The Official Medicare Set Aside Blog And Information Resource: Medicare Debt Recovery Using the False Claims Act

Posted by:  :  Category: Medicare

In honor of Tax Day by swanksalotAnd so the story goes: the claimant worked for a privately-owned beverage distribution company in Smyrna, Georgia where he fell during work in March 2008. He applied for work comp benefits and was denied by AIG. Although the HR director was upset by the WC denial, the president of the TPA that administers the company’s employee health benefit plan advised her not to appeal the denial and told her that the plan would pay the claims and assist with compensation benefits. He spoke with the family, then notified the HR director that the employee declined FMLA leave and instead elected COBRA continuation coverage under the health plan. After few brief calls from the TPA and an email attaching the letter sent to the employee regarding the COBRA election, the employer believed that COBRA was elected and the matter taken care of. Instead, 180 claims totaling $341,802.09 were submitted to Medicare and it would like to be reimbursed. Claimant died at the end of May, and given that I’ve obtained all of this information from a discovery order, it is impossible to tell at this point whether his WC claim should have been compensable or not. As it stands, the primary issue is the COBRA election.
Source: medicaresetasideblog.com

Video: Obama Disputes Romney, Ryan Medicare Claims

Bentley Virtual Symposium (Nov 14): Data Mining Medicare claims

Radiologists claim that performing two or more CT (Computed Tomography) scans in succession is rarely necessary, yet the practice of multiple CT scanning of patients during the same visit has continued in recent years. This talk discusses how to use the Medicare claims database to review the evidence and identify factors that contribute to this practice.
Source: kdnuggets.com

Republicans Trying To Defuse “Cutting” Medicare Claims from Democrats

Although so many seniors are reliant on Medicare, many free-market advocates claim that Medicare has been one of the primary reasons why hospital costs are so expensive. The reasoning behind this claim stems from the belief that the government may have inflated the industry due to subsidizing payments, which in return affects the appropriate price. The solution, according to free-market advocates, is to cut government spending on healthcare for citizens and end the government-sponsored health insurance oligopoly so there is a free-market in healthcare, which will drive prices down according to what the consumer can appropriately pay; just like any other market. Many argue in defense of this claim stating that it will take time for prices to drive down, which could cause many problems for the elderly that have paid into the program.
Source: spreadlibertynews.com

Howard Dean compares Romney Medicare claim to Soviet ‘propaganda techniques’

Lately, Mitt Romney and Paul Ryan have been claiming that President Obama cut $716 billion from Medicare. As we and many others have noted, the claim is deeply misleading: Those cuts affect providers and insurance companies, and leave seniors’ care untouched. Meanwhile, Ryan’s own plan for Medicare would end the program as we know it, turning it into a system of vouchers, and leaving many seniors unable to foot the bill for coverage, studies have shown.
Source: msnbc.com

Fighting a Medicare Claim Rejection

After undergoing a complicated and expensive procedure that more than likely causes stress, it only adds to the stress when Medicare rejects the claim. The time is supposed to be about healing, not worrying about something that was supposed to be covered.
Source: kopelsonclinic.com

Did He Read It? To Prove Ryan’s Medicare Claim, Limbaugh Cites Article That Debunks Ryan’s Medicare Claim

In fact, Ryan’s Medicare plan would affect all seniors. Under his proposal, a gap in Medicare coverage for prescription medicine, corrected by the Affordable Care Act, would be reopened, potentially costing seniors thousands more in drug costs. Ryan’s plan could also raise premiums for some, which could eventually threaten “Medicare’s long-term viability,” as the Center on Budget and Policy Priorities found.  
Source: mediamatters.org

Senators Caucus Vows To Protect Social Security, Medicare

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSSaw 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

Video: Obama To Cut Social Security And Medicare?

Daily Kos: A chastened AARP fights Social Security, Medicare, Medicaid cuts

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Source: dailykos.com

Highmark change in Medicare eye exam coverage irks some

• Another person sickened in Legionnaires’ disease outbreak at VA University Drive • Roethlisberger’s wife gives birth to son • Living a struggle for carless residents in Western Pennsylvania  • WPIAL finalists have chance to make history • Black Friday haters still expected to spend more on gifts this holiday season than last
Source: triblive.com

Keeping an eye on Social Security and Medicare

When elected officials talk about the future of Social Security and Medicare, it’s usually a lot of “Washington-speak.” AARP is working to change that by making sure everyone in North Carolina understands what’s being discussed in Congress and has opportunities to express personal points of view. We’ve enlisted a broad range of experts from all political views to share their ideas so you can understand the pros and cons of leading proposals on the table in Washington.
Source: bluenc.com

Health Premiums Could Wipe Out Social Security Boost; Medicare Enrollment Begins

Miami Herald: Marketing Medical Insurance To Individuals This time of year is a hectic, marketing-intensive period for Florida Blue and other insurers that sell Medicare policies. During the federal program’s annual election period, this year from Oct. 15 to Dec. 7, seniors can switch to a new underwriter of Medicare policies for their 2013 coverage. So, insurers are anxiously courting the Medicare population to keep current policyholders and add new ones…That kind of consumer marketing may become much more common in the under-65 market as healthcare reform unfolds, especially the individual mandate to obtain medical insurance or pay a penalty, starting in 2014. So next year, visitor traffic at the Florida Blue Centers in Miami, Fort Lauderdale and other locations around the state may increase substantially to include not only Medicare beneficiaries but also younger people shopping for individual health insurance (Seemuth, 10/14).
Source: kaiserhealthnews.org

Tea Party Patron Saint Ayn Rand Applied for Social Security, Medicare Benefits

Critics of Social Security and Medicare frequently invoke the words and ideals of author and philosopher Ayn Rand, one of the fiercest critics of federal insurance programs. But a little-known fact is that Ayn Rand herself collected Social Security. She may also have received Medicare benefits.
Source: firedoglake.com

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

Posted by:  :  Category: Medicare

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

Video: How to Navigate Medicare Reimbursement

Senators Urge CMS to Provide Information about Medicare and Medicaid Reimbursement for Compounded Drugs

Public Citizen, a consumer advocacy group, has written a letter to HHS Secretary Kathleen Sebelius, asking her to direct the HHS Office of the Inspector General (OIG) to conduct an investigation into CMS’ policies with respect to reimbursement for compounded drugs. Public Citizen cited conflicting provisions of the Medicare Benefit Policy Manual that, on the one hand, instruct carriers to deny coverage for drugs that have not been approved by the FDA and, on the other hand, direct carriers not to deny coverage for such drugs unless directed to by CMS. Public Citizen also noted that CMS is aware of the dangers posed by compounded drugs. In 2007, its four regional Durable Medical Equipment (DME) Medicare Administrative Contractors (MACs) denied coverage for compounded inhalation drugs administrated via nebulizers, noting that the drugs were not FDA-approved and citing safety concerns. The senators, Public Citizen, and the public await the agencies’ response.
Source: wolterskluwerlb.com

CMS Guidance on Medicare Reimbursement for Fungal Meningitis Treatment

FDA advises healthcare professionals to follow-up with patients who have been administered an injectable product shipped by NECC on or after May 21, 2012, including an ophthalmic drug that is injectable or used in conjunction with eye surgery, or a cardioplegic solution. FDA does not urge patient follow-up at this time for NECC products of lower risk such as topicals (for example, lotions, creams, eyedrops not used in conjunction with surgery) and suppositories, or for patients who may have received an NECC product in these categories before May 21, 2012. Patients who received an NECC product prior to May 21, 2012 and who have not experienced symptoms of infection to date are at less risk of infection because of the amount of time that has elapsed since that date. FDA is not recommending that healthcare providers follow-up with these patients unless they have reported symptoms of infection.
Source: managemypractice.com

President, GOP Leaders Begin Talks To Avoid Medicare Payment Cuts

In a conference call with House Speaker John Boehner (R-Ohio) and other top lawmakers, Obama urged them to set aside partisan differences to develop a solution for the sequester. Following the conference call, Boehner said Republicans are willing to accept a budget deal that would raise federal revenues as long as the administration does not “continue to duck the matter of entitlements” (
Source: californiahealthline.org

