Medicare Part B Premiums Up $5 Per Month Next Year

Posted by:  :  Category: Medicare

TWO YEARS OF RUIN by SS&SSCQ HealthBeat: Medicare Part B Premium Increase Modest For 2013 With health care inflation relatively stable, officials at the Centers for Medicare and Medicaid Services released rules Friday that include a $5-per-month increase in Medicare Part B premiums and a $28 hike in the hospital inpatient deductible. The Part B premium will reach a milestone, however, topping $100 a month. The monthly payment for Part B, which covers doctor visits, outpatient hospital services, home health care and other items, will be $104.90 next year, compared to the current $99.90. And the deductible for inpatient hospital stays will go to $1,184 in 2013 from $1,156 this year. One item will be decreasing: the Part A monthly premium, which pays for inpatient hospital stays, skilled nursing facilities and some home care for about 1 percent of Medicare beneficiaries who do not automatically qualify for the program. That premium will be $441 a month, down $10 a month from this year (11/16).
Source: kaiserhealthnews.org

Video: Medicare Chief Actuary: Spiking Part B Premiums

AARP Statement on 2013 Medicare Part B Premium Increase

AARP is a nonprofit, nonpartisan organization, with a membership of more than 37 million, that helps people 50+ have independence, choice and control in ways that are beneficial to them and society as a whole. AARP does not endorse candidates for public office or make contributions to either political campaigns or candidates. We produce AARP The Magazine, the definitive voice for Americans 50+ and the world’s largest-circulation magazine; AARP Bulletin, the go-to news source for the 50+ audience; AARP VIVA, a bilingual lifestyle multimedia platform addressing the interests and needs of Hispanic Americans; and national television and radio programming including My Generation and Inside E Street. The AARP Foundation is an affiliated charity that provides security, protection, and empowerment to older persons in need with support from thousands of volunteers, donors, and sponsors. AARP has staffed offices in all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. Learn more at www.aarp.org.
Source: aarp.org

Monthly Premiums for Medicare Part B Set To Increase Slightly in 2013

Meanwhile, premiums for Medicare Part A — which pays for inpatient hospitals, skilled-nursing facilities and some home health care services — will decline by $10 to $441 in 2013. Part A deductibles will increase by $28, from $1,156 last year to $1,184 in 2013 (Zigmond,
Source: californiahealthline.org

Finally the Medicare Part B Premium for 2013 is announced!

Since the Social Security Cost of Living Adjustment is 1.7% for 2013, this should be less than anyone’s increase in their monthly Social Security retirement benefit.  If you receive only $700 a month from Social Security (one of the lowest amounts), your Social Security benefit should increase $11.90, leaving you a small increase in monthly income after the Medicare Part B premium has been deducted from your check.   
Source: retirementeducationplus.com

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

These 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

Medicare fees rise for 2013

After putting in some of my hard earned wages and our goverment “at work” borrowing it, Social Security should not be cut. Our president and congress continue getting their same salary for life while some of us are barely keeping our heads above water. These politicians should only be paid when they are in office and limited to the time they are working for us. They miss votes, get paid for public appearances, write books, campaign, travel all over, appear on TV shows and we are paying those costs plus their salary. Even with my 401K, it is a struggle. I was a casualty of the crash. Too young to afford to retire and too old to find another job in a difficult market. I had to go on Social Security as soon as I was eligible. My $950 a month doesn’t cover my expenses but I can’t do without it. Gas, groceries, taxes, have all gone up but my benefit keeps shrinking. Being a woman and being paid less than my male counterparts hurts me more now than it did when I was working. Change was for the worst and I’m certainly not moving forward!
Source: bankrate.com

Medicare Premium Changes Announced for 2013

Earlier this year CMS 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. However, the good news is that the increase 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: hcafnews.com

CMS Announces 2013 Medicare Premiums and Deductibles

When making its calculations, CMS maintained a contingency margin in the event that actual costs surpass anticipated costs. This year, CMS found that the two most important factors affecting its calculation of the contingency margin were the impending changes to the physician fee schedule that are scheduled to result in a nearly 30 percent reduction in physician fees; and anticipated sequestration, mandated by the Budget Control Act of 2011 (P.L. 112-125), that could decrease benefit payments by up to 2 percent and result in a $4.3 billion reduction in expenditures. CMS explicitly stated that the Secretary of HHS directed the agency, when calculating the contingency margin, to assume that Congress would change the physician fee decrease to 0 percent. In making its calculation, CMS also assumed that the sequestration requirements would be either reduced or postponed. Although far from controlling, the agency’s assumptions could be cause for cautious optimism among providers and beneficiaries who anxious about the potential cuts.
Source: wolterskluwerlb.com

Information on Medicare part b premiums for 2013

The standard Medicare Part B premium is determined by a formula contained in the 1997 Balanced Budget Act, which set the premium at 25 percent of total program costs.  The remaining 75 percent of program costs are financed through general revenues. The Medicare Modernization Act of 2003 (MMA) requires higher-income beneficiaries to pay a higher percentage of program costs, resulting in multiple tiers of premiums based on income. The 2013 and 2014 Part B premiums haven’t been decided yet. Also note: There has been lots of confusion about Medicare Part B premium rates in recent years, because Medicare beneficiaries who receive Social Security were protected from premium increases in 2010 and 2011 under what is called the “hold harmless” provision, which freezes Medicare Part B premiums if there is no Social Security cost-of-living adjustment.
Source: medicareplansstcharles.com

Find Out What Medicare Covers, on Medicare.gov | HelpingYouCare®

Posted by:  :  Category: Medicare

Medicare health plans provide Part A and Part B benefits to people with Medicare who enroll in these plans, which include Medicare Advantage Plans, Medicare Cost Plans, Demonstration/Pilot Programs, and Programs of All-inclusive Care for the Elderly (PACE).
Source: helpingyoucare.com

Video: How to create an australia.gov.au account and register for online services using an activation code

5 mistakes retirees make choosing a Medicare plan

It’s also easier to find quality plans this year, according to the Centers for Medicare & Medicaid Services, which has beefed up its star ratings system to alert consumers to the best-performing plans and remind those stuck in continuously low-performing ones that they can switch plans. Beneficiaries have 127 four-star or five-star Medicare Advantage plans from which to choose, up from 106 during open enrollment for 2012. And those in original Medicare have 26 high-performing prescription drug plans at their disposal, up from 13 last year.
Source: sltrib.com

ABCs of Medicare: What is Part C?

