Don't Cut Social Security

Posted by:  :  Category: Medicare

Social Security Adminstration building on Edsall Rd - 100-0027 by Rev. Xanatos Satanicos Bombasticos (ClintJCL)American pensions were some of the hardest hit in the world by the Great Recession, falling in value by over a quarter in 2008, with only modest recovery since then. But private pensions already had become a less steady leg of retirement security prior to the recent recession. Since the early 1980s, businesses have gradually shifted responsibility for pensions onto workers, with predictable results. In 1981, approximately 60 percent of private sector workers were covered by a pension with a guaranteed payout. Today only about 10 percent of private sector workers have guaranteed payout pensions. Meanwhile, 401(k)-type retirement contribution plans have gone from covering only about 17 percent of the private workforce to about 65 percent today (see Figure 3).
Source: alternet.org

Video: Social Security: Just the Facts

Daily Kos: Fiscal cliff discussions break down after Republicans demand Social Security cuts

a Second Great Depression aren’t they?  It’d be nice if we were led by Congressmembers who cared more about the country than their own personal careers and overall political power.  That’s what I find so bothersome about this.  It’s all about winning the Crossfire style point, not about doing what’s right for the country.  Meanwhile the fate of everyone else hangs in the balance.  Whether you’re a wealthy investment banker who could see major losses to your networth due to the market crash brought about all this uncertainty or you’re unemployed relying on unemployment insurance just to survive and risk losing it.  Or if you’re just anyone who needs to know whether they can pay their bills or whether they’re going to see a massive increase in taxes.  
Source: dailykos.com

Daily Kos: THIS JUST IN: Social Security still not a driver of U.S. debt

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Source: dailykos.com

Social Security: Will Obama Cave?

Correct me if I am wrong, but isn’t one of the primary drivers of inflation the increasing cost of energy (in it’s various forms)? If the ‘Chained CPI’ lives by the concept that the consumer will seek other, less-expensive alternatives…what can replace gasoline for the car or electricity or natural gas for the home? How about food costs? Switching to less expensive items will often require switching to less healthy, processed alternatives. Such a food shift would reduce quality of life and cause a cost shift to the healthcare system. The Democrats will completely lose me if they do not stick to their guns on the $250,000 income level and stay away from social security benefits. I make about $120,000 per year. I would rather revert to pre-Bush tax rates for all rather than cave to the Republicans. We have a serious deficit and debt situation…reducing tax income generation as a negotiating tactic borders on the insane. Let the tax cuts expire then submit a new bill in the Senate to re-establish the tax cuts (or some level of tax cuts) to those under $250,000 income and restore expired unemployment benefits. Let the Republicans vote against it in the house to their peril. Re-establish full social security tax with-holdings. Expand income levels that can be taxed for social security and Medicare, if necessary. Raise the social security tax slightly to compensate for any future bumps in the road. Do not con us and do not try to manipulate us. We know that the social security fund is not the problem. We know that the Bush tax cuts were a huge contributing factor in past and current debt and deficit increases…especially the tax cuts for the wealthiest individuals. Policies changes need to reflect that reality that over the past several decades the economic status of middle income groups has decayed while the wealthy have substantially gained and this trend needs to be reversed…or our economy and society will fail.
Source: prospect.org

California insurance firm over billed Medicare $424 million

Posted by:  :  Category: Medicare

Grand Bargain Watch - Save Social Security by DonkeyHoteyAccident Arnold Schwarzenegger Arrest Arroyo Grande Atascadero Avila Beach California Cal Poly Campaign 2012 Court Crime Environment Estate Financial Inc. Event Photos Fire Grover Beach Guns Jerry Brown Kelly Gearhart Labor Unions Lawsuit Medical Marijuana Morro Bay Music New Job Nipomo Oceano Opinion Paso Robles Paso Robles Police PG&E Pismo Beach Politics Public Education Public Health Sad Sam Blakeslee San Luis Obispo San Luis Obispo County San Luis Obispo County Sheriff San Luis Obispo County Supervisors San Luis Obispo Police Taxes Water Wine
Source: calcoastnews.com

Video: What is a Medicare health insurance exchange?

Raising the Medicare Age Is a Uniquely Terrible Idea

Medicare currently is significantly more cost effective than private insurance. Raising the Medicare retirement age would mean shifting many older people from a more cost effective government program to a less efficient private insurance system. This would not just force those near retirement to pay the full cost of their insurance, but since private insurance is a worse bargain these seniors would need to pay even more to get the same level of coverage Medicare would have provided.
Source: firedoglake.com

What Is A Medicare Supplement

There are ten different Medicare supplement plans.  Each one is given a different letter.  The letters skip a few here and there because plans that were once available have been retired and the labeled the new plans with the next letter in the alphabet so as not to create confusion for people who were grandfathered in on the old plans.  The plans themselves cover a varying number of combinations of the nine different coverage gaps that were left by the coverage you get with Medicare Part A and Medicare part B.  The Gaps include: the deductible, coinsurance, first three pints of blood and hospice care from Medicare Part A, The deductible and coinsurance for Medicare Part B, skilled nursing facility care, and expenses for foreign travel emergencies. Which plan you select dictates how many or what combination of these coverage gaps are covered.  Plan A covers only four of the gaps while Plan F covers all nine.
Source: seanbrock.com

OPINION: don't raise the Medicare eligibility age

Proponents of this idea say its time has come because starting in 2014, insurers will no longer be able to deny coverage to anyone because of age or health status, thanks to the Affordable Care Act.  People who can’t get coverage through the workplace will by then be able to shop for it on the state exchanges. But insurers will still be able to charge older people three times as much as younger folks. That would pose afinancial hardship for many seniors. The Kaiser Family Foundation estimates that two-thirds of 65 and 66–year-olds would have to pay at least $2,200 a year more for coverage than they would if they were on Medicare.
Source: publicintegrity.org

The Prognosis of Medicare

With the fate of the Affordable Care Act now assured, we have received many questions about what Health Care Reform means for Medicare and will there be further cuts in benefits in 2013.  The short answer is no, at least not yet.  This fall has been an especially confusing time for Medicare beneficiaries.  The elections coincided with the Medicare open enrollment period where all the insurance companies aggressively advertise and try to woo people to join their plans.  All of these events together create confusion with a deluge of information, misinformation and rumors about what is likely to happen to Medicare next year.
Source: insuranceconnection.net

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

Are There Several Medicare Insurance Companies?

