How Medicare Risk Adjustment Program Is Used To Compensate Managed Care Plans

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BANKRUPT! by SS&SSNow with the risk adjustment program, the payments from patients with multiple diseases are likely to increase, compared to what they were in the past. This program emphasizes that the providers of the Medicare Advantage Plan need to revise the list of customers they offer their services to on a regular basis. They also need to attract doctors and physicians who are capable of treating patients with different diseases effectively. Since many patients suffer from diabetes, chronological illness and heart disease, hospitals and medical facilities should design programs that address the needs of patients with these diseases as well.
Source: nationalsecuritydrone.com

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

All About Medicare Risk Adjustment

The Medicare Risk Adjustment program was launched in 2000 by the Centers for Medicare and Medicaid Services (CMS) to compensate managed care organizations. This program gathers information of treatment offered to patients in different facilities and on the basis of this information, Medicare determines how much to pay them. For this purpose, CMS uses ICD-9 codes to indicate different treatments and prepares a comprehensive report. The payment structure determined by using this system is more accurate and reliable compared to what it was earlier because the previous system relied only on geographic and demographic information to determine compensation of a facility.
Source: tow-truck-insurance.net

House Republican Plan to Overhaul Medicare Opposed by Original Advocate

While Ryan’s plan does put a limit on the number and variety of plans that insurance companies could offer, it’s important to consider a few things. A full 25 percent of beneficiaries are already enrolled in private plans through Medicare Advantage. In 2012, however, Medicare will still spend 7 percent more for beneficiaries enrolled in Medicare Advantage plans than if those beneficiaries were in traditional Medicare. And as Center for American Progress Managing Director of Health Policy Topher Spiro has argued, “There is no evidence that private plans provide better quality than traditional Medicare, and the quality of private plans is highly uneven.” The example of Medicare Advantage demonstrates that premium support plans would likely cost more without guaranteeing increased quality of care.
Source: americanprogress.org

Medicare Risk Adjustment – A Brief Input

Medicare Risk Adjustment is a term used to describe about the payment method authorized by Balanced Budget Act of 1997 & utilized by the Centers for Medicare & Medicaid Services (CMS) to make improvements in payment accuracy to Medicare Advantage Organizations.  However, to make such methodology be effectively possible, the ICD-9 coding plays the big part of the process.  ICD-9 coding determines the degree of severity of patient’s health condition through its numerical indexing of illness diagnosis, hospital procedures and other pertinent clinical data.  From such system, Medicare risk adjustment can analyze and provide the appropriate allowable funds that is to be reimbursed to physicians and amount that can be covered during hospitalization.
Source: ezinemark.com

GAO report on Medicare Advantage risk adjustment

We found that diagnostic coding differences exist between MA plans and Medicare FFS and that these differences had a substantial effect on payment to MA plans. We estimated that risk score growth due to coding differences over the previous 3 years was equivalent to $3.9 billion to $5.8 billion in payments to MA plans in 2010 before CMS’s adjustment for coding differences. Before CMS reduced 2010 MA beneficiary risk scores, we found that these scores were at least 4.8 percent, and perhaps as much as 7.1 percent, higher than the risk scores likely would have been as a result of diagnostic coding differences, that is, if the same beneficiaries had been continuously enrolled in FFS. Our estimates suggest that, after accounting for CMS’s 3.4 percent reduction to MA risk scores in 2010, MA risk scores were too high by at least 1.4 percent, and perhaps as much as 3.7 percent, equivalent to $1.2 billion and $3.1 billion in payments to MA plans.
Source: pnhp.org

LeadingAge: MedPAC June 2012 Report: Recommendations on PACE Expansion

After the changes in Recommendation 1 take effect, the secretary should establish an outlier protection policy for new PACE sites to use during the first three years of their programs to help defray the exceptionally high acute care costs for Medicare beneficiaries. The secretary should establish the outlier payment caps so that the costs of all of this chapter’s recommendations do not exceed the savings achieved by the changes in Recommendation 1.  
Source: leadingage.org

Daily Kos: Rick Scott on Medicaid expansion: If I can’t steal it, Florida does not want it