Dems Face Internal Divide On Medicare, Safety Net Questions

National Journal: Bold Medicare Reform May Require Going Beyond The CBO Score Liberal Democrats would rather not see any cuts to entitlement programs — period. Instead, they argue, the U.S. government needs to put policies in place that will bring down the costs of health care overall. Make care cheaper to administer, the argument goes, and Medicare and Medicaid won’t cost the federal government so much. It’s a beguiling idea with one big flaw: The Congressional Budget Office isn’t always able to put a dollar figure on how much money Democrats’ ideas would save. As Washington negotiators work toward a debt-reduction deal, Democrats want reducing the cost of care to be part of the conversation. But budget negotiators want to be able to talk in dollars. CBO’s scoring rules “much too much embed the status quo. They require levels of certainty about the costs and benefits that defy many forms of innovation,” said Donald Berwick, a Center for American Progress senior fellow and former administrator of the Centers for Medicare and Medicaid Services (Quinton, 11/20).
Source: kaiserhealthnews.org

Medicare Payments Could Increase By $10 Billion in 2013

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

Pending Medicare reimbursement rate cut impacts UMMS bid for St. Joseph

&summary=Talks+between+state+and+federal+health+officials+about+changing+hospital+reimbursement+rates+under+Maryland%E2%80%99s+unique+Medicare+waiver+have+emerged+as+a+central+factor+in+the+University+of+Maryland+Medical+System%E2%80%99s+ongoing+bid+to+acquire+the+struggling+St.+Joseph+Medical+Center.&source=Maryland+Daily+Record’ title=’Share with Lindedin’ onclick=’target=”_blank”;’ rel=’nofollow’>
Source: thedailyrecord.com

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

Hospitals’ Medicare funds at risk

Posted by:  :  Category: Medicare

NYC TO WALL ST.: BUSH / CHENEY: DROP DEAD. by eyewashdesign: A. Golden“Changing the way we pay hospitals will improve the quality of care for seniors and save money for all of us,” said U.S. Department of Health and Human Services Secretary Kathleen Sebelius in a press release when the agency launched the initiative last year. “Medicare will reward hospitals that provide high-quality care and keep their patients healthy. It’s an important part of our work to improve the health of our nation and drive down costs. As hospitals work to improve their performance on these measures, all patients – not just Medicare patients – will benefit.”
Source: thenewyorkworld.com

Video: New York: Medicare Fraud Summit Remarks (DOJ)

New Changes in the Delivery of Medicaid Home Care Services in N.Y.C.

QUEENS, N.Y., Sept. 15, 2012 /PRNewswire-iReach/ — Beginning Monday, September 17, 2012, applications for Home Care will not be accepted at the local Community Alternative Systems Agency (CASA) offices, with limited exceptions. The CASAs, the department of the N.Y.C. Human Resources Administration that processes Home Care applications, will only accept Home Care applications for those applying for Hospice, Consumer-Directed Personal Assistance Program (CDPAP), Traumatic Brain Injury (TBI) Waiver participants or applicants, Nursing Home Transition & Diversion Waiver (NHTDW) participants or applicants or those seeking Lombardi (long term home health care waiver program services).
Source: seniorlivingcare.com

#O18: Romney & Obama in NYC

“When Paul Ryan was picked as Mitt Romney’s running mate back in August, Medicare was pushed to center stage as the main issue of the elections. Ryan is the architect of the plan to turn Medicare into a voucher program–a move that would end the popular and efficient public program as we know it and jeopardize the health of close to 50 million elderly and disabled Americans. He and other Republican leaders also want to block-grant Medicaid. While most Democrats oppose these proposals, they have their own plans to drastically cut these safety net programs if they enter into an anticipated ‘grand bargain’ on the deficit.”
Source: wordpress.com

Health Insurance in NYC and Area: Medicare Annual Enrollment Period 2012

The 2012 Medicare Annual Enrollment Period is from October 15 to December 7th. This is the time period that anyone with Medicare coverage can look to switch their supplement coverage or add a Medicare Advantage or stand alone prescription drug plan. Basically, those eligible for Medicare can shop around and select a plan that suits their needs and lifestyle. Of course, if you are just turning 65 you have a 7 month period (IEP) to choose additional coverage in addition to your Part A and Part B coverage. If you know someone with special medical needs and/or conditions they may qualify to switch plans at any time of the year using what is known as a Special Enrollment Period. (SEP). This SEP is also available to those who qualify for both Medicare and Medicaid (dual eligible). In both cases you can switch plans as many times as you like year round. Because of the complexity and number of plan options available it is important to seek the help and advise from a specialist in this field. I offer my services as your trusted advisor. Please feel free to contact me and I will do my best to help you with this important health care decision. I am appointed and certified with United Healthcare (AARP), Empire Blue Cross, Aetna, Emblem and Easy Choice  for plans in the NYC and surrounding county area. Visit my website at www.kirkdevereux.com Kirk Devereux 914-393-3872 kirkdevereux@gmail.com
Source: blogspot.com

NYC Business Group President Warns Seniors Of Medicare

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Source: nycbusinessgroup.com

What if a New York City health care provider participates in a Medicare fraud scheme?

When  such a  scheme is far-reaching an is run by an organization such as a nursing home or a home health care agency, the conspiracy may also involve patient  recruiters who pay Medicare beneficiaries to sign blank forms for the service that Medicare will then  be billed for.  Then, physicians and other health care providers may be paid to  sign referrals and other documents necessary for billing the fraudulent claims to Medicare. Other health care  personnel,  including assistance, and including the nurse or  physical therapist who  is supposed to  have provided  the service being billed, also create  false medical records in order  to  back up the claim.
Source: jpoassociates.com

FindPlansNow.com offers the best Medicare Supplement NYC

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Source: briefingwire.com

The Brian Lehrer Show:

30 Issues: Getting Real On Medicare and Social Security

I enjoyed listening to your guests discuss social security and medicare, but I found myself becoming increasingly irritated with the reference to "elderly entitlement." I was born in 1952 and began working part-time when I was 14. I recall being shocked with my first paycheck, which was quite small because it seemed that so much of my money was being taken out for federal taxes and SSI. Now I am 60 years old and reluctantly retiring because of a disability. I’ve worked 46 years and paid into SSI all those years. To me it isn’t entitlement. I worked for it. Entitlement implies getting something for nothing. Can’t this nation find a different set of words to describe this insurance that I have been paying into for so long and never yet received a penny from. It just sounds wrong. And I do feel ‘entitled’ to something from SSI as I have contributed to it for so long. Though frankly I never thought it would still be around when I reached retirement because the "experts" have been claiming for years that SS was going bankrupt. Hence I loved James Galbraith’s assessment for the future. Hope he is a visionary!!
Source: wnyc.org

PR: “Grimm” Reaper March Dramatizes Attack On Medicare, Tax Breaks for Millionaires

Led by costumed “Grimm Reapers of Medicare,” the protestors marched to Congressman Grimm’s Brooklyn Office. Along the way protestors passed out “checks” from Representative Grimm made out to the wealthiest Americans for $160,000 a year.  The checks, including a banner-sized one held by marchers, symbolized the vote Grimm cast before leaving on August vacation that gives $160,000 a year in tax cuts to the wealthiest Americans who make over $1 million a year while raising taxes on 25 million working families.
Source: newdealfornewyork.org

Weprin Spends Big Bucks On NYC Broadcast TV

Turner has been outraised more than three-to-one by Weprin, but in the race’s waning days, several outside conservative groups are coming to his aid. The Republican Jewish Coalition plans to blanket every Jewish household in the district with mailers from former New York City Mayor Ed Koch who’s crossed party lines to back Turner as a rebuke to the president’s Israel policies, and another direct mail piece from Holocaust survivor Golda Koppelman.
Source: nationaljournal.com

State reaches $13.4 million fraud settlement with NYC hospital, is negotiating with Yonkers hospital

