S.C. Hospice Firm Busted for Alleged Medicare Fraud

Posted by:  :  Category: Medicare

The Pfelons of Pfizer: Too Crooked to Fail and Don't Go to Jail (g1a2d0052c1) by watchingfrogsboil“As budget pressures increase it is more important than ever to protect Medicare dollars and vigilantly guard against needless health spending,” Daniel R. Levinson, Inspector General of the U.S. Department of Health and Human Services, said in a statement. “The company and its owner have agreed to federal monitoring and reporting requirements designed to avoid such problems in the future.”  The investigation was jointly handled by the U.S. Attorney’s Office for the District of South Carolina, the Justice Department’s Civil Division and the Office of the Inspector General of the Department of Health and Human Services. The claims resolved by this settlement are allegations only, and there has been no determination of liability, the Justice Department noted.
Source: patch.com

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

Medicare Discloses Hospitals’ Bonuses, Penalties Based On Quality

The program is one of several Medicare is launching to make hospitals and doctors accountable for quality and more careful stewards of public money. In October, Medicare also began reducing payments to 2,217 hospitals because too many of their patients ended up back in their care within a month. Medicare already gives bonuses to the private Medicare Advantage insurance plans that score well on quality metrics. In 2015, the health law calls for the government to begin a quality payment program for physician groups of 100 professionals or more, and that is to be expanded to all doctors by 2017.
Source: kaiserhealthnews.org

Travel for Seniors: South Carolina

This post is a guest post by John Walters who is a freelance writer who attended the 1973 Clarion West science fiction writing workshop and is a member of Science Fiction Writers of America.  He writes mainstream fiction, science fiction and fantasy, and memoirs of his wanderings around the world.  For many years he lived in Greece with his Greek wife and five sons and taught English as a second language to help pay the bills, but he has recently moved back to the United States and now lives in San Diego. 
Source: medicareecompare.com

Medicare Fraud involving SC Hospice Company : South Carolina Nursing Home Blog

Harmony Hospice Care, a South Carolina hospice company owned by Daniel J. Burton will pay the federal government nearly $1.3 million in a settlement with DOJ for filing false claims to Medicare.  Harmony Hospice Care was filing claims for hospice care under Medicare for patients who did not qualify.  Harmony Hospice Care has locations in Columbia, Greenville, Hartsville and Union.
Source: scnursinghomelaw.com

Medicare phone scam targets elderly South Carolinians

WMBF reports that the phone calls are coming from 409-579-1214 and entice the recipient with a new card coming in January and free medical supplies. You can read the full article and get tips for keeping your or your loved one’s personal information safe.
Source: thedigitel.com

My Experience Applying for Medicare Online

Posted by:  :  Category: Medicare

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

Video: eHealth Technology: Broker Exchange Software as a Service platform

You Can Apply For Medicare Online

The nice thing about applying online is that you do not need to wait for an appointment.  You can fill out your application when you are ready from your own home.  As you are filling out your application, you may save it at any time during the application process and finish it when you are ready, so you do not have to worry about possible interruptions.  The web site is very secure, so your information is protected.  Once you complete the application, you will receive a receipt and an application number so that you can log in anytime to check your application status.
Source: mexicoonmymind.com

IRS: Discussion of the Additional Medicare Tax

The following questions and answers provide employers and payroll service providers information that will help them as they prepare to implement Additional Medicare Tax which goes into effect in 2013. Additional Medicare Tax applies to individuals’ wages, other compensation, and self-employment income over certain thresholds; employers are responsible for withholding the tax on wages and other compensation in certain circumstances. The IRS has prepared these questions and answers to assist employers and payroll service providers in adapting systems and processes that may be impacted.
Source: investment-fiduciary.com

Medicare Silver Bullets: What’s The Best Way To Control Costs?

If I could make only one change, it would be a massive reform of Medicare’s payment policies. Right now, Medicare payment policies drive overuse, waste, inappropriate and sometimes harmful use of services. There should be a number of changes, such as paying in ways that encourage the use of team-based care, telephone, group and e-visits, more flexibility to allow nurses and other health professionals to operate at “the top of their licenses” with physician oversight and in the most quality and cost-effective ways. The more we can bundle payments to reward improved health (not just health care), and allow providers to self-organize to deliver the greatest benefits for patients and value or payers, the better off we will all be. The most successful providers tend to be integrated delivery systems. Although we will never have enough such systems around the whole country, we can develop and support as many of these as possible and also have payment models that foster virtual integrated delivery systems and reward the best performers, that is, the ones that provide the safest care in the most efficient manner.
Source: kaiserhealthnews.org

The Medicare age is still 65

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Source: cedarspringspost.com

CMS Announces 2013 Provider Enrollment Application Fee Amount : Health Industry Washington Watch

CMS recently published a notice announcing a $532.00 calendar year 2013 application fee for institutional providers that are initially enrolling in the Medicare or Medicaid program or the Children’s Health Insurance Program (CHIP); revalidating their Medicare, Medicaid or CHIP enrollment; or adding a new Medicare practice location. This fee is required with any enrollment application submitted on or after January 1, 2013 and on or before December 31, 2013. 
Source: healthindustrywashingtonwatch.com

Aetna Launches Medicare Mobile Field Enrollment Tool For iPad

Aetna (NYSE: AET) today announced that it will launch a new Mobile Field Enrollment tool for iPad for its in-field Medicare sales agents and brokers. Licensed Aetna agents and brokers will now have access to a secure, efficient and easy-to-use alternative to paper applications. This tool will allow them to capture Medicare enrollment applications in an online or offline mode on the iPad, providing a straightforward, user-friendly experience for consumers enrolling in an Aetna Medicare plan.
Source: medcitynews.com

The Changing Landscape of Medicare for 2013 and Beyond

Posted by:  :  Category: Medicare

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

Video: United Healthcare Oxford Medicare Advantage Denies Coverage

Preventive & screening services

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Source: medicare.gov

Disease Management Care Blog: The Dilemma of Medicare Coverage of “Reasonable and Necessary” Care and Why It’s Important

