CMS Announces First 27 Participants in Medicare Shared Savings Program

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSThe announcement comes after CMS in January launched the Pioneer Accountable Care Organization program that created 32 new ACOs, and the Physician Group Practice Transition Demonstration, which created six new ACOs (
Source: californiahealthline.org

Video: medicare savings program for NAPCA

CMS Selects First Accountable Care Organizations in the Medicare Shared Savings Program

The Centers for Medicare and Medicaid Services (CMS) selects 27 Accountable Care Organizations (ACOs) “to participate in the Medicare Shared Savings Program,” according to a release from CMS. “All ACOs that succeed in providing high quality care – as measured by performance on 33 quality measures relating to care coordination and patient safety, use of appropriate preventive health services, improved care for at-risk populations, and the patient experience of care – while reducing the costs of care – may share in the savings to Medicare.” Additionally, “Two of the ACOs announced today applied for a version of the program that allows them to earn a higher share of any savings, in return for which they have agreed to be held accountable for a share of any losses if the costs of care for the beneficiaries assigned to them increase” and “Five of the 27 ACOs that are starting in April will participate in the Advance Payment ACO Model established by the CMS Center for Medicare and Medicaid Innovation (Innovation Center) to encourage rural and physician-based ACOs to participate in the Shared Savings Program. Under this model, each participating ACOs will receive advance payments to help cover the costs of establishing the infrastructure needed to coordinate care for the beneficiaries they serve. The advance payments will be repaid from shared savings earned by the ACO. If an ACO does not complete the full, initial agreement period of the Shared Savings Program, CMS will in most cases pursue full recoupment of advance payments.”
Source: kff.org

Physicians Leading Majority of ACOs in Medicare Shared Savings Program

This week, CMS unveiled the 27 health systems it has chosen to participate in Medicare’s Shared Savings Program as accountable care organizations (ACOs). But what’s most interesting about the announcement is not the number of ACOs that will be formed, but the type of ACOs that will be formed. “There were some people who feared that the only entities that would participate would be hospital-dominated systems,” Jonathan Blum, director of the Center for Medicare at the CMS, said in a call with reporters, according to ModernHealthcare. “That has not happened.” In fact, just over half of the health systems chosen to participate in the shared savings program — which will receive financial incentives if they manage to improve quality of patient care at reduced costs — are physician-led, according to CMS. [For more information on ACOs from a physician-perspective, read "ACOs: A Guide for Physicians."] Essentially, it appears that more and more physicians are embracing new models of care — and they are beginning to take the lead when it comes to adopting them. Not only that, larger healthcare systems and hospitals appear to be looking for physicians to take on more leadership roles. Why? As reimbursement shifts from volume of services to value of services, physicians will help determine a health system’s financial success or failure. That’s because physicians work closest with patients, they make the key treatment decisions, and as a result, they play a key role in quality and cost of care. “To be successful, healthcare organizations can no longer afford to use the ‘us’ (practitioners) against ‘them’ (administrators) paradigm,” Christine Mackey-Ross, a senior vice president of the executive search firm Witt/Kieffer, wrote in a recent article appearing in The Atlantic. “They need a combined talent approach that puts the best minds on the field, advancing quality, safety, and cost goals together.” She notes that there has already been a “major uptick” in the number of physicians who are taking on new leadership roles major healthcare systems, such as that of chief quality officer and chief clinical integration officer. In fact, according to Witt/Kieffer, 64 physician CEOs are already leading healthcare systems across the country, and many more physician executives are in the talent pipeline. Also in the pipeline? Many more physician-led ACOs. CMS is reviewing another 150 applications from additional ACOs seeking to enter the program in July. For now, the 27 ACOs just announced will serve an estimated 375,000 beneficiaries in 18 states, according to CMS. Florida and New York will each boast five ACOs; North Carolina and New Jersey, three; California, Texas, and Massachusetts, two; and Arizona, Kentucky, Georgia, Wisconsin, and New Hampshire, one. What do you think? Will new models of care like ACOs and new reimbursement trends result in more physician leadership roles? If so, how do you think that will influence the healthcare delivery system?
Source: physicianspractice.com

CMS announced today the selection of the first 27 Accountable Care Organizations

Of these 27 ACOs, 5 are participating in the Advance Payment ACO Model. This Model was established by the CMS Innovation Center to encourage rural and physician-based ACOs to participate in the Shared Savings Program. The Advance Payment ACOs receive advance payments to help cover the costs of establishing the infrastructure needed to coordinate care for the beneficiaries they serve.
Source: jathomas.com

27 Health Systems Selected For Shared Savings ACO Program

The Hill: More Than 1 Million Medicare Beneficiaries Enrolled In Health Law Savings Program More than one million Medicare beneficiaries are now enrolled in programs of the healthcare reform law that aim to reward doctors and hospitals for working together to improve the coordination and quality of care while saving money, the Obama administration announced Tuesday. Twenty-seven so-called “Accountable Care Organizations” have signed contracts with the Medicare agency to serve 375,000 beneficiaries in 18 states, the Medicare agency announced. The organizations are located in Arizona, California, Connecticut, Florida, Georgia, Illinois, Kentucky, Massachusetts, Mississippi, New Hampshire, New Jersey, New York, North Carolina, Pennsylvania, South Carolina, Texas, Vermont and Wisconsin (Pecquet, 4/10).
Source: kaiserhealthnews.org

HIT Exchange: New Affordable Care Act program to improve care, control Medicare costs, off to a strong start

A new program that will help physicians, hospitals, and other health care providers work together to improve care for people with Medicare is off to a strong start, the Centers for Medicare & Medicaid Services (CMS) announced today.   Under the new Medicare Shared Savings Program (Shared Savings Program), 27 Accountable Care Organizations (ACOs) have entered into agreements with CMS, taking responsibility for the quality of care furnished to people with Medicare in return for the opportunity to share in savings realized through improved care. The Shared Savings Program and other initiatives related to Accountable Care Organizations are made possible by the Affordable Care Act, the health care law of 2010. Participation in an ACO is purely voluntary for providers and beneficiaries and people with Medicare retain their current ability to seek treatment from any provider they wish.   The first 27 Shared Savings Program ACOs will serve an estimated 375,000 beneficiaries in 18 States. This brings the total number of organizations participating Medicare shared savings initiatives on April 1 to 65, including the 32 Pioneer Model ACOs that were announced last December, and six Physician Group Practice Transition Demonstration organizations that started in January 2011. In all, as of April 1, more than 1.1 million beneficiaries are receiving care from providers participating in Medicare shared savings initiatives.   “We are encouraged by this strong start and confident that by the end of this year, we will have a robust program in place, benefitting millions of seniors and people with disabilities across the country,” said CMS Acting Administrator Marilyn Tavenner.   Anyone who has multiple doctors may have experienced the frustration of fragmented and disconnected care: lost or unavailable medical charts, trouble scheduling an appointment or talking to a doctor, duplicated medical procedures, or having to share the same information over and over with different doctors.   Accountable Care Organizations are designed to lift this burden from patients, while improving care and reducing costs. The Shared Savings Program was created by the Affordable Care Act after a number of efforts in the private sector showed that improving care can lead to lower costs. The selected ACOs include more than 10,000 physicians, 10 hospitals, and 13 smaller physician-driven organizations in both urban and rural areas. Their models for coordinating care and improving quality vary in response to the needs of the beneficiaries in the areas they are serving. CMS is reviewing more than 150 applications from ACOs seeking to enter the program in July.   To ensure that savings are achieved through improving and providing care that is appropriate, safe, and timely, an ACO must meet strict quality standards. For 2012, CMS has established 33 quality measures relating to care coordination and patient safety, appropriate use of preventive health services, improved care for at-risk populations, and the patient and caregiver experience of care.   CMS also announced today that five ACOs are participating in the Advance Payment ACO Model beginning April 1. This model will provide advance payment of expected shared savings to rural and physician-based ACOs participating in the Shared Savings Program that would benefit from additional start-up resources. These resources will help build the necessary care coordination infrastructure necessary to improve patient outcomes and reduce costs, such as new staff or information technology systems. CMS is reviewing more than 50 applications for Advance Payments that start in July.   To learn more about the ACOs announced today, visit: http://www.cms.gov/apps/media/fact_sheets.asp   For more information on the Advanced Payment ACO Model, including the participating ACOs, visit: http://innovations.cms.gov/initiatives/ACO/Advance-Payment/.
Source: hitexchangemedia.com

Could you be saving money?

