The Best Health Insurance Companies

Posted by:  :  Category: Medicare

Grand Bargain Watch - Save Social Security by DonkeyHoteyBCBS Medicare Plan F offers several different benefits. It starts with the basic coverage that every plan has, such as Medicare Part A coinsurance for a full year after Medicare benefits cut off. Skilled nursing coinsurance is taken care of for an additional 80 days after the 20-day cutoff that Medicare pays for. It also pays for foreign emergency care after a deductible has been paid. It all sounds great, rightc This is what makes Plan F so popularits comprehensive coverage. However, this coverage has a deductible attached to it that makes Plan G look like an attractive alternative.
Source: healthinsurance-medical.com

Video: Medicare Supplement Plans – Medigap Questions Answered

Where you can Hunt for Medicare Supplement Estimates?

beauty quotes Medigap plans can be bought by way of individual insurance companies and are designed fill up the particular holes neglected by way of primary Medicare plans. Most of these plans aid write about the expenses involving Medicare-covered products and services including co-insurance, insurance deductibles or co-payments. A lot of the subjected location by way of primary Medicare is usually used treatment by way of Medigap plans. Those people who are going to your primary Medicare plus Medigap coverage, Medicare insures a great approved level of this treatment price after that the particular Medigap coverage pays their write about. beauty quotes Medicare benefit ideas such as a PPO or The hmo are methods to obtain advantages of Medicare whilst Medigap plans merely nutritional supplement the benefits of Medicare coverage. Despite the fact that, bought plus publicized by way of individual providers, Medigap plans ought to comply with guidelines developed by Federal and state government. Points to Understand When you invest in Medicare supplemental insurance Rates: Previous to any person try to find Medicare supplemental insurance estimates, he or she need to make sure that they’re already going to Medicare Element Some sort of plus Element M. Men and women, who’re going to swap out of Medicare benefit prefer to primary Medicare, ought to make application for Medigap until the finish on the insurance policy coverage. Plans Ourite, H, I plus L aren’t bought ever again, although folks are able to keep them if they are already going to them. Only 1 individual is often insured a single Medigap coverage, so in the event of married couple your wife and husband really need to pay for self-sufficient coverage. A strong covered with insurance body’s necessary to fork out individual prices pertaining to Medicare Element M plus Medigap coverage. Medigap top quality would go to in which you organization you are enrolled together with. Greatest time for you to try to find Medicare supplemental insurance Rates: A good time to search for estimates is appropriate until the start application time period pertaining to Medigap. Each year individual insurance companies change the Medicare supplemental insurance estimate, it’s the same better to investigation when you are intending to buy it, simply because then you will definately get the newest estimates. Insurance companies aren’t ready to utilize health care underwriting during this time period which suggests they are unable to go on the adhering to: Don’t register any person with Medigap coverage in good grounds involving health conditions. Charge any person over an gent who has absolutely no health conditions. Will make a individual wait until the insurance policy coverage may turn. The reason why investigation Medicare supplemental insurance estimates when you are primary suitable? Individuals who apply at subscribe to Medicare coverage following start application time period should experience health care exam out of doctors selected by way of the insurance broker. Anyone will also be energized over standard costs useful while in start application time period. beauty quotes As well as hardest, a criminal record can even be denied the policy by way of the insurance broker if it’s not happy with this outcomes of a criminal record. Therefore begin hunting for estimates just like you’re just about to develop into suitable and the start application time period will be in.
Source: blogspot.com

Health Insurance For Diabetics

Must be able to show that you can manage your condition. If you have type 1 or type 2 diabetes, it is important to be able to implement a reasonable plan for the management of diabetes. This is one of the factors that consider the life insurance companies in order to sell you coverage, and if you can show your blood sugar is well organized, is able to lead a healthy lifestyle and does not carry any complications arising from diabetes, you will not only get coverage, you will also get lower premium rates. Search for a policy that considers your overall health. Some health insurance policies do not focus on certain health conditions which may have at the time of the application. There are also those that consider your overall health.
Source: privatehealthinsurancespot.com

Downtown Bike Hounds: Ways Seniors Get Cheap Car Insurance

Drivers who are at least 50 years old and members of AARP are eligible for discounts from participating insurance companies. The exact amount of the discounts varies depending on the insurance provider’s guidelines. Keep in mind the age at which you qualify for the discounts is set by the insurance company. In other words, just because you are eligible to join AARP at 50 does not mean you automatically qualify for discounts offered to seniors if the discounts are contingent upon you meeting age requirements.
Source: blogspot.com

Doctors and Madicine: Medical Insurance Companies

AETNA     AFLAC     American Family Insurance     American Medical Security     American National Insurance Company     Anthem Insurance     Assurant, Inc.     Asuris Northwest Health     BlueCross BlueShield Association     Celtic Insurance Company     CIGNA     College Health IPA     Connecticare Inc.     Continental General Insurance Company     Golden Rule Insurance Company     Group Health Cooperative     Group Health Inc.     Harvard Pilgrim Health Care     Health Markets     HUMANA     Insurance Services of America     Intermountain Healthcare     Kaiser Permanente     LifeWise Health Plan of Arizona     LifeWise Health Plan of Oregon     LifeWise Health Plan of Washington     Medica Minnesota     Medical Mutual     Oregon Health Insurance     Oxford Health Plans, Inc.     Principal Financial Group, Inc.     Shelter Insurance     Unicare Health Insurance     UnitedHealth Group Inc.     Vista Health Plan     Walter Jarvis Insurance Services     WellPoint     WPS Health Insurance Read more: Health Insurance Company list of united states http://www.medindia.net/patients/insurance/health-insurance-companies/health-insurance-companies-united-states.htm#ixzz20GV73dgM
Source: blogspot.com

Underdog: Medicare for All…You Bet`Cha !

In another example of Democrats pre-emptively caving to Republican obstructionists and their insurance company lobbyist friends, the starting position for the Democrats was a compromise in the form of a public health care option that might compete side-by-side with private insurance plans.
Source: blogspot.com

Medical identity theft growing

Medical identity thieves may pose as employees of insurance companies, doctors’ offices, clinics, pharmacies and government agencies to get people to reveal personal information. Then, they use it to commit fraud, such as submitting false claims for Medicare reimbursement, according to FTC, which deals with identity theft cases.
Source: clarionledger.com

Your Affordable Care Act Rebate Can Save Lives

Obamacare will destroy the health insurance industry if no exceptions are made. If the 80/20 rule was the only impact on the health insurance companies, some of them would still manage to survive, but Obamacare removes both the ability of health care insurance companies to use risk to determine how much to charge and how much to pay out. This is the nail in the coffin for health insurance companies because they are no longer needed. There will be no private health insurance company except those who are facades for the government within a decade. The government will be the only health care insurance provider and will not be under the same strictures of being efficient that it places on private insurers. We will be in a worse situation in the long run in terms of the ratio of how much we pay goes into overhead. The really bad thing is that none of this deal with making health care actually sustainably affordable because the real driver for escalating health care costs is the year after year demand side subsidization of the health care industry by the government. Touching Medicare/Medicaid and related programs in a meaningful way is taboo, so either we fork out more for health care or we build up towards another massive economic crisis by having the government pay for it with debt.
Source: eclectablog.com

