As Alaska Goes, So Goes…

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OBAMAS DEATH PANEL------ GUESS WHAT FOLKS IT'S ALIVE AND WELL---"CRAZY PALIN" NOT SO CRAZY NOW by SS&SSAmerican Medical Association cancer CBO consumer driven health care diabetes doctors drugs electronic medical records email emergency room EMR ER exercise FDA genetics Health Care Access Health Care Costs health care quality health insurance health IT health policy Health Reform Health Savings Accounts heart disease hospital HSA insurance life expectancy Massachusetts Medicaid Medicare medicare advantage NHS ObamaCare obesity pay for performance public option SCHIP seniors socialized health care Social Security stimulus tax unemployment Uninsured
Source: ncpa.org

Video: Medicine Dish: Medicaid and Medicare Data for American Indians and Alaska Natives

Fairbanks Alaska Office Of Children’s Services Stole Our Grand Children For Profit: DETROIT SOCIAL WORKERS PLEAD GUILTY TO MEDICARE FRAUD

There is no doubt that the federal government is cracking down on Medicare fraud. With the national debt steadily creeping upwards and some lawmakers looking for reasons to cut the program, the government has become more aggressive in its pursuit of charges related to healthcare fraud. Unfortunately, this sometimes results in innocent people getting caught in a widely thrown net and needing the help of attorneys to defend against federal charges. Incidentally, since 2007 the Medicare Fraud Strike Force has pressed charges against a total of 1,330 people who were collectively accused of fraudulently billing Medicare for over $4 billion. Recently, three Detroit social workers fell into that category. They pleaded guilty to conspiracy to commit healthcare fraud for perpetuating a scheme that attempted to defraud Medicare out of $3.1 million. The investigation was conducted by the FBI and the Department of Health and Human Services. According to court records, the Detroit residents operated a company called New Century Adult Day Program Services LLC in Flint, Michigan. From November 2009 to April 2012, the three defendants apparently billed Medicare for services that were never rendered. The defendants were accused of attracting Medicare recipients to their business by promising patients medication. Once in the office, the social workers allegedly told the patients they were required to sign up for psychotherapy services before they could see a doctor. The defendants would then use the patients’ signatures on registration forms to create documents billing Medicare for the services. Out of the amount billed, Medicare paid $740,394. All three Detroit residents face up to 10 years in prison and a $250,000 fine. Two of the defendants are scheduled for sentencing on Jan. 8, 2013, while the third is scheduled for Jan. 29, 2013.
Source: blogspot.com

BCBS, Priority Health rank highest in state for Medicaid, Medicare

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

Video: Excellus BCBS Medicare plan travels with you

Medicare Targets Health Plans With Low Ratings

Medicare officials are encouraging 525,000 beneficiaries to switch out of these 26 Medicare Advantage and drug plans that have received low ratings for three consecutive years and enroll in better plans for next year. The poor performing plans will have this warning symbol next to their names on Medicare’s plan finder website to steer shoppers to other plans.
Source: kaiserhealthnews.org

Florida Blue Is New Name for BCBS of Florida

They are also trying to decrease or hold steady their Medicare supplement rates while competitor AARP is increasing their supplement rates by 5%.  This new approach is a welcome change from the old BCBS of Florida who seemed to rely on their name recognition and less on robust benefits or a value based approach.  In less than a week the new benefit information for 2013 will be released.  Starting on October 15th you will be able to enroll into one of the Florida Blue plans if you want.  I will have updated information on this site so check back regularly.  If you have not already, sign up for my free mini-course in the upper right hand corner!
Source: medicare-plans.net

Common health insurance questions answered: What is medicare advantage?

