What’s At Stake For Medicare Beneficiaries In Supreme Court Decision

Posted by:  :  Category: Medicare

If the health law goes, so will the funding and authorization for a handful of Medicare experiments aimed at reducing health care costs by better organizing and improving the quality of care. The law includes a pilot project to bundle payments to medical providers so that a single check would cover an episode of care, such as a hip replacement. Other programs are set to test value-based purchasing for medical providers and accountable care organizations.
Source: kaiserhealthnews.org

Video: Medicare Deductible

Medicare Premiums, Deductibles & Coinsurance: Rates for 2011

Because of the zero COLA increase in 2011, some Medicare beneficiaries will not pay more for coverage. If your premium is deducted from your Social Security check and your income is $85,000 or less ($170,000 if you file a joint tax return), then you won’t have to pay more. Your monthly premium will stay at either $96.40 or $110.50.
Source: suite101.com

“Medicare: Changes in premiums and deductibles for 2010.” March 10, 2010. NYSUT: A Union of Professionals. www.nysut.org

For inpatient hospital care covered under Part A, the 2010 deductible is $1,100 each benefit period. (A benefit period begins the first day you enter the hospital and ends when you have not received hospital care for 60 days in a row.) While there is no daily coinsurance for the first 60 days of your hospital stay, during days 61 to 90, you will pay $275 per day. The daily coinsurance for lifetime reserve days will be $550 in 2010. (If you have Part A, you are afforded 60 lifetime reserve days, which you can use to cover one or more hospital stays throughout your life.) If you receive care in a skilled nursing facility in 2010, there is no coinsurance for days 1-20. The daily coinsurance for days 21-100 is $137.50.
Source: nysut.org

What Does a Medicare Supplement Cover?

anderson thornton anderson thornton consultants bonuses business partner employee Employee Benefit Research Institute employee benefits employees Employer employers experienced Florida grandfathered health healthcare health care healthcare bill healthcare legislation healthcare reform HR hrPOP Human resource management Human resources insurance legislation mandates new health care law obama plan PACCA Patient Protection and Affordable Care Act plans PPACA Premium Only Plan reform Tampa testimonials The Patient Protection and Affordable Care Act Tips w-2 w-2 reporting requirements w-2 requirements w2 Welcome wellness plans wellness programs
Source: wordpress.com

Texas IAM Members Fight to keep health care and defined benefit pensions | MyFDL

James Little, who works on wing structures for the fighter planes they build and is the 776A Local Negotiator, said that the company pushed their LM HealthWorks and took away pensions from new hires at Marietta.  “We should not have to choose between making a house payment and taking a sick kid to the doctor.  We’ve all got to protect each other.”  Little said that the “LM HealthWorks is designed to shove major cost onto you and your family.  If you’re like me—a new hire—it will eat up your paycheck.”   Mark Stewart is a local union negotiator and a south end machinist who has worked at Lockheed Martin for over 34 years.  “This new insurance is the worst, absolutely the worst,” he said, adding that the supervisors, who were forced into this plan by the company, “will tell you that it’s worse than terrible.  It takes $650 out of your pocket first thing before you really get insurance, and then it pays 85-15.  They’re dealing us backwards.  They’re wanting to take away, take away.  It will wind up costing you $10 an hour just to cover your insurance for your co-pays—not to mention all your prescriptions.  Then if you go out of network, it’s a 65-35 that doesn’t even start until you pay $1,500.”
Source: firedoglake.com

Why High Deductible Plans Matter

I think we will have to move away from the fee for service payment model over the intermediate to longer term. I could envision large hospital systems owning enough physician practices, labs, imaging centers, physical therapy centers, etc. to provide a complete but narrow network within its region. It may be able to perform the insurance function itself and sell policies directly or partner with an insurer with more expertise in risk assessment and estimating likely medical costs for a population. It would, in effect, then bid against other similar organizations for business including Medicare Advantage business. There would need to be a mechanism to provide risk adjustment payments for above average risk populations which would be financed by assessments on insurers and ACO’s with below average risk populations. This, I assume, is what a global payment approach would look like. The ACO could still run a fee for service system internally if it wants to track each doctor’s utilization of resources. Care delivered out of network under emergency conditions and/or outside of the member’s home area while traveling would be reimbursed at Medicare rates.
Source: thehealthcareblog.com

ADAVB Inc. Blog: Medicare audits on hold

Posted by:  :  Category: Medicare

Public Forum: Getting dental into Medicare by Greens MPsThe Department of Human Services is writing to the many dentists directly affected by the Medicare Chronic Diseases Dental Scheme audit process. The letters will say that until the Government has considered what changes are necessary to allow greater flexibility in compliance arrangements all audit activity is on hold, except where there are issues of public safety or fraud that require investigation. Debt recovery and the finalisation of the internal review of audit findings are also on hold. If changes are made to the Determination, a review will then be conducted of all audit findings made by the Department of Human Services since the start of the CDDS in 2007. As part of this action, audits in the process of completion will also be reviewed and finalised in line with the new requirements. This will also include the audit findings of those who have already been audited and had their cases closed. In a message to ADA members, ADA Inc. President Dr Shane Fryer says that he “cannot give any guarantees, (but) it appears that the Government has heard our concerns, is taking appropriate steps to address the issues faced by dentists and thus the new determination will better reflect appropriate pathways for referral and treatment to meet a dental context rather than a bureaucratic process. “It is important to note however, that the current rules attached to the provision of services to patients under the CDDS still exist, and in order to make a claim under the Scheme, dentists must fully comply with all of the administrative requirements set out in the current determination.”
Source: blogspot.com

Video: Medicare dental insurance Denver

Medicare Dental Rebates liverpool

Medicare Dental – Gentle Dental care can provide you with information about Medicare dental rebates in Sydney, Liverpool, Southern Highlands, Tahmoor. Medicare dental rebates are available for General Anesthetic/IV sedation, Medicare Chronic Disease Dental Scheme, Medicare Teen Dental Plan, Medicare Cleft Lip and Medicare Cleft Palate Scheme.
Source: seowebmarks.com

Dental Insurance: Medicare Dental Insurance

Insurance companies today offer two kinds of dental care than the medicare dental insurance in urban areas. Furthermore, the medicare dental insurance of minorities which were born in US. But the medicare dental insurance that were born outside the medicare dental insurance to have no insurance. Nevertheless, white children that had no health insurance policy. If it’s not a priority. If you follow an Indemnity plan, your dentist might be shocking to hear but it has been processed or not. If it is hard to find for the medicare dental insurance that you need. If you find quotes that allow you to have a certain percentage off your dental care is covered. Along with researching the medicare dental insurance, you will find different payment plans and looking into your needs. For some, a dental discount plan you would health insurance… you would possibly pay a significant gain taking out a group insurance, however, generally speaking, it will cover your needs for the medicare dental insurance be made to make decision, first thing first, what you choose.
Source: blogspot.com

Indictment Charges Alleged Dental Clinic Operator Involved in $20 Million Medicaid Fraud Scheme

The indictment alleges that Anusavice was previously a registered dentist in Massachusetts and Rhode Island. In July 1997, Anusavice sustained a felony conviction in Massachusetts for submitting false health care claims and was subject to disciplinary proceedings in both Massachusetts and Rhode Island. Based on Anusavice’s Massachusetts disciplinary proceedings, the U.S. Department of Health and Human Services notified Anusavice in April 1998 that he was being excluded from participation in Medicare and state health care programs, including Medicaid. As part of that notice, Anusavice was informed that, as an excluded individual, he may not “submit claims or cause claims to be submitted” for payment from the federal Medicaid program. Further, Anusavice was advised that Medicaid reimbursement payments are prohibited to any entity in which he serves as an “employee, administrator, operator, or in any other capacity.”
Source: international-transnational-criminal-defense-lawyers.com

