More on “Murphy Voted To Cut Medicare $716 Billion”

Posted by:  :  Category: Medicare

House Republican Press Conference on Health Care Reform by House GOP LeaderAARP Praised The Senate Health Care Bill For Strengthening And Improving Medicare For Seniors, Moving Toward Closing The Donut Hole. In a December 2009 statement, AARP CEO A. Barry Rand said, “This morning the Senate brought us closer to meaningful health care reform than we have ever been before. Passage of the Senate health care reform bill clears the way for Congress to enact legislation in the coming weeks that will protect and strengthen Medicare, ensure millions more Americans can get affordable health coverage and sharply curtail discriminatory insurance company practices that keep those most in need out of the system. The bill passed by the Senate makes needed progress to prevent coverage denials due to health status and limit insurance companies from charging older Americans much more for coverage because of their age. It also begins to close the dangerous gap in Medicare drug coverage known as the doughnut hole, and Senate leaders have committed that a final bill will close the gap entirely by 2019, in keeping with the President’s pledge. In addition, the Senate bill adds important new Medicare benefits, like free preventive care, and encourages states to provide more home and community-based long-term care services and supports instead of costlier institutional care.” [AARP Press Release, 12/24/09]
Source: ctnews.com

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

Navigating Medicare's Open Enrollment Period

Medicare beneficiaries who are happy with their plans do not need to do anything, if they don’t want to change. But it is still a good idea to check options, Ms. Metcalf advises, to make sure a version of Medicare is the best one in terms of cost and coverage. If, for instance, you have the original version of Medicare and pay extra for prescription drug coverage (so-called Part D coverage), you may want to make sure important medications you need are still covered under your plan, to avoid having to pay more for them.
Source: nytimes.com

Study Finds Premium Support Plan Could Raise Medicare Premiums In Many Parts of Country

The study modeled the impact of a generic version of premium support, under which beneficiaries would receive a defined subsidy, or voucher, to buy health insurance in a competitive market instead of getting a guaranteed set of benefits as Medicare has traditionally provided. That payment would be tied to the second lowest cost plan offered in an area or traditional Medicare, whichever is lower. This kind of a change is a central part of the House Republican budget written by Rep. Paul Ryan of Wisconsin, now the GOP’s vice-presidential candidate, and it has also been embraced by GOP presidential nominee Mitt Romney. Even a few Democrats have flirted with such a plan as a way to leverage market efficiency to rein in the spiraling cost of Medicare.
Source: kaiserhealthnews.org

Why Private Medicare Plans Don't Cost Less

Many contend that the government “overpays” for people enrolled in private plans, since traditional Medicare could have covered these patients for less money. But the reason it would have cost less is partly that the government has done a woeful job in figuring out how much to pay the private plans. The government compensates insurers based on the health of their enrollees at the start of the year. Plans with healthier patients receive less money than those with sicker ones to reflect the likelihood that healthier people will use less care. Healthier patients enroll in Medicare Advantage plans, so in, principle, plans should be reimbursed less by the government for enrolling these patients (the technical term for this process is “risk adjustment”). But for decades, the government has failed to determine who is healthy and who is sick with any precision, with the result that private plans receive larger payments to cover their patients’ costs than necessary. This botched payment system gives insurers an incentive to spend more time selecting the healthiest patients, and less time treating them more efficiently.
Source: nytimes.com

PoliGraph: DFL falsely links state lawmakers to Medicare

The flier states that Wiener “will be just another Republican vote against closing the Medicare prescription drug donut hole.” The DFL is referring to a kink in the Medicare Part D program, which covers drug benefits for seniors. Once Medicare beneficiaries reach a certain coverage threshold, they have to pay for their prescriptions until they reach the catastrophic coverage threshold.
Source: publicradio.org

Medicare open enrollment: Will Obamacare end Medicare Advantage?

Should you be worried that Medicare Advantage plans will economize by reducing your benefits? “The plans are required to provide all Medicare benefits, so there’s no way they can cut them,” Gold explains. That includes the free preventive services added to Medicare by the Affordable Care Act. And Advantage plans that include a drug benefit are closing the doughnut hole just the same as stand-alone Part D drug plans. The only area where plans can even consider cutting back are for optional services such as dental and vision benefits, but the plan finder on Medicare.gov still features plenty of plans that have these bonus features.
Source: consumerreports.org

Mayor’s Health Line Expands to Offer Medicare Counseling

addictions_prevention AIDS/HIV award bike_helmets BostonMRC boston_moves_for_health breast_cancer cancer child_safety clinic community_health_spotlight community_meeting contest diabetes event flu food_day free_classes girls health healthy_eating heat hepatitis homeless_services injury_prevention in_the_community lead_poisoning_prevention mental_health news news_release oral_health outstanding photo recipes resources safety smoke_free stay_active sugary_beverages teens video violence_prevention volunteering window_falls youth
Source: wordpress.com

AMA committee endorses Ryan

“The [AMA] policy identifies changes that must be made to strengthen the traditional Medicare program (i.e., restructuring beneficiary cost-sharing, including modifying Medigap rules, and changing the eligibility age to match Social Security),” the Council writes, “and expresses support for giving beneficiaries a choice of plans for which the federal government would contribute a standard amount (i.e., a ‘defined contribution’) toward the purchase of traditional fee-for-service Medicare or another health insurance plan approved by Medicare. The Council firmly believes that implementing a defined contribution system, with strong regulatory protections for patients, is a responsible and feasible approach to strengthening the Medicare program.”
Source: hotair.com

Idaho insurance department helps with Medicare open enrollment this fall

Medicare members who received letters telling them their plans are being terminated have up to two months after the plan’s end date to enroll in a new one. But a choice must be made by Dec. 31, or the insurance coverage will revert to Original Medicare without prescription drug benefits.
Source: idahostatesman.com

Medicare Open Enrollment Underway

Medicare’s open enrollment period is now underway, giving current or newly eligible Medicare beneficiaries the opportunity to sign up for benefits or make changes to existing coverage.   The open enrollment period began Oct. 15 and continues until Dec. 7. And, as senior citizens review or consider changing their Medicare benefit plans, Attorney General Dustin McDaniel issued this consumer alert today to help consumers as they navigate their Medicare options.   A recent survey by the Kaiser Family Foundation showed that nearly one in four American senior citizens were unaware of their annual opportunity to review or change Medicare coverage. More than a third of seniors surveyed said they review or compare coverage options only once every few years, rarely, or never.   “Medicare beneficiaries have the option every year to review the coverage that’s right for them, depending on their health-care needs,” McDaniel said. “As with any insurance product, it’s always good practice to shop around for the best plan.”   In addition to typical Medicare coverage, beneficiaries must join a Medicare Prescription Drug Plan (Medicare Part D), unless they have prescription coverage under another recognized plan. Beneficiaries may choose to enroll in a Medicare Advantage Plan, which operates like an HMO or PPO and may also include a prescription drug benefit.   To select a plan, compare plans and coverage, or estimate costs, visit www.medicare.gov. Senior citizens are encouraged to make changes as soon as possible to allow coverage to begin uninterrupted on Jan. 1, 2013.   Beneficiaries may be able to join other types of Medicare health plans as well. Click here for more information on how to select a plan.   Medicare beneficiaries may also call a 24-hour hotline, (800) MEDICARE, with questions about coverage options. In Arkansas, the Senior Health Insurance Information Program, or SHIIP (click here) is available to assist Medicare beneficiaries.   McDaniel noted that his Consumer Protection Division often sees an uptick in Medicare-related scams during the open enrollment period. He urged beneficiaries and their families to use caution when sharing sensitive personal or financial information.   Scammers in the past have asked Medicare beneficiaries for information such as bank account numbers or Social Security numbers over the phone. Medicare rules prohibit these types of calls, though. No beneficiary should provide that type of information to someone who calls them, no matter whether the caller sounds official.   The Attorney General’s Consumer Protection website (click here) offers tips and resources to help consumers avoid Medicare-related scams and other types of scams and fraud. Consumers may also download a free, electronic copy of the Medicare Protection Toolkit on the website.
Source: arkansasmatters.com

Deforming Medicare into a Competitive Bidding System (interlude)

