Obamacare: The Upcoming Medicare Tax Hike and What to Do About It

Posted by:  :  Category: Medicare

Newsweek Magazine (February 16, 2009) ... Lenders Add Bigger Fannie, Freddie Fee – Thanks to Payroll Tax Cut (January 15, 2012) ...item 2.. Dupuy: GOP trying to sell pyrmaid scheme to voters (September 3, 2012) ... by marsmet526In other words, if your income is more than $200,000 for a single person, $125,000.00 for a married person that doesn’t file jointly, or $250,000.00 for a married couple filing jointly, you can expect to pay the tax.  It will be assessed on your net investment income or the excess of your modified adjusted gross income over the applicable amount.  If your income isn’t over the threshold that applies to you, you don’t need to worry about the tax.
Source: lexisnexis.com

Video: Healthcare Takeover – Up Taxes, Debt, and Cut Medicare

A proposal for reforming federal taxes

There is a constant debate between the Democrats and Republicans about Federal taxes and programs such as Social Security, Medicare and Medicaid.  Recently at a private fundraising event, a secretly taped video highlighted Mr. Romney’s views about taxes, entitlements and redistribution of income.  He stated that 47% of the Americans who do not pay federal income taxes and do receive entitlements would vote for President Obama because of their dependency on government.  This remark seems to imply that there is a massive transfer of income from taxpayers to non-taxpayers and entitlement receivers in Obama presidency.  However, we find that even before Obama’s presidency, despite growth in entitlements which represent redistribution of income, income inequality has increased over a period of time.  
Source: standard.net

Lawmakers Spar On Medicare Advantage Plans

Medpage Today: Congress Spars Over Medicare Advantage Plans Democrats and Republicans traded jabs this week on health reform’s impact on Medicare Advantage plans, with one side praising the law’s effects and the other predicting it will hurt the program. Republicans in the House of Representatives held a hearing Friday on Medicare Advantage plans and took the opportunity to bash cuts in the plan under the Affordable Care Act (ACA) saying it will negatively impact enrollment and benefits for seniors enrolled in the plan. Ways and Means Health Subcommittee Chair Wally Herger (R-Calif.) said in his opening statement that the ACA’s $300 billion in cuts over the next decade will lead to higher cost sharing (Pittman, 9/21).
Source: kaiserhealthnews.org

IRS provides answers on the new 0.9% Medicare tax

Likewise, if former employees receive group-term life insurance in excess of $50,000, and the resulting income exceeds $200,000, you still don’t have to collect the additional tax from employees. You follow your normal procedure—report the income as wages on your 941 form and make a current period adjustment to reflect the uncollected taxes.
Source: businessmanagementdaily.com

FACT CHECK: Obama Misleads on Medicare, Taxes, and Regulations

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Source: heritage.org

What Employers Need To Know About The New Additional Medicare Tax On High Earners : Hunton Employment & Labor Law Perspectives

The Administrative Task Force plays a critical role in keeping our OSHA practice current and vibrant.  We follow developments daily and we work together to analyze the impact that proposed and actual changes will have on the law in general and specifically on our client’s industries. Employers today face an unprecedented range of workplace safety and OSHA legal issues as government increases worker safety and health regulation and demands meticulous reviews by its OSHA inspection force.
Source: huntonlaborblog.com

Mitt Romney’s shocking comments

Some frightening facts: When President Obama took office, our national debt totaled $10.6 trillion. And in the 3 ½ years since then, the national debt has passed $16 trillion and continues to rise. So who is lending us this enormous amount of money? According to a Wall Street Journal opinion piece, foreign Treasury bond purchases since 2009 have fallen almost 70%—countries like China and Japan are no longer willing to fund our government excesses. And in the same timeframe, private sector Treasury bond purchases (those made by U.S. banks, mutual funds, corporations, and individuals) have dropped by 85%. In truth, most lenders and foreign nations think that buying our debt is much riskier today, and many ratings firms agree. S&P downgraded U.S. debt in August 2011; Egan-Jones downgraded U.S. debt in April 2012 and again in September 2012; and Moody’s has threatened a downgrade in 2013 if the U.S. debt continues to rise.
Source: schillingshow.com

Will Tax Increases on Dividends be a Non

If tax rates rise as scheduled, taxpayers in the top marginal income tax bracket could see the tax on their qualified dividend payments rise from 15% in 2012 to 39.6%. Factoring in of the scheduled Medicare tax on net investment income of 3.8%, and the personal exemption phaseout and limitation on itemized deductions, the total tax on dividends could reach 43.4% in 2013.
Source: valueinvestingcenter.com

Medicare and ambulance services

Posted by:  :  Category: Medicare

It is important to remember that the decision letter you receive at each level of appeal will explain additional appeal rights you may have. You should read these decision letters carefully.   If you have questions about a Railroad Medicare claim, you can call a toll-free customer service line at (800) 833-4455, Monday through Friday, from 8:30 a.m. until 7:00 p.m. Eastern time. For the hearing impaired, call TTY/TDD at (877) 566-3572. This line is for the hearing impaired with the appropriate dial-up service and is available during the same hours customer service representatives are available.
Source: utu.org

Video: You Can Help Fight Medicare Fraud

CMS Unveils New Medicare Summary Notice

kslaw.com 1 of 1 March 12, 2012 CMS Unveils New Medicare Summary Notice On March 7, 2012, CMS introduced a redesigned claims and benefits notice for Medicare beneficiaries. The new notice, said CMS in a press release, is part of a broader consumer protection effort to make information about the program “clearer, more accessible, and easier for beneficiaries and their caregivers to understand.” Notably, the notice contains a new “How to Report Fraud” section, instructing beneficiaries to report instances of suspected Medicare fraud. The notice lists the receipt of free medical services and billing for services not received as examples of fraud. The notice also explicitly advises beneficiaries that vigilance can pay off—tips that lead to “uncovering fraud” may result in financial rewards. Other new features of the redesigned notice include: • A set of defined terms used throughout the notice. • A clear explanation of where the beneficiary stands with respect to his/her deductible and whether Medicare has approved all services. • “[C]onsumer-friendly descriptions for medical procedures.” CMS will soon make the new notice available to beneficiaries online at www.MyMedicare.gov. Beginning in 2013, CMS will send notices to beneficiaries each quarter. Click here to view the new notice and here to read the corresponding press release. Reporter, Greg Sicilian, Atlanta, +1 404 572 2810, gsicilian@kslaw.com. Health Headlines – Editor: Dennis M. Barry dbarry@kslaw.com +1 202 626 2959 The content of this publication and any attachments are not intended to be and should not be relied upon as legal advice.
Source: jdsupra.com