New York and the federal government filed complaints-in-intervention against six other New York hospitals, SpecialCare Hospital Management Corp. and SpecialCare CEO Robert McNutt. The state and federal government settled four years ago with Our Lady of Mercy Medical Center in the Bronx. There are agreements in principle with Columbia Memorial Hospital in Hudson and SpecialCare Management Corp. There are settlement negotiations with Benedictine Hospital in Kingston and Long Beach Medical Center in Nassau County. New Parkway Hospital in Queens is bankrupt.
Source: lohudblogs.com

Medicare Open Enrollment: find comfort in convenience

Posted by:  :  Category: Medicare

Romney Ryan Plan for Student Loans by DonkeyHoteyLike most people, I take comfort in the things I’m familiar with. I choose to shop at the supermarket around the corner because I know exactly where to find the things I’m looking for. Sure, I might be able to save a little more money by shopping at a different store on the other side of town, but I choose to stick with what I’m most comfortable. We all like to get a good deal, but convenience is a big part of the value.
Source: medicare.gov

Video: Learn About Medigap Plans

Maryland Medicare waiver plan still unresolved

Thanksgiving is just a day away, and you know what that means: Food, football and mall stampedes. Oh, and one other thing: Barbara Mikulski is due for a letdown. The Democratic U.S. senator said in October that she wanted to see a plan for revising the state’s Medicare waiver by Thanksgiving. Health officials say they’re still working on it, but won’t have before Turkey Day. The waiver is that integral piece of Maryland’s health care system that allows the state to set its own Medicare…
Source: ewallstreeter.com

Why Private Medicare Plans Don't Cost Less

Many contend that the government “overpays” for people enrolled in private plans, since traditional Medicare could have covered these patients for less money. But the reason it would have cost less is partly that the government has done a woeful job in figuring out how much to pay the private plans. The government compensates insurers based on the health of their enrollees at the start of the year. Plans with healthier patients receive less money than those with sicker ones to reflect the likelihood that healthier people will use less care. Healthier patients enroll in Medicare Advantage plans, so in, principle, plans should be reimbursed less by the government for enrolling these patients (the technical term for this process is “risk adjustment”). But for decades, the government has failed to determine who is healthy and who is sick with any precision, with the result that private plans receive larger payments to cover their patients’ costs than necessary. This botched payment system gives insurers an incentive to spend more time selecting the healthiest patients, and less time treating them more efficiently.
Source: nytimes.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

Kaiser Permanente Georgia Offers Seniors Tips for Selecting a Medicare Plan

 Kaiser Permanente is Georgia’s largest not-for-profit health plan. Its mission is to provide high quality, affordable health care services to improve the health of its members and the communities it serves. Kaiser Permanente serves more than 235,000 members in a 28-county service area including metro Atlanta with care focused on their total health and guided by their personal physicians, specialists, and team of heath care providers. Expert and caring medical teams are supported by industry-leading technology and tools for health promotion, disease prevention, state-of-the art delivery, and world-class chronic disease management. Nationally, Kaiser Permanente is recognized as one of America’s leading health care providers, serving mort than 9 million members in nine states and the District of Columbia. For more information, visit www.kp.org.
Source: patch.com

Medicare Open Enrollment: Now is the Time to Review your Medicare Plan

Comparing Medicare plans is a relatively simple process, but having a friend or family member review the materials with you may be helpful. The official Medicare website has a tool at that helps you find and compare all of the plans available in your area. This is a great way to get started and at least gives you the overview of what your choices will be. When reviewing the plans, focus on the actual benefits they provide. For example, if you take prescription drugs, you might want to pay particular attention to the coverage offered while you are in the prescription drug coverage gap or “doughnut hole.” If you need help comparing coverage options, you can work with your local Area Agency on Aging for assistance and information. Remember: The open enrollment dates are strict! Oct. 15 – Dec. 7 is your only window of opportunity until 2013.
Source: aarp.org

Medicare open enrollment: How can I find a better plan?

What about doctor availability? On the Medicare site you can directly compare up to three plans, and when I selected your current plan and these other two plans, I saw that your current plan says it has 1001-1500 “physicians and providers,” compared to 4001-5000 for the other two plans. For each plan you can click on “View provider and physician network website,” which takes you away from Medicare.gov and onto the plan’s own website, where you can search its provider directory to judge for yourself whether it has enough doctors to meet your needs.
Source: consumerreports.org

New Medicare Plan 2012 Rolling Out Soon

Earlier, the Medicare’s skilled care services were not given to those patients who showed no sign of improvement like people suffering from Alzheimer’s disease, Parkinson’s disease, multiple sclerosis or patients that have had a stroke. But in a recent court hearing, it has been decided that these services would now be available for all those who need help to preserve their health from further worsening.
Source: topnews.us

Rubio: Ryan’s Medicare Plan Helps Romney in Florida

When Mitt Romney tapped Paul Ryan to be his vice presidential running mate, conventional wisdom dictated that Romney had put himself at a distinct disadvantage in the key battleground state of Florida, where Ryan’s controversial plan to reform Medicare wouldn’t sit well with millions of government-dependent seniors. Florida Sen. Marco Rubio isn’t buying it. In an interview with National Journal, Rubio argued that Ryan’s proposal will help — not harm — Romney’s chances of winning the Sunshine State. He predicted that older voters will support Romney and Ryan because they are trying to “save Medicare” instead of pretending that nothing is wrong with the fiscally unsustainable program. “Look, you have three million people in the state who are on Medicare — one of whom is my mom, one of whom is Paul Ryan’s mom,” Rubio said. “These are people who understand the reality of Medicare: that it’s spending more money than it takes in; that anyone who’s in favor of leaving it the way it is is in favor of bankrupting it.” Rubio praised the GOP ticket for tackling the hot-button topic of entitlement reform at a time when many politicians won’t acknowledge the problems facing the Medicare program. “They’re looking for real solutions on how to solve this,” Rubio said. “Mitt Romney and Paul Ryan are offering a way to save Medicare that doesn’t change it at all for current beneficiaries. And I think people here are going to be excited about that.”
Source: nationaljournal.com

