DownWithTyranny!: Ryan And Boehner Want A Second Shot At Destroying Medicare And Medicaid

Posted by:  :  Category: Medicare

Occupy St Pete march through downtown St Pete, No. 3 by Fifth World ArtNot a day goes by on Twitter when the GOP noise machine doesn’t puke out something like this (these are all from yesterday morning): The biggest problem with passing the budget, of course, is that the GOP is using it to push forward their dangerous and radical right-wing social agenda (as even Newt Gingrich readily admitted, calling Ryan’s budget “right-wing social engineering”; see video above). The Republicans seem convinced this is a winning issue for them– ending Medicare and Medicaid. In fact, Boehner and Ryan are threatening to insert it into this year’s budget again. Boehner was on Fox News Sunday citing how Ryan and Democrat Ron Wyden have a “bipartisan” idea of how to push forward the Republican Party’s dangerous right-wing social agenda. At a GOP strategy session on Friday, Ryan told the Republican House Members, many of whom are scared to death that trying to destroy Medicare may not prove to be a good idea in an election year, “We’re not backing off on the kinds of reforms that we’ve advocated, but we have to write it… We’ve done more to normalize the idea of premium support than anything at all. We’re confident that these are the right policies. There’s an emerging bipartisan consensus that’s occurring on doing premium support reform to Medicare is the best way to save Medicare.” By bipartisan he means Wyden and a motley crew of reactionary and despised Blue Dogs. Rob Zerban, Ryan’s Democratic opponent, is far more in touch with what the American people are looking for than Ron Wyden and the mangy Blue Dogs. “Paul Ryan just announced he is taking a second swing at Medicare,” writes Zerban. “His ‘new’ plan is devastating to Medicare as we know it, but the big difference is that he found one Democrat to help him!” Here is what has been happening– Paul Ryan has introduced a new plan to start the privatization of Medicare. He convinced a “Democrat,” Ron Wyden, to join in this effort. Ron Wyden, like Paul Ryan, has raked in an alarming amount of lobbyist money from the health insurance industry. Make no mistake– this is no bipartisan effort! Almost all Democrats, including President Obama, are strongly opposed to this plan. Here is what the White House Communications Director had to say: [this scheme could] “cause the traditional Medicare program to “wither on the vine” because it would raise premiums, forcing many seniors to leave traditional Medicare and join private plans. It would shift costs from the government to seniors. At the end of the day, this plan would end Medicare as we know if for millions of seniors.” It is clear what this plan is designed to do. Both Paul Ryan and Wyden admit that it will likely not save anyone any money! The only upside is a big giveaway to private insurance companies at the expense of our seniors. This is sham bipartisanship and the voters of Wisconsin are not fooled! Ryan has to be stopped. Wall Street has every intention of making him president someday. The DCCC has studiously ignored him– if not protected him– for a decade. Rob Zerban is taking him on with zero help from “ex”-Blue Dog Steve Israel, the chair of the DCCC. Zerban just forced Ryan to switch his position and back away from supporting SOPA. He deserves our help, and you can give him some right here at the ActBlue Stop Paul Ryan page. (I should add that Ryan has probably taken more sleazy, corporate cash than any other Member of the House and currently has $4.6 million sitting in his campaign warchest, virtually all of it from corporate special interests.)
Source: blogspot.com

Video: Medicare and Medicaid: What’s it all mean?

Hospice: A Medicare and Medicaid Profit Center?

A new legal battle has begun to churn, as recently reported at Kaiser Health News. Yet another healthcare company is being accused of taking advantage of the elderly and their families to draw the greatest yield from Medicare and Medicaid coffers. Here a large company, operating across several states, is accused of actively recruiting and cycling patients through nursing home and hospice services.
Source: kylekrull.com

Mass. dentist admits doing paper clip root canals
(AP)

Authorities Rebels Tsunami Serial Killer Lawyer Woman Moammar Gadhafi Imf Chief People Murder Trial Afp Insider Trading Libya Nuclear Plant Federal Prosecutors Casey United States Michael Jackson Reuters New York City Case Ap Fbi Testimony Prosecutor Japan Attorneys Dominique Strauss Kahn Barack Obama Rampage Prosecutors Muammar Gaddafi Federal Judge Jurors Lawyers Rod Blagojevich
Source: clipsy.org

Medicare and Medicaid Cuts Bring Financial Woes To… · Stories · Baltimore Fishbowl

Health care reform and cuts to Medicaid and Medicare have really hit — wait for it — doctors hard. Physicians are probably not the first people you think of struggling from cuts to social programs, but with a little imagination it’s not hard to see how their practices could be adversely affected. The major issue is that Medicare and Medicaid have been paying out less in reimbursements to physicians. A large percentage of physicians say they lose money treating patients on Medicare or Medicaid, and 40 percent plan to “drop out of patient care in [the] next one to three years in response to reform.”  It’s already caused many doctors to either restrict the number of Medicare/Medicaid patients they accept or sell their practices. What does a less profitable medical profession mean for us here in Hopkinsville, I mean, Baltimore?
Source: baltimorefishbowl.com

Spending Cuts Implied by Romney’s Proposals

What do such cuts mean to actual people?  Well, cutting Social Security benefits by 17% by 2016 would reduce the average monthly benefit from $1,230 to $1,020 and push more than 2.6 million additional people into poverty.  But Gov Romney has said he wants to protect current retirees and those 55 and up (like me!) from such cuts.  Doing so would push that 17% to 24%, and put Medicaid and Medicare right in the crosshairs:
Source: jaredbernsteinblog.com

St. Joseph County COA’s Medicare & Medicaid Assistance Program saves seniors more than $82,000

Swartz said the COA’s three MMAP counselors spent most of their time during the October 15th through December 7th “open enrollment” period assisting with Medicare Prescription Drug Comparison and enrollment, Low Income Subsidy, Medicare Savings, and Advantage Plans comparison.  One-on-one counseling was provided to 118 clients and – of that number – 60 benefited from savings totaling $82,124.97 a year.  The savings came from “enrolling them in a plan that was cheaper than what they had for last year, enrolling them for the first time in a Medicare Prescription drug plan, enrolling clients in the Low Income Subsidy program through Social Security that would assist them with paying for their prescription drug premium and low co-payments for each of the prescriptions, or enrolling them in the Medicare Savings program that would assist them in paying for their Part B premium of $99.90 a month.”
Source: rivercountryjournal.info

Medicare: Demonstrating That Patients Should Be In Control

A program that did the former has already been tested in Medicaid, the government health insurance program for the poor. In the early part of the last decade, the states of Florida, Arkansas and New Jersey received permission from the federal government to set up “Cash and Counseling” programs for disabled people on Medicaid. Beneficiaries were given accounts to pay for workers who provide personal assistance and, in some instances, to purchase supplies, assistive devices or home modifications. They would have to meet with a counselor to set up a plan for how to spend the account.
Source: investors.com

Obama Administration Seeks to Lower $300 Billion Medicare/Medicaid Costs

Those initiatives, says HHS, are a demonstration program to test two new financial models to help states improve quality and share in the lower costs that result from better coordinating care for individuals enrolled in Medicare and Medicaid; another demonstration program to help states improve the quality of care for people in nursing homes by providing these individuals with the treatment they need without having to unnecessarily go to a hospital, and a technical resource center available to all states to help them improve care for high-need high-cost beneficiaries.
Source: seniornews.com

Easy to Use Patient Scheduling Software

A scheduling system should be flexible enough to enable scheduling of different types of appointments by patients. Another important feature that a good system should have is security. There are laws that protect patient information and so you should always strive to make sure that patient information is protected and no unauthorized person can gain access to it. The system should have a user login feature that gives access to various staff with different access levels. If the patient scheduling system is online, then data should be protected against hackers by a good security feature to make sure that no one gets into the programs sensitive data. A good scheduling system is supposed to have an automated calling system that can make calls to patients at specific dates to remind them of upcoming appointments.
Source: somervillefoodscene.com

