Rim Country Gazette: $65 million in Rx savings for AZ Medicare

Posted by:  :  Category: Medicare

Racism by elycefelizPeople with Medicare who hit the donut hole in 2010 received a one-time $250 rebate.  In 2011, people with Medicare began receiving a 50 percent discount on covered brand name drugs and 7 percent coverage of generic drugs in the donut hole.  This year, Medicare coverage for generic drugs in the coverage gap has risen to 14 percent.  Coverage for both brand name and generic drugs in the gap will continue to increase over time until 2020, when the coverage gap will no longer exist.  
Source: blogspot.com

Video: Medicare Advantage Plans Arizona- 1.800.643.7544

Arizona Hospice Company To Pay $3.7 Million For Fraudulently Billing Medicare

Hospice Family Care Inc., a hospice company based out of Mesa, Arizona, has agreed to pay $3.7 million to the federal government to settle allegations that it submitted false claims to Medicare.  The company and its former owners, Nancy Smith and Nancy Turner, agreed to settle allegations that it sought payments from Medicare for patients who were ineligible or partially ineligible for hospice care and for billing Medicare for a higher level of care than what was medically necessary for certain patients.
Source: fraudwhistleblowersblog.com

Arizona Medicare Supplement Plans

The medical needs of senior citizens are often continual and increasingly more expensive to keep up with on a regular basis. There are many instances where people are unable to keep up with the risings costs of health care which makes them avoid treatment or simply undergo minor forms of care that are within budget which can cause significant health risks and concerns. Anyone currently enrolled in this program and looking for added assistance should be capable of choosing from Arizona Medicare supplement plans to help offset their expenses.
Source: annuitycampus.com

Daily Kos: Ben Quayle thinks that he’s saving Medicare from the Affordable Care Act by privatizing it

According to Mr. Quayle: 1. When asked why he would support privatizing Medicare when the cost to administer Medicare is currently at 3% and estimated to be 17-20% under the privatized plan, he responded that Medicare’s administrative costs are too low at 3%.  They should be much higher because there is so much fraud and waste in Medicare and the administrators aren’t doing a good job finding it.  (Does this mean he wants to grow government & add regulation?  And what about the Affordable Care Act, Mr. Quayle?  There are specific provisions designed to crack down on fraud, waste, and abuse in Medicare.) 2. The Affordable Care Act is bad for seniors on Medicare.  (What about the free annual physicals and preventative care screenings for seniors?  Closing the doughnut hole?) 3. Social Security and Medicare are contributing to our debt and we must cut them in order to have a solvent society.  (Nevermind that Social Security hasn’t added a dime to our deficit!  But what good are facts?) 4. If you’re 55 or older you shouldn’t care about these changes because they won’t affect you, anyway.  (Um, Mr. Quayle, most folks 55 and older have children and grandchildren they care about very much.  So, YES, they should care about these changes, and YES, they should speak up at town hall.)
Source: dailykos.com

Arizona Pharmacies May Be Next Targets of Medicare Fraud Sweep

The 2,637 suspect pharmacies billed Medicare approximately $5.6 billion in 2009. Many pharmacies were flagged because they billed extremely high dollar amounts or numbers of prescriptions per beneficiary or per prescriber. This could mean that a pharmacy is billing for drugs that are not medically necessary or were never provided to the beneficiary, according to the Department of Health and Human Services. Other pharmacies roused suspicion because they dispensed high numbers of pain medications.
Source: arizonawhitecollarcrimeattorney.com

NQF Endorses Readmissions Measures

Posted by:  :  Category: Medicare

THE PEOPLES LEADER by SS&SSH. Stephen Lieber, CAE, HIMSS President and CEO, stated that, “HIMSS, like the rest of the country, is relieved that questions about the healthcare reform law have now been settled and the nation can move forward with the essential work of transforming healthcare in America. Health information technology is critical to the ongoing transformation in our nation.” As the Chicago-based HIMSS has emphasized in the past, while there are many potential implications for health IT in the ACA, the Medicare and Medicaid Electronic Health Records Incentive Program was never in jeopardy regardless of the outcome of this case; that program was authorized by the HITECH Act, which was part of the American Recovery and Reinvestment Act (ARRA) of 2009, and not ACA, which was separate legislation passed in 2010.
Source: healthcare-informatics.com

Video: Roskam Bill Saves Medicare Tens of Billions

“The Basics” Chiropractic Medicare: MAY Newsletters 2012

Medicare carriers in each state are implementing visit restrictions for chiropractic care. The Federal Law indicates there are NO limits in Medicare for the chiropractic adjustment as long as it is Medically necessary. Since very few chiropractors know the correct way to “Document the Chiropractic Necessity of Care”, we are now facing those limits by default. Nobody is challenging the Medicare carriers and they are getting away with unlawful limits.
Source: blogspot.com

Home Health Software Provider Announces Part Two of “Survivor’s Guide to Medical Appeals” Webinar Series

Presenter Michael McGowan brings an insider’s knowledge of the medical review process to the webinar series. As a former OASIS coordinator for the state of California, McGowan’s expertise led him to launch Medicare Appeals Development, an organization that specializes in guiding home health care agencies through regulatory labyrinths and helping them maximize reimbursements. In Part two of the “Survivor’s Guide” series, McGowan takes a highly detailed approach to compliance, covering topics that include problematic data patterns and the impact CASPER reports can have on home health agencies.
Source: careanyware.com

Health Informatrix: Medicare EHR Incentive Programs Appeals Deadline Has Been Extended

CMS affords providers with a two-level appeal process: an informal review and a request for reconsideration. Within the two-level appeal process, there are three types of appeals that can be filed in the Medicare EHR Incentive Program: (1) eligibility, (2) meaningful use, and (3) incentive payment appeals. 
Source: healthinformatrix.com

Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline, CPT Code Billing: Time limit for Medicare appeals