Many people with limited income and resources may qualify for Medicare’s “Extra Help” program, but they must apply to find out. You could be one of them. You may qualify if you have up to $16,755 in yearly income ($22,695 for a married couple) and up to $13,070 in resources ($26,120 for a married couple). Get more information about Medicare’s “Extra Help” program.
Source: medicare.gov

CMS Announces 27 Shared Savings ACO Program Participants — Akin Gump Health Reform Resource Center

As required by the Affordable Care Act, CMS established the Medicare Shared Savings ACO program.  Under this program, ACOs are charged with improving care coordination for Medicare fee-for-service beneficiaries.  ACOs that participate in the program have the opportunity to share in Medicare cost savings they achieve.  In some circumstances, CMS holds ACOs accountable for failing to achieve cost savings (i.e., by making ACOs partially responsible for costs above established benchmarks). 
Source: aghealthreform.com

S. 2101 (110th): Medicare Savings Program Improvement Act of 2007

Medicare Savings Program Improvement Act of 2007 – Amends title XIX (Medicaid) of the Social Security Act (SSA) with respect to the Qualified Medicare Beneficiaries (QMB) and Specified Low-Income Medicare Beneficiaries (SLMB) programs (Medicare Savings Program) to increase the income eligibility levels for: (1) QMBs to 135% of the federal poverty level (FPL); and (2) SLMBs to 150% of the FPL. Eliminates the application of estate recovery for Medicare Savings Program beneficiaries. Modifies the asset tests for QMBs and SLMBs. Directs the Secretary of Health and Human Services to provide for expedited enrollment under the Medicare Savings Program through Social Security offices. Provides for treatment of QMBs, SLMBs, and other dual eligibles as Medicare beneficiaries.
Source: govtrack.us

CMS picks 27 ACO participants for shared

  More than 10,000 physicians, 10 hospitals, and 13 smaller physician-led entities and serve an estimated 375,000 beneficiaries will be included in the first ACOs. The announcement follows the January launch of the modified Pioneer Model ACOs with 32 healthcare groups and six Physician Group Practice Transition Demonstration organizations.
Source: 7medical.com

latest news: CMS Provides $46.5 Million to State Health Insurance Programs (SHIPs)

The SHIPs provide personalized, one-on-one counseling, information, education and outreach to help people understand their Medicare benefits. Medicare beneficiaries can get assistance with information and support for Medicare prescription drug coverage, Medicare Advantage plans, Medicare supplemental insurance policies, Medicare Savings Programs, long-term care insurance and financing, and other public and private health insurance coverage options. SHIPs also assist eligible participants to enroll in these programs and plans.
Source: blogspot.com

House Appoves Bill To Kill Medicare Cost Panel

Posted by:  :  Category: Medicare

Healthcare Costs by Images_of_MoneyMcClatchy: GOP-Led House Votes To Delete Plank Of Health Care Law The House of Representatives voted Thursday to repeal a key part of the 2010 federal health care law, triggering a bitter, partisan debate that’s likely to be repeated throughout this election year. The Republican-led House voted 223-181 to do away with a new 15-member board designed to help control Medicare costs, a move that the Democratic-dominated Senate is likely to reject. Yet the House effort had considerable bipartisan support at one time, before it became mired in election-year politics. Both parties see their positions on the health care overhaul as important to their re-election efforts (Lightman, 3/22).
Source: kaiserhealthnews.org

Video: What Does Medicare Cost?

House of Representatives Votes to Eliminate Medicare Cost

Critics, including employers and health care organizations, are concerned that the IPAB will undermine Medicare by giving an independent, undemocratic body primary control over key health care decisions. They argue that repeal the authority given to the Board will “restore the doctor-patient relationship in Medicare” and keep the costs of private health care in check. Conversely, proponents of the IPAB argue that it is necessary to keep Medicare spending within reasonable limits and protect the program’s solvency. 
Source: upenn.edu

Medicare Policy Needs Viagra

The Ryan plan is similarly misguided. Medicare recipients aren’t “consumers” of health care. When shopping for clothes we (I’m Medicare eligible) can choose between Walmart and Nieman Marcus. That’s consumerism. But when cancer or heart disease occur we don’t “shop” at a cancer or cardiac mall — we seek doctors and nurses we trust and put ourselves in their hands. The negative reaction to Ryan’s proposal shows that U.S. society won’t accept putting the risk of cost overruns onto Medicare recipients alone any more than Congress accepts putting that risk uniquely onto physicians.
Source: thehastingscenter.org

Is Medicare cost growth slowing down?

Modern Principles of Economics Launching The Innovation Renaissance The Great Stagnation: How America Ate All the Low-Hanging Fruit of Modern History, Got Sick, and Will(Eventually) Feel Better Create Your Own Economy: The Path to Prosperity in a Disordered World Discover Your Inner Economist Good and Plenty: The Creative Successes of American Arts Funding Judge and Jury: American Tort Law on Trial Markets and Cultural Voices: Liberty vs. Power in the Lives of Mexican Amate Painters (Economics, Cognition, and Society) The Voluntary City: Choice, Community, and Civil Society (Economics, Cognition, and Society) Creative Destruction: How Globalization Is Changing the World’s Cultures Changing the Guard: Private Prisons and the Control of Crime What Price Fame? In Praise of Commercial Culture Entrepreneurial Economics: Bright Ideas from the Dismal Science
Source: marginalrevolution.com

House repeals Medicare cost board on party lines

IPAB would have the power to force cuts to service providers like drug companies if Medicare costs rise beyond predetermined levels. A Republican Medicare plan announced this week would also limit Medicare cost increases, but rely more on market competition.
Source: goerie.com

The Medicare Problem is the Healthcare Problem

The trouble is that this high level of capital investment does not seem to be buying improved outcomes. One crude indicator: life expectancy numbers have tended to stagnate in the U.S. in recent years. The CIA Factbook now ranks the U.S. 50th in the world for life expectancy, just ahead of Taiwan but behind Portugal.
Source: thedailybeast.com

House Repeals Medicare Cost Board

Drawing a new election-year fault line between the parties, the Republican-controlled House voted Thursday to repeal a Medicare cost-control board that has yet to be named but is called for in President Obama’s healthcare overhaul law. The GOP has branded the Independent Payment Advisory Board a rationing panel, and Republicans hope the symbolic 223-181 vote to repeal it will persuade seniors that they, and not the Democrats, are the best stewards of Medicare. IPAB would have the power to force cuts to service providers like drug companies if Medicare costs rise beyond predetermined levels. A Republican Medicare plan announced this week would also limit Medicare cost increases, but rely more on market competition. If it sounds like a debate among Washington insiders, Rep. Jack Kingston (R-GA), said he would have no trouble explaining to constituents why he voted to repeal the board. “Do you remember death panels?” said Kingston, referring to the debunked accusation by former GOP vice presidential candidate Sarah Palin that Obama’s healthcare law would allow bureaucrats to withhold life-saving care from the elderly. “It’s not necessarily a death panel, but it is a rationing panel and rationing does lead to scarcity for some,” he added. “Who’s going to get the needed treatment, an 85-year-old or the 40-year-old with children?” The healthcare law explicitly bars the board from rationing care, shifting costs to Medicare recipients or cutting their benefits. But critics say squeezing service providers will stifle medical innovation, achieving a similar result. Many House Democrats also oppose the board, but for different reasons. They feel it diminishes the role of Congress in deciding Medicare policy. But Republicans made it difficult to attract Democrat votes for repeal by adding other politically charged provisions to their bill. “Republicans don’t want to see IPAB repealed now because they want to run against it,” said Scott Gottlieb, a former senior FDA official in the George W. Bush administration. “I think there will be an effort to repeal it after the election.” The House vote came a day before the second anniversary of the healthcare law, and just ahead of next week’s Supreme Court deliberations on its constitutionality. Political gamesmanship aside, it highlighted major differences between the parties on Medicare, the giant healthcare program for nearly 50 million seniors and disabled people. READ FULL ARTICLE
Source: newmediajournal.us

