Challenged on Medicare, GOP Loses Ground

Posted by:  :  Category: Medicare

Romney Ryan Plan for Student Loans by DonkeyHoteyAt the heart of the conflict is the proposal backed by Mr. Romney and Mr. Ryan to change the way Medicare works in an effort to drive down health care costs and keep the program solvent as the population ages. Under their plan, retirees would get a fixed annual payment from the government that they could use to buy traditional Medicare coverage or a private health insurance policy. Supporters say the change would hold expenses down by introducing more competition into the system.
Source: realclearpolitics.com

Video: GOP Backs Off Ryan Medicare Plan

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

Posted by:  :  Category: Medicare

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

Video: What Are The Ohio Medicaid Eligibility Guidelines

Where the Candidates Stand on Medicare and Medicaid

Under the Ryan plan, federal Medicaid grants would be adjusted only for inflation, but not health care costs, which grow at a much higher rate. The CBO estimates Ryan’s plan would save the federal government $800 billion over the next 10 years. Another study conducted by Bloomberg News shows that the block-grants could decrease Medicaid funding by as much as $1.26 trillion over the next nine years. Actual Impact                                                                                                     
Source: co.uk

Do You Have Questions About Medicare Eligibility?

If a person receives Social Security benefits, they are automatically signed up for Medicare. However, if you are 65 and delay receiving Social Security, you may still sign up for Medicare, but this will not be done automatically. You will need to personally contact the Social Security Administration to receive this benefit. You are also not automatically signed up when your spouse is eligible or signed up for benefits. You must sign up for Medicare coverage individually and this may be done online, or by making an appointment and visiting your nearest Social Security office.
Source: todaysseniors.com

Whistleblower Alleges Overbilling Of Medicare By Florida Hospice

Douglas Stone was an executive at the Hospice of the Comforter, based in Altamonte Springs, when he learned that the company was overbilling Medicare for patient stays. He filed a whistleblower lawsuit alleging Medicaid/Medicare fraud against the Florida nursing home a year ago; the U.S. Department of Justice recently intervened and will now be pursuing the Medicare fraud claims.
Source: federalwhistleblowerlawyers.com

Challenged on Medicare, G.O.P. Loses Ground

Initially, polls suggested that the Republican strategy was working. Democrats fretted that Mr. Romney would win the retiree-heavy Florida and increase his support nationwide among older voters, who lean Republican anyway. David Winston, a Republican pollster, wrote a month ago of “a structural shift in the issue” that left the parties in “a dead heat” and Mr. Obama unable to mount an effective response.
Source: wordpress.com

Undoubtedly Masterpiece!! Beautiful type E1 available for Sale in Hattan [Arabian Ranches] at 8Million!!

Posted by:  :  Category: Medicare

With a choice of luxury and executive villa types, these single-family detached homes offer a fusion of heritage and modernity that both appeal and invite. What lends Hattan homes their distinguished character and style is the use of traditional Arabic architectural design and characteristic elements such as enclosed courtyards, open terraces, sand and earthy colors.
Source: blogspot.com

Video: COO Sharon Grambow talks about living at Sun Health Senior Living

Another ‘tell it like it is’ masterpiece from my friend "Sam"

          3. My Social Security payments,  and those of millions of other Americans, were safely tucked away in an interest bearing account for decades until you political  pukes decided to raid the account and give OUR money to a bunch of zero ambition  losers in return for votes, thus bankrupting the system and turning Social  Security into a Ponzi scheme that would have made Bernie Madoff  proud.
Source: posterous.com

Masterpiece: Clint Eastwood And The Empty Chair (Podcast)

2010 Elections Apple Barack Obama Berkley Business & Economy business news California Congress Congress Dean Heller Democratic Democratic Party (United States) Domestic Policy Economic Policy Facebook Florida Google Harry Reid Herman Cain John Boehner Medicare Mitt Romney Nevada Newt Gingrich New York Times obama Obama Administration Patient Protection and Affordable Care Act Paul Ryan Policy Politics President Republican Republicans Science science news Senate Shelley Berkley Tea Party tech news United States United States Congress United States Senate Washington White House
Source: theminorityreportblog.com

Universal Health Care Group Adds Dr. Keith Singer as Medical Director

About Universal Health Care Universal Health Care Group is the parent company of Universal Health Care, Inc., a managed care company that has been providing Medicare Advantage Health Plans to Medicare eligible beneficiaries since 2003 – most notably the “Medicare Masterpiece® Plan” and “Medicare Masterpiece® PPO,” as well as Florida Medicaid benefits through its “Universal U-First®” Plans. The Group is also parent to Universal Health Care Insurance Company, Inc., which offers the popular Medicare Advantage “ANY ANY ANY® Plan.” Currently, the Group is serving over 95,000 individuals located in eleven states (Florida, Arizona, Georgia, Louisiana, Maryland, Mississippi, Nevada, Pennsylvania, South Carolina, Texas, and Utah). For more in-depth information about the Company and the services we offer, please visit our website at www.univhc.com.
Source: madduxpress.com

Daily Kos: Mitt’s Medicare madness

Mr. Romney subscribes to a set of fantasies out of the Chamber of Commerce playbook that all the familiar activities of status quo wealth generation could easily continue via the marvelous invisible hands of unfettered corporatism, if only the deadweight of government restrictions and the squandering of borrowed public “money” were swept away. His choice of running mate, Congressman Paul Ryan, is meant to embody all those notions — but more than that appeal to the inchoate mob of Tea Partiers who want to get the gubment’s hands off their goshdarn medicare. Anyway, the net effect of Mr. Romney’s business fantasies are so inadequate to the contractive forces underway that they would amount to pissing up the massive rope of history in a hurricane of events. Anyway, bear in mind that, whatever else is going on out there right now in the three-ring circus of presidential politics, events are in the driver’s seat, not personalities, and the seeming quiescence of things on the late summer scene is an illusion that will soon dissipate.
Source: dailykos.com

