Tricare Help – How can I get information on Medicare Part C?

Posted by:  :  Category: Medicare

OBAMACARE WATCH:....THE PUSH IS ON, ........THEY WILL CONTROL WHAT YOUR DOCTOR KNOWS AS WELL AS WHAT HE OR SHE TREATS by SS&SSIn addition, prescription drug costs through TFL are less costly than under Medicare Part D. In fact, the Defense Department advises that the only people who may benefit from Part D coverage are those whose incomes are so low that they qualify for financial aid to pay their Medicare Part B premiums. Moreover, enrollment in Part D will preclude your use of the Tricare Mail Order Pharmacy program, under which you can get a 90-day supply of drugs for the same price that you would pay for a 30-day supply from a local retail pharmacy.
Source: militarytimes.com

Video: MedicareWire: It’s Medicare Made Clear [er] – News & Reviews

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?
Source: internet-millionaire-articles.com

Who Sells Medicare Supplement Plans in….?

So, how do you find out who sells Medicare Supplement plans in your state? First and foremost, you should be able to obtain a list from the state department of insurance. Some of the states have this information online; however, it should be taken with a grain of salt. In our experience, possibly due to neglect or time constraints or the constantly-changing nature of insurance, this information is often out of date. Medicare also maintains a database of the companies that offer Medicare Supplements by zip code at www.medicare.gov. Again, this information can be very outdated or outright incorrect, but it is another resource.
Source: medicare-supplement.us

GAO urges CMS to tighten meaningful use verification

GAO made four recommendations to CMS in order to improve processes to verify whether providers met program requirements for the Medicare and Medicaid EHR programs, including opportunities for efficiencies. HHS agreed with three of GAO’s recommendations, but disagreed with the fourth – that CMS offer to collect certain information on states’ behalf. GAO continues to believe this action is an important step to yield potential cost savings, GAO officials said in their report.
Source: healthcaremgt.net

Medicare Immunization Billing Revised on ADVANCE for Health Information Professionals

This educational tool is designed to provide education on Medicare-covered preventive immunizations. It includes coverage, coding and billing information on the influenza, pneumococcal and Hepatitis B vaccines and their administration.
Source: advanceweb.com

Affordable Care Act Saved People on Medicare Over $3.4 Billion on Prescription Drugs

Washington, DC–(ENEWSPF)–April 30, 2012.  Thanks to the Affordable Care Act, seniors and people with disabilities with Medicare have saved a total of $3.4 billion on prescription drugs from the enactment of the law through March of 2012.  The Centers for Medicare & Medicaid Services (CMS) released data today showing that, in the first three months of 2012 alone, more than 220,000 people saved an average of $837 on the prescription drugs they purchased after they hit the prescription drug donut hole, for a total of $184.5 million in savings.  These savings build on the law’s success in 2010 and 2011, when more than 5.1 million people with Medicare saved over $3.2 billion on prescription drugs.
Source: enewspf.com

EHR and Meaningful Use in the News

One of athenahealth’s concerns about the Meaningful Use program has been the lack of a method to verify that physicians across the country have met the measures. Thankfully, that’s not an issue for athenahealth. Since we operate in the cloud, we can see even the smallest grains of data in the network. In fact, we have been able to regularly report out on the progress of our client physicians on their path to Meaningful Use of an EHR as they met and attested to the measures.
Source: athenahealth.com

Getting More Accurate Tobacco Information to Consumers

We are also forging new territory as we seek to ensure that tobacco companies provide accurate information and will not be able to mislead American consumers, especially by making it sound like certain products are less risky than they are. The landmark Family Smoking Prevention and Tobacco Control Act signed by President Obama gives FDA the authority to ensure the claims for tobacco products marketed to reduce risk or exposure, such as “low tar” or “light,” are truthful and demonstrated by sound science.
Source: medicare.gov

Be Cautious for Life Threatening Diseases

One of the best preparations and cautions that people can do to prevent being infected by these diseases is by gathering as much and complete information as possible. It is not at all hard to be done. Today, there are so many media that can provide any information that people need to know better about any type of disease, such as pustular psoriasis or any rarer types. Books, magazines, tabloids and many other printed media will help them understand the disease well with the information available. Besides, people can also use internet for better and more complete variety of information. Simply by visiting certain online sites, they will be able to gather any information that they need, starting from the cause of the disease, cure, prevention, and many others.
Source: hip-medicare.com

Vacancies in Florida: Mgr Telesales

Posted by:  :  Category: Medicare

Mgr Telesales – Medicare Job ID: 2012-18805 # Positions: 1 Location: US-FL-Tampa Search Category: Sales & Marketing Type: Regular Full-Time (30+ hours) Posted Date: 4/24/2012 More information about this job: Summary: JOB SUMMARY : Responsible for managing support operations related to Medicare Sales, including telesales, sales tracking processes, business process flows, training… . For more detail information about this job opprtunity please read the description above, and if you interested on this job just click on the Apply Now button, you will be redirected to the official website
Source: blogspot.com

Video: GBMC Primary Care – Debbie Jones, CRNP

Perfect Storm Batters Managed Care Profits (Aetna, Amerigroup, Coventry, Health Net, Health Spring, Humana, Kaiser, United and Wellpoint)

