Medicare Supplement Plans

Posted by:  :  Category: Medicare

Medical Drugs for Pharmacy Health Shop of Medicine by epSos.deMedicare coverage has become restricted. Those who are just beginning, or have already reached their Golden years, are more susceptible illness.  To benefit from sickness benefits with ample coverage, a Medicare Supplement is a must. To find the right Medicare Supplement plan for you, medicarequotefinder.com is the way to go.  Search for the Medicare supplement that will complement your already existing Medicare coverage. Sometimes Medicare Supplements can be difficult to understand.  There are many different plans with many different types of coverage, and occasionally you get lost when all you want is to find the Medicare Supplement that you know will work best for you. Medicarequotefinder.com doesn’t want you to feel lost in the maze of Supplement plans. They make it easy to maneuver through their site to find what you need.
Source: medicarequotefinderblog.com

Video: California Medicare Supplement Insurance Plans 1-800-243-8100

How To Determine The Best Medicare Supplement Insurance Texas

An aging population needs more health care attention so as to remain in good health. What this implies is that the veterans are bound to spend more of their retirement savings on the medical expenses. Turning to insurance companies for health insurance can prove very decisive. There are quite a number of health insurers who offer supplements, and at times it can be a challenge to pick the one that suits your interest. It is imperative that before choosing the right medicare supplement insurance Texas people do research to have enough knowledge of the types that are available in the market.
Source: havleenterprises.com

Pick The Correct Way Of Acquiring The Very Best Medicare Supplement Rates That Fulfills All Of Your Further Medical Bills Just By The Due Date

Persons normally obtain health insurance coverage ideas to become additional complicated! It has in actual fact turn into a lot more widespread and complicated together with the improvement of modern protection plans everyday! For those who are a person who’s in search of the best guidance on Medicare nutritional supplement prices, experienced assistance appropriate on your desk is simply less complicated within the present market place! So how appear? Intermediaries on-line has produced it a lot more obvious at no cost! Ahead of the growth of medicare wellness plans in the United states of america, beneficiaries typically expected somewhat advice in deciding on the appropriate coverage for their living. But using the widened scope top towards the substantially welcomed Medicare supplemental insurance schemes, supervision or help from good quality intermediaries has without doubt turn into inevitable. An insured individual can ordinarily understand, investigation, analyze and decide on personal before essentially choosing up their form of Medigap Plans with no any external advice. But at situations where there the marketplace changes without prior discover or there available newer firms with much more beneficial supplement prices, aid from the specialists would absolutely be fruitful. Hence intermediaries that provide their benevolent services on the web in educating and guiding medicare beneficiaries around the merits of Medicare nutritional supplement insurance coverage policies could extremely properly be utilized with out any second- believed. These on the web brokerage sites invite medicare insured individuals and folks who match for your identical to get a detailed know-how around the profitable medigap policies beneath procedure from a number of insurers inside the state or nation as well as the top quality fee that they repair on. Quick dietary supplement price comparisons via on the net calculators make them the ideal spot for any one who wishes to discover about the ideal supplier inside the state. These intermediary authorities that work on-line, render their services just free-of-cost to all insured beneficiaries with all the only motive of building a best-fit premium charge Related Site for the latter.
Source: mandatedterritory.info

Tips On Choosing A Medicare Supplement Insurance

It is important to note how a company prices their policies. Check to see how much you are required to pay now and in the future. Plans may be priced as community rated, issue age rated or attained age rated. When it is community rated, your premium is not based on age and is the same for all. Second pricing means that premiums are lower for people who buy a plan when younger and will not change as you get older. Latter pricing plans are low for younger buyers but increases as one ages. Premiums may go up for all pricing due to inflation.
Source: queryanswer.com

NEW TO MEDICARE!! WHAT IS MY BEST OPTION? » Toni Says

**There is an important disclaimer at the bottom of page 57 of the handbook and it states:  ‘If you join a Medicare Advantage plan, you don’t need a Medigap/Medicare supplement policy and if you already have a Medigap/Medicare supplement, you can’t use it to pay the out of pocket or co pays for the Medicare Advantage plan’.  It also states that “if you already have a Medicare Advantage plan, you can’t be sold a Medigap/Medicare supplement policy.”** 
Source: tonisays.com

Democrats committed to protecting social security and Medicare, despite loose talk from David Plouffe

Posted by:  :  Category: Medicare

Racism by elycefelizAs Congress returned Monday, the debate over [social security and Medicare], which many Democrats see as the core of the party’s identity, was shaping up as the Democratic version of the higher-profile struggle among Republicans over taxes. In failed deficit reduction talks last year, Mr. Obama signaled a willingness to consider substantial changes in the social safety net, including a gradual increase in the eligibility age for Medicare and limits in the growth rate of future Social Security benefits. An urgent question hanging over the new round of deficit talks is which of those changes Mr. Obama and Congressional Democrats would accept today. While a potential change in calculating Social Security increases was part of the talks with Speaker John A. Boehner last year, the White House press secretary, Jay Carney, made clear on Monday that the administration was not considering changes to the retirement program as part of the deficit talks. “We should address the drivers of the deficit, and Social Security is not currently a driver of the deficit,” Mr. Carney said.
Source: blogforarizona.com

Video: Arizona Medicare Supplement Plans- 1.800.643.7544

Bivens Launches in Arizona; Draws Contrast Over Medicare

Throughout 2011, House Budget Chairman Paul Ryan’s budget proposal that revamps Medicare has been a central point of contention in several federal races. If former Arizona Democratic Party Chairman Don Bivens has his way, the issue will also emerge in the Arizona Senate race that already includes Republican Rep. Jeff Flake as a candidate. “Points of difference: Jeff Flake supports the Ryan budget, which the Wall Street Journal has described as ending Medicare as we know it. I am in favor of preserving Medicare and Social Security benefits for seniors,” Bivens said in an interview with Hotline On Call Monday, after officially announcing his candidacy. “If the Democrats indeed put forth a liberal lawyer and former Party Chairman, the voters will have a clear choice come November,” responded Flake in a statement. In his announcement video and the interview, Bivens decried the fighting in Washington. He said he is running to provide a voice for the middle class. “The middle class is getting pinched and we have too many of our politicians back in Washington that are more concerned about bickering than about getting stuff done,” he said. Bivens is the first Democrat to declare. But he may not be the only. Aides to Democratic Rep. Gabrielle Giffords have been wooing former Surgeon General Richard Carmona to enter the race. For his own part, Bivens steered clear of commenting on Carmona.
Source: nationaljournal.com