On reaching age 65 you become eligible for enrollment in Medicare. Medicare has two parts. Part A covers hospitalization and does not cost the recipient anything. Part B covers most out-patient services and has a monthly premium, taken out of your Social Security benefits. Part B premiums can vary, depending on your adjusted gross income from two years previously. In 2012, the basic premium is $99.00.
Source: seniorcorps.org

Superior Care Provided By Medicare Plans

For getting complete coverage for your health care expenses, you need to select most suitable Medicare plans. You need to Compare Medicare Advantage plans and Medicare Supplemental plans and then select the Best Medicare Advantage Health policies that are able to meet your varying health care or medicals needs. In order to get maximum benefits from Medicare plans, you have to take lot of care to choose most suitable one. Before selecting a plan, you have to analyze your health care needs and current health insurance. If you have a standalone prescription drug plan, then you don’t need to choose Medicare Part D plan. Overestimating the value of this will increase your overall cost. You have to choose plan that suitably fits your expectations, budget and lifestyle. Superior Care Provided By Medicare Plans
Source: blogspot.com

Insurance Companies Rip Medicare Off for $282.6 Billion

In addition, private insurance plans cherry-pick by selectively recruiting the healthiest seniors whose care will cost much less than the premiums they generate for the company. As the article concludes, both Republicans and Democrats who championed Medicare HMOs in the eighties and nineties argued that “market-based” privately financed Medicare would be more efficient and save money. In fact the opposite is the case. As with privatized prisons, charter schools, public water systems and private military contractors like Blackwater and Halliburton, this is yet another form of corporate welfare – another way to bilk taxpayers out of hundreds of billions of dollars to increase CEO salaries and shareholder dividends. Health-care CEOs had the highest median pay of any industry in the 2010 The Wall Street Journal CEO Compensation Study.
Source: aegauthorblogs.com

Romney’s proposal for Medicare would benefit insurance companies, raise costs for seniors

As part of the Affordable Care Act, $716 billion was cut from Medicare spending (not funding). A big chunk of this cut was reducing spending on the Medicare Advantage program, a failed privatization plan. Medicare Advantage turned over a part of Medicare to private health insurance companies. But instead of costing less, it has always cost more than the government Medicare program to provide the same benefits. This is a no-brainer since the private, for-profit insurance companies have to pay dividends and huge executive salaries that Medicare does not. This is why 98% of Medicare spending goes to health care, while private insurance companies have spent only 80% or even less, with the rest going to shareholders, executives and waste. The Affordable Care Act tries to reign in this spending.
Source: fightbacknews.org

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

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

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

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

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

6 Questions To Ask Before Moving Into a Nursing Home Facility

The Centers for Disease Control and Prevention state that an elder is twice as likely to suffer a fall in a nursing home as he or she is in the community. In fact, the CDC says that the average nursing home patient suffers 2.6 falls per year and that physical restraints do nothing to reduce the risk. If you have ever visited a nursing home and noticed a preponderance of residents in wheelchairs, it may be a response to liability as much as disability. A corollary to this: if residents are discouraged from being ambulatory, their leg strength may quickly diminish.
Source: billlosey.com

Senior Care in Humble, TX: Open Enrollment for Medicare –Now through Dec 7, 2012

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

Elder Care Services to 2016 : ReportsnReports

VII. INDUSTRY STRUCTURE 153 General 153 Industry Composition 153 Market Share 157 Competitive Strategies 163 Marketing 166 Mergers & Acquisitions 168 Cooperative Agreements 176 Company Profiles 180 Active Day, see Senior Care Centers of America ADT Corporation 181 Adult Day Care Group 182 Advocat Incorporated 183 Advocate Hospice, see Gentiva Health Services Aegis Therapies, see GGNSC Holdings Altura Homecare & Rehab, see Skilled Healthcare Group Amedisys Incorporated 185 American Senior Communities LLC 187 AseraCare, see GGNSC Holdings Assisted Living Concepts Incorporated 190 Atria Senior Living Group Incorporated 191 Beacon Hospice, see Amedisys Benedictine Health System 192 Brookdale Senior Living Incorporated 194 Capital Senior Living Corporation 197 Chemed Corporation 200 CK Franchising, see Sodexo Comfort Keepers, see Sodexo Cornerstone Hospice, see Skilled Healthcare Group Countryside Hospice Care, see Sun Healthcare Group Covenant Care Incorporated 202 Ecumen 203 Emeritus Corporation 204 Evangelical Lutheran Good Samaritan Society 207 Extendicare Incorporated 210 Family Comfort Hospice, see Chemed Five Star Quality Care Incorporated 212 Genesis HealthCare Corporation 214 Gentiva Health Services Incorporated 217 GGNSC Holdings LLC 220 Griswold Home Care Incorporated 222 Harbinger Hospice, see Sun Healthcare Group HCP Incorporated 223 Heart to Heart Hospice of Starkville, see Gentiva Health Services Home Instead Incorporated 225 Horizon Bay Realty, see Brookdale Senior Living Hospice of Hackensack University Medical Center, see Amedisys Interim HealthCare Incorporated 226 Kindred Healthcare Incorporated 228 LCS LLC 232 Life Alert Emergency Response Incorporated 234 Life Care Centers of America 235 LivHOME Incorporated 236 Manor Care Incorporated 238 Masonicare 240 National HealthCare Corporation 242 North Mississippi Hospice, see Gentiva Health Services Odyssey HealthCare, see Genesis HealthCare ParaMed Home Health Care, see Extendicare Philips Lifeline, see Royal Philips Electronics Professional HealthCare, see Kindred Healthcare Royal Philips Electronics NV 246 SavaSeniorCare LLC 248 Senior Care Centers of America Incorporated (formerly Active Day) 249 Skilled Healthcare Group Incorporated 251 Sodexo 254 Sun Healthcare Group Incorporated 256 Sunrise Senior Living Incorporated 258 Tyco International Limited 261 United Home Care Group, see Gentiva Health Services VITAS Healthcare, see Chemed Other Elder Care Companies 263
Source: reportsnreports.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

Louisiana Law Blog: Recent Developments in Medicare Set Aside

Posted by:  :  Category: Medicare

Running Amok Again by elycefelizSpecifically, the District Court held that no federal law requires an MSA in personal injury settlements for future medical expenses. The District Court held that while MSA’s are prudent in settlements for future medical expenditures in the workers’ compensation context, they are not required outside that context. The District Court further commented that to require personal injury settlements to specifically apportion future medical expenses would prove burdensome to the settlement process and, in turn, discourage personal injury settlements. Finally, the District Court dismissed the September 29, 2011 advices of the CMMS described above by pointing out that “interpretation such as those in opinion letters, like interpretations containing policy statements, agency manuals, and enforcement guidelines lack the force of law.” Christensen v. Harris County, 529 U.S. 576, 587 (2000).
Source: louisianalawblog.com

