United Healthcare Oxford Medicare Advantage Denies Coverage

Posted by:  :  Category: Medicare

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Source: louisianahealthcareplans.com

Video: United Healthcare Oxford Medicare Advantage Denies Coverage

The Official Medicare Set Aside Blog And Information Resource: New York Medicare Advantage Update

But that left arguments about federal preemption. Plaintiffs argued that their claims arise under state contract law and the NY anti-subrogation statute, not under the Medicare Act. The Supremacy Clause of the U.S. Constitution clearly states that where a state statute conflicts with, or frustrates, federal law, the former must give way. Furthermore, the Medicare Act contains a very broad, express preemption clause. Lastly, the Medicare Advantage secondary payer statute itself states that MA organizations may charge primary payers “[n]otwithstanding any other provision of law.” 42 U.S.C. § 1395w-22(a)(4). Whether the 3rd Circuit is correct and the MAO has a private cause of action under the MSP or not is immaterial to the question of whether the NY state statute is preempted. Plaintiffs must first exhaust all administrative remedies available under the Medicare Act before seeking redress in court.
Source: medicaresetasideblog.com

[WATCH]: United Healthcare Oxford Medicare Advantage Denies Coverage

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Source: insurancequotes24-7.com

[WATCH]: United Healthcare Oxford Medicare Advantage Denies Coverage

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United Healthcare Insurance: United Healthcare Oxford Medicare Advantage Denies Coverage

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Source: insurancequotes24-7.com

2013 Medicare Advantage and Medicare Part D Data now Available on MedicareQuoteEngine.com

At Ritter Insurance Marketing, we realize that agents need access to the most up to date information as soon as possible to begin studying available plans for their Medicare beneficiary clients.  MedicareQuoteEngine.com is a tool designed exclusively by Ritter Insurance Marketing to assist agents in finding suitable Medicare Supplement, Medicare Advantage and Medicare Part D plans for their clients.
Source: ritterim.com

Obamacare Means a Mandate For More Inflation and a Higher Gold Price :

According to the US Senate Budget Committee, the Affordable Care Act (“Obamacare”) will cost the US federal government an additional $17 trillion dollars (+$17,000,000,000,000.00) in health care spending over the next seventy-five (75) years. This $17 trillion will be added to all the other health care spending—i.e., $38 trillion for Medicare; $20 trillion for Medicaid; and $7 trillion for Social Security—to make a grand total of $82 trillion dollars (82,000,000,000,000.00). Very concerning, indeed.
Source: theintelhub.com

Complaints about Medicare Advantage Mount…While Congress Contemplates Slashing Fees Traditional Medicare Pays Docs

Some private insurers are suffering, the Times pointed out, because “corporate customers are cutting back on the medical coverage they give employees.”  So insurers need taxpayer dollars to keep their bottom line strong.  “Humana is transforming itself into a big-time government contractor.  It will get almost three-fourths of its projected $1.28 billion in pretax profit this year from Medicare, mainly from the Advantage program,” the Times reported, “while UnitedHealth, the industry giant, draws about 15 percent of this year’s projected pretax profit of $7.48 billion from Medicare.”  One in five of the nation’s 43 million Medicare enrollees is now in the Medicare Advantage program and by 2009 “government spending on Medicare Advantage is projected to exceed $100 billion annually.”
Source: healthbeatblog.com

Aetna Announces Lifetime Renewals on Medicare Advantage and PDP Policies

Actually, I have had many stay on for over 7 years. But, I also think that there are variables involved like 1) the stability of your market – my markets Los Angeles Cty and San Antonio, Tex have both been high capitation markets, making them stable with their benefits and not leaving the service area high and dry. 2) the stability of the companies that you place your business with- I put a lot of my SoCal ppl with Caremore (which has always given away the store with benefits) and SCAN, which had held unique status for many years as a "social HMO". The Secure Horizons mbs from the 2004-2005 enrollment period have long since scattered. I’m down to about 4 of those. In my current market (San Antonio), there are ONLY 4 players. Secure Horizons is very dominant because it gets a ton of support from its powerful medical groups. They have excellent retention because the medical groups help so much. Most of my SH business would still be on SH if I hadn’t switched them years ago. Humana is constantly cutting down the docs’ capitations and making the referral process tougher. As a result, it’s getting harder to retain those members as doctors drop Humana left and right. Aetna is really investing $$ and effort in the Texas markets. I like them a lot at this point. They recently added Hermann Memorial in Houston- a big coup. 3) the importance of serving your customer base (goes without saying) If a company only pays for 6 years, it would be much harder to ask a client to switch simply because they will have been on a plan for too long and will not change because they don’t like to switch plans. It’s a trait that all ppl have, but espec the elderly. Then again, anything could happen with Medicare Advantage. But I’d rather sell for one that offers lifetime renewals than 6 years "just in case".
Source: insurance-forums.net

Former Oxford Tax Collector’s Pension to be Revoked

Moreover, a pension is earned by persons that act in good faith in their public position, not those that use position of public trust as a personal slush fund. I believe that if Karen Guillet pleads guilty and wants a reduced sentence, she needs to restore the funds she stole to the public as a condition of probation (which is probably not possible) but, at a minimum, give up her pension. The public would have taken care of her with a pension on retirement for her years of service if she simply had waited patiently for that retirement …. but she opted to betray that trust … and therefore, a revocation of that pension appears warranted.
Source: patch.com

Medicare Open Enrollment: Be a smart shopper

Posted by:  :  Category: Medicare

meds: it's obscene by fallsroadin the Medicare program. Average premiums for prescription drug coverage and Medicare health plans will stay around the same in 2013. People who are in Medicare’s prescription drug coverage gap (“donut hole”) will continue to save money in 2013 with big discounts on brand-name prescription drugs. Since the health care law was enacted in 2010, more than 5.5 million people with Medicare have saved nearly $4.5 billion on prescription drugs in the donut hole. 
Source: medicare.gov

Video: Medicare Prescription Drug Coverage

Dispelling Some Rumors About Medicare And The Health Law Limiting Care

Medicare Part D prescription drug plans vary widely, both in terms of which drugs are covered and in how much beneficiaries must pay out of pocket for them. But Medicare drug plans must cover at least two drugs in each drug class or category, such as cardiovascular agents, which would include cholesterol-lowering medications, and blood- glucose regulators such as oral anti-diabetes drugs. In addition, the plans must cover nearly all the drugs in six protected classes, including cancer drugs, HIV/AIDS drugs, antidepressants, antipsychotics, anticonvulsants and immunosuppressant drugs.
Source: kaiserhealthnews.org

