Uwe Reinhardt explains the complexities in pricing of Medicare Advantage plans

Posted by:  :  Category: Medicare

Congress should stop wasting our public funds in these efforts to push us into private plans. If they took the same public and private funds already being spent and used those to improve the benefits of the traditional Medicare program (especially reducing cost sharing and capping out-of-pocket spending), then we would have an even better Medicare program. In fact, it could become the basis of the Improved Medicare for All that many of us long for but has remained elusive to a large extent because of the elevated stature that the private insurance industry holds in the Halls of Congress.
Source: pnhp.org

Video: Medicare Plan Finder Lesson 1: Getting Started

Daily Kos: Washington Makes It Clear: Medicare Will Now Be Targeted to Pay Down Deficit

The Huffington Post describes what’s coming next: “The fiscal cliff has not been averted. If anything, the U.S. faces an even more ominous deadline in a few months. The debt ceiling was hit as of New Year’s Eve. The U.S. Treasury will dip into its tool bag to keep the country’s borrowing ability going, but that will last only about two months. Also in early March, the sequestration — $110 billion in across-the-board spending cuts, half in defense and half in domestic programs — springs back, unless Congress finds a way to offset it with other spending cuts. Weeks later, the law that keeps the government funded expires. It all means that, in late February and early March, Congress will face a sequestration, a government default and a government shutdown. Republicans say they’ll use the leverage created by the debt ceiling to force Obama to accept spending cuts, particularly in entitlement programs. Obama resisted that notion on Dec. 31, saying he wants more tax increases and won’t accept Republican plans to “shove” spending cuts past him. “If they think that’s going to be the formula for how we solve this thing, then they’ve got another thing coming,” he said. However, once the fiscal cliff deal passed, the President’s message changed making it clear cuts to Medicare will be offered up to pay down the deficit: “I agree with Democrats and Republicans that the aging population and the rising cost of health care makes Medicare the biggest contributor to our deficit. I believe we’ve got to find ways to reform that program without hurting seniors who count on it to survive. And I believe that there’s further unnecessary spending in government that we can eliminate.” President Obama statement, January 1 There are ways to make Medicare more efficient and save money, in fact, many of those ideas were already implemented in the Affordable Care Act.  Going forward Congress should also consider allowing Medicare to negotiate with drug makers for lower prescription drug costs in Part D and allowing drug re-importation which would save billions in the Medicare program. Unfortunately, both of these common sense proposals are opposed by conservatives, many of the same fiscal hawks, who’d rather reduce spending by cutting benefits instead of curtailing the excessive payments to the highly profitable pharmaceutical industry.
Source: dailykos.com

How To File A Medicare Appeal

Beneficiaries in Medicare Advantage plans follow similar appeals procedures, except the initial appeal must be made within 60 days of the denial. Information can be found at http://www.medicare.gov/claims-and-appeals/file-an-appeal/medicare-health-plan/medicare-health-plan-appeals.html. If a service or treatment has been denied, an expedited appeal can be requested from the plan if waiting for a regular appeal decision could jeopardize the member’s health. Expedited appeals are not permitted solely for payment denials. For more details about expedited Medicare Advantage appeals, see section 50 of the Medicare Managed Care Manual at http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/mc86c13.pdf .
Source: kaiserhealthnews.org

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

Between January 1–February 14, if you’re in a Medicare Advantage Plan, you can leave your plan and switch to Original Medicare. If you switch to Original Medicare during this period, you will have until February 14 to also join a Medicare Prescription Drug Plan to add drug coverage. Your coverage will begin the first day of the month after the plan gets your enrollment form.
Source: medicare.gov

CMS’s Privacy Problem: Data Breaches, Medicare Numbers, and Inaction : Data Privacy Monitor : Lawyers & Attorneys for Information Security, Breach Notifications, Online Privacy, Cloud Computing & Financial Privacy: Baker Hostetler Law Firm

CMS’s continued use of social security numbers as Medicare numbers has been under scrutiny for several years. Since 2002, the U.S. Government Accountability Office (GAO) has repeatedly recommended that CMS use a different methodology in assigning Medicare numbers in order to protect social security numbers. In May 2008, the OIG issued a report urging CMS to remove social security numbers from Medicare cards in order to prevent identity theft. CMS has consistently refused to modify its methodology, citing logistical and cost constraints. In an August 2012 hearing before the House Ways and Means Committee, Tony Trenkle, CMS’s Chief Information Officer, testified that transitioning to a new methodology “would be a task of enormous complexity and cost that, undertaken without sufficient planning, would present great risks to continued access to healthcare for Medicare beneficiaries.” Mr. Trenkle estimated that the cost of a smooth transition could be as high as $845 million, and he cautioned the committee that the transition would mean a substantial change for physicians treating Medicare patients. This recent string of CMS data breaches has captured the attention of lawmakers, who once again are calling for CMS to act.
Source: dataprivacymonitor.com


As you can see from various articles ((1) http://www.modernphysician.com/article/20130103/MODERNPHYSICIAN/301039973?AllowView=VW8xUmo5Q21TcWJOb1gzb0tNN3RLZ0h0MWg5SVgra3NZRzROR3l0WWRMWGJWZjBDRWxYek9UYktwUGZUamg5b1g4WFFERmhzbHhKSnNUYk9XNkU9&utm_source=link-20130103-MODERNPHYSICIAN-301039973&utm_medium=email&utm_campaign=mpdaily; (2) http://www.philly.com/philly/business/20130103_Hospitals_to_eat_Medicare_budget_s__doc_fix.html), the funding for this year’s resolution comes from a reduction in payments to other Medicare providers, spread over a number of years.  Therefore, in resolving next year’s, 2014, physician reduction, this source of funding will not be available.
Source: njhealthcareblog.com

Daily Kos: Medicare also going over the “cliff”

Single-payer financing models, in which one government entity is the sole third-party payer of health care costs, can achieve universal access to health care without barriers based on ability to pay. Single-payer systems generally have the advantage of being more equitable, with lower administrative costs than systems using private health insurance, lower per capita health care expenditures, high levels of consumer and patient satisfaction, and high performance on measures of quality and access. They may require a higher tax burden to support and maintain such systems, particularly as demographic changes reduce the number of younger workers paying into the system. Such systems typically rely on global budgets and price negotiation to help restrain health care expenditures, which may result in shortages of services and delays in obtaining elective procedures and limit individuals’ freedom to make their own health care choices. Pluralistic systems, which involve government entities as well as multiple for-profit or not-for-profit private organizations, can assure universal access, while allowing individuals the freedom to purchase private supplemental coverage, but are more likely to result in inequities in coverage and higher administrative costs (Australia and New Zealand). Pluralistic financing models must provide 1) a legal guarantee that all individuals have access to coverage and 2) sufficient government subsidies and funded coverage for those who cannot afford to purchase coverage through the private sector. http://www.annals.org/…
Source: dailykos.com

Quality, not quantity of care new criteria for Medicare reimbursement

“The Hospital Value-Based Purchasing Program is one of a host of Affordable Care Act programs that put patients at the center of the Medicare system,” stated Medicare on the organization’s blog. “We’ve known for a long time that when Medicare paid providers based on how much work they did and not on how well they did for patients, too often patients got services and tests that didn’t improve their health.  Providers already must publicly report the steps they take to provide quality care to Medicare beneficiaries; Hospital Value-Based Purchasing gives these efforts additional teeth.”
Source: voxxi.com

Guaranteed Issue Medicare Periods

Posted by:  :  Category: Medicare

Since MA plans may not reduce their benefits or increase premiums or cost-sharing during the plan year, you will only be notified of any reduction in benefits or increase in premiums or cost-sharing for the new plan year during the Annual Election Period (AEP) which allows you to disenroll from your Medicare Advantage plan. The AEP is October 15 – December 7 each year. If you disenroll during this period, the effective date of your disenrollment will be January 1 of the following year. A MA plan may, however, discontinue its contract with a provider anytime
Source: floridahealthinsurancebroker.com

Video: Medicare Advantage vs. Medicare Supplement Insurance

Fibromyalgia General Discussions at DailyStrength: medicare advantage or medigap?

DailyStrength will be undergoing scheduled site maintenance, starting Saturday, January 5th beginning at 10pm EST (7pm PST). This should take anywhere from 12-20 hours to complete. During that time, you will not be able to register as a new member or make any new posts.
Source: dailystrength.org

Can I get dental coverage from a Medigap policy?

Medigap does not pay for everything. It is meant to supplement Medicare, not replace it. Medicare pays the defined portion, and then your Medigap policy kicks in to pay for costs it covers. Unlike Medicare Advantage, Medigap is not part of your Medicare coverage, but is instead a supplemental policy which makes your existing Medicare coverage more useful and less expensive. Medigap has separate premiums that must be paid in addition to the premiums for your Medicare Part A and Part B insurance.
Source: usinsurancenet.com

When Can I Get Out of My Medicare Advantage Plan?