House Republicans try to kill Medicare cost

Republican Conference Chairman Rep. Jeb Hensarling, R-Texas, center at lectern, accompanied by fellow GOP lawmakers speak to reporters on Capitol Hill in Washington, Thursday, March 22, 2012, after the House voted along party lines to repeal a Medicare cost-control board that’s part of President Barack Obama’s health care overhaul law. From left are: Rep. Larry Bucshon, R-Ind., Rep. Phil Gingrey, R-Ga., Rep. Joe Pitts, R-Pa., Rep. Jeb Hensarling, R-Texas, Rep. Fred Upton, R-Mich., and Rep. Bill Cassidy, R-La. (AP Photo/J. Scott Applewhite)
Source: manyhands.com

Obama sticks to same Medicare cost

Obama also proposes things that his fellow Democrats won’t like. He wants wealthier seniors to pay more for Medicare, and changes the deductible for doctors’ visits for seniors who enrolled after 2017. He also adds a new co-payment for home health services and increases premiums if seniors choose to have a supplemental “Medigap” plan.
Source: govexec.com

Five Half Truths And Lies About Mitt Romney

- Nothing changes for current seniors or those nearing retirement – Medicare is reformed as a premium support system, meaning that existing spending is repackaged as a fixed-amount benefit to each senior that he or she can use to purchase an insurance plan – All insurance plans must offer coverage at least comparable to what Medicare provides today – If seniors choose more expensive plans, they will have to pay the difference between the support amount and the premium price; if they choose less expensive plans, they can use any leftover support to pay other medical expenses like co-pays and deductibles – “Traditional” fee-for-service Medicare will be offered by the government as an insurance plan, meaning that seniors can purchase that form of coverage if they prefer it; however, if it costs the government more to provide that service than it costs private plans to offer their versions, then the premiums charged by the government will have to be higher and seniors will have to pay the difference to enroll in the traditional Medicare option – Lower income seniors will receive more generous support to ensure that they can afford coverage; wealthier seniors will receive less support – Competition among plans to provide high quality service while charging low premiums will hold costs down while also improving the quality of coverage enjoyed by seniors
Source: ohiomm.com

First in Series on Medicare DSH and Top Cost Report Appeal IssuesHall Render Blogs

One key appeal rule change requires cost reports ending on or after December 31, 2008 to have all appeal issues included as Protested Items in Line 30 on Worksheet E, Part A.  Please ensure that your potential appeal issues are being preserved when you file your cost report.  It is also possible to file an amended cost report prior to the issuance of the NPR for that year.  If you protest more than one issue, please ensure that you are itemizing each issue and the impact.
Source: hallrender.com

More than 30 million with Medicare used free preventive services in 2011

Posted by:  :  Category: Medicare

Wall Street by elycefelizThe report discussing Medicare preventive services found that more than 25.7 million Americans in traditional Medicare received free preventive services in 2011. The report also looked at Medicare Advantage plans and found that 9.3 million Americans – 97 percent of those in individual Medicare Advantage plans – were enrolled in a plan that offered free preventive services.  Assuming that people in Medicare Advantage plans utilized preventive services at the same rate as those with traditional Medicare, an estimated 32.5 million people benefited from Medicare’s coverage of prevention with no cost sharing.
Source: medicare.gov

Video: Whitehouse: Cuts to Social Security and Medicare Benefits Have No Place in Debt Talks

Retrospective Risk Adjustment

Risk adjustment plays a very large role within the health care industry, and especially in connection to how the Centers for Medicare and Medicaid Services allocate funds for plan members. Risk adjustment is centered around the need to determine how much a health plan member is going to cost in terms of services and treatments needed and rendered. It is through risk adjustment that providers are compensated by CMS as well as how much the plan enrollee will have to pay. As the importance of risk adjustment continues to grow and be highlighted by the health care industry providers, the number of types of risk adjustment methods continues to grow.
Source: acnetreatmentzone.info

Research Roundup: Medicare Vs. Private Plans

Archives Of Internal Medicine: Obesity Treatment For Socioeconomically Disadvantaged Patients In Primary Care Practice – Low-income patients are underrepresented in clinical trials and are disproportionately prone to obesity and the related problems of high blood pressure and heart disease. Researchers conducted a 24-month trial of more than 300 low-income, obese patients from various Boston community health centers, randomizing participants “to usual care or a behavioral intervention that promoted weight loss and hypertension self-management using eHealth components. The intervention included tailored behavior change goals, self-monitoring, and skills training, available via a website or interactive voice response.” The intervention resulted in “modest weight losses, improved blood pressure control and slowed systolic blood pressure” (Bennett et al., 4/9). Kaiser Family Foundation: How Does The Benefit Value Of Medicare Compare To The Benefit Of Typical Large Employer Plans? A 2012 Update — This study, updated from 2008, found that “Medicare remains less generous on average than typical large employer health plans, even after recent improvements in the program’s drug coverage. Overall, Medicare would cover $11,930 on average of the $14,890 in estimated annual spending for an individual age 65 and older, less than would be covered under either the federal employee plan ($12,260) or the typical PPO comparison plan ($12,800) for an individual age 65 and older. The gap was narrower in 2011 than it was in 2007, largely due to provisions in the Affordable Care Act that provide discounts on brand-name drugs purchased in the Medicare drug benefit’s coverage gap, or “doughnut hole” (McArdle, Levinson, Stark and Neuman, 4/4). The Heritage Foundation: Saving The American Dream: Comparing Medicare Reform Plans – The Heritage Foundation has proposed a premium support plan for Medicare as part of a comprehensive defict reduction package. This backgrounder looks at that proposal and five other plans that offer such supports. In a plan with a premium support, sometimes called a voucher, the government makes a fixed payment to Medicare beneficiaries, who then can shop for appropriate health insurance.  The author writes that, while details vary, each requires “traditional Medicare to compete with private plans, using competitive bidding to determine market-based payments to health plans, requiring upper-income retirees to pay more for their benefits, providing extra assistance to lower-income enrollees, and adding a risk-adjustment mechanism to guarantee market stability and security for older and sicker retirees. The breadth of the consensus on key policy components could be the basis for a strong bipartisan agreement” (Moffit, 4/4).
Source: kaiserhealthnews.org

Medicare and Social Security Disability Benefits

Jeanne Larson of Medicare Information Office shared her expertise about Medicare and Social Security Disability Benefits. Judith Bendersky and eanne Larson work together helping those who need disability insurance. They know this can be so confusing, applying for benefits is overwhelming!
Source: multiplesclerosis-relief.com

Daily Kos: DCCC Chair Steve Israel: Caving on Medicare benefits would devastate candidate recruitment

Unlike Social Security, there are ways to cut Medicare spending without cutting benefits—you can do things like authorizing Medicare to negotiate prices for prescription drugs. But if you go ahead and slash Medicare benefits for seniors who can’t afford it, you’re taking away the single most powerful campaign issue congressional Democrats have. Just ask Kathy Hochul. Without Paul Ryan’s plan to run against, she wouldn’t be in Congress today. And if Democrats agree to Republican demands for Medicare benefit cuts, they’ll be taking Ryan’s plan off the table. Good candidates will sit on the sidelines, and Democratic chances for recapturing the House will go up in smoke. It would be a huge political blunder. Democrats should continue to fight against it.
Source: dailykos.com