Video: Structured Medicare Set Aside

COURT APPROVES LIABILITY MEDICARE SET ASIDE

, No. 6:11-cv-0941, 2012 U.S. Dist. LEXIS 124690 (W.D. La. Aug. 30, 2012), the court confirmed the adequacy of the parties’ proposed Medicare Set Aside (“MSA”) in a liability settlement. Plaintiff was severely injured while working as a crane mechanic aboard a liftboat, and he settled his personal injury action for $785,000.00. The settlement agreement required the plaintiff to establish an MSA to pay for his future medical expenses. The plaintiff filed a declaratory judgment action seeking (1) approval of the settlement, (2) a declaration that the interests of Medicare were adequately protected by setting aside a sum of money to fund the plaintiff’s reasonably anticipated future medical expenses related to the injuries claimed and released in the lawsuit, and (3) an order setting that amount aside from the settlement proceeds and depositing it into an interest-bearing checking account to be self-administered by the plaintiff.
Source: themedicarespa.com

Dawson Disantis & Myers, LLC: Ohio BWC Implements New Medicare Set

As most Ohio self-insured employers know, one of the most difficult hurdles in settling a workers’ compensation claim is the Medicare Set-Aside.  On November 5, 2012, BWC Administrator Stephen Buehrer announced a new BWC policy which addresses the MSA threshold for state funded settlements.  BWC will issue a Medicare set-aside letter only if 1.) the settlement is $100,000 and over or 2.) if the settlement is over $10,000 and the injured worker is already on Medicare or has a reasonable expectation of receiving Medicare within 30 months. While Buehrer’s policy announcement appears to address settlement of state fund claims, self-insured employers can look to the BWC’s MSA thresholds for guidance.  Of course, Dawson Disantis & Myers, LLC encourages SI employers to discuss MSA for Ohio workers’ compensation settlements further with legal counsel. Buehrer’s MSA policy letter is below:
Source: blogspot.com

The New Frontier of Liability Medicare Set Asides: Part 3

A large problem with today’s MSP compliance hysteria is that defense attorneys and insurers are routinely including “kitchen sink” language in their releases to address Medicare. This language frequently shifts all of the responsibility of creating a Medicare set aside to the injury victim while identifying an arbitrary amount to be set aside. This practice is dangerous because those releases typically have the injury victim acknowledge a responsibility to set funds aside while picking an arbitrary, usually small, amount to be set aside. This is a bad practice and exposes the injury victim as well as plaintiff counsel since if CMS ever refused to pay for Medicare covered services related to the injury there would be no way to justify the amount of the set aside. A better practice is to actually do an MSA analysis, which may or may not include getting a formal MSA allocation done. There are certain instances where an MSA may be unnecessary based upon factors present in the case such as a private primary health insurance policy, Workers’ Compensation coverage for future medical or where there is no future Medicare covered expenses related to the injury. These should be identified and the release language specifically tailored to that exception but with an indication that Medicare’s future interests where considered with nothing needing be set aside. If the case requires the full-blown MSA analysis, it should be done and the cost of doing so passed along as a client cost. Most MSA allocation reports cost between two thousand and three thousand dollars, which is a small price to pay for the proper analysis of the client’s future Medicare covered services. The allocation gives all parties the proper amount to be set aside, arguably subject to a reduction formula.
Source: legalexaminer.com

Medicare Set Aside Trusts: Critical Issues Surrounding Personal Injury Awards

A Medicare Set-Aside (MSA) is a fund set aside from the proceeds paid from the settlement of a Workers’ Compensation or personal injury liability case. A portion of the settlement is set-aside to pay for future medical expenses related to the injury that would otherwise be paid by Medicare. Previously, MSAs were only required in Workers’ Compensation Cases. New rules will require MSAs for most personal injury liability cases where the plaintiff may receive Medicare benefits in the future. Register for this important seminar to learn how the Medicare Set-Aside requirements will apply to personal injury lawsuits.
Source: ali-cle.org

CMS officials issue reminder on Medicare secondary payer laws

Posted by:  :  Category: Medicare

Participating Medicare providers, physicians, and other suppliers must not accept from beneficiaries any co-payments, coinsurance payments, or other payments, for services rendered when the primary payer is an employer-managed care organization (MCO) insurance plan, or any other type of primary insurance such as an employer group health plan, U.S. Centers for Medicare & Medicaid Service (CMS) officials warned in a new Medicare Learning Network (MLN) Matters® article last month.
Source: newsfromaoa.org

Video: Navigating the Medicare Secondary Payer Act

Medicare Secondary Payer: Will the SMART Act Pass This Year?

At the moment, H.R. 1063 has 100 sponsors yet Congressman Murphy stated that it needs 190 before they are able to progress to a mark up. The other issue it is dependent upon is scoring by the Congressional Budget Office (CBO). The bill must prove to have no negative impact on the budget, yet CMS will not speculate as to how much it will cost or recover on behalf of Medicare, therefore the bill will be subject to dynamic scoring and CBO will forecast what effect reactions to the policy are expected to have on the budget. Congressman Murphy alluded to a RAND report which apparently demonstrated that an exclusion of claims that settle for under $5,000 will still result in 90% of Medicare recoveries yet only use 43% of resources needed to obtain the reimbursements, therefore it seems plausible for the CBO to find a positive impact. If the additional sponsors are obtained and the bill scores, the goal is to push it before the August recess. If that doesn’t happen, Dave Farber of Patton Boggs feels strongly that legislation will pass when Congress resumes before the election and the SMART Act has a good shot given that it is good for the budget, big and small business, Medicare beneficiaries and the Medicare trust fund. If it does not get passed prior to the election, there will be one last shot when Congress returns for the lame duck session, but after that, it is expected that a new bill will need to be drafted and the entire will process start over next year.
Source: lexisnexis.com

The Medicare Secondary Payer Act: Ethical Considerations in Settling Cases

Before the MSP Act became a major issue in workers’ compensation and other cases involving personal injuries, attorneys were often not mindful of their obligations under the act and its potential ethical ramifications. Prior to the year 2000, a number of jurisdictions issued advisory opinions regarding the conduct of lawyers with respect to the settlement of liability or workers’ compensation claims, or both, and the resolution of unpaid liens for medical providers as a condition of settlement. However, these advisory opinions were short and vague. For example, in 1996, the state of North Carolina issued a rather benign statement indicating that lawyers in a personal injury claim may not execute an agreement to indemnify the tortfeasor’s liability insurance carrier against unpaid liens for medical providers.
Source: mnbenchbar.com

