage or any extra help you may get paying for prescription drugs.Also look for your Medicare & You handbook.  Like an old friend, it shows up around the same time every year. This year, it may be in your email inbox instead – if you decide to “go green” and asked to get it electronically. But whether it’s on your computer or on your bookshelf, now is the time to take it out and find out what’s new in Medicare.
Source: medicare.gov

Do Gym Memberships Help Medicare Advantage Plans Attract …

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

Medicare launches accountable care program

3D Technology: Increasing the Need for Optometric Vision Therapyby Toni BristolThe use of 3D technology is growing exponentially. People who may have been able to ‘get by’ and adapt to life without depth perception or intermittent depth perception, are discovering they have a problem. When they go to their eye doctor what treatment options will be presented? […]
Source: newsfromaoa.org

The Way It Is Against Medicare Add To Insurance

For Mary this is the quality of your life issue, not really your life and death. The advantage options for this sort of supplemental plan frequently include vision gains, dental benefits, coverage for medicare insurance members of the family, drug co-pays, office visit co-pays, etc. Once you know the major brands of Medicare Supplement Insurance agencies and the address of these respective official internet sites, it is all to easy to visit those sites and do any window shopping within the facilities offered by these lenders on purchasing Medicare supplement policies. But be sure to have to result in the medical advantages plan before ones own policy begins. One of these is it is illegal to provide any individual multiple gap insurance policy because only 1 is necessary which are the same benefits regardless of what company you invest in. Even should your insurance coverage professional refuses (and that is unusual), you can seek the advice of the California State Insurance protection Department.
Source: leftrightmgmt.com

Healthcare IT, Medicare, Medicaid, HIE, Health Information Exchange

Medicaid efficiency and quality is important area of focus. Not surprisingly, NCSL explains that the current economic turbulence is troubling Medicaid budgets and, as such, nearly every state has engaged in cost-containment in one form or another. “States are not just cutting to meet budget demands,” NCSL points out. “State policymakers – looking toward the 2014 eligibility expansion of Medicaid dictated by the ACA – are exploring innovative ways to improve the value of the Medicaid program.” These include aligning incentives with outcomes, testing new payment models, building new delivery systems such at patient-centered medical homes (PCMH), as well as integration services for patients under both Medicaid and Medicare.
Source: hitechanswers.net

LOS ANGELES WOMAN SENTENCED TO 60 MONTHS IN PRISON FOR HER ROLE IN A $6.2 MILLION MEDICARE FRAUD SCHEME

In March 2011, Vasquez pleaded guilty to conspiracy to commit health care fraud. In her plea agreement, Vasquez admitted that from 2007 to 2008, she conspired with others to use a series of fraudulent Los Angeles-area medical clinics to defraud Medicare. Vasquez admitted that her co-conspirators used the identities and Medicare provider numbers of physicians who both worked and did not work at the clinics to submit false claims to Medicare for reimbursement for services the physicians did not perform and for power wheelchairs, medical equipment and diagnostic tests that the physicians did not order or prescribe. According to court documents, physician assistants recruited to work at the clinics by Vasquez, and working at her direction and the direction of others, performed services that were medically unnecessary and prescribed and ordered the wheelchairs, medical equipment and diagnostic tests that were medically unnecessary.
Source: bestdefender.com