Note: It’s Time! Medicare Open Enrollment is the time of the year beneficiaries have to review plan options and ask questions about different plans. This period runs from October 15-December 7, 2012. The National Hispanic SMP (NHSMP) encourages you to consider reviewing your Medicare drug or health care plan, but it is not mandatory. For more information, visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227).
Source: nhcoa.org

Medicare Local row exposes health jobs as hot issue

The Croakey blog is a forum for debate and discussion about health issues and policy. It is moderated by Melissa Sweet, a freelance journalist with a personal and professional bent towards public health perspectives. Regular contributors include members of the Crikey Health and Medical Panel.
Source: com.au

Chronic Conditions No Longer Barrier to Medicare Services

Posted by:  :  Category: Medicare

Healthcare in America: Who's Paying Who? And Who's Getting What? (g1a2d0014c1) by watchingfrogsboilIn fairness to Medicare providers, I suspect that many denials of coverage were an over zealous response to the Federal governments continued efforts to combat Medicare fraud and abuse. Training guidelines for nursing home administrators and physical therapists are replete with warnings about providing unneccessary services (i.e. Medicare abuse). Also, although the Medicare manual provisions did not include an “improvement standard” they were sufficiently vague regarding services for those with chronic conditions that not only providers, but also administrative law judges found the subject confusing. Additionally, Medicare providers often assumed (falsely) that if they erred, the patient would appeal the denial of coverage. In practice, the mechanics of appealing the denial of coverage often seemed daunting for many older adults who perceived the effort to be an exercise in futility.
Source: chicagonow.com

Video: Medicare Spending Per Beneficiary Measure National Provider Call – February 9, 2012

Bloomberg: Consumers Pay the Price of Provider Consolidation

3rd Party Studies ACOs Admin Costs affordability Age Rating Cadillac Tax cbo Cost-Shift Delivery System Reform Employers Essential Benefits Exchanges GRP Health Insurance Tax Health Plan Innovations Health Plan Satisfaction House hearings House legislation KI MA McCarran-Ferguson Medical Prices Medical Tests medicare medigap MedMal MLR Morning Headlines MT Patient Safety premiums Profits Provider Consolidation PWC Quality Rate Review Readmissions Reform RZ Senate hearings Senate legislation Small Business The Link Vilification Waste Fraud and Abuse
Source: ahipcoverage.com

CMS Issues Final Rules on Medicaid, Medicare Provider Payment Rates

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

Viewpoints: Medicare Provider Cuts ‘Won’t Work'; A ‘Pamphlet Isn’t A Plan’

Politico: A Glossy Pamphlet Isn’t A Plan One of the benefits of having served the people of Utah in the Senate for as long as I have is that I’ve been able to work with many presidents from both parties. … Yet in this year’s historic presidential election, we have an incumbent president who either knowingly refuses to tell the American people what his plan for our nation would be if reelected … A look at the health care section is remarkable for its look backward – not forward – to ObamaCare, hardly an achievement in most people’s eyes since the president promised that it would hold down health care costs, which it’s failed to do (Sen. Orrin Hatch, 10/24). Roll Call: On Mitt Romney, Medicare And Making The Math Work The political appeal behind pledging not to touch Medicare benefits for current and soon-to-be seniors is obvious. The political appeal of attacking the president for slashing the Medicare program by $716 billion and pledging to restore it is equally obvious. The political appeal of promising to cut deficits and debt and cap government spending at 20 percent of  the GDP is also apparent. But the combination of the three is utterly inconsistent and impossible. Something has to give — the question is what. It is that question the 113th Congress will have to confront immediately if Romney wins, with no palatable answer (Norman Ornstein, 10/25).
Source: kaiserhealthnews.org

Is Medicaid’s Access Problem Fictitious? Not really

The reality is that the GAO report merely reinforces what should be common sense about Medicaid – if you pay providers less than private insurance, you will encounter access problems. But it also indicates that there is something systemic about younger (under 18) and older (over 65) patients that causes them to have fewer access problems than working-age adults, even with Medicaid. The aggregate numbers presented earlier in this post include children covered under Medicaid and Medicare/Medicaid dual-eligibles (seniors who qualify for Medicaid and Medicare). Children are likely will be healthier and will likely be seeing a care provider for more routine causes like a checkup or a flu shot. Because these are more routine, less expensive procedures, it will be easier to find a provider. For dual-eligibles, Medicare would cover many routine procedures; because of its higher reimbursement rate compared to Medicaid, access problems would be mitigated. As a report from MedPAC in 2004 confirms, dual-eligibles generally have good access to care, and those with supplemental insurance, even better.
Source: medicalprogresstoday.com

Medicare to Pay for Transitional Care Management

De Peralta’s Robert Wood Johnson Foundation grant-funded transition program, which started earlier this year, provides a nurse practitioner visit with the patient before discharge and follow-up home visits by a master’s-prepared nurse from the Robert Wood Johnson Visiting Nurses, a partnership between Robert Wood Johnson University Hospital and Visiting Nurse Association Health Group. Transition care focuses on ensuring patients take the right medications and follow-up promptly with their physician or primary provider.
Source: nursezone.com

Health Law Alert: Focus on Long Term Care: 2013 OIG Work Plan: Key Issues for Skilled Nursing Facilities/Nursing Facilities

The OIG is adopting a new initiative to review providers and suppliers that received Medicare payments after CMS referred them to the Department of the Treasury (Treasury) for failure to refund overpayments. It will determine the extent to which they ceased billing under one Medicare provider number but billed Medicare under a different number after being referred to Treasury. CMS may deny a provider’s or supplier’s enrollment in the Medicare program if the current owner, physician, or nonphysician practitioner has an existing overpayment at the time of filing an enrollment application. Federal law requires CMS to seek the recovery of all identified overpayments. According to the work plan, the Debt Collection Improvement Act of 1996 (DCIA) requires Federal agencies to refer eligible delinquent debt to Treasury for appropriate action.
Source: jdsupra.com

