Opinion: VA system inadequate to meet veterans’ health care needs

Posted by:  :  Category: Medicare

Healthcare solution >> more doctors by / // /To address the growing health care needs of our veterans, communities across Colorado are starting to  pursue innovative solutions. The Department of Veterans Affairs has invested $580.2 million to build the new Denver VA Medical Center facility on the University of Colorado’s Anschutz Medical Campus.  The Mental Health Center of Denver and the VA have developed a new partnership to speed up the evaluation of post-combat veterans with possible Post-Traumatic Stress Disorder and Traumatic Brain Injury.   Pikes Peak Hospice & Palliative Care participates in We Honor Veterans, a pioneering campaign developed by National Hospice and Palliative Care Organization in collaboration with the Department of Veterans Affairs.
Source: healthpolicysolutions.org

Video: Medicare Solutions

Settlement Eases Rules for Some Medicare Patients with Chronic Illnesses ‹ Social Justice Solutions

This new regulation equalizes the medical access of many elderly and disabled individuals currently receiving services through Medicaid.  As the population ages these services will be needed more and more, allowing individuals to access services that will help them attempt to maintain their quality of life while suffering from conditions which make this difficult. While it will likely cost the government more, it is a step in the right direction of health care access equality. I wonder though, how these changes will be impacted if Romney was to take office.
Source: socialjusticesolutions.org

Rowan woman gets prison for Medicare fraud

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Source: salisburypost.com

Diabetes screenings, supplies, and training – Medicare has you covered

If you’re at high risk for developing diabetes, Medicare covers up to two fasting blood glucose (blood sugar) tests each year. If your doctor accepts assignment, you pay nothing for these tests. You may be at high risk for diabetes if you’re obese, have high blood pressure, high cholesterol, or a family history of diabetes. Talk to your doctor to find out when you should get your free screening test.
Source: medicare.gov

Medicare enrollment starts

But what’s lurking ahead for MA and traditional fee-for-service Medicare is a reality: for the numbers to work, the government must pay doctors and hospitals less, and via the Affordable Care Act, the differential payments to MA plans will also be lower. So, for seniors, the choice between FFS and MA is important, but the reality is that both are likely be more strict about utilization and both are likely to face intense pressures to manage their administrative costs aggressively. I doubt seniors are likely to notice either in the near term, but it’s certain they will see a difference long-term.
Source: deloitte.com

Two Women Sentenced to Prison for Health Care Fraud Conspiracy, Illegal Kickbacks, and Forged Prescriptions for Controlled Substances

CHARLOTTE, NC—A Rowan County woman and her Mecklenburg County co-conspirator were sentenced to prison on Friday, November 2, 2012, in United States District Court for their role in a scheme to defraud Medicare and Medicaid and related offenses, announced Anne M Tompkins, United States Attorney for the Western District of North Carolina. Chief United States District Court Judge Robert J Conrad, Jr sentenced Karen Wills (a/k/a Karen Boykin and Karen Jackson), 43, of Salisbury, to serve 97 months in prison, followed by three years of supervised release. She was also ordered to pay $786,316 as restitution to Medicaid, Medicare, and Medco Health Solutions. Wills’ co-defendant, Wendy Gibson (a/k/a Wendy Fitzgerald), 40, of Charlotte, was sentenced to 48 months in prison followed by three years of supervised release. Judge Conrad ordered Gibson to pay $358,330 as restitution to Medicare, Medicaid, and Medco Health Solutions. In January 2012, Wills and Gibson pleaded pled guilty to one count of health care fraud conspiracy, one count of paying and receiving illegal kickbacks, and one count of conspiracy to distribute controlled substances. Wills pleaded guilty to one additional count of health care fraud conspiracy. United States Attorney Tompkins is joined in making today’s announcement by Attorney General Roy Cooper, who oversees the North Carolina Medicaid Investigations Division (MID); Derrick Jackson, Special Agent in Charge, Department of Health and Human Services, Office of the Inspector General (HHS-OIG), Office of Investigations, Atlanta Region; Chris Briese, Special Agent in Charge of the Federal Bureau of Investigation (FBI), Charlotte Division; Russell F Nelson, Special Agent in Charge of the United States Secret Service (USSS), Charlotte Field Division; Greg McLeod, Director of the North Carolina State Bureau of Investigation (NC SBI); Sheriff Kevin L Auten of the Rowan County Sheriff’s Office; and Chief Rodney D Monroe of the Charlotte-Mecklenburg Police Department (CMPD). According to filed documents, statements made in court, and Friday’s sentencing hearings: From around January 2008 to around 2009, Wills, Gibson, and others engaged in an illegal kickbacks scheme involving power wheelchairs. Wills used her position with her employer’s company to submit fictitious referrals for patients to receive medically unnecessary power wheelchairs from Gibson’s employer’s company. In some instances, Wills forged a physician’s signature on required qualification documents, while Gibson tracked and directed payment to those referrals. The defendants admitted to concealing the illegal kickback payments by falsely representing on invoices and checks that the payments were for nursing and billing services. This scheme resulted in payments for the medically unnecessary equipment from Medicare and Medicaid in excess of $300,000. The defendants also conspired to distribute controlled substances and to commit health care fraud. Wills admitted that she forged a physician’s signature on prescription pads she misappropriated from her employer and issued fraudulent prescriptions in Gibson’s name. The prescriptions were written for controlled substances including oxycodone and hydrocodone/acetaminophen pills. Gibson admitted that she used her health insurance prescription benefit program to pay for the fraudulent prescriptions, resulting in payments in over $30,000 for these fraudulent prescriptions. Wills and Gibson obtained and illegally distributed approximately 3,000 oxycodone pills and approximately 5,000 hydrocodone/acetaminophen pills. According to filed documents and statements made in court, from around 2008 to January 2011, Wills and others participated in a scheme to defraud Medicare and Medicaid by submitting false and fraudulent claims for medical services which were medically unnecessary. From around 2008 to January 2011, Wills also participated in a separate scheme to defraud Medicare and Medicaid by submitting false and fraudulent claims for medical services, including electromyography (EMG) and anorectal manometry (AM), among others. These diagnostic and treatment procedures were medically unnecessary, not provided, or both. As a result of this scheme, Medicare and Medicaid paid over $400,000 in reimbursement payments to the fraudulent claims. From around August 2008, Wills and others became aware of the investigation into the fraudulent billing practices. In an effort to cover the fraudulent scheme, Wills created several false EMG and AM reports and placed them in patient files. As part of her guilty plea, Willis admitted that the amount of loss intended to be caused by the scheme was in excess of $400,000 but less than $1,000,000. Wills has been in federal custody on these charges since August 2011. She will be transferred to the custody of the Federal Bureau of Prisons upon designation of a federal facility. Gibson is released on bond and will be ordered to report to a federal facility to serve her prison sentence. Federal sentences are served without the possibility of parole. The investigation into Wills and Gibson was handled by HHS-OIG, MID, FBI, USSS, NC SBI, CPMD, and Rowan County Sheriff’s Office. The prosecution is being handled by Assistant United States Attorney Kelli Ferry of the United States Attorney’s Office in Charlotte. The investigation and charges are the work of the Western District’s joint Health Care Fraud Task Force. The task force is a multi-agency team of experienced federal and state investigators and prosecutors, working in conjunction with criminal and civil Assistant United States Attorneys, dedicated to identifying and prosecuting those who defraud the health care system and reducing the potential for health care fraud in the future. The task force focuses on the coordination of cases, information sharing, identification of trends in health care fraud throughout the region, staffing of all whistle blower complaints, and the creation of investigative teams so that individual agencies may focus their unique areas of expertise on investigations. The task force builds upon existing partnerships between the agencies, and its work reflects a heightened effort to reduce fraud and recover taxpayer dollars. If you suspect Medicare or Medicaid fraud, please report it by phone at 1-800-447-8477 (1-800-HHS-TIPS) or e-mail at HHSTips@oig.hhs.gov. Reported by: FBI
Source: 7thspace.com