Maximizing Medicare Prescription Drug Coverage

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

Medicare Prescription Drug Plan

The most important thing when you are researching Prescription Drug Coverage is to take into account your prescriptions.  There are so many formularies and plans, it is hard for any of us to find the best plan for ourselves without a little help.  Luckily, technology is able to help us.  www.MedicareEcompare.com has a tool that enables you to enter all of your prescriptions and instantly allows you to compare standalone PDP plans or MAPD plans with your estimated annual cost based on your needed prescriptions, age, demographics and more.
Source: medicareecompare.com

Medicare beneficiaries get more free stuff. Let’s throw in the towel, no health care is “affordable”

HHS Secretary Kathleen Sebelius also announced that, because of the health care law, more than 5.5 million seniors and people with disabilities saved nearly $4.5 billion on prescription drugs since the law was enacted. Seniors in the Medicare prescription drug coverage gap known as the donut hole have saved an average of $641 in the first eight months of 2012 alone. This includes $195 million in savings on prescriptions for diabetes, over $140 million on drugs to lower cholesterol and blood pressure, and $75 million on cancer drugs so far this year. Also in the first eight months of 2012, more than 19 million people with original Medicare received at least one preventive service at no cost to them.
Source: quinnscommentary.com

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

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: thecommunityword.com

Making Sense Of Medicare Part D Open Enrollment

Each year, plan premiums, deductibles, prescription co-payments and annual out-of-pocket expenses can change. When considering what plan works best for you in terms of cost, it is important to consider all these elements (premiums, deductibles and co-payments) in order to calculate the total cost of the plan. Drugs covered under Medicare Part D may also vary from plan to plan and from region to region. It’s important to re-evaluate your plan if your prescriptions have changed, you’re traveling more frequently or have moved. Selecting the right plan can save you money and put you on a path to better health.
Source: sandiegonewscape.com

Penalties can occur if you don’t sign up for Medicare Prescription Drug Plans when you are first eligible

Terri Trepanier is the Owner of Balanced Care and a licensed insurance broker in New Hampshire and Maine.  Located in Rochester, NH, she specializes in helping individuals and businesses with their Health Insurance, Dental Insurance, Life Insurance, Disability Insurance, Long Term Care Insurance, Medicare Supplemental, Medicare Prescription Drug Plans, Accident, Critical Illness, and Cancer Plans.    Terri knows the importance of insurance products and how they help individuals and families.    She continually strives to give her clients the Peace Of Mind that each of us deserves.
Source: balancedcarehealth.com

Need Help Selecting a Medicare Prescription Drug Plan?

Does just thinking about selecting the right Medicare prescription drug plan send you into a panic? You’re probably not alone as over 100,000 Granite Staters wander through this process every year during Open Enrollment. See Also: 8 Things You Can Do During Medicare Open Enrollment   Medicare Open Enrollment – October 15 through December 7 – is the one time each year when ALL people with Medicare can see what new benefits Medicare has to offer and make changes to their coverage for Part C (Medicare Advantage health plans) and Part D (Medicare prescription drug coverage.) “Open enrollment is a good time for people to review their current plans,” said AARP New Hampshire State Director Kelly Clark. “Insurance plans can change their prescription coverage and out-of-pocket costs. We want to make sure AARP members and others get the best coverage at the best price.” For those wanting assistance in finding the right choice for their particular health needs and preferences, help is just a phone call away. New Hampshire ServiceLink’s Medicare specialists are available to offer free, confidential and unbiased assistance. Make an appointment online for the ServiceLink office nearest you, call toll-free at 1-866-634-9412. ServiceLink Resource Centers and Medicare Specialists can be found in several locations:
Source: aarp.org

8 Mistakes to Avoid During Medicare’s 2013 Annual Enrollment Period

5) Ignoring long-term care needs: According to an Opinion Research survey sponsored by PlanPrescriber.com, paying for long-term care is a top concern for baby boomers. Original Medicare will only pay for care in a skilled nursing facility for up to 100 days, and beneficiaries typically have to pay for a portion of those costs out of pocket. And, in most cases, Medigap plans will only cover out-of-pocket costs for services that are also covered by Medicare. So, once Medicare stops paying, your Medigap plan will stop filling in the gaps. But, long-term care insurance is available to help fill in the gaps.
Source: seniorlivingcare.com

Different Kinds Of Medicare Vision Benefits

Posted by:  :  Category: Medicare

'tis I by McBethTo qualify for Part B Medicare (thats the portion that allows for the doctors billing), a person must be at least 65 years of age or have received Social Security Disability Benefits for a 24 month period. For those individuals 65 years of age and older and still working or qualifying for a group insurance plan, they may select Medicare to be the secondary insurance. Medicare allows for cataract extraction, either one or both eyes, and there are no restrictions on the time period between doing the first eye and the second eye. The decision to have cataract surgery may involve additional testing by a doctor. The costs you incur for these test are allowed by Medicare. Eyeglass frames and lenses after cataract surgery, if necessary, may be covered under Medicare also. Artificial eye replacement also is listed among Medicare procedures eligible for coverage.
Source: zajilmedia.com

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

The Delusions in Ryan's Medicare Vision

But the likelihood that Americans born in 1957 or after are going to accept a two-class deal in which they have to pay for older peoples’ generous benefits while expecting far less for themselves is about zero. As time goes on, there will be progressively more voters born after 1957 and fewer born before. Thus, the politically numerous would either demand that older Americans’ Medicare benefits be dragged down to their promised levels or that the whole voucher business be dropped. And who could blame them?
Source: realclearpolitics.com

Summary Box: Sorting Medicare Advantage choices

ABOUT MEDICARE ADVANTAGE: This is a privately run, subsidized version of the government’s Medicare program for seniors and the disabled. These plans can come with extras like vision or dental coverage in addition to basic Medicare coverage.
Source: mysanantonio.com

eberick: Categories Medicare vsp vision providers Archives October 27, 2012 October 26, 2012 October