Medicare Secondary Payer (MSP) Program: Proposed Rules for the Treatment of Funds Intended for Future Medical Expenses 

[1] See 77 Federal Register 35917 (June 15, 2012), [CMS–6047–ANPRM].  [2] See section 1862(b) of the Social Security Act (the Act), 42 U.S.C. §1395y(b)(2)(Medicare Secondary Payer Program) http://www.ssa.gov/OP_Home/ssact/title18/1862.htm. [3] 42 U.S.C. §1395y(b)(2)(B). [4] 42 U.S.C. §1395y(b)(2)(B)(i). [5] 42 U.S.C. §1395y(b)(2)(B)(iv). [6] 42 U.S.C. §1395y(b)(2)(B)(iii). [7] For information about CMS activity related to MMSEA, see http://www.cms.gov/Medicare/Coordination-of-Benefits/MandatoryInsRep/index.html?redirect=/mandatoryinsrep/. [8] See §111, 42 U.S.C. §1395y(b)(8). [9]  See 42 U.S.C. §1395y(b)(8)(B). [10]  See 42 U.S.C. §1395y(b)(7). [11] See, Reporting Workers Compensation case information: https://www.cms.gov/Medicare/Coordination-of-Benefits/WorkersCompAgencyServices/reportingwc.html; set-aside arrangements: https://www.cms.gov/Medicare/Coordination-of-Benefits/WorkersCompAgencyServices/wcsetaside.html; coordination of benefits: https://www.cms.gov/Medicare/Coordination-of-Benefits/WorkersCompAgencyServices/WCMSAP.html. [12] In commenting, please refer to file code CMS–6047–ANPRM. CMS will not accept comments sent via FAX. Comments may be submitted electronically to http://www.regulations.gov; via regular mail (Attention: CMS–6047–ANPRM P.O. Box 8013, Baltimore, MD 21244–8013); express or overnight mail (Attention: CMS-6047-ANPRM, Mail Stop C4-26—5, 7500 Security Boulevard, Baltimore, MD 21244-1850; or by hand or currier (Room 445– G, Hubert H. Humphrey Building, 200 Independence Avenue SW., Washington, DC 20201., telephone (410)-786-1066 in advance of delivery by hand or currier.)
Source: medicareadvocacy.org

H.R.6435: Medicare Secondary Payer and Late Enrollment Penalty Family Fairness Act of 2012

9/19/2012–Introduced.Medicare Secondary Payer and Late Enrollment Penalty Family Fairness Act of 2012 – Amends title XVIII (Medicare) of the Social Security Act to apply the eligibility requirements of Medicare special enrollment periods, secondary payer rules, and late enrollment penalties in a way to take into consideration the current employment status of all family members of an employee (currently, only the employment status of the employee or of the employee's spouse).
Source: opencongress.org

Gould & Lamb to Host Medicare Secondary Payer Compliance Breakout :Gould & Lamb

Program Moderator, Bret Cade, Executive VP of Sales at Gould & Lamb, LLC will lead the day long seminar. Planned presentations include Medicare Secondary Payer Act 101: The Reader’s Digest Version by Roy Franco, Esq., Principal at Franco Signor, LLC, The Eye in the Sky: Mandatory Insurer Reporting by Scott Huber, Vice President of Information Technology at Gould & Lamb, LLC and Jeff Gurtcheff, VP and General Manager at PMSI, Render Unto Caesar What is Caesar’s: Conditional Payments  Resolution by Wanda Reas, Esq., Partner at Znosko & Reas, P.A. and John Cattie with the Garretson Resolution Group, So Let It Be Written, So Let It Be Done: A Legislative and Case Law Update by Mark Popolizio, Esq., Senior Legal Counsel at Crowe Paradies and Roy Franco, Esq., Principal at Franco Signor, LLC, Seeing the Forest Through the Trees: MSA/LMSA Trends by Rafael Gonzalez, Director of Medicare Compliance & Post Settlement Administration at Gould & Lamb, LLC, Celia Mendez, Esq., Mediator & Attorney at Moreland & Mendez, P.A., and Cynthia Sage, Esq., Corporate Counsel at FCCI Insurance Group. The program will end with MSP Compliance in the Real World: A Roundtable Discussion where all of the previously mentioned speakers will be joined by Skip Brechtel, Chief Technical Officer at CCMSI, Wade McGuffey, Esq., of Goodman, McGuffey, Lindsey & Johnson, LLP, and the Honorable David Langham, Deputy Chief Judge of Workers’ Compensation Claims.
Source: themedicarecomplianceblog.com

The Rules of The Medicare Secondary Payer

6 ways to improve the orthopedics practice A Study in 5010 and Podiatry Q Codes Benefits of EMR/EHR billing and coding issues EHR electronic health records EMR EMR consultant emr dictation integration emr integrated medical billing services EMR revolution EMR software EMR support EMR support company EMR support services HITECH incentives icd9 to icd10 ICD 10 implementation Increasing Revenues Through Medical Billing iSource medical billing medical billing office medical coding medical rata Medical records medical reports medical transcription medical transcription and billing medical transcription service industry Orthopedic surgeons orthopedic transcription outsourcing medical billing patient records revamping the revenue management cycle services The Benefits of EMR The Hour Of Reckoning The integration of pacs into orthopedic emr tips Transcribers transcription provider trends for orthopedic tutorial US Healthcare
Source: medicaltranscriptionsservice.com

THE MEDICARE SECONDARY PAYER RECOVERY PORTAL, A NEW ONLINE SELF

The Centers for Medicare & Medicaid Services (CMS) have implemented a new web-based tool that was created to assist parties resolve liability insurance, no-fault insurance, and workers’ compensation Medicare recovery cases. The tool is called the Medicare Secondary Payer Recovery Portal (MSPRP) and it provides users with the ability to access case specific information over the Internet, replacing written communication and the necessity of placing calls to a Medicare Secondary Payer Recovery Contractor. The MSPRP will allow users to perform various activities, including submitting proof of representation or consent to release documentation, requesting conditional payment information, disputing claims included in a conditional payment letter, and submitting case settlement information.
Source: themedicarespa.com

House Panel Approves Changes to Medicare Secondary Payer (MSP), Medical Loss Ratio Rules : Health Industry Washington Watch