Payson Daily Bugle: How Medicare covers hospice care

You can get inpatient respite care in a Medicare-approved facility (such as a hospice inpatient facility, hospital, or nursing home) if your caregiver needs a rest. You can stay up to five days each time. You can get respite care more than once, but it can only be provided on an occasional basis.
Source: blogspot.com

Medicare Supplement Plans Comparison – Some questions to make the process…

Posted by:  :  Category: Medicare

"Every citizen should be a soldier. This was the case with the Greeks and Romans, and must be that of every free state." ` Thomas Jefferson. by eyewashdesign: A. GoldenChoosing a plan is the first thing that one should do. Price comparison is the second job that one must keep at the priority list. After having a right plan in hand, price comparison can be done without worrying for the coverage or features. Medicare supplement insurance is one of the best types of insurance policies that one can buy for the family. It is also essential to create a checklist of to –do things before getting involved in buying an insurance policy. What kind of services you want? What type of treatments or medications you could require in the coming years? If you have good understanding of all such things, it will be easy for you to decide upon a right policy.
Source: sarticles.in

Video: Guide to Using Joppel for Medicare Insurance

ZPIC or Medicare Audit and Site Visit Checklist

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Source: wordpress.com

NEW MEDICARE WEBSITE HELPS PATIENTS REVEAL FRAUD

The government is now enlisting seniors in fighting rampant Medicare Fraud throught he creation of a newe Medicare website, www.mymedicare-.gov.The new site, which includes larger type and explanations of medical services will allow seniors to know if any healthcare provider has fraudulently billed them and the government. According to the GAO, last year, Medicare saved the taxpayers over $4 billion as a result of whistleblowers coming forward to report healthcare fraud.
Source: wordpress.com

Medicare and Medicaid Doctor Directory

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Source: kampusamasya.com

PoliGraph: Cravaack Medicare claim misses on numbers

The feature examines statements made by Minnesota politicians and checks them for accuracy. Based on data analysis, document reviews and interviews with non-partisan analysts, statements are rated either true, false or inconclusive. PoliGraph is a collaboration between Minnesota Public Radio News and the Humphrey School of Public Affairs at the University of Minnesota. More
Source: publicradio.org

What happened to Highmark Medicare Services?

Physicians and medical billing companies should not face many disruptions as a result of this transition. According to Novitas Solutions, the current Highmark Medicare website will be fully transitioned to the new Novitas site by March 30, 2012. During the transition, visitors to the old website (https://www.highmarkmedicareservices.com) will be automatically re-directed to the new Novitas Solutions website (https://www.novitas-solutions.com), where a new header and page logo can be seen. Bookmarks that users may already have for the Highmark website will purportedly still work with the new page. The Electronic Payer ID has not appeared to change, so claims submission and processing should remain unaffected by the transition. For more information, see the Informational Alert here: https://www.novitas-solutions.com/partb/info-alerts.html.
Source: healthcarebiller.com

Hospital Owner Makes $43 Million Medicare Settlement

Posted by:  :  Category: Medicare

Gang of Six - Cartoon by DonkeyHoteyThe settlement resolves allegations pertaining to twenty-five inpatient rehabilitation facilities that Dallas-based Tenet has owned and operated throughout the country.  These facilities are designed for patients who need an intense rehabilitation program that requires a multidisciplinary, coordinated team approach to improve their ability to function. Because the patients treated at these facilities require more intensive rehabilitation therapy and closer medical supervision than is provided in other settings, such as acute care hospitals or skilled nursing facilities, Medicare generally pays at a higher rate for rehabilitation care.
Source: patch.com

Video: Georgia Medicare Supplements

As Fiscal Years Start To Wind Down, States Confront Medicaid Issues

Kansas Health Institute News: KanCare Reorganization Moves Forward Had either the House or Senate rejected the order, the reshuffle would have been halted. … [Brownback administration officials] said moving long-term care services from the Kansas Department of Social and Rehabilitation Services would cement their efforts to better coordinate care for elderly and disabled Medicaid beneficiaries. Brownback has forecast at least $850 million in savings over five years for the state and federal governments thanks to KanCare (Shields, 4/12). 
Source: kaiserhealthnews.org

Complement Your Georgia Medicare Supplement With Dental, Vision and More…

Based in beautiful Jackson Hole, Wyoming, we currently market health insurance in 18 different states from our website IndividualHealth.com. I have worked in the domestic and international markets for most of my adult life. Recently we launched a newly revamped website www.tetonmarketing.com which has a primary focus on music and Native American Flutes and hand crafted items made in Wyoming. Check it out! I want the Insurance Simplified Blog to be a place you can visit from time to time and read about real world issues that individuals and families face daily. Our parent website IndividualHealth.com we like to think of as a virtual brochure. But with the blog I want to talk about the topics behind the brochure. Also check out our blog www.JacksonHoleTim.com which is “All Things Wyoming, Everything Jackson Hole” . If you love the Yellowstone basin this is blog for you! Then when you are ready check out our new Social Network site Jacksonholetim.ning.com – this is a place you can connect with other who visit and live in Wyoming. And finally we have just launched another new blog. Jackson Hole Tim (www.jacksonholetim.com) is a new place to visit that talks about “All things Wyoming, Everything Jackson Hole”. I hope you find these blog helpful.
Source: wordpress.com

Georgia Radiation Oncology Clinic Settles Medicare Whistleblower Case

Radiotherapy Clinics of Georgia (RCOG), a radiation oncology practice located in Decatur, Ga., and its affiliates have agreed to pay $3.8 million to settle claims that they violated the False Claims Act after allegedly billing Medicare for medical treatments that were unnecessary or went beyond what is permitted by Medicare rules, according to the U.S. Justice Department. Two whistleblowers will receive $646,000 as their share of the proceeds. Read More.
Source: whistleblowerprotection.com

CMS Reveals First 27 ACOs in Medicare Shared Savings Program

The ACOs span 18 states and will cover roughly 375,000 beneficiaries. Five of the 27 ACOs are participating in the Advance Payment ACO Model, under which each ACO will receive advance payments to help cover the costs of establishing an ACO infrastructure. The names of the Advance Payment ACOs were not disclosed in the news release. CMS is now reviewing more than 150 applications from ACOs seeking to participate in MSSP beginning July 1. Of those applicants, more than 50 are applying for the Advance Payment ACO Model. The first 27 ACOs to participate in the MSSP program are listed here, along with their respective locations: 1. Accountable Care Coalition of Caldwell County, LLC (N.C.) 2. Accountable Care Coalition of Coastal Georgia 3. Accountable Care Coalition of Eastern North Carolina, LLC 4. Accountable Care Coalition of Greater Athens Georgia 5. Accountable Care Coalition of Mount Kisco, LLC (N.Y.) 6. Accountable Care Coalition of the Mississippi Gulf Coast, LLC 7. Accountable Care Coalition of the North Country, LLC (N.Y.) 8. Accountable Care Coalition of Southeast Wisconsin, LLC 9. Accountable Care Coalition of Texas, Inc. 10. AHS ACO, LLC (N.J.) 11. AppleCare Medical ACO, LLC (California) 12. Arizona Connected Care, LLC (Arizona) 13. Chinese Community Accountable Care Organization (N.Y.) 14. CIPA Western New York IPA, doing business as Catholic Medical Partners (N.Y.) 15. Coastal Carolina Quality Care, Inc. (N.C.) 16. Crystal Run Healthcare ACO, LLC (N.Y. and Pa.) 17. Florida Physicians Trust, LLC 18. Hackensack Physician-Hospital Alliance ACO, LLC (N.J.) 19. Jackson Purchase Medical Associates, PSC (Ky.) 20. Jordan Community ACO (Mass.) 21. North Country ACO (N.H.) 22. Optimus Healthcare Partners, LLC (N.J.) 23. Physicians of Cape Cod ACO (Mass.) 24. Premier ACO Physician Network (Calif.) 25. Primary Partners, LLC (Fla.) 26. RGV ACO Health Providers, LLC (Texas) 27. West Florida ACO, LLC
Source: beckersorthopedicandspine.com

