Medicare Fraud Protection Tips from Cleveland Medicare Fraud Attorney

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 marsmet524In addition, there are certain things that a supplier, healthcare provider, or doctor may do that should also raise suspicions. For instance, if you are offered free equipment or services, but then you are asked to supply your Medicare number, it may be a sign you are about to become a victim of fraud.
Source: christophermellino.com

Video: Medicare Covered Power Chair – Do You Qualify? – Toll Free Phone Hotline

Ryan Says GOP Will Protect Medicare

Politico Pro: Ryan’s Medicare ‘Raid’ Charge Open To Debate Paul Ryan accused President Barack Obama of “raiding” Medicare to pay for his own health care reform law — a claim that has already put Democrats on defense on the fight over entitlement reform. Ryan’s claim: Obama took $716 billion from Medicare to pay for his law, thus cutting the entitlement program. The problem: that’s not entirely true, as many fact-checking outlets have noted. While the Obama health care law does take money from Medicare providers, it does not shift the costs to beneficiaries. It pays Medicare Advantage private health plans less, trims annual increases that hospitals, home health and nursing homes receive under Medicare, and imposes new fees on drug and device makers (Kenen, 8/29).
Source: kaiserhealthnews.org

Does Medicare Call Your House?? Or is this Medicare Fraud?? » Toni Says

I have a problem and I need your help.  I am a 79 year old female who lives alone in Meyerland. Yesterday, a representative from Medicare called me asking all types of personal questions. I told them, I did not give personal information over the phone.  I’m concerned this could be a scam, but then if it was Medicare, I’m concerned I could have made a mistake.  Can you please advise me what I should do or where I could call to see if Medicare is trying to contact me?  Thanks in advance…Alice from Houston,TX
Source: tonisays.com

Where Can I find Information On Medicare Insurance?

The website www.Medicare.gov is an exceptional resource for finding information about Medicare insurance. At Medicare.gov one can enter a zip code along with any prescriptions one takes, and the system will list the Medicare Advantage plans and Medicare Part D (prescription) plans for the zip code in order of least expensive to most expensive. This allows one to find out how much prescription copayments are for a Medicare Advantage plan or Part D (prescription) plan.
Source: todaysseniors.com

Where is Your Practice Losing Money? Part II

The other loss of revenue that astounds me is the number of employees who are authorized or simply have access to write off unpaid charges.  It is one of the questions I ask every time I do a practice assessment.  Most people tell me that their front office or clinical staff does not know how to do anything on the financial side – all they know how to do is schedule appointments.  Even in the billing office, billers and coders have carte blanche ability to write off anything they want.  The question nobody can answer is “How often does someone write off a friend or family member’s copay or outstanding balance?  How often does a person posting insurance payments accept the payment as correctly paid-in-full and write off the remainder owed by the patient?  How often does an A/R specialist look at a claim denial and decide it is not worth appealing?  These questions, and others, give reason to believe that practices and hospitals are writing off millions of dollars inappropriately.  They do not even know why because they are not tracking denials or adjustments.  Everything gets lumped under “insurance adjustment”.  Best practice is to have a manager review all claim denials once they have been worked and post those write-offs with specific denial codes.  The practice should have a written policy that describes how much a biller can write off without approval, when a patient balance gets sent to collections, when a physician decides what gets written off and when someone other than the physician needs to approve write-offs.
Source: efficiencyinpractice.com

The 7 misleading claims Mitt Romney has made about Medicare

Accountable Care Organizations AHA AHIP American Medical Association American Recovery and Reinvestment Act Bart Stupak cadillac plans CBO CLASS Act community health centers comparitive effectiveness Congressional Budget Office CT scans Dartmouth Atlas Project Donald Berwick Donald Verrilli EPA Families USA gender rating Highmark Independent Payment Advisory Board individual mandate Internet Iraq War John McCain joke Jon Stewart Kaiser Family Foundation Kathleen Sebelius living wills Max Baucus Mitt Romney New York Times Paul Clement Paul Ryan PhRMA PTSD Ron Wyden S-CHIP Scott Brown Senate Finance Committee Sick Around America small business Tom Coburn Tom Daschle
Source: whatifpost.com

Medicare and Cash Based Physical Therapy – a Full Overview

Let’s explore an example based on the “Maintenance” scenario above. Once you have determined that the patient will be continuing treatment on a maintenance basis, you need to explain and have them sign the ABN. After the next visit with the (now cash-paying) patient, you will submit a claim to Medicare with a GA Modifier. The GA Modifier tells Medicare that you have an ABN on file for the patient, and also prompts them to automatically deny the claim. After doing this once, you do not need to continue submitting claims for that patient’s non-covered services. (Please note that this paragraph is directed at those practices who have a relationship with Medicare. If you are not enrolled in Medicare with a Provider number, you cannot submit in any bill … even one with a GA Modifier to get a denial.)
Source: drjarodcarter.com

Excess Readmissions Mean Lower Medicare Reimbursement Rates for More than 2,000 Hospitals, Including 131 in Florida

administrative complaint Administrative Hearing attorney Centers for Medicare & Medicaid Services CMS dea defense attorney department of health Department of Health and Human Services Department of Justice doctor doh DOJ drug enforcement administration emergency suspension order ESO false billing false claims act FBI florida health attorney health care fraud health law hipaa investigation medicaid medicare medicare audit Medicare fraud Medicare fraud attorney Medicare investigation nurse nurses orlando overbilling overpayment pain clinics pain management pharmacies pharmacist pharmacists pharmacy physician physicians pill mills
Source: wordpress.com

Heritage: Debunking Medicare Reform Myths

Abstract: Medicare patients today face reduced access to care, which will inevitably be rationed through the Affordable Care Act’s relentless payment cuts. On paper, Medicare will continue to appear as a model of administrative cost control, but real administrative costs—borne by doctors, hospitals, and clinics—will continue to soar, and medical professionals will struggle to comply with the numerous rules and reporting requirements governing care delivery. Medicare premium support, long a bipartisan proposal, is the best alternative to this unhappy scenario. It would guarantee better choices and broader access to quality care, faster innovation in care delivery, and less waste and fraud in medical transactions. It would also deliver superior cost control. For the next generation of taxpayers and retirees alike, there is no better future.
Source: theminorityreportblog.com

Private versus public health insurance

Outlook: “Evidence shows those programs work to improve care for patients and lower health care costs. Our research has done a tremendous amount of work looking at hospital readmissions. We have a readmission crisis in this country. Patients who are discharged from the hospital are not getting appropriate follow-up. In a fee-for-service system, there isn’t an incentive for hospitals and doctors to take steps to prevent that from happening. If patient goes back to the hospital, they get paid again. What private plans have done is they’ve implemented programs … to make sure patients get appropriate follow-up care to avoid unnecessary, costly trips to ER. Readmission rates in the Medicare Advantage program are 20 to 30 percent lower than the Medicaid fee-for-service program.”
Source: insurancequotes.com

Everything You Need to Know About Medicare Enrollment

Posted by:  :  Category: Medicare

If you are working still, you may not want to enroll when you turn 65. If your place of employment has insurance that you can participate in, this would still be your primary coverage insurance. Medicare would be the secondary insurance. If this is the case, you can delay Medicare enrollment until you don’t have insurance coverage through your employer. You should always check with the Social Security office to be sure waiting to enroll is the right thing to do.
Source: seniorcorps.org

Video: Medicare and You – Resources for Open Enrollment

Major Improvements to Medicare Online Enrollment System

The AO or DO of an organization that is listed in the Individual Control section of an enrollment will be permitted to e-sign the applicable certification and/or authorization statements and CMS 588 (Electronic Funds Transfer) within Internet-based PECOS instead of being directed to a separate PECOS E-signature Application. However, if the AO or DO is not the individual completing the application or if they do not currently have access to PECOS, they will continue to receive an email directing them to the separate PECOS E-signature Application.
Source: hcafnews.com

Medicare 101 – The Basics You Need to Know!

