Aetna, ConnectiCare Push Collaborations With Health Providers In Private Medicare Plans

Posted by:  :  Category: Medicare

Treatment of some Medicare patients presents unique challenges, the insurers say. Patients who require more than basic care often have several doctors or other points of contact in the medical care system, which means coordinating treatments can be more difficult. For instance: ConnectiCare said a typical Medicare patient sees more than seven doctors in a year and uses nine different medications, so a key piece of its pilot program will be identifying high-risk patients and providing data to help coordinate their care.
Source: courant.com

Video: Videos matching: connecticare medicare advantage

Arcadian Health Names John Wells as Chief Performance Officer

Arcadian Health, founded in 1997, provides Medicare Advantage coverage through its affiliates in the following 15 states: Arizona, Arkansas, California, Georgia, Louisiana, Maine, Missouri, New Hampshire, New York, North Carolina, Oklahoma, South Carolina, Texas, Virginia and Washington. The plans are offered under the following local product names: * Arcadian Community Care (Louisiana and California) * Arcadian Health Plan (Oklahoma) * Arkansas Community Care * Columbia Community Care * Desert Canyon Community Care (Arizona)* Ozark Health Plan * Northeast Community Care (Maine and New York)* Southeast Community Care (Georgia, North Carolina, South Carolina and Virginia)* Spokane Community Care * Texarkana Community Care * Texas Community Care.
Source: wordpress.com

CT Medicare Advantage, Medicare Supplement, Prescription Drug Plans

Our agency is expanding! Shortly we will be Medicare Advantage and Medicare Supplement brokers. (We will continue to help Connecticut residents buy medical insurance.) We will be offering Zero Premium Policies (that right, some of the policies require none of your money be sent to the insurance company!) as well as other policies with premiums and enhanced benefits.
Source: 1800insurancect.com

ConnectiCare Enters Medicare Advantage Market

Consumers looking for a Medicare Advantage product will find many options to match their health insurance needs from ConnectiCare. Individuals, who enroll in our Medicare Advantage plans, will receive all the benefits of original Medicare plus benefits such as disease management programs, health and wellness support, limited dental benefits and more.
Source: wordpress.com

Connecticare Sets The Stage For Fun In 2010

PRLog (Press Release) – May 25, 2010 – Inspired by timeless adages such as “Laughter is the Best Medicine” and “An Active Mind is a Healthy Mind,” ConnectiCare has created the 2010 “Setting the Stage” program for its VIP Medicare members. The program will provide free admission to events such as trivia game shows, dance classes, museums, movies, comedy shows and more to give members incentive to stay active and healthy. “Our ‘Setting the Stage’ program will provide free admission to a number of fun events around the state for our VIP Medicare members. It’s a great way to help keep our members feeling vital, fit and always smiling,,” says Tony Tedeschi, Director of Medicare Program Management with ConnectiCare. “Additionally, we are hosting four trivia competitions at locations around the state to see who knows the most about the 1950s through the 1980s. The top three contestants will advance to a final challenge in September in Cromwell hosted by Scot Haney of WFSB TV 3 and Better Connecticut, where the top finisher will be crowned the ‘Know it by Heart’ trivia king or queen. It should be lots of fun and an event-filled summer for all of our members.” Details about all of the ConnectiCare VIP Member exclusive events can be found on ConnectiCare’
Source: prlog.org

Flu shots available Tuesday in Fairfield

Insurance plans accepted for flu shots and/or pneumonia shots include: Aetna, Medicare Part B; Connecticare — commercial plans and Medicare Advantage plans; Anthem Blue Cross and Blue Shield — commercial plans and Medicare Advantage Plans. Without that specific insurance coverage plans, the cost for the flu shot is $25 and for the pneumonia vaccine it is $45. People getting inoculations should bring their insurance cards to the clinic.
Source: ctnews.com

Insurer Teams With Medical Group To Improve Patient Care

The second part of the program involves end-of-life care, a term that invokes stigmas after debate about federal health care reform. In this instance, the term means that patients will meet with their doctors and health insurer to talk about treatment options before it’s a last-minute decision in an intensive-care unit, said Dr. Paul Bluestein, ConnectiCare’s chief medical officer.
Source: courant.com

Medicare Advantage, Medicare « Insurance News from Crowe & Associates

Medicare Advantage plan designs are set for 2010.  The general trend was that everyone lowered benefits and raised premiums.  Some of the change can be attributed to the cut in funding for Advantage programs (approximate 4% decrease in funding vs. the traditional 4%-6% increase in funding) but some of it most surely be due to utilization and frequency.
Source: croweandassociates.com

Medicare Advantage Plans Connecticut 2012 « Insurance News from Crowe & Associates

There are a limited number of Medicare Advantage plans available in Connecticut for 2012.  The list includes plans from Connecticare, AARP/United, Aetna, Anthem BlueCross BlueShield and Wellcare.   Our agency has clients with all companies and plan types in Connecticut and we are happy to share the good and bad of them with you.
Source: croweandassociates.com

Aetna Ends Two Medicare Advantage Programs In Connecticut

The plan terminations in Connecticut, Cherniak said, aren’t related to the debate over reducing Medicare reimbursements to fund health care reform. Medicare Advantage plans have higher reimbursements than so-called “plain-vanilla” Medicare and have come under particular scrutiny from Congress.
Source: courant.com

Emdeon Current: New Payer Transactions

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

Medicare Supplemental Insurance Comparison Website Adds 250,000 Insurance Companies to Their Database

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSThe website “Medicare Supplemental Insurance Comparison” announced today that it has added over 250,000 insurance companies to their database. According to a website spokesperson this makes them one of the most thorough Medicare supplemental insurance comparison websites on the Internet today. The website can be found at http://medicaresupplementalinsurancecomparison.net/ The launch of the website came at the heels of an eagerly anticipated two-month walk up to launch date. As Medicare supplemental insurance comparison websites become more popular, a website which boasts one of the largest databases of reputable insurance companies was in high demand. “We knew that we had to provide our clients with something that they never have seen before,” said Kristin Humphreys, director of marketing. “In the past, when visiting these types of websites, visitors had to provide sensitive information such as their name or address. We knew that the latest in technology could do area specific searches with only a zip code. This not only protected the privacy of our clients but it also made our software about 50% faster than the most popular websites on the market. So far the reception for our new website has been overwhelmingly positive.” Indeed, the sheer demand for these types of websites has created a rush to implement the latest in technology and search software. With the addition of the 250,000 insurance companies to their database, Medicare Supplemental Insurance Comparison is expected to take the lead in the market. “Analysts project our website to be one of the most popular on the web as we enter the first quarter of 2013,” said Michael Montgomery, CEO of Medicare Supplemental Insurance Comparison. “The simple reason for this is because of the monetary and time investment we put into our search software and extensive database. Our clients are provided with side-by-side comparisons of all the most reputable Medicare supplemental insurance companies in their area, and they can source them without ever having to give over their personal information. This is a first in the industry, and it will soon become the standard.” To learn more about Medicare Supplemental Insurance Comparison, or to get a free anonymous side-by-side comparison of all the best Medicare supplemental insurance companies in a given area, please visit: http://medicaresupplementalinsurancecomparison.net/ About Medicaresupplementalinsurancecomparison.net Medicaresupplementalinsurancecomparison.net was created in September of 2012 to help shoppers get the best rates for Medicare supplemental insurance. The website utilizes the absolute latest in price quote technology, and has recently added 250,000 insurance comparison companies to their database.
Source: sbwire.com

