HIPAA/COBRA/MEDICARE *Upcoming Seminars*

Posted by:  :  Category: Medicare

Kate Bardsley, Association Manager of MAIA’s sister association MassAHU, came to me this morning with some information for MAIA members. Actually, she must have been in early, because she tracked me down in the hallway while I still had my coat on. But that’s the way Kate is…she gets things done, no matter the time or place!
Source: wordpress.com

Video: Medicare Part D and Pharmaceutical Advertising

Free Seminar Thursday on Medicare Perscription Drug Coverage

A share of your prescription costs: Once you’ve satisfied the annual deductible, if any, you’ll generally need to pay 25% of the next $2,610 of your prescription costs (i.e., up to $652.50 out-of-pocket) and Medicare will pay 75% (i.e., up to $1,957.50). After that, there’s a coverage gap; you’ll need to pay 100% of your prescription costs until you’ve spent an additional $3,727.50. (Some plans offer coverage for this gap.) However, once your prescription costs total $6,657.50 (i.e., your out-of-pocket costs equal $4,700–you’ve paid a $320 deductible + $652.50 + $3,727.50 in drug costs–and Medicare has paid $1,957.50), your Medicare drug plan will generally cover 95% of any further prescription costs. For the rest of the year, you’ll pay either a coinsurance amount (e.g., 5% of the prescription cost) or a small co-payment for each prescription.
Source: patch.com

Medicare Seminars For Senior Market

Only a small percentage of our total Medicare Advantage certified agents have success with seminars. Most them have deep roots in their markets or already have large blocks of enrollments that need to move. The key is getting seniors to attend your seminar and that takes money. Medicare Advantage companies can help you with CMS approved marketing material and your FMO should be able to connect you to the right departments at the companies. If seminar selling was easy, every agent would do them. The presentation is the easy. Getting people to attend is hard part. Also – If you end up having seminars, make sure you file them with the Medicare Advantage plan you are presenting. There are several CMS rules around seminars and the company will be able to point you in the right direction.
Source: insurance-forums.net

A FREE Seminar on Medicare Supplemental Coverages

There are two different seminar times available. If you have any questions or would like to register, please click on the seminar you want to attend on below and email us your name and phone number. You can also register by calling Cinda at (810) 714-4504.
Source: wordpress.com

Medicare Seminar October 30 2012 @ 7 PM

Dear Friends: Please join me for a United Health Care Seminar at my office on Tuesday, October 30, 2012 at 7 PM. I will give everybody the 2013 view of the Medicare Advantage Plans, the Medicare Supplements and the various Drug Plans. There will be no selling of plans on that evening. There will be coffee, cookies and soft drinks. The goal here is to understand what to do at age 65. Questions will be answered. Looking forward to seeing you. Please RSVP @ 386 860 0001 X7 and ask for Ron Silverman
Source: silvermaninsurance.com

Medicare Orientation Seminar at the Starr

This two-hour seminar is a basic overview of Medicare and what it covers for people approaching the age of 65 and their caregivers. Also Covered: Medicare Prescription Drug Plans, EPIC, and Medicare Advantage Plans.
Source: wordpress.com

Sharp Offers Free Seminars to Help Seniors Understand Medicare Options

Do you have a friend or family member who’s turning 65 this year? Or do you know someone who is already a Medicare beneficiary? This is the time of year that Medicare-eligible seniors can choose or modify their health insurance plan for 2013. The enrollment period for Medicare in 2013 begins on Oct. 15 and ends on Dec. 7, 2012.Making decisions about Medicare coverage can sometimes be confusing. That’s why you’re invited to attend one of Sharp’s neighborhood meetings to learn about Medicare.
Source: sandiegobargainmama.com

Burmese Community Activities and Events: No Family Left Behind Medicare Seminar, Dec 12, 2010

Jan 12, 2013 – Karen Traditional 2752nd New Year Celebration, Oakland Jan 19, 2013 – San Francisco 2013 New Year Concert, Daly City Feb 17, 2013 – Mudita Shwe Kyaung Sticky Rice Festival, Hayward Feb 24, 2013 – Dhammananda Vihara Sticky Rice Festival, Half Moon Bay April 14, 2013 – Dhammananda Vihara Burmese New Year Festival, Half Moon Bay May 19, 2013 – Dhammananda Vihara Buddha Day Festival, Half Moon Bay May 26, 2013 – San Francisco Bay Area Burmese (Myanmar) Community Thingyan 2013, Union City
Source: blogspot.com

Provider idenification Numbers 

Posted by:  :  Category: Medicare

NPI Number-National Provider Identifier Number was created in order to simplify all the different ID number for each insurance.  Effective May 23, 2007  all providers had to have an NPI number to bill insurance and also to identify themselves as referring physicians.  A new uniform billing form was created to accommodate these new NPI numbers.(see Uniform Billing Forms).  The doctor or group associated with the NPI will be the address in box 33 a of the CMS form/ or for a facility box   of the UB-04 form.  that is who will receive the insurance payment.
Source: survivinghealthinsurance.com

Video: Videos matching: medicare ptan lookup

Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline, CPT Code Billing: Chest X

Denial Reason, Reason/Remark Code(s) M-80, CO-18 – Duplicate Service(s): Same service submitted for the same patient, same date of service by same doctor will be denied as a duplicate CPT codes: 93010, 71010, 71020 Resolution/Resources First: Verify the status of your claim before resubmitting. You can determine the status of a claim through the Palmetto GBA Online Provider Services (OPS) tool or by calling the Palmetto GBA Interactive Voice Response unit (IVR). Online Claim Status Verification through OPS
Source: medicarepaymentandreimbursement.com

RAIL ROAD MEDICARE REQUESTS FOR PROVIDER’S PTAN#

Medical Billing Solution, Medical Billing Training Program, About Outsourcing Services, Medical Billing Process and Concept, Tips to Medical Biller, Specialist. Medical Insurance Billing Denial Guidelines. Medical Billing Training Articles and Software Review. Medicare Billing CPT code ,ICD-9 DX Code Update.
Source: whatismedicalinsurancebilling.org

フェスティバル開催 : onedotzero_nippon2004 team blog

onedotzero_nippon 2004 official site roppongihills tokyo city view spiralhall Levi’s(R) redloop Levi Strauss Japan sound republic about_onedotzedro「adventures in moving image」 このキーワードを持つフェスティバルonedotzero(ワンドットゼロ/ UK)。常に世界のトップクリエイターに注目される存在であり、且つ映像クリエイティブに敏感な世界の若者達を刺激し続ける圧倒的な存在感。実験的なアーテリジェンス、先進的な映像表現、インタラクティブ、G、アニメーション、モーショングラフィック、ショートストーリー、ミュージックビデオ、クロスメディアクリエイティブなどが、世界中から集結する最大規模のムービングイメージフェスティバル、青山スパイラルにて10月1〜3日に開催決定! 9月23日〜30日 エキシビジョン 六本木ヒルズの各所にて、毎時19時よりスタートする映像と建築を一体化させたエキシビジョン。今年のonedotzero8タイトルシークエンス(作:オウテカ×アレクサンダー・ラタフォード)等、フェスティバル開催前にいち早く体験。30日のみ、翌日より開催するフェスティバルの各プログラムから、選りすぐりの作品をリミックスした特別先行上映があります! 9月30日 前夜祭 20時30分〜24時40分 10月1日より開催のフェスティバルに先駆け、六本木ヒルズ大展望台(東京シティビュー)にて、『onedotzero』ならではの都市と映像と音楽が交錯する前夜祭を開催します。大展望台(東京シティビュー)入場料のみでパーティーへ参加できます(同入場料で森美術館の観覧も可能)。 10月1,2,3日 フェスティバル 本年度は映像クリエータ集団、“シャイノーラ”の特別上映プログラム「sh*te+shynola」の他、本国でも大人気の日本人クリエーター作品を紹介する「J-star04」、ミュージッククリップを中心とした「wavelength04」など、人気のプログラム全8プログラムをスパイラルホール(青山スパイラル3F)で3日間にわたって上映。 profile team onedotzero onedotzero_nippon 2004を中心に目玉のプログラムからワークショップ参加のアーティスト情報まで、表から裏まで色々な視点からお届け致します。 team sound republic エキシビジョンから前夜祭の企画を担当。アート・音楽・映像・ファッションを得意分野とする彼らが、今回はonedotzeroとチームを組み暗躍。
Source: co.jp