Medicare and Medicaid Dodge a Bullet – For Now

Advocate Spotlight AED Air Pollution American Heart Month awards CDC CEO Nancy Brown Childhood Obesity Child Nutrition Act Cigarettes Congenital Heart Disease CPR Department of Health and Human Services Dr. Clyde Yancy Dr. Robert DiBianco Exercise Facebook Family Smoking Prevention and Tobacco Control Act FIT Kids Act Food and Drug Administration Getting Healthy Health Insurance Coverage Heart Disease Heart Disease and Stroke Prevention Program HEART for Women Act Heart Walk Josh Miller HEARTS Act Lobby Day Medicare National Institutes of Health National Physical Activity Plan Nutrition Education and Wellness in Schools Act Patient Protection and Affordable Care Act Pre-existing Conditions research SCHIP Share Your Story Smoking Cessation social media sodium Stroke Sudden Cardiac Arrest Awareness Month WISEWOMAN Workplace Wellness Week You’re the Cure
Source: heart.org

THE Consortium: January 3rd Marked the One Year Milestone for the Medicare and Medicaid EHR Incentive Programs

January 3rd was the one year anniversary of the start of registration for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. Over the past year, there has been a tremendous amount of interest in the incentive programs as providers across the country have implemented EHRs. Year one highlights include: 43 states have started their Medicaid EHR Incentive Programs Over 176,000 people have registered for the Medicare and/or Medicaid EHR Incentive Programs Over $2.5 billion has been paid in incentive payments to eligible professionals (EPs) and eligible hospitals and critical access hospitals (CAHs) across the country CMS has created useful resources to participants in the Medicare and Medicaid EHR Incentive Programs. A few new resources include: An Introduction to the Medicare EHR Incentive Program for Eligible Professionals- this interactive guide walks EPs through every aspect of the Medicare program, and provides helpful resources and tips along the way. Updated User Guides- CMS has updated the registration and attestation user guides, which direct EPs and eligible hospitals through CMS’ registration and attestation system. There are five guides that all can be downloaded from the Educational Materials page of the CMS website. Provider Testimonial Videos- these videos, which can be found on the CMS YouTube channel, highlight providers’ experiences participating in the EHR Incentive Programs. A Look Ahead As we move into 2012 and the second participation year of the Medicare and Medicaid EHR Incentive Programs, CMS is hopeful that providers will begin or continue their participation in the programs, and take advantage of these incentives for meaningful use of EHRs. If you are considering registering for the programs, but have not done so yet, take a look at the CMS EHR website and use our eligibility tool to find out if you can participate. Remember: 2012 is the last year in which EPs can receive a full incentive payment in the Medicare EHR Incentive Program. Beginning in 2013, EPs will receive a smaller overall total payment.
Source: blogspot.com

Why Medicaid Matters to Medicare Beneficiaries and Their Families 

[1] Kaiser Family Foundation, Medicaid Matters:  Understanding Medicaid’s Role in Our Health Care System, March 2011, available at http://www.kff.org/medicaid/upload/8165.pdf (site visited Mar 25, 2011); Total Number of Medicare Beneficiaries 2010,  available at http://www.statehealthfacts.org/comparemaptable.jsp?ind=290&cat=6 (Site visited Mar 25, 2011) [2] Kaiser Family Foundation, “The Medicaid Program At a Glance,” March 2007, available at http://www.kff.org/medicaid/upload/7235-02.pdf (site visited Mar 25, 2011) [3]See, e.g., The Burden of Out-of-Pocket Costs on Medicare Beneficiaries, Feb. 24, 2011, at http://www.medicareadvocacy.org/2011/02/the-burden-of-out-of-pocket-costs-on-medicare-beneficiaries (Site visited Mar. 28, 2011) [4]  Gretchen Jacobson, Tricia Neuman, Anthony Damico, Barbara Lyons, “The Role of Medicare for People Dually Eligible for Medicare and Medicaid,” Kaiser Family Foundation, Jan 2011, available at http://www.kff.org/medicare/upload/8138.pdf (Site visited Mar 25, 2011) [5] See note i. [6] The Affordable Care Act, Pub. L. 111-148 (Mar. 23, 2010) §§4103, 4104, eliminates cost-sharing for Medicare preventive services. [7]  David Rousseau, Lisa Clemans-Cope, Emily Lawton, Jessica Langston, John Connolly and Jhamirah Howard, “Dual Eligibles:  Medicaid Enrollment and Spending for Medicare Beneficiaries in 2007,” Kaiser Commission on Medicaid and the Uninsured, December 2010 [8] Genworth Financial, Executive Summary – Genworth 2010 Cost of Care Summary, April 2010, available at http://www.genworth.com/content/etc/medialib/genworth_v2/pdf/ltc_cost_of_care.Par.85518.File.dat/Executive%20Summary_gnw.pdf (Site visited Mar 25, 2011). The median daily rate for a semi-private nursing home room is $185, or $67,525/year in 2010, according to this report. [9] “Spending for non-Medicare-covered services was also high. Among users of services, median OOP spending was highest for LTC facility services. In fact, the majority of LTC facility users incurred high OOP costs. Median OOP spending for users of such facilities was $7,611, with 10 percent of users paying at least $41,937 OOP for room and board and health care-related services during 2006. It is likely that these residents were self-financing their nursing facility stay before eventually qualifying for Medicaid.” Nonnemaker, Lynn, and Shelly-Ann Sinclair. Insight on the Issues: Medicare Beneficiaries’ Out-of-Pocket Spending for Health Care, AARP Public Policy Institute. January 2011, pg 7, available at http://assets.aarp.org/rgcenter/ppi/health-care/i48-oop.pdf  (Site visited Mar. 28, 2011). (Hereafter Nonnemaker, et al.) [10] See note 1. [11]  See note 2; see also Medicaid and CHIP Payment and Access Commission (MACPAC), “Report to Congress on Medicaid and CHIP,” March 2011, Figure 1-3, p. 20. [12] The Kaiser Commission on Medicaid and the Uninsured, “Medicaid’s Optional Populations:  Coverage and Benefits,” February 2005, available at http://www.kff.org/medicaid/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=51052 (Site visited Mar 25, 2011) [13] Id. [14]  Note, however, that the maintenance of effort requirement included in the Affordable Care Act protects individuals who maintain Medicaid eligibility under a Medicaid category currently offered in their state from losing their Medicaid coverage.  See Affordable Care Act, Pub. L. 111-148 and 111 -152  (Mar. 23, 2010 and Mar. 30 2010) § 2001 (b) amending 42 U.S.C. § 1396(a) and adding § 1396(gg). [15] Nonnemaker, et al at note 10.
Source: medicareadvocacy.org

Neural Technologies Launches Real

Neural Technologies’ solutions empower organizations to minimize financial risk to their business, providing comprehensive risk management capability in the areas of fraud, bad debt, customer attrition, collections, revenue assurance and security. Neural Technologies has been ranked several times in the Sunday Times Tech Track 100 league table of the UK’s top technology companies. It was named Large Technology Supplier of the Year 2008 by the British Computer Society and was awarded an IT Excellence Award in 2011. Visit http://www.neuralt.com for more information.
Source: collectionagencymedia.com

iMedicor to provide CMS Certified Gateway for Secure and Private Exchange of Health Information over the Internet

“Our new association with iMedicor’s SocialHIE allows The SunCoast RHIO to build upon the iMedicor technology with our planned certification of the CMS esMD and HIH platform beginning in April 2012,” added Louis Galterio, CEO and Managing Director of SunCoast RHIO. “Being an HIH is a natural fit for us and allows the provider community a direct way to address reporting, security and compliance so that the revenue cycle is not slowed down by the introduction of new regs. In fact, our solution gives our participants new tools to enhance revenue. The iMedicor SocialHIE package is the perfect delivery method that wraps all the new standards and regulations into an easy-to-use format that we know the healthcare community will respond to in a very favorable manner.”
Source: emrdailynews.com

Bull Of The Day: UnitedHealth Group (UNH)

Though certain headwinds such as high unemployment, growing medical cost, pressure from Health Care overhaul, etc. remains, we believe the company will beat the odds given its diversified business model with leading market share positions in the Commercial, Medicare and Medicaid markets. A solid balance sheet and a highly conservative investment portfolio will further help it to outperform its peers.   UNITEDHEALTH GP (UNH): Free Stock Analysis Report   To read this article on Zacks.com click here.  
Source: dailymarkets.com