Medicare Part D coverage is only available through Medicare private drug plans. Enrollment in Part D is optional for most people since the economics of this benefit will depend on your current drug coverage and drug needs. Start by checking the plan you currently have to see how it will coordinate with Medicare. There are situations where having Part D could cause you or your family members to lose other health care coverage. If your current drug coverage is as good as or better than Part D you can keep it without penalty. There is a penalty to enroll later if you do not have coverage and do not enroll when you are first eligible.
Source: rodgers-associates.com

2013 Medicare Advantage Plans

The Annual Dis-enrollment Period begins January 1st and continues through February 14th. During this time you can cancel your current plan and return to original Medicare. You are not allowed to enroll in another Medicare Advantage plan until the following years enrollment period. You can enroll in a stand-alone Part D plan and submit an application for a Medicare supplement if you choose, where you may be subject to medical underwriting.
Source: partdplanfinder.com

Kaiser Permanente’s Medicare Plan Website Recognized as a Benchmark for Excellence

About Kaiser Permanente Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 9 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: www.kp.org/newscenter.
Source: kp.org

WellPoint Q1 2011 Results: Medicare Advantage Growth & Online Sales

Interestingly though, there are only a couple mentions of WellPoint’s Medicare (Senior) business on their most recent earnings call.  First, WellPoint saw higher than expected growth in their Medicare Advantage enrollments.  For those of you who sold their plans, WellPoint’s enrollment growth was probably a no brainer.  Their Medicare Advantage plans were extremely competitive in states like California, Ohio, Virginia, and New York.  Below is a quote from the call:
Source: agentpipeline.com

Medicare Enrollment Important Dates

Insurance companies and their agents are allowed to start marketing activities at this time as well. Although plans are made public, companies and their agents are not allowed to accept enrollment applications until the annual Open Enrollment Period begins.
Source: affordablemedicareplan.com

Medicare providers urged to enroll in online system to fight fraud

Medicare issued $47 billion in improper payments in 2009, which accounted for about 43 percent of the $110 billion the government wrongfully disbursed that year, Daniel Werfel, controller for the Office of Management and Budget, told a Senate panel on Tuesday. Complicating matters for CMS, the stimulus package calls for the agency to start cutting bonus checks up to $44,000 over five years to Medicare health care providers that install an electronic health records system. CMS said it will rely on PECOS to verify Medicare eligibility.
Source: nextgov.com

Obamacare and Medicare Advantage Cuts: Undermining Seniors’ Coverage Options

Seniors Forced Back into Poorly Performing Traditional Medicare. Large reductions in MA will force a mass migration back into the traditional FFS program, which is the source of many problems observed in American health care. Medicare FFS provides strong incentives for fragmented care that is poorly coordinated across institutions and provider settings. The result is an emphasis on volume instead of quality care for patients. Moreover, downsizing the role of MA plans will make it more difficult to pursue the kinds of structural changes that are needed to ensure that Medicare can be financially sustained over the long term.
Source: tomtayloronline.org

Low cognitive ability impairs enrollment in Medicare supplemental plans

The largest health insurance is United Health Care, which offers all types of health insurance system. If you are planning to have a unified health care plans, there are several choices are available to purchase, you can use the best suited insurance. Some of their plans include copay, short term medical, student offer coverage, health savings accounts and they also dental insurance for those who have coverage through their employer dont get. individuals and families, a United Healthcare Insurance looking for, with many of the same advantages as the Employers should provide select copay. You must pay a fixed fee for preventive care and doctor visits, but after the payment, 100% testing of the costs are covered. Health care reform is a new feature in the practice came after Obama won the political battle. This is a very new service available to all Americans, but few have the knowledge of health care reform, this article focuses entirely on fact, inform the American people about health reform and the benefits they are going to get through approval of this plan. In this article I have all the advantages you will shape health care reform will be listed below. United Health Care is a popular choice and based on the company, registering one of five Medicare beneficiaries in their health plans. They also offer coverage through Secure Horizons, Evercare Choice and America. United Healthcare Medicare plans in a number of options that HMO plans, supplement insurance plans, special needs plans, and Medicare Part D offers prescription drug plans include. These plans offer different types of coverage and the best time for you to meet your individual health condition. United Healthcare also plans to Medicare Supplement Insurance. This insurance can help in the costs incurred by Medicare Part A and Part B. The special needs programs are only for people with certain medical conditions and life situations and are not open for general registration. United Healthcare is also widely accepted is a great advantage for students who attend a school may be far from home. However, your school will provide to United Healthcare for the benefit of their particular student insurance increase. Hope this article was necessary in providing important information about United Health Care, if you want more about United Healthcare Report They know how healthvote.com Source: southerninitiative.com Source: medicarehelpco.com
Source: medicarehelpco.com

End Medicare As We Know It? Ryan's Plan Would Expand On a Medicare Idea That Seniors Know and Like.

And, as The New York Times made clear in an article over the weekend, these sections are working well enough that the administration has seen fit to brag about their successes. To some extent this is just political: Administrations want to be able to say that their programs work. but there are real successes here, especially relative to the traditional Medicare alternative. For example, The Times notes, the administration has pointed to a 10 percent increase in enrollment in Medicare Advantage, as well as a 7 percent decrease in average plan price. So average plan costs are decreasing, and more seniors are choosing to enroll in Medicare’s system of private plans. And as I noted last week, there’s new evidence to suggest that private insurers operating in the program provide equal benefits to traditional Medicare at lower cost.
Source: reason.com

New BenefitView Dashboard Lets Employers Track Retirees’ Medicare Enrollment Progress

“Before our transition started, we wanted to make sure our retirees first understood that they were going to get more choice and control over their Medicare health benefits. Then we wanted to provide retirees with all the right information they needed to participate,” said Melissa (Missy) Hartfiel, benefits planner, Global Compensation and Benefits for International Paper. “With BenefitView, we can instantly see all the data on our progress – the number of retirees contacted, the number of calls and enrollments completed, how quickly our retirees were being answered, and the length of those calls. This inspired a lot of confidence in the Extend Health solution. As a non-techy, I also appreciated that BenefitView is visual and easy to use – there was no learning curve and I got all the data I wanted with one click.”
Source: wordpress.com

Medicare Inpatient vs. Outpatient Under Observation and Hospital Costs

Her family only learned about the problem the day Arnau left the hospital, says her daughter Mimi Auer, who is considering appealing the decision. At first she thought it was a mistake. But staff at the rehab facility told her they’d had four cases like her mother’s just the previous week. "Four cases of the same situation, [in which Medicare patients] had to pay for the nursing home because they’d been on observation in the hospital," Auer protests. "What’s going on here?"
Source: aarp.org

Senior Benefit Services, Inc.