Posted by:  :  Category: Medicare

INDIVIDUALS.—Section 1905 of the Social Security Act (42 U.S.C. 1396d), is amended— (A) in subsection (b), in the first sentence, by inserting ‘‘subsection (y) and” before ‘‘section 1933(d)”; and (B) by adding at the end the following new subsection: ‘‘(y) INCREASED FMAP FOR MEDICAL ASSISTANCE FOR NEWLY ELIGIBLE MANDATORY INDIVIDUALS.— ‘‘(1) AMOUNT OF INCREASE.—øReplaced by section 1201(1)(B) of HCERA¿ Notwithstanding subsection (b), the Federal medical assistance percentage for a State that is one of the 50 States or the District of Columbia, with respect to amounts expended by such State for medical assistance for newly eligible individuals described in subclause (VIII) of section 1902(a)(10)(A)(i), shall be equal to— ‘‘(A) 100 percent for calendar quarters in 2014, 2015, and 2016; ‘‘(B) 95 percent for calendar quarters in 2017; ‘‘(C) 94 percent for calendar quarters in 2018; ‘‘(D) 93 percent for calendar quarters in 2019; and ‘‘(E) 90 percent for calendar quarters in 2020 and each year thereafter.
Source: dailykos.com

Video: How to Apply For Medicaid in Florida Online

Rick Scott on Medicaid expansion: If I can’t steal it, Florida does not want it

Before Rick Scott was elected governor of Florida, he was implicated in one of the biggest Medicare fraud cases in history. Scott was CEO of Columbia/HCA when it was fined $ 1.7 billion and found guilty of swindling the government. Later, Scott invoked the Fifth Amendment 75 times in a 2000 deposition in a later civil case.
Source: hotspyer.com

Gov. Scott: Florida will not implement insurance exchanges or expand Medicare

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Source: websiteurl.org

Obamacare and Civil Disobedience

As with any action that involves society at large, prudence should be used by anyone who wishes to engage in civil disobedience for the sake of changing the laws or improving society. What is noticeable about the examples of civil disobedience upon which we look back and are proud is that they were conducted in a humane and non-violent way. People like Dr. Martin Luther King, Jr., Rosa Parks and the Founding Fathers did not seek to uproot the foundations of civil society or to massacre or wreak destruction upon their oppressors. They desired simply to right a wrong, and were determined not to let the pomp of tyrants deter them from obeying the natural law and their consciences. And they succeeded. Let us hope that Governor Scott’s refusal to comply with Obamacare brings about a similar result.
Source: acton.org

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

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

9 Health Care Reform Changes for 2012

5010 ABC Home Health Care Inc. accountable care organizations Agency for Health Care Administration Amedisys Barack Obama Bill Nelson Centers for Medicare & Medicaid Services Cliff Stearns companionship services exemption ContinuLink 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 LHC Group Lisa Remington Marco Rubio Marilyn Tavenner 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

UniCare MedicareRx Rewards Part D

Posted by:  :  Category: Medicare

When comparing other plans to either MedicareRx Rewards plan you should research the formularies. The same drug may be placed into different tiers by different companies. The UniCare website includes a prescription look up tool that will allow you to get a more accurate picture of your total cost. Other factors when comparing plans include: copay or coinsurance amounts, coverage in the gap, mail order benefits and pharmacy network.
Source: affordablemedicareplan.com

Video: Unicare Medicare Advantage Plans – Compare to 180+ Companie

UniCare to Reimburse AHIP Online Certification Course Fee

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Source: medicaresupplementalco.com

Medicare unicare prior authorization forms.com // getty images tsuneo yamashita

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Source: freeblog.hu

Is Coventry or UniCare Dropping Your Coverage: Know Your Rights

If you voluntarily disenroll because you decide a Medicare Advantage plan is not right for you, you may have a right to Medicare supplement coverage as long as you have not been covered by a Medicare Advantage plan before and you disenroll from the Medicare Advantage plan within 12 months of your enrollment. This right is limited to the same Medicare supplement in which you were most recently previously enrolled, excluding any outpatient prescription drug coverage. If you do not have a right to get your same Medicare supplement coverage back, you will have to complete the medical questions on an application for Medicare supplement and the insurance company can deny your application.
Source: bloghealth.net

Texas Medicare Part D Plans

After reviewing all pertinent data for each plan, you should have a pretty good idea as to which plan is the most suitable with the lowest monthly premium. You have found your best plan. Even if you live in the most remote rural County, you should be able to find a winner among the 33 Part D plans available in Texas.
Source: partdplanfinder.com

