Gynecologist Gets 5 Years For Role In $5.4M Medicare Fraud Scheme

Posted by:  :  Category: Medicare

Evidence at trial showed that the patients were not referred to the clinics by their primary care physicians, or for any other legitimate purpose, but rather were recruited with prescriptions for controlled substances, cash payments, and fast food. The three clinics then billed the Medicare program for various diagnostic tests that were medically unnecessary.
Source: cbslocal.com

Video: Sterling Stairlift

Medicare, Abortion Grab Attention In Some House, Senate Races

Politico: Wisconsin Senate: Can Tommy Thompson Recapture Magic? The last time Tommy Thompson appeared on a ballot Mike Holmgren was the head coach of the Packers, “ER” was the top-rated show on television and Twitter was still a decade away from mainstream popularity. The year was 1998, and Thompson sailed to a fourth term as governor, disposing of his Democratic opponent by a 21-percentage-point margin. … Yet, there’s evidence that Thompson’s more recent work in Washington has tarnished his sterling image back home. Thompson served as a senior partner at the Beltway lobbying powerhouse Akin Gump, making millions as a consultant on health care issues after serving as Health and Human Services secretary under President George W. Bush (Cantanese, 10/23).
Source: kaiserhealthnews.org

Medicare Supplemental Insurance: Pat Creech Insurance

401k business business insurance cheap life insurance finance forex forex trading home insurance how to trade forex income protection income protection insurance instant life insurance insurance Life Insurance life insurance quote life insurance quote on line life insurance quotes Medicare Supplemental Insurance no medical life insurance package insurance parcel insurance shipping insurance term life insurance term life insurance quotes trade forex
Source: insurancequotes24-7.com

Facts about ACA and Medicare

What Is the Truth about the ACA and Medicare? This video – titled  “Affordable Health Care – A Human Right and A Moral Imperative” was produced by OneWorld Progressive Institute a year ago to address this very question. It is a valuable antidote to much of the misleading and outright false information being spread today about Medicare and the new Affordable Care Act.  The sole intent of such misinformation is to frighten some of the most vulnerable people in the country.  The same thing happened in 1965 when Medicare was being debated.
Source: ning.com

Nigerian Doctor Jailed in U.S. for Medicare fraud

A 63-year-old Nigerian physician, Jonathan Agbebiyi, of Sterling Heights, Michigan, has been sentenced to 60 months imprisonment for his role in a $5.4 million medicare fraud scheme, elombah.com has learnt. This was contained in a statement issued by the United States Attorney Barbara L. McQuade. According to the statement
Source: elombah.com

Dr. Jonathan Agbeyiyi, gynecologist, gets five years for $6.7 million Medicare fraud

Ameritox ASTRO Bernie Ness CAP Client Billing College of American Pathologists David Neal Shepard Florida Forensic pathology Healthcare Fraud IMRT In-Office Pathology Inc. in office lab Jean Mitchell Joe Plandowski Joseph Sonnier kickback LabCorp laboratory lawsuit legislation Medicaid Medicaid Fraud Medical malpractice Medicare Medicare Fraud MedTox Millennium Laboratories Myriad Genetics Ontario pathologist Pathology Pathology Malpractice Physician self-referral press release prostate biopsies prostate cancer Quest Diagnostics radiology Self Referral stock Supreme Court Urology Whistleblower
Source: pathologyblawg.com

Providers Hold Bills to Achieve Higher Pay from Settlements.

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

Event Recap: Let’s Talk #HIT with David Harlow

The term ‘Accountable Care Organization (ACO)’ first cropped up in 2006 during a Medicare Payment Advisory Commission meeting. Initially named by Eliot Fisher, the Director of the Center for Health Policy Research at Dartmouth, an ACO is defined as a healthcare payment and delivery model where a network of providers and/or organizations agree to share the responsibility, accountability and cost of a patient’s treatment plan. These goals are achieved by a greater focus on wellness, increased inter-departmental communications, and improved access to patient information. After a certain amount of time, providers analyze and compare patient’s care and payment data to similar beneficiaries. In addition, the Center for Medicare and Medicaid Services (CMS) introduced “Bundled Payment” plans, wherein patients receive one bill across a longer episode of care—such as a knee replacement—rather than a series of claims from multiple providers. If these collaborative efforts help the network save funds due to lower costs through reduced treatments, the network shares in the savings.
Source: scratchmm.com

CMS Letter on Poor Performing Medicare Advantage Plans

CMS has also created an SEP allowing beneficiaries one chance to move from a “poor” performing plan to one that is rated 3-Star or higher after January 1, 2013.  This SEP is not agent driven however, so in order for someone to take advantage of this, the individual must call 1-800-MEDICARE. There are no timeframes, end dates, etc. associated with this SEP and CMS will be granting the SEP on a case-by-case basis. Beneficiaries will be receiving letters regarding this as well.
Source: agentpipeline.com

Sterling Investors Medicare Supplement Plans

It’s human nature for a person to constantly feel secured. If they feel safe, if they feel like they don’t have to worry, then they can enjoy themselves. They can be themselves. This idea can apply to many contexts. If parents are dropping their kids off at a well-maintained and secured daycare, they know they’re in good hands. Family members double check their supplies to be sure they’re completely prepared for the camping trip. The very same idea goes for seniors and healthcare insurance. Elderly people and their families want to be certain that they are receiving top quality healthcare insurance. They also want to have options that meet their requirements.
Source: gomedigap.com

Medicare Supplement Claims/Provider File Analyst

Job Title: Medicare Supplement Claims Analyst – Provider/Network Focus FLSA: Non-exempt Reports to: Supervisor, Medicare Supplement Claims Class: CU9 Summary… From Sterling Life Insurance Company – 22 Jun 2012 21:58:40 GMT – View all Bellingham jobs
Source: washingtonjobdaddy.com

CPIDs 2161 and 1620 Guardian Healthcare No Longer Accepting Electronic Claims Effective 01/01/2012

Effective immediately, t he following payer will no longer accept electronic claims with dates of service on or after 01/01/2012: CPID 2161 Guardian Healthcare – Professional CPID 5975 Guardian Healthcare – Institutional Electronic claims with dates of service on or after 01/01/2012 must now be submitted to the following payer: CPID 6111 Sterling Medicare Advantage – Professional CPID 1620 Sterling Medicare Advantage – Institutional If you have already submitted electronic claims to Guardian Healthcare this year, those claims may have been rejected and will need to be submitted to Sterling Medicare Advantage. Please be sure to submit electronic claims to the correct payer. If you have any questions, please contact Client Services at 1-888-348-8457, option 2.
Source: collaboratemd.com

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

Posted by:  :  Category: Medicare

bag & contents - Stolen by quadrapopThe 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: Medicare Quote Engine Software Enhancement Demo

Social Security & Medicare Changes for 2013

The Social Security Administration (SSA) announced on Tuesday, October 16, 2012 that the 2013 social security wage base will be $113,700, an increase of $3,600 from the 2012 wage base of $110,100.  As in prior years, there is no limit to the wages subject to the Medicare tax; therefore all covered wages are still subject to the 1.45% tax.  Wages paid in excess of $200,000 in 2013 will be subject to an extra 0.9% Medicare tax that will only be withheld from the employees’ wages.  Employers will not pay the extra tax.
Source: oasisky.com

Physical Therapy Software: Billing Medicare

Medicare is the standard setter for payers throughout the country and they seem to always be changing and evolving the way that they pay therapists. One question that comes to mind is how can you effectively bill Medicare while still keeping the flow of your system quick and easy to understand? As Medicare creates new rules and gets them set into place, other insurances are quick to follow, so it is necessary to understand how to bill Medicare in the early going or you risk the chance of being left behind. The big question that you need to ask is how can my practice management system help me bill Medicare properly?
Source: rehabsoftware.com

Owner of Medical Clinics in Euless and Houston Pleads Guilty to Role in Health Care Fraud Conspiracy That Involved Nearly $3 Million in Fraudulent Billings