Preventive & screening services

Posted by:  :  Category: Medicare

great hed by EsthrThe page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

Video: Obama Cuts Medicare but Plays ‘Mediscare’ All the Same

Massachusetts Health Stats: The 2012 Medicare Data Book Section 5: Democrats’ Medicare Advantage ‘Cherry Picking’ Claim Another Lie

Massachussetts Health Stats is an as-needed look at statistics about the Massachusetts healthcare delivery and insurance market and industry, including aspects of Medicare as they relate to Massachusetts seniors and the Medicare-eligible disabled. 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

WSJ explains why Medicare data is hidden : Covering Health

The Wall Street Journal, in conjunction with the nonprofit Center for Public Integrity, attempted for nearly a year to obtain the database. As part of the effort, the CPI filed a lawsuit against the Department of Health and Human Services, which houses the Medicare program. The Journal and CPI wanted the data at no cost; the government wanted $100,000 for eight years of data. In a settlement, The Journal and CPI obtained the requested data at a substantially reduced fee. They later obtained a decryption key to identify individual providers but signed a contract agreeing not to publish such identities in most cases.
Source: healthjournalism.org

Frisco couple, Plano man indicted on health

The indictment, unsealed on Wednesday, charges Stanley Thaw and Kincaid each with one count of conspiracy to commit health care fraud and five substantive counts of health care fraud. Stanley and Kernell Thaw each are charged with three counts of making false statements to a financial institution. Each of the three defendants is charged with three counts of money laundering.
Source: dallasnews.com

Health Insurance in NYC and Area: Medicare Annual Enrollment Period 2012

The 2012 Medicare Annual Enrollment Period is from October 15 to December 7th. This is the time period that anyone with Medicare coverage can look to switch their supplement coverage or add a Medicare Advantage or stand alone prescription drug plan. Basically, those eligible for Medicare can shop around and select a plan that suits their needs and lifestyle. Of course, if you are just turning 65 you have a 7 month period (IEP) to choose additional coverage in addition to your Part A and Part B coverage. If you know someone with special medical needs and/or conditions they may qualify to switch plans at any time of the year using what is known as a Special Enrollment Period. (SEP). This SEP is also available to those who qualify for both Medicare and Medicaid (dual eligible). In both cases you can switch plans as many times as you like year round. Because of the complexity and number of plan options available it is important to seek the help and advise from a specialist in this field. I offer my services as your trusted advisor. Please feel free to contact me and I will do my best to help you with this important health care decision. I am appointed and certified with United Healthcare (AARP), Empire Blue Cross, Easy Choice and Amerigroup for plans in the NYC and surrounding county area. Visit my website at www.kirkdevereux.com or www.amghealthplans.com Kirk Devereux 914-393-3872 kirkdevereux@gmail.com
Source: blogspot.com

Medicare Fraudsters Sentenced To Prison After $45M Scheme

• Lazaro Delgado, after serving a nine-year prison sentence for drug dealing, acquired two home healthcare agencies that billed Medicare $4.1 in phony claims. Delgado hid his role by putting the businesses, Loyal Home Health and Loving Nursing, in the names of straw owners. Delgado, who stole the ID numbers of physicians and patients in the Medicare network to submit fraudulent claims, collected $1.8 million for purported medical services in 2010-11. Delgado recently pleaded guilty and faces sentencing.
Source: cbslocal.com

Protect Your Health with Covered Shots

You take your car for scheduled maintenance service just to make sure it’s fine, right? And, like most of us, you have things like car and homeowners insurance just in case you need it. Shouldn’t you take just as much precaution with yourself to make sure you stay healthy? Keeping your immune system strong is a lifelong, life-protecting job, but we’ve got you covered. Your Medicare
Source: medicare.gov

Medicare Weight Loss Counseling and Collecting Social Security Benefits

A. Yes, if you are officially obese — with a body mass index (BMI) of 30 or higher. Use an online BMI calculator or ask your doctor for your BMI number. Medicare will pay for one counseling session a week for the first month, and five more monthly sessions. If you’ve lost at least 6.6 pounds by the end of the sixth month, you can get six more monthly sessions. Otherwise, you must wait six months before Medicare will cover another weight-loss attempt. Sessions are covered under Medicare Part B, with no copayment or deductible if they’re conducted by a qualified practitioner in a primary care setting. Doctors use the code GO447 to bill Medicare for the service. Enter for chance to win a $5,000 spa vacation for two!
Source: aarp.org

Are Medicare’s incentives large enough to cause real behavior change?

The program is part of a major shift for Medicare, which historically has paid hospitals and doctors based on the nature of services they provided to patients without taking into account how good a job they did. Medicare has already launched several trial programs that are intended to reward hospitals based on performance, but those are voluntary; the value-based purchasing program is the first one that will be applied to nearly all acute care hospitals regardless of whether they want to participate. It kicks in at the same time that 2,211 hospitals will also begin losing money because of high readmission rates, another program created in the health law.
Source: medcitynews.com

Three Midnight Rule For Medicare SNF Explained: How To Get CMS To Pay for a Nursing Home Stay.

