CMS Allows Medicare Providers to Submit Documents Electronically to CMS Contractors

Posted by:  :  Category: Medicare

George W. Bush by cliff1066™If providers do want to participate in the esMD program, they must first find out if their review contractor accepst esMD transactions. Additionally, providers will have to obtain access to an esMD gateway. To obtain access to a gateway, providers can either build their own or hire a Health Information Handler (HIH) to construct the gateway system. To find out which HIHs offer esMD gateway services to providers, click here. To learn more about requirements for participating in the esMD program, click here.
Source: thehealthlawfirm.com

Video: Pinellas County: Medicare Advantage Plans Florida- Zero premium

Federal Jury Convicts South Florida Doctors of Medicare Fraud

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Source: wordpress.com

Booman Tribune ~ A Progressive Community

During “active investigations” regarding potential criminal activity, fraud, or theft regarding a prescribed controlled substance, a law enforcement agency may request a patient’s prescription information through the prescription drug monitoring program director. Proponents of the prescription database claim that it will be used as a tool to flag potential problems with prescriptions and alert medical staff rather than as a direct method of generating criminal charges. Supporters say it will really serve to help doctors and pharmacists who “suspect” a problem by allowing them to assess whether or not a patient is “shopping” for the prescriptions at multiple locations. On the other hand, the potential for law enforcement to comb the database during a “pending investigation” seems quite likely. In the past, such an investigation may have required a search warrant authorized by an impartial judge or at least a lawfully issued subpoena. Now, the information is available simply upon request to a bureaucratic agency.
Source: boomantribune.com

Feds in Miami: Millions stolen from Medicare wound up in Cuban banking system

While Sanchez was a target of the ongoing investigation, prosecutors say dozens of crooked Medicare providers — who offered HIV and medical equipment services — all took part in the laundering scheme set up for one reason: To hide the money.
Source: allstardirect.com

Florida’s congressional Democrats talk Medicare

Democratic Reps. Alcee L. Hastings of Miramar, Debbie Wasserman Schultz of Weston, Kathy Castor of Tampa, Ted Deutch of Boca Raton, and Frederica Wilson of Miami met Thursday to talk about Medicare — without the Republicans in the Florida delegation. They haven’t met all together since early 2011.
Source: typepad.com

Florida Elder Law and Estate Planning: Medicare beneficiaries: What can you expect if the Affordable Care Act is overturned?

, that period when Medicare does not cover your prescriptions. Right now, the doughnut hole begins when drug expenditures exceed $2930, and ends when expenditures reach $4700.  Under the Affordable Care Act, pharmaceutical companies have offered seniors in the doughnut hole a 50% discount on brand-name prescription drugs, and a 14% discount on generics.  Last year, over three million Americans in the doughnut hole saved a $2 billion. Although the drug companies could voluntarily continue offering these discounts, they will be under no legal obligation to do so.
Source: blogspot.com

Owner and Employee of Miami Home Health Company Sentenced to Prison in $22 Million Medicare Fraud Scheme

Morales was the president and Dominguez was an employee of Prime Home Health Services Inc., a Florida home health agency that purported to provide home health care and physical therapy services to eligible Medicare beneficiaries.   According to plea documents, Morales conspired with patient recruiters for the purpose of billing the Medicare program for unnecessary home health care and therapy services.  Morales and her co-conspirators paid kickbacks and bribes to patient recruiters in return for the recruiters providing patients to Prime Home Health, as well as prescriptions, plans of care (POCs) and certifications for medically unnecessary therapy and home health services for Medicare beneficiaries.  Dominguez distributed the kickbacks and bribes to co-conspirator patient recruiters and knew that the payment of kickbacks and bribes was in violation of federal criminal laws.  Morales used these prescriptions, POCs and medical certifications to fraudulently bill Medicare for home health care services, which Morales knew was in violation of federal criminal laws.
Source: enewspf.com

Guilty plea submitted in Medicare fraud case in Florida

The man faced a charge of health care fraud conspiracy in connection to these allegations. Yesterday, the man pled guilty to this charge. According to the article on the Naples Daily News’ website which reported this story, the man could receive a prison sentence of up to 10 years in this case. The article did not mention if a sentencing hearing for the man has yet been scheduled.
Source: criminallawsarasotafl.com

Feds: Stolen Medicare money wound up in Cuban banks

Prosecutors say Oscar Sanchez, 46, was a key leader in a group that funneled $31 million in Medicare dollars into banks in Havana — the first such case that directly traces money fleeced from the beleaguered program into the Cuban banking system.
Source: politicsmiami.com

South Florida’s Pronto Post Prepares for the 2012 Medicare Open Enrollment Season

“Pronto has developed relationships with several Medicare insurance providers in South Florida, such as AvMed and Preferred Care Partners,” Pronto’s general manager Andrew Diamond said. “Florida is a huge market for Medicare providers, and South Florida has a large Hispanic population eligible for Medicare. As our insurance partners grow, some expand the number of countries that we prepare kits for, and some are looking to expand their service into neighboring states.”
Source: virtual-strategy.com

MedPAC Recommends Higher Upfront Costs for Medicare Beneficiaries

Posted by:  :  Category: Medicare

The Tea Party pretends to be a populist party but that is misleading, for it was created with a few thousand “true believers” financed by the rich and powerful within the Republican party, This is exactly what happened in Germany in the 30s; Fascism. by WonderlaneThe article says that 90% of Medicare beneficiaries have “Medigap and other supplemental insurance policies”. This is incorrect because 25% of Medicare beneficiaries are enrolled in Medicare Advantage which are “Medicare replacement plans” and not supplements. Medicare Advantage plans would seem to be the future of Medicare because every plan includes co-pays for each service received. These co-pays certainly make people think twice about expensive tests or things like physical therapy. Advantage plans are required by Medicare to set a cap on out-of-pocket expenses. These caps currently range from $2,000 to $6,700 per year. The only problem I see with Medicare Advantage is that these are “for profit” businesses run by insurance companies. Profits (and administrative costs like marketing) add up to billions of dollars each year – and this is money that should be staying in the Medicare coffers.
Source: californiahealthline.org

Video: Medicare

How is Medicare Financed?

Note: For simplicity, I have focused on the annual flow of taxes and benefits. The same insight applies if you want to think of Social Security and Medicare as programs in which workers pay payroll taxes to earn future benefits. That’s approximately true for workers as a whole in Social Security (but with notable differences across individuals and age cohorts and uncertainty about what the future will bring). But it’s not true at all for Medicare.
Source: wallstreetpit.com

Romney Lies About Medicare/Medicaid Change Of Address Form

And then, if Obama politely suggests that based on Romney’s stated support for ending Medicare as we know it, it appears that Romney in fact wants to end Medicare as we know it, Romney will cry foul.  And the Washington Post FactChecker will back him up, reasoning that since the Ryan plan would retain the word “Medicare” to describe a program that shares nothing in common with Medicare as currently structured, it is somehow wrong to describe it as ending Medicare as we know it.
Source: talkleft.com

retired doc’s thoughts: The litigation to allow seniors to refuse Medicare Part A goes deeper in the rabbit hole

Of course,I agree you should be able to decline Medicare without penalty.But the trial court and now the appellate court see things differently. The case has proceed slowly through the legal system and now a three judge panel has ruled against the plaintiffs. It seems that there is a CMS rule book regulation that states if a person refuses Medicare Part A he will not receive the social security benefits he would have otherwise be eligible for. If one accepts Medicare A and then later decides to decline this “entitlement”he will stop receiving SS payments and have to repay what he had previously received. Earlier a judge in the case said in effect that Medicare benefits were a “mandatory entitlement”. Note this draconian rule was not written into the Medicare law or anything else that should have statuary power and came into existence in something called the Program Operations Manuel System (POMS) which apparently is simply advice for the program administrators and never went through any formal rule making process. See here for the latest development in this case.
Source: blogspot.com