Making the Medicare Summary Notice Easy to Understand

This MSN redesign is part of a new initiative, “Your Medicare Information: Clearer, Simpler, At Your Fingertips,” which aims to make Medicare information clearer, more accessible, and easier for beneficiaries and their caregivers to understand.  CMS will take additional actions this year to make information about benefits, providers, and claims more accessible and easier to understand for seniors and people with disabilities who have Medicare.  This MSN redesign reflects more than 18 months of research and feedback from beneficiaries to provide enhanced customer service and respond to suggestions and input.
Source: medicarearticles.com

New Medicare Summary Notice Designed to Help Fight Fraud

“Consumer protection starts with making sure consumers not only get timely and accurate information, but that they understand what services they’re receiving from Medicare,” said Acting Administrator Marilyn Tavenner.  “The new Medicare Summary Notice empowers Medicare’s seniors and people with disabilities.  The statement is easier to understand and navigate, and makes clear what information to check and how to report potential fraud.  The new MSN also makes it easier for people with Medicare to understand their benefits and file appeals if a claim is denied.”
Source: wolterskluwerlb.com

6 Features of CMS’s Redesigned Medicare Summary Notice

In light of ongoing healthcare reform there is a push for clarity, as several of our stories illustrate this week. Medicare claims forms have been redesigned so that beneficiaries and their caregivers can better understand them, check for important facts and potential fraud. The subject of fraud is particularly timely given the story that has been circulating for the last week involving the arrest of a physician, the office manager of his medical practice, and five owners of home health agencies. They’ve been charged with allegedly participating in a nearly $375 million healthcare fraud scheme involving fraudulent claims for home health services.
Source: hin.com

AARP Provider Online Tool

AARP life insurance is a very complicated financial matter and must be approached with care and with the help of a certified professional who is skilled in working specifically with AARP life insurance. Asking friends and family for a referral to a good AARP life insurance agent can be one of the best ways to find a good one. A recommendation from someone you know always carries the most weight and can be better than just blindly searching online, not knowing what you might run into….
Source: ezinemark.com

Concerned about Medicare Part D Coverage? Join the Upcoming Teleconference

Posted by:  :  Category: Medicare

TWO YEARS OF RUIN by SS&SSAs you may know, Medicare Part D is a vital Federal program to the more than 3 million New Yorkers who participate. Part D provides disabled Americans and seniors access to affordable, life-saving medicines. The most recent Medicare Today survey found that 88% of seniors are satisfied with their coverage.
Source: newyorkhealthworks.com

Video: 2012 Medicare Part D Drug Coverage Updates

Compliance Alert: Medicare Part

As part of the Patient Protection and Affordable Care Act of 2010 (ACA), Plan Sponsors with group health plans which include prescription drug benefits now must provide the annual Part-D Creditable Coverage Notice by October 15, 2012. Before 2011, Plan Sponsors were to provide the notice no later than November 15, the first day of the Medicare Part-D open enrollment period. ACA changed the Part-D open enrollment to be the period between October 15 and December 7.
Source: andreini.com

Medicare Part D Premiums Holding Steady

Thanks to the marvels of medical science, our parents are living longer than ever before. Adults over age 80 are the fastest growing segment of the population; most will spend years dependent on others for the most basic needs. That burden falls to their baby boomer children. In The New Old Age, Paula Span and other contributors explore this unprecedented intergenerational challenge. You can reach the editors at newoldage@nytimes.com.
Source: nytimes.com

AHIP Testimony: Value Offered by Health Plans Participating in the Medicare Advantage Program

  Medicare Advantage plans also protect beneficiaries from catastrophic health care costs.  In 2012, all Medicare Advantage plans offer an out-of-pocket maximum limit for beneficiary costs, and about 78 percent of Medicare Advantage enrollees are in plans that have annual out-of-pocket maximums of $5,000 or less.  These out-of-pocket maximums – which are not offered by the Medicare FFS program – help protect Medicare beneficiaries from catastrophic health care expenses that otherwise might pose a serious threat to their financial security.  Medicare Advantage plans also help reduce out-of-pocket costs for enrollees by reducing premiums for Part B and Part D, and by limiting cost-sharing for Medicare-covered services, including primary care physician visits and inpatient hospital stays.
Source: ahipcoverage.com

Shingles Vaccinations Not Covered For Some Medicare Beneficiaries

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

Medicare Part D Coverage Gap

Gary Phillips is a licensed insurance agent based in western North Carolina. He specializes in the senior market and is knowledgeable in multiple insurance lines including Medicare, Medigap, Long-Term Care, Part D Prescription Drugs, Part C Medicare Advantage, Health, Life and Final Expense insurance. He also enjoys writing and helping others. www.bizpartner.homestead.com
Source: seniorliving.net

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

Spreading the Word on Medicare Part D

Ten thousand baby boomers will turn 65 today. This will happen again tomorrow, the next day and every day until 2030. With such a significant growth in Medicare eligible Americans, ensuring effective coverage and access to medicines well into the future is a priority. As New York Times’ blogger Paula Span noted on The New Old Age recently, Medicare Part D is providing stability for millions of seniors. From Span’s post:
Source: phrma.org

ACA Saved Medicare Beneficiaries $4.5B in Rx Drug Costs, HHS Says

This is good news for the seniors on Medicare. I am about to become one. However, we must ask oursleves where did the money come from to create this “savings”? How were the additional revenues created to cover the “donut hole”? Drug comapanies were required to essentially discount there charges to CMS to have their drugs covered by Medicare Part D. I have not seen there profits drop proportionately. The average wholesale costs for tehse drugs were raised 17% before the ACA chnages were enacted! They have continued to be increased this year. In essence, the non-Medicare patient has been paying for this….another example of a “transfer of wealth” in order to “be fair”. Dr. Apgar…former Chief Medical Officer Medicare Advantage Plan.
Source: californiahealthline.org

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

Social Security and You: Medicare Part D

While all Medicare beneficiaries can participate in the prescription drug program, some people with limited income and resources also are eligible for “Extra Help” to pay for monthly premiums, annual deductibles and prescription co-payments. Extra Help is worth about $4,000 a year. To figure out whether you are eligible for Extra Help, Social Security needs to know your income and the value of any savings, investments and real estate (other than the home you live in). To qualify, you must be receiving Medicare and your annual income must be limited to $16,755 for an individual or $22,695 for a married couple living together.
Source: mysanantonio.com

