Not Happy with Your Medicare Advantage Plan? Change it!

Posted by:  :  Category: Medicare

Congressman Kendrick B. Meek by cliff1066™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

Video: Understanding Medicare Advantage Plans

Uwe Reinhardt explains the complexities in pricing of Medicare Advantage plans

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

Uwe E. Reinhard: The Complexities of Comparing Medicare Choices

Each private plan would have had to offer a benefit package that covered at least the actuarial equivalent of the benefit package provided by the traditional fee-for-service Medicare. Medicare’s contribution (or “premium support”) to the full premium for any of these choices, including traditional Medicare, would have been equal to the “second-least-expensive approved plan or fee-for-service Medicare” in the beneficiary’s county, whichever was least expensive. That premium support payment would have been adjusted upward for the poor and the sick and downward for the wealthy.
Source: nytimes.com

Research Roundup: Medicare Advantage Plan Beneficiaries May Get More Appropriate Services; CHIP Participation Grows

Urban Institute/Robert Wood Johnson Foundation: Medicaid/CHIP Participation Among Children And Parents – “Despite the economic downturn, most states have maintained or expanded Medicaid and CHIP for children, by expanding eligibility to higher income and immigrant children, undertaking enrollment and retention simplifications, and implementing new policy options,” the authors wrote about coverage rates between 2008 and 2010. The rate of eligible children participating in Medicaid or CHIP grew to 86 percent nationwide and the number of eligible children who were not insured fell by 500,000 in that time, the study found. Participation rates for eligible parents were lower, however. The authors conclude that the 2009 law designed to improve participation of children in the program “may have contributed to increased take-up for Medicaid/CHIP among children, but that additional efforts will be needed, particularly among parents, to achieve high levels of Medicaid enrollment under the Affordable Care Act ACA” (Kenney et al., 12/3).
Source: kaiserhealthnews.org

What is the Cadillac Medicare Advantage plan

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

Medicare Advantage 2013 Spotlight: Plan Availability and Premiums

This data spotlight report examines trends in the Medicare Advantage marketplace, including the choices available to Medicare beneficiaries in 2013, premium levels and other plan features. It finds almost all plans offered this year will be available again in 2013, despite concerns that reductions in payments to plans under the Affordable Care Act would result in widespread pullouts from Medicare Advantage plans. If all beneficiaries choose to remain in their current plans, monthly premiums would increase about 10 percent, or $4, on average. The analysis also examines the types of plans available (HMOs, PPOs, etc.), changes in out-of-pocket limits, and the availability of special needs plans.
Source: kff.org

Health Plans Providing Value to Medicare Advantage Beneficiaries

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

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

What’s the Right Medicare Advantage Plan for You, Part 1

A good place to help determine the right plan for you is  www.medicare.gov. There’s a Plan Compare section where you can see how all of the Medicare plans stack up against each other. Once you fill in your personal information, applicable plans will be listed. You can even fill in all of your current prescriptions to determine what your annual drug cost would be with each plan. You can filter your search by several factors: monthly premium, annual drug deductible, drug options, plan ratings, coverage options, special needs plans and plans by company.
Source: healthplusdifference.org

Health First Health Plans Offers Medicare Advantage Plans

At Health First Health Plans, eligible beneficiaries can choose from a suite of Medicare options, including four Medicare Advantage plans with Part D Prescription Drug coverage (MA-PD), one Medicare Advantage Plan without Part D prescription drug coverage (MA), two stand-alone Prescription Drug Plans (PDP), and Supplemental Plans (Medigap).  Typically, you may enroll in a Medicare Advantage plan only during the annual enrollment period from October 15 through December 7 of each year.  There are exceptions that may allow you to enroll in a Medicare Advantage plan outside of this period (otherwise known as Special Election Periods).
Source: spacecoastbusiness.com

NewsDaily: Analysis: Obama may turn Medicare reform into wider health debate

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 marsmet526Medicare, long considered a program that U.S. politicians would touch at their peril, is acknowledged, along with the national Medicaid program for the poor, to be a major driver of the deficit. The aging population puts Medicare on a collision course with major financial difficulties; the so-called Medicare trust fund is on pace to run out of money in 2024.
Source: newsdaily.com

Video: Medicare Spending Per Beneficiary Measure National Provider Call – February 9, 2012

SEQUESTER: Reductions to Medicare Providers, Biomedical Researchers Could Take Effect Jan. 1

Meanwhile, biomedical researchers are concerned that a long-term stay over the fiscal cliff could result in job losses and significantly reduced grants, the U-T San Diego reports. According to U-T San Diego, scientists would be able to sustain research efforts if the government goes over the cliff for a short period because most scientists funded by NIH receive multiyear grants, and most institutions have some discretionary funds. However, in the long term, NIH could be forced to significantly cut research grants, likely providing smaller and shorter awards (Robbins, U-T San Diego, 12/29/12).
Source: ahlalerts.com

Medicare Bundled Payment Challenges

Under its current structure, Medicare – as with private insurance – reimburses providers based on the complexity (determined somewhat arbitrarily through the Resource Based Relative Value Scale) and volume of their procedures. Predictably, as with any volume-based payment system, this encourages overuse of the system and contributes to fraud. While private insurance, not reliant on taxpayer money, has significant incentive to reduce waste and fraud resulting in higher overhead, Medicare instead has an incentive to keep such “overhead” costs low, resulting in unrealistically low administrative expenses (if Medicare were to combat fraud at the same level as private insurance, their administrative expenses would likely be similar). These dynamics mean that fee-for-service reimbursements may work with private insurance (which tries to reduce waste and fraud) but may not be appropriate for a government program with less incentive to do so.
Source: medicalprogresstoday.com

Congress passes on chance to fix Medicare doctor pay

4. My girlfriend is in med school and I can attest to how much work goes into it. Four years of med school, three years of residency (4 for surgery) and then 3-5 for a fellowship if the person so chooses to subspecialize. They take 3 board exams, 1 after 2nd year, 1 during 4th year and 1 during residency. They also recertify every 10 years for their specialty. However, their testing is no more comprehensive than a lawyers (believe me, I’ve watched and listened to my girlfriend study). They merely get tested on a set number of things for their boards that don’t encompass all of medicine for each exam. These are also only like 4 hour exams. To clue you into what a NY attorney must do I’ll explain: (1) We must take the MPRE which is an ethics exam which is 60 multiple choice questions (not really difficult but the questions are intentionally tricky and often not straight forward) within 3 years of taking the bar exam; (2) The bar exam consists of approximately 2 days made up of four three and a half hour parts (That’s 14 hours total). These parts are 50 multiple choice and 6 essays based on 27 different areas of NY State law. The second day is 200 multiple choice questions based on Federal and Common law. See, I had to memorize 3 entirely separate systems of law and be able to regurgitate that knowledge on command. Doctors do not do anything near that. My girlfriend (who is at the top of her class and has scored in the top 3% of the nation on her boards) has never written an essay. Doctor’s strictly memorize and get tested by answering multiple choice questions. There’s very little “analysis.” In fact, I’m often shocked by how little they teach doctors to analyze issues. They seldom teach doctors basic medical things, mostly concentrating on obscure diseases that one hundredth of one percent of people would ever get. In terms of training, yeah the residency is “training” just like when someone gets hired for a job, they get “on the job training.” In fact, after the 1 year internship, a doctor can open their own practice.
Source: nbcnews.com

Physicians want permanent fix for long

The sustainable growth rate formula used by the Centers for Medicare and Medicaid Services to calculate payments to physicians is based on varied criteria that include the gross domestic product, estimated changes in fees for services and the number of beneficiaries enrolled in Medicare. As the years have gone by, the taxpayer costs of freezing the formula so there would be no cuts in rates continued to rise.
Source: kansas.com