Posted by:  :  Category: Medicare

Wall Street by elycefelizMedicare will pay a portion of these SNF costs (the rest of which are picked up by patients’ supplemental policies) for a up to 100 days for every benefit period.   Once these days are used up,  the patient will be financially responsible for any other skilled nursing benefits until the next benefit period begins.  How does Medicare define a benefit period?   A benefit period ends when you have not been in a hospital or in a  SNF for 60 consecutive days.  Once a new benefit period begins you will need another three midnight stay to qualify for additional SNF days (up to 100 days every benefit period).  If Medicare won’t pay for additional days, neither will the supplemental policy as these policies will usually only cover the portion of approved days that Medicare doesn’t cover. Most patients who use up 100 days of SNF benefits would never go another 60 days in a row without being admitted to the hospital.  They use up their 100 days for a reason. They cannot avoid living at home without avoiding frequent hospital level care.  Clinically, what I see is that most patients who have used up their 100 days in a benefit period will are palliative care candidates or require long term care in a nursing home.
Source: blogspot.com

Video: Medicare and the Federal Employees Health Benefits (FEHB) Program

Understand Medicare benefits to Plan for Aging Parent’s Care

To help you better understand the options of care available for your parent in the community, Genworth offers an explanation of the four primary types of providers, including home care agencies and nursing homes. NPR also recently ran an informative piece entitled, “Financial Planning For The End Of Life” which offers more suggestions and tips on how to plan to pay for end-of-life care.
Source: cheaplikemeblog.com

Medicare Part A Premiums, Deductibles, Copays and Coinsurance Explained

Medicare Part A hospital deductible:  A deductible is the amount you must pay before Original Medicare begins to pay.  In 2012, the Part A deductible is $1,156.  This deductible is benefit period specific.  A benefit period begins the day that you are admitted as an inpatient and ends when you have not received any further inpatient hospital or skilled nursing care for 60 days in a row.  A new benefit period begins after these 60 days and you must pay the inpatient deductible for each benefit period.  There is no limit to the number of benefit periods.
Source: medicareecompare.com

Medicare Open Enrollment Time: Prep Course

Medicare Advantage: Also known as Medicare Part C Part C was designed to give Medicare beneficiaries the option of buying coverage through a private health insurance company. These plans provide coverage for all the same services as Part A and B, but are administered by private carriers. These plans often include additional benefits.
Source: gohealthinsurance.com

Understanding Medicare Benefit Periods

Under Part A the patient must pay a deductible for every "hospital benefit period." Unlike most health insurance, where deductibles must be satisfied once every year, usually between January and December, there can be several Medicare hospital benefit periods in a calendar year. In 2010 the Part A deductible per benefit period is $1,100. A benefit period begins on the day a patient enters the hospital and ends after there has not been any hospital or skilled nursing care for 60 days. If the patient is discharged from the hospital or a skilled nursing facility and returns to either within 60 days of discharge, it is considered to be the same benefit period and there is no need to pay another deductible. However, if the patient remains out of skilled medical care (either hospital or skilled nursing facility) for more than 60 days and then goes back to the hospital, a new benefit period begins and another Part A deductible of $1,100 is required.
Source: texasagingnetwork.com

Three Methods To Discover The Greatest Value In Medicare Supplement Insurance Plans

advantage Benefit coinsurance com Complement cost cowl firm health information insurance medical health insurance medical insurance plan Medicare medicare beneficiaries medicare benefit medicare drug plan medicare insurance medicare part c medicare part d medicare plan medicare protection medicare supplement medicare supplemental insurance medicare supplement insurance medicare supplement plan medicare supplements Medigap medigap plans number person personal insurance coverage plan premium prescription prescription drug coverage private insurance companies Protection provider Safety sixty Social state supplement website
Source: fluxfeatures.com

Medicare Spending Growth Slows : South Carolina Nursing Home Blog

Posted by:  :  Category: Medicare

The Pfelons of Pfizer: Too Crooked to Fail and Don't Go to Jail (g1a2d0052c1) by watchingfrogsboilCBO Director Doug Elmendorf said at a press conference that the slower growth in Medicare is consistent with slower health care cost growth throughout the economy, which many analysts have observed.  The report also looked at Medicaid. Federal outlays for the program are expected to total only 1.7 percent of GDP next year and 2.4 percent of GDP in 2022 as the program expands under the 2010 health law.  In comparison to its March projections though, the CBO said Medicaid spending would decrease by $325 billion, or 7 percent, from 2013 to 2022. The bulk of that reduction is due to the Supreme Court’s ruling on the health law, which makes optional an expansion of the program that the law essentially required all states to put in place.
Source: scnursinghomelaw.com

Video: South Carolina Medicare

Medicare Fraudsters Sentenced To Prison After $45M Scheme

• Lazaro Delgado, after serving a nine-year prison sentence for drug dealing, acquired two home healthcare agencies that billed Medicare $4.1 in phony claims. Delgado hid his role by putting the businesses, Loyal Home Health and Loving Nursing, in the names of straw owners. Delgado, who stole the ID numbers of physicians and patients in the Medicare network to submit fraudulent claims, collected $1.8 million for purported medical services in 2010-11. Delgado recently pleaded guilty and faces sentencing.
Source: cbslocal.com

Medicare in South Carolina

Curious about Medicare Supplements in the southern state of South Carolina? Click to learn the basics! Stay informed http://www.medicaresupplementsmadeeasy.com/2012/medicare-supplement-articles/south-carolina-medicare-medicare-supplements.php
Source: medicaresupplementsme.com

Some states now offer ODs Medicaid EHR incentives

The entry of optometrists into state Medicaid EHR Incentive Programs comes as the result of lobbying efforts by the AOA to get the Centers for Medicare & Medicaid Services (CMS) to clarify incentive program rules, as well as successful efforts by state optometric associations to assist state Medicaid departments in filing necessary state Medicaid plan amendments with the CMS to allow participation by optometrists in their incentive programs.
Source: newsfromaoa.org

Medicare program offers insight into nursing home safety

Families in South Carolina can use this free resource to help narrow down the facilities that seem like the best fit, and then conduct in-person visits from there. Nursing home negligence is a top concern among families who require residential placement for their loved ones, and Nursing Home Compare can help shine a light on which facilities offer the highest standard of care. For those families who believe that their loved one has experienced nursing home negligence or abuse, the first step is to investigate the avenues available for legal recourse. A well-executed lawsuit can not only result in punitive measures for the individuals and institutions responsible, but can also give families the financial means to secure quality care for their loved one.
Source: florencescpersonalinjuryattorneys.com