Romney Lies About Medicare/Medicaid Change Of Address Form

Posted by:  :  Category: Medicare

There were periods during my government service when the business-does-it-this-way was fashionable.  Public private partnership (acronym PPP) became popular.  At some point what tended to happen or be realized was the understanding that the public service does not have, cannot have the same “bottom line” as a for-profit organization.  Wall Street exemplifies the outsize for-profit situation these days…I do not think most people want the government to emulate that value system when it comes to exercising government authority.  And, frankly, when you look at it, the basic myth at bottom of the business school takeaway about efficiency has a lot of flaws…not the least of which is that large, major corporations with their overpayment of failing executives and with their taking-care-of-the-top first motif are the opposite of even the the narrowest definition of “efficiency.”  
Source: talkleft.com

Video: SHIIP Medicare Enrollment Basics.flv

Insurance Agents Look to Dataman Group for New Prospects in their Areas

Dataman Group helps Insurance Agents find the right prospects for the Medicare Supplement Plans they offer. Most Agents simply select prospects in the zip-codes/counties closest to their location and select those individuals that recently turned 65 or are Turning 65 in the next few months.  These individuals must sign up for a program no later than December 31st and smart marketers will contact prospects in their area as soon as possible.
Source: typepad.com

Major Improvements to Medicare Online Enrollment System

5010 ABC Home Health Care Inc. accountable care organizations Agency for Health Care Administration Amedisys Barack Obama Bill Nelson Centers for Medicare & Medicaid Services Cliff Stearns companionship services exemption ContinuLink 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 LHC Group Lisa Remington Marco Rubio Marilyn Tavenner 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

a Blog on Medical Billing, Coding, Reimbursement and Health Care Office Management: Medicare Enrollment Form CMS

Medicare Enrollment Form CMS-855 Are Now Being Accepted 60 Days Prior to Effective Date! This is a good news for all Part B physicians! Because this used to be a 30 days time frame! Now, you have 60 days in advance to file your physician’s enrollment application before the effective date or “start date” at a new medical practice office. So if for instance, you have a start date at a new practice of August 1st, you have 60 days before the 1st of August to submit the enrollment application. Read more about this new change from Medicare Learning Network Matters
Source: medicalcodingandbillingblog.com

More out of Medicare. #204802

Little known facts about Me dicare – it does not pay for everything. Baby-boomers must read this. http://grabbingsand.com/2183623m157x2744473 CompareMe dicarePlans PO Box 7022 New York NY 10116 CompareMe dicarePlans is committed to your privacy. If you prefer to not receive email from us in the future, please visit this link http://grabbingsand.com/2183624m157x2744473 and follow the instructions or send us a letter or postcard to the address above. to remove yourself http://grabbingsand.com/unsub.php or write Account management options are available here. Cancellations are handled promptly. Or Write Us: 11400 W. Olympic Blvd. Suite 200 Los Angeles, CA 90064 US.
Source: bubble.ro

Medicare Provider Enrollment: Revalidation Required: Michigan Attorneys

Health care reform law requires that providers who enrolled in Medicare prior to March 25, 2011, submit enrollment revalidation information upon request by the Centers for Medicare and Medicaid Services ("CMS") or its contractors.  Any provider that fails to submit the requested revalidation information within 60 days of receiving such a request risks interruption or deactivation of Medicare billing privileges.  Revalidation for all providers who enrolled in Medicare prior to the above date will occur between now and March of 2015 on a steady basis.  Providers can check the lists provided at CMS’s website to determine if they were already sent a revalidation notice that was perhaps overlooked in the mail.
Source: healthlawyersblog.com

Medicare This Week: 11 Stories About Balance Billing, eRX, PQRS, 5010, EHR, and Revalidation

Users can now complete and submit EFT Agreements electronically with the option to e-sign the document. If the provider/supplier submits the EFT agreement electronically and chooses not to e-sign, they shall include a hardcopy form of the completed and signed EFT agreement with its supporting documentation to the contractor. Providers/suppliers are still required to physically mail confirmation of account information on bank letterhead, or a voided check whether the EFT is submitted electronically or via the paper version.Along with the documentation, it is also important that the provider/supplier print and mail the enrollment submission confirmation page containing the web tracking ID. This will ensure that the supporting documents mailed to your MAC get associated with your electronic application submission.
Source: managemypractice.com