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Source: blogspot.com

Supplementing Your Medicare Coverage With Dental Insurance – PlanPrescriber Provides Seven Recommendations for 2012 / eHealth

eHealth, Inc. (NASDAQ: EHTH) is the parent company of eHealthInsurance, one of 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 eHealth’s technology solutions (www.eHealthTechnology.com), is also a leading provider of health insurance exchange technology. eHealth 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 online tools to help beneficiaries navigate Medicare health insurance options through PlanPrescriber.com (www.planprescriber.com) and eHealthMedicare (www.eHealthMedicare.com).
Source: ehealthinsurance.com

Blue Care Network expands Medicare Advantage service area, Blue Cross and Blue Care Network add plan options

In addition, BCN Advantage members will now be able to “buy up” to more comprehensive dental and vision benefits for a modest additional premium. Members will receive partial coverage on restorative services such as fillings, root canals, crowns and crown repairs. They’ll also get an allowance for frames and lenses to improve their vision health.
Source: hcwreview.com

Independence Blue Cross Offers 2013 Medicare Advantage Plan With $0 Monthly Premium

Independence Blue Cross is a leading health insurer in southeastern Pennsylvania. With our affiliates, we have 3.1 million members nationwide. For nearly 75 years, we have been enhancing the health and wellness of the people and communities we serve by delivering innovative and competitively priced health care products and services; pioneering new ways to reward doctors, hospitals, and other health care providers for coordinated, quality care; and supporting programs and events that promote wellness. To learn more about how we’re changing the game, visit www.ibx.com. Connect with us on Facebook at ibx.com/facebook and on Twitter at @ibx. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.
Source: globenewswire.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

Medicare Advantage Plans Can Lower Overall Expenses

Here are some additional important factors to consider before selecting a MAPD. First, again it should be stated that most Medicare Advantage plans have a network of doctors and hospitals and unless you are selecting a PPO plan must use the providers in the network except in cases of emergency treatment. Next, most HMO Advantage plans require your main (primary) doctor to refer you to any other doctor in the network. Again, most require this referral practice but there are a few “Open Access” plans that are still HMO’s however don’t require the selection of a primary care doctor or referrals to seek medical care.
Source: medicareinsurancetexas.com

Health Law Viewed As A Big Winner On Election Day

Medscape: Obama Edges Out Romney To Win Reelection Voters tonight reelected President Barack Obama by a narrow margin, giving the Democrat 4 more years to implement the Affordable Care Act (ACA) in the face of continued opposition by Congressional Republicans. …  A poll conducted by Reuters/Ipsos November 2 showed that 42 percent of probable voters thought Obama had a better plan on health care compared with 39 percent who favored Romney. Likewise, Obama held a 42 percent to 35 percent edge over Romney when it came to public confidence in their plans for Medicare. However, Romney bested Obama on those issues among seniors, who said they preferred the Republican as president. The same patterns on health care issues emerged in a tracking poll conducted last month by the Kaiser Family Foundation, which pointed to an additional Obama advantage: 51 percent of Americans trusted the president to make decisions about women’s reproductive health choices and services. Romney’s support level on this issue was only 33 percent (Lowes, 11/7).
Source: kaiserhealthnews.org

5 Services Medicare Won’t Pay For

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

Medicare Advantage: Anthem Medicare PPO Alternative in Las Vegas, NV

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSThe second option is to upgrade to a Medicare Supplement.  Because your plan is not renewing, you have the guarantee issue right to a supplement.  You cannot be denied for health history.  The monthly cost will be higher than that of the PPOs, but a supplement will give you freedom to see any doctor that accepts Medicare and you will no longer have co-payments if you select a Medicare Supplemental Plan F.
Source: suncityfinancial.com

Video: Anthem Medicare Advantage Plans | Enroll in Medicare

Anthem Medicare Connecticut « Insurance News from Crowe & Associates

The PPO offers substantially better benefits than the HMO to such an extent it does not make much sense for a consumer to consider the plan.  The PPO utilizes the nation anthem BCBS nationwide network.  It has out of network benefits which are almost par withe in network benefits.  They have $0 copay for a primary doctor and $0 copay for some generic drugs as well.  Two of the better benefits are the Hospital benefit which is $250 a day for 6 days in or out of network.  Meaning that you can go to a non participating hospital and pay the same as if it was an in network hospital.  The outpatient surgery benefit is a max copay of $250 which is the best available.  Lastly, the out of pocket max on this plan is $3,400 in and out of network combined which is far better than any other advantage plan in CT.
Source: croweandassociates.com

Anthem Medicare Advantage Plans: Offering Affordable Freedom of Choice

BCBS Medicare PPO Advantage Plan gives you more of the benefits that you need and expect, including built-in prescription drug coverage. All three plans under the BCBS Medicare PPO umbrella offer all of the benefits of original Medicare along with several services that are not generally covered, as well as the convenience of one of the largest provider networks in the state.
Source: abchealthplans.com

Scope of Appointment Resources

CMS requires agents to obtain a Scope of Appointment (SOA) before they meet with a prospect on Medicare Advantage and Medicare Part D plans.  There are a few exceptions.  UnitedHealthcare produced a pretty comprehensive job aid for agents (UHC SOA Job Aid).  On the last page, it lists three situations when a SOA is not required. 
Source: wordpress.com

Your Health: Medicare open enrollment under way

A: All Medicare enrollees should have gotten notice by now that the Medicare open enrollment season has begun. Medicare beneficiaries have through Dec. 7 to decide whether they want to stay with their current plan — whether it’s a Medicare Advantage managed-care plan or original Medicare — or switch coverage to something else.
Source: timesdispatch.com

Medicare in Las Vegas, NV: Anthem Preferred PPO Is Leaving Las Vegas in 2013

In 2013, the Anthem Preferred PPO Medicare Advantage (MA) Plan will no longer be available in Clark County.  If you are a member of the Anthem PPO, you must choose another option before December 31, 2012, or you will go back to original Medicare on January 1, 2013. The fact that this plan is not continuing may be disconcerting, but it may also be a good opportunity.  If you have been denied a Medicare Supplement in the past due to health reasons, you can no longer be denied.  In other words, if you are on Anthem PPO right now, you have a guarantee issue right for a Medicare Supplement in 2013. As an Anthem member, you have two options:
Source: suncityfinancial.com

Humana to Purchase Arcadian Health Plans

Arcadian Health Plans announced on Thursday, August 25th, they signed a purchase agreement with Humana, Inc. for an undisclosed amount. With approximately 64,000 members, Arcadian offers Medicare Advantage plans in 15 states throughout the country. This deal will take several months, but should be completed before the end of 2011. Arcadian will operate business as usual and will continue to work with independent brokers to offer competitive Medicare Advantage plans during the upcoming AEP.
Source: wordpress.com