Medicare ACOs: Healthcare providers and the ACO (Part 4)

One of the ACO’s primary care physicians, Dr. Smith, has a large number of beneficiaries with DM.  She establishes a diabetic management program that includes longer than average physical examinations by the doctor, which reduces the number of patients she can see each day and the reimbursement she will receive.  [In our last installment, we reviewed that ACO physicians continue to be reimbursed by CMS on a fee-for-service (FFS) basis for the Medicare-covered services they provide.] Dr. Smith launches a diabetic education and monitoring by nurses who regularly call the diabetic beneficiaries and inquire about their health, medication and dietary compliance, etc.  The doctor developed this program because studies show that patient education and engagement are crucial to good diabetic management and lower medical costs.
Source: askccg.com

HHS Should Help Curb Medicare Identity Theft, Lawmakers Say

The Social Security number is THE driver behind identity fraud and one of the central reasons why Medicare loses billions of dollars each year to fraud. Politicians constantly talk about how Medicare is going bankrupt to bad policy or bad budgeting but no one ever talks about how to stop the billions lost because of identity fraud. Prevention is needed, and getting rid of the SSN is a good start. To replace the SSN, Health ICONN from TASCET is the answer. With Health ICONN, identity fraud simply cannot occur. Identities remain protected and billions will be saved. This is the direction healthcare is going.
Source: ihealthbeat.org

Feds Say Nursing Homes Overbilled Medicare By $1.5 Billion

Posted by:  :  Category: Medicare

The study released this week by the inspector general’s office of the Department of Health and Human Services concluded that nursing homes billed about a quarter of claims incorrectly in 2009 – the year it studied. Most of those claims were “upcoded,” which means Medicare was billed for services that were more extensive than what was provided or needed. Many of the claims were for intensive physical, speech or occupational therapy.
Source: kaiserhealthnews.org

Video: How to Save Medicare $30 billion: www.UpgradeThe Card.org

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

Transforming Medicare into a Premium Support System: Implications for Beneficiary Premiums

The analysis does not attempt to model any specific proposal, but is generally based on an approach included in House Budget Chairman Paul Ryan’s fiscal year 2013 budget plan, the proposal Chairman Ryan co-sponsored with Senator Ron Wyden of Oregon, and; in the plan put forward by former Senator Pete Domenici and Dr. Alice Rivlin. In the first two proposals, people who are at least 55 years old, including current beneficiaries, would be exempt from the new system. Republican presidential nominee Gov. Mitt Romney has supported a premium-support system along these lines.
Source: kff.org

Medicare Extends Enrollment Period For Those Affected By Sandy

The Centers for Medicare & Medicaid Services “understands that many Medicare beneficiaries have been affected by this disaster and wants to ensure that all beneficiaries are able to compare their options and make enrollment choices for 2013,” Arrah Tabe-Bedward, acting director for the Medicare Enrollment and Appeals Group, wrote in a Nov. 7 letter to health insurance companies and State Health Insurance Assistance Programs.
Source: kaiserhealthnews.org

The President’s Planned Changes to Medicare: Costly for Seniors

Comments are subject to approval and moderation. We remind everyone that The Heritage Foundation promotes a civil society where ideas and debate flourish. Please be respectful of each other and the subjects of any criticism. While we may not always agree on policy, we should all agree that being appropriately informed is everyone’s intention visiting this site. Profanity, lewdness, personal attacks, and other forms of incivility will not be tolerated. Please keep your thoughts brief and avoid ALL CAPS. While we respect your first amendment rights, we are obligated to our readers to maintain these standards. Thanks for joining the conversation.
Source: heritage.org

As Medicare Fraud Evolves, Vigilance Is Required

Medicare abuse and fraud costs taxpayers tens of billions of dollars every year. The Centers for Medicare and Medicaid Services, or C.M.S., estimated that in 2010, the two programs together made more than $65 billion in improper federal payments. An April 2012 study by a RAND Corporation analyst and former C.M.S. administrator estimated that fraud and abuse cost Medicare and Medicaid as much as $98 billion in 2011.
Source: protectingmedicare.org

Medicare Open Enrollment Runs Thru Dec 7

Posted by:  :  Category: Medicare

As reported in previous issues of this newsletter, the Obama Administration has engaged in a steady stream of propaganda, at taxpayers’ expense, to try to convince the public in general, and seniors in particular, that President’s health care law is beneficial to them. Some of the most recent examples of these blatant pro-Obama efforts include government news releases: PEOPLE WITH MEDICARE SAVE $4.8 BILLION ON PRESCRIPTION DRUGS BECAUSE OF THE HEALTH CARE LAW PEOPLE WITH MEDICARE HAVE MORE HIGH QUALITY CHOICES, which claims, “As a result of provisions in the Affordable Care Act, Medicare is doing more to promote enrollment in high quality plans and alert beneficiaries who are enrolled in lower quality plans… The Affordable Care Act also added new benefits to Medicare, including in the Medicare Advantage program.” NEW PROGRAM TO INCREASE QUALITY IN NURSING FACILITIES, which claims, “The Initiative will be run collaboratively by the CMS Medicare-Medicaid Coordination Office and the Center for Medicare and Medicaid Innovation, both created by the Affordable Care Act to improve health care quality and reduce costs in the Medicare and Medicaid programs.” HHS CONTINUES TO SUPPORT STATE EFFORTS TO BUILD AFFORDABLE INSURANCE EXCHANGES, which claims, “Because of the Affordable Care Act, consumers and small businesses will have access to Exchanges starting in 2014.” HEALTH CARE LAW ENSURES CONSUMERS GET CLEAR, CONSISTENT INFORMATION ABOUT HEALTH COVERAGE THROUGH THE AFFORDABLE CARE ACT, AMERICANS WITH MEDICARE WILL SAVE $5,000 THROUGH 2022 The “Affordable Care Act” is the nickname which HHS has given to Obamacare. It is not the official name of the law. Despite this heavy-handed propaganda, most seniors understand the President’s health care law cuts $716 Billion from Medicare to finance other aspects of Obamacare. These savings are achieved by rationing health care for seniors through the Independent Payment Advisory Board (IPAB).   A previous issue of this newsletter reported that Dick Gephardt, the House Democratic leader before Nancy Pelosi, explained the devastating nature of IPAB:
Source: 60secondactivist.com

Video: Medicare Age-In

Medicare & You Handbook 2013 for Medicare Open Enrollment

To start your enrollment, you should a Medicare & You 2013 handbook. If you have not received your handbook, you should go to the website Medicare.gov to learn where the handbook is available to read or download an PDF version of the 2013 Medicare & You Handbook. You can also get by calling 1-800-MEDICARE to request a paper booklet to your mailing address.
Source: hotbuzz4u.com

Medicare’s annual enrollment period begins Oct. 15.