 The tempest of newly eligible Medicare beneficiaries looks to be the primary driver of large scale federal intervention and spending.  Certainly ERISA will be expanded by the administration to centralize federal authority, and public access to federally available plans. Expect to see real reforms offering national programs that supersede NIAC for Individual and small Group insurance, and go beyond HIPPA protections to large Group coverage.  One thing is dangerously certain.  If the healthiest Group lives get to switch to a better rate or federal plan, it will leave the sickest employees with the same plan and massively drive up experience rated premium in 1-3 years.  If the opposite happens where only the sickest members get Federal insurance, it means massive new taxes in an era of record setting deficits.  There is no free lunch.  Both scenarios point to a society that does not want to continue paying for their runaway insurance premiums, and that could easily be relegated to accepting a National health plan.  We have been warning against the perils of unchecked medical cost-shifting from Medicare and Medicaid to the commercial life for some time.  We are beyond the tipping point where premiums growth is unsustainable for many individual and small groups who continue to bare the brunt at 20% 2009 rate increases.  New Medicare lives will stretch federal spending. Protecting medical plan access to the 45 million uninsured, and offering coverage without preexisting medical condition exclusion is the issue. The numbers tell us that large group plans have real difficulties.  If our DC sausage maker blows the structure of protecting Individuals and Small Groups, it has real chance of bankrupting underwriting Large Group commercial plans.
Source: hightable.com

Amerigroup Reports First Quarter 2012 Results

Accounting News & Issues Acquisitions, Mergers and Takeovers Advocacy Group Opinion Animals & Pets Animal Welfare Asian American Awards Broadcast Feed Annoucement Children Clinical Trials & Medical Discoveries Conservation, Recycling Contracts Corporate Expansion Corporate Social Responsibility Dividends Earnings Earnings Forecasts & Projections Earnings Reports Economic News, Trends, Analysis Environmental Issues Federal Executive Branch & Agency Financing Agreements Foreign Policy & International Affairs Hispanic Investments Opinions Joint Ventures Labor & Union Legal Issues Licensing Market News New Products & Services Not For Profit Oil and Gas Discoveries Patent Law Personnel Announcements Real Estate Transactions Restructuring & Recapitalization Sales Reports Senior Citizens Shareholders’ Rights Plan Small Business Services Stock Offering Surveys, Polls and Research Trade Show Women
Source: theta-trader.com

Medicaid HMO Stocks Can Bounce Back

Centene (ticker: CNC) and Amerigroup (AGP) exclusively serve Medicaid and Medicare. On April 6, the state of Ohio surprised everyone by dropping them, as well as rivals Molina Healthcare (MOH) and WellCare Health Plans (WCG), and picking other firms to handle Medicaid plans next year.
Source: barrons.com

Overtime Settlement for Amerigroup Marketing Reps Announced by Morgan and Morgan

(EMAILWIRE.COM, April 03, 2012 ) Orlando, Florida

Medicare, “Medigap” and Medicare Advantage Plans

Posted by:  :  Category: Medicare

Senate Dems Protest Medicare Cuts by Talk Radio News ServiceYes. Another example: Citing language in the ACA, the Department of Health and Human Services has exempted Medicare Supplement carriers from so-called “rate review rules.” This means that Supplement carriers will be free to increase the rates and premiums they charge for the coverage without HHS oversight. This exemption will become important in a few years, when the ACA’s “guaranteed issue” standards are fully implemented. At that point, people will probably be paying more for Medicare Supplement coverage, even though the plans will likely cover less.
Source: online-health-insurance.com

Video: Medicare Drug Coverage – Part D Plans

Medicare Part D Prescription Drug Plans – Health Care in a Rough Economy

For someone who is not actually too involved in politics, I can’t help but be curious on the Obamacare issues which are being challenged as unconstitutional. As an employed individual, it is very important to be properly informed of the developments that have a direct effect on our lives not to mention the essential health insurance coverage. What comes to my mind as of this moment is the Medicare Part D Prescription Drug Plans.
Source: oasl.info

How to prepare for IL Medicare

If you’re going to be turning 65 in the near future there are several things you should know while preparing yourself for IL Medicare insurance coverage. There is specific information that you’ll need concerning Medicare and you shouldn’t rely on others to gather it for you. You need to contact the Social Security Administration to find out if you’re eligible for Medicare. The Social Security administration determines who is eligible for the health program and also enrols them. However, if you’re a railroad retiree, the Railroad Retirement Board will handle the enrollment process for Medicare.
Source: abchealthplans.com

Medicare Part D Open Enrollment is Almost Upon Us!

Many advisors will suggest that a person shop around amongst the many different carriers offering the prescription drug coverage’s. This will allow the person Medicare to see what options are available to them and to select the most appropriate plan choice. Many will notice that there are plans that differ from state-to-state. The plan premium may also vary from place-to-place..
Source: medicarequotefinderblog.com

Director, Quality Management Medicare Part D / Benecard PBF / Orlando, FL Job

2. Medicare Health & Drug Plan Quality and Performance Ratings – Acquisition, management and analysis of clinical, operational and survey data related to the Medicare Advantage and PDP Star performance ratings. – Conduct statistical analysis, data modeling, preparing complex reports and studies for a variety of uses including cost analysis, quality improvement, enhancing operations and addressing identified issues. – Oversee the design and management of database and reporting applications used to provide accurate and current status of quality measures and initiatives impacting the measures. – Oversee the development and implementation of new programs, approaches and standard reporting capabilities in conjunction with the implementation of new/existing quality measures. – Work with various business units to ensure consistency with enterprise reporting standards and financial goals. – Monitor regulatory updates, participates in professional organizations related to Medicare Advantage and PDP quality programs and provides updates and recommendations to impacted internal and external entities
Source: healthjobsnow.com

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

2012 Blue Cross Blue Shield of Texas Medicare Part D Plans

With two plans to choose from, Blue Cross Blue Shield of Texas makes it easy to find the right prescription drug coverage that fits your medical needs and your budget. If you’re looking for the most affordable rates, the Value plan offers a lower monthly premium in exchange for a small deductible. With the Value plan, you still get comprehensive coverage with a small copay and discounts on brand name drugs. If you’re looking to have no deductible, the Plus plan offers the same quality coverage for a little more monthly and a small copay for all generic drugs. 
Source: texasmedicarehealth.com