CMS Reveals First 27 ACOs in Medicare Shared Savings Program

The ACOs span 18 states and will cover roughly 375,000 beneficiaries. Five of the 27 ACOs are participating in the Advance Payment ACO Model, under which each ACO will receive advance payments to help cover the costs of establishing an ACO infrastructure. The names of the Advance Payment ACOs were not disclosed in the news release. CMS is now reviewing more than 150 applications from ACOs seeking to participate in MSSP beginning July 1. Of those applicants, more than 50 are applying for the Advance Payment ACO Model. The first 27 ACOs to participate in the MSSP program are listed here, along with their respective locations: 1. Accountable Care Coalition of Caldwell County, LLC (N.C.) 2. Accountable Care Coalition of Coastal Georgia 3. Accountable Care Coalition of Eastern North Carolina, LLC 4. Accountable Care Coalition of Greater Athens Georgia 5. Accountable Care Coalition of Mount Kisco, LLC (N.Y.) 6. Accountable Care Coalition of the Mississippi Gulf Coast, LLC 7. Accountable Care Coalition of the North Country, LLC (N.Y.) 8. Accountable Care Coalition of Southeast Wisconsin, LLC 9. Accountable Care Coalition of Texas, Inc. 10. AHS ACO, LLC (N.J.) 11. AppleCare Medical ACO, LLC (California) 12. Arizona Connected Care, LLC (Arizona) 13. Chinese Community Accountable Care Organization (N.Y.) 14. CIPA Western New York IPA, doing business as Catholic Medical Partners (N.Y.) 15. Coastal Carolina Quality Care, Inc. (N.C.) 16. Crystal Run Healthcare ACO, LLC (N.Y. and Pa.) 17. Florida Physicians Trust, LLC 18. Hackensack Physician-Hospital Alliance ACO, LLC (N.J.) 19. Jackson Purchase Medical Associates, PSC (Ky.) 20. Jordan Community ACO (Mass.) 21. North Country ACO (N.H.) 22. Optimus Healthcare Partners, LLC (N.J.) 23. Physicians of Cape Cod ACO (Mass.) 24. Premier ACO Physician Network (Calif.) 25. Primary Partners, LLC (Fla.) 26. RGV ACO Health Providers, LLC (Texas) 27. West Florida ACO, LLC
Source: beckersspine.com

Information About Arizona Medicare Plans

It is very important for people to take time to consider which plan will work best for them. This can take time and energy since choosing the right provider is not as easy as it once was. Costs and things covered are important. However, the doctors and networks included are important as well. It is a good idea to view quality ratings. The Centers for Medicare and Medicaid Services has a rating system that is easy to understand. Health and drug plans are rated according to which plans have the best customer service and are of the highest quality. The higher the amount of stars a plan has, the better. It is also good for people to take a look at the hospital selection offered by a plan. The best providers include several facilities. This can prevent people from having to drive far away in order to receive the best treatment possible.
Source: clasificadosdesalud.com

Options for Medicare Beneficiaries discussed by an Arizona Broker

PRLog (Press Release) – Dec. 12, 2012 – Options available to Medicare Beneficiaries besides Original Medicare Medicare Part A which covers inpatient treatment for Medicare Beneficiaries and Medicare Part B which provides for outpatient services are both available to seniors and some people on disability under age 65 and is referred to as original Medicare.  However, original Medicare by itself can leave the senior with significant out of pocket expense. “As an Independent Insurance Broker in Arizona” states Ralph Bredahl with Arizona Medicare Advisors, “I find a lot of confusion among seniors on what is available to them to help with medical costs. I trust this list will help to answer some of the questions that I hear”   http://www.ArizonaMedicareAdvisors.com Medicare Supplement also called a Medigap plan; a supplement pays for many of the costs that are not covered by Medicare.  It is a separate plan and the company providing the coverage may ask health questions. There are certain times and situations where a beneficiary is guaranteed issue.  Also, there are several Medicare supplement plans available. Plan A, B, C, F, G, K, L, M and N.  Not all companies carry all plans. I won’t go into the differences here but it is important to point out that all plan types are the same with every company. In other words Plan F with company A will be the same basic coverage as Plan F with company B.  Arizona Medicare Advisors can answer your questions on plans in Arizona but consult a broker licensed in your state for particulars. http://ArizonaMedicareAdvisors.com Part D Prescription Drug Plan provides coverage for prescription drugs and has copays for various tiers of drugs. In addition, it has a premium that is paid by the beneficiary. Low income seniors can apply for assistance with the premiums and copays through social security. There is an open enrollment and special enrollment periods. If a senior declines to enroll when eligible they will have a penalty if enrolled later. As with Medigap Arizona Medicare Advisors can answer your questions on plans in Arizona but consult a broker licensed in your state for particulars Medicare Advantage is also known as part C. These plans are available in Arizona and in many other areas as well. Once again, check with your local broker. With a Medicare Advantage plan the beneficiaries opts to receive their medical coverage from a private company. The company must provide coverage as good as or better than original Medicare. The plans provide coverage for Part A and for Part B and often incorporate Part D into the plan. Like the Part D plans, Medicare Advantage plans are guaranteed issue and have open enrollment. There is also a disenrollment period if the senior wants to return to original Medicare. http://ArizonaMedicareAdvisors.com Ralph Bredahl Arizona Medicare Advisors.com 602-390-8573
Source: prlog.org

Arizona Medicare Supplement Plans

The medical needs of senior citizens are often continual and increasingly more expensive to keep up with on a regular basis. There are many instances where people are unable to keep up with the risings costs of health care which makes them avoid treatment or simply undergo minor forms of care that are within budget which can cause significant health risks and concerns. Anyone currently enrolled in this program and looking for added assistance should be capable of choosing from Arizona Medicare supplement plans to help offset their expenses.
Source: annuitycampus.com

Hospitals urge OIG to investigate RACs

Posted by:  :  Category: Medicare

The PARTY Is OVER ...item 4.. Today, Mitt Romney Lost the Election (Sep 17, 2012 6:02 PM ET) ...item 5.. James Brown - Get On The Good Foot, Soul Power, Make It Funky Soul Train 1973 ... by marsmet471Moreover, Pollack noted in his letter that overlapping and duplicative efforts among RACs and other CMS contractors overwhelm providers. "For example, RACs, MACs and ZPICs are all charged with reviewing hospital Medicare claims, and hospitals may be required to respond to simultaneous audits of the same claims or to duplicative record requests. These redundant audits drain time, funding and attention that could more effectively be focused on patient care," he wrote.
Source: fiercehealthfinance.com