Tenet Healthcare ‘Proud’ To Settle Medicare Fraud Charges For $43 Million

The Obama administration has pledged to improve the government’s ability to detect Medicare and Medicaid fraud as it happens instead of just working backwards to chase dollars already lost. The health care reform law enacted two years includes new anti-fraud tools the administration says helped
Source: ptmanagerblog.com

Georgia DOJ Settlement: Letter to Georgia, Department of Justice, Independent Monitor Regarding Concerns About Navigant Report

(1) The Navigant Report, which recommends a Medicaid Redesign, does not give any consideration to how the Settlement Agreement would be carried out under a redesign despite the fact that the implementation would begin in the fourth year of the five year Settlement Agreement and have a major impact on it; (2) The recommended Medicaid redesign likely would prevent the state from complying with the Settlement Agreement; and (3) The Redesign likely would substantially debilitate or eliminate the Department of Behavioral Health and Developmental Disabilities, which the state created after repeatedly expressing the importance of having a department that focused solely on people with mental illness, substance abuse issues, and developmental disabilities.
Source: blogspot.com

Why Medicare plans in California stay in great hype?

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSMedicare indemnity plans are available in every country and state but having one in California has some more advantages as compared to other states. The benefits of choosing from the Medicare plans in California can give a special advantage. You can switch to any company on your birth date every year under Medicare supplement member scheme. In fact, you can switch to any other company throughout year. The new company sends application to the underwriting department on their own behalf after reviewing the overall health status.
Source: zigyasu.com

Video: Shop and Compare Medicare Insurance Plans

Research Roundup: Medicare Vs. Private Plans

Archives Of Internal Medicine: Obesity Treatment For Socioeconomically Disadvantaged Patients In Primary Care Practice – Low-income patients are underrepresented in clinical trials and are disproportionately prone to obesity and the related problems of high blood pressure and heart disease. Researchers conducted a 24-month trial of more than 300 low-income, obese patients from various Boston community health centers, randomizing participants “to usual care or a behavioral intervention that promoted weight loss and hypertension self-management using eHealth components. The intervention included tailored behavior change goals, self-monitoring, and skills training, available via a website or interactive voice response.” The intervention resulted in “modest weight losses, improved blood pressure control and slowed systolic blood pressure” (Bennett et al., 4/9). Kaiser Family Foundation: How Does The Benefit Value Of Medicare Compare To The Benefit Of Typical Large Employer Plans? A 2012 Update — This study, updated from 2008, found that “Medicare remains less generous on average than typical large employer health plans, even after recent improvements in the program’s drug coverage. Overall, Medicare would cover $11,930 on average of the $14,890 in estimated annual spending for an individual age 65 and older, less than would be covered under either the federal employee plan ($12,260) or the typical PPO comparison plan ($12,800) for an individual age 65 and older. The gap was narrower in 2011 than it was in 2007, largely due to provisions in the Affordable Care Act that provide discounts on brand-name drugs purchased in the Medicare drug benefit’s coverage gap, or “doughnut hole” (McArdle, Levinson, Stark and Neuman, 4/4). The Heritage Foundation: Saving The American Dream: Comparing Medicare Reform Plans – The Heritage Foundation has proposed a premium support plan for Medicare as part of a comprehensive defict reduction package. This backgrounder looks at that proposal and five other plans that offer such supports. In a plan with a premium support, sometimes called a voucher, the government makes a fixed payment to Medicare beneficiaries, who then can shop for appropriate health insurance.  The author writes that, while details vary, each requires “traditional Medicare to compete with private plans, using competitive bidding to determine market-based payments to health plans, requiring upper-income retirees to pay more for their benefits, providing extra assistance to lower-income enrollees, and adding a risk-adjustment mechanism to guarantee market stability and security for older and sicker retirees. The breadth of the consensus on key policy components could be the basis for a strong bipartisan agreement” (Moffit, 4/4).
Source: kaiserhealthnews.org

The Best Medicare Supplement Plan

Although these differences abound, they are easily deciphered, and you can get the best Medicare Supplement plan by merely comparing the options and choosing the plan that makes the most sense for your unique situation. Here is some information about choosing a Medigap plan if you are turning 65. We would always recommend, whether it is us or someone else, using an independent brokerage/agency. This allows you to compare multiple options in a centralized place, so that you can make an informed choice from all of the options. In most cases, this informed choice should be the company that is most competitively priced for your age and zip code.
Source: medicare-supplement.us

beSpacific: How Does the Benefit Value of Medicare Compare to the Benefit Value of Typical Large Employer Plans?

“This study compares the value of Medicare’s fee-for-service benefits last year with the value of benefits in two large employer health plans – a large health plan serving federal employees and a typical large employer Preferred Provider Organization (PPO) plan. For individuals ages 65 and older, the study finds that Medicare remains less generous on average than typical large employer health plans, even after recent improvements in the program’s drug coverage. Overall, Medicare would cover $11,930 on average of the $14,890 in estimated annual spending for an individual age 65 and older, less than would be covered under either the federal employee plan ($12,260) or the typical PPO comparison plan ($12,800) for an individual age 65 and older. The gap was narrower in 2011 than it was in 2007, largely due to provisions in the Affordable Care Act that provide discounts on brand-name drugs purchased in the Medicare drug benefit’s coverage gap, or “doughnut hole.”
Source: bespacific.com

Medicare Supplemental Health Insurance Resources Online

When looking into health insurance of any kind the rules, regulations and stipulations often make it so that every word on the policy seems foreign and a bit sketchy. The policy is never laid on it terms that one without industry knowledge would completely understand. Words such as co-payment, deductible, family allowance, preventative vs. routine care often times add confusion in really understanding what is being offered. Health Insurance in general is difficult to understand and often leads us to believe we are being manipulated let alone getting into the next generation of health insurance, Medicare. How is one to determine exactly what is being offered and to finally settle upon a policy that best fits the need with Medicare and Medigap supplemental insurance policies? One way to gain information on recent updates and current information on Medicare and Medigap is online. Although the internet is a terrific source of information people often find that they would like to speak with someone to make sure what they understand is exactly what is meant. Many companies will offer information online along with a telephone number to speak with advisors who will offer guidance into the technical aspects of what is being offered. This is especially important when it comes to Medicare Supplemental Insurance aka: Medigap Supplemental Insurance. Many insurance companies offer supplemental insurance plans for Medicare. The one thing to remember is that with all Medicare and Medigap policies the coverage will be the exact same no matter where it is purchased. The prices will vary due to the company sponsoring the plan. When you purchase Medicare supplemental insurance plan g or Medicare supple insurance plan n the coverage at one company will be the exact same as another. The difference will be the cost of the policy and this can be varied do to the level of service offered. The great thing about many online companies is that they offer clients to compare Medicare supplemental insurance rates and plans offered by multiple insurance companies without offering up any personal information. These same sites often offer the chance to buy Medigap supplemental insurance through them acting as a facilitator in getting you the best supplemental insurance rate and coverage to fit your exact need. They offer online support as well as assistance free help over the phone. Advisors that are up to date on all topics related to Medicare will assist you in obtaining the right coverage for your need at a desirable price. Medigap Plan G, Plan F and Plan N are currently the most popular option amongst Medicare recipients. When considering a plan that will work for your situation it is important to look at everything that is covered by the plan and as well as what is not covered. We will take a look into just one of the many Medicare supplemental plans, plan N. Medigap supplemental insurance plan N offers one feature that many people find incredibly important in their Medicare Health Coverage; it covers the twenty percent of the doctor and hospital bills left over from traditional Medicare coverage. The twenty percent that is covered has no limit and is often astronomical when talking about major illness or injury. Take for instance a one hundred thousand dollar procedure. Medicare traditionally covers eighty thousand and the recipient is left to cover the other twenty percent on his or her own. Medigap supplemental insurance plan N would be one of the many Medigap plans that cover this extra expense. In addition plan N covers the part A yearly deductible. However plan N does not cover the Medicare plan B deductible. It also uses a method known as cost-sharing when handling doctor’s office visits. This would that you either pay twenty percent or twenty dollars whichever is less when going in for an office visit. With this plan there is also an additional out of pocket co-pay due for emergency room visits. With any plan the options will need to be weighed. The benefits and drawbacks should be looked at with a cost analysis to determine what scenarios are most likely to occur in your life. Medicare supplemental insurance plans are enough different that a plan should be a best fit for your Medicare health insurance needs.
Source: abcarticledirectory.com