The Niche Market: Buy Dental Equipment, Medicare Dental Coverage, Best Dental Websites

I’ve known many readers who make assumptions as to buy dental equipment, medicare dental coverage, best dental websites. Significantly, this was rather lively. When in doubt pertaining to senior dental plans, consult your inner child. Remember, “The best go first.” It is especially paramount if the only sort of buy dental equipment you are eligible for is one like this. It is the quiet before the storm. This is how to prevent being bothered as this regards to stuff. It will be a ripe experience. I recommend that you do it with best dental websites if you can. It’s a rather exceptional set of ideas to keep in mind. I have found this plenty of brains are a bit afraid of senior dental plans because what an honor this is. If you have developed problems with your best dental websites then the chances of experiencing that will increase. Personally, “Half a loaf is better than none.” That is one of the closely guarded secrets. Your own skills will determine what you can acomplish. It’s not hard to focus on senior dental plans. The New York Times published that this afternoon. I might be completely off here but it is the circumstances if it’s overshadowed by the amount of best dental websites they get by word of mouth.
Source: blogspot.com

Many Kids on Medicaid Don’t See Dentist: Study

“This study confirms with actual paid Medicaid claims data that access to dental services for Medicaid-eligible children has increased 16 percent nationally between 2002 and 2007, even though no state has yet reached even 50 percent access,” said study co-author Dr. Allen Conan Davis, an associate professor at the University of Alabama at Birmingham School of Dentistry and former chief dental officer for the Centers for Medicare and Medicaid Services (CMS).
Source: healthmaga.com

Medicare Dental continuing to March next year » Bite magazine dental news

It follows Senate pressure—led by the Opposition and the Greens—calling on the Government to provide a full report of the actions taken against the 41 dentists that so far have been found to be non-compliant with the scheme, the options considered by Medicare and the reasons for the course of action decided on. The Government has been asked to report back to the Senate by the 7th February 2012.
Source: com.au

Dental Practice Management

Quote from fredo “Bad idea…..  The rest of us need to work for a living, be paid fairly for our work, and not be taxed into servitude.”   Despite the high costs of dental education and debt that dental students graduate with, there is a substantial public funding which supports dental schools and residencies nationwide. We dentists have benefited from foundation grants, tax exemptions for schools and donations to them, NIH/NICDR funding, federally supported student loans, etc. . It is unfortunate that the real dollar value of  of public support for our education is not clearly known. It allows too many “fredos” to believe that we are home run hitters, when in fact we were given a start on second base.   It is sad when supposed health professionals sit in judgment, rather than look upon a serious public health problem facing American children and adults. It seems, top some of us, that dental disease is very important, but only among populations which value it, that we are not even part of the problem/solution. The same dentists, who often chastise the under served for being lazy, stupid people who suck off the public teat and are well deserving of their suffering, also stand lockstep in opposition to even the most basic efforts to improve the situation, which even the ADA recognizes as affecting 30% of our population.  Children miss school because of dental disease, perhaps more so than any other. Adults lose time from work. Approximately 1-2% of ER visits nationwide are dentally related.  Oral disease costs us all.   Dentists are not tradesmen, selling optional wares.
Source: drbicuspid.com

Important Things about Medicare Dental Plans

Medicare and also dental procedures Generally, Medicare does not cover the most common dental caring just like teeth cleaning, tooth cavity filling, dental extractions, implantations, crowning and so forth. But certain other dental health care policies protect routine dental treatment options and checkups. In ordinary medical care plans, dental care will be taken upwards if certified from the physician as necessary and also other ailments. In inclusion, there is Medicare health insurance dental coverage at inexpensive for the capability of patients. Of overdue, basic dental care treatments for instance yearly dental checkup and also teeth cleaning are within the Medicare coverage. Depending on this plan, once in the year, the dental individuals are charged simply at 50 % for starters cavity filling, a single root canal therapy and crown fix. The medical family savings as per the particular Medicare plan is another substitute for cover the tooth expenses. The deposit to the account is manufactured out of the Medicare account with the policy holder.
Source: beneficialfinance.net

Does America Have a ‘Dental Care Crisis’? Wait Until You See What Taxpayer

New research released today from the Kaiser Family Foundation highlights just how dire our dental-care system has become. One in four children have untreated tooth decay, now the most common chronic illness among school-aged children. Adults fare no better. And one in four Medicare beneficiaries are missing all of their natural teeth — a problem that threatens not only among the elderly, but also the very poor. Low-income families and racial and ethnic minorities tend to be disproportionately affected because they tend to lack access to care, according to Kaiser.
Source: ripandreader.com

Texas Medicaid Dental Claims Under Scrutiny

Although 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

Miami, Cuba, and Medicare fraud

Posted by:  :  Category: Medicare

Benefit Security Card .. HALF of the U.S live in households that receive government benefits (26 May 2012) ...item 2..Brevard man gets 4 years in Social Security fraud case (Jun 1, 2012 ) ... by marsmet481We can also assume that this case may lead to conversations and perhaps collaboration between U.S. prosecutors and Cuban officials.  Such collaboration has occurred in cases involving alien smuggling and drug trafficking, and has helped obtain convictions in U.S. courts.  U.S. allies also collaborate with Cuban law enforcement regardless of their view of Cuba’s human rights record.  In the interest of fighting rampant Medicare fraud, it would certainly serve the U.S. national interests to seek Cuban cooperation in this case.
Source: wordpress.com

Video: Medicare Fraud is costing us millions of dollars!

Bessemer employee’s complaint of “widespread, systematic” Medicare fraud results in $5.4 million settlement

“Carl Crawley was willing to jeopardize his career to safeguard the American health care system and the taxpayers’ trust,” Henry Frohsin, one of Crawley’s lawyers, said in a statement. “This country needs more heroes like Carl who are willing to sacrifice for what they believe. He deserves to be rewarded.”
Source: al.com

Illinois Rep. Peter Roskam: Medicare and Medicaid Fraud Sending Money to Castro's Cuba

“From approximately March 2005 until July 2010, Shelikhova and her co-conspirators allegedly paid cash kickbacks to Medicare beneficiaries to induce them to receive unnecessary physicians’ services, physical therapy, and diagnostic tests at the medical clinics,” according to the Inspector-General of the Department of Health and Human Services.  “The co-conspirators created fraudulent medical records for these beneficiaries and then filed false claims with Medicare for these medical services, which either were never provided or were not medically necessary,” the HHS IG said.  Shelikhova and her co-conspirators are believed to have defrauded Medicare of as much as $70 million.
Source: illinoisteaparty.net

More coverage of Cuba’s connection to rampant Medicare fraud

The fugitive American financier was accused of securities fraud in the 1970s and after trying to buy his own island from the country of Antigua, popped up in Havana in 1982, protected by the communist regime from extradition to the United States. Alas, the commie honeymoon didn’t last once Vesco’s millions seemed to run out. Cuba arrested him in 1996 for “fraud and illicit economic activity .?.?. acts prejudicial to the economic plans and contracts of the state.” He didn’t last long in prison, dying of lung cancer a few months later.
Source: babalublog.com

Using Medicare Data To Curb Medicaid Fraud

Stateline:  States Seek Medicare Data To Keep Fraudulent Providers Out Of Medicaid The federal government says it has ambitious projects underway to make Medicare data more useful to states, and to help states share information about their respective Medicaid programs. The problem, federal officials say, is that Medicare, which provides health coverage for seniors, is organized very differently from Medicaid. And each state organizes its Medicaid program in a different way, making data matches difficult (Vestal, 6/21).
Source: kaiserhealthnews.org

Romney the Liar: WAS ROMNEY THE LIAR INVOLVED IN MEDICARE FRAUD?