Excite エキサイト: ページが見つかりません

エキサイトに関するご意見・ご要望等を承っております。 より良いサービスをご提供できるようご協力ください。 ご利用頂きましてありがとうございます。
Source: exblog.jp

GAO: Additional Imaging Self

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 marsmet524Additional imaging service referrals by providers who self-referred cost Medicare approximately $109 million, according to a U.S. Government Accountability Office report. The report, “Higher Use of Advanced Imaging Services by Providers Who Self-Refer Costing Medicare Millions,” examined the rate of imaging referrals among providers who self-referred and those who did not, and the accompanying costs. Results showed that from 2004 through 2010, the number of self-referred MRI services increased by more than 80 percent, while the number of non-self-referred MRI services increased by only 12 percent. Overall, self-referring providers referred roughly twice as many imaging services in 2010 as providers who did not self-refer, according to the report. GAO estimates self-referring providers likely made 400,000 more referrals for advanced imaging services in 2010 than they would have if they were not self-referring, resulting in an approximate cost of $109 million to Medicare. Moreover, these additional referrals pose a risk to patient safety due to increased radiation exposure, according to the GAO report. The differences in referral rates between self-referring and non-self-referring providers remained after accounting for practice size, specialty, geography and patient characteristics, according to the report. To address the high rate of imaging service referrals among self-referring physicians, GAO made three recommendations to the administrator of CMS: 1. Insert a self-referral flag on its Medicare Part B claims form and require providers to indicate whether the advanced imaging services for which a provider bills Medicare are self-referred or not. 2. Determine and implement a payment reduction for self-referred advanced imaging services to recognize efficiencies when the same provider refers and performs a service. 3. Determine and implement an approach to ensure the appropriateness of advanced imaging services referred by self-referring providers. While HHS said it would consider the third recommendation, it did not concur with the first two. For the first recommendation, HHS said CMS believes a new checkbox on the claim form would be complex to administer and may not characterize referrals accurately. For the second recommendation, CMS commented that an additional payment reduction may cause providers to refer more services in an effort to maintain their income, according to the report.
Source: beckershospitalreview.com

Video: Canvas-CMS1500-HEALTH-INSURANCE-CLAIM-FORM Black Berry.mp4 – Mobile App – GoCanvas.com

Tricare Help – What should I do with a bill from the ER?

To verify that, call the customer service reps for the managed-care contractor for the Tricare region in which you live. If your managed-care contractor says that you should pay the bill and file a claim for reimbursement, you must file the claim within one year of the date that the medical care was provided. To file a claim, you need to complete and submit a Tricare claims form, DD Form 2642. You can download forms and instructions from the Tricare website or from the website of your Tricare regional contractor. You can also obtain forms and instructions at any Tricare Service Center or any military treatment facility.
Source: militarytimes.com

Medicare claim form cms1500

08 1500 health insurance claim1aINSURED146S IDNUMBERFOR PROGRAM IN ITEM 14INSURED146S NAME Last Name First Name Middle InitialaINSURED146S DATE OF BIRTHcINSURANCE PLAN NAME OR PROGRAM NAME13INSURED146S OR AUTHORIZED PERSON146S SIGNATURE I authorize FHEALTH INSURANCE CLAIM BACK OF FORM BEFORE COMPLETING SIGNING THIS FORM12PATIENT146S OR AUTHORIZED PERSON146S SIGNATUREI authorize the release of any medical or other information necessaryto process this claimI Source: Medicare claim form cms1500
Source: wordpress.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

NFCC Financial Education Blog

Eligibility. Medicare provides health care benefits to people age 65 and older and those under 65 with certain disabilities or end-stage renal disease. For most people, the initial enrollment period is the seven-month period that begins three months before the month they turn 65. If you miss that window, you may enroll for the first time between January 1 and March 31 each year, although your coverage won’t begin until July 1. To apply for Medicare online, visit this site.
Source: nfcc.org

IRS Reverses Position on Deducting Medicare Premiums

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 marsmet526The IRS Confirms the Deduction Until recently, there has been some confusion as to whether Medicare premiums paid by a self-employed individual, a partner in a partnership or a more than 2% shareholder of an S corporation qualified for this deduction.  The IRS recently confirmed in a Chief Counsel Advice (CCA) that if you otherwise qualify for the above-the-line deduction for health insurance premiums, you may be able to deduct your Medicare premiums.  The CCA concludes that all Medicare parts are insurance constituting medical care and that all Medicare premiums may be deductible – not just the supplemental medical insurance of Medicare Part B.
Source: herbein.com

Video: What is Medicare, What is Medicaid and What is the Difference? (50)

Obamacare will Increase Ohio Individual Insurance Premiums by up to 85%

Allen County Ohio Patriots Akron Tea Party – Summit 912 Anderson Tea Party Buckeye Firearms Association Central Ohio 9-12 Project Gahanna/New Albany 912 Project The Children of Liberty Cincinnati 9/12 Project Cincinnati Tea Party Clinton County Tea Party Clermont County Tea Party Columbus Tea Party Dayton Tea Party Eastern Hills Tea Party Eastern Ohio Concerned Citizens Fairfield County Tea Party Findlay 9.12 Project Firelands Patriots Grand Lake Patriots Grove City 912 Highland County Tea Party Hocking Hills Tea Party Patriots Holmes County Liberty Coalition
Source: ohiolibertycoalition.org

Dispelling Some Rumors About Medicare And The Health Law Limiting Care

Medicare Part D prescription drug plans vary widely, both in terms of which drugs are covered and in how much beneficiaries must pay out of pocket for them. But Medicare drug plans must cover at least two drugs in each drug class or category, such as cardiovascular agents, which would include cholesterol-lowering medications, and blood- glucose regulators such as oral anti-diabetes drugs. In addition, the plans must cover nearly all the drugs in six protected classes, including cancer drugs, HIV/AIDS drugs, antidepressants, antipsychotics, anticonvulsants and immunosuppressant drugs.
Source: kaiserhealthnews.org