10 Ways To Lower Your Medical Bills

Health care spending accounts and Health Savings Accounts. Health care spending accounts and Health Savings Accounts let you deduct your contributions from federal, state and local income tax, as well as Social Security and Medicare taxes. Health care spending accounts allow you to designate how much comes out of your paycheck up to the maximum limit your employer sets. Health savings accounts allow you to save money in a specially designated account. Both allow you to use the saved funds toward qualified medical expenses tax free. Qualified services can include prescription drugs, co-payments, eyeglasses and more. The difference is with a health care spending account, you lose whatever you haven’t used each year. With a health savings account, you need an HSA qualified health plan, but you get to keep the money you haven’t used indefinitely.
Source: cheapmedicalinsuranceusa.com

Kent Bottles Private Views: Health Insurers & the PPACA: Extinction or Reinvention? Part II

As early as 2007 their subsidiary Ingenix bought The Lewin Group, a respected health policy think tank in Northern Virginia. A Lewin report in 2009 claimed to show that a public option would force 119 million Americans out of their private health plans and into the government sponsored plan. Although the Lewin report was shown to be faulty, the GOP used it to great advantage in excluding the public option from the final PPACA bill. (
Source: blogspot.com

NEW TO MEDICARE!! WHAT ARE MY OPTIONS »

Step #1:  Decide if you want “Original Medicare” or a Medicare Advantage plan.  Talk to your doctor and see which plan he/she recommends.  Many doctors are accepting “Original Medicare” and not Medicare Advantage plans.  If you have a doctor that is in the Medicare Advantage plan’s provider directory, make sure you call to verify that he/she is still accepting that particular Medicare Advantage plan.  Sometimes providers are in the directory, but stopped accepting the plan long before it went to print.  The main difference between “Original Medicare” and Medicare Advantage plans is “Original Medicare” works only with Medicare and generally, you or your supplemental coverage pay the deductibles or coinsurances.
Source: medicaretruths.com

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

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

What the Health Care Ruling Means for Medicare

Posted by:  :  Category: Medicare

"Citizenship is a tough occupation which obliges the citizen to make his own informed opinion and stand by it." ~ Martha Gellhorn  by eyewashdesign: A. GoldenAnd the gradual closing of the dread “doughnut hole” gap in Part D drug coverage by 2020 will proceed, bolstered by discounts that have already lowered drug costs. “The average Medicare beneficiary will continue to save an average $650 a year,” Max Richtman, who leads the National Committee to Preserve Social Security and Medicare, said in Thursday’s teleconference. “That’s real money, especially for seniors.”
Source: topangaparkassistedliving.com

Video: Medicare Provider, Assisted Living

Fla. Assisted Living Facility Owner Sent to Prison for $1.1 Million Medicare Fraud Scheme

The kickback scheme involved funneling patients to a fraudulent mental health provider, American Therapeutic Corporation, in exchange for illegal healthcare kickbacks. Denica, the owner of Robyll Care Assisted Living Facility, admitted she knew ATC falsely billed Medicare for partial hospitalization programs (PHP)—a form of intensive treatment for severe mental illness—based on her fraudulent referrals, court documents say. 
Source: seniorhousingnews.com

Tallassee Assisted Living, LLC Nursing Home

Nursing care facilities cater to several types of patients: some patients require short-term rehab while recovering from surgery; others require long-term nursing and medical supervision. In addition, some nursing homes offer specialized care programs for Alzheimer’s or other illnesses, or short-term respite care for frail or disabled persons when a family member requires a rest from providing care in the home. Please note that you can help compare nursing homes by looking at the Medicare ratings of a given facility (Medicare has a 5-star rating system for comparing nursing homes). There are various ways for paying for care in a nursing home. Make sure you know your loved one’s Medicare and Medicaid eligibility, and understand how you can use tools like long term care insurance to pay for nursing home care.
Source: ourparents.com

Medicare Assisted Living Benefits

Assisted Living is not covered by Medicare. Medicare, along with a Medicare Advantage plan or a Medicare Supplement, will partially pay for short term (100 days) skilled nursing at a facility (with restrictions). Medicaid will pay for assisted living but you need to qualify by having low income and little assets. If you have too much in assets you will be required to dispose of those assets (within limits) and pay what you can toward the assisted living. If you have too much income you will have to use all income (within limits) to pay then Medicaid will pay the balance.
Source: comforcare.com

Closing of MicAnd Assisted Living means residents will have to move

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Source: fredericksburg.com

Azalea Court Assisted Living Nursing Home

Nursing care facilities cater to several types of patients: some patients require short-term rehab while recovering from surgery; others require long-term nursing and medical supervision. In addition, some nursing homes offer specialized care programs for Alzheimer’s or other illnesses, or short-term respite care for frail or disabled persons when a family member requires a rest from providing care in the home. Please note that you can help compare nursing homes by looking at the Medicare ratings of a given facility (Medicare has a 5-star rating system for comparing nursing homes). There are various ways for paying for care in a nursing home. Make sure you know your loved one’s Medicare and Medicaid eligibility, and understand how you can use tools like long term care insurance to pay for nursing home care.
Source: ourparents.com

Grandview Estates Foster Home Assisted Living

Grandview Estates Foster Home 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

Assisted Living of Albertville

Assisted Living of Albertville 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

Westbrook Assisted Living, LLC

Westbrook Assisted Living, Llc, located in Geneva, Alabama provides the following services: Assisted Living and Micro-Community: Residential Care Facility. Westbrook Assisted Living, Llc has an average user review rating of 4 stars. Westbrook Assisted Living, Llc has an average hospital, Wiregrass Medical Center, located nearby, which scored a 72 out of 100 in its most recent Medicare review. The Westbrook Assisted Living, Llc’s nearest hospital is 1 miles away. The zipcode (36340) in Alabama, where Westbrook Assisted Living, Llc is located, has an average safety rating based on recent crime statistics. A more detailed description of the types of care for Westbrook Assisted Living, Llc can be found here.
Source: ourparents.com

Hueytown Retirement Lodge Assisted Living

Hueytown Retirement Lodge 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

Old Town Home Assisted Living

Old Town Home 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

Senior Citizens Nutrition Center Assisted Living

Senior Citizens Nutrition Center 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

South Dale Seniors Assisted Living

Also, South Dale Seniors is an in-home care provider. In Home care could be either medical (“skilled”) or non-medical (“custodial”) support services delivered at the home of the senior. “skilled” service providers who usually provide various medical care needs and “custodial” care providers who provide services for daily living such as bathing, dressing, and meal preparation but may also extend to assistance with transportation, paying bills, making appointments, and simply being there to provide companionship and emotional support. Home Care services are generally available 24 hours a day, seven days a week and are sometimes paid for directly by the client or through a variety of public and private funding sources such as Medicare and/or Medicaid. Make sure you know your loved one’s Medicare and Medicaid eligibility, and understand how you can use tools like long term care insurance to pay for in home care.
Source: ourparents.com