First and foremost, you should apply for the supplement plan with either a February 1 or March 1 effective date. Approval on a Medigap policy can take 2-3 weeks to complete underwriting. So it is important to do this well in advance of when you want the plan to start. For example, if you want to make the changeover effective 2/1/13, apply early in January for the supplement (or even during the last couple weeks of December). Once your Medigap plan is approved, you can proceed with returning to Medicare with a Part D plan. The easiest way to do this is to call Medicare (1-800-MEDICARE) and select a Part D plan, while at the same time disenrolling from your Medicare Advantage plan. You cannot have both a Part D plan and a Medicare Advantage plan, so this changeover can be done within the same phone call. Make the changeover effective either 2/1/13 (if doing it in January) or 3/1/13 (if doing it between 2/1 and 2/14).
Source: medicare-supplement.us

Medigap vs. Medicare Advantage Plan

Medicare Advantage comprises a variety of private health plans — most often HMOs and PPOs — that Medicare offers as a coverage alternative to the traditional program. Every plan must cover all the same benefits that traditional Medicare covers. But the plans can charge different copayments (often lower than the traditional program but not always) and offer extra benefits. Most charge a monthly premium in addition to the Part B premium, but some don’t. Most include prescription drug coverage at no additional cost. Some cover routine hearing and vision services, usually as a separate package for an additional premium. Another difference from the traditional program is that most plans require you to go to doctors and other providers within their service network or pay higher copays for going out of network.
Source: aarp.org

Health Care Guide to Debt Limit Battle Includes Possible Home Health Copay

While we dodged a copay this time around, cost sharing will most certainly be a part of the equation when Congress resumes its discussion next month about how to cut federal spending. In short – now is not the time to be complacent! Click the button below and tell your representative and senators that the home health care industry saves Medicare money and that a copay would be harmful to seniors, spending and to thousands of providers, many of which are small businesses, in a time when our industry is booming and jobs are sorely needed. TAKE ACTION NOW!
Source: hcafnews.com

Medigap Vs. Advantage plans

All of this makes Medicare Advantage plans sound much more attractive than traditional Medicare, but the reality is lots of people don’t like the access to care they get from Medicare Advantage plans. Researchers from the Commonwealth Fund, a nonprofit foundation that promotes better health care, found that 15 percent of  people with Medicare Advantage policies rated their insurance as fair or poor. That is more than double the number of dissatisfied Medicare/Medigap plan participants — just 6 percent of those with traditional Medicare coverage and Medigap plans rated their coverage as fair or poor.
Source: bankrate.com

BCBSM Transition: Medigap and Medicare Advantage in Michigan

As hearings continue in our state capitol on the transition of Blue Cross Blue Shield of Michigan to a nonprofit mutual, here is the full presentation that Mark Cook, vice president of Governmental Affairs for Blue Cross Blue Shield of Michigan, gave Monday to the Michigan House of Representatives Insurance Committee.
Source: mibluesperspectives.com

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

Between January 1–February 14, if you’re in a Medicare Advantage Plan, you can leave your plan and switch to Original Medicare. If you switch to Original Medicare during this period, you will have until February 14 to also join a Medicare Prescription Drug Plan to add drug coverage. Your coverage will begin the first day of the month after the plan gets your enrollment form.
Source: medicare.gov

Medicare vs Medicare Advantage

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

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

Free Online Games: This Medicare Supplement Plan F Is Also 1 Among The Medigap Plans Which Gives Rewards Towards The Customers

Posted by:  :  Category: Medicare

Whenever you program to pick a coverage then you will need to seek advice from together with your family members and selected the very best a single, if you ever really feel very complicated then it is easy to seek the aid from the issue to ensure that they may assist you to choose the best a single. The foremost factor that you just should really search ahead of you consider the policy is definitely the protection that may be needed to fulfill your requires, along with the 2nd factor which you must look into is whether or not the amount of the strategy is restricted to your budget if all these are comfy for you personally in a unique plan then you could very well take them and get pleasure from the rewards. This medigap plan f is offered by many private insurance coverage issues and also you can decide the one particular that’s beneficial for you. These medicare dietary supplement plan presents many different estimates and you might get them totally free. To understand way more relating to this medigap plan f along with their benefits you’ll be able to call them straight else view the web page whichever is comfy and from these each you will get to understand regarding their plans and also the way you are going to be benefited with it. You may also follow them on twitter cultural networking site to know the updates, they hold updating their status to ensure that people can know their work even better. To know their offers and information you are able to join them on the publication which will be tremendously necessary for each of the shoppers to know the updates from the ideas. Each policy has its personal way of benefits so before you pick the coverage be sure that concerning the rewards and believe twice in regards to the want for you personally and after that takes up the plan, they are the basic items which has to become known ahead of you take up the policy. The high quality in each policy relies upon on the coverage and it really is sure that what ever may well be the plan that is definitely taken you might acquire the benefit.
Source: blogspot.com

Video: Medigap Plan f

Online Appointment Booking: This Medicare Supplement Plan F Is Also 1 Among The Medigap Ideas Which Provides Benefits To The Clients

Whenever you plan to opt for a policy then it’s important to consult together with your loved ones and chose the very best one, if you ever really feel incredibly puzzling then you can actually search for the help from your issue in order that they are going to enable you to choose the ideal 1. The foremost factor which you should certainly look before you take the coverage is the protection that is needed to meet your needs, as well as the 2nd factor that you just should appear into is no matter whether the quantity of the program is restricted to your price range if all these are comfortable to suit your needs inside a distinct plan then you are able to relatively well consider them and enjoy the benefits. This medigap strategy f is offered by a great number of personal insurance issues and also you can opt for the one particular that is helpful to you. These medicare supplement program gives you a range of estimates and you may get them at no cost. To know much more relating to this medigap plan f as well as their positive aspects you’ll be able to get in touch with them straight else view the web-site whichever is comfortable and from these both you can get to understand about their plans plus the way you are likely to be benefited with it. You can also follow them on twitter cultural networking site to understand the updates, they retain updating their standing so that persons can know their function even improved. To know their provides and information you are able to join them around the newsletter that will be really vital for all of the customers to understand the updates of your ideas. Each coverage has its personal way of advantages so just before you pick the coverage make sure that concerning the advantages and assume two times concerning the have to have to suit your needs and after that takes up the coverage, these are the fundamental points which has to be known just before you take up the coverage. The high quality in every coverage depends upon the protection and its certain that what ever may perhaps be the coverage that is definitely taken you can expect to acquire the benefit.
Source: blogspot.com

Ideal Medigap plans for women

However, for women who don’t need to see doctors and specialist many times in a year, Medigap Plan N is a good alternative.  Although you have to pay for copayments and meet deductibles, this plan has a lower monthly premium compared to other Medigap policies.  Medigap policy N offers good coverage at a lower rate.
Source: wordpress.com

Guaranteed Issue Medicare Periods

Since MA plans may not reduce their benefits or increase premiums or cost-sharing during the plan year, you will only be notified of any reduction in benefits or increase in premiums or cost-sharing for the new plan year during the Annual Election Period (AEP) which allows you to disenroll from your Medicare Advantage plan. The AEP is October 15 – December 7 each year. If you disenroll during this period, the effective date of your disenrollment will be January 1 of the following year. A MA plan may, however, discontinue its contract with a provider anytime
Source: floridahealthinsurancebroker.com

Health Law Prompts Review Of Some Medigap Plans; Defining Who Gets Dependent Status

Your plan and Plan C are the most popular Medigap plans, chosen by nearly two-thirds of beneficiaries. Those are also the policies that provide significant “first dollar” coverage: they pay the deductibles for both the hospital and outpatient portions of the traditional Medicare program (Parts A and B) as well as the 20 percent coinsurance required for doctor visits, and cover other services as well. People with these supplemental plans may pay virtually nothing for medical services beyond their premiums.
Source: kaiserhealthnews.org

Tech Tent: The New Medigap Plan F Is The Most Appealing Insurance Coverage Plan For The Retirees In America

Insurance plans are of excellent aid towards the senior citizens across the world. In countries like The usa exactly where the senior folks are drastically respected from the neighborhood, the role of social insurances plans has an enormous impact inside the minds in the seniors. The state administrators manage these insurance coverage organizations to give highest positive aspects to the senior citizens in all parts in the nation. In america the Medigap Plan F seems to attract additional folks as it has a lot of positive aspects more than the Medicare Supplement plan offered by the insurance companies. The significant advantage appears to be its present of covering the numerous from pocket bills produced from the insurance companies. This draws in lots of people to select the Medigap Plan F in lieu of the old Medicare Supplement Plan F ideas. Govt regulation by means of the Reasonably priced Act ensures the seniors to store around for the insurance coverage rates. The potential Medicare Supplement plan is still preferred by a lot of as the plan has got additional benefits than another plans. Within the current context of aggressive surroundings, the medigap plan f is preferred by folks of some area for a lot of reasons. The strategy F presents the biggest safety in the miscellaneous and out of pocket expenditures. Every one of the seniors who’ve attained the age of sixty five should recognize the numerous solutions available to them. This strategy has some drawbacks too because the cost of insurance coverage varies in a lot of states. This compels the seniors to go for your plans in the reduced expense. As there’s no uniformity is noticed within the high quality payments there’s always a resistance supplied to these ideas. At time these seniors get baffled in picking the best ideas for them. In such situations one particular really need to seek advice from the specialists prior to taking the best possibilities. The common Medigap Plan F provides a varied deductable in distinct states throughout the nation.
Source: blogspot.com