Hospitals, Providers to Lose $11.1B From Medicare Sequestration Cuts

Last summer, the bipartisan Joint Select Committee on Deficit Reduction, more commonly known as the “supercommittee,” was unable to reach an agreement on ways to reduce the national deficit. As such, the Budget Control Act of 2011’s sequestration process became the default plan to reduce the deficit by $1.2 trillion over the next 10 years via across-the-board budget cuts to all government agencies. In the sequestration plan, roughly $109 billion of cuts would be implemented every year from fiscal year 2013 to FY 2021. Defense spending would take the biggest hits with cuts of 9.4 percent. Nondefense spending would be reduced by 8.2 percent, most entitlement programs by 7.6 percent and Medicare by 2 percent. Two percent of Medicare’s budget ($554.3 billion) is roughly $11.08 billion. Medicare providers — ranging from hospitals and physician practices to home health agencies and hospices — would see reductions in their payments, but Medicare beneficiaries would not lose any of their benefits. Over the next 10 years, Medicare providers stand to lose upwards of $120 billion. In addition to the Medicare cuts, the National Institutes of Health would also have to “halt or curtail scientific research, including needed research into cancer and childhood diseases,” according to the OMB’s report. President Barack Obama and the OMB said the sequestration process is a “blunt and indiscriminate instrument,” and the reductions could be “destructive” to the country’s social programs, national security and other governmental functions. President Obama has called on Congress to “act responsibly” and put forward a new proposal. “[Sequestration] is not the responsible way for our nation to achieve deficit reduction,” according to the OMB’s report. “The President has already presented two proposals for balanced and comprehensive deficit reduction. It is time for Congress to act. Members of Congress should work together to produce a balanced plan that achieves at least the level of deficit reduction agreed to in the BCA that the President can sign to avoid sequestration. The administration stands ready to work with Congress to get the job done.”
Source: beckersspine.com

Cuts to California Medicaid could hurt reform, providers say

Chris Perrone, a deputy director at the California HealthCare Foundation, a not-for-profit health policy group, said California already has very low payment rates compared to other states, and some findings suggest that access is already poor. One study found that California reimburses primary care physicians an average of 53% of Medicare, the federal healthcare program for seniors, he said. According to the state Department of Health Care Services, Medi-Cal pays $24 for a 15-minute visit to the doctor’s office. By comparison, Medicare would pay roughly $70. Some Democratic lawmakers want the state to rescind the cuts approved last year. At the time it was passed, AB 97 was projected to save $660 million, with half the savings going to the state’s general fund. “We’re now in a much different environment than we were when we first made those cuts, so given the opportunity, I would like to see those restored,” said Sen. Ed Hernandez, a Democrat from Baldwin Park and chair of the Senate Health Committee. The federal healthcare law seeks to increase health coverage by 2014 by creating new online insurance markets for individuals and small businesses to shop for subsidized private coverage, and by expanding Medicaid for low-income people. Medicaid is known as Medi-Cal in California and currently serves 7.7 million adults and children. Gov. Jerry Brown has not said whether California will commit to fully expanding its Medi-Cal program to take advantage of federal funding. Under an expansion, Medi-Cal would cover people up to 138 percent of the federal poverty line, or about $15,400 for an individual. It’s estimated such a move would add between 1 million and 1.4 million people to Medi-Cal. The state is also in the process of moving 900,000 kids from the children’s health insurance program known as Healthy Families to Medi-Cal. “The court decision does not change the state’s commitment to ensure access to healthcare for Medi-Cal members in a manner that fully complies with federal and state law,” said Norman Williams, a spokesman for the state Department of Health Care Services. More than 400 hospitals and about 130,000 doctors, pharmacists, dentists, and other health care providers participate in the Medi-Cal program. However, the state doesn’t track whether some of them have stopped accepting new Medi-Cal patients or limit the number of patients they take. “If you’re going to set payment standards for pharmacies and for the other providers which are below their cost, and they won’t provide services, then all those millions of people coming into Obamacare in California are going to get third-world medicine,” said Lynn S. Carman, an attorney for a group of pharmacies. Carman said his group intends to file an appeal next week seeking to be heard by the full court, not just the three-member panel in the 9th U.S. Circuit Court of Appeals that ruled Thursday. Molly Weedn, a spokeswoman for the California Medical Association, which represents 35,000 doctors, said it’s expected that the 10% cut won’t take effect while health providers pursue their legal challenge. But Brown’s finance officials have indicated the state expects to see additional savings by having the cut applied retroactively to June 2011. The doctors group warned that if the cut is upheld, many physicians will have little option but to stop taking qualified patients because the reimbursements do not meet the cost of overhead and supplies to treat them. Faced with multibillion budget deficits in recent years, the state Legislature already approved a series of Medi-Cal benefits cuts, some of which are still awaiting federal approval. For example, the state has cut dental care for adults and weeded out services such as podiatry, psychiatry and optometry. Health reform does bring a glimmer of hope to California’s low reimbursement rates. Primary care providers are expected to receive a temporary two-year payment boost under the federal health care law to match Medicare rates. But California will only get the boost if it maintains its current rates, said Anthony Wright, executive director of Health Access California, a group that lobbies for healthcare for the poor.
Source: modernhealthcare.com

Which providers have most benefited from EHR incentives for Medicare?

Prior to the close of 2012, the Centers for Medicare & Medicaid Services (CMS) recently released its final figures during the calendar year for the EHR Incentive Programs. Including the numbers from November 2012, CMS has paid more than $9.3 billion in meaningful use incentives to 176,561 unique eligible professionals (EPs) and hospitals (EHs). With today marking the end of the reporting period for EHs seeking maximum incentives, these numbers are likely to swell shortly as these providers have as long as two months to attest.
Source: ihealthtran.com

State Medicaid Changes: Cuts and Increases During Recession to Medicaid Benefits and Provider Payments

An expert on Medicaid, Medicare, and health reform, Kip Piper, MA, FACHE, is a consultant, speaker, and author. Kip Piper advises health plans, hospitals and health systems, states, and pharma, biotech, medical device, HIT, and investment firms. With 30 years’ experience, Kip is a senior consultant with Sellers Dorsey, top specialists in Medicaid and health reform. He is also a senior advisor with Fleishman-Hillard and TogoRun. For more, visit KipPiper.com. Follow on Twitter @KipPiper, Google +, Facebook and connect on LinkedIn.
Source: piperreport.com

Medicaid waiver reveals frictions between providers, hospitals

The Texas waiver pivots on the collaboration of hospitals and doctors to reduce the hospitalization rates of Medicaid enrollees and get them into medical homes to receive proper preventative care. As much as $11.4 billion could be provided by the Centers for Medicare & Medicaid Services for the waiver, according to the Austin American-Statesman. However, the proposed programs are exposing frictions between the various provider communities in the Lone Star State.
Source: fiercehealthfinance.com

Notes from the Cliff: The Deal and Its Impact on Medicare 

Cong. Tit. VI (2012) [2] Id. at  §§ 601, 603, 607, 608, 610, 621, 643 (2012) [3] For more information on the Sustainable Growth Rate See The Sustainable Growth Rate Formula and Health Reform, The Center on Budget and Policy Priorities, (April, 2010) http://www.cbpp.org/files/4-21-10health2.pdf & Mary Agnes Carey,  ‘Doc Fix’ In ‘Fiscal Cliff’ Plan Cuts Medicare Hospital Payments, Kaiser Health News, Jan. 1, 2013, http://capsules.kaiserhealthnews.org/index.php/2013/01/doc-fix-in-senate-fiscal-cliff-plan-cuts-medicare-hospital-payments/ [4] There is a separate $1,900 per year cap for occupational therapy [5] See also the Medicare Improvements for Patients and Providers Act of 2008, Pub. L. No 11-275, codified at 42 U.S.C. §§ 1320b-14, 1396u-5(a) (2010).
Source: medicareadvocacy.org

Doctors billing Medicare patients at higher rates, report finds

“This is an urgent problem,” Dr. Mark McClellan, who directs the Engelberg Center for Health Care Reform at the Brookings Institution in Washington, told the CPI. McClellan, a former director of the Centers for Medicare and Medicaid Services, or CMS, said the agency must send a message that it “won’t stand by and do nothing … that they are paying attention to this.”
Source: nbcnews.com