Medicare: Save Money on Premiums and Copayments in 2013

More plans offer lower copays at "preferred" pharmacies: In 2013, for example, more than half the 32 Part D plans in California will charge lower copays at preferred pharmacies than at regular network ones — with savings of between $2 and $28 for the same prescription. Sounds like a deal, but be careful: If a plan’s preferred pharmacies aren’t within a convenient distance, you may be better off in another plan.
Source: aarp.org

In Ohio, Obamacare to Increase Individual Insurance Premiums by 55

With the Presidential election one week away, it’s worth reviewing how Obamacare will impact the residents of key swing states. In Ohio, as elsewhere, Obamacare will drive up the cost of private health coverage, especially for those who buy insurance on their own. A non-partisan study found that, by 2017, individual premiums in Ohio will increase by as much as 85 percent. In addition, Obamacare will deeply cut Medicare Advantage for more than 700,000 Ohio seniors enrolled in the program. And more than 30 percent of Ohio physicians say that they will place new or additional limits on accepting Medicare patients. Read on for more details.
Source: theglobalintelligence.net

Top Medicare Part D Plan Costs Spike in 2013

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

A sobering breakdown of the effects of Obamacare in swing states

The Affordable Care Act of 2010 (aka “Obamacare”), the healthcare law that is arguably Barack Obama’s single worst and yet biggest accomplishment as President of the United States, will have disastrous effects on many of the very states that he is desperately hoping to win in order to stay in office. From higher premiums to providers refusing to accept Medicare patients, swing state voters should do their homework before casting their votes.
Source: redalertpolitics.com

Chart: Medicare Costs for Seniors Increase Under Obama’s Plan

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Source: heritage.org

CBO: Health Programs Will Account for Larger Share of GDP in 2020

The MLR provision in the ACA resulted in 13 million U.S. residents receiving $1.1 billion in rebates in 2012. CBO estimated that the legislation would result in an initial reduction in rebates to consumers of 60% to 70%, followed by a 40% to 50% reduction by 2022. The measure also would increase premiums by an average of 0.2% over the next several years, CBO estimated (Attias,
Source: californiahealthline.org

Ask The Experts: Retirement

First, please review previous Q&As to see if your question already has been answered. If you cannot find the answer, submit your question to our Retirement expert at fedexperts@federaltimes.com PLEASE NOTE! Do not submit ANY questions via the Comments form. Questions submitted via the Comments form will NOT be answered!
Source: federaltimes.com

Faultline USA: Breaking: Medicare Supplemental Insurance Premiums Skyrocketing

When Billy signed on with United Mutual of Omaha, in August of 2010, the monthly premium was $92.26. In August of 2011, his anniversary date with the policy, the premium increased to $101.49, a 10% increase which was not necessarily unexpected since at that time overall medical costs were supposedly rising at about 9% per year.
Source: blogspot.com

8 Mistakes to Avoid During Medicare’s 2013 Annual Enrollment Period

Posted by:  :  Category: Medicare

5) Ignoring long-term care needs: According to an Opinion Research survey sponsored by PlanPrescriber.com, paying for long-term care is a top concern for baby boomers. Original Medicare will only pay for care in a skilled nursing facility for up to 100 days, and beneficiaries typically have to pay for a portion of those costs out of pocket. And, in most cases, Medigap plans will only cover out-of-pocket costs for services that are also covered by Medicare. So, once Medicare stops paying, your Medigap plan will stop filling in the gaps. But, long-term care insurance is available to help fill in the gaps.
Source: seniorlivingcare.com

Video: Learn About Medigap Plans

AARP Medigap Rates 2013 New York « Insurance News from Crowe & Associates

I would like to dispel some common misconceptions with Medicare supplement plans (Also called Medigap) Medicare supplement plans DO NOT have a network.  You may go to any doctor that accepts Medicare.   Medicare supplement do not have drug coverage, you need to purchase a part D plan in order to obtain drug coverage.   Medicare Supplements are secondary to Medicare.  When you go to the doctor or hospital, you show them your original Medicare card and that is what they will bill.  The supplement will pick up the costs that original Medicare does not cover.  There is not any Medical underwriting in the state of Connecticut if you are turning 65 or if you have had continuous coverage for a retirement plan, a different supplement or a Medicare Advantage plan.
Source: croweandassociates.com

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

Consumer reps: Medigap is not the bad guy

In the current draft of the NAIC cover letter, drafters state that, “We strongly disagree with the assertion that Medigap is the driver of unnecessary medical care by Medicare beneficiaries. Medigap insurance pays benefits only after Medicare has determined that the services are medically necessary and has paid benefits. Medigap cannot alter Medicare’s determination and the assertion that first-dollar coverage causes overuse of Medicare services fails to recognize that Medigap coverage is secondary and that only Medicare determines the necessity and appropriateness of medical care utilization and services.”
Source: lifehealthpro.com

LTCI: Top 6 Medicare myths

5) The Medicare supplement plan won’t cover my drugs. The good news is that most drugs are covered through prescription drug plans, reports Stapleton. But the insureds need to check with the plan to ensure the drug is covered and know what the co-payments are. While that’s not an issue with generics, it can be with brand-name drugs. Because financial advisors can’t spend their time researching each plan’s drug coverage, Stapleton suggests getting a sense of which Medicare-approved pharmacy providers are competitive in their area. “There are some great options out there,” he says. “CVS has a great plan. First Health Coventry has a great plan. Humana Walmart has a great plan. There are some really good (vendors) to choose from.”
Source: wordpress.com

Summit MediGap: How does Medicare & Medigap insurance work?

(prescription drug coverage) is voluntary and the costs are paid for by the monthly premiums of enrollees and Medicare.  Unlike Part B in which you are automatically enrolled and must opt out if you do not want it, with Part D you have to opt in by filling out a form and enrolling in an approved plan.
Source: blogspot.com

Federal Retiree Weighs Whether To Keep FEHB Or Switch To Medigap

Q. I am an American citizen who’s retired and living abroad in Spain. Our retirement residency visa requires Spanish health insurance coverage, which meets our needs well. However, Medicare won’t accept foreign plan coverage in lieu of Part B coverage. If I eventually return to the United States and want Part B coverage, I will be penalized for each year that I haven’t been paying for it. But paying now for coverage I can’t use doesn’t seem fair. Please advise.
Source: kaiserhealthnews.org