Epic Beard — BFS Beard

If you would like to remedy impotence you don’t need medicines, you can get a hard hard-on by getting the enclosed herbs and not only do they get you a tougher hard-on, these herbal remedies will do something which medicines simply can’t do and that’s increase your libido at the same time – lets consider a take a look at how they work. Herbal remedies about the other hand, improve your libido so you benefit from the total sexual experience. Numerous males get frustrated when they take medicines simply because there is no increase in sexual intercourse generate plus they need manual stimulation of the penis to get hard. Nitric oxide performs the vital function of opening up the blood vessels which lead to the penis, so they are wide enough to consider the increased quantity of blood in, to stiffen the penis. Firstly to get a hard hard-on, you have to have higher amounts of nitric oxide produced within the body and the reason for this really is simple – no erection can consider place if amounts are too low. Testosterone is the key male sexual intercourse hormone and is required for sex drive and sexual stamina and the good news is – Horny Goat Weed and Cnidium (which we have already mentioned) will give amounts a increase. You ought to also however take Tribulus, simply because not just is it the greatest testosterone boosting herb, it also contains a unique blend of nutrients which increase sex drive and increase intensity and pleasure from orgasm. If you would like to remedy impotence rapidly and normally, you are able to get all the above herbal remedies in the best organic erection pills and they will get you a harder erection and also improve your sexual intercourse generate in the exact same time – try them and you’ll be glad you did. he cause herbs are a much better option to man made drugs is – they have no dangerous side affects and simply because they improve sexual intercourse drive which is something guy created drugs merely cannot do, lets take a take a look at how the herbs work. If you want to obtain an erection, you need to boost your amounts of nitric oxide. Nitric oxide may be the crucial natural chemical which permits an erection to arrive to fruition – no erection can consider place without having it. Prescription drugs do this but you don’t require them, the herbal remedies Horny Goat Weed, ginseng and Cnidium, will do this as well as well as better news is – they do it safely and naturally. Herbal remedies can get you a hard hard-on and treat impotence naturally – but they can also improve your libido which can be important, for that complete all round sexual experience. Numerous males are left frustrated by man made medicines because, they get them hard but they often need manual stimulation and this leads to an incomplete sexual encounter. The good news is – herbal remedies can get you difficult, without guide stimulation plus they do this in several methods that are outlined under. Testosterone is required for sexual stamina andlibido and Horny Goat Weed and Ginseng (which we have already mentioned) improve amounts but you ought to also take an additional couple of herbs which are Tribulus and Tonkgat Ali. Last bit not least, the mind also plays a crucial role in terms of sexual health and if you are stressed, anxious worried or depressed, you won’t have the ability to focus on sex. You can consider herbs that will enhance your mood and two good ones are – Maca and Ginkgo Biloba which both enhance mood and give the physique an energy increase at the exact same time. In the greatest organic libido supplements and not only will they treat impotence and provide you with a difficult hard-on, they will also improve sexual intercourse drive and general amounts of wellness in the exact same time. psychological impotence is nearly guaranteed to impact men at least as soon as in their existence. Prior to people didn’t see this as an actual concern, they merely chalked it up to old age. But in today’s society this is actually treated as a problem. There are numerous methods for individuals to recover from psychological impotence. Through recent many years mental treatments have arrive a long way through long arduous research and practice. Now that we know both the reasons for the problems and the way to alleviate them, it’s imperative that you simply consider benefit of them. A large issue that can trigger psychological impotence is either related to a past issue or it’s temporary. It can truly be a cycle of fear. A single issue can result in the fear of re-occurrence can create anxiety which will cause the initial issue just as we feared. Even tough this kind of psychological impotence is fairly stream lined. You ought to never be ashamed of this problem, and numerous men around the world suffer from it each single day. This is the result of your emotions effecting you physically. A great way to solve this problem would be to become relaxed prior to you become physical. Music and atmosphere is a great method to get into a seductive mood. Things for example these are great for lowering tension which may trigger the problems. Also you’ll need to become wary of exactly how a lot you are drinking. A man can lose his capability to turn out to be aroused whilst consuming alcohol. No matter what you do, too much alcohol can kill it for you. If depression may be the reason you are suffering, it is greatest to solve that problem prior to you are able to use a real actual relationship. Basically mental impotence stems from a problem with your mental outlook. You’ll not preform well at all if you’re depressed. Also, you have to realize that other relationship difficulties can stem from depressive disorders. But all in all the best way to offer with mental impotence is to visit your physician. The physician will let you know what you can do to offer with your problems and how you are able to go about treating it. Realize that you simply are not alone, and also you have many routes about the path of curing your mental impotence. Do not let embarrassment maintain you from finding out the way to offer with this issue. If you want to remedy impotence naturally, the good news is you are able to and not just can you get a difficult hard-on, just like you can with man made medicines; herbal cures will improve your sexual intercourse generate and your overall level of wellness which can be some thing prescription medicines merely can’t do. Man made medicines increase nitric oxide secretion and allow a lot more blood into the penis but so Ginseng, Cnidium and Horny Goat Weed which being organic herbal remedies have none of the side affects of man created drugs. If you want to cure impotence, you should improve your levels of nitric oxide because nitric oxide regulates blood flow to the penis and it does this by relaxing and widening the blood vessels which supply the penis with blood. Numerous men who consider guy created medicines get a difficult erection but have no sexual desire plus they end up needing guide stimulation to get an hard-on and this really is frustrating. If you would like to appreciate the all round sexual experience you need to have a strong sex drive and herbal remedies can improve this as well. Herbal remedies improve sexual intercourse generate simply because they improve testosterone and also the Ginseng and Horny Goat Weed are excellent testosterone boosters but you should also consider Trubulus which is seen as the best testosterone enhancing herb of all. The best herbal sexual intercourse pills for men that will give you much better sexual wellness and better levels of wellness in the exact same time – so if you would like to remedy impotence naturally try them and get more from sex and more from existence. Unfortunately many males will endure diabetes impotence before they do something about their blood sugar level. The diabetic has a poison within their bloodstream known as glucose. Diabetes impotence is when the poison is cutting of existence to the male organ. The bloodstream is coming polluted and it is affecting the circulation. Males might lose the capability to maintain intimacy. They might be able to start but then won’t be able to finish. Studies show the body without typical blood sugar levels is aging faster than 1 having a typical sugar range. Male impotence refers towards the problem referred to also as Erectile Dysfunction, where for one reason or an additional, blood is not flowing to the penis properly, to ensure that an hard-on can be achieved. Leads to for that illness range from 8 out of 12 of the top prescribed medicines of our day to the outcome of psychological disorder and actual deformity. Countless medicines list impotence as a side impact from the treatment, and a number of nerve damaging conditions can trigger ED. Depressive disorders, anxiety, and tobacco use are all stated leads to for impotence also. Male impotence has a number of different causes for the hydraulic problem that leads to the penis to not function correctly. Smokers are 85% a lot more at risk to be in this group. The most shocking statistic nevertheless, is that only a mere 10% of those afflicted with Erectile dysfunction or a similar concern seek remedy and help. Impotence is really a serious condition that affects 25% of our population sixty five years of age and older. 5% of middle aged males and older today are afflicted by ED as well. After reading a couple of facts about the subject one hopes it is enough to consult your physician or begin to make changes to stifle the results of the problem and better your high quality of life immediately. If it is just a couple of times then it should not be worried upon but if it is frequent or enough to bring you worry and stress then you need to look into just what is causing it. Impotence or Erectile Dysfunction happens to most males occasionally and for a variety of causes. It’s interesting to note that most men as well as doctors (is it because they are male?) believe that most impotence causes stem from the mental aspects or way of life aspects of the man’s existence. But it can also be interesting to note that 60% from the men that do go to their doctor with impotence difficulties wind up becoming diagnosed with diabetes. So my recommendation is that if you’re getting a issue with impotence that’s causing you concern at least go to your doctor to obtain the physical reasons out from the way. It is also interesting to note that 80% of men with impotence problems have a physical reason for getting them. Not performing any exercising and being a couch potato. That is lots of leads to to go through, but if you have or are performing any of them then the first thing you are able to do is stop doing them or go to your doctor for help. However, consuming alcohol or utilizing any other intoxicants or adulterants can make it difficult for the human body to achieve an hard-on. Alcohol and recreational drugs are recognized to be some from the most infamous libido enhancers for many years and many years. Getting a glass of wine or two during social events may not be this kind of a poor idea, but the rate to which the alcohol affects your libido negatively or positively truly is dependent upon your physique kind and size and weight. For example, should you weigh 165 pounds or so you could consume as much as about a half of the bottle of wine before seeing a reduce in your erectile functioning, Getting a glass of wine or two during social events might not be this kind of a bad idea, however the rate to which the alcohol impacts your libido negatively or positively really is dependent upon your physique type and size and weight. Anything that affects a man’s testosterone in any way could possibly negatively have an effect on that man’s sexual intercourse generate in a negative way. Whilst drugs and alcohol could lead to sexual interaction in many circumstances. No matter what you choose to drink or what you plan to accomplish following drinking takes location, positive decisions about consuming and drug usage are of utmost importance when considering your impotence. Consider making existence changes immediately should you ever hope to determine complete improvement without having the use of medication. Nitric oxide and Impotence go hand in hand, simply because no man can ever get an erection without having it however the good news is you do not need to consider guy made medicines to increase amounts, you can improve nitric oxide naturally and safely. These herbs will not only increase amounts of nitric oxide, they may also improve amounts of the crucial male sexual intercourse hormone testosterone, enhance blood flow all around the body, keep sperm healthy and reduce tension and anxiety which can often cause impotence. You’ll discover all of the above herbs in the best men’s sex pills and they may also contain L Arginine; this isn’t a herb but a natural amino acid which assists the physique produce nitric oxide and if you boost amounts by getting it being a supplement. It’s been known as natures Viagra and with good cause – it helps you obtain a tougher hard-on and boosts sexual desire and is really a supplement all males ought to consider, for much better sexual wellness. You are able to get all of the above libido enhancers and a lot more, in the greatest natural hard erection pills that will help you remedy impotence safely and normally plus they may also boost your general degree of wellness in the same time. 1000s of men endure with impotency, frequently turning to potentially risky drugs. That�s why the Blakoe Ring is revolutionary. It�s verified to become the safest and most effective solution to these problems. This increases blood circulation to the sexual organs, helping the physique to regain its organic capabilities. It also improves conditions for example: low sexual intercourse generate, reduced sperm count, underdeveloped genitals, and premature ejaculation. Male impotence remedies are an very popular subject right now simply because numerous males are treating their erectile dysfunction naturally. Simply because male impotence is triggered by a lack of blood circulation below the belt, these remedies may assist you to by tomorrow. Start your physical exercise program today! Remember the rush following a good function out? It is proven that exercising has thousands of advantages such as: boosting flow, flushing cholesterol, reducing stress and increasing endorphins happy chemicals. Begin at 30 minutes a day and work up to an hour. Practice breathing methods like only breathing via your nose for five minutes. You are able to do this at your function desk and you’ll be decreasing stress and boosting circulation amounts. Start your exercise program these days! Remember the rush after a good function out? It’s proven that exercising has 1000s of advantages such as: boosting flow, flushing cholesterol, reducing tension and growing endorphins happy chemicals. You are one of the few but there are 1000s of men who suffer from youthful male impotence. Don’t be discouraged because there are numerous ways to increase circulation downstairs and increase your libido. Erectile dysfunctions are usually a physical problem like poor circulation. You will find a variety of leads to for ED but most individuals are afflicted by this typical disease because of poor circulation. Lower flow amounts could be triggered by as well a lot stress, a bad diet, bad way of life choices or even a lack of vitamins or nutrients. Vitamin therapy is also well-liked with this remedy for erectile dysfunctions. Investigation is showing a powerful correlation that most males who are afflicted by this disease are deficient in vitamin A. You will find numerous things you should know about your diet however the greatest rule of thumb is to keep your eating habits simple and fresh. Attempt to avoid fattening foods which are fried. Avoid certain things like alcohol, cigarettes and caffeine. All of these listed items are drugs which alter the body in same shape or form. Investigation does display that avoiding these can help increase circulation downstairs. You will find also plenty of herbs which have been shown to have a good impact. For instance, horny goat weed is really a common and effective herb that is shown to become a testosterone booster, aphrodisiac and also tension reducer. Deep breathes Did you know that simply trying deep breath exercises every day can help increase flow levels and reverse impotence? Start with large exhales and inhales for 5 minutes and do this 3 times daily. All males over the age of 30 experience impotence as least once within their lifetime. Estimating the numbers is difficult simply because less than 2 men in 10 seek remedy for impotence difficulties. The conclusion is impotence is a very typical problem in males. The big issue is it seems that for a big quantity of men, their ability to obtain an erection and have sex is viewed as an integral part of their masculinity and potency and can be debilitating to his mental wellness. Very first reaction of a man dealing with impotence is to create excuses or avoid sexual situations with his partner in an effort to forget about the condition. This tendency can often leave the partner feeling unloved, unattractive and unwanted. Encountering this problem, males should think very first that this really is a really typical male problem. He is neither alone nor unusual. There are over hundred million partners of impotent males. consequence, the man’s failure to communicate his problem might contribute to frustration, stress or depression in his partner, or even cause relation failure. Couples who can talk openly about this condition have a great benefit. Sharing fears and worries is a very first step toward feeling better. Woman’s emotions regarding the impotence of her partner could be complex as nicely. But she should not overlook that the male partner is heading through similar powerful emotions. Woman’s assist and understanding of situation is really essential. Inside a spirit of friendly cooperation, she should offer her support in solving partner’s problem going together to determine a doctor. Male impotence is a problem whereby a guy is not capable of sexually pleasing the woman in his life. This may be simply because of a weak erection more popularly known as erectile dysfunction. Whenever you believe about it for a while you slowly realise that a large portion of the male population prides itself for being effectively dangerous in bed. And while some of those allegations may be true a large whole lot of them are false. These substances greatly decrease the circulation of blood close to the physique because of the deposition of fats in major arteries. The moment blood pressure decreases the veins in the penis are starved of the rapid flow they have to erect a penis that’s stiff sufficient for successful sexual penetration. Substance abuse has been cited being a trigger of erectile dysfunction. Alcohol; cigarettes; and difficult drugs like cocaine should be gotten rid of correct way. Not so long ago it was discovered that impotence and diabetes go hand in hand. This means decreasing ones intake of foods with a lot of sugar is one way of fighting impotence. When you have diabetic issues and continue to abuse sugar your diabetic issues will worsen and so will impotence affect you a lot more adversely. If you do not know if you have diabetic issues it would be a good tie to know so that you simply head straight into insulin treatment. The following time you’ve sexual intercourse be certain to be calm and confident. Occasionally sex related problems are attributed to anxiety and nervousness. Perhaps you’re as well embarrassed about showing a particular component of the body you believe she will laugh at. Forget about everything and try to have fun. A carefree attitude is essential when it comes to sexual intercourse. Viagra is really a pharmaceutical drug that’s utilized by a lot of males to trigger and preserve a stiff hard-on. For some males this works truly well but there are individuals who don’t have that a lot success with it. But sometimes the problem of getting a hard hard-on stems from getting too a lot intercourse inside a short period of time. To have the ability to get a quick and difficult erection you ought to have the space of about 3 days until you have sex again. Impotence is happen when a man can not achieve or preserve an hard-on within sufficient time to please himself and obviously, his partner. Impotence is often only though of affecting older males, nevertheless it is quite common place in young men as well. Impotence in young men can be really stressful and it can also become a downward spiral due to the fact that 1 poor experience can cause a huge quantity of self doubt and anxiety. Impotence in young men can cause further difficulties with low self esteem and other life issues in themselves as nicely as their relationships. But, possibly because impotence is not something which can be openly discussed. Most males will develop impotence at some point in their life. But in the majority of cases it’s a 1 off occurrence, not a lengthy term one. When impotence occurs over the long term it is deemed a problem and this really is when professional advice and testing is needed. The options for impotence treatment in youthful males are usually not to take strong prescription drugs. An alternative is herbal remedy as these are gentler and don’t cause side effects. A youthful male is also extremely unlikely to want to take Viagra as they consider being an older mans impotence drug. The next choice is to have a healthy lifestyle. Avoid high consumption of alcohol and drugs. Exercise frequently to make your blood flow smooth. Take a wholesome and balance diet. Impotence in young men usually disappears as they gain encounter and confidence in sexual situations and is really rarely triggered by a serious actual problem. At the same, practicing a wholesome lifestyle is better option then to remedy the impotence later. Exercise has literally hundreds of benefits but 1 particular 1 is that it will increase flow amounts towards the penile regions. It has also been shown to reduce stress.
Source: epicbeard.net