Posted by:  :  Category: Medicare

Effective October 1, 2012 on in force business only for United World 2010 Modernized Medicare Supplement plans (Policies effective on or after June 1, 2010) in Alabama and South Dakota and November 1, 2012 in Montana, the rate adjustments will affect plans  A, B, F, G, and M.
Source: srbenefit.com

Video: Alabama Medicare

Alabama Cop Roughs Up Disabled Woman for Taking Pictures at a High School Football Game

Hadder then called a patrol car and had Sanford charged with criminal trespass. At her trial in March 2012, Hadder not only confirmed Sanford and Dudley’s record of events, but defended himself by saying, “I am also trained in pain compliance so if I had to I could have induced pain for compliance but I didn’thave to.” That’s probably because Sanford, who has brain damage and walks with a cane as a result of her accident, didn’t resist him in any way. 
Source: reason.com

AARP Alabama: You’ve Earned A Say

www.medicareplansofamerica.com Alabama Seniors get more protection with medicare advantage plans. Get an online medicare insurance plan quote today. Medicare enrollment is open to Seniors 65 and up for the most part in Alabama. Learn more about new medicare options in AL. Additional Alabama Medicare Supplement sites: www.medicareadvantageplans.us www.trinitymedcare.com
Source: healthinsuranceandmedicareupdate.com

Private versus public health insurance

Outlook: “Evidence shows those programs work to improve care for patients and lower health care costs. Our research has done a tremendous amount of work looking at hospital readmissions. We have a readmission crisis in this country. Patients who are discharged from the hospital are not getting appropriate follow-up. In a fee-for-service system, there isn’t an incentive for hospitals and doctors to take steps to prevent that from happening. If patient goes back to the hospital, they get paid again. What private plans have done is they’ve implemented programs … to make sure patients get appropriate follow-up care to avoid unnecessary, costly trips to ER. Readmission rates in the Medicare Advantage program are 20 to 30 percent lower than the Medicaid fee-for-service program.”
Source: insurancequotes.com

Medicare in focus as Obama, Ryan trade charges

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Source: alnotes.com

Obama vs. Romney Medicare Plans

Posted by:  :  Category: Medicare

SAM_2075 by TakeDownCravaackMASON CITY, IA – The focus is on Iowa, where both President Barack Obama and presumptive Republican candidate Mitt Romney are showing a strong presence in the state. Today the Obama camp held press conferences in two Iowa cities to discuss an important topic for senior citizens. Mike and Carol Iverson are very familiar with their medical bills. Mike said "I stopped totaling it up when it reached over half a million." He had arthritis in his leg, but developed a mysterious staff infection that moved into his joints and led to some serious consequences. He said "One shoulder had to be removed and I now have a metal rod from hip to ankle on my right leg. I don’t have a shoulder, so I’m missing both a shoulder and a knee." Today, he and his wife shared their personal struggles at a press conference in Mason City, but it’s not a medical condition they’re concerned with at this moment. Instead, they’re worried about a potential Romney-Ryan medicare plan for Iowa seniors. Carol Iverson said "I don’t want to take a chance on it, because of the voucher plan and everything. It strikes me that what’s working is working and lets stay with it." Mike says that medicare played a huge role in getting him through his own hospital bills, but if current medicare plans were to change, he doesn’t fear for himself, but for future generations. He said "I may not have that many years left that I have to worry too much about it anyway, but I worry about other people coming up." Democrats fear that Romney’s plan would turn medicare into a voucher system and raise senior’s healthcare costs by nearly $6,400 a year However we spoke with a local political analyst to get some perspective on the other side of things and NIACC’s John Schmaltz tells us a Romney-Ryan plan most likely wouldn’t change anything for current seniors or those near retirement. Schmaltz said, "Governor Romney’s plan is trying to take a complex subject and simplify it. It’s looking at preserving the plan, he’s not gutting it, throwing it out , no scare tactics on this at all. What he wants to do is strengthen the system." He also says that Obama’s plan would end up taking $716 billion out of medicare and under a different plan, people would be able to "shop" around for their own coverage. But no matter which way you lean politically, you can expect a passionate debate about the cost of the nation’s health in the coming months.
Source: kimt.com

Video: Minnesota Channel – Medicare Rx: Enrollment Countdown

Romney and Obama now fight for edge on Medicare

Romney and the White House also condemned a new round of anti-Israel remarks by Iranian President Mahmoud Ahmadinejad. Romney told 80 people at a fundraiser overlooking the Long Island Sound: "Ahmadinejad of Iran made another series of vile statements about Israel, and excising Israel from the body of humanity, and so forth. And you recognize how critical it is to have leadership that describes precisely what it believes, describes what actions it’s willing to take, and stands for something."
Source: publicradio.org

Ezra Klein: Romney’s Medicare chart comes up blank

&summary=I+pine+for+Ross+Perot%E2%80%99s+campaign.+Not+the+candidate+himself%2C+though+he+had+his+charms.+But+the+charts+and+graphs.&source=Politics+in+Minnesota’ title=’Share with Lindedin’ rel=’nofollow’ style=’background-image: url(http://politicsinminnesota.com/wp-content/plugins/tdc-sociable-toolbar/imagecol.png); background-position:0px -510px’>linkedin
Source: politicsinminnesota.com

Minnesota Medicaid, Medicare fraught with overspending

The U.S. House of Representatives Committee on Oversight and Government Reform found that the state used an accounting trick in order to leverage federal reimbursement of state Medicaid spending as far back as 2010: “The state was intentionally lowering the rates paid to the managed care companies for plans outside the Medicaid program and increasing the rates within the Medicaid managed care program,” a House staff report reads.
Source: dailycaller.com

People with Medicare save over $4.1 billion on prescription drugs

The health care law also makes it easier for people with Medicare to stay healthy. Prior to 2011, people with Medicare had to pay extra for many preventive health services. These costs made it difficult for people to get the health care they needed. For example, before the health care law passed, a person with Medicare could pay as much as $160 for a colorectal cancer screening.  Thanks to the Affordable Care Act, many preventive services are offered free of charge to beneficiaries, with no deductible or co-pay, so that cost is no longer a barrier for seniors who want to stay healthy and treat problems early.
Source: hometownsource.com

Medicare: Private insurers not always cheaper

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Source: carinsuranceminnesotaquote.com

Pawlenty claim about Obama Medicare 'cuts' deemed 'misleading'

Speaking of … Jason Stein at the Milwaukee Journal Sentinel reports: “A secret probe into those around Gov. Scott Walker has continued after the June 5 recall election and expanded beyond Milwaukee County and into state government, new records show. The documents show that Milwaukee County District Attorney John Chisholm’s office continues its John Doe investigation into Walker’s administration even as the inquiry has gone publicly quiet over the summer. The records obtained by the Milwaukee Journal Sentinel through an open records request show that a Milwaukee County prosecutor sought personnel records from Walker’s office and another state agency in June and then met with a top state lawyer the next day. … the new records confirm that prosecutors are also seeking information from Walker’s state administration and did so as recently as June … Milwaukee County Assistant District Attorney David Robles on June 18 made an open records request to both Walker’s office and the state Department of Administration for all communications ‘related to the designation and determination of individuals as ‘key professional staff’ of the Office of the Governor’ since the time Walker took office on Jan. 3, 2011.” Sally Jo Sorensen does a good job of breaking down the dynamics of an Allen Quist-Tim Walz race down south. In her Bluestem Prairie blog, she writes: “What will November bring? Walz enjoys a huge cash advantage, boundless energy, an experienced campaign staff and seems to be liked by most Southern Minnesotans. But while Quist is a little different as we say in these parts, the district voters are independent-minded and far from any madding major media market. Will superfund dollars flow into the district?  Depends upon internal polling most likely — for now, it’s not thought to be competitive. And surely the twitter hubbub about Quist’s odd but decades’ old statements — popularized by Mother Jones and the Parry Campaign (band name anyone?) — should drive some  dollars in Walz’s direction from progressives terrified at the thought of a Bachmann mentor in Congress. Another fascinating fact: Mike Parry lost to Quist in the same counties that he lost in the January 2010 election — including his home county of Waseca. In his home senate district, he won Steele County by 59 votes, while losing Rice County as well as Waseca County.”
Source: minnpost.com

Report: No Area Of U.S. Cheats Medicare More Than S. Fla.