If you get sick, health insurance should cover all the “stuff” necessary to make you better, right? While that sounds good in principle, Uncle Sam has made it a lot more complicated than that.  As we continue to struggle with health reform, this New England Journal article on “Medicare’s Enduring Struggle to Define Reasonable and Necessary Care” is very timely. According to Drs. Neumann and Chambers, Medicare has always covered medical services that are “reasonable and necessary.” As new approaches, drugs and medical technologies have been released, you’d think coverage would be based on an objective analysis of outcomes and cost effectiveness. You’d be wrong. Years of differing interpretations, patient advocacy, Congressional meddling, regulatory carve-outs and case law have generated a miasma of bureaucratic complexity that will guarantee the incomes of thousands of lawyers for years to come. Not that CMS hasn’t tried to be reasonable about “reasonable and necessary.” According to the article, in 1989 CMS specifically proposed that the words “cost effective” could be used to assess new technology. That proved too controversial. It later tried “least costly alternative language” for coverage of durable medical equipment and Part B medications.  This too was dismantled by the courts when plaintiffs argued that the term “reasonable and necessary” could only be applied to medical services, not to the costs of those services. How ironic. Even though CMS is making “value-based purchasing” judgements for hospital payments and costs can be factored in the coverage of preventive services, that still doesn’t apply to new technologies and drugs. The latest dysfunction is CMS’ pretzel logic of “coverage with evidence  development” approach to medical devices, essentially agreeing to coverage that is conditional on CMS’ evaluation of additional outcomes data.  Unfortunately, CMS’ ability to collect and interpret these kinds of data in the current political environment remains an open question. Outside of Medicare’s cost travails, why is all of this important? 1) Medicare’s price tag was $509 billion in 2010, taking 12% of the federal budget. While there are other drivers of cost, such as aging, coverage arrangements, income, pricing, administrative costs and defensive medicine, technology could account from 38% to more than 65% of the current growth (inflation) in spending.  Medicare’s historic inability to control this does not bode well for future cost projections. 2) This is not a partisan issue and there are no partisan solutions. 3) Commercial insurers generally use Medicare’s coverage criteria to define their own benefit structure.  Medicare’s problems are everyone else’s. 4) This is another reason why Medicare is banking on ACOs.  By delegating management and the associated risk of all these thorny coverage issues, they’re hoping ACOs can do within three years what CMS couldn’t do in three decades. We’ll see.
Source: blogspot.com

What’s New for Medicare Recipients for 2013

If your primary-care doctor or other primary-care practitioner determines you’re misusing alcohol, you can get up to four face-to-face counseling sessions per year (if you’re competent and alert during counseling). A qualified primary-care doctor or other primary-care practitioner must provide the counseling in a primary-care setting such as a doctor’s office.
Source: patch.com

Medigap: Providing Financial Security and Peace of Mind for Medicare Beneficiaries

Proponents of limiting first-dollar coverage in Medigap often cite the findings from a 1970’s RAND experiment to make the case zero cost-sharing leads to higher health care spending.  AHIP commissioned a white paper to examine the relevance of this study to current Medicare beneficiaries. The white paper found that the RAND study “was set in a reimbursement environment far different from today’s Medicare,” and noted that “a higher proportion of Medicare beneficiaries are low income (and low wealth), and so the impact of higher cost-sharing may be magnified for this population.” The authors conclude that “an across-the-board ban on first-dollar coverage Medigap plans is an overly blunt tool for lowering healthcare expenditures and invites adverse, unintended consequences.”
Source: ahipcoverage.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 to Broaden Medicare Coverage for Chronic Conditions

6. Manual revisions will clarify that SNF, HH, and OPT coverage of therapy to perform a maintenance program does not turn on the presence or absence of a beneficiary’s potential for improvement from the therapy, but rather on the beneficiary’s need for skilled care. a. The manual revisions will clarify that, under the SNF, HH, and OPT maintenance coverage standards, skilled therapy services are covered when an individualized assessment of the patient’s clinical condition demonstrates that the specialized judgment, knowledge, and skills of a qualified therapist (“skilled care”) are necessary for the performance of a safe and effective maintenance program. Such a maintenance program to maintain the patient’s current condition or to prevent or slow further deterioration is covered so long as the beneficiary requires skilled care for the safe and effective performance of the program. When, however, the individualized assessment does not demonstrate such a necessity for skilled care, including when the performance of a maintenance program does not require the skills of a therapist because it could safely and effectively be accomplished by the patient or with the assistance of non-therapists, including unskilled caregivers, such maintenance services will not be covered under the SNF, HH, or OPT benefits.
Source: lymphedemablog.com

Putting a Donut Hole Back in Medicare: Proposals to Increase Medigap Costs Put Vulnerable Beneficiaries at Risk 

[1] See Medicare Supplement Insurance First Dollar Coverage and Cost Shares Discussion Paper, National Association of Insurance Commissioners (NAIC), Senior Issues Task Force, Medigap PPCA Subgroup, (October 2011), available at: http://www.naic.org/documents/committees_b_senior_issues_111101_medigap_first_dollar_coverage_discussion_paper.pdf.  Also see, e.g., Leadership Council on Aging (LCAO) issue brief “Reforming Medigap Plans by Shifting Costs onto Beneficiaries: A Flawed Approach to Achieving Medicare Savings” (December 2012), available at: http://www.lcao.org/docs/LCAO-Medigap-Issue-Brief-12-12.pdf [2] Medigap Reform: Setting the Context, Kaiser Family Foundation, (September 2011), available at http://www.kff.org/medicare/8235.cfm. [3]Medigap Reform: Potential Effects of Benefit Restrictions on Medicare Spending and Beneficiary Costs, Kaiser Family Foundation, (July 2007), available at http://www.kff.org/medicare/8208.cfm. [4] See, e.g., previous Weekly Alerts, including finding drug savings in Medicare (November 2011) http://www.medicareadvocacy.org/2012/11/15/deficit-reduction-and-medicare-save-money-without-harming-beneficiaries/ ; Prescription Drug Rebates (July 2011) http://www.medicareadvocacy.org/2011/07/21/debunking-medicare-myths-drug-rebates-for-dual-eligibles/ ; and additional options for achieving Medicare savings (June 2011) http://www.medicareadvocacy.org/2011/06/09/so-what-would-you-do-real-solutions-for-medicare-solvency-and-reducing-the-deficit/.
Source: medicareadvocacy.org

Losing your Group Medicare coverage? Is your Medicare plan being terminated? December 7 may not be your enrollment deadline.