On September 20, 2012, the House Energy and Commerce Committee approved by voice vote H.R. 1063, the Strengthening Medicare and Repaying Taxpayers (SMART) Act. The legislation would make a series of procedural changes to MSP rules intended to “speed up the process of returning money to the Medicare Trust Fund while reducing costly legal barriers for both large and small employers.” The panel also approved on a 16-14 vote H.R. 1206, the Access to Professional Health Insurance Advisors Act. The legislation would amend the Affordable Care Act’s (ACA) health insurance medical loss ratio (MLR) rules to exclude from the calculation of the MLR certain commissions paid to independent insurance brokers and agents. H.R. 1206 also would require HHS to defer to a state’s determinations as to whether enforcing the MLR requirement will destabilize their respective individual or small group health insurance markets. Neither bill has been considered by the full House to date.
Source: healthindustrywashingtonwatch.com

Understanding Medicare Secondary Payer

It is important to understand Medicare billing requirements which can be somewhat complex. Consider attending training events and opportunities. Providers must ensure that those responsible for preparing and submitting claims to Medicare are aware of proper submission guidelines and regulations. Knowing the answers to the following questions can help your billing process a lot easier.
Source: about.com

Medicare Secondary Payer and “Future Medicals” A Movement Toward a Standardized Process?

CMS states that its interests should be considered in every settlement where the claimant, “reasonably anticipates receiving, or should have reasonably anticipated receiving Medicare covered…services after the date of “settlement…”.  To accomplish this purpose, CMS proposes options  ranging from absolute exemptions on one end of the spectrum (i.e., CMS defined a set of circumstances in which no further action would be necessary / no “set aside” required) to alternatives on the other end of the spectrum that involve a) the beneficiary paying for all future injury-related care out of his/her settlement proceeds until they are exhausted or b) submitting a proposed Medicare Set Aside arrangement (similar to the current process in workers’ compensation).With regard to the latter options, it is important to note that CMS acknowledges that perhaps thresholds could be established (i.e., a dollar amount below which no action is necessary even if one of the other exemptions do not apply).
Source: dritoday.org

MO Chapter, American Academy of Pediatrics

Posted by:  :  Category: Medicare

Joe the Plumber - To Flush The System ... More scams aim to ensnare Brevard seniors - Their ingenuity is boundless, Archer said. (Jul 2, 2012) ... by marsmet524Beginning in January 2013 Medicaid primary care services provided by physicians with a specialty designation of family medicine, general internal medicine or pediatric medicine are eligible for increased payments for primary care Evaluation and Management (E/M) codes 99201-99499.
Source: moaap.org

Video: Missouri Medicare Supplement Insurance Plans Call 816-318-7050

The A, B, C and D of Medicare

These plans change every year and it is expected that the monthly premium for part D of a basic plan will be about $30, which is no change from this year.  If you are not settling for a basic plan, review your options.  Some plan premiums have risen dramatically from last year and there are also more bargain plan options.  If you are already enrolled in a plan, you may want to give it a once over to ensure there is no premium hike on it and then compare it to some of the bargain options.  Also before you make your final decision on which drug plan you would like to go with ensure that the deductible is not too high that it may be well worth paying a higher premium elsewhere.  Plans, for 2013, can tack on deductible of up to $325.00.
Source: fiohinvestments.com

Radiology, News, Education, Service

Williamson said he doesn’t believe any unnecessary tests were ordered, and that all exams were performed properly. However, the hospital is planning to hire independent radiology experts to conduct an in-depth review and advise the hospital if any additional steps are needed. If the review shows that patients could benefit from further imaging review or testing, the hospital will directly contact those patients and doctors, Williamson said.
Source: auntminnie.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

No compromise on entitlement spending, Democrats urge McCaskill

As the deadline for a deal on a fix to the fiscal cliff looms, a group of Democratic organizations — including the American Federation of State, County and Municipal Employees, Service Employees International Union, and the National Educators Association — launched a new television ad in Missouri on Friday urging McCaskill to oppose “any cuts” to Medicare, Medicaid, and Social Security.
Source: politicmo.com

Medicare Scam Prevention to be Taught by Insurance Expert, Police

Con artists and scammers constantly invent new ways to take advantage of elderly people. “The Medicare Open Enrollment Period is the perfect opportunity to dupe seniors,” said St. Louis County officer Dusty Poncin. “Identity thieves are targeting Medicare recipients for their personal and financial information, and then running up huge bills in their names before anyone is the wiser.”
Source: patch.com

Blue Shield Medicare in San Jose, CA

This brings me to my next point of the mysterious bill you get in the mail from Medicare.  One of our current clients just signed up for a Blue Shield Medicare Supplement plan.  The plan is about $97/mo which is great!  However, she got a bill in the mail from “Medicare” asking her to pay over $500.  What?!  We were just as confused.  I called up Blue Shield last week to check and see if everything had gone correctly and she was enrolled for exactly the $97/mo and no penalties had been given.  Nope—just fine on the Blue Shield side.   I called and emailed said client back and let her know not to worry about her Medicare Supp plan, but we’d like to review that bill she received in the mail from “Medicare.”
Source: brauerinsurance.com

Medicare Agency Rules in favor of Patient Access to CRNA Care

Even though Missouri CRNAs have had a temporary regulatory setback regarding the provision of Chronic Pain services under fluoroscopy, this is excellent news for our brothers and sister across the nation providing chronic pain care to rural, senior, and economically disadvantaged Americans! This is one more piece of evidence to permanently end the Missouri restriction.
Source: moana.org

House Bill Would Limit Document Requests in Medicare Fraud Cases

Graves said, “Doctors and nurses should be focused on caring for patients, not trying to comply with the ever-increasing requests for documents.” He added that the current audit process is especially burdensome for smaller, rural hospitals that are ill-equipped to handle the increased administrative work (Kasperowicz, “Floor Action Blog,” The Hill, 10/18).
Source: californiahealthline.org

Health Plans Providing Value to Medicare Advantage Beneficiaries

Posted by:  :  Category: Medicare

Maryland Health Insurance Plan Federal Press Announcement by MDGovpicsHealth plans are working with seniors and people with disabilities in Medicare Advantage plans to ensure that beneficiaries receive health care services on a timely basis, while also emphasizing prevention and providing access to disease management services for their chronic conditions.  These coordinated care systems provide for the seamless delivery of health care services across the continuum of care. Physician services, hospital care, prescription drugs, and other health care services are integrated and delivered through an organized system whose overriding purpose is to prevent illness, improve health status, and employ best practices to swiftly treat medical conditions as they occur, rather than waiting until they have advanced to a more serious level.
Source: ahipcoverage.com