Florida Medicare Part D Plans

Posted by:  :  Category: Medicare

Joe the Plumber - To Flush The System ... More scams aim to ensnare Brevard seniors - Their ingenuity is boundless, Archer said. (Jul 2, 2012) ... by marsmet524Anyone who require for this medical facility can opt for this service in any case if he or she is with limited source of income. Those who do not earn much have facility of getting extra help for various services that included in medication part D plan. $4,000 is almost amount that you will get as an extra help from these medication plan. Monthly premium and it can also be your prescription payment for which you will get all help. This can act as big saving for those who do not earn much. So make sure that are you clearing criteria of getting that much help.
Source: medicare-supplement-advisor.org

Video: doctors in naples fl Accepting New Medicare Patients 239-676-3410

In Florida, Medicare is not a senior

The law does not lower the bottom-line of future Medicare spending but reallocates some of what would have been spent under old rules. The reductions come mostly from payments to providers and private insurers who offer plans in lieu of traditional Medicare. The money will cover annual physicals, preventive care and more generous prescription drug coverage. Republicans argue that fewer physicians and hospitals will accept Medicare, meaning fewer services. Obama argues that better access to preventive care and drugs will prevent more expensive hospitalizations.
Source: dailycaller.com

Florida man sentenced in Medicare fraud case

Being accused of having been involved in a Medicare fraud scheme can be a very serious allegation. Major criminal charges can be brought against an individual in connection to such an allegation. If a person is convicted of Medicare fraud-related charges, he or she can be given serious criminal punishments. Such punishments can be very impactful on an individual.
Source: criminallawsarasotafl.com

Medicare and You 2013: Florida Medicare and Medicaid

There are several pieces to the Medicare program, and each comes with specific enrollment rules and costs. It is important to understand how these parts work together, along with how they work with other senior healthcare coverage you may have such as Veteran’s Healthcare or Employer/Retiree Insurance.
Source: agingwisely.com

Rubio: Ryan’s Medicare Plan Helps Romney in Florida

When Mitt Romney tapped Paul Ryan to be his vice presidential running mate, conventional wisdom dictated that Romney had put himself at a distinct disadvantage in the key battleground state of Florida, where Ryan’s controversial plan to reform Medicare wouldn’t sit well with millions of government-dependent seniors. Florida Sen. Marco Rubio isn’t buying it. In an interview with National Journal, Rubio argued that Ryan’s proposal will help — not harm — Romney’s chances of winning the Sunshine State. He predicted that older voters will support Romney and Ryan because they are trying to “save Medicare” instead of pretending that nothing is wrong with the fiscally unsustainable program. “Look, you have three million people in the state who are on Medicare — one of whom is my mom, one of whom is Paul Ryan’s mom,” Rubio said. “These are people who understand the reality of Medicare: that it’s spending more money than it takes in; that anyone who’s in favor of leaving it the way it is is in favor of bankrupting it.” Rubio praised the GOP ticket for tackling the hot-button topic of entitlement reform at a time when many politicians won’t acknowledge the problems facing the Medicare program. “They’re looking for real solutions on how to solve this,” Rubio said. “Mitt Romney and Paul Ryan are offering a way to save Medicare that doesn’t change it at all for current beneficiaries. And I think people here are going to be excited about that.”
Source: nationaljournal.com

Florida Poll: Romney Leads Obama Overall, On Medicare

Mitt Romney has opened up an enormous lead over President Barack Obama in Florida, according to a new Miami Herald/El Nuevo Herald/Tampa Bay Times poll. Romney now leads the president by 7 points — 51 percent to 44 percent — in the Sunshine State, his largest lead since a hypothetical Quinnipiac poll conducted in September 2011.
Source: businessinsider.com

Looming Medicare cuts may greatly affect Florida’s hospitals

As I watched the presidential candidates talk about sequestration during their last debate, I couldn’t help but wonder if the average citizen really understands the potential effect of sequestration on healthcare. The sequester, under the Budget Control Act of 2011, is set to begin on January 2, 2013 unless Congress comes up with another solution to cut $1.2 trillion, yes that is trillion with a “t”, in federal spending over the next ten years. Working in healthcare policy, sequester has become a word used on a daily basis as these automatic cuts would have a serious effect on Medicare reimbursement for providers like Orlando Health. However, when I listen to the media, it seems the main focus of the discussion revolves around the military spending cuts rather than the other cuts included in the legislation. Please understand, by no means am I trying to downgrade the significance of the military cuts—a 10 percent cut to mandatory military spending is novel. My goal here is to not downgrade the detrimental power of any of these automatic cuts, but to specifically highlight the threat that these cuts have on Medicare reimbursements.
Source: winniepalmerhospital.com

Central Florida Medicare Guide for iPad

Central Florida Medicare Guide is your one-stop, all-purpose resource for navigating the 2013 Medicare enrollment period. From health-care plans to prescription-drug plans, CFMG and the Florida Media Group’s award-winning health reporters and editors have you covered for all the plans available to Central Florida residents. Download your Central Florida Medicare Guide now!
Source: iosnoops.com

Krugman: Romney win means ‘savage cuts’ to Medicaid

Posted by:  :  Category: Medicare

Counter demonstration: wingnuts by tswedenBecause the state has fared a little better than much of the country since 2006, lowering its poverty rate against the country as a whole, its matching share for Medicaid has risen from 25 to about 30 percent, but only theoretically. President Obama’s stimulus act pumped $750 million into the state’s coffers for Medicaid from 2009 through 2011, reducing the state’s match to 20 percent. It produced state budget surpluses and let the state’s Medicaid trust fund grow for two years. Now the trust fund is vanishing and the state will enter the 2013 fiscal year next July needing an extra $350 million or more to maintain nursing home care, the institutions and community services for disabled children and adults and hospital and physician care for low-income children.
Source: arktimes.com

Video: Arkansas Medicare Supplements

Arkansas Medicaid Officials Apply For $60 Million Federal Grant

The grant application notes that the estimated cost to the state for this system transformation will be about $32.8M over a three and a half year period beginning in January 2013.  That’s a significant sum, but putting it into perspective, that would allow us to achieve lasting and fundamental quality and cost improvements for less than 1% of our current annual expenditures with the potential, if successful, to return over $1 billion in savings to the state Medicaid program through 2020.
Source: talkbusiness.net

Medicaid: Docs Cautious About Arkansas Payment Plan

As in many states, Arkansas’ Medicaid program was hit hard by the 2008 financial crisis. State revenues dropped and enrollment skyrocketed. And now, when the $300 million shortfall that the state faces for its 2013 Medicaid budget is combined with lost federal matching funds, Arkansas stands to lose about $1 billion in Medicaid money for next year.
Source: arkansasmutual.com