Health Alliance Plan (HAP) is a Michigan-based, nonprofit health plan that serves more than 50,000 Medicare beneficiaries enrolled in HAP Senior Plus HMO, HAP Senior Plus HMO-POS, Alliance Medicare PPO, Medicare Supplement and Prescription Drug Plans. HAP partners with leading physicians and hospitals, employers and community organizations to improve the quality of health care and enhance the health and well-being of the lives we touch. HAP offers award-winning preventive services, disease management, wellness programs and customer service.
Source: healthcareinmichigan.com

AARP/UHC Medicare Advantage

Posted by:  :  Category: Medicare

I was training a new agent in Florida today, the appointment we had was set from a mailer we sent to T-65. The client showed us a envelope from an Agency in Tarpon Springs, FL. They had sent an AARP/UHC Medicare Advantage with yellow highlights for the customer to sign including the scope of appointment and a returned envelope. What would you do?
Source: insurance-forums.net

Video: Medicare Part C Defined: Medicare Advantage Plans — UHC TV

United Healthcare AARP Medicare Complete Medicare plans for 2013

AARP AARP Connecticut AARP Medicare AARP Medicare Complete AARP Medigap AARP Medigap 2013 AARP Rates 2013 AARP Supplement AARP Supplement 2013 Anthem Anthem High F plan Anthem Medicare Anthem Medigap Anthem Supplement Coverage Gap Donut Hole Drug Help High Deductible F supplement LIS Connecticut Medicare Medicare Advantage Medicare Complete Medicare Complete connecticut Medicare Connecticut Medicare for Dummies Medicare Guide Medicare Introduction Medicare part B Medicare part D Medicare prescription drug plans Medicare Rx Medicare Saving program Medicare Supplement Medicare Supplement Connecticut Medigap Medigap rates 2013 Medigap rates NY 2013 MSP Connecticut Part D Part D Drug help Rx Help Rx help connecticut united healthcare United Healthcare AARP United Medicare complete 2013
Source: croweandassociates.com

UHC Announces Changes to its Medicare Advantage Audits

UHC will no longer use MedAssurrant, the contractor that previously conducted its payment integrity audits. UHC will also make changes in the way that it conducts its Risk Adjustment Date Validation (RADV) audits. These audit request letters will be more clear about the reason for the audit and provide consistent information on follow-up medical record review, audit requests, and post-audit claim payment determinations. UHC will also update its payment integrity and recovery practices. Currently, UHC asks physicians to refund the full amount paid on the original claim and then resubmit the claim using the recommended coding. In the first quarter of 2012 physicians will only need to resubmit the claim with the recommended coding and refund only the difference between the amount UHC originally paid and the amount that should have been paid using the new coding. Physicians who disagree with UHC’s recommended coding should appeal the claims.
Source: wordpress.com

Madame Defarge: Avoid Working w/ United HealthCare, Medicare Advantage Plan, unless you are an IN

Well, I’ve got nothing better to do than to organize a bunch of paperwork to send to United HealthCare Appeals Department which entails printing out all of the patients’ outpatient psychotherapy notes, creating a face page, sending a copy of it to the NC Insurance Commissioner as the client did not understand that a Medicare Advantage company can be an oxymoronic term.  Almost one-half year’s worth of weekly billing had been rejected x2 (it takes time to wind thru their system while I continue to honor my relationship w/ the client and see her) on the basis of:                           Error Code: 0979: Member Self Directed Out of Network So, for United Healthcare, if the Medicare provider is not ‘in network’ to that company, if the client picks that company as their Medicare Provider, you will not be paid.  The woman on the line at United HealthCare, as she tried to talk the client out of switching back to Medicare insisted, “You could have seen oe of the providers we have” to which the client stated, “But I’ve been seeing Dr. Hammond since my husband died”—–indicating that the administration of United Healthcare has no idea of the nature of outpatient therapy.  Hey: just switch over to that fella down the road.  Right. She called them the other day to switch back to regular Medicare—–where I recommend ALL my clients to stay.  I haven’t had any recent trouble w/ Humana but two years ago they insisted I send all of my patients’ session notes in order to pay me.  And by the way, that reminds me that the company that Humana had outsourced the outpatient mental health care only authorized until mid-year. Whoopee!  More paperwork to create for Humana.  WE NEED A ONE PAYER SYSTEM THAT IS CENTRALLY ADMINISTERED.
Source: blogspot.com

Regional VP For United Healthcare In SoCal Discusses Important Medicare Information

[…] STUDIO CITY (CBSLA.com) — Regional Vice President for United Healthcare Medicare & Retirement in Southern California, Michael McCarthy, stopped by KCAL9 Sunday to make Medicare beneficiaries aware of the enrollment deadline!Source: cbslocal.com […]
Source: cbslocal.com

United Healthcare Medicare Advantage Changes Brand in 2012

No, the Secure Horizons Medicare Advantage plan is not going away, but the branding for Secure Horizons is.  The plan is to start by branding the Medicare Advantage plan as AARP Secure Horizons by United Healthcare so that anywhere you see the Secure Horizons brand you will also see by United Healthcare.  Starting in 2012 you will see AARP United Healthcare without the Secure Horizons.  This is because most seniors are familiar with the United Healthcare branding as they probably had or knew someone who had United Healthcare medical insurance at some time in the past.  The Secure Horizons branding was not familiar to most seniors, and was just causing confusion. See my post reviewing their plans:
Source: medicare-plans.net

United HealthCare Medicare Advantage Dental Coverage

The team here at Stateline Senior Services in Somers, CT 06071 has been getting a lot of questions recently in regards to dental coverage.    Usually, you can only add options to your medical plan when you sign up for the coverage.  For our clients that have United Healthcare Medicare Advantage, you are in luck-if you want to add dental.  They allow their existing members to add the dental coverage at anytime during the year.  You can call them today and the coverage would start on July first.  The coverage has a $1000 maximum benefit that all basic, major and restorative work would apply to.  The preventative care that you would have done does not go towards the maximum benefit.  That means you can still get your cleanings, exams and x-rays done every six months and not have that count towards that total maximum benefit.  You do have the option of staying in-network and having the preventative care covered 100%, or if you go out of  network, it will be covered at 100% of the allowable plan charge.  You could be charged the extra amount that the plan would not pay for.  You can have fillings, crowns and major restorative work done and it would all be covered at 50% of the cost.  This coverage is offered at $32.00 per month, per person.  You can call the customer service number on the back of your membership card to add this coverage at anytime if you would like. All of this information can also be found in you Summary of Benefits book that you received when you joined the plan.  If you should have any other questions or need additional information, you may always call our office.
Source: statelineseniorservices.net

Outsource Marketing Solutions blog: UHC Single brand for Medicare Advantage

While most popular attention over Medicare this year has focused on new plans that cover prescription drugs, analysts view Medicare Advantage plans as critical profit opportunities for health insurance companies. Read on….
Source: typepad.com