Don’t Believe the Actuaries, Medicare Is Far From Safe

In 2011, Medicare covered 48.7 million Americans — and cost nearly $550 billion. There’s now a $280-billion gap between the premiums and taxes the program takes in and the benefits it pays out. Since the last presidential election, the amount by which benefit payments exceed dedicated tax collections has nearly quadrupled. This fiscal trend is unsustainable. Medicare is inadequately financed over the next ten years, according to the Trustees. And with the “Baby Boom” generation starting to retire, there is even more pressure on Medicare’s costs.
Source: capoliticalnews.com

Medicare 101: Making Your Health Care Coverage Options Easy to Understand

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Source: health-insurance-247.com

Florida Man Accused Of Laundering Millions Of Medicare Money

In a motion filed Monday in U.S. District Court in Miami, prosecutors said Oscar Sanchez, a 46-year-old U.S. citizen and native of Cuba, provided cash to the masterminds behind the alleged fraud in exchange for a fee. They also said Sanchez conspired to send money from the Medicare fraud first to shell companies in Canada before it was passed on through a Trinidad bank and eventually onto Cuba.
Source: cbslocal.com

Report: Enrollment up, premiums down for Medicare Advantage

Posted by:  :  Category: Medicare

NEW REPORT HIGHLIGHTS MEDICARE ADVANTAGE INSURERS’ HIGHER ADMINISTRATIVE SPENDING by Leader Nancy PelosiThe Kaiser Family Foundation found that this year, enrollment in the program grew by 10 percent — jumps were seen in all but two states — and that the average premium paid by enrollees dropped by $4. The program now covers more than 13 million beneficiaries, or 27 percent of the Medicare population, the report stated.  In 2010, after the healthcare reform law passed, the Obama administration predicted that Medicare Advantage premiums would fall for enrollees as a result of officials’ negotiations with insurers. This ran contrary to the opinions of lawmakers and some policy experts, according to The New York Times. The law’s cuts to the program are expected to save $136 billion over 10 years. A related project, aimed at moderating pain from the cuts with quality bonuses to MA insurers, has received criticism from federal investigators as being wasteful.
Source: thehill.com

Video: What Is Medicare Advantage?

Medicare Advantage Enrollment Grows by 10 Percent

Kaiser Family Foundation just released a Data Spotlight on 2012 Medicare Advantage Enrollment. The report shows that 2012 MA enrollment increased 10 percent from 2011 levels with the addition of 1 million new enrollees. The report also noted that MA enrollment has doubled since 2005. Given the payment cuts in the Medicare Modernization Act and Affordable Care Act, this market penetration is surprising. And MA is poised for even more growth in the next several years with the shift of retirees from employer drug coverage due to the loss of the Retiree Drug Subsidy tax benefits, state initiatives that are shifting dual eligibles into managed care, and the arrival of the baby boomers who are familiar with PPO products. It not unrealistic to imagine that MA plans could cover one-third of all Medicare beneficiaries. Some of the 2012 growth is probably due to the fact that premiums in all plans except Regional PPOs decined in 2012. This trend cannot continues since the ACA payment cuts are still being phased in and the quality demonstration providing higher bonuses will end after 2014. Plans are expected to increase premiums and reduce benefits beginning next year. As long as MA remains a better value than Medigap, we should expect to see enrollment continue to increase.
Source: gormanhealthgroup.com

CMS Announces Medicare Advantage Demonstration Project; Also Issues New Proposed Rules to Medicare Advantage Plans

The Centers for Medicare and Medicaid Services announces a three-year demonstration project with financial incentives to improve quality. The project, which begins in 2012, will award Medicare Advantage plans earning the highest performance rating “the largest bonuses equal to 5 percent. Additionally, all Medicare Advantage plans that have a score of three stars and higher will qualify for a bonus payment in 2012.” CMS also issued proposed changes to the Medicare Advantage and the Medicare Prescription Benefit programs (Medicare Part C and D) that codify “clarifications to CMS authority to negotiate plan bids, [expand] restrictions on charging higher cost-sharing than traditional Medicare for certain services, and [limit] long-term care pharmacy waste by specifying efficient dispensing practices.” One of the pharmacy proposals includes a plan to require Part D sponsors to return unused medications for credit and reuse.
Source: kff.org

Medicare Advantage 2012 Data Spotlight: Enrollment Market Update

This data spotlight examines the growth in private Medicare Advantage plan enrollment in 2012, with a record 13 million Medicare beneficiaries enrolled as of March, representing 27 percent of all Medicare beneficiaries.  Enrollment jumped by more than 1 million enrollees from the previous year and increased in every state except Alaska and New Hampshire.
Source: kff.org

Medicare Advantage Sees Lower Premiums

Republicans do not believe in the free market or capitalism.  They believe in rent-seeking and crony capitalism.  That is why they are afraid to let pro-profit health care compete with government run plans.  If the private sector could outcompete an inefficient government, there would be nothing to fear.  If the private sector can only win if propped up by government, and isolated from competition, it is rent-seeking crony capitalism.
Source: wonkwire.com

Will Medicare Advantage be cut in 2013?

In a recent Washington Post article, researchers at the Urban Institute reported that the average two-income household wherein a couple earned an average of $89,000 a year and retired in 2011 would have paid $114,000 in Medicare payroll taxes during their careers, but would receive medical services – including prescriptions and hospital care – worth $355,000.
Source: ehealthinsurance.com

MedPAC Recommends Higher Upfront Costs for Medicare Beneficiaries

The article says that 90% of Medicare beneficiaries have “Medigap and other supplemental insurance policies”. This is incorrect because 25% of Medicare beneficiaries are enrolled in Medicare Advantage which are “Medicare replacement plans” and not supplements. Medicare Advantage plans would seem to be the future of Medicare because every plan includes co-pays for each service received. These co-pays certainly make people think twice about expensive tests or things like physical therapy. Advantage plans are required by Medicare to set a cap on out-of-pocket expenses. These caps currently range from $2,000 to $6,700 per year. The only problem I see with Medicare Advantage is that these are “for profit” businesses run by insurance companies. Profits (and administrative costs like marketing) add up to billions of dollars each year – and this is money that should be staying in the Medicare coffers.
Source: californiahealthline.org

Medicare Advantage or Medicare Supplement: Which to sell?