DALLAS—The owner/operator of medical clinics located in Hurst and Houston, Texas, Ovsanna Agopian, 57, pleaded guilty today before United States Magistrate Judge Paul D Stickney in federal court in Dallas to one count of conspiracy to commit health care fraud. Her husband, Vagharshak Smbatyan, 60, who is charged in the same case with making a false statement to a government agency, entered a not guilty plea today in federal court in Dallas before Judge Stickney. Today’s announcement was made by United States Attorney Sarah R Saldaña of the Northern District of Texas. Agopian, aka “Joanna Ovsanna Agopian” and “Joanna Smbatyan,” faces a maximum statutory sentence of 10 years in federal prison and a $250,000 fine. In addition, restitution could be ordered. A sentencing date was not set. Agopian currently resides in Houston, Texas; her husband, Smbatyan, resides in Grenada Hills, California. Both remain on bond. According to documents filed in the case, Agopian was the operator of Euless Healthcare Corporation (EHC), located on West Bedford Euless Road in Hurst, Texas; and Medic Healthcare Incorporated (Medic) located on Bonhomme Road in Houston. EHC operated from approximately March 2010 to May 2011, and Medic operated from approximately October 2009 to May 2011. Agopian admitted that she conspired with co-defendants Tolulope Labeodan, Godwin Umotong, Leslie Omagbemi, Munda Massaquoi, and Comfort Gates to submit, or cause to be submitted, fraudulent claims to Medicare for diagnostic tests, falsely representing that the tests were performed, and falsely representing that the tests were performed at either EHC or Medic. The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention and Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and the Department of Health and Human Services (HHS) to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. Since their inception in March 2007, strike force operations in nine locations have charged more than 1,480 defendants who collectively have falsely billed the Medicare program for more than $4.8 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers. The investigation is being conducted by HHS-Office of Inspector General, the FBI, and the Medicaid Fraud Control Unit of the Office of the Attorney General of Texas. Assistant United States Attorneys Michael McCarthy and Michael Elliott are in charge of the prosecution. To learn more about the HEAT Strike Force, please visit: www.stopmedicarefraud.gov Reported by: FBI
Source: 7thspace.com

The truth behind the $716 billion in Medicare cuts

While the $716 billion figure has become reified in the rhetorical battle, there has been little analysis of the proposed savings and whether they would hurt Medicare beneficiaries. Although Romney and Ryan have accused the president of “robbing the Medicare program,” the $716 billion in Medicare savings under Obamacare are actually primarily reductions in over-payments to private insurers, hospitals, and other health care providers. Ryan accused the president and vice president of “getting caught with their hand in the cookie jar” —but he, too, had included these very savings in his own House budget.
Source: msnbc.com

Eagle Pass Business Journal

We hear a lot of back and forth about the Affordable Care Act — the federal health care law — but not much about how it affects people with Medicare. When you sort through all the rhetoric, one thing is clear: The 2-year-old law contains some real benefits for those who get their health insurance through Medicare. Take the “doughnut hole” in Medicare’s prescription drug program. During the first few years of the drug benefit, many seniors had to bear the full cost of their prescriptions once they reached this gap in coverage. It was a burden for most. But under the Affordable Care Act, seniors who fall into the hole are getting bigger and bigger price breaks on their drugs each year. By 2020, the gap will disappear. This year, for instance, you get a 50 percent discount on your brand-name drugs and a 14 percent discount on your generics while you’re in the doughnut hole. Those savings have added up to $197 million for almost 300,000 Texans with Medicare over the last year. That’s an average savings of $661 per person.
Source: epbusinessjournal.com

“The Basics” Chiropractic Medicare: Learn, Compliance, Paperless & Attestation

Going paperless is fabulous as long as you have a good Chiropractic software in your practice. I use Chirotouch software. This software leads you through the process of becoming paperless. I have to say, after doing written notes for forty-four (44) years, it is absolutely great to make a few clicks on the computer and not only have S.O.A.P. notes completed, but also produce “Documentation” by Federal Standards for Medicare, PI, etc.
Source: blogspot.com

FAQ: The Medicare EHR Incentive Program

Before dispensing incentive funds, the government wants to verify that eligible medical professionals are actively using EHR technology, not just purchasing it to avoid penalties. There is a list of minimum of criterion that medical professionals must meet to prove they will “meaningfully use” certain features of their EHRs. These requirements specify that an EHR must support 10 mandatory features, in addition to five optional features out of a list of 10. Medical practitioners must be actively using these features on their EHR for at least 90 days to meet government requirements for the incentive.
Source: softwareadvice.com

5 Ways Doctors Can Use EMRs to Boost Profitability

All of this reduces the amount of time you spend documenting visits and managing your practice. And since time is money, you should quickly recoup your investment in an EMR. If the time spent with each patient drops from 20 minutes to 18, you can probably get two more patients per day, which at just $100 in revenue per patient would increase revenue $50,000 per year. If you have ten office staff and you’re able to reduce their workload by 10 percent, you’ll end up saving an entire employee’s salary, or perhaps using your employees for more revenue-generating activities.
Source: softwareadvice.com

Advantra Medicare Advantage Changes

Posted by:  :  Category: Medicare

A major benefit of an Advantage plan is having a limit on your annual maximum out-of-pocket costs but the required coinsurance feature makes it a lot more likely that you will need this benefit compared to other Advnatra Medicare Advantage plans.
Source: affordablemedicareplan.com

Video: Videos matching: advantra medicare advantage

Coventry Health Care Adds Cornerstone Health Care (P.A.) to their Advantra Medicare Advantage Provider Network in North Carolina.

Cornerstone Health Care has nearly 300 providers (including primary care and specialty physicians, and mid-level professionals) in more than 70 locations in High Point, Winston-Salem, Greensboro, Summerfield, Thomasville, Archdale, Trinity, Jamestown, Kernersville, Lexington, Asheboro, and Advance.
Source: agentpipeline.com

Altius Health Plans Altius Advantra Medicare Review

Altius Health Plans offers Medicare health insurance programs for residence of Utah and a county in Wyoming.  Altius Advantra and Altius Advantra Preference are Medicare Advantage HMO plans available in Box Elder, Cache, Daggett, Davis, Duchesne, Morgan, Rich, Salt Lake, Summitt, Tooele, Wasatch, and Weber counties in Utah as well as Uintah county in Wyoming.  Altius Advantra is an HMO-POS plan, and Altius Advantra Preference is a plain HMO only available in Davis, Salt Lake, and Tooele counties.  The coverage does include Part D drug coverage as well as health benefits.  Below is a review of the benefits they offer:
Source: medicare-plans.net

Will Your Medicare Advantage Plans Still Be Available In 2010

All plans must send you a notice of termination if there plan is terminating. When a plan terminates they do NOT enroll you in a part D plan. In some cases a plan may try to change you to another plan that they offer, however in they are still required to notify you in writing and give you the full details and you still have the option of changing plans if you are not satisfied with the benefits offered. In the case of Advantra Plans this year, you will need to choose another Medicare Plan. Some Advantra Freedom plans were offered as MAPD which means that the plan itself included the prescription drugs. You may also have a PFFS and a seperate Part D. If the part D is seperate you should still have RX coverage. If you do want to keep Advantra as your Part D you can still get a seperate Part D plan as long as it is a PFFS. You should call a broker and get a list of comparable options. You can ask for health plans only if you wish. Also if you just want an evidence of coverage you can call Advantra back or visit http://www.choicesformedicare.org and request one. Make sure you are specific in your request and they will know what to send.
Source: wordpress.com