Medicare is a fee-for-service insurance program in which the federal government serves as an insurance agent for the nation’s retired population (Oberlander 2003). Medicare Part A, financed through payroll tax contributions, covers hospital care for seniors. Medicare Part B is a voluntary program that pays for doctors’ visits and outpatient services; nearly 98 percent of those eligible take up this benefit, and currently monthly premiums on seniors cover 25 percent of costs, with general revenues paying the rest. Complex cost-sharing arrangements characterize the program, with annual deductibles and co-payments for hospital visits and doctors’ visits on top of the monthly premiums for Part B. There is no cap on out-of-pocket expenses for beneficiaries, and all together, beneficiaries are liable for about half the cost of acute care (Moon 2001). Also, Medicare was not designed to cover all needs, as most long-term care and prescription drugs were excluded from coverage.
Source: correntewire.com

A Better Understanding of the Medicare Supplement Plans

There is one thing which is quite noteworthy about the Medicare Insurance Plans and it is the fact that the changes that take place in these plans are often for betterment but sometimes they can also be the other way round. This is the reason why there is an acute necessity to stay informed about the Medicare insurance plans. A person who is already there with the Medicare insurance plans and a person who wants to enroll for the plans have to be very vigilant about the major changes that take place in the plans in order to remain on the best side of things. The main confusion that lies in choosing the Medicare plans is the fact that there is the availability of a number of plans, all having their own specific benefits and facilities to offer. All the plans are different from each other and they all have their rates as fixed upon by the government. The coverage and the expenditure on the plans differ at a very wide scale because of the great difference that lies in the rates of the different plans available in the market.
Source: memics.org

Opinion: Freedom key to Romney’s health care plans

Gov. Romney says that he would increase choice and competition, reduce wasteful spending by equalizing the tax treatment of individually-purchased and employer-provided health plans, and rescue Medicare by replacing the Obama Administration’s Medicare cuts with premium support. He would also cure Medicaid’s dysfunctional spending incentives by using block grants that would better serve the poor and sick by freeing states to design innovative programs that fit their populations.
Source: healthpolicysolutions.org

The California Medicare Supplement Plan Landscape

Posted by:  :  Category: Medicare

319 | Tragedies of Medicine by The DoctrMaybe you’re tired of the A, B, C soup that seems to be swirling around you when you glance at the newly received California Medicare supplement plan offerings and with good reason. There are so many A’s, B’s, and F’s, that you would think you’ve come full circle back to kindergarten. We hope to shed some light on the subject of California Medigap plans to make clear how the various plans differ and reduce the chance of brochure induced headache, a very serious condition NOT covered by Medicare. So let’s dive into the California Medigap plans with a quick scan of what Traditional Medicare does, and more importantly, does not cover. California Medicare is best thought of as an 80/20 plan with deductibles, two of them to be exact. It generally breaks down the core benefit (which account for the majority of your health care cost outside of medication which we’ll save for another article on California Part D) into hospital (Part A) and physician (Part B) costs. That’s the first two letters you’ll see before even looking at California Medicare supplement plans. Remember the “Part” part of the name since that tells you we’re talking about traditional Medicare and not a California Medigap plan. Part. Part. Part. Medicare section. Part A is generally facility based (hospital, surgi-center, etc) while Part B is generally physician based. Now that we understand the bulk of what makes up your health care costs, let’s look at the California Medicare supplement plans. The California medicare plans are A, B, C, D, F, F high deductible, G, K, L, M, and N. In general, they increase in benefits (and cost) from A through F. The remaining generally add in cost sharing to the Medicare supplement subscriber but offer lower prices. For all the California Medigap plans, the main categories of traditional Medicare that they fill the gaps in are the following: Part A deductible, Part A co-insurance, Part B deductible, Part B co-insurance, Part B excess, Hospice Care, Skilled Nursing Facility, Foreign Emergency Travel, 1st 3 pints of blood, and Preventative co-insurance. The lettered California Medicare plans differ in these categories listed above. The F plan covers all these categories and remains the most popular California Medigap plan on the market. All the plans cover the Part A co-insurance completely. A through F cover the Part B co-insurance while G through N have varying degrees of coverage. It’s probably best to look at a California Medicare supplement plan comparison chart to make it clear but we’ll discuss the primary issues to concentrate on when deciding on your Medigap plan. We want to focus on the costs that can either be very large or uncapped. This would be the Part B Excess charge (doctors can charge up to 15% higher than standard Medicare rate), Skilled Nursing Facility, and Part A deductible. The other expenses are probably less exorbitant but still important. The key is this – we’re not talking 100’s of dollars of difference in monthly premium between each California medicare plan so why take on the risk when it’s probably $10-20 difference per month between given plans. That’s why the F plan is so popular. It covers all the main gaps in California Medicare at a relatively low price. Also keep in mind that you’re entering a period of time when medical care (very expensive medical care) becomes more common and frequent regardless of your health at the time of enrolling. It’s a bad bet to buy a less rich California Medigap plan and save a few bucks only to pay much more later on. Take a look at the comparison chart at californiamedigap.com to get a better understanding and we’re happy to walk through your plan options as licensed California Medicare agents but all roads lead to the F plan. We’re happy to be your road map. Dennis Jarvis is a licensed insurance agent concentrating on California Medicare supplement insurance.

Medicare/Medicaid Regulatory Rep

Posted by:  :  Category: Medicare

OBAMACARE WATCH:....THE PUSH IS ON, ........THEY WILL CONTROL WHAT YOUR DOCTOR KNOWS AS WELL AS WHAT HE OR SHE TREATS by SS&SSJob Description: The ideal candidate will have Medicare and Medicaid regulatory experience, but this is not required. Someone who is a quick learner, attentive to detail, demonstrates some basic analytical abilities and has worked in at least MS Word and Excel a little bit would be fine. The Regulatory Representative & Enrollment is ultimately responsible for accurate and expedient processing of all membership transactions of Medicare, Medicaid and Commonwealth Care members insuring that all regulations set by CMS and EOHHS are being met. This includes all verbal and written communication as well as data entry. The Regulatory Unit Representative must have the ability to analyze various situations and be able to make independent decisions on best practices in the interest of the members and the health plan. The Regulatory Unit Representative will be considered the main resource person for all issues regarding the eligibility and enrollment/disenrollment of Medicare, Elder Service Plan, Mass Health and Commonwealth Care members. At all times, Regulatory Representatives must be knowledgeable of and adhere strictly to all regulations set by regulatory agencies including CMS and EOHHS. Primary job responsibilities: Screen all Medicare transaction forms to insure enrollment/disenrollment guidelines are being met and information provided is complete and meets CMS requirements Telephonic and written correspondence to members as required by Regulatory agencies meeting CMS and EOHHS guidelines Maintenance of CMS approved letters in Global Works system, including updating letter log as needed Process membership transactions in IDX system in a timely manner to meet CMS and EOHHS guidelines Serve as a resource person to outside departments on enrollment issues Reconcile monthly membership on all Regulatory Unit lines of business using multiple systems including Access database and MMC2020 software Reconcile various special status reports (including Prescription Advantage and CMS subsidy levels) in a timely manner to ensure proper membership status and payments includes working with other internal and external staff As part of a Paid for Performance measurement as required by EOHHS, track all HRAs sent and received Assist Premium Billing representatives in the reconciliation of financial data as required Interact with external customers which include members, providers and government agencies Interact with all components of the system including physicians, management and staff Answer member calls as part of an ACD line Respond to Customer Service cases meeting required Service Level Agreements Ensure all required documentation is available for random audits performed by IntegriGuard, CMS or any other agency/contractor requesting such information Work with management to maintain Policies and Procedure manual Special projects as assigned Education: High School graduate
Source: net-temps.com

Video: Medicare Audit Guidelines for Chiropractors – Initial Visits

Minneapolis Criminal Defense Lawyer

The indictment was filed in U.S. District Court of Eastern District of Pennsylvania, although Orthofix’s home office is located in Minnesota. The case says that Orthofix was able to submit claims directly to Medicare for reimbursement in the amount of 80% of the cost of the devices, ranging between $3,500 and $4,400 each. The Medicare policy also states that Medicare requires a written physician’s statement that says the bone fracture has not healed at all before and during treatment.
Source: caplanlaw.com

Individual Tax Credits to Trigger Employer Penalties

The final regulations provide that employer contributions to health savings accounts (HSAs) do not affect the affordability of employer-sponsored coverage because HSA amounts may generally not be used to pay for health insurance premiums. Contributions to health reimbursement arrangements (HRAs) that may only be used to reimburse medical expenses also do not affect the affordability of employer-sponsored coverage. The regulations do not address how HRA contributions that can be used to offset the employee’s cost of coverage are treated for purposes of determining the affordability of employer-sponsored coverage. The IRS states that this type of HRA contributions, as well as wellness incentive programs that increase or decrease an employee’s share of premiums, may be addressed in future guidance. 
Source: momentousins.com