Study: Medicare Part D “donut hole” does not linked to increase in heart attacks

After a small deductible, Part D drug plans typically cover 75 percent of drug costs up to a certain dollar figure, which was $2,400 in 2007. After a beneficiary reaches that level, there is no coverage until the person has spent potentially thousands of dollars out of pocket, then coverage kicks back in.
Source: medcitynews.com

Medicare code denial MA130 and action

Posted by:  :  Category: Medicare

Code Pink R-E-P-P-E-N' ENDS! by eyewashdesign: A. GoldenMA 130 – Claims returned as unprocessable as appeal requests There are large volume of appeals have been filed on claims that were returned as unprocessable. An unprocessable claim is one that was filed with incomplete and/or invalid information. Claims that are unprocessable cannot be appealed. Therefore, when a provider files an appeal on an unprocessable claim, the correspondence is returned to the provider with a letter instructing the provider to refile a new claim. Response letters are typically not generated for at least 30-40 business days after the original request was submitted. To avoid delays in payments, providers must resubmit claims returned as unprocessable. Filing an appeal only delays payment on claims and could result in a timely filing denial if the incomplete/invalid claim is not re-filed with the correct information with the timely filing period. Identifying an unprocessable claim Claims returned as unprocessable will typically include the MA130 remittance advice message with a corresponding reason code message to denote why the claim was incomplete or invalid. Communication letters to top providers that file appeals on unprocessable claims CMS will be sending communication letters to providers in the future if appeals are continually filed on unprocessable claims. These letters will provide details on the number of appeals requests received on unprocessable claims by the applicable providers and the impacts that such requests have on regular appeal and inquiry inventories.
Source: insuranceclaimdenialappeal.com

Video: Medicare denial code

Important Traits to Choose Medicare Billing Specialist

In the world of science and technology, when everything can be done with just a click of a button or mouse, then why not medical billing? It is one of the important fields on healthcare industry gaining immense popularity among professionals. Since the Obama administration has stressed upon online channeling of the patient’s medical records, various government and private health institutions has made it a necessary step to recruit skilled and knowledgeable billing specialists into their arena. This remarkable step has helped many doctors, health practitioners or institutions to keep an up to date online records of patient’s data in relation to the treatment undertaken and amount of payment made for the same. Although, keeping a track of all the expenses incurred by the patient may become a tedious task for doctor or practitioner. To overcome such issues he plans to pick a good medical billing specialist for his assistance. Well! Hiring a billing consultant may help the practitioner manifolds but choosing the one might prove a challenging task! Never mind, picking the right Medicare billing specialist becomes all that simple and easy, once you undergo the following steps:
Source: ezinemark.com

Medicare Wellness Visits: One Visit a Year… But 3 codes?

Affordable Care Act AMA appointment reminder calls California CCHIT Certification/Licensing CMS Coding Data Security DEA E-Prescribing e-prescription EHR EMR EMR/EHR Ethics Final Rule Florida Fraud Healthcare IT HHS HIPAA HITECH Act Immigration Inside MTBC meaningful use medicaid Medicare Medicare/Medicaid medicare cuts Med Mal MTBC EMR New Jersey OIG ONC Patient Billing Pharma PQRI Privacy Quality of Care Real Time Claims Adjudication Reimbursement Stark I/II Technology Uninsured
Source: mtbc.com

American Power: Obama Tops Romney on Medicare

Americans see Social Security and Medicare as earned benefits, not handouts. Folks in many cases have paid decades of taxes to support the system. By the time they reach retirement they expect to cash out. So conservative proposals to shore up the system always face stiff headwinds, not because we don’t need reform either. Even if reforms won’t effect current retirees, folks still think changing the structure of benefits will gut the nature of the entitlement. We had a debate on this in 2005, when President Bush sought to restructure Social Security and Medicare. So it’s no surprise that Romney/Ryan haven’t been getting much support here. USA Today has some numbers on that, “Romney fights on Medicare but Obama retains advantage.” And Paul Ryan got booed yesterday at the AARP convention:
Source: blogspot.com

Medicare denial code CO 50 , CO 97 & B15

Medical Billing Solution, Medical Billing Training Program, About Outsourcing Services, Medical Billing Process and Concept, Tips to Medical Biller, Specialist. Medical Insurance Billing Denial Guidelines. Medical Billing Training Articles and Software Review. Medicare Billing CPT code ,ICD-9 DX Code Update.
Source: whatismedicalinsurancebilling.org

Paul Ryan gets loudly booed at AARP convention

“Our plan empowers future seniors to choose the coverage that works best for them from a list of plans that are required to offer at least the same level of benefits as traditional Medicare. This financial support system is designed to guarantee that seniors can always afford Medicare coverage – no exceptions,” he said. “Our idea is to force insurance companies to compete against each other to better serve seniors, with more help for the poor and the sick – and less help for the wealthy.”
Source: digitaljournal.com

Bupa Great North CityGames: US wins 6

Posted by:  :  Category: Medicare

BUPA-NHS Reversion by imjustcreativeJason Richardson, the silver medalist from London, and World Champ in 2011 in the 110 meter hurdles, gave Lawrence Clarke of GBR a quick lead. ” I just sat there, then started hurdling” noted a smiling Jason Richardson. Richardson and Ryan Wilson caught Clarke about hurdle 4, and then Richardson took off, winning in 13.41 to Wilson’s 13.48 to Clarke’s 13.57. ” I want to congratulate Aries Merritt who set the WR this season and competed with me all season long. Hurdlers compete against each other every week of the season. I think this brings more attention to our event.”  Jason Richardson, one of the most articulate athletes in any sport, has lot to say about making the sport more entertaining, and we will be interviewing him soon on his thoughts. 
Source: runblogrun.com

Video: Bupa. Find A Healthier You

Metlifecare sells Christchurch site to Bupa Care for $9.4 mln

Metlifecare posts annual loss on $99.9M writedown in property valuation Metlifecare investor’s stake to be sold at 2.2% discount after bookbuild Metlifecare shares in trading halt for book build Metlifecare shareholders vote in favour of amended merger deal Metlifecare amends merger deal again Metlifecare merger with Vision Senior, Private Life Care deemed fair to minorities Metlifecare reduces merger sweetener for Vision shareholders Metlifecare to buy Vision Senior Living and Private Life Care for $216M Metlifecare 1H underlying profit drops 38% Metlifecare completes $45.5M capital raising for debt reduction, expansion
Source: co.nz