Private 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

CareFirst BCBS extends disease management, home service contracts

In addition, CareFirst extended its contract with Healthways, which is helping the insurer deliver its network-wide Patient-Centered Medical Home (PCMH) program. CareFirst’s PCMH program, launched in 2011, is designed to provide primary care providers with a more complete view of members’ needs and of the services they receive from other providers to better manage individual risks, keep them in better health and produce better outcomes, especially those with chronic conditions. PCMH covers about 1 million people in Maryland, Northern Virginia and Washington, D.C.
Source: medicarebyphone.com

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

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

Blue Medicare Advantage: Blue Cross Blue Shield of Illinois

In 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

Anthem Medicare Advantage Plans: Offering Affordable Freedom of Choice

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

Blue Cross Overhaul Makes Headway, Raises Concerns

Supporters, including the company, say the aim is to level the regulatory playing field for all health insurers. The proposed overhaul aims to modernize but not sell Blue Cross, which is governed by a separate state law from other insurers and typically waits much longer for its rate changes to be reviewed. Streamlining regulations, they say, is particularly important, as health insurers gear up for the implementation of the federal Affordable Care Act and try to meet a March deadline for getting its products and rates ready for an online health exchange where people can compare and buy their own insurance plans.
Source: cbslocal.com

Liberal group outlines substantial Medicare cuts

Posted by:  :  Category: Medicare

Kinky For Governor by Big Grey MareUpper-income seniors would also be affected by another part of the plan. Currently, seniors making at least $85,000 for an individual and $170,000 for a couple pay higher monthly premiums for outpatient and prescription coverage. The plan would gradually increase the share of seniors facing higher premiums until it comprises the top 10 percent of beneficiaries. It would also boost those premiums by 15 percent.
Source: ktre.com

Video: TRS Care Aetna Medicare Plans

Viewpoints: ‘Bad Idea’ About Repealing Medicare Cost Board; Conservatives Say Health Law Repeal Fight Is Not Over

The New York Times: A Bad Idea Resurfaces House Republicans like to talk about the need to find common ground with President Obama to make progress on important national issues, especially after the election. Yet within days, they were setting an agenda to eliminate an important element of his signature domestic achievement, the Affordable Care Act. Representative Eric Cantor of Virginia, the majority leader, recently proposed that House Republicans set their sights on repealing the part of the law that creates an independent board that is supposed to help limit growth in Medicare spending (11/17).
Source: kaiserhealthnews.org

Texas firm to pay millions in Medicare fraud case

HOUSTON — A Dallas-area medical manufacturer has agreed to pay $42 million in penalties to settle civil and criminal cases related to fraudulent claims it made to Medicare and other federal health care programs when selling bone growth stimulator devices, the Justice Department announced Thursday.
Source: columbiamissourian.com

Information for Medicare Beneficiaries

This week, open enrollment began for Medicare and runs through December 7, 2012. It is important for current Medicare beneficiaries to review their plans on an annual basis to ensure satisfaction with their current coverage. Some of the optional changes to your coverage you may wish to make during this period, which would take effect in 2013, are:
Source: texasgopvote.com

Dr. Patel Opens new San Antonio Medicare Clinic

Texas Bariatric Specialists (TBS) focuses on delivering long-term weight loss solutions, and is committed to providing quality, compassionate care with the most advanced, safest and medically effective weight loss options available for their patients. Services include Lap Band, Gastric Bypass and Gastric Sleeve surgeries, as well as the revision of failed weight loss surgery. In addition, TBS offers both pre- and post-operative counseling and support through a behavioral weight loss psychologist, nutritional counseling through a certified dietician/nutritionist, a nutritional resource store, insurance concierge services and affordable financing options. Medically successful non-surgical weight loss programs are also available.
Source: texasbariatricspecialists.com

TSCRA Insurance Services has your Medicare supplements covered

Did you know TSCRA Insurance Services offers Medicare supplements? Regardless of your current insurance provider, if you’re about to turn 65, call us at 1-800-252-2849 for more information. TSCRA Insurance Services handles a wide variety of products for members, including individual plans and small business groups for 2 to 50 employees, vision, dental and more. Visit our website at tscrainsurance.com and click on “Health & Well-Being” in the yellow menu bar to find out more.
Source: tscra.org