Themis Medicare invites applications for Regulatory Manager

Posted by:  :  Category: Medicare

DAMN!! -- I THINK WE'RE F*%KED by SS&SS1) Periodical internal self-Auditing of the API plant, Research center & external auditing of raw & packing materials, towards compliance, everything concerned to the quality of product entering into regulatory markets to match the international regulations / standards & strict requirements. 2) Quality Compliance Activities related to I) API development Synthesis lab II) API development Analytical lab III) Quality Control Development 3) Search the patent for the existing generic API and their synthetic route. 4) Maintaining the Quality management . 5) Review and approve BMR, Analytical Reports and All Technical documents like specifications, development reports, method validations etc. 6) Evaluation of the changes, investigation of deviations and Quality compliance activities, OOS, OOT, BMR and BPR etc. 7) Conduct the trainings on the GLP as per the requirement of the associates to improve the awareness. 8) Support product transfer activities. 9) Provide technical support service to sales & marketing, answering customer technical enquiries, recommending products, role holder communicates with production, R&D, technical, sales and marketing contacts both internally and externally, and support R&D, Quality Assurance, and Quality Management. 10) Follow GMP practices and Sops, Review records and tracking of data.
Source: pharmatutor.org

Video: Medicare Shared Savings Program and Advance Payment Model Application Process

Aetna Launches Medicare Mobile Field Enrollment Tool For iPad

Aetna (NYSE: AET) today announced that it will launch a new Mobile Field Enrollment tool for iPad for its in-field Medicare sales agents and brokers. Licensed Aetna agents and brokers will now have access to a secure, efficient and easy-to-use alternative to paper applications. This tool will allow them to capture Medicare enrollment applications in an online or offline mode on the iPad, providing a straightforward, user-friendly experience for consumers enrolling in an Aetna Medicare plan.
Source: medcitynews.com

Air Force Station Faridabad / Station Medicare Centre Faridabad Lady Medical Officer

Air Force Station Faridabad / Station Medicare Centre Faridabad has invited applications for the following MO / Dentist / Psychologist /Aya Jobs.These are Part Time Jobs on contract basis.Those who are interested in career AFC Faridabad may apply for recruitment to these posts as follows – 
Source: corbee.asia

Where To File Application

1505.1 Where do you file your application for Social Security or Medicare benefits? File your application for Social Security benefits: At a Social Security office or with an authorized Social Security employee (Retirement, Spouse, Disability, and Medicare applications may be filed on the Internet at http://www.socialsecurity.gov); At a U.S. Foreign Service post if you are not a resident of the U.S. or could lose benefits because of extended absence from the U.S. (in the Philippines, applications may be filed at the U.S. Veterans Affairs Regional Office in Manila); In certain cases, with the Railroad Retirement Board or the Department of Veterans Affairs (see §1506); or In certain cases, with a provider of hospital services that is participating in the Social Security hospital insurance program. This provision protects you if you are: Age 65 or older; Eligible for hospital insurance benefits; and Admitted to a hospital for inpatient services without ever having filed an application with us. Note: There is no similar provision for medical insurance. These applications can only be filed at specific times. (See Chapter 24.)
Source: georgia-social-security-office.us

AOA spurs CMS to correct OD Medicare contractor enrollment glitch

Although a fix has taken longer than the CMS first anticipated, the AOA has received direct assurances from the CMS that any optometrist who experienced difficulties with the system or with a contractor can now proceed with enrollment, though it is possible that it may still take a few days for the notice to reach contractor customer service representatives.
Source: newsfromaoa.org

Printable Disability Application Form

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Source: emusician.com

Mutual of Omaha Announces Changes to Medicare Supplement Plan N Underwriting

Mutual of Omaha has announced underwriting changes to their Plan N Medicare Supplements.  This will affect all Mutual of Omaha companies including United World and United of Omaha.  Exceptions will include New York, where health questions may not be asked (per state regulations) and in open enrollment or other guarantee issue situations where health questions normally do not apply.
Source: wordpress.com

Download Medicare discount drug card: measuring the savings: forum before the Special Committee o…

The Act increases Medicare prescription drug. a June 15 hearing before the Senate Finance Committee.. in the United States (as if drug. the savings from the Medicare drug discount card as. Special Rules for States—Eligibility. . Space Technology and Applications International Forum, STAIF 2005 :. Savings and Costs Due to the Medicare Drug Benefit and. Medicare Rx of United. of the Medicare discount-drug-card. Suddenly Senior – A Place for Everyone Who’s Become Old Before. Federal Register
Source: diigo.com

Disease Prevention and Health Promotion in Medicare Locals Program

The Disease Prevention and Health Promotion in Medicare Locals Program seeks to build an evidence-based sustainable approach to disease prevention and risk factor reduction that is integrated with primary health care, to help manage the emerging challenges for the health system of an ageing population and an increasing burden of chronic disease. The Program builds upon the Medicare Locals’ role to be responsive to their communities’ health needs and reduce service fragmentation by improving overarching coordination between services and programs in their local regions – irrespective of their funding sources or delivery organisations.
Source: com.au

Tallahassee retirees and students rally to defend Medicare from ‘fiscal cliff’ budget cuts

Posted by:  :  Category: Medicare

on the move by drivebybiscuits1Republican lawmakers, like Southerland, have pushed for deep cuts to programs that support workers and retirees, like Medicare and Medicaid. President Barack Obama and the Democratic Senate have proposed a compromise that includes meager tax hikes for the richest 2%, coupled with cuts to Social Security and Medicare in the form of increasing the eligibility age.
Source: fightbacknews.org

Video: Gypsum Boards Joint Filling&Designworking From Muthoot Medicare Kottayam.Working For ”DESIGNTECH KOTTAKKAL”

AFGE request: Take action to support Soc. Sec., Medicare & Medicaid, December 5th » 11th Legislative District Democrats

On Wednesday, December 5th, AFGE Local 3937 will lead actions statewide  to support Social Security, Medicare & Medicaid. The locations and times are below. The message will be: –    No cuts to Social Security, Medicare, or Medicaid, including cost of living adjustments
Source: 11thlddems.org

Should cell phones be allowed in school pros

Should Cell Phones be Allowed in Schools? – Buzzle Supporters of cell phones in school argue that student cell phones have many benefits, like improving student safety and enhancing learning. // // // Cell Phones In School .info Wants To Know, Should cell phones be allowed in School? Parents and students often debate this topic. Most o The question of whether cell phones should be allowed in schools has been hotly debated over the years. Check out the pros and cons to permitting cell phones in school. Should Cell Phones Be Allowed In School — Ask a Teacher -
Source: blogse.nl

Nomophobia: Is your cellphone addiction covered?