Finally, it’s important to look at the value of each specific type of Medicare Advantage plan.  Medicare Advantage plan types are HMO, PPO and Private Fee for Service (PFFS).  Generally speaking, HMO plans are best able to manage networks, coordinate care, manage diseases and limit provider access.  This makes them most efficient in limiting claims cost.  The next most efficient would be PPO products with PFFS products as the least efficient.  Therefore, all other things being equal, an HMO should be able to deliver the most additional value, followed by a PPO and lastly, a PFFS plan.
Source: ritterim.com

Medicare Advantage Star Ratings: Detaching Pay from Performance

Because criteria for evaluation are not published until after the period for which performance will be evaluated, there is no possibility that MA plans will be able to improve their performance to achieve the goals CMS intends to incentivize. Any adjustment plans will be able to make to their bids or plan offerings would have to be aimed at increasing enrollment in counties with the highest bonuses and rebates based on data from performance in previous years, possibly at the expense of improving their performance in the future.
Source: thehealthcareblog.com

Daily Kos: Mitt Romney: Let’s make it easier to commit Medicare fraud than to register to vote

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 Carewho will point this out? We do it all the time here, because we are among tens-hundreds?-of thousands of careful, literate readers who want to know the truth. The mainstream media? Not so much. Politicians will not call each other out, apparently, given their use of the terms “misspoke” and “misrepresented” instead of “lied” when discussing even their opponents. The sheer number of them from Republicans makes it nearly impossible for us make any of them “stick” in the voters minds–and of course, most get hit with the “both sides do it anyway” stance by everyone–so there is little to no downside to lying when slandering one’s opponent, other than to one’s conscience. And this is where most Dems (well, most liberals, at any rate) get hurt; we have consciences, so we feel bad if we lie, we try to avoid it, and we apologize or atone for misdeeds when caught, at the very latest. Paradoxically, that makes us weaker in the eyes of the voting public, instead of more reliable and honest.
Source: dailykos.com

Video: Medicare Physician Feedback Program: Payment Standardization and RIsk Adjustment

Medicare eRx Incentive Deadline Looming

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Source: mtshealthcare.net

Stop Fraud As A Medicare Consumer And Watch dog

Virtually all Healthcare vendors are trustworthy and honest. Nonetheless, as with anything else some are not. Medicare is certainly a large government organization that it becomes an effortless target for scams. Many Government agencies are working with Medicare to prevent these fraudulent activities. How does fraud usually happen? Its actually easy to do and merely requires that the Healthcare provider charges Medicare for products and services that have not been provided. Of course many of us have no idea exactly what services were carried out anyway. This costs Medicare an incredible sum of money and as we all know Medicare is under a great deal of financial stress. The fraudulence results in higher premiums for everyone.
Source: mylucky777.com

The Official Medicare Set Aside Blog And Information Resource: Physician Accountability in Medicare Billing

Physicians have been the subject of many of my recent rants because so many of the problems that we encounter with MSP issues can be attributed directly to them. We can’t control their excessive treatment plans or lazy billing practices, but neither can we convince CMS that these problems exist. In conditional payment recoveries, it is impossible to get CMS to adjust its recovery to account for commingled billing. Physician billing offices will frequently reuse forms pre-filled with patient information, including all diagnosis codes ever treated by that physician whether during that visit or not. From their perspective, it doesn’t matter because they do not get paid by the treatment, but by the time spent. Unfortunately for those on the other end of that transaction, it makes a huge difference and the private sector has been absorbing those payments for the benefit of Medicare for many years. The other issue is indifference in who gets billed. Patients don’t understand that it makes a difference who gets billed and physicians doesn’t care who pays so long as someone pays. Many of what are deemed conditional payments are not conditional at all – they were made by mistake due to lack of notice of secondary payer issues. But the one thing that all of these scenarios have in common is that the problems all originate in the physician’s billing office. Well, perhaps no more…
Source: medicaresetasideblog.com

Breaking News Regarding Medicare Provider Revalidation Process

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Source: hcafnews.com

That’s not ‘how government works’

“The form he gets to change address is 33 pages long — 33 pages long. He calls someone to ask how to fill it out. He calls someone in government. They tell him what to do. He sends it in. They sent it back. It wasn’t done right, got to do it again, another 33 pages. He calls another person. They tell him what to do. Doesn’t get it right the second time. The third time’s the charm, though. This takes several months during which time he’s not getting the checks for the work he’s doing for people who need his care. That’s how government works.”
Source: msn.com

The Center for Fiscal Equity: Medicare Physician Payments

Chairman Baucus and Ranking Member Hatch, thank you for the opportunity to submit my comments on this topic. This topic is key to the question of the affordability of health care entitlements. It is useful to compare the impact of how provider limits have been dealt with between the Medicare and Medicaid programs. Medicare provider cuts under current law have been suspended for over a decade, the consequence of which is adequate care. By way of comparison, Medicaid provider cuts have been strictly enforced, which has caused most providers to no longer see Medicaid patients, driving them to hospital emergency rooms and free clinics with long waiting periods to get care. The Affordable Care Act works toward increasing funds for Medicaid providers, which is necessary to get people out of emergency rooms. The same act, however, counted on assuming that Medicare provider cuts would be implemented – a heroic assumption – in order to pass according to budget rules. Now that the Act is passed, however, the fiction that current law will be maintained can be dispensed with. Parity between Medicare and Medicaid is desirable, although without mandatory sick leave, it will not keep poor people from having to use emergency room care, although it will benefit nursing home patients who will be able to see a doctor without hospitalization. Separating Medicaid into a program for retirees and a program for the non-retired working and non-working poor will allow the retiree program to be fully federalized and managed with Medicare, rather than the separate management that occurs now under CMMS, which is part of the problem. That simple step will add clarity to this issue. There are many ways of achieving parity, however great care must be used so that these don’t constitute a race to the bottom. Cost shifting should not be used as a substitute for cost saving, especially if such shifting violates the tenants of social insurance. The whole purpose of social insurance is to prevent the imposition of unearned costs and payment of unearned benefits by not only the beneficiaries, but also their families. Cuts which cause patients to pick up the slack favor richer patients, richer children and grand children, patients with larger families and families whose parents and grandparents are already deceased, given that the alternative is higher taxes on each working member. Such cuts would be an undue burden on poorer retirees without savings, poor families, small families with fewer children or with surviving parents, grandparents and (to add insult to injury) in-laws. Recent history shows what happens when benefit levels are cut too drastically. Prior to the passage of Medicare Part D, provider cuts did take place in Medicare Advantage (as they have recently). Utilization went down until the act made providers whole and went a bit too far the other way by adding bonuses (which were reversed in the Affordable Care Act). There is a middle ground and the Subcommittee’s job is to find it. Resorting to premium support, along with the repeal of the ACA, have been suggested to save costs. Without the ACA pre-existing condition reforms, mandates and insurance exchanges, however, premium support will not work because people will have no assurance of affordable coverage. This, of course, assumes that private insurance survives the imposition of pre-existing condition reforms. If it does not, the question of both premium support and the adequacy of provider payments is moot, since if private insurance fails the only alternatives are single-payer insurance and a pre-emptive repeal of mandates and protections in favor of a subsidized public option. The funding of either single-payer or a public option subsidy will dwarf the requirement to fund adequate provider payments in Medicare and Medicaid. Resorting to single-payer catastrophic insurance with health savings accounts would not work as advertised, as health care is not a normal good. People will obtain health care upon doctor recommendations, regardless of their ability to pay. Providers will then shoulder the burden of waiting for health savings account balances to accumulate – further encouraging provider consolidation. Existing trends toward provider consolidation will exacerbate these problems, because patients will lack options once they are in a network, giving funders little option other than paying up as demanded. Shifting to more public funding of health care in response to future events is neither good nor bad. Rather, the success of such funding depends upon its adequacy and its impact on the quality of care – with inadequate funding and quality being related. Ultimately, fixing health care reform will require more funding, probably some kind of employer payroll or net business receipts tax – which would also fund the shortfall in Medicare and Medicaid (and take over most of their public revenue funding). We will now move to an analysis of funding options and their impact on patient care and cost control. The committee well understands the ins and outs of increasing the payroll tax, so we will confine our remarks to a fuller explanation of Net Business Receipts Taxes (NBRT). Its base is similar to a Value Added Tax (VAT), but not identical. Unlike a VAT, an NBRT would not be visible on receipts and should not be zero rated at the border – nor should it be applied to imports. While both collect from consumers, the unit of analysis for the NBRT should be the business rather than the transaction. As such, its application should be universal – covering both public companies who currently file business income taxes and private companies who currently file their business expenses on individual returns. The key difference between the two taxes is that the NBRT should be the vehicle for distributing tax benefits for families, particularly the Child Tax Credit, the Dependent Care Credit and the Health Insurance Exclusion, as well as any recently enacted credits or subsidies under the ACA. In the event the ACA is reformed, any additional subsidies or taxes should be taken against this tax (to pay for a public option or provide for catastrophic care and Health Savings Accounts and/or Flexible Spending Accounts). The NBRT can provide an incentive for cost savings if we allow employers to offer services privately to both employees and retirees in exchange for a substantial tax benefit, either by providing insurance or hiring health care workers directly and building their own facilities. Employers who fund catastrophic care or operate nursing care facilities would get an even higher benefit, with the proviso that any care so provided be superior to the care available through Medicaid. Making employers responsible for most costs and for all cost savings allows them to use some market power to get lower rates, but no so much that the free market is destroyed. This proposal is probably the most promising way to arrest health care costs from their current upward spiral – as employers who would be financially responsible for this care through taxes would have a real incentive to limit spending in a way that individual taxpayers simply do not have the means or incentive to exercise. While not all employers would participate, those who do would dramatically alter the market. In addition, a kind of beneficiary exchange could be established so that participating employers might trade credits for the funding of former employees who retired elsewhere, so that no one must pay unduly for the medical costs of workers who spent the majority of their careers in the service of other employers. The NBRT would replace disability insurance, hospital insurance, the employer contribution to OASI, the corporate income tax, business income taxation through the personal income tax and the mid range of personal income tax collection, effectively lowering personal income taxes by 25% in most brackets. Note that collection of this tax would lead to a reduction of gross wages, but not necessarily net wages – although larger families would receive a large wage bump, while wealthier families and childless families would likely receive a somewhat lower net wage due to loss of some tax subsidies and because reductions in income to make up for an increased tax benefit for families will likely be skewed to higher incomes. For this reason, a higher minimum wage is necessary so that lower wage workers are compensated with more than just their child tax benefits. Thank you for the opportunity to address the committee. We are, of course, available for direct testimony or to answer questions by members and staff.
Source: blogspot.com