Palmetto's Loss of Jurisdiction E Medicare Contract Raises Questions About Fate of MolDx Program

Hundreds of conserved, non-coding DNA elements have been independently jettisoned in multiple mammalian lineages during evolution, according to a study by Stanford University researchers Michael Hiller, Bruce Schaar, and Gill Bejerano. By aligning and comparing sequences from 44 genomes, the trio tracked down more than 600 conserved, non-coding DNA elements that have vanished from at least two mammalian lineages, including almost three-dozen otherwise conserved elements that have been lost from the human lineage. “Our study uncovers an interesting aspect of the evolution of functional DNA in mammalian genomes,” the Stanford team writes, adding that “experiments are necessary to test if these independently lost [conserved, non-coding DNA elements] are associated with parallel phenotype changes in mammals.”
Source: genomeweb.com

Former Orthofix Manager Charged With Medicare Fraud

Mr. Racey was connected with a scheme to submit $250,000 in fraudulent claims for bone stimulators that did not meet Medicare’s guidelines. In order to meet federal guidelines for reimbursement, Mr. Racey allegedly forged patients’ medical records and altered physician prescriptions. If convicted, Mr. Racey faces a maximum possible sentence of 10 years imprisonment, a $250,000 fine and a $100 special assessment, along with restitution and forfeiture.
Source: beckersorthopedicandspine.com

Annual Wellness Visits; RVU Reductions; Physician Scribes

The rules were recently updated in the Medicare teaching guidelines. They state: “Any contribution and participation of a student to the performance of a billable service must be performed in the physical presence of a teaching physician or resident in a service that meets teaching physician billing requirements (other than the review of systems [ROS] and/or past, family, and/or social history [PFSH], which are taken as part of an E&M service and are not separately billable). You, the student, may document services in the medical record; however, the teaching physician may only refer to your documentation of an E&M service that is related to the ROS and/or PFSH. The teaching physician may not refer to your documentation of physical examination findings or medical decision making in his or her personal note. If you document E&M services, the teaching physician must verify and re-document the history of present illness and perform and re-document the physical examination and medical decision making activities of the service.”
Source: physicianspractice.com

What Is The Best Way To Make A Medicare Supplement Comparison?

Posted by:  :  Category: Medicare

Start by asking your current medical providers if they are providers under the plan. If they are not, then you have the choice of changing doctors and other medical facilities, or looking at another plan for a medicare supplement comparison. You want to make sure that any medical support services you use are also providers. When you find a supplement plan that covers your providers you can now review the services they cover, the deductibles, and the co-pays. By reviewing this data you can determine if the plan is right for you. Almost any supplement plan is worth the cost.
Source: seniorcorps.org

Video: Medicare Supplemental Insurance Plan Benefit Comparison California

Has Your Medicare Supplement Gone UP in Price?

During this time of year we can help you make sure you have the best price and coverage for your doctor and hospital care.  Many people think all they need is a Part D comparison, but why pay more for your Medicare Supplement than you have to?  Medicare only pays 80% of your doctor and hospital costs.  If you are turning 65 and in your open enrollment, you cannot get turned down for coverage during those months no matter what kind of health issues you may be experiencing.  That is why it is so important NOT to get a Medicare Advantage Plan!!!  Start off with the BEST coverage available!!
Source: mypartdusa.com

The California Medicare Supplement Plan Landscape

Maybe you’re tired of the A, B, C soup that seems to be swirling around you when you glance at the newly received California Medicare supplement plan offerings and with good reason. There are so many A’s, B’s, and F’s, that you would think you’ve come full circle back to kindergarten. We hope to shed some light on the subject of California Medigap plans to make clear how the various plans differ and reduce the chance of brochure induced headache, a very serious condition NOT covered by Medicare. So let’s dive into the California Medigap plans with a quick scan of what Traditional Medicare does, and more importantly, does not cover. California Medicare is best thought of as an 80/20 plan with deductibles, two of them to be exact. It generally breaks down the core benefit (which account for the majority of your health care cost outside of medication which we’ll save for another article on California Part D) into hospital (Part A) and physician (Part B) costs. That’s the first two letters you’ll see before even looking at California Medicare supplement plans. Remember the “Part” part of the name since that tells you we’re talking about traditional Medicare and not a California Medigap plan. Part. Part. Part. Medicare section. Part A is generally facility based (hospital, surgi-center, etc) while Part B is generally physician based. Now that we understand the bulk of what makes up your health care costs, let’s look at the California Medicare supplement plans. The California medicare plans are A, B, C, D, F, F high deductible, G, K, L, M, and N. In general, they increase in benefits (and cost) from A through F. The remaining generally add in cost sharing to the Medicare supplement subscriber but offer lower prices. For all the California Medigap plans, the main categories of traditional Medicare that they fill the gaps in are the following: Part A deductible, Part A co-insurance, Part B deductible, Part B co-insurance, Part B excess, Hospice Care, Skilled Nursing Facility, Foreign Emergency Travel, 1st 3 pints of blood, and Preventative co-insurance. The lettered California Medicare plans differ in these categories listed above. The F plan covers all these categories and remains the most popular California Medigap plan on the market. All the plans cover the Part A co-insurance completely. A through F cover the Part B co-insurance while G through N have varying degrees of coverage. It’s probably best to look at a California Medicare supplement plan comparison chart to make it clear but we’ll discuss the primary issues to concentrate on when deciding on your Medigap plan. We want to focus on the costs that can either be very large or uncapped. This would be the Part B Excess charge (doctors can charge up to 15% higher than standard Medicare rate), Skilled Nursing Facility, and Part A deductible. The other expenses are probably less exorbitant but still important. The key is this – we’re not talking 100’s of dollars of difference in monthly premium between each California medicare plan so why take on the risk when it’s probably $10-20 difference per month between given plans. That’s why the F plan is so popular. It covers all the main gaps in California Medicare at a relatively low price. Also keep in mind that you’re entering a period of time when medical care (very expensive medical care) becomes more common and frequent regardless of your health at the time of enrolling. It’s a bad bet to buy a less rich California Medigap plan and save a few bucks only to pay much more later on. Take a look at the comparison chart at californiamedigap.com to get a better understanding and we’re happy to walk through your plan options as licensed California Medicare agents but all roads lead to the F plan. We’re happy to be your road map. Dennis Jarvis is a licensed insurance agent concentrating on California Medicare supplement insurance.

Analysis: Payers look to share cost of failed medical devices with manufacturers

Posted by:  :  Category: Medicare

“The (insurance) plans are being more aggressive. The reason it gets so much more focus now is because there are so many cases,” said Mark Fischer, chairman of Rawlings & Associates, a unit of the Rawlings Group that helps insurance companies recoup payments from the party that was deemed at fault for claims, a legal service known as subrogation.
Source: medcitynews.com

Video: How to Get on Closed Insurance Panels

What are the Best and Worst States to Practice Medicine?