The Official Medicare Set Aside Blog And Information Resource: Section 111 Enforcement in 2013?

Posted by:  :  Category: Medicare

DC Voting Rights by dbkingAnother point of interest in the OIG’s plan is the compendia utilized to determine Part D off-label exclusion exceptions. One compendia in particular basically publishes any study; therefore, few drugs are excluded from coverage despite lack of FDA approval for the specific use. Because the compendia are not required to publish conflict information, and it is unclear whether CMS conducts any oversight of the strength of the compendia’s conflict policies, the OIG will be looking next year to determine “the extent to which the prescription drug compendia oversee conflicts of interest through reporting requirements and/or mitigation policies and the number and nature of the compendia’s reported conflicts.” We can only hope that this might resolve that one study of 16 people that determined that Lidoderm patches were effective for treating general pain that causes us to have to fund them in MSAs for life.
Source: medicaresetasideblog.com

Video: Consumer Financial Protection Efforts: Answers Needed (Part 1 of 2)

NGHP Section 111 Reporting Mid Year Review :Gould & Lamb

Earlier this year, the Department of Health and Human Services (DHS) issued a Medicare Learning Center ‘News Flash’ advising Medicare fee for service providers on proper procedures for identifying primary payers and making correct and timely billing submissions to Medicare. Despite this notification and training of CMS contractors, there remain widespread reports of injured parties contacting insurers or their agents seeking remedy for affected Medicare treatment and services disrupted by NGHP Section 111 reporting. Along with the administrative burden on the industry, there is frustration over the inability to affect resolution.
Source: themedicarecomplianceblog.com

U.S. House of Representatives Passes SMART Act

Bradley v. Sebelius CDC Centers for Medicare and Medicaid Services CMS COBC Conditional Payments Coordination of Benefits Contractor David Korch GAO HHS liability LMSA Mandatory Insurer Reporting MARC MARC Coalition Medicaid Medicare Medicare Secondary Payer Medicare Secondary Payer Act Medicare Secondary Payer Recovery Contractor Medicare Secondary Payer Statute Medicare Set-Asides Medicare Set Aside Medivest MIR MMSEA MSA MSP MSPRC NAMSAP ORM RREs SCHIP Section 111 settlement SMART Act Social Security The Centers for Medicaid and Medicare Services TPOC US Department of Justice US v. Hadden US v. Harris WCMSA WCRC workers’ compensation
Source: medivest.com

CMS Extends Section 111 Reporting Deadline and Dollar Thresholds

Bradley v. Sebelius CDC Centers for Medicare and Medicaid Services CMS COBC Conditional Payments Coordination of Benefits Contractor David Korch GAO HHS liability LMSA Mandatory Insurer Reporting MARC MARC Coalition Medicaid Medicare Medicare Secondary Payer Medicare Secondary Payer Act Medicare Secondary Payer Recovery Contractor Medicare Secondary Payer Statute Medicare Set-Asides Medicare Set Aside Medivest MIR MMSEA MSA MSP MSPRC NAMSAP ORM RREs SCHIP Section 111 settlement SMART Act Social Security The Centers for Medicaid and Medicare Services TPOC US Department of Justice US v. Hadden US v. Harris WCMSA WCRC workers’ compensation
Source: medivest.com

MMSEA Section 111 Mandatory Insurer Reporting Updates : Life Sciences Legal Update

Second, CMS has posted revised guidance pertaining to liability insurance (including self-insurance) responsible reporting entities (RREs) where the claims involve exposure, ingestion, and implantation issues. In the guidance, CMS explains its policies for claims involving exposure, ingestion, and implantation. Specifically, CMS discusses when Medicare will, and will not, assert a recovery claim against the settlement, judgment, award, or other payment, and when the MMSEA, Section 111 mandatory reporting rules must (or need not) be followed. CMS also provides examples of various factual scenarios involving exposure, ingestion, and implantation, and discusses how its policies will be applied to each.
Source: lifescienceslegalupdate.com

Medicare, Medicaid, and SCHIP Extension Act (MMSEA) Section 111 Reporting: Identifying Reporting Triggers – 2011 Updates

—For reporting taking place during the first year, 2012, claims having a TPOC of $5,000 or less do not need to be reported. In the second year, 2013, the threshold drops to $2,000. In 2014, the threshold drops again to $600. Finally, in 2015, all TPOCs, regardless of size, must be reported. After less than enthusiastic feedback from the industry of the eroding threshold limits in subsequent years in liability claims, CMS was quick to point out that that they may consider changing these thresholds or leaving them in place longer than originally outlined in the March 20, 2009 Alert memo and in MMSEA Section 111 Medicare Secondary Payer Mandatory Reporting: Liability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers’ Compensation User Guide, Version 3.2 (August 17, 2011), at 71–72. Therefore, it is important to keep abreast of the latest CMS promulgations concerning Section 111 reporting. The webpage to monitor closely is www.cms.hhs.gov/MandatoryInsRep.
Source: lexisnexis.com

Section 111 Medicare Secondary Payer Reporting Update

The Centers for Medicare and Medicaid Services (“CMS”) announced an option which will allow for payment of a simple fixed percentage on small dollar liability insurance or self-insurance settlements for physical trauma-based injuries. Effective November 7, 2011, in cases where the settlement is $5,000 or less, a Medicare beneficiary may opt to resolve Medicare’s recovery claim by paying Medicare 25% of the total settlement instead of using the standard recovery process.
Source: dritoday.org

Medicare Section 111 Reporting Requirements

Group health plans must report to the Centers for Medicare and Medicaid Services (CMS) Social Security Numbers or Medicare Insurance Claim Numbers for employees and their covered family members who might have Medicare coverage in addition to coverage under the employer group health plan.  Many employers with fully-insured health plans have been contacted by their insurers to collect SSNs and HICNs for their participating employees.  Self-funded plans may have their own reporting requirements.  The reporting, required under Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007, helps CMS identify Medicare-covered individuals with group health plan coverage that should pay claims primary to Medicare.
Source: basusa.com

Section 111 of the MMSEA & Medicare Liens: A Harbinger of Settlement Delays?