THE ARKANSAS LEADER: TOP STORY >> Mills would want Medicaid expansion

By ERNIE DUMAS Special to the Leader Expanding health insurance so that it covers nearly everyone in Arkansas and not just the aged, the disabled and poor children who are insured by the system crafted 50 years ago by Rep. Wilbur D. Mills of Kensett (White County) is nearing reality. Or so it was thought until two events intervened: the U.S. Supreme Court’s June decision upholding all but one part of the Patient Protection and Affordable Care Act and the election four months later that gave Republicans a bare majority in the Arkansas legislature. Whether some 215,000 people, Arkansas’ poorest, will be insured will be up largely to those Republicans when the legislature convenes in January, and because nearly all of them ran for office vaguely opposing “Obamacare” it would seem to be foregone that the poor in Arkansas will still be without coverage when the law kicks in fully at the end of next year. But the politics of “Medicaid expansion” has turned out to be more dangerous than the politicians imagined when they were condemning Obamacare and promising to do what they could to thwart every part of it in Arkansas. It will not be only the 215,000 men and women who will be eligible for government help on their hospital and doctor bills who will disappointed if the Medicaid expansion is blocked. Not many of the very poor vote anyway. But tens of thousands of others, including the frail elderly and disabled in nursing homes and their families, will be hurt even more if the Republicans block Medicaid expansion. In fact, everyone, including people who are already insured and otherwise unaffected by the Affordable Care Act, will be impacted because their own hospital bills and insurance premiums may go up as a result of the state’s refusal to expand Medicaid. Legislators will have to factor the politics of all that when they vote whether to appropriate federal and state funds to expand Medicaid to cover childless men and women whose incomes leave them below 133 percent of the federal poverty line. Under Arkansas’ Constitution, it takes three-fourths of both houses to pass nearly all appropriations, so only 26 members of the 100-member house or nine of the 35 senators can block any appropriation. Congressman Mills, by then the most esteemed member of the U.S. House of Representatives, cobbled together the lengthy 1965 amendment to the Social Security Act that created Medicare and Medicaid, the former to cover hospital and physician care for the elderly and permanently disabled and the latter to help the elderly frail in nursing homes and the poor who qualified for public assistance and poor children. Medicaid was to be a partnership between Washington and state governments, and the states could choose how much health coverage to give to the poor beyond certain programs that were mandated for every state that participated. Mills’ state was very poor and he established a cost-sharing formula that favored poor states. The federal government would pay at least half the costs of Medicaid, but the precise federal share would vary according to each state’s ranking on per-capita incomes. Because Arkansas has always been near the bottom, its share has ranged between 20 and 30 percent and the federal government’s between 70 and 80 percent. States like New York and Massachusetts always bear half the costs in their states. That formula, which shifts a little each year when the per-capita income rankings of the states are compiled, is a source of the Republican legislators’ dilemma. It is complicated business and requires a little attention. A HELPFUL GUIDE First, a primer on the Affordable Care Act, which was fiercely hated in Arkansas when Congress passed it in 2010, although Arkansas’ senior senator then, Blanche Lincoln, helped write it and the other senator, Mark Pryor, voted for it in spite of heavy mail against it. Opposition has relaxed as people learn more about it and many realize its benefits for them, but Republicans in many parts of the state still found it a good election issue. The law is long and complicated, but it has four major provisions. (1) Medicare is expanded to give people free health screenings and to pay more of their prescription costs, and Medicare’s long-term outlays are reduced by scaling back payment rates to hospitals and other providers and by reducing the government subsidies to insurance companies that sell managed-care plans to Medicare recipients. (2) Insurance companies next year will no longer be able to deny coverage to people with pre-existing conditions like cancer, heart trouble or diabetes. (3) Medicaid is expanded in 2014 to cover the able-bodied adult poor at 100 percent federal cost until 2018, when the states will begin to pick up a rising share, which will be capped in 2021 at 10 percent. (4) Employers with more than 50 full-time employees and individuals who are uninsured will be required to purchase an insurance plan from an array of plans offered by insurance companies in an exchange or market organized by either the state or federal government. Arkansas Republicans want the federal government to run the exchange; Beebe wants the state to run it. Large employers and individuals who opt not to participate will pay a tax to the government, although the tax will be lower than the cost of insurance. The federal government will help people pay for the insurance if their family incomes are between 133 and 400 percent of the federal poverty line, which for a family of four this year would be between $23,000 and $92,000. If family incomes are below 133 percent of the poverty line, they are eligible for Medicaid. The Supreme Court upheld all the Affordable Care Act except the provision that required states to participate in the Medicaid expansion. Although states already are required to participate in a few Medicaid programs, the court said they could elect not to participate in this expansion.  A big majority of states will participate, but several Republican governors promptly said they would keep their states out of the coverage of poor adults even though their states would bear none of the initial costs. Gov. Beebe said it was a no-brainer for Arkansas and he expects Arkansas to embrace the coverage, but if the Legislature doesn’t pass the appropriation that authorizes the federal expenditures the 215,000 Arkansans who are eligible will not be covered. Since the election, several Republican legislators have softened and said that they might support the Medicaid expansion, maybe with a few conditions. WORKING POOR If Arkansas does not participate in the Medicaid expansion, it will create a perverse situation. Everyone in Arkansas will have access to health care, most of them with insurance subsidized by the government, except the poorest workers, typically those earning minimum wage up to $12 an hour or who do not have full-time jobs. The Affordable Care Act was a bonanza for Arkansas from the outset, as the state’s surgeon general, Dr. Joe Thompson, said. Since Arkansas is so poor and so few people are insured, the two major elements of the law — the insurance exchanges and Medicaid expansion — will flush billions of dollars into the Arkansas economy while improving the health and security of its people. Two hundred thousand Arkansans who do not have health insurance, mainly because they cannot afford it, will get federal help paying the premiums. For those whose incomes are barely above 133 percent of the poverty line, the government will pay most of the premiums. Another 215,000 will be eligible for Medicaid, and the state will bear none of those costs until 2018. All those federal dollars will turn over several times in the Arkansas economy — six times according to the Walton College of Business’ model, and increase the state’s revenues from income and sales taxes. But if Arkansas stops the Medicaid expansion the effect will be worse than simply denying the medical care to the 215,000 and keeping the federal money out of the Arkansas economy. That is because it also will deprive Arkansas of an additional subsidy that will help pay for some Medicaid services that are currently borne by the state. The Affordable Care Act shifts those costs, estimated at $128 million over two years, to Washington but only if the state expands Medicaid. Here is what no one calculated: Since the economic collapse in 2007, Arkansas has fared better than the nation as a whole. It did not experience the depth of unemployment and the decline in personal incomes that afflicted industrial states and those along the seaboard, like Florida. So Arkansas rose a little each year in the per-capita income rankings, and its Medicaid matching rate went up accordingly a little each year. A slight percentage adjustment results in tens of millions of dollars of extra state spending and a reduction in federal costs. As a result, between 2008 and 2012, Arkansas experienced a big shortfall in state Medicaid matching money, but the state was lucky in another way. President Obama’s big stimulus program in 2009 sent Arkansas $825 million over three years to stabilize its Medicaid coverage during the recession. The $825 million more than made up for the state matching shortfall and enabled the state to bank its Medicaid trust fund, made up of soft-drink taxes.  Since the stimulus money ran out, Arkansas has been rapidly spending the trust fund to cover Arkansas’ higher Medicaid match. The trust fund will run out and when the new fiscal year begins next July, Arkansas will face a shortage of perhaps $350 million in state Medicaid matching funds for its current programs. If the state has to slash services to save that $350 million it also will lose $1.2 billion in matching federal aid, so the total cuts would be close to $1.5 billion a year. PAINFUL CUTS No one talks about raising taxes to avoid cuts in medical services. Instead, Beebe’s Medicaid office has outlined a number of cost savings it intends to implement next year, but none of them comes near closing the $350 million gap. The big step that would close it would be to end assistance for nursing home patients who can get to the bathroom and dining hall without assistance. Republican legislators said last month they thought that was a bluff, that the state wouldn’t put 15,000 of the elderly sick on the streets. But the administration said it would not end coverage for children or the disabled in the state’s children’s colonies, which would be the other options. If the Medicaid expansion is adopted and the federal government picks up the $128 million of state’s costs for current programs, that would reduce the state’s shortfall by a third. That provides an additional incentive for legislators to approve the expansion. There is an even greater incentive. Hospitals and the American Medical Association, which never before endorsed a universal health-care bill, supported the Affordable Care Act even though it calls for reducing Medicare payments for hospital stays and certain procedures. The reason was that the law required people to get insured and if they were below 135 percent of poverty to be covered by Medicaid. No longer will hospitals and clinics have to absorb billions of dollars a year in charity care and raise their room rates for paying patients on Medicare or private insurance to cover the losses. Hospitals are required to treat patients even if they have no assets or insurance. Last year, Arkansas’ community hospitals absorbed $338 million in free care for patients who couldn’t pay. HOSPITALS LOSE But if Medicaid is not expanded, the hospitals, especially rural hospitals in parts of the state where more than half the people have no insurance and can’t pay for extended hospital and physician care, face a financial crisis. Their Medicare reimbursements will go down under the Affordable Care Act, but their unpaid charitable care would continue. The same is true for doctors, although many doctors now do not accept Medicaid patients or poor people who cannot pay at the desk. For that reason, hospital administrators and boards will be lobbying the legislature in January to expand Medicaid. For some hospitals, it means life or death. The health and peace of mind of a quarter-million low-income citizens is not a big pressure point for politicians who did not count on them for votes and support in the first place. Hospital boards, families of the nursing home patients and other Medicaid recipients, and businessmen expecting the billions of federal money flushing into their communities — those people can mount some pressure. HELPING STATE Dr. Thompson, the surgeon general, thinks the Medicaid expansion and the subsidized premiums for people with incomes four times the poverty level offer a more far-reaching advantage for the state. Over time, providing health insurance for all low-income residents will overcome a longtime problem for small towns and rural Arkansas—the lack of primary-care doctors and facilities. Since most residents of rural counties, especially in eastern and southern Arkansas, do not have health insurance unless they qualify for Medicare or they work for a business that covers them, small towns do not attract medical graduates and the communities cannot sustain hospitals. Most patients cannot pay for extended care or else they pay over long periods. Doctors find community practices hard and so unremunerative that they leave after a few years. When nearly everyone has private insurance, Medicaid or Medicare, that will change. New doctors will find small towns a rewarding practice. And access to health care will make small towns and regional centers appealing for business and industry. If they get chambers of commerce on board, the Medicaid controversy will be settled promptly. Ernie Dumas, formerly of the Arkansas Gazette, is the dean of Arkansas journalsts.
Source: blogspot.com