Video: Roskam Bill Saves Medicare Tens of Billions

Providers Filed 85% of Medicare Appeals in 2010

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

In brief: Appeals process, acquisitions and readmissions

Pride Mobility Productsand Specialty Equipment Market Association (SEMA) recently unveiled the Victory ES 10, a mobility scooter customized by car designer Chip Foose. Foose, best known for his television show “Overhaulin’,” drew up the hot rod modifications for the scooter, adding a roadster grill, pinstriping and color-keyed upholstery for a vintage look…Breathe IDTF now allows its HME provider customers to receive text message alerts when their patients have qualified for oxygen using the Breathe Oximetry System. Receiving text messages in the field helps the provider’s sales reps know when to follow up with physicians and get patients on oxygen faster, the company stated…PDG Drives Technology, a manufacturer of motor control systems for industrial and mobility electrics vehicles, including power wheelchairs, has been acquired by Curtiss-Wright, an engineering company…The Braff Group closed its 200th transaction on its 17th deal this year, the Pittsburgh-based M&A firm has announced. Since launching in 1998, The Braff Group has completed an average of 14 deals per year.
Source: hmenews.com

Court: You Can Appeal Medicare Decisions About Hospice Services

That’s a victory of sorts, because it makes it clear that beneficiaries have the right to challenge a hospice provider’s refusal to provide a service that a doctor deems necessary, Mr. Deford said. But it’s disappointing because it doesn’t ensure that people receive a notice of their right to appeal when they enter hospice care, or that any mechanism exists for expedited appeals – an important protection for people who are dying.
Source: nytimes.com

Providers File The Bulk Of Medicare Appeals

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

ALJ Appeals Frequently Favorable To Providers; OIG Calls For Reforms

In the current review, the OIG found ALJs reversed in favor of appellants for 56 percent of appeals. In contrast, qualified independent contractors (QICs), the prior level of appeal, decided fully in favor of appellants in 20 percent of FY 2010 appeals. The OIG found that this difference was due to ALJs differing from QICs in their interpretation of Medicare policies, their degree of specialization and their use of clinical experts. Interviews with QICs and ALJ staff showed that ALJs tended to interpret Medicare policies less strictly than QICs. Additionally, QICs specialize in a Medicare program area (Part A, Part B, or DMEPOS); however ALJs typically decide appeals involving all Medicare program areas due to random assignment. QICs have medical directors and clinicians on staff to review decisions, but ALJs do not, and ALJ staff noted that ALJs have thus tended to rely on testimony and evidence from treating physicians.
Source: jdsupra.com

The Changing Landscape of Medicare for 2013 and Beyond

The Affordable Care Act included a number of changes to the Medicare program.  Preventative care coverage has been expanded to cover many screenings.  Participants can take advantage of an annual wellness exam to plan which screenings are appropriate for them each year.  Healthcare reform included changing the “donut hole” provision to Medicare’s drug coverage (part D) and the donut hole will be phased out by 2020 (the donut hole is a period in which recipients pay all drug costs when they reach a certain cost level, up until reaching catastrophic coverage).  In 2013, people who hit the donut hole will have additional help/discounts during that period.
Source: seniorhomes.com

Appeal Rights for Hospice Care Patients

The entire case is detailed in a recent post in The New Old Age a blog through the New York Times, titled “Court: You Can Appeal Medicare Decisions About Hospice Services.” As this blog post notes, Emily was denied coverage for a pain medication while in hospice and in the last stages of life. Consequently, Howard paid for them out of pocket and later (after Emily’s passing) appealed to Medicare to cover the expenses for doctor-ordered medication. While initially told there was no such Medicare appeals process and was turned away, Howard learned otherwise.
Source: tesarlaw.com

Right to Appeal Medicare Decisions for Hospice Patients

The entire case is detailed in a recent post in The New Old Age a blog through the New York Times, titled “Court: You Can Appeal Medicare Decisions About Hospice Services.” As this blog post notes, Emily was denied coverage for a pain medication while in hospice and in the last stages of life. Consequently, Howard paid for them out of pocket and later (after Emily’s passing) appealed to Medicare to cover the expenses for doctor-ordered medication. While initially told there was no such Medicare appeals process and was turned away, Howard learned otherwise.
Source: briskelderlaw.com

HMS RAC Audit Series: Medicare Appeals Council Review

The written request must be received within 60 days of receipt of the ALJ’s decision and must specify the issues and findings being contested. A decision is generally issued within 90 days.  If a decision is not made within that timeframe, the case can be escalated for Judicial Review.
Source: wordpress.com

New AMIC Survey Data Shows 2010 Medicare Payment Cuts Forcing Physician Practices and Imaging Providers to Reduce Patient

In the past, the Obama Administration has proposed using RBMs in the Medicare program.  However, the Department of Health and Human Services (HHS)  previously weighed in on prior authorization in the Medicare program, noting in 2008 that a prior authorization program could be “inconsistent with the public nature of the Medicare program,” since such programs rely on private companies using proprietary systems to deny care prescribed by a physician.  HHS also noted that the Medicare appeals process guaranteed to every beneficiary could overturn a “high proportion” of denials, rendering the policy ineffective.  In an environment of reduced reimbursements, the AMIC survey further demonstrates that application of RBMs is an ineffective model imposing unnecessary administrative costs on practices, thereby creating artificial barriers for patients in need of care.
Source: rightscanrighttime.org

Can You Appeal a Denied Medicare Claim?

In 2010, 40 percent of Part A appeals and 53 percent of Part B appeals were granted, according to the Centers for Medicare & Medicaid Services, which administers Medicare (CMS). Even in the case of big ticket durable medical equipment appeals, 44 percent of appeals were successful. More than half of appeals to Medicare Advantage and prescription drug plans are successful, too.
Source: hunterestategroup.com

OIG Report: ALJs Need Training

2012 Election Accreditation ACO Affordable Care Act Billing Careers in Home Care care transitions CMS dual eligibles Education Emergency Prep EOEA Face-to-Face Falls Prevention Family Caregiving federal budget Federal Regulations Home Care & Hospice Alliance of Maine Home Care Association of New Hampshire Home Care Careers Home Health Care Home Health Compare hospice House of Representatives innovation Managed Care Massachusetts MassHealth Mass Regulations Medicaid Medicare New England Careers New England Home Care Conference & Trade Show nurse delegation nursing patient choice Patient Satisfaction PECOS PPS Redistricting State Budget telehealth therapy U.S. Congress VNA
Source: wordpress.com

ibm medicare options: Appealing denial of coverage

When you are denied coverage for a medical procedure or a prescription drug it is important to do an appeal with your insurance company.  If you have a Medicare sanctioned plan the appeals process is governed by Medicare law.  Sometimes it takes a couple of iterations to get to an independent group (that is – not the private insurance provider) to get a fair assessment. I just wanted to remind you that IBM secondary insurance and Aetna Integration insurance is not governed by the Medicare appeal process laws because it is not government sanctioned medigap or secondary insurance.  For those insurance policies if you are not satisfied with the decision they render you have to complain to the department of insurance in your state.  It is unlikely doing that will change the decision but it is important to complain because those departments track complaints and put pressure on insurance companies that are generating a lot of complaints. I don’t know what the appeals process is for IBM’s prescription drug insurance plan.  Although it is a “creditable” plan, I am not sure if the company (CVS Caremark) is required to have the same appeals process as a government sanctioned prescription drug plan (PDP).  If you are choosing the IBM prescription insurance plan you should ask the question.  If it does not conform then your appeals are totally handled by CVS – which means there is no independent review and your chances of reversing a decision are slim.  If someone has an answer please post a comment.
Source: blogspot.com