, 2009 WL 1117399 (M.D.Fla.) where the defendant put Medicare’s name on the settlement check even though the settlement agreement made no mention of Medicare.  The defendant insisted that federal law (namely 42 CFR 411.24) forced it to put Medicare’s name on the check.  The plaintiff assured the defendant that Medicare would be reimbursed out of the settlement proceeds and went so far as to agree to indemnify the defendant for any Medicare claims.  The defendant refused to remove Medicare as a payee on the check.  Predictably, the attorneys went back to the judge.
Source: wordpress.com

Medicare, Medicaid & Subrogation Compliance Blog: CMS delays Section 111 reporting on certain liability claims of under $100,000

The September 30, 2011 memo is copied in full below. For the uninitiated TPOC stands for Total Payment Obligation to the Claimant. Also please keep in mind this additional reporting requirement falls squarely on the shoulders of the liability insurers (including self-insurance). It is not an additional requirement for the plaintiff:
Source: plaintiffsresource.com

CMS Update on MMSEA Section 111 Mandatory Insurer Reporting : Health Industry Washington Watch

CMS recently issued updated information regarding the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), Section 111 "Mandatory Insurer Reporting" requirements. The recent updates address: (1) a revised implementation timeline for certain liability insurance (including self-insurance) total payment obligation to claimant settlements, (2) revised guidance on claims involving exposure, ingestion, and implantation issues, (3) upcoming improvements to the Medicare Secondary Payer (MSP) program, (4) a new exception for certain settlements paid into a qualified settlement fund and (5) a new way for certain injured Medicare beneficiaries to satisfy their past and future MSP obligations. For more information, see Reed Smith’s summary on our Life Sciences Legal Update blog
Source: healthindustrywashingtonwatch.com

Viewpoints: Politicians Flirting With Danger On Medicare Eligibility Age; Maybe Doctors Should Be Paid Less

Posted by:  :  Category: Medicare

The Medicare NewsGroup: Progressives Launch Medicare Defense Campaigns It remains to be seen whether the White House will go beyond the above-stated “savings” and venture into the realm of even-more radical reform at this point in the fiscal-cliff battle. The next tier of savings may involve chipping away at the Medicare’s expensive, but-popular, “fee for service” model, which many progressives have suggested needs to be reexamined and possibly abandoned over time. Despite the pitched battle that has created this political equivalent of a World War I-style stalemate, radical reform—if it comes at all—will most likely be delayed … It’s far too complicated and politically toxic to undertake now as Congress faces a year-end deadline with no compromise in sight  (John F. Wasik, 12/12).
Source: kaiserhealthnews.org

Video: Debunking the “Raise the Medicare Eligibility Age” Argument

Liberals Oppose Increasing Medicare Eligibility Age

The Hill reported that, at her weekly news conference, Pelosi was even more dogmatic.   “Don’t even think about raising the Medicare age,” she said.  “We are not throwing America’s seniors over the cliff to give a tax cut to the wealthiest people in America.” Pelosi must be the only person in the entire country who doesn’t know that, as part of a package to increase taxes on the wealthiest people, spending cuts in entitlement spending would be included as a way of keeping Medicare solvent.   As for Pelosi’s claim that an increase in the Medicare eligibility age would “have little to show for it in long-term deficit reduction,” you would think the House Minority Leader would consult the facts before making such a public statement.   The Congressional Budget Office calculates that, just a two year age increase, from 65 to 67, would result in a net savings of $113 Billion over the next decade. But maybe $113 Billion is “little” to Pelosi. Another issue of The Hill stated that the outgoing chairman of the House Democratic Caucus, Rep. John Larson (CT), said that Democrats are willing to cut more from entitlement programs, but warned that direct benefit cuts “would be a big leap for our caucus.” That’s the point. If the eligibility age is not increased, the alternative will be to ration benefits, i.e. deny high-cost treatments to seniors nearing the end of their lives.   There is already a dangerous mechanism in place for doing this in Obamacare, the Independent Payment Advisory Board (IPAB), which former Congressman Dick Gephardt (MO) (pictured), Pelosi’s predecessor as House Democratic Leader, said would have “devastating consequences for the seniors and disabled Americans.” To prevent IPAB from being used for euthanasia for the elderly, it is absolutely essential the eligibility age for Medicare be increased. Of course, special provision must be made for those persons whose poor health requires them to retire sooner than provided by law and to receive Medicare benefits upon retirement. The Social Security Administration states that the life expectancy in the U.S. is now 83 for men and 85 for women. There are many good reasons to raise the eligibility ages for both Social Security and Medicare. The previous issue of What’s Happening with Seniors Benefits: How to Save Medicare—And How Not To The previous issue What’s Happening with Conservatives and the Tea Party: GOP Lost 174 State Legislative Seats   Previous issues of both newsletters. Follow Art Kelly on Twitter @ArthurKellyJr
Source: 60secondactivist.com

Could raising the Medicare eligibility age from 65 to 67 avoid fiscal cliff?

Pelosi’s point of contention is the GOP’s unwillingness to raise taxes on the wealthiest Americans while making older Medicare beneficiaries pay higher premiums. In a recent op-ed for USA Today, Pelosi argues that Democrats are willing to discuss reducing health expenditures in the Affordable Care Act while not undermining Medicare as a whole.
Source: scpr.org

Will Medicare eligibility rise?

This is CRAZY!!! Why does the average American who has been paying into the system for years now have to wait longer to retire? Why does the Average American who has been paying for Medicare have to pay MORE into the system to fund it???? Agree w/ many other comments here… Why are the POLITICIANS not paying into this plan, and a health care plan??? THEY need to be paying into the system too. They make more money than most American’s and they should be paying into the system too. The reason why things are NOT getting resolved is because they don’t have any interest in the things that interest us.. Until we MAKE them PAY into the Social Security programs & take away their medical plans, only then will they care about they systems in which we have entrusted them to fix. THEY need to REMEMBER, their positions are ELECTED positions, they are NOT entitled to their salaries, benefits etc… Their salaries should be cut, they should pay into these plans & they should not have this income for their lifetime… The reason why things are not changing is because we don’t MAKE THINGS CHANGE….
Source: bankrate.com

Daily Kos: Open thread for night owls: Raising Medicare eligibility age would hurt minorities most

un-Constitutional, since illness and injury are not age-dependent. Separating populations by age and income is little more than a sop to segregationist sentiments — sentiments which, in turn, merely satisfy an ideological commitment to hierarchy as a fundamental principle of society. Ranking humans in order to give some more or less authority over others is not natural. If humans are equal, admittedly an ideological commitment, but one that is enshrined in our organizing document, then hierarchy is in basic conflict. Insisting on it merely serves to undermine our democracy. Of course, we have a long history of not living up to our aspirations. But, that’s what moving forward is about. If we are going to make progress, then irrelevant distinctions have to be removed. Medicare should be an option for all, especially now that all income earners are paying into it. Money, btw, is a social utility. People who use it incur some obligations for our communal certification that their IOUs are good. If some people get along with handshakes, more power to them. We won’t expect them to pay in.
Source: dailykos.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

Daily Kos: Are Democrats abandoning raising the Medicare eligibility age?

Meteor Blades, skybluewater, SME in Seattle, bink, Renee, Angie in WA State, cslewis, Sylv, chuck utzman, Irfo, hester, slinkerwink, Gooserock, PeterHug, Andrew C White, eeff, willyr, TX Unmuzzled, Duncan Idaho, jancw, expatjourno, eyeswideopen, bronte17, cyberKosFan, Einsteinia, susakinovember, whenwego, pedrito, Nate Roberts, Eddie C, revsue, psnyder, figbash, 2laneIA, defluxion10, RebeccaG, grrr, lcrp, inclusiveheart, ybruti, lonespark, Wife of Bath, Sybil Liberty, Skennet Boch, drofx, radarlady, 3goldens, ichibon, irate, sc kitty, Alice Venturi, wallys son, Flint, dewtx, Dobber, Laurence Lewis, ratzo, bleeding blue, Sun Tzu, skyounkin, markdd, Ozzie, spunhard, xaxnar, Jim R, splashoil, Jim P, begone, Born in NOLA, velaski, Patriot Daily News Clearinghouse, vigilant meerkat, Kimball Cross, rl en france, martyc35, kestrel9000, DarkestHour, triv33, twigg, real world chick, el cid, sceptical observer, Timothy J, Clive all hat no horse Rodeo, bstotts, ms badger, sea note, BentLiberal, ammasdarling, Tamar, One Pissed Off Liberal, phonegery, fabucat, Habitat Vic, tgypsy, puakev, beth meacham, dclawyer06, deepeco, jedennis, leonard145b, madgranny, trueblueliberal, JDWolverton, MKinTN, CroneWit, mconvente, TruthFreedomKindness, also mom of 5, HappyinNM, wayoutinthestix, zerone, prettyobvious, Involuntary Exile, elwior, treesrock, KJG52, jamess, Therapy, Lujane, tofumagoo, petulans, venger, Tonga 23, JamieG from Md, Nica24, Mike Taylor, maggiejean, prettygirlxoxoxo, Rhysling, cybrestrike, J M F, Throw The Bums Out, Scott Wooledge, Alex Budarin, maryabein, Zotz, mkor7, papahaha, kevinpdx, sfarkash, Lacy LaPlante, emptythreatsfarm, FogCityJohn, flitedocnm, Crabby Abbey, Progressive Pen, Polly Syllabic, sunny skies, ATFILLINOIS, melpomene1, gulfgal98, Lady Libertine, ItsSimpleSimon, Puddytat, Egalitare, sharonsz, addisnana, Betty Pinson, ericlewis0, cocinero, Oh Mary Oh, fiercefilms, stevenaxelrod, Onomastic, mama jo, Liberal Capitalist, Mr MadAsHell, BlueJessamine, OhioNatureMom, smiley7, marleycat, thomask, Wolf10, whaddaya, ratcityreprobate, stlsophos, Willa Rogers, Mentatmark, SouthernLiberalinMD, allergywoman, SycamoreRich, wolf advocate, Cordyc, anodnhajo, SparkyGump, cwsmoke, pistolSO, Siri, Citizenpower, IndieGuy, rustypatina, S F Hippie, effervescent, Trotskyrepublican, JGibson, congenitalefty, Mr Robert, BobSoperJr, geojumper, radical simplicity, MartyM, pittie70, Vote4Obamain2012, avsp, marty marty, dotdash2u, George3, wasatch, Marjmar, fauve, Sue B, simple serf, Illinois IRV, jbob, Linda1961, Panama Pete, goodpractice, The Hamlet, alice kleeman, Jollie Ollie Orange, marcr22, chicklet, pragmaticidealist, MBishop1, Catkin, Chas 981
Source: dailykos.com