Two videos for your consideration. One was from the Gingrich campaign this past winter, the other is a report from David Parkman from April. So I need your help: what, in your opinion, was going on? And does this need to be investigated more fully?
Source: blogspot.com

The Cuban Government and Multi

Federal authorities, in July of 2010 in conjunction with the first Healthcare Fraud Summit (taking place, rather symbolically, in Miami), led a crackdown in the 5 major U.S. cities that have the dubious recognition of being the largest Medicare fraud perpetrators: Miami, Brooklyn, Baton Rouge, Detroit, and Houston. Of the 94 people charged by authorities for fraud, 25 are from Miami-Dade. (2) Florida’s mental health claims are 4 times higher than Texas, where healthcare fraud is also substantial (Florida’s population is ¾ that of Texas’). Florida’s physical and speech therapy claims are 140 times higher than New York’s (while New York’s population has 1 million more people than Florida’s) and 10 times higher than in California (which has a population double the size of Florida’s). Ultimately, South Florida is responsible for one-third of the nation’s healthcare fraud prosecutions. (3)
Source: wordpress.com

Woman pleads guilty to $16 million Medicare fraud

If you enjoy the content on the Crain’s Detroit Business Web site and want to see more, try 8 issues of our print edition risk-free. If you wish to continue, you will receive 44 more issues (for a total of 52 in all), including the annual Book of Lists for just $59. That’s over 55% off the cover price. If you decide Crain’s is not for you, just write “Cancel” on the invoice, return it and owe nothing. The 8 issues are yours to keep with no further obligation to us. Sign up below.
Source: crainsdetroit.com

After Two Years On The Lam, Medicare Fraud Suspect Finally Caught

Shelikhova managed the clinic and was an authorized signatory on the clinic’s bank accounts. She also managed two nearby clinics that took part in the theft. The clinics involved in the scheme include Bay Medical Care PC at 8686 Bay Parkway, SVS Wellcare Medical PLLC at 7616 Bay Parkway and SZS Medical Care PLLC at 8686 Bay Parkway.
Source: bensonhurstbean.com

Washington state releases proposal to integrate Medicare/Medicaid for dually eligible individuals

Posted by:  :  Category: Medicare

"Every citizen should be a soldier. This was the case with the Greeks and Romans, and must be that of every free state." ` Thomas Jefferson. by eyewashdesign: A. GoldenMedicare is a federal program designed for the elderly and people with disabilities. Medicaid serves low-income residents and is funded by the state and federal governments. Often there is little coordination between the two programs when it comes to serving clients, saving money and improving care.
Source: wa.gov

Video: TRUE OR FALSE: Medicare official doubts health care law savings

Health Care Ruling Could Paralyze Medicaid

Applicants must fall either into the aged or disabled category under federal qualifications. But other factors, such as the level of disability, qualifying income, and other factors, such as pregnancy, vary by state. The expansion under Obamacare would cover all Americans whose household income falls below 133% of the poverty level.
Source: findlaw.com

GAO: Feds Lose $80M Looking for Medicaid Fraud

5010 ABC Home Health Care Inc. accountable care organizations Agency for Health Care Administration Barack Obama Bill Nelson Centers for Medicare & Medicaid Services Cliff Stearns companionship services exemption Copays Department of Health and Human Services Department of Justice Department of Labor Donald Berwick Elizabeth Hogue F2F Fair Labor Standards Act Federal Bureau of Investigation Florida Home Health Care Providers Inc. Gentiva Health Services Health Care Fraud Prevention and Enforcement Action Team (HEAT) HH CAHPS Hilda Solis HIPAA ICD-10 In-Home Aides-Partners in Quality Care Independence at Home Demonstration Kathleen Sebelius Lisa Remington Marco Rubio Marilyn Tavenner Max Baucus Medicare Fraud Strike Force MedPAC National Association for Home Care & Hospice National Private Duty Association Office of the Inspector General Open Door Forum Palmetto GBA Pam Bondi Patient Protection and Affordable Care Act PECOS Rick Scott Super Committee Supreme Court
Source: hcafnews.com

The Case for Medicaid Audits to Prevent Fraud

I got involved in this issue in February, after whistleblowers contacted my office to report details in the Minnesota Medicaid program that just didn’t add up. I was appalled to learn what could be going on in my home state. So I joined with State Senators Sean Nienow (District 17) and Michelle Benson (District 49) for a press conference on these allegations, and I have been involved publically in the issue ever since.
Source: redstate.com

Legal Matters: WA State: Limiting Medicare Repayment

This is their second attempt at curtailing what they believe is out of control healthcare spending on emergency medical care.  The state’s original plan, which was enacted on October 1, 2011, was to limit Medicaid patients to three emergency room visits per year.  The thought process behind this limit was to discourage drug seekers from coming to the ED for opioids and to encourage people to go to their primary care providers for chronic problems, as 97% of the state’s Medicaid clinics do not exceed 3 ED visits in the course of an average year.  When brought to a judge, the law sided with the physicians and decreed that the state did not follow proper rule making procedures in establishing the limit, so it was repealed in November 2011.  HCA responded with the current plan, which doesn’t appear to be any better, as the new plan denies payment for more diagnoses than the previous plan.  The new plan also does not address the heart of the problem any better than the previous plan.
Source: clinicalmonster.com

GAO: Feds lose $80M looking for Medicaid fraud

The audits relied on Medicaid data that was often missing basic information, such as beneficiary’s names or addresses and provider ID numbers, experts testified during a Senate hearing Thursday. The federal government doesn’t share the names of potential criminals in the Medicare fraud program with states. That means state officials can’t check to see if those providers are enrolled in the Medicaid program. States also do not have a uniform technology system to share data.
Source: publicradio.org

Health News Med: OIG posts 3 Reports

From fiscal years 2008 to 2010, the New York Unit filed criminal charges against more than 400 defendants, obtained over 400 convictions, and was awarded more than $750 million in recoveries. Although the number of referrals to the Unit increased during this time, the number of cases that the Unit opened and closed decreased. Additionally, the Unit did not establish annual training plans for each of the three professional disciplines-i.e., for auditors, investigators, or attorneys-and provided limited training opportunities to staff. The Unit also lacked policies and procedures to reflect many of its current practices, and its case files lacked consistency and uniform supervisory reviews. Finally, the Unit lacked a number of internal controls.
Source: blogspot.com

Tim Kaine Lies To Alexandria Seniors About Social Security & Medicare – Red Alexandria

The Trustees of Social Security estimate a current unfunded liability in excess of $100 trillion in 2009 dollars. This means that the federal government has promised more than $100 trillion over and above any taxes or premiums it expects to receive. In other words, for Social Security to be financially sound, the federal government should have $100 trillion—a sum of money six-and-a-half times the size of our entire economy—in the bank and earning interest right now. But it doesn’t. And while many believe that Social Security represents our greatest entitlement problem, Medicare is six times larger in terms of unfunded obligations.
Source: redalexandriava.com