Myths and Realities of Ryan and Medicare

Posted by:  :  Category: Medicare

Medicare Bros by pasa47His insincerity in dealing with the problems facing Medicare is every bit as brazen. In contrast to Ryan, who admits that tough choices and significant revisions in its structure and management must be made, Obama postures as if it will continue forever in its present state, with funding magically available from unlimited economic sources. This is particularly egregious since it was his own establishment of socialized medicine (Obamacare) that has inflicted the worst damage to Medicare. In order to balance the books on Obamacare, the current medical coverage for seniors would be forced to forfeit $700 billion from its coffers. Yet we are told that no reduction would be experienced by recipients. No need to do the math, just take his word for it. The worst aspect of this situation is that liberals do not care if Medicare eventually implodes, as long as it waits until after November 6 to do so.
Source: hawaiireporter.com

Video: Healthcare: Plain & Simple “Medicare” – Hawaii News Now, KGMB and KHNL

The hunt is afoot for Medicare Part D [log in]

Today      Obituaries      Local      Police      Court news      Weather      Business      Property transfers      Education     
Source: reporter-times.com

Hawaii U.S. Senate: Hirono Trounces Lingle

Speaking to supporters at her campaign headquarters, Lingle said, “As I told each one of you … one of the great things about campaigns is that you make lifelong friends. And we have certainly made them in this race.”
Source: civilbeat.com

Open Enrollment 2013: Medicare Part D Benefits Improve but Premiums an…

While Medicare Part D prescription drug plan premiums are generally expected to remain steady in 2013, this PPI Fact Sheet by Leigh Purvis and Lee Rucker finds that premiums for many popular plans will actually be considerably higher than they were in 2012. Many plans are also increasing cost-sharing and their reliance on utilization management tools for covered prescription drugs. Medicare beneficiaries should closely examine their 2013 prescription drug plan choices during open enrollment for Part D.
Source: aarp.org

Medicare agrees to cover TMS treatment for depression in TN, GA, AL

Posted by:  :  Category: Medicare

Jessica Sundheim by On Being“TMS will now be available to more patients, giving them the hope of living a life free of depression,” said Burton Hills-based Dr. Scott West, who was the first local psychiatrist to acquire the TMS machine, a space-age contraption that looks similar to a dentist’s chair. West has been using TMS to treat patients since 2010. (See our September magazine story here.)
Source: nashvillepost.com

Video: Tennessee Medicare Supplement

Democrats Tie TN Health Care Compact to Medicare Cuts

The releases generally follow arguments presented against the bills in the Legislature by some Democrats. The Republican sponsors, Sen. Mae Beavers of Mount Juliet and Rep. Mark Pody of Lebanon, argued the measure just opened up one possible option for the state to consider and that, given federal problems with Medicare and Medicaid, the state might be able to do a better job managing the programs.
Source: knoxnews.com

Medicare: Protecting the Cornerstone of Middle Class Security

Secondly, this scheme has a broken funding mechanism that will quickly undermine current benefits. Under the shortsighted Republican proposal, Medicare funds would be transferred to Tennessee under a block grant. But block grant funding doesn’t keep pace with medical inflation, meaning Tennessee could lose hundreds of millions of dollars in federal funding. The funding gap between the block grant and the actual cost of care for seniors would inevitably result in reduced benefits for seniors and higher premiums or new taxes — all shouldered by low- and middle-income folks.
Source: brewer4you.com

Beacon CEO on Paul Ryan’s Medicare proposal

Beacon Center budget business-friendly cities charter schools climate congress corporate welfare reform death tax dr. milton friedman education education reform energy policy entrepreneurs estate tax government government handouts government reform government waste Governor Bredesen Governor Haslam healthcare income tax inheritance tax jobs Justin Owen legislation mass transit nashville ObamaCare pork Pork Report property rights regulation school choice small business state budget stimulus taxation tax credits taxes taxpayers tenncare reform transparency transportation welfare
Source: beacontn.org

Tennessee State Museum exhibition is guitar

Nashville pickers will also come into play for String Fever, a benefit concert for the Tennessee State Museum Foundation on Dec. 12. Vince Gill, who contributed several of his own guitars to the collection, will perform with nearly two dozen of the city’s most revered players, including Marty Stuart, Steve Wariner and Steve Cropper, most of whom will have to drive only a short distance to make it to the stage. Polycarpou says The Guitar similarly benefits from being in Nashville, a city he calls “the center of the guitar world.”
Source: tennessean.com

Tennessee Guerilla Women: Ronney’s VP Pick: Enemy of Medicare

Let the campaign begin. Romney is announcing Paul Ryan as his VP choice, as I write. In other words, the all male, all white Romney team hopes to slash Medicare and all social safety net programs that are not designed for Romney’s fat-rat buddies. Are you paying attention Florida?
Source: blogspot.com

House Calls Nurse Practitioner

Title: House Calls Nurse Practitioner – Full time or Part time- Memphis, TN Location: US-TN-Memphis Job Number:_506805 Care Improvement Plus Practitioners is now a part of UnitedHealth Care Medicare & Retirement. UnitedHealthcare Medicare & Retirement is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. Imagine joining a group of professionals and clinicians who are working to improve health care for people over 50. Consider the influence you can have on the quality of care for millions of people. Now, enhance that success with enthusiasm you can really feel. That”s how it is at UnitedHealthcare Medicare & Retirement. Every day, we”re collaborating to improve the health and well being of the fastest growing segment of our nation”s population. And we”re doing it with an intense amount of dedication. Here, you will discover a culture that grows through challenge. That evolves by being flexible. That succeeds by staying true to our mission to make health care work effectively and efficiently for seniors. Put your best to work for us, and discover extraordinary opportunities for growth. Position Summary House Calls Nurse Practitioners conduct in-home health assessments on enrolled Medicare Advantage members. A House Calls Nurse Practitioner will complete visits on members within a geographic area of responsibility. The nature of the House Calls visit can vary and could include performing an annual health assessment, a post discharge visit, or visiting more complex members more than once per year. General Responsibilities: Conduct in-home assessments on health plan members. Average visit is 45-60 minutes in length. House Calls Assessment includes: Past medical history Review of systems Physical examination Medication review Depression screening Responsible for checking vitals, conducting a physical exam that includes monofilament test, urine dipstick, and foot exam (as appropriate). Identify diagnoses to be used in care management and active medical management in the furtherance of treatment. Formulate a list of current and past medical conditions using clinical knowledge and judgment and the findings of your assessment. Communicate findings in your assessment that will be used to inform members PCP of potential gaps in care. Identify needs and opportunities to generate clinical referrals to Care Improvement Plus and / or the primary care physician. Educate members on topics such as disease process, medication, and compliance. Compliance with all HIPAA regulations and maintain security of protected health information (PHI). Qualifications: Required Education and Experience: NP (license and national certification, or the ability to obtain national certification and/or NP license in state of assignment) Minimum of 1 year clinical experience in their highest level of education, clinical setting preferred. Family, Geriatrics, or Adult certification required (Acute Care certification in states where permitted outside a hospital setting) Experience in gerontology, cardiology, internal medicine, or endocrinology a plus. Home care or home visit experience a plus. Required Knowledge, Skills, and Abilities: Ability to obtain reliable transportation in order to complete home visit assessments Excellent administrative, organizational and verbal skills are required. Professional image and behavior are required. Strong communication skills with the geriatric or Medicare population. Ability to navigate on the internet and work with personal computer. Ability to work independently. Detail oriented. Dependable and reliable. UnitedHealth Group is working to create the health care system of tomorrow. Already Fortune 25, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we”re doing a lot of good. Through our family of businesses and a lot of inspired individuals, we”re building a high-performance health care system that works better for more people in more ways than ever. Now we”re looking to reinforce our team with people who are decisive, brilliant – and built for speed. Come to UnitedHealth Group, and share your ideas and your passion for doing more. We have roles that will fit your skills and knowledge. We have diverse opportunities that will fit your dreams. Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing. Job: Mid-Levels Location: Memphis, TN, 38111, USA
Source: thejobdaddy.com