ABCHealthPlans Generates Easy Insurance Shopping Options for Bolingbrook Families

It is necessary for the insurance buyers to get thoroughly acquainted with the terms and conditions underlying different Illinois Medicare insurance policies. This makes the entire process protracted and tedious for the consumers. Now, ABCHealthPlans.com provides not only easy alternative to Compare Medicare Supplement plans, but also the assistance of expert agents to answer to all the insurance related queries, round-the-clock.
Source: briefingwire.com

Hospital Compare From Medicare Has Not Helped to Save Lives

“This isn’t a total indictment of public reporting … or of Hospital Compare,” says Andrew Ryan, an author of the study and assistant professor of public health at Weill Cornell Medical College. But the way the program was structured during the time period it was studied doesn’t appear to have significantly reduced the number of patient deaths, at least for these conditions.
Source: georgia-medicareplans.com

The place to Research for Medicare Supplement Rates

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSEarlier than an individual lookup for Medicare Supplement rates, he or she ought to make positive that they are by now enrolled in Medicare Element An and Element B. Men and women, who are considering to swap from Medicare advantage approach to original Medicare, should apply for Medigap just before the finish of the protection. Plans E, H, I and J are not sold anymore, but men and women can preserve them if they are now enrolled in it. Only 1 particular person can be lined in a solitary Medigap policy, so in circumstance of married few both equally the husband and spouse have to pay for impartial policy. An insured particular person is needed to pay out independent rates for Medicare Piece B and Medigap coverage. Medicare health supplement premium goes to the personal organization you are enrolled with.
Source: officerelocationmagazine.com

Video: Medicare Supplement Plans | Questions about Medicare Supplement Plans

Neuroplasticity Marketing & Sales

Triple your adsense commissions with this cutting edge wp plugin. Automatically turn your WordPress search boxes into a Google Money Making “Adsense For Search” Search Field. Also adds Google search fields to each page and post in your wordpress site or b
Source: office-phone-systems.info

Ask MTG Questions, MTG Help and MTG Rules

Before an individual lookup for Medicare Supplement prices, he or she must make positive that they are now enrolled in Medicare Aspect An and Element B. Men and women, who are scheduling to swap from Medicare benefit method to original Medicare, should apply for Medigap just before the finish of the protection. Plans E, H, I and J are not sold anymore, but persons can hold them if they are now enrolled in it. Only a single man or woman can be covered in a solitary Medigap policy, so in case of married pair both of those the husband and spouse desire to choose impartial policy. An insured man or woman is needed to pay out independent rates for Medicare Piece B and Medigap coverage. Medicare health supplement premium goes to the personal firm you are enrolled with.
Source: askmtg.com

Ask The Experts: Retirement

A. You are making assumptions that may not be valid. While it’s conceivable that you could save money by shifting your coverage to self only and your wife’s to Medicare and a supplemental, you need to check out the real costs to be sure. While Medicare Part A is free, Part B isn’t. Also, supplemental plans are tricky rascals whose costs and coverage are all over the lot. More importantly, you need to make sure that the resulting benefits will at least match what she would have under your FEHB plan plus Medicare. Because I doubt that they will, I urge you be very careful before you put your wife at risk to save a few bucks.
Source: federaltimes.com

The Best Medicare Supplement Plan

Although these differences abound, they are easily deciphered, and you can get the best Medicare Supplement plan by merely comparing the options and choosing the plan that makes the most sense for your unique situation. Here is some information about choosing a Medigap plan if you are turning 65. We would always recommend, whether it is us or someone else, using an independent brokerage/agency. This allows you to compare multiple options in a centralized place, so that you can make an informed choice from all of the options. In most cases, this informed choice should be the company that is most competitively priced for your age and zip code.
Source: medicare-supplement.us

Medicare Supplement Health Insurance

Medicare supplement health insurance helps you to save your money and it ensures easy purchase of its plans. There are advisors who can assist the clients in answering questions pertaining to this health insurance plan. In a discussion by the partisans, the Medicare supplement health insurance plans are also meant to reduce the first dollar coverage. Those who enrolled in the in this plan are required to pay $ 530 as an annual surcharge. The implication of this is that the federal government will have saved approximately $ 50 billion in a period of ten years. The plan to make this health insurance plan assist in reducing the deficit in the federal governments is underway.
Source: lookupinsurance.com

What Are Medicare Supplement Plans?

A Medigap policy is a health insurance policy sold by private insurers to pay health care costs that are not covered by Medicare. Medigap policies are regulated by federal and state law and there are standardized policies labeled A through N.  The coverage under each of these types of policies is the same no matter what company sells it.  In other words, all Medigap A plans are the same, all Medigap C plans are the same and so on.
Source: findlocal-insurance.com

Is Your Medicare Dietary supplement Insurance coverage Created Similarly

Medigap has been additional to the Medicare dietary supplement insurance plan plans that are intended to allow hold citizens healthier. An individual may well suppose that the only main difference somewhere between Medigap options is the price tag that goes with them, but that might not be the case. Method F rates $1336.72 every year when ordered from United Entire world Insurance Firm. That equivalent prepare expenditures $1720.45 on a yearly basis when obtained from Genworth Lifespan and Annuity Insurance policies Service. As earlier than, the equivalent plan charges $2182.02 per year when ordered from Bankers Lifespan and Casualty Insurance Corporation. It appears that the truth of the matter is Medigap is not normally put together equally.
Source: easyarticle.org

Understanding Mississippi Medicare Part D

Posted by:  :  Category: Medicare

Healthcare solution >> more doctors by / // /It provides skilled nursing facility, which is for a short time and you need to pay certain nominal charges after you exceed a fixed duration. The next part is about the services of the physician, which includes outpatient services, home care services and permanent medical devices. You have to pay a certain percentage of amounts when you reach the level of the deductible, which should be verified. It is, therefore, important for a citizen in enrolling during the right period for Medicare to receive the best of facilities and advantages under the Medicare program offered by the federal government for most government employees after retirement. Part D tells about the cost of the prescription drugs, which is not approved for reimbursement in the hospital. It includes both branded medicines and genetic drugs of different manufacturers. It does not get included in the social security amount. The main intention of the Medicare program is to offer coverage of insurance to aged and retired citizens and also to them that are dependent on children working in the government sector.
Source: matureandhealthier.com

Video: Mississippi Medigap Insurance

Highmark (MAC Jurisdiction H) Dates Released

The Centers for Medicare & Medicaid Services (CMS) recently released the Medicare Administrative Contractor (MAC) transition dates for Jurisdictions 4, which covers Texas, Colorado, New Mexico and Oklahoma,  and 7, which covers Louisiana, Arkansas and Mississippi.  As previously reported, CMS is consolidating these two jurisdictions into a new Jurisdiction H, and has awarded the contract for administering all Medicare Part A and B operations to Highmark Medicare Services. After an unsuccessful appeal by TrailBlazer Health Enterprises and Pinnacle Business Solutions, the current MACs for these regions, implementation is moving forward.
Source: lilesparker.com