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

Health Net Terminates Agreements with Six Tenet Healthcare Hospitals

• AB 1846 (Gordon) establishes a regulatory licensing framework for consumer owned and operated plans (CO-OPs), which are designed to foster the creation of consumer-driven, nonprofit health insurance organizations. • AB 1761 (Perez) prohibits people or entities from representing, constituting, or otherwise providing services on behalf of the California Health Benefit Exchange without having a valid agreement with the Exchange. • AB 999 (Yamada) modifies the process for LTC rate development to protect consumers from excessive premium rate volatility. It is considered one of the strongest LTC consumer protection measures in the nation. • AB 2138 (Blumenfield) provides increased funding for district attorneys to investigate and prosecute health and disability insurance fraud in collaboration with CDI enforcement personnel. • SB 1216 (Lowenthal) and SB 1448 (Calderon) ensure that CDI has the regulatory authority to protect consumers in response to changes brought by the globalization of the insurance business and insurer use of reinsurance. • SB 1216 provides a framework for when a California-based insurer cedes business to a non-U.S. based reinsurer. Commissioner Dave Jones notes that the recession brought to light the need for regulators to have more authority to evaluate the risks that a non-insurance entity poses on an insurer in a holding company system. • SB 1448 updates California’s Insurance Holding Company System Regulatory Act so the financial status of an insurer in a holding company system can be assessed. • AB 2303 (Assembly Committee on Insurance) gives the insurance commissioner the authority to take over an insurer that the U.S. Treasury Secretary determines is insolvent or in danger of becoming insolvent. • SB 1170 (Leno) expands restrictions on misleading advertising tactics directed at seniors and senior veterans. It would enhance the notification requirements for an agent or broker to meet with a senior in their home to sell an insurance product. • SB 1184 (Corbett) is designed to stop unscrupulous insurance agents and brokers who charge a fee to help senior veterans qualify for veterans’ aid programs when these services are readily available for free for those who qualify. Insurance agents and brokers cannot be involved in obtaining senior veterans’ benefits with the sole purpose of financial gain. • AB 1747 (Feuer) requires a life insurer to send a pending lapse notice to the policyholder within 30 days of nonpayment. The policyholder must be able to name one or more people to receive a copy of the pending lapse notice or termination of a policy for nonpayment of premium. People can easily lose the critical protection of life insurance if just one premium is accidentally missed, even if they have been paying premiums on time for many years, notes Commisioner Dave Jones.
Source: calbrokermag.com

Medigap Plans and the Affordable Health Care Act

Medicare does not cover every type of medical expense or treatment. For this reason many senior citizens feel they should choose MA (Medicare Advantage) private plans for insurance. This is because they feel Medicare Medigap plans may be too expensive. Mistakenly too many seniors think the MA plans are best because they low, or even zero monthly premiums. The MA plans also frequently cover prescription drugs, vision and other problems. The problem is that all MA plans have many hidden charges that come out of the wallet of those trusting seniors. In some cases these unexpected costs can add up to many thousands of dollars.
Source: seniorcorps.org

Diabetes screenings, supplies, and training – Medicare has you covered

Posted by:  :  Category: Medicare

If you’re at high risk for developing diabetes, Medicare covers up to two fasting blood glucose (blood sugar) tests each year. If your doctor accepts assignment, you pay nothing for these tests. You may be at high risk for diabetes if you’re obese, have high blood pressure, high cholesterol, or a family history of diabetes. Talk to your doctor to find out when you should get your free screening test.
Source: medicare.gov

Video: Medicare diabetic supplies

Congress Passes Bill to Avoid “Fiscal Cliff,” With Medicare Doc Fix, Other Medicare/Medicaid Extensions

The legislation requires CMS, for services furnished on or after January 1, 2014, to adjust payments relating to the end stage renal disease (ESRD) bundled payment rate to reflect changes in utilization of certain drugs and biologicals. In making reductions, CMS must take into account the most recently available data on average sales prices and changes in prices for drugs and biological reflected in the ESRD market basket percentage increase factor. The legislation also delays until January 1, 2016, implementation of oral-only ESRD-related drugs in the ESRD prospective payment system. HHS also must conduct an analysis by January 1, 2016, of the case mix payment adjustments relating to ESRD bundled payments, and make appropriate revisions to such case mix payment adjustments. The Government Accountability Office (GAO), no later than December 31, 2015, must prepare a report to Congress on how HHS has addressed implementation of payments for oral-only ESRD-related drugs in the bundled ESRD prospective payment system.
Source: wolterskluwerlb.com

The Fiscal Cliff for Physicians : International Insurance News

1. Documentation and Coding Adjustment This provision is set to save around $10.5 billion dollars. The Documentation and Coding Adjustment helps Medicare to recover overpayments made to hospitals in 2008, when a program known as Medicare Severity Diagnosis Related Groups (MS-DRGs) began. MS-DRGs made it easier for doctors to document severe patient conditions and complications, especially when a patient was experiencing more than one health issue at a time. Along with better documentation came easier coding procedures for doctors to submit to Medicare in order to receive payment. According to the Centers for Medicare & Medicaid Services (CMS), however, the MS-DRG system was being misused and Medicare was again and again being asked to pay too much. CMS found that while more medical cases were being labeled (and billed to Medicare) as high severity, there had been “no real overall change in patient severity or in the resources hospitals must use to furnish inpatient.” The Center therefore recommended to Congress that Medicare be allowed to recoup with interest these overpayments from hospitals, and with passage of the Documentation and Coding Adjustment in the Taxpayer Relief Act, it appears that the government has agreed.
Source: globalsurance.com

Patients’ Concerns with Mail Order Diabetes Test Supplies, Waste Documented in New Report

Third, the report raises questions about the cost assumptions of mail order DTS. Many of those unrequested supplies are likely to go to waste, without CMS accounting for it. Moreover, for 20 percent of beneficiaries, mail order billed CMS inappropriately at a higher rate, overcharging Medicare. Community pharmacies play a vital role as the safety net in providing DTS to beneficiaries. As shown by the report, beneficiaries turn to their local community pharmacist when they can no longer obtain the product that their prescriber has determined is best for them through mail and when they are dissatisfied with mail. As such, community pharmacists are motivated to stock products which local physicians prescribe and beneficiaries prefer.
Source: wordpress.com

Free Diabetic Supplies *must qualify

I have several family members with diabetes and I know how expensive supplies can be! Qualify to receive a meter in the color of your choice, and meal planning tools such as our recipe book, meal planner, blood sugar tracker, and more. Yours at no cost when you qualify. Click here to see if you qualify. (Note: I personally do not have Diabetes so I did not even attempt to qualify to get more information.)
Source: moolasavingmom.com

Medicare, Medicaid, and Other Health Provisions in American Taxpayer Relief Act of 2012 (Updated)

Extension of Family-to-Family Health Information Centers:  This provision continues the Family to Family Health Information Centers (F2F HIC) to assist families of children and youth with special health care needs in making informed choices about health care in order to promote good treatment decisions, cost-effectiveness and improved health outcomes.  The centers are intended to help families navigate the health care system so that their children can get the benefits they need through Medicaid, CHIP, SSI, early intervention services, other government programs, and private insurance.  F2F HICs also train health care providers and policymakers and advocate for a family-centered “medical home” for every child. There is one F2F HIC in every state and the District of Columbia.
Source: piperreport.com

Liberty Medical exits Medicare market

The moves should come as no surprise. Since April 2012, when Express Scripts, in a $29 billion deal, merged with Medco Health Solutions, then-parent of Liberty, Express Scripts has made it clear that Liberty Medical would not figure in its future plans. With a national mail-order program set to kick off in July 2013 and increased documentation requirements, the market isn’t an attractive prospect for many companies, although a few, like Arriva, are positioning themselves to be a large player in the market. Earlier this year, Arriva acquired Direct Diabetic Source and AmMed Direct.
Source: hmenews.com

Free Medicare Diabetes Supplies, Diabetic Meters

Proper monitoring and medication is the key to keep diabetes under control. Don’t hesitate, grab your diabetic supplies to keep an eye on your condition. We offer you diabetes supplies and diabetic meters for free or no cost based on your medicare package. Our diabetes supply package includes gluco-meter, test strips and lancets. Use your medicare benefits wisely.
Source: classifiedadall.com

Diabetes and Medicare have You Confused?

Remember Medicare Part B has a deductible ($140 in 2012) and 20% coinsurance that you must pay.  Some Medicare Advantage plans or Medicare supplemental health plans may cover more, but you have at least 80% coverage after the deductible.  Remember that is 80% of the Medicare-approved amount.  In Minnesota a physician may not charge more than the Medicare-approved amount, but this limiting law may not necessarily apply to supplies.  In any state if the supplier accepts Medicare assignment, they can only charge the Medicare-approved amount.  It might be worth your time to find a provider who accepts assignment.  Sometime in the future (possibly July 2013) if Health Care Reform still exists, you may only be able to get Medicare coverage for these supplies from Medicare-approved suppliers.
Source: retirementeducationplus.com

OIG Reports That Diabetes Test Suppliers Improperly Billed Medicare

The United States Department of Justice aggressively pursues companies that improperly bill Medicare for diabetic supplies.  An example of this policy protecting taxpayer funds is reflected in the government’s case against Ammed Direct LLC, a False Claims Act lawsuit in which  Barrett Law Office, PLLC  represented the whistleblower. 
Source: barrettlawofficetn.com

Humana Medicare supplement will pay for diabetic supplies?