The Annual Notice of Changes will tell you what is changing with your plan in 2013. Pay close attention to any changes in your plan’s drug list to make sure your drugs are still covered and that the co-pays are not increasing. If you have a Medicare Advantage plan, check to see that all of your doctors and other providers are still in your plan’s network.
Source: allsup.com

CVS: New Medicare Part D Booklet with 20% off Coupon (+ Nexxus Scenario)

Albertsons Albertsons Matchups Amazon Bashas Bashas Matchups Catalinas coupons CVS CVS Matchups Daily Recap events Facebook Food Food City freebies Frugal Living Fry’s Fry’s Matchups Funnies Giveaways Grocery Trips Groupon Instant Win Games kmart Magazines Matchups Miscellaneous Movies Online Deals Photo Cards Photos Reader Grocery Trips Rebates Recipes Recyclebank Retail safeway Safeway Matchups Staples Surveys Target Uncategorized Walgreens Walgreens Matchups Wal Mart
Source: thecentsableshoppin.com

Do I Need Both Medicare and Private Insurance?

Determining whether a Medicare private insurance plan for gap coverage is necessary to supplement Medicare is much less complex. The gaps in the Medicare Plans – A, B, C and D – are pretty much the same for all participants. Plan D, for example, covers prescription drugs to reduce the cost burden for the senior. However, Plan D only covers up to $2,930 of the total Medicare and participant cost together. If the insured has additional need for prescribed medication, they must pay the additional as an out of pocket expense until the combined total is $4,700. The amount of $4,700 triggers the “catastrophic” cost of medication provision. The $1,700 difference between the two amounts is the gap. The issue now is whether the $1,700 gap will result in a financial hardship for the insured. If that were the case, purchasing a Medicare private insurance plan to supplement Medicare would be the prudent choice.
Source: seniorcorps.org

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

Posted by:  :  Category: Medicare

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

Video: Medicare Provider Enrollment 3.wmv

REMINDER: Medicare Open Enrollment Ends December 7th!

Health Insurance Exchanges: The Health Insurance Exchanges are a set of state-regulated and standardized health care plans where individuals may purchase health insurance that is eligible for federal subsidies. The intention of the Exchanges is to help insurers comply with consumer protections and to compete in cost-efficient ways that ultimately lower overall health costs. The Exchanges are state-run and are called American Health Benefits (AHB) Exchanges. For states that choose not to create an exchange, the federal government will create one for residents of that state.
Source: hydroassoc.org

CMS Call on Medicare Provider Enrollment (Oct. 10) : Health Industry Washington Watch

New York, London, Hong Kong, Chicago, Washington, D.C., Beijing, Paris, Los Angeles, San Francisco, Philadelphia, Pittsburgh, Oakland, Munich, Abu Dhabi, Princeton, Northern Virginia, Wilmington, Silicon Valley, Dubai, Century City, Richmond, Greece
Source: healthindustrywashingtonwatch.com

5 mistakes retirees make choosing a Medicare plan

It’s also easier to find quality plans this year, according to the Centers for Medicare & Medicaid Services, which has beefed up its star ratings system to alert consumers to the best-performing plans and remind those stuck in continuously low-performing ones that they can switch plans. Beneficiaries have 127 four-star or five-star Medicare Advantage plans from which to choose, up from 106 during open enrollment for 2012. And those in original Medicare have 26 high-performing prescription drug plans at their disposal, up from 13 last year.
Source: sltrib.com

Upcoming CMS National Provider Call

Do you have unanswered questions regarding the Medicare provider enrollment revalidation process? In the continued effort to reduce fraud, waste, and abuse, the Centers for Medicare & Medicaid Services (CMS) implemented new screening criteria to the Medicare provider/supplier enrollment process beginning in March 2011. All providers and suppliers who enrolled in the Medicare program prior to Friday, March 25, 2011, will be required to revalidate their enrollment under this new risk screening criteria required by the Affordable Care Act (section 6401a). Today, we would like to notify our readers that the Centers for Medicare & Medicaid Services (CMS) will hold a National Provider Call next Thursday, October 27, at 12:30 pm EST. Providers and suppliers are encouraged to attend this call so they may understand what to expect and learn how to prepare for this process. Between now and March 2013, Medicare Administrative Contractors (MACs) will send notices to individual providers/suppliers regarding their screening categories and more. Newly-enrolling and revalidating providers and suppliers are placed in one of three screening categories – limited, moderate, or high – each representing the level of risk to the Medicare program for the particular category of provider/supplier, and determining the degree of screening to be performed by the MAC processing the enrollment application. (Providers/suppliers who enrolled on or after Friday, March 25, 2011 have already been subject to this screening, and need not revalidate at this time.) To learn more, register for the upcoming National Provider Call. Here are the details you will need to register: Date: Thursday, October 27, at 12:30 pm EST How to register for the call:
Source: kinnser.com