DownWithTyranny!: The Fighting Begins

Five of the Blue America House candidates and all three of the Blue America Senate candidates won their races Tuesday. We’ll hold them accountable, not that we have to… they think the same way we do about it. But what about the progressive groups who helped oust Allen West for Patrick Murphy? What about the progressive groups who helped oust Joe Walsh for Tammy Duckworth? What about the progressive groups who helped oust Ann Marie Buerkle for Dan Maffei? What about the progressive groups who helped oust Chip Cravaack for Rick Nolan? What about the progressive groups who helped oust Roscoe Bartlett for John Delaney? What about the progressive groups who helped oust Bobby Schilling for Cheri Bustos? What about the progressive groups who helped oust David Rivera for Joe Garcia? What about the progressive groups who helped oust Dan Lungren for Ami Bera? Will those groups hold their successful candidates accountable? I hope so. (Blue America didn’t endorse any of them because we didn’t think they could be counted on. We’ll see– unless Obama and Boehner manage to do the whole thing in the lame duck session before the freshmen take office.)
Source: blogspot.com


Nashville, TN. April 13, 2012 – Michael Hamilton of Provost Umphrey Law Firm LLP and Patrick Barrett of Barrett Law Office, PLLC are pleased to announce that AmMed Direct, LLC, a provider of diabetic testing supplies and other durable medical equipment, has agreed to pay $18 million to settle allegations that it submitted false claims to Medicare and TennCare by billing for sales that it solicited through prohibited telephone cold calls to Medicare and TennCare beneficiaries. Moreover, it was alleged that AmMed did not timely refund money to Medicare or TennCare relating to supplies that beneficiaries had returned.
Source: barrettlawofficetn.com

CMS approves Medicare RAC to review E&M claims

Although most optometrists and other physicians do not frequently bill this code, a report by the Office of the Inspector General (OIG) of the U.S. Department of Health & Human Services (HHS) earlier this year found that 2.2 percent of physicians who consistently bill higher level E&M codes were optometrists.
Source: newsfromaoa.org

Simplee’s payment portal for for health care gets boost from Medicare support — Tech News and Analysis

Posted by:  :  Category: Medicare

Bubbles? Take something like 'Not I! ...item 1.. Wakulla Republicans Protest Against Taxes in the County (September 06, 2011) ... by marsmet552But Shoval’s goal is to make Simplee the trusted destination for patients to make all of their out-of-pocket health payments, from hospitalization to dentist visits to primary care appointments. Between 2006 and 2010, Shoval said, the yearly amount that an average family pays out of pocket climbed nearly 80 percent, from $2,000 to $3,600.  As the consumer-driven healthcare movement makes consumers even more responsible for their medical spending, he believes there is an opportunity for Simplee to be the central hub for all of their transactions.
Source: gigaom.com

Video: Medical Billing Tips – Coding for Medicare Flu Shots

2013 Medicare Physician Fee Schedule: Issues of Interest to Independent Laboratories

In an apparent attempt to address a controversial policy announced by Palmetto GBA in August 2012, CMS revised the description of HCPCS code G0416 (surgical pathology; gross and microscopic examination for prostate need saturation biopsy sampling, 1-20 specimens) to cover 10-20 specimens.  According to CMS, this change will  ”better reflect the interaction of this service, and associated RVUs, with billing for surgical pathology.”  This change is open for public comment.  Laboratories presumably may now use 88305 if billing for less than 10 jars, but this revision does not address the confusion created by Palmetto GBA’s policy – or the NCCI edit on which it is based – because those statements seemed to say that laboratories must use G0416 regardless of collection methodology (and not just in the case of saturation biopsies).  
Source: jdsupra.com

Use the Right Medicare Modifiers

GA Modifier: This modifier indicates that an ABN has been provided to the patient.  It will allow the provider to bill the patient if not covered by Medicare. When this modifier is used, Medicare will automatically assign the patient liability if the claim is denied. For instance, if the reason for providing a particular test is not medically necessary, the provider would expect the claim to be denied. So, before the test is performed, the patient is made to sign the ABN which explains that the claim will be denied. The patient will have to pay for the service.
Source: outsourcestrategies.com