Texas Attorney General Missing the Mark on Medicare

True, so many people have been trapped into dependence upon government intentionally to win votes; nevertheless, a means must be provided for protecting those already ensnared into the system or close to falling into it. Still, playing games under the fraudulently ratified and unconstitutional 16th Amendment should end asap with the elimination of the Gestapo IRS and a despotic, unaccountable private central banker-controlled Federal Reserve, both egregious tyrannies upon a free people.  A free people should never have to beg for their own money back from an oppressive, unconstitutional, wasteful, malfunctioning and bureaucracy-unaccountable federal government so far removed from the people and even now teetering on complete absorption into a One World Government.
Source: wetexans.com

Affordable Care Act Not So Affordable : Eastern Group Publications

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READ THE HEALTHCARE BILL NOW... by roberthuffstutterComments are intended to further discussion on the article topic. EGPNews reserves the right to not publish, edit or remove comments that contain vulgarities, foul language, personal attacks, racists, sexist, homophobic or other offensive terminology or that contain solicitations, spam, or that threaten harm of any sort. EGPNews will not approve comments that call for or applaud the death, injury or illness of any person, regardless of their public status. Questions regarding this policy should be e-mailed to service@egpnews.com.
Source: egpnews.com

Video: 2011 HEAT Provider Compliance Training – Overview of Centers for Medicare and Medicaid Services

Obamacare’s to cut $200 billion from Medicare Advantage to fund Medicaid.

“The quality and variety of the selections you will find on EducationViews.org is second-to-none on the internet today. Since 1997 we have been providing this service at no cost to education professionals, the public in general and policy makers. Hope you enjoy the articles and commentary. Please forward us to your friends and associates. EducationViews.org is maybe the most effective way to transforming educators. The daily email offers a direct and easy way for busy teachers to grow philosophically. I was skeptical, but once you open the email and decide to read a story, you are hooked and it becomes a daily ritual to check out what’s happening. Educating teachers as to what is really going on in the schools opens up a new worldview and vision of thinking most have not been exposed to. The end result, better informed teachers who have a more effective understanding of the principles that make academic achievement a reality. Great job. The more email addresses of educators you get on your list, the bigger the impact and the more kids you will positively influence.
Source: educationviews.org

Why Premium Support? Restructure Medicare Advantage, Not Medicare

Premium support proponents argue that replacing public insurance with vouchers to purchase private (or public) coverage will harness market forces to contain costs. But the debate often ignores traditional Medicare’s administrative efficiency, purchasing power and the rewards to risk selection that accompany competition among plans. We show that despite Medicare Advantage (MA) plans’ success in enrolling beneficiaries, they have been unsuccessful in lowering costs. Except in 15 percent of counties, MA costs per beneficiary exceed costs for traditional Medicare. Fiscal prudence warrants limiting MA payments to 100 percent of traditional Medicare costs, while keeping payments to MA plans below traditional Medicare in the highest cost counties.
Source: urban.org

Medicare agrees to pick up the tab for obesity counseling — Health — Bangor Daily News — BDN Maine

Unfortunately, those best prepared to provide obesity counseling will not be able to bill directly to do so. CMS has limited who is able to bill for those services to primary care physicians and practitioners, including nurse practitioners, clinical nurse specialists and physician assistants. Those with expertise in the field, such as registered dietitians, are not eligible to bill directly. Medicare will cover services from “auxiliary” providers only if the service is provided in a physician’s office suite and the physician is immediately available to provide assistance and direction.
Source: bangordailynews.com

Health Benefits for the Uninsured

Many Social Security Disability Insurance (SSDI) beneficiaries have serious health care needs, but, under current law, most are not eligible for Medicare until 29 months after the Social Security Administration (SSA) has established the onset of their disability. To test whether providing immediate health care and related services leads to improved health and better return-to-work outcomes for newly entitled SSDI beneficiaries, SSA funded the five-year Accelerated Benefits (AB) Demonstration. AB will provide the first set of rigorous findings on the efficacy of providing earlier access to health benefits for a population of beneficiaries who have no medical coverage when they first become entitled to disability cash benefits. This policy brief provides an overview of the AB project and describes findings from the initial phase of enrollment from October and November 2007 and plans for full implementation.
Source: mdrc.org