Video: The 6 Minute Muscle Building Meal Plan – Healthy Dinners

More Health Plans, Employers Begin To Pay for Telehealth Services

For example, WellPoint, the nation’s second-largest health insurer, plans to offer in its employer and individual plans remote consultations with physicians using laptop webcams or video-enabled smartphones and tablets. The company will include its new LiveHealth Online program in employer plans in California and Ohio next year and aims to expand the service to commercial plans by late 2014.
Source: ihealthbeat.org

Big Holes Exposed in NRA's Mental Health Plan

LAPIERRE: We have backed the National Instant Check system, we have backed putting anyone adjudicated mentally incompetent into the system. Now I know where you’re going with this. They come up with this whole, “oh, it’s a gun show loophole.” There’s not a gun show loophole. It’s illegal for felons to do anything like that, to buy guns. What the anti-Second Amendment movement wants to do is put every gun sale in the country under the thumb of the federal government. Congress debated this at length. They said if you’re a — a hobbyist or collector, if someone in West Virginia, a hunter, wants to sell a gun to another hunter, they ought to be able to do it without being under the thumb of the federal government. 
Source: alternet.org

Lawmakers Question IT Contract for Federal Health Plan Exchange

Under the federal health reform law, states by January 2014 must create health insurance exchanges to provide coverage options for individuals and small businesses.  The insurance exchanges will rely on a solid IT foundation to connect with advanced eligibility systems for Medicaid and other state-administered health programs.
Source: ihealthbeat.org

More employees covered by self

Following the passage and implementation of the Patient Protection and Affordable Care Act (PPACA), there has been speculation that an increasing number of smaller employers would opt for self-insurance. One reason is a widespread presumption among employers that the PPACA’s coverage requirements, and the new taxes the statute imposes, will work to drive up the cost of health coverage. “Employers generally, and small employers particularly, are concerned about the rising cost of providing health coverage and may view self-insurance as a better way to control expected cost increases,” noted Paul Fronstin, director of EBRI’s health research and education program, in a media release.
Source: homechannelnews.com

Romney health plan would cost US, group says

If and when in the distant future we feel a need to enroll in Tricare and take advantage of the benefits I earned while serving, we will, but as of now we both feel it is more important that we don’t and let those who honestly need it be able to have it. We have discussed this several times and when we hit Medicare age we would then use it. For now we just don’t need it. Why take from a system we really do not need to take from? To us that isn’t fair to those who actually need it. We both make more than enough money to fund our own way. We both take good care of ourselves and are in perfect health. We both have successful companies and are not hurting financially. A simple principle to our life is self sufficiency and saving intelligently for a rainy day, not rely on others to pay our way when we can provide for ourselves. Even though we could have afforded a much larger and more expensive house and cars we didn’t feel it was necessary. The more people take the less their is to give. We have tens of thousands of vets who need the most from those programs and for us to take from it means less to them. I recently read a story about a soldier who needed a powered wheelchair and the one thing that was holding it up is the cost. So some private donors stepped up to the plate and got this wounded warrior what he needed. They also renovated his house for him so he could get around it easier. This guy served and sacrificed but the gov couldn’t take full care of him because of cost. Stories like this formed our decisions. Our country is broke in case you haven’t heard already. When I enlisted in 1983 I did it for the love of my country and not to squeeze every nickle and dime I could from it. I certainly did benefit greatly from my time served thru education and opportunities provided to me. That doesn’t mean I feel ill will towards those of you who do use your military medical benefits (Tricare, DEERS, and VA), you earned it. For us it isn’t necessary yet.
Source: nbcnews.com

WellStar, Piedmont Healthcare Partnering on Health Plan

Piedmont Healthcare’s Ronnie Brownsworth, M.D., CEO of the newly formed health plan, has expertise in population health models as well as experience negotiating with managed care companies. A practicing neurologist for 12 years, Brownsworth earned his MBA with an emphasis on healthcare while gaining experience in physician practice administration and integration. He soon found himself on the hospital side as chief medical officer and vice president of quality as well as developing and running a highly successful health-system-based health plan for Saint John’s Health System in Springfield, Mo.
Source: patch.com

A checklist for reviewing health plans for 2013

Examine whether private health exchanges have a place in the health benefits strategy.  While relatively few employers expect to drop their medical plans entirely, some are considering private exchanges for retirees, active employees or both. Exchanges reduce the administrative burden for employers and can give members more flexibility in selecting insurance products to meet their needs.
Source: hrmorning.com

Demystifying Georgia’s Plans for Health Insurance Exchange

Where Does That Leave Georgia’s Healthcare Consumers? Georgians will be able to utilize a federal health insurance exchange to shop for best-fit policies. According to a recent Healthcare IT News report, the federal exchange will include “an initial application, plan evaluation tools and consumer support such as a website with chat capability and 24-hour call center through which to compare plans, check eligibility for affordability programs and to enroll in a qualified health plan.” Those qualified health plans may begin submitting applications to join the federal exchange next April.
Source: ajc.com

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

Posted by:  :  Category: Medicare

Gravel MediGap by Mike Licht, NotionsCapital.comProponents 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

Video: Learn About Medigap Plans

Insurance Commissioners Reject Calls To Limit Seniors’ Medigap Policies

Medigap policies are popular with seniors because Medicare does not cap out-of-pocket expenses. The policies are not cheap — the average premium nationwide was $178 a month in 2010 — but they protect subscribers from unexpected high medical bills, which is important to people on fixed incomes. The C and F Medigap plans cover nearly all of the out-of-pocket costs that beneficiaries would usually pay.  Two thirds of people who buy Medigap plans have incomes below $40,000 a year — about the same income levels for all Medicare beneficiaries.
Source: kaiserhealthnews.org

Finding the Right Medigap Insurance

Although all the Medigap plans are standardized, Medigap rates may vary from one insurer to another. According to a study carried out by Weiss Ratings premium rates for Plan A range from a low of $439 to a high of $5776. This shows that you cannot assume that all insurers offer the same rates. It is best to shop around and compare rates from different insurers. You should also compare the cost of Medigap plans at different ages such as 65 and 70. This will give you a good idea of your annual premiums. In addition, factor out-of-pocket expenses in your Medigap plan costs. This includes expenses for purchasing prescription drugs or processing claims.
Source: seanbrock.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

Insurance Officials Warn Against Premium Hikes for Medigap Coverage

The group argues that doing so would backfire and cause higher spending because beneficiaries would stop seeking out necessary medical care when they need it. After nearly 18 months of research and discussions into increased cost-sharing proposals, none of the studies provided evidence that would encourage beneficiaries to seek out appropriate physicians’ services, NAIC says.
Source: californiahealthline.org

Medicare open enrollment: What’s the best Medigap policy?