Medicare diabetic supplies life: query Penny k : Does Humana Medicare supplement spend for diabetes care Very best Answer : response tsunami all depends. You need to be very cautious with this mess. Now, if your parents in a property if they are very good they get both Medicare and Medicaid. this is what pays for all. if you care in a property with an adult and someone else you need to have to complete. they will not inform you when you are in a residence. (Your own residence) I will do
Source: typepad.com

InsureBlog: Make cash off Medicare?

We are all aware, all of us but those running the program, of the rampant fraud in Medicare; most perpetrated by providers. I see a whole new type of fraud developing. It started with an increase in commercials advertising free no hassle products to those with Medicare. “offering FREE diabetic supplies to Medicare and private insurance members” then I started seeing another type of advertising; “Thank you for visiting Dollars4DiabeticSupplies. We will continue to purchase your extra diabetic supplies in the future so please bookmark us and return to our site again. We value your diabetic supplies and time and we take our mission seriously.” So one company gives away free supplies to Medicare beneficiaries and another buys, for cash, excess supplies…..could there be a connection here? This is in addition to the already serious problem of pill peddling. But we are expected to believe EMRs, MLR, and Exchanges will fix this whole cost problem.
Source: blogspot.com

Iowans Ask State to Deny Proposed Health Insurance Premium Hike

Posted by:  :  Category: Medicare

Source: kbur.com

Video: 59% Increase In Health Insurance Costs!

Grant to help with jobless workers health insurance premiums

The supplement, awarded to the Maryland Department of Labor, Licensing and Regulation, will be administered in partnership with Alabama, Delaware, the District of Columbia, Maryland, Mississippi, South Carolina and Virginia. The funds will allow the provision of two to three months of “gap filler” payments for unemployed individuals in those states who are receiving Trade Adjustment Assistance benefits and are eligible for the Health Coverage Tax Credit program. Under the program, eligible individuals can receive 72.5 percent of premium costs for qualified health insurance programs. These payments cover the period of time it takes to complete Internal Revenue Service enrollment, processing and first payment under the HCTC program.
Source: wmbfnews.com

Health insurance: US paying more for less, report finds

Willowbrook…Thanks for the informed information. I am in total agreement with you. Our company has offered outstanding insurance benefits for 30 years. It has done what insurance is supposed to do and that is provide support when an illness happens. We have been fortunate that they have stayed ahead of the curve and did this because it helped attract the best employment base. We have also had pretty good preventative care and yes we paid for that and as we get older it becomes more important. 16 years ago our out of pocket was $500 for the birth of our daughter. Three years later our sons cost $100 out of pocket. Currently the company is still trying to provide good health care insurance for all of their employees. The system has changed a bit. New hires and low wage employees are offered the same insurance with the same premiums bit the deductible is considerably lower so that they can afford to have effective insurance. They can afford to cover their children, although some choose to take the SChip program. Now our premiums have increased, deductibles have increased, Medical costs have increased and yet we still get very good health care here in America. I say here in America because for a time we lived in England. Now the company offered us private insurance for which we paid vat at an extraordinary cost. So in order to save money we kept the kids on private insurance, it was certainly worth it and they received incrediable care. My darling dear one and I used the NHS doctors. What an incredible waste of time and seriously detrimental experience. Where our NHS doctor was incredibly interested in our American system they didn’t care so much for their own. It really didn’t take much medical skill to follow their system of protocols and offer meds instead of treatment. I spent our time there with two slipped disks that were diagnosed as depression. Because as the parliamentarians knew so much about health care they determined if a woman comes in complaining about pain it must be depression. So I was given anti-depressants to treat back pain. When the anti-depressants didn’t work then they offered pain meds and muscle relaxers to treat what was still considered depression. That actually helped and I felt less and did more damage over the time we lived there. When we came home I went to a pain doctor who immediately ordered an MRI and found that there was an actual physical component to my complaints. He ordered a treatment of traction and strengthening exercises and when the pain went away so did the irritable and depressed me. Now my darling dear one went in for a chronic laryngitis problem. Sometimes it was accompanied by soar throat and always with a discomfort swallowing. The protocol there was over the counter lozenges. Not once did the physician touch my husbands throat to feel the nodule. The nodule was discovered in a well care check-up once we returned home. He went to an ENT who did a needle biopsy and determined there was a need for surgery to remove half of his thyroid. The surgery seemed to go well even though the found two more nodules, one on the lobe they were taking and one on the other lobe. So that was supposed to be that. Unfortunately, the biopsy proved his nodules to be cancerous. So they opened him back up and took the other lobe. Loosing your thyroid is a very difficult. It alters a normal life in so many ways. After the surgery I did my bit to move heaven and earth to get my darling into MD Anderson. We have been very fortunate that the surgeon was exceptional and have gone through five years of Anderson follow up with 15 more to go to assure the cancer does not show up anywhere else. Currently, he is considered clean and clear but it is terribly taxing on him to keep his replacement med balanced. He gained an incredible amount of weight through the first four years, always with a need to tinker with dosage. About two year ago his weight and dosage were at odds again which created a situation where his replacement was an overdose. This included a trip to the ER in the ambulance where the staff determined they needed to stop his heart in order to get the proper rhythm back. There is a whole sureal aspect of consciousness that occurs when a medical team is trying to stop a heart. After the third attempt they were successful in getting his rhythm right again. When he started to loose weight he again was at risk of OD so we went to Anderson, at this point he was clean so we saw a PA. She was a horrible person and her efforts rewarded my darling dear one with another trip back to the ER. So will we ever trust a another PA, not likely and certainly not when it comes to our children’s health. So if those of you in the blogosphere wish for something tantamount to the NHS I am sure you can find a low rent type of policy to cover that. As for my darling and my children they deserve smart medicine and we are willing to pay for the ability to access professionals who are actually paid to know medicine above a protocol determined by legislators.
Source: nbcnews.com

Health insurance premium hikes kick in today for thousands of school district employees

Just like last year, employees are eligible to get discounts of $50 per month if they go through the district’s “Wellness Rewards” plan — which includes getting various preventative tests done and answering online questionnaires. Also, like last year, employees who smoke or do not sign an affidavit that they do not use tobacco will be charged an additional $50 per month for insurance.
Source: whatis-healthinsurance.com

Obamacare’s health insurance premium subsidies:

Calculate your own subsidy with this tool from the Kaiser Family Foundation. (Click on the graphic.) Enter your income, age, household size, and your best guess as to whether healthcare where you live is "higher than," "about the same as," or "lower than the national average." (What you know about wages and the cost of real estate in your area, compared to other parts of the country, will help answer that question.)
Source: healthinsurance.org

Health Insurance Costs Rise Faster than Income

The opinions expressed in WebMD User-generated content areas like communities, reviews, ratings, or blogs are solely those of the User, who may or may not have medical or scientific training. These opinions do not represent the opinions of WebMD. User-generated content areas are not reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other reason except for compliance with our Terms and Conditions. Some of these opinions may contain information about treatments or uses of drug products that have not been approved by the U.S. Food and Drug Administration. WebMD does not endorse any specific product, service or treatment.
Source: webmd.com

Get Ready for ‘Rate Shock’ as Some Health Insurance Premiums to Double in 2014

“Just one piece alone, more than half of the U.S. public [in the individual insurance market] is in a plan at 50 percent or lower actuarial benefit. If you go up to 60 percent, as required by law, you’ve got a huge bump already,” Bertolini noted. “And this is the reason why you’re seeing such pressure between the states and the federal government on exchanges. Whose exchange do you want to show that price increase on? And surely, the federal government doesn’t want to show that. So I think this is going to be a big debate. And as Frank mentioned earlier, we’re putting these things through into rate increases and we’re getting them through the regulators. So I think that is going to be the big story for 2014, as these rates start going to the market, probably the latter part of this year, 2013.”
Source: amac.us

Family Health Insurance Costs Up 62 Percent Since 2003

Modern Healthcare: Worker’s Spending On Health Premiums Surges 74% in 8 Years The cost of employee health insurance grew faster than income in every state, an analysis of data from 2003 to 2011 shows, and health benefits increasingly failed to protect workers from the cost of getting injured or ill. The analysis of health insurance in the workplace by the health policy foundation the Commonwealth Fund underscored the financial strain on household and business budgets from the country’s rising health care costs. Fast-growing premiums outpaced wages, the report said, and have “been consuming resources that employers might otherwise have earmarked for salary or wage increases, for other benefits or for hiring additional workers.” A worker, on average, spent $3,962 on family premiums in 2011, an increase of 74 percent from 2003. Meanwhile, the average family premium totaled $15,022, an increase of 62 percent from 2003, the report said. “It’s real money,” said Cathy Schoen, senior vice president of the Commonwealth Fund (Evans, 12/12).
Source: kaiserhealthnews.org

Aetna CEO: Obamacare will cause health insurance premiums to double in some markets

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Source: conservatives4palin.com

Rise in Health Insurance Costs Outpacing Income Growth, Report Finds

As health care costs and insurance premiums have gone up annually by double digits, and many wage earners receive a COLA adjustment, ranging from 2% to 4%, this is not a surprising finding. What is surprising is that policy wonks or believe that there is light at the end of the tunnel, ie, the groundwork has been laid for cost reductions. Not gonna happen. Competition is still rampant, which increases costs; incentives are still not aligned between Doctors, patients, hospitals and insurers which promotes higher costs; patients still have little incentive to change their lifestyle issues which contributes to more chronic disease problems and wasted dollars, etc. Kaiser and VA have the best systems to address these problems and the hope is that ACO’s will move more people in that direction. But, hope is not a plan and absent a more fundamental change in how people are insured and how care is delivered, the healthcare costs will continue to outpace income growth.
Source: californiahealthline.org