Oaks on Parkwood Assisted Living Facility Nursing Home

Nursing care facilities cater to several types of patients: some patients require short-term rehab while recovering from surgery; others require long-term nursing and medical supervision. In addition, some nursing homes offer specialized care programs for Alzheimer’s or other illnesses, or short-term respite care for frail or disabled persons when a family member requires a rest from providing care in the home. Please note that you can help compare nursing homes by looking at the Medicare ratings of a given facility (Medicare has a 5-star rating system for comparing nursing homes). There are various ways for paying for care in a nursing home. Make sure you know your loved one’s Medicare and Medicaid eligibility, and understand how you can use tools like long term care insurance to pay for nursing home care.
Source: ourparents.com

Homeland Assisted Living Facility, LLC Nursing Home

Nursing care facilities cater to several types of patients: some patients require short-term rehab while recovering from surgery; others require long-term nursing and medical supervision. In addition, some nursing homes offer specialized care programs for Alzheimer’s or other illnesses, or short-term respite care for frail or disabled persons when a family member requires a rest from providing care in the home. Please note that you can help compare nursing homes by looking at the Medicare ratings of a given facility (Medicare has a 5-star rating system for comparing nursing homes). There are various ways for paying for care in a nursing home. Make sure you know your loved one’s Medicare and Medicaid eligibility, and understand how you can use tools like long term care insurance to pay for nursing home care.
Source: ourparents.com

Why Many Find the Medicare Set

Posted by:  :  Category: Medicare

Running Amok Again by elycefelizLike most governmental programs, most everyone involved in Medicare set-aside arrangements as they pertain to Workers’ Comp probably end up confused and anxious. The process, which allocates a portion of a worker’s settlement from Workers’ Comp to go toward future medical expenses can be very complex even for those who are regularly involved in it. Should there be a failure to give Medicare notice of a settlement, steep penalties could result. Further, Medicare is not allowed to make payments which are legally the responsibility of another party. Worst of all, the injured employee could find themselves ineligible for Medicare if all issues were not dealt with properly when the settlement occurred. It is recommended that a set-aside agreement be engaged in which takes a percentage of the settlement from Workers’ Comp for impending medical expenses; once this amount is gone—and accounted for—Medicare will kick in for the injured employee.
Source: joshilaw.com

Video: Structured Medicare Set Aside

National Alliance of Medicare Set

It is a federal statute establishing that Medicare is the payer of last resort when a Medicare recipient is injured. Medicare’s responsibility to pay for the medical bills arising out of the injury is secondary to the party responsible for the injury. When the injured plaintiff recovers an award from a lawsuit or settlement, Medicare must be reimbursed for the portion that was for past medical expenses and set aside the portion for expected future medical expenses.
Source: oasislawfirm.com

Do I Need A Medicare Set Aside Agreement?

If you are considering closing your medicals for your work injury, you need to take into consideration Medicare’s interest .  Do you need a Medicare Set Aside agreement?  If the employee is a Medicare Recipient or is reasonably expected to become a Medicare Recipient within 30 months, you will have to have one.  There are other issues to consider so one must be careful when considering closing their medicals.
Source: hughesandcoleman.com

Federal Circuit Court Finds Part C Medicare Advantage :Gould & Lamb

The court also recognized that Congress’s goal in creating the Medicare Advantage program was to harness the power of private sector competition to stimulate experimentation and innovation that would ultimately create a more efficient and less expensive Medicare system. See, e.g., H.R. Rep. No. 105-217, at 585 (1997) (Conf. Rep.) (stating that MA program was intended to “enable the Medicare program to utilize innovations that have helped the private market contain costs and expand health care delivery options”). It was the belief of Congress that the MA program would “continue to grow and eventually eclipse original fee-for-service Medicare as the predominant form of enrollment under the Medicare program.” Id. at 638. The MA program was thus, like the MSP statute, “designed to curb skyrocketing health costs and preserve the fiscal integrity of the Medicare system.” Fanning v. United States, 346 F.3d 386, 388 (3d Cir. 2003).
Source: themedicarecomplianceblog.com

What Is The Medicare Set Aside?

The goal of Medicare is to aid provide insurance coverage for individuals who otherwise would find it dense or impossible to obtain it. The program is administered by the administration and many of its functions are contained specifically within the program. Tags:
Source: eduspeaks.com

Medicare Secondary Payer and “Future Medicals” A Movement Toward a Standardized Process?

Posted by:  :  Category: Medicare

CMS states that its interests should be considered in every settlement where the claimant, “reasonably anticipates receiving, or should have reasonably anticipated receiving Medicare covered…services after the date of “settlement…”.  To accomplish this purpose, CMS proposes options  ranging from absolute exemptions on one end of the spectrum (i.e., CMS defined a set of circumstances in which no further action would be necessary / no “set aside” required) to alternatives on the other end of the spectrum that involve a) the beneficiary paying for all future injury-related care out of his/her settlement proceeds until they are exhausted or b) submitting a proposed Medicare Set Aside arrangement (similar to the current process in workers’ compensation).With regard to the latter options, it is important to note that CMS acknowledges that perhaps thresholds could be established (i.e., a dollar amount below which no action is necessary even if one of the other exemptions do not apply).
Source: dritoday.org

Video: 2010 Consultation Coding Medicare as Secondary Payer (MSP)

Medicare Secondary Payer Statute: New Reporting Requirements For Products Liability And Toxic Tort Clients By Sharon Caffrey, Christopher Crosswhite and John Lyons