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

Brane Space: Why I am Thankful……for MEDICARE

The pre-Medicare era was nasty, brutish and saw most elderly either dying in an impecunious state, or simply alone…..of some disease or infection. By 1960, the then Democratic contender for the presidency John Fitzgerald Kennedy had seen enough and as documented in a period issue of LIFE magazine (December 19, 1960, page 31) proposed for the first time a system of elderly medical care and insurance operating under the Social Security System. Now, as I glance at the recently tabulated bill (from UCSF Hellen Diller Cancer Center)  for my treatment of prostate cancer, I thank JFK and my lucky stars (my ‘lucky stars’ in the sense of detecting the cancer this year and not when I was scrounging for a private plan prior to Medicare) that Medicare was available and still essentially intact. That bill tabulation, for those who might be interested, came to $42, 776 and this encompassed a breakdown of different contributors, from anesthesia ($4,124) to radiology services ($16,768) to recovery room ($2, 090) to operating room services ($14,994).   The bill, after Medicare Part B kicked in, came down to $1,299 of which most will be paid by my Medicare Supplement Plan (F). Now, flash back to when I was 62 and the best insurance on offer to me was an AARP plan with $15,000 deductible and only  limited coverage. Had I been detected with prostate cancer back then, I’d have had to come up with virtually all of the $42,000.  At most, the private AARP plan might have covered $11,000 or so. (And this is assuming the cancer was detected after enrollment and not before – else I’d have been denied based on having a “pre-existing condition”.) In that case, having been given the diagnosis, I’d have had little choice but to skip any immediate treatments and hence, the cancer would plausibly have metastasized until – by the time I finally did qualify for Medicare (last year) – the costs of treating advanced prostate cancer would’ve been drastically more expensive. (In that case I’d have likely required multiple treatments, including external beam radiotherapy, androgen suppression in addition to high dose brachytherapy) I point this out because one of the alleged “solutions” to the “fiscal cliff” – grabbing so many hysterical headlines right now – is to extend the age to 67, to qualify for Medicare. To say this is monumentally STUPID, is putting it mildly! In fact, rather than limiting Medicare costs it will explode them – which doesn’t require Mensa-level intellect to figure out! If Dems yield on this to the Ryan-led “fiscal cliff” wheeling and dealing Repukes, then all hell will break loose on the Left flank. The Left understands that those 65-67 yr. old seniors caught in the proposed ‘donut’ coverage wait, will be like I might have been – and postpone essential medical care rather than go broke. Then, when they do finally qualify for Medicare, their problems will be much worse and require far more resources, medical costs to fix. This ain’t rocket science! As it is, Medicare is NO freebie! This needs to be repeated over and over again! The supplemental Part F insurance that paid the balance of my prostate cancer treatment bill comes to $139 a month along. This is in addition to the regular Medicare premium of $99 a month. In addition, no dental coverage exists, so my wife and I had to cough up over $2,700 recently to cover the costs of new crowns, fillings and dental cleanings. This isn’t any kind of luxury because most people know that once your dental health goes, the rest of your health generally follows. Healthy teeth, after all, are critical to good nutrition and avoidance of chronic inflammation! We aren’t talking ‘cosmetic” dentistry here!  And I won’t even add the $1, 500 or so every other year or so for new glasses. Another BIG Thankfulness acknowledgement here – that Ryan and Romney LOST the election! Imagine the path we’d now be on if the Ryanesque “vouchers” were the new Medicare? Hell, I’d have exhausted my $10,000 voucher in a heartbeat then have had to pay the balance of the $42,776 bill and that isn’t even looking at any other health problems that I’ve had the past six months (inlcuding ear infection, strained back muscle).   Under Ryan’s plan and with no government mandate for providing care, why should the profit -oriented insurance companies put themselves on a downward treadmill or “losing wicket” as we call it in Barbados? They wouldn’t if they had any grain of sense. Without a mandate or order from the government, you can also bet your sweet bippy they’d reject any elderly person with a pre-existing condition. This would be the proverbial no-brainer for them! Thus, by the time JFK proposed a government health plan linked to Social Security, in 1960, America’s seniors were more than ready. More than ready to stop being parasitized by commercial outfits, or humiliated by the likes of states under the odious Kerr-Mills plan (which required adult kids to cover costs). The only main opponents were the AMA which (p. 68) “ran newspaper ads and TV spots declaring Medicare was socialized medicine and a threat to freedom” and blowhards like Ronnie Reagan who made idiotic recorded talks trying to scare people by asserting (ibid.): “One of the traditional methods of imposing statism on a people has been by way of medicine”. Fortunately, most seniors who’d actually experienced the dregs of capitalist medical bestiality didn’t buy this hog swill. They organized under groups like the National Concil of Senior Citizens (see image) and turned the tables by imposing relentless pressure on representatives (the most intransigent of whom were Southern Democrats, who LBJ had to finally confront and read the ‘riot act’). Eventually, the opposing voices were muted and Medicare was passed in 1966. For those interested in what elder health care was like before Medicare get the Oxford University Press monograph, entitled: One Nation Uninsured, by Jill Quadagno, which also gets to the bottom of why there is such massive political aversion to any kind of genuine health care coverage in this country which doesn’t drag in the profit motive. As for the “fiscal cliff” – let’s not let our reps toss us over it for the sake of bankster slime (like Lloyd Blankfein) and return us to an era where seniors had to sink or swim medically!
Source: blogspot.com

Avoiding The ‘Fiscal Cliff’ Likely Means Changes In Medicare

Posted by:  :  Category: 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

Video: What Are The Ohio Medicaid Eligibility Guidelines

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

Daily Kos: A chastened AARP fights Social Security, Medicare, Medicaid cuts

Alumbrados, Sylv, RF, Ray Radlein, filkertom, slinkerwink, glitterscale, abarefootboy, Gooserock, NYmom, saraswati, mimi, emal, Bob Love, tommurphy, Sherri in TX, Vico, mslat27, akeitz, Matilda, exNYinTX, RubDMC, Zinman, missLotus, boadicea, themank, farmerhunt, antirove, fight2bfree, Eyesbright, duncanidaho, i dont get it, Steveningen, Bluehawk, defluxion10, lcrp, MagentaMN, Brian82, Diana in NoVa, FlyingToaster, zerelda, KayCeSF, Sassy, sebastianguy99, Gowrie Gal, lavaughn, maybeeso in michigan, marina, ichibon, citizenx, MT Spaces, Brooke In Seattle, Ice Blue, Jim R, splashoil, Jim P, begone, barbybuddy, Born in NOLA, martini, Shirl In Idaho, irishwitch, Patriot Daily News Clearinghouse, myboo, vigilant meerkat, profundo, Russgirl, HoundDog, Gorette, KenBee, Wary, blueoasis, DarkestHour, OMwordTHRUdaFOG, means are the ends, sea note, Palmetto Progressive, Aaa T Tudeattack, ammasdarling, One Pissed Off Liberal, john07801, Cronesense, Habitat Vic, Loudoun County Dem, gloriana, yoduuuh do or do not, DvCM, Mary Mike, dclawyer06, MI Sooner, millwood, carpunder, uciguy30, GeorgeXVIII, leonard145b, TomP, W T F, JDWolverton, TruthFreedomKindness, wayoutinthestix, OleHippieChick, Sixty Something, Aureas2, Involuntary Exile, elwior, Its any one guess, Lujane, rssrai, RandomNonviolence, Gemina13, Parthenia, Karl Rover, greengemini, divineorder, ewmorr, jennylind, zaka1, jomi, papahaha, sfarkash, Larsstephens, Johnnythebandit, secret38b, biggiefries, Crabby Abbey, Progressive Pen, Egalitare, stevenaxelrod, cany, Wisdumb, allenjo, I love OCD, allisoneisall, freesia, BlueJessamine, ardyess, FarWestGirl, KelleyRN2, PedalingPete, PorridgeGun, IllanoyGal, merrily1000, CherryTheTart, createpeace, corvaire, peregrine kate, whaddaya, cjo30080, Vatexia, jolux, ratcityreprobate, just another vortex, stlsophos, PrometheusUnbound, quill, StonyB, cwsmoke, Williston Barrett, pistolSO, IndieGuy, Jakkalbessie, a2nite, JGibson, This old man, Mr Robert, lunachickie, arizonablue, wasatch, onceasgt, AppleCider, gypsytoo, mtnlvr1946, Icicle68, rigcath, Fairlithe, shinobi9
Source: dailykos.com

Undernews: Raising Medicare age is bad for your health

Huffingoton Post – Although two years may not seem like much, advocates for seniors have warned that making older Americans wait for Medicare jeopardizes their health and their finances without doing much to cut health care spending or the deficit. Private health insurance for older people is more expensive because their health care costs are higher. Those with chronic medical conditions need regular care to prevent life-threatening problems. In today’s marketplace, many older Americans go without health insurance while they wait for their 65th birthdays, often waiting for medical care they need and getting sicker in the process, said David Certner, the legislative policy director for AARP. “A lot of people were just holding on until they got to Medicare age until they could actually get insurance,” Certner said. Making people wait will force some older people to stay in the workforce to keep their coverage, drive poorer seniors into Medicaid, and leave others with no coverage at all, he said. “It is a real threat,” Certner said. “We take this very seriously now as something that is on the table.” Deficit reduction plans like those authored by House Budget Committee Chairman Paul Ryan (R-Wis.) would raise the Medicare eligibility age to 67. Obama discussed the proposal with House Speaker John Boehner (R-Ohio) during budget talks last year, so it may return.
Source: blogspot.com

Maximize Your Medicare: The Blog: Why “Quick Guides,” “Idiot’s Guides” Don’t Work For Medicare