Special Bupa Healthcare Discounts

At REPs we’re constantly on the lookout for new, exciting benefits for YOU the member. We’ve worked hard to secure a fantastic partnership with Bupa, offering special discounts on selected products for REPs members only!
Source: wordpress.com

Bupa first aged care provider to achieve Nursing Council approval

“Having a NCNZ approved PDRP became a key aim. It would close the gap between nurses in DHBs and Aged Residential Care and provide our nurses with an opportunity to showcase their knowledge and skills- and to have that commitment and professionalism recognised”. adds Langlands.
Source: co.nz

Court: You Can Appeal Medicare Decisions About Hospice Services

Posted by:  :  Category: Medicare

That’s a victory of sorts, because it makes it clear that beneficiaries have the right to challenge a hospice provider’s refusal to provide a service that a doctor deems necessary, Mr. Deford said. But it’s disappointing because it doesn’t ensure that people receive a notice of their right to appeal when they enter hospice care, or that any mechanism exists for expedited appeals – an important protection for people who are dying.
Source: nytimes.com

Video: Medicare Hospice, American Journal Of Palliative Care

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

Medicare Change Resolution Needed Before New Year

“The deficit committee had a unique opportunity to stabilize the Medicare program for America’s seniors now and for generations to come,” he said. “Once again, Congress failed to stop the annual charade of scheduled Medicare physician payment cuts and short-term patches, which spends more taxpayer money to perpetuate a policy everyone agrees is fatally flawed.”
Source: libertyhomecare.com

Understanding the Medicare hospice benefit

While attending a national hospice conference a few years back, I recall listening to Mary Labyak, one of the earliest pioneers of hospice care in our country. I’d heard Mary speak previously and, although I never had the honor of knowing her, she was a mentor for me throughout my career. Mary stated, “When you’ve seen one hospice, you’ve seen one hospice.” I was puzzled for a moment but quickly understood—and she was certainly correct in her declaration. Hospices across the country were continuing to find new and innovative ways to deliver services, developing programs that meet the unique needs of their communities. One is as different as the next. Some hospices are small, focused on providing care within a small geographic area, while others are large with a nationwide reach. Some service urban environments while others meet the challenges of servicing rural communities. Some are not-for-profit providers, some are for-profit, and others are government sponsored. It can be a challenge to navigate through the array of programs that may be available to you, and for this I refer you to my prior blog “Choosing a hospice: Finding the right program for you and your loved one.”
Source: wordpress.com

Appeal Rights Confirmed for Medicare Hospice Beneficiaries in Case Brought By Center for Medicare Advocacy 

Circuit Court of Appeals today also confirmed that Medicare hospice patients have the right to appeal denials of services. The defendant, Secretary of Health and Human Services Kathleen Sebelius, acknowledged after this lawsuit was filed, that Medicare hospice beneficiaries have a right to appeal coverage denials. However, the plaintiff, Howard Back could not know that, or access the appeal system, since he was told otherwise at every attempt to appeal. The 9
Source: medicareadvocacy.org

Can hospice function under Medicare premium support?

How common is it for MA patients to elect hospice as compared to traditional Medicare? MA patients are more likely to choose hospice than are beneficiaries in traditional Medicare, though the gap has been shrinking (47.8% of MA decedents v. 43% FFS in 2010; 30.9% MA v. 20.5% FFS in 2000 p. 288; longstanding p.141-143). MA plans have a financial incentive to encourage hospice selection because it pushes end-of-life costs to traditional Medicare, though a study testing whether making hospice a part of the capitation payment for MA* concluded that it would only save traditional Medicare a modest amount of money. However, this study focused on enrollment in hospice during the last month of life, which covers around two-thirds of users, using data from the 1990s. Since then, the expansion of hospice in Medicare has grown steadily, primarily through increased use of hospice by older beneficiaries, and via an increase in the use of hospice by persons with non-Cancer terminal diagnoses (like CHF and dementia). This means the tails of one side of the distribution (long users) have gotten a lot longer (90th percentile 150 days in 2000, 250 days in 2010 while the 25th percentile stay has been 5-6 days for 20 years. There is a literature on the correlates of hospice choice that partially line up with the correlates of MA advantage selection that I will post on later (urban, white, higher education and higher income are all more likely to choose MA, and hospice, even within traditional Medicare).
Source: samefacts.com

[WATCH]: Medicare Hospice, American Journal Of Palliative Care

www.hospicecarehome.com www.hospicecarehome.com www.hospicecarehome.com Medicare Application, Hospice Palliative Hospice Medicaid, Terminally Ill Care Medicaid Insurance, Palliative Medicare Medicaid, Comfort Care Medicare Fraud, Long Term Care Free video, video sharing, watchvideo of hospice care, hospice services, palliative care, medicaid, hospice palliative care, hospice and palliative care, medicare, end of life care Hospices, Home Health Care, Home Health Care Agencies, Hospice
Source: wordpress.com

The Medicare Hospice Benefit Explained

Congress established the Medicare Hospice Benefit in 1983 to ensure that all Medicare beneficiaries could access high-quality end-of-life care. Today, more than 65 percent of hospice patients are Medicare beneficiaries. The Medicare Hospice Benefit offers dying Americans the option to experience death free of pain, with emotional and spiritual support for both themselves and their families.
Source: hrrv.org

US Intervenes In False Claims Act Lawsuit Against Florida

The lawsuit, filed by HOTCI’s former vice-president of finance, Douglas Stone, alleges that HOTCI knowingly submitted false claims to Medicare for hospice care for patients who were not terminally ill.  Specifically, the lawsuit contends that HOTCI’s chief executive officer verbally instructed HOTCI employees to admit Medicare recipients for hospice care even where there had not yet been a determination that they were eligible for the hospice benefit.  The lawsuit also alleges that, after being notified that it would be audited by its Medicare contractor, HOTCI formed an internal committee to review the eligibility of its Medicare patients and discharged at least 150 patients in 2009-2010 as being ineligible for the Medicare hospice benefit.
Source: fraudwhistleblowersblog.com