Carrier appeals process for redeterminations and Over payment appeal address The Medicare Part B appeals process for redeterminations (first appeal level) changed for services processed on or after January 1, 2006. If you disagree with the initial claim determination, regardless of the amount in controversy, you must first request a redetermination with the carrier. All documentation should be submitted with your request for a redetermination. For redeterminations, the second level of appeal is now called a reconsideration (formerly a Hearing). Requests must be made within 180 days from the date of the redetermination. Reconsiderations (second appeal level) are performed by CMS-contracted entities called Qualified Independent Contractors (QICs) instead of the carrier or a contracted Hearing Officer. The QIC for Florida is Q2 Administrators; their address and reconsideration request form can be found in the Part B Forms section. The amounts in controversy for Administrative Law Judge (ALJ, third appeal level) and Federal Court Review (fifth appeal level) typically change each year on January 1. Refer to the chart below for the current threshold amounts. There are still five levels of appeal, and providers still must progress through the appeals process one step at a time and within the applicable time frames and monetary thresholds. It is important to follow instructions received with your redetermination decision letter. All information on where to request the next level of appeal will be provided to you within that letter. The five levels of appeal are as follows: 1st Level – Redetermination Time limit to file request: 120 days from date of receipt of the initial determination notice Monetary threshold: None Request is sent directly to the carrier 2nd Level – Reconsideration Time limit to file request: 180 days from date of receipt of the redetermination Monetary threshold: None Request is sent directly to the QIC 3rd Level – Administrative Law Judge (ALJ) Hearing Time limit to file request: 60 days from the date of receipt of the reconsideration Monetary threshold: At least $130.00 remains in controversy (requests filed on or after January 1, 2010). 4th Level – Departmental Appeals Board (DAB) Review Time limit to file request: 60 days from the date of receipt of the ALJ hearing decision Monetary threshold: None 5th Level – Federal Court Review Time limit to file request: 60 days from date of receipt of DAB decision or declination of review by DAB Monetary threshold: At least $1,350.00 remains in controversy for requests filed on or after January 1, 2012; $1,300.00 for requests filed prior to January 1, 2012. Overpayment appeals address The address for overpayment appeals is as follows: First Coast Service Options Inc. Overpayment Redetermination (Review Request) P.O Box 45248 Jacksonville, FL 32232-5248 Note: It is very important that overpayment appeals are sent to the correct address to ensure proper handling.
Source: medicarepaymentandreimbursement.com

Medicare Rights Center sides with court’s decision

Posted by:  :  Category: Medicare

TWO YEARS OF RUIN by SS&SSThe Supreme Court’s decision means that seniors and people with disabilities will be able to look forward to the law’s future benefits, including closure of the Medicare Part D doughnut hole by 2020; a new requirement that Medicare Advantage plans use at least 85 percent of revenues on beneficiaries’ medical services rather than overhead and salaries; and increased solvency of the Medicare Hospital Trust Fund for an additional 8 years, until 2024.
Source: benefitspro.com

Video: Medicare Local – Medicare Marketing and Leads

Three Ways to Improve Lead Generation Direct Mail in a Shorter Annual Election Period

Best practices:If there’s no time or budget for testing, go back to previous successful campaigns and see what worked. Use the knowledge gained from previous campaigns, even if they weren’t specifically designed to test in a controlled manner. The historic performance, adjusted for any changes to benefit structure, current events, industry regulations or CMS changes, can be a decent baseline for projections and improvements.Note: If you’re just beginning a lead generation test, or if you’ve never measured the performance of a direct mail piece, any new or updated packages should be tested against previous direct mail packages—and tracked individually, consistently and accurately.
Source: finelight.com

Aetna Announces Lifetime Renewals on Medicare Advantage and PDP Policies

Actually, I have had many stay on for over 7 years. But, I also think that there are variables involved like 1) the stability of your market – my markets Los Angeles Cty and San Antonio, Tex have both been high capitation markets, making them stable with their benefits and not leaving the service area high and dry. 2) the stability of the companies that you place your business with- I put a lot of my SoCal ppl with Caremore (which has always given away the store with benefits) and SCAN, which had held unique status for many years as a "social HMO". The Secure Horizons mbs from the 2004-2005 enrollment period have long since scattered. I’m down to about 4 of those. In my current market (San Antonio), there are ONLY 4 players. Secure Horizons is very dominant because it gets a ton of support from its powerful medical groups. They have excellent retention because the medical groups help so much. Most of my SH business would still be on SH if I hadn’t switched them years ago. Humana is constantly cutting down the docs’ capitations and making the referral process tougher. As a result, it’s getting harder to retain those members as doctors drop Humana left and right. Aetna is really investing $$ and effort in the Texas markets. I like them a lot at this point. They recently added Hermann Memorial in Houston- a big coup. 3) the importance of serving your customer base (goes without saying) If a company only pays for 6 years, it would be much harder to ask a client to switch simply because they will have been on a plan for too long and will not change because they don’t like to switch plans. It’s a trait that all ppl have, but espec the elderly. Then again, anything could happen with Medicare Advantage. But I’d rather sell for one that offers lifetime renewals than 6 years "just in case".
Source: insurance-forums.net

PA Man Charged in $5.4 Million Ambulance Fraud Scheme

Posted by:  :  Category: Medicare

The indictment alleges that between 2006 and April 2011, Hlushmanuk and others devised a scheme to defraud Medicare of more than $5.4 million dollars. According to the indictment, Hlushmanuk used a straw owner to fraudulently open Starcare Ambulance because he was otherwise ineligible to own the company. Starcare primarily transported dialysis patients and fraudulently billed Medicare for patient transport for patients who could walk and whose transportation by Medicare was not medically required. The scheme involved transports in vans and fraudulent representations to Medicare’s administrative contractor, Highmark Medicare Services, to induce them to pay for these services. The indictment seeks forfeiture of $5,443, 315, as well as a 2006 Hummer.
Source: coudynews.com

Video: Pittsburgh Celebrates Medicare’s Anniversary

Novitas Solutions, formerly called Highmark Medicare Services, announces hundreds of health care jobs coming to Harrisburg, Pittsburgh areas