Medicare Is Undoubtedly In Financial Trouble; Let us Eliminate The Fraud

The majority of Healthcare providers are trustworthy and honest. However, as with everything else a few are not. Medicare is especially a great target for deceitful activity. Numerous government agencies are battling against Medicare fraudulence. How does fraud normally happen? Its really easy to do and only requires that the Healthcare provider bills Medicare for services which have never been given. Naturally most of us have no clue precisely what services were carried out anyway. This costs Medicare an incredible amount of cash and as everyone knows Medicare is under a great deal of financial stress. The fraud eventually ends up costing the Medicare receiver more money in premiums.
Source: shoplocalsisq.com

Medical Coding Wiki: Important UpDates and Information for Medicare Billing 2012

Posted by:  :  Category: Medicare

Gang of Six - Cartoon by DonkeyHoteyDiscontinuance of verification of foreign born status in provider enrollment: Effective immediately, providers are no longer required to provide information, which verifies the legalized status of enrollment applicants including those individuals referenced in any ownership related information. This is part of an ongoing Centers for Medicare & Medicaid Services (CMS) review of current enrollment requirements to eliminate unnecessary burden on providers as well as delays in the enrollment process
Source: medicalcodingwiki.com

Video: Medicare Part D Prescription Drug Plan Basics

Using Your Medicare Prescription Dru …

As the new year begins, people with Medicare who have already joined a Medicare drug strategy can take advantage of the new Medicare prescription drug coverage. Since this is a new plan for Medicare, you may well have questions about how to use your Medicare drug strategy. For instance, what if you joined a program but haven’t received a plan ID card in the mail yet? Or, what if your drugs were covered by Medicaid and fraud in medicare you’re not certain how to get your medicines now? Whatever questions you have, Medicare has answers. First Pharmacy Trip Here are some ideas men and women with Medicare can use to make positive their very first trip to the pharmacy goes smoothly: • When you initial join a Medicare drug plan, you’ll get an acknowledgement letter in the mail about a week right after you join. Your strategy ID card ought to arrive 3 to five weeks later. • If you need to go to the pharmacy just before types of fraud your ID card arrives, bring the acknowledgement letter from your plan, your Medicare and/or Medicaid card, and a photo ID. • Save the receipts from your pharmacist. • For additional help, call 1-800-MEDICARE, 24 hours a day, seven days a week. Folks with Medicare and Medicaid If your pharmacist is getting difficulty confirming what program you’re in or no matter whether you also get Medicaid, he can also call a unique toll-cost-free quantity that Medicare set up for pharmacists to get aid. Individuals with Medicare who also get Medicaid ought to be in a position to get their prescriptions filled with minimal copayments and no deductibles. How to Join a Strategy If you haven’t joined a Medicare drug program but, don’t worry. You have until May possibly 15, 2006 to select and join a program what is medical fraud without having having to pay a penalty
Source: motorsportworld.tv

Diverse Approaches To Avail Medicare …

Considering that the administration standardizes every one prepare, you cannot find any distinction inside protection which is available from insurance firms marketing Medigap designs. At this time there will however turn out to be large variations in payments to the same insurance policy coverage. Medicare Supplement Plans are designed to acquire the difference on Medicare health insurance Component A plus B including co-pays along with deductibles. Unfortunately, less than Medicare health insurance, about to catch exclusively making payment on the Element T regular monthly top quality, but also you are answerable for all these added, out-of-pocket charges. Medicare supplemental health insurance Insurance policies deal with most, if not all, for these “gaps.” Underneath are the most famous Medicare health insurance Additional Insurance coverage in addition to their numerous insurance plan.
Source: motorsportworld.tv

Medicaid and Medicare have been paying for weight loss procedures since 2006: laura vandervoort smallville season 10

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Source: seesaa.net

Practical Insights: Dealing with Medicare Part B and COBRA Coverage

Posted by:  :  Category: Medicare

wordy informative signage by damian mGenerally, the Socal Security Act provides that individuals may enroll in Medicare Part B (which covers doctors visits and other outpatient services) when they reach age 65. If they fail to do so during a seven-month initial enrollment period surrounding their 65th birthday, they can enroll during an annual “general enrollment” period that occurs each January 1- March 31, with coverage becoming effective the following July1, though they will incur a penalty in the form of permanently higher Part B premiums (10% increase for each year of available coverage that is foregone). However, actively employed individuals who have employer-provided health coverage can postpone signing up for Medicare Part B until after age 65. When they lose the employer-provided coverage or terminate employment, whichever happens first, they are then provided an eight-month “special enrollment period” (“SEP”) during which they can sign up for Medicare effective immediately and without penalty.
Source: fordharrison.com

Video: Guide to Medicare Part A and Part B

Brad Hunter, CPA: Medicare Part B

This is the part you pay for each month which is withheld from your social security payment. If your income is less than $85,000 and you file a single return, or if your income is less than $170,000 and you file a joint return, then the monthly premium is $99.90. If you make over those amounts, then your monthly premium increases from $139.90 to a maximum of $319.70 for 2012. It is like a little mini tax return.
Source: bradhuntercpa.com

MedPAC Urges Changes In Medicare Beneficiaries’ Co

Medpage Today: MedPAC Proposes Payment Change Congress should pass a bill that would restructure the “outdated” fee-for-service payment mechanism, the nonpartisan MedPAC recommended. MedPAC’s plan would charge an additional fee for the 90% of Medicare beneficiaries who have fee-for-service supplemental insurance. Under the plan, beneficiaries would have to pay 20% of the supplemental policy’s premium to Medicare. In its report released Friday, MedPAC offered a number of other recommendations aimed at improving Medicare’s fee-for-service model, which has remained essentially unchanged since the creation of the program in 1965 (Walker, 6/16).
Source: kaiserhealthnews.org

Medicare Part B Drugs « Insurance News from Crowe & Associates

There is one exception to this.  If the patient/member picks up the drug at the pharmacy and then has it administered to them by the doctor or at the facility, it may still fall under the Medicare part D drug benefit.  The difference is that the patien actually purchased it at the pharmacy vs. it being supplied by the doctor of facility.
Source: croweandassociates.com

I want to cancel medicare part B! Please help.