Grandstanding Over Medicaid Begins in Florida, South Carolina

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

Medicare At Center Of Tug

Politico: Pelosi Blasts Ryan Medicare Plan At Convention Nancy Pelosi teed off on Republican vice presidential candidate Paul Ryan’s Medicare plan, saying Democrats “created” the senior health care program and “will not let them take it away.” In a 25-minute speech to the California Democratic Party delegation, Pelosi said that “nothing less than the character of our country” is on the ballot this November – a familiar refrain from the House minority leader, who is trying to make Republican plans to reshape Medicare a major issue for the fall campaign. “We’re going to reject the Ryan plan, which is a transparent trick to end Medicare,” Pelosi said during a gathering over breakfast. “It’s just plain wrong to privatize, voucherize and end Medicare as we know it” (Sherman, 9/3).
Source: kaiserhealthnews.org

Medicaid Expansion: Costs or Savings for South Carolina?

Good news is that more people will be covered under the program, and though it will cost more in Medicaid, it will mean savings elsewhere for South Carolina.  Although the Milliman report includes significant state savings from increased drug rebates ($335.5 million), lowered costs for uncompensated hospital care ($217.5 million) and four years of enhanced federal match for the Children’s Health Insurance Program (CHIP) ($130.2 million), it does not look at state savings outside the SCDHHS budget. Those would include significant increases to the number of Department of Mental Health patients made eligible for Medicaid, meaning that the feds would pick up at least 90% of costs now paid by state dollars. Nor does it address eliminating coverages for those currently eligible at above 138 % of FPL. That includes pregnant women who would be eligible for subsidized private insurance through the Health Benefits Exchange, so no longer need Medicaid coverage
Source: theruoffgroup.com

Electronic Medical Records

Posted by:  :  Category: Medicare

Jessica Sundheim by On BeingAs any high-school student  submitting applications for colleges can attest , many of our most paperwork-intensive processes have become  digitized .  The Common Application and most other universities/colleges   applications have become digitized,  just one of the examples that highlights  a momentous shift in the way we  deal with paperwork.  While this shift has been visible for some time , there is a new development  that  firmly   illustrates the significance  of the  shift  : the Medicare and Medicaid EHR Incentive Program.
Source: meccabrowser.com

Video: Medicare Shared Savings Program and Advance Payment Model Application Process

New Changes in the Delivery of Medicaid Home Care Services in N.Y.C.

The potential effect of these changes is that the managed care providers will be paid a fee for providing a bundle of services that will cause them to limit the amount of Home Care services provided.  It could also result in a number of seniors being recommended or referred to nursing homes if the managed care provider decides that the amount of Home Care services needed is more than they want to provide.  Legal advocacy to prevent unwarranted referrals to nursing homes will be required. Seniors and others receiving Medicaid may also have to change their doctor if that doctor is not part of the managed care plan’s network of doctors.    
Source: ulitzer.com

DAR File No. 36710 (Rule R414

There is no measurable impact to Medicaid providers because instances of provider misconduct are rare. In most cases, other providers can fill in for providers who are excluded or terminated from the Medicaid program. Providers who are excluded from the Medicaid program will see a loss of revenue, but it is impossible to estimate how many recipients they may lose and for which services. The Department does not anticipate any out-of-pocket expenses to Medicaid recipients due to a lack of access to services.
Source: utah.gov

Temporary visa no medicare

If it stated on your visa that you can not get medicare then it means that you will not be able to claim back any percentage of the cost of Doctors visits. There is a reciprocal agreement between the two countries for emergency medical care in hospitals ( free ), but not for regular visits to the Doctors.Not that many Doctors bulk bill these days ( in fact none do where I live ), so it has never been free but I do get a percentage back through medicare Do keep the receipts for your blood tests etc though, because whilst you won’t be able to claim back any money on medicare right now as your visa stipulates, you will once you have applied for permanent residence or other long stay visa and it can be backdated. That’s what I did. I am not sure how much your prescriptions will work out at.
Source: pomsinoz.com

Medicare Therapy Caps: Changes Effective October 1, 2012 and the Impact on Hospital Outpatients and OthersHall Render

.  Beginning October 1, 2012, requests for exceptions for medically necessary outpatient therapy services that exceed $3,700 per calendar year will be subject to a manual review process.  Providers will be phased into this manual review process by being placed in one of three phases.  Providers in Phase I will be subject to the process beginning October 1, 2012, providers in Phase II will be subject to the process beginning November 1, 2012 and providers in Phase III will be subject to the process beginning December 1, 2012.  The manual exception process does not apply to a provider until its designated phase has begun.  CMS will send a mailing to providers to inform them of which phase they have been placed into.  This manual review process will be in addition to the automatic exception process for the $1,880 cap already in place and will act as a second level of the exception process.
Source: hallrender.com

Medicare Shared Savings Program & Advance Payment Model Application Process

With the March 2010 passage of the ‘Patient Protection and Affordable Care Act (PPACA), the ‘follow the money’ floodgates are once again opening for hospitals, physicians, integrated delivery systems, health plans, and consultants. This time, instead of migrating ‘HMO lite’ (neither staff nor group model) platforms into mainstream medicine via IPAs, or MeSH model JV’s, we’re now talking about their ‘new and improved’ successors broadly cast as ‘Accountable Care Organizations aka ‘ACOs’.
Source: wordpress.com

Are Medicare Health Plans Available To Non

Legal residents are eligible for free coverage under Part A if they or their spouses paid Medicare taxes for a minimum of ten years. If a legal resident did not make the minimum number of payments, the resident is still eligible for Part A but must make premium payments for the coverage. Legal residents are also eligible for Part B but must make premium payments for the coverage, regardless of any Medicare taxes paid. Legal residents also have the option to receive their Part A and B coverage through Part C Medicare health plans, which are typically health maintenance organizations. Depending on the insurer chosen for Part C, the individual may receive benefit coverage greater than that offered through Parts A and B in exchange for using a limited network of health providers. Legal residents can also choose to enroll in prescription drug coverage under Part D but must make premium payments. Legal residents can also receive their Part D coverage through a Part C insurer.
Source: seniorcorps.org