Claims processing requires a lot of training. It is a production-oriented job that requires computer knowledge and technical skills. Entry-level wages are typically low. Employees will be expected to maintain proficiency, accuracy and performance standards or they will risk losing their job…..for the liberals out there, this means that the newly hired employees will be expected to work for their pay.
Source: pennlive.com

Highmark Medicare Services Awarded New Contract from Centers for Medicare & Medicai… ( New Deal Means an Additional 480 posi…)

Related medicine news : 1. Highmark Blue Cross Blue Shield Provides Online Physician Quality Information to Members 2. Highmark Blue Shield to Open Highmark Direct, a Health Insurance Retail Store 3. Highmark Blue Cross Blue Shield to Open Highmark Direct, a Health Insurance Retail Store 4. Highmark Inc. Teams with Operation Warm to Provide New Winter Coats for Children in Need 5. Dont Know How Much an X-Ray Costs You? Highmark Network Providers Will Begin Having Conversations With Highmark Members About Their Actual Cost of Care 6. Highmark Employee Volunteers Receive $9,500 in Grants for Nonprofit Organizations 7. Highmark Healthy High 5 School Challenge Grant Program Enables Pennsylvania Schools to Implement or Enhance Healthy Lifestyle Programs for Students 8. Highmark Foundation Extends Subsidy for Health eTools for Schools(R) through 2013 9. Zix Corporation to Participate in $29 Million Highmark e-Prescribing/eHealth Initiative 10. Highmarks SMART(TM) Registry Reports Aid the Chronically Ill 11. Highmark Blue Cross Blue Shield, United Concordia and Catholic Charities Join Forces to Offer Free Health, Dental Services This Saturday
Source: bio-medicine.org

New Medicare Administrative Carrier for Jurisdiction 12 Highmark Medicare Services Acquired by Diversified Service Options Inc

Diversified Service Options (DSO) acquired Highmark Medicare Services (Highmark) on January 1, 2012. DSO is a holding company and a wholly-owned subsidiary of Blue Cross and Blue Shield of Florida, Inc. (BCBS Florida). Highmark had the contract with the Centers for Medicare & Medicaid Services (CMS) to be the Medicare Administrative Contractor (MAC), formerly known as a “Carrier” or “Fiscal Intermediary,” for Jurisdiction 12, which includes Delaware, New Jersey, Pennsylvania, Maryland and Washington, D.C. For Part B services, Jurisdiction 12 also includes the counties of Arlington and Fairfax in Virginia and the city of Alexandria in Virginia.
Source: thehealthlawfirm.com

Highmark Medicare Services Changes Name to Novitas Solutions, Inc.

Please read the following bulletin from Highmark Medicare Services. The affected payers are: CPID 2456 Delaware Medicare CPID 5912 Delaware Medicare CPID 3677 J12 Mutual of Omaha DC,DE,MD,NY,PA CPID 7402 Maryland Medicare CPID 5554 Maryland Medicare CPID 2464 Maryland Medicare (MONTG,PRINCE GEORGE) CPID 1465 New Jersey Medicare CPID 5503 New Jersey Medicare CPID 5598 Pennsylvania Medicare CPID 2457 Pennsylvania Medicare CPID 2461 Virginia Medicare (ALEX,ARLGTN,FAIRFAX) CPID 1522 Washington DC Medicare CPID 2459 Washington DC Medicare Reported by Highmark Medicare Services: As announced March 1, 2012, Highmark Medicare Services is changing its name to Novitas Solutions. Effective March 10, 2012, Highmark Medicare will begin migrating the current Highmark Medicare website to our new Novitas Solutions website. We are targeting completing our name change to all active webpage content by March 30, 2012. The new Novitas Solutions website URL will be https://www.novitas-solutions.com. Additional details, including Frequently Asked Questions, are available at https://www.novitas-solutions.com/partb/info-alerts.html. Re-enrollment is Not required. The clearinghouse will continue processing as normal. If you have any questions, please contact Client Services at 1-888-348-8457, option 2.
Source: collaboratemd.com

What happened to Highmark Medicare Services?

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

Novitas Solutions will bring 250 full

But there were no guarantees regarding the location of new jobs resulting from future contracts. At the time of the sale, Highmark Medicare Service employees were devoted mostly to processing Medicare claims for a region that includes Pennsylvania and several nearby states. That contract is ongoing.
Source: pennlive.com

More Healthcare Choices With Highmark Medicare

Few folks have comfortable money to cover anesthesia expenditures when they get sick. In order to make top quality health care readily available to the majority, health insurance enjoy Medicare is invented by the government as an promise which those are protected from the fees incurred once availing one. The process of wellbeing protection follows a financial fee construct often in the kind of monthly quality deductions by the protection provider to the salary of an customized. The financial savings which build-up at the time of time from these premiums are utilized for paying health care. Normally, a wellness protection has provisions to adhere to earlier than an insured customized may be eligible for cover. In Medicare for instance, individuals aged 65 or older, completely disabled, or those using kidney failure, are entitled to use it so that their medical prices are much more affordable.
Source: turtlenecksweaterssweaters.com

More Healthcare Options With Highmark Medicare

Few people possess ample cash to include anesthesia expenses when these folks get sick. In order to make quality medical care readily available to the majority, well being insurance coverage prefer Medicare is invented by the the federal government as an assurance which individuals are guarded from the prices incurred once availing one. The approach of health insurance follows a financial fee structure usually in the kind of monthly top quality deductions by the insurance websites to the salary of an individual. The savings which build-up at the time of time from these premiums are used for spending medical care. Typically, a wellness insurance coverage has provisions to adhere to prior to an insurance policyholder personalized may be qualified for coverage. In Medicare for instance, folks aged 65 or older, permanently disabled, or individuals using kidney failure, are entitled to use it so which their anesthesia costs are much more affordable.
Source: naturaldisasters.co