Avik Roy: Let’s Raise Medicare’s Eligibility Age

American Medical Association cancer CBO consumer driven health care diabetes doctors drugs electronic medical records email emergency room EMR ER exercise FDA genetics Health Care Access Health Care Costs health care quality health insurance health IT health policy Health Reform Health Savings Accounts heart disease hospital HSA insurance life expectancy Massachusetts Medicaid Medicare medicare advantage NHS ObamaCare obesity pay for performance public option SCHIP seniors socialized health care Social Security stimulus tax unemployment Uninsured
Source: ncpa.org

Listen Up, White House! Take Medicare Eligibility Age Off The Table NOW.

…with the electorate. Act 1. A disaster scenario (created by the WH & Congress) aptly named a ‘fiscal cliff’ MUST be solved by Dec. or we’ll all die. Both parties posture and pose and pretend to hold out for a deal their base supports. Act 2. Media run non-stop stories about the fiscal cliff ‘disaster’. Theme: If no compromise is reached before (artificial) deadline life will end for us all. Good cop, bad cop drama ensues. Act 3.The WH/Congress leak Pete Peterson’s plan to a couple of insiders to float. Outrage from both bases. Media frenzy. WH/Congress wait out the storm. Act 4. Float a slightly more palpable plan with “tweaks”. Media insiders in both parties give it a tepid thumbs up claiming it was the best they could do given the intransigence of the other party. Act 5. Tweaked entitlement “reform” bill gets bipartisan support. Act 6: The public finds out 9 mos later about the poison pills lobbyists for Pete Peterson wrote into the bill. Act 7. Medicare age raised to 67. SS cola ‘tweaked’. Taxes raised 2% on millionaires. Captial Gains tax untouched. Defense cuts- not so much.
Source: crooksandliars.com

Are you ready for 2013? 4 questions to ask yourself

Posted by:  :  Category: Medicare

Don’t forget, if you have Medicare Part B and are in Original Medicare, you’ll have to meet your deductible before your Medicare coverage pays for services and supplies. Next year, the Medicare Part B deductible will be $147. Make sure to plan your health care budget to account for the increased cost of doctor visits for the time that it will take to cover your deductible.
Source: medicare.gov

Video: Is Freedom Blue PPO a Medicare Supplement?

Blue Cross & Blue Shield of NC Shows High Blue Medicare Ratings

[…] affordable BCBSNC blue advantage Blue Cross blue cross nc blue options Blue Options HSA coinsurance compare copay deductible dental blue dental insurance article dental insurance guide dental insurance information dental insurance tips finance health Health care health insurance health savings account Health Savings Accounts help with prescriptions high deductible health plan insurance Life Cover life insurance life insurance article life insurance guide life insurance information life insurance tips long term care insurance article long term care insurance guide long term care insurance information long term care insurance tips medicare NC North Carolina out-of-pocket ppo premiums rx help savings Term Life InsuranceSource: richdayhealthplans.com […]
Source: richdayhealthplans.com

Ask A Medical Biller: Legacy Identifier for Blue Medicare PPO

Medical Billing and Coding Keyword Tags: medical billings and claims, medical billings claims, medical claims electronic billing, claim billing software, electronic medical claim billing, lytec medical billing software, medical billing schools, medical coding and billing schools, medical billing schools online, medical coding and billing schools online, medical billing classes online, online medical billing school, medical billing and coding courses online, courses online, medical billing classes, chiropractic software, online courses medical billing, medical office billing software
Source: blogspot.com

Find the Coverage You Need with Blue Medicare PPO

There are many Medicare Advantage plans available for you when you enroll in Medicare, so it is important to choose wisely. All of these plans offer different features, though of course they all have to provide the same basic level of coverage. By choosing a plan from Blue Medicare PPO, you can get the best care possible for yourself as you age. Medicare is a vital program, and it is important to be smart in your enrollment. You do not want to have to worry about whether a particular procedure will be covered, or whether you can get the medications you need for your condition.
Source: tamilpoomi.com

American Blue Cross: Blue Cross and Medicare sitting in a tree making network money off the Seniors & Elderly, first comes the money then your health. Wealth b4 ur healt

Provider Directory Blue Medicare PPO Provider Directory The Blue Medicare PPO plan is a preferred provider organization (PPO) plan. All Blue Medicare PPO contracted network providers are available to the members through self-referral, with the exception of services that require preauthorization. We work with our contracted health care practitioners to help ensure that care is accessible, coordinated, timely, and provided in a manner and setting that promotes positive patient-physician relationships. The Texas Provider Directory (PDF, 1298KB) provides a list of the Blue Medicare PPO network providers. The Provider Directory also provides a list of Blue Medicare PPO’s network pharmacies. We call the pharmacies on this list “our network of pharmacies” because we have made arrangements with them to provide prescription drugs to Plan members. A network pharmacy is a pharmacy where beneficiaries obtain prescription drug benefits provided by Blue Medicare PPO. In most cases, your prescription drugs are covered under Blue Medicare PPO only if they are filled at a network pharmacy or through our mail order pharmacy service. You are not required to go to the same pharmacy to fill your prescriptions, you can go to any of our network pharmacies. We will fill prescriptions at non-network pharmacies under some special circumstances. For additional details, you can check the Evidence of Coverage (PDF, 371KB) Our Service Area: The Blue Medicare PPO provider network is comprised of contracted hospitals, provider groups, and independent physicians. You should check the on-line Provider directory for the current list of network providers. Can I choose my doctors? Blue Medicare PPO has formed a network of doctors, specialists and hospitals. You can use any doctor who is part of our network. You may also go to doctors outside of our network. The health providers in our network can change at any time. However the listing found on this site is updated monthly. What happens if I go to a doctor who isn’t in the network? You can go to doctors, specialists or hospitals in-network or out-of-network. You may have to pay more for the services you receive outside the network, and you may have to follow special rules prior to getting services in- and/or out-of-network. Referrals and Care from an Out-of-Network Provider Your out-of-pocket costs will be higher if you use out-of-network providers than if you use network providers. When network providers are not available in your service area due to network inadequacy or continuity of care and you have to use out-of-network providers for your medical services, Blue Medicare PPO will waive the out-of-network deductible and pay for the services at the in-network benefits levels. Although referrals are not required by our plan, you may wish to get a prior authorization to receive a lower cost to you. When you have an appointment with an out-of-plan or out-of-network physician/professional provider which is necessary due to network inadequacy or continuity of care, to receive the lower out-of-pocket cost, the services must be reviewed and authorized by Utilization Management prior to you receiving care. You need to obtain prior-authorization for the request for an out-of-network provider to be paid as in-network by calling 1-800-441-9188 for the Utilization Management area. Back to top SIDE NAVIGATION Questions? For more information call: 1-866-308-4781 For the hearing or speech impaired: 1-800-538-0380 8 a.m. – 5 p.m., CST, Monday – Friday FAQs Who is eligible to enroll for Blue Medicare PPO? How is Blue Medicare PPO different from Medicare Supplement health insurance coverage? How can Blue Medicare PPO be offered at such an economically priced plan premium? What would my payment responsibility be if it becomes necessary for me to use an out-of-network specialist provider due to a network inadequacy? Related Information Adult Wellness Guidelines (PDF, 92KB) Medicare.gov* Enrollment Information Summary of Benefits (PDF, 116KB) Evidence of Coverage (PDF, 371KB) Terms & Conditions Grievances, Appeals and Exceptions Privacy Notice Contact Us * By clicking this link, you will leave the Blue Medicare PPO Web site. FOOTNOTES * By clicking this link, you will leave the Blue Medicare PPO Web site. PDF indicator Indicates a file in portable document format (PDF). To view this file, you may need to install Adobe® Reader®*. The latest version of Adobe Reader has built-in screen reader capability. Other accessibility tools and information can be downloaded at http://access.adobe.com*. If your screen reader cannot read these PDFs, download the latest version of Adobe Reader*, with built-in screen reader capability. Other accessibility tools and information can be downloaded at http://access.adobe.com*. H4531_WEB_Websitef File & Use Certified Last updated 7/12/2007
Source: blogspot.com