2012 Changes to Medicare in Illinois

Here’s another change involving Medicare Advantage plans that may impact your decision to buy or not to buy. As of 2012, they are prohibited from having higher cost sharing requirements for critical services like chemotherapy, skilled nursing and other services. In addition, administrative expenses and profits have been reduced, forcing many providers to rethink if they are going to continue offering Medicare Advantage plans.
Source: ssiinsure.com

InsureBlog: Shingles Vaccine

If an adult or child has direct contact with the shingles rash on someone and has not had chickenpox as a child or a chickenpox vaccine, they can develop chickenpox, rather than shingles. There are shingles vaccines, but they cannot be administered when you have an active flare up. Two popular shingles vaccines are Zostavax and Varivax. Your doctor may prescribe a medicine that fights the virus, called an antiviral. The drug helps reduce pain and complications and shorten the course of the disease. Acyclovir, famciclovir, and valacyclovir may be used. The medications should be started within 24 hours of feeling pain or burning, and preferably before the blisters appear. The drugs are usually given in pill form, in doses many times greater than those recommended for herpes simplex or genital herpes. Some people may need to receive the medicine through a vein (by IV). Strong anti-inflammatory medicines called corticosteroids, such as prednisone, may be used to reduce swelling and the risk of continued pain. These drugs do not work in all patients. Other medicines may include:
Source: blogspot.com

CMS Releases New Medicare Advantage and Medicare Part D Rules, Implements Several Provisions of ACA : Duane Morris Health Law

On April 12, 2012, the Centers for Medicare & Medicaid Services (“CMS”) released a final rule with comment period (“Final Rules”) implementing changes to the Medicare Advantage program and Medicare’s prescription drug benefit program, referred to as Medicare Parts C and D, respectively. Part C and D plan sponsors and other participants should carefully review the changes, particularly those related to increased transparency and exclusion from Parts C and D. The Final Rules are the latest effort by CMS to improve accountability, transparency, and effectiveness of the Medicare program. 
Source: duanemorris.com

Nothing found for Defenders

Posted by:  :  Category: Medicare

Deputy Administrator and Director for the Center of Medicare at CMS Jonathan Blum visits Christiana Care to speak about accountable care organizations by Christiana CareThe page you are looking for no longer exists. Perhaps you can return back to the site’s homepage and see if you can find what you are looking for. Or, you can try finding it with the information below.
Source: healthtipsblogspot.com

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

UroMed Expands Nationwide Insurance Network Coverage For Urological Supply Customers

About UroMed Catheters Headquartered in Suwanee, GA [a suburb of Atlanta], UroMed is one of the nation’s leading providers of single-use catheters, urological and disposable medical supplies, including intermittent catheters, closed system catheters, condom catheters, pediatric catheters and continence care products. UroMed is nationally accredited for Medicare reimbursement and most state Medicaid plans, and partners with private health insurance providers and health plans to provide patients with single-use catheters, catheter kits and incontinence products. UroMed also has seven staffed regional offices located in Boston, MA; Columbia, SC; Jacksonville, FL; Dallas, TX; Carlsbad, CA; Knoxville, TN; Richmond, VA; and Baton Rouge, LA; enabling next-day delivery after a customer’s initial medical supply order. For more information, please visit http://www.uromed.com or call 1-800-841-1233.
Source: wordpress.com

Medicare, “Medigap” and Medicare Advantage Plans

Yes. Another example: Citing language in the ACA, the Department of Health and Human Services has exempted Medicare Supplement carriers from so-called “rate review rules.” This means that Supplement carriers will be free to increase the rates and premiums they charge for the coverage without HHS oversight. This exemption will become important in a few years, when the ACA’s “guaranteed issue” standards are fully implemented. At that point, people will probably be paying more for Medicare Supplement coverage, even though the plans will likely cover less.
Source: online-health-insurance.com

Becoming a Medicare Provider

Medicare Providers for Part B or Medical Insurance are usually composed of private doctors or those who have expertise on a certain field. Patients of Part B usually receive outpatient care and preventive services such as chemotherapy, dialysis, blood transfusion, mastectomy and other services that will help maintain the health of a person seriously sick. The patients also get medical and prosthetic equipment such wheelchairs, cranes, artificial breast, and artificial breasts. These Medicare providers help the people get extra wellness programs such as those for vision, hearing and dental. Lastly, they also direct the patients to cheap Medicare-approved prescription drugs that the patients need. Being Medicare providers requires an extensive application. There are many requirements needed for those who want to apply in this kind of job. If one wants to be a provider, first and foremost, he has to review the existing rules, requirements and qualifications of Medicare. Other than that, there are also federal rules and regulations that one has to follow, depending on what state a person is in. Second, it is important to be certain on what part of Medicare (Part A or B) that one wants to serve in. Be sure that the part suits one’s abilities. A person who has no expertise in kidney problem can surely not go to Part B. On the other hand, it is just a waste if an expert in cancer will just go to Part A. After choosing the right part, the person has to get an NPI (National Provider Indicator) number. Why the person finishes ensuring an NPI number, he should be ready to apply for a Medicare-provider application by contacting the Medicare carrier in his or her area. The Medicare carrier will help the applicant on questions she or he might have. The applicant will be given a Medicare application by the carrier. Complete the application form provided and never forget to give documents such as drug-enforcement administration (DEA) certificate, IRS form W-9, Medicare provider letter and a copy of your business license. Upon reviewing all the terms, mail the application to the carrier and wait until they finish processing one’s application of becoming a Medicare provider.
Source: ezinemark.com