Some of those with drug or alcohol addictions were lured from out of state with promises to put a roof over their heads. Once they arrived, with their valuable Medicare cards in hand, they would be squeezed into Broward and Miami-Dade halfway houses and steered to Biscayne Milieu’s purported mental-health programs, according to prosecutors. But if they dropped out of the group therapy sessions, they would lose their housing.
Source: cbslocal.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

Medicare and Cash Based Physical Therapy – a Full Overview

Posted by:  :  Category: Medicare

What's In My Bag... by Amy DiannaLet’s explore an example based on the “Maintenance” scenario above. Once you have determined that the patient will be continuing treatment on a maintenance basis, you need to explain and have them sign the ABN. After the next visit with the (now cash-paying) patient, you will submit a claim to Medicare with a GA Modifier. The GA Modifier tells Medicare that you have an ABN on file for the patient, and also prompts them to automatically deny the claim. After doing this once, you do not need to continue submitting claims for that patient’s non-covered services. (Please note that this paragraph is directed at those practices who have a relationship with Medicare. If you are not enrolled in Medicare with a Provider number, you cannot submit in any bill … even one with a GA Modifier to get a denial.)
Source: drjarodcarter.com

Video: Tax Forms & Deductions : How to Calculate Medicare Taxes Withheld

Health Insurance: Medicaid Medicare Eligibilty

The state of health insurance right now is nothing less than atrocious. The amount of people who either have no insurance or who lack enough insurance is going up all the time. It is exponentially higher than it has ever been before. While it is possible to get by without insurance, it is not the best idea. After all, you never know when a health emergency will strike you or your family. You do not want to be left in the lurch when that happens. In this case, it could literally be deadly. No doubt you know the importance of finding the best insurance. But, where do you actually find it?
Source: agoodplace4all.com

Viewpoints: Romney, Ryan Rely On ‘The Magic Asterisk'; Frightening Voters Over Medicare Cuts

JAMA: The Republican Ticket: Mitt Romney, Paul Ryan, And The Magic Asterisk The press has focused a lot on the similarities between Mitt Romney and Paul Ryan. They are both technocratic, they espouse tax cuts, and they believe in a balanced budget. But there is a deeper similarity as well: they both believe deeply in the “magic asterisk.” The magic asterisk was the invention of David Stockman, budget director to Ronald Reagan. Stockman, who needed to show a more favorable budget than the Reagan tax cuts would justify, put in an asterisk and noted “future savings to be identified.” … Since then, the magic asterisk has become a staple of budgets that don’t add up and wishful economic thinking. What Stockman invented, however, Romney and Ryan have perfected (Cutler, 8/29).
Source: kaiserhealthnews.org

Report: No Area Of U.S. Cheats Medicare More Than S. Fla.

Some of those with drug or alcohol addictions were lured from out of state with promises to put a roof over their heads. Once they arrived, with their valuable Medicare cards in hand, they would be squeezed into Broward and Miami-Dade halfway houses and steered to Biscayne Milieu’s purported mental-health programs, according to prosecutors. But if they dropped out of the group therapy sessions, they would lose their housing.
Source: cbslocal.com

Romney Lies About Medicare/Medicaid Change Of Address Form

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

Daily Kos: The neverending Republican war on Medicare

by cracking down on fraud, reduce the deficit & save the program but keeps age at 65. When I buy a house listed for 500K and negotiate the price down to 300K because of repairs I argue it needs or because I promise to buy all my houses in the future  through this guy. It’s not  a cut to the house? The house is still the same house I just saved myself 200K on the purchase so that’s what BO did, add 716 billion $ in savings to medicare by cracking down on waste and fraudulent claims, while not just keeping benefits but enhancing the same medicare benefits, then  adding years to Medicare. So Dems added those savings back into medicare to save seniors money on preventative care & free prescription drugs (Closing the donut hole as they call it), so seniors now get their prescription drugs without out of pocket costs. Of course Ryan Myth have to frame the 716 billion dollar savings from Obama as a cut because that’s what their plan actually does –which is cut medicare funds for seniors/benificiaries. Dems are crazy if they don’t get a clue & frame the argument themselves for what it is: Dems don’t cut medicare, they add savings to medicare whereas Ryan Myth do cut it so that’s why they have to frame the argument as a cut & pretend Dems are cutting too. Dems are not cutting, they’re saving $ so big difference. Dems better start setting the narrative instead of letting Rethugs set the narrative thereby arguing on their turf. Wise up, Dems, this is your program, we all know it so don’t let the wolf argue to the baby sheep that he’s their best protector for them over over their own mother. Dems are not Myth who would eat his young (He promised to repeal O’Romneycare & increase waste spening blowing up the deficit), Dems are proud of medicare, ss medicaid and welfare reform. Dems are the “socialists” who have always argued for medicare and so-called socialist programs or are rethugs embracing “socialism” now? Seriously this argument is so stupid from Rethugs to make, I’m surprised they’re not being laughed at by the few serious reporters around. This argument is so surreal from rethugs it doesn’t pass the giggle test, all it takes is one swift attack from Dems and they’re out of the water. Dems need to bring out those 2010 TV ads where Rethugs used their moms to reassure voters they would protect medicare and promised they would never vote against medicare…and what did they do as soon as they were elected? They made liar put of their own moms as 98% of rethugs voted to support Ryan’s budget which cuts medicare into a voucher coupon program that places cost burden on seniors, requiring seniors to come out of pocket for $6500 to cover medicare expenses. In addition, Ryan Myth re-opens the donut hole so seniors have to start coming out of pocket on prescription drugs again which are now covered for seniors due to the 716 billion $ savings BO added into medicare with health care, medicare reform. So BO, the “socialist” big spender adds savings to a program, lowering the gov’t spending and the deficit VS Ryan Myth who want to make gov’t bigger by adding waste, pork, fraud claims to favor the millionaire insurance company owners but Bo’s the “socialist” big spender & Ryan Myth are the fiscal hawks? Yea, right, tell us another funny story boys. Dems need to go hard with this, in lockstep. Rethugs are going to be forceful, bold since they’re desperately lying but Dems have truth on their side, so we need to be bolder & never let up on driving this truth home. Shame them with those TV ads where they pimped out their own sweet innocent moms & made liars out of their own moms, as soon as they were elected. Anybody who would make a liar out of their own moms would do anything, even sell out their own country to a group of oligarch billionaires who want to go to war with Iran.
Source: dailykos.com

Political Place: August 30, 2012

To call Paul Ryan’s budget “extreme” would deny the fact that it was approved in Congress with bi-partisan support (extreme?) and ignore the second fact that Barack Obama’s budget was unanimously rejected by both houses of Congress (extreme!). Next, providing choices to younger Americans will help avert the disaster that awaits the broadly acknowledged unsustainable program known as Social Security. Most seniors have been well served over our lifetime through investments in our economy by way of a fluctuating but long-term growing stock market. Whimsy and fantasy would better describe current government policies and programs when it comes to a reliable return on investment (can you say “green energy”?).
Source: mysundaynews.com

Fraud detection in Medicaid / Medicare

One industry example mentioned in the reports: In one brash scheme, immigrants set up a network of fraudulent medical-supply stores in the Southwest, hoping to cheat Medicaid and Medicare. The gang hired recruiters to bring them innocent patients eligible for Medicaid or Medicare. They then paid off local doctors to prescribe motorized wheelchairs worth $7,500 but instead gave them motor scooters worth just $1,500, pocketing the difference. Investigators shut down the scheme after noticing billings for wheelchairs in Arizona, Texas, and other states scaling into the hundreds of millions of dollars.
Source: analyticbridge.com