Maximize Your Medicare is Not a Glorified Ad Simply put, yourself in my place: I am not allowed by law to offer a product to readers through this book. One needs to consider the writer/sponsor of a publication, which may be an advertisement disguised as an information guide. You may have received pamphlets, and they are not necessarily factually incorrect, but they are not necessarily complete, either. Seniors are confused, NOT “Dummies” or “Complete Idiots” I think that titles like “Complete Idiot’s Guide….” or “…for Dummies” are insulting. In Maximize Your Medicare, jargon is explained in plain-spoken English, even though I am academically and professionally qualified to speak in jargon. “Quick” guides can’t work, and the stakes for Medicare-eligible persons is way too high for me to simply say “do this,” or “do that.”  People’s situations are different, and must be thought through independently. Real-life examples called “This Happens” provide illustrations of what has happened to others.
Source: blogspot.com

Ohio Workers’ Comp Settlements & Medicare

 In Ohio attorneys for injured workers are normally paid a contingent fee on settlements of workers’ compensation claims.  The attorney fee (typically between 25 percent and 40 percent) is charged on the gross amount of the settlement.  The question has been raised as to whether an attorney can charge a contingent fee on the medical portion (MSA portion) of the settlement.  In Ohio there is no prohibition on an attorney charging a contingent fee on the medical portion of a settlement.  Rule 1:5 of the Rules of Professional Conduct permits a reasonable contingent fee with no restriction regarding the medical portion of a settlement. At least one court decision directly addressed this issue. In Hinsinger v. Showboat Atlantic City, 2011 N.J. Lexis 96 (January 21, 2011), the issue was whether the CMS regulations and directives permit an attorney to recover fees for a judgment or settlement obtained on behalf of a client from the Medicare set-aside itself.  The court held that the attorney could recover fees from the MSA.  The court recognized the value of the legal services of the attorney in achieving the entire settlement including the MSA portion of the settlement.  Keeping in mind that the attorney fee must be reasonable, I have been unable to find any prohibition to an attorney charging a contingent fee on the MSA portion of an Ohio workers’ compensation settlement.
Source: hnb-law.com

AMA Medicare position perpetuates unethical practices.

ACA affordable care act affordable health care American healthcare American Medical Association Barack Obama be healthy Business Circadian rhythm diet diets doctors health healthcare health care healthcare bill health care bill health care providers Health Care Reform healthcare reform healthcare USA health insurance health insurance plans health reform Medicaid medical medical health care medical insurance Medicare medications Medicine Metabolism Mitt Romney nutrition nutritional information obamacare obesity Patient Protection and Affordable Care Act Paul Ryan pharmaceuticals Romney Romney health United States weight gain weight loss
Source: ourhealthcaresucks.com

President, Lawmakers Move Toward Deal To Avoid Medicare Cuts

Speaking outside of the White House after the meeting, House Minority Leader Nancy Pelosi (D-Calif.) said, “We understand our responsibility here. We understand that it has to be about cuts, it has to be about revenue, it has to be about growth, it has to be about the future.” She added, “I feel confident that a solution may be in sight” (Calmes,
Source: californiahealthline.org

Maryland Medicare waiver plan still unresolved

Thanksgiving is just a day away, and you know what that means: Food, football and mall stampedes. Oh, and one other thing: Barbara Mikulski is due for a letdown. The Democratic U.S. senator said in October that she wanted to see a plan for revising the state’s Medicare waiver by Thanksgiving. Health officials say they’re still working on it, but won’t have before Turkey Day. The waiver is that integral piece of Maryland’s health care system that allows the state to set its own Medicare…
Source: ewallstreeter.com

Brane Space: Why I am Thankful……for MEDICARE

The pre-Medicare era was nasty, brutish and saw most elderly either dying in an impecunious state, or simply alone…..of some disease or infection. By 1960, the then Democratic contender for the presidency John Fitzgerald Kennedy had seen enough and as documented in a period issue of LIFE magazine (December 19, 1960, page 31) proposed for the first time a system of elderly medical care and insurance operating under the Social Security System. Now, as I glance at the recently tabulated bill (from UCSF Hellen Diller Cancer Center)  for my treatment of prostate cancer, I thank JFK and my lucky stars (my ‘lucky stars’ in the sense of detecting the cancer this year and not when I was scrounging for a private plan prior to Medicare) that Medicare was available and still essentially intact. That bill tabulation, for those who might be interested, came to $42, 776 and this encompassed a breakdown of different contributors, from anesthesia ($4,124) to radiology services ($16,768) to recovery room ($2, 090) to operating room services ($14,994).   The bill, after Medicare Part B kicked in, came down to $1,299 of which most will be paid by my Medicare Supplement Plan (F). Now, flash back to when I was 62 and the best insurance on offer to me was an AARP plan with $15,000 deductible and only  limited coverage. Had I been detected with prostate cancer back then, I’d have had to come up with virtually all of the $42,000.  At most, the private AARP plan might have covered $11,000 or so. (And this is assuming the cancer was detected after enrollment and not before – else I’d have been denied based on having a “pre-existing condition”.) In that case, having been given the diagnosis, I’d have had little choice but to skip any immediate treatments and hence, the cancer would plausibly have metastasized until – by the time I finally did qualify for Medicare (last year) – the costs of treating advanced prostate cancer would’ve been drastically more expensive. (In that case I’d have likely required multiple treatments, including external beam radiotherapy, androgen suppression in addition to high dose brachytherapy) I point this out because one of the alleged “solutions” to the “fiscal cliff” – grabbing so many hysterical headlines right now – is to extend the age to 67, to qualify for Medicare. To say this is monumentally STUPID, is putting it mildly! In fact, rather than limiting Medicare costs it will explode them – which doesn’t require Mensa-level intellect to figure out! If Dems yield on this to the Ryan-led “fiscal cliff” wheeling and dealing Repukes, then all hell will break loose on the Left flank. The Left understands that those 65-67 yr. old seniors caught in the proposed ‘donut’ coverage wait, will be like I might have been – and postpone essential medical care rather than go broke. Then, when they do finally qualify for Medicare, their problems will be much worse and require far more resources, medical costs to fix. This ain’t rocket science! As it is, Medicare is NO freebie! This needs to be repeated over and over again! The supplemental Part F insurance that paid the balance of my prostate cancer treatment bill comes to $139 a month along. This is in addition to the regular Medicare premium of $99 a month. In addition, no dental coverage exists, so my wife and I had to cough up over $2,700 recently to cover the costs of new crowns, fillings and dental cleanings. This isn’t any kind of luxury because most people know that once your dental health goes, the rest of your health generally follows. Healthy teeth, after all, are critical to good nutrition and avoidance of chronic inflammation! We aren’t talking ‘cosmetic” dentistry here!  And I won’t even add the $1, 500 or so every other year or so for new glasses. Another BIG Thankfulness acknowledgement here – that Ryan and Romney LOST the election! Imagine the path we’d now be on if the Ryanesque “vouchers” were the new Medicare? Hell, I’d have exhausted my $10,000 voucher in a heartbeat then have had to pay the balance of the $42,776 bill and that isn’t even looking at any other health problems that I’ve had the past six months (inlcuding ear infection, strained back muscle).   Under Ryan’s plan and with no government mandate for providing care, why should the profit -oriented insurance companies put themselves on a downward treadmill or “losing wicket” as we call it in Barbados? They wouldn’t if they had any grain of sense. Without a mandate or order from the government, you can also bet your sweet bippy they’d reject any elderly person with a pre-existing condition. This would be the proverbial no-brainer for them! Thus, by the time JFK proposed a government health plan linked to Social Security, in 1960, America’s seniors were more than ready. More than ready to stop being parasitized by commercial outfits, or humiliated by the likes of states under the odious Kerr-Mills plan (which required adult kids to cover costs). The only main opponents were the AMA which (p. 68) “ran newspaper ads and TV spots declaring Medicare was socialized medicine and a threat to freedom” and blowhards like Ronnie Reagan who made idiotic recorded talks trying to scare people by asserting (ibid.): “One of the traditional methods of imposing statism on a people has been by way of medicine”. Fortunately, most seniors who’d actually experienced the dregs of capitalist medical bestiality didn’t buy this hog swill. They organized under groups like the National Concil of Senior Citizens (see image) and turned the tables by imposing relentless pressure on representatives (the most intransigent of whom were Southern Democrats, who LBJ had to finally confront and read the ‘riot act’). Eventually, the opposing voices were muted and Medicare was passed in 1966. For those interested in what elder health care was like before Medicare get the Oxford University Press monograph, entitled: One Nation Uninsured, by Jill Quadagno, which also gets to the bottom of why there is such massive political aversion to any kind of genuine health care coverage in this country which doesn’t drag in the profit motive. As for the “fiscal cliff” – let’s not let our reps toss us over it for the sake of bankster slime (like Lloyd Blankfein) and return us to an era where seniors had to sink or swim medically!
Source: blogspot.com