What Rural Needs to Know About the New Medicare

FactCheck.org describes the differences (8/22/12): “The Obama approach is to stay with government-provided traditional Medicare while putting pressure on health care providers to deliver care more efficiently, and instituting new payment models and coordination of care to cut costs. The Romney-Ryan plan turns to competition among insurance companies to lower costs and premium support payments to induce seniors to pick their health plans based on price.”
Source: dailyyonder.com

Exchanges Part 2: What to look for and what to look out for

Despite having invested many millions in our technology platform, we’ve found that there’s no substitute for a knowledgeable helping hand when choosing the best health plan. Extend Health employs hundreds of knowledgeable, licensed professionals who spend time on the phone with our consumers to make sure they’ve considered the important elements of their medical needs, prescription drug needs and lifestyle needs when choosing a plan. Our technical systems set the high bar in the private Medicare exchange marketplace, but our benefit advisors are our secret sauce. They bridge the gap between the technology side and the real-life decision points that go into picking the best health coverage for each individual.
Source: wordpress.com

Understanding Your Medicare Application

To be eligible for an online application, you must prove your identity by answering a series of questions. You will also be required to prove your eligibility – you should be at least 61 years and 9 months old, you must be planning to start your Social Security benefits within the next 4 months, you must live in the United States and you must be willing to receive your Social Security benefits through direct deposit.
Source: blogspot.com

Shingles Vaccinations Not Covered For Some Medicare Beneficiaries

Posted by:  :  Category: Medicare

A. Shingles is a painful rash caused by a virus that can lead to long-term nerve damage called postherpetic neuralgia. All Medicare Part D prescription drug plans cover the shingles vaccine, which is recommended by the Centers for Disease Control and Prevention for people age 60 and older. But Medigap plans, which may cover the deductible and coinsurance amounts for services provided under Medicare Parts A and B (hospitalization and outpatient care), don’t offer any financial help on the co-payments for vaccines and other drugs covered under Part D.
Source: kaiserhealthnews.org

Video: United Healthcare Oxford Medicare Advantage Denies Coverage

Health Insurance in NYC and Area: Medicare Annual Enrollment Period 2012

The 2012 Medicare Annual Enrollment Period is from October 15 to December 7th. This is the time period that anyone with Medicare coverage can look to switch their supplement coverage or add a Medicare Advantage or stand alone prescription drug plan. Basically, those eligible for Medicare can shop around and select a plan that suits their needs and lifestyle. Of course, if you are just turning 65 you have a 7 month period (IEP) to choose additional coverage in addition to your Part A and Part B coverage. If you know someone with special medical needs and/or conditions they may qualify to switch plans at any time of the year using what is known as a Special Enrollment Period. (SEP). This SEP is also available to those who qualify for both Medicare and Medicaid (dual eligible). In both cases you can switch plans as many times as you like year round. Because of the complexity and number of plan options available it is important to seek the help and advise from a specialist in this field. I offer my services as your trusted advisor. Please feel free to contact me and I will do my best to help you with this important health care decision. I am appointed and certified with United Healthcare (AARP), Empire Blue Cross, Easy Choice and Amerigroup for plans in the NYC and surrounding county area. Visit my website at www.kirkdevereux.com or www.amghealthplans.com Kirk Devereux 914-393-3872 kirkdevereux@gmail.com
Source: blogspot.com

Preventive & screening services

The page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

“Medicare & You” goes paperless

and access all the same information found in your printed handbook. You can learn what’s new for the year, how Medicare works with your other insurance, get Medicare costs, and find out what Medicare covers. Even better, the handbook information on the web is updated regularly, so you can instantly find the most up-to-date Medicare information.
Source: medicare.gov

Health Care Reform May Impact Your Employment and Severance Agreements

Employers that fail to satisfy these requirements may face an excise tax equal to $100.00 per day during the period of noncompliance for each “affected employee.” For this purpose, the IRS has defined affected employees to include each employee who is discriminated against as a result of the arrangement. If the violation is the result of an unintentional failure the maximum penalty is the lesser of (i) 10% of the total amount paid by the company in the previous year with respect to health insurance, or (ii) $500,000. The penalty is enforced on a voluntary self-reporting basis whereby the IRS requires violating employers to file a special tax return. More draconian penalties apply if the IRS discovers the violation in connection with an audit.
Source: bklawyers.com

Medicare Part D Notice of Creditable Coverage

If you are an employer that provides prescription drug coverage to employees and their dependents as part of your employer-sponsored health insurance plan, you must notify all of your Medicare-eligible employees and dependents of their options regarding Medicare Part D prescription drug coverage.  Since it is difficult to know for sure who among your employees and their dependents may be Medicare eligible, we recommend sending this notice to all participants in your employer-sponsored health insurance plan.
Source: holdenagency.com