The lack of state income tax in some states also makes for a desirable environment to practice medicine.  This is the case in the state of Tennessee. The state has become a prime spot for physicians to start or transition their careers because of the lure of entrepreneurship. Another factor that influences the desirability of a place to practice is a strong sense of community among physicians. States like Texas provide a collegial, supportive atmosphere among physicians despite suffering some of the same stressors other states are enduring like declining reimbursement and increasing overhead.  This is shown through the membership the state has in the Texas Medical Association, which has reached a staggering 46,000 total members.
Source: fidelismp.com

When Medical Devices Go Bad

Many people unknowingly have been exposed to high levels of PCBs. Recently 3 schools in NY City were found to have dangerous levels of PCBs throughout. PCBs are a dangerous toxic substance that doesn’t break down easily and can cause chloracne, bleeding and neurological disorders, liver damage, spontaneous abortions, malformed babies, cancer, and death. GET THE FACTS! Overexposure to PCBs.com
Source: breakinglawsuitnews.com

Fidelis Care Helps Capital Region Seniors Access Care

AAHomecare AARP Alliance for Home Health Quality and Innovation Almost Family Apria Healthcare Group Bank of America Brookdale Senior Living CareLinx Centers for Medicare & Medicaid Services CMS Emeritus Senior Living Employee Benefit Research Institute Ensign Group featured Fidelis Care First Care Home Health Care Gentiva Health Services Genworth Griffin Home Health HCR Home Care HHS Home Health Depot Home Health International Home Health International Inc. Houston Compassionate Care Jordan Health Services LHC Group Inc LSU Medical Staffing Network Healthcare Medicare Medistar Home Health MedPAC Microsoft MMRGlobal National Association for Home Care & Hospice National Association for Home Care and Hospice PACE Paraprofessional Healthcare Institute Partnership for Quality Home Health Care Partnership for Quality Home Healthcare PeopleFirst Homecare Res-Care Inc. Stephenson Entrepreneurship Institute VA VIDA Senior Resource Source: homehealthcarenews.com
Source: medicaresupplementalco.com

Health Care Reform Beyond Obamacare

Former counselor to the Treasury secretary in the Obama administration says that we need death panels, or something like it, to ration health care or the cost of Medicare will swamp the federal budget.
Source: wordpress.com

2012 Medicare Physician Fee Schedule

I also am new to the RVU process but have a fairly good understanding of what needs to be done. However, I have been unable to find any information on what a Transitioned Non-Facility verses a Fully Implemented non- Facility is. I noticed the PE RVU is higher for the Fully Implemented non-facility. Someone told me it represents where you are at in your implementation of EHR???? I am waiting for a callback from CMS but if anyone has an answer it would be appreciated. Pat Carlson Open Cities Health Center
Source: physicianspractice.com

Medtronic Settles Sprint Fidelis Family of Defibrillation Leads Lawsuits

Under the terms of the agreement, Medtronic has agreed, subject to certain conditions, to settle U.S. lawsuits and claims pending as of October 15, 2010 for a total payment of $268 million.  The payment includes an amount for attorneys’ fees and administrative expenses.  The parties will file joint requests to terminate the Multi-District Litigation (MDL) and Minnesota state court proceedings related to the Sprint Fidelis leads and to dismiss the plaintiffs’ appeals pending before the U.S. Court of Appeals for the Eighth Circuit and the Minnesota Court of Appeals. The parties will also request dismissal of other Fidelis-related cases throughout the country. Medtronic can cancel the agreement if certain conditions are not met, and the agreement can be terminated by either party if the MDL proceedings are not terminated.
Source: gustafsongluek.com

Ryan Girl Emerges: Bikinis Yoga Let Me See Those Baby Blues – Let’s Get Fiscal Video – Send it Viral

“The Roman Republic fell, not because of the ambition of Caesar or Augustus, but because it had already long ceased to be in any real sense a republic at all. When the sturdy Roman plebeian, who lived by his own labor, who voted without reward according to his own convictions, and who with his fellows formed in war the terrible Roman legion, had been changed into an idle creature who craved nothing in life save the gratification of a thirst for vapid excitement, who was fed by the state, and directly or indirectly sold his vote to the highest bidder, then the end of the republic was at hand, and nothing could save it. The laws were the same as they had been, but the people behind the laws had changed, and so the laws counted for nothing.” – President Theodore Roosevelt
Source: wordpress.com

Medicare Governance and Provider Payment Policy

Posted by:  :  Category: Medicare

OBAMAS DEATH PANEL------ GUESS WHAT FOLKS IT'S ALIVE AND WELL---"CRAZY PALIN" NOT SO CRAZY NOW by SS&SSMedicare’s decision-making processes leave policies on provider payment vulnerable to “micromanagement” by Congress and the White House. If they continue as they are, they could jeopardize delivery system changes central to current health reform proposals. Ad hoc intervention in response to pressure from narrow interests can result in policies that do not serve the broader priorities of beneficiaries and taxpayers and that are unsound economically. Establishing a new Medicare policy board, as proposed by the Obama administration and Congress; transforming the Medicare agency into an independent agency or new department; and conducting analyses of congressionally proposed payment policy changes before they are voted on could further insulate payment decisions from political interference.
Source: rwjf.org

Video: Medicare Spending Per Beneficiary Measure National Provider Call – February 9, 2012

Vice Presidential Debate: True/False Quiz on Medicare

Comments are subject to approval and moderation. We remind everyone that The Heritage Foundation promotes a civil society where ideas and debate flourish. Please be respectful of each other and the subjects of any criticism. While we may not always agree on policy, we should all agree that being appropriately informed is everyone’s intention visiting this site. Profanity, lewdness, personal attacks, and other forms of incivility will not be tolerated. Please keep your thoughts brief and avoid ALL CAPS. While we respect your first amendment rights, we are obligated to our readers to maintain these standards. Thanks for joining the conversation.
Source: heritage.org

Becoming a Medicare Provider

Medicare is a health program administered by the government of the United States of America that provides health benefits and health insurance to people who are 65 years old and above. They also provide health benefits and aids to those who are not 65 years old but are physically disable or have congenital disorder. These candidates for Medicare should have been a resident of the country for at least five years. Medicare program has approved physicians and medical facilities that the people can visit. These Medicare providers provide different services depending on what area the patient is in. There are different parts of Medicare these Medicare providers can serve in. First is Medicare Part A or known as Health Insurance. The providers of this area give inpatient care in nursing homes or hospitals. They take care of the semiprivate room, food and tests for the patients. Medicare Providers for Part B or Medical Insurance are usually composed of private doctors or those who have expertise on a certain field. Patients of Part B usually receive outpatient care and preventive services such as chemotherapy, dialysis, blood transfusion, mastectomy and other services that will help maintain the health of a person seriously sick. The patients also get medical and prosthetic equipment such wheelchairs, cranes, artificial breast, and artificial breasts. These Medicare providers help the people get extra wellness programs such as those for vision, hearing and dental. Lastly, they also direct the patients to cheap Medicare-approved prescription drugs that the patients need. Being Medicare providers requires an extensive application. There are many requirements needed for those who want to apply in this kind of job. If one wants to be a provider, first and foremost, he has to review the existing rules, requirements and qualifications of Medicare. Other than that, there are also federal rules and regulations that one has to follow, depending on what state a person is in. Second, it is important to be certain on what part of Medicare (Part A or B) that one wants to serve in. Be sure that the part suits one’s abilities. A person who has no expertise in kidney problem can surely not go to Part B. On the other hand, it is just a waste if an expert in cancer will just go to Part A. After choosing the right part, the person has to get an NPI (National Provider Indicator) number. Why the person finishes ensuring an NPI number, he should be ready to apply for a Medicare-provider application by contacting the Medicare carrier in his or her area. The Medicare carrier will help the applicant on questions she or he might have. The applicant will be given a Medicare application by the carrier. Complete the application form provided and never forget to give documents such as drug-enforcement administration (DEA) certificate, IRS form W-9, Medicare provider letter and a copy of your business license. Upon reviewing all the terms, mail the application to the carrier and wait until they finish processing one’s application of becoming a Medicare provider. If you are looking for the best medicare providers and supplemental medicare insurance, visit our site for more tips and information. Contact us for free medicare advice. If you are looking for the best http://www.medicarerep.com/ medicare providers and http://www.medicarerep.com/ supplemental medicare insurance, visit our site for more tips and information. Contact us for free medicare advice.
Source: abcarticledirectory.com

Time for a Medicare switcheroo?

. While only about 3 million out of 50 million Medicare enrollees encounter the much-vaunted doughnut hole, if you are one of them it can be expensive. The doughnut hole is the gap in Part D coverage when all costs are paid by enrollees out of their own pockets. As a result of the Affordable Care Act, in 2013, the government is fiddling with the doughnut hole to lessen its impact. Recipients enter the doughnut hole at $2,970 — $40 later than in 2012 — and catastrophic coverage kicks in $50 later at $4,750. As they traverse the doughnut hole, next year recipients will pay 47 percent of premium drug costs, down from 50 percent this year, and 79 percent of generic drug costs, down from 86 percent this year. If you are likely to fall into the hole, it is especially important to make sure you’re signed up for the most economical plan for you. As you can see — even with the reductions — these are whopping costs.
Source: bankrate.com

Health First Health Plans’ “Choosing the Right Medicare Advantage Plan”

“We have complex case managers who help members with cancer or high-risk diseases navigate the health care system,” explains Dr. Brady, who’s an internal medicine physician who originally joined the Health First Physicians Group team in 2003 and has treated many Medicare beneficiaries. “In addition to our hospital transition program, we have a physician home visiting program that allows homebound members to receive care. We have a 24-hour-a-day nurse line that allows members to speak to a nurse any time of day, as well as many online wellness and disease management tools, including online and telephone-based health coaching. And, members with certain diseases qualify for state-of-the-art telemonitoring of their blood pressure, weight, and blood sugar levels to help their physician manage their condition.”
Source: spacecoastlivinghealth.com

Pennsylvania providers already feeling Medicare cuts, worrying about more to come

Among several examples: Hospitals now may lose Medicare money if too many patients are readmitted within 30 days of discharge — for any reason. The Centers for Medicare and Medicaid Services cut home health payment rates by 3.79 percent in 2011 and 2012, and will cut home health by another 1.32 percent in 2013, said Jennifer E. Battista, communications director of the Pennsylvania Homecare Association. Another Medicare program for rural hospitals that serve a high number of seniors also was left unfunded. At Wayne Memorial Hospital in Honesdale, Wayne County, that will cost $1.7 million.
Source: medcitynews.com

Medicare open enrollment: How can I find a better plan?