Medicare Covers Hospice and Comfort Care

Posted by:  :  Category: Medicare

When I'm 64 by MuffetIf your doctor has certified that your loved one is terminally ill, Medicare covers hospice care, which is usually provided in the home. Medicare will still pay for covered benefits for any health problems that aren’t related to your loved one’s terminal illness. Get more details about Medicare’s coverage.
Source: medicare.gov

Video: MEDICARE COVERS THE SLEEVE

Health Care Coverage Comparison

Medicare is a federal health insurance plan for people over 65 years old and some disabled people. It is the primary insurance carrier for old people and the disabled. On the other hand, blue cross is the secondary insurer that covers most of what the primary insurer fails to pay (BlueCross BlueShield Association, 2009). In its design, Medicare does not cover all health care costs which mean clients covered by Medicare are responsible for a high percentage of their health care costs. Medicare patients have to dig deep into their pockets in order to repay for some of healthcare cost.  It has been established that doctors often charge more for the services they deliver than what Medicare will pay and patients are left with a deficit to cover for medical services.  Comparing the medical cost between Medicare and Blue Cross, it is evident that in Blue cross, one pays 2 a month while in Medicare you pay ,156.80 per year.
Source: pi4soa.org

Hinkle, Fingles & Prior, Attorneys at Law

For more information, contact us now. You may also use our contact form to schedule a free workshop at your school or organization. Comments and suggestions for future articles are welcome. The articles provided on the Hinkle, Fingles & Prior website are for your information and may be reprinted in publications, however copyrights cited for each apply. Each reprint must include the author’s name and contact information for Hinkle, Fingles & Prior, Attorneys at Law as follows: Hinkle, Fingles, & Prior, P.C., Attorneys at Law is a multi-state law practice with offices in Lawrenceville, Cherry Hill, Florham Park, and Paramus, New Jersey, and Plymouth Meeting and Bala Cynwyd, Pennsylvania. The firm’s partners and associates lecture and write frequently on topics of elder law, estate planning, special needs trusts, guardianship, special education, health care insurance & Medicaid, and accessing adult services, and are available to speak to groups in New Jersey and Pennsylvania at no charge. For more information, visit http://www.hinkle1.com/ or call (609) 896-4200, or (215) 860-2100.
Source: hinkle1.com

Reminder: Medicare Covers Obesity Prevention with No Cost

[1] CMS Press Release available at: http://www.cms.gov/apps/media/press/release.asp?Counter=4189&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&sr [2] See §4104(a) of the Affordable Care Act (ACA), Pub. L. 111-148 (March 30, 2010), inserting preventive services in §1861(ddd) of the Social Security Act, 42 U.S.C. §1395x(ddd). [3] See the full decision on the national coverage determination at: http://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?&NcaName=Intensive%20Behavioral%20Therapy%20for%20Obesity&bc=ACAAAAAAIAAA&NCAId=253& [4] Finkelstein EA, Trogden JG, Cohen JW, Dietz W.  "Annual Medical Spending Attributable to Obesity: Payer- and Service-Specific Estimates." Health Affairs. 2009; 28(5):w822-w831.
Source: medicareadvocacy.org

A Delay In Signing Up For Medicare Can Lead To Big Penalties

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

David Sayen: What Medicare Covers in the Hospital

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Source: noozhawk.com

What Is Medicare ? Part 3

· Durable Medical Equipment: Items such as oxygen, wheelchairs, walkers, and hospital beds needed for use in the home. For certain equipment, such as wheelchairs and hospital beds, Medicare pays rental fees for up to 13 months (36 months for oxygen). After this, you own the equipment, and Medicare pays for maintenance. For Medicare to cover your equipment, you must go to a supplier that is enrolled in Medicare. You pay coinsurance, and Part B deductible applies. In some cases, if you buy the equipment without renting it first, Medicare pays no part. New: In 2008, you may have to use certain Medicare-contract suppliers to get certain durable medical equipment in some geographic areas. Call 1-800-633-4227 begin_of_the_skype_highlighting            1-800-633-4227     end_of_the_skype_highlighting for more information. TTY users should call 1-877-486-2048 begin_of_the_skype_highlighting            1-877-486-2048     end_of_the_skype_highlighting.
Source: tulsasrealestateblog.com

Kansas Medicare Part D Plans

Posted by:  :  Category: Medicare

United We STAND. by eyewashBut if you are interested in enrolling in a Medicare Advantage plan, you may find a plan that includes Part D coverage. You will more than likely have more options for plans with Medicare drug coverage than not. You cannot enroll in an HMO, PPO or HMO-POS plan without coverage and purchase a stand-alone plan. If you enroll in a PFFS Medicare advantage plan without Part D coverage, you can purchase a stand-alone plan.
Source: partdplanfinder.com

Video: Kansas Medicare Supplements

Kansas Medicare health insurance Supplement

You can also make your Medicare health insurance original schedule more collateralled and taking effect by performing a medigap insurance which supplement and supplement an original one the majority honestly not to mention strongly. You should not miss this when you always want to be the maximal coverage from your original Medicare health insurance plan. And is particularly the only strategy to get which. Medigap insurance coverage or Medicare health insurance supplemental insurance always maximizes may enhance the the plan holder.
Source: dcacfresno.org

Senior Medicare Patrol (SMP) Volunteer Coordinator Job In Topeka, KS, United States On PublicInterestCrossing

Job Profile Demonstrated oral and written fluency in English and Spanish As the Senior Medicare Patrol (SMP) Volunteer Coordinator you will Improve understanding, detection and reporting of Medicare and Medicaid fraud for beneficiaries, health care professionals, members of the public, and Senior Medicare Patrol (SMP) volunteers and counselors; Work with SMP staff, the Administration on Aging (AoA), the Centers for Medicare and Medicaid Services (CMS), and community partners to conduct SMP volunteer recruitment and training across the state; Encourage and promote the recruitment of SMP volunteers and counselors by coordinating recruitment efforts with state-wide promotional efforts; working with community partners to recruit Spanish-speaking volunteers; identifying and recruiting local and statewide partner organizations that can provide Spanish-language fraud information and assistance to their clients; Work with the SMP Project Coordinator to develop and conduct SMP volunteer training and education in both English and Spanish; develop a training regimen that results in knowledgeable volunteers; establish a yearly training calendar; develop and update Spanish-language training materials as needed; provide technical assistance to SMP volunteers and coordinators; relay fraud reports and assist with data collection as needed; conduct research to answer complex or technical program questions; and stay current on health care fraud and other scams being perpetrated across the country; Assist SMP Project Coordinator with data entry as requested; Assist with preparation of program grants and reports as requested by the program director; Respond to educational inquiries by the public; Assist with the preparation of program grants and reports as requested by the program director; Assist with evaluation of the effectiveness of the training program and the competence of volunteers and counselors; Coordinate efforts with other KDOA program staff and other agencies; Complete other assignments given by the Secretary, the Secretary’s designee, or the position’s supervisor; Job Requirements Required Qualifications Demonstrated oral and written fluency in English and Spanish Experience in providing information through formal oral presentations or written communication Experience in providing trainings, public education programs, and question-and-answer sessions Experience in creating collaborations between public and private organizations Preferred Qualifications Bachelor’s degree in social services, human services, or related field Experience using PowerPoint and Word to develop training materials and programs Knowledge of Medicare, Medicaid and other insurance programs How you will be evaluated: Demonstrated fluency in both English and Spanish Excellent oral and written communication skills Ability to work independently Ability to travel throughout Kansas Knowledge of the principles and techniques of training Ability to both write and review technical documents and program reports Ability to research in technical areas such as insurance and program eligibility Ability to collaborate with community-based organizations Ability to establish and maintain effective working relationships with diverse populations NOTE: Due to grant requirements regarding conflict of interest, the person hired for this position cannot be a licensed insurance agent. ******If you press the apply now button, you will be taken to the **MEMBERS ONLY**SIGN UP NOW***. Website where you will be able to apply for this position.****** **** Salary – n/a – Job URL Sign up now!
Source: publicinterestcrossing.com