No more Medicare Advantage leads

Posted by:  :  Category: Medicare

TWO YEARS OF RUIN by SS&SSThe carriers will love all of this because it puts everyone on an equal playing field and drives everyone in through their telemarketing and bypasses the agents which they also love to do. Some zamboni of the phone slams them into an MA and an hour later they dont know what the hell they have or who to call about it. I suppose it is also a windfall for captive agents who get some feed off the tv ads and mailings and not have to compete with the independents at the local buffet. However, after next enrollment season, the entire field looks grim for them too. This bill only address how to market. Other legislation will address whether they will be offered at all. The PFFS piece has already taken a fatal hit. As with the PFFS plans, congress will probably not kill MA’s but cut their subsidies and then tell the carriers to do what they want. Then when the carriers raise their rates to cover costs or failure to realize savings then the public will just say "what the hell, I can get a full med supp without the smoke and mirrors of an MA for another fifty bucks a month beyond what the MA would cost me." Winter
Source: insurance-forums.net

Video: Start Selling Medicare Advantage – Great Opportunity

Medicare Advantage Future

It appears that the Advantage plans eventually will be limited to lower incomes where it will be based on people on medicaid or dual eligible. It simply can’t go to the way of having one area in the country offer it and not in others. Can this be unconstitutional? Insert from the congress blog:The candidates’ positions on Medicare Advantage – The Hill’s Congress Blog "Medicare Advantage plans are paid based on a legislative formula, and any payments they receive above what is necessary to provide the basic Medicare benefit must be provided to the beneficiaries of the plans in the form of expanded benefits, such as lower deductibles and copayments for services. Once the election is over and the artificial and temporary bump-up in payments is terminated, as it inevitably will be, the Medicare Advantage plans will be forced to pare back benefits, and enrollment in the plans will drop." "This should not be surprising. The traditional Medicare fee-for-service insurance is an extremely inefficient model. There is no incentive for either the providers or the enrollees (most of whom have supplemental coverage beyond Medicare) to control the use of services. Thus, the volume and intensity of service use rises dramatically each year. Moreover, there is no coordination among those providing medical services to the patients, which leads to fragmented and low-quality care in too many instances." Since traditional med sups are considered inefficient in controlling costs and the fact the president wants to cut spending on advantage plans it leaves a big gap of uncertainty of which way we go with medicare. I would hope we get rid of the political animal and try to come up with the most efficient way to run medicare for future generations to come as the country ages. What is your take?
Source: insurance-forums.net

Medicare HMOs reduce utilization, researchers say

“Although we could not assess the appropriateness of services, some of our findings suggest that the use of services may be more appropriate within Medicare Advantage HMOs,” the researchers said. “For instance, relative to beneficiaries in traditional Medicare, Medicare Advantage HMO enrollees are more commonly treated with cardiac bypass surgery, in accord with current guidelines. Additionally, lower rates of emergency department use suggest that Medicare Advantage HMOs may be treating patients in less costly primary care or urgent care settings.”
Source: lifehealthpro.com

Kaiser Permanente Leads the Nation with Six 5

About Kaiser Permanente Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 9 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: www.kp.org/newscenter.
Source: kp.org

Part D Offers Enrollment Flexibility for People Affected by Hurricane Sandy

If you, or someone you rely on for help with Medicare decisions, were affected by Hurricane Sandy, Medicare can help. If the storm caused you to miss the enrollment deadline, you can still make a plan choice for 2013. Medicare will help you enroll in a plan. If you call before December 31st, your coverage will start January 1, 2013.
Source: phrma.org

Too Many Medicare Advantage Choices Can Decrease Enrollment

To examine the effects of multiple plan options on enrollment in Medicare Advantage, the authors looked at 21,815 enrollment decisions from 2004 to 2007 made by 6,672 participants in the Health and Retirement Study, a national longitudinal survey conducted biennially by the University of Michigan. They found that if fifteen or fewer plans were available in a region, more choices usually led to an increase in Medicare Advantage enrollment. When the number of options surpassed thirty, as it did in 25 percent of US counties, more choice was associated with decreased enrollment in the program.
Source: healthaffairs.org

Using Medicare Advantage to Gain Political Advantage

It is almost certainly true that quality suffers when reimbursement rates are reduced. It is also appears to be true that competition amongst private providers in Medicare Advantage is leading to efficiencies that aren’t present in traditional Medicare, which we should probably take as a lesson. It is also often the case that when the government pays more for something, it spends more, and when it pays less for something, it spends less. But what all this really reveals is the folly of trying to control health spending through government-designed payment schemes. 
Source: reason.com

Reductions in Medicare Advantage Payments: Impact on Seniors

[35]This is slightly different conceptually from the elasticities explained in elementary economics textbooks. Those elasticities are typically the “price elasticity of supply” and the “price elasticity of demand,” which measure the effect of a change in price on either supply or demand in isolation from the other. The price elasticity of demand is the ratio of the percent change in the quantity demanded to the percentage change in the price, assuming the supply function stays the same. Likewise, the elasticity of supply assumes the demand function remains unchanged. However, this study follows the example of the CMS actuary and calculates a “benchmark elasticity of enrollment,” a combined elasticity that is the ratio of the percent change in the MA benchmark to the percent change in MA enrollment. This elasticity captures both the supply effect and the demand effect. The supply effect results from lower revenue to MA plan providers, and the demand effect results from MA plans having to provide less generous benefits.
Source: heritage.org

Highmark change in Medicare eye exam coverage irks some

Posted by:  :  Category: Medicare

• Report: 27 dead, including 18 children, in Conn. school shooting • Dan Rooney resigns as U.S. ambassador to Ireland • Peduto declares for mayor, secures Fitzgerald endorsement • Kovacevic: Some extra pepper for PirateFest • Clairton seniors hurdle tragedies, find success
Source: triblive.com

Video: Pittsburgh Celebrates Medicare’s Anniversary

Novitas Solutions, formerly called Highmark Medicare Services, announces hundreds of health care jobs coming to Harrisburg, Pittsburgh areas

The prospect of new jobs arises from a large, new contract that was in limbo at the time of the sale. The contract, which involves administering Medicare claims for seven Southwestern states, was expected to create 500 new jobs in Pennsylvania, with about 260 coming to the Harrisburg area.
Source: pennlive.com

New Medicare Administrative Carrier for Jurisdiction 12 Highmark Medicare Services Acquired by Diversified Service Options Inc

Diversified Service Options (DSO) acquired Highmark Medicare Services (Highmark) on January 1, 2012. DSO is a holding company and a wholly-owned subsidiary of Blue Cross and Blue Shield of Florida, Inc. (BCBS Florida). Highmark had the contract with the Centers for Medicare & Medicaid Services (CMS) to be the Medicare Administrative Contractor (MAC), formerly known as a “Carrier” or “Fiscal Intermediary,” for Jurisdiction 12, which includes Delaware, New Jersey, Pennsylvania, Maryland and Washington, D.C. For Part B services, Jurisdiction 12 also includes the counties of Arlington and Fairfax in Virginia and the city of Alexandria in Virginia.
Source: thehealthlawfirm.com

What happened to Highmark Medicare Services?