Video: Compare Medicare Supplement Plans | Supplemental Medicare Insurance

Medicare Supplemental Insurance

Let’s face it; America’s health care system has been in ruin for the past decade. If someone has serious medical problems and are not on a private expensive insurance plan they often end up in debt for the rest of their lives. The current Medicare and Medicaid programs try their best to help people, but just do too little for too few people and as a result is ineffective. President Obama has made various efforts to revamp this broken system through the National Healthcare Act commonly referred to as Obamacare, but his valiant efforts have largely been slowed down and nullified by the Republican party. But expanding coverage and giving more people their right to health insurance through Medicare supplemental insurance is a step in the right direction for a better future for America.
Source: novairis.com

How To Know If You Need Medicare Supplemental Insurance

If you require a lot of medical attention, getting the most coverage you can afford makes sense. Whether you have cancer, chronic illnesses, a major health condition, or regular visits to hospitals and specialists, supplemental insurance will help ensure that everything you need is covered and affordable. Getting Medicare supplemental insurance is also a good idea if your regular Medicare policy does not cover something specific that you need, such as a prescription medication, a certain type of service, or additional medical care that you need. Talk to your doctors and healthcare providers about your current health and the steps you will need to take in order to stay healthy. This will give you a good idea of what you need, and whether Medicare will cover it. If not, seek out a supplemental insurance plan.
Source: dzida.org

Supplemental Health Insurance Resources

When looking into health insurance of any kind the rules, regulations and stipulations often make it so that every word on the policy seems foreign and a bit sketchy. The policy is never laid on it terms that one without industry knowledge would completely understand. Words such as co-payment, deductible, family allowance, preventative vs. routine care often times add confusion in really understanding what is being offered. Health Insurance in general is difficult to understand and often leads us to believe we are being manipulated let alone getting into the next generation of health insurance, Medicare. How is one to determine exactly what is being offered and to finally settle upon a policy that best fits the need with Medicare and Medigap supplemental insurance policies?
Source: pedalin.org

Medicare Claims Crossover Process Impacted By Storm Sandy

The Centers for Medicare & Medicaid Services (CMS) Coordination of Benefits Contractor (COBC) is alerting all providers, physicians, and suppliers about the impact Storm Sandy has had upon the Medicare claims crossover process in the northeast.  As a result, the Medicare claims crossover process is operating slower than normal, creating delays in payments from their patients’ supplemental payers.
Source: wordpress.com

Baicker: The insurance value of Medicare

Beneficiaries without any supplemental coverage thus do not have enough insurance and face too much risk. This risk is one reason that 90% of beneficiaries obtain some other type of insurance (e.g., retiree health benefits, Medigap, Medicare Advantage, or Medicaid). But beneficiaries with generous supplemental coverage probably have too much insurance. “Too much insurance” may seem like a nonsensical concept, but there is ample evidence that when copayments are lower, patients consume more care, much of which is of questionable benefit to health. The systemwide effects are considerable: the increasing prevalence of health insurance in the United States is estimated to be responsible for about half the increase in per capita health care spending between 1950 and 1990. Having little or no cost sharing may lead enrollees to consume low-value care and drive up the cost of Medicare for everyone.
Source: pnhp.org

Do You Need Medicare Supplemental Insurance?

One huge benefit of a Medicare supplemental insurance plan is that it will not be nearly as expensive as a traditional plan. After all, the supplemental insurance will not have to cover all of your bills. This reduces the risk by reducing the total amount of money that you will need. Even though you will feel like you are getting a high level of coverage, the insurance company will not feel the same pressure. For example, perhaps you have $10,000 worth of bills and Medicare will only pay for $8,000. The insurance plan merely has to pick up the extra $2,000. Therefore, you can pay as much as you would for low level coverage, but you will get a much better service.
Source: loneframe.com

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

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

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

Is a Medicare Supplement Necessary Under the Obamacare Plan?

Even with the new changes to Medicare, seniors that want to reduce their risk to the potential of high medical bills will need a Medicare supplement policy. Obamacare does nothing to change the 80/20 rule (e.g., Medicare pays approximately 80% of your medical bills and leaves you stuck with 20% of the liability). All of the reasons people purchase supplemental health insurance and a prescription drug plan still exist. Your Medicare Part B still has no “Out-Of-Pocket” limits and Medicare still does not pay for for your prescription drugs.
Source: medigapandyou.com

Physicians at Akron's Summa Health Move Forward Boldly on an ACO

Posted by:  :  Category: Medicare

Like anything, it was all over the place. But most of the physicians were very excited, excited at the idea that we could improve care, could communicate among ourselves in a better way. In the past, everyone’s done their own thing in their own way. But this has been physician-led; the board has a physician majority. So this has very much been a physician-driven model, and the physicians are very excited. Of course, there’s always some skepticism; but the physicians have been very involved and have been working hard on this. And I’m very proud of them—the docs I get to work with, they’ve really done a wonderful job of embracing it and getting into it.
Source: healthcare-informatics.com

Video: Medicare Age-In

SummaCare Selects Burgess Software As Its Comprehensive Medicare Pricin… ( ALEXANDRIA Va. Jan. 6

Related medicine news : 1. INTEGRIS Health Selects Allscripts Care Management for Its 13 Hospitals 2. Berkshire Medical Center Selects Desktop Alert for Mass Notification Solutions 3. Jefferson Regional Medical Center Selects iSirona DeviceConX for Medical Device Integration 4. Park Avenue Nursing and Rehabilitation Center Selects PatientPlacement.com Web-based Long-Term Care Software to Automate Admissions and Boost Census Performance 5. Atrius Health Selects rL Solutions for Improved Patient Safety and Quality of Care 6. Kimball Health Services Selects HMS to Provide Information Technology Infrastructure 7. American Well Selects First DataBanks Drug Data for Use in Online Physician-Patient Care Consultations 8. Berkshire Medical Center Selects Desktop Alert for Mass Notification Solutions 9. National Cancer Institute Selects Ogilvy Public Relations Worldwide for Comprehensive Multi-Year Communications Support 10. Simon Property Group Selects New York Merchants Protective Co., Inc. for Fire-alarm Services 11. Nonin Medical Selects nParallel to Design and Craft its New Tradeshow Exhibit
Source: bio-medicine.org