PECOS: A Medicare Benefit for your Practice

Henderson Medical Billing Solutions LLC is an outsourced Medial Billing and Practice Management service located in Murrieta, California.  Henderson Medical Billing Solutions provides medical billing services to solo providers to mid-level practices throughout the United States.  Henderson Medical Billing Solutions offers Full Practice Management, Medical Billing, HIPAA Compliance Auditing and Training to medical and non-medical providers.  In addition, Henderson Medical Billing Solutions offers Accounts Receivables Recovery and New Practice Start-Up services.  Our staff includes certified practice managers and billers who are committed to the success of increasing provider revenue reimbursement.  To learn more about how we can maximize revenue and increase your practices productivity Contact us today.
Source: hendersonmbs.com

Health Law Alert: Focus on Long Term Care: 2013 OIG Work Plan: Key Issues for Skilled Nursing Facilities/Nursing Facilities

The OIG is adopting a new initiative to review providers and suppliers that received Medicare payments after CMS referred them to the Department of the Treasury (Treasury) for failure to refund overpayments. It will determine the extent to which they ceased billing under one Medicare provider number but billed Medicare under a different number after being referred to Treasury. CMS may deny a provider’s or supplier’s enrollment in the Medicare program if the current owner, physician, or nonphysician practitioner has an existing overpayment at the time of filing an enrollment application. Federal law requires CMS to seek the recovery of all identified overpayments. According to the work plan, the Debt Collection Improvement Act of 1996 (DCIA) requires Federal agencies to refer eligible delinquent debt to Treasury for appropriate action.
Source: jdsupra.com

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

Medicare Open Enrollment Ends December 7

December 7 is the last day of Medicare Open Enrollment when you can switch, drop or add a Medicare Advantage Plan (Part C) and Prescription Drug Plan (Part D).  The decision making process can be a confusing and challenging one and as a Health Agent, certified by the Center For Medicare and Medicaid Services to represent major private insurer’s with Medicare contracts, I welcome the opportunity to provide assistance to Beneficiaries and those “aging-in” to Medicare.
Source: patch.com

Medicare Part D Open Enrollment Clinics in Lenoir County

Lenoir County Seniors’ Health Insurance Information Program (SHIIP) operating under the NC Department of Insurance and in conjunction with Lenoir County Cooperative Extension will provide two counseling clinics during the week of December 3, 2012. This will be the last week of counseling clinics in Lenoir County for 2012. Medicare Part D Open Enrollment ends on December 7, 2012.
Source: ncsu.edu

Medicare Provider Enrollment: Revalidation Required: Michigan Attorneys

Health care reform law requires that providers who enrolled in Medicare prior to March 25, 2011, submit enrollment revalidation information upon request by the Centers for Medicare and Medicaid Services ("CMS") or its contractors.  Any provider that fails to submit the requested revalidation information within 60 days of receiving such a request risks interruption or deactivation of Medicare billing privileges.  Revalidation for all providers who enrolled in Medicare prior to the above date will occur between now and March of 2015 on a steady basis.  Providers can check the lists provided at CMS’s website to determine if they were already sent a revalidation notice that was perhaps overlooked in the mail.
Source: healthlawyersblog.com

Medicare Physician Enrollment: Staying Alive

The first one: “Let’s say a Practice that operates an IDTF has been enrolled for about ten years. The practice submitted a voluntary revalidation two years ago and thinks its enrollment info is up to date. And then CMS sends a letter to the practice that says ‘a Doctor Jones had his license revoked and because the practice failed to report it within the appropriate time frame, the practice’s Medicare billing privileges have been revoked.’ The practice asks itself and asks, ‘who is Doctor Jones?’”
Source: physicianspractice.com

OIG’s Plan for Nursing Facilities

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

Western NY Voters Worried About Medicare

Posted by:  :  Category: Medicare

OWS_18_oct_DSC_0144 by Michael FleshmanEarlier in the day, Hochul spent her morning at the Hillview Diner, in nearby Depew, N.Y., asking breakfast-goers for their votes. Concerns over potential changes to Medicare arose at nearly every table. After chatting with Hochul, Sue and Mike Sanker said they’d both be voting with her for one main reason – the Republican budget. “I don’t want them to turn Medicare into a voucher program,” said Sue Sanker. She said she’d seen the commercials saying Corwin was for the changes to Medicare — an attack used in ads aired by both Hochul and, beginning this week, by the Democratic Congressional Campaign Committee. The newly-formed House Majority PAC also plans an ad blitz beginning next week hammering Corwin over Medicare. Don Pascucci of Clarence said he is still undecided on who he’d vote for in the election, but identified Medicare and the rising deficit as the two issues most important to him. While Pascucci, who considers himself an independent, agrees that “the spending has to stop,” he was not enthused about the Ryan plan. “This Medicare plan, it’s an open-ended voucher program,” he said. “That concerns me.” Corwin supports the Ryan plan. In a district where nearly 15 percent of the population is senior citizens, she has been stressing that it would not affect Medicare for voters over age 55. But she argues that Ryan’s proposal is needed because Medicare is unsustainable in its current form. A new federal report this week said Medicare will go broke in 2024, five years earlier than previously projected. “There’s a lot of criticisms of a plan that I’m supporting, but I haven’t seen any other plans offered from [Hochul and Davis], and I think that that’s too big of an issue to just ignore,” Corwin said in a Friday interview. She’s also been getting support from the Medicare plan’s architect: Ryan sent out a fundraising appeal from his Prosperity PAC on Friday asking for last-minute fundraising help on the New York Republican’s behalf. “Throughout the campaign, [Corwin] has voiced her support for my budget proposal. This will come as no surprise to many of you, but the playbook the Democrats and special interests have been using to attack me is being used right now in New York’s 26th District. You know the drill: they spread all kinds of falsehoods about the Path to Prosperity and see what sticks. Jane Corwin needs our help,” Ryan wrote, setting a $5,000 contribution goal. On Friday, his PAC donated $2,500 to Corwin. Though May 2, Corwin reported raising $304,000 in donations, but has largely been underwriting the campaign herself. On Friday, she added another $500,000 of her own money, bringing the total that she has financed to nearly $2.5 million and surpassing the $2.1 million that Davis — who isn’t accepting outside contributions — gave his campaign. Republicans, meanwhile, tried to take advantage of Hochul’s fundraising, pouncing on a New York City fundraiser she held that featured House Democratic Leader Nancy Pelosi among the guests. As House speaker last year, Pelosi was a favorite target of Republicans. This year, they are painting Hochul as the San Francisco Democrat’s “hand-picked candidate. “Kathy Hochul just doesn’t get it,” said Corwin spokesman Matthew Harakal. “Voters across the country rejected Nancy Pelosi’s tax-and-spend economic policies which have brought our economy to a screeching halt, but Kathy Hochul continues to push that same failed agenda.”
Source: nationaljournal.com