Why ObamaCare Will Make Health Insurance More Expensive

Charging health insurers rather than consumers is intended to disguise the fact that the effect is essentially the same. As the Joint Committee on Taxation (JCT) wrote last summer, “the fee on health insurance providers is similar to an excise tax based on the sales price of health insurance contracts.” And the likely effects on the insurance market are pretty clear. According to the JCT, those taxes “may be borne by: consumers in the form of higher prices; owners of firms in the form of lower profits; employees of firms in the form of lower wages; or other suppliers to firms in the form of lower payments.” The Congressional Budget Office came to the same conclusion, noting in 2009 that the fees “would largely be passed through to consumers in the form of high premiums for private coverage.”
Source: reason.com


Posted by:  :  Category: Medicare

DC Voting Rights by dbkingThe Strengthening Medicare and Repaying Taxpayers Act (SMART Act) was recently passed by both the House and the Senate.  The next step is for President Obama to sign the bill into law.  The purpose of the SMART Act is to make the Medicare Secondary Payer system more efficient.  Below is a list of key provisions of the SMART Act.
Source: themedicarespa.com

Video: Billing Medicare as Secondary Insurance


Source: wordpress.com

Workers’ Compensation: Class Action by Medicare Advantage Beneficiares Dismissed By Federal Court

A federal class action, by a group of plaintiffs who alleged that they were a class of Medicare-eligible individuals enrolled in a Medicare Advantage plan, and received benefits under part C of the Medicare program, was dismissed by a federal court under the preemption doctrine. In an action removed to Federal court, the plaintiffs sought to bring a class action in state court alleging that New York state law applied regarding reimbursement for for monetary settlements from third-party tortfeasors.
Source: blogspot.com

CMS officials issue reminder on Medicare secondary payer laws

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

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

Love It or Hate It: Medicare Secondary Payer Enforcement Is Here to Stay

With regard to the Supreme Court, it remains unknown if it will take cert in Hadden. Does it have all the elements of a case ripe for cert? Absolutely. It is a federal question with conflicting decisions in the Sixth and Eleventh circuits and has a huge public policy component in the way it deters the settlement of insurance claims. The Court has already decided equitable apportionment with regard to Medicaid reimbursements in Ark. Dept. of Human Servs. v. Ahlborn (547 U.S. 268 (2006)) and on June 25, 2012, agreed to hear US Airways v. McCutchen (663 F.3d 671 (3d Cir. 2011)) which questions an ERISA plan participant’s obligation to provide full reimbursement to the plan administrator for medical expenses recovered from a third party. While each of these cases has entirely different legal aspects, the underlying issue in each is simply equity. Without some level of fairness, parties to insurance claims cannot resolve them without judicial intervention, and our judicial system cannot absorb this burden. Facing its own financial crisis, 60 federal court facilities in 29 states were considered for closing this year in an effort to reduce costs. It is assumed that the courts cannot absorb the burden of hearing only the medical component of claims that were otherwise voluntarily settled among the parties.
Source: lexisnexis.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

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


What happens if a former employee and dependent(s) are currently on COBRA and the former employee experiences a second event?  More specifically, what happens when an employee and dependent(s) are on COBRA and the former employee turns 65 making him Medicare entitled?  Does the spouse get the additional months of Cobra up to 36 months for the secondary qualifying event?
Source: cornerstoneinsurancegroup.com

2013: The year we become the health care nation

Posted by:  :  Category: Medicare

Vintage health insurance card (woman's) 2nd half 1914 by Crazy House CapersMedicare and Medicaid are the biggest element of our most serious national problem: crushing federal debt. Washington has evaded the debt crisis for the past two years but can’t do so any longer. The Congressional Budget Office recently projected that “spending on the major health care programs would grow from more than 5% of GDP today to almost 10% in 2037 and would continue to increase thereafter.” Without changes, health care alone will consume more of the federal budget than all discretionary spending does now — defense, law enforcement, courts, and all regulatory agencies. Every time we have to reconcile taxes and spending or approve a federal budget or raise the debt limit, we’ll face the inescapable need to cut Medicare’s and Medicaid’s growth. And every time an elected official whispers such a thing, large groups of citizens will scream.
Source: cnn.com

Video: National Health Insurance Debate Under Nixon

California Given Green Light To Run Own Health Insurance Market

U.S. Health and Human Services Secretary Kathleen Sebelius announced Thursday that California was among seven new states that received conditional approval to operate their own insurance exchanges. Arkansas was approved to operate a partnership exchange with the federal government.
Source: cbslocal.com

WASHINGTON: Red states, too, get health care nod from Obama

Under Obama’s law, plans in the new marketplaces will have to cover a set of “essential” benefits, including hospitalization, doctor visits, prescriptions, prevention and care for pregnant women and young children. Cost to the consumer will be the main difference among plans, with four levels of coverage: bronze, silver, gold, and platinum. A consumer with a bronze plan will pay lower monthly premiums, but would face higher cost sharing for medical care.
Source: heraldonline.com

Polokwane resolution #8: National health insurance

During the pilot projects, people using identified hospitals will only feel the benefits from the strengthening of the health systems through infrastructure revitalisation and improving service delivery. There will be no financial benefits yet for patients, as envisaged in the NHI green paper. Health Minister Aaron Motsoaledi said the funding structure used to finance NHI pilot projects was "neither intended to ensure that patients are not left with any out-of-pocket liabilities; nor to ensure that all providers, particularly district hospitals, are paid".
Source: co.za

Govt looks to rein in budgets

The freeze on the National Health Security Fund has already caused hardship for some state hospitals as they cannot expand services, acquire advanced equipment or even hire staff to meet growing demand. This year, nearly Bt200 billion will be spent to operate the three main health insurance plans – the National Health Security Fund (NHSF), Social Security Fund (SSF) and Civil Servant Medical Benefit Fund (CSMBF). The NHSF will get the lion’s share of Bt109 billion, or Bt2,755.60 per head, to serve 48 million people. The SSF will get Bt27 billion, or Bt2,500 per head, to serve 11 million subscribers, and the CSMBF Bt60 billion, or about Bt12,000 per head, for 5 million bureaucrats and their families. Among the three national welfare funds, the CSMBF enjoys the biggest healthcare budget. During the past three years, the government tried to limit the budget for the schemes, but their health expenses rose drastically and were not reduced to a satisfactory level. The government tried to clamp down on the CSMBF by controlling expenses for glucosamine sulphate, which is used to treat arthritis. A regulation issued last year succeeded in cutting glucosamine reimbursements from Bt600 million to Bt10 million. This year, the government plans to implement more measures to limit the CSMBF’s total budget to Bt60 billion. The government will also rein in the NHSF by keeping its per-head budget at Bt2,755.60 for three years from 2012-14. “The government did not give us a clear answer for why it had to cut the budget,” Dr Winai Swasdivorn, secretary-general of the National Health Security Office, said yesterday. “It might have its own reasons. Maybe it wants to spend more on other things rather than healthcare,” he said. The healthcare budget for the NHSF has been ramping up dramatically, averaging 10 per cent each year, he said. The NHSF’s per capita healthcare budget rose from Bt1,200 in 2002 to Bt2,755.60 last year. Healthcare costs are accelerating faster than gross domestic product (GDP). They now account for 12-13 per cent of the government’s total expenditures. Only 32.8 million of the 48 million people covered by the NHSF have received medical services under the universal healthcare scheme. However, the government’s measure to contain the NHSF’s budget would not affect medical services under the universal healthcare scheme. It might affect the government’s expenditures instead, Winai added. Public Health Minister Pradit Sinthawanarong said the budget cap for the NHSF would not undermine the quality of medical services. “We’ll adjust mindsets and improve work processes to become more effective,” he said. The government will implement measures to curb the exploding cost of healthcare schemes, such as managing human resources, managing medical services like the private sector, increasing income for the NHSF by providing medical services for 400,000 local administration officials and migrant workers, and creating a centre of excellence in medical care. Due to the tight budget, hospitals must learn to share medical resources among themselves, said Dr Narong Sahamethaphat, permanent secretary of the Public Health Ministry. Prince of Songkla University’s hospital is one of many state hospitals that has had to freeze projects and services. Dr Sutham Pinjaroen, dean of the medical school, said that since the measure to limit the per capita budget of the NHSF took effect last year, the hospital lacked enough money to extend medical services for local people, purchase medical devices and construct more buildings for patient wards. It could not hire doctors and nurses. At least 80 nurses have resigned and applied for new medical jobs at private hospitals. “The government must put more money into the fund to end this problem. State hospitals can’t shoulder this burden alone,” he said. To cope with medical inflation in the future, the government should set uniform standards for the basic care offered by these three funds, said Dr Samrit Srithamrongsawat, director of the Health Insurance System Research Office. Then if patients need additional care or treatment such as expensive medicine or a special room, they would be asked to pay for their own expenses and could not get reimbursed. For example, his office recently found that most pregnant women who subscribe to the CSMBF had asked for a caesarean operation instead of giving birth naturally. “Since a caesarean is more expensive than spontaneous vaginal delivery, if the government wants to save money, it must think about what kinds of medical treatment patients should pay for on their own,” he said. “Remember we can’t use taxes to please everyone,” he added.
Source: nationmultimedia.com

‘Obamacare’ Offers Young Adult Health Care and Peace of Mind 

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Source: thehartfordguardian.com

What countries have national dental insurance?