Shingles Vaccinations Not Covered For Some Medicare Beneficiaries

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

pack nucleon: Medicare Buz ? Blog Archive ? Tom Strauss leads a new vision for …

I want my representatives to start representing. Members of Congress get a much better retirement plan than you and I do. They can even collect after being convicted of a crime while still in office and they take a lot more days off than our employers would allow for us little people. So I think we should begin holding our representatives to a higher standard or at least one equal to what is expected of us by our employers. The system for paying all of our elected representatives should be changed to a salary plus bonus plan. The bonus would only be paid when a representative leaves office or is re-elected. When we go to the ballots there should be a new question on every ballot in every state which would determine whether or not our representatives collected their bonus; Did Mr. /Ms (Insert name here) represent your interests to the best of his/her ability? If the majority feels that the representative did their best then the bonus is paid as soon as the current term expires. However, if the people feel that they were not properly represented then there is no bonus. I think that a system like this would force our elected officials to keep in touch and understand how we are feeling about the issues. Oh Yeah, from now on when someone running for office says that they are going to change this or change that, I for one want to see the plan. If someone says they can do better than the current elected officials we should have the right to know how they intend to do it before we vote for them. Source: arkansasmedicarepros.com
Source: blogspot.com

SilverSneakers Medicare Programs

So, what exactly is SilverSneakers?  SilverSneakers is essentially a gym membership or fitness club membership to participating centers across the country.  You can find participating gyms by going to www.silversneakers.com and typing in your zip code.  You can find out if your Medicare plan offers Silver Sneakers by calling 1-888-423-4632.  Here are some of the features offered by SilverSneakers.
Source: medicare-plans.net

SummaCare Health Insurance

Recognized nationally for its coverage of health insurance plan and Medicare health SummaCare has become one of the health insurance companies first in northern Ohio. Its members range from a service area of ??18 counties in northeast Ohio, and maintain a network of over 6,000 providers and hospitals 30. To accommodate members who travel outside the coverage area, have also established relationships with other national provider networks to ensure the best possible coverage for their members.
Source: typepad.com

Summacare.com Estimated Value $1,296.00 USD

The information in this whois database is provided for the sole purpose of assisting you in obtaining information about domain name registration records. This information is available “as is,” and we do not guarantee its accuracy. By submitting a whois query, you agree that you will use this data only for lawful purposes and that, under no circumstances will you use this data to: (1) enable high volume, automated, electronic processes that stress or load this whois database system providing you this information; or (2) allow,enable, or otherwise support the transmission of mass, unsolicited, commercial advertising or solicitations via facsimile, electronic mail, or by telephone to entitites other than your own existing customers. The compilation, repackaging, dissemination or other use of this data is expressly prohibited without prior written consent from this company. We reserve the right to modify these terms at any time. By submitting an inquiry, you agree to these terms of usage and limitations of warranty. Please limit your queries to 10 per minute and one connection. Registrant: SUMMACARE 10 North Main Akron, Ohio 44308 US Registrar: Domain.com Domain Name: SUMMACARE.COM Created on: 27-NOV-96 Expires on: 26-NOV-17 Last Updated on: 12-NOV-10 Administrative, Technical Contact: , Networking networking@summacare.com SUMMACARE 10 North Main Akron, Ohio 44308 US 330-472-2002 Domain servers in listed order: NS1.SUMMACARE.COM NS2.SUMMACARE.COM End of Whois Information
Source: widestat.com

Choosing the right Medicare plan during open enrollment

Review your services and benefits: You or your caregiver should list the medical services you used this year. Were your benefits a good match for those services? How much did you pay for deductibles and co-payments? Are the premiums or co-pays of your existing medical insurance expected to increase next year? If yes, by how much?
Source: cleveland.com

Tom Strauss leads a new vision for patient care at Summa Health System

The first thing you’ve got to realize is that you can’t make everybody happy. That’s the hard one, especially for somebody like me who really prefers to have people holding hands singing ‘Kumbaya.’ The other area is trying to micromanage. You cannot in this environment micromanage. You’ve got to empower your people and let them go. They will make mistakes and that’s OK as long as they learn from their mistakes. I would think trying to stay in the old system, trying to stay in the old ways was a mistake that got us starting to transform toward population health and population management.
Source: sbnonline.com

Local hospital plans healthy: SummaCare, AultCare serving communities, eye growth in future.

Jun. 18–Hospitals nationwide are pulling the plug on their hospital-owned health insurance plans. But a handful — including at least two in Northeast Ohio — are sticking it out and helping maintain competition within the communities they serve. Leaders from Summa Health System’s SummaCare in Akron and Aultman Health Foundation’s AultCare in Canton say they’re committed to remaining a locally owned option for the thousands of area businesses and consumers. SummaCare is a vital part of Summa Health System, said Thomas J. Strauss, Summa’s president and chief executive. About 15 percent of Summa’s hospital revenues come from SummaCare, making the health plan the system’s largest payer aside from Medicare and Medicaid, he said. ‘If you’re just a hospital, you only get paid when patients are sick,’ he said. ‘There’s no incentive for you to keep that patient well and out of the hospital. If you’re an integrated system, you can actually work on true wellness and generate benefit financially to keep patients out of the hospital. ‘I’m absolutely convinced this is part of the future.’ Likewise, Aultman Health Foundation views AultCare as a vehicle to pass on lower charges at Aultman Hospital to the community, said Joe Novak, AultCare’s vice president for provider services. The hospital only contracts with AultCare, Novak said. ‘The goal was to not have a profit and keep the money in town,’ he said. Both local insurers operate with razor-thin margins. SummaCare has an operating margin of 2 percent to 3 percent each year, while AultCare’s averages less than 1 percent. In comparison, the health insurance industry posts an average operating margin of 6 percent, with some publicly traded companies approaching double-digit margins, said Rick Byrne, Ohio market analyst for HealthLeaders InterStudy, an industry research firm in Nashville. Unlike their larger competitors, hospital-owned insurers aren’t looking to make big bucks, said Cathy Eddy, president of the Health Plan Alliance, a group based in Texas that represents 37 provider-owned health plans. ‘The plan helps support the overall objectives of the system,’ she said. During the 1980s and into the mid-1990s, many hospitals were looking to diversify and develop strategies to get more patients, Eddy said. AultCare started in 1985, and SummaCare started five years later. Many hospitals also got into the insurance business because of potential changes in the way hospitals were paid, said Alan Bleyer, Akron General Health System’s president and chief executive. Akron General acquired HomeTown Health Network in 1999 when it purchased Massillon Community Hospital. Back then, he said, it appeared the industry was moving toward paying hospitals capitated rates. Under that scenario, insurers pay contracted hospitals a set amount of money per enrollee per month regardless of the amount of care provided. Evolving strategy
Source: blogspot.com