Physicians and medical billing companies should not face many disruptions as a result of this transition. According to Novitas Solutions, the current Highmark Medicare website will be fully transitioned to the new Novitas site by March 30, 2012. During the transition, visitors to the old website (https://www.highmarkmedicareservices.com) will be automatically re-directed to the new Novitas Solutions website (https://www.novitas-solutions.com), where a new header and page logo can be seen. Bookmarks that users may already have for the Highmark website will purportedly still work with the new page. The Electronic Payer ID has not appeared to change, so claims submission and processing should remain unaffected by the transition. For more information, see the Informational Alert here: https://www.novitas-solutions.com/partb/info-alerts.html.
Source: healthcarebiller.com

Highmark Medicare Services Changes Name to Novitas Solutions, Inc.

Please read the following bulletin from Highmark Medicare Services. The affected payers are: CPID 2456 Delaware Medicare CPID 5912 Delaware Medicare CPID 3677 J12 Mutual of Omaha DC,DE,MD,NY,PA CPID 7402 Maryland Medicare CPID 5554 Maryland Medicare CPID 2464 Maryland Medicare (MONTG,PRINCE GEORGE) CPID 1465 New Jersey Medicare CPID 5503 New Jersey Medicare CPID 5598 Pennsylvania Medicare CPID 2457 Pennsylvania Medicare CPID 2461 Virginia Medicare (ALEX,ARLGTN,FAIRFAX) CPID 1522 Washington DC Medicare CPID 2459 Washington DC Medicare Reported by Highmark Medicare Services: As announced March 1, 2012, Highmark Medicare Services is changing its name to Novitas Solutions. Effective March 10, 2012, Highmark Medicare will begin migrating the current Highmark Medicare website to our new Novitas Solutions website. We are targeting completing our name change to all active webpage content by March 30, 2012. The new Novitas Solutions website URL will be https://www.novitas-solutions.com. Additional details, including Frequently Asked Questions, are available at https://www.novitas-solutions.com/partb/info-alerts.html. Re-enrollment is Not required. The clearinghouse will continue processing as normal. If you have any questions, please contact Client Services at 1-888-348-8457, option 2.
Source: collaboratemd.com

Highmark Medicare LCD’s Proposed : Med Law Blog

Highmark Medicare Services has published the initial draft set of LCDs as part of its plans to fulfill CMS requirements to consolidate ICEs by July 1, 2008. Highmark’s instructions for submitting comments for the proposed Local Coverage Determinations (LCDs) and the proposed LCDs are included in the attached link. The following LCDs are included:
Source: medlawblog.com

More Healthcare Choices With Highmark Medicare

Few folks have adequate money to include anesthesia bills once these folks get sick. In order to make quality medical care readily available to the majority, well being insurance prefer Medicare is invented by the the us government as an assurance that individuals are protected from the prices incurred when availing one. The procedure of wellbeing insurance follows a financial fee structure generally in the kind of month-to-month premium deductions by the insurance coverage sites to the salary of an personalized. The financial savings that gather at the time of time from these insurance plan are used for spending health care. Typically, a wellness protection has provisions to adhere to earlier than an policyholder personalized might be eligible for cover. In Medicare for instance, people aged 65 or older, permanently inept, or individuals with kidney failure, are entitled to use it so which their medical charges are a lot more affordable.
Source: ivegotcoveragereview.com

State announces changes to prescription drug plans for retirees, pensioners

Some individuals qualify for extra help to pay for prescription drug premiums and costs. Those who want to see if they qualify can call Medicare at 1-800-MEDICARE (1-800-633-4227) any time (TTY users should call 1-877-486-2048); the Social Security Office at 1-800-772-1213 between 7 a.m.-7 p.m., Monday through Friday (TTY users should call 1-800-325-0778); or the state Medicaid office.
Source: udel.edu

Healthcare BPO News: Highmark Medicare Services to Begin Processing Claims in New Jersey

In fiscal year 2007, Highmark Medicare Services processed about 48.8 million claims and served approximately 2.3 million beneficiaries and 57,000 providers. As the MAC for J12, Highmark Medicare Services is expected to process approximately 131 million claims annually, accounting for more than 11 percent of the national Medicare fee-for-service workload. Highmark Medicare Services will be working on behalf of approximately 4.2 million beneficiaries and 137,000 physicians and practitioners.
Source: blogspot.com

Roundup: Ga. ‘Provider Fee’ Defeat Could Mean $430M Less For Medicaid; Calif. Stem Cell Board Criticized

Posted by:  :  Category: Medicare

Save Medicare --Jim Parker by faulThe Lund Report: Medicare Payments Favor Hospitals Dr. Don Berwick believes the Triple Aim is critical to the success of health care reform over the next few years. That means better care for individuals, better health for populations and lower health care costs. “The fundamental flaw in American health care is fragmentation,” said the former administrator of the Centers for Medicare and Medicaid Services, who appears in Portland next Thursday to keynote the 2012 State of Reform Conference. The health care delivery systems are facing an identity crisis, he told The Lund Report. “Are they going to continue raising prices and costs or redesign health care so costs start to fall. This isn’t about rationing or withholding care. It’s about getting costs down while improving care. If it doesn’t happen, we’ll go over the fiscal cliff. An extra dollar taken by health care that’s not needed is a dollar denied for a school or a road. This is not free money that health care is taking. It’s coming from somewhere else” (Lund-Muzkant, 12/6).
Source: kaiserhealthnews.org

Video: Georgia Health Insurance Medicare

Window Closing On 2013 Medicare Open Enrollment

5 days remain in Medicare Open Enrollment, which runs thru December 7. This is the last day the Center for Medicare and Medicaid Services allows Medicare Beneficiaries to switch, add or drop how they want to receive Medicare health benefits in 2013. I am certified by CMS and represent major private insurers with Medicare contract and welcome the opportunity to provide assistance in what can be a challenging decision. If I can be of service call me 404-593-9663 or email bob.smith@insphereis.com
Source: patch.com