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

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

35 Statistics on America’s Payor Mix

Figures reflect payor mixes from 2009, the latest year available. For categories marked “n/a” the survey had deemed those figures as not meeting a standard of reliability or precision. United States Medicare: 40.9 percent Medicaid: 17.2 percent Worker’s compensation and other government programs: 2 percent HMO or PPO: 14 percent Blue Cross Blue Shield, other private insurance: 16.5 percent Self-pay: 4.9 percent Other payments: 1.2 percent Northeast Medicare: 42.9 percent Medicaid: 15.7 percent Worker’s compensation and other government programs: 1.2 percent HMO or PPO: 16.6 percent Blue Cross Blue Shield, other private insurance: 16.6 percent Self-pay: 3.2 percent Other payments: > 1 percent Midwest Medicare: 44.5 percent Medicaid: 16 percent Worker’s compensation and other government programs: n/a HMO or PPO: n/a Blue Cross Blue Shield, other private insurance: 19.2 percent Self-pay: 4.5 percent Other payments: > .5 percent South Medicare: 41.7 percent Medicaid: 16 percent Worker’s compensation and other government programs: 3 percent HMO or PPO: 11.3 percent Blue Cross Blue Shield, other private insurance: 15.8 percent Self-pay: 6.2 percent Other payments: 1.5 percent West Medicare: 32.9 percent Medicaid: n/a Worker’s compensation and other government programs: n/a HMO or PPO: 18.4 percent Blue Cross Blue Shield, other private insurance: n/a Self-pay: n/a Other payments: n/a
Source: beckersspine.com

Texas Medicare Advantage Disenrollment : Learn Your Options

Posted by:  :  Category: Medicare

Newsweek Magazine (February 16, 2009) ... Lenders Add Bigger Fannie, Freddie Fee – Thanks to Payroll Tax Cut (January 15, 2012) ...item 2.. Dupuy: GOP trying to sell pyrmaid scheme to voters (September 3, 2012) ... by marsmet526If 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

Video: Medicare Supplemental Insurance | Medicare Benefits Direct

Looking Into Different Aspects Of Medicare Supplemental Insurance

One issue that is near and dear to our hearts when considering health insurance is prescription drug coverage.  It is notable to understand that any Medicare Supplemental Policy you currently purchase will not come with prescription drug coverage.  This is something that needs to be purchased through separately and is referred to as Medicare Part D prescription drug coverage.
Source: seniorhealthdirect.com

Fixing Medicare With More Direct

As I’m sure you remember, when the Senate passed the Medicare bill in 1965, President Lyndon Johnson said, "We have proved, once again, that the vitality of our democracy can shape the oldest of our values to the needs and obligations of today." Now that you’re 47, it’s time we start thinking about the needs and obligations of a new day. When we think of the health care system, we should be thinking about how to better care for everyone in it — including workers.
Source: aarp.org

New Medicare Tax Goes Into Effect January 2013: Year

Deferred compensation is not generally subject to Medicare until it is vested and ascertainable. For defined benefit plans, this means that Medicare tax often is not paid until an employee terminates employment, when the total value of the plan benefit is ascertainable. For defined benefit deferred compensation plans that currently have vested and accrued benefits, the employee can electively pay FICA taxes presently for vested, accrued benefits on an estimated basis. If such early elections are made in 2012, the additional Medicare tax can be avoided for amounts accrued and vested this year. Early FICA inclusion will also exempt the future value of that amount from any additional FICA tax, including the additional .9 percent rate applicable to years after 2012.
Source: jdsupra.com

AMA Resources Available to Support Passage of Medicare ‘Direct Contracting’

Diamond Level Platinum Level Gold Level rmsource, Inc. Wells Fargo Insurance Services Silver Level Ford Harrison Medical Protective SunTrust United HealthCare Group Bronze Level Allscripts Apex Technology Bactes Imaging Solution Biz Technology Solutions, Inc. Call-A-Nurse ChoiceHealth, Inc. CNP Technologies Computer Service Partners Coverys DataMax Eastman Kodak Company Fifth Third Bank Healthcare First Citizens Bank Gateway EDI GMK Associates, Inc. Gordon Asset Management, LLC Greenway Medical Technologies, Inc. Henry Schein Medical Humana, Inc. JBA Benefits (Allergy Services, LLC) LabCorp Management Services On-Call Marketing Works McNeary, Inc. Medicus Insurance Company MedLinks Transcription, Inc. MedWaste Solutions NCHA Strategic Partners One Source Document Solutions ONLINE Information Services Physician Discoveries Physicians’ Alliance of America Prince Parker & Associates Professional Recovery Consultants Solstas Lab Partners Stanley Benefits Stern & Associates The Doctors Company TriMed Technologies Corp Virtual OfficeWare, Inc./GE Healthcare
Source: wordpress.com

Lifeline Direct Insurance Introduces Connecticut Medicare Supplement Insurance

When purchasing Connecticut Medicare supplement insurance coverage, you will need to have a physician in mind. Many physicians in Connecticut take most types of Medicare supplement insurance found on the internet. If you have a doctor that you ordinarily visit, ensure that they consider the supplement insurance plan that youre thinking of buying. Using a report on medical doctors that you know in your area of Connecticut will help tremendously with this method. You do not want to buy Connecticut Medicare supplement insurance coverage only to discover later on that the physicians which acquire your policy are not ones you would like to visit, stated by Matthew Loughran, from Lifeline Direct Insurance Services.
Source: directory-net.com

Worried About Medicare Cuts? Free Up Cash Flow with a Reverse Mortgage

The bank determines the limit to how much money they will pay you over time based on the value of the home and your age. Each loan is different because each person and home are different. In order to learn how much you would qualify for on a monthly basis, and in total, call a professional mortgage lender to learn how they can help. Mortgage bankers that work with reverse mortgage clients understand the complexity of the loan program and getting approved. You do not want to work with a lender that only does these loans occasionally. They are more complicated and it is important to fully understand what the program looks like. Additionally retirees need to understand that if you get a reverse mortgage it will take the place of your only home loan. You will not be able to have a reverse mortgage and equity loan as an example.
Source: directyourownloan.com

Lifeline Direct Insurance Introduces Kentucky Medicare Supplement Insurance

“Regardless of what part of Kentucky you reside in, you have more important things to use your funds on when compared with costly supplement Medicare insurance policies. For this reason, you should seek out Kentucky Medicare supplement insurance plans online. Through online shopping, you will be furnished with many no cost quotes with regard to insurance coverage from several firms. Simply evaluate these types of estimates before you purchase the one that is most fitting to your situation,” stated by Matthew Loughran, from Lifeline Direct Insurance Services.
Source: virtual-strategy.com

Saving Medicare Through Premium Support

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

2013 Changes to Social Security and Medicare

Among married couples, frequently the higher earner applies for benefits early while the lower earner delays in order to receive a higher benefit. However, if the higher earner claims early and then dies first, he or she has essentially shortchanged the lower earner’s survivor benefit. One optimization strategy is for the higher earner to delay his or her benefit to ensure that the lower earner will always be able to claim the highest possible benefit possible.
Source: fidelityadviser.com

Democrats Wary Of Medicare Benefits Cuts Being Discussed In Fiscal Talks

Posted by:  :  Category: Medicare

House Republican Press Conference on Health Care Reform by House GOP LeaderThe Hill: Democrats Want GOP To Show Hand On Medicare In Deficit Negotiations Democrats wary of accepting any entitlement benefits cuts are asking Republicans to show them their plans if they want to make Medicare means-testing a part of a lame-duck fiscal package. GOP leaders have floated the idea of hiking Medicare costs for wealthier beneficiaries – a proposal President Obama has repeatedly backed – as a condition of any deal to prevent a slew of tax hikes and spending cuts from taking hold Jan. 1. But Speaker John Boehner (R-Ohio), the GOP’s point man in the negotiations, has declined to specify the Republicans’ wish-list for entitlement reform – at least publicly. And it’s unclear whether means-testing would be enough to win GOP support for a deal that would also hike tax rates on households with annual family income above $250,000 (Lillis, 12/16).
Source: kaiserhealthnews.org

Video: What is a Medicare health insurance exchange?

Signing Up for Medicare Benefits, Act Now!

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Source: webmd.com

Medicare Wellness: A Long Term Approach Creates Long Term Benefits

As Members of Congress continue to debate the cuts that could take place in Medicare, it’s important that we point them to the ramifications of their ideas and highlight that the only way to sustainably control costs is to have a greater focus on efforts that coordinate care and promote wellness and disease prevention rather than proposals that would increasing seniors’ financial responsibility or other similar ideas that would discourage positive self-management. While the long-term approach may not show the immediate cost savings, it will lead to a healthier population and a solvent program down the road.
Source: phrma.org

Raised Medicare Eligibility Age, and Other Links

American Medical Association cancer CBO consumer driven health care diabetes doctors drugs electronic medical records email emergency room EMR ER exercise FDA genetics Health Care Access Health Care Costs health care quality health insurance health IT health policy Health Reform Health Savings Accounts heart disease hospital HSA insurance life expectancy Massachusetts Medicaid Medicare medicare advantage NHS ObamaCare obesity pay for performance public option SCHIP seniors socialized health care Social Security stimulus tax unemployment Uninsured
Source: ncpa.org

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

What is the Cadillac Medicare Advantage plan

A plan’s network of providers: People often think Medicare Advantage plans are only offered as part of healthcare management organizations (HMOs), but many are also preferred provider organizations (PPOs). With HMOs and PPOs, insurance companies typically have a list doctors, specialists and hospitals that are preferred so when you go to those providers, you presumably pay a lower price for care. Either that, or the insurer covers more of your out of pocket costs, or both. Your costs typically differ if you get “in network” care versus “out of network” care. You’re more likely to think of a plan that includes your doctors, specialists and hospitals at a lower price to be a Cadillac plan.
Source: ehealthinsurance.com

Medicare Experts Discuss Proposal to Raise Eligibility Age

Juliette Cubanski, associate director for the Program on Medicare Policy at the Kaiser Family Foundation; Gail Wilensky, senior fellow at Project HOPE, and a former Medicare and Medicaid administrator; David Certner, federal policy director at AARP, who previously served as chairman of the ERISA Advisory Council at the Department of Labor; and Paul Dennett, senior vice president for health reform at the American Benefits Council, which represents Fortune 500 companies, and a congressional staff veteran; discussed the costs and benefits of raising the eligibility age.
Source: c-span.org

Deforming Medicare into a Competitive Bidding System (part 1)

FEHBP requires that all plans cover the same medical services. In spite of this, some plans offer more dental and vision coverage than others. However, the primary “choice” is whether to pay now or pay later. Those who choose plans with lower premiums (taken out of biweekly or monthly pay-checks) face higher deductibles and co-payments when they actually need medical care. Often this results in higher overall cost to those who choose what looks like a less-expensive plan. Seeing physicians “out of network” costs more in a “basic”plan than in a “standard” or “high option” plan. We know from many studies that higher co-payments lead low- and even middle-income people to postpone needed medical care. Since FEHBP premiums are independent of the employee’s income, lower-wage workers are likely to choose a “basic” plan and thus face the barrier of higher costs when they have to seek care. And many, of course, will not be able to afford to pay for any plan.
Source: correntewire.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

What Is Medicare Part D Insurance?