By-Lined Article MEDICARE SECONDARY PAYER STATUTE: NEW REPORTING REQUIREMENTS FOR PRODUCTS LIABILITY AND TOXIC TORT CLIENTS By Sharon Caffrey, Christopher Crosswhite and John Lyons December 8, 2009 New Jersey Law Journal Beginning January 1, 2010, extensive new Medicare reporting obligations will apply to insurance companies and other businesses, including products liability and toxic tort defendants that make payments to Medicare beneficiaries as a result of verdicts or settlements resolving liability claims. These organizations — known as Responsible Reporting Entities ("RREs") — will be required to report virtually all settlements, judgments, awards, and other resolutions of claims establishing responsibility for payments to Medicare beneficiaries, so that Medicare may determine whether it has a stake in any part of the payment. The reporting will also enable Medicare to refuse payment for future medical care relating to the injuries that were the subject of the liability claim. Failure to report may result in significant financial penalties against the RRE. Congress established these reporting obligations in Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 ("MMSEA"), codified at 42 U.S.C. Section 1395y (b)(8). Section 111 of MMSEA requires RREs to report any payment obligation to a Medicare beneficiary when the obligation results from a claim potentially involving past or future medical expenses. RREs must notify Medicare, regardless of whether there is an admission of fault, and must provide Medicare the total amount to be paid by the RRE — including compensatory and punitive damages, as well as payments made to spouses. Although Medicare will consider the allocation of damages agreed to by the parties or that made by a court, Medicare takes the position that it is not bound by these allocations and is free to recover amounts in excess of those designated for medical expenses by a court or settlement agreement. Organizations should immediately determine whether they are an RRE under the statute and, if so, promptly register with the Centers for Medicare and Medicaid Services ("CMS") and implement procedures to ensure that all payment obligations to Medicare beneficiaries established on or after January 1, 2010, are properly reported to CMS. Section 111 imposes substantial civil penalties on RREs that do not report payments to Medicare beneficiaries. The statute provides for penalties of up to $1,000 per day for each claim that an RRE does not report. Although the September 30 deadline for RREs to register with CMS has passed, RREs that missed the deadline can still register online. Uses of Information Medicare has indicated that it will use the information from RREs in two ways. First, Medicare will use it to recover benefits it had previously paid for the treatment of the injury for which a plaintiff was compensated. Although this right of recovery has existed since the 1980s, there has never been an efficient mechanism for Medicare to learn of payments to beneficiaries and initiate the recovery process. The new MMSEA reporting requirements are expected to significantly enhance Medicare’s ability to recover payments for medical care furnished to beneficiaries that receive compensation for their injuries. Additionally, RRE submissions will allow Medicare to more effectively deny payment on future medical claims related to the injury for which the beneficiary was compensated. RREs are initially required to provide a narrative description of the plaintiff’s alleged injury, but within two years will be required to provide ICD-9 diagnoses and cause of injury codes to CMS. This information will allow Medicare to deny claims that it determines are related to the prior injury and will likely have the effect of increasing settlement demands, as plaintiffs will no longer be able to assume that Medicare will pay their future medical expenses related to the injury. Although there has been no substantive change to Medicare’s right to deny future claims if a primary payer exists, Medicare has lacked until now a comprehensive database with the necessary information to recover past payments or deny new medical claims. Discovery Defense counsel should consider amending their interrogatories to determine, at the beginning of a case, whether a plaintiff is a Medicare beneficiary or when the plaintiff expects to begin receiving Medicare benefits. Interrogatories may also seek information about the plaintiff’s Medicare Identification Number, when Medicare entitlement began, and whether any claims for the plaintiff’s medical care related to the injuries alleged in the lawsuit have been paid by, or filed with, Medicare. Medicare has recognized that RREs, such as products liability defendants, will need a way to determine whether a plaintiff is a Medicare beneficiary, so CMS has developed a system that allows registered RREs to query a database of Medicare beneficiaries at any time. This is an important tool, and RREs should query the name of every plaintiff through the Medicare beneficiary database periodically and, most importantly, at the time when a settlement is negotiated or a verdict is reached. For latent diseases, such as asbestos-related conditions, the new reporting requirements increase the importance of determining the dates of exposure to the allegedly toxic substances. CMS has determined that only claims resulting from at least one post-December 5, 1980, exposure are reportable under the MMSEA requirements. Therefore, defense counsel should use discovery to determine the exact dates of exposure, but the significant penalties for failing to report a claim suggest that defendants should err on the side of caution and report all claims where the dates of exposure are ambiguous. Settlements At this time, there are concerns about the confidentiality of settlement agreements, as Medicare regulations require that the existence and amount of all settlements be reported, regardless of whether the parties kept the agreement confidential. Although some commentators have speculated that settlement amounts may be available via Freedom of Information Act requests, there is no precedent suggesting that Medicare would voluntarily turn over this information. Such data may be protected from routine disclosure by CMS under the Health Insurance Portability and Accountability Act and the Privacy Act. Rather, a bigger concern is that the terms of a confidential settlement may become public if Medicare is required to take legal action to recover payments it made prior to the settlement. Medicare would likely use the settlement amount and other information reported to CMS by the RRE, and possibly the settlement agreement itself, if available, as evidence in its suit. It is also possible that the information reported by a RRE could be made public during a Medicare beneficiary’s administrative appeal or lawsuit contesting a denial of benefits based on a submission of an RRE. The new MMSEA reporting requirements will also likely make it difficult for defendants to settle claims where Medicare has already paid a significant amount towards the plaintiff’s medical care for the injury that is the subject of the litigation. This might be especially true in instances where the plaintiff has significant injuries but the defense on causation is strong and the defendant has been willing only to make a negligible settlement offer to resolve the matter. Plaintiffs may also be unwilling to settle claims if there is a possibility of significant ongoing medical expenses, as Medicare will know of the settlement and will likely refuse to pay any claims relating to the injury that was the subject of the settlement. In these cases, plaintiffs may prefer to try the case, hoping that Medicare will respect the allocation made by a judge or a jury between medical expenses and compensatory damages, punitive damages, loss of consortium, etc. The MMSEA Section 111 User Guide by CMS currently states that "[t]he CMS is not bound by any allocation made by the parties even where a court has approved such an allocation. The CMS does normally defer to an allocation made through a jury verdict or after a hearing on the merits." (CMS MMSEA Section 111 Medicare Secondary Payer Mandatory Reporting User Guide, at 76). Plaintiffs may begin to try cases where there is the prospect of significant future medical expenses, as it is possible that Medicare will begin paying for medical claims related to the suit after the verdict’s allocation for future medical expenses is exhausted. If there are any prior payments by Medicare relating to the injury that was the subject of the suit, then attorneys on both sides should ensure that the Medicare right of reimbursement is satisfied before the plaintiff receives any money. Every settlement agreement should clearly delineate which party is responsible for confirming the amount of any Medicare payment and reimbursing this amount in its entirety — typically the plaintiff is in the best position to do so. Defendants should ensure that any Medicare right of reimbursement related to the injury alleged in the suit is satisfied in full, since CMS takes the position that the Medicare primary payer ultimately remains liable for any unpaid Medicare lien. MMSEA imposes significant, and expensive, burdens on products liability and toxic tort defendants, as well as their insurers. As there are significant financial penalties for noncompliance, all organizations should immediately determine if they are an RRE under the statute. If so, RREs should immediately register with CMS and take the necessary steps to ensure that they are able to comply with the reporting requirements by January 1, 2010. Sharon Caffrey is a partner in the Philadelphia office of Duane Morris and is the co-head of the products liability and toxic torts division of the firm’s trial practice group. Christopher Crosswhite is a partner in the health law practice group in the Washington, D.C., office. John Lyons is an associate in the trial practice group in the Philadelphia office. This article originally appeared in the New Jersey Law Journal and is republished here with permission from law.com.
Source: jdsupra.com

No allocation of Medicare secondary payer claim in PI case

The administrative law judge and the district court rejected that argument and required full reimbursement. The 6th Circuit appellate court affirmed. The court found that the key language under Medicare’s secondary payer statute, 42 U.S.C. § 1395y(b)(2)(B)(ii), was the primary plan’s (Pennyrile’s) responsibility to make payment. The court noted that the 2003 amendments to the statute defined that term. The court found that the scope of the plan’s “responsibility” for the beneficiary’s medical expenses, and the beneficiary’s own resulting obligation to reimburse Medicare, is ultimately defined by the scope of the beneficiary’s own claim against the third party. That was true even if the beneficiary later compromised as to the amount owed on the claim, and even if the third party never admitted liability. The court stated that Hadden did not demand that Pennyrile pay for only 10 percent of his medical expenses incurred as a result of his accident; he demanded that Pennyrile pay for all of the expenses. The court found that choice had consequences, one of which was that Hadden had to reimburse Medicare for those same expenses. (From NAELA eBulletin)
Source: lienresolutiongroup.com