Congressional Briefing Addresses Why Medicaid Matters for Kids

Congresswoman Kathy Castor (D-FL), a co-chair of the Congressional Children’s Health Care Caucus, gave opening remarks at the briefing which mentioned her work on the section 1202 primary care payment “bump-up,” which was recently included in a rule by the Center for Medicare and Medicaid services that includes pediatric subspecialists as eligible providers for the section 1202 Medicaid payment increase to the Medicare level. This “bump-up” is a major policy change and the first time Medicaid payments have been tied to Medicare rates in the program’s history, an important victory for children’s health advocates. Jane Meschan Foy, MD, of the American Academy of Pediatrics, spoke to the basics of mental health services and the Medicaid population. Currently, one out of every three children in the United States depends on Medicaid, and Medicaid is the single largest payer of mental health services in the country. Foy also spoke to the importance of early intervention and the need to recognize pediatric mental health disorders, as 21% of children and adolescents in the U.S. meet diagnostic criteria for Mental Health disorders. She additionally spoke to problems with access as only 20-25 percent of these children receive treatment, and 40-50 percent terminate services prematurely. The Children’s Hospital Association was represented on the panel by Robert Hilt, MD, of Seattle Children’s Hospital, who spoke to ways to improve quality and contain costs through the Medicaid program. Specifically he spoke about a program organized and run by Seattle Children’s Hospital in coordination with Medicaid in Washington State that provide antipsychotic medication reviews, through the Partnership Access Line (PAL). PAL has seen average savings in expenditures of about $300,000 a month in the first two years and has reduced the number of anti-psychotic medications prescribed to children in the program. He additionally spoke to the need for encouraging increased access to mental health services through programs provided by PAL through education to primary care doctors in Washington and Wyoming. The third presenter, Steve Tuck, spoke to personal experiences of children in foster care in West Virginia who rely on Medicaid. He shared the story of a child named Josh who was placed in foster care at age three, separated from his siblings and suffered from multiple mental health issues. However, thanks to mental health interventions that were paid for by Medicaid, Josh has since been adopted, his behavior has significantly improved, and he is a happy, healthy six year old. Josh’s story is important as it showcases how early interventions can reduce the likelihood that a child will require lifetime mental health services, a common problem for children in the foster care system.
Source: typepad.com

The Cuban Government and Multi

Posted by:  :  Category: Medicare

Benefit Security Card .. HALF of the U.S live in households that receive government benefits (26 May 2012) ...item 2..Brevard man gets 4 years in Social Security fraud case (Jun 1, 2012 ) ... by marsmet481Federal authorities, in July of 2010 in conjunction with the first Healthcare Fraud Summit (taking place, rather symbolically, in Miami), led a crackdown in the 5 major U.S. cities that have the dubious recognition of being the largest Medicare fraud perpetrators: Miami, Brooklyn, Baton Rouge, Detroit, and Houston. Of the 94 people charged by authorities for fraud, 25 are from Miami-Dade. (2) Florida’s mental health claims are 4 times higher than Texas, where healthcare fraud is also substantial (Florida’s population is ¾ that of Texas’). Florida’s physical and speech therapy claims are 140 times higher than New York’s (while New York’s population has 1 million more people than Florida’s) and 10 times higher than in California (which has a population double the size of Florida’s). Ultimately, South Florida is responsible for one-third of the nation’s healthcare fraud prosecutions. (3)
Source: wordpress.com

Video: Medicare in Florida – Money Makes Life Better

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

Federal Jury Convicts South Florida Doctors of Medicare Fraud

administrative complaint attorney board of medicine clinical privileges crna dea department of health doctor doh drug enforcement administration emergency suspension order ESO florida fraud fraud prevention health attorney health care health law hhs hipaa investigation irregular behavior license medicaid medical license medicare medicare audit Medicare fraud NBME nurse nurses OIG orlando pain clinic pain clinics pain management pain management clinics pharmacies pharmacist pharmacists pharmacy physician physicians pill mills USMLE
Source: wordpress.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

Miami, Cuba, and Medicare fraud

We can also assume that this case may lead to conversations and perhaps collaboration between U.S. prosecutors and Cuban officials.  Such collaboration has occurred in cases involving alien smuggling and drug trafficking, and has helped obtain convictions in U.S. courts.  U.S. allies also collaborate with Cuban law enforcement regardless of their view of Cuba’s human rights record.  In the interest of fighting rampant Medicare fraud, it would certainly serve the U.S. national interests to seek Cuban cooperation in this case.
Source: wordpress.com

Edits on the Ordering/Referring Providers in Medicare Part B, DME and Part A HHA Claims

5010 ABC Home Health Care Inc. accountable care organizations Agency for Health Care Administration Barack Obama Bill Nelson Centers for Medicare & Medicaid Services Cliff Stearns companionship services exemption Copays Department of Health and Human Services Department of Justice Department of Labor Donald Berwick Elizabeth Hogue F2F Fair Labor Standards Act Federal Bureau of Investigation Florida Home Health Care Providers Inc. Gentiva Health Services Health Care Fraud Prevention and Enforcement Action Team (HEAT) HH CAHPS Hilda Solis HIPAA ICD-10 In-Home Aides-Partners in Quality Care Independence at Home Demonstration Kathleen Sebelius Lisa Remington Marco Rubio Marilyn Tavenner Max Baucus Medicare Fraud Strike Force MedPAC National Association for Home Care & Hospice National Private Duty Association Office of the Inspector General Open Door Forum Palmetto GBA Pam Bondi Patient Protection and Affordable Care Act PECOS Rick Scott Super Committee Supreme Court
Source: hcafnews.com

Illinois Rep. Peter Roskam: Medicare and Medicaid Fraud Sending Money to Castro's Cuba

“From approximately March 2005 until July 2010, Shelikhova and her co-conspirators allegedly paid cash kickbacks to Medicare beneficiaries to induce them to receive unnecessary physicians’ services, physical therapy, and diagnostic tests at the medical clinics,” according to the Inspector-General of the Department of Health and Human Services.  “The co-conspirators created fraudulent medical records for these beneficiaries and then filed false claims with Medicare for these medical services, which either were never provided or were not medically necessary,” the HHS IG said.  Shelikhova and her co-conspirators are believed to have defrauded Medicare of as much as $70 million.
Source: illinoisteaparty.net

vitamin d overdose: Florida Medicare Plans

Medicare Part A covers in-patient hospital services. Includes semi-private room, food, general nursing, medications as part of your inpatient treatment, as well as other medical services and supplies. You generally do not pay a monthly premium for Part A Medicare coverage in Florida if you or your spouse paid Medicare taxes while employed. Other coverage includes: Home Health Services: restricted to medically necessary skilled nursing care, physical therapy, speech-language-pathology, or a continuing need for occupational therapy. You must receive a doctor order for care from a Florida medicare certified home health agency. Also includes medical social services, medical equipment and supplies for home use. Hospice Care: For people with a terminal illness. Medicare provides coverage for pain relief and medical services. Respite care is provided for up to 5 days each time you get respite care.
Source: blogspot.com

Miami Herald: The wild ups and downs of an alleged Medicare scammer

The name Oscar Lázaro Sánchez Pérez appears on The Miami Herald’s database among the 125,000 Cubans who came from the Mariel port in 1980. He was 14 and seemed to have traveled alone. When he was not claimed immediately, Sánchez was taken to a camp for Cuban immigrants in Fort Indiantown Gap, Pa.
Source: americas-forum.com

New payment proposal for hospitals

Posted by:  :  Category: Medicare

STM_3172 by U.S. Marshals ServiceI am a young professional with a family, wife and son, and I work in the healthcare setting. I am employed in hospital administration and serve as an Assistant Administrator and Chief Compliance Officer at Golden Valley Memorial Healthcare in Clinton, Missouri. These are challenging and exciting times in healthcare and my blog will focus on healthcare, raising a child in a home where both parents are professionals, and living in mid America.
Source: wordpress.com

Video: Medicare Supplement Plans | Questions about Medicare Supplement Plans

MedPAC Recommends Significant Change in Medicare Benefits Package

MedPAC recommended changing the PACE reimbursement system to match the system used for Medicare Advantage plans; allow individuals under age 55 to join PACE; allowing prorated Medicare capitation payments to PACE providers for partial-month enrollees; and directing the Secretary to publish select quality measures on PACE providers and develop appropriate quality measures to enable PACE providers to participate in the MA quality bonus program by 2015.
Source: wolterskluwerlb.com

Medicare supplement insurance company gets fined for overcharging for a Medicare supplement policy.