Welcome to the NeuroTalk Communities! You are currently viewing our boards as a guest which gives you limited access to view most discussions and our other features. By joining our free community you will have access to post topics, communicate privately with other members (PM), respond to polls, upload content and access many other special features. Registration is fast, simple and absolutely free so please, join our community today! If you have any problems with the registration process or your account login, please contact contact us.
Source: psychcentral.com

Who Is Eligible For Medicare Part B

If you do not have Part A: Even people who do not have Part A coverage can certainly choose Medicare Part B as long as they satisfy a few Medicare eligibility requirements. For starters, they should be citizens of the United States. Even non-citizens are eligible, provided they have been admitted following all the specified legal requirements and have resided in the US for five years or more. Secondly, people who are aged 65 years and above are eligible for Medicare Part B. Even if you do not have Part A, you can qualify for the Part B by filling out the necessary paperwork and remitting the monthly premium specified by the insurance provider.
Source: online-biz-articles.com

Medicare Teleseminar Exposes Startling New Way Medicare Cuts Coverage for 1.4 Million Beneficiaries

This growing trend to downgrade coverage without notifying hospital patients is just one way out-of-pocket costs are going up for beneficiaries. An AARP Public Policy Institute analysis of a survey found beneficiaries paid for over half of their own health care. Even with good health, Medicare.gov estimates out-of-pocket costs are around $ 6,800 per year. Beneficiaries need the opportunity to discuss their situation with people who are up-to-date about how Medicare works. Medigap Advisors live Medicare Teleseminar will be hosted by experts who are independent from the companies that design Medicare plans.
Source: nptuner.com

Medicare B: What You Should Know in Order to Maximize Your Benefits

As required in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, beginning in 2007 the Part B premium a beneficiary pays each month is based on his or her annual income.  Specifically, if a beneficiary’s “modified adjusted gross income” is greater than the legislated threshold amounts ($85,000 in 2012 for a beneficiary filing an individual income tax return or married and filing a separate return, and $170,000 for a beneficiary filing a joint tax return) the beneficiary is responsible for a larger portion of the estimated total cost of Part B benefit coverage. In addition to the standard Part B premium, affected beneficiaries must pay an income-related monthly adjustment amount.  These income-related amounts were phased-in over three years, beginning in 2007.  About 4 percent of current Part B enrollees are expected to be subject to these higher premium amounts.
Source: protectingpatientrights.com

Choosing Wisely: Screening for Abdominal Aortic Aneurysms

Recently, the American College of Physicians (ACP) convened a workgroup to identify ways practicing clinicians can contribute to the delivery of high-value, cost-conscious health care. They suggest we limit the use of many common screening and diagnostic tests in ways that do not reflect high-value care.
Source: wordpress.com

Who Is Eligible For Medicare Part B

Posted by:  :  Category: Medicare

If you do not have Part A: Even people who do not have Part A coverage can certainly choose Medicare Part B as long as they satisfy a few Medicare eligibility requirements. For starters, they should be citizens of the United States. Even non-citizens are eligible, provided they have been admitted following all the specified legal requirements and have resided in the US for five years or more. Secondly, people who are aged 65 years and above are eligible for Medicare Part B. Even if you do not have Part A, you can qualify for the Part B by filling out the necessary paperwork and remitting the monthly premium specified by the insurance provider.
Source: online-biz-articles.com

Video: Guide to Using Joppel for Medicare Insurance

Research Roundup: Raising Medicare’s Eligibility Age

Journal Of The American College Of Radiology: Imaging And Insurance: Do The Uninsured Get Less Imaging In Emergency Departments? – Using data from the 2004 National Hospital Ambulatory Medical Care Survey, researchers compared treatment among patients who were uninsured, those covered by Medicaid and those with other types of insurance and found that the uninsured patients received 8 percent fewer imaging tests than patients with non-Medicaid insurance and that Medicaid enrollees received 10 percent fewer than those with other insurance. They conclude: “Further research is needed to understand whether insured patients receive unnecessary imaging or if uninsured and Medicaid patients receive too little imaging” (Moser and Applegate, January 2012). Archives Of Pediatrics And Adolescent Medicine: The Interplay Of Outpatient Services And Psychiatric Hospitalization Among Medicaid-Enrolled Children With Autism Spectrum Disorders — For children with Austism Spectrum Disorders (ASD), barriers to care — such as lack of qualified practitioners and poor insurance coverage — increase the chances that they will be hospitalized for psychiatric reasons. The researchers looked at a large national sample of Medicaid-covered children with ASD to see if “increasing outpatient services results in reduced use of costly and restrictive service.” The researchers found that each $1,000 increase in spending on outpatient services like respite care over 60 days “resulted in an 8% decrease in the odds of hospitalization” (Mandell et. al., 1/2) New England Journal Of Medicine:  Fitness Memberships And Favorable Selection In Medicare Advantage Plans — Researchers used national figures from the Centers for Medicare and Medicaid Services to see what kind of changes occurred when 11 Medicare Advantage plans incorporated a gym membership as a part of their covered benefits: “Persons enrolling in plans after the addition of a fitness-membership benefit reported significantly better general health, fewer limitations in moderate activities, less difficulty walking.” The authors noted that creating an insurance risk pool for Medicare Advantage plans, as well as  for small business and individual plans, violates the 2010 health law. However, a benefits package that caters to a healthier subset of seniors may have the same effect as creating a risk pool (Cooper and Trivedi, 1/11).
Source: kaiserhealthnews.org

Daily Kos: Old Waitress says, “Don’t Raise Medicare Eligibility Age!”

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Source: dailykos.com

Daily Kos: Why is Raising Medicare Eligibility to Age 67 a Bad Idea? Here’s Why.

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Source: dailykos.com

Brad DeLong: Raising the Medicare Eligibility Age Is a Really Bad Idea Blogging: Is This a Problem with the Media or with the Congressional Budget Office?