THE Consortium: Colorado Medicare Claims Transition from Trailblazers to Novitas Solutions

As of October 19,  Trailblazers stopped receiving all mail and requests in their role as the Medicare Contractor and forwarded these to Novitas Solutions. All future communication must go through Novitas. Since Novitas has prior experience as a MAC for a number of eastern states, CMS anticipates that the transfer to a new MAC will go smoothly, with few disruptions for Medicare beneficiaries or providers. However, providers should prepare for possible delays and implementation glitches.
Source: blogspot.com

PECOS: A Medicare Benefit for your Practice

Henderson Medical Billing Solutions LLC is an outsourced Medial Billing and Practice Management service located in Murrieta, California.  Henderson Medical Billing Solutions provides medical billing services to solo providers to mid-level practices throughout the United States.  Henderson Medical Billing Solutions offers Full Practice Management, Medical Billing, HIPAA Compliance Auditing and Training to medical and non-medical providers.  In addition, Henderson Medical Billing Solutions offers Accounts Receivables Recovery and New Practice Start-Up services.  Our staff includes certified practice managers and billers who are committed to the success of increasing provider revenue reimbursement.  To learn more about how we can maximize revenue and increase your practices productivity Contact us today.
Source: hendersonmbs.com

4 Retirement Problems Obama Must Fix

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Source: annuitythinktank.com

Lower 3rd Quarter Earnings For Health Net, Humana

Posted by:  :  Category: Medicare

Los Angeles Times: Health Net Posts Plunge In Profit, Strikes Deal With California Woodland Hills insurer Health Net Inc. said third-quarter net income plunged 71%, but its shares rose as the company resolved a dispute with California officials over reimbursement for government health programs. Health Net disappointed investors in August when it slashed its full-year profit outlook and reported higher-than-expected medical costs. On Monday, Chief Executive Jay Gellert … cited a wide-ranging agreement with California healthcare officials as a major step forward (Terhune, 11/6).
Source: kaiserhealthnews.org

Video: Health Net Medicare Part D Insurance – Compare to 180+ Comp

Health Net’s CEO Discusses Q3 2012 Results

Well, I think there’s – first of all there was a lot of risk to the State in the litigation. So I think that it had already in one year got into court and it had been resolved in our favor. So, it puts the state in a position where it had a significant amount of vulnerability into very near-term. So, the State I think has relieved itself of a lot of fiscal pressure, which I think was very wise, but the other thing is I think that California has the bottom three or four cost per beneficiary in Medicaid. The state in California is really – is kind of gone as low as it can go in terms of these costs. And, in the instances where things have kind of gotten disruptive because of a one-year situation, they’ve ended up paying substantially more having to clean it up. So, I think that the stability of relationship with all the financial pressures on the state is a very positive thing for them and I think it allows us to look at longer-term systemic change in terms of some of the stuff we’re doing without having to – I guess haggle on a quarter-by-quarter basis.
Source: seekingalpha.com

Arts Of Insurance: Shares of Health Net Inc. climbed Monday

Shares of Health Net Inc. climbed Monday after the health insurer said it had resolved Medicare disputes with the state of California and received several contract extensions. Health Net provides commercial health insurance and administers Medicaid and Medicare coverage, and it does most of its business in California. Health Net said it is ending litigation against the state’s Department of Health Care Services regarding cuts to Medicare and Medicaid reimbursement rates, and its four existing Medi-Cal contracts were each extended by five years. The Woodland Hills, Calif., company also said it will develop a new process to help the agency meet its actuarial targets and a new way to dispute payment rates. The settlement ends a dispute over the way Health Net is paid to administer California’sMedicaid program, programs for seniors and disabled people, and a pilot program for people who are eligible for both Medicare and Medicaid. It also covers any future Medicaid expansions by the federal government, Health Net said. Shares of Health Net jumped $2.99, or 13.2 percent, to $25.67 in afternoon trading. California had approved 10-percent cuts in a number of Medicare and Medicaid reimbursement rates, and Health Net said the reductions might have been effective retroactive to July 2011. Health Net’s new contract extensions cover seven counties where the company does business. The new deals will expire between 2018 and 2022. Health Net also reported its third-quarter results on Monday. The company said its net income fell to $18 million, or 22 cents per share, from $124.6 million, or $1.48 per share. Net income from its government and Western U.S. businesses totaled 38 cents per share. Revenue grew 3 percent, to $2.78 billion from $2.69 billion. Analysts were expecting net income of 36 cents per share in net income and $2.8 billion in revenue, according to FactSet. The company’s quarterly income was weighed down by $7.2 million in charges related to cost reductions and a $4.7 million loss from divested operations. Health Net sold its Medicare prescription drug plan business to CVS Caremark Corp. on April 1. Source: insurancenewsnet.com
Source: blogspot.com

Healthnet Medicare in Arizona

Today, Medicare is a little more complicated than it was originally simply because there has been a lot of changes, reforms, and additions made. In the beginning it was simply to offer health care for those over 65 years old but that has changed quite a bit and now includes those with disabilities as well as having different parts to Medicare. When you first become eligible for Medicare you are placed in the Original, which consists of Part A and B, which is the health care portion and it also includes the drug prescription plan, which is Part D.
Source: platinumcube.com

Arizona Attorney General, Tom Horne

PHOENIX (Monday, July 30, 2012) — Attorney General Tom Horne today announced that 30-year old Tucson resident Megan Monroe Racz has been indicted by the State Grand Jury on charges related to insurance fraud involving senior citizens. All 37 of Racz’s alleged victims are aged 65 or older. “Insurance fraud, especially when it involves the most vulnerable in society is a terrible crime,” Horne said. “The state Department of Insurance is to be commended for its investigation of these alleged offenses, and my office will work very hard to vigorously prosecute this case.” The State alleges that Racz, acting in her capacity as an insurance agent, during the Medicare open enrollment period from November 2011 through December 2011 transferred the Health Net Medicare supplemental policies of 37 people, four who were deceased at the time, to United Health Care supplemental polices without the consent of the policyholders. These unauthorized transfers were brought to the attention of the Arizona Department of Insurance by United Health Care, Health Net, and policyholders, who were notified their Health Net Medicare supplemental policies were being cancelled or who received information about new United Health Care policies that they never requested. United Health Care and Health Net worked together to see that none of the policyholders’ Medicare coverage lapsed. The State alleges Racz received over $25,000.00 in commissions for transferring the Medicare supplemental policies. Racz was formally indicted on one count of Fraudulent Schemes and Artifices, a class 2 felony; one count of Theft, a class 2 felony; six counts of Aggravated Identity Theft, class 3 felonies; two counts of Identity Theft, class 4 felonies; and four counts of Forgery, class 4 felonies. These charges are merely allegations, and the defendant is presumed innocent until and unless proven guilty. This matter was handled by Assistant Attorney General Beverly Rudnick. The case was investigated by the Arizona Department of Insurance Fraud Unit.
Source: azag.gov

Health Net posts plunge in profit, strikes deal with California

The understanding with a California Department of Health Care Services finished association lawsuit over supervision reimbursement. As partial of a agreement, Health Net said, a state will extend 4 existent Medi-Cal contracts by 5 years and yield additional payments if a association incurs larger-than-expected waste as new supervision programs get underway subsequent year.
Source: olegun.com

Medicare Advantage Medicare Supplement Long Term Care Insurance in Phoenix Arizona by Western Asset Protection

is a family owned and operated insurance brokerage firm specializing in Medicare Advantage andMedicare Supplement products. We are able to assist independent insurance professionals by providing a portfolio of strong Medicare Advantage or Medicare Supplement products to meet your clients needs.
Source: westernasset-us.com