Letters to the editor on Medicare cuts, Kansas time warp

Congress is debating several key policy issues, including legislation to prevent a nearly 30 percent reimbursement cut to physicians and other health care providers under Medicare. Part of the debate involves how to offset the costs associated with these policies so that the national budget deficit is not increased. Keeping the deficit in check is necessary, though cost offsets within the Medicare program should not disproportionately affect particular health care providers.
Source: kansas.com

5 Star Medicare Part D Plans in Kansas

50% discount on name brand drugs 2011 Medicare Part D Plans 2011 medicare premium change medicare coverage closing the donut hole Copayment Cosinurace currently working disenroll Doctor Office Visit donut hole drug plan Emergency Room Visit find medicare part d health care reform help with medicare HIV testing how to use medicare plan finder Kansas Medicare Part D Medicaid Medicare medicare advantage plans medicare classes medicare fraud medicare part b medicare part c Medicare Part D medicare part d 2011 Medicare Part D Rebate checks medicare plan finder medigap Plan N medigap policies new to medicare no copay preventitive services non renewal obamacare paper checks Part A Part B premium for medicare preventitive services retired Social Security what happens when plan goes away wichita kansas
Source: wordpress.com

Calif. Discloses Hospital Infection Rates; Kansas City Health Center Gets Facelift

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

Another Guilty Plea in Medicare Fraud Case

The fallout from the American Therapeutic Corp. case continued today as a Miami woman entered a guilty plea in federal court. The $200 million Medicare fraud case has led to 20 indictments of doctors, administrators, executives and others in South Florida. Ten criminal defendants have already entered guilty pleas or been found guilty at trial. The rest have been scheduled for trial in April.
Source: miamifederalcriminaldefenseattorney.com

Filling the Medicare Doughnut Hole

The so-called "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: kylekrull.com

Roundup: Fla. Medicare HMO Closed; Tufts And BCBS Resume Talks

uhetemejih.wordpress.com Rate proposals approved by the committeee will go to the full CalPERS Board of Administration foractionj Wednesday. Basic HMO rates for state workers will rise an average of 3.43 percent in 2010, down from almost 6.6 percenr in 2009. The rate hikesd run from a lowof 0.32 percent for Blue Shield Net Valuw to a high of 4.9 percent for Figures for public agency worker s vary by region. Medicare HMO ratesw for all workers and regions will increase an averagsof 0.27 percent in but vary from a 12.27 drop for members of Blue Shield Access+ to a 6.5 percenr increase for Kaiser members. “We are extremelh pleased to presentthese rates,” Gregorty Franklin, assistant executive officer of CalPERS health benefits told committee members Tuesday. “Negotiationes were extremely tough. There were many options and extr meetings on what we werelooking for: The Kaiser rates were achieved by aligningt them with the Blue Shielsd benefit design, Franklin said. Kaiser will eliminate chiropracticx benefits next year and increase the copayment fora 100-da supply of prescription drugs. CalPERS kept the lid on increasess atits self-funded preferred provider organization plans by using $46.y7 million in surplus reserves to “buyh down” rates. The average PPO rate increaser for state workers in 2010is 3.29 but it runs from a low of 1.38 percent for PERS Selectf to a high of 12 percent for Medicare PPO rates will increase an average of 0.27 percent in all but they range from a 12.27 percentt drop for Blue Shield Access+ to a 6.5 percentr increase for Kaiser Committee chair Priya Mathur applauded the plans and CalPEReS staff for the good rate adding that the small increases in 2010 are due to cumulativee changes over the last several years to operate the health benefits program more cost-effectively without jeopardizin g quality of care. Source: blogspot.com
Source: medicaresupplementalco.com

Free Medicare counseling at Guadalupe Center

All Medicare beneficiaries are eligible for Part D coverage, but they must enroll first. People enrolled in Part D still pay out-of-pocket costs for their prescriptions, but there is an additional program meant to help those who have trouble doing so. Called Extra Help, this program reduces prescription-drug costs for Medicare patients who meet low-income guidelines. Many Medicare beneficiaries do not know about the program. Thousands of eligible Missourians are missing out on help paying for their prescription drugs, according to the federal government.
Source: kcstar.com

Hinkle, Fingles & Prior, Attorneys at Law

Posted by:  :  Category: Medicare

For more information, contact us now. You may also use our contact form to schedule a free workshop at your school or organization. Comments and suggestions for future articles are welcome. The articles provided on the Hinkle, Fingles & Prior website are for your information and may be reprinted in publications, however copyrights cited for each apply. Each reprint must include the author’s name and contact information for Hinkle, Fingles & Prior, Attorneys at Law as follows: Hinkle, Fingles, & Prior, P.C., Attorneys at Law is a multi-state law practice with offices in Lawrenceville, Cherry Hill, Florham Park, and Paramus, New Jersey, and Plymouth Meeting and Bala Cynwyd, Pennsylvania. The firm’s partners and associates lecture and write frequently on topics of elder law, estate planning, special needs trusts, guardianship, special education, health care insurance & Medicaid, and accessing adult services, and are available to speak to groups in New Jersey and Pennsylvania at no charge. For more information, visit http://www.hinkle1.com/ or call (609) 896-4200, or (215) 860-2100.
Source: hinkle1.com

Video: EHR: Medicare, Medicaid EHR Incentive Program Webinar for Eligible Professionals

Worm’s Lifespan Dramatically Extended By Tiny Amounts Of Alcohol

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

Obama Administration Seeks to Lower $300 Billion Medicare/Medicaid Costs

Those initiatives, says HHS, are a demonstration program to test two new financial models to help states improve quality and share in the lower costs that result from better coordinating care for individuals enrolled in Medicare and Medicaid; another demonstration program to help states improve the quality of care for people in nursing homes by providing these individuals with the treatment they need without having to unnecessarily go to a hospital, and a technical resource center available to all states to help them improve care for high-need high-cost beneficiaries.
Source: seniornews.com

Why Medicaid Matters to Medicare Beneficiaries and Their Families 

[1] Kaiser Family Foundation, Medicaid Matters:  Understanding Medicaid’s Role in Our Health Care System, March 2011, available at http://www.kff.org/medicaid/upload/8165.pdf (site visited Mar 25, 2011); Total Number of Medicare Beneficiaries 2010,  available at http://www.statehealthfacts.org/comparemaptable.jsp?ind=290&cat=6 (Site visited Mar 25, 2011) [2] Kaiser Family Foundation, “The Medicaid Program At a Glance,” March 2007, available at http://www.kff.org/medicaid/upload/7235-02.pdf (site visited Mar 25, 2011) [3]See, e.g., The Burden of Out-of-Pocket Costs on Medicare Beneficiaries, Feb. 24, 2011, at http://www.medicareadvocacy.org/2011/02/the-burden-of-out-of-pocket-costs-on-medicare-beneficiaries (Site visited Mar. 28, 2011) [4]  Gretchen Jacobson, Tricia Neuman, Anthony Damico, Barbara Lyons, “The Role of Medicare for People Dually Eligible for Medicare and Medicaid,” Kaiser Family Foundation, Jan 2011, available at http://www.kff.org/medicare/upload/8138.pdf (Site visited Mar 25, 2011) [5] See note i. [6] The Affordable Care Act, Pub. L. 111-148 (Mar. 23, 2010) §§4103, 4104, eliminates cost-sharing for Medicare preventive services. [7]  David Rousseau, Lisa Clemans-Cope, Emily Lawton, Jessica Langston, John Connolly and Jhamirah Howard, “Dual Eligibles:  Medicaid Enrollment and Spending for Medicare Beneficiaries in 2007,” Kaiser Commission on Medicaid and the Uninsured, December 2010 [8] Genworth Financial, Executive Summary – Genworth 2010 Cost of Care Summary, April 2010, available at http://www.genworth.com/content/etc/medialib/genworth_v2/pdf/ltc_cost_of_care.Par.85518.File.dat/Executive%20Summary_gnw.pdf (Site visited Mar 25, 2011). The median daily rate for a semi-private nursing home room is $185, or $67,525/year in 2010, according to this report. [9] “Spending for non-Medicare-covered services was also high. Among users of services, median OOP spending was highest for LTC facility services. In fact, the majority of LTC facility users incurred high OOP costs. Median OOP spending for users of such facilities was $7,611, with 10 percent of users paying at least $41,937 OOP for room and board and health care-related services during 2006. It is likely that these residents were self-financing their nursing facility stay before eventually qualifying for Medicaid.” Nonnemaker, Lynn, and Shelly-Ann Sinclair. Insight on the Issues: Medicare Beneficiaries’ Out-of-Pocket Spending for Health Care, AARP Public Policy Institute. January 2011, pg 7, available at http://assets.aarp.org/rgcenter/ppi/health-care/i48-oop.pdf  (Site visited Mar. 28, 2011). (Hereafter Nonnemaker, et al.) [10] See note 1. [11]  See note 2; see also Medicaid and CHIP Payment and Access Commission (MACPAC), “Report to Congress on Medicaid and CHIP,” March 2011, Figure 1-3, p. 20. [12] The Kaiser Commission on Medicaid and the Uninsured, “Medicaid’s Optional Populations:  Coverage and Benefits,” February 2005, available at http://www.kff.org/medicaid/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=51052 (Site visited Mar 25, 2011) [13] Id. [14]  Note, however, that the maintenance of effort requirement included in the Affordable Care Act protects individuals who maintain Medicaid eligibility under a Medicaid category currently offered in their state from losing their Medicaid coverage.  See Affordable Care Act, Pub. L. 111-148 and 111 -152  (Mar. 23, 2010 and Mar. 30 2010) § 2001 (b) amending 42 U.S.C. § 1396(a) and adding § 1396(gg). [15] Nonnemaker, et al at note 10.
Source: medicareadvocacy.org