Magnolia Manor of Columbus Nursing Center

Posted by:  :  Category: Medicare

Save Medicare --Jim Parker by faulMagnolia Manor of Columbus Nursing Center – West is a large, not for profit, nursing home with 166 beds based in Columbus, GA. At last check, the facility had 133 residents indicating that it is 80% occupied which is about average within the state of Georgia. The provider accepts both medicare and medicaid programs, and provides resident counseling services. This nursing home and assisted living facility, is not located in a hospital or a continuing care retirement community (CCRC). As of July 2011, the medicare rating for Magnolia Manor Of Columbus Nursing Center West, was 1 star, which is a lower rating than 76% of nursing homes in Georgia. We have compared the detailed Medicare data for Magnolia Manor Of Columbus Nursing Center West with other senior care providers in Georgia. When compare to the state averages for staffing, the number of registered nurse (RN) hours per resident per day is about average; Certified nursing assistant (CNA) hours per resident per day is about average; The number of licensed practical (LPN) or vocational nurse hours per resident per day is about average. The most recent health inspection was on 08/26/2010. To view the full report for this facility, and to understand more about its Medicare rating, go to here
Source: ourparents.com

Video: Georgia Health Insurance Medicare

Morningside of Columbus Assisted Living

Morningside of Columbus is an assisted living facility. Assisted living facilities are an apartment-style habitat designed to focus on providing assistance with daily living activities. They provide a higher level of service for the elderly which can include preparing meals, housekeeping, medication assistance, laundry, and also do regular check-in’s on the residents. Basically, they are designed to bridge the gap between independent living and nursing home facilities. When thinking about how to pay for care, assisted living facilities are generally less expensive than nursing homes, if assisted living is a viable option for your loved one.
Source: ourparents.com

Elder Care in Buckhead, GA

You may be eligible for benefits through Medicaid. Medicaid programs vary by state, so you will need to check with your state Medicaid office for more information. • Eligibility: People with disabilities are eligible in every state. In some states, people with disabilities qualify automatically if they get Supplemental Security Income (SSI) benefits. In other states you may qualify depending on your income and resources (financial assets). • “Buy-Ins”: Some states also have “buy-in” programs that allow people with disabilities with incomes above regular Medicaid limits to enroll in the Medicaid program. Children with disabilities can qualify for Medicaid either under these disability-related rules, or based on family income. • Expansion in 2014. Starting in 2014, the Affordable Care Act will expand the Medicaid program to cover people under age 65, including people with disabilities, with income of about $15,000 for a single individual (higher incomes for couples and families with children). • Help for disabled people: This expansion helps low-income adults who have disabilities but don’t meet the disability requirements of the SSI program. The expansion also helps those whose income is above their state’s current eligibility levels.
Source: atlantahomecaretoday.com

RMS Helps Greystone Healthcare Management Increase Medicare Patient Days By 11.5 Percent

Patient Placement Systems (PPS) announced today that Greystone Healthcare Management has realized increases in Medicare patient days by 11.5 percent, gains facilitated by the use of the Web-based PPS Referral Management System at its 27 skilled nursing facilities.
Source: freereleasepress.com

Obamacare Gets a Thumbs Up: What Does It Mean?

That was a quote from Nathan Deal. Apparently he’s not the only one who is aware of the cost to Georgia – "The law’s massive unfunded mandate will force Georgia alone to add 650,000 to 700,000 new Medicaid enrollees, an increase of 35 percent and that will cost taxpayers an estimated additional $4.83 billion over the next 10 years. – Sam Olens, Georgia Attorney General While I do want medical care available for everyone, I do not want the Federal Government to have the authority to DEMAND that every citizen PURCHASE something. I’m also concerned about how – and who – will determine those of us who can "afford our own healthcare". Those who can’t afford healthcare will "be given healthcare through the Government". The Liberal side of our Government is pushing toward a single payer healthcare system and therefore could determine that NONE of us can afford our own…
Source: patch.com

Medicaid News: Ga. Working On Reshaping Program

Stateline: Medicaid Fraud Busters Learn From Experience Nationwide, the federal government estimates it lost $22 billion of its share of Medicaid funding last year to what it calls “improper payments,” according to its payment accuracy survey. This suggests that the loss to state treasuries was also in the tens of billions. How do flagrant violations of Medicaid procedure go unnoticed by federal and state regulators for so long?  The answers are not simple. … As fraudsters’ schemes grow bigger and more elaborate, state Medicaid agencies are forced to create equally elaborate schemes to thwart them. But the more paperwork and audits they require from doctors, dentists, pharmacists and other health care providers who serve the needy, the more Medicaid officials worry they will have trouble attracting enough providers willing to accept Medicaid’s low fees (Vestal, 6/4).
Source: kaiserhealthnews.org

CMS Releases Updated Information about PECOS

Posted by:  :  Category: Medicare

2012 Election Accreditation ACO Affordable Care Act Billing Careers in Home Care care transitions CMS dual eligibles Education Emergency Prep EOEA Face-to-Face Falls Prevention Family Caregiving federal budget Federal Regulations Home Care & Hospice Alliance of Maine Home Care Association of New Hampshire Home Care Careers Home Health Compare hospice House of Representatives innovation Managed Care Massachusetts MassHealth Mass Regulations Medicaid Medicare New England Careers New England Home Care Conference & Trade Show nurse delegation nursing patient choice Patient Satisfaction PECOS PPS Redistricting Rhode Island Partnership for Home Care State Budget telehealth U.S. Congress Vermont Assembly of Home Health Agencies VNA
Source: wordpress.com

Video: Audio Educator: Medicare Enrollment PECOS And the CMS 855

Medicare This Week: June 8th, 2012, 4010 Ends July 1st, ePrescribing Hardship Exemptions, Improvements to PECOS

Effective July 1, 2012 only ASC X12 Version 5010 (Version 5010) or NCPDP Telecom D.0 (NCPDP D.0) formats will be accepted by Medicare Fee-For-Service (FFS). Providers that are still conducting one or more of the Version 4010 transactions electronically, such as submitting a claim or checking claim status, or rely on a software vendor, billing service or clearinghouse to do this on their behalf, are affected by this change. Now is the time to contact your software vendor, billing service or clearinghouse, when applicable, if you have not done so already to ensure you are ready. Transactions conducted by Medicare Administrative Contractor (MAC), fiscal intermediary (FI) or carrier telephone interactive voice response (IVR) systems, Direct Data Entry (DDE) and Internet Portals, for those contractors with Internet Portals, are not impacted.
Source: managemypractice.com

Are you wondering when PECOS will be activated?