Medicare Reimbursements and Shortages of Sterile Injectable Pharmaceuticals

This paper investigates the rise in shortages of sterile injectable pharmaceutical drugs in the US. I examine a policy change in 2005 that differentially reduced Medicare Part B payments for pharmaceuticals. Drugs that were subject to a greater pol- icy change because they serve older patient populations have had greater increases in shortages. I interpret these results using a model of capacity choice with supply uncertainty. I conclude that Medicare’s generous payments before the policy change provided manufacturers with incentives to invest in capacity or induced entry. The effect on total welfare of lowering payments is theoretically ambiguous.
Source: stanford.edu

Medicare Open Enrollment: The Tools Are There to Help Your Loved Ones Make Good Plan Choices

A recent study found that seniors (often with the help of their support systems like you and me) are learning from their experience with Part D over time and switching plans when they can save money, or when a different plan better fits their individual health needs. The study, which we have highlighted in our Rx Minute newsletter this month, shows that seniors are adapting to get the best drug coverage for their money. Research PhRMA sponsored found that even in 2006, Part D’s first year, seniors disproportionately chose plans with lower premiums and deductibles and broader choice of medicines. In sum, choice works, benefiting seniors.
Source: phrma.org

Competitive Bidding in Medicare Advantage

, April 29, 2009, for a fuller de­scription of these plans, how they are currently paid, other proposals to change the payment sys­tem, and arguments for and against doing so.) Under the Obama administration’s proposal, companies in a given geographic area would sub­mit bids to cover Medicare beneficiaries, as they do now. But they would then be paid the average of their bids, plus some additional amounts as de­tailed below. Insurers submitting below-average bids would receive the average payment; they could use the difference between their bids and the average payment amount to provide addition­al benefits to enrollees. Companies with above-average bids would charge members a premium to make up the shortfall between the average pay­ment and their bids.
Source: rwjf.org

Key House Medicare Subcommittee Will Have New Leaders; Rep. Stark Loses Election Bid :: “The Pink Sheet” :: Elsevier Business Intelligence

Rep. Pete Stark, D-Calif., often a critic of the pharmaceutical industry, lost his re-election bid, leaving the top Democratic spot open on the Ways and Means Committee’s Health Subcommittee. Subcommittee Chairman Wally Herger already planned to retire. All members of the Senate HELP and Finance Committees up for re-election won their races.
Source: elsevierbi.com

Examples of Taxpayers Facing Medicare Tax Increase under Health Care Bill

The health care bill passed by the House of Represenatives on Sunday (Senate bill plus reconciliation) includes, among many other tax increases, two tax hikes on high-income taxpayers set to go into effect in 2013. One of the increases is a higher employee Medicare tax on wages earned above $250,000 (married; $200,000 for singles). The other tax hike is a 3.8 percent Medicare tax on investment income earned by couples earning more than $250,000 in modified adjusted gross income ($200,000 for singles). Investment income includes such sources as rental income, dividend income, interest income, income from trusts, and most capital gains.
Source: taxfoundation.org

Learn About Medicare Changes November 14

Posted by:  :  Category: Medicare

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Source: patch.com

Video: Vice President Joe Biden on Medicare – Blacksburg, VA

Sound Medicine: What do potential changes in Medicare mean for future senior citizens?

Mitt Romney

Rep. Issa Subpoenas HHS Records On Medicare Advantage Program

Posted by:  :  Category: Medicare

Cassandra Q. Butts by Center for American ProgressCQ HealthBeat: HHS Inspector General Raps CMS On Medicare ID Theft Protection Federal Medicare officials reported 14 breaches of medical information in two years affecting nearly 14,000 beneficiaries, but they failed to notify those affected in a timely way and often did not give them much information about the violation, the Office of Inspector General for the Department of Health and Human Services said in a new report. In response to worries about medical identity theft, the government has set up a database with the Medicare ID numbers of 284,000 beneficiaries and 5,000 providers that have been involved in medical identity theft in the past or are regarded as vulnerable. But Medicare contractors have problems using the database, and few remedies are available for those whose numbers have been compromised, the OIG report said (Norman, 10/22).
Source: kaiserhealthnews.org