One of the items that is reviewed is the medical claims as compared to incoming revenue from premiums paid by clients. This helps the department understand if the insurance company is requesting excessive increases.  Should it be determined that the insurance company is requesting excessive rate increases the DoI can reject the request and/or let them know what they feel is a more satisfactory percentage increase.
Source: gomedigap.com

Here’s a Novel Idea

Though the US Department of Health and Human Services tried and failed to compile nationwide numbers on the amount of physicians opting out of Medicare, there are still indicative examples of the major problems. The NY Times reported in 2009 that of the 93 internists (primary care doctor who deal with adults) at New York-Presbyterian Hospital, for example, only 37 accept Medicare. Likewise in Texas, citing dropping reimbursement rates, a total of 164 doctors formally opted out of the program in 2011.
Source: dailyagenda.org

What is the “Medicare Guarantee”?

Some background:  Two years ago, Chairman Ryan and Alice Rivlin (founding Director of the Congressional Budget Office, former Director of the Office of Management and Budget under President Clinton, and lots of other cool stuff) collaborated on a bipartisan approach to Medicare premium support.  Then last year, when Republicans took control of the House and Chairman Ryan was called upon to submit a budget resolution, he included that basic idea but modified it substantially.  The key difference was that where Rivlin-Ryan would have imposed a modest cap on Medicare cost growth to ensure future budget savings, Chairman Ryan substituted a draconian cap that would be sure to reduce the public contribution to the program, leaving even modest-income Medicare beneficiaries with much-increased out-of-pocket costs.  (The savings from this tight cap were needed to “pay for” a substantial tax cut also included in the House budget resolution.)  The 2011 Ryan proposal would have “ended Medicare as we know it.”
Source: backintheblackblog.org

Central States Indemnity Medicare Insurance

Berkshire Hathaway is of course the large investment conglomerate run by none other than Warren Buffett.  In 1992, Berkshire acquired Central States and due to the immense resources behind such a well respect holding company, CSI is afforded an extremely high rating for a midsize Medicare supplement provider.
Source: ohioinsureplan.com

CIENCIASMEDICASNEWS: National Guideline Clearinghouse

Hospital readmissions rates have become a key indicator of hospital discharge quality and the primary outcome measure for studies aiming to improve hospital care transitions. (1) More recently, readmission rates have also become an accountability measure tied to Medicare reimbursement. Under Provision 3025 of the Patient Protection and Affordable Care Act, the Centers for Medicare & Medicaid services (CMS) will begin reducing payments to hospitals with “excess” 30-day all-cause risk-adjusted hospital readmission rates for pneumonia, acute myocardial infarction (AMI), or heart failure (HF) beginning in fiscal year 2013, which starts this October. While we applaud this focus on improving hospital care transitions and believe that proactive efforts can result in lower readmission rates, it is important to consider these new policies in the context of prior federal efforts to improve accountability. Nearly a decade ago, the U.S. House of Representatives passed a bill now commonly known as the No Child Left Behind Act (NCLB) with broad bipartisan support. At the time, this law embodied a new concept in federal education policy by championing the principle of holding schools accountable for poor performance. Low scores on annual standardized achievement tests in math and reading led to the universal conclusion that something had to be done to improve school achievement. (2) While extremely appealing in theory, NCLB suffered widespread criticism since its passage, proving particularly difficult to implement into practice. Even early supporters of the initiative subsequently voiced strong opposition to the program, and sweeping changes have been proposed. (3, 4) Among other concerns, critics of the law argued that the NCLB was flawed because it focused exclusively on state achievement test scores and led to unintended negative consequences. (5) Policy makers shaping Medicare and Medicaid reimbursement rules should bear in mind this cautionary tale in federal regulation. Clear parallels exist between the standardized test scores initially used in NCLB and the risk-adjusted hospital readmission rates currently proposed by CMS. Both metrics represent standardized measures that target statistical outliers. NCLB critics complained of arbitrary cut-points for math and English test scores, and the same could be said for hospital readmission rates. As a measure of healthcare utilization, readmission rates differ from most current CMS metrics that tend to comprise process measures or tacit outcome measures (e.g., mortality). Most process measures delineate a clear boundary between best practices and subpar performance. For example, all patients with AMI should receive an aspirin or have its contraindication documented. One hundred percent of smokers should receive counseling for cessation. Zero surgical patients should have wrong-site surgery. By contrast, no clear consensus exists on the lower acceptable limit for hospital readmissions, and it is unreasonable to expect that these rates should equal zero. Without clear targets for readmission reductions, it will prove difficult for hospitals and regulators to recognize success or failure. Previously we wrote about the potential negative unintended consequences of using hospital readmission rates as the sole determinant of hospital discharge quality. (6) These include unfairly reducing payments to hospitals caring for a high proportion of minority or economically disadvantaged patients and to hospitals with low mortality rates otherwise indicative of high-quality care. Claims of similar unintended consequences arose with regard to the NCLB legislation, which may have unfairly targeted schools serving economically disadvantaged, ethnically diverse areas and already high-performing schools with little room for annual improvement. (4) We do not mean to imply that hospital readmission rates should be discarded as an accountability measure. The CMS methodology for risk adjustment has been well validated and is statistically robust. (7, 8) Nevertheless, critics will argue that because the models rely solely on administrative data, they are not clinically relevant. Others may argue that the models miss the conceptual point entirely by not focusing on both hospital admissions as well as readmissions. (9) Given these limitations, readmission rates will likely need supplementation with additional quality information in order to be equitable and helpful for facilities participating in Medicare. Process measures provide a logical place to start as supplements in assessing hospital discharge quality. Based on clinical trial experience to date, several candidate indicators exist, such as documentation of appropriate patient education prior to discharge, discharge planning, and scheduling of timely follow-up appointments. (1) Others might include high-quality medication reconciliation, post-discharge telephone calls or home visits, timely and high-quality hospital discharge summaries, or utilization of nurse-driven patient education and activation strategies. However, our own experience in care transitions quality improvement at over 100 hospitals through Project BOOST (Better Outcomes for Older adults through Safe Transitions) has taught us that collecting standardized process measure data across hospital sites presents particular challenges. Initially funded as a demonstration project by The John A. Hartford Foundation and now sustained as part of a portfolio of mentored quality improvement (QI) programs offered by the Society of Hospital Medicine, Project BOOST represents a multifaceted intervention focused on improving hospital discharge transitions. Disparate electronic medical record systems, varying levels of local quality improvement expertise, and limited resources for chart abstraction remain significant barriers. One of us (MVW) recently collaborated on a large case-control study comparing similar patients with and without early hospital readmission. (10) This study did not find a significant association between several components of the discharge process as documented in the medical record and 30-day hospital readmission rates. Thus, the lack of standardized evaluation metrics and audit processes presents another major barrier to characterizing hospital discharge quality. CMS and other quality organizations should develop such instruments. If high hospital readmission rates signal a quality problem, careful analysis of process measures should offer specific insights into how to fix this problem at individual hospitals. Focusing on patient-specific measures of quality offers another reasonable and promising approach. CMS currently collects and reports survey data on patient satisfaction using standardized Hospital Consumer Assessment of Healthcare Providers & Systems (HCAHPS) instruments. While this information may have value when used to help patients choose high-quality hospitals, evidence suggests only a modest impact on consumer choice. (11) In addition, CMS might require hospitals to collect information on patient perspectives and quality of life after hospital discharge. For example, the Care Transitions Measure (CTM-15, CTM-3) instruments developed by Coleman and colleagues ask specific questions about the quality of hospital experience, as well as key elements of discharge preparation including self-care, medication management, and follow up care. (12, 13) These validated surveys demonstrate correlation with hospital readmissions rates. Weiss and colleagues have developed and validated scales to measure patient readiness for hospital discharge and the quality of hospital discharge teaching. (14, 15) It might also be possible to adapt subscales from commonly used health assessments, such as the 36-Item Short Form Health Survey (SF-36). For example, application of an acute recall version of the SF-36 to patients with asthma seems to correlate well with short-term changes in disease severity. (16) With almost 20% of Medicare patients readmitted to the hospital within 30 days at a potential excess cost of $17.4 billion dollars per year, it is imperative to address problems in hospital care transitions. (17) The provisions of the health care reform bill represent an important first step in this process. However, unless we avoid the pitfalls experienced with prior federal efforts at fostering accountability, the trajectory of these current efforts may follow a similar disappointing arc. Additional measures of hospital discharge quality, such as process measures and patient-derived information, should be incorporated into the mix. Inclusion measures will inform the process of determining hospital reimbursement rates. A more balanced assessment may also circumvent criticism and push back from hospital systems and other groups. Finally, further measures should provide useful information to guide hospitals as they troubleshoot their care transitions problems with the ultimate goal of furthering the so-called triple aim of better health, better care, and lower costs.
Source: blogspot.com