Arkansas Medicare Insurance Plans

The Arkansas Medicare Insurance plans are health program that is provided by the state federal government. This is for those whose age is 65 years or more. There are also exceptions who can apply such as those with severe kidney problems. This is a kind of social insurance policy that helps keep all monetary risks at check. This also provides protection from incurring medical debt. The Medicare insurance plan provides protection which is more social than those by private insurers. There are not many risks involved in terms of ensuring the financial solvency to the insurer.
Source: medicarearkansas.com

Eyes Turn To Arkansas’ Bold Effort To Cut Medicaid Costs, Add Transparency

First, the three entities analyzed historical billing data to determine the state’s highest-volume and most costly medical conditions. Then, they each individually targeted three conditions for which they would track the costs for “episodes of care” — meaning the total charges of treating patients for that specific illness, everything from office visits, to medications and specialty care. The conditions included perinatal care, upper respiratory infections, attention deficit/hyperactivity disorder, hip and knee replacements, and congestive heart failure.
Source: kaiserhealthnews.org

Your Health Care: Understanding Medicare & Medicaid

Navigating the health care system can be challenging for anyone, but for the more than 9 million people who are eligible for both Medicare and Medicaid, it can be especially difficult.   Medicare and Medicaid have similar names but are actually very different programs. People who are eligible for both, known as “dual eligibles,” must understand the differences in eligibility requirements and coverage details in order to access the health care services that are available to them. This is especially important for the 60 percent of dual eligibles who suffer from multiple chronic conditions, such as diabetes and heart disease. Getting the health care coverage they need to appropriately manage their conditions is critical to their well-being.   The 118,000 dual eligibles in Arkansas and their caregivers should take the following steps to help simplify their health care experience and get the best care available.   1. Understand the differences in coverage and eligibility between Medicare and Medicaid.   Medicare is a program managed by the federal government that provides health care benefits to people age 65 and older and disabled individuals. Medicare covers medical care services such as physician visits, hospital stays and prescription drug costs.   Medicaid is a health care benefits program managed by the Arkansas state government. Unlike Medicare, each state sets its own guidelines regarding Medicaid eligibility and services. For those enrolled, Medicaid pays for most long-term care as well as Medicare deductibles, co-payments and other health care costs that beneficiaries would otherwise pay for out of pocket.   2.  Explore health care options in Arkansas that provide adequate support for dual eligibles.   For dual eligibles, the coordination of benefits between Medicare and Medicaid can be confusing, as beneficiaries typically have separate membership cards and different points of contact for their benefits questions. One option to address this challenge that has risen to the forefront of Arkansas efforts in recent years is what’s known as a Medicare Advantage Special Needs Plan.   Offered by private companies, these plans can be chosen in place of traditional Medicare. Special Needs Plans support dual-eligible individuals by serving as a single entity that coordinates all aspects of care. These plans focus on the unique needs of dual eligibles, offering customized care and support to manage their complex health care needs. Specialized services available with Special Needs Plans may include in-home visits, social support services and help when transitioning home from the hospital.
Source: thecitywire.com

State Highlights: Texas Begins New Women’s Health Program

Posted by:  :  Category: Medicare

i don't need your rockin' chair... by jmtimagesThe Texas Tribune: Amid Legal Drama, Texas Takes Over Women’s Health Program Texas is funding the [Women’s Health Program] on its own because the federal government pulled funding after the state blocked Planned Parenthood from participating. The Texas version still serves low-income women who would qualify for Medicaid if they became pregnant. It will cover about 110,000 women between 18 and 44 years old with free well-woman exams, basic health care and certain family planning services. … The big change is where women can go for those services. Women using the plan may not receive any health care from Planned Parenthood or any medical provider “affiliated” with abortion providers (Philpott, 1/3).
Source: kaiserhealthnews.org

Video: TRS Care Aetna Medicare Plans

Hospitals in Texas Outperform Those in Other States on Medicare Bonus Payments

Locally, five hospitals will receive bonuses of more than .7 percent for each Medicare patient—including three affiliated with Baylor Health Care System (see accompanying chart). On the other hand, five hospitals will receive penalties between .66 and .92 percent. The calculations reflect bonuses and penalties based on the value-based purchasing bonuses and the October penalties for excessive hospital readmissions. The maximum value-based gain or loss was 1 percent.
Source: dmagazine.com

Texas Medicare Advantage Disenrollment : Learn Your Options

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

Medicaid Eligibility in Texas

Following an initial check of the information, all applicants are required to visit a Health and Human Services Commission Benefits office. This visit interviews the applicant to ensure all information is present and correct – forming the final part of the application. Applicants who have specific reasons why they cannot travel to the Health and Human Services Commission Benefits office may be able to complete the review by telephone, or a representative may make a home visit.
Source: tex.org

Texas Man Accused of Falsely Billing Medicare and Medicaid is Arrested

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Source: dcfederaldefenseattorney.com

Texas Attorney General Missing the Mark on Medicare

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

Information for Medicare Beneficiaries

This week, open enrollment began for Medicare and runs through December 7, 2012. It is important for current Medicare beneficiaries to review their plans on an annual basis to ensure satisfaction with their current coverage. Some of the optional changes to your coverage you may wish to make during this period, which would take effect in 2013, are:
Source: texasgopvote.com

When should I apply for Medicare?

Posted by:  :  Category: Medicare

Benefit Security Card .. HALF of the U.S live in households that receive government benefits (26 May 2012) ...item 2.. Brevard man gets 4 years in Social Security fraud case (Jun 1, 2012 ) ... by marsmet481If you’re not receiving Social Security benefits, however, consider signing up soon. As does the Social Security Administration, Long recommends that you apply three months before your 65th birthday to ensure your coverage begins the month you turn 65.
Source: cnn.com

Video: Medicare Enrollment | Medicare Sign Up | Apply for Medicare

Ask The Experts: Retirement

First, please review previous Q&As to see if your question already has been answered. If you cannot find the answer, submit your question to our Retirement expert at fedexperts@federaltimes.com PLEASE NOTE! Do not submit ANY questions via the Comments form. Questions submitted via the Comments form will NOT be answered!
Source: federaltimes.com

Medicaid Eligibility Streamlining: Modified Adjusted Gross Income Test for Medicaid Eligibility in 2014

Implementing the Modified Adjusted Gross Income standard requires states to make massive changes to their information systems, databases, procedures, and work flows.  States must convert their entire eligibility systems and existing data files to the new methodology.  Conversion to MAGI also plays a critical role in Health Insurance Exchanges.  Every Exchange applicant must be pre-screened for Medicaid and CHIP eligibility, and MAGI will be used to determine eligibility for federal subsidized premiums and cost sharing for Qualified Health Plans in Exchanges.  So while the new income standard is not effective until January 1, 2014, everything must be tested and operational by the start of the Exchange open enrollment period on October 1, 2013.  And all this must all be done at the same time as state Medicaid agencies implement a wide range of other changes to comply with ACA.  Examples include creation of web portals for individuals to apply online for Medicaid and with electronic signatures, and changes to Medicaid primary care rates.
Source: piperreport.com

Tricare Help – Can wife, over 65 but ineligible for Medicare, be put on Tricare Prime?