THIRD CIRCUIT HOLDS THAT MAOs HAVE A PRIVATE RIGHT OF ACTION AGAINST PRIMARY PAYERS UNDER THE MSP ACT

On appeal, the Third Circuit reversed the judgment of the district court. The key issue before the court was whether 42 U.S.C. § 1395y(b)(3)(A), the MAO secondary payer provision, grants a private right of action to Humana.  Examining this provision, the court held that its plain text “establishes a private cause of action for damages . . . in the case of a primary plan which fails to provide for primary payment . . . in accordance with” the MSP Act. Specifically, the court reasoned, the MAO secondary payer provision is broad enough to encompass an MAO such as Humana. GlaxoSmithKline’s argument that the MAO secondary payer provision does not incorporate the entirety of the MSP Act was unavailing because the MAO provision itself provides a cause of action, not its reference to the MSP Act. The court noted that prior decisions failed to reach this point because they merely examined the MA provisions of the Medicare Act, not the text of the MAO secondary payer provisions.
Source: themedicarespa.com

Medicare Secondary Payer Recovery Portal is Live

This Blog/Web Site is made available by the publisher for educational purposes only as well as to give you general information and a general understanding of the law, not to provide specific legal advice. By using this blog site you understand that there is no attorney client relationship between you and the Blog/Web Site publisher. The Blog/Web Site should not be used as a substitute for competent legal advice from a licensed professional attorney in your state.
Source: wordpress.com

The Official Medicare Set Aside Blog And Information Resource: MSPRC announcement regarding The Medicare Secondary Payer Recovery Portal (MSPRP)

MEDVAL, LLC provides pre-settlement and post-settlement services for high exposure workers’ compensation and liability claims that require Medicare’s interests to be protected pursuant to 42 USC 1395y(b)(2). As the first firm in the country to provide a fully integrated, one-stop solution for the Medicare Set-Aside process, we can recommend Medicare Set-Aside arrangements, submit them to the Centers for Medicare and Medicaid Services (CMS) for approval, provide annuity and lump sum funding options, provide post-settlement medical trust administration, and pharmacy benefit management to our clients all under one umbrella.
Source: medicaresetasideblog.com

The Medicare Secondary Payer Act: Ethical Considerations in Settling Cases

Before the MSP Act became a major issue in workers’ compensation and other cases involving personal injuries, attorneys were often not mindful of their obligations under the act and its potential ethical ramifications. Prior to the year 2000, a number of jurisdictions issued advisory opinions regarding the conduct of lawyers with respect to the settlement of liability or workers’ compensation claims, or both, and the resolution of unpaid liens for medical providers as a condition of settlement. However, these advisory opinions were short and vague. For example, in 1996, the state of North Carolina issued a rather benign statement indicating that lawyers in a personal injury claim may not execute an agreement to indemnify the tortfeasor’s liability insurance carrier against unpaid liens for medical providers.
Source: mnbenchbar.com

National Alliance of Medicare Set

It is a federal statute establishing that Medicare is the payer of last resort when a Medicare recipient is injured. Medicare’s responsibility to pay for the medical bills arising out of the injury is secondary to the party responsible for the injury. When the injured plaintiff recovers an award from a lawsuit or settlement, Medicare must be reimbursed for the portion that was for past medical expenses and set aside the portion for expected future medical expenses.
Source: oasislawfirm.com

H.R.5284: Medicare Secondary Payer and Workers’ Compensation Settlement Agreements Act of 2012

4/27/2012–Introduced.Medicare Secondary Payer and Workers' Compensation Settlement Agreements Act of 2012 – Amends title XVIII (Medicare) of the Social Security Act to: (1) create an exception to Medicare secondary payer requirements for certain workers' compensation settlement agreements, and (2) provide for the satisfaction of such requirements through use of qualified Medicare set-asides under workers' compensation settlement agreements.
Source: opencongress.org

Medicare Second Payer Act Will be Topic at Workers’ Compensation Educational Conference

Ongoing registration for the 2012 gathering reflects the global perspective of the conference, with an expected 8,000 participants from over 35 states and a number of foreign countries. The conference itself has been expanded to four days to accommodate the several hundred speakers presenting discipline-specific programs, break-out sessions and CEU opportunities. Of particular interest are a National Trends’ program featuring three national medical directors; a Risk Managers’ break-out paneled by two insurance company presidents; and a two-day “Center for Excellence: The Study of Medical Cost Drivers in Workers’ Compensation,” sponsored by Liberty Mutual. Additionally, more than 300 exhibitors will present information on their products and services.
Source: briefingwire.com

Workers' Rights Law Blog

This case involved detailers who alleged that they were entitled to overtime wages when they worked over forty hours per week. The pharmaceutical sales industry is highly regulated. In particular, federal law restricts who can sell prescription drugs. Instead of actually selling the prescription drugs — because it is illegal for them to do so — the detailers call on physicians, seeking to get them to make a “nonbinding commitment” to prescribe, in appropriate cases, the drugs sold by the detailers’ employer. Each week, the petitioners spent approximately forty hours in the field calling on physicians, plus another ten to twenty hours attending events and engaging in other ancillary tasks. They were paid a base salary, plus incentives that were based on the sales of drugs their territory, but they were not paid overtime wages.
Source: galaneslaw.com

DRI MSP Task Force Advisory: The Third Circuit Finds Medicare Advantage Plans Afforded the Same Right of Private Action as Medicare under the Medicare Secondary Payer Act

Humana filed its complaint based on the claim that under the MSP it was granted secondary payer rights and thus it was entitled to reimbursement for covered expenses it paid related to Claimants in the Avandia MDL action.  Humana also sought equitable relief in the form of an order compelling GSK to identify settling Avandia claimants to MAOs who may have covered them.  In dismissing the complaint, the district court determined that:  (1) Medicare’s private right of action set forth in 42 U.S.C. § 1395y(b)(3)(A) does not apply to MA Plans; (2) the secondary payer provisions of the Medicare Advantage program, (found in 42 U.S.C. § 1395w-22(a)(4)), did not create a private cause of action (either express or implied); (3) the MA statute’s silence on the existence of a private cause of action for MAOs was not ambiguous, but rather indicative of Congressional intent to not create a private cause of action for MAOs; and (4) absent any such ambiguity there was no need to defer to a CMS regulation that granted MAOs parity with Medicare.  Finally, the district court denied Humana’s request for equitable relief to order GSK to disclose information about settlements that Humana’s enrollees entered into with GSK, holding that Humana, not GSK, had access to information about which Avandia claimants were enrolled in Humana plans and could act accordingly to remind its enrollees of their obligations to disclose any settlement they might reach with GSK.
Source: forthedefense.org

Mo. To Change Medicare 'Spend Down' Rules

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 marsmet524Alyson Campbell, the director of the Department of Social Services’ Family Services Division, told lawmakers that, in some cases, department staff had been incorrectly giving credit for the full amount of a person’s medical bill – even if parts of it were paid for by Medicare or private insurance or were written off altogether by the person’s medical provider. That means some people in the program might have received Medicaid coverage for which they were not truly eligible.
Source: kmbc.com

Video: Missouri Medicare Supplement Insurance Plans

Medicare Fraud: Lebanon Mo. Therapist Claims He Worked Everyday Except Christmas for 3 Years