As you have heard and read, the original date for the next phase of the Medicare Provider Enrollemnt, Chain, and Ownership System (PECOS) was published in the Federal Register as being June 26th, right around the corner. However, the Centers for Medicare and Medicaid Services (CMS) has yet to confirm an activation date.
Source: glmi.com

Important “PECOS” Update…

In 2010, Congress required the use of national provider identifiers for ordering and referring physicians on claims for medical equipment or services from laboratories, imaging providers and suppliers. CMS later issued an interim regulation requiring all physicians who order supplies or refer services, including those from specialists, to be enrolled in PECOS by July 2010, but CMS delayed enforcement of that rule as the agency worked to validate and update enrollment records. Enforcement would have meant that claims for items or services would be rejected unless the ordering or referring physician also was in the enrollment system, not just the physician who provided the care.
Source: vgm.com

CMS Responds to Inquiry on HHA PECOS Status

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 ContinuLink Copays Department of Health and Human Services Department of Justice Department of Labor 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

CMS Posts Medicare Learning Network Enrollment Fact Sheet to Help Educate Ordering Physicians

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 ContinuLink Copays Department of Health and Human Services Department of Justice Department of Labor 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

Save Time – Submit Your Medicare Enrollment Application through Internet

Any Organizational Provider applications that are submitted via internet-based PECOS will require the user completing the application to provide an email address for the authorized official/delegated official (AO/DO) of the application as part of the submission process. The AO/DO can then follow the instructions in the email and electronically sign the application. This applies to Institutional Providers; Clinics, Group Practices, and Certain Other Suppliers; and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers.
Source: wordpress.com


This fact sheet is designed to provide education on how physicians and non-physician practitioners should enroll in the Medicare Program and maintain their enrollment information using Internet-based PECOS. It includes information on how to complete an enrollment application using Internet-based PECOS and a list of frequently asked questions and resources.
Source: codingahead.com

Medical Billing and Coding blog by Medical Reimbursement, Inc.: Basics of Internet

Do you know how to use Internet-based PECOS to enroll in the Medicare Program?  A fact sheet produced by the Centers for Medicare and Medicaid Services (CMS) provides this information for physicians and non-physician practitioners The fact sheet highlights the following:
Source: blogspot.com

Texas company bilked Medicare out of millions: Attorney

Posted by:  :  Category: Medicare

Kinky For Governor by Big Grey MareThe owner and three employees of RGV DME, a onetime medical supplier near the U.S.-Mexican border in Pharr, Texas, each face allegations of 22 counts of health care and wire fraud, conspiracy and aggravated identity theft, according to a federal indictment unsealed on Thursday.
Source: cuistanbul.com

Video: Medicare Supplements in Texas: What to Look For When Choosing a Plan

Study on Tort Reform in Texas

American Statesman reported on a new study that proves tort reform does not lower premiums for doctors or reduce health care costs.   The study found no evidence that health care costs in Texas dipped after a 2003 constitutional amendment limited payouts in medical malpractice lawsuits.  Proponents guaranteed that health care costs and insurance costs for doctors would go down dramatically.  However, the only thing that decreased was the quality of care at nursing homes.
Source: medicaidnursinghome.ca

Cigna Acquires Medicare Advantage Plans From Humana Covering 3,500 in Texas

The federal government required Humana to sell the Medicare Advantage plans as part of approval for buying Arcadian Management Services. Cigna will offer the new customers Medicare Advantage plans through its subsidiary HealthSpring, which the Bloomfield-based health insurer acquired in January for $3.8 billion.
Source: courant.com

USDOJ: Second Owner of Houston

The former co-owner of a Houston-area home health care company was sentenced in Houston to 108 months in prison for his participation in a $5.2 million Medicare fraud scheme, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).   Princewill Njoku, a former co-owner and administrator at Family Healthcare Group, was sentenced yesterday by United States District Judge Nancy Atlas in the Southern District of Texas to 108 months in prison, followed by three years of supervised release.   Njoku was ordered to pay $5.1 million in restitution jointly and severally with his co-defendants.   In January 2011, Njoku pleaded guilty to one count of conspiracy to commit health care fraud, one count of conspiracy to pay illegal kickbacks to patient recruiters and sixteen counts of paying such illegal kickbacks.   According to court documents and other evidence presented to the court, Family Healthcare Group, a Houston home health care company, purported to provide skilled nursing to Medicare beneficiaries.  According to the evidence, Princewill Njoku paid co-conspirators to recruit Medicare beneficiaries for the purpose of Family Healthcare Group filing claims with Medicare for skilled nursing that was medically unnecessary or not provided.  Njoku and his co-conspirators then falsified documents to support the fraudulent payments from Medicare. Njoku is the ninth defendant sentenced in connection with this scheme, including Njoku’s co-owner, Clifford Ubani, who also received a 108 month sentence earlier this month.   One remaining defendant awaits sentencing. The sentence was announced by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; United States Attorney Kenneth Magidson of the Southern District of Texas; Special Agent-In-Charge Stephen L. Morris of the FBI’s Houston Field Office; Special Agent-in-Charge Mike Fields of the Dallas Regional Office of HHS’s Office of the Inspector General (HHS-OIG) and the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU). This case is being prosecuted by Trial Attorney Charles D. Reed and Deputy Chief Sam S. Sheldon of the Criminal Division’s Fraud Section. The case was investigated by the FBI, HHS-OIG, Texas OAG-MFCU and the Federal Railroad Retirement Board-OIG, and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the United States Attorney’s Office for the Southern District of Texas. Since their inception in March 2007, Medicare Fraud Strike Force operations in nine locations have charged more than 1,330 defendants who collectively have falsely billed the Medicare program for more than $4.4 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 the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov . Contact: Department of Justice Main Switchboard – 202-514-2000 Reported by: US Department of Justice
Source: 7thspace.com