What you need to do is contact your local Social Security Administration office and make them aware that your wife is not eligible for Medicare Part A under either her own work history or yours. As such, she should be eligible to receive a “Notice of Disapproved Claim” from the SSA. Once you have that in hand, take it to your nearest military installation ID Card/DEERS office. DEERS is the Defense Enrollment Eligibility Reporting System, the Defense Department’s eligibility portal for Tricare. The SSA’s “Notice of Disapproved Claim” should be sufficient to allow your wife to retain eligibility for Tricare Prime, Standard and Extra even though she is already past her 65th birthday, once you update your wife’s DEERs registration file and get a new ID card for her.
Source: militarytimes.com

You Can Apply For Medicare Online

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

IRS Issues Proposed Rules for New Medicare Tax on High Wage Earners’ Net Investment Income; Whether Tax Applies to 404(k) Dividends is Unclear 

Code section 404(k) permits plan participants, to the extent provided under the plan, to elect to receive dividends on employer stock either (1) paid directly to them in cash or (2) paid to the plan and reinvested in additional shares of employer stock.  Arguably, if the participant elects to have the dividends paid to the plan and reinvested in additional employer stock, this tax should not apply because the participant will ultimately receive the value of the dividend as a distribution from the plan, which would be reported on Form 1099-R.  But if the participant elects to receive the dividends directly in cash, it is possible the tax might apply because such dividends, reported on Form 1099-DIV, are otherwise taxed as “ordinary dividends.”  Absent additional guidance from the IRS, it is unclear whether and to what extent 404(k) dividends should be included as net investment income for purposes of this tax.  The proposed regulations can be found here.
Source: haynesboone.com

Too Young to Apply for Medicare but Need Health Coverage? Understand Your Options

If COBRA is no longer an option, you might consider a private insurance plan or, if possible, join your spouse’s employer-provided health plan. For those with pre-existing medical conditions that make it difficult to get coverage, PCIPs, or pre-existing condition insurance plans, are also an option. Once you have been uninsured for six months, consumers are eligible to apply for state-run PCIPs that accept “high risk” applicants at lower prices than private providers. These plans are available until December 31, 2013, after which insurance providers will be unable to turn away applicants due to a pre-existing condition.
Source: reversemortgagecalculator.com

3 Tips for Avoiding Pitfalls in Medicare Enrollment

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Source: iaminvest.com

Saving money on health costs: Extra Help program

monthly premiums, annual deductibles, and prescription copayments in your Medicare drug plan. Did you know that the Extra Help program is estimated to be worth about $4,000 dollars per person, per year? Even if you’re not sure you’d qualify, it’s worth filling out an application to see.
Source: medicare.gov

When can you apply for Medicare??

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Source: australiaforum.com

The Medicare age is still 65

There is no additional charge for Medicare hospital insurance (Part A) since you already paid for it by working and paying Medicare tax. However, there is a monthly premium for medical insurance (Part B). If you already have other health insurance when you become eligible for Medicare, you should consider whether you want to apply for the medical insurance. To learn more about Medicare and some options for choosing coverage, read the online publication, Medicare, at www.socialsecurity.gov/pubs/10043.html or visit www.Medicare.gov.
Source: ironmountaindailynews.com

Do You Qualify for Medicare's Extra Help Program?

Every individual who qualifies represents an important potential benefit to our tribal communities. Social security is responsible for implementing that benefit; we call it “extra help.” Many Medicare beneficiaries won’t have to file for assistance because they’ll automatically get it based on benefits they receive.
Source: indiancountrytodaymedianetwork.com

Ask The Experts: Retirement

Posted by:  :  Category: Medicare

Jessica Sundheim by On BeingFirst, please review previous Q&As to see if your question already has been answered. If you cannot find the answer, submit your question to our Retirement expert at fedexperts@federaltimes.com PLEASE NOTE! Do not submit ANY questions via the Comments form. Questions submitted via the Comments form will NOT be answered!
Source: federaltimes.com

Video: Patty and Richard say, “Apply online for Medicare” (20 seconds) – Social Security

To promote and expand the application of telehealth under Medicare and other Federal health care programs, and for other purposes. (2012; 112th Congress H.R. 6719)

So, yes, we display the House Republican Conference’s summaries when available even if we do not have a Democratic summary available. That’s because we feel it is better to give you as much information as possible, even if we cannot provide every viewpoint.
Source: govtrack.us

Saving money on health costs: Extra Help program

monthly premiums, annual deductibles, and prescription copayments in your Medicare drug plan. Did you know that the Extra Help program is estimated to be worth about $4,000 dollars per person, per year? Even if you’re not sure you’d qualify, it’s worth filling out an application to see.
Source: medicare.gov

Notes from the Cliff: The Deal and Its Impact on Medicare 

Cong. Tit. VI (2012) [2] Id. at  §§ 601, 603, 607, 608, 610, 621, 643 (2012) [3] For more information on the Sustainable Growth Rate See The Sustainable Growth Rate Formula and Health Reform, The Center on Budget and Policy Priorities, (April, 2010) http://www.cbpp.org/files/4-21-10health2.pdf & Mary Agnes Carey,  ‘Doc Fix’ In ‘Fiscal Cliff’ Plan Cuts Medicare Hospital Payments, Kaiser Health News, Jan. 1, 2013, http://capsules.kaiserhealthnews.org/index.php/2013/01/doc-fix-in-senate-fiscal-cliff-plan-cuts-medicare-hospital-payments/ [4] There is a separate $1,900 per year cap for occupational therapy [5] See also the Medicare Improvements for Patients and Providers Act of 2008, Pub. L. No 11-275, codified at 42 U.S.C. §§ 1320b-14, 1396u-5(a) (2010).
Source: medicareadvocacy.org

Expiration of the Long Term Care Hospital Development Moratorium: A Lasting Development Opportunity?

Many general acute care hospitals and post-acute care providers (in certificate of need and noncertificate of need states alike) have begun contemplating developing new LTCHs after expiration of the moratorium.  These organizations, however, should be aware that the ACA grants CMS authority to impose an administrative moratorium on the enrollment of new Medicare providers and suppliers of a specific type in a particular geographic area. CMS may impose a new moratorium by announcing it in the Federal Register if CMS determines that there is significant potential for fraud, waste or abuse.  In making such a determination, CMS may consider such factors as whether a state Medicaid program has declared a moratorium on a particular provider or supplier type and whether a rapid increase in enrollment within a given provider or supplier category has occurred or is likely to occur.  Organizations may wish to consider drafting unwind provisions into their operating documents, leases and other contracts to account for the possibility of CMS’ imposition of an administrative moratorium.  It may also become important for parties with plans for LTCH expansion to submit their provider enrollment applications as soon as possible after expiration of the moratorium, since approved enrollment applications will not be impacted by application of a CMS administrative moratorium.
Source: greisguide.com

Aetna Launches Medicare Mobile Field Enrollment Tool For iPad

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

Medicare revalidation, DMEPOS fee still prompt questions among ODs

“Medicare covers post-op eyeglasses for cataract patients only if the glasses are provided by a DMEPOS supplier who is enrolled in Medicare,” Dr. Jordan said. “If the optometrist is not enrolled in Medicare for DMEPOS, then the glasses are not covered. Neither the doctor nor the patient can obtain reimbursement for the glasses from Medicare if the supplier is not enrolled. If a Medicare beneficiary wants to pay out-of-pocket for eyeglasses from a supplier who is not enrolled in Medicare, she or he may do so, but the doctor should be sure to explain to the patient that the glasses would be covered if they were obtained from another supplier who is enrolled in Medicare. In addition, the doctor should be certain to have an ABN form signed by the patient acknowledging that although she/he could have these glasses covered elsewhere she/he agrees to pay the doctor out-of-pocket and that he or she cannot get reimbursement from Medicare.”
Source: newsfromaoa.org