Director’s Blog: Raising the Ages of Eligibility for Medicare and Social Security: If the eligibility age was raised above 65, fewer people would be eligible for Medicare, and outlays for the program would decline relative to those projected under current law. CBO expects that most people affected by the change would obtain health insurance from other sources, primarily employers or other government programs, although some would have no health insurance. Federal spending on those other programs would increase, partially offsetting the Medicare savings. Many of the people who would otherwise have enrolled in Medicare would face higher premiums for health insurance, higher out-of-pocket costs for health care, or both.
Source: typepad.com

Medicare Sales Representative for CA

Great sales are the result of strong purpose, conviction and pride – pride in your ability and your product. UnitedHealth Group offers a portfolio of products that are changing the world. We are the right place to apply and build on your skills and talents. The job of Medicare Individual Sales Rep is responsible for increasing the membership, revenue and profitability through the direct sale of the organization’s products and services to Medicare eligible individuals in their assigned territory. Incumbents sell a portfolio of Medicare health related products using a solutions based sales approach, combined with industry and consumer demographic expertise to assess personal needs and assist prospects in selecting the product which best suits their individual clinical, financial and life stage.
Source: careers.org

Meaningful Use Significantly Benefits Radiologists

Radiologists who choose to upgrade to the new ARRA-defined standards of meaningful use will see a notable enhancement of health care service to patients. The intent of meaningful use is to help ensure that radiologists who use Electronic Health Records (EHRs) implement the software in a manner that supports higher quality and more efficient delivery of services. Most radiologists do qualify for these benefits and discover that implementing meaningful use is advantageous to radiologists in several significant ways.
Source: yourseofree.com

Medicare Eligibility and Coverages: Medicare Health Insurance Eligibility, Coverages and Costs

Eligible American residents can apply for Medicaid at any Social Security office. If the person applying for health insurance or their spouse has worked for at least 10 years in Medicare-covered employment, there is typically no cost for Medicare health insurance Part A and applicants are automatically eligible. However, there are costs for Medicare Part B. This portion of the Medicaid health insurance has a general sign-up or enrollment period that started on January 1st and ends on March 31st each year. Medicare coverage begins on July 1st of the year of enrollment. Although eligibility is fairly open, there are mitigating factors that can increase standard Medicare costs.
Source: suite101.com

Romney Proposes Raising Medicare Eligibility Age in 2022

A cogent example is the value of colonoscopies. The NE Journal of Medicine study shows that the procedure reduces the incidence of colorectal cancer and saves lives, cutting the death rate in half.   The procedure can cost thousands of dollars. The GAO found that only a quarter of all Medicare beneficiaries ages 65 to 75 had been so screened, and about 59 percent of men and women between the ages of 50 and 74  were tested.  While not the most pleasant procedure, it is important for all over 50.  Implementation would not be without new cost, certainly in the shorter term.
Source: talkleft.com

Romney Offers Proposal To Gradually Increase Medicare Eligibility Age

Romney said that his proposal would begin in 2022. Under the proposals, the Medicare eligibility age would increase by one month annually. “In the long run, the eligibility ages for [Medicare and Social Security] will be indexed to longevity so they increase only as fast as life expectancy,” Romney said (Espo, AP/Contra Costa Times, 2/24).
Source: californiahealthline.org

Medicare 101: Making Your Health Care Coverage Options Easy to Understand

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Source: health-insurance-247.com

Fraud Costs All Of Us When Discussing About Medicare insurance

Posted by:  :  Category: Medicare

Insurance for All Signs by L33tminionVirtually all Healthcare vendors are legitimate and honest. Nonetheless, as with anything else some are not. Medicare is definitely a large government organization that it becomes an easy target for fraud. Many Government agencies are working with Medicare to halt these fraudulent activities. How does fraud normally happen? Its basically very easy to do and just requires that the Healthcare provider charges Medicare for products and services that have not been supplied. Naturally most of us have no clue exactly what services were carried out anyway. This costs Medicare an incredible amount of money and as you know Medicare is under a good deal of financial pressure. The deception winds up costing the Medicare recipient additional money in premiums.
Source: birdwatchingblog.net

Video: Top 10 Medicare Insurance Tips

Never Enable The Hospital To Get Your Personal savings; Find Supplement Medicare Insurance protection

Senior will have a portion of their healthcare needs covered under the Medicare health insurance program. This is why that Four out of five seniors purchase supplemental health coverage. The supplemental insurance coverage assists in co-payments, insurance deductibles, and coinsurance expenses. Most of the policies will provide emergency healthcare coverage if someone is traveling outside the US.. This program operates like any other insurance in that a month-to-month premium is paid directly to a private insurance company and not Medicare. This insurance coverage is underwritten through private insurance providers. A persons statement will be delivered monthly together with all treatments which have been covered on the senior citizens behalf.
Source: mylucky777.com

Do not Allow The Hospital To Just take Your Personal savings; Acquire Supplement Medicare Insurance protection

Senior will have a portion of their healthcare needs covered under the Medicare health insurance plan. That is why that 4 out of 5 senior citizens purchase supplemental health coverage. This insurance is designed to pay co-payments, coinsurance, as well as deductibles. Many of the plans will give you unexpected emergency health care coverage if someone travels outside the United States of America. This program operates like all other insurance policy in that a monthly premium is paid directly to a private insurance carrier and never Medicare. This insurance is underwritten through private insurance firms. An individuals statement is going to be sent out monthly along with all treatments which have been covered on the senior citizens behalf.
Source: glob-inc.com

Medicare Insurance California » Yapperz.com

That is to say, if the open enrollment window of time has been missed, then medical underwriting could be required and individuals with a disability could not qualify for extensive coverage. Those who are taken into disability, but lined below an employer sponsored plan can later on implement for Medigap insurance policy when they independent from company. California Medicare Anniversary or Birthday Rule California is extremely unique in that it gives a annually anniversary when Medicare beneficiaries can change to like protection. Really couple of states supply this profit. The annually anniversary is also referred to as the “birthday rule” and encompasses the thirty day period of the insureds birthday. Throughout this one thirty day period window, consumers can switch Medicare insurance policy plans so extended as they are not upgrading to much more complete protection. If an improve is preferred, then health-related underwriting will be needed. Like protection simply implies the same (or less) Medicare supplement insurance coverage coverage. For illustration, consumers on Plan F can buy a new Program F from a competing insurance coverage firm in order to reduce their monthly premiums. This may be done each and every few of several years when Medicare complement rates have had an previously mentioned regular top quality increase. In summary, citizens of CA who are qualified for Medicare have many possibilities offered to them when purchasing for a Medicare supplement insurance policy strategy. It may be sensible to operate with an independent agent who can supply prices from several competing businesses. This can aid hold month to month prices minimal at inception as nicely as in the long term. Buyers possessing Medigap insurance policies previously mentioned or under age 65 really should examine all of their possibilities during their birthday month. This annually anniversary can be utilised to buy like coverage at a lower cost, as a result maintaining decrease premiums every calendar year. Medicare is a wellness insurance coverage strategy that is presented by the authorities and is managed by the Centers for Medicare and Medicaid Providers. The eligibility requirements for a person to apply for Medicare Insurance policy are as follows: 1. Getting sixty five several years outdated or far more, two. Being 65 years and having some sort of imparity or imparities, three. Possessing finish stage renal disease, necessitating kidney transplant or dialysis treatment procedure. Medicare provides a couple of positive aspects to the consumers. They are categorized in 4 distinctive groups. Allow us get a brief search at the different sorts of positive aspects that Medicare has to provide to men and women. Part A offers the Hospital Insurance coverage. It helps in covering for inpatient treatment in hospitals and skilled nursing amenities. Portion B provides the Healthcare Insurance. This class addresses healthcare services to people who are undergoing treatment processes outdoors hospitals, solutions from physicians and medical professionals and specified occupational therapies. Portion C is basically the combination of Part A and Component B. it is meant to offer more advantages at a very low cost. Part D offers with the expenses incurred in prescription medication. It provides a particular person with greater accessibility to medications that are essential. As we can see, a standard Medicare program can’t suffice the needs of an aged individual who needs health-related advantages. senior health insurance california, medicare part d california, medicare insurance california
Source: yapperz.com