Dr. Brian Johnson, director of addiction psychiatry at SUNY Upstate Medical school in Syracuse, N.Y., says, “Addiction is a serious thing, and it’s important not to trivialize it the way some people do when they say they are ‘addicted’ to a TV show or to chocolate. By definition, addiction occurs when someone experiences repeated harm from ‘x’ or whatever it is they are addicted to, which is usually something enjoyable.”
Source: insurance.com

Online Reverse Cell Phone Lookup Directory Now Available at NumberFinder.net

PRLog (Press Release) – Dec. 14, 2012 – Jon Haldeman, CEO and founder of NumberFinder announces the availability of NumberFinder.net, the online reverse cell phone lookup website. “Being able to conduct a reverse phone lookup, i.e. find the name and address of the phone owner, is usually needed most when you have the least time to do it”, Jon says, “Reversing a landline number is moderately difficult as the data is generally available to the public. Cell phone numbers are a different story.” Mobile network operators in the USA and most of the world do not release phone books even though the owner data (name and address) is not technically private. This information is not protected by privacy laws, so it is made available for a fee to companies who run 3rd party reverse cell phone lookup services. “Due to the fact that there are multiple mobile network carriers plus landlines plus unpublished numbers, there can’t be any official “phone book” service. All of this is done by 3rd party providers and the company that can get access to a larger share of number owner data wins.”, Jon explains. “We are proud that NumberFinder.net has very impressive coverage. More than 300 million of phone numbers (including mobile, landline and even unpublished numbers) are accessible in our database, which is updated daily via agreements with major mobile carriers and phone companies.” When a basic phone number search at Google or Yahoo doesn’t help in identifying the number owner, specialized reverse phone directories are the only way to find out who is hiding behind the 10 digits on your smartphone or caller ID device.   Each day, thousands of families across the USA suffer from prank calls, illegal telemarketing calls and even phone scams with seniors being especially vulnerable. For example, a popular scam from August 2012 involved scammers calling Medicare recipients and pretending that they are Medicare employees. The victims are threatened to being cut off from the benefits unless they disclose their personal information such as SSN or bank account number. Being able to check the identity of the caller via a reverse phone directory is an important safeguard against many types of phone scams. Jon reminds everyone to register for the National Do Not Call registry if they haven’t done so yet. The Do Not Call registry was established in 2004 and is the most efficient way to limit telemarketing calls that you receive. Once you have dealt with telemarketers, the remaining mystery calls can be easily traced via the NumberFinder directory. The NumberFinder reverse cell phone directory can be accessed at http://numberfinder.net
Source: prlog.org

Call Paul Ryan’s Medicare subsidy the get

If the Ryan plan’s Medicare subsidy is based on the next-to-least-expensive plan, lots of people will choose the cheapest insurance plan, and they’ll get what they pay for. They’ll cross their fingers and hope they’ll never need cutting-edge cancer or heart disease treatment. Health care providers will be in the untenable situation of having to tell patients their insurance covers only a less-than-best treatment.
Source: dallasnews.com

Is it a Revolution to Talk About Medicare Means Testing When Medicare is Already Means Tested?

House Minority Leader Nancy Pelosi could also prove an obstacle to new means testing in a fiscal-cliff bill. On Thursday, the California Democrat argued that entitlement reform should not be a part of the lame-duck negotiations. She’s calling instead for Congress to tackle those issues next year as part of a broader tax-and-spending package. “That should be left to next year,” she said. “That’s a longer conversation about where we go [on entitlements].”
Source: reason.com

Miami Assisted Living Facility Owner Sentenced For Medicare Fraud

Posted by:  :  Category: Medicare

"Citizenship is a tough occupation which obliges the citizen to make his own informed opinion and stand by it." ~ Martha Gellhorn  by eyewashdesign: A. Golden           The owner of a Miami-Dade County assisted living facility (ALF) was sentenced today to 15 months in prison for her role in a kickback scheme that funneled ALF patients to fraudulent mental health providers American Therapeutic Corporation (ATC) and Health Care Solutions Network (HCSN), announced U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; Michael B. Steinbach, Acting Special Agent in Charge of the FBI’s Miami Field Office; and Special Agent in Charge Christopher B. Dennis of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami Office.
Source: browardnetonline.com

Video: Medicare Provider, Assisted Living

Medicare Providers Cannot Object to RAC Decision to Re

Court documents state that Palomar Medical Center provided therapy to an individual who needed rehabilitative services following a hip surgery. At the time the therapy was delivered, Medicare reimbursed the facility. However, as RAC investigation determined that the services were not reasonable and necessary, and could have been delivered in a less expensive setting such as a nursing home or rehabilitation facility.
Source: about.com

Integrating Medicare and Medicaid: What’s Happening Now, and What It Means for Assisted Living and Other LTSS

This webinar, sponsored by the Assisted Living Consumer Alliance, explains the dual eligible integration process, with a focus on how the new demonstrations will affect long-term services and supports (LTSS) and their significance to assisted living and other long term services and supports. Speakers are Georgia Burke and Eric Carlson, attorneys from the National Senior Citizens Law Center. Jody Spiegel, Director of Bet Tzedek’s Nursing Home & Assisted Living Advocacy Project, will be the moderator.
Source: nsclc.org

Medicare Bills Rise as Records Turn Electronic

Some experts blame a substantial share of the higher payments on the increasingly widespread use of electronic health record systems. Some of these programs can automatically generate detailed patient histories, or allow doctors to cut and paste the same examination findings for multiple patients — a practice called cloning — with the click of a button or the swipe of a finger on an iPad, making it appear that the physicians conducted more thorough exams than, perhaps, they did.
Source: topangaparkassistedliving.com

Does Medicare Pay for Assisted Living

In some states, though, Medicaid can pay for assisted living in certain participating facilities. If the state Medicaid program where your parents live does cover some assisted living, you would have to find an assisted living facility that participates in Medicaid. But all this depends on whether your mother would qualify for Medicaid, which she can do only if your parents have low income and assets (other than their home). To see about the Medicaid eligibility rules for assisted living in the state where they live, you can go to the Medicaid information page at the federal government’s Govbenefits web page.
Source: caring.com

Essential information about assisted living care

Seniors for Living is a free service that helps you and your family research, evaluate, contact, and compare Senior Housing options. Our resources include partnerships with hundreds of senior housing communities and home care providers; daily blog posts about all things boomer and seniors; a vibrant community on Twitter and Facebook; and a bi-monthly #ElderCareChat on Twitter — all of which can help guide you in your own personal senior housing and senior care decision.
Source: seniorsforliving.com

Eldercare Resource Center: Medicaid’s Assisted Living Benefits: A Good Option for the Lucky Few