The Medicare age is still 65

There is no additional charge for Medicare hospital insurance (Part A) since you already paid for it by working and paying Medicare tax. However, there is a monthly premium for medical insurance (Part B). If you already have other health insurance when you become eligible for Medicare, you should consider whether you want to apply for the medical insurance. To learn more about Medicare and some options for choosing coverage, read the online publication, Medicare, at www.socialsecurity.gov/pubs/10043.html or visit www.Medicare.gov.
Source: ironmountaindailynews.com

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

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

Understanding the Medicare Advantage Disenrollment Period

Disenrollment requests during the MADP are effective on the first day of the month following the submission of the request. Individuals will automatically return to Original Medicare and will need to apply and qualify for a Medicare Supplement plan if they chose that option.  Individuals who enroll in a standalone Part D plan during the MADP will receive an effective date of either 2/1/13 or 3/1/13 depending upon the application date.
Source: agentpipeline.com

The Medicare age is still 65

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Source: cedarspringspost.com

Preventive & screening services

Posted by:  :  Category: Medicare

Denied coverage because of a pap smear by Paul SchreiberThe page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

Video: Shocking! When States Expand Their Medicare Coverage, Less People Die

Medicare Coverage for Immune Deficiency Care at Home Advanced by House

The proposal (HR 1845), passed 401-3 under suspension of the rules, garnered wide bipartisan support in the House, with more than 40 Democrats and more than two dozen Republicans signing on as co-sponsors to Brady’s bill. Proponents contend the legislation is needed to enhance therapeutic innovation and further patient access to plasma protein therapies.
Source: primaryimmune.org

Uwe E. Reinhard: The Complexities of Comparing Medicare Choices

Each private plan would have had to offer a benefit package that covered at least the actuarial equivalent of the benefit package provided by the traditional fee-for-service Medicare. Medicare’s contribution (or “premium support”) to the full premium for any of these choices, including traditional Medicare, would have been equal to the “second-least-expensive approved plan or fee-for-service Medicare” in the beneficiary’s county, whichever was least expensive. That premium support payment would have been adjusted upward for the poor and the sick and downward for the wealthy.
Source: nytimes.com

Settlement Proposed for Medicare Coverage of Home Health Care

The changes would apply to the traditional Medicare program and private Medicare Advantage plans. More than 10,000 beneficiaries whose claims were denied before Jan. 18, 2011 — when the lawsuit was filed — are expected to benefit as their claims would be re-examined under the new standards, the Times reports.
Source: californiahealthline.org

Administration proposal would ease Medicare coverage for SNF stays

While Medicare advocacy and provider groups hail the proposed changes, the administration has not said how the government would pay for the added coverage. Experts and legal officials with the Department of Health and Human Services acknowledge the cost of this reversal could be substantial. Others suggest it could save the government money since physical therapy and home health are typically less expensive than care delivered in hospitals and nursing homes, the newspaper noted.
Source: mcknights.com

Are you ready for 2013? 4 questions to ask yourself

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

Liberalism: Does the fiscal

But Mr Chait goes on to make a different point: while it looks as though entitlement programmes are nearly impossible to cut, just about everything else the government does is much more vulnerable. Everything from food inspections to foreign aid to environmental regulation to legal defence for the indigent to scientific research to the national parks to education to road, rail and air infrastructure to…pretty much everything. These programmes are diverse and often have small constituencies. There is, basically, a lot of stuff that the government does. And when you ask the public, you find that they want the government to do these things. But public attention is a very limited commodity; it’s impossible to actually marshal public attention to each of the individual programmes that get cut when “government” gets cut. What’s happened over the past 30 years, and in an accelerated tempo over the past two years, is that everything the government does apart from wars and transferring money to old and poor people has gotten creamed. The savings are trivial in comparison with the overall long-term debt picture, which is almost entirely a function of Medicare and Medicaid spending. But the cuts have effectively curtailed the vision of liberals who want government to do things like invest in basic scientific research, improve infrastructure, kick-start green technology and support education. In that sense, it’s true, the ability of Republicans to block Democrats from expanding the tax base has been a conservative victory.
Source: economist.com

Learn how to challenge Medicare coverage denial

Decisions made by drug plans can also be appealed. You should request a written explanation from the plan for why a prescription is not covered and ask for an exception if you or the prescriber believe you need the drug. You would pay for the drug during the appeal, but you should keep receipts: If the denial is overturned, the drug plan will reimburse for its share of the bill. (While an appeal is under way, drug discount cards or manufacturer or pharmacy discounts may reduce your costs.)
Source: voxxi.com

Marci’s Medicare Answers

If your Medicare Advantage or Part D plan does not cover your drug, your plan should provide you with a 30-day transition fill at some time during the first 90 days of the year. A transition fill is a one-time, 30-day supply of a Medicare-covered drug that Medicare prescription drug plans must cover, when you’re in a new plan or when your existing plan changes its coverage. You should also talk to your doctor about switching your drug to one that is covered by your plan or ask for help in sending a formal request to your plan to cover the drug. If you have questions about whether your Medicare Advantage or Part D plan covers those medications and if there are any rules you must follow in order to get the medications, you should contact the plan directly.
Source: homeboundresources.com

Closing The Medicare Part D Program Doughnut Hole: The End Is In Sight!

Posted by:  :  Category: Medicare

J Center Medicare D Seminar 11-21-06 by Korean Resource Center 민족학교There’s also some encouraging research confirming what a lot of us intuitively sense: that making prescription drugs more affordable saves money down the road by keeping people healthier. When people with diabetes get their insulin regularly, for example, they’re more likely to stay out of the hospital. Of course this is great for them; no one likes going to the hospital. But it’s good for all of us, because hospital care is expensive, and keeping people healthy and out of the hospital is one of the most obvious ways of bringing health care costs under control. Recently, the Congressional Budget Office – the green eyeshade folks who keep track of the cost of everything the government does – concluded that making prescription drugs in Medicare more affordable does, in fact, save some money later on by reducing things like hospital admissions. As a result, filling in the doughnut hole is going to cost about 40 percent less than was previously forecast. At a time of tight budgets, that’s great news for all of us.
Source: smmirror.com

Video: Medicare Part D

‘If I’d Had To Wait Until 67 For Medicare, I’d Be Dead’

A proposal to raise the Medicare eligibility age from 65 to 67 to ratchet down spending is one of the more explosive ideas in the fiscal talks between House Speaker John Boehner and the White House. The negotiations are aimed at a deficit deal to avert automatic tax increases and spending cuts slated to take effect Jan. 1.  Liberal Democrats say they loathe the Medicare proposal, but the White House has not taken a public position on it.
Source: kaiserhealthnews.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

Understanding the Medicare Advantage Disenrollment Period

Disenrollment requests during the MADP are effective on the first day of the month following the submission of the request. Individuals will automatically return to Original Medicare and will need to apply and qualify for a Medicare Supplement plan if they chose that option.  Individuals who enroll in a standalone Part D plan during the MADP will receive an effective date of either 2/1/13 or 3/1/13 depending upon the application date.
Source: agentpipeline.com

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

OIG Report Poses Potential Problems For Medicare Providers

According to the report, providers (physicians, suppliers, hospitals, etc.) filed 85% of all Medicare appeals in 2010; beneficiaries accounted for 11%; and state Medicaid agencies accounted for the remaining 3%.  Furthermore, a small number of providers accounted for the majority of appeals.   For example, one provider appealed over 1,000 claims, whereas the average provider appealed 6 claims. Additionally, ALJs reversed 56% of all prior-level decisions at appeal, in favor of appellants.  Reversals were highest for Part A providers – 62% (hospital appeal reversals were 72%).  Reversals for Part B providers were 59%; DMEPOS suppliers were 53%; Part C providers were 18%; and Part D providers were 19%.
Source: dmagazine.com

Fiscal Cliff And Medicare

[T]hese negotiations amounted to a test of liberalism’s ability to raise revenue, and it isn’t clear that this outcome constitutes a passing grade: If a newly re-elected Democratic president can’t muster the political will and capital required to do something as straightforward and relatively popular as raising taxes on the tiny fraction Americans making over $250,000when those same taxes are scheduled to go up already, then how can Democrats ever expect to push taxes upward to levels that would make our existing public programs sustainable for the long run?
Source: businessinsider.com