What about doctor availability? On the Medicare site you can directly compare up to three plans, and when I selected your current plan and these other two plans, I saw that your current plan says it has 1001-1500 “physicians and providers,” compared to 4001-5000 for the other two plans. For each plan you can click on “View provider and physician network website,” which takes you away from Medicare.gov and onto the plan’s own website, where you can search its provider directory to judge for yourself whether it has enough doctors to meet your needs.
Source: consumerreports.org

Insurer UnitedHealth's 3Q profit jumps 23 percent

Medicare Advantage plans are privately run, subsidized versions of the government’s Medicare program for the elderly and disabled people. UnitedHealth is the largest provider of these plans, and it made a couple of acquisitions within the past year to help spur growth. Big health insurers have been snapping up smaller Medicare Advantage plan providers to prepare for the millions of Baby Boomers who will become eligible for this coverage over the next couple decades.
Source: mysanantonio.com

Accountable Care Organizations: a primer

The 2010 national health law creates ACO incentives for Medicare, but only addresses Medicaid in a modest way. It authorizes a demonstration project for creation of pediatric ACOs within Medicaid and the State Children’s Health Insurance programs, although funding is not yet available. The law does not specifically apply ACOs to the rest of the Medicaid population — pregnant women, seniors and people with disabilities, and millions of other poor adults (after the law’s slated expansion in 2014).
Source: mylocalhealthguide.com

6 Steps You Must Take During Medicare Annual Enrollment

The opinions expressed in WebMD User-generated content areas like communities, reviews, ratings, or blogs are solely those of the User, who may or may not have medical or scientific training. These opinions do not represent the opinions of WebMD. User-generated content areas are not reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other reason except for compliance with our Terms and Conditions. Some of these opinions may contain information about treatments or uses of drug products that have not been approved by the U.S. Food and Drug Administration. WebMD does not endorse any specific product, service or treatment.
Source: webmd.com

Report: Medicare ID Theft a Burden on Providers, Beneficiaries

OIG Recommendation: Develop a Method for Ensuring That Beneficiaries Who Are Victims of Medical Identity Theft Retain Access to Needed Services CMS should mitigate the damage of medical identity theft by ensuring that beneficiaries retain their access to services if their Medicare numbers have been misused by others. Misuse of a beneficiary’s number could delay or prevent that beneficiary from receiving needed services, particularly when the services are subject to a cap. CMS could insert an indicator in the beneficiary claim record that would exclude certain claims from frequency and utilization edits, allowing for payment of legitimate claims for victims of medical identity theft. CMS could also develop other methods for providing assurances and documentation to these beneficiaries that their access to services will not be restricted as a consequence of the theft.
Source: insidepatientfinance.com

Reminder: Optometrists subject to $500+ fee for Medicare DMEPOS enrollment

Optometrists who wish to provide eyeglasses for cataract patients under Medicare are subject to a new durable medical equipment prosthetics, orthotics and supplies (DMEPOS) registration fee every three years, according to the AOA Advocacy Group.  As reported in AOA publications previously, the fee was put in place in March 2011 over the objections of AOA and other physician organizations when the Centers for Medicare & Medicaid Services (CMS) decided to treat all DMEPOS suppliers as institutional fraud risks.
Source: newsfromaoa.org

Study Finds Premium Support Plan Could Raise Medicare Premiums In Many Parts of Country

The study modeled the impact of a generic version of premium support, under which beneficiaries would receive a defined subsidy, or voucher, to buy health insurance in a competitive market instead of getting a guaranteed set of benefits, as Medicare has traditionally provided. That payment would be tied to the second-lowest-cost plan offered in an area or traditional Medicare, whichever is lower. This kind of a change is a central part of the House Republican budget written by Rep. Paul Ryan of Wisconsin, now the GOP’s vice-presidential candidate, and it has also been embraced by GOP presidential nominee Mitt Romney. Even a few Democrats have flirted with such a plan as a way to leverage market efficiency to rein in the spiraling cost of Medicare.
Source: aarp.org

Medicare scam relies on gathering personal data

Posted by:  :  Category: Medicare

What's In My Bag... by Amy DiannaThe 75-year-old south Everett woman sensed something was amiss nearly from the moment she answered the phone. The man asked for her by her first and last names. He told her he was phoning from Washington, D.C., and that he wanted to send her a new insurance card to go with her Medicare card. He asked if he had her correct address, reading it aloud. Then he said he needed to know the name of her bank. What he didn’t know is the woman had previously worked as a vice president at a local bank. She said she didn’t want her name disclosed because she worries about further contact from the man or his organization. “I said, ‘I’m sorry, I won’t give you that information,’ ” she said. The caller promptly hung up. “I’m not stupid,” she said. “There’s no way I’d give information on my bank account to anybody calling me on the phone.” Jean Mathisen, program director of the fraud fighter call center for AARP Washington, said she has no doubts about what was going on. “Clearly she was being targeted for fraud,” Mathisen said. Unfortunately, attempted scams involving Medicare aren’t unusual and there are many ways they can be conducted. Sometimes scammers offer a product for free, such as diabetes testing strips or motorized scooters, she said. What they’re after is the person’s Medicare number, Mathisen said. Even if the attempted fraud isn’t targeting the Medicare patient, scammers may be attempting to fraudulently bilk Medicare for services. Such fraudulent Medicare claims cost the government billions of dollars every year, she said. Scammers are adept at preying on people’s fears, Mathisen said. One of the latest is to refer to the current political debates about possible cuts to Medicare or changes the callers say are occurring due to the Affordable Care Act, or the federal health care law. “They say I’m with Medicare and there are changes in 2013 and I need you to answer some questions to continue with Medicare,” Mathisen said. Sometimes they want access to financial information, she said. “They’ll ask for your Social Security number, which is your Medicare number. “We’re asking people not to answer questions,” Mathisen said. “If someone calls on the phone and says they’re calling from Medicare, our advice is to say: I do not answer questions over the phone unless I initiate the call.” Sharon Salyer: 425-339-3486 or salyer@heraldnet.com Who to call Anyone who thinks that they have been contacted about a possible Medicare scam can call the Senior Medicare Patrol, part of the state Insurance Commissioner’s Office, at 800-562-6900.
Source: heraldnet.com

Video: Los Angeles: Medicare Fraud Summit Beneficiary/Consumer Panel

How to Prevent Medicare Card Identity Theft

Note: You’ll notice that your Medicare ID has one or two additional letters or numbers following the digits of the SSN. These identify what kind of beneficiary you are, according to the Social Security Administration. For example, the letter T mainly indicates that you are entitled to Medicare, but are not yet filed for Social Security retirement benefits; whereas W1 indicates that you are a widower who is eligible for Medicare through disability. For the purposes of your photocopy, it doesn’t matter whether you delete these final letters (or letter-number combinations) or leave them in. Also of interest: You can help fight health care fraud. 
Source: aarp.org

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

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

consent form example: lost my medicare card Five O Clock Concerts (5

people lived near the mines. Romans were the first Hallstatt lake- side settlers. The store s owners are committed to sharing Hallstatt s fascinating history, and often display lost my medicare card old town paintings and folk art. Five O Clock Concerts (5-Uhr-Konzerte): These con- certs next to St. Peter s in the old town are cheaper, sincethey feature lost my medicare card young artists ( 12, July Sept Thu Tue at 17:00, noconcerts Wed or Oct June, 45 60 min, tel. 0662/8445-7619, www.5-uhr-konzerte.com). While the series is formally named after the brother of Joseph lost my medicare card Haydn, it offers music from various masters.
Source: blogspot.com