Health Care Reform Implementation Update May 1, 2012 : Hot Button Blog

On Wednesday (4/25), the House Energy and Commerce Committee approved a proposal package that aims to save the federal government about $114 billion over 10 years by repealing several Patient Protection and Affordable Care Act provisions. Some of the proposals included in the package would repeal the law’s Prevention and Public Health Fund, repeal HHS’ unlimited direct appropriation to establish state health exchanges, cut funding for the Consumer Operated and Oriented Plan program, which would provide government loans to nonprofit health plans and repeal Medicaid maintenance-of-effort requirements.
Source: hotbuttonblog.com

How to Apply for a Medicare Provider Transaction Access Number

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

Senior Living Investment Brokerage: Take a Number

In a SNF transaction, it is commonplace for the buyer to assume the seller’s Medicare Provider Agreement.  Of course there are exceptions, but they are rare as each of our 25 SNF transactions in 2011 saw the Provider Agreement passed to the buyer.  In fact, the assumption of the Medicare Provider Agreement is also assumed by CMS, as the Medicare Provider Enrollment application (CMS-855A Form) states: “A CHOW typically occurs when a Medicare provider has been purchased (or leased) by another organization.  The CHOW results in the transfer of the old owner’s Medicare Identification Number and Provider Agreement (including any outstanding Medicare debt of the old owner) to the new owner.”  If the purchaser (or lessee) elects not to accept a transfer of the provider agreement, then the old provider agreement would be terminated, and the purchaser or lessee is considered a new applicant.  Given the inherent successor liability issues associated with such an assumption, it begs the question “why don’t more buyers terminate the agreement and apply for a new provider number?”  Well, CMS has made this very difficult from an operational perspective; these types of initial surveys have been given less priority over the standard annual survey and routinely take more than six months to occur.  In fact, we have heard of instances of this taking over one year to complete.  Until an operator obtains Medicare certification, it will not be able to charge for Medicare residents.  So, the impact, or risk, of going through the recertification process is directly related to the facility’s Medicare exposure (mix-revenue dependence) – those with a significant portion of their census/revenues tied to Medicare would be more averse to terminating the existing agreement.  It is paramount for each buyer of a SNF to receive appropriate consultation and direction when considering whether or not to assume the seller’s Medicare Provider Agreement.
Source: blogspot.com

How To Detect Medicare Fraud

Because of the vital part Medicare has in society, it is important to utilize it advisably and refrain from abusing the system. There are several instances of Medicare fraud today that is causing loss of taxpayer’s money annually. Medicare fraud occurs when a beneficiary is billed for medical treatments, or supplies that were never really administered and Medicare paid for it.  It isn’t acceptable in any situation as it is a mode of cheating. As a beneficiary, it is your duty to carefully check the Medical Statement Notices (MSN) that you receive, to make sure that everything is in order.
Source: dirwp.com

Medicare Diabetes: Medicare Diabetes Coverage

Posted by:  :  Category: Medicare

To get the best Medicare Diabetes Coverage, a strong understanding of each yearly change Medicare makes or have a great pharmacy to manage this for you. Fortunately, some online mail-order pharmacies not only handle all the Medicare paperwork, but they offer discounts on test strips and other supplies. Many offer free glucose meters in exchange for your loyalty. Many diabetic testing supplies are available to you at no additional costs, and the rest at discounts if you take the time to look into your Medicare diabetes options. So many factors come into play here, that it is best to go to sites like MedicareGlucoseMeters.com to get a full break down of options or simply call them if not sure.
Source: blogspot.com

Video: The Medicare Diabetes Screening Project – Savannah, Georgia News Coverage: WSAV News 3 at 6

Dealing with MediCare limitations on diabetes test strips, etc

Does anyone have suggestions as to how to prepare for the apparently inevitable problems of getting an adequate number of glucose test strips and other supplies once I turn 65 in a few months. Are there things I should do now? My doctor says Medicare only approves one or two test strips a day. I use 7 to 10, depending on the day, and what activities I’m involved with on that day. I also have the CGM device, which I understand is not covered. I will have supplemental insurance. Has anyone tried appealing these decisions by both Medicare and the supplemental insurance programs, and has anyone had success? I did talk to someone at Dexcom who told me they aren’t even trying to get Medicare to approve their device. That is frustrating to me, since I find the Dexcom much more useful to my general control issues and quality of life than any other device, including the insulin pump. I have Type I diabetes.
Source: tudiabetes.org

Medicare and Durable Medical Equipment

There are also apparatuses outside this basic definition and are known as DMEPOS.  This means aside from DME’s there are also prosthetics, orthotics, and other supplies related.   Prosthetics is an artificial device extension that replaces missing or defective body parts.  Under this device category are other familiar devices such as hearing aids, gastric bands, and dentures.  On the other hand, orthotics is an orthopaedic device made to support or correct the function of a limb or torso.  This group of apparatuses can also assist movements, speed up the rehabilitation of a patient with fractures after cast, and also reduce pain caused by a certain bone or joint condition.
Source: articledeck.com

Medicare Diabetes Coverage: Getting Supplies Covered by Medicare for Diabetes

To get Medicare diabetes supplies covered by Part B or Part D requires a better understanding of how Medicare works and what Part covers what diabetic medical supplies. This at least is important if you intend to do all of your paperwork directly with Medicare to obtain your diabetes supplies. Fortunately, there are online pharmacies that are professional and offer this service with your loyalty as a customer. It is something they do on a daily basis with a large percentage of their customers and many times have specialists for this purpose. Places like Advanced Diabetes Supply make it their business to get you the lowest price possible so that staying with them is the obvious choice. Medicare covered diabetic testing supplies are split up into different plans, at different tiers and formalities. This is what makes it complex. It depends on your income and what type of diabetic you are i.e.(using insulin pump or needles). Besides handling this, many online pharmacies will offer a free glucose meter to new customers and set up easy plans that take what would be multiple payments and pages of paperwork into one transaction by communicating with Medicare and doctors if needed to ease the process.
Source: blogspot.com