McCarty is a licensed psychologist and private practitioner who provided psychotherapy services to recipients of both Medicare and Medicaid in their homes in the Lebanon area. The federal indictment alleges that since Aug. 22, 2008, McCarty has submitted Medicare and Medicaid claims for at least 19 beneficiaries for which he was paid $1,276,334.
Source: jameshoyer.com

#Family Dental St. Peters Mo

If you are receiving Medicare and/or Medicaid, it can often be difficult to find a doctor, be it a general practitioner or specialist, who will accept your insurance. Unfortunately the payment schedules set up by the government have resulted in many doctors opting out of the system because they simply cannot afford the substantially lower payments for Medicaid/Medicare services as well as afford to pay for the substantially greater paperwork involved in taking such patients.
Source: blogspot.com

AG Koster announces settlement with Walgreens over gift cards

Nationally, Walgreens will pay participating states and the federal government $7.9 million in civil damages for the Medicaid, Medicare, TRICARE, and Federal Employees Health Benefits programs. This amount is based on the total amount Walgreens offered in gift cards and gift checks. Medicaid programs nationwide will receive $643,230 of the settlement, with the rest going to other federal programs.
Source: mo.gov

Huntsboro Senior Citizen Center Senior Community

How Do I Begin The Search For Care Options?What are the different options, and when are they viable options to consider?How do i know if my loved one is suffering from alzheimer’s disease?What assistance is available to help pay for care?What does medicare cover?How do i talk with my parents about making a transition?How to manage the family stress levels during this period?Are there any alternative options available for care?When does in-home care care make sense?What to look for, and how do i interview a care provider?
Source: ourparents.com

Head Of CT Health Exchange Explains How People Will Shop For Insurance

Posted by:  :  Category: Medicare

it has all of the GOVERNMENT OPTIONS, but will they really tax the CADILLAC health plans? by roberthuffstutterWhat should happen, if everything works right, is that if I’m coming in as Kevin Counihan, and I put in my information and my residency and my family status and my income and the other types of information, and I press a button, this information shoots in real time to these variety of different interfaces [an information hub that connects federal agencies]. Those interfaces in real time are going to match my income up. They’re going to match my residency, my incarceration status, my family size, get that verified, shoot that back and say, ‘Kevin, you’re not eligible for Medicaid, you’re not eligible for subsidized insurance. However, you’re eligible for unsubsidized coverage and here are five health (insurers) in your zip code that offer coverage.’ From that, they’ll be divided into tiers (platinum, gold, silver and bronze to signify the quality of benefits offered). The idea is these five carriers will come back and say, ‘In Kevin’s zip code you’ve got these five carriers and they’re offering the following products in the platinum area, in the gold, in the silver and in the bronze. Why don’t you pick on three of them and see what they look like?’
Source: courant.com

Video: Know the TRUTH about the Government Health Care Bill HR3200 – Key Points

Supreme Court Decision Puts Health Plans Under Fire To Complete ACA

A board certified labor and employment attorney widely known for her extensive and creative knowledge and experienced with these and other employment, employee benefit and compensation matters, Ms. Stamer continuously advises and assists employers, employee benefit plans, their sponsoring employers, fiduciaries, insurers, administrators, service providers, insurers and others to monitor and respond to evolving legal and operational requirements and to design, administer, document and defend medical and other welfare benefit, qualified and non-qualified deferred compensation and retirement, severance and other employee benefit, compensation, and human resources, management and other programs and practices tailored to the client’s human resources, employee benefits or other management goals.  A primary drafter of the Bolivian Social Security pension privatization law, Ms. Stamer also works extensively with management, service provider and other clients to watch legislative and regulatory developments and to deal with Congressional and state legislators, regulators, and enforcement officials about regulatory, investigatory or enforcement concerns.
Source: slphrbenefitsupdate.com

College Health Plans: Exploring The Options

Starting this year, the health law requires many student plans to meet most of the standards applied to policies sold by insurers to individuals, including coverage of a set of preventive services without a co-pay and a phased-in ban on annual dollar limits, which many plans previously used to keep prices down.  Many plans that provide limited coverage are raising their premiums as much as 50 percent to comply with the new law’s requirements for coverage, according to Stephen Beckley, a student insurance consultant and co-organizer of the Lookout Mountain Group, an organization of college health professionals. Right now, prices of those skimpy plans are typically $400 to $620 per year.
Source: kaiserhealthnews.org

Denver Broncos and Rocky Mountain Health Plans Caravan Across Colorado

Attendees will have the opportunity to participate in a Rocky Mountain Health Plans Training Camp where participants of all ages can test sills in football-style workouts and participate in workouts seen at the NFL Combines. These workouts will include activities like the vertical jump, 40-yard sprint time, and much more. Participates will also have the opportunity to sign a Wellness Pledge. Upon signing, they will be entered to win a “Broncos dream weekend” courtesy of the Denver Broncos.
Source: rmhp.org

What to Do with MLR Rebates under Employer

The Patient Protection and Affordable Care Act (the “Act”) imposes on health insurance issuers or carriers Medical Loss Ratio (MLR) standards which dictate that a certain proportion of the carriers’ income be spent on medical care and quality improvement activities. Insurance… Read More…
Source: lexisnexis.com

Employee Mistakes with Healthcare Plans

Workers also err on deductibles. They tend to avoid plans with high deductibles, even though they may end up spending more on plans with lower deductibles but higher premiums. A person may not want a plan with a $1,200 yearly deductible, but may actually end up paying more than that over the course of the year in premiums. Benefits managers can help here again by calculating the comparative costs and showing them to the employee so that he or she can see the difference.
Source: baysidesolutions.com

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Posted by:  :  Category: Medicare

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Source: wessharp.com

Video: Learn About Medigap Plans

Medigap Advisors Hosts Live Questions and Answers after Healthcare Reform Ruling

Long says, “Millions of newly insured people will be wanting to take advantage of their low-cost benefits, so Medicare actuaries are predicting doctor shortages.” He is concerned that healthcare reform encourages doctors to form Accountable Care Organizations or ACOs. Long warns beneficiaries: “You will not necessarily see the same doctor at each visit, and you will probably not be allowed to get care from doctors outside of the ACO. Because of the way that ACOs are compensated, there are incentives for them to provide less service. It is your responsibility to take an active role in your care, to ask questions and demand the treatment you feel you deserve.”
Source: medigapadvisors.com

Is it Time to Check Your Medigap Rate? — The Senior Gazette

A client recently contacted me because she felt like the insurance company from which she was purchasing her Texas Medicare supplemental insurance was no longer competitive.  Her rates, like most, had gone up.  But one thing she had failed to do when she first purchased her Texas Medigap plan was to really shop around.  Unfortunately, when a person is turning 65 they get inundated with such a large amount of information about Medicare and Medicare insurance that many just block it all out and go with what they know.  They often stick with an insurance company with which they are familiar and purchase from them. Sticking with the familiar is often the easiest course of action. When you already feel confident in a company you can throw all that mail in the trash.  That is what this lady from Texas had done, until she became aware that she was paying too much for her insurance.
Source: theseniorgazette.com