Pennsylvania Health Insurance

HealthAmerica’s Commercial and Medicare Advantage Plans Among Tops in Nation for Quality and Service on U.S.News & World Report/NCQA “America’s Best Health Plans 2008-09″ List Harrisburg and Pittsburgh, Pa. – November 10, 2008 — HealthAmerica’s HMO, POS, and Medicare Advantage plans were ranked among the nation’s top 20 best commercial and Medicare health plans according to a joint ranking by U.S.News & World Report and the National Committee for Quality Assurance (NCQA). Nationally, HealthAmerica was ranked 12th among 287 commercial plans; HealthAmerica’s Medicare Advantage plan, Advantra, ranked 18th among 216 plans nationally. HealthAmerica and HealthAmerica Advantra have ranked as one of the top 50 best health plans in the U.S. News/NCQA “Americaýs Best Health Plans” list* every year since 2005. “We are honored to be recognized among the best health plans in the nation,” said Kirk E. Rothrock, president and chief executive officer of HealthAmerica. “We are dedicated to providing the best possible quality and service, so we are pleased to see our efforts recognized by NCQA, U.S. News and World Report, and, most importantly, by our members and our customers.” The National Committee for Quality Assurance and U.S.News and World Report collaborated to rank the nationýs best commercial, Medicare, and Medicaid health plans. The ranking appears in the November 17 issue of U.S.News and on its website www.usnews .com/healthplans HealthAmerica”s and Advantra”s rankings are based on their Healthcare Effectiveness Data and Information Set (HEDISý)** 2008 scores and the results of a Consumer Assessment of Healthcare and Provider Systems (CAHPS) survey of members. HEDIS is a set of standardized performance measures covering effectiveness of care, preventive care, treatment, and customer satisfaction. CAHPS is a standardized survey in which members rate the quality of care and service that they receive from doctors, specialists, office staffs, and insurers. In these ratings, HealthAmerica’s commercial health plans were rated higher than the national average in all 15 key measures of medical services and member satisfaction and higher than the Pennsylvania state average in 12 of the 15 key measures***. HealthAmerica’s HMO, POS, and Medicare Advantage plans’ status of “Excellent” from NCQA was also a factor in determining the U.S. News/NCQA “America’s Best Health Plans 2008″ ranking**** The U.S.News/NCQA “Americaýs Best Health Plans 2008″ list is drawn from measures of prevention, treatment, and customer experience. These measures are compiled in NCQA”s Quality Compass 2008*****, which publicly reports comparative results of more than 400 commercial health plans covering 85 million Americans. Health plans throughout the country were evaluated on issues such as access to care, prevention efforts, treatment of diseases such as diabetes and heart disease, and members were surveyed on their satisfaction to calculate an overall quality score. * “America’s Best Health Plans” is a trademark of U.S. News & World Report. **HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). ***The source for this data is Quality Compass 2008 and is used with the permission of the National Committee for Quality Assurance (NCQA). Quality Compass is a registered trademark of NCQA. NCQA is a private, non-profit organization dedicated to improving health care quality. The 12 measures are: Child immunization (combo II), well child visits 3 to 6 years, colorectal cancer screening, prenatal care, first-trimester postpartum care, cervical cancer screening, breast cancer screening, diabetes-lipid profile (screen), controlling hypertension, cholesterol screening for patients with cardiovascular conditions, rating of all health care, rating of health plan. ****National Committee for Quality Assurance accreditation outcomes are: Excellent, Commendable, Accredited, and Denied. Applies to HMO and POS plans. *****Quality Compass is a registered trademark of NCQA. NCQA is a private, non-profit organization dedicated to improving health care quality. About HealthAmerica For over 33 years, HealthAmerica has provided health benefit solutions to employers across Pennsylvania. HealthAmerica offers a broad range of traditional and consumer-directed health insurance products, including managed care, HSAs, self-funded, Medicare, indemnity, nongroup and pharmacy plans. Serving 12,000 businesses and over 660,000 members as of December 31, 2007, in Pennsylvania and Ohio, HealthAmerica offers progressive medical management, innovative wellness programs, and statewide and national provider networks. HealthAmerica is ranked as one of “Americaýs Best Health Plans, 2006″ by U.S. News & World Report; its HMO and POS products have an “Excellent” accreditation by the National Committee for Quality Assurance. HealthAmerica has corporate offices in Pittsburgh and Harrisburg, Pennsylvania, and employs over 2,200 people in the commonwealth.
Source: blogspot.com

Medicare Advantage Plans and PFFS Plans

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Source: merchantcircle.com

HealthAmerica best Health Insurance within U.S.

About HealthAmericaFor more than thirty-three years, HealthAmerica provides presented health help methods of employers over Pennsylvania. HealthAmerica supplies a extended range connected with traditional and consumer-directed health care insurance products, such as handled care, HSAs, self-funded, Medicare, indemnity, nongroup as well as pharmacy plans. Serving 12,000 firms and through 660,000 users since of December 31, 2007, in Pennsylvania and also Ohio, HealthAmerica offers sophisicated health care management, modern wellness programs, as well as statewide and countrywide issuer networks. HealthAmerica can be graded together regarding “America’s Best Health Plans, 2006″ by U.S. News & World Report; its HMO as well as POS merchandise have an “Excellent” certification by the National Committee for Quality Assurance. HealthAmerica has company places of work around Pittsburgh plus Harrisburg, Pennsylvania, plus employs above 2,200 persons in the commonwealth.
Source: blogspot.com

insurance: MEDICARE ADVANTAGE/MEDICARE HEALTH PLANS

Medicare Advantage/Medicare Health Plans SHIIP Publications: Frequently Asked Questions About Medicare Advantage PFFS Plans Is A Medicare Advantage Private-fee-for-service Plan Right For Me Medicare Advantage Comparison Guide (2008) Your Guide To Medicare Private-fee-for-service Plans Medicare Advantage Summaries of Benefits SHIIP Publications: Aarp Medicarecomplete Choice Aarp Medicarecomplete Plus Plan 1 Aarp Medicarecomplete Plus Plan 2 Advantra Freedom – Plan 1, Plan 2 (005), Plan 5 (001) Advantra Freedom – Plan 2 (010),plan 3 (006-013), Plan 5 (002) Advantra Savings (msa) – Plan 1 Aetna Medicare Open Plans America’s 1st Choice – Patriot Plus And Presidential Plus America’s 1st Choice – Patriot-presidential Blue Medicare HMO Plans Blue Medicare PPO Plans Cigna Medicare Access Plans One, Two And Three – Version A Cigna Medicare Access Plans One, Two And Three – Version B Cigna Medicare Access Plans One, Two And Three – Version C Cigna Medicare Access Plans One, Two And Three – Version D Evercare – Dh – Special Needs Plan Evercare – Ih – Special Needs Plan Evercare – Mh – Special Needs Plan Fidelis – Secure Comfort – Special Needs Plan Fidelis – Secure Comfort Plus – Special Needs Plan Fidelis – Secure Independence – Special Needs Plan Health Net Pearl – Plans 009-014-015 Healthmarkets Care Assured Plans Humana – Special Needs Plan Humana Goldchoice – H1804 -216 Sb08 Humana Goldchoice – H1804-007 Sb08 Humana Goldchoice – H1804-016 Sb08 Humana Goldchoice – H1804-217 Sb08 Humana Goldchoice – H1804-278 Sb08 Humana Goldchoice – H1804-279 Sb08 Humanachoiceppo – H3405-001 Sb08 Humanachoiceppo – H3405-002 Sb08 Humanachoiceppo – Regional – R5826-003 Sb08 Securehorizons Medicaredirect Plan 3 Securehorizons Medicaredirect Plan 3a Securehorizons Medicaredirect Rx Plan 51 Securehorizons Medicaredirect Rx Plan 51a Securehorizons Medicaredirect Rx Plan 54 Securitychoice Classic-enhanced-plus-enhance Plus – Area A – Securitychoice Classic-enhanced-plus-enhanced Plus – Area B Securitychoice Essential-essential Plus Southeast Community Care – Dual Plus Plan – Special Need Plan Southeast Community Care – Plus Plan Sterling Option I Sterling Option Ii Sterling Option Iii Sterling Option Iv Today’s Options – Basic Plus, Value Plus, Premier Plus Today’s Options – Basic, Value, Premier Today’s Options Powered By Ccrx Unicare 2008 Msa Summary Benefits WelLCare Benefit Summary A WelLCare Benefit Summary B WelLCare Benefit Summary C WelLCare Benefit Summary D WelLCare Benefit Summary E
Source: blogspot.com