CMS Finalizes Rules Regarding Eligibility for Medicare Prescription Drug Subsidy : Duane Morris Health Law

On January 17, 2012 the Centers for Medicare & Medicaid Services (“CMS”) adopted as a final rule changing Medicare’s Extra Help Program.  The Extra Help Program is a prescription drug coverage low-income subsidy created through the Affordable Care Act (“ACA”).  Effective January 18, 2012, the final rule incorporates the ACA’s changes to the Extra Help Program by extending eligibility for one year after the death of a beneficiary’s spouse that would otherwise decrease or eliminate the subsidy.  The final rule also implements changes to the Medicare Improvements for Patients and Provider Act of 2008 by excluding from a resource (for purposes of Extra Help eligibility) the value of life insurance policies or income for food, shelter, and certain household bills.   
Source: duanemorris.com

Links and 2011 changes that you may need to know

NY  issued a new Administrative Directive on July 11, 2011 that will make  it more difficult to protect assets from nursing home costs. In essence,  a Medicaid applicant can set aside money for burial space items for a  child, brother, sister, and the spouses of those family members to  protect that money from being treated as an available resource for  Medicaid. This is a plannning technique that I have used often to  protect assets from being used to pay for nursing home costs. Now  Medicaid requires you to do that the month prior to getting on Medicaid.  The problem is that many people consult with a lawyer after there is an  emergency so even if you set up the burial space agreements, if you  dont set them up before you go into a nursing home, you can lose  Medicaid qualification for each month you havent set up the agreements,  which in NY can cost you $8,500 to $11,000 a month. This is a rediculous  law merely intended to hurt and not help people who want to try to  protect some of their assets and not lose everything because they are  going into a nursing home. So you may want to plan ahead and consider  the use of burial space agreeements prior to going into a nursing home  to protect some of your life savings for the people you love instead of  giving the money to a nursing home.
Source: free-alzheimers-support.com

Medicare Supplement Quotes

Posted by:  :  Category: Medicare

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

Video: VTS_01_1.VOB Omeca Best, Medicare Supplement revzech cowhn 1/10/2012

Medicare Supplemental Insurance Is the Best Security for Old Age

A Medigap policy is often called “Medicare Supplement Insurance”. It is a private health insurance that is designed to supplement Original Medicare. So, it helps to pay some of the health care costs that Original Medicare doesn’t cover.
Source: typepad.com

Determining To get the best Medicare Supplemental Insurance Plan

Some would want that their prescription drugs will be covered by medicare insurance as well. This is possible with Part D or Prescription Drug Plan, which you can enroll by the time you become eligible to enroll for Medicare Part An and B. Availing of the Part D plan at some time later will charge you extra fees for penalty. Unlike medicare supplement insurance plans, part D is not well standardized so you need to be extra careful in choosing which company to partner with. As mentioned earlier, medicare supplemental insurance plans are standardized across all health insurance companies. They will vary somehow in the manner they do customer service or the price of the premiums. It would be wise to know first which particular medicare supplement contract plan is best for you before comparing that chosen medicare supplement insurance plan with another company. To go for the best you can go to GOMEDIGAP, the one trusted most by many over the years.
Source: articlesalive.net

Senior Health Insurance

How to Appeal Medicare Decisions

Posted by:  :  Category: Medicare

If you have Medicare, you have rights. You have the right to receive medical care, services, procedures and items that are medically necessary. Should Medicare deny coverage for anything that you or a physician feels is medically necessary, there is an appeals process. It’s a fairly quick and painless procedure, and 80%-90% of those appealing Medicare decisions end up winning on appeal.
Source: levinefurman.com

Video: Medicare and Appeals

Navigating Medicare RAC Audits: The Best Defense Is a Good Offense

Just as with almost any audit, your ability to justify medical necessity is crucial during RAC audits. According to the Centers for Medicare and Medicaid Services (CMS), lack of medical necessity justification is a common reason for overpayment decisions. More often than not, however, the only real problem is that the provider didn’t sufficiently document why the treatment was appropriate. To avoid overpayment decisions, you must make sure your documentation: 1) is comprehensive, and 2) fully illustrates medical necessity.
Source: dailypracticeblog.com

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

Public policy favors settlement: our courts cannot handle adjudicating every insurance claim involving a Medicare beneficiary, let alone all those with a reasonable anticipation of becoming one, to determine Medicare’s stake, particularly when Medicare routinely refuses to participate. There is an art to settling insurance claims that involves a lot of tried and true practices based upon financial and legal implications, resulting in the best possible compromise of all parties. Parading that evidence through a court of law does not change the facts as to why the parties elected not to see a case through to trial. Yet CMS refuses to compromise its claim absent a ruling on the merits of the claim. This represents an enormous waste of government resources, both judicial and federal, given that the private sector already paid for the analysis that led up to the value of the settlement. Nevertheless, insurers routinely pay these demands because “it’s not enough money to fight over” or “there’s no winning against CMS’ track record,” thus the agency grows stronger and makes more wild demands and creates new overreaching policies and the problem continues. But I digress.
Source: medicaresetasideblog.com

Matthews Law Firm, Bartow Health Care Compliance and Criminal Defense

The calendar year 2012 AIC threshold amounts are $130 for ALJ hearings and $1,350 for judicial review. This will be the third straight year that ALJ threshold amounts remain at $130, while the threshold amount for judicial review has increased by $50.00.
Source: matthewspa.com

86% of Providers Drop Appeal After a QIC Denial is Issued

 Despite the fact that ALJ hearings are typically conducted by teleconference, the process can still be quite intimidating.  ALJs almost always place testifying providers and their designated “experts” under oath before taking their testimony.  Additionally, if a provider has introduced new evidence into the record, it will be required to show “good cause” for its admission at this late stage of the proceedings.  Finally, most providers find that the ALJ handling their case is quite knowledgeable and typically has extensive experience analyzing coverage requirements and assessing the adequacy of a provider’s documentation.  Providers who have failed to adequately prepare for the hearing are likely to find that the process can be quite difficult.   
Source: aljappeal.com

Texas Attorney Maintains Watchful Eye on Proposed Changes to Social Security Benefits