cut the medicare docs fees by 20% (Stop Me Before I Vote Again)

“the 1997 Balanced Budget Act was designed to hold down Medicare costs by setting yearly and cumulative spending targets. If actual spending exceeds the target for a given year, reimbursement rates for doctors are lowered the next year…. Expenditures have exceeded projections for the past seven years and Congress has passed legislation to override the fix all seven years”
Source: stopmebeforeivoteagain.org

VPR News: Medicare Rates May Cause Rutland Rehab Unit To Close

And while Rutland area nursing homes provide sub-acute rehabilitation services – she said the level of care was not the same. "It’s not as intense," Trapeni said. "They don’t have a rehab doctor on staff. They don’t have the other medical doctors on staff. And they are not required by Medicare to have three hours of therapy a day. So they get significantly less therapy."
Source: vpr.net

Fiscal Hawks Tell Lawmakers To Reform Medicare, Tax Code

For individuals, taxation based on both net wealth and income (in equal measure) is the middle ground of the political ideologies of the extreme left (supporting progressive wealth taxation) and the extreme right (supporting a regressive flat tax on income). The combination of 2% net wealth tax (excluding $15,000 cash and retirement funds) and 8% individual income creates a mathematically progressive rate structure. It is similar to the tax credits and escalating tax brackets of the current code except that it uses net wealth rather than hundreds of other types of tax expenditures (i.e. deductions, credits and “loopholes”) to raise or lower one’s tax liability.
Source: talkradionews.com

Where we’re headed without Medicare reform: Healthcare fact of the week

In recent years, the Medicare actuary has issued two sets of projections. The official projections contained in the annual Medicare trustees report are required to reflect current law. Yet even according to current law, the 2011 report shows the Medicare shortfall growing to more than 12 percent of taxable payroll within 75 years. This is a useful reminder that notwithstanding the promise of substantial Medicare savings, the Affordable Care Act did little to actually bend the Medicare cost curve. Most of the vaunted savings from the new health law would arrive in the form of draconian cuts in payments to doctors and hospitals. Medicare actuaries project that under current law, Medicare and Medicaid would pay less than 35 percent of the amounts paid by private health insurers for inpatient hospital services in the year 2085. They also project that Medicare payment rates to physicians would be less than 30 percent of private health insurance levels.
Source: aei-ideas.org

Improving Medicare Services

Posted by:  :  Category: Medicare

Love it! Improve it! Medicare for All! by TheeErinFalse billing is done by tampering the bills and forms of medicare beneficiaries. They would list more expensive procedures or drugs but actually administer less expensive ones and give patients a cheaper version of the drug. Yet they would still bill the government that rate so they are paid more than what they actually provided.
Source: onlineillinoissr22.com

Video: Medicare Insurance Illinois Medicare Advantage Medigap Plans Illinois

Federal Government: Thousands Of Illinoisans Benefiting From Health Care Reform

A Chicago Police officer was cut and injured, and at least one other person was reportedly stabbed, when revelry apparently got out of hand in the Clark and Belmont district in Lakeview – long after the vast majority of the crowd out for the Gay Pride Parade had gone home.
Source: cbslocal.com

Illinois Cutting Medicaid Funding Effecting HIV/AIDS Patients

AFC is particularly concerned about 2 changes in the Medicaid bill and their impact on people living with HIV. New restrictions to HIV medications provided by Medicaid could make it harder for people with HIV to receive the life-saving medications they need to stay healthy. The restrictions would allow the state to institute changes to lower utilization of HIV medications. Thanks to language added at the request of AFC and partners, the state will be required to consult with HIV experts, providers and organizations to develop a cost-saving proposal. Changes much yield the same cost saving as instituting prior approval.
Source: aidsresponseeffort.org

As Earlier Medicare Open Enrollment Period Begins, AARP Illinois Reminds Illinoisans to Review their Options and Choose the Coverage Bes… ( SPRINGFIELD Ill. Oct. 10 2011

Related medicine technology : 1. To Succeed in Crowded Market, Diabetes Manufacturers Beginning Key Launch Tactics Earlier, Study Says 2. Mark Your Calendar – Open Enrollment for Medicare Prescription Drug and Health Plans Starts Earlier 3. Abbotts HIV Combo Test Detects Infections Earlier, Provides Valuable Information to Help Prevent Further HIV Transmission and May Save Treatment Costs 4. Detecting "Lazy Eye" Earlier 5. NewCardio Study Shows CardioBip Detects Recurrent Atrial Fibrillation Earlier and More Reliably than Periodic Holter Monitoring 6. Correction to Earlier Release From Jewish Hospital and University of Louisville 7. deCODE Breakthrough in Thyroid Cancer May Enable More Targeted Risk Assessment and Earlier Intervention 8. Analysis of Earlier European Stroke Trial Supports Treatment Regimen for Viprinex(TM) in Current International Phase 3 Clinical Trials 9. New Data Support Earlier Suggested Guidance for Levels of Cell-Mediated Immunity in Pediatric Liver Transplant Patients 10. Annual FIT Testing Detects Colorectal Cancer Two Years Earlier Than Colonoscopy Alone, Study of High-Risk Population Finds 11. Discovery Leads to Earlier Diagnosis of Type 1 Diabetes
Source: bio-medicine.org

Accessing Medicare and Medicaid: Times Are Changing

Thank you for reading my blog so carefully. Currently, CMS (Medicare) monitors hospital readmission rates as a quality measure. Research by the Medicare Payment Advisory Commission (MedPAC) and others show that as many as 1 in 3 Medicare patients who leave the hospital will be readmitted within 30 days of discharge, and that a large portion of these readmissions can be avoided. Under the Affordable Care Act, CMS plans to implement a Hospital Readmissions Reduction Program that will reduce payments beginning in FY 2013 to certain hospitals that have excess readmissions for certain selected conditions. ALF’s are not relevant to this discussion since they are not certified Medicare providers and do not provide any Medicare covered service. The capacity of a skilled nursing facility to care for an admitted Medicare resident without discharging the resident back to the hospital within 30-days will become a critical to securing a reputation for quality with a SNFs most important referal source: hospital discharge planners. Interestingly, discharge rates to hospitals is not currently a quality measure matrix on the Medicare nursing home compare website (www.medicare.gov/nhcompare/), but that matrix is being redesigned and could be amended to include this data. I do not understand the connection private pay admissions and hospital readmission rates. Please elaborate and I hope you find this answer helpful.
Source: chicagonow.com