Blue Cross, Blue Care Network expand service areas, add plan options

Posted by:  :  Category: Medicare

If you enjoy the content on the Crain’s Detroit Business Web site and want to see more, try 8 issues of our print edition risk-free. If you wish to continue, you will receive 44 more issues (for a total of 52 in all), including the annual Book of Lists for just $59. That’s over 55% off the cover price. If you decide Crain’s is not for you, just write “Cancel” on the invoice, return it and owe nothing. The 8 issues are yours to keep with no further obligation to us. Sign up below.
Source: crainsdetroit.com

Video: Medicare Plans from Blue Cross and Blue Shield of Minnesota and Blue Plus

Blue Cross Blue Shield of Michigan

Blue Cross Blue Shield of Michigan, a nonprofit organization, provides and administers health benefits to 4.7 million members residing in Michigan in addition to members of Michigan-headquartered groups who reside outside the state. The company offers a broad variety of plans including: Traditional Blue Cross Blue Shield; Blue Preferred, Community Blue and Healthy Blue Incentives PPOs; Blue Care Network HMO; BCN Healthy Blue Living; Flexible Blue plans compatible with health savings accounts; Medicare Advantage; Part D Prescription Drug plans, and MyBlue products in the under-age-65 individual market. BCBSM also offers dental, vision and hearing plans. Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. For more company information, visit
Source: bcbsm.com

Blue Cross Blue Shield of Michigan Offers New Medicare Plans

HMO’s (health maintenance Organizations) let you select a primary care physician from the BCBS provider network and this PCP manages your overall care. He or she will refer you to a specialist or to a selected hospital for care should you need additional services beyond his scope of practice. Referring yourself to an outside provider will cause a forfeit of benefits and out-of-pocket costs. The four BCBSM HMO products, formerly known as Options 1, 2, and 3, will now be known as BCN Advantage Elements, Classic , and Prestige. The Blues Care Network will also continue to offer the BCN Advantage Basic Plan.
Source: emaxhealth.com

Flash Of Genius: The Sole Scene: URGENT: WPS J8 MAC Medicare change starts at 2:00 Thursday 7/12/2012

. WPS officially starts payor id 08202 on Monday July 16, however they have announced “Dark Days” of Friday July 13 through Tuesday July 17. A dark day is a business day during the cut-over period when the Medicare claims processing system is not available for normal business operations. System dark days may occur between the time the outgoing claims administration contractor ends its regular claims processing activities and the incoming claims administrative contractor begins its first day of normal business operations. Genius is not certain what would happen if you sent Medicare claims with the new payor id between 2:01pm Thursday through 12:00am Monday.It is possible that BCBSM or WPS might hold them until they finish their dark days and process them normally, but we do not have any confirmation from BCBSM or WPS that this actually will happen. Therefore Genius recommends you do all of your Medicare billing before 2pm on Thursday July 12.Then do no Medicare billing until July 16 or later.On July 16 go to your Insurance Code Files and change payor id 00953 to 08202. Don’t change anything else and don’t change it before July 16. Click here for step-by-step instructions for changing the payor id in THOMAS. After you have changed your payor id on July 16 or later you should be able to resume sending your Medicare claims.
Source: blogspot.com

More on Proposed Cuts to Medicare Advantage: Seniors Would Save Far More Than They Lose

“It turns out that the additional benefits and flexibility created by recent increases in MA payment rates simply weren’t worth very much to seniors,” Frakt writes. “Consumer surplus loss associated with cuts in payments to MA plans will be only 14 cents per dollar saved. . . the truth is that under Obama’s plan a small fraction of Medicare beneficiaries will lose their MA benefits and/or face higher costs. However, the potential savings are enormous and research shows that the benefit cuts needed to achieve them will not be terribly missed.”
Source: healthbeatblog.com

Change in specialty designation for physicians

Primary specialty will come from the CAQH UPD application Beginning July 1, 2012, the BCBSM online provider search will display both primary and secondary specialties, if applicable. The specialty listed will be taken from the CAQH UPD application, regardless of board certification status, provided credentialing requirements are met.
Source: mi-osteopathic.org

Claims: Multiple Payers: Reports may contain invalid provider name

Payer Batch Totals Reports (SB) for the following CPID’s may have included an incorrect provider name due to a payer processing issue. No other claim information has been affected by this issue. The issue began on January 1, 2012 and was resolved by January 31, 2012. The payers affected are listed below: CPID 1421 Michigan Blue Shield CPID 1913 Medicare Plus Blue – Medicare Advantage Plan CPID 2145 Medicare Advantage DME (DMEnsion) CPID 2287 Medicare Plus Blue – Medicare Advantage Plan CPID 2426 Blue Care Network HMO CPID 3514 Michigan Blue Cross CPID 3531 Michigan Blue Cross – FEP CPID 3532 Blue Care Network HMO Please be aware of the incorrect provider name returned on payer reports. The payer will not be sending corrected reports. If you have any further questions, please contact Client Services at 1-888-348-8457, option 2.
Source: collaboratemd.com

Silver Cross Physicians Join New Blue Medicare Advantage (HMO) Plan

Learn how to protect yourself from some of the expenses Medicare doesn’t cover. Attend a free Our All-in-One Package: Medicare Advantage Prescription Drug (MAPD) program in the Silver Cross Hospital Conference Center, Pavilion A, 1890 Silver Cross Blvd., New Lenox.  One-hour sessions will be held on Oct. 26 and Nov. 1, 16 and 28 at 10 a.m. and 1 p.m.  Each seminar features an informative presentation followed by a question and answer session with a BCBSIL Product Specialist.  A sales person will present information and applications. Free valet parking and shuttle service will be available.  Refreshments will be served.  Register to attend by calling BCBSIL at 1-877-632-5920, TTY/TDD 711, 8 a.m. – 8 p.m., local time, 7 days a week.  For accommodation of persons with special needs at a sales meeting, call 1-877-632-5920, TTY/TDD 711. Friends and family members welcome.
Source: patch.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

President Obama and Governor Romney have presented two radically different visions of healthcare reform

Posted by:  :  Category: Medicare

Bubbles? Take something like 'Not I! ...item 1.. Wakulla Republicans Protest Against Taxes in the County (September 06, 2011) ... by marsmet552To achieve near universal coverage, the ACA introduces subsidies for individuals earning between 133% and 400% of the federal poverty line ($11,170 for individuals; $23,050 for a family of four) to purchase coverage and it extends eligibility for federal programs for all individuals earning below 133% of the federal poverty line. Previously, only nine states provided Medicaid coverage to adults without dependent children and the median upper income threshold for Medicaid eligibility for parents was 64% of the federal poverty line (Families USA, 2012). The ACA maintains the current employer-sponsored insurance market and creates a new market for individuals to purchase insurance.
Source: ac.uk

Video: Medicare Open Enrollment 2011 … Compare Medigap Insurance Rates

How to Make the Most of Medicare Reimbursements in 2011

Thus, depending on Medicare alone to float the budget of an individual medical office is not sage financial advice. While it is true that the economy is rebounding, once Medicare rates are secured for 2011 medical offices will be stuck with those figures for 12 full months. Further, Washington lobbyists who advocate for the best interest of physicians will continue to assert that Medicare reimbursements are sub-par but even those efforts are bigger picture and will not affect your A/R in the next quarter.
Source: questns.com

Pa. Home Health Care Providers Worried About Medicare Cuts

AAHomecare AARP AARP Public Policy Institute Alliance for Home Health Quality and Innovation Almost Family Amedisys Amedisys Inc. American Association for Homecare American Association for Long Term Care Insurance Apria Healthcare Group Brookdale Senior Living Care.com Center for Medicare Advocacy CMS Employee Benefit Research Institute Ensign Group featured First Care Home Health Care Gentiva Gentiva Health Services Gentiva Health Services Inc. HHS Home Health Depot Home Health International Home Visit Doctors Houston Compassionate Care Humana IntegraCare Intel-GE Care Innovations Jordan Health Services Kindred Healthcare Mathematica Policy Research MDLIVE MedPAC Microsoft Milford Regional Medical Center National Association for Home Care & Hospice Nationwide Northwestern Medicine Paraprofessional Healthcare Institute Partnership for Quality Home Healthcare PHI Sentara Healthcare VA Visiting Nurse Association
Source: homehealthcarenews.com

Do we really need wrinkle cream?