DIABETES MEDICARE COVERAGE

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Source: elderauthority.com

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

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

More than 100 charged in massive Medicare fraud busts in 7 cities in scams …

More than 100 charged in massive Medicare fraud busts in 7 cities in scams … Washington Post MIAMI — Federal authorities charged more than 100 doctors, nurses and social workers in seven cities with Medicare fraud Tuesday in a nationwide crackdown on unrelated scams that allegedly bilked the taxpayer funded program of more than $450 million … 100 charged in Medicare fraud busts in 7 cities
Source: 247healthnews.net

Diabetic Supplies Covered By Medicare

Keep in mind that there may be limits on the quantity of testing supplies you can receive in any given time frame. Also, you cannot submit claims for supplies yourself. All claims must be submitted by Medicare-enrolled pharmacies and suppliers. In addition, you must request refills on your supplies, as automatic shipments from suppliers will not be covered by Medicare.
Source: affordablemedicareplan.com

Medicare and CGMS Coverage

My pump, cgm, and supplies for both are currently covered by the insurance policy I am covered under by my employer. But I am planning on retiring in a few month and will be under COBRA for the next 14 month. So far so good, I will still have all my diabetic supplies covered. However when I turn 65 (July 2013) and go under Medicare it seems I will no longer be covered. Based on your post it seems an appeal letter would be my next step. The problem I have is that I have been fanatical about controlling my blood glucose for twenty plus years and have never had an A1C over 6.2. I exercise several hours every day (100 plus miles a week on my bike, tennis five days a week, one hour plus walking my dogs every day). I have always tested my BG ten times a day and now with pump and cgm I am down to about seven samples a day. Blood work, eye exams, physicals will all show I am basically not diabetic. But because of this effort to maintain such tight control of my BG I am now asymptomatic for hypoglycemia. My endocrinologist is very cooperative but I do not see how I could make a case of medical necessity, even though it is because of all the technology that I am able to maintain my BG control.
Source: kellywpa.com

Montana Health Insurers Post Profits In 2011

Posted by:  :  Category: Medicare

Old people read alone... by Ed Yourdonaccess health insurance affordable health insurance business health insurance cheap health insurance child health insurance program cobra health insurance company health insurance compare health insurance federal health insurance health health and dental insurance Health insurance health insurance benefits health insurance for families health insurance plan health insurance policy health insurance rates individual health insurance insurance life and health insurance low cost health insurance Medical insurance national health insurance new jersey health insurance new york state health insurance no health insurance online health insurance short term health insurance texas health insurance wisconsin health insurance
Source: healthinsurancesservice.com

Video: New West Medicare .mov

Solos, Structured Settlements, & Medicare Set Asides

Solo attorneys need to know what is happening in the structured settlement industry for a more successful practice.  New Solo host, Attorney Kyle R. Guelcher, a solo practitioner looks to the experts, Ringler Associates Consultant Peter Early, and Vincent Polinsky, Director of Operations at Ringler Medicare Solutions, to explain the evolving role of the structured settlement consultant today. Hear the discussion about the advantages of a Medicare Set-Aside, and the benefits overall to your client’s settlement.
Source: legaltalknetwork.com

New West Health Services Splitting up

The IHC Group is an organization of insurance carriers, managing general underwriters, third-party administrators and marketing affiliates that has been providing health, life, disability, dental, vision and medical stop-loss insurance solutions to groups and individuals for almost 30 years. With over $1.3 billion in assets, members of The IHC Group include Independence Holding Company (NYSE: IHC), American Independence Corp. (NASDAQ: AMIC), Standard Security Life Insurance Company of New York, Madison National Life Insurance Company, Inc. and Independence American Insurance Company. Each insurance carrier in The IHC Group has a financial strength rating of A- (Excellent) from A.M. Best Company, Inc., a widely recognized rating bureau that rates insurance companies on their relative financial strength and capability to meet policyholder obligations. Collectively, the companies in The IHC Group provide insurance coverage to more than one million individuals and groups. For more information about The IHC Group, visit www.ihcgroup.com. Madison National Life, Standard Security Life, and the IHC Group are not connected with or endorsed by the U.S. Government or the federal Medicare program. Source: theinsurancepress.com
Source: medicaresupplementalco.com

New West May Transfer Some Business to Blue Cross

Blue Cross spokesman Tim Warner said the company hopes to close the deal soon. “This is a competitive market. Blue Cross is competing for business,” Warner said. “In this case, we are competing for the business of some major hospitals in Montana.” The deal must pass regulatory approval. State Auditor Monica Lindeen, whose office regulates insurance in Montana, said Wednesday that she would work with the state and federal justice departments to make sure Montanans can still expect quality service after the proposed transfer. Attorney General Steve Bullock said his office will examine the deal to see if it complies with antitrust laws. The hospitals, New West and Blue Cross have been discussing a possible deal for several months, and the hospitals signed a letter of intent last week. If the hospital deal goes through, New West would then consider transferring the rest of its commercial health business to another, yet-to-be-determined insurer, Lee Newspapers reported. Warner declined to say if Blue Cross plans to buy additional New West business. If the second transfer goes through, New West would have 9,500 customers enrolled in Medicare Advantage, a private health plan that receives part of its premiums from the Medicare program and must offer a benefit package at least as good as Medicare’s. It’s unclear how the proposed changes will affect New West customers in terms of price or health coverage or what will happen with New West’s more than 100 employees.
Source: flatheadbeacon.com

Editorial: Ruthless 'Social Darwinism' 