5 Medicare Trends for Surgery Centers to Watch

1. Quality program reporting requirements for ASCs. As of October 2012, ambulatory surgery centers are required to participate in a quality reporting program for Medicare if they accept Medicare patients. Non-compliance will see a 2 percent reduction in reimbursement rates in the future. To maximize reimbursement from Medicare, make sure you are capturing all eight quality measures and any additional measures added in the future. “ASCs should consider appointing a point person who will be responsible for ensuring that the ASC will be able to comply with the new reporting requirements,” says Ms. Carney. “If they fail to implement and report these quality reporting measures, they will see their rates cut in 2014.  Surgery centers are better off now than in 2008, but they still receive less reimbursement than hospitals and we are still seeing a migration from inpatient procedures to ASCs.” The designated leader for quality reporting in each center should attend training to become familiar with the codes that need to be documented. If the codes aren’t documented and the center is selected for an audit, they will lose money. “There may be some financial considerations involved for the ASC to invest in an individual’s training,” says Ms. Carney. “If you outsource billing, you should speak to your IT vendors, billing companies or both to ensure that they will be able to add the quality data codes to claims.” 2. Value-based purchasing programs. While surgery centers aren’t required to meet the standards of value-based purchasing yet, it’s something that could come down the pipe in the near future. Hospitals are already implementing value-based programs, and Congress has discussed requiring these programs in ASCs as well. “There are pros and cons to value based purchasing for ASCs,” says Ms. Carney. “The ASC could support their argument for bringing more cases into their setting if their data is good, or they will be punished if their data is bad.” Value-based purchasing relies on rewarding providers with high patient satisfaction, clinical outcomes and quality with higher reimbursement; those that don’t meet these standards will receive a lower rate. “CMS doesn’t have the authority to reduce payments yet based on quality reports, but it is a recommendation for a report to Congress,” says Ms. Carney. “For now, it appears the commissions belief is that value based purchasing programs for ASCs should include a relatively small set of measures that primarily focus on clinical outcomes, with some process, structural and patient experience measures.” 3. Punishment for provider complications. It will be important going forward to make sure patients don’t acquire additional injuries or conditions during their time at the surgery center. This means minimizing complications like wrong-site surgery and maximizing infection control. “If someone comes in with a wound on their leg and leaves with another issue, that’s evidence that something was missed and that’s a hit against you,” says Ms. Carney. “There is a potential for an adjustment downward in payment going forward. You want to make sure you are capturing as much Medicare payment as possible.” Look at a small set of measures, such as primary clinical outcomes, processes, structure and patient experience measures, to make sure you are efficient and effective. Implementing an electronic medical record could make reporting and workflow easier. “You have to be extremely efficient and effective,” says Mr. Macies. “If the CMS continues on the path they are on, you are going to be penalized if you are not using EMR to report quality. Maintain efficiency and get an EMR in place so you don’t experience those penalties. An EMR will also help you with patient safety by warning you of such events as patient fall risks, allergies, drug to drug  interactions and fire risk” 4. More ASC utilization in the future. Medicare, as well as commercial payors and providers participating in accountable care organizations, will be directing patients to the high quality, low cost provider in their community, which is often the surgery center. “Medicare wants to utilize ASCs because they are so much more cost effective,” says Ms. Carney. “ASC growth has slowed down substantially over the past few years, along with ASC reimbursement rates and the economy as a whole. When people are comfortable, we will see an upswing again. We can still get financing and resources for new ASCs, and they need to be prepared for Medicare patients.” Become attractive to Medicare and other providers, as well as cash-pay patients who are looking for a high quality surgical setting. These cases can help your center become more financially secure. “Prepare for value based purchasing and quality reporting,” says Ms. Carney. “You want to have the Rock Star ASC people wanting to come to your center and you will get reimbursed financially depending on what regulations come out.” 5. Treating Medicare patients is viable for ASCs in the future. While Medicare has historically low reimbursements, rates are increasing in some areas. The rates are tied to CPI, but under the Patient Protection and Affordable Care Act, you reduce CPI growth by productivity growth. “For Medicare, provided you are doing quality reporting, I would say it’s a viable option for ASCs in the future,” says Ms. Carney. “Do what you have to do to capture the maximized Medicare dollar. That’s the way you are going to lose or gain revenue.” As more people become Medicare-eligible, a large portion of an ASC’s patient base will be covered by Medicare. It may not be possible to do without those patients, so focus on maximizing potential reimbursement. “The margins for Medicare and Medicaid patients in ASCs are pretty thin these days, and have  always been less than hospitals,” says Mr. Macies. “The challenge that most ASCs have is with the aging population, with around 10,000 people becoming Medicare eligible every day. It’s a growing population and it’s difficult to conceive how you can run your business without treating Medicare patients.”   Maximizing reimbursement through high quality care delivery and maximizing efficiency in your operations through systems like an EMR will make treating Medicare patients viable and profitable. More Articles on Surgery Centers: How Will Obama’s Re-Election Impact Healthcare? ASC Industry Leaders Respond 8 Steps for Profitable Materials Management at Orthopedics ASCs 8 Steps to Re-Negotiate Profitable Payor Contracts in 2013
Source: beckersasc.com

FR&R Home Health Bulletin: Update to Medicare Reimbursement Rates for Vaccinations for Home Health Agencies

For a seasonal flu or pneumococcal vaccination, there is an administration component and vaccine component to be billed to Medicare Part B.  The administration is billed using Bill Type 34X, Revenue Code 0771, Diagnosis Code V04.81 for influenza vaccination, V03.82 for pneumococcal vaccination or V06.6 for both influenza and pneumococcal vaccinations, and HCPCS Code G0008 for influenza administration and HCPCS Code G0009 for pneumococcal administration.  Reimbursement is based on the Hospital Outpatient Prospective Payment System (OPPS) amounts and is subject to the lower of the fee schedule amount or billed charges.  If the charges are less than the fee schedule amount below, then reimbursement will be at the lower charged amount.  
Source: frrcpas.com

Medicare and Simplee Bring Transparency to Medical Billing

The majority of Medicare patients maintain eligibility with a second insurance plan through their employer, resulting in a complex claims process that involves several independent organizations. Simplee has, over time, earned the reputation of providing end users with an easy to understand, consumer-friendly dashboard which enables claims tracking and medical bill payment processing. Simplee is the first company in this market space to support Medicare claims processing.
Source: histalkmobile.com

HHS DOJ Letter on Improper Medicare Billing

On September 24, 2012, the Department of Health and Human Services (HHS) and the Department of Justice (DOJ) issued a letter concerning improper Medicare billing to the following hospital organizations; American Hospital Association, Federation of American Hospitals, Association of Academic Health Centers, Association of American Medical Colleges and the National Association of Public Hospitals and Health Systems.  Electronic health records have the potential to save both money and lives, but the HHS and the DOJ have discovered indications that providers are utilizing the new technology in order obtain payments for which they are not entitled.  The false documentation of care issues that they addressed are as follows:
Source: hchealthcareconsultingllc.com