Mississippi Medicare Leads

A common list among Medicare supplement and Medicare Advantage insurance agents you could purchase from Affordablemedicareleads would focus in on individuals who are approaching the age of 65.  By focusing on this demographic you are certain to find those that are new to Medicare and are looking for either a Medicare supplement or Medicare Advantage plan that you are offer.  The downside to focusing on individuals turning 65 is that these individuals are new to Medicare and be quite confused.   They are getting bombarded by a number of different agents, not to mention their mail box is being flooded by numerous different insurance carriers.  Affordablemedicareleads can provide another list that is commonly used by Medicare insurance agents.  That would simply be individuals that are in the age range of 67-78.  By calling or mailing this age demographic what you are going to find this that #1; their agent the initially enrolled them in their plan is long gone by now.  #2; they have been on Medicare for at least a couple of years an have most likely to have had at least one premium increase.  They should understand that by now Plan F is Plan F and if you can offer them the same plan at a lower rate, you may just be able to gain a client.  By not going over the age of 78 will help you focus in on the more healthy individuals.
Source: affordablemedicareleads.com

CMS Reveals First 27 ACOs in Medicare Shared Savings Program

The ACOs span 18 states and will cover roughly 375,000 beneficiaries. Five of the 27 ACOs are participating in the Advance Payment ACO Model, under which each ACO will receive advance payments to help cover the costs of establishing an ACO infrastructure. The names of the Advance Payment ACOs were not disclosed in the news release. CMS is now reviewing more than 150 applications from ACOs seeking to participate in MSSP beginning July 1. Of those applicants, more than 50 are applying for the Advance Payment ACO Model. The first 27 ACOs to participate in the MSSP program are listed here, along with their respective locations: 1. Accountable Care Coalition of Caldwell County, LLC (N.C.) 2. Accountable Care Coalition of Coastal Georgia 3. Accountable Care Coalition of Eastern North Carolina, LLC 4. Accountable Care Coalition of Greater Athens Georgia 5. Accountable Care Coalition of Mount Kisco, LLC (N.Y.) 6. Accountable Care Coalition of the Mississippi Gulf Coast, LLC 7. Accountable Care Coalition of the North Country, LLC (N.Y.) 8. Accountable Care Coalition of Southeast Wisconsin, LLC 9. Accountable Care Coalition of Texas, Inc. 10. AHS ACO, LLC (N.J.) 11. AppleCare Medical ACO, LLC (California) 12. Arizona Connected Care, LLC (Arizona) 13. Chinese Community Accountable Care Organization (N.Y.) 14. CIPA Western New York IPA, doing business as Catholic Medical Partners (N.Y.) 15. Coastal Carolina Quality Care, Inc. (N.C.) 16. Crystal Run Healthcare ACO, LLC (N.Y. and Pa.) 17. Florida Physicians Trust, LLC 18. Hackensack Physician-Hospital Alliance ACO, LLC (N.J.) 19. Jackson Purchase Medical Associates, PSC (Ky.) 20. Jordan Community ACO (Mass.) 21. North Country ACO (N.H.) 22. Optimus Healthcare Partners, LLC (N.J.) 23. Physicians of Cape Cod ACO (Mass.) 24. Premier ACO Physician Network (Calif.) 25. Primary Partners, LLC (Fla.) 26. RGV ACO Health Providers, LLC (Texas) 27. West Florida ACO, LLC
Source: beckersorthopedicandspine.com

Medicare moves to tie doctors’ pay to quality and cost of care

Twenty-thousand physicians in four Midwest states received a glimpse into their financial future last month. Landing in their e-mail inboxes were links to reports from Medicare showing the amount their patients cost on average as well as the quality of the care they provided. The reports also showed how Medicare spending on each doctor’s patients compared with their peers in Kansas, Iowa, Missouri and Nebraska. Read full article > >
Source: heave-ho.org

27 Health Systems Selected For Shared Savings ACO Program

The Hill: More Than 1 Million Medicare Beneficiaries Enrolled In Health Law Savings Program More than one million Medicare beneficiaries are now enrolled in programs of the healthcare reform law that aim to reward doctors and hospitals for working together to improve the coordination and quality of care while saving money, the Obama administration announced Tuesday. Twenty-seven so-called “Accountable Care Organizations” have signed contracts with the Medicare agency to serve 375,000 beneficiaries in 18 states, the Medicare agency announced. The organizations are located in Arizona, California, Connecticut, Florida, Georgia, Illinois, Kentucky, Massachusetts, Mississippi, New Hampshire, New Jersey, New York, North Carolina, Pennsylvania, South Carolina, Texas, Vermont and Wisconsin (Pecquet, 4/10).
Source: kaiserhealthnews.org

CMS Announces First Accountable Care Organization (ACO) Approvals : Med Law Blog

Accountable Care Organizations are designed to lift this burden from patients, while improving care and reducing costs. The Shared Savings Program was created by the Affordable Care Act after a number of efforts in the private sector showed that improving care can lead to lower costs. The selected ACOs include more than 10,000 physicians, 10 hospitals, and 13 smaller physician-driven organizations in both urban and rural areas. Their models for coordinating care and improving quality vary in response to the needs of the beneficiaries in the areas they are serving. CMS is reviewing more than 150 applications from ACOs seeking to enter the program in July.
Source: medlawblog.com

Medicare Doesn’t Cover Custodial Care

It can sometimes be a very intimidating and frustrating process to try to care for your loved one when they are ill or elderly. It makes it much easier when Medicare covers the type of situation that your loved one is in and this is why it is hard if your loved one needs “custodial care”. This term is covered below in the exact wording as it is defined by Medicare.
Source: medicare-medicaid.com

ACLA Lauds New Health Affairs Study

AMA Code of Ethics AmeriPath anatomic pathology ASTRO Chesapeake Urology Associates client billing College of American Pathologists Colorado damages cap direct billing Drug test Florida Forensic pathology fraud Grandfather clause IMRT In Office Pathology Jean Mitchell kickback LabCorp laboratory lawsuit legislation Mayo Clinic Medicaid Medical malpractice Medicare Medicare fraud Myriad Genetics non compete pathologist Pathology payouts Physician self-referral Prometheus Laboratories prostate cancer Quest Diagnostics Radiation therapy self referral Stark Law stock Supreme Court United States Supreme Court Urology Whistleblower
Source: pathologyblawg.com

CMS unveils 27 Medicare ACOs

The Centers for Medicare & Medicaid Services today announced its long-awaited list of 27 Accountable Care Organizations (ACO) under the Medicare Shared Savings Program, as well as five Advance Payment ACOs, both beginning April 1. The 27 Medicare ACOs through the Shared Savings Program will serve an estimated 375,000 beneficiaries in 18 states. Coupled with the 32 Pioneer ACOs and six Physician Group Practice Transition Demonstration organizations that both started in January, the total 65 ACOs will serve 1.1 million Medicare beneficiaries, CMS said in a statement.
Source: fiercehealthcare.com

14 Hospitals to Pay Over $12M for Kyphoplasty Procedures

The Justice Department has now reached settlements with more than 40 hospitals totaling over $39 million to resolve false claims allegations related to kyphoplasty claims submitted to Medicare. These settlements follow the government’s 2008 settlement with Medtronic Spine LLC, corporate successor to Kyphon Inc., which paid $75 million to settle allegations that the company defrauded Medicare by counseling hospital providers to perform kyphoplasty procedures as an inpatient procedure even though the minimally-invasive procedure should have been done in many cases on an outpatient basis.
Source: false-claims-act.com

Managed Healthcare Executive: Health Plans in Ideal Position to Identify Readmission Risks

Posted by:  :  Category: Medicare

Try new Ryan Plan Senior Food - coming to a Republican Congress near you by EN2008The March edition of Managed Healthcare Executive includes an article, “Health plans in ideal position to identify readmission risks,” which highlights the essential role of health plans in reducing preventable hospital readmissions – a top priority for policymakers and health care stakeholders.  The article notes the wealth of information health plans can access to help identify patients at high risk of hospitalization or readmission and the unique position of these plans to put in place programs to help reduce unnecessary readmissions.
Source: ahipcoverage.com