Medicare agrees to cover TMS treatment for depression in TN, GA, AL

“TMS will now be available to more patients, giving them the hope of living a life free of depression,” said Burton Hills-based Dr. Scott West, who was the first local psychiatrist to acquire the TMS machine, a space-age contraption that looks similar to a dentist’s chair. West has been using TMS to treat patients since 2010. (See our September magazine story here.)
Source: nashvillepost.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 process 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 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 OPEN ENROLLMENT ENDS DECEMBER 7

Medicare Open Enrollment allows beneficiaries to switch, add or drop a Medicare Advantage Plan. This can be a challenging and confusing process and I want to offer my services to those seeking to navigate the process. I am a health agent certified to represent major private insurers with Medicare contracts and welcome the opportunity to provide guidance with no obligation.
Source: patch.com

Georgia Cancer Specialists Settles with Feds over Medicare Billing

The civil settlement resolves the United States’ investigation into Georgia Cancer Specialists’ practices relating to billing for evaluation and management (E&M) services on the same day as a related procedure. Generally, providers are not permitted to bill both E&M services and a related procedure on the same day under the Medicare program’s regulations. In specific circumstances, providers can avoid this prohibition by submitting their claims marked with modifier -25, which tells Medicare to pay both the procedure and the E&M service. Here, the U.S. Attorney’s Office alleged that Georgia Cancer Specialists applied modifier -25 to claims that did not qualify for its use, leading to overpayments by Medicare.    
Source: patch.com

Senior Care in Sandy Springs, GA: Open Enrollment for Medicare –Now through Dec 7, 2012

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

Remember the $716 billion in Medicare ‘cuts’?

But the argument was burdened by some rather glaring flaws. For one thing, Romney’s criticism wasn’t true. For another, the $716 billion in Medicare savings were embraced by congressional Republicans, including Romney’s running mate, in the GOP budget plan. As Bill Clinton said at the Democratic convention, it “takes some brass to attack a guy for doing what you did.”
Source: msnbc.com

MEDICARE OPEN ENROLLMENT ENDS DECEMBER 7

ATTENTION MEDICARE BENEFICIARIES: Medicare Open Enrollment allows beneficiaries to switch, add or drop a Medicare Advantage Plan. This can be a challenging and confusing process and I want to offer my services to those seeking to navigate the process. I am a health agent certified to represent major private insurers with Medicare contracts and welcome the opportunity to provide guidance.
Source: patch.com

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

PECOS: A Medicare Benefit for your Practice

Posted by:  :  Category: Medicare

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

Video: Audio Educator: Medicare Enrollment PECOS And the CMS 855

Important “PECOS” Update…

In 2010, Congress required the use of national provider identifiers for ordering and referring physicians on claims for medical equipment or services from laboratories, imaging providers and suppliers. CMS later issued an interim regulation requiring all physicians who order supplies or refer services, including those from specialists, to be enrolled in PECOS by July 2010, but CMS delayed enforcement of that rule as the agency worked to validate and update enrollment records. Enforcement would have meant that claims for items or services would be rejected unless the ordering or referring physician also was in the enrollment system, not just the physician who provided the care.
Source: vgm.com

Medicare This Week: June 8th, 2012, 4010 Ends July 1st, ePrescribing Hardship Exemptions, Improvements to PECOS

Effective July 1, 2012 only ASC X12 Version 5010 (Version 5010) or NCPDP Telecom D.0 (NCPDP D.0) formats will be accepted by Medicare Fee-For-Service (FFS). Providers that are still conducting one or more of the Version 4010 transactions electronically, such as submitting a claim or checking claim status, or rely on a software vendor, billing service or clearinghouse to do this on their behalf, are affected by this change. Now is the time to contact your software vendor, billing service or clearinghouse, when applicable, if you have not done so already to ensure you are ready. Transactions conducted by Medicare Administrative Contractor (MAC), fiscal intermediary (FI) or carrier telephone interactive voice response (IVR) systems, Direct Data Entry (DDE) and Internet Portals, for those contractors with Internet Portals, are not impacted.
Source: managemypractice.com

Improvements to the Medicare Internet

Users will soon be able to see if their revalidation application has been received and processed by the Medicare Administrative Contractor (MAC).  In addition to a “Revalidation Notice Sent” date, a “Revalidation Received” date and a “Revalidation Complete” date will be displayed on the My Enrollments page. The “Revalidation Notice Sent” date and the “Revalidation Received” date will display on the My Enrollment page for 120 days. The “Revalidation Complete” date will display on the My Enrollments page indefinitely. There are some problems with this system as it has been reported that some physicians are appearing on the page as having been sent a revalidation notice but there is no record of the notice being sent by the Contractor. CMS is aware of this problem and they are investigating it we will notify you when they have discovered the cause of the problem and possible solutions.
Source: 4dmed.com

Grand Prairie Reporter: Texas General Hospital Receives Medicare Certification

Posted by:  :  Category: Medicare

i don't need your rockin' chair... by jmtimagesCherie Newman also reported, “This would not have been possible without the passion of Dr. Hashmi, Suleman Hashmi, management team and its employees.” She stated, “It was a daily challenge, with being told what we were doing could not be done, but Grand Prairie now has not only has the highest quality, most luxurious hospital in the metroplex, but where you will receive the most passionate patient care in the metroplex.”
Source: grandprairiereporter.com

Video: Medicare Supplements in Texas: What to Look For When Choosing a Plan

Texas Medicare Advantage Disenrollment : Learn Your Options

If saving money is a goal, you may want to consider a Medicare Supplement Plan. In Texas, there are several different plans to choose from, all with different combinations of benefits and coverage options.  High deductible plan F may be a good solution for reducing out-of-pocket expenses and the monthly cost may be significantly lower than you might expect. With great benefits, no network restrictions and lower costs, a Medicare Supplement plan may be a good alternative to your Texas Medicare Advantage plan.  Remember, if you choose to disenroll in your Medicare Advantage plan, you will still need to qualify for a Medicare supplement plan and you will be enrolled in Original Medicare.
Source: texasmedicarehealth.com

Medicare scam targets a Sherman woman

DURANT, Okla. – Dr. Cordell Adams (’82) will be the guest speaker at Southeastern Oklahoma State University’s Fall Commencement. Two ceremonies will be held on Saturday, December 15, at 10 a.m. and 2 p.m. in the Bloomer Sullivan Arena. A reception for all graduates, their families and friends is scheduled for 11:30 a.m. – 1 p.m. in the Visual & Performing Arts Center. Read More
Source: kxii.com

Houston doctor convicted in Medicare scheme

education research patient care Wildart Giuseppe Colasurdo students award UTPhysicians faculty IMM geriatrics neurology neuroscience awards obesity stroke UTMost memoriam Memorial Hermann CME MD Anderson Cancer Center internal medicine Red Duke orthopaedic surgery teaching Andrew Casas Children’s Memorial Hermann Hospital news Dyer tips4u Savitz grant aging rheumatology Alzheimers clinical trial cancer University of Houston Flu Frank Yatsu Cinco Ranch acute aortic dissection UTHealth cheves smythe UT Medical School
Source: uth.edu