Maximizing Medicare Prescription Drug Coverage

Medicare beneficiaries take an average of 29 prescriptions per year, spending approximately $1,300 on medications annually.[1] Individuals with chronic conditions such as heart failure often pay more than double that amount.[2]   Fortunately, there is a voluntary program called Medicare Part D that helps beneficiaries pay for their prescription drugs. Beneficiaries can access prescription drug coverage either from a stand-alone Part D prescription drug plan or from a Medicare Advantage plan that bundles coverage of medical, hospital and prescription drug benefits in one plan.   Enrolling in Part D prescription drug coverage is one way beneficiaries can help manage their prescription drug costs, but they should be aware that all Part D plans include a coverage gap, which is often called the “donut hole.” In the coverage gap, beneficiaries’ out-of-pocket costs on their prescription drugs increase significantly.   Summer is the time of year when many beneficiaries enter the coverage gap, making this an opportune time for beneficiaries with Medicare Part D to remind themselves of the following tips that may help them save money on their prescription drugs and make the most of their benefits.    1. Get Help with Managing Multiple Medications Beneficiaries who have a chronic condition that requires them to take multiple medications every day should consider enrolling in a Medicare Advantage Chronic Special Needs Plan. These specialized Medicare Advantage plans combine Medicare coverage with additional support services, some of which are designed to help ensure that members are able to afford their medications and understand how to take them as directed. Many Special Needs Plans also offer personalized pharmacist counseling and drug formularies designed for Medicare beneficiaries with complex health care needs.    2. Understand How the “Donut Hole” Works All Part D plans include a coverage gap. After spending $2,930 in out-of-pocket costs on their drug coverage, beneficiaries will reach the coverage gap. Currently, beneficiaries in the gap pay 50 percent of the cost of their brand-name prescriptions and 86 percent of the cost of generic drugs. In an effort to prepare for the increased expenses while in the gap, beneficiaries should monitor their plan’s Evidence of Coverage statement to get a clear sense of their drug expenditures and see how close they are to reaching the gap.   3. Apply for “Extra Help” with Drug Costs  For beneficiaries with limited income and resources, Extra Help is a federal program that provides an average of $4,000 of additional assistance with prescription costs. According to the Social Security Administration, many beneficiaries who qualify for this program don’t know they are eligible. Medicare beneficiaries must apply for this program, and the amount of assistance is based on annual income and assets. For more information about the Extra Help program, contact the Social Security Administration at 1-800-772-1213.   4. Take advantage of cost-savings on prescription drugs. Beneficiaries enrolled in a Medicare Advantage plan that includes drug coverage should check their plan details to see if they could save money on their prescriptions, such as by using mail-order pharmacy benefits, switching to generic or lower-tier drugs, or taking advantage of special programs available with some plans.   5. Explore “PAP” Programs Several pharmaceutical manufacturers sponsor Patient Assistance Programs (PAPs) that may reduce prescription drug expenses. Some companies offer financial assistance or free products, but all manufacturers have their own rules and grant assistance on a case-by-case basis. For more information, contact the Partnership for Prescription Assistance program at 1-888-477-2669.   For more information about Medicare Part D, contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day, seven days a week. The Arkansas State Senior Health Insurance Information Program (SHIIP) provides free counseling and support to help beneficiaries understand their Medicare coverage options, including prescription drug coverage. To contact the SHIP office in Arkansas, call 1-800-224-6330.    Ray Morris is the community outreach manager for Care Improvement Plus in Arkansas. Care Improvement Plus is a UnitedHealthcare Medicare Solution providing specialized Medicare Advantage coverage for underserved and chronically ill beneficiaries throughout Arkansas.  
Source: thecitywire.com

Health Insurance in NYC and Area: United Healthcare Senior Healthplan Specialist

Posted by:  :  Category: Medicare

I am certified and appointed with United Healthcare to help people with information, or to enroll in a Medicare Advantage plan (MA,MAPD), a Medicare Supplement plan or a stand alone prescription plan (Part D plan). The Medicare Annual Enrollment Period is from October 15 to Dec 7 this year. This is the period every year that those with a Medicare coverage plan can switch to another plan if they so choose. I am here to help so feel free to contact me and we can arrange to meet at your convenience to go over all your options. I can also help those just turning 65 with one of United Healthcare’s Medicare plans that help with health costs that Medicare does not cover. These people have a 7 month period to sign up for coverage. 3 months before birthday, one month of birthday, and 3 months after 65th birthday. This is known as the Initial Enrollment period. Go to this link for a list of United Healthcare/ AARP Medicare plans in your zip code and to search for your doctor or hospital: https://www.aarpmedicareplans.com/home.html You can then give me, Kirk Devereux a call at 914-393-3872 and I will help you in any way I can to understand or enroll.
Source: blogspot.com

Video: United Healthcare Oxford Medicare Advantage Denies Coverage

AARP/UHC Medicare Advantage

I was training a new agent in Florida today, the appointment we had was set from a mailer we sent to T-65. The client showed us a envelope from an Agency in Tarpon Springs, FL. They had sent an AARP/UHC Medicare Advantage with yellow highlights for the customer to sign including the scope of appointment and a returned envelope. What would you do?
Source: insurance-forums.net

Unitedmedicarerx.com:

united medicarerx, united healthcare, medicare rx plan, prescription drug plan, medicare part d, medicare plan part d, medicare prescription drug plan, medicare drug coverage, medicare drug plans, medicare eligibility, medicare enrollment, medicare part d
Source: seovalidator.net

Madame Defarge: Avoid Working w/ United HealthCare, Medicare Advantage Plan, unless you are an IN

Well, I’ve got nothing better to do than to organize a bunch of paperwork to send to United HealthCare Appeals Department which entails printing out all of the patients’ outpatient psychotherapy notes, creating a face page, sending a copy of it to the NC Insurance Commissioner as the client did not understand that a Medicare Advantage company can be an oxymoronic term.  Almost one-half year’s worth of weekly billing had been rejected x2 (it takes time to wind thru their system while I continue to honor my relationship w/ the client and see her) on the basis of:                           Error Code: 0979: Member Self Directed Out of Network So, for United Healthcare, if the Medicare provider is not ‘in network’ to that company, if the client picks that company as their Medicare Provider, you will not be paid.  The woman on the line at United HealthCare, as she tried to talk the client out of switching back to Medicare insisted, “You could have seen oe of the providers we have” to which the client stated, “But I’ve been seeing Dr. Hammond since my husband died”—–indicating that the administration of United Healthcare has no idea of the nature of outpatient therapy.  Hey: just switch over to that fella down the road.  Right. She called them the other day to switch back to regular Medicare—–where I recommend ALL my clients to stay.  I haven’t had any recent trouble w/ Humana but two years ago they insisted I send all of my patients’ session notes in order to pay me.  And by the way, that reminds me that the company that Humana had outsourced the outpatient mental health care only authorized until mid-year. Whoopee!  More paperwork to create for Humana.  WE NEED A ONE PAYER SYSTEM THAT IS CENTRALLY ADMINISTERED.
Source: blogspot.com