HRT – Hormone Replacement Therapy has almost saved my life. Having been forced to have a hysterectomy due to health issues years prior to reaching natural menopause, I was bombarded with terrible discomfort and health issues including severe depression, unyielding insomnia, constant headaches and forgetfulness among other issues. Since I do not have insurance and cannot afford a medicine cabinet full of pharmaceuticals, this one miracle drug – HRT – relieved all of the symptoms I was suffering from. I intend to stay on it as long as possible. BTW I am in extremely good shape for a woman my age, exercise vigorously, watch my diet, etc. For most woman, the dangers of HRT are exceedingly exaggerated. I would recommend it completely. As far as erectile dysfunction and all that other male stuff – I have found it is just cheaper (and better) to find a younger man !! Thanks HRT !!!!!
Source: bankrate.com

Medicare Premiums, Deductibles & Coinsurance: Rates for 2011

Because of the zero COLA increase in 2011, some Medicare beneficiaries will not pay more for coverage. If your premium is deducted from your Social Security check and your income is $85,000 or less ($170,000 if you file a joint tax return), then you won’t have to pay more. Your monthly premium will stay at either $96.40 or $110.50.
Source: suite101.com

CMS Issues Final Rules on Medicaid, Medicare Provider Payment Rates

The payment increase applies to physicians practicing in family medicine, general internal medicine, pediatric medicine and related subspecialties, such as board certified pediatric cardiologists. The rule clarifies that primary care services delivered by medical professionals working under the personal supervision of a qualifying physician, such as nurse practitioners, also are eligible for the higher payment rate (Reichard,
Source: californiahealthline.org

Medicare Rate Cuts Affect Nursing Homes

, it would begin cutting reimbursement rates for post-acute care to nursing homes by 11.1% in order to cover a $4 billion budget shortfall from 2010. Then, as part of the “Middle Class Tax Relief and Job Creation Act of 2012,” Congress cut Medicare payments to nursing facilities by reducing reimbursements for Medicare co-payments that beneficiaries or state Medicaid programs did not make. Unfortunately, these cuts are also coming at the same time that many states are cutting Medicare payments to nursing homes as well. Nursing homes are losing money on several fronts, which is causing significant difficulties.
Source: cambridgecap.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

Is Government Provision the Answer? (Part I)

Studies by Milliman3 and others4 show that when all costs are included, Medicare costs more, not less, to administer. Further, raw numbers show that, using Medicare’s own accounting, its administrative expenses per enrollee are higher than private insurance. They are lower only when expressed as a percentage—but that may be because the average medical expense for a senior is so much higher than the expense for nonseniors. Also, an unpublished, ongoing study by Milliman finds that seniors on Medicare use twice the health resources as seniors who are still on private insurance, everything equal. Ironically, many observers think Medicare spends too little on administration, which is one reason why one out of every ten dollars of Medicare spending is lost to fraud. Private insurers devote more resources to fraud prevention and find it profitable to do so.
Source: ncpa.org

Medicare Advantage Insurance Explained

The American Healthcare Education Coalition is a national, non-profit, public interest organization that pushes for free Market solutions to our healthcare issues.  According to the AHEC the affect of The Affordable Care Act (commonly known as Obamacare) is detrimental to Medicare Advantage, and their study of its negative impact shows the following:  Cuts to Medicare Advantage started right away in 2010 after the passing of The Affordable Care Act, with payment rates in 2011 being frozen at the 2010 levels. Medicare Advantage payment rates for doctors are being slashed from 2012-2017 and hospitals and medical providers will be cut in the government-managed, fee-for-service Medicare program. A portion of these cuts automatically get passed to Medicare Advantage Plans in the form of lower maximum rates.
Source: capeinthesand.com

Affordable Health Care Act may impact Medicaid and Medicare patients

Author Sandra Decker, PhD, an economist at the National Center for Health Statistics of the US Centers for Disease Control and Prevention (CDC) noted that the findings serve as a useful baseline from which to measure the anticipated impact of Affordable Care Act provisions that could increase Medicaid payment rates to primary care physicians in some states while boosting up the number of individuals with healthcare coverage. She reported a low acceptance rate of new Medicaid patients of 40.4% in New Jersey and a high of 99.3% in Wyoming. In general, acceptance rates generally were higher in states with higher Medicaid fee-for-services rates, expressed as a percentage of Medicare’s rates in 2008. For example, Medicaid rates in Wyoming in 2008 were close to 150% of the reimbursement for a Medicare patient; this marked the nation’s highest rate. In contrast, New Jersey’s Medicaid rates were the nation’s lowest: 37% of Medicare. Nationwide, the average Medicaid-to-Medicare fee ratio is 74.2.
Source: emaxhealth.com

Healthcare: The US presidential policy debate

Baicker, K and A Chandra (2005), ‘The Labor Market Effects of Rising Health Insurance Premiums’, NBER Working Paper No. 11160, February. Collins, S, S Guterman, R Nuzum, M Zezza, T Garber and J Smith (2012), ‘How the Obama and Romney Plans Stack Up’, The Commonwealth Fund. CBO (2009), ‘The Long-Term Budget Outlook’. CBO (2011), ‘CBO’s Analysis of the Major Healthcare Legislation Enacted in March 2010’. CBO (2012a), ‘The 2012 Long-term Budget Outlook’. CBO (2012b), ‘Letter to the Honorable John Boehner Providing an Estimate for H.R. 6079, the Repeal of Obamacare Act’. CBO (2012c), ‘The Long-Term Budgetary Impact of Paths for Federal Revenues and Spending Specified by Chairman Ryan’. Cutler, D and D Ly (2011), ‘The (Paper) Work of Medicine: Understanding International Medical Costs’, Journal of Economic Perspectives 25(2): 3-25. Families USA (2012), ‘ObamaCare versus RomneyCare versus RomneyCandidateCare – A National and State-by-State Analysis’. GAO (2010), ‘The Federal Government’s Long-Term Fiscal Outlook, January 2010 Update’. Herring, B, K Bundorf and M Pauly (2011), ‘Do Workers Bear the Cost of Rising Health Insurance Premiums Through Lower Wage Raises’, University of Chicago Center For Health Economics Discussion Paper. Ilzetzki, E and J Pinder (2012), ‘A briefing on the US economy and presidential election promises’, VoxEU.org. Institute of Medicine (2012), ‘Best Care at Lower Cost: The Path to Continuously Learning Healthcare in America’. Pessoa, J and J Van Reenen (2012), ‘Decoupling of Wage Growth and Productivity Growth: Myth and Reality’, LSE mimeo.
Source: voxeu.org

Hospitals’ Readmissions Rates Not Budging

Medicare calculates readmission rates over three years. The most recent rates are based on readmissions spanning July 2008 through the end of June 2011. The Medicare data published Thursday on its Hospital Compare website showed that 19.7 percent of heart attack patients were readmitted within 30 days of discharge, a drop of only 0.1 percentage point from the previous year’s figures, which were based on the years 2007 through 2010. The data show that 24.7 percent of heart failure patients were readmitted, also a 0.1 point decrease. Pneumonia readmissions actually increased by 0.1 percentage points, to 18.5 percent of all Medicare pneumonia patients.
Source: kaiserhealthnews.org

Hospitals' Medicare readmisson rates aren't improving

But it’s not all good. This reform was driven primarily to achieve financial goals and to drive the health care system toward better performance. Unfortunately, since the quality movement started in the 1990s, the health care community has made only fitful and uneven progress toward guaranteeing patient safety. It was thought that financial incentives —or in this case, financial penalties—would be required to motivate hospitals to move the dial forward. The penalties also act to remind the hospitals that resources are limited.
Source: reportingonhealth.org