FREE Sample of Nivea for Men Platinum Protect Body Wash

Albertsons Albertsons Matchups Amazon Bashas Bashas Matchups Catalinas coupons CVS CVS Matchups Daily Recap events Facebook Food Food City freebies Frugal Living Fry’s Fry’s Matchups Funnies Giveaways Grocery Trips Groupon Instant Win Games kmart Magazines Matchups Matchups Miscellaneous Movies Online Deals Photos Reader Grocery Trips Rebates Recipes Recyclebank Retail safeway Safeway Matchups Staples Surveys Target Uncategorized Walgreens Walgreens Matchups Wal Mart
Source: thecentsableshoppin.com

Walking Solo: Piece of 3.14159265359

I have a friend I’ve known since high school. I’ve had some of my best moments with him. The first concert I’ve ever been to was with him. It was The Chemical Brothers back in 1999 at the Metropolis and was the first time I’ve ever been star struck when we met the guys in the alley in the back of the building after the show. We went back there again several times for that band and also for The Crystal Method, Amon Tobin and The Beastie Boys. Ken Jordan and Scott Kirkland from The Crystal Method were the coolest guys ever. Every time after their show we would go meet them and have a talk about all sorts of things. The first time was around the time when George W. Bush initiated the war in Iraq so we had a very long political discussion about that. The second time around we met them in the back alley and I got my Vegas album signed! But, that wasn’t enough. They went in their tour bus and signed us some posters and they took pictures with us and all. And that’s just a SAMPLE of what kind of time I’ve spent with my friend. Also, a funny little anectode, the ID number our social medicare cards start with the first three letters of our last name and the first letter of our first name. In highschool, someone noticed that my friend’s ID on his card was FOUF. (Pronounced foof because we’re stinkin’ cheese eatin’ surrender monkeys.) It has been his nickname ever since. One thing about my friend is that he gets into these phases. In high school he got into running. He would run something like 20km (that’s about 12.5 miles) in one shot from the east-end of Montreal to the Olympic Stadium and back. Then he got into chess, then into boxing and probably some other stuff. Lately he met someone who was into chess and he fell back into that phase and was really eager to play with someone. He kept bugging me about it and I had some free time Saturday night so I suggested we go to Café π.
Source: blogspot.com

"b notice" "backup withholding" example

First B Notice IMPORTANT TA X NOTICE ACTION IS REQUIRED Backup Withholding Warning! We need a Form W-9 from you before: _______________________. Otherwise; backup withholding will begin on Account Number Current Name on Account Current TIN on Account The Internal Revenue Service (IRS) has notified us that the taxpayer identification number (TIN) on your account with us does not match its records. The IRS considers a TIN as incorrect if either the name or number shown on an account does not match a name and number combination in their files or the files of the Social Security Administration (SSA). If you do not take appropriate action to help us correct this problem before the date shown above, the law requires us to backup withhold on interest, dividends, and certain other payments that we make to your account. The backup withholding rate is: __ [set forth rates/dates] In addition to backup withholding, you may be subject to a $50 penalty by the IRS for failing to give us your correct Name/ TIN combination. This notice tells you how to help us make your account records accurate and how to avoid backup withholding and the penalty. Why Your TIN May Be Considered As Incorrect. An individual’s TIN is his or her social security number (SSN). Often a TIN does not match IRS records because a name has changed through marriage, divorce, adoption, etc., and the change has not been reported to SSA, so it has not been recorded in SSA’s files. Sometimes an account or transaction may not contain the correct SSN of the actual owner. For example, an account in a child’s name may reflect a parent’s SSN. (An account should be in the name and SSN of the actual owner.) What You Need To Do for Individuals If you have never been assigned a social security number (or if you lost your social security card and do not know your SSN), call your local SSA office and find out how to obtain an original (or a replacement) social security card. Then apply for it. If you already have a social security number: Compare the name and SSN on your account with us (shown at the beginning of this notice) with the name and SSN shown on your social security card. Then use the chart on the next page to decide what action to take.
Source: accountingportal.com

Annual Enrollment for Medicare Advantage (Part C) & Part D: October 15 – December 7 

Posted by:  :  Category: Medicare

Even beneficiaries who were satisfied with their 2012 plans need to review their plan options for 2013.  Part D and MA plans may have made changes to their coverage, provider networks and other plan features.[3] Plan information for 2013 will be available on the Medicare Plan Finder at www.medicare.gov.[4]  For the computer-savvy, the Medicare Plan Finder is an excellent plan comparison tool, allowing users to enter all their drugs and drug dosages, compare up to three plans at a time, save their drug information for later use, and actually enroll in a plan on-line.  This is the best – if not only – way to truly compare the many plans available to choose from.  People who cannot use the Plan Finder themselves may contact 1-800-Medicare, or their State Health Insurance Assistance Program (SHIP), for assistance with evaluating, selecting, and enrolling in a Part D plan.
Source: medicareadvocacy.org

Video: Medicare Advantage Enrollment 2012

Navigating Medicare's Open Enrollment Period

Medicare beneficiaries who are happy with their plans do not need to do anything, if they don’t want to change. But it is still a good idea to check options, Ms. Metcalf advises, to make sure a version of Medicare is the best one in terms of cost and coverage. If, for instance, you have the original version of Medicare and pay extra for prescription drug coverage (so-called Part D coverage), you may want to make sure important medications you need are still covered under your plan, to avoid having to pay more for them.
Source: nytimes.com

Medicare open enrollment: What’s the best Medigap policy?

The difficulty for consumers is that the nature of Medigap makes it a lot harder to shop for than Medicare Advantage. Here’s why. Medicare Advantage plans are regulated and overseen on a national level. Medicare routinely collects all kinds of information on them about customer satisfaction and quality of care. In addition, the premium of a specific Medicare Advantage plan is the same for each customer. As a result, it’s possible (as I explained yesterday) to go to Medicare.gov and compare Medicare Advantage plans in detail, including quality ratings and price. It’s also why we can publish rankings of Medicare Advantage HMOs and PPOs through our partnership with the National Committee on Quality Assurance.
Source: consumerreports.org

As Open Season Begins, More Medicare Advantage Plans Get Top Ratings

Detroit Free Press: Medicare Changes: What You Need To Know This Year Beginning this year, [Michigan] beneficiaries of chronically poor-performing plans will be notified by mail that there might be better options elsewhere and those beneficiaries may switch to the highest-performing plans throughout 2013. Medicare for the first time will cover screenings for depression, obesity, sexually transmitted diseases and alcohol misuse. It also will cover behavioral therapy for cardiovascular disease. Under health care reform, Medicare discounts continue to deepen on drugs in the donut hole (Erb, 10/14). The Columbus Dispatch: Medicare Will Prod Users To From Low-Rated Advantage Plans The federal government said yesterday that it will become more aggressive about moving people off poorly performing Medicare plans and onto higher-scoring ones. The Centers for Medicare and Medicaid Services said they will mail letters to people enrolled in 26 poorly rated plans nationwide — plans that have received 2.5 or fewer stars on a 5-star scale for the past three years. The letters will encourage those people to enroll in plans that score better on the government measures of patient health outcomes and satisfaction (Sutherly, 10/13). 
Source: kaiserhealthnews.org

6 Steps You Must Take During Medicare Annual Enrollment

The opinions expressed in WebMD User-generated content areas like communities, reviews, ratings, or blogs are solely those of the User, who may or may not have medical or scientific training. These opinions do not represent the opinions of WebMD. User-generated content areas are not reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other reason except for compliance with our Terms and Conditions. Some of these opinions may contain information about treatments or uses of drug products that have not been approved by the U.S. Food and Drug Administration. WebMD does not endorse any specific product, service or treatment.
Source: webmd.com

Why Private Medicare Plans Don't Cost Less

Many contend that the government “overpays” for people enrolled in private plans, since traditional Medicare could have covered these patients for less money. But the reason it would have cost less is partly that the government has done a woeful job in figuring out how much to pay the private plans. The government compensates insurers based on the health of their enrollees at the start of the year. Plans with healthier patients receive less money than those with sicker ones to reflect the likelihood that healthier people will use less care. Healthier patients enroll in Medicare Advantage plans, so in, principle, plans should be reimbursed less by the government for enrolling these patients (the technical term for this process is “risk adjustment”). But for decades, the government has failed to determine who is healthy and who is sick with any precision, with the result that private plans receive larger payments to cover their patients’ costs than necessary. This botched payment system gives insurers an incentive to spend more time selecting the healthiest patients, and less time treating them more efficiently.
Source: nytimes.com