NGHS, United still in contract talks

x3Cpx3EIn one week, many residents may be left without affordable access to one of the areax26rsquox3Bs largest health systems.x3C/px3Ex0Dx0Ax3Cpx3EAccording to Northeast Georgia Health System, as of Aug. 22 its services will be considered out of network with UnitedHealthcare unless negotiations for a new contract come to fruition.x3C/px3Ex0Dx0Ax3Cpx3Ex26ldquox3BThis means many families across Northeast Georgia will have limited access to our facilities and our physician group and may be required to leave the area for the services they now receive close to home unless they want to pay higher outx2Dofx2Dpocket costs imposed by United,x26rdquox3B said Melissa Tymchuk, a spokeswoman for the health system, in a press release.x3C/px3Ex0Dx0Ax3Cpx3EThe current contract is set to expire on Aug. 21 and if a new agreement is not reached by then, the system and its physician group, Northeast Georgia Physicians Group, will be out of network as of Aug. 22.x3C/px3Ex0Dx0Ax3Cpx3Ex26ldquox3BUnitedHealthcare has been conducting frequent negotiations with Northeast Georgia Health System,x26rdquox3B said Tracey Lempner, spokeswoman for United, in an email. x26ldquox3BWe believe that we have put together a contract that is fair and offers our members access to quality, affordable care.x3C/px3Ex0Dx0Ax3Cpx3Ex26ldquox3BWe are hopeful that we will reach a new agreement with Northeast Georgia Health System and continue to negotiate the final details of a new contract.x26rdquox3Bx3C/px3Ex0Dx0Ax3Cpx3ETymchuk confirmed the two organizations are meeting again this morning.x3C/px3Ex0Dx0Ax3Cpx3Ex26ldquox3BWe are hopeful every day that wex26rsquox3Bll come away with a completed contract,x26rdquox3B she said. x26ldquox3BBut wex26rsquox3Bre hoping (today) they can get together and come to some resolution on some of these pieces.x26rdquox3Bx3C/px3Ex0Dx0Ax3Cpx3EAccording to a press release issued by the health system, negotiations began this January. It was hoped the talks would wrap up by June 20.x3C/px3Ex0Dx0Ax3Cpx3EBut, Tymchuk said, sometimes these contract negotiations go right up to the deadline.x3C/px3Ex0Dx0Ax3Cpx3Ex26ldquox3BIt has happened before,x26rdquox3B she said. x26ldquox3BWe did go late into the process with Cigna last year. It certainly doesnx26rsquox3Bt happen with every contract, thank goodness, but it can happen from time to time where you just canx26rsquox3Bt come to an agreement until right before the deadline. Itx26rsquox3Bs certainly not how we want it to play out.x26rdquox3Bx3C/px3Ex0Dx0Ax3Cpx3ETymchuk said some language in the new contract is what is holding up the process x26mdashx3B not reimbursement rates that can sometimes bog down talks.x3C/px3Ex0Dx0Ax3Cpx3Ex26ldquox3BWe pressed forward, and in fact, most contract terms about reimbursement rates have been settled for some time. However, we are not willing to compromise on contract language that threatens our financial stability, limits our ability to improve coordination of care in the future or puts quality of care at risk. We canx26rsquox3Bt accept an agreement that harms our patientsx26rsquox3B future local access to inx2Dnetwork care or relationships with their valued health care providers.x26rdquox3Bx3C/px3Ex0Dx0Ax3Cpx3EBut some United insurance holders said the uncertainty is worrisome.x3C/px3Ex0Dx0Ax3Cpx3Ex26ldquox3BI canx26rsquox3Bt make my sonx26rsquox3Bs yearly appointment because I donx26rsquox3Bt know where Ix26rsquox3Bm going to make the appointment,x26rdquox3B said Tonya Weckler, a United policyholder. x26ldquox3BI would imagine that there are a lot of people in Gainesville that have UnitedHealthcare.x26rdquox3Bx3C/px3Ex0Dx0Ax3Cpx3ETymchuk said certain patients may be able to still receive care after Aug. 21 if negotiations do not prove successful. Patients who are hospitalized, pregnant or currently undergoing active treatment for acute or chronic conditions could be covered under continuity of care conditions.x3C/px3Ex0Dx0Ax3Cpx3EPatients would have to confirm that with United.x3C/px3Ex0Dx0Ax3Cpx3Ex26ldquox3BIt does put patients, employees and employers in a bad position where theyx26rsquox3Bre not sure whatx26rsquox3Bs going to happen with their insurance,x26rdquox3B said Tymchuk. x26ldquox3BIt can cause uncertainty and itx26rsquox3Bs not something we want happening for our patients.x26rdquox3Bx3C/px3E Source: gainesvilletimes.com
Source: medicaresupplementalco.com

2013 AHIP Medicare Training Reimbursement Offer From Ritter

I would like to get contracted with UHC Medicare Advantage. Can I switch over to you guys as the FMO if I signed up with another but did not complete my certifications with UHC and have no writing number?
Source: ritterim.com

UHC Announces Changes to its Medicare Advantage Audits

UHC will no longer use MedAssurrant, the contractor that previously conducted its payment integrity audits. UHC will also make changes in the way that it conducts its Risk Adjustment Date Validation (RADV) audits. These audit request letters will be more clear about the reason for the audit and provide consistent information on follow-up medical record review, audit requests, and post-audit claim payment determinations. UHC will also update its payment integrity and recovery practices. Currently, UHC asks physicians to refund the full amount paid on the original claim and then resubmit the claim using the recommended coding. In the first quarter of 2012 physicians will only need to resubmit the claim with the recommended coding and refund only the difference between the amount UHC originally paid and the amount that should have been paid using the new coding. Physicians who disagree with UHC’s recommended coding should appeal the claims.
Source: wordpress.com