Mutual of Omaha Medigap Rate Increases

2)  In June of this year, “modernized” Medicare Supplement plans began. With changes required for new “modernized ” plans,  each Medicare Supplement company was starting over with a “new book of business” as of June 1.  This meant that premiums for plans starting in June 2010 could be lower because they had no claims history.  But the older plans – sold before June 2010 – now have no new, younger, healthier members paying premiums.  Plans with older, sicker  people will likely have higher expenses and lower profits, requiring higher premiums next year.
Source: georgia-medicareplans.com

5 Questions you should Ask Before Purchasing a Medigap (Medicare) Policy

The first step in purchasing a Medigap Policy is to review a government published guide, such as Choosing a Medigap Policy, and decide which of the 11 standardized plans fits your lifestyle and needs. If you want a policy that covers all the “gaps” that Original Medicare does not cover choose Plan F. However, if you are more concerned about a lower monthly premium, then consider a High Deductible Plan F or plans like K or L, which only provide partial payment for your doctor visits.
Source: inzinearticles.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

Excellus Medicare Part D plans gets top rating

Posted by:  :  Category: Medicare

Excellus BlueCross BlueShield’s Simply Prescriptions Medicare Part D drug plan has won plaudits from the Centers for Medicare and Medicaid Services as the only stand-alone Part D program in New York, and one of three nationally, to win CMS’ five-star rating.
Source: townstart.com

Video: Excellus BCBS Medicare plan travels with you

Excellus BlueCross BlueShield Emphasizes Fitness For Seniors

Any American who is 65 years old or older has access to Medicare, but only covers a limited amount of health care costs. That’s why many seniors purchase Medicare Supplement plans from private insurance companies to fill in the coverage gaps.
Source: gohealthinsurance.com

AG office to sue Excellus Blue Cross Blue Shield (News

AG office to sue Excellus Blue Cross Blue Shield (News 10 NBC Rochester) Attorney General Andrew Cuomo’s office will sue Rochester-based insurer Excellus claiming it defrauded consumers… Blue Devils beat Tigers (Ravalli Republic) CORVALLIS – Blue Devil Dalton Sybrant posted 31 points as the Corvallis boys earned a nonconference 88-48 win over the visiting Darby Tigers Thursday. Mountain State Blue Cross Blue Shield CEO to give up daily duties on July 1 (The Charleston Gazette) PARKERSBURG, W.Va. — The president and chief executive of West Virginias largest private health insurer plans to leave that post on July 1.Gregory K. Smith led Mountain State Blue Cross Blue Shield for the past 15 years. In July, Smith will become the non… Frustrations mount as hospital remains locked in insurance battle with Blue Cross (Rapid City Journal) Spearfish Regional Hospital and Wellmark Blue Cross and Blue Shield still don’t have a contract, despite growing frustration from the community and help from a consultant.
Source: medicare-news.com

Involuntary Changes to MCSO Retirees Medical Benefits

A retired MCSO Deputy began receiving various documents from the Monroe County Human Resources Department. The documents advised him that form(s) enclosed with the documents had to be completed by his 65th birthday or he would lose all of his medical benefits. When the retired Deputy reached the age of 65, he received more written correspondence from the Monroe County Department of Human Resources concerning his medical benefits coverage for both himself and his spouse; specifically, that his primary care coverage was changed to Medicare (we have been informed/advised that this happens to everyone). Furthermore, the Deputy’s secondary coverage was involuntarily changed to Excellus Medicare Blue Choice (HMO-POS). For over fifty years, it has been customary for retirees to remain in the same plan throughout the length of their retirement; this, however, seems to no longer be the case. Secretary Flannery advised SOAR President Ed Ramsperger of the situation and also spoke with Monroe County Deputy Sheriff’s Association (MCDSA) Jail Union President Wayne Guest. President Guest felt that this was a very important issue and invited Secretary Flannery and President Ramsperger to the next Jail Union Board meeting to discuss the matter. The retired Sheriff’s Deputy who originally contacted Secretary Flannery was also invited to share his experiences at the meeting. At the Jail Union Board meeting, this topic was discussed and the Jail Union Board voted unanimously to “take on” the matter and begin a dialog with the Monroe County administration to determine just what was happening and how to get the matter solved to the satisfaction of all involved.
Source: monroecountysoar.com

Broome County Health Department Announces 2011

The clinics are open to anyone ages three and up. The fee for the flu vaccine is $25 (cash or check only). If you are 65 years of age or older and subscribe to traditional Medicare Part B, Excellus Medicare Blue PPO, Today’s Options or CDPHP Medicare the health department will bill your insurance plan. Pneumonia shots will also be offered at the flu clinics for Medicare Part B recipients age 65 and older. If your children’s immunizations are covered by medical insurance, parents are advised to seek flu shots for them at their regular medical provider. This can help cut down on out of pocket costs, especially for children who require a second dose of the vaccine because of their age. Children 6 months through 8 years of age who did not receive at least one dose of the 2010-2011 vaccine, or whom it is not certain whether the 2010-2011 was received, should receive 2 doses of the 2011-2012 seasonal vaccine.
Source: gobroomecounty.com

Do I Need Medicare Parts B And C If I’m A Federal Retiree?

While enrolling in Medicare Part B is optional, a federal retiree may consider it a wise choice. An FEHB plan will sometimes waive deductibles, coinsurance and co-payments for federal retirees with Medicare Part B. Medicare Part B covers services that an FEHB may not, such as home health care, medical supplies, durable medical equipment and orthopedic/prosthetic devices. Federal retirees must be currently enrolled in Medicare Part B before getting Medicare Part C. A federal retiree with Medicare Part C will benefit from reduced premiums, but may have to visit doctors or providers in a specific network and have higher out-of-pocket expenses.
Source: seniorcorps.org

OIG Report Signals Likelihood of Increased Scrutiny of Evaluation and Management Coding

Posted by:  :  Category: Medicare

Bubbles? Take something like 'Not I! .....item 1..Wakulla Republicans Protest Against Taxes in the County (September 06, 2011) ... by marsmet552By Neil W. Hoffman, Ph.D. On May 8, 2012, the Office of Inspector General of the U.S. Department of Health and Human Services (OIG) published its first in a series of reports on evaluation and management (E/M) services billed under Medicare Part B.[i] As described in this initial report, the OIG reviewed E/M coding trends by physicians from 2001 to 2010. The OIG also identified those physicians who consistently billed more complex and expensive (i.e., higher-level) E/M codes in 2010. The OIG found that, from 2001 to 2010, physicians increased their billing using higher-level E/M codes across all types of E/M services. From 2010 data, the OIG identified approximately 1,700 physicians who consistently billed using higher-level E/M codes. These physicians practiced in nearly all states and were of similar specialties. They also treated Medicare beneficiaries of similar ages and having similar diagnoses as those treated by other physicians. The OIG made no determination in this study as to whether such E/M claims were inappropriate, but it indicated that, in subsequent evaluations, it will do so. Accordingly, physicians can anticipate increased scrutiny of claims for E/M services, particularly where consistent use of higher-level codes is apparent from Part B claims data. Reasons for the Study Increasing payments for E/M services was one reason for this study. Between 2001 and 2010, the OIG reported a general increase in Medicare Part B payments from $77 billion to $110 billion (a 43 percent increase). However, Part B payments for E/M services increased from $22.7 billion to $33.5 billion (a 48 percent increase) over this same period. Also during this period, the number of E/M services billed increased from 346 million to 392 million (a 13 percent increase), and average Medicare payment per E/M service increased from $65 to $85 (a 31 percent increase). The OIG’s belief that E/M services are vulnerable to fraud and abuse was another reason for this study. The OIG cited that, in 2009, two providers paid more than $10 million in settlement of allegations of fraudulent Part B billing for E/M services. The OIG also cited a finding of the Centers for Medicare & Medicaid Services (CMS) that, of all Medicare Part B services, a disproportionate number of improper payments have been made for certain E/M visit types. Reported Findings
Source: physiciansnews.com