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Source: wvgazette.com

Safe Horizons Medicare Advantage

Posted by:  :  Category: Medicare

The first benefit of the HMO is the decrease cost sharing by using community providers. HMO plans typically have extra advantages that is probably not present in different types of plans. HMO plans are sometimes available in metropolitan areas with a greater population and a comprehensive supplier network. Make sure that you are comfortable with the supplier community earlier than you choose this sort of plan.
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Video: United Healthcare Secure Horizons & Oxford – Medicare Advantage Denies Coverage

Safe Horizons Medicare Advantage

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Source: bestfinancialtrading.com

Safe Horizons Medicare Advantage

The primary good thing about the HMO is the lower price sharing by using community providers. HMO plans usually have additional benefits that may not be found in different varieties of plans. HMO plans are often out there in metropolitan areas with a better population and a comprehensive supplier network. Make sure that you are comfortable with the supplier community before you choose this type of plan.
Source: themoneyfinances.com

Secure Horizons Medicare Advantage

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Source: thebestforexinvestment.com

Secure Horizons Medicare Advantage

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Secure Horizons Medicare Advantage

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Source: mutualfundstraders.com

Secure Horizons Medicare Advantage

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Source: financeinvestingmarket.com

Illinois: Teacher Certificate Illinois

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HERES YOUR TOP TEN by SS&SSHowever, the teacher certificate illinois that the teacher certificate illinois with many benefits and perks that simply cannot afford private health insurance policy to meet any kind of a five year revocation or revocation until your 21st birthday. A third or subsequent offense means a license revocation period of two years in Illinois. Furthermore, gas prices are remarkably reasonable in Illinois. The lowest priced Illinois gas tends to run as much as ten to twenty cents below the teacher certificate illinois per gallon. Especially if one plans to drive his or her about the IL homeowner insurance rates might not be the teacher certificate illinois of the certificate illinois marriage this up, you need to know, where the marriage certificate illinois in the birth certificate illinois and they began providing services for drug and alcohol abuse; is there are different options, bother governmental and private, that you contact a highly qualified Illinois DUI attorney can help pay for exorbitant basic monthly bills in addition to Illinois Schools would need to look beyond test scores to things like attendance, grades, extra-curricular activities, and discipline rates.
Source: blogspot.com

Video: Understanding Medicare Basics – 2010 Medicare Open Enrollment Webinar

Medicare and Medicare Supplemental Plans Presentation Thursday

Are you Turning 65 and confused about your Medicare supplement plan options? Please join us for a free seminar titled “A Winning Combination: Medicare & the Right Medicare Supplement Plan” Blue Cross and Blue Shield of Illinois will present a free, informative program on Medicare and Medicare Supplemental Plans on Thursday, April 5th, 2012 at 3:00pm at a Yorkville restaurant located at 1206 N. Bridge St. Yorkville, Illinois.  
Source: patch.com

IL Dept of Insurance Recognized for Exemplary Performance of its Senior Health Insurance Program

SPRINGFIELD–(ENEWSPF)–April 17, 2012.  The Illinois Department of Insurance (DOI) has received recognition from the U. S. Centers for Medicare and Medicaid Services (CMS) that Illinois excels in several areas related to exemplary performance for its Senior Health Insurance Program.  The Senior Health Insurance Program (SHIP) is a free statewide health insurance counseling service for Medicare beneficiaries and their caregivers.  SHIP is sponsored by the Illinois Department of Insurance.  CMS notified DOI earlier this month and commended the department for the high ranking received on its National Performance Reporting (NPR) stats. 
Source: enewspf.com

Seniors Stop Taking Heart Drugs In Medicare ‘Donut Hole’ in Oswego, IL

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Source: myeldercareblog.com

Calling out Medicare scams

Diabetes patients, beware when you pick up the phone. Calls claiming to be from Medicare are not. If they offer you free glucose meters or diabetic test strips, that’s a red flag, because Medicare never makes calls offering supplies or services.
Source: salutedomani.com

About Health Transparency

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update Medicare payment policies and rates for inpatient stays to general acute care hospitals paid under the Inpatient Prospective Payment System (IPPS) and long-term care hospitals (LTCHs) paid under the LTCH Prospective Payment System (PPS).   The proposed rule would strengthen the Hospital Value-Based Purchasing Program (VBP Program) to further Medicare’s transformation from a system that rewards volume of service to one that rewards efficient, high-quality care.  This program, which was required by the Affordable Care Act, will adjust hospital payments beginning in FY 2013 and annually thereafter based on how well they perform or improve their performance on a set of quality measures.   Specifically, CMS is proposing to add the Medicare spending per beneficiary measure to the Hospital VBP Program, which would affect payments beginning in FY 2015.  This measure would include all Part A and Part B payments (after removing differences attributable to geographic payment adjustments and other payment factors) from three days prior to an inpatient hospital admission through 30 days post discharge with certain exclusions.  The proposed measure would be risk-adjusted for the beneficiary’s age and severity of illness.   The proposed rule also includes a new outcome measure that rewards hospitals for avoiding certain kinds of life-threatening blood infections that can develop during inpatient hospital stays. This measure, the central line-associated bloodstream infection measure, supports ongoing work by CMS and other hospital safety leaders to reduce healthcare-associated infections through the Partnership for Patients initiative.
Source: ipro.org

HealthNet Will Pay MA Renewals FOR LIFE

Posted by:  :  Category: Medicare

Here’s the e-mail that I received today: Dear Valued Partners: Just in case you didn’t hear the good news regarding Health Net’s change in compensation rules for 2012 we are sending this reminder. The CMS Marketing Guidelines shown below discusses the fact that a plan is required to pay Producer compensation for a 6-Year Cycle. After the 6-Year Cycle is complete it is then up to the plan sponsor whether or not to continue to pay agents the renewal compensation. You will be glad to know that in 2012 Health Net modified it’s compensation policy to now pay renewal compensation past the end of the 6-Year Cycle and for as long as the Member remains continuously enrolled in the Health Net Medicare Product that the Producer enrolled them in. I trust that you will find this favorable and a confirmation that Health Net remains committed to the broker channel! Thanks for your continued loyalty to Health Net. PS. This is retroactive to all Medicare Advantage business you have written with Health Net. 2012 CMS Marketing Guidelines (Embedded image moved to file: pic08405.jpg) 2012 Health Net Compensation Schedule (Embedded image moved to file: pic08826.jpg) Please call your Account Executive or Broker Services at 800-708-7646 if you have any questions. We want to thank you for your continued partnership and support!!!
Source: insurance-forums.net