Ryan takes factual shortcuts in speech

What’s left for Romney to cut is benefit programs other than Medicare and Social Security, which include food stamps, welfare, farm subsidies and retirement benefits for federal workers. The remaining pot of money includes the day-to-day budgets of domestic agencies, which have already borne cuts under last year’s budget deal. There’s also widespread congressional aversion to cutting most of what remains on the chopping block, which includes health research, NASA, transportation, air traffic control, homeland security, education, food inspection, housing and heating subsidies for the poor, food aid for pregnant women, the FBI, grants to local governments, national parks and veterans’ health care.
Source: standard.net

Community health centers marked by Medicare fraud in Louisiana, other states

Despite the prevalence of Medicare fraud and other forms of health care fraud, it is important for each and every person accused of these crimes to take the steps to protect themselves and claim their rights. Failing to do so can lead to a false or inaccurate conviction and a future of having to deal with the consequences of conviction.
Source: batonrouge-criminallawyer.com

Daily Kos: Romney/Ryan will raise Medicare eligibility age for current seniors

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 marsmet524If the increases in eligibility age are raised now because of the fiscal “crisis” and those under 55 are supposed to be dumped altogether, what guarantee is being offered that a further “crisis” caused by counter-productive Republican policies won’t prompt them to reduce eligibility further?  If their solution hastily offered now is to cut eligibility, why would that not be their preferred option during the next manufactured “crisis?”  The Republicans have already let it be known that they will never look at increasing revenues through upward changes in the tax rates, so any total revenue increases must come disproportionately from increases in the national economy, except they’ll have already cut taxes further reducing revenues.  Why should they get a third shot at dynamic scoring for revenue increases when the prior experiments under Reagan failed and Bush II totally cratered the economy?  
Source: dailykos.com

Video: Suicidal Train: Republicans Vote To Abolish Medicare & Raise Retirement Age (Part 1)

Issue Worth Exploring: Raising the Medicare Eligibility Age May Harm Minorities

Candidate Position, Quotation, Person Career, Social Issues, Federal assistance in the United States, Healthcare reform in the United States, Presidency of Lyndon B. Johnson, Medicare, Paul Ryan, United States National Health Care Act, The Path to Prosperity, Economy of the United States, Social Security, Politics of the United States, Government, Medicaid, J. Duncan Moore Jr., Congressional Budget Office, WIS, Mitt Romney, Republican Party, purchase insurance, media coverage, congressman, co-founder, The Medicare NewsGroup, Association of Health Care Journalists, substitute insurance, health insurance, chair, Washington, Maya Rockeymoore, National Committee, presidential race
Source: reportingonhealth.org

If You Oppose Single Payer Insurance, Take Your Parents Off Medicare and Pay for Their Medical Bills Yourself

And we ask that you inform your insurance company that you don’t care how much they spend on administrative salaries as compared to actual healthcare (because patient care must be 85% of premiums under the new healthcare reform law); we ask that if you lose your job, you accept that you have no health insurance and incur massive debt if you need coverage; we ask that if you are an employer who will now be getting a tax credit for providing healthcare insurance to employees that you refuse to take the tax credit under the new law; and we ask that you if become extremely sick and are tossed off your insurance that you accept your fate and abide by your principles and pay for your care and your growing debt.
Source: truth-out.org

Medicare 101 – The Basics You Need to Know!

Medicare Part D coverage is only available through Medicare private drug plans. Enrollment in Part D is optional for most people since the economics of this benefit will depend on your current drug coverage and drug needs. Start by checking the plan you currently have to see how it will coordinate with Medicare. There are situations where having Part D could cause you or your family members to lose other health care coverage. If your current drug coverage is as good as or better than Part D you can keep it without penalty. There is a penalty to enroll later if you do not have coverage and do not enroll when you are first eligible.
Source: rodgers-associates.com

Canuckclicks Article Directory: Find Deals in Medicare Supplemental Insurance (Medigap)

If you’re confused by the different prices of Medicare Supplement Insurance plans, you’re not alone. Since Congress standardized Medigap plans, every Plan A, for instance, provides the same coverage. While Massachusetts, Minnesota and Wisconsin maintained their own plan versions; Medigap plans were logically offered with increasing levels of coverage. Plan A included the least coverage, and Plan J had the most coverage. Still, prices for the same plan vary widely. For the most popular Plan F, prices were found to range from $1,022 to $2,504 a year, and such discrepancies remain common. In 2001, the General Accounting Office investigated and found prices ranging from $467 to $1,202 for Plan A, and from $2,059 to $5,658 for Plan J. Breaking the Medigap Plan Price Code Don’t despair! Each Medigap plan with the same letter has the same coverage. Decide which plan coverage works for you, and then look for the best price on that plan. According to the director of the Medicare Policy Project for the Kaiser Family Foundation, “The wide fluctuations in premiums have very little to do with the benefits.” Insurance companies set Medigap prices in different ways that explain how premiums will increase over time. In most states, Medigap plan pricing systems fall into three categories: attained-age, issue-age, or community-rated policies. Attained-age policies typically offer the lowest premiums to start, but their premiums increase faster. You’ll pay more as you get older. The premiums for issue-age policies are based on your age when you buy the plan. The price won’t increase just because you are getting older (although premiums will still increase for healthcare inflation), but 80-year-olds will find the plans more expensive to buy than 70-year-olds. The founder of the Medicare Rights Center warns that, “As a general rule, the attained-age policies start out looking inexpensive but end up costing a whole lot more than the issue-age policies.” With community-rated policies, people in the same area pay the same price regardless of their age. As with issue-age policies, premiums will not increase just because you’re getting older after your initial purchase. Until around age 68, AARP typically offers a discount of up to 20 percent on such policies. Getting the Best Medigap Price over Time Forget the cliché that, “You get what you pay for.” In this case, a lower-price doesn’t equate to less service. Service rarely varies among Medigap insurance companies, which basically work automatically. If Medicare pays 80 percent of your bill, Medigap will pick up the other 20 percent. Focus on what the Medigap plan will cost you over time, and remember that you’ll have a hard time changing plans when you’re older unless your health remains good. It’s advisable to stick with plans that don’t raise your premiums just because you’re getting older. That means it’s safer to choose community-rated or issue-age type policies even if the premiums start out a little higher. More Ways to Get the Best Medigap Plan If you sign up within the first six months after you enroll in Medicare part B, insurers can’t raise your rate or deny coverage based on your health. After that open-enrollment period, you’ll need to be in good health to change plans with two exceptions. There are a few guaranteed-issue plans that you can get in spite of health problems, such as AARP policies that are not sold through agents. Otherwise, if you’re in New York, all the plans are guaranteed-issue so it’s easier to change plans. In that case, check out available plans annually to maintain the best coverage at the best price. Be aware that a few companies still require you to submit paperwork yourself. Most companies handle that electronically to save you the trouble, which can be burdensome if you’re in poor health. While the coverage is identical, company standards do vary. Even though one company may not sell you a plan, another one may offer you a good rate. Independent agents can typically guide you to insurers more likely to accept particular health conditions. Be sure you never drop your existing coverage before the new policy is in effect.
Source: blogspot.com

Polls Find Mixed Views on Medicare Proposals From GOP, Democrats

The NRCC on Sunday also began airing a television ad aimed at North Carolina’s 7th district incumbent Rep. Mike McIntyre (D), Roll Call reports. The ad focuses on McIntyre’s vote against Ryan’s budget proposal and says that McIntyre has voted against every plan to save Medicare from going bankrupt. The narrator continues that McIntyre’s opponent, David Rouzer (R), “will preserve, protect and strengthen Medicare”(Miller, Roll Call, 8/27).
Source: californiahealthline.org