Video: Medicare Supplement Plans – Changes for 2010

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

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

Dold, Schneider Spar on Medicare

Rep. Dold voted, twice, for a plan that ends Medicare as it exists today for those under 55. Don’t pay attention to what he says – look at his votes: he voted twice for the Ryan budget; if the Senate and Executive branches had been Republican, it would be law. Period. If you look at the specifics of the plan, you will see there is nothing moderate about it. He can say he supports many more moderate plans all day long, but I would only believe those words if they were backed by principled votes against the Ryan plan. The proposed Wyden-Ryan was not passed by the house – the Ryan Plan was. Mr. Dold, you will be held to account for your deeds, not your words.
Source: patch.com

Major Changes Coming to Physician Reimbursement

The proposed rule also includes steps to better align definitions, measures, and quality reporting requirements across various programs, such as the Physician Quality Reporting System, the eRx Incentive Program, the Medicare and Medicaid EHR Incentive Programs, and the Medicare Shared Savings Program.
Source: physicianspractice.com

Patient Protection and Affordability Care Act of 2010 & Medicare Part D :Gould & Lamb

About the Author: William F. Bell, Jr. is the Senior Clinical Pharmacy Specialist for Gould & Lamb, LLC. His primary responsibility is the review of a claimant’s pharmacotherapy regimen and the identification of off-label medications in a Medicare Set Aside Allocation. He has given numerous presentations on the subject of medication management and how it relates to Workers’ Compensation and Medicare Set Aside Claims. Bill has also authored two continuing education articles for the Pharmacist’s Letter, a nationally known education resource for practicing pharmacists.
Source: themedicarecomplianceblog.com

Changes to Medicare Upheld by the Supreme Court Ruling on the Affordable Care Act

New dates for Medicare’s Annual Enrollment Period (AEP) – During AEP, Medicare beneficiaries have the option to review and change their Medicare Part D and/or Medicare Advantage health coverage prior to the coming plan year when new plan benefits go into effect. Prior to the passage of the ACA, Medicare’s AEP began on November 15 and ended on December 31. But, the ACA changed those dates for the 2012 plan year. The 2012 AEP began on October 15 and ended on December 7, 2011. These dates are currently in place for all AEP’s going forward.
Source: ehealthinsurance.com

Daily Kos: The return of the Republican Medicare frauds

Beginning 2023, the guaranteed Medicare benefit would be transformed into a government-financed “premium support” system. Seniors currently under the age of 55 could use their government contribution to purchase insurance from an exchange of private plans or traditional fee-for-service Medicare. But the budget does not take sufficient precautions to prevent insurers from cherry-picking the healthiest beneficiaries from traditional Medicare and leaving sicker applicants to the government. As a result, traditional Medicare costs could skyrocket, forcing even more seniors out of the government program. The budget also adopts a per capita cost cap of GDP growth plus 0.5 percent, without specifying how it would enforce it. This makes it likely that the cap would limit the government contribution provided to beneficiaries and since the proposed growth rate is much slower than the projected growth in health care costs, CBO estimates that new beneficiaries could pay up to $2,200 more by 2030 and up to $8,000 more by 2050. Finally, the budget would also raise Medicare’s age of eligibility to 67. Again, the specifics may vary, but Mitt Romney’s prescription for Medicare is essentially the same poison pill as the “Ryden” model. As the New York Times documented in November: Mr. Romney’s proposal would give beneficiaries the option of enrolling in private health care plans, using what he, like Mr. Ryan, called a “premium support system.” But unlike the [original] Ryan plan, Mr. Romney’s would allow older people to keep traditional Medicare as an option. However, if the existing government program proved more expensive and charged higher premiums, the participants would be responsible for paying the difference. Which brings us to the final irony of the Republican Medicare frauds. The only potential bright spot#&151;and it’s a small one if indeed it is one at all#&151;in the premium support plan backed by Paul Ryan and Mitt Romney is that their proposals in essence endorse the approach of the Affordable Care Act Republicans so loathe. As Ezra Klein explained, “Paul Ryan and Ron Wyden want to bring Obamacare to Medicare”: But the secret of these types of premium-support platforms is that they are, in essence, a vindication of the Affordable Care Act. The cost containment is supposed to come through competition between plans, and works like this: “All plans, including the traditional fee-for-service option, would participate in an annual competitive bidding process to determine the dollar amount of the federal contribution seniors would use to purchase the coverage that best serves their medical needs. The second-least expensive approved plan or fee-for-service Medicare, whichever is least expensive, would establish the benchmark that determines the coverage-support amount for the plan chosen by the senior. If a senior chose a costlier plan than the benchmark, he or she would be responsible for paying the difference. Conversely, if that senior chose a plan that cost less than the benchmark, he or she would be given a rebate for the difference.”
Source: dailykos.com

www.medicare.com website value, information, statistics ,keywords, traffic, and earnings

Posted by:  :  Category: Medicare

Statout.com estimate that medicare.com makes $30 per day and is worth about $22,662. Medicare.com is hosted in San Antonio, United States, has a Google Pagerank of 5, is active on the IP 72.32.146.26 and receive about 16,656 Page(s) View per day. The current Alexa ranking is #333,118. Medicare.com has an age of 16 years 230 days and its listed in Dmoz directory.
Source: statout.com

Video: The Centers for Medicare & Medicaid Services (CMS) Korean Language Video

Find Child Care Options Near You and Get Help Paying for Them

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Source: medicarecard.com

MEDICARE SUPPLEMENT RATE INCREASES

Summer brings us sunshine, heat and Medicare Supplement Rate Increases!  There are many options out there so you really should shop when facing a substantial rate increase.  Right now we have two different carriers who have come out to the market with new rate pools at about 20% less than everyone else. 
Source: medicaremazeadvisors.com

Why Did I Lose My Medicare Part D? »

handbook, the new Medicare rule was first explained and Social Security sent out letters informing Medicare beneficiaries that they would have additional premium including the Part D prescription drug premium.  The new IRMAA (Income Related Medicare Adjusted Amount) rule has never really been publicized and only if your income is higher can you be affected.  IRMAA states that if your income is above $85,000 for an individual or $170,000 for a couple, then, you may pay an income related adjustment amount (additional monthly premium), in addition to your Medicare prescription drug premium.  The IRMAA Part D premium can range from $11.40 to $66.40 which is based on your reported income.
Source: medicaretruths.com