Video: Cut Medicare Advantage Program

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

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

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

House Cmte. Looks at Status of Medicare Advantage Program

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

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

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

Fact Check on Medicare Advantage

  Medicare Advantage plans also protect beneficiaries from catastrophic health care costs.  In 2012, all Medicare Advantage plans offer an out-of-pocket maximum limit for beneficiary costs, and about 78 percent of Medicare Advantage enrollees are in plans that have annual out-of-pocket maximums of $5,000 or less.  These out-of-pocket maximums – which are not offered by the Medicare FFS program – help protect Medicare beneficiaries from catastrophic health care expenses that otherwise might pose a serious threat to their financial security.  Medicare Advantage plans also help reduce out-of-pocket costs for enrollees by reducing premiums for Part B and Part D, and by limiting cost-sharing for Medicare-covered services, including primary care physician visits and inpatient hospital stays.
Source: ahipcoverage.com

OPINION: Who wins with Medicare Advantage?

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

WASHINGTON: Medicare premiums going up $5 a month for 2013

Posted by:  :  Category: Medicare

New Online Rx System Makes UM Student 'Top Entrepreneur' Finalist by University of Maryland Press ReleasesObama’s health care law reined in Medicare spending by curtailing payments to hospitals, insurers, drug companies and other service providers. Democrats want to focus the next round of cuts on providers, particularly pharmaceutical companies. But Republicans are looking for more significant changes in the program, such as increasing the eligibility age to 67.
Source: heraldonline.com

Video: Patty and Richard say, “Apply online for Medicare” (20 seconds) – Social Security

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

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

Medicare Part D Counseling Offered

“The amount of coverage offered for medications and medical services varies from company to company.  It is to your benefit to subscribe to a plan that covers those medications and services you need.  Since the Area Agency on Aging of Deep East Texas (AAADET) does not offer or sponsor any plan, we are one of the few independent sources of information and counseling available in the region,” said AAADET Program Director, Holly Anderson.  AAADET Benefits Counselors will ask questions about your health and prescriptions.  Based on the information you supply, they can tell you which program would benefit you the most.
Source: countylifeonline.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

My Experience Applying for Medicare Online

Once submitted you are advised: “Thank you! Your data has been received and we are working to process your request. You will be able to check the status of your action online in 5 business days. To check the status, go to http://www.socialsecurity.gov. You will need to enter your Confirmation Number to get status information, so please put this number in a safe location. We hope you found our internet application convenient to use and easy to understand.” Well, we three found the online application process both convenient and easy. I applaud Social Security for an excellent implementation and the person-to-person customer service I received when I had a question.
Source: medicarebenefits.com

Redesign of Medicare.gov site to improve online experience for beneficiaries

“We did a lot of research into what sort of information beneficiaries and their caregivers really wanted most at their fingertips, and I think users will find this redesign very helpful,” said Acting Administrator Marilyn Tavenner. “We’ve simplified the language and the homepage layout to make it easier and faster for visitors to get answers and a better understanding of Medicare necessary to get more control over their health care.”
Source: newsfromaoa.org

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

The page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

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

A Bogus Mass Mailing about Medicare That Just Won’t Die

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 marsmet524The income threshold that triggers higher amounts was originally calculated so that it rose with the rate of inflation. But the recent health reform law froze the income thresholds which means more seniors will have to pay the higher premiums. Initially, about five percent of all Medicare beneficiaries were paying higher premiums each year based on a sliding scale. This year, the income-related premium ranges from about $140 per month to $320 and affects individuals with incomes greater than $85,000 and families with incomes over $170,000. By the end of the decade about 10 percent of seniors will pay a higher income-related premium.
Source: preparedpatientforum.org