Romney/Ryan Medicare plan bad for America’s health

We currently have the most competitive, free market health insurance system ever devised in the history of the world for people under 65 years of age. How is that working? For the past 40 years, health care costs have increased annually at two to three times the costs of virtually everything else in the economy. Up to 50 million Americans can’t afford insurance. Health insurance costs are killing small businesses.
Source: thegazette.com

Medicare Enrollment Important Dates

Posted by:  :  Category: Medicare

Insurance companies and their agents are allowed to start marketing activities at this time as well. Although plans are made public, companies and their agents are not allowed to accept enrollment applications until the annual Open Enrollment Period begins.
Source: affordablemedicareplan.com

Video: Submitting Your Medicare Enrollment Application

Medicare: Know Your Rights, Recognize Fraud

“Cold” call or use door-to-door marketing. Insurance agents may contact you about your current plan if you are enrolled in a plan with their company. Insurance companies may contact you for a disenrollment survey if you leave the plan. Insurance companies may contact you if you have given them permission to contact you. (Note: signing up for information at an event or returning a postcard counts as “permission.”) With your permission, an agent may schedule a time to meet with you in your home, but he/she may not come unannounced.
Source: thagroup.org

Be Prepared: Audit Activity on the Increase

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Source: wordpress.com

2013 Medicare Advantage Plans

The Annual Dis-enrollment Period begins January 1st and continues through February 14th. During this time you can cancel your current plan and return to original Medicare. You are not allowed to enroll in another Medicare Advantage plan until the following years enrollment period. You can enroll in a stand-alone Part D plan and submit an application for a Medicare supplement if you choose, where you may be subject to medical underwriting.
Source: partdplanfinder.com

Medicare Issue Reverberates During Convention

Medpage Today: GOP Docs Have Unique Stake In Ryan As Veep Under Ryan’s proposal, which would be applicable to those who turn 65 after 2022, Medicare would provide an average of $8,000 to help offset the cost of buying private health insurance. Those eligible would still have a choice to enroll in the traditional fee-for-service Medicare program — but would receive premium support for that option just as those using private plans would. Ryan’s proposal, part of his overall budget plan, would also raise the age of eligibility from 65 to 67 and reopen Medicare Part D’s “doughnut hole.” It also calls for repealing the Affordable Care Act. The GOP-controlled House passed Ryan’s budget plan each of the last 2 years. However, it stalled in the Democratic-controlled Senate. Republican physician congressmen attending the party’s national convention say they like the Ryan proposal (Frieden, 8/29). 
Source: kaiserhealthnews.org

Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline, CPT Code Billing: Which enrollment form to use 855A, 855B, 855I , 588 for what reason

Medicare Enrollment Application In the enrollment process, CMS collects information about the applying provider or supplier and secures documentation to ensure that the he or she is qualified and eligible to enroll in the Medicare Program. Depending upon provider or supplier type, one of the following forms is completed to enroll in the Medicare Program  Form CMS-855A/Medicare Enrollment Application for Institutional Providers: Application: Application used by institutional providers to initiate the Medicare enrollment process or to change Medicare enrollment information  Form CMS-855B/Medicare Enrollment Application for Clinics/Group Practices and Certain Other Suppliers: Application used by group practices or other organizational suppliers, except DMEPOS suppliers, to initiate the Medicare enrollment process or to change Medicare enrollment information  Form CMS-855I/Medicare Enrollment Application for Physicians and Non-Physician Practitioners: Application used by individual physicians or NPPs to initiate the Medicare enrollment process or to change Medicare enrollment information  Form CMS-855R/Medicare Enrollment Application for Reassignment of Medicare Benefits: Application used by individual physicians or NPPs to initiate reassignment of a right to bill the Medicare Program and receive Medicare payments or to terminate a reassignment of benefits; and Form CMS-855S/Medicare Enrollment Application for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Suppliers: Application used by DMEPOS suppliers to initiate the Medicare enrollment process or to change Medicare enrollment information. The following forms are often required in addition to the Medicare Enrollment Application: Form CMS-588/Electronic Funds Transfer (EFT) Authorization Agreement: Medicare authorization agreement for EFTs (for providers who choose to have payments sent directly to their financial institution); And CMS Standard Electronic Data Interchange (EDI) Enrollment Form: Agreement executed by each provider of health care services, physician, or supplier that intends to submit electronic media claims (EMC) or other EDI transactions to Medicare. This form is available from Medicare Carriers, FIs, A/B MACs, and Durable Medical Equipment Medicare Administrative Contractors and must be completed prior to submitting EMC or other EDI transactions to Medicare. The following optional form is submitted if the provider or supplier wishes to enroll as a Medicare participating provider or supplier:  Form CMS-460/Medicare Participating Physician or Supplier Agreement: Agreement to become a Part B participating provider or supplier who will accept assignment of Medicare benefits for all covered services for all Medicare beneficiaries. The Participating and Nonparticipating Providers and Suppliers Section of this chapter provides additional information about participating in the Medicare Program. The above forms are available at http://www.cms.hhs.gov/CMSForms/CMSForms/list.asp on the CMS website.
Source: medicarepaymentandreimbursement.com

Coding Ahead: New Physician Specialty Code for Centralized Flu

The Centers for Medicare & Medicaid Services (CMS) established a new non-physician practitioner specialty code for Centralized Flu effective January 1, 2013. The new non-physician practitioner specialty code for Centralized Flu is C1 and is only applicable to the CMS-855B enrollment application. Make sure that your billing staffs are aware of this change for 2013. Medicare physician/non-physician practitioner specialty codes describe the specific/unique types of medicine that physicians and non-physician practitioners (and certain other suppliers) practice. Physicians self-designate their Medicare physician specialty on the Medicare enrollment application (CMS-855B) or Internet-based Provider Enrollment, Chain, and Ownership System (PECOS) when they enroll in the Medicare program. However, non-physician practitioners are assigned a Medicare specialty code when they enroll. The specialty code becomes associated with the claims submitted by that physician or non-physician practitioner. Specialty codes are used by CMS for programmatic and claims processing purposes and the new code for Centralized Flu, C1, will be added to PECOS and recognized as the non-physician practitioner code for Centralized Flu. Reference:
Source: codingahead.com

Medicare and Medicaid Costs (Utility Post)

Posted by:  :  Category: Medicare

Budget vs Budget by boris.rasinThe go-to source on Medicare Advantage is the official Medpac report (pdf), which currently finds MA plans costing on average 7 percent more than conventional Medicare. This is less than the premium a few years ago; apparently (pdf) because several changes in Medicare policy more or less incidentally put the squeeze on MA plans. So far those plans are still expanding, but time will tell.
Source: nytimes.com

Video: Medicare vs Medicaid

State Roundup: Ohio Sets Plan For People On Both Medicaid And Medicare; Minn. Asks Feds For Money

California Healthline: Why Basic Health Plan Failed And Why COOPs May Succeed No one knows exactly what the Basic Health Program would have looked like in California — and now we’ll likely never know. The state Legislature recently shelved the idea by relegating SB 703, by Senate Health Committee Chair Ed Hernandez (D-West Covina), to the “holding committee” in the Assembly Committee on Appropriations. That effectively killed the bill. Meanwhile, another Assembly measure (AB 1846), by Assembly Member Richard Gordon (D-Menlo Park), would establish a legal framework to set up Consumer Operated and Oriented Plans (COOPs). That proposal, like BHP, is an option under the federal health reform law with a lot of questions surrounding it. Unlike BHP, the COOPs bill is a floor vote away from the governor’s desk and appears to have widespread support (Gorn, 8/27).
Source: kaiserhealthnews.org