Raising Medicare age would hurt seniors and the economy

The much-touted Republican plan to raise the eligibility age of Medicare would raise health care costs for seniors, hurt the overall economy, and put increasing pressure on older Americans, a study by the Kaiser Family Foundation found. “This is a policy change that seems straightforward, but has surprising ripple effects,” Tricia Neuman, Medicare specialist with Kaiser, said. “It’s a simple thing to describe … but I don’t think people have thought through the indirect effects.” The idea of raising Medicare’s eligibility age became a national demand of Republicans after House Budget Chair and vice-presidential candidate Paul Ryan put forward his budget, which called for massive cuts to Medicare, Social Security, Medicaid and other federal programs that help poor and working Americans, while pushing continued huge tax cuts for the wealthy. Among the indirect cost shifts the Kaiser study identified are the following; * Higher Medicare premiums for those on Medicare because younger (and healthier) 65- and 66-year-olds would be kept out of the program, raising Medicare’s insurance costs.  Kaiser said the cost increases for seniors could top three percent due to this change. * An increase in costs for companies providing health care to their workers due to older workers staying on company health care plans instead of going onto Medicare at that age. * Higher premiums for those on private insurance programs across the board as older, and less healthy, workers are forced to stay with private insurance rather than moving onto Medicare, as they now do. * Much higher out-of-pocket expenses for more than two-thirds of older adults, as they are forced to wait two years longer to be Medicare-eligible. * Kaiser and the nonpartisan Congressional Budget Office (CBO) projected a huge increase in uninsured Americans if Medicare eligibility is raised by two years. Texas and other states where Republican administrations have said they will refuse the federal increase in Medicaid under the Affordable Care Act are expected to be particularly hard hit. Republicans, led by House Speaker John Boehner of Ohio, continue, even after suffering a historic defeat in the recent elections, to make the change in Medicare eligibility a centerpiece in their campaign to slash federal spending for poor and working Americans while keeping major tax cuts for the wealthy. While President Obama is taking a tougher post-election position in budget talks, some Democrats appear ready to accept raising the Medicare eligibility age. Steny Hoyer, leading Democrat from Maryland, said last week that the Medicare eligibility shift is “clearly on the table.” The AFL-CIO, AARP, Alliance for Retired Americans and other organizations representing working and retired Americans are working hard at mobilizing their grassroots base, demanding “No cuts to Medicare, Medicaid, and Social Security – have the wealthy pay their fair share.” “These vital programs have not caused the deficit,” ARA President Barbara Easterling said in a recent public letter. “Instead, reckless tax cuts and loopholes for the wealthy and greedy Wall Street behavior have. Make those who caused the deficit pay for it.” Tim Burga, president of the Ohio AFL-CIO, in a radio interview last week, compared the so-called “fiscal cliff” to the Mayan Cclendar, which some alarmists have stated sets this year as the “end of the world.”   “I think we’ll be here the day after both of these phony, made up, so-called ‘crises’,” he said. ” The point is that we can’t let self-promoting corporate snake oil salesmen stampede us off of a real cliff, destroying real programs that really help real people and our real economy.”
Source: peoplesworld.org

Daily Kos: Durbin on Medicare age hike: ‘Not on the table from the White House’

Given that Republicans refuse to put anything specific on the table, that means it’s not on the table at all, and if it ever did get on the table, Republicans would have to be the ones to put it there. But Republicans are trying this weird negotiating strategy of not only demanding cuts in programs like Social Security, Medicare, and Medicaid, but they are also demanding that Democrats identify the cuts and therefore take responsibility for them. If Democrats were to do that, Republicans would obviously turn right around and attack Democrats for proposing the cuts that Republicans demanded.
Source: dailykos.com

Texas Attorney General Missing the Mark on Medicare

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

Medicare Supplemental Insurance Texas For All Individuals Has Turn Into A Straightforward Activity Together With The Inception Of Companies Like Medigap

Medicare supplement insurance is necessary for each person to possess irrespective with the age team in particular in a extremely populated state like Texas that is situated in a developed nation just like the United states of america of America. Today the quantity of mysterious diseases are going up, so would be the quantity of mishaps that take place each day hence to cater to the many financial needs, its vital for 1 to adopt Medicare supplements insurance. medicare supplement insurance texas is gaining good quality and have confidence in using the inception of companies like the Medigap Insurance suppliers. Absent would be the days when many people were ignorant about the importance of Medicare dietary supplements insurance coverage, now absolutely everyone appears out for fine plans to undertake Medicare supplement insurance insurance policies to come back for their rescue in situation of crisis or disaster. Medigap is amongst the most beneficial organizations in Texas that presents a wide range of Medicare supplemental insurance coverage plans. The Medicare supplemental insurance plans from your Texas primarily based enterprise is offered for men and women of all age groups and all lessons of the society. The Medigap insurance company in Texas not only gives good Medicare supplements insurance coverage little bit also presents an incredibly superior customer service because of its consumers all day so as to help them make use of the healthcare plans consequently. The Medicare supplemental insurance coverage ideas from the Medigap insurance enterprise at Texas are also presented at really low rates so that its produced cost effective for everybody. One may even adhere to the website in the Medigap insurance ideas as a way to study about the Medicare supplements insurance plans which can be becoming offered by them and pick out a strategy based on their desires or desires. Healthcare insurance coverage is made necessary in a lot of the nations across the world and specially inside a condition like Texas so it truly is generally smart to opt for a company such as the Medigap insurance coverage corporation that provides quite a few high quality Medicare supplemental insurance ideas at incredibly very low prices.
Source: posterous.com

Stakeholders Focus On Addressing Medicare Physician Payment Issues

Posted by:  :  Category: Medicare

Congressman Kendrick B. Meek by cliff1066™CQ HealthBeat: Details Emerging On Possible Physician Payment Patches Health care stakeholders are urging Congress to prevent scheduled cuts in payments to Medicare physicians, as details on another annual patch are getting caught up in the deficit-reduction negotiations. Lobbyists and provider groups are meeting with congressional staffers to try to discuss details of how to avert the payment reductions, although aides say details may not be ironed out between the parties until a broader deficit agreement is reached. A payment patch for Medicare physicians, also known as a “doc fix,” is likely to be included as part of a larger deal. With much still unresolved on a deficit-reduction agreement, lawmakers have been mostly quiet on how to avoid the expiring Medicare physician payment rates. But lobbyists say some details are being discussed — particularly the tricky issue of how to offset the cost of a payment patch (Ethridge, 12/3).
Source: kaiserhealthnews.org

Video: Medicare Physician Feedback Program: Payment Standardization and RIsk Adjustment

How Likely Are Physician Offices to Accept Medicare and Medicaid?