Medicare Targets Health Plans With Low Ratings

Posted by:  :  Category: Medicare

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

Video: COO Sharon Grambow talks about living at Sun Health Senior Living

Daily Kos: Mitt’s morphing Medicare lie

The diary says that it is a Romney “lie”  that doctors are turning away medicare patients.   You say its been going on for years.  I actually agree with you  and have experienced what Romney is claiming with my own aging family members.   It has been getting harder to get doctors you want under medicare  and frankly  its hard to see how the problem would not increase under the Obamacare scenario.  Medicare is in the process of being slammed  by the baby boom generation right at the time Obama wants to cut payments.   It really doesn’t matter whether you parse the definition of who gets cut-  doctors need hospitals for many procedures so cutting hospital payments  can affect doctors in an indirect manner.  As seniorhood approaches for  me and my wife, alarm bells go off when a program  for the elderly we paid into for years expecting decent services after retirement looks like it could be diminished by transferring funds to a new program for healthier younger people.     Senior or soon to be senior voters need to consider this carefully  and Obama supporters need to present better arguments than “Romney is a lying liar”.
Source: dailykos.com

Universal Health Care Group CEO Dr. Akshay Desai Reappointed to Florida State Board of Education.

This appointment requires confirmation by the Florida Senate. About the Florida State Board of Education: The Florida State Board of Education is essentially a committee comprised of seven members appointed by the Governor. These members are charged with the task of guiding and directing public K-12 and also community college education within the state of Florida. The Board meets monthly to discuss issues and consummate its mission ‘to increase the proficiency of all students within one seamless, efficient system, by providing them with the opportunity to expand their knowledge and skills through learning opportunities and research valued by students, parents, and communities, and to maintain an accountability system that measures student progress toward the highest student achievement, seamless articulation and maximum access, skilled workforce and economic development, and quality efficient services.’ The Board’s relentless dedication to student improvement stands apparent as FCAT scores increased across the board this year. All details surrounding the Board, its rules, and funding allocation are accessible to the public at http://www.fldoe.org/board/. About Universal Health Care Universal Health Care Group is the parent company of Universal Health Care, Inc., a managed care company that has been providing Medicare Advantage Health Plans to Medicare eligible beneficiaries since 2003 – most notably the ‘Medicare Masterpiece[R] (HMO)’ and ‘Medicare Masterpiece[R] (PPO)’ plans, as well as Florida Medicaid benefits through its ‘Universal U-First[R]’ plans. The Group is also parent to Universal Health Care Insurance Company, Inc., which offers the popular Medicare Advantage ‘ANY ANY ANY[R] plans.’ Currently, the Group is serving approximately 160,000 individuals located in 13 states. For more in-depth information about the Company and the services we offer, please visit our website at www.univhc.com (see also Medicare and Medicaid).
Source: blogspot.com

Universal Health Care Group Adds Dr. Keith Singer as Medical Director

About Universal Health Care Universal Health Care Group is the parent company of Universal Health Care, Inc., a managed care company that has been providing Medicare Advantage Health Plans to Medicare eligible beneficiaries since 2003 – most notably the “Medicare Masterpiece® Plan” and “Medicare Masterpiece® PPO,” as well as Florida Medicaid benefits through its “Universal U-First®” Plans. The Group is also parent to Universal Health Care Insurance Company, Inc., which offers the popular Medicare Advantage “ANY ANY ANY® Plan.” Currently, the Group is serving over 95,000 individuals located in eleven states (Florida, Arizona, Georgia, Louisiana, Maryland, Mississippi, Nevada, Pennsylvania, South Carolina, Texas, and Utah). For more in-depth information about the Company and the services we offer, please visit our website at www.univhc.com.
Source: madduxpress.com

What Information Does The Medicare Website Provide?

The Medicare website is also useful resource in locating state organized sections of the Medicare program. Medicare is not the same in every state; however they are represented by many regional firms. This requires phone numbers and access, which Medicare provides as well as how often they do it. In this case from 7am to 7pm, Monday through Friday. There is also an automated 24 hour system in two languages, English and Spanish. Even when telephone help isn’t concerned, there is also an incredible amount of PDF’s to consult online.
Source: seniorcorps.org

A lakefront masterpiece: Culture abounds in Windy City

For further outdoor culture

Dems Face Internal Divide On Medicare, Safety Net Questions

Posted by:  :  Category: Medicare

Senate Dems Protest Medicare Cuts by Talk Radio News ServiceNational Journal: Bold Medicare Reform May Require Going Beyond The CBO Score Liberal Democrats would rather not see any cuts to entitlement programs — period. Instead, they argue, the U.S. government needs to put policies in place that will bring down the costs of health care overall. Make care cheaper to administer, the argument goes, and Medicare and Medicaid won’t cost the federal government so much. It’s a beguiling idea with one big flaw: The Congressional Budget Office isn’t always able to put a dollar figure on how much money Democrats’ ideas would save. As Washington negotiators work toward a debt-reduction deal, Democrats want reducing the cost of care to be part of the conversation. But budget negotiators want to be able to talk in dollars. CBO’s scoring rules “much too much embed the status quo. They require levels of certainty about the costs and benefits that defy many forms of innovation,” said Donald Berwick, a Center for American Progress senior fellow and former administrator of the Centers for Medicare and Medicaid Services (Quinton, 11/20).
Source: kaiserhealthnews.org

Video: United Healthcare Oxford Medicare Advantage Denies Coverage

Medicare Locals a plus for health and economy, says Sprogis

The population health role of Medicare Locals has never been attempted in Australia before and was never envisaged in the Divisions of General Practice. The importance of population health work is in gaining a deep understanding of health needs and health gaps in order to close those gaps, reduce the costs of inappropriate emergency department use and hospital admissions and make primary health care services easier to navigate.
Source: com.au

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

Senators Urge CMS to Provide Information about Medicare and Medicaid Reimbursement for Compounded Drugs

Public Citizen, a consumer advocacy group, has written a letter to HHS Secretary Kathleen Sebelius, asking her to direct the HHS Office of the Inspector General (OIG) to conduct an investigation into CMS’ policies with respect to reimbursement for compounded drugs. Public Citizen cited conflicting provisions of the Medicare Benefit Policy Manual that, on the one hand, instruct carriers to deny coverage for drugs that have not been approved by the FDA and, on the other hand, direct carriers not to deny coverage for such drugs unless directed to by CMS. Public Citizen also noted that CMS is aware of the dangers posed by compounded drugs. In 2007, its four regional Durable Medical Equipment (DME) Medicare Administrative Contractors (MACs) denied coverage for compounded inhalation drugs administrated via nebulizers, noting that the drugs were not FDA-approved and citing safety concerns. The senators, Public Citizen, and the public await the agencies’ response.
Source: wolterskluwerlb.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