Medicare Part D and Medicare Advantage Changes for 2013

The Affordable Care Act includes provisions that, over time, are reducing the cost of prescription drugs for people who fall into the coverage gap, or “donut hole.” In 2011 and 2012, the discount for brand name drugs was 50%; in 2013 and 2014, it will increase to 52.5%, and will grow after that until it reaches 75% in 2020.
Source: wordpress.com

House Oversight chair threatens to subpoena Sebelius over Medicare slush fund

Issa set a deadline of 5:00 PM Thursday for the production of the documents, or else it’s subpoena time.  I doubt that’s going to get him anywhere with the lawless Obama Administration, which didn’t exactly fall all over itself to comply with those Fast and Furious subpoenas.  And Kathleen Sebelius flaunts laws that inconvenience her, such as the Hatch Act, with impunity.  She only needs to run out a few more weeks until the election.  Then she’ll either be protected by the general “let’s stop obsessing over the past” spirit of transition to a new Administration after the holiday break, or… well, let’s just say Barack Obama’s not going to develop a sudden new respect for the law, once he knows he’ll never have to answer to voters again.
Source: humanevents.com

Medicare Advantage enrollment projected to grow 11 percent in 2013

Health and Human Services Secretary Kathleen Sebelius said the latest data shows that the reform law’s curbs on premium rate increases and other regulations on private insurers has made Medicare Advantage more accessible to the nearly 50 million senior citizens and disabled Americans who are Medicare beneficiaries.
Source: medcitynews.com

Medicare Open Enrollment Underway

Medicare’s open enrollment period is now underway, giving current or newly eligible Medicare beneficiaries the opportunity to sign up for benefits or make changes to existing coverage.   The open enrollment period began Oct. 15 and continues until Dec. 7. And, as senior citizens review or consider changing their Medicare benefit plans, Attorney General Dustin McDaniel issued this consumer alert today to help consumers as they navigate their Medicare options.   A recent survey by the Kaiser Family Foundation showed that nearly one in four American senior citizens were unaware of their annual opportunity to review or change Medicare coverage. More than a third of seniors surveyed said they review or compare coverage options only once every few years, rarely, or never.   “Medicare beneficiaries have the option every year to review the coverage that’s right for them, depending on their health-care needs,” McDaniel said. “As with any insurance product, it’s always good practice to shop around for the best plan.”   In addition to typical Medicare coverage, beneficiaries must join a Medicare Prescription Drug Plan (Medicare Part D), unless they have prescription coverage under another recognized plan. Beneficiaries may choose to enroll in a Medicare Advantage Plan, which operates like an HMO or PPO and may also include a prescription drug benefit.   To select a plan, compare plans and coverage, or estimate costs, visit www.medicare.gov. Senior citizens are encouraged to make changes as soon as possible to allow coverage to begin uninterrupted on Jan. 1, 2013.   Beneficiaries may be able to join other types of Medicare health plans as well. Click here for more information on how to select a plan.   Medicare beneficiaries may also call a 24-hour hotline, (800) MEDICARE, with questions about coverage options. In Arkansas, the Senior Health Insurance Information Program, or SHIIP (click here) is available to assist Medicare beneficiaries.   McDaniel noted that his Consumer Protection Division often sees an uptick in Medicare-related scams during the open enrollment period. He urged beneficiaries and their families to use caution when sharing sensitive personal or financial information.   Scammers in the past have asked Medicare beneficiaries for information such as bank account numbers or Social Security numbers over the phone. Medicare rules prohibit these types of calls, though. No beneficiary should provide that type of information to someone who calls them, no matter whether the caller sounds official.   The Attorney General’s Consumer Protection website (click here) offers tips and resources to help consumers avoid Medicare-related scams and other types of scams and fraud. Consumers may also download a free, electronic copy of the Medicare Protection Toolkit on the website.
Source: arkansasmatters.com

HHS: Medicare Advantage enrollment is up, premiums down

Medicare Advantage plans cover skilled nursing facility stays following acute episodes and other post-acute care. MA also includes special needs plans for chronically ill and disabled individuals such as dual eligibles. Republicans raised concerns over an MA demonstration project in June that gave quality bonuses to plans with more stars.
Source: mcknights.com

Medicare Pricing Released for Most Flu Vaccine Codes

Posted by:  :  Category: Medicare

90656 Influenza virus vaccine, trivalent, preservative free, when administered to individuals 3 years and older, for intramuscular use (Use for Medicare flu shots using the vaccine Fluarix) (Medicare reimbursement $12.39) single dose syringe
Source: managemypractice.com

Video: Guess That Code Episode 2

My Medical Bill Advocate: Medicare HCPCS Codes

Level II of the HCPCS is a standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician’s office. Because Medicare and other insurers cover a variety of services, supplies, and equipment that are not identified by CPT codes, the level II HCPCS codes were established for submitting claims for these items. 
Source: blogspot.com

Pitfalls in Billing Pharmaceuticals to the Medicare Program

It is clear there are multiple pitfalls for the compliant billing of pharmaceuticals to Medicare Part B. Hospitals need to ensure, to the extent possible, that their pharmacy CDM is accurate with correct HCPCS and revenue codes, that unit conversion modules or tables are set up correctly, that self-administrable drugs have been identified as such and revenue code fields are set to toggle between 637 and 250 based on bill type. Noncovered drugs should be billed to the patient, not Medicare. Drugs integral to the procedure should be set up as supply items, not billed as noncovered. Nursing documentation, including that on an electronic medication administration record, should indicate date, time and nurse responsible for administration and the amount of drug given—and wasted—if any. Only wasted drugs in single-dose vials can be billed to the program and only if documentation in the medical record meets the requirements. 
Source: bkd.com

Coding Ahead: List of 2011 HCPCS codes

G0402 Initial preventive physical examination; face to face visits, services limited to new beneficiary during the first 12 months of Medicare enrollment G0389 Ultrasound, B-scan and /or real time with image documentation; for abdominal aortic aneurysm (AAA) ultrasound screening 80061 Lipid panel 82465 Cholesterol, serum or whole blood, total 83718 Lipoprotein, direct measurement; high density cholesterol (hdl cholesterol) 84478 Triglycerides 82947 Glucose; quantitative, blood (except reagent strip) 82950 Glucose; post glucose dose (includes glucose) 82951 Glucose; tolerance test (gtt), three specimens (includes glucose) 97802 Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes 97803 Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes 97804 Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes G0270 Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes G0271 Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes G0123 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision G0124 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician G0141 Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician G0143 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with manual screening and rescreening by cytotechnologist under physician supervision G0144 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system, under physician supervision G0145 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision G0147 Screening cytopathology smears, cervical or vaginal, performed by automated system under physician supervision G0148 Screening cytopathology smears, cervical or vaginal, performed by automated system with manual rescreening P3000 Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision P3001 Screening papanicolaou smear, cervical or vaginal, up to three smears, requiring interpretation by physician Q0091 Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory G0101 Cervical or vaginal cancer screening; pelvic and clinical breast examination 77052 Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation, with or without digitization of film radiographic images; screening mammography (list separately in addition to code for primary procedure) 77057 Screening mammography, bilateral (2-view film study of each breast) G0202 Screening mammography, producing direct digital image, bilateral, all views G0130 Single energy x-ray absorptiometry (sexa) bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel) 77078 Computed tomography, bone mineral density study, 1 or more sites; axial skeleton (e.g., hips, pelvis, spine) 77079 Computed tomography, bone mineral density study, 1 or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel) 77080 Dual-energy x-ray absorptiometry (dxa), bone density study, 1 or more sites; axial skeleton (e.g., hips, pelvis, spine) 77081 Dual-energy x-ray absorptiometry (dxa), bone density study, 1 or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel) 77083 Radiographic absorptiometry (e.g., photodensitometry, radiogrammetry), 1 or more sites 76977 Ultrasound bone density measurement and interpretation, peripheral site(s), any method G0104 Colorectal cancer screening; flexible sigmoidoscopy G0105 Colorectal cancer screening; colonoscopy on individual at high risk G0121 Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk 82270 Blood, occult, by peroxidase activity (e.g., guaiac), qualitative; feces, consecutive G0328 Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous G0103 Prostate cancer screening; prostate specific antigen test (PSA) 90655 Influenza virus vaccine, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use 90656 Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use 90657 Influenza virus vaccine, split virus, when administered to children 6-35 months of age, for intramuscular use 90660 Influenza virus vaccine, live, for intranasal use 90662 Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use Q2035 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria) Q2036 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval) Q2037 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use, (Fluvirin) Q2038 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone) Q2039 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified) G0008 Administration of influenza virus vaccine G9141 Influenza A (H1N1) immunization administration (includes the physician counseling the patient/family) G9142 Influenza A (H1N1) Vaccine, any route of administration 90669 Pneumococcal conjugate vaccine, polyvalent, when administered to children younger than 5 years, for intramuscular use 90670 Pneumococcal conjugate vaccine, 13 valent, for intramuscular use 90732 Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use G0009 Administration of pneumococcal vaccine 90740 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use 90743 Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use 90744 Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use 90746 Hepatitis B vaccine, adult dosage, for intramuscular use 90747 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use G0010 Administration of hepatitis B vaccine G0432 Infectious agent antigen detection by enzyme immunoassay (EIA) technique, qualitative or semi-qualitative, multiple-step method, HIV-1 or HIV-2, screening G0433 Infectious agent antigen detection by enzyme-linked immunosorbent assay (ELISA) technique, antibody, HIV-1 or HIV-2, screening G0435 Infectious agent antigen detection by rapid antibody test of oral mucosa transudate, HIV-1 or HIV-2 , screening G0436 Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes. G0437 Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes. G0438 Annual wellness visit, including PPPS, first visit G0439 Annual wellness visit, including PPPS, subsequent visit
Source: codingahead.com