Questions about Medicaid’s assisted living benefits are probably the second most common questions we receive. The first being the more rhetorical “what do you mean Medicare doesn’t pay for assisted living?”. The latter has a simple answer, but the former is much more complicated as Medicaid benefits vary from state to state. Our organization recently undertook a major research project to determine just what Medicaid will pay for with regards to assisted living in the year 2012. The first and most important point to make is that institutional or long term care Medicaid does not pay for assisted living. It is intended to help improvised individuals who require nursing home care. However, Medicaid Waivers in many states do provide assistance to individuals in assisted living residences. To avoid future confusion, we should mention that Medicaid Waivers are often referred to HCBS, Home and Community Based Services,1915 Waivers and sometimes Demonstration Projects. The second, and also critically important point to make, is that unlike institutional Medicaid, Waivers are not entitlements. An entitlement program means that if one meets the eligibility requirements, they receive the benefits. Waivers, on the other hand, have enrollment caps (or slots in Medicaid parlance). Each Waiver is approved to assist a limited number of persons and once the limit has been reached, a waiting list is started. Another finding from our study was that the types of assisted living benefits varied by state and can be loosely grouped into one of three categories. 1) Personal Care Only – these states will pay for their waiver participants personal care costs regardless of the location in which they reside. Therefore, assisted living residents could expect the personal care portion of their assisted living bills to be covered, at least up to Medicaid’s allowable reimbursement rates. 2) Nursing Home Level Care – similar to above, these states pay for personal care but also cover other nursing home level types of care for waiver participants. Again, independent of residence. 3) Complete Assisted Living – in these states, their Medicaid Waivers will pay for both personal care, nursing home level care and the room and board costs for the participants. Individuals must reside in assisted living communities which accept Medicaid reimbursements. While the number of individuals receiving Medicaid help in assisted living is limited as is the amount of assistance they receive; the situation is not all doom and gloom. In fact, the long term view (current political environment aside) can almost be considered rosy. Ten years ago, approximately half the number of states provided assistance and we fully expect this positive trend will continue. Ten years from now, Medicaid Waivers in all 50 states will likely be covering assisted living for the elderly in some capacity. We’ve consolidated the results from our study into a State by State Guide to Medicaid’s Assisted Living Benefits in which we explore each state’s coverage, its limitations and other state based alternatives.
Source: blogspot.com

OIG Report: Assisted Living Facilities need better compliance with federal regulations for HCBS

In its December 2012 Report, “Home and Community-based Services in Assisted Living Facilities,” the Office of the Inspector General (OIG) took a deeper look into the Centers for Medicare & Medicaid Services (CMS) waivers that allow coverage of HCBS by State Medicaid Programs. The waivers examined in this report include 1915 (c) and Section 115 research and demonstration. HCBS services, according to 42 CFR § 440.180(b), can include case management and homemaker services, personal care services, home health aide services as well as other services that are meant to aid in keeping people from being moved to a more traditional long term care setting.
Source: cmscompliancegroup.com

Miami Pharmacy Owner Pleads Guilty to Participating in $23 Million Health Fraud

The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.
Source: thehealthlawfirm.com

OIG: Assisted living needs to up information, compliance levels on HCBS

The OIG is asking the Centers for Medicare & Medicaid Services to put out more guidance on HCBS compliance with federal requirements. Assisted living programs might not be giving enough information about access to HCBS funds, the agency said. Methods for eligibility include Section 1915 c waivers or Section 115 research and demonstration waivers. The 1915 c waiver allows Medicaid to cover HCBS, but the OIG wants more information about the services, their compliance to the plan and their cost.
Source: mcknights.com

Elder Law Report Explains Medicaid Planning

Estate Planning, Probate and Living Trusts Information Center for Indianapolis, Fishers, Carmel, Noblesville, Greenwood, Plainfield, Geist, Greenfield, Brownsburg, Westfield, Zionsville, Hamilton County, Marion County, Hendricks County, Hancock County, Johnson County, Boone County, Indy, Central Indiana, Naptown Indiana, Frank & Kraft, Attorneys at Law
Source: frankkraft.com

United Healthcare AARP Medicare Complete Medicare plans for 2013

Posted by:  :  Category: Medicare

AARP AARP Connecticut AARP Medicare AARP Medicare Complete AARP Medigap AARP Medigap 2013 AARP Rates 2013 AARP Supplement AARP Supplement 2013 Anthem Anthem High F plan Anthem Medicare Anthem Medigap Anthem Supplement Coverage Gap Donut Hole Drug Help High Deductible F supplement LIS Connecticut Medicare Medicare Advantage Medicare Complete Medicare Complete connecticut Medicare Connecticut Medicare for Dummies Medicare Guide Medicare Introduction Medicare part B Medicare part D Medicare prescription drug plans Medicare Rx Medicare Saving program Medicare Supplement Medicare Supplement Connecticut Medigap Medigap rates 2013 Medigap rates NY 2013 MSP Connecticut Part D Part D Drug help Rx Help Rx help connecticut united healthcare United Healthcare AARP United Medicare complete 2013
Source: croweandassociates.com

Video: Medicare Basic Overview by United Healthcare Medicare Solutions

Is United Healthcare Medicare Supplemental Insurance My Only Option?

For most United Healthcare Medicare supplemental insurance subscribers, the plan is a lifesaver—making accessible important, lifesaving health and medical treatments, surgeries and medicines. Many believe that because Medicare doesn’t cover a particular procedure or treatment, that this is the end of the road for them—hardly the case. Unfortunately, many that suffer from mental health disorders find themselves in this situation—for one reason or another, the CMS (the Center for Medicare & Medicaid Services) doesn’t cover very many mental health-related medicines and treatments.
Source: seniorcorps.org

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

United Healthcare Medicare plans

As an example, United Healthcare Medicare HMO plans are super easy to utilize and comprehend. Simply pay out a set fee whenever you will need healthcare providers. You understand upfront precisely what the expenses will be and are not surprised by a huge physician’s expenses. An HMO plan charge you a collection price with an doctor office visit, emergency room go to, and hospital stay. The particular fees are generally under you’d probably pay using conventional Medicare health insurance insurance coverage. The sole probable issue with the HMO program’s you need to utilize physicians inside community until you need crisis attention. If you are using a doctor outside of the system, you should spend entire out-of-pocket price.
Source: blogspot.com

Join UnitedHealthcare for a National Medicare Education Week Event!