The difficulty for consumers is that the nature of Medigap makes it a lot harder to shop for than Medicare Advantage. Here’s why. Medicare Advantage plans are regulated and overseen on a national level. Medicare routinely collects all kinds of information on them about customer satisfaction and quality of care. In addition, the premium of a specific Medicare Advantage plan is the same for each customer. As a result, it’s possible (as I explained yesterday) to go to Medicare.gov and compare Medicare Advantage plans in detail, including quality ratings and price. It’s also why we can publish rankings of Medicare Advantage HMOs and PPOs through our partnership with the National Committee on Quality Assurance.
Source: consumerreports.org

Consumer reps: Medigap is not the bad guy

In the current draft of the NAIC cover letter, drafters state that, “We strongly disagree with the assertion that Medigap is the driver of unnecessary medical care by Medicare beneficiaries. Medigap insurance pays benefits only after Medicare has determined that the services are medically necessary and has paid benefits. Medigap cannot alter Medicare’s determination and the assertion that first-dollar coverage causes overuse of Medicare services fails to recognize that Medigap coverage is secondary and that only Medicare determines the necessity and appropriateness of medical care utilization and services.”
Source: lifehealthpro.com

Medigap Cost Sharing: Helpful or Harmful?

One-and-a-half years of research helped to convince NAIC that reducing Medigap’s benefits could ultimately backfire, causing Medicare costs to rise because seniors delay or avoid seeking the medical care they need until it is too late to contain health care costs. These findings are cited in a draft letter from NAIC to Secretary of Health and Human Services Kathleen Sebelius in which NAIC urges Sebelius not to institute cost sharing changes. The letter is expected to receive final approval from NAIC this week.
Source: gohealthinsurance.com

Medigap Cost Sharing: Helpful or Harmful?

One major battle that could decide the future of Medicare supplement insurance products – otherwise known as Medigap plans – is currently being waged between various government constituents. The Senior Issues Task Force is fighting efforts on behalf of the Obama administration to add “nominal cost sharing features” to Medigap plans C and F. In […]
Source: ewallstreeter.com

MediGap Advisors fills Need for Seniors

I am president of Medigap Advisors.  I have been helping individuals get the best value in health insurance for over 25 years. I believe in free-market consumer-driven healthcare solutions including HSAs and HRAs, and greater healthcare price transparency.  In my blogs and other writings I share strategies for lowering healthcare and health insurance costs, ideas for improving our healthcare system, and techniques and lifestyle strategies for optimizing personal health.  I was also founder and publisher of The Paleo Diet Newsletter, and like to show people how they can avoid medical expenses in the first place through lifestyle changes.
Source: wordpress.com

Protect Your Seniors (and Yourself): Medigap Prices For 2013 Released

If you find a better price, then you can change Medigap carriers if you can answer the health questions.  In 2014, this restriction will no longer exist. That said, you can be charged higher rates based on height, weight, gender, and tobacco use.  
Source: protectyourseniors.com

Does Obamacare Really Ban Medigap?

This entry was posted in Health Care and tagged Barack Obama, healthinsurance, Houston, insurance agent, katy, Medicare, Medicare Advantage, Medigap, Obamacare, Original Medicare, Patient Protection & Affordable Care Act, richmond, rosenberg, sugar land, Texas, TX. Bookmark the permalink.
Source: wordpress.com

“Health Expenditure Risk and Annuitization: Evidence from Medigap Cover” by Daniel W. Sacks

Theoretical research suggests that health expenditure risk can have an ambiguous influence on the annuitization decisions of the elderly. I provide empirical evidence on this linkage, by estimating the impact of supplemental Medicare insurance (Medigap) coverage on the annuity demand of older Americans. I use local variation in prices as an instrumental variable to address the possible endogeneity of Medigap coverage, an identification strategy motivated by the fact that Medigap policies are not medically underwritten, and Medigap insurance is required by law to be standardized, so prices reflect neither individual characteristics nor product quality. Medigap coverage has a strong impact on annuitization: the extensive margin elasticity is 0.39, the overall elasticity of private annuity income with respect to Medigap coverage is 0.56. These results are robust to controls for health, wealth, and preferences, as well as other robustness tests. They imply that medical expenditure risk has a large impact on underannuitization.
Source: upenn.edu

Local prescription drug plan earns top marks from Medicare

Posted by:  :  Category: Medicare

BlueCross BlueShield Rx PDP contracts with the federal government and is a stand-alone prescription drug plan with a Medicare contract. The plan is administered by Excellus BlueCross BlueShield in cooperation with Empire BlueCross, Empire BlueCross BlueShield, BlueCross BlueShield of Western New York and BlueShield of Northeastern New York. It’s available to Medicare eligible members who reside in New York State.
Source: readmedia.com

Video: Excellus BCBS Medicare plan travels with you

Medicare Enrollment Begins Today

Of course, many who might be interested are Kodak retirees. Kodak recently announced it had stuck a deal with the Retirees committee to end retiree health care and survivor income benefits by the end of the year. That means thousands could be shopping around for new plans soon. “Since 1935, our company has been taking care of our friends and neighbors and we want to continue doing that, especially when a major employer like Kodak is facing changes,” said Jim Redmond, Excellus BCBS. “For the Kodak employees, if they’re Medicare eligible, they’ve got a lot more choices. If they’re under the age of 64, the choices become a little more difficult. Every individual situation is different. You really do need to sit down and figure out what is going to be best for you.”
Source: ynn.com

Excellus Bluecross Blueshield rebates $3.1 million to New Yorkers

“My office will continue to look out for New Yorkers who face improperly denied health insurance claims and ensure that they are repaid the money they are owed. We are pleased that Excellus Bluecross Blueshield has refunded money to thousands of New Yorkers,” stated Attorney General Eric T. Schneiderman.
Source: lifehealthpro.com

Excellus BlueCross BlueShield Emphasizes Fitness For Seniors

Any American who is 65 years old or older has access to Medicare, but only covers a limited amount of health care costs. That’s why many seniors purchase Medicare Supplement plans from private insurance companies to fill in the coverage gaps.
Source: gohealthinsurance.com