Medicare Freedom Horses and Texas

Today Texas remains one of the more independent States of our nation.  There are often rumors of Texas citizens wanting to succeed from the union.  Even Texas seniors on Medicare lean towards independence.  Medicare leave senors venerable to some serious financial burdens.  One of the biggest drivers for poverty in old age are medical costs.  This is precisely why Texas Medicare supplemental insurance is so popular. Many Texas senors purchase a Texas Medigap plan when they first turn 65.  By law this is when insurance companies have to sell Medicare supplements regardless of most preexisting medical conditions.  The rates are very affordable and Texas Medicare supplement Plan F covers all the gaps in Medicare, there are no co-pays or deductibles, and once you have a Texas Medigap plan it is guaranteed renewable.
Source: clairiere-epona.org

Texas firm to pay millions in Medicare fraud case

“Orthofix is very pleased that it has reached formal agreements to resolve all issues associated with the government’s investigation of sales of its bone growth stimulator devices. The company has been in a lengthy period of full cooperation with the federal government and now can move forward in pursuit of its mission to serve patients,” Brien T. O’Connor, a Boston attorney for Orthofix said Thursday in a statement.
Source: columbiamissourian.com

Kan. firm to pay $6.1 million Medicare settlement

WICHITA, Kan. (AP) – The U.S. Justice Department says a Kansas hospice care provider and its Texas-based parent company have agreed to pay $6.1 million to settle allegations they submitted false claims to the Medicare program.
Source: kltv.com

Texas company bilked Medicare out of millions: Attorney

MCALLEN, Texas (Reuters) – Federal agents on Thursday arrested four employees of a now-defunct Texas medical equipment supplier who are accused of bilking Medicare and Medicaid out of millions of dollars via fake claims, including some made on behalf of dead people, according to court documents. The owner and three employees of RGV DME, a onetime medical supplier near the U.S.-Mexican border in Pharr, Texas, each face allegations of 22 counts of health care and wire fraud, conspiracy and aggravated identity theft, according to a federal indictment unsealed on Thursday. …
Source: newshourly.net

57% of Medicare Doctors Used EHR System in 2011, GAO Says

Posted by:  :  Category: Medicare

Yarmuth Meeting 3 by Greater Louisville Medical SocietyIt also found that 22% of the sampled Medicare physicians first began using an EHR system to document evaluation and management services in 2011, the year that CMS started issuing meaningful use incentive payments. Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified EHR systems can qualify for Medicaid and Medicare incentive payments.
Source: ihealthbeat.org

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

Senator Paul Introduces Access to Physicians in Medicare Act

The Access to Physicians in Medicare Act aims to repeal the current reimbursement formula known as the Sustainable Growth Rate (SGR) and replace it with the same formula used to calculate cost-of-living increases for Social Security benefits with a cap set at 3 percent so that physicians will be able to practice medicine without the threat of massive pay cuts each year. This legislation is paid for by repealing the expansion of Medicaid and subsidy payments under Obamacare with any remaining savings going toward deficit reduction.
Source: randpaul2010.com

States Seek Medicare Data to Keep Fraudulent Providers Out of Medicaid

Glenn Prager used to be a Medicare fraud fighter for the federal government. Early this year he switched to Medicaid, taking a job as Arizona’s inspector general. His primary task is to keep crooked health-care providers out of the state’s $9 billion Medicaid system. If they slip in under the wire, he says, the goal is to catch them before any claims are paid. But six months into his new role, Prager is frustrated that he can’t get his hands on the Medicare data he used when he was a federal investigator. “The basic problem,” he says, “is a lack of coordination and communication between the two programs. There’s no other way to explain it.” Prager is not alone in his complaints. The National Association of Medicaid Directors released a report last month calling on the federal government to share Medicare data and improve collaboration with states in their mutual battle to reduce Medicaid fraud and abuse. Congress and the federal Government Accountability Office are also pushing the U.S. Department of Health and Human Services to provide better support for state fraud-busting efforts. The federal government says it has ambitious projects under way 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. The scale of the programs is also daunting. Medicaid covers 60 million low-income people and costs more than $400 billion a year. Already growing faster than any other item on states’ budgets, it is slated to expand by 16 million more people if the Affordable Care Act is upheld. Medicare covers 48 million people and costs more than $470 billion. While only a small number of the health-care providers who participate in either program break the rules for financial gain, the result of the fraud that does take place is a substantial drain on the money available to provide legitimate health-care services.  A majority of providers serve both Medicaid and Medicare, and the dishonest ones often steal from both programs at the same time. The federal government alone lost $22 billion to what it calls “improper payments” in the Medicaid program last year. Although no uniform method of calculating state losses exists, a similar amount was likely lost by states since they pay for about half of the program. Medicare lost $43 billion, according to federal data.
Source: govtech.com

Medicare Physician Payments: Lessons from the Private Sector

Hearing witnesses focused on Accountable Care Organizations and other possible solutions to bend the cost curve.  This emphasis is all well and good of most beneficiaries of Medicare, Medicaid and other forms of directly and indirectly subsidized insurance in most years.  Focusing on results is a worthy goal for both patient well being and cost control, provided the patient can be treated.  Medicare, however, devotes significant resources to the expensive care found in the last year of life, which may involve multiple hospitalizations, full time nursing services through Medicaid or a period of intensive care which ultimately proves unsuccessful.  In all of these circumstances, particularly the last, unless we are willing to either have doctors deny care or force survivors to pay bills that the government refuses to pay, some form of fee for service is necessary.
Source: salon.com

CMS Allows Medicare Providers to Submit Documents Electronically to CMS Contractors

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

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

Most Medicare docs used EHR in 2011

According to the inspector general’s report on the survey, 73% of Medicare physicians using an EHR system to document evaluation and management services in 2011 were using a certified system. Also, most physicians using an EHR reported manually assigning evaluation and management codes, despite the ability of many systems to do so automatically as a time-saving and accuracy-improvement step. Such services accounted for 45% of the top 20 procedure codes billed to Medicare in 2010, according to a report by HHS’ inspector general. The study was conducted at the request of officials in the Office of the National Coordinator for Health Information Technology, which is overseeing the EHR incentive program. That program began providing payments last year that could total $44,000 for each Medicare physician who uses a qualifying system. However, the CMS will begin Medicare payment reductions in 2015 for physicians who do not demonstrate meaningful use of certified EHR systems.
Source: modernhealthcare.com