“What’s Happening with Medicare and Medicaid” Public Forum

Janet Witt, Grassroots Manager for the National Committee to Preserve Social Security and Medicare, was invited to Manhattan by a joint effort from the North Central Flint Hills Area Agency on Aging, The Manhattan Alliance for Peace and Justice and the Manhattan Chapter of the National Alliance on Mental Illness.
Source: 1350kman.com

Attacks on ACA pits Medicare vs. Medicaid, Seniors against the Poor

It is true that the largest expenditure in the ACA budget is to pay for Medicaid expansion, about $930 billion through the end of the decade mostly by the federal government. But the result will be nearly 15 million newly insured Americans who will have access to primary care, preventing the need to use the emergency room for basic care and saving taxpayers on uncompensated care and costly, preventable hospitalizations. In addition, by insuring more people before they get to Medicare, we can save Medicare dollars. For example, more prevention of and screening for chronic diseases like hypertension and diabetes and behavior changes such as weight loss and smoking cessation can prevent the downstream, costlier sequelae of severe cardiovascular disease in older age. A recent study bears this out by demonstrating that Medicaid expansion in some states improved the health and mortality of its recipients compared to those states that did not expand its Medicaid insured.
Source: drsforamerica.org

Massachusetts Health Stats: The 2012 Medicare Data Book Section 3: Where Medicaid and Medicare Meet

NOTE: I’m going all Medicare all the time until further notice. There’s nothing happening in Massachusetts anyways. The legislature passed its health-care price controls, screwed a few percent of the population, and headed off to their second or third homes in the Berkshires or on the Cape for the rest of the Northern Hemisphere summer. And then they are off to the Democratic convention. Look to the postings list to the left to see what’s new. The Obama Parade of Medicare Lies is never ending. (What would you expect of a guy who lied about his dying mother’s insurance situation to get elected?) Otherwise, whenever, Massachussetts Health Stats is an as-needed look at statistics about the Massachusetts healthcare delivery and insurance market and industry. On both Medicare and Massachusetts health care, this blog overcomes the attempts from those on both the left and right of the political spectrum to use statistics to impose needless changes on one of the best healthcare systems in the world.
Source: typepad.com

Fraud detection in Medicaid / Medicare

One industry example mentioned in the reports: In one brash scheme, immigrants set up a network of fraudulent medical-supply stores in the Southwest, hoping to cheat Medicaid and Medicare. The gang hired recruiters to bring them innocent patients eligible for Medicaid or Medicare. They then paid off local doctors to prescribe motorized wheelchairs worth $7,500 but instead gave them motor scooters worth just $1,500, pocketing the difference. Investigators shut down the scheme after noticing billings for wheelchairs in Arizona, Texas, and other states scaling into the hundreds of millions of dollars.
Source: analyticbridge.com

NewsDaily: Aetna to buy Coventry in Medicare, Medicaid expansion

“The election and SCOTUS were not critical to our strategic thinking,” he said in an interview, referring to the U.S. Supreme Court’s June decision to uphold the “individual mandate” requiring that most Americans obtain health insurance by 2014 or pay a tax. “We think we had a very good opportunity to gain better access to government-based revenues at valuations that were very reasonable.”
Source: newsdaily.com

CBO update: Medicare, Medicaid will spend less

Health insurance fraud results in enormous losses every year – up to $260 billion, by some estimates. And while technology advances have made it easier for payers to protect their bottom line – these advances are also aiding criminals. Learn more.
Source: fiercehealthcare.com

dirt road anthem mediafire: First Health Part D Medicare Part D plan benefits such as premium Name Franchise dvk Gap cover star

Posted by:  :  Category: Medicare

Medicare Part D Insurance If you are new to Medicare or have the option to change plans, you may be interested in finding the best plan for Part D. But due to differences in individual needs and budget, there is no simple answer to the question of which plan is best. With 30 Part D plans available in Oregon in 2012, you really have your work cut out for you. Choosing a plan with the lowest premium or a recommendation well meaning friend or family member may not be your best option. The following list will allow you to compare the premiums, deductibles, types of plans (basic or advanced), whether or not there is additional insurance while you are in the donut hole and Medicare star rating of each plan. Compare Medicare plans without letters of your information Online dvk – Call (888) 310-0376 Oregon Part D Sterling Life Insurance Company Medicare Part D Plan Name benefits like premium Franchise Gap cover Star Rating Windsor Rx (PDP) Basic $ 31,10 $ 320 No Gap cover 3 SilverScript Insurance Company Medicare Part D Plan Name benefits like premium Franchise Gap cover Star Rating CVS Caremark Value (PDP) Basic $ 32,30 $ 320 No Gap cover 3 CVS Caremark Plus (PDP) Enhanced dvk $ 78.30 $ 0 No Gap cover 3 Asuris Northwest Health Medicare Part D Plan Name benefits like premium Franchise Gap cover Star Rating Asuris Medicare Script Basic (PDP) Basic $ 74,50 $ 195 No Gap coating 4 Asuris Medicare Script Enhanced (PDP) Enhanced $ 106.50 $ 0 Many universal 4 Medco Medicare Prescription Plan Medicare Part D plan benefits such as premium Name Franchise Gap cover Star Rating dvk Medco Medicare Prescription Plan – Value (PDP) Basic $ 43,10 $ 320 No Gap cover 4 Health Net Medicare dvk Part D plan benefits such as premium Name Franchise Gap cover Star Rating Health Net Orange variant 1 (PDP) Basic $ 35.80 $ 320 No Gap coverage 3 Health Net Orange dvk Option 2 (PDP) Enhanced $ 82.30 $ 0 No Gap cover 3 United American Insurance Company Medicare dvk Part D Plan Name benefits like premium Franchise Gap cover star rating of the United American – Preferred (PDP) Enhanced $ 51.30 $ 70 No Gap cover 2.5 United American – Select (PDP) Basic $ 42.20 $ 320 No Gap cover 2.5 First Health Part D Medicare Part D plan benefits such as premium Name Franchise dvk Gap cover star rating of the First Health Part D Premier (PDP) Basic $ 31.20 $ 250 No Gap cover 2.5 of the First Health Part D Value Plus (PDP ) Enhanced $ 25.20 $ 0 No Gap cover 2.5 of the First Health Part D Premier-Plus (PDP) Enhanced $ 102.00 $ 0 Some universal and some brands 3 Community CCRx PDP Medicare Part D plan benefits such as premium Name Franchise Gap cover Star Rating Community CCRx Basic (PDP) Basic $ 33,40 $ 320 No Gap coverage 3 Community CCRx Choice dvk (PDP) Enhanced $ 83.70 $ 0 No Gap cover 3 Aetna Medicare Medicare Part D plan benefits such as premium Name Franchise Gap cover star rating Aetna Medicare Rx Essentials (PDP) Basic $ 52,10 $ 320 No Gap cover 2.5 Aetna Medicare dvk Rx Premier (PDP) Enhanced $ 87.10 $ 0 Many Universal 2.5 UnitedHealthcare Medicare Part D plan benefits such as premium Name Franchise Gap cover Star Rating AP AARP MedicareRx (PDP) Basic $ 41.90 $ 0 No Gap coverage 3 AARP MedicareRx Enhanced (PDP) Enhanced $ 91.90 $ 0 Some universal 3 Humana Insurance Company Medicare Part D Plan Name benefits like premium Franchise Gap cover Star Rating Humana Enhanced (PDP) Enhanced $ 35.10 $ 0 No Gap coverage 3 Humana Complete (PDP) Enhanced $ 118.70 dvk $ 0 Many universal and some brands 3 Humana Walmart-Preferred Rx Plan (PDP) Basic $ 15.10 $ 320 No Gap cover 3 HealthSpring Prescription Drug Plan Medicare Part D plan benefits such as premium Name Franchise Gap cover Star Rating HealthSpring Prescription Drug Plan-Reg 30 (PDP) Basic $ 35.90 $ 320 No Gap cover 2.5 Unicare Medicare Part D plan benefits such as premium Name Franchise Gap cover Star Rating MedicareRx Rewards Standard (PDP) Basic $ 48.60 $ 320 No Gap cover two awards MedicareRx Plus (PDP) Enhanced $ 92.90 $ 0 Some universal 2 WellCare Medicare Part D plan benefits such as premium Name Franchise Gap cover Star Rating WellCare Signature (PDP) Enhanced $ 70.90 $ 0 No Gap cover 3,5 WellCare Classic (PDP) Basic $ 36.00 $ 320 No Gap cover 3.5 EnvisionRx Plus Medicare Part D plan benefits such as premium Name Franchise Gap cover Star Rating EnvisionRxPlus Silver (PDP) Basic $ 32.70 $ 320 No Gap cover 2,5 Rite Aid EnvisionRxPlus (PDP) Enhanced $ 66.70 $ 0 Some universal 2.5 Steps to finding the best Part D plan Finding the right Part D plan is not difficult if you have a methodology for sorting and comparing plans. The table above is a starting point. Determine what criteria are important to you and develop a short list. For example, if you want to plan Medicare Star Rating is higher than 3, and some cover, and
Source: blogspot.com