Video: Medicine Dish: Medicare Part D and Program Updates

Medicare premiums to go up $5 in 2013

WARNING: THREAD DRIFT HERE. This is an interesting comment to me because it gets at the psychology of taking SS early rather then late. Suppose we have two people A) Takes SS early and so the Medicare just comes out of a nice government check that floats in every month like clockwork. This person might say to themself "oh well, at least the health care is paid for without my having to dip into my portfolio". B) Has chosen to defer SS so the Medicare can seem to come right off the top of their spending from the portfolio. This person might say to themself "guess I cannot spend quite as much this year as I have to take care of this Medicare check". Now I’m not saying that W2R is thinking quite along the lines of the (B) case although I did note that unhappy face she posted . I do think that deferring SS can cause a defensive attitude towards saving that results in deferring spending until later years. Could be that the result is not quite enjoying the mid-60’s retirement years as much as is possible. Note, a totally rational approach would not go along the cases (A) and (B) above. But we are very much emotional creatures, even the most rational of us. Some of the case (A) or (B) thinking could be occurring at an unconscious level. Anyway, just my musings. This year I decided to take SS and it’s made me a lot happier emotionally. Rationally I might have been better off in later years to defer SS even longer. END OF THREAD DRIFT.
Source: early-retirement.org

Have You Updated All of Your Addresses with Medicare The Consequences of Not Doing So Are Severe

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

CVS Possibly Under Investigation for Medicare Fraud

administrative action administrative complaint attorney audit controlled substances dea DEA investigation defense attorney defense lawyer department of health Department of Health (DOH) doctor doh DOH investigation drug enforcement administration emergency suspension order false claims act florida fraud prevention health care fraud health law hipaa investigation legal representation licensing and regulatory medicaid medical license medicare medicare audit Medicare fraud Medicare investigation Medicare overbilling nurse nurses overbilling overprescribing pain clinics pain management pharmacies pharmacist pharmacists pharmacy physician physicians prescription drug trafficking
Source: wordpress.com

Rowan woman gets prison for Medicare fraud

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Source: salisburypost.com

Could biometric scanning reduce Medicare fraud?

The Biometrics Market is very diverse, ranging from Ultrasound Fingerprinting and Facial / Voice Recognition to Retinal and Iris Scanning. Biometrics can be complicated, but Hand Geometry, Facial Recognition and retinal scans are already being used by the military and law enforcement. However, the latter requires cooperation by potential patients due to the fact it can only be used within a few centimeters of the detection device. Individual iris scanning technology started in the 1990s, which is a little different because not only is it more accurate, it can recognize people from several centimeters to several meters away. The interesting thing about this technology is that it can be used for people who are incoherent, unconscious, the elderly, children, neonates and others. With that broad perspective of utilization, it provides a larger base of patient identification.
Source: libertyunyielding.com

Working Families Tell Congress To Protect Medicare, Medicaid And Social Security Eliminate Tax Cuts For Wealthiest 2 Percent

Retirees, activists and members of progressive and faith communities will host close to 100 events targeting members of Congress during the upcoming Lame Duck session.  Events will take place outside members’ offices, health clinics, Social Security offices, construction sites and other community locations. In Nashville, Tennessee, working families are gathering for a roundtable with Congressman Jim Cooper to thank him for his pledge to protect Medicare, Medicaid, and Social Security. In Missoula, Montana, working families are marching to their congressional office.
Source: enewspf.com

Providers Filed 85% of Medicare Appeals in 2010

Posted by:  :  Category: Medicare

THE LITTLE MAN KILLED MEDICARE FOR EVERYBONE by SS&SSA 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

Video: Medicare Supplement vs. Medicare Advantage Plans – A Doctor’s Perspective

Medicare Provisions Pay For Nursing Services

The Medicare Physician Fee Schedule Final Rule, issued Nov. 1 by CMS and set to take effect Jan. 1, 2013 after publication in the Federal Register, also includes new codes that describe “complex chronic care coordination,” a service typically provided by RNs. Though the rule will not allow separate billing for care coordination, some private insurers are likely to use the codes to reimburse providers directly for the service. Such reimbursement policies for care coordination could expand the RN job market. They could also raise recognition for nurses performing this long-held, core professional standard and competency considered integral to patient-centered care and the effective and efficient use of health care resources.
Source: nursefuture.com