UNITED STATES WILKINS v. UNITED HEALTH GROUP INCORPORATED, No. 10–2747., June 30, 2011

Posted by:  :  Category: Medicare

Appellants assert that 42 C.F.R. § 423.509, pursuant to which CMS may terminate a contract with a Medicare sponsor that fails to comply with the applicable marketing guidelines, demonstrates “[t]he relevancy and materiality of compliance” with the marketing guidelines. Appellants’ br. at 23. Indeed, section 423.509 states that “CMS may at any time terminate a contract if CMS determines that the Part D plan sponsor ․ [s]ubstantially fails to comply with ․ [m]arketing requirements in subpart V of this part.” 42 C.F.R. § 423.509(a)(8)(i); 42 C.F.R. § 422.510(a)(11) (same for MA organization). The same regulation, however, provides that before CMS may issue a notice of intent to terminate a Medicare contract it will provide a plan sponsor “a reasonable opportunity of at least 30 calendar days to develop and implement a corrective action plan to correct the deficiencies.” 42 C.F.R. § 423.509(c)(1)(i); 42 C.F.R. § 422.510(c)(1)(i). The regulation further provides, in section (c)(2)(iii), an exception for the 30–day correction period if the termination is based on “credible evidence, [that the Plan Sponsor] has committed or participated in false, fraudulent, or abusive activities affecting the Medicare, Medicaid, or other State or Federal health care programs, including submission of false or fraudulent data.” 42 C.F.R. § 423.509(a)(4); 42 C.F.R. § 422.510(c)(2)(iii) (referring to 42 C.F.R. § 422.510(a)(4)). The regulation also contains an exception to the requirement that a sponsor be allowed a 30–day correction period where CMS’s delay in termination, or the financial difficulties of the Plan Sponsor, pose an imminent and serious risk to the health of the individuals enrolled in the sponsor’s plan. 42 C.F.R. § 423.509(c)(2)(i)-(ii); 42 C.F.R. § 422.510(c)(2)(i)-(ii). Thus, sections 423.509 and 422.510 clearly demonstrate that compliance with the marketing regulations is a condition of participation and not a condition of payment as the regulations draw a line between the type of violations which are correctible and, if corrected, will allow the sponsor to continue as a Medicare program participant and the type of violations which lead to immediate termination of a CMS contract.
Source: findlaw.com

Video: GBMC Primary Care – Debbie Jones, CRNP

U.S. News & World Report/National Committee for Quality Assurance Ranks Great Lakes Health Plan among "America’s Best Health Insurance Plans" for 2009

The 2009-2010 ‘America’s Best Health Insurance Plans’ survey also recognized three other Michigan Medicaid plans in the Top 20. The results are published online at http://health.usnews.com/sections/health/health-plans/index.html and will be featured in the December 2009 issue of U.S. News & World Report. About the study This collaborative study ranked the nation’s commercial, Medicare and Medicaid health plans based on access to care (member’s ability to get needed care, quickly contact health plan customer service), overall member satisfaction, prevention services (health screenings, prenatal care, childhood and adolescent immunizations, avoiding antibiotic overuse and well-child visits), treatment (how well the plan takes care of ongoing health problems), and overall quality score (a combination of the scores from the four main categories above and NCQA accreditation). ‘America’s Best Health Insurance Plans’ is a trademark of U.S. News & World Report. About Great Lakes Health Plan Great Lakes Health Plan (GLHP) serves 204,000 people for Michigan Medicaid in 25 counties, including: Allegan, Berrien, Branch, Cass, Calhoun, Hillsdale, Huron, Jackson, Kalamazoo, Kent, Lenawee, Livingston, Macomb, Monroe, Muskegon, Oakland, Oceana, Ottawa, Saginaw, Sanilac, St. Clair, St. Joseph, Tuscola, Van Buren, and Wayne. The health plan is a unit of AmeriChoice, the public sector health care business of UnitedHealth Group (NYSE: UNH). UnitedHealth Group is a diversified Fortune 50 health and well-being company. AmeriChoice serves 2.7 million people in government-sponsored health care programs in more than 20 states and the District of Columbia. For more information, visit www.americhoice.com.
Source: blogspot.com

Tax Evasion and Medicaid/Medicare Fraud : South Carolina Nursing Home Blog

Since all Ameri-Choice checks come from the United Health’s home office they should be held equally responsible for any bribes, kickbacks, Stark, Fraud and inducements violations that may have occured. Federal and State Governments have developed such a depended position with this company, guess the laws and rules no longer apply for them. Protected vendor status sure, politics sure, limited government budgets sure, Federal and State officals looking the other way sure, and rather then stop these activities a strong desire not to rock the boat exists. The Government created this monster and now they don’t know what to do about it, like shooting yourself in your own foot etc. Tons of money to advance their national growth, its market positions, tons of money for political donations, tons of money to send 75 millon back to its home office from New York state alone, tons of money to suppot National TV shows, tons of money to pay hugh State fines, tons of money to hire the very best law firms, tons of money for hugh salarys and bonuses, all done on the back of the American taxpayor, you see this company receives all its money from the Federal State governments.
Source: scnursinghomelaw.com

united healthcare on consultation cpt code

Account Receivable billing Anesthesia billing Appeal Letter AR analysis AR Person role and reposnsibility ASC BCBS Eob Calling claim submission address Clearing House CMS – 1500 CMS – 1500 billing instruction CPT and HCPCS codes CPT Modifier Denial claim Denials and Actions DME billing Electronic claims submission Forms and Letters Glossary Glossary & medical Billing Concept. HMO and PPO Insurance Medicaid Medicaid denial reason codes Medical billing basics Medical billing concept Medical Billing Concepts Medical billing process Medical billing update Medical coding Medicare medicare codes Medicare CPT codes Medicare denial Medicare EOB reason codes Medicare secondary payer Medigap Misc Modifiers payments surgical billing Tips and Tricks Top ten Useful Websites
Source: medicalbillingguideline.org

Common health insurance questions answered: What is medicare advantage?