Video: Health Net Medicare Advantage – Compare to over 180 Compani

Health Net Sells Part D Plans to CVS

Through both the pre- and post-transaction activities, Health Net will continue being laser-focused on the needs of our Medicare PDP customers and providing them with high-quality prescription drug products and services. We are working hard to ensure that our current PDP customers and business partners experience a seamless transition of services, and are confident of this due to our current partnership with CVS Caremark.
Source: insuremekevin.com

Health Net of Oregon reminds adults: Arent vaccine Just for Kids

Health Net, Inc. is among the nation’s largest publicly traded managed health care companies. Its mission is to help people be healthy, secure and comfortable. The company’s health plans and government contracts subsidiaries provide health benefits to approximately 6.7 million individuals across the country through group, individual, Medicare, Medicaid and TRICARE and Veterans Affairs programs. Health Net’s behavioral health subsidiary, MHN, provides mental health benefits to approximately 7.0 million individuals in all 50 states. The company’s subsidiaries also offer managed health care products related to prescription drugs, and offer managed health care product coordination for multi-region employers and administrative services for medical groups and self-funded benefits programs.
Source: insurancenewstoday.org

CVS Caremark looks to purchase Health Net's stand

“We believe this proposed transaction is in the best interests of our Medicare PDP members and our stockholders,” stated Jay Gellert, president and CEO of Health Net. “Our Medicare PDP members, who have received certain services from CVS Caremark for five years, will now be affiliated with one of the nation’s largest Medicare PDP sponsors.
Source: drugstorenews.com

Diabetic Seniors Urged to Be Heart Smart

Health Net, Inc. is a publicly traded managed care organization that delivers managed health care services through health plans and government-sponsored managed care plans. Its mission is to help people be healthy, secure and comfortable. The company provides and administers health benefits to approximately 6.0 million individuals across the country through group, individual, Medicare (including the Medicare prescription drug benefit commonly referred to as “Part D”), Medicaid, Department of Defense, including TRICARE, and Veterans Affairs programs. Health Net’s behavioral health services subsidiary, Managed Health Network, Inc., provides behavioral health, substance abuse and employee assistance programs to approximately 5.0 million individuals, including Health Net’s own health plan members. The company’s subsidiaries also offer managed health care products related to prescription drugs, and offer managed health care product coordination for multi-region employers and administrative services for medical groups and self-funded benefits programs.
Source: marketwatch.com

Texas Medicaid Dental Claims Under Scrutiny

Posted by:  :  Category: Medicare

Public Forum: Getting dental into Medicare by Greens MPsAlthough the practice of using a statistically relevant sample to estimate the number of times something may be present in the universe of items has been around since the advent of higher mathematics, the application of this methodology to estimate the number of improper claims paid over a specific period of time is relatively new.  The application of statistical sampling to health care claims for this purpose dates back about twenty years to a decision by the U.S. Secretary of Health and Human Services (HHS) to authorize the use of statistical sampling in lieu of engaging in onerous claim-by-claim reviews. In Chaves County Home Health Services v. Sullivan, 931 F.2d 914 (D.C. Cir. 1991), the Federal District Court upheld extrapolation as being within the Secretary’s discretion.  The use of statistical sampling has spread over the years.  Federal agencies (such as HHS-OIG, CMS-contracted auditors, etc.), State agencies (such as HHSC-OIG) and even private insurance payors now capitalize on the use of this damages-estimating tool, usually to the detriment of the targeted health care provider.  To be clear, everyone recognizes that an “extrapolation” is merely a substitute for conducting a claim-by-claim review of every claim submitted by thee provider and paid by a payor during the period in question.  Nevertheless, the methodology is here to stay, regardless of the adverse impact it can have on a provider’s ability to remain in business.
Source: lilesparker.com

Video: Denticare: the Greens plan to make dental care part of Medicare

Keeping your aging parent’s smile bright: Tips for selecting dental coverage

Be sure your dentist takes your plan. If you have a preferred dentist, find out what plans they accept before you enroll in a plan. Websites like eHealthInsurance, and the licensed agents in their call center, can help you search for plans with your dentist in them. Stand-alone dental insurance policies are typically going to give you a far better price for services performed by dentists in their network. Almost all policies use a tiered cost-sharing system, and you pay the least out of pocket for services when you use a dentist from the plan’s network.
Source: transitionagingparents.com