The Bob Richardson Law Firm is a highly respected Texas personal injury and Social Security disability law firm. The firm is dedicated to providing skilled and professional legal services to clients in cases involving car accidents, motorcycle accidents, truck accidents, drunk driving accidents, construction accidents, workplace accidents and slip and fall accidents as well as representation to those seeking benefits for Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). The firm features offices in Austin and Waco and assists clients throughout Round Rock, Georgetown, Killeen, Temple, Cedar Park, Lakeway, Taylor, Belton and surrounding Texas communities. To learn more about The Bob Richardson Law Firm, call (800) 880-5100 or use the firms online form.
Source: carkeylocksmiths.org

Adjustment to the 2012 Amount in Controversy Thresholds for Medicare Appeals : Health Industry Washington Watch

annual adjustment in the amount in controversy (AIC) threshold amounts for Administrative Law Judge (ALJ) hearings and judicial review under the Medicare appeals process, effective for requests filed on or after January 1, 2012. The calendar year 2012 AIC threshold amounts are $130 for ALJ hearings (unchanged from 2011) and $1,350 for judicial review (up from $1,300 in 2011).
Source: healthindustrywashingtonwatch.com

FDA Law Blog: HP&M to Host Webinar on the FDA Appeals Process

FDA Law Blog is published for informational purposes only; it contains no legal advice whatsoever. Publication of FDA Law Blog does not create an attorney-client relationship. FDA Law Blog is the blog of Hyman, Phelps & McNamara, P.C. (“HPM”) and it is intended primarily for other attorneys and regulatory professionals. No part of FDA Law Blog –whether information, commentary, or other– may be attributed to HPM’s clients. Readers should be aware that HPM represents many companies in the food, drug, medical device, and health care industries, and therefore FDA Law Blog may occasionally report on news that relates to HPM clients. FDA Law Blog will always strive to be unbiased in its reporting. All information on FDA Law Blog should be double-checked for its accuracy and current applicability. Copyright 2011 Hyman, Phelps & McNamara, P.C.
Source: fdalawblog.net

⎫ !! Medicare advantage Sales $200 to $400 Dialy per client (polk county)

Posted by:  :  Category: Medicare

TWO YEARS OF RUIN by SS&SSThere are a lot of Medicare beneficiaries in Polk county that needs help. Let’s help them be placed in the right Medicare advantage plan…. Florida Insurance Organization. Is looking for (preferably Bilingual; Spanish & English) Health Agents to Run Medicare Advantage Leads. work local office traffic. As a Broker you get advanced Commissions!!! And Build a renewal Based Income.agents making $200 to $400 Daily Must have an active Florida Health License. Call Mr Betancourt for more info @ *** We offer: – part time, or full time positions – We will train you – Offer leads, we have leads that are SEP, or new to medicare; (they can enroll into new plans at anytime during the year) – If you’re new in medicare advantage, we will help you close your first deals – Office support – & much more -You can make $200 to $400 daily. ( I.E. you close 6 clients x $400 per new medicare client= $2400/ weekly) Please give us a call or submit your resume. Call Mr Betancourt for more info @ ***
Source: telecommuteanywhere.com

Video: Medicare Local – Medicare Marketing and Leads

NEED LEADS Medicare Advantage Leads

Welcome to the Lead Buyer Network. If this is your first visit, be sure to check out the FAQ by clicking the link above. You may have to register before you can post: click the register link above to proceed. To start viewing messages, select the forum that you want to visit from the selection below. Join the Lead Buyer Network Today! You must be associated with the Lead Generation Industry to be accepted as a member. If you are not sure if you comply with that statement, I suggest not joining.
Source: leadbuyernetwork.com

Using Custom Filters For Medicare Supplement Leads

People who are ignorant or know very little about these policies and supplement leads are your best bet for conversions. You can easily convince them if they are above sixty five years and make them understand the benefits they stand to gain from them. They can be made to understand that most elderly people do undergo blood transfusion at one point in time or other and these Medicare supplement leads can come in handy at that time. Agents on their part can prepare a detailed report about these leads and can forward it to customers as and when required. So using these custom filters on-line, you can easily have good conversion rates and this can in turn favor your business considerably. Hence the Internet has a medium can be your starting point in this journey.
Source: trendlearn.com

Picture Evaluation mobile site Ace Ventura: Animal Detective

Ace Ventura (Rick Carrey) has impressed himself a nice little investigative slot handling circumstances which involve pets of all variety models of watches. After saving an innocent puppy from an rude man, _ web proceeds the pooch to its appealing possessor and the person is compensated rather effectively. Star is having a hard time implementing business bottoms live up to but is wishing on locating a rare fowl that has a $10,000 bonus. During his check he receives a call from Melissa Robinson (Courteney Cox) who might be the head of PR for your Miami Dolphins. Melissa inspires Ace that someone has abducted Floral motif, The Miami Dolphins dolphin amulet, along with the Tremendous Tank is present in Miami within only some time.
Source: aminuu.com

Suggestions for Finding Medicare Supplement Leads

how to start a busienss selling medicare ideas for selling supplemental insurance to groups agent review on medicare supp leads medicare supplement selling medicare supplement leads $19 95 can i get free medical supplement leads? can you make a good living selling medicare insurance medicare supplements that are non profits Does anyone know a good leads company for medicare supplements medigap insurance supplement lead leads of people seeking medicare supplement plans do insurance agents make more selling medicare supplements? why are there so many places selling medicare supplements medicare supplement business agent reviews is it difficult to earn living selling medicare supplement insurance seo forum
Source: selling-medicare-supplements.com

Premier Insurance Partners Blog: Sell Medicare Advantage Year Round

AEP is over, but selling Medicare Advantage doesn’t have to stop. Plenty of opportunities still exist, and the best part is we have LEADS in several states. For those who are wondering how to continue selling MA plans, keep these items in the forefront:
Source: blogspot.com

Extra Healthcare Choices With Highmark Medicare

Posted by:  :  Category: Medicare

Few people have ample money to cover anesthesia expenses when they get sick. In order to make quality medical care available to the majority, health insurance coverage prefer Medicare is devised by the government as an guarantee which individuals are guarded from the expenses incurred when availing one. The process of wellbeing insurance coverage follows a financial fee construct often in the form of month-to-month high quality deductions by the protection websites to the wage of an individual. The financial savings which gather at the time of time from these costs are used for paying health care. Typically, a wellbeing protection has provisions to stick to just before an insurance policyholder individual can be suitable for coverage. In Medicare for instance, folks aged 65 or older, permanently handicapped, or individuals using kidney failure, are entitled to use it so that their medical costs are a lot more affordable.
Source: bareessentialsmineralmakeup.us

Video: Pittsburgh Celebrates Medicare’s Anniversary

Extra Healthcare Choices With Highmark Medicare : Annual travel Insurance : Annual Travel Insurance Over 65 : Annual Trip Insurance Elder

Few individuals possess ample income to cover anesthesia expenses when they get sick. To make top quality medical care available to the majority, wellbeing insurance like Medicare is invented by the government as an assurance which those are protected from the prices incurred once availing one. The approach of well being insurance follows a financial fee construct often in the kind of monthly premium deductions by the insurance coverage provider to the wage of an individual. The savings which build-up over time from these insurance plan are applied for having to pay health care. Normally, a wellness protection has provisions to adhere to before an insurance policyholder personalized can be eligible for cover. In Medicare for instance, individuals aged 65 or older, completely inept, or individuals with kidney failure, are entitled to use it so which their anesthesia costs are far more affordable.
Source: annualtravelinsuranceover65.org

Extra Healthcare Choices With Highmark Medicare

Few people possess sufficient money to include anesthesia bills once these folks get sick. To generate top quality medical care readily available to the majority, health insurance coverage enjoy Medicare is devised by the the us government as an assurance which those are guarded from the expenses incurred once availing one. The approach of health insurance coverage follows a financial fee structure frequently in the kind of monthly premium deductions by the insurance coverage sites to the salary of an customized. The savings which accumulate at the time of time from these premiums are utilized for having to pay medical care. Normally, a health insurance coverage has provisions to follow before an insured customized might be eligible for protection. In Medicare for instance, people aged 65 or older, completely incapable, or individuals using kidney failure, are entitled to use it so which their anesthesia expenses are more affordable.
Source: insulinjunky.com