Dixon Healthcare Solutions Inc.: Medicare Hospice Rate for 2013

CMS has published the Medicare Hospice Payment Rates for 2013.  This represents a 1.6% increase in payments for FY 2013.  This rate is comprised of a 2.6% market basket increase; less a 0.7% productivity adjustment; less 0.3% additional hospice-specific productivity adjustment to arrive at the 1.6% rate increase.  Listed below are the Medicare Hospice Payment Rates for 2013:
Source: blogspot.com

Benefits of Medicare Hospice Services

WAXAHACHIE, TX—U.S. Rep. Joe Barton (second from left) meets with area staff members at Odyssey Hospice’s South Dallas office to learn more about the ways that Medicare-supported hospice services can benefit Texans with life-limiting illnesses.  Among those attending the session were (left to right): Seeley Avery, Odyssey’s Regional Vice President-Sales; Rep. Barton; Pamela Bailey, Quality Manager; Jennifer Leggett, Account Executive; Larry Chesney, Clinical Liaison; Doris Barnes, Registered Nurse; Mark Cook, Area Vice President-Sales; and Trivia Spencer, Community Liaison.
Source: countylifeonline.com

ACA Saved Medicare Beneficiaries $4.5B in Rx Drug Costs, HHS Says

Posted by:  :  Category: Medicare

"Every citizen should be a soldier. This was the case with the Greeks and Romans, and must be that of every free state." ` Thomas Jefferson. by eyewashdesign: A. GoldenThis is good news for the seniors on Medicare. I am about to become one. However, we must ask oursleves where did the money come from to create this “savings”? How were the additional revenues created to cover the “donut hole”? Drug comapanies were required to essentially discount there charges to CMS to have their drugs covered by Medicare Part D. I have not seen there profits drop proportionately. The average wholesale costs for tehse drugs were raised 17% before the ACA chnages were enacted! They have continued to be increased this year. In essence, the non-Medicare patient has been paying for this….another example of a “transfer of wealth” in order to “be fair”. Dr. Apgar…former Chief Medical Officer Medicare Advantage Plan.
Source: californiahealthline.org

Video: Medicare Part B_1.wmv

Obama Medicare plan: No voucher but maybe a bill

President Barack Obama greets people in the crowd after speaking at a campaign event at the Summerfest Grounds at Henry Maier Festival Park, Saturday, Sept. 22, 2012, in Milwaukee. (AP Photo/Carolyn Kaster)
Source: washingtonexaminer.com

AHIP Testimony: Value Offered by Health Plans Participating in the Medicare Advantage Program

  Medicare Advantage plans also protect beneficiaries from catastrophic health care costs.  In 2012, all Medicare Advantage plans offer an out-of-pocket maximum limit for beneficiary costs, and about 78 percent of Medicare Advantage enrollees are in plans that have annual out-of-pocket maximums of $5,000 or less.  These out-of-pocket maximums – which are not offered by the Medicare FFS program – help protect Medicare beneficiaries from catastrophic health care expenses that otherwise might pose a serious threat to their financial security.  Medicare Advantage plans also help reduce out-of-pocket costs for enrollees by reducing premiums for Part B and Part D, and by limiting cost-sharing for Medicare-covered services, including primary care physician visits and inpatient hospital stays.
Source: ahipcoverage.com

Open Political Discussions: Why Medicare Needs to Negotiate Part B Drug Prices

Now generic Plavix (clopidogrel) has hit the market.  When I checked on how much this would cost my husband through his Medicare Part D plan provider United Healthcare, we were told the price was $70.00 for a thirty day supply of clopidogrel.  My husband is in the doughnut hole, and so we have to pay full price for whatever we purchase.  I checked the regular pharmacy price for this drug, and it was being sold for as low as $15.00 for a thirty day supply.  Why the discrepancy?  I have to think that once again, the negotiated price through our health care provider was ridiculously high because some kind of deal was cut with Bristol-Myers Squibb, although I have no proof.  Whatever the case, the cost of $70.00 compared to $15.00 can’t be justified.  Obviously the negotiated price is out of whack.
Source: blogspot.com

Medicare Part B Premium 2011 and 2012: Are Costs On The Rise?

Your Medicare Part B Premium is taken out of your social security check, usually on a monthly basis. If you can not afford to carry Medicare Part B agencies are available to assist you. They are: Medicaid, Supplemental Security Income, Qualified Medicare Beneficiary (QMB) Program, Specified Low-Income Medicare Beneficiary (SLMB) Program or theQualifying Individual (QI) Program. You can still be accepted even if your income is above the qualifying income limits.
Source: seniorcorps.org

The Basics of Medicare and Medigap Insurance

Medicare originally is understood to be Part A, which is hospital insurance and Part B, which is medical insurance.  This original coverage allows for many but not every medical or health related service and supply.  There is insurance available, called Medigap or Medicare Supplemental Insurance that covers expenses that are not covered under the general Medicare Part A and Part B. This includes things such as copayments, coinsurances, deductibles and expenses when traveling outside of the United States.  Believe it or not the out of pocket expenses can add up very quickly and before you know it you could have easily paid the monthly premium of a Medicare Supplement Plan.
Source: livingstonreporting.com

Medicare, Health Care Reform and 2013…

Five Star Ratings on Medicare Advantage Plans – To encourage Medicare Advantage plans to provide quality care, the ACA authorized Medicare to pay bonuses to Medicare Advantage plans, beginning in 2012, if they receive four or five stars on Medicare’s new five-star quality rating system. And, plans that received a 5 star rating would be able to enroll customers year-round; not just during Medicare’s annual enrollment period (AEP). (Source) The rating system measures how well plans: help customers stay healthy; perform on numerous customer satisfaction measures; price and safely administer drugs; and provide Medicare.gov updated plan information.
Source: ehealthinsurance.com

Your 2011 'Means Testing' Cost of Medicare Part B and Drug Premiums

The government pays a broad portion-75 percent-of the costs for the vast majority of beneficiaries while the beneficiary pays the remaining 25 percent. The ‘means testing’ Act allows government’s portion to be reduced for higher wage beneficiaries who began paying a larger division of the Part B premiums back in 2007 agreeing to their income. Each year, higher contributions are slated for ‘higher income’ beneficiaries.
Source: blogspot.com

What are the Effects of Repealing ObamaCare for Medicare Solvency and Its Impact on Beneficiaries?