Video: Touchstone Health 2011 Commercial 3: simple, modern medicare(TM)

CMS Makes Improvements to Medicare Drug Health Plans

The drug and health plan program updates, effective January 1, 2013, will help continue the trend of lower premiums and stable or improved benefits that beneficiaries in these programs have experienced over the last two years.  Earlier this year, CMS announced that MA premiums had dropped 7 percent over the past year while enrollment increased by about 10 percent. Based on the 2013 policies announced today, CMS looks forward to retaining access to MA plans as an affordable option for people with Medicare and ensuring that drug and health plan sponsors are accountable to America’s senior and disabled beneficiaries for improved quality of care and stable cost-sharing for the coming year.
Source: nebraskaruralhealth.org

Why I Feel Humana Provides the Best Medicare Health Plans

All Medicare supplemental companies do charge a premium for their policies which will average about 90 to $100 a month. In exchange for that premium the Medigap company will cover all of your medical expenses, and there is no provider network to be concerned with. So as long as your provider accepts original Medicare you are pretty much good to go!
Source: violaproject.com

Medicare Supplemental Insurance Plans

Obviously, there are many additional supplemental plans to select from such as plans The, W, D, Deb, Grams, At the, Nited kingdom, as well as M. These types of plans are cheaper compared to their own much more thorough alternatives, however will give you advantages which are more typical statements. Furthermore, a number of carriers provide higher insurance deductible Medicare supplement plans. (supplemental protection having a higher insurance deductible will not spend advantages before customer offers arrived at his / her insurance deductible.) Nevertheless, the actual T as well as Farrenheit plans stay most widely used along with senior citizens who would like to possess comprehensive insurance protection.
Source: best-insurance-quote.com

Nonprofit Health Plans Outperform For

No surprise to us, but in the latest annual National Committee for Quality Assurance ranking of the quality of care of Medicare and Medicaid health plans, nonprofit plans were by and far rated the best. According to the Alliance for Advancing Nonprofit Health Care, all of the top 10 private plans, 68 percent of the top quartile of plans, and 76 percent of the top quartile of Medicaid plans were nonprofit. Very detailed report cards on the individual plans may be viewed at the NCQA website (for example, this report card on Kaiser Permanente of Northern California). Below are the top plans in both categories:
Source: nonprofitquarterly.org

YOUR VIEW: Medicare survey to help improve services

CMS and insurance providers want to make sure Medicare beneficiaries are receiving the highest-quality medical care when they need it, from doctors they trust. The CAHPS survey is one of the tools used to achieve this goal. The survey responses help the government and Medicare plans identify ways to better serve beneficiaries and improve the quality of their health care experience.
Source: al.com

Health Plan Cost Increases Starting to Slow Down

“The reduced trend factors reported in our survey reflect that health insurers, who may have previously added margins to account for health care reform benefit changes mandated for 2011, have now removed those margins for 2012 projections,” said Daniel Levin, FSA, a Buck principal and consulting actuary who directed the survey. “The reduction also reflects lower expected costs as a result of the economic slowdown. Employees are trying to reduce their out-of-pocket expenses and are postponing elective medical services.”
Source: reevewillknow.com

‘Science is Fun': Complex Choices in Medicare Advantage Program May Overwhelm Seniors

Posted by:  :  Category: Medicare

Committee on Aging Forum by ct senatedemsThe researchers found that, on average, an increase in the number of plans was associated with increased Medicare Advantage enrollment, provided the number of available plan options was fewer than 15. When the number of options surpassed 30, as it did in 25 percent of U.S. counties, such increases were actually associated with decreased enrollment. More importantly, beneficiaries with low cognitive function were substantially less likely than their peers with high cognitive function to appreciate the advantages offered by these plans, choosing to remain in the traditional Medicare program instead.
Source: blogspot.com

Video: Understanding Medicare Advantage Plans

Tricare Help – Do Medicare

Neither Medicare nor Tricare require their beneficiaries to enroll in the Medicare Pharmacy Plan, Part D of Medicare. To the contrary, Medicare Part D is not recommended for Tricare for Life beneficiaries. The Office of the Assistant Secretary of Defense for Health Affairs is on record for saying that the only Tricare beneficiaries likely to achieve any financial advantage from Medicare Part D enrollment are those whose incomes are below the federal poverty level and who qualify for financial aid to help pay their Medicare Part B premiums.
Source: militarytimes.com

CMS Unveils 2013 Medicare Advantage Bidding Rules

CMS has released a Medicare program final rule that is set to appear in the Federal Register April 12. The agency also has released key 2013 Medicare Advantage and Medicare Part D program bidding documents: The rate announcement and the “final call letter.”
Source: lifehealthpro.com

Do Gym Memberships Help Medicare Advantage Plans Attract Healthy Seniors?

Bloomberg: Insurers Offer Gym Memberships With Medicare Programs The offer of a fitness club membership is helping insurers including UnitedHealth Group Inc. (UNH) and Humana Inc. (HUM) draw healthier and less costly patients to their Medicare programs, said researchers reporting in the New England Journal of Medicine. The study found 35.3 percent of new enrollees in a fitness membership benefit plan reported “excellent” or “very good” health, compared with 29.1 percent in the group without the benefit. The number of plans offering the memberships rose to 58 in 2008 from 4 in 2002, the researchers said (Frier, 1/12).
Source: kaiserhealthnews.org

A New Concept for Medicare Advantage Plans

Here’s a new concept for Medicare Advantage insurance: integrating its use as part of a long-term care system with basic benefits to help the patient avoid long stays in the hospital.  Essentially, the foundation of this concept is based on the idea that prevention is the key to keeping health care costs down.  Howard Gleckman  presents this interesting  approach to Medicare Reform in his article for Forbes.com.
Source: mostmedicare.com

Medicare Advantage Plans California

While looking out for the best health insurance company, it is important to check out the reviews of the company so as to be sure about the efficient working of Medicare Company. Some of the best Medicare providers cover prescription drugs, dental and vision care, gym and health membership as well. You can choose the Medicare advantage plan as well as it offer low copayments and covers services which are often exempted from Medicare. Some of the advantage plans also cover Part D prescription drug coverage. Thus, it is greatly dependent on an individual to choose from the available advantage plans like Preferred Provider Organization. Medicare Health Maintenance Organization, Private Fee for service plans, Medicare special needs plan and many more according to your personal choice. Start looking out for the plan which suits your need. 
Source: oagnepal.com

Medicare Advantage Plans Often a Poor Choice for Consumers

And it’s not just the quick sale that motivates agents to fraudulent action that harms their customers. Their payday for enticing their customers to enroll in Medicare Advantage is significantly higher. According to the same article, “Under a rate schedule set by the CMS, agents earn a typical $408 for every new Advantage customer, then $202 a year for each renewal (the rates are higher in a few states), vs. just $53 for signing up seniors for a Medicare prescription drug [Part D] plan, which are also offered by private insurers.” Plus the commission an agent earns for a Part D renewal is only $27.
Source: medinews360.com

Gym Memberships In Medicare Advantage Plans Cater To Healthy Seniors

The implication that Medicare Advantage plans are offering this benefit to attract healthier members in unfair and untrue. In fact, they offer these types of benefits to improve the attractiveness of their product such that membership increases, and with an expectation that these programs will help lower overall health care costs. With the advent of risk adjusted Medicare Advantage premiums, health plans have no financial incentive to cherry-pick very healthy members. They do, however, have an incentive to enroll members who want to be healthy (in other words, people who take their health care seriously), regardless of their current health status, and fitness programs are one way to attract those types of members. Remember that many of these fitness programs consist of stretching, modest weight-bearing exercise and water activities that help older people from falling, improve their mental health and assist in the management of expensive chronic diseases such as diabetes.
Source: kaiserhealthnews.org