Open Enrollment and Star Ratings for 2013

MA plans and PDPs have a number of concerns about the methodology used to establish the star ratings, including the age of the data (e.g. the 2013 ratings are based on 2011 data), the frequent changes in methodogy and the difficulty in improving scores from year to year. For most plans these ratings are good news and the star rating has gone up for most measures from 2012 to 2013. Three new measures focused on care coordination and improvement. For MA-PDs, the national average for the care coordination measure was 85 percent or 3.4 stars. Non-SNPs performed better on this measure than SNPs. The measure for net improvement showed that MA contracts on average achieved a score of 3.1 for Part C and 3.4 for Part D while PDPs achieved an average score of 4.1. However approximately 10 percent of the plans will see a lower bonus as a result of their new lower ratings and plans with 2.5 stars or less for three years in a row face the possibility of termination from the program.
Source: gormanhealthgroup.com

[WATCH]: Excellus BCBS Medicare: Am I covered when I travel?

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Source: insurancequotes24-7.com

National Influenza Vaccination Week December 4

(BINGHAMTON, NY) – In observance of National Influenza Vaccination Week, the Broome County Health Department will be holding a flu clinic on Monday, December 5, 2011 from 1:00 p.m. to 4:00 p.m. at their offices located at 225 Front Street, Binghamton. The clinic is open to anyone ages three and up. The fee for the flu vaccine is $25 (cash or check only). If you are 65 years of age or older and subscribe to traditional Medicare Part B, Excellus Medicare Blue PPO, Today’s Options or CDPHP Medicare the health department will bill your insurance plan.
Source: gobroomecounty.com

Medicare changes threaten access to radiation therapy

Posted by:  :  Category: Medicare

Bubbles? Take something like 'Not I! ...item 1.. Wakulla Republicans Protest Against Taxes in the County (September 06, 2011) ... by marsmet552Although this is not exactly a Science matter, more of a social issue, I’ll comment. The deeper story here is that with baby boomers moving into the “breakdown years” fundamentally, the numbers don’t fit for medical care (or social security). As a consequence, what we are seeing here is simply a (very early) symptom of the medical system hitting the wall. Now, we can hit that wall tow ways. We can do it fairly, and prioritize care to the young, without regard to income through a national health system. Or, we can use financial darwinian methods, by letting those without plenty of money fall under the tank treads, and by allowing insurers to ration care by bumping people off their policies. Currently, we are using the latter method. But this is the issue we need to face head on. A good science periodical would highlight articles on the data, and projections for what the situation will be in 15 years.
Source: sciencenews.org

Video: Medicare Supplement Plans – Changes for 2010

Obamacare: Drastic Medicare Cuts Equals Medicare Reform

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

Summary of Key Changes to Medicare in 2010 Health Reform Law  

This brief provides a detailed look at the improvements in Medicare benefits, changes to payments for providers and Medicare Advantage plans, various demonstration projects and other Medicare provisions in the law.  It includes a timeline of key dates for implementing the Medicare-related provisions in the law. Issue Brief (.pdf) Earlier Versions:
Source: kff.org

Health Care Reform Brings Major Medicare Changes

In addition, Centers for Medicare and Medicaid Services has begun this month reimbursing hospitals for Medicare services based on how well they follow “best practices” or clinical guidelines and how their patients respond to satisfaction surveys. This is known as “value-based purchasing” or “paying for performance.” Some hospitals will be paid less while higher-performing hospitals will be paid more. Beginning this month, Medicare is reducing payments to hospitals that had higher-than-expected readmission rates over the last three years for patients who returned within 30 days of being discharged after pneumonia, heart attack or heart failure. More conditions will likely be added in the future.
Source: northcarolinahealthnews.org

Romney draws on 2010 playbook in Medicare offensive

We have the segment of society that cannot afford private insurance (either by earning too little or by having too many other obligations) but also earn too much to qualify for government sponsored care through Medicaid. These people fall into two groups–group one goes to the doctor and pays for the services they receive, while group two goes to the doctor and does not pay for the services they receive. This second group of this segment of population has been claimed by many to be the reason why an enforcement of insurance use by all is necessary, as the doctors and hospitals claim to have raised prices to the insured to cover the cost of “deadbeats”. There are two problems with this idea: 1. Doctors and Hospitals admit to be steeling funding from guaranteed payers in order to cover the cost of the deadbeats, and 2. A vast majority of these deadbeats simply cannot afford to pay for the care because the costs are entirely too high–it is not that they choose to be sick and to cheat the system by walking away from their bills–and the costs are too high because the hospitals and doctors continue raising prices on the payers in order to cover those who can’t pay. We have to ask the question, will guaranteeing more payers (there will still be those who cannot be guaranteed) cause the costs to go down? It is doubtful, as the wages earned by those in the healthcare industry are some of the only wages that have outpaced ordinary inflation, so they are used to a certain lifestyle. Further we should ask the question, will guaranteeing more payers to a group that has proven itself to misuse their trusted position by dubiously increasing costs on people who could pay to offset losses and make extraordinary profits that allowed them such greater wage benefits as the vast majority of the rest of society, make that group somehow more trustworthy–ie will prices then stabilize, defying supply and demand (as supply of everything medical will decrease while demand will increase, which usually results in increased prices)? Furthermore we must recognize that the people who go bankrupt because of the cost of health care are the truly ill of this group and the group of employer-insured people above (not the privately insured as they obviously earn a good deal of money in order to afford private insurance). These people earn too much to qualify for medicaid. We can raise the medicaid floor, however the medicaid floor must remain at pace with wages. OR We can determine a way to bring cost of care back in line with overall costs and wages, so that care and insurance both become more affordable to everyone. This would probably mean the FTC or some entity like that coming down hard on doctors and hospitals for arbitrarily increasing cost of care to people not receiving the care, which sounds a lot like theft.
Source: nbcnews.com

Obama’s Medicare Plan: Seniors Will Pay More

Obama’s latest budgetary scheme for cost-shifting to seniors is just another indication that the Administration and its allies on Capitol Hill are running out of options. They have already cut the Medicare provider payments to achieve a 10-year “savings” estimated at $716 billion, but most of those “savings” will finance Obamacare. In a letter to Senator Jeff Sessions (R–AL), ranking member of the Senate Finance Committee, the CBO writes, “Unified budget accounting shows that the majority of the HI trust fund savings under PPACA would be used to pay for other spending and therefore would not enhance the ability of the government to pay for future Medicare benefits.”
Source: amac.us