Posted by:  :  Category: Medicare

319 | Tragedies of Medicine by The DoctrThe amounts differ from year to year. There is a deductible at the beginning of each calendar year. Currently it is a maximum of $320.00. Not all prescriptions are covered by all plans. There are co-pays for prescriptions. Your Medicare Part D Insurance covers your prescription costs until you reach $2,930.00 in expense, the “Donut Hole” you will pay your prescription costs until you reach $4,700. Beginning in 2012, while you are in the “Donut Hole”, the manufacturer pays 50% of the cost of name brand drugs and 14% of the cost of generic drugs and you pay the remaining 50% or 14%. Choosing the Right Plan is Important
Source: seniorcorps.org

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Medicare vs Medicare Advantage

For Part A and Part B of Medicare, members must pay 20% of costs out-of-pocket. For inpatient hospital visits, members must pay a $1,184 deductible for the first 60 days, and then $296 coinsurance per day until day 90. After day 90, members can have another 60 days at $578 per day in their lifetimes, after which they must pay all costs. The Part B deductible is $140 per year. Those who have Part D (prescription coverage) must also pay an average deductable of $325. After the deductible has been paid, members may either have a co-pay program, where they pay a flat fee for each drug, or co-insurance program, where they pay a percentage of the cost. However, members may face the “doughnut hole”: after the total cost of drugs exceeds $2,970, members must pay 47.5% of the cost of brand-name drugs and 79% of the cost of generic drugs. Once the cost of drugs has exceeded $4750, Medicare kicks in again, with 95% of drug costs covered.
Source: diffen.com

Daily Kos: Handy candidate comparison chart

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Source: dailykos.com

Medicare Rolls Out Quality Bonuses And Penalties

Kaiser Health News: Medicare Discloses Hospitals’ Bonuses, Penalties Based On Quality Medicare on Thursday disclosed bonuses and penalties for nearly 3,000 hospitals as it ties almost $1 billion in payments to the quality of care provided to patients. The revised payments, which will begin in January, mark the federal government’s most extensive effort yet to hold hospitals financially accountable for what happens to patients. In what amounts to a nationwide competition, Medicare compared hospitals on how faithfully they followed rudimentary standards of care and how patients rated their experiences (Rau, 12/20).
Source: kaiserhealthnews.org

Scandal Comparison Chart: Benghazi

“Occupy Wall Street” ‘Climategate’ 9/11/01 abortion al Qaeda Ambassador J. Christopher Stevens amnesty Andrew Breitbart anti-semitism Attorney General Eric Holder Benghazi Bureau of Alcohol Tobacco Firearms and Explosives campaign contributions Chicago class warfare Democrats Egypt Facebook freedom George W. Bush Gulf of Mexico Hamas hypocrisy Judge Andrew Napolitano Libya Medicaid Medicare Michelle Malkin Mitt Romney Muslim Brotherhood Nancy Pelosi national debt Operation Fast and Furious Prime Minister Netanyahu Rep. Darrell Issa Rep. Paul Ryan Secretary of State Hillary Clinton SEIU Sen. Harry Reid Shariah Law Speaker John Boehner Twitter Van Jones Vice President Joe Biden voter fraud
Source: commonamericanjournal.com

HOWIEINSEATTLE: “Handy candidate comparison chart”

(Click to enlarge) Jen Sorensen (Daily Kos): I find that people who spew the platitude that “the candidates are the same” tend to be the ones who have the least to lose if the wrong candidate is elected. At risk of sounding melodramatic, these elections truly are a matter of life and death. If you end the Affordable Care Act and millions of Americans lose their health insurance, people will die as a result. A recent estimate puts the number at 26,000 deaths per year due to lack of insurance; that’s more than a few September 11ths. Then there’s the Global Gag Rule, which Romney would reinstate. It rarely gets mentioned, but this policy wreaks havoc on women in impoverished nations. Romney would also end contributions to the U.N. Population Fund, which combats the spread of HIV and prevents 22,000 deaths annually. These are but a few examples. Turning Medicare into a voucher program, radicalizing the Supreme Court for a generation, and displaying an open hostility toward science probably won’t help things either. Obama isn’t perfect, but as far as I’m concerned, voting is a moral arithmetic problem with a clear answer.
Source: blogspot.com

The California Medicare Supplement Plan Landscape

Maybe you’re tired of the A, B, C soup that seems to be swirling around you when you glance at the newly received California Medicare supplement plan offerings and with good reason. There are so many A’s, B’s, and F’s, that you would think you’ve come full circle back to kindergarten. We hope to shed some light on the subject of California Medigap plans to make clear how the various plans differ and reduce the chance of brochure induced headache, a very serious condition NOT covered by Medicare. So let’s dive into the California Medigap plans with a quick scan of what Traditional Medicare does, and more importantly, does not cover. California Medicare is best thought of as an 80/20 plan with deductibles, two of them to be exact. It generally breaks down the core benefit (which account for the majority of your health care cost outside of medication which we’ll save for another article on California Part D) into hospital (Part A) and physician (Part B) costs. That’s the first two letters you’ll see before even looking at California Medicare supplement plans. Remember the “Part” part of the name since that tells you we’re talking about traditional Medicare and not a California Medigap plan. Part. Part. Part. Medicare section. Part A is generally facility based (hospital, surgi-center, etc) while Part B is generally physician based. Now that we understand the bulk of what makes up your health care costs, let’s look at the California Medicare supplement plans. The California medicare plans are A, B, C, D, F, F high deductible, G, K, L, M, and N. In general, they increase in benefits (and cost) from A through F. The remaining generally add in cost sharing to the Medicare supplement subscriber but offer lower prices. For all the California Medigap plans, the main categories of traditional Medicare that they fill the gaps in are the following: Part A deductible, Part A co-insurance, Part B deductible, Part B co-insurance, Part B excess, Hospice Care, Skilled Nursing Facility, Foreign Emergency Travel, 1st 3 pints of blood, and Preventative co-insurance. The lettered California Medicare plans differ in these categories listed above. The F plan covers all these categories and remains the most popular California Medigap plan on the market. All the plans cover the Part A co-insurance completely. A through F cover the Part B co-insurance while G through N have varying degrees of coverage. It’s probably best to look at a California Medicare supplement plan comparison chart to make it clear but we’ll discuss the primary issues to concentrate on when deciding on your Medigap plan. We want to focus on the costs that can either be very large or uncapped. This would be the Part B Excess charge (doctors can charge up to 15% higher than standard Medicare rate), Skilled Nursing Facility, and Part A deductible. The other expenses are probably less exorbitant but still important. The key is this – we’re not talking 100’s of dollars of difference in monthly premium between each California medicare plan so why take on the risk when it’s probably $10-20 difference per month between given plans. That’s why the F plan is so popular. It covers all the main gaps in California Medicare at a relatively low price. Also keep in mind that you’re entering a period of time when medical care (very expensive medical care) becomes more common and frequent regardless of your health at the time of enrolling. It’s a bad bet to buy a less rich California Medigap plan and save a few bucks only to pay much more later on. Take a look at the comparison chart at californiamedigap.com to get a better understanding and we’re happy to walk through your plan options as licensed California Medicare agents but all roads lead to the F plan. We’re happy to be your road map. Dennis Jarvis is a licensed insurance agent concentrating on California Medicare supplement insurance.

Preventive & screening services

Posted by:  :  Category: Medicare

OBAMACARE WATCH:....THE PUSH IS ON, ........THEY WILL CONTROL WHAT YOUR DOCTOR KNOWS AS WELL AS WHAT HE OR SHE TREATS by SS&SSThe page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

Video: Medicare Audit Guidelines for Chiropractors – Initial Visits

Settlement Eases Rules for Some Medicare Patients

Neither the Medicare law nor regulations require beneficiaries to show a likelihood of improvement. But some provisions of the Medicare manual and guidelines used by Medicare contractors establish more restrictive standards, which suggest coverage should be denied or terminated if a patient reaches a plateau or is not improving or is stable. In most cases, the contractors’ decisions denying coverage become the final decisions of the federal government.
Source: usbia.org

Former Orthofix Manager Charged With Medicare Fraud

Mr. Racey was connected with a scheme to submit $250,000 in fraudulent claims for bone stimulators that did not meet Medicare’s guidelines. In order to meet federal guidelines for reimbursement, Mr. Racey allegedly forged patients’ medical records and altered physician prescriptions. If convicted, Mr. Racey faces a maximum possible sentence of 10 years imprisonment, a $250,000 fine and a $100 special assessment, along with restitution and forfeiture.
Source: beckersspine.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