Does anyone recommend any countries? The UK, however, if you live in England and are over 16 and working you have to pay for dental treatment, prescriptions and any services or products from an opticians, so healthcare is not completely free. If you live in Scotland it is free and University is free there as well (but not for international students). What you also have to bare in mind is the reason why healthcare is free, the UK has very high tax and VAT, you should take that into account before you move anywhere.
Source: internationalstudenthealthinsurance.net

‘Obamacare’ Offers Young Adult Health Care and Peace of Mind

Photo caption Rumeisha Bowyer and, seated, her mother Deanna Bressler-Montgomery. Photo courtesy of Deanna Bressler-Montgomery LOS ANGELES — Motivated, and armed with an architectural degree, Rumeisha Bowyer set out to obtain employment in her field, with health care benefits thrown in. Two years and several full- and part-time jobs later, however, the 24-year-old is still searching for both. “It’s very frustrating because I know I’m very, very educated but nothing’s happening at the moment,” Bowyer noted. “And health care is very important because if I get really, really sick, I won’t be able to afford my own health insurance.” Bowyer’s mother, Deanna Bressler-Montgomery, is grateful that her daughter still has access to health care, thanks to the Affordable Care Act (ACA), comprehensive health care reform signed into law by President Obama in March 2010. ACA will allow Bowyer to remain on her mother’s health care insurance plan until she turns 26. Prior to the ACA, Bowyer, who is minimally obese, has asthma and eczema, would have aged out of her mother’s health insurance plan a lot sooner. Parents could only cover their children until they turned 19, unless they were disabled; or up to their 24th birthday if they were enrolled in college full time. Under the ACA, young adults can remain on their parents’ plan up to age 26, even if they are out of school, married or living on their own, if they cannot get health insurance through an employer. Now, Bowyer can continue receiving medications and treatment for her health problems, as well as preventive care services, like the kickboxing and nutrition classes she currently attends. “The weight training class is very beneficial because I’ve been struggling with weight for years. They offer free programs with the health insurance I have. If I didn’t have it, I would have to pay for a gym membership or do the basic run around the block, run around the corner, or run around the park,” Bowyer explained. Scheduling time for such activities during safe, daylight hours is challenging because she works two part-time jobs, the incomes from which don’t add up to even $1,000 a month. Still, Bowyer is saving the money she earns working her part-time jobs so she can start paying for her own insurance when she turns 26 and is dropped from her mother’s plan. Meanwhile, she continues to search for a job with benefits that will kick in before then, she said. According to the Center for Consumer I n f o r m a t i o n and Insurance O v e r s i g h t, an arm of the Centers for Medicare and Medicaid Services and a part of the Department of Health and Human Services,prior to the ACA, 42 percent of young adults switched or lost coverage once they graduated. In addition, 76 percent who were then uninsured did not get needed medical care. “The Affordable Care Act requires plans and issuers that offer dependent coverage to make the coverage available until the adult child reaches the age of 26. Many parents and their children who worried about losing health insurance after they graduated from college no longer have to worry,” explains the center on its website. In California, 435,000 young adults gained insurance coverage as of December 2011 due to the health care law, according to the National Health Interview Survey, a data collection program of the National Center for Health Statistics. Nationally, the provision has allowed 3.1 million young adults to get health coverage. “The ACA has meant my family saves money because I couldn’t afford to pay the $500 a month for her insurance. I can at least try to afford the 10 percent and not go into debt. It’s better than paying the whole thing,” Bressler-Montgomery said. For Bowyer, being able to stay on her mother’s health insurance plan has meant being able to buy asthma medication and keeping the disease under control. The 30-day supply of medication needed for her skin condition costs more than $100, and even with the $10 co-pay the family is able to cope, noted Bressler-Montgomery. She said she shudders to think of how much they would have had to pay out of pocket for Bowyer’s treatment had the young woman not been able to stay on her health insurance plan. “I don’t like the fact that (some people) call it ‘Obamacare,’’ she said. “I think it’s negative but if they want to call it that, that’s okay. It’s the best care they can get right now.” (This article was made possible by a New America Media fellowship sponsored by The California Endowment.)
Source: newamericamedia.org

Caribbean News Now!: BVI moves forward with national health insurance plan

ROAD TOWN, BVI — The government of the British Virgin Islands continues to move forward with its plans to introduce and implement national health insurance (NHI) in the territory to ensure that all residents have access to health care services. As such, a series of educational opportunities and consultations has begun to dialogue with public officers, the public, media, health practitioners, businesses and other stakeholders about the goals, objectives and benefits of NHI to the territory. On Thursday morning, permanent secretary in the Ministry of Health and Social Development Petrona Davies and chief medical officer and chairman of the NHI project steering committee, Irad Potter began consultation meetings with their staff. Davies said, “It is important that we educate and get feedback from our staff as they play a crucial role in strengthening our healthcare system. It is vital that they be kept abreast of what the NHI is, what it means for them, their families and ultimately the territory.” Potter said he is pleased that they can move forward with the public consultations and educating people about NHI, so that everyone understands why access to healthcare is important. In his 2013 Budget Address on November 15, Premier and Minister of Finance Dr Orlando Smith said that a critical component of government’s health reform strategy is restructuring the health financing system to provide equitable coverable for all the people of the BVI. He announced that the preliminary policy, financial and legislative framework for the viable operation of NHI had been completed and that government was keenly aware that achieving an appropriate balance in the funding of NHI is necessary for its long-term sustainability and growth. Once implemented, NHI will be operated by the Social Security Board and will be funded through a combination of government budgetary allocations, employer and beneficiary contributions, co-payments, surcharges and interest earned on the NHI Fund reserves.
Source: caribbeannewsnow.com

Will national health reform close ethnic and racial disparities? 

Part of Massachusetts’ success lies with its network of community health centers, which has been expanding over the past six years. Mattapan Community Health Center opened a new building in August, allowing it to double its capacity, says Azzie Young, the center’s executive director. It also offers on-site dental care and mammograms, removing more barriers for clients who might not have the time or means to travel far from home to more than one facility.
Source: truthisscary.com

Kyrgyzstan: Introduction of private national health insurance planned

It was noted that over the last 5 years there has been little progress in terms of health outcomes. He particularly mentioned the situation in the field of cancer, tuberculosis, HIV and maternal health problems. Furthermore, the poor quality of services and the difficulty of access to healthcare in the various regions were mentioned by government officials. It was therefore proposed that the health care needs to be reformed. In the corresponding proposal, less state intervention and the privatisation of state owned companies and hospital were proposed. These steps are aimed at attracting private investors.
Source: europe-health-care.eu

The Best and Worst of National Health Systems

Using data collected in 2000, the World Health Organization (WHO) used a system to rank countries around the world based on the state of their national health systems. Although the ranking process was abandoned due to academic criticism regarding the methodology and validity of the results, it’s interesting to consider how certain countries ranked in relation to others. Here we’ll take a look at either end of the spectrum, examining the top three and bottom three countries on the list.
Source: getholistichealth.com

Colonial Penn Medicare Supplement Insurance

Posted by:  :  Category: Medicare

Newsweek Magazine (February 16, 2009) ... Lenders Add Bigger Fannie, Freddie Fee – Thanks to Payroll Tax Cut (January 15, 2012) ...item 2.. Dupuy: GOP trying to sell pyrmaid scheme to voters (September 3, 2012) ... by marsmet526• Long-term hospitalization. Medicare only covers a small portion if any of the cost for those people who need to be hospitalized. Colonial Life Medicare supplement insurance on the other hand, covers all or most of your hospitalization depending on the type of supplemental insurance you purchase. This is a huge benefit to most elderly people who simply do not have the income to pay those large hospital bills.
Source: lifeinsurancequotesnreviews.com

Video: Life Insurance Training | Health Insurance Training | Join Today

Medicare Targets Health Plans With Low Ratings

Medicare officials are encouraging 525,000 beneficiaries to switch out of these 26 Medicare Advantage and drug plans that have received low ratings for three consecutive years and enroll in better plans for next year. The poor performing plans will have this warning symbol next to their names on Medicare’s plan finder website to steer shoppers to other plans.
Source: kaiserhealthnews.org

Daily Kos: Medicare also going over the “cliff”

Single-payer financing models, in which one government entity is the sole third-party payer of health care costs, can achieve universal access to health care without barriers based on ability to pay. Single-payer systems generally have the advantage of being more equitable, with lower administrative costs than systems using private health insurance, lower per capita health care expenditures, high levels of consumer and patient satisfaction, and high performance on measures of quality and access. They may require a higher tax burden to support and maintain such systems, particularly as demographic changes reduce the number of younger workers paying into the system. Such systems typically rely on global budgets and price negotiation to help restrain health care expenditures, which may result in shortages of services and delays in obtaining elective procedures and limit individuals’ freedom to make their own health care choices. Pluralistic systems, which involve government entities as well as multiple for-profit or not-for-profit private organizations, can assure universal access, while allowing individuals the freedom to purchase private supplemental coverage, but are more likely to result in inequities in coverage and higher administrative costs (Australia and New Zealand). Pluralistic financing models must provide 1) a legal guarantee that all individuals have access to coverage and 2) sufficient government subsidies and funded coverage for those who cannot afford to purchase coverage through the private sector. http://www.annals.org/…
Source: dailykos.com