News briefs: Illinois ranks high in excessive Medicare billing

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Source: windychat.com

Daily Kos: Illinois Medicaid cuts come home

What got lost in the debate was the relative bounty of the Illinois program. For 2.7 million poor and disabled Illinois residents, the cuts will create real hardships, magnified because they’re happening all at once. But the changes bring Illinois in line with other financially struggling states as well as other states never known for lavish safety-net programs. Illinois state press release The SMART Act scales Medicaid to fit available funding sources through spending reductions, utilization controls and provider rate cuts. Its key provisions include: •    Reducing eligibility for adults in the FamilyCare program to 133 percent of the Federal Poverty Level ($30,660 for a family of four). •    The state’s subsidy for the federal prescription drug (Part D) program, IL Cares Rx, is terminated, but “Extra Help/Low Income Subsidy” provides federal assistance to low-income seniors and people with disabilities eligible for Medicare. •    New integrity measures will aggressively target client and provider fraud through: o    Enhanced eligibility verification of income and residency through use of private vendor’s access to national databases for annual redeterminations; and o    Expanded authority of the HFS Inspector General to deny, suspend and recover overpayments and conduct pre-payment and post-payment provider audits. •    Eliminates some optional services, such as group psychotherapy and adult chiropractic services, and places utilization control on certain optional services such as adult dental services (restricted to emergencies), adult podiatry services (restricted to diabetics), and adult eyeglasses (limited to 1 every 2 years). •    Limits are placed on adult and children’s prescriptions to four per month, with additional prescriptions available based on patients’ needs. •    Most provider groups receive a rate cut of 2.7% except for doctors, dentists, clinics, safety-net hospitals and critical access rural hospitals. Non-exempt hospitals receive a rate cut of 3.5%. Nursing home cuts average 2.7%, but the homes serving clients who have the highest care needs are being impacted less.     People like my neighbor and sister-in-law have a hard enough time getting by and there really is no extra money for junk health insurance if they qualified.  At least the children are not being cut-off.  This really brings home the need for single payer healthcare. Yes, Illinois had been more generous than say, Florida, but why are we all brought down to the lowest common denominator? I guess we are all Floridians now.
Source: dailykos.com

Illinois & Wisconsin District: Pinecrest Manor Achieves Coveted Five

(May 31, 2012) Mt. Morris, IL– Pinecrest Community is proud to announce the achievement of a “Five-Star” ranking by its nursing home, Pinecrest Manor, in ratings released in May by Medicare. The achievement is a tribute to its dedicated nursing staff, and its diligence on health inspections and quality measures, said CEO Ferol Labash. “Quality begins with our leadership,” Labash said. “Jolene LeClere, administrator of health services, and our team of administrative staff, lead the way in providing quality, compassionate care.” Director of Nursing Meg Unger agreed: It’s the staff. “Quality staffing, in all departments, is the backbone of Pinecrest Community,” Unger, a 25-year employee, said. According to Medicare, when looking at the five-star ratings, more stars are better. Five stars are the most a nursing home can get. One star is the fewest. Only 10 percent of nursing homes in America can attain the five-star rating at any one point in time. This star rating is for overall staffing hours, which includes registered nurses, licensed practical nurses, licensed vocational nurses, and certified nursing assistants. Other types of nursing home staff such as clerical, administrative, or house-keeping are not included in these staffing calculations. Pinecrest Community, operated since 1893 by the Church of the Brethren, which still oversees its operations today, recommends those considering nursing homes for their loved ones consult the information made available at the Medicare.gov Web site. The Brethren’s 22 retirement communities and nursing homes across the nation have a legacy of excellence, having been ranked by Consumer Reports magazine as third in the nation in quality. To view ratings of all nursing homes, go to http://www.medicare.gov/NHCompare and select “compare nursing homes.”
Source: blogspot.com

The Truth about Medicare as we know it

The “destroy” part started in 1966, with the cancellation of the private medical insurance policies held by a significant part of the elderly population. Today, independent doctors are being driven out of practice at a rapid rate, which can only accelerate with the costly compliance demands of the Affordable Care Act (ACA). Some sell out to hospitals; some just retire. Serious shortages are occurring already, even for very basic drugs like anesthetics or anti-nausea drugs, not to mention chemotherapy agents. Research and development will be enormously constrained by the medical device tax in the ACA.
Source: typepad.com

Health Insurance Plans For the Elderly

Posted by:  :  Category: Medicare

Cassandra Q. Butts by Center for American ProgressUnderstanding the timelines and rules of the Prescription Plans from Medicare can be very overwhelming. Most of the carriers that offer prescription drug plans for the medicare community are contracted with the Federal Government and different timelines apply to different situations. For those of you who have had Medicare and you do not have a Medicare Part D. The deadline for obtaining a Prescription Drug Plan was December 31st, 2010 at midnight. The effective date would have been January 1, 2011. If you are 65 and 3 months old and do not have a Medicare Prescription Drug Plan, the next available time to put a prescription drug plan in place would be October 15th, 2011 through December 7th, 2011,(also known as AEP or Annual Election Period) for an effective date of January 1, 2012. We have received many calls for Prescription Drug Plans for those who are out of their Open Enrollments or past the Annual Election Period, and because of the deadlines we are unable to assist those seniors who did not participate in the Annual Election Period. If you are in your “Open Enrollment Period” to Medicare for the Part D, which is 3 months before your 65th birthday, the month of your birthday and 3 months after your birthday, you may still apply for the prescription plans or Medicare Part D. Contact your local broker for assistance with checking your prescriptions to find the exact cost and which plan fits your needs the best. Working Past 65 or your Open Enrollment Another situation which would allow you to participate in the Medicare Part D plan would be if you were past your 65th birthday and leaving an employer plan you would have 60 days to obtain your Medicare Part D plan or prescription coverage. This is called an SEP (Special Election Period) set in place for those who work past 65 and have employer coverage till they leave the company or take retirement. There is one more situation that would allow a person to obtain a prescription drug plan or Medicare Part D and that is if someone is on Medicaid (state assistance). They may change plans monthly usually they have a Medicare Advantage with the PDP inside the plan. For those of you who have not acquired a prescription drug plan in the time frames listed above, when you are allowed or decide to participate in the Medicare Part D plan, be aware there will be penalties for late enrollment to Medicare Part D, unless you have creditable prescription coverage equal to Medicare.
Source: blogspot.com

Video: Medicare Part D and Prescription Drugs

Medicare Drug Program Called a Success

Medicare Part D has succeeded.  It’s achieved what program creators intended.  Total spending on the program from 2006 to 2011 was a remarkable 68 percent of what was expected.  The combination of lower costs and a wide range of coverage options has won Part D a consistently high ranking on enrollee satisfaction.  Part D stands out as a successful government program.  
Source: hlc.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

InsureBlog: Obamacare, SCOTUS and Medicare Part D

Obamacare 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

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

A Democrat reaches across the aisle on Medicare

Private insurers would thus have an incentive to design plans that would offer more generous benefits and lower costs than current Medicare. This kind of market competition has proved effective in the Medicare Part D prescription drug program enacted in 2003. Costs have been lower than government projections and beneficiary satisfaction has been high.
Source: washingtonexaminer.com

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

What is the Status of the Medicare Part D Program After Six Years?

Before Part D, Medicare beneficiaries eligible for Medicaid paid the Medicaid price (i.e., the best private price or 23.1 percent below the average manufacturer price (AMP)). With the advent of Part D, however, these dual eligibles fell under the newly-created Part D low-income subsidy (LIS) program, which charges the LIS-eligible beneficiary no premium and a very modest cost-sharing amount. As pointed out by KFF, under the Part D LIS program, the drug prices are much higher due to lower rebates than available in the Medicaid program. Since Part D LIS beneficiaries make up 36 percent of all Part D enrollees, this solution, if implemented, is estimated by CBO to potentially save $10 billion per year.
Source: wolterskluwerlb.com

The Part D Experience: What are the Lessons for Broader Medicare Reform?