Representatives from United Healthcare will share important Medicare information and give an overview on social media.  Hands-on computer training will follow the presentation and will help you explore online resources for understanding.
Source: wordpress.com

United Healthcare Acknowledges Payment Shortcomings : AAFP Leader Voices

Honestly, Dr. Cain, does United think we’ll swallow this load of hooey? They ask us to believe that: “United’s leaders” had no idea that for over two decades they’ve been forcing take-it-or-leave-it sub-Medicare contracts on family physicians (“Gambling in Casablanca? I’m shocked”); that, with all the resources of the country’s largest insurer, they’ve been unable during the past 14 months to identify physicians with those contracts; that they’re “developing solutions” while doing absolutely nothing; and that, icing on the cake, they “recognize the value of primary care” but, in the linked article say they will pay “incentive payments and fees GROWING (my caps) to a range of $0.45 to $3.30 PMPM” for medical home services. Dr. Cain, these are not decent, honorable people. They are con men: their words are lies, and their actions show nothing but contempt for the AAFP and family physicians. Every year, we read of these meetings, and every year things get worse. This approach does not work. Let me repeat: this approach DOES NOT WORK. The AAFP must take a strong adversarial approach if it wants to adaquately represent its members. A couple of suggestions: a major publicity campaign aimed at patients and employers outlining the actions/inactions of United and other insurers; a hot-line so physicians with these contracts can identify themselves, with the AAFP forwarding this information to United (along with the suggestion that, since their “leaders” didn’t know about these contracts, they re-process all claims from the last 10 years!); a blog in which physicians can report their experiences in renegociating their contracts; and, most importantly, the AAFP must walk out of the PCPCC, with a simple, public statement that we can no longer work in any capacity with organizations that are so hostile to our members and so damaging to our speciality. No family physicians, no medical home: this would carry some weight! We must refuse to allow our good name and reputation to be used as cover by these groups. The AAFP HAS to draw a line beyond which they will no longer tolerate this abuse of their membership. Thank you.
Source: aafp.org

Member Spotlight: UnitedHealthcare

UnitedHealthcare is dedicated to helping people nationwide live healthier lives by simplifying the health care experience, meeting consumer health and wellness needs, and sustaining trusted relationships with care providers. Nationwide, the company contracts directly with more than 650,000 physicians and care professionals and 5,000 hospitals, and serves 38 million people. In New England, UnitedHealthcare serves more than 1.3 million people and works directly with 39,000 physicians and 230 hospitals, offering the full spectrum of health benefit programs:
Source: newenglandcouncil.com

UnitedHealth: Higher Earnings Despite Pressuers On Medicare, Medicaid Business

Bloomberg: UnitedHealth CEO Says Profit Pressures Squeezing Plans UnitedHealth Group Inc., the biggest U.S. health insurer, declined after Chief Executive Officer Stephen Hemsley said profit margins are being squeezed in its Medicare and Medicaid plans. … While UnitedHealth raised its 2012 profit forecast, the company is still coping with “minimal” rate increases in Medicare, the U.S.-backed plan for the elderly and disabled, Hemsley told analysts today on a conference call. He said the Minnetonka, Minnesota-based insurer may also consider pulling out of Medicaid markets in states where rates “aren’t sustainable” (Nussbaum, 7/19).
Source: kaiserhealthnews.org

Mercy Health Plans Announces New Name for Their Medicare Advantage Plans: Mercy Medicare… ( ST. LOUIS July 23 /

Posted by:  :  Category: Medicare

Related medicine news : 1. Redskins' Draft Pick Malcolm Kelly Energized By Trip To Mercy Ship In Liberia 2. Mercy Corps Delivers Lifesaving Supplies to China Earthquake Survivors 3. INSPIRIS and Mercy Care of Arizona Named Winners in URACs Best Practices in Consumer Empowerment and Protection Awards 4. VIDEO from Medialink and Philips: Philips Electronics Unveils First Imagination Light Canvas at the New Mercy Medical Center in Rogers AR 5. AmeriHealth Mercy Family of Companies Acquires Community Behavioral HealthCare Network of Pennsylvania 6. Area Dentists, University of Detroit Mercy Team Up to Provide Free Dental Care to Low-Income, Uninsured Detroit-Area Children on Saturday, February 2 7. University of Detroit Mercy School of Dentistry Moves to Larger Facility on New Corktown Campus 8. Independence Blue Cross Finalizes New Multi-Year Agreements with Mercy Health System and St. Mary Medical Center 9. Alameda County Hosts National Initiative to Reduce Health Disparities 10. AARP the Magazine Names the Top 10 Healthiest Places to Live in America 11. Mosaica Partners Kolkman to Chair HIMSS Healthcare Information Exchange Steering Committee
Source: bio-medicine.org

Video: Philadelphia: Medicare Fraud Summit Opening Remarks and Panel 1

Mercy Medicare Advantage HMO

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Source: posterous.com

Include Medicare enrollment in holiday to

This time of year, to-do lists take on more importance than ever before. While gearing up for the onslaught of holiday to-do’s, don’t let annual planning for the selection of health care coverage fall through the cracks. With little more than one week to go in the Annual Enrollment Period for Medicare, SummaCare offers the following advice to help make the right decision in a timely manner. For the second year, Medicare-eligibles only have through Dec. 7 to select and enroll in their plan of choice for 2013. What if you’re new to Medicare? Don’t get overwhelmed by all of the options. Instead, make a list of the things that are most important to you for health coverage so you know what to look for in a plan. Questions to ask include: •  What monthly premium can you afford? •  Do you need both medical and pharmacy benefits? •   Do you want to use certain doctors and hospitals? •  Does the plan include extra benefits and services like free gym memberships and other wellness programs? • Is the plan of high quality? How is it rated on Medicare’s “Plan Finder” tool at www.medicare.gov? What benefits are important to you? The list of benefits available is extensive, so if you try to review all of them, it can be overwhelming.  Focus on the benefits that are most important to you. The most common questions we hear are: •  Do you have comprehensive and affordable pharmacy coverage? •  What is the inpatient hospital co-pay and is there a cap or limit? •   What is your primary care physician co-pay? •   Do you have deductibles on medical or pharmacy? •   What value-added benefits are included for vision services, flu shots, fitness or wellness programs and online tracking tools? Help is available. Contact the health plans directly to talk to a knowledgeable sales representative about the choices available to you.  Also, look for helpful comparison charts that allow side-by-side comparisons of options. Go online. Look up plans in your area by visiting www.medicare.gov. If you have a specific plan you’re considering, visit the plan’s website directly for additional information. In many instances, applications can be submitted online – saving paperwork and time. SummaCare recently announced the addition of Mercy St. Vincent Medical Center, Mercy Children’s Hospital, Mercy St. Charles Hospital, Mercy St. Anne Hospital, Mercy Defiance Hospital, Mercy Tiffin Hospital, Mercy Willard Hospital and St. Rita’s Medical Center to its network. Additional information about the plans and expanded provider network can be obtained by calling 888-464-8440 (TTY 800-750-0750) or at www.summacare.com/medicare. About SummaCare Established in 1993, SummaCare offers a full line of health plans including PPO plans and Medicare Advantage plans plus life, dental and vision plans. Through its extensive network of more than 8,000 providers and more than 60 hospitals, SummaCare offers coverage to more than 225,000 members. SummaCare is recognized in Ohio by the Health Industries Research Company as a health plan with the most effective disease management programs for asthma, heart failure and diabetes. SummaCare is a health plan with a Medicare contract. The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, copayments and restrictions may apply. Benefits may change on January 1 of each year. Other providers are available in the network.
Source: sylvaniaadvantage.com