Genworth Financial to sell its Medicare supplement unit

The free TD-Digital app allows you to read The Times-Dispatch on your iPad or Android tablet just as it appears in print. You can flip through pages and skim headlines just as you would with the printed newspaper in your hands. View articles, photos, videos, games and more with easy-to-use touch navigation. Note: The app is free but a subscription purchase is required to view content. Click on TD-Digital for all the details.
Source: timesdispatch.com

Medicare Supplemental Insurance

We also offer a Plan F High Deductible Medicare Supplement Insurance plan* that is designed to save you money if you stay healthy and keeps the cost of insurance affordable. There is a one-time deduction that must be met each year with this plan. With a Medicare Supplement Insurance plan from Pekin Life Insurance Company you will also have access to discounts on eye exams, eyeglasses, contact lenses, LASIK correction surgery, hearing aids, hearing exams, and more at NO CHARGE.
Source: pekininsurance.com

HANYS Benefit Services: Questions and Answers on the Additional Medicare Tax

If a former employee receives group-term life insurance coverage in excess of $50,000 and the resulting income is in excess of $200,000, how does an employer report Additional Medicare Tax on this? The imputed cost of coverage in excess of $50,000 is subject to social security and Medicare taxes, and to the extent that in combination with other wages it exceeds $200,000, it is also subject to Additional Medicare Tax. When group-term life insurance over $50,000 is provided to an employee (including retirees) after his or her termination, the employee share of social security and Medicare taxes and Additional Medicare Tax on that period of coverage is paid by the former employee with his or her tax return, and is not collected by the employer. An employer should report this income as wages on Form 941, Employer’s Quarterly Federal Tax Return (or the employer’s applicable employment tax return), and make a current period adjustment to reflect any uncollected employee social security, Medicare, or Additional Medicare Tax on group-term life insurance. However, unlike the uncollected portion of the regular (1.45 percent) Medicare tax, an employer may not report the uncollected Additional Medicare Tax in box 12 of Form W-2 with code N.
Source: hanysbenefits.com

6 Reasons Joseph Stiglitz and Other Top Economists Think Means

Posted by:  :  Category: Medicare

Bernstein’s assertion that means-testing opponents are “fringe” is nonsense. Does that include Paul Krugman of the New York Times, who describes means-testing as “an even worse idea, on pure policy grounds, than even most liberals realize”? In researching this article, I communicated with several highly respected economists, including Nobel Prize-winner Joseph Stiglitz, James K. Galbraith, Dean Baker, and Thomas Ferguson. All of them expressed their concerns about means-testing and provided a variety of sound arguments against it. (Bernstein, after being roundly criticized, backtracked in a blog and admitted that means-testing is a bad policy idea and a questionable way to address income inequality. He just forgot that when he was on TV!)
Source: alternet.org

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

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

The Story of Medicare: A Timeline

Written and produced by Foundation staff, The Story of Medicare: A Timeline serves as a visual timeline of Medicare’s history, including the debate that led to its creation in 1965 and subsequent changes, such as the passage and repeal of the Medicare Catastrophic Coverage Act in the 1980s, the Medicare Modernization Act in 2003, and the Affordable Care Act in 2012. The seven-minute video also highlights the program’s impact on the 50 million elderly and disabled Americans it serves today, as well as the fiscal challenges it faces to ensure its long-term sustainability. Watch the video and share the story of Medicare with your colleagues, friends and family. Organizations are welcome to show the video at events and meetings.  Request  a download or DVD of the video at no charge. Additional resources on Medicare from the Kaiser Family Foundation can be found at www.kff.org/medicare.
Source: kff.org

Settlement Reached to End Medicare’s “Improvement Standard” 

Since 1987, Mrs. Berkowitz, an 81 year-old woman with Multiple Sclerosis, has frequently been told that her Medicare coverage and home health services are being discontinued because her MS "is not improving."  Each time, she has called on the Center to fight for her and ensure that her care continues.  Each time, the Center has successfully advocated to keep her Medicare and home care in place. People like Mrs. Berkowitz help the Center to know first-hand how harmful this illegal basis for Medicare denial is for people with long-term and chronic conditions.   As a result of working with her, and many other people with long-term conditions, the Center has been able to seek, and obtain, systemic change to help ensure fair access to Medicare coverage and necessary health care for all beneficiaries in similar circumstances.
Source: medicareadvocacy.org

Open Enrollment 2013: Medicare Part D Benefits Improve but Premiums an…

While Medicare Part D prescription drug plan premiums are generally expected to remain steady in 2013, this PPI Fact Sheet by Leigh Purvis and Lee Rucker finds that premiums for many popular plans will actually be considerably higher than they were in 2012. Many plans are also increasing cost-sharing and their reliance on utilization management tools for covered prescription drugs. Medicare beneficiaries should closely examine their 2013 prescription drug plan choices during open enrollment for Part D.
Source: aarp.org

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

Fraud Detection System Helped Medicare Save $115M, CMS Says

According to CMS, the system has saved Medicare about $32 million by removing fraudulent health care providers from the program and refusing to process suspicious charges. The remaining $84 million in one-year projected savings is expected to come as a result of having fewer fraudulent providers in the program (AP/Boston Globe, 12/14).
Source: ihealthbeat.org

‘Doc Fix’ In ‘Fiscal Cliff’ Plan Cuts Medicare Hospital Payments

The package would reduce hospital payments in two ways. First, it would cut $10.5 billion from projected Medicare hospital payments over 10 years for inpatient or overnight care through a downward adjustment in annual base payment increases. The Senate measure also would reduce Medicaid disproportionate share payments to hospitals by an additional $4.2 billion over the next decade.   These cuts are on top of those made to hospitals as part of the 2010 health care law.
Source: kaiserhealthnews.org

How doctors and hospitals have collected billions in questionable Medicare fees

Medicare has emerged as a potent campaign issue, with both Barack Obama and Mitt Romney vowing to tame its spending growth while protecting seniors. But there’s been little talk about some of the arcane factors that drive up costs, such as billing and coding practices, and what to do about them.  Our 21-month investigation documents for the first time how some medical professionals have billed at sharply higher rates than their peers and collected billions of dollars of questionable fees as a result. 
Source: publicintegrity.org

Medicare Voucher Plan Remains Unpopular

Six-in-ten (60%) Republicans call Ryan an excellent or good choice, 20% say he is an only fair or poor choice and 20% do not offer an evaluation. Nearly seven-in-ten (68%) conservative Republicans say Ryan is an excellent or good choice, just 16% give the selection an only fair or poor rating. Independents view the Ryan selection somewhat more negatively than positively – 30% call him an excellent or good choice, compared with 42% who say he is only a fair or poor choice; 27% of independents offer no rating. Democrats view the Ryan choice overwhelmingly negatively – 70% say he is an only fair or poor selection; just 8% say excellent or good.
Source: people-press.org

Is Medicare Solvent and Sustainable?

Solvency is a measure of whether Medicare’s two trust funds – the Hospital Insurance (HI) Trust Fund and the Supplementary Medical Insurance (SMI) Trust Fund – are able to pay the full cost of benefits prescribed by law on a timely basis. Sustainability is a much more subjective concept, one that cannot easily be addressed by the annual calculations of the Medicare trustees. Instead, it is a concept that is intended to reflect societal values and the political viability of the program as currently structured. Sustainability asks whether future Medicare spending is at a level that Americans are likely to be willing and able to pay for, based on projections of economic growth and spending. 
Source: nasi.org

Supreme Court Hears Arguments In Hospitals’ Medicare Claims Lawsuit

Posted by:  :  Category: Medicare

In honor of Tax Day by swanksalotPolitico: SCOTUS Asks Tough Questions On Hospitals’ Medicare Claims Lawsuit A majority of Supreme Court justices on Tuesday sounded skeptical of a suit brought by hospitals to reopen Medicare claims as much as 25 years old because of calculations that were found to have underpaid them. The justices heard oral arguments Tuesday in the case of Sebelius v. Auburn Regional Medical Center, a challenge brought by 18 hospitals that are seeking compensation from claims dating to 1987 (Norman, 12/5).
Source: kaiserhealthnews.org