The Love is Beautiful: Medicaid’s Youngest Face Dental Crisis

Folse’s Outreach Dentistry mobile clinic travels to schools around Louisiana, filling cavities and teaching children and parents about the importance of oral hygiene. In 2007, Congress held a hearing on the issue of children’s dental health after Deamonte Driver, a 12-year-old Maryland boy, died when a tooth infection spread to his brain. His mother, Alyce Driver, had been unable to find a dentist to treat him on Medicaid and could not afford to pay out of pocket. At the time, Leslie Norwalk, then-acting administrator for the Centers for Medicare and Medicaid Services, called his death “a failure on many levels.” And although she said that these types of dental services were covered, many dentists said that Medicaid reimbursement rates are too low. A study published in May 2011 demonstrated that despite efforts to boost the number of patients and providers in the Medicaid system, low-income families still had limited access to dental care — except when they were able to pay cash. The state of Florida got an F in children’s dental health in a 2011 report from the Pew Center on the States. In 2009, according to Pew, only 25.7 percent of Florida children on Medicaid saw a dentist. “The Medicaid rates are so low that dentists are not willing to participate in the Medicaid program,” said Dr. Frank Catalanotto of the University of Florida, Gainesville, Community Dentistry. “You can’t blame the dentists, really, because the cost of delivering the service is more than the reimbursement they receive.” Florida has some of the lowest rates. Ten pediatric dentists in four counties said they would not accept Medicaid — even for a child whose face hurt. And more than half of Florida’s counties — 36 — do not have one pediatric dentist who takes Medicaid, according to Pew. Dentists say that ignoring teeth can mean life or death. An infection can kill or promote heart disease, stroke, diabetes and osteoporosis. Children who do not receive dental care can suffer root canals and extractions before they reach 10 years old. At the Caridad Center in Boynton Beach, Fla., Falguni Patel, a first-year resident in pediatric dentistry, said it made her sad that there were certain groups of children who suffered more than others. “People think just because you have insurance that you’re going to have access to care — which is not the whole story,” she said. “They’re very few pediatric dentists that accept Medicaid in this area, so these children have nowhere to go even if they do have insurance. … It’s a big problem.”
Source: blogspot.com

Is Medicare covers dental care?

Certain surgical procedures to reconstruct an advantage while the removal of a tumor. Wiring of the teeth if it is part of the repair of a fractured jaw. Withdrawals are made in preparation for radiation treatment involving the mandible. Hospital stays can be covered if necessary for emergency dental procedures, even if the specific dental are not covered. Most dental treatments that are essential for a procedure that is covered, such as jaw reconstruction after injury. Dental splints may be covered if they are part of the treatment of a medical condition that is covered, as the dislocated jaw joints. In certain circumstances, the tests before major surgery such as heart valve replacement or kidney transplants. The review, but the treatment is covered by the study is to identify the risk of infection before surgery or complex. Hospital, if the severity of dental treatment requiring hospitalization. But not paying for dental care themselves. Infections after dental extractions can be covered. Inpatient hospital observation if necessary due to a threat to health.
Source: colafi2011.com

Supplementing Your Medicare Coverage With Dental Insurance – PlanPrescriber Provides Seven Recommendations for 2012 / eHealth

eHealth, Inc. (NASDAQ: EHTH) is the parent company of eHealthInsurance, one of the nation’s leading online source of health insurance for individuals, families and small businesses. Through the company’s website,www.eHealthInsurance.com, consumers can get quotes from leading health insurance carriers, compare plans side by side, and apply for and purchase health insurance. eHealthInsurance offers thousands of individual, family and small business health plans underwritten by more than 180 of the nation’s leading health insurance companies. eHealthInsurance is licensed to sell health insurance in all 50 states and the District of Columbia, making it the ideal model of a successful, high-functioning health insurance exchange. Through eHealth’s technology solutions (www.eHealthTechnology.com), is also a leading provider of health insurance exchange technology. eHealth provides a suite of hosted e-commerce solutions that enable health plan providers, resellers and government entities to market and distribute products online. eHealth, Inc. also provides online tools to help beneficiaries navigate Medicare health insurance options through PlanPrescriber.com (www.planprescriber.com) and eHealthMedicare (www.eHealthMedicare.com).
Source: ehealthinsurance.com

Understanding Qualifications for Medicaid

In 2014, the Affordable Health Care Act will make many changes to Medicaid. This will increase the eligibility level for almost all applicants under the age of 65 to 133% of the poverty level. Individuals who are 65 and older are not included in this provision because these applicants are typically covered by Medicare. Medicare is a similar government insurance program designed specifically for the elderly and disabled. Though this federally mandated change will not take effect until January 1, 2014, individual states may elect to enact the new eligibility requirements before that time. If you cannot pay for adequate health insurance, you should explore Medicaid options in your state to get medical coverage.
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Seniors Dental and Vision Benefits with Medicare

Some Medicare beneficiaries may have dental and vision coverage through other insurance plans. Some Medicare Advantagge plans, for instance, may have dental and vision benefits included. Some retirees, with company retirement benefits, may also have coverage. But normal routine coverage for dental and vision needs is not part of original Medicare, or even part of many Medicare Advantage or Medicare supplement plans.
Source: projektgenerika.org

Health Care Insurance for Sydney

As indicated by another contributor, providing health insurance benefits to employees would incur Fringe Benefits Tax for the company. Whilst it is commonly part of employment benefits in the USA, that is not the case in Australia. What you could do to encourage your employees to take up private health insurance is to talk to some of the health insurance providers (HCF, NIB, Medibank etc) and get them to offer your employees a discounted premium with no waiting periods. This may encourage both new membership and, if waiting periods waived, then current members of other funds might be convinced to swap. The funds want members and if they think they will get a bunch of members out of your company they may be happy to offer 8-10% discount on premiums. The range of premium costs varies as health insurance is very personal to the individual so considerations like whether you are single, married, with kids who need teeth work, ancillary benefits like chiropractic, physio, optical etc. and of course the type of hosptial cover (private room, etc) the individual wants. The premiums would be paid by the employee via direct debit from their bank accounts. These days the funds are not interested in receiving premiums via payroll deductions as they don’t want to wait for their money. Without private health insurance, people depend on the public hospital system which can mean long delays if eg surgery is required. Whilst doctors visits and some prescription drugs are available at reduced costs via Medicare (increasingly many doctors no longer bulk bill so we do have to pay a fee to see a doctor). There is no government provided dental cover but you can have this covered via private health insurance although not fully – there are yearly limits and the amount refunded is never what you have to pay the dentist!
Source: com.au