Posted by:  :  Category: Medicare

The PARTY Is OVER ...item 4.. Today, Mitt Romney Lost the Election (Sep 17, 2012 6:02 PM ET) ...item 5.. James Brown - Get On The Good Foot, Soul Power, Make It Funky Soul Train 1973 ... by marsmet471Private companies, such as Blue Cross Blue Shield Michigan and Blue Care Network, contract with Medicare to offer these plans to individuals who purchase their own coverage and through employer and union groups. Medicare beneficiaries who buy their own coverage have many plan options to consider. Insurers often offer several different benefit plans with various benefit levels and monthly premiums. They include extras to make their plans more attractive to prospective members. Some enhancements to look for are:
Source: ahealthiermichigan.org

Video: Medicare Supplement Plan G

Wyandotte, Michigan Medicare Supplement Plan G

In an earlier post on this blog, we looked at Medicare supplement plan F, and how it is the most popular supplement plan on the market.  With this post, we are going to look at Michigan Medicare supplement plan G, and how it might be the available product on the market.
Source: cheapinsuranceinmichigan.com

G.O.P. Offers Romney Plan as Compromise

Rep. Dave Camp, for instance, said in a Wednesday press release that “there is a better path forward than simply increasing tax rates, and one in which both sides can claim victory. … There is bipartisan support for tax reform that closes loopholes and lowers rates.” Eric Cantor said in a letter to his Republican caucus that “What would be best is a fundamental reform of the tax code that lowers rates, broadens the base, makes America’s business competitive again, and reduces the burden imposed by taxes on work and investment.”
Source: nytimes.com

Medigap: Sacramento, Placer Medicare Supplement Rates

Independent agent for health and life insurance in northern California. CA LIC. 0H12644. Focusing on families, individuals, self employed and small business. Representing several insurance carriers including Medicare Advantage and Part D Plans. Life insurance, final expence and funeral trusts. My pledge to my clients: 1. I respect your time and decisions. 2. I will not try to sell you something you do not want or need. 3. I will not call you after 5pm unless you ask me to.
Source: insuremekevin.com

Medicare Supplement and Medicare Advantage

As the annual enrollment period has begun, it is a good time to review the differences between Original Medicare, Medicare Supplements and Medicare Advantage.  Let’s start with Original Medicare.  This is a plan by the Federal Government for people 65 and older (there are also some ways to qualify if you are disabled in which you would qualify under age 65).  You have been paying for Medicare Part A (hospitalization) all of your life through a payroll deduction.  You will pay a Part B premium. It covers a lot of your health care, but NOT ALL of your health care.  There are a lot of “gaps”.  That is why Medicare Supplements are often times referred to as “Medigap” policies.  They are designed to fill the “gaps” in Medicare.  Medicare Supplements are offered by private insurance companies, but unlike the under 65 market, all Medicare Supplement plans are the same.  In other words, Plan F, is Plan F regardless if it is with United Health Care, or Blue Cross, or Aetna, or Mutual of Omaha.  So you do not have to wonder if Blue Cross is better coverage, or Aetna is better coverage, they are the same.  Now there are different supplement plans such as Plan N or Plan G, but again they are the same.
Source: isellhealth.com

Give Us Liberty: We couldn’t afford Medicare or Medicaid. They’re unfunded liabilities by trillions of dollars, when projected into the future. And the solution is

Posted by:  :  Category: Medicare

We need to get this to the Fiscal Cliff! What could go wrong? by DonkeyHoteyWe couldn’t afford Medicare or Medicaid. They’re unfunded liabilities by trillions of dollars, when projected into the future. And the solution is — what? To impose a third government insurance program that we can’t afford — ObamaCare? MUST READ ARTICLE FOR ALL AMERICANS…BE SURE SHARE WITH THE OBOTS YOU KNOW…SEE IF THEY CAN GET THEIR PEA-BRAINS AROUND THIS:
Source: blogspot.com

Video: Medicfusion Custom Forms – Medicare ABN Form

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

In Swing States, Obama Leads on Handling of Medicare

Mr. Romney and Mr. Ryan have called for curbing the growing costs of Medicare by making major changes to the program. Their plan would change Medicare for people who are now under 55 so that when they are eligible for coverage they would no longer receive a government-guaranteed, fee-for-service health plan but rather a fixed amount of money each year that they would use to purchase private health insurance or buy into a version of the existing Medicare program. But they have not provided enough details of their plan to assess how much it might increase out-of-pocket costs for future beneficiaries. Mr. Obama has pledged to preserve Medicare in its current form, but has spoken less about its rising costs.
Source: nytimes.com

Medicare News: Young Workers’ Benefits At Center Of Fiscal Debate

The Miami Herald: Feds: Medicare Millions Moved To Cuba Through Canada, Trinidad And Mexico A South Florida money-laundering network secretly transferred more than $30 million in illegal Medicare profits through a remittance firm with shell companies in not only Canada and Trinidad, but also in Mexico, according to court records filed Monday. Evidence of the widening network into Mexico surfaced in the federal plea agreement of a one-time Miami medical equipment provider who pleaded guilty Friday to his role in the money-laudering conspiracy (Weaver, 11/5).
Source: kaiserhealthnews.org

IRS Reverses Position on Deducting Medicare Premiums

The 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

Tax Tip Tuesday: Questions and Answers for the Additional Medicare Tax

If a former employee receives group-term life insurance coverage in excess of $50,000 and the resulting income is in excess of $200,000, how does an employer report Additional Medicare Tax on this? The imputed cost of coverage in excess of $50,000 is subject to social security and Medicare taxes, and to the extent that in combination with other wages it exceeds $200,000, it is also subject to Additional Medicare Tax. When group-term life insurance over $50,000 is provided to an employee (including retirees) after his or her termination, the employee share of social security and Medicare taxes and Additional Medicare Tax on that period of coverage is paid by the former employee with his or her tax return and is not collected by the employer. An employer should report this income as wages on Form 941, Employer’s QUARTERLY Federal Tax Return (or the employer’s applicable employment tax return), and make a current period adjustment to reflect any uncollected employee social security, Medicare, or Additional Medicare Tax on group-term life insurance. However, unlike the uncollected portion of the regular (1.45%) Medicare tax, an employer may not report the uncollected Additional Medicare Tax in box 12 of Form W-2 with code N.
Source: growaz.org

Montreal Simon: Stephen Harper’s Stealth Attack on Medicare

Total health-care costs as a share of the economy did rise when the economy tanked in 2008-9 but they have been falling for two years. For the past two years, provincial government health costs have also fallen as a share of GDP and as a share of their overall spending. Far from hitting the forecast 70 per cent, or even 50 per cent of program expenditures, provincial health costs are less than 38 per cent of program spending and falling.
Source: blogspot.com