Video: Obama Disputes Romney, Ryan Medicare Claims

Hospices’ Medicare Billing Practices Under False Claims Act Scrutiny

Recent actions by the Department of Justice (DOJ) in False Claims Act (FCA) whistleblower cases highlight one of the types of Medicare fraud that can occur in hospice care facilities. Hospices provide palliative care – medical treatment that concentrates on reducing the severity of a disease’s symptoms – to patients who decide to forego curative care of their illness. Medicare beneficiaries are entitled to hospice care if they have a terminal prognosis and are certified by a hospice physician as having six months or less to live. In one recent whistleblower case, South Carolina-based Harmony Care Hospice Inc. and CEO/Owner Daniel J. Burton paid the U.S. $1.287 million to resolve allegations that they knowingly submitted or caused to be submitted false claims for patients who did not have such a prognosis and thus were not eligible for hospice care. The qui tam case brought by two former Harmony employees is captioned United States ex rel. Singletary, et al. v. Harmony Care Hospice, Inc., et al., Case No. 2:10-cv-01404-PMD (D.S.C.). In another recent case, DOJ intervened in a whistleblower’s case against the Altamonte Springs, Florida-based Hospice of the Comforter, alleging that the nonprofit routinely over-billed Medicare for patients who didn’t qualify as terminally ill, sometimes keeping them in hospice care for as long as five years. The whistleblower in that case is a former nursing-home administrator who became the hospice’s vice president of finance in February 2008, and was later fired in retaliation for urging the hospice CEO and several board members to repay Medicare for the overbillings.
Source: bostonwhistleblowerlawyerblog.com

analyze the basic stand alone medicare claims public use files (bsapufs) with r and monetdb

so these files are baldly inferior to the unsquelched, linkable data only available through an expensive formal application process.  any researcher with a budget flush enough to afford a sas license (the only statistical software mentioned in the cms official documentation) can probably also cough up the money to buy the identifiable data through resdac (resdac, btw, rocks). soapbox: cms released free public data sets that could only be analyzed with a software package costing thousands of dollars.  so even though the actual data sets were free, researchers still needed deep pockets to buy sas.  meanwhile, the unsquelched and therefore superior data sets are also available for many thousands of dollars.  researchers with funding would (reasonably) just buy the better data.  researchers without any financial resources – the target audience of free, public data – were left out in the cold.  no wonder these bsapufs haven’t been used much. that ends now.  using r, monetdb, and the personal computer you already own (mine cost $700 in 2009), researchers can, for the first time, seriously analyze these medicare public use files without spending another dime.  woah.  plus hey guess what all you researcher fat-cats with your federal grant streams and your proprietary software licenses: r + monetdb runs one heckuva lot faster than sas.  woah^2.  dump your sas license water wings and learn how to swim.  the scripts below require monetdb.  click here for step-by-step instructions of how to install it on windows and click here for speed tests.  vroom. since the bsapufs comprise 5% of the medicare population, ya generally need to multiply any counts or sums by twenty.  although the individuals represented in these claims are randomly sampled, this data should not be treated like a complex survey sample, meaning that the creation of a survey object is unnecessary.  most bsapufs generalize to either the total or fee-for-service medicare population, but each file is different so give the documentation a hard stare before that eureka moment.  this new github repository contains three scripts: 2008 – download all csv files.R
Source: r-bloggers.com

Cops: Fugitive behind $1 million Medicare fraud nabbed in Canada

I personally know of 9 cases here in just one small area of Michigan that total almost 2 million, one defendant sentenced to 10 years and others have fled the country. Does anyone else thinks it time to stop screaming about cuts, and see what it would actually cost if it was administered correctly. Here its mostly Pakistani, Indian, and African doctors that operate for about three to five years before being indighted and then flee before trial. (these are just what I have seen and not a judgement on other well meaning doctors) My mother, for example, has retired from two jobs and has health care coverage for the rest of her life. She is the kind of person that looks at the bill, even if it is not hers. She had a little bit of a health scare and had to go to the hospital. When it was all said and done she found 5 different times that a service was double billed, billed without it being performed, or billed incorrectly. Most of those losses would have been to medicare, because private insurance denies first and pays second.
Source: nbcnews.com

Skilled Nursing Facilities Sent Incorrect Medicare Claims, Report Finds

The new report acknowledges that CMS reduced Medicare payments to skilled nursing facilities by $3.9 billion in fiscal year 2012 to correct for overpayments made in the previous year. In 2011, CMS changed the number of treatment categories that qualify for Medicare coverage from 53 to 66 to improve accuracy. “However, more needs to be done to reduce inappropriate payments,” the report states (Adams,
Source: californiahealthline.org

Signing False Medicare Claims Lands Nurse Behind Bars for 30 Months

administrative complaint Administrative Hearing attorney controlled substances criminal charges dea DEA investigation DEA raid defense attorney defense lawyer department of health Department of Health (DOH) Department of Justice (DOJ) doctor doh DOH investigation drug enforcement administration emergency suspension order false claims act florida fraud prevention health care fraud health law hipaa investigation legal representation licensing and regulatory medicaid medical license medicare medicare audit Medicare fraud Medicare investigation nurse pain clinics pain management pharmacies pharmacist pharmacists pharmacy pharmacy investigation physician physicians prescription drug trafficking whistleblower
Source: wordpress.com

Responding to some of President Obama’s Medicare claims

No you haven’t. The Affordable Care Act (ACA, also known as “ObamaCare”) slowed Medicare spending growth. The Medicare Hospital Insurance Trust Fund includes less than half of Medicare spending. You can argue that you have extended the life of this trust fund by “almost a decade,” but trust fund accounting ignores a more immediate cash flow problem.  Since the HI trust fund contains only IOUs from the government to itself, this accounting ignores the question of where to find the $296 B in cash this year to pay for Medicare spending above that covered by Medicare payroll taxes and premiums.  Medicare has never been a fully self-funded program, and even with the savings enacted in the Affordable Care Act, it is still an enormous pressure on the rest of the budget.
Source: keithhennessey.com

12 of the Largest False Claims Settlements in 2012

The following 12 settlements involved alleged False Claims Act violations, exceeded $1 million and were reached by hospitals and/or health systems within the past year. Settlements are arranged in descending dollar value. 1. Tenet Agrees to $42.75M Settlement for Alleged Medicare Overbilling In April, Dallas-based Tenet Healthcare agreed to a $42.75 million settlement to resolve allegations it overbilled Medicare for inpatient rehabilitation admissions. 2. HCA Agrees to $16.5M Settlement Over Anti-Kickback, False Claims Charges In September, Nashville, Tenn.-based Hospital Corporation of America, the U.S. Department of Justice and Tennessee agreed on a settlement in which HCA would pay $16.5 million for alleged violations of the False Claims Act and the Anti-Kickback Statute. 3. Morton Plant Mease Health in Florida Resolves False Claims Allegations With $10M In November, Clearwater, Fla.-based Morton Plant Mease Health Care agreed to pay $10.17 million to resolve allegations it violated the False Claims Act by overbilling Medicare. 4. Freeman Health in Missouri to Pay $9.3M for Alleged Stark Violations In November, Joplin, Mo.-based Freeman Health System agreed to a $9.3 settlement to resolve allegations that it knowingly compensated physicians in a manner that violated the Stark Law and False Claims Act. 5. Atlantic Health, Overlook Medical Center Settle Overbilling Allegations With $9M In June, Overlook Medical Center in Summit, N.J., and its parent, Atlantic Health System, agreed to pay roughly $9 million to settle allegations of Medicare overbilling. 6. Westchester Medical Center in New York to Pay $7M for Alleged Medicaid False Claims In October, Westchester Medical Center in Valhalla, N.Y., agreed to a $7 million settlement to resolve civil fraud allegations that the hospital submitted false claims to Medicaid for nearly 10 years. 7. Universal Health Services Agrees to Pay $6.85M to Settle False Claims Allegations In March, King of Prussia, Pa.-based Universal Health Services agreed to pay $6.85 million to settle charges it provided substandard psychiatric services to adolescent patients in Virginia. 8. Christus Spohn Health Pays $5.1M to Settle False Claims Allegations In June, Christus Spohn Health System, based in Kingsville, Texas, agreed to pay a $5.1 million settlement to resolve allegations its hospitals submitted false claims to Medicare. 9. Maury Regional in Tennessee Settles False Claims Allegations With $3.6M In July, Maury Regional Medical Center in Columbia, Tenn., agreed to a settlement of roughly $3.6 million to resolve False Claims Act allegations, which it voluntarily reported. 10. Excela Health Paid Nearly $2M to Settle Unnecessary Stenting Charges The state’s attorney’s office for the Western District of Pennsylvania collected $13.1 million from civil and criminal actions this past fiscal year, and $1.98 million of that came from a settlement with Greensburg, Pa.-based Excela Health over alleged improper stenting. 11. Memorial Health Care in Tennessee to Pay $1.28M for Alleged Stark Law Violations In August, Chattanooga, Tenn.-based Memorial Health Care System agreed to pay roughly $1.28 million to settle alleged violations of the False Claims Act and other federal laws. 12. Mayo Clinic to Pay $1.26M to Resolve False Billing Allegations In August, Mayo Clinic agreed to pay $1.26 million to resolve a federal lawsuit claiming it billed the government for surgical pathology services that were never rendered.
Source: beckersasc.com

Can You Appeal a Denied Medicare Claim?

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

Can You Appeal a Denied Medicare Claim? – Hanover Family Estate Planning Center

Patrick J. Kelleher & Associates, write about issues involving Estate Planning, Long-Term Care Planning, Massachusetts Medicaid, Massachusetts Veterans Benefits, Massachusetts Probate, Estate Administration, Wills & Trusts, Charitable Planning, Special Needs Planning, Estate Tax Planning, Business Succession Planning, and Asset Protection in the cities of Hanover, Rockland, and Marshfield, Massachusetts, and the surrounding areas.
Source: myfamilylifeplan.com

Baylor Must Pay for False Medicare Claims

The Baylor Health Care System allegedly filed false claims to several federal health care programs, including Medicare, for radiation oncology treatments. The system is accused of unnecessarily performing costly oncology procedures, when less expensive services would have been just as effective.
Source: houstoncrimedefense.com