The Sullivan Independent News

The Visiting Nurses Association will hold a flu shot clinic at the Sullivan Senior Center on Tues., Oct. 13 from 12 p.m.- 3 p.m. In order to be sure a vaccine is available for you, you must call or stop by the Senior Center and have your name put on the vaccine list. The VNA will be bringing 150 vaccines, but more will be available if we see more people are signing up. This will be a one-time clinic. Those planning to receive their vaccine may show up anytime from 12 p.m.-3 p.m. To avoid the congestion and long waiting periods, you may wish to wait a little later and not all show up at 12 p.m. Insurances accepted by the VNA for this clinic include: Medicare Advantage Plans, Essence, Coventry Advantra Freedom, GHP, Advantra, GHP Advantra Freedom, GHP Gold Advantage, Humana Choice PPO, Humana Gold Choice PFFS, Humanna Gold Plus HMO and Mercy Medicare Advantage. Other insurances that did not contract with the VNA and will not be accepted are: Medicare Advantage Plans, Secure Horizons, Aetna Medicare, Anthem Senior Advantage, Cigna Medicare Access, Sterling Option, Wellcare, Evercare or any other Medicare Advantage or out-of-state plans. Medicaid is not accepted. If you have another primary insurance, you may not use Medicare or Medicare Advantage. Those wishing to pay “out of pocket” for the vaccine may do so. The cost is $30. Visiting Nurses Association is a non-profit community based organization dedicated to serving the healthcare needs of your community. Please help us by giving us your correct insurance at the time of service.
Source: mysullivannews.com

Health America www.EasyToInsureME.com

This entry was posted on July 29, 2008 at 7:13 pm and is filed under a, america, blue cross pa, coventry, coventry health america, cvty, harrisburg, healh insurance pennsylvania, health, health america, health america one, health insurance, health insurance pa, healthamerica, healthamerica com, healthamerica cvty, healthamerica cvty com, insurance, lancaster, low cost health insurance pa, low cost pa health insurance, ohio, pa, pa health insurance, phila, philadelphia, pittsburgh, ppo, scranton, www healthamerica com, www healthamerica cvty. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.
Source: wordpress.com

Medicare covers hospice & comfort care

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 marsmet524, your loved one can get the care and support they need. This can include doctor and nursing services, counseling, medical supplies, pain medications, and other services. And, most importantly, hospice can provide much needed comfort while at home.
Source: medicare.gov

Video: Weekly Address: Medicare Officially Safer After Health Reform

Medicare Eyed As Part Of ‘Grand Bargain’

The Hill: Groups To Launch Campaign To Keep Federal Research Funding A coalition of groups is launching a campaign to emphasize federal funding for medical research ahead of negotiations on the “fiscal cliff.” Research!America and several dozen patient, industry and other health organizations have planned a week of advocacy starting Monday to convince lawmakers to “champion medical innovation.” … The automatic cuts would reduce budgets at federal health agencies by $3.8 billion unless Congress to stop them, according to Research!America (Vieback, 11/9). The Associated Press: Labor: Tax The Rich, Don’t Touch Safety Nets Labor’s massive voter turnout effort played a major role in helping President Barack Obama win Ohio, Nevada and Wisconsin, according to exit polls, and its leaders are now looking for a more liberal, pro-union agenda from the White House. … Topping labor’s wish list — for now — is a push to raise taxes on wealthy Americans and discouraging Obama from agreeing to any deal with Republicans over the looming “fiscal cliff” that cuts into Social Security and Medicare (Hanahel, 11/10).
Source: kaiserhealthnews.org

SHIP to address Medicare issues [log in]

Sports     HS sports     BNL     Mitchell     Orleans     Loogootee     Paoli     Shoals     Springs Valley     W. Washington      IU blog     Fantasy racing league
Source: tmnews.com

Obama’s Weekly Address: Setting The Record Straight On Medicare

Mitt Romney and his running mate Paul Ryan have been attacking the president for cutting $716 billion from the popular entitlement program. “Over the last few weeks, there’s been a lot of talk about Medicare, with a lot of accusations and misinformation flying around.  So today I want to step back for a minute and share with you some actual facts and news about the program,” Obama says.
Source: news92fm.com

Update All of Your Addresses with Medicare Immediately!

This entry was posted in Medicare and tagged administrative law judge(ALJ), Centers for Medicare & Medicaid Services (CMS), clinic, corrective action plan (CAP), durable medical equipment (DME) suppliers, fraud prevention, home health agencies, investigators, Medicaid Fraud Control Unit (MFCU), medical groups, medical practices, medicare, Medicare Administrative Contractors (MAC), Medicare administrative hearing, Medicare audits, Medicare number revocation, Medicare Provider Enrollment Chain and Ownership System (PECOS), Medicare site visits, Medicare termination, National Plan & Provider Enumeration System (NPPES), NPI Registry, nursing homes and other healthcare providers, OIG special agents, pharmacies, physicians, request for reconsideration, termination of Medicare billing privileges, Zone Program Integrity Contractors (ZPIC), zpic audit, ZPIC site visit. Bookmark the permalink.
Source: wordpress.com

Don’t Let Obama Cut Medicare, Medicaid, and Social Security

This is before the Tea Party swept into Congress, so there was no pressure on Obama to appease the right. By adopting Tea Party talking points on spending and comparing government to a family – what family do you know that has 8,100 tons of gold reserves, a space program and embassies in some 200 countries? – Obama legitimized debt as a major concern going into the 2010 election.

A little more history. Obama ran in 2008 on repealing the Bush tax cuts. But he reneged on his promise just one month into his presidency even though he was gushing with political capital, the right was in disarray and the Democratic-controlled Congress was ready to pass it. (After campaigning in 2012 on abolishing tax cuts for households earning more than $250,000, Obama indicated he was willing to renege once more days after being re-elected.)
Source: progressive.org

Weekly Address: Preserving and Strengthening Medicare

Advertisments (6) African-American/Black (25) Economy (41) Education (47) Energy (7) Environment (6) Federal (97) Gov 2.0 (458) Health (35) Latino/Chicano (4) Local (24) Minority Interest (82) Open Gov (26) SDVOB (17) Security (18) Tech (43) Uncategorized (3) Video Capability (2)
Source: opengovtv.com

Senators Caucus Vows To Protect Social Security, Medicare

Saw my first AARP ad regarding ‘the cliff’ yesterday. Seems they don’t think rushing into benefit cuts before the end of the year is a great idea. Surprise. The Repukes put themselves in this position, and now they have to decide if they’re going to go down swinging in their fight to protect millionaires. Personally, I’d almost like them to ‘stick to their guns’ and take their pathetic racist party down for good. Are there enough teabagger congresscritters to make that happen?
Source: crooksandliars.com

Daily Kos: Obama in weekly address: Tax cuts. Take two. For reals.

To allow the tax debate to be dictated by the losers tax plan (Mitt Romney’s) the republicans are going to get their way and act as if they are creating a more fair taxing of the rich by saying (Eliminate the loopholes and limit the itemized tax deductions of the WEALTHY and broaden the tax base) = A ruse to not raise the marginal tax rate on people making $250,000 or more. And i’m afraid that Obama and the democrats we just elected have tried to open that door to try and look bipartisan.    This is a serious mistake limiting tax deductions and broadening the tax base = GETTING MORE TAX REVENUE FROM THE MIDDLE CLASS. They throw in the word WEALTHY to complete the ruse.    I f they don’t do what we voted for ( Raise the marginal tax rate on $250,000 or more, make carried interest or capital gains to be taxed as regular income and take the cap off of Social Security to make it solvent for forever) The people we have just contributed to with money we don’t have, canvassed for on time we could have  used for ourselves and voted for to win office. Will have effectively used us!!!!!!MARK MY WORDS!!!
Source: dailykos.com

Weekly Address: Preserving and Strengthening Medicare // Current TV

We’re a TV network available on DirecTV, Comcast, Time Warner Cable, Dish Network, and more. Find us on your TV. While you are here you can watch videos from our TV shows, check our TV schedule, and participate in discussions with members of our community. Thanks for visiting, and let us know what you think!
Source: current.com

Do you get medicare w ssi

Posted by:  :  Category: Medicare

OBAMACARE WATCH:....THE PUSH IS ON, ........THEY WILL CONTROL WHAT YOUR DOCTOR KNOWS AS WELL AS WHAT HE OR SHE TREATS by SS&SSDoes anyone know about psychiatric hospitals and medicaid…currently I have semi decent health insurance that allows me to obtain decent to good care when I need inpatient treatment. Does anyone know if only county hospitals are covered on medicaid? I wouldnt get tge care I need at one of those county hospitals…i heard they dont provide any types of groups or therapy, they just stick you in a tv room and medicate you and the care is pretty lousy.
Source: mdjunction.com

Video: Medicare Part D and Prescription Drugs

Need Help with Medicare Choices? SHIP Advice to the Rescue

The programs are called SHIP programs (State Health Insurance Programs.)