Extra Healthcare Choices With Highmark Medicare

Few individuals have ample income to cover medical costs once these folks get sick. To generate quality medical care readily available to the majority, wellness insurance coverage prefer Medicare is devised by the government as an assurance which those are protected from the costs incurred once availing one. The course of action of wellness insurance coverage follows a financial fee structure generally in the form of monthly high quality deductions by the insurance coverage provider to the salary of an individual. The savings which gather at the time of time from these costs are utilized for paying medical care. Normally, a wellness insurance coverage has provisions to stick to before an insured individual might be eligible for cover. In Medicare for instance, individuals aged 65 or older, completely inept, or individuals using kidney failure, are entitled to use it so which their medical costs are far more affordable.
Source: filessharing.ws

More Healthcare Choices With Highmark Medicare

Few people have sufficient income to cover medical expenses once these folks get sick. To generate quality medical care available to the majority, health insurance coverage like Medicare is invented by the the federal government as an guarantee that individuals are protected from the charges incurred once availing one. The process of wellbeing insurance coverage follows a financial payment construct typically in the kind of monthly premium deductions by the insurance provider to the wage of an individual. The financial savings that build-up at the time of time from these car insurance are used for paying medical care. Commonly, a health protection has provisions to adhere to earlier than an insurance policyholder customized may be qualified for protection. In Medicare for instance, individuals aged 65 or older, completely inept, or those using kidney failure, are entitled to use it so which their medical prices are far more affordable.
Source: dentalplan.tk

More Healthcare Options With Highmark Medicare

Few individuals possess sufficient cash to include medical expenses once these folks get sick. In order to generate quality medical care available to the majority, wellbeing protection like Medicare is invented by the the us government as an assurance which those are guarded from the charges incurred when availing one. The procedure of health insurance follows a financial fee structure often in the form of month-to-month high quality deductions by the insurance coverage sites to the salary of an customized. The financial savings which accumulate over time from these premiums are employed for spending medical care. Usually, a health insurance coverage has provisions to follow before an insurance policyholder personalized can be suitable for coverage. In Medicare for instance, people aged 65 or older, completely incapable, or individuals with kidney failure, are entitled to use it so that their anesthesia expenses are a lot more affordable.
Source: misterbaqar.net

More Healthcare Choices With Highmark Medicare

Few folks have comfortable income to include medical costs when they get sick. In order to generate quality health care readily available to the majority, health insurance like Medicare is invented by the the us government as an promise that individuals are protected from the costs incurred once availing one. The course of action of health protection follows a financial payment construct frequently in the form of month-to-month quality deductions by the insurance coverage websites to the salary of an individual. The financial savings which gather at the time of time from these insurance plan are utilized for having to pay medical care. Generally, a wellness protection has provisions to follow prior to an insured personalized may be eligible for coverage. In Medicare for instance, folks aged 65 or older, completely handicapped, or those with kidney failure, are entitled to use it so that their medical costs are much more affordable.
Source: stuffnthingz.org

Diversified Service Options of Florida to Acquire Highmark Medicare Services

Highmark Medicare Services’ (HMS’) mission is to provide quality services and innovative solutions in the administration of our government contracts, according to our core values (fiscal responsibility, operational excellence, customer focus, continuous improvement, and commitment to integrity), in support of stakeholder goals. HMS is the MAC for J12, handling Medicare Part A and Part B fee-for-service claims and other administrative activities for more than 4.1 million beneficiaries. HMS is also the federal contractor for administering Section 1011 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003, which reimburses eligible providers for emergency services. For more information about HMS and its current businesses, please see www.highmarkmedicareservices.com.
Source: citybizlist.com

Medicare contract to boost Highmark hiring

The Medicare Services division said it was awarded a five-year, $406.5 million contract by the Centers for Medicare & Medicaid Services to process Medicare claims in seven states: Louisiana, Arkansas, Mississippi, Texas, Oklahoma, Colorado and New Mexico.
Source: pittsburghlive.com

Diversified Service Options to acquire Highmark Medicare Services

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Source: creditcardsindex.net

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

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

Suspect in Medicare fraud thought to have fled the country

Posted by:  :  Category: Medicare

Save Medicare --Jim Parker by faulThere is a story in the Atlanta Journal Constitution today about the owner of a medical clinic who apparently left the county shortly after federal investigators conducted a search of his business in relation to suspicions of Medicare fraud. Prosecutors will likely try paint this as an attempt to flee because the owner engaged in the alleged conduct. But it could also simply be a reaction to the feelings of helplessness and hopelessness that even an innocent person may feel when facing these types of charges.
Source: atlantafederalcriminaldefenseattorney.com

Video: Congressman Jack Kingston (R-GA) talks budget, preserving Medicare on MSNBC’s Hardball

Report spotlights ways to enhance health care for GA children

The report, titled “Modernizing Medicaid and PeachCare: Promising Program Design Options for Georgia’s Children” – was commissioned by Voices for Georgia’s Children and Georgians for a Healthy Future, and compares Georgia systems for child health coverage and access to those in a variety of other states.  Researched and prepared by Kellenberg Consulting, the study sought to identify existing programs that have improved health care outcomes, ensured access to vital services, controlled the utilization of available health care resources, and generated administrative cost savings.  The report is part of a larger initiative supported by the Georgia Healthcare Foundation – called Care for Georgia’s Kids: Modernizing Medicaid and PeachCare – which focuses on the importance of optimizing the provision of health care to Georgia’s neediest children.
Source: gapolitico.com

Medicare Supplement Plans in Georgia Free Offer Get a Senior Scooter Now – Qualify Easily

Medicare Supplement Plans in Georgia: Free Offer, Get a Senior Scooter Now – Qualify Easily is authored by Bob Vineyard,owner of Georgia Medicare Plans has over 35 years of practice in assisting citizens in Atlanta and all over the state in finding the most affordable health insurance plans in the market. When you allow Georgia Medicare Plans to assist, you can rest assured you will never pay too much for coverage.
Source: powerchairreview.com

Bobbie Paul: Cut Missiles, Not Medicare

Bobbie Paul serves as Executive Director of Georgia WAND. She has spent almost 25 years supporting the vision of WAND’s founder – Dr. Helen Caldicott – to gradually rid the world of nuclear weapons. She has helped the Georgia chapter define its three areas of concentration across the state and Southeast region:  Peace in Action, Environmental Justice and Empowering People to Act Politically. Paul has watch-dogged Savannah River Site (SRS) for over fifteen years and led campaigns to successfully restore Department of Energy (DOE) environmental monitoring of SRS in Georgia. Paul is a former theatre professional and the co-founder of a regional theatre company in St. Petersburg, Florida (now known as American Stage Company). She has worked for the US Department of State as a theatre specialist in Egypt and Jordan.
Source: gawand.org

Important Research From Medicare Demonstration Projects: Almost Nothing Works

In the past two decades, Medicare’s administrators have conducted demonstrations to test two broad approaches to enhancing the quality of health care and improving the efficiency of health care delivery in Medicare’s fee-for-service program. Disease management and care coordination demonstrations have sought to improve the quality of care of beneficiaries with chronic illnesses and those whose health care is expected to be particularly costly. Value-based payment demonstrations have given health care providers financial incentives to improve the quality and efficiency of care rather than payments based strictly on the volume and intensity of services delivered.
Source: careandcost.com

GA medicare supplemental insurance for disability

There are many supplemental insurance providers who provide discounts throughout begin enrollment. In some cases, the applicant’s achieve reduction can be as broad as 15%. This savings will carry more than into subsequent years helping to have premiums lower as the insured grows older. Additionally, some insurance businesses will require underwriting for common supplements, like concept J, if the applicant is more than 3 months past their 65th birthday. If applying during originate enrollment, health underwriting will not be required for understanding J.
Source: carinsurancesaga.com

New Heartland Medicare Supplement Plans Are Coming Out

DENVER- Heartland National Life Insurance company recently began offering their Heartland Medicare Supplement Insurance. Medicare National will be offering these plans through their Colorado based office. This new Medicare Supplement plan is poised to be one of the most competitive supplemental plans available. Keep in mind that while they are new to the Medigap market, the Heartland company has a very solid record in financial strength and taking care of their customers.
Source: deckmastersga.com