Online Medicare Forms: Appeal, Payment, Disclosure, Application

Medicare insurance forms for parts A, B, C and D are accessible online for electronic filings and mail in. Online forms include an application for Medicare, claim forms for patients requesting payments and Medicare appeal forms. Older Americans can apply for Medicare even if not planning to retire, as long as the person is close to 65 years old. Even when a person has been denied Medicare, appeal forms can be submitted online requesting a hearing or case review.
Source: suite101.com

Ask The Experts: Retirement

Q. I am three years and eight months younger than my wife. She had carried the insurance premium for both of us since 1976. I had to take up Blue Cross/Blue Shield this year myself, since Medicare is not a family plan. I plan to retire for health reasons on April 27, 2013, with 34 years of service, but I do not know if my Federal Employees Health Benefits plan will continue, due to the recent acquiring of my own plan. I was under her plan as a dependent for 35 years, but I am also a federal employee. If I retire, I do not know if I will be eligible for Medicare until I am 65.
Source: federaltimes.com

A hidden cost for Medicare Providers?

One of the problems with Medicare is the billions of dollars of fraud committed each year.  Some estimate as much as $50 billion annually is wasted by paying fraudulent claims. The Affordable Care Act attempts to address this, and included provisions to deter the “bad guys” from becoming Medicare providers, and beginning March 25, 2011,
Source: healthreformexplained.com

Still No Luck With Medicare Part B

He applied for Medicare Part B in March of 2012. It is now almost July of 2012, and Social Security is still choosing to drag their feet about approving his application. He absolutely does qualify for it. The problem is entirely because someone at Social Security was incompetent, and lost the form that my husband mailed to them. Now, he has to go to the local Social Security Office and try to straighten things out.
Source: families.com

2011 Medicare Supplement Coverage: Medigap Plan Numbers A

Posted by:  :  Category: Medicare

In 2011, Plans K, L and M do not cover 100% of all benefits at all times. Plan K covers 50% of Part B coinsurance/copayments, blood, Part A coinsurance/copayments for hospice care, coinsurance for skilled nursing facility care and the Part A deductible. Plan L gives 75% coverage for these benefits. Both of these options have yearly out-of-pocket limits of $4,640 (K) and $2,320 (L). Once you meet these limits (and any annual Part B deductible), plans will pay 100% for the rest of the year. Plan M restricts coverage of the Part A deductible to 50%.
Source: suite101.com

Video: Choosing A Medicare Supplement in Fl in 2011

Making Changes for Medicare Supplements 2011

Today, most relatively new customers only know of the 10 Medigap plans in current use. These plans are: A, B, C, D, F, G, K, L, M, and N. Notice, there’s a gap in between some of the letters. Why? Because before the changes made in 2010, there were plans named E, H, I, and J. Initially, there was a total of 12 Medigap policies, but in 2010, Medicare removed E, H, I, and J, and added M and N. One reason they made the reforms is to get rid of the policies and benefits that were of little use. Then, they added M and N as replacements, all the while making minor tweaks so that all the Medigap policies were polished to perfection.
Source: gomedigap.com

Motorola Development Community

If this is your first visit, be sure to check out the FAQ by clicking the link above. You may have to register before you can post: click the register link above to proceed. To start viewing messages, select the forum that you want to visit from the selection below.
Source: motorolafans.com

Nine out of Ten Seniors Satisfied with Their Medigap Coverage

Many Medicare beneficiaries are choosing to enroll in plans that contain at least some cost-sharing. High-deductible Plan F, and newer standardized Medigap plans K, L, M, and N—which have copayments, coinsurance or deductibles—made up 23 percent of new Medigap purchases in 2011. Plan N, which includes cost sharing of up to $20 for physician office visits and up to $50 for certain emergency room visits, represented 18 percent of newly purchased Medigap policies in 2011 and was the most popular of the newer plans.
Source: ahipcoverage.com

Medicare Supplement Plans Extend A Hand To Seniors

Even if you supplement Medicare with a Medicare Part D Prescription Drug plan, you may also enroll in one of the ten Medigap plans. During a six-month period that begins on the first day of the month in which you become 65 and you are enrolled in Part B, your application for a Medigap plan is guaranteed to be accepted regardless of your health problems. You may switch to a different plan during this time, and guaranteed acceptance also applies to the application for the other plan.
Source: rwandainformation.org