In summary, the Medicare provisions of the ACA played an important role in putting Medicare on stronger financial footing, while offsetting some of the cost of the coverage expansions of the ACA and also providing additional benefits to people on Medicare.  These savings were achieved primarily by reducing payments to providers (such as hospitals and skilled nursing facilities) and Medicare Advantage plans.  As a result of these changes, Medicare spending per beneficiary is projected to grow more slowly than private health insurance spending per capita over the next decade; premiums and cost-sharing for many Medicare-covered services are lower than what they would be without the ACA; delivery system reforms are being developed and tested; and the Medicare HI Trust Fund has gained additional years of solvency.  Some have argued that the Medicare savings in the ACA may come at the price of reductions in access to care in the future, while others believe the ACA will leverage greater efficiencies without necessarily creating access concerns.  Repeal of the ACA would undo these changes, raise costs for beneficiaries, and increase federal spending at a time when the nation is struggling to address the deficit and debt.
Source: decisionsonevidence.com

7 pointers for navigating Medicare open enrollment

These plans include HMO-style offerings under which care is coordinated through a network of doctors and hospitals, according to Cindy Polich, president of United HealthCare’s Medicare division. In-network pharmacies may offer cheaper prices for drugs, whether through an in-store or a mail-order option, Polich says.
Source: insurancequotes.com

i heart wags: $25 wags gift card for rx transfer

This offer is not valid for and cannot be used by any patient who, based on available plan information, is currently or has been a beneficiary of a federal healthcare program, such as Medicare Part D, Medicare Advantage, Medicare Part B, Medicaid, TRICARE or the Federal Employees Health Benefits Program anytime in the 6 months prior to coupon redemption. Purchase of a transferred prescription with valid refills is required and coupon must be presented at prescription payment. Offer does not apply to any prescription transferred from a Walgreens, Duane Reade or other pharmacy owned by the Walgreens Family of Companies. Some card restrictions apply. Transfer and coupon redemption must be completed by 12/31/12. Not valid with any other offers. Redeemable in store only
Source: iheartwags.com

The Medicare Coach: Repealing Affordable Care Act Could be detrimental to high income Medicare beneficiaries

Editorial: If you are not in one of the above AGI income brackets, do you realize that the Federal government is paying 75 percent of the cost of your Part B (doctor) expenditures while you are paying 25 percent? The cost today to provide your Part B (Medical) coverage is about $400 per month. Of the current 48 million Medicare beneficiaries, about 5 % or 2.4 million pay anywhere from $139.90 to $319.70 per month, (2012 updates), 78.3% pay $99.90 per month, while the Federal government pays the full $400 per month for some of the remaining 16.7% or 8 million beneficiaries, since many are considered dual eligible for Medicare and Medicaid due to disabilities and income below the poverty level guidelines.
Source: themedicarecoach.com

I’m a Veteran…Do I Need Part B? » Toni Says

Posted by:  :  Category: Medicare

Thanks for your service to our Country and being there when America needed you!!  I am glad you didn’t listen to your buddies and decided to email me.  Some people are dangerous when they give advice and have no idea of what the consequences can be or how this will impact your Medicare.  Actually you do not need “Part B” to receive medical care from the VA, but when you go outside of the VA for any medical treatment you do need Part B.  You might be ambulanced to another hospital that is not a VA facility for a medical emergency or you may go to MD Anderson for cancer treatment as examples, then you will pay 100% of the medical charges that “Part B” covers because you do not have Part B. Part B covers all of your outpatient needs, doctor services such as office visits and even surgery, MRIs, chemotherapy and the list can go on.   Without Part B of Medicare, a person can have to pay 100% out their pocket and this could be in the $1,000s or hundreds of thousands of dollars.
Source: tonisays.com

Video: Do I need to enroll in Medicare part B if I have VA benefits

Is Medicare Part B Enrollment Necessary?

Part B covers several medical needs that Part A does not. It helps cover many outpatient services you may need including doctor visits, clinical laboratory services, as well as some preventive services including examinations. Maybe this will clarify the situation better. The Original Medicare Part A is pretty black and white about coverage, leaving you to add Part B for any other medical coverage.
Source: seniorcorps.org

AHIP Testimony: Value Offered by Health Plans Participating in the Medicare Advantage Program

  Medicare Advantage plans also protect beneficiaries from catastrophic health care costs.  In 2012, all Medicare Advantage plans offer an out-of-pocket maximum limit for beneficiary costs, and about 78 percent of Medicare Advantage enrollees are in plans that have annual out-of-pocket maximums of $5,000 or less.  These out-of-pocket maximums – which are not offered by the Medicare FFS program – help protect Medicare beneficiaries from catastrophic health care expenses that otherwise might pose a serious threat to their financial security.  Medicare Advantage plans also help reduce out-of-pocket costs for enrollees by reducing premiums for Part B and Part D, and by limiting cost-sharing for Medicare-covered services, including primary care physician visits and inpatient hospital stays.
Source: ahipcoverage.com

Obama Medicare plan: No voucher but maybe a bill

President Barack Obama greets people in the crowd after speaking at a campaign event at the Summerfest Grounds at Henry Maier Festival Park, Saturday, Sept. 22, 2012, in Milwaukee. (AP Photo/Carolyn Kaster)
Source: washingtonexaminer.com

Practical Insights: Dealing with Medicare Part B and COBRA Coverage

Generally, the Socal Security Act provides that individuals may enroll in Medicare Part B (which covers doctors visits and other outpatient services) when they reach age 65. If they fail to do so during a seven-month initial enrollment period surrounding their 65th birthday, they can enroll during an annual “general enrollment” period that occurs each January 1- March 31, with coverage becoming effective the following July1, though they will incur a penalty in the form of permanently higher Part B premiums (10% increase for each year of available coverage that is foregone). However, actively employed individuals who have employer-provided health coverage can postpone signing up for Medicare Part B until after age 65. When they lose the employer-provided coverage or terminate employment, whichever happens first, they are then provided an eight-month “special enrollment period” (“SEP”) during which they can sign up for Medicare effective immediately and without penalty.
Source: fordharrison.com

Medicare Part B Enrollment « Insurance News from Crowe & Associates

If you’re 65 or older and you aren’t getting Social Security or RRB benefits yet (for instance, because you’re still working), you won’t get Part A and Part B automatically. People of any age diagnosed with ESRD and who meet certain requirements are also eligible for Medicare Part A and Part B, but must sign up for them.
Source: croweandassociates.com