Video: New York: Medicare Fraud Summit Civil Law Panel

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

Navigating Medicare's Open Enrollment Period

Medicare beneficiaries who are happy with their plans do not need to do anything, if they don’t want to change. But it is still a good idea to check options, Ms. Metcalf advises, to make sure a version of Medicare is the best one in terms of cost and coverage. If, for instance, you have the original version of Medicare and pay extra for prescription drug coverage (so-called Part D coverage), you may want to make sure important medications you need are still covered under your plan, to avoid having to pay more for them.
Source: nytimes.com

5 mistakes retirees make choosing a Medicare plan

It’s also easier to find quality plans this year, according to the Centers for Medicare & Medicaid Services, which has beefed up its star ratings system to alert consumers to the best-performing plans and remind those stuck in continuously low-performing ones that they can switch plans. Beneficiaries have 127 four-star or five-star Medicare Advantage plans from which to choose, up from 106 during open enrollment for 2012. And those in original Medicare have 26 high-performing prescription drug plans at their disposal, up from 13 last year.
Source: sltrib.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

In Swing States, Obama Leads on Handling of Medicare

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

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

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

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

NY Times: Settlement Eases Rules for Some Medicare Patients Glass Jacobson

We are sharing today an article written by Robert Pear for the New York Times a few weeks back about a proposed settlement of a class-action lawsuit that the Obama administration would uphold, allowing significant change in Medicare coverage rules.  Now that the President has been re-elected, we can be sure that these changes will take place. See what the changes entail:
Source: glassjacobson.com

AIDS Healthcare Foundation

As a result and on the heels of a recent pricing agreement on Gilead’s new four-in-one AIDS tablet that was reached with the ADAP Crisis Task Force (ACTF) of the National Alliance of State & Territorial AIDS Directors (NASTAD) on behalf of the nation’s hard-hit network of AIDS Drug Assistance Programs (ADAPs), officials from AHF pressed Gilead to similarly lower the price for Medicaid, Medicare, private insurers and other payors that otherwise face Gilead’s steep price tag for the new medication. AHF officials also sent letters to private insurers and state health department directors nationwide urging that those programs exclude Stribild from their drug formularies if the drug was not priced price-neutral to Atripla. On September 14, 2012, Janet Zachary-Elkind, Deputy Director, Division of Program Development & Management for the New York State Department of Health responded via letter noting that, “At this time, Stribild is not covered by the Medicaid program,” and that the state is also, “…evaluating coverage options and possible prior authorization requirements to ensure the product is utilized in a medically appropriate and cost effective manner…”
Source: aidshealth.org

New York Times Article Highlights Success of Medicare Advantage Plans

3rd Party Studies ACOs Admin Costs affordability Age Rating Cadillac Tax cbo Cost-Shift Delivery System Reform Employers Essential Benefits Exchanges GRP Health Insurance Tax Health Plan Innovations Health Plan Satisfaction House hearings House legislation KI MA McCarran-Ferguson Medical Prices Medical Tests medicare medigap MedMal MLR Morning Headlines MT Patient Safety premiums Profits Provider Consolidation PWC Quality Rate Review Readmissions Reform RZ Senate hearings Senate legislation Small Business The Link Vilification Waste Fraud and Abuse
Source: ahipcoverage.com

Medicaid will be at the center of next year’s budget debate

Posted by:  :  Category: Medicare

THE NATURAL by SS&SSThe one provision of the Patient Protection and Affordable Care Act that the U.S. Supreme Court struck down in June was expansion of Medicaid. The law forced states to raise their income eligibility levels to bring more low-income patients into the program, or lose all current funding. While upholding the individual mandate as an extension of Congress’ taxing power, the Supremes ruled that forcing states to modify their Medicaid agreements was a step too close to coercion.
Source: watchdog.org

Video: How do Medicare and Medicaid reimbursement rates affect commercial insurance?

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 Final Rule: Increased Medicaid Payment Rates for Primary Care

Earlier this year, the Department of Health and Human Services announced its proposed rule to implement the Affordable Care Act provision that Medicaid reimburse primary care providers at the same rate as Medicare. On November 1, 2012, CMS issued a final rule to implement this increased payment for calendar years 2013 and 2014. Effective January 1st 2013, eligible primary care providers will be paid at rates established by the Medicare fee schedule – rather than the state-established Medicaid rates (which are often lower – sometimes significantly lower – than the federally established Medicare rates). The matching rates apply to services provided by physicians and supervised non-physician providers (i.e. nurse practitioners) in the field of family medicine, general internal medicine, and pediatric medicine or related subspecialties. The federal government will be footing the bill for this expansion in payment, as 100 percent of the difference in payment between the state’s Medicaid rates and the Medicare rates will be paid for with federal dollars.
Source: healthcarebiller.com

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

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

Medicare Payments & the Sustainable Growth Rate (SGR)

To reduce cost, health policy experts have recommended a number of actions: better coordination of patient care among providers; the use of electronic medical records;  increased patient accountability; the elimination of duplicative or unnecessary tests; and, the replacement of the fee-for-service method of reimbursement with models that do not reward physicians based on the number of services they perform.
Source: rmhp.org

How Massachusetts hospitals increased Medicare reimbursement rates by 20 percent

Prior to 2012, the Nantucket Cottage Hospital was classified as a critical access hospital and therefore did not figure into the computations for the states’ IPPS [Inpatient Prospective Payment System] HWI [Hospital Wage Index] rural floor. However, as a result of being acquired by a large health system, the Nantucket Cottage Hospital converted to IPPS status, becoming the only rural IPPS hospital in the state of Massachusetts. This change resulted in the rural floor wage index being applied to 60 urban hospitals in the state of Massachusetts, increasing wage indexes for these hospitals from an average of 1.16 in FY2011 to 1.35 in FY2012.
Source: healthcare-economist.com