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

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

Thanks 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

The American Consumer Institute

Americans are facing challenges sometimes caused by questionable public policy and regulations that raise industry costs – both of which lead to higher consumer prices and fewer choices for consumers.  ACI’s focus is to support concepts which spur competition, encourage innovation, create jobs and benefit consumers overall, while maintaining reasonable and necessary consumer safeguards. We serve as an academic voice for consumers.  Our goal is to build awareness, survey consumer attitudes on public policy issues, facilitate discussion, and offer research-based solutions that have the best interest of consumers in mind. We encourage you to sign up for our periodic updates regarding important state and national issues, share this website with family and friends, financially support our research, and check back for updated news and resources.  Feel free to contact us and let your voice be heard.
Source: theamericanconsumer.org

Comparing Medicare plans? Ratings show some policies better than others — Health — Bangor Daily News — BDN Maine

The site will still be viewable but certain elements might display incorrectly. In order to enjoy all the features of our site, we recommended you upgrade to a newer, more secure browser. Read more ». If you don’t have administrator privileges for your computer, you can still take action. Google has developed a free plugin for Internet Explorer called Google Chrome Frame. You can install it on any computer, even if you can’t install applications, and it will ensure your computer stays secure and that you can still visit our website. Enable Google Chrome Frame now »
Source: bangordailynews.com

Do President Obama’s Medicare Policies Strengthen Medicare?

Reality Check: The Patient Protection and Affordable Care Act requires huge cuts to the Medicare programs, prompting a loss of benefits and causing many seniors to lose their plan altogether. More than 7 million seniors will have to lose access to their Medicare Advantage plan. About two-thirds of plan choices will disappear, resulting in a loss in benefits of about $3,700 per beneficiary.
Source: ncpa.org

Medicare Secondary Payer: Conditional Payment Reimbursement Policies for Certain Liability Settlements

Beginning February 21, 2011, CMS implemented an option permitting certain Medicare beneficiaries the ability to self-calculate Medicare’s conditional payment amount prior to settlement. As with other recent policies, the option is available only to liability insurance (including self-insurance) settlements and not workers’ compensation or no-fault claims and only when involving a physical trauma based injury and not ingestion, implantation or exposure. The dollar threshold was established at $25,000 or less and the date of incident must have occurred at least six months prior to the submission of the self-calculated amount to Medicare for review. The beneficiary must demonstrate that treatment has been completed and that no further treatment is expected through written physician attestation or a written certification by the beneficiary that there was no treatment for at least the 90 days prior to submission and that there is no further care expected. The election of this option bars the beneficiary from appealing the amount or existence of this debt, but the right to pursue waiver of recovery will remain.
Source: lexisnexis.com

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

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

CMS rule creates reimbursement opportunities for RNs

The American Nurses Association touted a new Medicare rule that calls for paying advanced practice RNs for primary care services intended to effectively manage patients

Two Miamians Convicted In $205 Million Medicare Fraud

Posted by:  :  Category: Medicare

Mashing the Aussie State: Geocoding Medicare office location data by ChiefTechThroughout the course of the fraud conspiracy, tens of millions of dollars in kickbacks were paid in exchange for Medicare beneficiaries, who did not qualify for PHP services, to attend treatment programs that were not legitimate PHP programs. ATC and ASI billed Medicare for more than $205 million in services to patients who did not need the services and to whom the appropriate services were not provided. According to the evidence, Ward, Eckert, and co-conspirators personally altered and caused the alteration of patient files and therapist notes for the purpose of making it appear, falsely, that patients being treated by ATC were qualified for PHP treatments and that the treatments provided were legitimate PHP treatments.
Source: browardnetonline.com

Video: Colonial Medical Supplies – Medicare approved DME.

Senior Care in Sharon, PA: Open Enrollment for Medicare –Now through Dec 7, 2012

Would a small increase in premiums result in a large reduction in health care costs you pay? Check, for example, what coverage is available for prescription drugs you take? Medicare representatives can create a report containing the costs and benefits of various insurance products if you supply them with a list of your drug prescriptions. Ask questions about participating doctors and clinics. Some Medicare Advantage plans limit which physicians a patient can visit.
Source: cgphomecarehermitage.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

Learn About Medicare Changes November 14

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Source: patch.com

Will Unions Fight Fiscal Cliff Cuts to Medicare and Social Security?