Blue Medicare Advantage: Blue Cross Blue Shield of Illinois

Posted by:  :  Category: Medicare

Gang of Six - Cartoon by DonkeyHoteyIn addition to your Part B premium, there are small copayments to receive care.  With copayments as low as $7 for Medicare covered primary care doctor’s office visits, $45 for Medicare covered specialist visits and $3  for generic prescription drugs, it’s easy to get the care you need when you need it. An Advantage plan includes all of your Part A and Part B Medicare benefits, prescription drug coverage and emergency care if needed for an additional $65 copayment. Coverage is convenient and hassle free, and with an extensive provider network, there are always quality doctors nearby, ready to help from a wide range of specialties.
Source: ssiinsure.com

Video: Attention Residents on Medicare in Illinois: information on Medicare Supplements

Big Education Ape: Democurmudgeon: Illinois Democrats Medicare Ad Most Effective Way to Defend the Program.

I was in Chicago over the weekend, and came across this ad on one of the local channels for Democratic congressional candidate Brad Schneider. The ad features a clip of President Lyndon Johnson describing the reason why he pushed so hard for Medicare. This ad should have been from the Obama campaign. Incredibly effective, it shows Medicare was created to solve a problem, not spread socialism.
Source: blogspot.com

Medicare Trying To Nudge Seniors Out Of Plans With Low Ratings

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

Democurmudgeon: Illinois Democrats Medicare Ad Most Effective Way to Defend the Program.

I was in Chicago over the weekend, and came across this ad on one of the local channels for Democratic congressional candidate Brad Schneider. The ad features a clip of President Lyndon Johnson describing the reason why he pushed so hard for Medicare. This ad should have been from the Obama campaign. Incredibly effective, it shows Medicare was created to solve a problem, not spread socialism.
Source: blogspot.com

Through Medicare Supplemental Insurance Illinois Residents Save Money

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Source: omc-host.tk

Medicare Reform: Battling the Myths  

As the political hunting season begins, the Obama campaign is quick to misinform the public about the Republicans’ plan for Medicare, arguing it would eliminate the program as we know it. Specifically in regard to Rep. Paul Ryan’s (R-Wisc.) proposed reform to Medicare, opponents are calling it a voucher system that would put seniors at the mercy of insurance providers. But a look at the facts shows that this is not the case, says Diana Furchtgott-Roth, a senior fellow at the Manhattan Institute.
Source: ima-net.org

Select Medicare Supplemental Insurance Illinois To Cover Gaps

To get good rates, many people get several rate quotes for Medicare supplemental insurance Illinois residents over 65 are eligible for. Aged people experience different medical conditions and need supplemental policies to offset the cost of this government program. Many patients will have medical conditions that existed before they joined with this program and will not be covered. The patient could be required to pay all expenses if other policies do not exist.
Source: vvy.in

Illinois Court Permits Ex

Viewing Washkowiak from this perspective, an important issue raised relates to the potential for collateral attack on the MSA. While the court in Washkowiak acknowledged the MSP’s objective of protecting Medicare’s secondary payer status, in the end it did not hold the MSA as sacrosanct and allowed monies to be taken from the allocation and given to a third party in an unrelated action. This then raises the question as to whether the MSA could be reachable by third parties in other actions outside of, and unrelated to, the workers’ compensation claim. For instance, could a creditor be entitled to MSA funds? Absent the potential applicability of statutes or other authority barring creditor claims in this situation,[fn24] the Washkowiak decision illustrates that the MSA may not necessarily be off limits.
Source: lexisnexis.com

How Health Care Reform is Making A Difference In Illinois

Our blog focuses on the professional and educational development of certified medical assistants (CMA’s), as well as nursing assistants. Celeste Botonakis has over 6 years of experience as a CMA. Working for a doctor’s office, she is well versed in keeping medical records, EKG’s, vitals, blood draws and other office tasks . Follow along, as she posts about the latest news, information and research in the field of medical assisting!
Source: nursingassistantguides.com

Democrats’ Medicare Offensive Falls Flat Against GOP

Posted by:  :  Category: Medicare

The Pfelons of Pfizer: Too Crooked to Fail and Don't Go to Jail (g1a2d0052c1) by watchingfrogsboil“I had felt that Medicare would have a big impact on the election. That didn’t happen,” said John Rother, president of the National Coalition on Health Care. “Admittedly, Republicans had a complicated proposal. But Democrats could have done more to raise the fear factor. I don’t think that [their point] got through that the proposal would erode the core benefit promised” in Medicare. He added that this year’s campaign revealed a growing political trend: “Issues have become less important than partisan ID, especially in moving voters.”
Source: kaiserhealthnews.org

Video: IVANS Makes Medicare Access Easier

Medicare premiums to go up $5 in 2013

It’s very easy. Your first monthly bill (that you’ll pay by mailing them a check) will have a phone number on it. Call the number and tell them you want to set up automatic payments. They’ll send you a form to fill out, which you’ll return with your bank information. After that, it’s simply deducted from your account each month. Simple. There is only one odd factor. Despite everything being automatic, they will still mail you a paper bill each month, with the wording on it that says it’s not a bill and you don’t have to pay it because you have automatic deduction. There is no way to stop these useless notices, but you can just ignore them.
Source: early-retirement.org

Providers File The Bulk Of Medicare Appeals

Medicare beneficiaries and providers can challenge the denial of a claim in several appeals stages, but the first two are decided by contractors working for Medicare who base their opinions on case files.  In the third step, which is the focus of the report, appellants have a hearing before a judge, testimony can be provided, witnesses can be cross-examined, and new evidence can be introduced.  The judges are lawyers in the Office of Medicare Hearings and Appeals, an independent agency within HHS.
Source: kaiserhealthnews.org

Economist’s View: Paul Krugman: Life, Death and Deficits

Life, Death and Deficits, by Paul Krugman, Commentary, NY Times: America’s political landscape is infested with many zombie ideas… And right now the most dangerous zombie is probably the claim that rising life expectancy justifies a rise in both the Social Security retirement age and the age of eligibility for Medicare… — and we shouldn’t let it eat our brains. … Now, life expectancy at age 65 has risen… But the rise has been very uneven…, any further rise in the retirement age would be a harsh blow to Americans in the bottom half of the income distribution, who aren’t living much longer, and who, in many cases, have jobs requiring physical effort that’s difficult even for healthy seniors. And these are precisely the people who depend most on Social Security. … While the United States does have a long-run budget problem, Social Security is not a major factor… Medicare, on the other hand, is a big budget problem. But raising the eligibility age, which means forcing seniors to seek private insurance, is no way to deal with that problem. … What would happen if we raised the Medicare eligibility age? The federal government would save only a small amount of money, because younger seniors are relatively healthy… Meanwhile, however, those seniors would face sharply higher out-of-pocket costs. How could this trade-off be considered good policy? The bottom line is that raising the age of eligibility for either Social Security benefits or Medicare would be destructive, making Americans’ lives worse without contributing in any significant way to deficit reduction. Democrats … who even consider either alternative need to ask themselves what on earth they think they’re doing. But what, ask the deficit scolds, do people like me propose doing about rising spending? The answer is to do what every other advanced country does, and make a serious effort to rein in health care costs. Give Medicare the ability to bargain over drug prices. Let the Independent Payment Advisory Board, created as part of Obamacare to help Medicare control costs, do its job instead of crying “death panels.” (And isn’t it odd that the same people who demagogue attempts to help Medicare save money are eager to throw millions of people out of the program altogether?) … What we know for sure is that there is no good case for denying older Americans access to the programs they count on. This should be a red line in any budget negotiations, and we can only hope that Mr. Obama doesn’t betray his supporters by crossing it.
Source: typepad.com

Why no outrage over Obama forcing Medicare beneficiaries to forgo care or pay thousands?