Medicare insurance Is Currently In Fiscal Trouble; Let us End The Fraudulence activity

Most healthcare suppliers are honest and also trustworthy. Unfortunately, you can find those that are not trustworthy! Medicare is particularly a great target for deceitful activity. Many Government agencies work with Medicare to stop these fraudulent activities. How does fraud typically happen? Its basically easy to do and just requires that the Healthcare provider charges Medicare for services that have never been delivered. Not surprisingly most of us have no idea what services were done anyway. This costs Medicare a huge sum of money and as everyone knows Medicare is under a lots of financial stress. The scams ultimately ends up costing the Medicare beneficiary more money in premiums.
Source: pewast.com

Feds in Miami: Millions stolen from Medicare wound up in Cuban banking system

While Sanchez was a target of the ongoing investigation, prosecutors say dozens of crooked Medicare providers — who offered HIV and medical equipment services — all took part in the laundering scheme set up for one reason: To hide the money.
Source: allstardirect.com

Medicare insurance Is Currently In Financial Trouble; Let’s Prevent The Deception

The vast majority of Healthcare providers are reputable and honest. Sadly, you will find those that are not truthful! Medicare is especially a good target for deceitful activity. A number of government agencies are combating against Medicare scams. How does fraud generally happen? Its actually quite simple to do and only requires that the Healthcare provider bills Medicare for services that have not been delivered. In most cases the individual has no clue the thing that was done and they do not question their medical providers. Naturally with Medicare being funded by tax payers along with the Medicare system is at risk of survival due to a shortage of funding. The fraudulence results in higher rates for everyone.
Source: oldcastro.net

Medicare insurance Is Undoubtedly In Fiscal Trouble; Let’s End The Deception

The vast majority of Healthcare suppliers are legitimate and honest. Regrettably, you will find those that are not truthful! Medicare is unquestionably a large government agency that it becomes an easy target for scams. A number of government agencies are fighting against Medicare scams. How does fraud normally happen? Its basically easy to do and merely requires that the Healthcare provider bills Medicare for services that have never been given. Not surprisingly most of us have no idea precisely what services were carried out anyway. This costs Medicare an enormous amount of money and as you know Medicare is under a good deal of financial pressure. The scams ends up costing the Medicare beneficiary more money in premiums.
Source: russellsabode.com

InsureBlog: Obamacare, SCOTUS and Medicare Part D

Posted by:  :  Category: Medicare

Medicare Part D Press Conference (44) by Korean Resource Center 민족학교Obamacare may be scrapped in part or completely if SCOTUS (Supreme Court of the U.S.) rules against the law as a violation of the Constitution. If that happens, there is speculation that the cost of medication for Medicare Part D  beneficiaries might increase.   Obamacare provides “the necessary legal framework” for drug companies to slash brand-name drug prices by half for seniors and people with disabilities when they enter a coverage gap in their Medicare drug plans, said Matthew Bennett, a spokesman for the Pharmaceutical Research and Manufacturers of America.  Eventually the discounts grow so that the gap, known as the doughnut hole, is closed by 2020.  But if (Obamacare) goes, the discounts may go, too. Part of Obamacare requires pharmaceutical manufacturers to provide a 50% discount on brand-name prescriptions filled in the Medicare Part D coverage gap beginning in 2011 and begins phasing-in federal subsidies for generic prescriptions filled in the Medicare Part D coverage gap. If Obamacare is struck down the drug companies are no longer required by law to discount their medication. If it isn’t obvious, the pharmaceutical companies are not reducing the price of the drugs out of the goodness of their heart under Obamacare. All Obamacare did was to create a cost shift to others not in Medicare that will pay a higher price than they would have without Obamacare. Another offshoot of the mandated discount is increasing the price of some medications which puts them in a higher tier under a drug formulary. In other words, they mark the drugs up so they can mark them down. Voluntary drug coverage was added to Medicare in 2006, but consumers and advocates have been eager to get rid of the coverage gap. Insurance coverage stops when the beneficiary and the insurer together have spent $2,930 for prescription drugs, excluding monthly premiums. Under Obamacare, beneficiaries then get a 50 percent discount on brand-name drugs and 14 percent on generics drugs. When the beneficiary alone has spent a total of $4,700, coverage restarts. At that point the drug plan picks up 95 percent of the cost. How is Medicare Part D voluntary if the government assesses a late enrollment penalty (LEP) if you do not buy a Part D when first eligible? So while the discounts, and closing the donut hole may go away if Obamacare is overruled, the truth is the discounts were more smoke and mirrors than anything . . . kind of like political promises. Drug companies could try to offer the discounts on their own but that effort could run afoul of federal antitrust laws that generally prohibit businesses from agreeing together to set prices for their products.  An individual drug company could offer Part D members coverage gap discounts, but it would have to steer clear of anti-fraud laws that ban a company from giving something of value to persuade beneficiaries to use its products. Isn’t it nice when the government interferes with free trade? For all the political promises, lies and distortions, Obamacare is not a good law and Medicare Part D is more illusion than actual insurance.
Source: blogspot.com

Video: Medicare Part D and Prescription Drugs

Medicare Drug Discounts At Risk If Court Strikes Health Law

Voluntary drug coverage was added to Medicare in 2006, but consumers and advocates have been eager to get rid of the coverage gap. Insurance coverage stops when the beneficiary and the insurer together have spent $2,930 for prescription drugs, excluding monthly premiums. Under the health law, beneficiaries then get a 50 percent discount on brand-name drugs and 14 percent on generics drugs. When the beneficiary alone has spent a total of $4,700, coverage restarts. At that point, the beneficiary picks up 5 percent of the costs.
Source: kaiserhealthnews.org

Medicare Part D Proves That Competition Lowers Health Care Spending

Few patients switching plans. Another critique of competition is that a general reluctance to switch plans “reflects the large number of plan choices available combined with the costs in terms of time and energy of doing research and of actually making a switch.” This claim, taken from behavioral economics, does not negate a person’s price sensitivity. Experience with the Federal Employees Health Benefits Plan (FEHBP) shows that about 5 percent of patients switch plans each year. This reluctance to switch reflects well-documented satisfaction with plan choices. This only proves that people make decisions based on many factors, including how much they like their plans.
Source: heritage.org

AARP Public Policy Institute Reviews Gap in Medicare Part D Coverage

A new report from the AARP Public Policy Institute looks at the potential effects of a provision in the health care law that provides drug subsidies and discounts to Medicare beneficiaries, ultimately eliminating the coverage gap known as the “doughnut hole.” According to the report, “As part of the new health care law, enrollees who reach the doughnut hole in 2011 will receive a 50 percent discount on brand-name and biologic drugs and a 7 percent discount on generic drugs while in the doughnut hole. These discounts will gradually increase until the doughnut hole is eliminated in 2020.” The report includes a table showing “the number and percentage of Part D enrollees by state who are helped by the closing of the doughnut hole.”
Source: kff.org

LET’S TALK ABOUT DRUGS……..MEDICARE PART D

Under Medicare Part D, private insurance companies will enter into contracts with the Department of Health and Human Services to provide insurance for prescription drugs.  The coverage requirements (such as use of formulary drugs, tier assignments, etc) under the plans will vary by state; to reflect differences in provider costs and patient demographics.
Source: retireusa.net

Medicare Part D Spending Trends: Understanding Key Drivers and the Role of Competition