Medicare Physician Payment: A Hollow Victory For The RUC

Judge Nickerson acknowledged the physicians’ core argument in the opening summary of the case facts: As CMS’ sole advisor on medical services valuation for two decades, the RUC is a “de facto” federal advisory committee that should fall under the public interest rules of the Federal Advisory Committee Act (FACA). The physicians argued that this flawed process has resulted in an over-valuing of specialty care, an undervaluing of primary care and a distortion of health care markets, utilization and cost. But the ruling ignored their argument, explicitly avoiding any evaluation or discussion of the requirement that federal advisory bodies adhere to FACA.
Source: healthaffairs.org

OIG report shows EHR use by physicians

Given the amount of choices, isn’t it surprising that such a small number of physicians are actually using a certified EHR? The purpose of the survey is to inform the ONC and by extension the Centers of Medicare & Medicaid Services (CMS) assess their efforts to facilitate the widespread adoption of EHR and health IT. What’s clear is that momentum is building but slowly. With penalties slated to begin in 2015, plenty of physicians are currently not doing enough to avoid paying fines. If incentives aren’t enough to promote adoption, perhaps penalties are.
Source: ehrintelligence.com

Reed Tinsley, CPA: Physicians and the new Medicare “Resource Use” Reports

According to CMS, making providers routinely pay attention to cost and quality is widely viewed as crucial if the country is going to rein in its health-care spending, which amounts to more than $2.5 trillion a year. It’s also key to keeping Medicare solvent. Efforts have begun to change the way Medicare pays hospitals, doctors and other providers who agree to work together in new alliances known as “accountable care organizations.” This fall, the federal health program for 47 million seniors and disabled people also is adjusting hospital payments based on quality of care, and it plans to take cost into account as early as next year.
Source: blogs.com

Doctors’ Use Of EHRs Expanding Quickly; Decline In Malpractice Claims Also Noted

Medpage Today: Liability Claims Drop With EHRs Switching over to electronic health records (EHRs) appears to dramatically cut malpractice suits, according to a small study of insurance claims. The adjusted rate of malpractice claims fell six-fold among physicians in practices that adopted computerized records, Steven R. Simon, MD, MPH, of the VA Boston Healthcare System and Brigham and Women’s Hospital, and colleagues found. The shift reflected a reduction in the number of all closed claims, rather than just in payouts, the group reported in a research letter published online in the Archives of Internal Medicine (Phend, 6/25).
Source: kaiserhealthnews.org

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

Top Five Reasons Obamacare Is Bad for Doctors

Creates a new board to further cut provider payments. Obamacare uses the Independent Payment Advisory Board (IPAB), a board of 15 unelected bureaucrats, to contain cost growth in Medicare by finding ways to cut spending to meet a new budget target. The board is limited in how it can achieve its goal, but one avenue definitely available is to further ratchet down provider payments. As IPAB cuts reimbursements, seniors will experience growing access problems as doctors discontinue seeing Medicare beneficiaries. If IPAB elects to limit seniors’ access to certain treatments and services—which is also within its abilities—patient choice and physician autonomy will also be sacrificed.
Source: capoliticalreview.com

Legal Advice Doctors Should Give Their Patients on Medicare, Medicaid

As one example (details changed for privacy): I recently spoke with the Smiths, a couple in their late 70s, at the insistence of their daughter, a physician. Like many people of their generation, their primary retirement and heathcare plan consists of social security and Medicare. The couple has retired to a Sunbelt state and now live in a modest home she purchased for them. Recently diagnosed with cancer, Mrs. Smith was covered only by Medicare and had a small supplemental insurance plan. Post-diagnosis, the Smiths’ physician informed them of the course of treatment required and the extraordinary expenses some of the drugs and treatment would require. Given their reliance on Medicare and the real possibility of needing Medicaid nursing home assistance and the medically related financial exposures they face, here’s what we calculated:
Source: physicianspractice.com

Free shredding service aims to foil identity thieves who prey on elderly

Posted by:  :  Category: Medicare

OBAMA: THE SOCIALIST/MARXIST/COMMUNIST -- UNMASKED FOR ALL TO SEE by SS&SSJimmy Lozano, a driver and shredder for Shred Masters, said his company is contracted with the state of Utah to provide shredding services at senior centers. He said he has driven his shredding truck as far south as St. George to provide communities with this service.
Source: standard.net

Video: Utah Medicare Advantage Plans for Seniors in 2012

Daily Kos: Is This a New ALEC SCHEME: The Health Care Compact to Replace Medicare? Try It!

Consider if one or more of these tags fits your diary: Civil Rights, community, Congress, Culture, Economy, Education, Elections, Energy, Environment, Health Care, International, Labor, Law, media, Meta, National Security, Science, Transportation, or White House. If your diary is specific to a state, consider adding the state (California, Texas, etc). Keep in mind, though, that there are many wonderful and important diaries that don’t fit in any of these tags. Don’t worry if yours doesn’t.
Source: dailykos.com

Utah Medicare Part D Plans

Whereas you can compare stand-alone plans to each other, you must compare the entire Advantage plan package to other Advantage plans. This complicates things a little. For instance, a plan with great drug benefits may be less than desirable for its medical benefits or provider network.
Source: partdplanfinder.com

Utah plays politics with Medicaid, Medicare

Another unintended consequence is that as benefits dwindle, people who are underinsured or uninsured and can’t get medical care could flood emergency rooms, as often happens now. Meantime, the number of caregivers who simply can’t afford to give care under Medicaid and Medicare coverage are simply not taking those patients anymore.
Source: utahseniorservices.com

The Medicare Daily Report: Utah Medicare Experiment, A Little Health Care History