2012 Medicare Open Enrollment Period

You can also enroll for the first time in a Part D plan during AEP if you did not enroll during your open enrollment window when you first became eligible for Medicare Part B.  If you do not have credible drug coverage, you may be subject to the Part D late enrollment penalty.  This penalty is calculated by adding 1% to your premium for each month you were not enrolled and should have been.
Source: ohioinsureplan.com

i heart wags: $25 wags gift card for rx transfer

This offer is not valid for and cannot be used by any patient who, based on available plan information, is currently or has been a beneficiary of a federal healthcare program, such as Medicare Part D, Medicare Advantage, Medicare Part B, Medicaid, TRICARE or the Federal Employees Health Benefits Program anytime in the 6 months prior to coupon redemption. Purchase of a transferred prescription with valid refills is required and coupon must be presented at prescription payment. Offer does not apply to any prescription transferred from a Walgreens, Duane Reade or other pharmacy owned by the Walgreens Family of Companies. Some card restrictions apply. Transfer and coupon redemption must be completed by 12/31/12. Not valid with any other offers. Redeemable in store only
Source: iheartwags.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

Is my federal employee health plan a better deal than Medicare?

That said, Naumann does suggest signing up for Medicare Part A as soon as you are eligible because it covers some hospital-related costs not covered by FEHB. What’s more, Medicare Part A doesn’t require a premium if you or your spouse have paid into Medicare for at least 10 years. For Medicare parts B, C and D, however, just remember that premiums are risk-adjusted, so the longer you wait to enroll, the higher the premiums you will have to pay.
Source: cnn.com

What Happens to Your Medicare Benefits When You Move Abroad?

Luckily, plans that offer medical insurance abroad are tailored to permanent and part-time residents of international locations, offer some portability for retirees who wish to travel and are both affordable and flexible. These plans allow a retiree to not only select a limit and deductible that is reasonable for their budget but also to choose coverage options that go well beyond just providing medical treatment. Some plans allow benefits for repatriation of remains and emergency medical evacuation as well as providing the usual overage for prescriptions, hospital stays and more.
Source: nyig.com

Director, Compliance & Regulatory Affairs

Posted by:  :  Category: Medicare

OBAMAS DEATH PANEL------ GUESS WHAT FOLKS IT'S ALIVE AND WELL---"CRAZY PALIN" NOT SO CRAZY NOW by SS&SSNewly created role will provide compliance oversight with requirements of all types across all plans.  Serve as senior leadership and main contact between key companies. Acquire information and requirements from company, translate into business relevant terms, and disseminate as needed through the organization. Manage local Medicare Compliance Directors and determine correct staffing levels based on size and needs of market. Provide plans with advice and expertise about Medicare compliance. Conduct internal compliance audits, write corrective action plans and work with Compliance Directors to ensure timely completion and compliance with federal, state and local regulatory requirements.  Communicate proactively with about program status and courses of action being planned. Oversee responses to all inquiries and audits. Oversee and audit national vendors with regard to compliance. Monitor and manage the Complaint Tracking Module and disseminate relevant information to the plan Compliance Directors. Assists Plans in maintaining relationships with state and local governing bodies with regard to Medicare. Support business development processes in evaluating and ensuring regulatory authority and compliance with new business regulations.
Source: scrubsandsuits.com

Video: clinical chart documentation review crosswalking CMS Medicare 2010 regulations.mov

7 pointers for navigating Medicare open enrollment

These plans include HMO-style offerings under which care is coordinated through a network of doctors and hospitals, according to Cindy Polich, president of United HealthCare’s Medicare division. In-network pharmacies may offer cheaper prices for drugs, whether through an in-store or a mail-order option, Polich says.
Source: insurancequotes.com

60 Days to Pay – Has Medicare Reached the Point of No Return?

“The rising cost of medical care, and particularly of hospital care, over the past decade has been felt by persons of all ages. Older persons have larger than average medical care needs.  As a group they use about two-and-a-half times as much general hospital care as the average for persons under age 65, and they have special need for long term institutional care. Their incomes are generally considerably lower than those of the rest of the population, and in many cases are either fixed or declining in amount. They have less opportunity than employed persons to spread the cost burden through health insurance. A larger proportion of the aged than of other persons must turn to public assistance for payment of their medical bills or rely on ‘free’ care from hospitals and physicians. Because both the number and proportion of older persons in the population are increasing, a satisfactory solution to the problem of paying for adequate medical care for the aged will become more rather than less important. In our society the existence of a problem does not necessarily indicate that action by the Federal Government is desirable. The basic question is: Should the Federal Government at this time undertake a new program to help pay the costs of hospital or medical care for the aged, or should it wait and see how effectively private health insurance can be expanded to provide the needed protection for older persons?”[24]
Source: garnerhealthcare.com

Georgia Cancer Specialists Settles with Feds over Medicare Billing

The civil settlement resolves the United States’ investigation into Georgia Cancer Specialists’ practices relating to billing for evaluation and management (E&M) services on the same day as a related procedure. Generally, providers are not permitted to bill both E&M services and a related procedure on the same day under the Medicare program’s regulations. 
Source: patch.com