5 Stocks to Avenge a Bad Court Ruling

Now that the health care debate has been decided, there will be more sense of stability in the sector. That’s good news for the biggest health care stocks out there, and one way to own those stocks is via the Health Care Select Sector SPDR (NYSE:XLV). This exchange-traded fund (ETF) holds the biggest and best companies in the health care industry, and now that the uncertainty over which way the court will go is out of the way, stocks in the sector will adjust to the “new normal” conditions. One thing the market loves more than anything is certainty, and even if the court’s ruling was a bad one, at least we aren’t wondering what it will do any longer—and that’s a positive for stocks in the space.
Source: investorplace.com

Medicare And Medicaid Provider Enrollment In The State Of Wisconsin

Posted by:  :  Category: Medicare

Jessica Sundheim by On BeingAfter the license is granted, a medicare certification will be granted after compliance with much more standards. If one is interested in providing the Medicaid program, he should apply for the same at the same time he applies for the Medicare program. It is to be noted that during the change of ownership the license is non transferable.
Source: medicarewisconsin.com

Video: Medicare Shared Savings Program and Advance Payment Model Application Process

Today News Laptop Bags for College Students: Medicare Applications

Well it’s really not as complicated as it seems. If you are a solo provider and you are using your social security number for your tax ID number then you need to complete an 855I, 588 EFT, and a CMS 460. The CMS 460 is the participating provider agreement. You only need to complete this if you choose to be a participating Medicare provider. The 588 EFT is the Electronic Funds Transfer form. Medicare requires that you accept EFT and they will transfer your payments directly into your bank account. The 855I is the individual provider application.
Source: blogspot.com

ACO Timeline: Key Dates and Application Process

These 89 new ACOs have entered into agreements with CMS, taking responsibility for the quality of care they provide to people with Medicare in return for the opportunity to share in savings realized through high-quality, well-coordinated care bringing the total number of organizations participating in Medicare shared savings initiatives to 154, including the 32 ACOs participating in the Pioneer ACO Model by the Center for Medicare and Medicaid Innovation announced last December, and six Physician Group Practice Transition Demonstration organizations that started in January 2011. As a result, as of July 1, more than 2.4 million beneficiaries are receiving care from providers participating in Medicare shared savings initiatives.
Source: wordpress.com

Weasel Zippers | Archives

The administration has accepted applications from 18 states to participate in the program, which would give states money to purchase managed-care plans for people who are either disabled or poor enough to qualify for both Medicare and Medicaid. HHS approved the first state plan, one for Massachusetts, last month.
Source: weaselzippers.us

At least Paul Ryan was going to wait a few years before killing Medicare. Barack Obama, on the other hand…

Bud parked three blocks over, walked up to the squadroom. No Exley, every desk occupied: men talking into phones, taking notes. A giant bulletin boar-d all Nite Owl–paper six inches thick. Two women at a table, a switchboard behind them, a sign by their feet: “R&I/DMV Requests.” Bud went over, talked over phone noise. “I’m on the Cathcart check, and I want all you can get me, known associates, the works. This clown was popped twice for statch rape. I want full details on the complainants, plus current addresses. He had three pimping rousts, no convictions, and I want you to check all the local city and county vice squads to see if he’s got a file. If he does, I want names on the girls he was running. If you get names, get DOBs and run them back through R&I, DMV, City/County Parole, the Woman’s Jail. “Details”. You got it?”
Source: correntewire.com

In Florida, Obama Talks Medicare

CNN: Medicare Takes Center Stage For Obama Campaign In Florida  In the senior-heavy coastal city of Melbourne on Sunday, President Barack Obama, armed with a new study, continued to hammer the Republican plan to reform Medicare. He highlighted a Harvard analysis, conducted by a former Obama adviser, that found seniors would pay more under the “Romney-Ryan plan,” compared to his plan, which he said will strengthen the entitlement program. Obama said GOP nominee Mitt Romney wants to “give money back to insurance companies and put them in charge of Medicare.” “Their voucher plan for Medicare would bankrupt Medicare. Our plan strengthens Medicare,” Obama told a crowd of 3,050 gathered at a sports and recreation center. “No American should have to spend their golden years at the mercy of insurance companies.” The focus on Medicare on Sunday was the latest effort by the president and his campaign to turn up the noise around the program and throw Romney off his message on jobs and the economy, especially important as the president continues to make a play for the senior vote ahead of the November election (9/9).
Source: kaiserhealthnews.org

DAR File No. 36566 (Section R414

(d) Except for PCN and UPP that are subject to open enrollment periods, the eligibility agency denies an application when the applicant fails to provide all requested verification, but provides all requested verification within 30 calendar days of the denial notice date. The new application date is the date that the eligibility agency receives all requested verification and the retroactive period is based on that date. The eligibility agency does not act if it receives verification more than 30 calendar days after it denies the application. The recipient must complete a new application to reapply for medical assistance;
Source: utah.gov

Shared Savings Collaborative Launched by the Premier Healthcare Alliance to Help ACOs with Medicare Applications : e Yugoslavia

Premier, a provider-owned performance improvement alliance of 2,600 hospitals and 86,000 other care sites, created the collaborative to aid in the MSSP’s challenging application process.Developed in October 2011, the MSSP allows Medicare to enter into contracts with individual accountable care organizations (ACOs) that agree to take responsibility for the quality of care furnished to individual beneficiaries. In return, these ACOs, which often include hospitals, primary care physicians, specialists, medical groups and post-acute providers, have the opportunity to share in savings realized through improved care.
Source: eyugoslavia.com