This brief commissioned by the Foundation examines factors that contributed to Medicare’s lower-than-expected spending on prescription drugs under the Medicare Part D drug benefit that started in 2006. Since its launch, Medicare has spent about 30 percent less on Part D benefits than the Congressional Budget Office originally projected. Some cite the program’s design, with private plans competing for enrollment, as the driving factor in lower spending; others point to factors in the overall market for prescription drugs as more influential. Author Jack Hoadley of Georgetown University examines the evidence on both sides of this debate. In addition to a discussion of the role of plan competition, the report cites a number of other factors that contributed to lower spending, including the growth in generic alternatives for popular-but-expensive brand-name drugs and a reduction in new brand-name drugs entering the market – trends that dampened prescription drug spending outside of Medicare as well.
Source: kff.org

Romney Lining Up With Ryan’s Medicare Plan As His Health Law Assertions Are Tested

Posted by:  :  Category: Medicare

White House Medicare Presentation by National Institutes of Health LibraryThe Wall Street Journal: Romney Embraces Hill GOP The moves by Mr. Romney defy fears among some conservatives that he would tack to the center after clinching enough delegates for the Republican presidential nomination. Instead, Mr. Romney is identifying himself with Mr. Ryan’s plans to rein in the size and scope of government — and he appears to be shrugging off the political risks of embracing its measures to curb the growth of Medicare and other safety-net programs (Hook, 6/17).
Source: kaiserhealthnews.org

Video: Medicare

AMA head says doctors need higher Medicare payments and lawsuit protection

Carmel praised portions of the law that already have gone into effect, but said the uncertainty surrounding the pending Supreme Court decision has thrust a “cloud of anxiety” over the entire profession.   Regardless of whether the Supreme Court strikes down the law or portions of it, Carmel and others who are voting delegates in deciding which positions the agency will adopt argued that both the Medicare and tort reform issues should be revisited.   Dr. Bruce Malone, an orthopedic surgeon from Austin, Texas and an AMA delegate, agreed after the meeting that the association should sharpen its focus on lobbying Congress for changes to Medicare reimbursements.
Source: chicagotribune.com

Florida Man Accused Of Laundering Millions Of Medicare Money

In a motion filed Monday in U.S. District Court in Miami, prosecutors said Oscar Sanchez, a 46-year-old U.S. citizen and native of Cuba, provided cash to the masterminds behind the alleged fraud in exchange for a fee. They also said Sanchez conspired to send money from the Medicare fraud first to shell companies in Canada before it was passed on through a Trinidad bank and eventually onto Cuba.
Source: cbslocal.com

Medicare pays outpatient providers twice, leading to $6M overpayments

Using Electronic Medical Records (EMR) instead of paper files has the potential to improve care for patients by boosting communication. Despite positive results related to EMR usage, questions remain. How can physician practices best use EMRs to focus business and clinical operations, improve outcomes and engage patients in healthcare decision making? Learn more.
Source: fiercehealthcare.com

MedPAC Recommends Higher Upfront Costs for Medicare Beneficiaries

The article says that 90% of Medicare beneficiaries have “Medigap and other supplemental insurance policies”. This is incorrect because 25% of Medicare beneficiaries are enrolled in Medicare Advantage which are “Medicare replacement plans” and not supplements. Medicare Advantage plans would seem to be the future of Medicare because every plan includes co-pays for each service received. These co-pays certainly make people think twice about expensive tests or things like physical therapy. Advantage plans are required by Medicare to set a cap on out-of-pocket expenses. These caps currently range from $2,000 to $6,700 per year. The only problem I see with Medicare Advantage is that these are “for profit” businesses run by insurance companies. Profits (and administrative costs like marketing) add up to billions of dollars each year – and this is money that should be staying in the Medicare coffers.
Source: californiahealthline.org

USDOJ: Brooklyn Doctor Convicted for Role in Medicare and Private Insurance Fraud Scheme

WASHINGTON – A Brooklyn board-certified colorectal surgeon, who owned and operated a New York medical clinic, was convicted for his role in a fraud scheme that billed Medicare and numerous private insurance companies for surgeries and other complex medical procedures that were never performed, the Department of Justice, FBI and Department of Health and Human Services (HHS) announced today. On Wednesday, June 13, 2012, after a two-week trial in federal court in Brooklyn, a jury found Boris Sachakov, M.D ., 43, guilty of one count of health care fraud and five counts of health care false statements.   The trial evidence showed that from January 2008 to January 2010, Sachakov, who owned and operated a clinic called Colon and Rectal Care of New York P.C ., defrauded Medicare and private insurance companies by billing for surgeries and medical services that he never provided.   According to trial testimony, several private insurance companies began investigating Sachakov after receiving complaints from patients that Sachakov had submitted claims for surgeries, including hemorrhoidectomies, that he never performed.    At trial, 11 of Dr Sachakov’s patients testified that they had not received the surgeries and other medical services for which Sachakov had billed their insurance companies.  The evidence presented at trial showed that the medical records Dr Sachakov created and maintained on these patients, including letters to the patient’s referring doctors, did not support the extensive billings he submitted.  After Dr Sachakov was confronted by two insurance companies about complaints of billings for surgeries that did not happen, the evidence at trial showed that Dr Sachakov sent letters to his patients, asking them to falsely certify in writing that they had received the phony surgeries. The indictment alleged that Sachakov submitted and caused the submission of over $22.6 million in false and fraudulent claims to Medicare and private insurance companies, and received more than $9 million on those claims. At sentencing, scheduled for September 24, 2012, Sachakov faces a maximum penalty of 35 years in prison and an $18 million fine.   The charges were announced by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; Assistant Director-in-Charge Janice K. Fedarcyk of the FBI’s New York field office; and Special Agent-in-Charge Thomas O’Donnell of the HHS Office of Inspector General (HHS-OIG). The case is being prosecuted by Trial Attorney Sarah M. Hall and Assistant Chief William Pericak of the Criminal Division’s Fraud Section.   The case was investigated by the FBI, HHS, the New York State Office of Medicaid Inspector General and the New York State Department of Financial Services, Criminal Investigative Division. The case was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section.   The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. Since their inception in March 2007, strike force operations in nine districts have charged 1,330 defendants who collectively have falsely billed the Medicare program for more than $4 billion.  In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers. To learn more about HEAT, visit: www.stopmedicarefraud.gov . Contact: Department of Justice Main Switchboard – 202-514-2000 Reported by: US Department of Justice
Source: 7thspace.com

Payroll Taxes Cover About a Third of Medicare Costs

But 94% of seniors pay a considerable extra increment above these numbers for their health care. In addition to the Part B premium noted in the article and out of pocket costs primarily for annual physicals, vision and dental services (which are mostly not covered by Medicare), many seniors pay for an employer sponsored retiree healthcare insurance plan, a large group pay extra for a Part C Medicare plan, about 15%-20% buy a private Medicare supplement policy (commonly called Medigap), a small percentage are in the VA system, and about 10%-20% of us have to apply for welfare.
Source: dmarron.com

If You Currently have Medicare insurance And Don’t Have Medicare supplemental insurance You Might Be In Economic Danger

Senior will have a percentage of their healthcare necessities covered under the Medicare insurance program. This is why that 4 out of 5 senior citizens purchase supplemental health coverage. This insurance coverage is designed to pay co-payments, coinsurance, and also deductibles. If a person is vacationing outside of the country and should needs hospital care then the insurance plan will activate. Just like any insurance the Medicare supplemental health insurance premium is paid monthly and it is not part of the Medicare system. The private insurance companies are the service provider for this coverage. An individuals statement will be sent monthly together with any and all treatments that have been covered on the senior citizens behalf.
Source: lifes-a-twitch.com