HCPCS Reimbursement Codes Announced for MediPlus Alginate Wound Dressings

“As an experienced master distributor, MediPurpose has done all the hard work for medical product distributors seeking to purchase high-quality wound care products at competitive prices,” said Riddle. “Our team of experts has completed all the regulatory, quality, reimbursement and logistics required to import the comprehensive line of MediPlus Advanced Wound Care products.”
Source: medipurpose.com

Telemedicine: How It Can Work for Your Medical Practice

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Source: transcription911.com

Handwriting Leads to Medical Office Mistakes

Electronic Health Record: Improved accuracy is just one benefit of integrating to an electronic medical record system. There are five major benefits of switching from a paper medical record to an electronic health record (EHR).
Source: about.com

Introduction to HCPCS Level I Coding

The NCCI also employs Medically Exclusive Code Pairs (MECs) which identify codes that cannot reasonably be reported together. The NCCI Coding Policy Manual that is published annually by CMS describes why the NCCI considers how some codes cannot be logically reported on the same healthcare claim. Most of these mirror the instructions contained in CPT, but because CMS deals with HCPCS codes rather than CPT codes, the rationale is not universal. Commercial health insurance policies may consider some pairs of codes acceptable for reimbursement, while the NCCI does not. Professional medical billers need to be able to recognize that while all CPT codes are HCPCS codes, not all CPT codes are used the same way when they are HCPCS codes. CPT is designed to report what actually occurred for statistical purposes. HCPCS is designed to report services as succinctly as possible for reimbursement.
Source: medicalbillingandcodingu.org

Medical Coding: HCPCS Questions

Medical Coding, Medical Coding Certification Details, Sample charts of Medical Coding, Medical Coding Companies in India, Medical Coding News, Medical Coding Interview Questions, Medical Coding Jobs in India, Medical Coding Sample Questions, Sample/Practice CPT questions, Sample/Practice ICD questions, Sample/Practice Coding Reimbursement Questions, Medical Coding Quiz, Medical Coding Sample Charts, Medical Coding Sample Scenarios, Sample Radiology Coding Reports, Sample Surgery Coding Reports
Source: blogspot.com

Cigna expands supplemental business

Posted by:  :  Category: Medicare

This acquisition grows Cigna’s reach in both the individual and Medicare Supplement markets, both which position the company well for thriving in a post-PPACA world. The deal also enhances Cigna’s distribution network of agents and brokers and extends global direct-to-consumer retail channel, Cigna says.
Source: benefitspro.com

Video: Florida Insurance Call 1-866-495-4111

American Financial (AFG) Closes Sale Of Medicare Supplement And Critical Illness Businesses

AFG’s balance supplemental insurance operations consist solely of its run-off long-term care business, which has a book value of approximately $170 million, and which will continue to be based in Austin, Texas. AFG’s Austin-based life and annuity operations will transition to its home office in Cincinnati, Ohio before the end of the year.
Source: istockanalyst.com

Medicare Supplement Plans That Save You Big

There are three great options through cigna medicare plans phoenix az. Medicare supplement plans work with the existing Medicare plan to provide increased coverage and lessen expenses. Medicare Advantage has co-pays and helps to decrease out of pocket expenses. There is also a stand alone prescription plan that works with Medicare to provide for prescription coverage, which Medicare does not provide.
Source: jacemilstead.com

Senior Marketing Specialists : SMS: Medicare Sales Trend Upwards

. We predicted the Medicare Supplement market would grow in 2012 to 10.4 million lives, generating $22.8 billion of premiums. Based on strong trends through August, however, CSG Actuarial predictive models are now showing the Medicare Supplement market will grow in 2012 to more than 10.5 million lives, generating over $23 billion of premiums. The number of 2012 Medicare Supplement lives is up more than 3% from 2011 while the premiums are up almost 5% over 2011.
Source: blogspot.com

Cigna To Increase Supplemental Health Insurance Offerings With Acquisition

Fox News/Dow Jones: Cigna To Buy Great American Supplemental Benefits For $295 Million Cigna Corp. (CI) has agreed to acquire American Financial Group Inc.’s (AFG) Medicare supplement and critical-illness businesses for approximately $295 million in cash, as the managed-care company looks to expand its presence in the individual and seniors markets. Cigna said its acquisition of Great American Supplemental Benefits Group, one of the largest manufacturers of supplemental health insurance products in the U.S., is expected to close in the second half of 2012. Great American generated approximately $325 million of revenue last year (5/10).
Source: kaiserhealthnews.org

A.M. Best Rates Cigna’s New Units

The financial strength ratings (“FSR”) and issuer credit ratings (“ICR”) of the subsidiaries of American Financial Group Inc. (AFG) – Loyal American Life Insurance Company, American Retirement Life Insurance Company, Central Reserve Life Insurance Company, Provident American Life and Health Insurance Company – have been removed from under review by the leading rating agency A.M. Best. This action follows the acquisition of these subsidiaries by health insurer CIGNA Corp. (CI) on August 31, 2012.  The action has been taken with positive implications. A.M. Best has raised the FSR to A- (Excellent) from B++ (Good) and ICRs to “a-” from “bbb” of Central Reserve Life and Provident American Life, respectively.  The rating agency also affirmed the FSR of A- (Excellent) and ICR of “a-” of Loyal American and the FSR of B++ and ICR of “bbb” of American Retirement Life. All the ratings are of investment grade status and carry a stable outlook. A.M. Best acknowledges the acquisition of these subsidiaries by Cigna. It believes that Central Reserve Life, Provident American Life and Loyal American will benefit from getting placed under Cigna. The company is quickly expanding into Government programs, which will boost sales of Medicare Supplement products of these units, thus causing top-line growth.
Source: investopedia.com

2013 Medicare Advantage Plans — Best Rated Florida Plans from AARP UnitedHealth, Blue Cross Blue Shield, Humana and Coventry

Now that open enrollment for 2013 has begun, seniors are looking for the best rated 2013  Medicare Advantage plans from large insurers like Blue Cross Blue Shield, AARP, Humana, Cigna and many others. Rates for the plans are now available.  While the rates are now available on the Medic are.gov website, rate updates are still pending for the Florida State insurance website, so Florida seniors that are searching for low cost Medicare Advantage plans will need to be careful that the rates that they see quoted are for 2013.
Source: medicaremedigaprates.com

Cigna buys supplemental insurer for $305M

Cigna is the fourth-largest commercial health insurer based on enrollment, trailing WellPoint Inc., UnitedHealth Group Inc. and Aetna Inc. It operates health care, group disability and life segments in the U.S., and has an international segment that sells individual insurance in several countries. The company also operates an expatriate business that provides insurance for people living outside their home countries.
Source: distilnfo.com