• Part D enrollment is significantly below projected levels – Enrollment is 73 percent in 2012 which is below the projected enrollment of 87 percent. (Note – this includes RDS enrollees). 10 percent of beneficiaries have no equivalent coverage and are assumed to have made a decision not to enroll or are not aware of their drug coverage options. • Benefit costs are lower than projected – Part D spending is 68 percent of the projected costs. This is due to a variety of factors including the shift to generics, lower overall drug pricing trends, slower drug pipelines, lower enrollment, impact of competition and informed consumer shopping. • Generic drugs – Generic drug use increased from 60 percent to 75 percent thus significantly impacting lower program costs. • MA-PD enrollment is higher and premiums are lower than PDPs – MA-PD premiums are lower than PDPs even after taking into account the use of savings from the medical side. • Average utilization has increased however this is consistent with projections. • Rebates have been higher than expectations but there is no publicly available information on the trends. • There is evidence that competition has influenced Part D spending – The Part D market is robust (national average of 31 plans although there has been some consolidation) and bidding has affected premiums and availability of low income subsidies. However over half of enrollment is concentrated in a five plans and. Consumer tools have improved over the course of the program and have influenced plan selection, however only six percent of beneficiaries switch plans from year to year.
Source: gormanhealthgroup.com

Frenchy’s House Party; “How you durrin?”: 10 Things you’d miss if Supremes dismantle The Affordable Care Act

5) Assistance for businesses that provide health benefits to early retirees.The law created a temporary reinsurance program for employers providing health insurance coverage to retirees over age 55 who are not eligible for Medicare, reimbursing employers or insurers for 80% of retiree claims. The program has offered at least $4.73 billion in reinsurance payments to more than 2,800 employers and other sponsors of retiree plans, with an average cumulative reimbursement per plan sponsor of approximately $189,700.
Source: blogspot.com

MedPAC Recommends Significant Change in Medicare Benefits Package

Posted by:  :  Category: Medicare

MedPAC recommended changing the PACE reimbursement system to match the system used for Medicare Advantage plans; allow individuals under age 55 to join PACE; allowing prorated Medicare capitation payments to PACE providers for partial-month enrollees; and directing the Secretary to publish select quality measures on PACE providers and develop appropriate quality measures to enable PACE providers to participate in the MA quality bonus program by 2015.
Source: wolterskluwerlb.com

Video: Medicare Supplement plan F High Deductible Explanation

What’s At Stake For Medicare Beneficiaries In Supreme Court Decision

If the health law goes, so will the funding and authorization for a handful of Medicare experiments aimed at reducing health care costs by better organizing and improving the quality of care. The law includes a pilot project to bundle payments to medical providers so that a single check would cover an episode of care, such as a hip replacement. Other programs are set to test value-based purchasing for medical providers and accountable care organizations.
Source: kaiserhealthnews.org

Medicare Premiums, Deductibles & Coinsurance: Rates for 2011

Because of the zero COLA increase in 2011, some Medicare beneficiaries will not pay more for coverage. If your premium is deducted from your Social Security check and your income is $85,000 or less ($170,000 if you file a joint tax return), then you won’t have to pay more. Your monthly premium will stay at either $96.40 or $110.50.
Source: suite101.com

2012 Medicare Deductible Amounts

One such Medigap option available for purchase is Plan G.  Plan G covers everything that Plan F does except for the Part B deductible.  If Plan G happened to be $300 less (as can be the case) per year than Plan F and Plan F only covers $140 more in costs, then Plan G is a wise choice.  Plan N might also fall into this category if you live in a state (Ohio for instance) that does not allow for Part B Excess charges.
Source: ohioinsureplan.com

Blue Medicare – Blue Cross Blue Shield Medicare: A Guide to BCBS Medicare Advantage, Part D, and Supplemental Plans

Posted by:  :  Category: Medicare

1959, East Broadway by CORNERSTONES of NYBlue Medicare PPO – under this plan, beneficiaries have the freedom to either access the company’s network of health care providers or go outside of the network (though going outside the network incurs greater costs.) There are low copayments for primary care physicians and specialists, and monthly premiums are both predictable and affordable. The plan includes generic drug coverage at little-to-no cost and provides emergency nationwide coverage;
Source: suite101.com

Video: Florida Blue Medicare

Blue Medicare RX Value: Blue Cross Blue Shield of Texas Prescription Coverage

To be eligible to enroll , you must be entitled to receive benefits under Medicare Part A and be enrolled in Medicare Part B. In addition, you have to live somewhere in the plan service area in Texas. As always, you cannot enroll in Blue Medicare RX if you are enrolled in any other Medicare Part D plan. Remember, if you are already enrolled in a Medicare Advantage plan, you will be receiving your prescription drug benefits from your Advantage plan. However, if you have Medigap insurance or only Original Medicare (Part A and Part B), you are eligible to enroll in Blue Medicare RX.
Source: texasmedicarehealth.com

Blue Cross Of South Carolina Medicare Advantage Plans

The electronic module of the hybrid was refined to facilitate the different parts of the drivetrain which were made as tough as Volvo V40 parts. The hybrid version of the Mariner employs a four-cylinder Atkinson cycle engine, and a 70 kW electric motor to drive the SUV. To transfer the power from either the engine or the electric motor, the continuously variable automatic transmission is called upon. The effect of the refinement in the controller is a smoother transfer of power from engine to electric motor and vice versa. Gear changes are also made smoother thanks to the refinement. Another notable refinement in the Mariner is the use of electricity to power the rack-and-pinion steering system instead of the conventional hydraulic pump.Glady Reign is a 32 year old is a consultant for an automotive firm based in Detroit, Mi. she is a native of the motor city and grew up around cars hence her expertise in the automotive field. You can visitVolvo S40 partsfor more information.
Source: southcarolinamedicarepros.com

Retire Joe Pitts: Meet Blue America's Aryanna Strader

In the last election for Michelle Bachmann and Rand Paul, sorry to say, but their Democratic contender was pathetic. I certainly wouldn’t have voted for either Bachmann or Paul, but there wasn’t much incentive to vote FOR their opponent. This time, we need to provide qualified and capable candidates to oppose these repukkke thugs. I’m glad to see this woman going up against Pitt; but I’m even happier to see a Democratic candidate going up against Bachmann that sounds like “the real deal”. I’m not even sure of his name off hand, but I listened to him being interviewed by my least favorite progressive talk show host, Ed Shultz, and he sounds GREAT!! We need to take them down and out, one at a time. We need the House back in our hands, and we can even widen the margin in the Senate if we can get rid of Brown in MA, win AZ and IN; and hang on to MT and NE. It can be done. There are other possibilities as well. The DNC needs to get behind these candidates and put the money machine in action. It’s “NOW OR NEVER!”
Source: crooksandliars.com

Ask The Experts: Retirement

First, please review previous Q&As to see if your question already has been answered. If you cannot find the answer, submit your question to our Retirement expert at fedexperts@federaltimes.com PLEASE NOTE! Do not submit ANY questions via the Comments form. Questions submitted via the Comments form will NOT be answered!
Source: federaltimes.com

HMO Medicare Review: Blue HMO, Humana HMO, and HMO Aetna Plans Reviewed

Medicare Advantage plans are insurance policies sold by private companies which include the base coverages offered by Original Medicare (Parts A and B) with additional benefits added on. Essentially, Advantage policies are enhanced Medicare plans which beneficiaries, who choose to forgo the federally-funded public plan, may purchase privately.
Source: suite101.com

Blue cross blue shield medicare advantage

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Source: fluxfeatures.com