Opinion: VA system inadequate to meet veterans’ health care needs

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 marsmet526To address the growing health care needs of our veterans, communities across Colorado are starting to  pursue innovative solutions. The Department of Veterans Affairs has invested $580.2 million to build the new Denver VA Medical Center facility on the University of Colorado’s Anschutz Medical Campus.  The Mental Health Center of Denver and the VA have developed a new partnership to speed up the evaluation of post-combat veterans with possible Post-Traumatic Stress Disorder and Traumatic Brain Injury.   Pikes Peak Hospice & Palliative Care participates in We Honor Veterans, a pioneering campaign developed by National Hospice and Palliative Care Organization in collaboration with the Department of Veterans Affairs.
Source: healthpolicysolutions.org

Video: 2009 Medicare TV spot for Priority Health Medicare plans – couple RV’ing

Priority Health Expands Its Medicare Offerings

2012 about Afghan after attack Bill Business campaign care case Celebrity China court Dead death Debate economy First from Health House Iran killed more News Obama Over Police politics Poll post President report Romney says Show Sports Syria Syrian Technology Times U.S. update Video World
Source: thenewsroom.info

Priority Health Launches Medicare Explained

Each page includes key Medicare information, a short video and a quiz designed to accommodate a number of different learning methods. These are supplemented with extra credit articles that include detailed information about Medicare topics, options and Priority Health plans. The Medicare Explained educational tool helps people learn how Medicare works, determine what type of plan they need and find the right Priority Health Medicare plan for their needs and their budget.
Source: longevitymedicine.me

Crain’s Week in the News: GM hiring, sports greats die, health care plans lauded

• The Washington, D.C.-based National Committee for Quality Assurance has rated the Medicaid plan offered by Blue Cross Blue Shield of Michigan and the Medicare Advantage plan by Priority Health as the best plans for their patient populations in Michigan based on more than 45 measurements, including quality and customer satisfaction. Twelve other Medicaid HMOs and seven Medicare plans in Michigan were ranked in the top 100, said the committee. Blue Cross Blue Cross Complete of Michigan ranked No. 4 nationally, and the Priority Health Medicare plan ranked 14th nationally.
Source: crainsdetroit.com

OPINION: Planning for Health Care After Retirement

Medicare Advantage offers everything Original Medicare covers, as well as other benefits such as predictable copays; prescription drug, dental and vision coverage; and gym memberships. Many Medicare Advantage plans also help you manage multiple physicians, appointments, and hospital and doctors visits. It usually costs less than Medigap, and typically has modest or minimal monthly premiums. For example, some Medicare Advantage plans have $0 monthly premiums and only require you to pay when you visit the doctor. This gives you the benefit of a prescription drug plan and preventive services, without a monthly premium. Medicare Advantage can range from $0 to $100. If you have prescription coverage, each drug starts at as little as $4 per fill.
Source: patch.com

Putting the Patient in the Center: Star Ratings Congress for Medicare Advantage Plans

This commitment starts at the very top of an organization, meaning that CEOs and their leadership teams must send a clear message to staff, partners and communities that they hold themselves and their organizations accountable to better experiences of care for their patients.  Higher quality also requires systemic thinking, such as building new systems and processes that support safe, effective, patient-centered, timely, efficient and equitable care.  One aspect of this systemic thinking is building a close relationship between health plans and their provider partners – and once again, putting patients at the center.  A commitment to training and culture growth can pull an entire health care system toward a new organizational DNA – one that is all about better health, better health care and lower costs.
Source: wordpress.com

Viewpoints: Obama Seeking ‘To Preserve’ New Spending; Medicare Rule Change For Disabled Is ‘Humane Thing To Do’

Milwaukee Journal Sentinel: The Facts On End-Of-Life Care Programs In 2001, my frail 94-year-old grandmother — a lifelong Wisconsinite — died in a way consistent with her wishes. But it wasn’t easy. It required relentless advocacy by her daughter, who signed “Do Not Resuscitate” paperwork three separate times in one week after my grandmother fell and was taken to the hospital with a serious brain injury. … All of this could have been avoided if a system had been in place that made it possible for health professionals to follow a seriously ill patient’s wishes when transferred from one facility to another. With a system in place, patients with advanced illness might have thoughtful conversations with doctors and family about treatments they do or do not want, complete advance directives and appoint trusted loved ones as their health care decision-makers when they cannot speak for themselves (Dr. Terri Schmidt, 10/23).
Source: kaiserhealthnews.org

Medicare confusing, but don’t put off enrolling

Posted by:  :  Category: Medicare

Benefit Security Card .. HALF of the U.S live in households that receive government benefits (26 May 2012) ...item 2.. Brevard man gets 4 years in Social Security fraud case (Jun 1, 2012 ) ... by marsmet481active adults bodybuilding Bright Eating Cathy Dyson Chris Margand Chuck Hashek Delise Dickard Dr. Delise Dickard Eddie’s World Eddie’s World column Ed Jones elder law Elizabeth McMaster Fit After 50 functional fitness Gone With the Wind happiness Inspired Aging Inspired Aging column Jennifer Motl Legal Ease Legal Ease column Live Well Medicaid Medicare mental health Neda McGuire New Horizons New Horizons column nutrition Orange County Phyllis Palestri power outages Rappahannock Area Agency on Aging salads self-help Senior Moments column Skydive Orange skydiving Steve Watkins storms therapist Valerie Hopson-Bell Virginia Insurance Counseling and Assistance Program Yoga
Source: fredericksburg.com

Video: Enrolling in Medicare

I’ll be 65 in the near future, is Medicare Part B, A or D right for me?

Keep in mind that enrolling in Medicare Part B must be done during open enrollment periods. If you decide not to sign up as soon you are eligible, you will not have another option until the next open enrollment period begins. If you expect to lose your current insurance over the course of the next year and you cannot afford to pay for COBRA, go ahead and enroll while you have the opportunity rather taking a chance on having no coverage when you need it.
Source: usinsurancenet.com

Nevada Daily Mail: Column: : It is now Medicare open enrollment

The prescription drug program may be included in a Medicare Advantage Plan or it can be a stand alone Part D. There is help for many people to assist with the cost of prescriptions. There are many that qualify for help and do not realize it. Those on Low Income Subsidy with Social Security need to apply for renewal each year. It will depend on the level of Low Income Subsidy for the amount of assistance received. Those on full LIS will have their Medicare Part B premiums paid, as well as their Part D Plan premiums and have a low co-pay for prescriptions. Many people can also get help from the Missouri Prescription Plan. Many can get help with prescriptions even if they do not qualifying for the low income subsidy. You must have a Plan D to receive help with the Missouri Drug Plan.
Source: nevadadailymail.com

Low cognitive ability impairs enrollment in Medicare supplemental plans

Because traditional Medicare leaves substantial gaps in coverage, many people obtain supplemental coverage to limit their exposure to out-of-pocket costs. However, some Medicare beneficiaries may not be well equipped to navigate the complex supplemental coverage landscape successfully because of their lower cognitive ability or numeracy—that is, the ability to work with numbers. We found that people in the lower third of the cognitive ability and numeracy distributions were at least eleven percentage points less likely than those in the upper third to enroll in a supplemental Medicare insurance plan. This result means that many Medicare beneficiaries do not have the financial protections and other benefits that would be available to them if they were enrolled in a supplemental insurance plan. Our findings suggest that policy makers may want to consider alternatives tailored to these high-need groups, such as enhanced education and enrollment programs, simpler sets of plan choices, or even some type of automatic enrollment with an option to decline coverage.
Source: pnhp.org

Medicare: Help enrolling or switching plans

Visit Medicare.gov. Its Plan Finder allows you to compare a wide range of costs across multiple drug and Medicare Advantage plans available in your county. It also has ratings on each plan’s performance and quality. Most important, it allows you to enter prescription drug names to gauge whether they’re covered and at what cost under a variety of plans.
Source: oregonlive.com

When and How Do I Enroll For Medicare?