Inpatients pay a one-time deductible ($1,156 during 2012) for all hospital services and medications provided during a hospital stay. By contrast, outpatients have to pay 20% of the Medicare-approved amount for each hospital service and the difference (usually significant) between what a hospital charges for medications and what their Medicare prescription drug plan will pay for medications purchased from network providers. Individuals have reported having to pay $18 for one baby aspirin and $71 for one blood pressure pill they can get at their local pharmacy for 16 cents.
Source: dailycaller.com

Fox Still Misleading On Medicare To Promote Romney

Under premium support, traditional Medicare would tend to attract a less healthy pool of enrollees, while private plans would attract healthier enrollees (as occurs today with Medicare and private Medicare Advantage plans). Although the proposal calls for “risk adjusting” payments to health plans — that is, adjusting them to reflect the average health status of their enrollees — the risk adjustment process is highly imperfect and captures only part of the differences in costs across plans that stem from differences in the health of enrollees. 
Source: mediamatters.org

Medicare to Cut Payments for Not Meeting Reporting Requirements

According to the website on PQRS from the Center for Medicare and Medicaid Services (CMS), “Beginning in 2015, if the eligible profes-sional or group prac-tice does not satisfactorily submit data on Physician Quality Reporting System quality measures, a 1.5 percent payment adjustment will apply. To avoid the 2015 adjustment, an eligible professional must satisfactorily report Physician Quality Reporting System quality measures during the 2013 reporting period (Jan. 1-Dec. 31, 2013).”
Source: nationalpsychologist.com

Avoiding Claim Denials for Incorrectly Billed Influenza Vaccines for Medicare Beneficiaries

Medicare Part B covers 100 percent of the cost of one flu shot once every flu season with no Part B deductible or coinsurance required if you are a provider who accepts assignment. However, a beneficiary could receive the seasonal flu vaccine twice in one calendar year for two different flu seasons and Medicare would reimburse the provider for each. For example, a beneficiary could receive a seasonal flu vaccination in January 2012 for the 2011 – 2012 flu season and another seasonal flu vaccination in November 2012 for the 2012 – 2013 flu season and Medicare would pay for both vaccinations. Medicare may cover additional seasonal flu vaccinations within the same flu season if documentation shows medical necessity.
Source: grassicpas.com

Don’t Let Obama Cut Medicare, Medicaid, and Social Security

This is before the Tea Party swept into Congress, so there was no pressure on Obama to appease the right. By adopting Tea Party talking points on spending and comparing government to a family – what family do you know that has 8,100 tons of gold reserves, a space program and embassies in some 200 countries? – Obama legitimized debt as a major concern going into the 2010 election.

A little more history. Obama ran in 2008 on repealing the Bush tax cuts. But he reneged on his promise just one month into his presidency even though he was gushing with political capital, the right was in disarray and the Democratic-controlled Congress was ready to pass it. (After campaigning in 2012 on abolishing tax cuts for households earning more than $250,000, Obama indicated he was willing to renege once more days after being re-elected.)
Source: progressive.org

Is it time for another lawsuit? Advocating to change the Medicare Hospice Benefit eligibility requirements

Posted by:  :  Category: Medicare

I have decided that there is compelling evidence that the Medicare Hospice eligibility requirements are outdated and need to be re-written.  These policies are not driven by patient need and the evidence is mounting that limiting access to hospice and palliative services actually increases the cost of health care at the end of life.  Those with concerns about the rise in the cost of the Medicare Hospice Benefit appear to put undue focus on the increasing length of stay of a number of hospice patients without considering that hospice and palliative care can be more cost effective than usual care.  This cost reduction does not come from “irrationally rationing” health care but by facilitating conversations that allow patients and families to understand prognosis and verbalize preferences and goals about end-of-life care.  These conversations enable health care providers to guide patients away from costly treatments and interventions that do not facilitate attainment of patients’ goals or add to the quality or length of their lives. If you agree that it is time for a change to the eligibility requirements, what can we do as hospice and palliative medicine providers to advocate for our patients to receive high-quality palliative and end-of-life care in a manner that makes sense? Do we wait until the results of the concurrent care demonstration project are in? Do we ask AAHPM, NHPCO, and HPNA’s Public Policy and Advocacy Committees to weigh in on the matter?  Or do we wait until the lawyers file another class-action lawsuit against Medicare? by: Shaida Talebreza Brandon (all opinions expressed are my own)
Source: geripal.org

Video: EHR: Medicare Incentive Program Attestation Webinar for Eligible Professionals

What Are the Medicare Eligibility Requirements?

Once reaching the age of 65 years old a person qualifies for medicare. One must also be a US citizen or a permanent legal resident. One of the last requirements is having paid into the medicare system while working. The general rule is having paid into the social security system with approximately 10 years of work, or 40 credits. An individual may also qualify off of their spouses working if necessitated. The spouse must be at least 62 and the qualifying individual must still meet the 65 year requirement. With additional proof an individual may also qualify based on the work benefits of a deceased or divorced spouse.
Source: seniorcorps.org

What’s The Difference Between Medicare and Medicaid?

Medicare and Medicaid are both government-sponsored programs designed to help cover healthcare costs. Because the programs have similar names, people are often confused about how the programs work and what coverage they offer. While both were established by the U.S. government in 1965 and are taxpayer funded, they are actually very different programs with differing eligibility requirements and coverage. In the most basic sense, Medicare is designed to help with long-term care for the elderly, while Medicaid covers healthcare costs for the poor, but there is much more to it than this.
Source: socyberty.com

Avoiding The ‘Fiscal Cliff’ Likely Means Changes In Medicare

REDUCE PAYMENTS TO PROVIDERS: Hospitals, physicians and other health care providers – many who are now facing payment cuts either in the 2010 health care law or from the upcoming “sequestration” reductions (or both) – may take another hit in a deficit deal. Among the options sometimes mentioned are limiting the amount of “bad debt” that hospitals and other providers can write off their taxes,  reducing federal funding for medical education and requiring more prior authorization for some medical services, such as imaging, to help reduce unnecessary care. Lawmakers looking for political cover from angry providers could cite the many deficit-reduction proposals that have advanced provider cuts: Obama’s 2011 deficit reduction proposal, the Simpson-Bowles plan and the Medicare Payment Advisory Commission, or MedPAC, which advises Congress on Medicare payment policy.
Source: kaiserhealthnews.org

Medicare to Cut Payments for Not Meeting Reporting Requirements

According to the website on PQRS from the Center for Medicare and Medicaid Services (CMS), “Beginning in 2015, if the eligible profes-sional or group prac-tice does not satisfactorily submit data on Physician Quality Reporting System quality measures, a 1.5 percent payment adjustment will apply. To avoid the 2015 adjustment, an eligible professional must satisfactorily report Physician Quality Reporting System quality measures during the 2013 reporting period (Jan. 1-Dec. 31, 2013).”
Source: nationalpsychologist.com

Functional Improvement not a Requirement for Medicare Payment

CMS will have its work cut out when launching the campaign to inform healthcare providers, Medicare contractors and Medicare adjudicators. They should not limit Medicare coverage to beneficiaries who have the potential for improvement.  Rather, providers, contractors and adjudicators must recognize “maintenance” coverage and a beneficiary’s need for skilled care that is performed or supervised by professional nurses and therapists. We must also assume CMS will issue guidance for determining what constitutes maintenance eligibility and how effective therapy will be if restricted by existing therapy cap limitations. Perhaps this windfall of rehabilitation access will be applied exclusively to patients with the most severe of chronic conditions such as Alzheimer’s disease, multiple sclerosis, Parkinson’s disease, stroke, spinal cord injuries and traumatic brain injury, and be applied only to ambulatory rehabilitation providers; IRFs and rehabilitation units of acute hospitals will not receive benefit of this new interpretation. All of a sudden, healthcare transformation begins to affect the rehabilitation sector in a meaningful way.
Source: mediserve.com