Daily Kos: Take Social Security off the table

Alumbrados, paradox, Ed in Montana, Angie in WA State, Sylv, oofer, hester, MouseThatRoared, expatjourno, hubcap, niemann, geordie, TracieLynn, cyberKosFan, susakinovember, chuckvw, marylrgn, bincbom, Terre, ctsteve, hopesprings, ninothemindboggler, Ryvr, 2laneIA, ranger995, Jujuree, lcrp, rambler american, Sybil Liberty, Skennet Boch, 3goldens, jrooth, ichibon, el dorado gal, democracy inaction, YucatanMan, where4art, LucyandByron, SBandini, Bob B, Jim R, skywriter, martini, detroitmechworks, tommymet, AoT, fou, blueoasis, megisi, praenomen, global citizen, SadieSue, democracy is coming, CA Nana, profh, means are the ends, Dreaming of Better Days, SD Goat, shaharazade, cpresley, One Pissed Off Liberal, phonegery, Old Gardener, Deadicated Marxist, Debs2, devis1, EdSF, puakev, FishOutofWater, david mizner, rantsposition, Rosalie907, bobswern, carpunder, uciguy30, GeorgeXVIII, South Park Democrat, fb, mconvente, TruthFreedomKindness, Roger Fox, Involuntary Exile, mikeconwell, monkeybrainpolitics, tofumagoo, RandomNonviolence, priceman, Robobagpiper, 207wickedgood, clent, McGahee220, divineorder, maryabein, DefendOurConstitution, geebeebee, bfitzinAR, papahaha, kevinpdx, Little Flower, Words In Action, melpomene1, gulfgal98, ItsSimpleSimon, 2020adam, xhale, Johnny Q, science nerd, redlum jak, sostos, implicate order, FarWestGirl, PedalingPete, PorridgeGun, evangeline135, OneL, PhilJD, jolux, dradams, quill, pistolSO, IndieGuy, a2nite, Ginger1, sreeizzle2012, Mr Robert, edebs, tytalus, George3, wasatch, CalBearMom, Lily O Lady, poopdogcomedy, rigcath, Jim Domenico
Source: dailykos.com

StrataPT News: Has your Medicare patient been discharged from Part A?

The repercussions are that you either do not receive payment at all or the payment that you did receive for your time and services is recouped by Medicare. This type of denial can be one of the most frustrating and unfortunate denials to receive because as the clinician, you have done everything correctly.  You provided skilled care, your documentation was compliant and claims were billed appropriately.  However, the ball is often dropped as a result of the patient failing to mention that they were also being seen by a home health agency. 
Source: stratapt.com

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

Posted by:  :  Category: Medicare

Cassandra Q. Butts by Center for American ProgressFor 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

Video: Diagnostic Ultrasound Medicare fee change Petition

Doctors billing Medicare patients at higher rates, report finds

“This is an urgent problem,” Dr. Mark McClellan, who directs the Engelberg Center for Health Care Reform at the Brookings Institution in Washington, told the CPI. McClellan, a former director of the Centers for Medicare and Medicaid Services, or CMS, said the agency must send a message that it “won’t stand by and do nothing … that they are paying attention to this.”
Source: nbcnews.com

The Opinion Blog: Face the Facts

FACT: Physicians treating Medicare patients face a 27 percent cut in fees in 2013 unless Congress again overrides the law. Twelve percent of the Medicare budget, or $67.6 billion, goes to doctors. Congress passed a law in 1997 mandating reductions in doctors’ fees to put a brake on Medicare costs, but has routinely overridden it ever since in a legislative maneuver known as the “doc fix.” If the “doc fix” is not repeated, the reduced payments to Medicare doctors are expected to save $11 billion in fiscal 2013. If the override votes continue, it is expected to add $316 billion to the federal deficit over 10 years.
Source: typepad.com

CBO Emphasizes Need To Trim Medicare Spending

The Hill: CBO: GOP Bill Revising Health Law Ratio Will Add To Deficit A Republican bill altering the healthcare law’s medical loss ratio (MLR) will add about $1 billion to the budget deficit over the next decade, the Congressional Budget Office (CBO) said Thursday. The Obama administration frequently touts the MLR as a policy that helps consumers. It mandates that insurers spend no less than about 80 percent of their premium dollars on medical care rather than administrative costs or profits. The difference insurance companies must send back to policyholders, producing more than $1 billion in consumer rebates this year. Rep. Mike Rogers’s bill (H.R. 1206) would exclude insurance brokers’ fee from counting as administrative costs under the ratio. Agents say the MLR in its current state threatens their business by incentivizing insurers not to work with them (Viebeck, 11/8).
Source: kaiserhealthnews.org

Fed Budgetary Experts Demolish CBO Health Cost Model, the Lynchpin of Budget Hysteria

Long-run projections of the U.S. federal budget have played a prominent role in discussions about fiscal policy and the design of major transfer programs for several decades. The projections typically show large fiscal imbalances owing to ramping up of retirement and health care costs relative to GDP. Health care costs are the key factor in these projections for two reasons. First, in current projections they are the prime source of growth of spending as a share of GDP. Second, they are the most uncertain part of the forecast. For example, the Congressional Budget Office’s most recent long run outlook shows spending on Medicare and Medicaid, the governments health programs for the old and poor, respectively, rising from 4.1 per cent of GDP in 2007 to 19.1 per cent of GDP in 2082.1 By contrast, Social Security benefits (the government’s main old-age pension program) increase only 2 percentage points, from 4.3 per cent of GDP in 2007 to 6.4 per cent in 2082. Another analysis by CBO suggests that an 80 per cent confidence band around the Social Security projection would be from 51⁄2 to 91⁄2 per cent of GDP.2 CBO did not present similar calculations for health spending; instead, they projected health spending under three different assumptions about the rate of growth of age-adjusted health care spending in excess of per capita income. Their projections show health spending ranging from 7 to nearly 40 per cent of GDP by 2082.
Source: nakedcapitalism.com

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

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

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

The “Appellate Gourmet (c)”: Attorney’s fees, injunctions, repeat violence and Medicare fraud, with arugula and Manchego cheese galettes

(Reuters) — Enrollment in Medicare Advantage, the private insurance segment of the popular U.S. health care program for the elderly, is expected to grow 11 percent next year while premiums remain steady, government health officials said Sept. 19. The U.S. Centers for Medicare and Medicaid Services estimated that 14.5 million people will enroll in Medicare Advantage plans in 2013, based on insurance industry expectations. That is up from 13.1 million people this year.
Source: blogspot.com

Accreditation for Office Based Surgery vs. Ambulatory Surgery Centers: Frequently Asked Questions