Financial Advisors to Up Direct Mail Effort to Seniors

claim that new technology has ‘complicated things.’ One of the most consistent marketing strategies for this group of professionals has been partnerships with related professionals like attorneys (46.3%) and direct mail (28%). This year, financial advisors expect to use direct mail programs heavily to target consumers who are turning 65 and need to learn more about Medicare and Medicare Supplement policies. The return on this format has historically been good and advisors expect that trend to continue.
Source: marketingforecast.com

Medicare Sales Representative for CA Job for Insurance Sales Web.com at UnitedHealth Group

Posted by:  :  Category: Medicare

San Diego, CA by Oggie DogThe job of Medicare Individual Sales Rep is responsible for increasing the membership, revenue and profitability through the direct sale of the organization’s products and services to Medicare eligible individuals in their assigned territory. Incumbents sell a portfolio of Medicare health related products using a solutions based sales approach, combined with industry and consumer demographic expertise to assess personal needs and assist prospects in selecting the product which best suits their individual clinical, financial and life stage.
Source: insurancesalesweb.com

Video: Kiefer Sutherland – Medicare Pledge

Daily Kos: Medicare for All California Bus Tour 2012 Kicks Off Tuesday, June 19!

No matter the outcome of the U.S. Supreme Court ruling on the Affordable Care Act, the grassroots fight to expand Medicare to all Americans forges ahead. Starting Tuesday, the California Nurses Association, National Nurses United and Campaign for a Healthy California are launching a statewide bus tour to conduct free health screenings and town halls, and to educate the public about how Medicare for all is less expensive and more equitable than our current fragmented, profit-driven healthcare system. The tour will run from June 19 to July 12 and will stop in 18 cities across California. The schedule is as follows:
Source: dailykos.com

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

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

Elder Care In Yorba Linda, CA: Medicare, Medicaid, and Private Pay Options

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Source: healthhomecare.info

San Bernardino CA Medicare Supplement Plans, Medicare Insur

I hope you obtain new knowledge about . Where you may put to easy use in your everyday life. And above all. View Related articles related to Medicare Supplement. I Roll below. I actually have recommended my friends to help share the Facebook Twitter Like Tweet. Can you share San Bernardino CA Medicare Supplement Plans, Medicare Insur.
Source: blogspot.com

Asheville, North Carolina, Resident Pleads Guilty to Participating in $63 Million Medicare Fraud Scheme : Nykom

Posted by:  :  Category: Medicare

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Source: nykom.com

Video: North Carolina Medicare Enrollment.wmv

The immediate winners in the ACA decision

More than 110,000 seniors received a $250 rebate to help pay for prescription drugs when they hit the donut hole in their Medicare coverage. Just in the first five months of 2012, more than 20,000 people in Medicare in North Carolina were able to take advantage of a 50 percent reduction in the costs of brand name prescription medication. More than 108,000 seniors in the state received that benefit.
Source: ncpolicywatch.com

Do you understand how Medicare works in North Carolina?

So what I always advise my clients is that they understand the Medicare language and how the different parts of Medicare work together to give them the ultimate in health insurance protection. So you should understand that part a of original Medicare covers hospital services like inpatient hospitalization home healthcare hospice and skilled nursing facility charges part B of original Medicare covers this is the charges while you are on a hospital any type of outpatient care by can outpatient the surgery office visits to your Dr. in your local hometown in part D of original Medicare is outpatient prescription drug coverage for medications that you feel like your local pharmacy or through a mail order service provider.
Source: jorgesuarez.info

SCOTUS upholding ACA a good sign for the nation

“In states that elect the Medicaid-expansion option,” explained Chris Koyanagi, policy director for the Judge David L. Bazelon Center for Mental Health Law, “not only will very-low-income people have access to health care coverage they now lack, but those states will benefit from 100% federal funding for services to this group for the first three years and 90% federal funding thereafter. This is still an extremely good deal for the states, as well as for scores of Americans in need of health and mental health care services.”
Source: bluenc.com

NextCare to pay $10 million settlement

The allegations resolved in the settlement announced Monday by the U.S. Justice Department were initially raised in a lawsuit filed in Charlotte against NextCare by former employee Lorin Cohen of Raleigh. Under the False Claims Act, private citizens can bring suit on behalf of the United States and share in the recovery. Cohen will receive $1.61 million as her share of the recovery.
Source: charlotteobserver.com