Doctors billing Medicare for patients’ unneeded, expensive tests

(NaturalNews) With all the outcry by politicians and the public over skyrocketing healthcare costs, maybe it’s time to take a look at how some doctors are running up patients’ bills for unneeded tests. A new study just published in Online First by Archives of Internal Medicine, a JAMA Network publication, concludes that diagnostic tests are frequently repeated on Medicare beneficiaries when there’s absolutely no compelling medical reason. It seems obvious the only other explanation is for physicians to make more money by billing Medicare numerous times for repeated tests for the same patients. H. Gilbert Welch, M.D., M.P.H., of Dartmouth College in Hanover, New Hampshire, and colleagues looked at patterns of repeat testing in a longitudinal study of Medicare beneficiaries. In all, they picked five percent of patients’ records at random from the 50 largest metropolitan statistical areas. “We examined repetitive testing for six commonly performed diagnostic tests in which repeat testing is not routinely anticipated. Although we expected a certain fraction of examinations to be repeated, we were struck by the magnitude of that fraction: one-third to one-half of these tests are repeated within a three-year period. This finding raises the question whether some physicians are routinely repeating diagnostic tests,” the authors noted in their paper. For example, among Medicare beneficiaries undergoing an echocardiography to examine their hearts, over half — 55 percent — had a second test within three years. Nearly half of imaging stress tests were also repeated in fewer than three years and so were about 50 percent of pulmonary function tests. About 46 percent of those having CT scans of the chest were repeated, 41 percent of bladder examinations by cystoscopy. About 35 percent of the beneficiaries were subjected to repeat upper endoscopies (exams of the digestive tract with a tube) within three years, too. So what’s so bad about this? Frequently repeating these high tech, expensive diagnosis tests in situations when there is no medical need, drives up Medicare costs (although, of course, it can put more money in the pockets of doctors.) But there’s also a health risk to patients subjected to over-done testing. “This has important implications not only for the capacity to serve new patients and the ability to contain costs but also for the health of the population,” the authors of the paper concluded. “Although the tests themselves pose little risk, repeat testing is a major risk factor for incidental detection and over-diagnosis.” That means people with no health problems can end up being subjected to anxiety over a diagnosis they should never have been given — to say nothing of potentially dangerous side effects from treatment for a “condition” that is harmless or non-existent. In an accompanying commentary, Jerome P. Kassirer, M.D., of Tufts University School of Medicine, Boston, and Arnold Milstein, M.D., M.P.H., of Stanford University School of Medicine stated: “After decades of attention to unsustainable growth in health spending and its degradation of worker wages, employer economic vitality, state educational funding and fiscal integrity, it is discouraging to contemplate the fresh evidence by Welch et al of our failure to curb waste of health care resources.” The new report is more evidence of a phenomenon Natural News has reported on in the past — doctors subjecting patients to inappropriate and downright unnecessary tests, apparently for money. For example, a study by University of California at San Francisco (UCSF) researchers found unneeded, expensive mammograms are being pushed on elderly women who are incapacitated from Alzheimer’s disease or other forms of dementia, especially if the women have savings or assets of $100,000 or more. Sources: http://archinte.jamanetwork.com/article.aspx?articleid=1392496 http://archinte.jamanetwork.com/article.aspx?articleid=1392495 http://www.naturalnews.com/028095_mammograms_Alzheimers.html
Source: naturalnews.com

2013 Medicare Part B premium and deductibles rise, but not by much

Posted by:  :  Category: Medicare

Wall Street by elycefelizThese and other parts of the law will result in significant savings. We estimate that the health care law will save the average person in traditional Medicare $5,000 through 2022. Earlier this year we projected that the standard premium for Medicare Part B (which covers certain doctors’ services, outpatient care, medical supplies, and preventive services) would rise by more than $9.00 a month in 2013. Today we announced that the actual rise will be lower—$5.00—bringing 2013 Part B premiums to $104.90 a month. By law, the premium must cover a percent of Medicare’s expenses; premium increases are in line with projected cost increases. Medicare Part B premiums have gone up slowly over the past five years – an average of less than 2 percent a year, or $8.50 total.
Source: quinnscommentary.com

Video: Jed Weissberg, MD, Talks About Medicare Advantage Health Plans and the Special Enrollment Period

Three Midnight Rule For Medicare SNF Explained: How To Get CMS To Pay for a Nursing Home Stay.

Medicare will pay a portion of these SNF costs (the rest of which are picked up by patients’ supplemental policies) for a up to 100 days for every benefit period.   Once these days are used up,  the patient will be financially responsible for any other skilled nursing benefits until the next benefit period begins.  How does Medicare define a benefit period?   A benefit period ends when you have not been in a hospital or in a  SNF for 60 consecutive days.  Once a new benefit period begins you will need another three midnight stay to qualify for additional SNF days (up to 100 days every benefit period).  If Medicare won’t pay for additional days, neither will the supplemental policy as these policies will usually only cover the portion of approved days that Medicare doesn’t cover. Most patients who use up 100 days of SNF benefits would never go another 60 days in a row without being admitted to the hospital.  They use up their 100 days for a reason. They cannot avoid living at home without avoiding frequent hospital level care.  Clinically, what I see is that most patients who have used up their 100 days in a benefit period will are palliative care candidates or require long term care in a nursing home.
Source: blogspot.com

Medicare Home Health: How Much Does Medicare Part A Pay?

Medicare pays 100% of the charges for hospice care, with two exceptions. First, the hospice can charge the patient up to $5.00 for each prescription of outpatient drugs the hospice supplies for pain and other symptomatic relief. Second, the hospice can charge the patient 5% of the amount Medicare pays for inpatient care in a hospice, nursing facility, or the like every time a patient receives respite care. There is no limit on the amount of hospice you can receive. At the end of the first 90 day period of hospice care, your doctor will evaluate you to determine whether you still qualify for hospice, meaning your disease is still considered fatal and you are still estimated to have less than 6 months to live. A similar evaluation is made after the next 90 day period, and again every 60 days thereafter. If your doctor certifies that you are eligible for hospice care, Medicare will continue to pay for it even if it exceeds the original six month diagnosis. And if your condition improves and you switch from hospice care back to regular Medicare coverage, you may return to hospice care whenever your condition warrants it.
Source: blogspot.com

Understanding Medicare Benefit Periods

Under Part A the patient must pay a deductible for every "hospital benefit period." Unlike most health insurance, where deductibles must be satisfied once every year, usually between January and December, there can be several Medicare hospital benefit periods in a calendar year. In 2010 the Part A deductible per benefit period is $1,100. A benefit period begins on the day a patient enters the hospital and ends after there has not been any hospital or skilled nursing care for 60 days. If the patient is discharged from the hospital or a skilled nursing facility and returns to either within 60 days of discharge, it is considered to be the same benefit period and there is no need to pay another deductible. However, if the patient remains out of skilled medical care (either hospital or skilled nursing facility) for more than 60 days and then goes back to the hospital, a new benefit period begins and another Part A deductible of $1,100 is required.
Source: texasagingnetwork.com

Understanding Medicare Glossary and Managing your Health Information Online

The way that Original Medicare measures your use of hospital and skilled nursing facility (SNF) services. A benefit period begins the day you are admitted as an inpatient in a hospital or skilled nursing facility. The benefit period ends when you have received any inpatient hospital care (or skilled care in a SNF) for 60 days in a row. If you go into a hospital or a skilled nursing facility after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There is no limit to the number of benefit periods.
Source: indoamerican-news.com

Medicare Part A & B Changes for 2013

 The Part B base premium (which the majority of people in Medicare pay) represents 25% of ¼ of the previous year’s Part B claims for everyone in Medicare.  Those of higher income pay a higher percentage for their Part B premium.  Those on Medicare and drawing Social Security will not see a raise in their Part B premium unless there is an increase in their Social Security, so for 2009 through 2011 the Part B premium for existing Medicare beneficiaries remained static.  New beneficiaries, however, were charged an incrementally higher Part B premium.  In 2012 the Part B premium for all beneficiaries were adjusted up/down to $99.90 and those drawing Social Security benefits received a 3.6% increase.
Source: medicaremazeadvisors.com

Understand Medicare benefits to Plan for Aging Parent’s Care

To help you better understand the options of care available for your parent in the community, Genworth offers an explanation of the four primary types of providers, including home care agencies and nursing homes. NPR also recently ran an informative piece entitled, “Financial Planning For The End Of Life” which offers more suggestions and tips on how to plan to pay for end-of-life care.
Source: cheaplikemeblog.com

Florida Elder Law and Estate Planning: Medicare may no longer use improvement standard to deny short