Accessibility Codes Americans with Disabilities Act State & city-specific requirements In all cases, surveyors would expect to see reasonable separation of unrelated tasks and certainly clean and soiled work rooms. Q. Why accreditation for office-based surgery? A. 1. Often fulfills state requirements for office based surgery. 2. Expedites third-party payment. 3. May favorably influence liability insurance premiums. 4. Favorably influences managed care contract decisions. 5. Enhances community confidence. 6. Aids in professional staff recruitment. Ambulatory surgery center accreditation: The vast majority of commercial payors require accreditation (above and beyond state license, as applicable, and always Medicare certification) in order for the ASC to become a participating provider with their network. Documentation as proof must be submitted with the ancillary application before the request for ASC participation will even go through the company’s credentialing process. Q. What is deemed status? A: In order for a healthcare organization to participate in and receive payment from the Medicare or Medicaid programs, it must meet the eligibility requirements for program participation, including a certification of compliance with the Conditions of Participation (or Conditions for Coverage, CfCs, for health care suppliers) set forth in federal regulations. This certification is based on a survey conducted by a state agency on behalf of the Centers for Medicare & Medicaid Services. However, if the state will not provide initial or ongoing Medicare surveys, using a national accrediting organization is the answer. They have and enforce standards that meet or exceed Medicare’s CoPs (or CfCs). CMS grants accrediting organization “deeming” authority. Note that state departments of health have been given the guidance from CMS to put ASC surveys for Medicare on a non-emergent basis. For most types of healthcare providers or suppliers, accreditation is voluntary and seeking deemed status through accreditation is an option, not a requirement. Seeking a Medicare certification survey through an accreditation organization for purposes of Medicare certification, however, is not an option … that is, if the ASC wants facility fees! Q: Who is responsible for Medicare surveys? A: Whoever did the initial survey is responsible unless told otherwise. For instance, if the state did the initial survey but an accreditation organization did just the accreditation, you would not have to ask the organization for another Medicare survey. On the other hand, if the accreditation organization was asked to perform the initial Medicare survey, not requesting it on the next accreditation cycle, would indicate that the ASC was dropping their participation and the state would be notified. This would prompt a survey from the state. Resources: ο American Association of Ambulatory HealthCare ο Joint Commission on Accreditation of Healthcare Organizations ο American Association for Accreditation of Ambulatory Surgery Facilities
Source: beckersasc.com

Medicare Open Enrollment Ends Soon

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SS“A lot can happen in a year,” says Linda F. Fitzgerald, state president of AARP Massachusetts, which represents more than 800,000 members age 50 and older in the commonwealth.  “You may have been diagnosed with a new medical condition, changed medications, or moved.  There may also be changes to your Medicare plan.  Now is the time to take a close look at your medical needs – including prescription drugs – and make sure you have the Medicare plan that’s best for you.”
Source: patch.com

Video: Understanding Medicare Advantage Plans

Obama administration hides Medicare Advantage cuts in demonstration project

“Over the next few years the Affordable Care Act cuts about $156 billion worth of subsidies from Medicare Advantage plans,” Herrick said. “Nearly one in four seniors are enrolled in a Medicare Advantage plan. Half of these may lose their plans, as plans that are no longer profitable close due to the budget cuts. However, millions of seniors being thrown off their private Medicare plans in an election year is not something that’s welcome by the Administration.
Source: consumerinsuranceguide.com

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

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

Q&A: Medicare open enrollment too often overlooked

Medicare does not cover everything. You still have to pay out of pocket. This year, the Part A deductible is $1,156 if you go in the hospital. For Part B, there’s a $140 deductible, plus 20 percent of everything over that. If you have outpatient therapy for cancer, it could be $10,000 a month, so your share would be $2,000. It can really add up to big money.
Source: sltrib.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

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

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

CBO Emphasizes Need To Trim Medicare Spending

Posted by:  :  Category: Medicare

The Hill: CBO: GOP Bill Revising Health Law Ratio Will Add To Deficit A Republican bill altering the healthcare law’s medical loss ratio (MLR) will add about $1 billion to the budget deficit over the next decade, the Congressional Budget Office (CBO) said Thursday. The Obama administration frequently touts the MLR as a policy that helps consumers. It mandates that insurers spend no less than about 80 percent of their premium dollars on medical care rather than administrative costs or profits. The difference insurance companies must send back to policyholders, producing more than $1 billion in consumer rebates this year. Rep. Mike Rogers’s bill (H.R. 1206) would exclude insurance brokers’ fee from counting as administrative costs under the ratio. Agents say the MLR in its current state threatens their business by incentivizing insurers not to work with them (Viebeck, 11/8).
Source: kaiserhealthnews.org

Video: What Does Medicare Cost?

Best Bets for Reducing Medicare Costs for Dual Eligible Beneficiaries: Assessing the Evidence

With pressure mounting to slow the growth in federal health care spending, policymakers are exploring ways to reform the way care is delivered to the 9 million low-income Medicare beneficiaries who also receive Medicaid – a group that on average is sicker and frailer than other Medicare beneficiaries, and therefore receive significantly more care at greater cost. Major efforts are underway at the federal and state level to better coordinate care for this population and lower health care costs – with some estimates projecting hundreds of billions of dollars in savings over the next decade.
Source: kff.org

Medicare cost control in action

Modern Principles of Economics Launching The Innovation Renaissance The Great Stagnation: How America Ate All the Low-Hanging Fruit of Modern History, Got Sick, and Will(Eventually) Feel Better Create Your Own Economy: The Path to Prosperity in a Disordered World Discover Your Inner Economist Good and Plenty: The Creative Successes of American Arts Funding Judge and Jury: American Tort Law on Trial Markets and Cultural Voices: Liberty vs. Power in the Lives of Mexican Amate Painters (Economics, Cognition, and Society) The Voluntary City: Choice, Community, and Civil Society (Economics, Cognition, and Society) Creative Destruction: How Globalization Is Changing the World’s Cultures Changing the Guard: Private Prisons and the Control of Crime What Price Fame? In Praise of Commercial Culture Entrepreneurial Economics: Bright Ideas from the Dismal Science
Source: marginalrevolution.com

Medicare Payments Could Increase By $10 Billion in 2013

The report also forecasts the costs of eliminating the Budget Control Act of 2011, which calls for automatic reductions for defense and nondefense programs, including entitlements, from fiscal year 2013 through 2021. In August, the CBO estimated those sequestration cuts would reduce Medicare spending by about $4 billion in FY 2013.
Source: dmagazine.com

Reducing Costs for Dual Eligible Medicaid and Medicare Beneficiaries is Tricky

It is impossible to write about elder care in America, without consistently revisiting the subject of caring for dual-eligible beneficiaries. Older adults (those +65 years of age) account for 61 percent of this population of 7 million who are eligible for full benefits under the Medicaid and the Medicare program. The remaining dual-eligible beneficiaries are  younger Americans with physical disabilities who qualify for SSI benefits. Dual-eligibles tend to be low-income individuals with few financial assets and unfortunately also tend to have significantly higher rates of serious health conditions, ADL limitations and cognitive impairments. As the chart (below) illustrates, they represent a disproportionate portion of total expenses for both the Medicare and Medicaid programs. It is not surprising that reducing spending (while improving care delivery) for this population is the holy grail of policymakers in Washington and every state capital in the nation.
Source: chicagonow.com

Is Medicare Spending the Biggest Driver of the Deficit?