Pinellas County: Medicare Advantage Plans Florida

Posted by:  :  Category: Medicare

Joe the Plumber - To Flush The System ...More scams aim to ensnare Brevard seniors - Their ingenuity is boundless, Archer said. (Jul 2, 2012) ... by marsmet524I hope you will get new knowledge about . Where you can offer use in your day-to-day life. And just remember. View Related articles associated with Medicare Supplement. I Roll below. I actually have recommended my friends to assist share the Facebook Twitter Like Tweet. Can you share Pinellas County: Medicare Advantage Plans Florida- Zero premium.
Source: blogspot.com

Video: Florida Medicare Advantage Plans – Supplement Health Insuran

Xerox Healthcare Recovery Services: CMS and Medicare Advantage Plans by Myco Dang

In response to recent adversarial position against the federal regulation, the Centers for Medicare & Medicaid Services (CMS) issued a memorandum regarding Medicare Secondary Payment Subrogation rights. (See attachment). CMS reaffirmed its intention in its regulations to give Medicare Advantage Organizations (MAOs) and Prescription Drug Plan (PDP) the right under the existing Federal law to be secondary payers. CMS reaffirmed its position that MAOs are entitled to exercise the same rights to recovery that the Secretary exercises under the Medicare MSP regulations. Despite recent court rulings to the contrary, CMS maintains that the existing MSP regulations apply to MAOs and PDPs and are not limited to seeking remedies in State Court.
Source: blogspot.com

The Disadvantages of Medicare Advantage Plans

  Therefore, it is not shocking to expect that the Medicare beneficiary will get less benefits in the end when they are now managed by health insurance companies with higher overhead than Medicare, getting less money from Medicare to cover the same patients, and being expected to make a profit (spend less on patient care). Some of the plans are only paying for 85% of the wholesale drug costs. For example, on a drug like Lucentis or Eyelea for Wet Macular Degeneration, this would be a gap of $300 dollars that would be a loss to the caring physicians that purchase the drugs from the pharmaceutical companies then bill the insurance companies. This makes caring for patients in plans like these impossible. The Medicare Rights Center recently published a report Too Good To Be True: The Fine Print in Medicare Private Health Care Benefits. The report was based on thousands of beneficiary calls to the Medicare Rights Center and listed nine common problems with Medicare Advantage plans.
Source: retinaassociatesflorida.com

Florida Medicare Supplement

 The World    Australia    China    India    Indonesia    Malaysia    New Zealand    Nigeria    Pakistan    Philippine    Singapore    Turkey*    United Arab Emirates    United Kingdom    United States  
Source: dewalist.com

Florida Medicare Supplement

Avoid SCAM: 1) Do NOT send money for shipping the pet from abroad, they are scams. 2) Beware the seller or buyer who is from overseas. 3) Avoid bank wire service and western union because they has no buyer protection. 4) The safety way is to deal locally with people you can meet in person. 5) More about How to Avoid SCAMs.
Source: cathaylist.com

9 Health Care Reform Changes for 2012

5010 ABC Home Health Care Inc. accountable care organizations Agency for Health Care Administration Amedisys Barack Obama Bill Nelson Centers for Medicare & Medicaid Services Cliff Stearns companionship services exemption ContinuLink 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 LHC Group Lisa Remington Marco Rubio Marilyn Tavenner 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

Florida 1 of 3 States With Top

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Source: flaglerlive.com

Illinois Medicare Advantage

Medicare Advantage, also called Medicare Part C, is another option offered as part of Medicare. It’s provided through private insurance companies approved by Medicare and is available to anyone currently eligible for Illinois Medicare. When you join a Medicare Advantage plan, you receive your Part A (hospital) coverage as well as your Part B (medical) coverage and even some coverage Original Medicare does not provide. In fact, many plans offer Part D (prescription drug) coverage as well as dental and in some cases, even vision. While out-of-pocket expenses vary between insurance companies, you always pay a monthly premium in addition to your Part B premium and receive all your benefits through your Medicare Advantage plan.
Source: ssiinsure.com

The process of Florida Medicare Advantage

As we grow old, there are thousand types

Ever Wonder How Much Medicare Pays for Hip and Knee Replacement

Posted by:  :  Category: Medicare

THE LITTLE MAN KILLED MEDICARE FOR EVERYBONE by SS&SSBetween 1998 and 2007, the Medicare reimbursement rate decreased 21 percent for total hip arthroplasty and 20 percent for total knee arthroplasty, according to the report. The researchers surveyed 1,120 patients in an outpatient office setting, asking patients what they thought orthopedic surgeons should receive for total joint arthroplasty and how much they thought Medicare actually paid surgeons. Patients were also asked the same questions about cardiac surgeons who perform open heart coronary bypass surgery and surgeons who perform appendectomy.
Source: nicholascappello.com