SK&A released its report titled, “Physician Office Acceptance Government Insurance Programs,” which showed 83.6 percent of medical providers accept Medicare and 67 percent accept Medicaid, though a decline may be imminent. The Patient Protection & Affordable Care Act will give 30 million Americans access to healthcare, many on Medicaid. But 31 percent of physicians said they would not accept new Medicaid patients, according to a National Ambulatory Medical Care survey. SK&A’s survey of 271,451 office-based physicians found larger, affiliated practices have higher Medicare and Medicaid acceptance rates, while smaller, non-affiliated practices have lower rates. Offices with daily volumes greater than 31 cases had an acceptance rate of 85.5 percent for Medicare and 69.6 percent for Medicaid. Also, healthcare system-owned and hospital-owned practices are more likely to accept Medicare, at 89.1 percent, compared with non-hospital or healthcare system-owned practices, at 82.7 percent. Medicaid acceptance is about 83 percent for hospital or healthcare-owned practices and only 64 percent for non-hospital or system owned. The top specialties accepting Medicaid are dialysis, critical care medicine and nephrology. The lowest acceptances rates come from bariatrics, occupational medicine and holistic medicine. More Articles on Revenue Cycle: Fitch: Non-Profit Hospitals May See Some Stability in 2013 Physician Groups Gear Up to Fight for SGR Repeal University Hospitals’ Fundraising Campaign Reaches $1B Goal
Source: beckershospitalreview.com

Medicare Doctor Reimbursement Battle Heats Up in Earnest

The California Medical Association (CMA) has argued for Medicare geographic payments to be based on actual market costs. The association, which represents physicians in both rural and urban areas, said any payment changes should more precisely reflect the costs of running a practice from each type of locale. “The current system is outdated and not distributing payments accurately,” said CMA President James G. Hinsdale, MD. “A great example is San Diego, a county that is still designated as rural and clearly is not. Our belief at CMA is that payment accuracy will help to improve seniors’ access to care in these underpaid regions.”
Source: reportingonhealth.org

Odds and Ends: 2013 Medicare Physician Fee Schedule

, 2012. This policy and payment update sets the Medicare therapy cap amount for outpatient therapy services and payment. According to the American Physical Therapy Association (APTA), this fee schedule established the 2013 therapy cap exception at $1,900 but this exception will only last till December 31, 2012 unless the Congress extends it. In addition, the APTA notes that this rule also “includes a 26.5% reduction to Medicare payment rates for physicians, physical therapists, and other professionals due to the flawed sustainable growth rate formula.” They also mentioned that this reduction can be avoided if the Congress acts by the end of the year (as it repeatedly has done since 2003) and change the growth rate formula such that the “aggregate impact on payment for outpatient physical therapy would be a positive 4% in 2013.”
Source: mtbc.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

CMS Issues Final CY 2013 Medicare Physician Fee Schedule (MPFS) Rule

On November 1, 2012, CMS issued the final Medicare physician fee schedule (MPFS) rule for calendar year (CY) 2013.  This rule, among other things, is expected to increase payment to family physicians by 7% and other primary care physicians between 3% – 5% so long as Congress overrides the statutorily required Sustainable Growth Rate (SGR) reduction (as it has done every year since 2003).
Source: jdsupra.com

ICYMI: Health Affairs Article: Medicare Advantage Provides Higher

A recent article in the latest edition of Health Affairs provides further evidence that Medicare Advantage plans are delivering higher-quality care to seniors and people with disabilities than the fee-for-service (FFS) part of Medicare.  Data from the article show that Medicare Advantage beneficiaries utilize some health care services, such as the emergency department and ambulatory surgery or procedures, at a rate 20-30 percent lower than those in FFS Medicare.  This data suggests that Medicare Advantage enrollees “might use fewer services and be experiencing more appropriate use of services than enrollees in traditional Medicare.”
Source: ahipcoverage.com

Just Announced: CMS Issues Final Medicare Physician Payment Rule for 2013

This afternoon, the Department for Health and Human Services (HHS) announced it has issued the Medicare Physician Fee Schedule Final Rule for 2013.  According to a news release from HHS, this new rule will ensure doctors are paid the same rates for treating Medicare and Medicaid patients, without raising the costs for states.
Source: stateofreform.com

Utah works on ACO tenets in Medicaid overhaul

Posted by:  :  Category: Medicare

OBAMA: THE SOCIALIST/MARXIST/COMMUNIST -- UNMASKED FOR ALL TO SEE by SS&SSThe Utah Medicaid reform proposal says that the state now wants to improve Medicaid by adding more ACOs while tweaking the model to “implement payment reforms and more appropriately aligns financial incentives in the health care system.” As part of the Medicaid overhaul, the Central Utah Clinic and the proposed ACOs will handle 70 percent of Utahn Medicaid patients and, according to the Salt Lake Tribune, will have the goal of saving $770 million in tax payer money over seven years. But this process is in a state of flux at the moment as both the Utah Health Policy Project (UHPP) and Utah Medicaid Inspector General agree that Utah needs to thoroughly examine how it defines accountable care while keeping the patients in mind.  The UHPP is 501-C-3 nonprofit organization that is trying to work with both insurance payers and healthcare providers to offer quality, affordable healthcare.
Source: ehrintelligence.com

Video: Utah Medicare Advantage Plans for Seniors in 2012

Obamacare Successful In “Bending The Healthcare Cost Curve”…Up.

While subsidies in the law will shield some people, other consumers who make too much for assistance are in for “premium rate shock,” Mark Bertolini, who runs the third-biggest U.S. health-insurance company, told analysts yesterday at a conference in New York. The prospect has spurred discussion of having Congress delay or phase in parts of the law, he said.
Source: therionorteline.com

Report Generation Delay for CPID 2458 Utah Medicare

The payer listed below is experiencing issues affecting Professional 5010 999, 277CA, and 835 reports generation for claims submitted from 08/07/2012 to present. The clearinghouse is working diligently with the payer to resolve the issue and ensure reports are received. CPID 2458 Utah Medicare Please be aware of delays in the report for claims submitted during the timeframe above. If you have any questions, please contact Client Services at 1-888-348-8457, option 2.
Source: collaboratemd.com

Utah Medicare Part D Plans

Whereas you can compare stand-alone plans to each other, you must compare the entire Advantage plan package to other Advantage plans. This complicates things a little. For instance, a plan with great drug benefits may be less than desirable for its medical benefits or provider network.
Source: partdplanfinder.com

From grandparents to grandchildren

In the Obama era, the deficit is shrinking at the fastest pace in generations. What’s more, President Obama offered Republicans a $4 trillion debt-reduction package — which GOP leaders turned out — and proposed a series of policy proposals — the Affordable Care Act, cap and trade, DREAM Act — all of which would have reduced the deficit, and all of which Republicans refused to consider.
Source: msnbc.com

AARP: Don’t raise the eligibility age for Medicare

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