 The pretext for this betrayal of the working people-friendly profile he promoted while on the campaign trail is the politically manufactured “fiscal cliff” crisis of triggered spending cuts and tax increases slated for January 1st. But the fiscal cliff itself was created by the Obama administration — with Republican participation — to create an atmosphere of “urgency” that would force politicians to act. The U.S. debt is easily financed by investors who continue to pour their money into buying U.S. Treasury bills — so if not for Obama’s fiscal cliff, no debt crisis would exist.   The goal of the fiscal cliff is to scare the public into accepting that a debt crisis exists that requires historic cuts to Medicare, Medicaid, Social Security, and other popular social programs.   Politicians ignore the fact that Social Security is self funded, and therefore doesn’t contribute to the national debt. Politicians also ignore the fact that the U.S. debt is largely the result of bank bailouts, decades of steadily lower taxes on the rich and corporations, and the Iraq and Afghanistan wars, combined with an insane military budget that subsidizes weapons manufacturers.   So how do Democrats and Republicans plan to address the fiscal cliff?   The pro-Democrat Huffington Post writes:   … President Barack Obama is proposing a grand bargain that would reduce the deficit by $4 trillion[!] over 10 years, relying on a 3-to-1 mix of spending cuts [to popular social programs] and revenue increases.   A 3-to-1 ratio is presented as a “compromise” or a “balanced” approach. Of course, it is entirely possible to have no cuts to social programs by raising revenue by taxing the rich and corporations who’ve accumulated literally trillions of dollars.   The Huffington Post continues:   … lawmakers [Democrats and Republicans] will likely target Social Security, Medicare, Medicaid and a host of other social programs that help those with the fewest advocates in Washington, including people on food stamps, veterans, retiring federal workers, home health care workers and the elderly[!!].   The article also states that Obama “could be open” to raising the Medicare eligibility age to 67, and cutting Social Security in relation to inflation, by lowering the yearly cost of living adjustment for beneficiaries.   What has Labor’s response been to this madness? The President of the AFL-CIO, Richard Trumka, sent an interesting letter that congratulated union members on “their victory” (electing Obama), while saying only a few paragraphs later:   So it’s up to us to fight like hell for the working people in our communities. We need to work to make sure the rich pay their fair share, there are no cuts to our benefits, and programs that safeguard our country’s future — like Medicare, Medicaid, and Social Security — are safe for generations to come.   Well done! Even though Trumka fails to educate his members about the Democrats role in the grand bargain.   The next day the AFL-CIO announced that they had already begun a campaign to fight against these cuts (the Service Employees International Union has a similar campaign freshly launched):   Retirees, activists and members of progressive and faith communities will host close to 100 events targeting members of Congress during the upcoming Lame Duck session. Events will take place outside members’ offices, health clinics, Social Security offices, construction sites and other community locations.   This is a good start. But MUCH bigger mobilizations are needed, and FAST. Unions spent hundreds of millions of dollars to get “their” candidate elected, and now if labor would like to remain relevant in the eyes of the broader community, they’ll need to pony up and pour resources into fighting Obama’s grand bargain.   If labor helps lead a fightback against these cuts — as was done in Wisconsin and Chicago — there is potential to make new alliances with community groups and re-gain the broader communities’ support. This would also likely lead to more people wanting to join unions, since workers are attracted to strong, capable organizations that are prepared to defend their interests.   Countless polls have concluded that the vast majority of working people in the U.S. support taxing the rich (even Republican-voting workers) and they do not want to see cuts to Social Security, Medicare, and Medicaid. If the AFL-CIO and Change to Win coalitions lead a real fight with massive demonstrations that demand No Cuts and Tax the Rich, they could quickly change the public debate, and push back the two-party grand bargaining in Washington DC.   Organizing only small actions with limited resources guarantees defeat.   For more articles visit us at workerscompass.org
Source: phillyimc.org

Medicare Aims to Improve User Experience

This entry was posted on Friday, September 7th, 2012 at 11:56 am and is filed under Consumer-Driven Healthcare, Customer Service, Healthcare Reform, Medication Management, Prescription Drugs. 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: hin.com

Medicare Enrollment Starting; Help Sessions Scheduled

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Source: coudynews.com