You become eligible for Medicare at age 65 or younger, if disabled. This is called the Initial Enrollment Period. You have seven months to enroll, starting three months before your 65th birthday. Do not delay doing this, as there could be penalties. Keep in mind that you can sign up directly by contacting Medicare, or you can enroll through a private insurer that has a Medicare Advantage Plan. (This is a plan that offers extras, like dental or prescription plans.)
Source: seniorcorps.org

Coaching Class Online: Get help enrolling in Medicare Savings Programs

Do it for yourself or a loved one- enroll in a Medicare Savings Program and start saving on your health care now! By answering a few questions, a Medicare recipient can find numerous programs they may qualify for by having a simple, single conversation with a health advocate. According to a recent study of based investment financial advisers, the growing concerns are causing more indecision and inertia at a time when Boomers need to be more than ever involved in their financial future. More than of third of the current senior citizen population said, in a California study, that they did not feel confident about making financial decisions, even those who have saved more than $300,000; they are uncertain about how long their nest eggs will last and worry as to how to put this money into a diverse portfolio without all their funds disappearing, and as pensions disappear many can not rely on 401k’s as back up anymore. Unfortunately many American seniors are not aware of the various outreach programs that are available to them. Implementing outreach efforts to improve the awareness of the communities in all 50 states is a top priority with Altegra Health because when seniors participate in Medicare savings programs not only do seniors save money but they receive free education on other public and private programs that can greatly reduce their financial burdens. Why are so many Americans in the dark about knowing and participating in benefits that they can take full opportunity to participate in, right now? According to the National Academy of Social Insurance (NASI) the identified barriers to enrollment can be as simple as lack of awareness- many seniors are not aware that Medicare Savings Programs exist, those who are aware are often unsure what agencies to turn too, some programs are administered by the federal government while other programs are administered by state or local governments. Many eligible individuals can be difficult to reach or communicate with because they are older and may have limitations such as difficulty seeing or hearing, and or lack of necessary transportation to services close to them. Speaking with someone may also be frustrating if English is not their primary language which can also cause some difficulty- according to seniors. Due to a perception that enrollment can be cumbersome, many are afraid that lengthily form applications and documentation can result in confusion, hassle, and too much personal information needed, so in many cases people just give up. However enrollment does not have to be that confusing in fact the best way to avoid all confusion with enrollment and benefit qualification, even if English isn’t your primary language or you are hard of hearing is to talk with a health advocate at Altegra Health. Their highly skilled staff is proficient at initiating and maintaining an open, productive relationship with their clients and government agencies throughout the entire application process. If an applicant needs assistance to obtain a necessary document Altegra Health’s staff is there to help- in some cases a Field coordinator is even available to go to the client’s home and perform the interview in-person where they have the needed application forms readily available in hard copy or accessible in electronic formats. With an outreach and advocacy staff to help with document image, and the technology to transmit entire application packets, official forms, and eligibility verifications, electronically; they help you avoid potential mail delays. Altegra Health aids tens of thousands of older adults and disabled individuals every year through applications for Medicare Savings Programs, (MSPs), Extra Help (Low Income Subsidy) and other community assistance programs. Participating in these programs not only improves the financial well being of low-income individuals, reduces financial barriers to health care, and can lead to better health outcomes for eligible Medicare beneficiaries.
Source: blogspot.com


Enroll in a Medicare Part C plan.  If you currently have Medicare Parts A and B with no supplemental insurance, or Parts A and B with a “Medicare supplement” insurance policy (commonly called a “Medigap” policy), you can enroll in a Medicare Part C plan during Open Enrollment.  You would be covered effective January 1, and you would drop your Medigap plan, if any.  Part C plans are also called Medicare Advantage plans or Medicare Health Plans.  Unlike Medigaps, they don’t simply target the gaps in Medicare, they completely replace Medicare with a private insurance policy that covers everything Medicare covers, plus extras.  It’s not official, but you might think of the “C” as standing for “Comprehensive” coverage.  Many of the plans include Medicare Part D drug coverage.  (Note:  if you enroll in a Part C plan, your ability to later switch to a Medigap policy is limited.  It’s almost a one-way route.)
Source: retireusa.net

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

Posted by:  :  Category: Medicare

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

Video: Medicare Plan Finder at a Glance

Medicare Trying To Nudge Seniors Out Of Plans With Low Ratings

Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, an industry trade group, said the letter to beneficiaries is “premature” because the ratings system is flawed.  It is based on measures that do not sufficiently take into account, for example, plans serving a disproportionate number of beneficiaries with multiple chronic conditions or special needs, or who live in medically underserved areas.  “These are unique challenges to providing care to those populations,” he said.
Source: kaiserhealthnews.org

Choosing a Medicare Part D Prescription Plan

People with arthritis are typically prescribed medications to control symptoms and progression of the disease. For arthritis patients who have qualified for Medicare benefits, there are Medicare Part D prescription plans available. Open enrollment for Medicare plans started October 15, 2012 and ends on December 7, 2012. What does this mean for you? It’s time to review your options, even if you already have a Medicare Part D prescription plan. If you have started new drugs or stopped any that you were taking last year, or if your insurer changed their drug formulary list, you may no longer have the best Medicare Part D plan for you.
Source: about.com

RxAmerica Agrees to $5 Million Settlement Surrounding Alleged Medicare Part D Plan False Pricing

Navigating the Medicare system can unfortunately be extraordinarily complicated and difficult.  There are numerous sub-programs within Medicare and they each operate differently and frequently have different sets of rules and regulations.  One such sub-program is the Medicare Prescription Drug Program, more commonly known as Part D.  Part D participants are offered coverage for their prescription drugs, however, in order to obtain the coverage participants need to join a Medicare-approved plan or a Part D plan.  There are many different Part D plans available to participants and each varies in terms of the drugs they cover, the amount they reimburse for those drugs, and the deductibles and co-pays their participants are required to pay.  In order to help them steer through all of the various choices and find the best Part D plan for their specific needs, the Centers for Medicare & Medicaid Services (CMS) has created a Plan Finder tool for participants.  The Plan Finder uses drug pricing information submitted by the Part D plan providers to CMS in order to help participants estimate the cost of each plan based on the specific drugs they would need.
Source: wordpress.com

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

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

Comparing Medicare prescription drug plans

Also, be aware that if you’re a low-income beneficiary and your annual income is under $16,755 or $22,695 for married couples living together, and your assets are below $13,070 or $26,120 for married couples, you may be eligible for the federal Low Income Subsidy known as “Extra Help” that pays Part D premiums, deductibles and copayments. For more information or to apply, call Social Security at 800-772-1213 or visit socialsecurity.gov/prescriptionhelp.
Source: pomeradonews.com

Reader’s Digest Value Rx Review

If you are fortunate enough to review the formulary and all of your drugs are covered, this may be a suitable plan. This is especially true if you would like to save money on a magazine subscription. Beyond that, you may want to wait until the plan can be rated and more information is readily available.
Source: partdplanfinder.com

Kaiser Permanente’s Medicare Plans In California Get Top Ratings In The Nation For The Second Straight Year

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

2013 Medicare Annual Enrollment Period: eHealth Identifies Nine Costly Mistakes to Avoid for Medicare Advantage Customers / eHealth

Posted by:  :  Category: Medicare

Joe the Plumber - To Flush The System ... More scams aim to ensnare Brevard seniors - Their ingenuity is boundless, Archer said. (Jul 2, 2012) ... by marsmet524eHealth, Inc. (NASDAQ: EHTH) is the parent company of eHealthInsurance, America’s first and largest private health insurance exchange where individuals, families and small businesses can compare health insurance products from leading insurers side by side and purchase and enroll in coverage online. eHealthInsurance offers thousands of individual, family and small business health plans underwritten by more than 180 of the nation’s leading health insurance companies. eHealthInsurance is licensed to sell health insurance in all 50 states and the District of Columbia. Through the company’s eHealthTechnology solution (www.eHealthTechnology.com), eHealth is also a leading provider of health insurance exchange technology. eHealthTechnology’s exchange platform provides a suite of hosted e-commerce solutions that enable health plan providers, resellers and government entities to market and distribute products online. eHealth, Inc. also provides powerful online and pharmacy-based tools to help seniors navigate Medicare health insurance options, choose the right plan and enroll in select plans online through its wholly-owned subsidiary, PlanPrescriber.com (www.planprescriber.com) and through its Medicare website www.eHealthMedicare.com. 
Source: ehealthinsurance.com