Report estimates health plan overbilled Medicare $424M

Dec. 17, 2012 – Medicare may have overpaid an estimated $424 million to PacifiCare of California’s Medicare Advantage plan based on risk assessments that in many cases made patients seem sicker than they were, according to a federal oversight agency. Medicare Advantage plans send patient diagnosis codes to Medicare, which boosts plan rates if clients are affected by serious medical conditions. A new report by the U.S. Health and Human Services inspector general says PacifiCare was paid extra for treating patients with cancer or a dangerous bloodstream infection even though medical records didn’t describe those ailments. UnitedHealth Group, which now owns PacifiCare of California, disputed the inspector general’s findings, saying the review of 100 cases could not be generalized to hundreds of other claims. “The audit does not follow Medicare’s own guidelines, standards or accepted methodology for validating risk-adjustment payments,” a statement by UnitedHealthcare Medicare & Retirement says. “In fact, it differs significantly from (Medicare’s) adopted methodology. The OIG appears to have relied instead on a methodology of its own making.” The inspector general’s office reviewed UnitedHealth’s response before issuing the report and maintains that its methods are valid. The report, released Thursday, calls on Medicare to review its findings and discuss them with PacifiCare. A Centers for Medicare & Medicaid Services representative said the agency, which administers the Medicare program, is aware of the report and is willing to work on the matter with PacifiCare. Medicare Advantage plans collect patient diagnoses from doctors and hospitals that are used to assign risk scores to clients. Patients with serious medical conditions entitle the plans to heightened per-patient, per-month Medicare payments. The inspector general reviewed a 2007 contract between Medicare and PacifiCare. Under that contract Medicare paid PacifiCare $2.3 billion to administer care for 188,829 clients. The review examined 100 clients’ risk scores, diagnostic codes and related medical records. The inspector general concluded that 55 risk scores were valid, but 45 were not supported by information in patient charts. The inspector general found that PacifiCare submitted a diagnosis code for a genetic disorder characterized by abnormal brain function in a patient whose records only discussed a fever and a cough. Another patient was reported to have prostate cancer when medical records discussed a shoulder suture removal. For a third patient, PacifiCare submitted a diagnosis code for “unspecified septicemia,” a lethal infection of the bloodstream, when medical records discussed a knee surgery and did not mention a bloodstream infection, the report says. The inspector general directed PacifiCare to repay Medicare $224,388 that was overpaid as a result of the 45 charts with unsupported diagnoses. Applying the estimated overpayment rate to 188,000 PacifiCare patients under the 2007 contract, the inspector general estimated that Medicare overpaid about $424 million. UnitedHealth said in its statement that it has worked with Medicare to improve the accuracy of health plan payments and will continue to do so. “Payment accuracy is in the best interests of UnitedHealth, our health care system partners, and Medicare as we collaborate to provide coverage and care that Medicare beneficiaries need, at a price they can afford,” the statement says. The report comes amid a series of watchdog agency and news reports that examine enhanced Medicare payments that can flow to health providers if they overstate the intensity of patient demands or the severity of their medical conditions. The inspector general found in November that Medicare overpaid nursing homes by about $1.5 billion in 2009 based on claims that patients needed “ultra high” levels of therapy. The report found that claims were “upcoded” because the records showed that the patients either did not need or get the therapy in many cases. The Washington Post also examined “ultra high” therapy use in 2010, focusing on a chain that operates dozens of homes in California. The Center for Public Integrity reported in September that doctors and other medical professionals are steadily billing higher rates for treating Medicare patients, signaling a possible increase in billing abuse. And California Watch reported on high rates of severe medical conditions that entitled Prime Healthcare Services, a growing California-based chain, to bonus payments. Prime Healthcare has said its Medicare billings are legal and based on appropriate patient care. www.CaliforniaWatch.org
Source: yubanet.com

Proposed Settlement Could Expand Medicare Coverage

Presently, Medicare guidelines indicate that coverage should be denied if a patient reaches a plateau and is not improving.  As a result, if a patient suffering from a chronic condition could not demonstrate a likelihood of medical or functional improvement, Medicare would not pay for home health care, skilled nursing home stays, or outpatient therapy.  Since many families could not afford these services out-of-pocket, many patients ultimately did not receive the recommended treatment.
Source: clgattorney.com

Proposed Settlement May Extend Coverage to More Medicare Home Health Patients

If finalized, this change in policy is likely to be welcomed by home health agencies.  Over a period of many years, agencies have been stymied in their efforts to provide services to patients like the plaintiffs and similar patients across the country.  The historic lack of coverage for services to such patients has caused home health agencies to confront difficult legal, economic, and ethical dilemmas.  Even if agencies could afford to continue to provide substantial free services to such patients, it appeared that the provision of free services violated applicable prohibitions of the Office of Inspector General (OIG) of HHS regarding the provision of free services to patients that exceed $10.00 at a time or $50.00 in the aggregate during a calendar year.  Agencies would welcome relief from difficult dilemmas and an opportunity to provide care to as many patients as possible.
Source: accreditednursing.com

Aging and Parkinson’s and Me: Pending Medicare Settlement Eases Rules for Home Health Care

Legal Challenge  Two years ago, a U.S. District Court in Burlington, Vt. ruled in the case of Anderson v. Sebelius that Medicare should pay for the home health services to prevent deterioration in a patient’s condition even though there was no likelihood of medical or functional improvement. The lawsuit was brought by Sandra Anderson, who had been receiving visiting nurse services at home since she suffered a stroke in 2004. But when she returned home after being hospitalized for a second stroke, the home care service was denied, using the stability presumption. She sued, claiming a violation of her Fifth Amendment due process rights. The Vermont District Court Judge wrote: A patient’s chronic or stable condition does not provide a basis for automatically denying coverage for skilled services…. Skilled care may, depending on the unique condition of the patient, continue to be necessary for patients whose physical situation is stable. A nationwide class-action lawsuit was brought to broaden the applicability of this ruling. Last month — two years after the Vermont ruling — a proposed settlement was negotiated with lawyers from the Justice Department and the Department of Health and Human Services. It has been submitted to Christina C. Reiss, the chief judge of the Federal District Court in Vermont, who is expected to approve it. She would then have authority to enforce it for up to four years. Under the settlement,  federal officials agreed to rewrite the Medicare manual to make clear that Medicare coverage of nursing and therapy services “does not turn on the presence or absence of an individual’s potential for improvement” but instead is based on the patient’s need for skilled care. Independent medical experts agree that the settlement will increase Medicare costs for the federal government. On the other hand, it could save money when, for example, the provision of home skilled care allows the patient to avoid more expensive hospital or nursing home care. Moreover, physical therapy is subject to a cap each year. In 2012, that limit is $1,880 for both occupational and physical/speech therapy. Beneficiaries can request an exception to double this amount if they can show that the therapy will help “achieve prior functional status or maximum expected functional status within a reasonable amount to time.” The language in that exception wouldn’t help me if the physical therapy was designed to address my degenerative Parkinson’s disease. But it might apply if the therapy was designed to ease my back pain and get me back to where I was before the 2011 car crash and fractured vertebra. Hmmm. The rules for when this exception is available sound much like the now-discredited stability practice with respect to home health care services. Another law suit? Another two years of litigation? The lawyers win again.
Source: blogspot.com

California insurance firm over billed Medicare $424 million

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Source: calcoastnews.com

What Is The Best Method For Making A Medicare Supplement Plans Comparison?

Posted by:  :  Category: Medicare

A list of physicians and healthcare professionals, by geographical location, can be found on the official Medicare website: https://questions.medicare.gov/find-a-doctor . This is an easy and convenient method to find participants in local areas. Every year there is an open season when individuals have the opportunity to make a Medicare supplement plans comparison to ensure both providers and services will continue. As with the original Medicare Parts A and B, the monthly fees for Medicare supplement plans are reviewed and adjusted on an annual basis. The Medicare monthly costs for Parts A, B, and D can be found at www.medicare.gov/costs/ . Supplemental insurance carriers will notify participants of any changes in annual fees or altered services during the November to December timeframe. Anyone who wants to change or drop a current insurance carrier can do so during the annual open season, January through March. Comparing costs today will lower individual expenses tomorrow.
Source: seniorcorps.org

Video: Medicare Supplemental Insurance Plan Benefit Comparison California

Medigap: Sacramento, Placer Medicare Supplement Rates

Independent agent for health and life insurance in northern California. CA LIC. 0H12644. Focusing on families, individuals, self employed and small business. Representing several insurance carriers including Medicare Advantage and Part D Plans. Life insurance, final expence and funeral trusts. My pledge to my clients: 1. I respect your time and decisions. 2. I will not try to sell you something you do not want or need. 3. I will not call you after 5pm unless you ask me to.
Source: insuremekevin.com

medicare supplemental insurance comparison

People of California have a wide selection of insurance policies available to them if they become Medicare eligible. California Medicare Supplement ideas provide a considerable benefit over other states. As a Medicare Supplement participant in California you’re permitted to swap corporations each.
Source: forumscloud.com

Things to know about Medicare Supplement and Health Insurance

Medicare supplement and health insurance is a remarkable resource for individuals of different backgrounds who desire to have financial well being after they retire from their jobs. Supplemental insurance comes into picture along with your regular health insurance plan to fill in the gaps wherever you would or else have to pay through your pocket. Medicare supplement health insurance becomes important for you since your regular medical insurance can take care of nearly 80% of your total medical costs. This leaves a significant 20% cost, which you have to arrange for, from your savings. Having a supplement medical insurance can lower your out-of-pocket expenses significantly without replacing the primary plan. This simply adds to your original plan making you fully covered and filling the gaps. These plans are often called Medigap plans and you have number of options when it comes to choosing the right for you.
Source: wordpress.com

Compare Medicare Supplements

When you compare Medicare Supplements you should also be aware that attained age-rated-rated plans are based on your age when you apply. Premiums are usually low when you are 65. After a decade, these plans may be the most expensive and if your health fails, you may not be able to change plans to lower your premiums.
Source: co.uk

Compare Medicare Supplement Insurance Plans

This is the basic plan. Its coverage includes: Medicare Part A coinsurance, Medigap coverage for hospital benefits, Medicare B coinsurance, Medicare B copayments, first three pints of blood, Part A hospice care coinsurance or copayments, and Medicare preventive care Part B insurance. By law, all Medicare Supplement insurance carries must offer this plan.
Source: ihealthcoalition.org

Has Your Medicare Supplement Gone UP in Price?

During this time of year we can help you make sure you have the best price and coverage for your doctor and hospital care.  Many people think all they need is a Part D comparison, but why pay more for your Medicare Supplement than you have to?  Medicare only pays 80% of your doctor and hospital costs.  If you are turning 65 and in your open enrollment, you cannot get turned down for coverage during those months no matter what kind of health issues you may be experiencing.  That is why it is so important NOT to get a Medicare Advantage Plan!!!  Start off with the BEST coverage available!!
Source: mypartdusa.com