Video: 2011- 4/19 MEDICARE PATIENTS HAVE SHORTER HOSPITAL STAY AFTER HIP REPLACEMENT BUT

MHS Indiana Helpful Tips for Billing HIP

Physical therapy / occupational therapy / situational therapy claims, when billed with the Revenue codes 042X, 043X, and/or 044X, need to be billed with appropriate CPT codes and modifiers. You will need to follow Medicare guidelines when billing for these services. For example, the Revenue Code 0420 would need to be billed using the appropriate CPT and the appropriate modifier, such as GP.
Source: mhsindiana.com

Al Sharpton Encourages Americans To Vote At 2012 BET Awards

“There are people that want to take away our rights, we wanna change Medicade and Medicare. I support and love the president but whatever you do vote, because this election is not just about Obama, it’s about yo mama, and we better vote or they’re gonna’ take all that from us.”
Source: hiphopwired.com

Hip Replacement Class Action Suits And How Medicare And Health Insurers Will Be Getting All The Money : Pennsylvania Injury Law Report

The most widespread medical implant failure in the United States in decades, involving thousands of all-metal artificial hips that need to be replaced prematurely, has entered the money phase. Medical and legal experts estimate the hip failures may cost taxpayers, insurers, employers and others billions of dollars in coming years, contributing to the soaring cost of health care. The financial fallout is expected to be unusually large and complex because the episode involves a class of products, not a single device or just one company. The case of Thomas Dougherty represents one particularly costly example. He spent five months this year without a left hip, largely stuck on a recliner watching his medical bills soar. In August, Mr. Dougherty underwent an operation to replace a failed artificial hip, but his pelvis fractured soon afterward. The replacement hip was abandoned and then a serious infection set in. Some of the bills: $400,776 in charges related to hospitalizations, and $28,081 in doctors’ bills….The so-called metal-on-metal hips like Mr. Dougherty’s, ones in which a device’s ball and joint are made of metal, are failing at high rates within a few years instead of lasting 15 years or more, as artificial joints normally do.The wear of metal parts against each other is generating debris that is damaging tissue and, in some cases, crippling patients.
Source: pennsylvaniainjurylawreport.com

Medicare Coverage Gap May Cause Seniors to Forgo Antidepressants

“If patients discontinue their appropriate medication therapy abruptly, they could be placing themselves at risk for medication withdrawal effects and for relapse or recurrence,” Zhang and colleagues wrote. “If they do not notice any effects, they might decide not to resume taking antidepressants. Thus, a gap in drug coverage could place older adults in harm’s way, as a result of disruptions in appropriate maintenance antidepressant pharmacotherapy.”
Source: blogspot.com

burning pain over left hip bone

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Source: musiccitynews.com

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

Collectible Phone Card: Health Plan of Florida (HIP) ‘Get The HIP Medicare Advantage’ PROOF › Have you noticed the debt is exploding? And it's not all because of Medicare

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Source: 2417.de

Summary of trends: HHS’ Bundled Payments for Care Improvement initiative

1. Retrospective Payment Bundles – Payers & providers set a target price for an episode of care. Participants are paid using the Original Medicare fee-for-service system, and then add an administrative budget reconciliation process at the conclusion of each episode. While some feel this method does not represent true bundled payment, it is used because the technical and administrative infrastructure is already in place for providers and payers. Setting up a “true” bundled payment system would require an expensive investment in changing billing practices. The types of episodes that work for retrospective payment bundles are:
Source: wordpress.com