Up until about 1970, the government more or less balanced its budget. There were surplus years and deficit years, but on average, the government ran a surplus of about $2 billion over the period 1929 through 1969. Starting in 1970, the government began to run sustained deficits, and by 1982, the government had spent a cumulative total of about $80 billion in excess of revenues received since 1929. At this point, what was essentially a flat line accelerates into what looks like exponential growth in debt. The deficit really starts to go off the cliff in 2008 with a $600 billion deficit, and the government outspends its revenues in excess of $1 trillion in each of the final three years of data. So where is this deficit and debt coming from? Is it entirely due to the fact that the government provided a fiscal stimulus, or perhaps due to the bailout of the banking system? Do we have a deficit because income tax revenues are too low? Is there a mass of wasteful spending, or is the government spending too much on defense?
Source: mygovcost.org

ARRA News Service: By the Numbers: Medicare Costs for Seniors to Rise Under President’s Plan

Sarah Morris, Heritage Investigates: Under current law, as amended by Obamacare, seniors enrolled in traditional Medicare can expect to face higher Part B and Part D premiums. Moreover, President Obama has planned in his 2013 budget proposal to increase income-related Part B and Part D premium coverage by 15 percent. As a result, out-of-pocket costs are expected to rise by 2017 under the president’s budget proposal. Under Obama’s plan, “seniors will pay more — a lot more — and they will pay this steep price in many different ways,” Heritage’s Robert E. Moffit, Rea S. Hederman and Alyene Senger explain in a new paper analyzing the impact on seniors. Americans may have diverse opinions on Medicare reform but what remains certain is that Medicare “as we know it” is already a thing of that past.
Source: blogspot.com

SMART Act Would Reduce Medicare Spending by $45 Million

42 USC §1395y(b)(8) Allocation Centers for Medicare & Medicaid Services (CMS) Centers for Medicare and Medicaid Services CMS conditional payment conditional payments Franco Signor Franco Signor LLC Future Medicals Hadden v. U.S. Jeffrey J. Signor Kate Dolan Liability Medicare Set-aside Arrangement LMSA Mandatory Insurance Reporting MARC Medicare Medicare & Medicaid Schip Extension Act of 2007 Medicare beneficiary Medicare Secondary Payer Medicare Secondary Payer Act Medicare Secondary Payer Compliance Medicare Secondary Payer Manual Medicare Secondary Payer Statute Medicare Set Aside Medicare Trust Fund MMSEA MSP MSP compliance MSP exposure MSPRC ORM Primary Plan protect Medicare’s interests reimbursement reimbursement rights Roy A. Franco Roy Franco SCHIP Extension Act Section 111 Section 111 Mandatory Insurance Reporting Section 111 reporting WCMSA Workers’ Compensation
Source: francosignor.com

CBO: As They Stand, Medicare Payment Rates to Cost $10B More in FY 2013

The non-partisan Congressional Budget Office has estimated the financial repercussions of maintaining Medicare’s current payment rates to physicians, finding it would increase federal spending by $10 billion in fiscal year 2013. The CBO says if lawmakers override the anticipated 27 percent reduction to physician reimbursement — part of the sustainable growth rate formula, which is scheduled to take place Dec. 31 — federal spending on Medicare would consequentially exceed amounts projected in the CBO’s baseline. Lawmakers have overridden the scheduled fee reductions each year since 2003. “For example, if payment rates stayed as they are now, outlays for Medicare would be $10 billion higher in fiscal year 2013 and $16 billion higher in fiscal year 2014,” according to the report. The report also forecasts the costs of eliminating the Budget Control Act of 2011, which calls for automatic reductions for defense and nondefense programs, including entitlements, from fiscal year 2013 through 2021. In August, the CBO estimated those sequestration cuts would reduce Medicare spending by about $4 billion in FY 2013. In its new report, the CBO projects a combined scenario: If Medicare’s current payment rates for physicians are maintained and the sequestration cuts are eliminated. Those events would increase federal spending by roughly $40 billion in fiscal year 2013 and $61 billion in FY 2014, according to the report.
Source: beckershospitalreview.com

Judge Orders Halifax Health to Release Internal Emails in Whistleblower Case

Posted by:  :  Category: Medicare

A federal judge has ordered Daytona Beach, Fla.-based Halifax Health to release internal documents as part of a whistleblower lawsuit alleging Medicare fraud, according to a Daytona Beach News-Journal report. Halifax’s former director of physician services, Elin Baklid-Kunz, filed suit in 2009, claiming the health system’s physicians admitted patients for unnecessary procedures and improperly collected Medicare payments. The Department of Justice joined the suit in September 2011. In his order, Judge Thomas B. Smith wrote that two emails between the hospital’s finance and legal departments showed “that Halifax was engaged in or about to be engaged in fraudulent conduct” when it sought legal advice, according to the report. Officials from Halifax Health have denied any wrongdoing. They said the court’s order to release the internal documents is based on “unproven allegations and does not reflect any judicial findings of fact or law regarding the merits of the allegations,” according to the report. Halifax lawyers argued the documents were protected due to attorney-client privilege.
Source: beckershospitalreview.com

Video: TELG’s David Scher on the Implications of Recent Supreme Court Decision for Medicare Whistleblowers

Whistleblower Lawsuit Alleging Medicare Fraud Against Blackstone Medical, Inc., Dismissed

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Source: wordpress.com

Whistleblower Alleges Overbilling Of Medicare By Florida Hospice

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

Justice Department Joins False Claims Act Medicare Fraud Lawsuit

According to the lawsuit, HOTCI’s chief executive officer verbally instructed HOTCI employees to admit for hospice care patients with Medicare coverage, without determining whether those patients were in fact eligible for hospice benefits. Medicare hospice benefits are reserved for terminally ill patients with a life expectancy of six months or less. Under hospice care, because the patient has elected to end curative care and allow the disease to run its normal course, medical treatment is focused on providing patients with relief from pain and stress. Once informed by its Medicare contractor that a formal audit would be conducted, HOTCI formed an internal committee to review hospice eligibility of its Medicare patients.  Between 2009 and 2010, the company had to discharge at least 150 patients after determining that they were ineligible for Medicare hospice benefits.
Source: employmentlawgroupblog.com