An Assault On DEMOCRACY: Medicare Eligibility Age In Fiscal Cliff Negotiations Puts Older Americans In The Crosshairs

“Two more years would have been, I would say, devastating,” said Weintraub, who works part time counseling older people on their benefits at the Medicare Rights Center in New York. “It would’ve made a major difference, not only monetarily, just in my health,” he said. He put off a blood test he needed for months waiting for his Medicare benefits to kick in because he couldn’t afford it, he said. Weintraub was able to manage during the two years he didn’t have health insurance, even though he had to pay $161 a month out of pocket for a prescription drug and $100 each time for four or five doctor visits a year to monitor his blood pressure and try to prevent a heart attack or stroke. “I was lucky, thank God,” he said. Others who gamble they can wait out the last few months before becoming eligible for Medicare aren’t as fortunate, said Jeffrey Cain, the president of the American Academy of Family Physicians and the chief of family medicine at Children’s Hospital Colorado in Aurora. Earlier this year, a patient with diabetes and high blood pressure, whom Cain called Mr. Hernandez, hadn’t been in the office for a visit for at least five months. When he finally reappeared complaining of shortness of breath and leg pain, Cain learned the patient had lost his job and his health insurance and had stopped taking his medications because he couldn’t afford them. Mr. Hernandez paid a visit right after turning 65 and getting on Medicare, Cain said. The patient wasn’t available for an interview, Cain said. The American Academy of Family Physicians hasn’t taken a position on changing the Medicare eligibility age. The consequences were devastating, as the man’s health rapidly deteriorated, Cain said. “Mr. Hernandez had a heart attack and had his kidney fail during those months that he had to quit taking his medicine because he couldn’t afford the medicine, he couldn’t afford to come and see me,” Cain said. “Mr. Hernandez now can’t do the regular things in his life he would normally do and he’s going to die earlier.” The Congressional Budget Office estimates that raising the Medicare eligibility age to 67 would cut federal Medicare spending by about 5 percent, or $124.8 billion, from 2012 to 2021, and raise health care expenses for people who had to wait two more years. Included in that analysis is higher spending on Medicaid for poor, older people and on health insurance tax credits for middle-class people under health care reform. This approach might reduce the federal budget deficit on the ledger but it doesn’t actually save anyone any money, said Joe Baker, the president of the Medicare Rights Center. Older people who can get insurance will pay more, Medicaid costs will go up, and employers will bear higher medical costs for older workers who stay employed just to keep their health benefits, he said. “This is just a shell game,” Baker said. “What this basically is, is a cost shift, not a cost savings. This is a proposal to basically take a group of people, 65- and 66-year-olds, and say rather than have them on the federal government’s books in toto, let’s keep them in a private marketplace.” Two big reasons advocates for older Americans like the AARP endorsed Obama’s health care reform law is that it didn’t reduce the Medicare’s benefits and it sought to ease the way for people over 50 to buy health insurance. The health care reform law is supposed to help older people by forbidding health insurance companies from turning down anyone with pre-existing conditions and capping older people’s premiums to three times what younger people pay on the law’s regulated health insurance “exchanges.” But enacting reforms to the private health insurance market isn’t an excuse to raise the Medicare age, especially since Obamacare won’t be in effect until 2014, Certner said. “The health care reform act should help in terms of getting more coverage available to people,” Certner said. “But let’s face it, the exchanges aren’t up and running yet. You shouldn’t even be talking about this issue right now.”
Source: blogspot.com

OIG’s Plan for Nursing Facilities

The OIG has also made state inspections a priority. Specifically, whether state agencies are following up on correction plans created in response to deficiencies identified during state nursing home inspections. There will also be a focus on the efforts of state agencies and the Centers for Medicare and Medicaid Services (CMS) to improve performance. Enforcement decisions, including follow-up actions and the implementation of corrective measures in response to complaints and survey results are a core focus in this area.
Source: seniorhomes.com

Economist’s View: Paul Krugman: Life, Death and Deficits

Life, Death and Deficits, by Paul Krugman, Commentary, NY Times: America’s political landscape is infested with many zombie ideas… And right now the most dangerous zombie is probably the claim that rising life expectancy justifies a rise in both the Social Security retirement age and the age of eligibility for Medicare… — and we shouldn’t let it eat our brains. … Now, life expectancy at age 65 has risen… But the rise has been very uneven…, any further rise in the retirement age would be a harsh blow to Americans in the bottom half of the income distribution, who aren’t living much longer, and who, in many cases, have jobs requiring physical effort that’s difficult even for healthy seniors. And these are precisely the people who depend most on Social Security. … While the United States does have a long-run budget problem, Social Security is not a major factor… Medicare, on the other hand, is a big budget problem. But raising the eligibility age, which means forcing seniors to seek private insurance, is no way to deal with that problem. … What would happen if we raised the Medicare eligibility age? The federal government would save only a small amount of money, because younger seniors are relatively healthy… Meanwhile, however, those seniors would face sharply higher out-of-pocket costs. How could this trade-off be considered good policy? The bottom line is that raising the age of eligibility for either Social Security benefits or Medicare would be destructive, making Americans’ lives worse without contributing in any significant way to deficit reduction. Democrats … who even consider either alternative need to ask themselves what on earth they think they’re doing. But what, ask the deficit scolds, do people like me propose doing about rising spending? The answer is to do what every other advanced country does, and make a serious effort to rein in health care costs. Give Medicare the ability to bargain over drug prices. Let the Independent Payment Advisory Board, created as part of Obamacare to help Medicare control costs, do its job instead of crying “death panels.” (And isn’t it odd that the same people who demagogue attempts to help Medicare save money are eager to throw millions of people out of the program altogether?) … What we know for sure is that there is no good case for denying older Americans access to the programs they count on. This should be a red line in any budget negotiations, and we can only hope that Mr. Obama doesn’t betray his supporters by crossing it.
Source: typepad.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

Medicare Open Enrollment Deadline Extended Due to Superstorm Sandy

Posted by:  :  Category: Medicare

Federal officials are giving those hit by Superstorm Sandy a break. The Centers for Medicare and Medicaid Services (CMS) has extended the December 7 deadline for Medicare Open Enrollment.  A new deadline has not been established yet, but as long as Medicare beneficiaries call Medicare’s 24-hour information line at 1-800-Medicare, they can still enroll after the deadline. Representatives will review available plans and complete the enrollment process over the phone.
Source: gohealthinsurance.com

Video: Spanish Telenovela for CMS “Medicare esta de su lado”

CMS Issues Final 2013 Medicare Physician Fee Schedule Rule, Including Other Part B Policy Updates : Health Industry Washington Watch

Under the final rule, the 2013 MPFS conversion factor will be $25.0008, compared to $34.0376 in 2012. As noted, Congress could override the 26.5% SGR cut on either a temporary or permanent basis. Other provisions of the rule impact reimbursement for different types of services. For instance, the final rule seeks to benefit primary care physicians by authorizing separate payment to a patient’s community physician or practitioner to coordinate the patient’s care in the 30 days following a hospital or skilled nursing facility (SNF) stay. On the other hand, certain specialists, like diagnostic radiologists, would be negatively impacted by CMS’s continued expansion of the multiple procedure payment reduction (MPPR) policy. Under the final rule, on January 1, 2013 CMS will implement its policy, discussed in the CY 2012 final rule, applying the MPPR when one or more physicians in the same group practice furnish the interpretation of advance imaging services to the same patient, in the same session, on the same day. CMS also will apply the MPPR to the technical component of certain cardiovascular and ophthalmology diagnostic services for 2013. Under this policy, CMS will make full payment for the highest paid cardiovascular or ophthalmology diagnostic service and reduce the technical component payment for subsequent cardiovascular or ophthalmologic diagnostic services furnished by the same physician or group practice to the same patient on the same day by 25% for cardiovascular diagnostic services or 20% for ophthalmologic diagnostic services.
Source: healthindustrywashingtonwatch.com