“President Reagan, the great apostle of modern conservatism, persuaded a Democratic Congress in 1988 to enact the biggest expansion of Medicare since the program’s creation in 1965.  For the first time, there would be financial protection against catastrophic illness, with a limit on out-of-pocket payments.  To avoid worsening the federal deficit, the expansion would be paid for by the people benefiting from it: the Medicare beneficiaries themselves.  Poor people would pay little or nothing, and seniors making $35,000 a year or more would pay $800 a year for this new protection.”
Source: blogspot.com

Popular Medicare drug program targeted in Utah GOP primary battle

But the drug benefit has become extremely popular with seniors. And the healthcare law that President Obama signed in 2010 expands the benefit by closing a hole in the Part D coverage known as the “doughnut hole,” (although Obama’s law, unlike the original legislation, offsets the cost of the expansion with other spending cuts and new taxes).
Source: us-senators.com

Report: Enrollment up, premiums down for Medicare Advantage

Posted by:  :  Category: Medicare

'The election of Obama would, at a stroke, refresh our country's spirit' by Renegade98The 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: Medicare Benefits Made Clear: News, Reform & Obamacare Exposed!

Medicare Advantage Enrollment Goes Up As Premium Costs Decline

The Hill: Report: Enrollment Up, Premiums Down For Medicare Advantage The 2010 healthcare law contained cuts to Medicare Advantage that were strongly opposed by Republicans and insurance companies. The program offers care to seniors through private insurers that contract with the Medicare agency. … The program now covers more than 13 million beneficiaries, or 27 percent of the Medicare population, the report stated. … The law’s cuts to the program are expected to save $136 billion over 10 years (Viebeck, 6/12).
Source: kaiserhealthnews.org

March 2012: Rural Medicare Advantage Enrollment Update

Key Findings: 1) Despite reductions in payment to Medicare Advantage (MA) plans as mandated by the Affordable Care Act, rural MA enrollment has grown 13% since 2011, from 1.5 million enrollees to over 1.7 million in 2012. 2) Comparatively, urban enrollment grew 9% during this time. 3) Recent MA enrollment data also reveals that Preferred Provider Organizations are now the dominant type of Medicare Advantage plan in rural America.  (Source: Rural Health Research & Policy Centers)  [Read article]
Source: worh.org

Medicare Advantage Plans Connecticut 2012 « Insurance News from Crowe & Associates

There are a limited number of Medicare Advantage plans available in Connecticut for 2012.  The list includes plans from Connecticare, AARP/United, Aetna, Anthem BlueCross BlueShield and Wellcare.   Our agency has clients with all companies and plan types in Connecticut and we are happy to share the good and bad of them with you.
Source: croweandassociates.com

How to choose a Medicare Advantage plan

• Total costs: Look at the plan’s entire pricing package, not just the premiums and deductibles. Compare the out-of-pocket maximums plus the copays and coinsurance charged for doctor office visits, hospital stays, diagnostic tests, visits to specialists, prescription drugs and other medical services. This is very important because if you choose an Advantage plan, you’re not allowed to purchase a Medigap supplement policy, which means you’ll be responsible for paying these expenses out of your own pocket.
Source: pomeradonews.com

How To Choose Among The Greatest Medicare Advantage Plans

When you commence to get close to the age of 65, you may be miserable about your growing years, however there are some excellent benefits waiting for you. You have been working your entire lifetime in order to get both Social Security and Medicare and today is the fair age to commence reaping the rewards. Though these are fantastic benefits to own, they also come with their honest share of challenges and one of those is selecting the fair Medicare Advantage Plans. Tags:
Source: eduspeaks.com

GAO: Cancel Medicare Advantage demo that squandered $8B

The Government Accountability Office is calling for an end to what it says is an ineffective Medicare Advantage bonus program, which has wasted more than $8 billion, The New York Times reported. The Medicare Advantage Quality Bonus Payment Demonstration, which would cost $8.3 billion over 10 years, with 80 percent of the cost occurring in the first three years, has thus far yielded mediocre care and is unlikely to produce results, the GAO said in its sharp criticism of the experimental project, reported the NYT. As an alternative to the traditional healthcare program for seniors, Medicare Advantage is a popular private insurance with more than 3,000 private plans that serve about 12 million beneficiaries, the Associated Press reported. The demonstration project under the Obama administration, however, dolls out most of the bonus money to plans that receive only 3 to 3.5 stars out of 5 on Medicare’s rating scale. The GAO called for the cancellation of the project, as it’s the costliest demonstration in Medicare history, the AP reported. The Centers for Medicare & Medicaid Services fought back, stating that the demonstration supports the national strategy to improve care, patient outcomes and population health and explained the reasoning for the bonus structure for even the average performers. The demonstration project tests to see if plans with quality ratings lower than 4 stars that earn bonus payments will result in efficiency and better care, CMS noted.   “The changes made under the demonstration project provide financial incentives for quality improvement and reward improvement throughout the ratings continuum,” CMS said. To learn more: – read the NYT article – here’s the AP article – check out the GAO report (.pdf) Related Articles: OIG: Medicare, Medicaid anti-fraud program is ineffective Medicare Advantage plans get 3.07% growth rate in 2013 CMS cracks down on Medicare Advantage claims CMS proposes 2.5% rate hike for Medicare Advantage plans Medicare Advantage enrollment grows 10% as insurers compete
Source: fiercehealthcare.com

United Healthcare Oxford Medicare Advantage Denies Coverage

John King Van Rensselaer (1847-1909) Image by Penn Provenance Project Armorial bookplate of John King Van Rensselaer (1847-1909), president of the Stirling Fire Insurance Company. His wife, Mrs. John King Van Rensselaer (née May Denning King) (1848-1925), was an author of works on cultural history. In 1917 she addressed the New York Historical Society and called its meetings "uninteresting and dull" and the building which housed its collections, "a deformed monstrosity filled with curiosities, ill-arranged and badly assorted." Her suggestions for improving these conditions, receiving no support at the meeting, were referred to a committee. (Cf. "Tells Historical Society It Is Dead," New York Times 3 January 1917).
Source: insurancewonders.info