In the past, Medicare would continue to cover skilled nursing care and short-term rehabilitation, like physical and speech therapy, only if the patient demonstrated that he had the potential to improve as a result of treatment. Obviously, those with chronic conditions like Alzheimer’s Disease, heart disease, Parkinsons, Lou Gehrigs disease, arthritis – in other words, those who could not meet the so-called improvement standard — were most impacted by this rule. (In fact, the so-called “improvement standard” was technically never a part of Medicare law; it had simply become the de facto standard used by Medicare decision makers.)
Source: blogspot.com

Medicare Medigap Plans and Skilled Nursing

It’s important to understand how Medicare and Medigap plans will handle the ever increasing use of Skilled Nursing care. With the big push to move people from facility based care (think hospital during a surgery) to less intensive skilled nursing care either in a facility or at your home following such a surgery, we want to make sure to adequately understand how it handled by Medicare and the plans that supplement it called Medicare supplements. First, let’s start with an explanation of what skilled nursing is and more importantly, what it is isn’t. Skilled nursing is generally care provided to a person by nursing staff. This may sound redundant but it’s important to clearly understand it. Such care may be the maintenance of IV’s or physical therapy. In general, it’s the next care level down from that provided under a direct doctor’s supervision. In order to receive benefits under Medicare for skilled nursing, the practitioners and/or facility must be Medicare approved so make sure this is the case before proceeding especially with home based care. One note, skilled nursing is generally given to help you recover from a given situation (say following a surgery) or prevent a health condition from getting worse. It is generally considered short term based (up to 100 days with Medicare) and is not intended for custodial care. Custodial care is designed to help a person with everyday issues such as bathing, clothing, getting in/out of bed and the like if that’s the only care that is needed. Custodial care falls under the heading of Long Term Care which is not covered under Medicare and requires other preparations such as purchasing a Long Term Care policy. Let’s look at what Medicare considers to be “short term” when dealing with skilled nursing care. We’ll first look at Traditional Medicare’s coverage of skilled nursing and then look at how Medicare supplements work to fill in the “gaps” in coverage. Traditional Medicare covers the first 100 days of skilled nursing with variable levels of coverage. For the first 20 days, Medicare will pay the qualified skilled nursing expenses in full with qualified providers. For days 21 through 100, you will pay a co-payment for the cost. The copay changes each year as most things with Medicare do but 2012’s copay is $146. After day 100, traditional Medicare will not pay anything. So what starts the 100 day period. The rules are a little more involved but we’ll try to summarize as best as we can with the added instruction that you should check the detailed Medicare rules for your particular situation. In a nutshell, you need a 3 day stay in a hospital to trigger the 100 day potential period. There’s no limit to the number of benefit periods but other rules apply. Outside of the 100 day cap, a benefit period will generally end if you haven’t been in a hospital or received skilled nursing for 60 days. So how do Medicare supplements work with the traditional Medicare benefits? Essentially, the C-G plus M,N Medicare Medigap plans will cover the copay ($146 for 2012 per day) that Medicare does not pick up. The K and L plan will cover a percentage of the Skilled Nursing co-pay (50 and 75% respectively). A Medicare supplement does not extend your total # of days past the 100 mentioned which is important to understand for longer term care issues (again, Long Term Care comes into light here). Skilled nursing is increasingly a common way for facilities to reduce costs and free up bed space as a midway level of care. Expect this trend to continue going forward and this need speaks loudly to the benefits of the F Medicare supplement plan among other reasons. Dennis Jarvis is a licensed insurance agent concentrating on medicare supplement insurance.

Medicare Targets Health Plans With Low Ratings

Posted by:  :  Category: Medicare

The Pfelons of Pfizer: Too Crooked to Fail and Don't Go to Jail (g1a2d0052c1) by watchingfrogsboilMedicare 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

Video: I am a Medicare Advisor for Texas, South Carolina Michigan and California

SC senior facilities ranked on patient care

On May 2, 2012, Agape Rehabilitation of Conway was surveyed as a part on an annual inspection conducted by the Department of Health and Environmental Control, Division of Certification.  The Division of Certification surveys health facilities that participate in the Medicare and Medicaid programs, including nursing homes and facilities for persons with intellectual disability. These facilities are surveyed with unannounced site visits. Survey teams include nurses, pharmacists, social workers, dieticians, qualified intellectual disability professionals and generalists.
Source: wmbfnews.com

Grandstanding Over Medicaid Begins in Florida, South Carolina

Nevertheless, this is a good argument for one of my favorite policy prescriptions: we should federalize Medicaid. There’s never really been any good argument for making it a joint state-federal program, and there are plenty of good arguments for taking this monkey off the backs of state budgets and letting the federal government run the whole thing, just like they do with Medicare. Now, with the Supreme Court imposing new limits on federal authority to manage joint programs, we have yet another argument for federalizing it.
Source: motherjones.com

Change in Medicare : South Carolina Nursing Home Blog

Kaiser Health News reported that nursing home industry groups are cheering Medicare’s move to  increase coverage and payments to nursing home, home care and physical therapy bills for patients.   "For decades Medicare’s guidelines cut off coverage of ”skilled” nursing and home care services if patients weren’t shown to be improving. The care in question might have been physical therapy for stroke victims, home nurse visits for those with Alzheimer’s or post-hospital nursing home care for diabetics. Once their conditions plateaued or started deteriorating, Medicare would stop paying."
Source: scnursinghomelaw.com

Grappling With Details of Medicare Proposals

Still, it’s clear the proposed changes would shift costs from the federal government to retirees. An early version of a Republican plan would have more than doubled out-of-pocket health expenses for older adults, to $12,500 in 2022, the Congressional Budget Office estimated. “All scenarios will require seniors to pay more,” said Robert Moffit, senior fellow at the Heritage Foundation, a conservative research organization in Washington. To think otherwise, he said, “is a fantasy.”
Source: nytimes.com

Kent Pike Receives Medicare license in North and South Carolina

kpike Pike ad’s this licence to enhance his current product portfolio and will be able to serve a new client base by offering them Medicare and Long-Term Care solutions. Pike will continue to still offer Life and Health to the under age 65 market in North and South Carolina. “I enjoy working with people and I want to help them understand the products and benefit options available to them, so they can make an informed decision about their insurance coverage. I now can offer a full array of benefits with the addition of Medicare and Long-Term Care” said Pike. Insphere Insurance Solutions is a distribution company that specializes in meeting the life, health, Medicare, long-term care and retirement insurance needs of small business and middle-income individual and families through its portfolio of products from nationally recognized insurance carriers. Pike has completed his training and is licensed to sell Medicare products from Humana and United Health Care, and John Hancock for Long-Term Care Needs. Kent Pike can be reached at 704-437-4038. His email address is kpike@insphereis.com You can also visit Kent on his website at www.insphereis.com/
Source: prlog.org

Medicare issuing 2011 PQRS, eRx bonuses with “L” on RAs

For that reason, carrier accounting systems may place a negative sign before the dollar amount of a levy on a remittance notice. However, “in the case of PQRS and eRx incentive payments, the LE indicator represents an incentive payment and although the negative sign may appear on the remittance advice, the amount indicated does not represent a withhold or overpayment amount,” the Palmetto website continued. Both Medicare electronic and paper remittance advice provide additional coding to help practitioners identify PQRS and eRX incentive payments, the carrier noted.
Source: newsfromaoa.org

Medicaid Expansion: Costs or Savings for South Carolina?

Good news is that more people will be covered under the program, and though it will cost more in Medicaid, it will mean savings elsewhere for South Carolina.  Although the Milliman report includes significant state savings from increased drug rebates ($335.5 million), lowered costs for uncompensated hospital care ($217.5 million) and four years of enhanced federal match for the Children’s Health Insurance Program (CHIP) ($130.2 million), it does not look at state savings outside the SCDHHS budget. Those would include significant increases to the number of Department of Mental Health patients made eligible for Medicaid, meaning that the feds would pick up at least 90% of costs now paid by state dollars. Nor does it address eliminating coverages for those currently eligible at above 138 % of FPL. That includes pregnant women who would be eligible for subsidized private insurance through the Health Benefits Exchange, so no longer need Medicaid coverage
Source: theruoffgroup.com