Providers Filed 85% of Medicare Appeals in 2010

A study from the HHS Office of Inspector General (pdf) found that hospitals and other Medicare providers filed 85 percent of payment appeals at the administrative law judge level, 56 percent of which went in favor of providers, and the OIG concluded that serious improvements are needed to clarify Medicare policies. Medicare providers and beneficiaries may appeal certain decisions regarding claims for healthcare services. For example, hospitals may appeal payment recoupments from Recovery Auditors, or RACs, if they believe their actions were consistent with Medicare law and standards. There are four general levels of appeal: Level One goes to CMS Medicare Administrative Contractors, Level Two goes to CMS Qualified Independent Contractors, Level Three goes to ALJs and Level Four goes to the Medicare Appeals Council. The ALJ level is the most common platform of the four. The OIG looked at the 40,682 Medicare appeals filed to ALJs in fiscal year 2010. It found that hospitals, physicians and other providers filed 34,542 of those appeals, or roughly 85 percent. In addition, a small number of providers accounted for nearly one-third of all appeals. The OIG tagged 96 providers as “frequent filers,” meaning they filed at least 50 appeals each. One provider filed 1,046 appeals alone. For 56 percent of appeals that made it to level three, ALJs also reversed 56 percent in favor of appellants, indicating a “number of inconsistencies and inefficiencies in the Medicare appeals process,” according to the OIG’s report. The OIG had 10 recommendations for CMS and the Office of Medicare Hearings and Appeals, including more coordinated training on Medicare policies to ALJs and QICs, better identification and clarification of Medicare policies that are unclear, and digitization of appeal case files. CMS and OMHA concurred fully or in part with all of the OIG’s recommendations.
Source: beckershospitalreview.com

The End of Customer Service

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Source: thecre.com

CMS officials issue reminder on Medicare secondary payer laws

Participating Medicare providers, physicians, and other suppliers must not accept from beneficiaries any co-payments, coinsurance payments, or other payments, for services rendered when the primary payer is an employer-managed care organization (MCO) insurance plan, or any other type of primary insurance such as an employer group health plan, U.S. Centers for Medicare & Medicaid Service (CMS) officials warned in a new Medicare Learning Network (MLN) Matters® article last month.
Source: newsfromaoa.org

CMS Announces New Medicare Reimbursement Rates for 2013

The final rule promotes quality of care for patients by ensuring that home health agencies that are out of compliance with Federal health and safety standards, known as the Conditions of Participation, can correct their performance and achieve prompt compliance. The rule provides agencies with the opportunity to achieve compliance through new methods, such as directed plans of correction or directed in-service training. It also permits CMS to impose alternative sanctions in addition to termination for agencies that do not maintain or achieve compliance with Federal health and safety standards. The rule establishes new survey and certification requirements for home health agencies including definitions for types of surveys, survey frequency, surveyor qualifications, and the opportunity for Informal Dispute Resolution. Finally, this rule extends certain requirements concerning the hospice quality reporting program to subsequent years.
Source: insidepatientfinance.com

Medicare Open Enrollment: Be a smart shopper

in 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

ACO Tally Could Double By January, Says CMS Official

CQ HealthBeat: CMS Official: Number Of Medicare ACOs Could Reach 300 In January The total number of accountable care organizations contracting with Medicare might double in January, the head of the federal Center for Medicare and Medicaid Innovation predicted Tuesday. Currently, 153 ACOs contract with Medicare to provide team-based care that meets certain savings and quality requirements under a so-called shared-savings model. When a third round of such contracts is announced in January, as many as 300 ACOs will have inked agreements, said the Centers for Medicare and Medicaid Services official, Richard Gilfillan (Adams, 11/13).
Source: kaiserhealthnews.org

CMS Issues Final Rules on Medicaid, Medicare Provider Payment Rates

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

Medicare imposes marketing and enrollment suspensions on HealthNet, Arcadian and Universal American (Today’s Options).

Arcadian had their webinar today as well. On the call the moderator did not and would not discuss the other companies. It was very refreshing for me to see that respect for the competitors. One of the things we did discuss was the sanctions, while marketing practices were a component, a large part of the sanctions revolved around Rx administration. The Rx vendor is not specifically mentioned nor will I name them. I am however disappointed that no specific action is to be taken when this vendor is responsible for issues with ALL the companies receiving sanctions. All of the companies/MAPD Plans are working hard with the CMS to correct the issues and will be back to marketing in 4 to 6 months. My feelings go out to all of the beneficiaries that will miss out on these plans. In some markets, the sanctioned plans are the most intelligent option.
Source: wordpress.com

More Time to Enroll in Medicare If You Live in Storm Areas

Posted by:  :  Category: Medicare

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

Video: Medicare Annual Enrollment Help from SHINE

Okla. Medicare Assistance Program educates seniors about fraud

“Even though we’re not the direct victims of fraud, how much the fraud is costing us because of what we’re having to pay, the additional amount – for instance the additional taxes we’re paying and the additional medicare expenses that we’re paying – because other people are the victims of fraud,” he said.
Source: kxii.com

Columbia Qui Tam Lawyer Praises Whistleblowers For Assistance In Governments Recovery Of Millions Of Dollars From CVS On Medicare Fraud Claims

The Louthian Law Firm, P.A., of Columbia, S.C., has been obtaining fair compensation for personal injury victims since 1959. The firm was founded by Herbert Louthian, who has more than 50 years of trial experience and is licensed to practice in all courts in South Carolina. In addition to cases involving whistleblower claims, the Louthian Law Firm also handles cases involving nursing home abuse, personal injury cases involving medical malpractice; car, truck and motorcycle accidents; and other serious and catastrophic injuries throughout South Carolina. The firms office is located in the Marlboro Building, Suite 300, 1116 Blanding Street, Columbia, SC 29201 (local phone (803) 454-1200). For a free, confidential case evaluation, contact the firm by phone at (866) 410-5656 or through its online contact form.
Source: directory-net.com

Jehlen: Review your Medicare Options, Save Money

The full implementation of Obamacare over the next couple of years makes reevaluating your Medicare options even more important. You will notice many positive changes and reviewing options will maximize your savings. Most notably, Obamacare will close the Medicare Part D “donut hole.” Currently, if your yearly prescription drug costs exceed a certain amount ($2,930 in 2012), but your out-of-pocket costs have not reached the point where you qualify for “catastrophic coverage” ($4,700 in 2012), you fall into the donut hole. Starting in 2012, seniors got a 50% discount on brand-name prescription drugs and 14% discount on generic prescriptions. These discounts will increase incrementally until 2020, when 75% of prescription drug costs for people in the donut hole will be covered by Medicare.
Source: insidemedford.com

GRAY MATTERS: How to find the best Medicare prescription drug plan

There are 32 different prescription drug plans for 2013. Monthly premiums range from $15 to $118. Eighteen plans have higher premiums next year, eight have decreased premiums. Fourteen plans will charge a $325 annual deductible, three plans charge a partial deductible and 15 plans do not charge any deductible. Twenty-one plans do not offer any coverage in the gap in coverage. Eleven plans offer some coverage in the gap. Some plans change from one name or company to another, and most have changes in drug coverage or costs.
Source: times-standard.com

Do You Need Help With Your Medicare Choices? Visit Your SHIP Office NOW!

The State Health Insurance Assistance Program, or SHIP, is a national program that offers one-on-one counseling and assistance to people with Medicareand their families. Through federal grants directed to states, SHIPs provide free counseling and assistance via telephone and face-to-face interactive sessions, public education presentations and programs, and media activities. If you have questions about your Medicare or Medicare-related options (for example, Medicare Part D, Medicare Advantage, or Medigap health insurance), your local SHIP can provide the answers you need to get the best health insurance plans for your needs.
Source: myhealthcafe.com

Medicare Rx Open Enrollment

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

Medicare: Help enrolling or switching plans

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