CMS Issues Final Rules on Medicaid, Medicare Provider Payment Rates

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

5 Medicare Trends for Surgery Centers to Watch

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

Medicare Announces 2013 Payment Rates

Dan is the Founder and President of Clearwater Florida based Liberty Search Associates a full service executive and management search and recruiting firm. He is a 20 year veteran of the human resource management and recruiting industry. His experience involves sourcing and hiring thousands of people while working for three global corporations. In 2002, Dan was specializing in health care recruitment while working as an executive recruiter for the world’s largest management recruiting firm. By 2003, he gained further healthcare experience while working directly for a Healthcare System as a market recruiter for a division of 15 acute care hospitals in West Central Florida. Here he had the opportunity to recruit all levels of nursing and other healthcare leaders. Dan started Liberty Search Associates in 2004 and recruits highly talented people that are motivated and self-directed. They are proven health care professionals with ability and aspirations for career growth and unique opportunities. Dan works with client hospitals and surgery centers nationwide to bring them the very best talent for key leadership positions. Dan and his wife Donna live near Clearwater, Florida. They have a son, Matthew, who is attending middle school.
Source: libertysearch.com

Beware of fraud during Medicare enrollment

Posted by:  :  Category: Medicare

"Every citizen should be a soldier. This was the case with the Greeks and Romans, and must be that of every free state." ` Thomas Jefferson. by eyewashdesign: A. Golden“Consumers should be suspicious of unsolicited calls from anyone claiming to be from Medicare,” Matthew Fehling, BBB president and CEO, said in a statement. “Medicare will generally not make unsolicited calls to update information, issue a new card or offer free medical equipment. We recommend seniors hang up and call a trusted Medicare number if they have questions regarding their benefits.”
Source: consumerinsuranceguide.com

Video: Medicare Covered Power Chair – Do You Qualify? – Toll Free Phone Hotline

Newton police warn of possible Medicare scam

Newton police remind residents to be suspicious of anyone who calls asking for personal information. Residents should never give a credit card or bank account number or provide Social Security information to anyone over the phone unless the resident has initiated the call in themselves.
Source: newtonindependent.com

Health First Health Plans Offers Free Medicare Seminars

Our four not-for-profit hospitals—Health First Cape Canaveral Hospital in Cocoa Beach, Health First Holmes Regional Medical Center in Melbourne, Health First Palm Bay Hospital in Palm Bay, and Health First Viera Hospital which opened in Viera on April 2, 2011- form the core of Health First’s family in Brevard County on Florida’s Space Coast. Other services include outpatient centers; the county’s only trauma center; home care; specialized programs for cancer, diabetes, heart, stroke, and rehabilitative services; central Brevard’s largest medical group; four fitness centers; and Medicare Advantage, commercial POS, and commercial HMO health plans.
Source: spacecoastdaily.com

BBB warns seniors about Medicare scammers

“Consumers should be suspicious of unsolicited calls from anyone claiming to be from Medicare,” said Kim States, BBB president. “Medicare will generally not make unsolicited calls to update information, issue a new card or offer free medical equipment. We recommend seniors hang up and call a trusted Medicare number if they have questions regarding their benefits.”
Source: tucsonsentinel.com

Is Medicaid’s Access Problem Fictitious? Not really

Posted by:  :  Category: Medicare

The reality is that the GAO report merely reinforces what should be common sense about Medicaid – if you pay providers less than private insurance, you will encounter access problems. But it also indicates that there is something systemic about younger (under 18) and older (over 65) patients that causes them to have fewer access problems than working-age adults, even with Medicaid. The aggregate numbers presented earlier in this post include children covered under Medicaid and Medicare/Medicaid dual-eligibles (seniors who qualify for Medicaid and Medicare). Children are likely will be healthier and will likely be seeing a care provider for more routine causes like a checkup or a flu shot. Because these are more routine, less expensive procedures, it will be easier to find a provider. For dual-eligibles, Medicare would cover many routine procedures; because of its higher reimbursement rate compared to Medicaid, access problems would be mitigated. As a report from MedPAC in 2004 confirms, dual-eligibles generally have good access to care, and those with supplemental insurance, even better.
Source: medicalprogresstoday.com

Video: Boston: Medicare Fraud Summit Providers Panel

The Disability Information and Resource Centre

Medicare benefits will not be paid for any dental services under the Medicare Chronic Disease Dental Scheme after December 1st 2012. Patients without a GP care plan in place before September 8th 2012 will not be able to access the Medicare Chronic Disease Dental Scheme before it closes on December 1st 2012.
Source: org.au

Daily Kos: What’s behind that smile: dental care and insurance

Let me first explain a bit of the ongoing struggle we faced with the insurance companies as we sought to provide true patient-based care, and the Orwellian language the companies used.  Insurance companies make fee schedules, based on the codes for all the different dental procedures.  These schedules show what the companies accept as the base price for each procedure, and the percentage of that price they will pay.  Depending on the plan, some or, perhaps, many of the procedure codes may not be covered, regardless of what the plan language claims.  The insurance company calls their accepted prices “customary” or “necessary and reasonable”.  What does that mean?  It doesn’t mean that those prices are actually necessary or reasonable, or that other prices are unnecessary or unreasonable.  It certainly doesn’t mean they are really customary, because each company has its own fee schedule, and they often vary widely.  (Some companies claim they survey dentists to get average fees, but despite knowing all the providers within a wide radius, we knew nobody who charged so little.)  No: it simply means that those prices are what the insurance company has determined are the minimum they can pay and still get away with convincing people to buy their insurance.  Even better, insurance companies almost never publish their fee schedules.  It’s a guessing game.  We aggregated claim payment data and used it to forecast what each company might pay for current or future treatment.  However, there was no telling when a company might change their fee schedule, or even change what procedure codes they considered “eligible”.  Furthermore, procedures lumped under the same code are not one-size-fits-all: a filling may be quick, or it may become incredibly complicated and time-consuming (say if a person generates a lot of saliva, or if his/her teeth are somewhat unusually shaped) – yet the insurance company insists there is only one “allowable” price to pay for each code.  Adhering to a fee schedule makes it very difficult to customize care to a patient’s true needs.
Source: dailykos.com