Video: Don’t be confused by medicare supplement insurance – contact SelectQuote Senior

Call Paul Ryan’s Medicare subsidy the get

If the Ryan plan’s Medicare subsidy is based on the next-to-least-expensive plan, lots of people will choose the cheapest insurance plan, and they’ll get what they pay for. They’ll cross their fingers and hope they’ll never need cutting-edge cancer or heart disease treatment. Health care providers will be in the untenable situation of having to tell patients their insurance covers only a less-than-best treatment.
Source: dallasnews.com

Medicare Rx Open Enrollment

There’s never been a better time to check out Medicare coverage. With the new health care law, there are new benefits available to people with Medicare, including lower prescription costs, wellness checkups and preventive care. The new law also provides better ways to protect beneficiaries from fraud, making Medicare stronger for all of us and for future generations.
Source: patch.com

Beware of fraud during Medicare enrollment

“Consumers should be suspicious of unsolicited calls from anyone claiming to be from Medicare,” Matthew Fehling, BBB president and CEO, said in a statement. “Medicare will generally not make unsolicited calls to update information, issue a new card or offer free medical equipment. We recommend seniors hang up and call a trusted Medicare number if they have questions regarding their benefits.”
Source: consumerinsuranceguide.com

Medicare Enrollment in Florida

You can go online to request they contact you by clicking here or call them at 1-800-963-5337 to request an appointment with a SHINE volunteer.  If you cannot locate one in your county (or it’s taking too long for them to get back to you), you can request an appointment with someone in an adjacent county.  Also, visit SHINE’s website for community events going on in your county now through December 7
Source: ohalllaw.com

Consider a House Call Position for Medicare Patients

In Portland, Ore., Housecall Providers Inc. is one of 16 agencies nationwide participating in the federal program – and the only one west of Texas. The nonprofit employs four physicians, three physician assistants and almost 20 nurse practitioners. Two registered nurses were hired as transition advocates for the Independence at Home patients. They work with patients’ families and caregivers to educate them about health changes that would warrant a phone call for help.
Source: healthcallings.com

Help available for seniors during Medicare open enrollment period

Gross said two other important changes are coming to Medicare Part D next year. The "donut hole" or "coverage gap" will continue to close. In 2013, individuals will pay 47.5 percent for brand-name drugs covered by the plan and the cost of generic drugs will be reduced from 86 percent to 79 percent. Each year these costs will drop until the donut hole is closed.
Source: newtonindependent.com

Medicare scam targets seniors

The most recent scam involves callers posing as a telemarketing company hired by Medicare to contact all South Dakota Medicare recipients to alert them that new Medicare identification cards will be mailed soon. The caller continues by trying to verify account information to assure that funds will go into the appropriate account. The callers are relentless, making numerous calls to the same individuals. They threaten that if the information is not provided coverage will be lost including prescription drug coverage.
Source: kotatv.com

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

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

South Florida Authorities Arrest More Than 30 Suspects For Medicare Fraud

What is the statute of limitations on physician PEER REVIEW miss use. I was wrongly accused of over use of TPA in a stroke patient in 2005 by a neurologist that covered himself when he did not respond in a timely manner to a stroke alert in a fairly young, 40 year old, patient. The newly assigned regional physician, who wanted to move up the corporate ladder by removing all the individual ER directors in the three hospital group that had contract with the large national ER group, used the incident and complaint by the neurologist to initiate a PEER REVIEW meeting in which he the only physician to speak on the incident and bullied the only other physician at the meeting to silence and wrote the entire meeting up himself. Two later I was called and told I was taken of the schedule with no notice. I had to scrabble to find work to support my family and middle school age children. At the time I had no medical evidence to prove that I had actually done the correct course of action, bu
Source: thehealthlawfirm.com

Elizabeth Hogue on the Proposed Settlement That May Extend Coverage to More Medicare Home Health Patients

If finalized, this change in policy is likely to be welcomed by home health agencies. Over a period of many years, agencies have been stymied in their efforts to provide services to patients like the plaintiffs and similar patients across the country. The historic lack of coverage for services to such patients has caused home health agencies to confront difficult legal, economic, and ethical dilemmas. Even if agencies could afford to continue to provide substantial free services to such patients, it appeared that the provision of free services violated applicable prohibitions of the Office of Inspector General (OIG) of HHS regarding the provision of free services to patients that exceed $10.00 at a time or $50.00 in the aggregate during a calendar year. Agencies would welcome relief from difficult dilemmas and an opportunity to provide care to as many patients as possible.
Source: hcafnews.com

Medicare Trying To Nudge Seniors Out Of Plans With Low Ratings

Posted by:  :  Category: Medicare

Cassandra Q. Butts by Center for American ProgressRobert Zirkelbach, a spokesman for America’s Health Insurance Plans, an industry trade group, said the letter to beneficiaries is “premature” because the ratings system is flawed.  It is based on measures that do not sufficiently take into account, for example, plans serving a disproportionate number of beneficiaries with multiple chronic conditions or special needs, or who live in medically underserved areas.  “These are unique challenges to providing care to those populations,” he said.
Source: kaiserhealthnews.org

Video: Understanding Medicare Advantage Plans

Health First Health Plans Offers Medicare Advantage Plans

At Health First Health Plans, eligible beneficiaries can choose from a suite of Medicare options, including four Medicare Advantage plans with Part D Prescription Drug coverage (MA-PD), one Medicare Advantage Plan without Part D prescription drug coverage (MA), two stand-alone Prescription Drug Plans (PDP), and Supplemental Plans (Medigap).  Typically, you may enroll in a Medicare Advantage plan only during the annual enrollment period from October 15 through December 7 of each year.  There are exceptions that may allow you to enroll in a Medicare Advantage plan outside of this period (otherwise known as Special Election Periods).
Source: spacecoastbusiness.com

Early Evidence Suggests Medicare Advantage Pay For Performance May Be Getting Results

The ACA phases out higher payments previously given to all MA plans. Instead, Medicare in 2012 began paying bonuses only to plans with strong performance on clinical quality, service measures and patient experience of care measures. Medicare bases the 2012 bonus payments on 2011 plan performance, as rated by a five-star system. This system incorporates Health Effectiveness Data Information Set (HEDIS®) and other quality measures, Consumer Assessment of Health Plans (CAHPS®) patient experience results (See Note 1 below.), and results of the Health Outcomes Survey (HOS) that tracks patient-reported outcomes over time. It also includes metrics such as complaints Medicare received about the plan, customer service for drug benefit plans, and beneficiary access and performance problems identified in audits by Medicare.
Source: healthaffairs.org

Obamacare ‘Surprise’ Threatens Access to Medicare Advantage Coverage, AMAC Charges

The Association of Mature American Citizens [http://www.amac.us] is a vibrant, vital and conservative alternative to those traditional organizations, such as AARP, that dominate the choices for mature Americans who want a say in the future of the nation.  Where those other organizations may boast of their power to set the agendas for their memberships, AMAC takes its marching orders from its members.  We act and speak on their behalf, protecting their interests, and offering a conservative insight on how to best solve the problems they face today.
Source: amac.us

Who wins With Medicare Advantage?