Tea Partiers Rally Against Obamacare

Posted by:  :  Category: Medicare

Dear Kate, Did you ever consider coming to a Tea Party meeting? Do you know what the Tea Party is all about? Do you know Obamacare is an assault on your individual sovereignty? Socialized healthcare is the key to a Socialist state. Therefore, your constitutional rights are violated and destroyed. Do you realize this law fundamentally changes the relationship between you and your doctor? Do believe a government bureaucracy is admissible to intervene in the relationship between you and your doctor? Do you really think the 500 billion dollars that is taken out of the broken Medicare system to fund this bill is going to save Medicare? Do you like the idea of rationing healthcare? Do you think the imposition of a half trillion-dollar tax hike to fund this disaster is wonderful? Interfering in commerce by raising more taxes on business and then govt. forcing employers to provide health insurance? Do you believe Americans should be forced to pay taxes to fund Obamacare for Abortions? How would you like it if we just started to make a judgment on you Ms. Kate when we do not know anything about you? Do you embrace liberty? Or do believe that the Government should impose their will on you when they deem it necessary? Now Kate, you tell me. Do you actually believe this law is good? Since you know so much, can you please tell everyone how government is supposed to work? Joseph T. Abbruscato – Bayshore Tea Party Group
Source: patch.com

Video: Medicaid Strategy – New Jersey Elder Law

NJ IMPACT: HEALTH CARE LAW DELIVERS FREE PREVENTIVE SERVICES TO 528,640 PEOPLE WITH MEDICARE IN NEW JERSEY

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Source: icepn.com

Poll: Do You Agree with Supreme Court Healthcare Ruling?

Stew – you are the guy that the politicians love. Nice, affable, fall into line with simple logic. It is quite the opposite – it is UNAFFORDABLE health care. As I outlined above, it is only affordable for those receiving it, because by and large the now uninsured aren’t paying for their own health care. You and I are, in the form of a myriad of higher taxes designed to mask the fact that you are paying welfare for someone else. Two portions of your payroll taxes rise, which in effect takes another 2-3% of your paycheck out of your hands. Capital gains taxes, FSA and HSA limitations…all money out of your pocket to pay for someone else. Conceptually, I applaud the safety net that civilized nations have, but do I really have to pay for ALL of the welfare benefits now given out. I mean, most people in Wayne are in the top 10% of wage earners nationally. Did you know that the top 10% are already paying something like 90% of all taxes nationally, and that the bottom 50% pay NO FEDERAL TAX at all? Essentially, every working person, particularly those making above say $60,000 per year, is carrying your own burden as well as one other person’s burden on your back. You are working almost entirely for someone else. Obamacare only adds to that exponentially. Please stop being so simplistic. This is what the power structure fees on – most of the public only understands soundbytes and trivial facts. Stew you’ve been hoodwinked.
Source: patch.com

Grandstanding Over Medicaid Begins in Florida, South Carolina

Nevertheless, this is a good argument for one of my favorite policy prescriptions: we should federalize Medicaid. There’s never really been any good argument for making it a joint state-federal program, and there are plenty of good arguments for taking this monkey off the backs of state budgets and letting the federal government run the whole thing, just like they do with Medicare. Now, with the Supreme Court imposing new limits on federal authority to manage joint programs, we have yet another argument for federalizing it.
Source: motherjones.com

N.J. Hospitals Face $97 Million in Med… ( Impact of New Payment Rule Could Reac…)

Related medicine news : 1. Security Officers Who Protect Kaiser Hospitals Rally With Community Supporters for Access to Affordable Healthcare 2. Minnesota Hospitals Pay $2.28 Million to Settle Medicare Fraud Charges Involving Kyphoplasty 3. Minnesota Hospitals to Pay U.S. $2.28 Million to Settle False Claims Act Allegations 4. Top International Hospitals Join Medeguide 5. Top Five Things Hospitals Need to do in Order to Remain Safe and Secure 6. CPM Resource Center and The Shams Group Partner to Help Hospitals Integrate Evidence-Based Clinical Content Into Information Systems 7. U.S. News Media Group Announces Americas Best Hospitals Video Series 8. Organ Donation Policies Vary Among Childrens Hospitals 9. Secretary of Health Unveils Pennsylvanias New Portable Hospitals in Lehigh County 10. Kaiser Foundation Health Plan and Hospitals Report First Quarter 2009 Financial Results 11. TouchPointCare Introduces TPC Transition Home to Help Hospitals Reduce Unplanned Readmissions
Source: bio-medicine.org

Horizon Blues chooses family friend for non

Horizon Blue Cross Blue Shield of New Jersey, the state’s oldest and largest health insurer, is a not-for-profit health services corporation, providing medical, dental, and prescription insurance products and services. Horizon BCBSNJ is an independent licensee of the Blue Cross and Blue Shield Association, serving 3.6 million members with offices in Wall, Mt. Laurel, and West Trenton, N.J.
Source: ifawebnews.com