Medicare dental closure leaves town without dentist » Bite magazine dental news

There was a last-ditch attempt to save the Medicare scheme, primarily because of the gap between the closure of that scheme and the start of the next. The next problem, Dr Fryer of the ADA explained, is the 2012/13 Federal Budget will provide about $225 million for dental health over the latter half of the 2012/13 year and the following year, but even if waiting lists are reduced by 30 per cent, the National Advisory Council on Dental Health estimates it will cost $343 million per annum to address the public sector waiting lists.
Source: com.au

Anthem Blue Cross Blue Shield Medicare Supplement Plans Are Affordable…

Based in beautiful Jackson Hole, Wyoming, we currently market health insurance in 18 different states from our website IndividualHealth.com. I have worked in the domestic and international markets for most of my adult life. Recently we launched a newly revamped website www.tetonmarketing.com which has a primary focus on music and Native American Flutes and hand crafted items made in Wyoming. Check it out! I want the Insurance Simplified Blog to be a place you can visit from time to time and read about real world issues that individuals and families face daily. Our parent website IndividualHealth.com we like to think of as a virtual brochure. But with the blog I want to talk about the topics behind the brochure. Also check out our blog www.JacksonHoleTim.com which is “All Things Wyoming, Everything Jackson Hole” . If you love the Yellowstone basin this is blog for you! Then when you are ready check out our new Social Network site Jacksonholetim.ning.com – this is a place you can connect with other who visit and live in Wyoming. And finally we have just launched another new blog. Jackson Hole Tim (www.jacksonholetim.com) is a new place to visit that talks about “All things Wyoming, Everything Jackson Hole”. I hope you find these blog helpful.
Source: wordpress.com

How Can Medicare Benficiaries Pay For Dental Care?

There are a few ways to get some help with these costs. Of course, seniors can buy dental insurance plans. You will pay a premium, and in return, you should get some of your costs covered. You can compare plans and prices at most sites that allow you to compare and quote health insurance. You might also consider a dental discount plan. This will not give you insurance, but may give you steep discounts if you agree to use the plan network of service providers.
Source: jeddahstudios.com

Medicare CPA Approximates Providers Received $6.6 Billion despite Tax Debts Accountant Miami

The report found that current federal law does not prohibit Medicaid providers who owe federal taxes from participating in Medicaid or receiving Medicaid payments. In addition, the report found that the IRS is limited to issuing a one-time tax levy to collect the unpaid taxes owed to the federal government. If the payment does not cover the tax debt owed, then the IRS has to issue another levy. Medicaid payments have never been continuously levied because they are not considered or do not qualify as “federal payments” under federal law.
Source: vieracpa.com

Studies Suggest Doctors, Dentists Can’t Keep Up With Health Law’s Insurance Expansion

Modern Healthcare: Medicaid Providers Tough To Find For Many States, Report Says More than half of U.S. states and territories surveyed earlier this year by the Government Accountability Office reported it was a challenge to find enough dentists, specialists, primary-care doctors or other providers to care for Medicaid patients, a newly released report said. The online survey of the District of Columbia, U.S. states and five territories, conducted between February and May, found dentists were the most problematic provider. … Mental health and substance abuse provider participation was a challenge for 17 of the surveyed Medicaid officials, and the same was true for primary care (Evans, 11/18).
Source: kaiserhealthnews.org

Medicaid providers tough to find for many states

More than half of U.S. states and territories surveyed earlier this year by the Government Accountability Office reported it was a challenge to find enough dentists, specialists, primary-care doctors or other providers to care for Medicaid patients, a newly released report said. The online survey of the District of Columbia, U.S. states and five territories, conducted between February and May, found dentists were the most problematic provider, with 30 surveyed Medicaid officials who reported a challenge ensuring enough were participating in Medicaid. Twenty-six Medicaid officials named specialists as a challenge. Mental health and substance abuse provider participation was a challenge for 17 of the surveyed Medicaid officials, and the same was true for primary care, the report said.
Source: modernhealthcare.com

Benutzer:TonyaJwn – Galaxy On Fire 2

With the possibility of a dental calamity increasing over time, Medicare has show up with unique dental plans also. These plans cover your dental requirements at economical prices and save your self the immense clinic payments to you you would need to spend were it not for Dental Texas Medicare plans. Certain salient options that come with the strategies are as follows: They’re affordable. One reason why dental insurance coverage by Medicare are fast increasing repute is that they are very economical and can be attached also by the lower middle-income group strata of the culture. More over, Medicare has launched at the least 50% co-insurance cost amounts for root canal treatments, basic dental check-ups, and cavity stuffing treatments in per year. Hence, these options are very popular. They could be run like a savings account. Medicare features a few account offers where you may maintain adding reasonably limited that would be distributed around you anytime you’ve a dental problem. The in-patient whose consideration exists could extract the mandatory sum of cash and make certain they have proper solutions on time at good hospitals without bothering much in regards to the costs involved. Considerable insurance choices are made available. Once you subscribe to a dental Medicare insurance cover, there are variety dental alternatives that are provided. If you have an elimination problem and that’s affecting your tooth and jaw, the charges will be carried by the organization. When you have a chin problem and a tooth problem to look after, the trouble would be borne by the organization, and etc, i.e. check my reference. Any dental injury will be covered by the business and thus Medicare dental insurances are fantastic.
Source: pf-control.de

The business behind dental treatment for America’s poorest kids

Kool Smiles does far more crowns than average on children age 8 and under on Medicaid, according to an analysis of 2010 Medicaid data in two states done by CPI and FRONTLINE. In Texas, a child under the age of 9 at Kool Smiles has nearly a 50-50 chance of getting a crown as a restoration to treat problems like cavities, our analysis found. That compares to a one in three chance on average at other providers. And in Virginia, a child 8 or under on Medicaid going to Kool Smiles is twice as likely on average to get crowns than at other dental offices.
Source: publicintegrity.org