Questions about Federal Medicare

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Source: journalscene.com

Emdeon Current: New Payer Transactions

Posted by:  :  Category: Medicare

Claims Management Services, Payer ID: 39141 Clarian Health Plans Inc., Payer ID: 95444 Connecticare – Medicare, Payer ID: 78375 CoreSource Little Rock, Payer ID: 75136 DiaTri LLC, Payer ID: 36439 Employee Benefit Systems, Payer ID: 42149 Fallon Community Health Plan, Payer ID: 22254 GHI – Medicare Private Fee for Service, Payer ID: 22937 GHI – New York (Group Health Inc.), Payer ID: 13551 GHI HMO, Payer ID: 25531 Geisinger Health Plan, Payer ID: 75273 Group Health Cooperative of South Central Wisconsin, Payer ID: 39167 Group Health Inc., Payer ID: 22937 HIP – Health Insurance Plan of Greater New York, Payer ID: 55247 Harrington Health-Kansas (formerly known as Fiserv Health-Kansas), Payer ID: 62061 Harvard Pilgrim Health Care, Payer ID: 4271 ISLAND HOME INSURANCE COMPANY, Payer ID: IU Medical Group Primary Care, Payer ID: SX172 Integra Group, Payer ID: 31127 LIFE Pittsburgh, Payer ID: 25181 Landmark Healthcare Inc, Payer ID: LNDMK MED PAY, Payer ID: 88058 MEDICA HEALTH CARE PLAN INC., Payer ID: 78857 March Vision Care Inc., Payer ID: Call Meritain Health / Agency Services, Payer ID: 64158 Meritain Health/North American Administrators, Payer ID: 64157 Metropolitan Health Plan, Payer ID: 10850 Montefiore Contract Management Organization, Payer ID: 13174 Network Health, Payer ID: 4332 Network Health Insurance Corp-Medicare, Payer ID: 77076 North American Administrators Inc., Payer ID: 64157 North American Health Plan, Payer ID: 64157 North American Preferred, Payer ID: 64157 Northstar Advantage, Payer ID: 60058 ODS Health Plan, Payer ID: 13350 PacificSource Health Plans, Payer ID: 93029 Paragon Benefits Inc., Payer ID: 58174 Prism-First Health, Payer ID: 37303 Screen Actors Guild, Payer ID: 99289 Touchstone Health PSO, Payer ID: 23856 Trellis Health Partners, Payer ID: 36397 Vytra Healthcare, Payer ID: 22264 Weyco Inc., Payer ID: 38232 Wisconsin Department of Corrections, Payer ID: 74101 Anthem Blue Cross, Payer ID: 47198 Associated Benefits, Payer ID: 50266 Blue Cross Blue Shield of New Mexico, Payer ID: SB790 Blue Cross Blue Shield of Oklahoma, Payer ID: SB840 Illinois Medicaid, Payer ID: SKIL0 Nebraska Medicaid, Payer ID: SKNE0 New Hampshire Medicaid, Payer ID: SKNH0 Eligibility Inquiry and Response Ameritas Group, Payer ID: AMERITAS Ameritas Life Insurance Company, Payer ID: 425 CoreSource – FMH, Payer ID: CORSE00204 CoreSource – FMH, Payer ID: CRSKC CoreSource – Little Rock, Payer ID: CORSE00205 CoreSource Little Rock, Payer ID: CRSAR Coresource – FMH, Payer ID: 204 Coresource Little Rock, Payer ID: 205 First Ameritas of New York, Payer ID: 426 First Ameritas of New York, Payer ID: AMTAS00426 First Reliance Standard Life Ins Co., Payer ID: 428 First Reliance Standard Life Insurance Company, Payer ID: AMTAS428 MMSI, Payer ID: 85 MMSI, Payer ID: MMSI Medica, Payer ID: 404 Medica, Payer ID: MEDIC Medical Mutual of Ohio, Payer ID: 211 Medical Mutual of Ohio, Payer ID: MMO00211 Nippon Life Benefits, Payer ID: NIPON Peoples Health, Payer ID: PPLSH Reliance Standard Life Insurance Company, Payer ID: 427 Reliance Standard Life Insurance Company, Payer ID: AMTAS00427 SAMBA Health Benefit Plan, Payer ID: SAMBA Standard Insurance Company, Payer ID: 429 Standard Insurance Company, Payer ID: AMTAS00429 Standard Life Insurance Company of New York, Payer ID: 430 Standard Life Insurance Company of New York, Payer ID: AMTAS00430 ameritas, Payer ID: AMTAS00425 Blue Cross Blue Shield of Pennsylvania (Highmark), Payer ID: BCPAC Blue Cross Blue Shield of Pennsylvania – Highmark, Payer ID: 440 Mountain State, Payer ID: MTNST Affinity Health Plan, Payer ID: AFNTY New Jersey Medicaid, Payer ID: AID19 New Jersy Medicaid, Payer ID: NJ South Dakota Medicaid, Payer ID: AID28 South Dakota Medicaid, Payer ID: SD Claim Status And Response: Ameritas Group, Payer ID: AMERITAS Ameritas Life Insurance Company, Payer ID: 425 CoreSource – FMH, Payer ID: CORSE00204 CoreSource – FMH, Payer ID: CRSKC CoreSource – Little Rock, Payer ID: CORSE00205 CoreSource Little Rock, Payer ID: CRSAR Coresource – FMH, Payer ID: 204 Coresource Little Rock, Payer ID: 205 First Ameritas of New York, Payer ID: 426 First Ameritas of New York, Payer ID: AMTAS00426 First Reliance Standard Life Ins Co., Payer ID: 428 First Reliance Standard Life Insurance Company, Payer ID: AMTAS428 MMSI, Payer ID: 85 MMSI, Payer ID: MMSI Medica, Payer ID: 404 Medica, Payer ID: MEDIC Nippon Life Benefits, Payer ID: NIPON Peoples Health, Payer ID: PPLSH Reliance Standard Life Insurance Company, Payer ID: 427 Reliance Standard Life Insurance Company, Payer ID: AMTAS00427 SAMBA Health Benefit Plan, Payer ID: SAMBA Standard Insurance Company, Payer ID: 429 Standard Insurance Company, Payer ID: AMTAS00429 Standard Life Insurance Company of New York, Payer ID: 430 Standard Life Insurance Company of New York, Payer ID: AMTAS00430 For all payers, visit https://access.emdeon.com/PayerLists/
Source: blogspot.com

Video: Standard of Living in the United States and China, Medicare Prescription Drug Benefit (2012)

Delay in Electronic Remittance Advice (ERA) for Multiple CPIDs

Due to a payer processing issue, there has been a delay in some Professional and Institutional Electronic Remittance Advice (ERA) for the following payers for check dates 06/29/2012 through present: CPID 3533 and 1452 Connecticut Medicare CPID 3519 and 4442 New York Empire Medicare CPID 7401 New York GHI Medicare CPID 1463 New York Upstate Medicare CPID 3500 Indiana Medicare CPID 1445 Indiana Medicare CPID 5506 Illinois Medicare CPID 3515 Michigan Medicare CPID 5530 West Virginia Medicare CPID 5536 Virginia Medicare CPID 5512 Wisconsin Medicare CPID 1947 RHHI Home Health Region V-Service Area 7 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 files for the dates above. If you have any questions, please contact Client Services at 1-888-348-8457, option 2.
Source: collaboratemd.com

Medicare MSPRC contract change

Although there has not  been a formal announcement  it appears that the new contactor to perform recovery activities on behalf of Medicare will be Group Health Incorporated (GHI).  GHI is a familiar entity to Medicare as GHI has been the Medicare Coordination of Benefits (COB) since 1999. Under the new contract GHI will expand its role to include the recovery portion of the Medicare process.
Source: lienresolutiongroup.com