Joshua Wilson CPA: ACTUAL COSTS OF HIRING EMPLOYEES

First, let’s just start with the bare minimum.  In GA, a business owner can expect to pay about 11% more than just the employee hourly wage or salary wage given.  Where does this 11% number come from?  As everyone  knows, the employer is required to withhold Social Security and Medicare from the employees income**.  What some new business owners forget is that they have to pay the company portion of Social Security and Medicare as well.  This additional amount is equal to 7.65% of the employees pay.  Next, there is State and Federal Unemployment.  In GA, a business just starting to have payroll will start out with a State Unemployment rate of 2.7% .  The Federal Unemployment rate in GA currently is 0.9% (with credit reduction).  A lot of new business owners are shocked when they file their first payroll reports.  So a business owner just starting out with payroll needs to budget about 11% more than the actual wages.
Source: gwinnettaccountant.com

Expectations low for election

The House is expected to pass its version of the fiscal 2013 budget, while the Senate may choose to punt the issue for the third consecutive year. Republicans and Democrats will eventually have to agree on a series of appropriations bills, though such a deal could well slide to a post-election lame-duck session.
Source: thepresidency.us

Victory for Men’s Health; Medicare Will Keep Covering Prostate Cancer Screening

Kucinich was joined in his campaign for men’s health by Representatives Dan Burton (R-IN), Don Young (R-AK), Robert Aderholt (R-AL), Joe Baca (D-CA), Marsha Blackburn (R-TN), Michael Burgess (R-TX), G.K. Butterfield (D-NC), Andre Carson (D-IN), Yvette Clarke (D-NY), William Lacy Clay (D-MO), Steve Cohen (D-TN), Gerald Connolly (D-VA), John Conyers (D-MI), Danny Davis (D-IL), Eliot Engle (D-NY), Michael Fitzpatrick (R-PA), Raul Grijalva (D-AZ), Martin Heinrich (D-NM), Mazie Hirono (D-HI), Tim Holden (D-PA), Eleanor Holmes-Norton (D-DC), Sheila Jackson-Lee (D-TX), Jesse Jackson, Jr. (D-IL), Leonard Lance (R-NJ), Billy Long (R-MO), Michael Michaud (D-ME), James Moran (D-VA), Tim Murphy (R-PA), Randy Neugebauer (R-TX), Donald Payne (D-NJ), Bill Posey (R-FL), David Price (D-NC), Charlie Rangel (D-NY), Silvestre Reyes (D-TX), Laura Richardson (D-CA), Jon Runyan (R-NJ), Bobby Rush (D-IL), David Scott (D-GA), Adam Smith (D-WA), Edolphus Towns (D-NY), Maxine Waters (D-CA), Frank Wolf (R-VA) and John Yarmuth (D-KY).
Source: menhealthwizard.com

Medicare Provider Enrollment Toolkit and PECOS help

Posted by:  :  Category: Medicare

Medical practices have long suffered with a cumbersome Medicare provider enrollment process. As an alternative to the paper enrollment form (CMS-855), the Centers for Medicare & Medicaid (CMS) developed the Internet-based Provider Enrollment, Chain and Ownership System (PECOS).
Source: mgma.com

Video: Audio Educator: Medicare Enrollment PECOS The CMS 855.mp4

Medicare EHR attestation deadline set for Feb. 29

Under the Medicare EHR Incentive Program, health care practitioners can earn up to a total of $44,000 ($48,400 in federally designated health professional shortage areas) over the six-year life of the program if they install EHR systems that are certified for use under the program and achieve compliance with the program’s EHR utilization criteria, known as “meaningful use” standards.
Source: newsfromaoa.org

Pecos County officers say they have identified body

111 S. Highland Ave.; PO Box 867 Marfa TX 79843 info@marfapublicradio.org; www.marfapublicradio.org Mission: to provide radio that unites the community and promotes cultural enrichment through presentation and focus on the importance of art, education, quality of life and the local economy. Volunteer Opportunities: Music filing, loading, audio editing, clerical duties, and potential on-air hosting of news programs. Station Director: Tom Michael, 432-386-0601; tom@marfapublicradio.org Programming & Production Manager: Rachel Lindley, 432-729-4578; rachel@marfapublicradio.org
Source: typepad.com

News from Medicare & Other Payers for the Week of January 23, 2012: 5010 National Provider Call This Week; Most Insurances Will Be Required to Cover Birth Control Without Co

In August 2011, the Department of Health and Human Services issued an interim final rule that will require most health insurance plans to cover preventive services for women including recommended contraceptive services without charging a co-pay, co-insurance or a deductible. The rule allows certain non-profit religious employers that offer insurance to their employees the choice of whether or not to cover contraceptive services. Today the department is announcing that the final rule on preventive health services will ensure that women with health insurance coverage will have access to the full range of the Institute of Medicines recommended preventive services, including all FDA -approved forms of contraception. Women will not have to forego these services because of expensive co-pays or deductibles, or because an insurance plan doesnt include contraceptive services. This rule is consistent with the laws in a majority of states which already require contraception coverage in health plans, and includes the exemption in the interim final rule allowing certain religious organizations not to provide contraception coverage. Beginning August 1, 2012, most new and renewed health plans will be required to cover these services without cost sharing for women across the country.
Source: managemypractice.com

“The Basics” Chiropractic Medicare: No Out

Newsletter November 9, 2011 Chiropractic Medicare Dear Doctors and Staff, 1.  No Out-of-pocket Expense – Medicare 2.  CMS 855i or PECOS 3.  Medicare Fees 1.  It is against the law to practice No Out-Of-Pocket expense in Medicare.  If you are a participating provider, you have signed a contract with the Federal Government that you will “accept assignment” on ALL Medicare patients.  The Medicare reimbursement of 80% always comes to the doctor.  However, the doctor MUST collect the other 20% from either the patient or the patient’s supplemental insurance.  Only accepting the 80% of what Medicare pays is called No Out-Of-Pocket expenses, which is a breach of Medicare law. 2.  CMS 855i Application or PECOS must be completed by All Chiropractors.  If you have not gone on line and completed PECOS or downloaded CMS 855i off the CMS website and completed…DO IT NOW!  If you do not, there will be NO Medicare reimbursement in the near future. 3.  Our Medicare fees have been posted for 2012.  All have been decreased by about 21%.  We again wait on Congress to move on this issue, the same as earlier this year.  With any luck, we may have our fees restored with minimal increases over 2011.
Source: blogspot.com

Improve Your Medical Billing Efficiency With PECOS

Medicare bonus expenditures really have your enrolled in PECOS. Medicare and Medicaid service providers apply go through motorized Physical health nations such as Units Otherwise e-prescribing To start with right match meaningful Incorporate specs, just might be suitable for government monthly payments in accordance With the rise of U. s. Collection and Respond of time (ARRA), Title XIII, called All HITECH Federal regulation. Are generally purchased aside More to do with This cold Lower your expenses: http://www.cms.hhs.gov/Recovery/11_HealthIT.asp.
Source: personalhealthcaretips.com

PECOS: Will your Medicare claims be rejected?

It is not too late to enroll in PECOS and avoid possible denials. The Centers for Medicare & Medicare Services (CMS) had previously announced that, beginning January 3, 2011, it would automatically deny claims for services ordered by physicians not yet enrolled in PECOS.  However, due to enrollment backlogs and other systems issues, CMS decided to delay the start of these automatic claims edits.
Source: wordpress.com

International Chiropractors Association

CMS began using a new national provider enrollment system, the Provider Enrollment Chain and Ownership System (PECOS), in 2002. Over the last few months CMS has expanded the use of the PECOS system to physician and non-physician practitioners in the District of Columbia and the 50 states. The goal of CMS in developing this program is to standardize the Medicare enrollment process using an electronically maintained national system. Once provider information is entered into and maintained in the PECOS system, that information will be available to all Medicare Administrative Contractors (MAC) across all jurisdictions.
Source: chiropractic.org