Over the past several years, the largest insurers — Unitedhealth, WellPoint, Aetna, Cigna and Humana — have reported record profits, even during the quarters when enrollment in their employer-based and individually purchased health plans declined because of the recession. They’ve been able to do this in two ways: by taking in significantly more in premiums from their commercial customers than they have paid out in medical claims, and by persuading increasing numbers of retirees to enroll in their Medicare Advantage plans. If you enroll in one of their plans, the government sends a check to the insurance company you choose for your coverage. The amount varies depending on where you live. You might have to pay an additional premium out of your own pocket for better drug coverage, a broader network of providers, reduced copayments and discounts on gym memberships.
Source: wendellpotter.com

Hopedale Medical Complex Offers Medicare Advantage Educational Seminars

Some options for changing your coverage include: – Change back to the Original Medicare from a Medicare plan. – Change from Original Medicare to a Medicare Advantage Plan. – Change from a Medicare Advantage Plan back to Original Medicare. – Switch from one Medicare Advantage Plan to another Medicare Advantage Plan. – Switch from a Medicare Advantage Plan that doesn’t offer drug coverage to a Medicare Advantage Plan that offers drug coverage. (Part D) – Select the right supplement insurance to help pay some of your health care costs not covered by Medicare. – Join a Medicare Prescription Drug Plan. (Part D) – Switch from one Medicare Prescription Drug Plan to another Medicare Prescription Drug Plan. – Drop your Medicare prescription drug coverage completely.
Source: hopedalemc.com

The impact of Obamacare cuts on Medicare Advantage Plans

The PPACA, as amended, also introduces MA bonuses and rebate levels that are tied to the plans’ quality ratings. Beginning in 2012, benchmarks will be increased for plans that receive a 4-star or higher rating on a 5-star quality rating system. The bonuses will be 1.5 percent in 2012, 3.0 percent in 2013, and 5.0 percent in 2014 and later. An additional county bonus, which is equal to the plan bonus, will be provided on behalf of beneficiaries residing in specified counties. The percentage of the “benchmark minus bid” savings provided as a rebate, which historically has been 75 percent, will also be tied to a plan’s quality rating. In 2014, when the provision is fully phased in, the rebate share will be 50 percent for plans with a quality rating of less than 3.5 stars; 65 percent for a quality rating of 3.5 to 4.49; and 70 percent for a quality rating of 4.5 or greater.
Source: quinnscommentary.com

OPINION: Who wins with Medicare Advantage?

Over the past several years, the largest insurers — Unitedhealth, WellPoint, Aetna, Cigna and Humana — have reported record profits, even during the quarters when enrollment in their employer-based and individually purchased health plans declined because of the recession. They’ve been able to do this in two ways: by taking in significantly more in premiums from their commercial customers than they have paid out in medical claims, and by persuading increasing numbers of retirees to enroll in their Medicare Advantage plans. If you enroll in one of their plans, the government sends a check to the insurance company you choose for your coverage. The amount varies depending on where you live. You might have to pay an additional premium out of your own pocket for better drug coverage, a broader network of providers, reduced copayments and discounts on gym memberships.
Source: publicintegrity.org

Fact Check on Medicare Advantage

  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

House Cmte. Looks at Status of Medicare Advantage Program

The head of the Medicare Payment Advisory Commission said his organization is trying to craft a new formula for Medicare payments to doctors.  Glenn Hackbarth says the goal is to release that recommendation this fall.  Since 1998 Congress has passed legislation every year known as the “doc fix” overriding scheduled cuts in Medicare payments.  At a Ways and Means Subcommittee hearing, Mr. Hackbarth also presented the recommendations in MedPAC’s latest report.  It includes a 1% increase in hospital payments and a 1% increase in physician fees.
Source: c-span.org

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

How Much Does Medicare Advantage Cost?

eHealth, Inc. (NASDAQ: EHTH) is the parent company of eHealthInsurance, the nation’s leading online source of health insurance for individuals, families and small businesses. Through the company’s website, www.eHealthInsurance.com, consumers can get quotes from leading health insurance carriers, compare plans side by side, and apply for and purchase health insurance. eHealthInsurance offers thousands of individual, family and small business health plans underwritten by more than 180 of the nation’s leading health insurance companies. eHealthInsurance is licensed to sell health insurance in all 50 states and the District of Columbia, making it the ideal model of a successful, high-functioning health insurance exchange. Through the company’s eHealthTechnology solution (www.eHealthTechnology.com), eHealth is also a leading provider of health insurance exchange technology. eHealthTechnology’s exchange platform provides a suite of hosted e-commerce solutions that enable health plan providers, resellers and government entities to market and distribute products online. eHealth, Inc. also provides powerful online and pharmacy-based tools to help seniors navigate Medicare health insurance options, choose the right plan and enroll in select plans online through its wholly-owned subsidiary, PlanPrescriber.com (www.planprescriber.com) and through its Medicare website www.eHealthMedicare.com.   
Source: ehealthinsurance.com

Because I Am On A Medicare Advantage Plan But Am Moving To A Different County Do I Get To Change Plans?

Yes.  By moving to a different county (or state), you will have to change medical groups and the Medicare Advantage plans available in that new county may be different/limited and/or have different copays and cost of drugs.   Because you are not familiar with the doctors in your new area, you may want to consider going with a Medicare supplement plan so that you have freedom of choice to select your new doctors.  If you decide to initially sign up with a Medicare supplement, you may, during the year, ensure that all of your doctors are in the same medical group and will take a Medicare Advantage plan so that you can switch to one of the local HMOs during the next Annual Enrollment. 
Source: personalmedicareadvisor.com

How much does Medicare Advantage cost?

Plans with $0 Monthly Premiums: Among the 43,306 plans available in 2013, 13,741 plans (32 percent) will be offered at a cost of $0 above what a Medicare beneficiary already pays for Medicare Part B. By comparison, 14,297 plans (33 percent) were available with a $0 monthly premium in 2012 and 13,821 plans (35%) were available in 2011.
Source: ehealthinsurance.com

Frisco couple, Plano man indicted on health

Posted by:  :  Category: Medicare

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

Video: Cheryl Bradley lectures on Medicare Billing

Maximize Billing Opportunities for the Medicare AWV

The practice may decide to have the pre-visit Health Risk Assessment  along with the required physical vitals (blood pressure, height , weight, pulse ) collected by a medical assistant (MA) or licensed nurse practitioner (LPN) and then ready for review by the MD or DO. CMS allows this preliminary collection of data by an MA or LPN under the supervision of an MD or DO, or even a PA or NP.
Source: physicianspractice.com

The Use of Electronic Health Records Is Increasing Medicare Billing: Is It Also Increasing the Amount of Care Physicians Provide?

Yet by focusing doctors on a particular checklist of items, EHR systems could also prevent physicians from considering problems that aren’t on the list. Standardization in medical practice is not always a good thing; today’s fringe treatment may be tomorrow’s gold standard. This type of standardization may be particularly unwise if it is done in the context of EHR systems, which may be focused on recording data that is important for billing or care coordination purposes rather than on reminding doctors about best practices. If this is the case, EHR systems may be nudging doctors to provide unnecessary care, which is the last thing our overburdened health care system needs. If EHR systems are actually changing the way doctors practice by providing standardized checklists and reminders, EHRs should be created with quality of care in mind.
Source: harvard.edu

Medicare Fraud Strike Force presses billing charges

“Today’s arrests put criminals on notice that we are cracking down hard on people who want to steal from Medicare,” said Health and Human Services (HHS) Secretary Kathleen Sebelius.  “The health care law gives us new tools to better fight fraud and make Medicare stronger.  In addition to the arrests made today, HHS used new authority from the health care law to stop future payments to many of the health care providers suspected of fraud, saving Medicare resources and taxpayer dollars from being lost to fraud in the first place.”
Source: ehrintelligence.com

How doctors and hospitals have collected billions in questionable Medicare fees

Medicare has emerged as a potent campaign issue, with both Barack Obama and Mitt Romney vowing to tame its spending growth while protecting seniors. But there’s been little talk about some of the arcane factors that drive up costs, such as billing and coding practices, and what to do about them.  Our 21-month investigation documents for the first time how some medical professionals have billed at sharply higher rates than their peers and collected billions of dollars of questionable fees as a result. 
Source: publicintegrity.org