Video: Unicare Medicare Supplement Quotes – Compare to 180+ Compan

UniCare MedicareRx Rewards Part D

Alabama, Alaska, Arizona, Arkansas, Connecticut, Delaware, Florida, Hawaii, Idaho, Illinois, Iowa, Kansas, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Montana, Nebraska, New Jersey, New Mexico, New York, North Carolina, North Dakota, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Washington, Washington D.C., West Virginia and Wyoming.
Source: affordablemedicareplan.com

UNiCAre STATe iNDeMNiTY PLAN COMMUNiTY CHOiCe

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Source: projectedu.com

UniCare to Reimburse AHIP Online Certification Course Fee

Health Plan news Insurance Plans health insurance medicare Health Insurance Plan web2.0 medical insurance health politics health care Healthcare medical affordable insurance Health Insurance Policy reference insurance-health Health Plans aetna Insurance Plan affordable health insurance Health Insurance Coverage Insurance Company premiums Individual Health Insurance health insurance companies Insurance Coverage Family Insurance Health Insurance Plans Google Health Insurance Company Family healthinsurance Obama health care reform Family Health Insurance government health coverage Group Health Insurance insurance care Health Quotes bookmarks unicare Insurance Companies Source: choosinghealthinsurance.net
Source: medicaresupplementalco.com

WellPoint’s Indiana Blue chief to lead UniCare unit (The Indianapolis

WellPoint’s Indiana Blue chief to lead UniCare unit (The Indianapolis Star) Dennis Casey is leaving his post as president of WellPoint’s Anthem Blue Cross and Blue Shield of Indiana to lead the company’s UniCare subsidiary in Chicago. Cross Country Update (13 WMAZ Macon) You must be a member to add a comment! The Mercer men’s and women’s cross country teams were each slated to finish eighth by the Atlantic Sun coaches as announced by the conference office Monday afternoon. Study: Blue-Eyed People ‘Smarter’ than Brown-Eyed (Fox News) A new study shows that blue-eyed people tend to achieve more in activities that require intellect and strategic thinking than those with brown eyes.
Source: medicare-news.com

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

Medicare Annual Enrollment: Clearing Up the Confusion

Market Press Release

Mississippi Federal Judge Says Court Lacks Jurisdiction To Hear Medicare Dispute

Posted by:  :  Category: Medicare

Healthcare solution >> more doctors by / // /HATTIESBURG, Miss. – A Mississippi federal appeals court on Aug. 2 partially granted the defendants’ motion to dismiss a dispute over the payment and liabilities for services provided under a Medicare provider agreement prior to the transfer of the Medicare provider number (Delco Inc. v. Corporate Management Inc., et al., No. 11-90, S.D. Miss.; 2012 U.S. Dist. LEXIS 107959).Full story on lexis.com
Source: lexisnexis.com

Video: Congressman Alan Nunnelee Embraces “Ryan Budget” and Medicare Changes | MPB News

Mississippi Medicare Part D Plans

Annual open enrollment for Part D begins on October 15th and continues through December 7th. If you submit an application during the enrollment period and feel that you have found a better plan, you can submit another application as long as you are still with that enrollment period.
Source: partdplanfinder.com

MHA’s Executive Briefing: Medicare Inpatient PPS: Final Rule for FY2013

The Centers for Medicare & Medicaid Services (CMS) issued its fiscal year (FY) 2013 final rule for the hospital inpatient and long-term care prospective payment systems (PPS) on Aug. 1. The final rule will take effect Oct. 1. The rule affects inpatient PPS hospitals, critical access hospitals (CAHs), PPS-exempt cancer hospitals, and long-term care hospitals (LTCHs). In addition, this year, the rule contains policies affecting inpatient psychiatric facilities and ambulatory surgical centers. CMS did not make any changes affecting CAHs.
Source: typepad.com

Mississippi Medicaid Changes from the 2012 Legislative Session

For inpatient hospitals, the new APR-DRG methodology will be similar to DRG-based payment methods currently used by Medicare. All inpatient stays will be classified in one of 1,256 APR-DRGs based on the difficulty of the case. The payment amount for each stay will be derived by multiplying the APR-DRG relative weight by a budget-neutral base rate established by the Mississippi Division of Medicaid (DOM). Hospitals will be paid more for complex cases and less for more routine procedures. Policy adjustments will be made for pediatric mental health, adult mental health and obstetrics and newborns, to enhance payments made for the most at-risk Medicaid beneficiaries. Expected benefits of the change are as follows:
Source: healthcarereforminsights.com

Update: Delay in Electronic Remittance Advice (ERA) for CPIDs 3579 Louisiana Medicare, 5556 Mississippi Medicare

Update: This issue has been resolved. All affected ERA has been received and processed. Original Notice Sent August 8, 2012: Due to a payer processing issue, there has been a delay in Institutional Electronic Remittance Advice (ERA) for the following payers for file dates 08/02/2012 through the present: CPID 3579 Louisiana Medicare CPID 5556 Mississippi Medicare The clearinghouse is working with the payer to receive all outstanding ERA files as quickly as possible. Additional updates will be forwarded as more information becomes available. Please be aware of a delay in the delivery of ERA for file dates above. If you have any questions, please contact Client Services at 1-888-348-8457, option 2.
Source: collaboratemd.com

Jackson doctor gets 14 years for health care fraud » The Mississippi Link

The evidence at trial showed that none of the services that were billed to Medicare and Medicaid were provided or supervised by a doctor, or by a licensed physical therapist. Instead, the therapy services were provided by employees of Central Mississippi Physical Medicine Group, none of which were trained or licensed physical therapists.
Source: themississippilink.com

Hitting hard on Medicare: Romney, Obama go at it

In the days leading to Ryan’s selection, opinion polls generally showed a close race with Obama holding a modest advantage despite a sluggish economy and unemployment of 8.3 percent. Romney’s pick for a running mate drew enthusiastic support from conservatives pleased that he had tapped a lawmaker known as an intellectual leader of the effort to rein in big government benefit programs and reduce future deficits.
Source: msgulf.com