Integrated Managed Care Model for Dual Eligibles Reduces Readmissions

This analysis was subject to some limitations. For example, while we captured both full and partial duals in the Medicare FFS dual eligible control group, the Mercy Care Plan only enrolls full duals. Although our results were risk-adjusted, because partial duals may have access to greater resources than full duals, the difference in populations may have had some impact on our findings. Also, to identify the Medicare FFS dual eligibles in the 2009 Standard Analytic Files, Avalere was limited to using indicators known to either undercount or overcount duals depending on the state. The analysts used a linear regression method to risk adjust the measures of inpatient utilization, ED visits and adults’ access to preventive/ambulatory health services. Alternative methods are frequently used to model these types of quality measures, particularly for patient-level risk adjustment. We explored these other model structures and found these alternatives did not provide any considerable gains in model fit or predictive power.
Source: healthaffairs.org

What is a Medicare Benefits Schedule number?

Posted by:  :  Category: Medicare

For in-hospital services, the Medicare rebate will pay 75% of the Medicare Benefits Schedule fee and if you have private health insurance your Health Fund pays the remaining 25% as a benefit towards your doctors’ bills.  Some doctors and specialists charge more than the MBS fee. If this happens, you have to pay the ‘gap’, which is the difference between the MBS fee and what the doctors charge.
Source: wordpress.com

Video: Medicare Australia and Seeing a Doctor: nib Health Insurance Explained

Department of Human Services introduces a Medicare Benefits Schedule (MBS) item enquiry email service

Aboriginal and Torres Strait Islander people Australia Canada Case studies Centrelink Children Customer experience Data Department of Human Services Disabilities Disability services Egovernment Employment Error and Fraud Europe Evaluation Families Gov 2.0 Health Homelessness Housing Information and Communications Technology Innovation Internet Law and Legislation Local government Mental health Mobile Open Government Participation Privacy Public administration Public Sector Remote Seniors Service delivery Social inclusion Social media Statistics Surveys United Kingdom United States Vulnerable welfare Youth
Source: gov.au

Key tax and superannuation changes in 2013

• The Dad and Partner pay will be available to eligible working fathers and partners who: – care for a child born or adopted from January 1, 2013 – work full-time, part-time or are casual, seasonal, contract or self-employed workers – have worked at least 330 hours – just over a day a week – in 10 of the 13 months before the birth of their baby with no more than an eight week gap  between two consecutive working days – earned $150,000 or less in the previous financial year, and – fulfil the Australian residency test. • The SchoolKids Bonus replaces the Education Tax Refund. Around a million families will receive a cash handout of $820 for every high school child and $410 for every primary school child as part of the new bonus. The direct, upfront payments require no paperwork. • The Government will limit eligibility for Family Tax Benefit Part A to young people under 18 years of age or, where a young person remains in secondary school, the end of the calendar year in which they turn 19. Individuals who no longer qualify for FTB Part A may be eligible to receive Youth Allowance. • All unemployed single parents will lose the Parenting Payment when their youngest child turns eight. For unemployed partnered parents, the payment will stop when their youngest child turns six. Although the cut-offs were introduced in 2006, it did not apply to parents who were already receiving the support payment. Now, it will apply across the board and force these parents on to the Newstart Allowance while they seek employment. Also, recipients of the Parenting Payment will have compulsory part-time participation requirements when their youngest child turns six. • There will be a more generous income test for single principal carer parents on Newstart Allowance that will allow them to earn around $400 more per fortnight before ceasing eligibility for payment. • Individuals can travel overseas and continue to receive income support payments such as the Parenting Payment, Austudy, Rent Assistance and Family Tax Benefit Part A and B – among others – for only six weeks as opposed to 13 weeks. • The government will increase a number of visa application charges for skilled graduates, partners, working holiday makers and temporary overseas workers. • The government will restrict telehealth services to those patients for whom distance is the most significant barrier to accessing specialist care, meaning the eligibility criteria for the Medicare Benefits Schedule will be amended to exclude patients in outer metropolitan areas and major cities of Australia.
Source: com.au

Len Saunders, Health, Fitness, and Wellness for Children

Len has received praise for his leadership in the fight against childhood obesity from professional athletes, celebrities, and President’s of the United States, as well as being invited to the White House on numerous occasions. He has also won multiple awards at the state and national levels for his efforts to keep children healthy and fit. Len’s approach to children’s health, fitness, and wellness is quite simple, but extremely effective. Len is best known for creating Project ACES, an event in which millions of school children worldwide exercise simultaneously in May each year.
Source: lensaunders.com

Why.Not.Medicare Benefit Schedule ?

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Source: gdf-jorge-antunes.com

Skin cancer bill to skyrocket by 2015

Most of such skin ‘cancers’ don’t need disfiguring surgery as there are special creams, such as Curaderm (developed by an Australian), that have been shown in randomised controlled trials to be effective in removing the lesions at minimal cost and without scarring. They are not being used, mainly because it would affect the number of patients that surgeons would have.
Source: edu.au

myMBS for iPhone – Search the Australian Medicare Benefits Schedule

News.iPhoneWorld.ca is a new service from iPhone World. We call it iNews aggregator, and rightly so: our iNews aggregator fetches the latest stories about all things i — Apple, iPhone, iPod, iTouch and iPad, as well as select tech news — from leading online publications. It’s automatically updated every 5 minutes, is categorized for easy browsing, currently contains close to 100 sources with more being added all the time. Registered users can create custom news feeds and vote up articles. iNews Aggregator is still in an early beta testing stage, though it’s open for the public. As such some things might not work as expected, while the category filters are still slightly off. We’re working on fixing these features and are in the process of adding new ones. May 5, 2010: iNews Aggregator now features a comments system and a brand new design. Stay tuned for more coming soon!
Source: iphoneworld.ca