Medicare Part D Premiums Holding Steady

Thanks to the marvels of medical science, our parents are living longer than ever before. Adults over age 80 are the fastest growing segment of the population; most will spend years dependent on others for the most basic needs. That burden falls to their baby boomer children. In The New Old Age, Paula Span and other contributors explore this unprecedented intergenerational challenge. You can reach the editors at newoldage@nytimes.com.
Source: nytimes.com

Figuring out the Medicare Part D market

Over the years, the marketers of Part D plans have made them increasingly complex, adding tiers of varying prices and using “medication management” techniques, which can make patients and doctors jump through veritable hoops to get a prescription filled. The Medicare News Group
Source: marketwatch.com

Medicare Part D: A First Look at Part D Plan Offerings in 2013

NOTE: Originally released in October 2012, this data spotlight was updated in November 2012 to reflect revised data from the Centers for Medicare and Medicaid Services. 
Source: kff.org

The A, B, C and D of Medicare

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

Medicare Part D: It Pays to Shop Around

Politicians often tout the value of the free market, arguing that more choice results in a better deal for consumers. In the case of Medicare Part D coverage, the array of choices don’t always translate into better decision-making and more savings. Perhaps there are too many choices. Plans change from year to year, a drug that may have a high co-pay on one plan may have a tiny co-pay on another. A drug that was covered by a particular plan one year may be dropped from coverage the next.  The researchers conclude that “beneficiaries need more targeted assistance from the government to help them choose plans, such as customized communications about the most cost-effective plans that would cover their medication needs.”
Source: lexisnexis.com

Counting Health Care Changes In The ‘Fiscal Cliff’ Deal

Posted by:  :  Category: Medicare

Joe the Plumber - To Flush The System ... More scams aim to ensnare Brevard seniors - Their ingenuity is boundless, Archer said. (Jul 2, 2012) ... by marsmet524There are some small bites at the Affordable Care Act in there, too. The biggest pay-for – as they call them on Capitol Hill – are hospital payments. These are old payments under Medicare that will bring in about $10.5 billion, and then there’s another hit to hospitals, disproportionate share hospitals, hospitals that take a disproportionate share of charity and low-income patients. And that brings in another $4 billion. Then there’s another combination of smaller cuts that the hospital industry so far, they say that they don’t really like them, that they’re being hit disproportionately, but when the “fiscal cliff” negotiators got toward the end of the line, these were the easiest cuts to make.
Source: kaiserhealthnews.org

Video: What is a Medicare health insurance exchange?

Uwe E. Reinhard: The Complexities of Comparing Medicare Choices

Each private plan would have had to offer a benefit package that covered at least the actuarial equivalent of the benefit package provided by the traditional fee-for-service Medicare. Medicare’s contribution (or “premium support”) to the full premium for any of these choices, including traditional Medicare, would have been equal to the “second-least-expensive approved plan or fee-for-service Medicare” in the beneficiary’s county, whichever was least expensive. That premium support payment would have been adjusted upward for the poor and the sick and downward for the wealthy.
Source: nytimes.com

Just Caring: Meeting the Health Care Needs of the Elderly (and Everyone Else)

Private insurance plans might be legally obligated to offer plans that covered some fairly substantial package of Medicare benefits, but plans might have extraordinarily high copayments and deductibles such that access to costly but effective medical care was essentially rationed by ability to pay.  The political advantage of this approach is that advocates can say government is not rationing care; Medicare recipients are freely making rationing decisions for themselves.  This is hidden or invisible rationing, which is intrinsically unjust.  Of course, if the care that Medicare recipients were denying themselves were marginally beneficial, non-costworthy care, then the moral objections would be largely dissipated.  But the economically less well-off would not be able to make such distinctions; they would be denying themselves as often as not effective costworthy medical interventions as well as non-costworthy interventions.  In short, the current basic equity of the Medicare program would end and access to needed health care for the elderly would reflect the differential access to care determined by individual ability to pay characteristic of the rest of the insurance market.
Source: msubioethics.com

Medicare Physician Payment Cut Delayed

Hospital Medicare programs will bear the brunt of the doctor payment cut delay. Initiatives that could be affected include payments for end-stage renal disease treatment; a re-pricing of these payments was proposed after a report from the Government Accountability Office that suggested the federal government is over-paying for these procedures. If approved as part of the bill, re-pricing would save about $4.9 billion. Low income patients may feel the impact of the decision as well, as the bill calls for re-basing Medicaid Disproportionate Share hospital payments – a move that would save about $4.2 billion.
Source: gohealthinsurance.com

2013: The year we become the health care nation

Medicare 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

5 Affordable Health Insurance Options One Can Find in This Market

If you don’t qualify for the options listed above, you are still able to qualify for private health insurance. If you do not currently have health insurance coverage or if you have difficulty affording your currently health insurance plan, you may want to consider private insurance options. Some of these private insurance options may even provide you with low cost care. Using healthcare.gov will give you tools for it. This online tool, which is free of charge, will help you find health insurance policies in your location that offer the lowest premiums and the lowest out of pocket costs. Also, if you have a pre-existing health condition, this tool will help you find the coverage you need in addition to all other options you may qualify for. In conclusion, you will be able to find the most affordable health care option.
Source: emaxhealth.com

Liberalism: Does the fiscal

But Mr Chait goes on to make a different point: while it looks as though entitlement programmes are nearly impossible to cut, just about everything else the government does is much more vulnerable. Everything from food inspections to foreign aid to environmental regulation to legal defence for the indigent to scientific research to the national parks to education to road, rail and air infrastructure to…pretty much everything. These programmes are diverse and often have small constituencies. There is, basically, a lot of stuff that the government does. And when you ask the public, you find that they want the government to do these things. But public attention is a very limited commodity; it’s impossible to actually marshal public attention to each of the individual programmes that get cut when “government” gets cut. What’s happened over the past 30 years, and in an accelerated tempo over the past two years, is that everything the government does apart from wars and transferring money to old and poor people has gotten creamed. The savings are trivial in comparison with the overall long-term debt picture, which is almost entirely a function of Medicare and Medicaid spending. But the cuts have effectively curtailed the vision of liberals who want government to do things like invest in basic scientific research, improve infrastructure, kick-start green technology and support education. In that sense, it’s true, the ability of Republicans to block Democrats from expanding the tax base has been a conservative victory.
Source: economist.com

Congress passes on chance to fix Medicare doctor pay

4. My girlfriend is in med school and I can attest to how much work goes into it. Four years of med school, three years of residency (4 for surgery) and then 3-5 for a fellowship if the person so chooses to subspecialize. They take 3 board exams, 1 after 2nd year, 1 during 4th year and 1 during residency. They also recertify every 10 years for their specialty. However, their testing is no more comprehensive than a lawyers (believe me, I’ve watched and listened to my girlfriend study). They merely get tested on a set number of things for their boards that don’t encompass all of medicine for each exam. These are also only like 4 hour exams. To clue you into what a NY attorney must do I’ll explain: (1) We must take the MPRE which is an ethics exam which is 60 multiple choice questions (not really difficult but the questions are intentionally tricky and often not straight forward) within 3 years of taking the bar exam; (2) The bar exam consists of approximately 2 days made up of four three and a half hour parts (That’s 14 hours total). These parts are 50 multiple choice and 6 essays based on 27 different areas of NY State law. The second day is 200 multiple choice questions based on Federal and Common law. See, I had to memorize 3 entirely separate systems of law and be able to regurgitate that knowledge on command. Doctors do not do anything near that. My girlfriend (who is at the top of her class and has scored in the top 3% of the nation on her boards) has never written an essay. Doctor’s strictly memorize and get tested by answering multiple choice questions. There’s very little “analysis.” In fact, I’m often shocked by how little they teach doctors to analyze issues. They seldom teach doctors basic medical things, mostly concentrating on obscure diseases that one hundredth of one percent of people would ever get. In terms of training, yeah the residency is “training” just like when someone gets hired for a job, they get “on the job training.” In fact, after the 1 year internship, a doctor can open their own practice.
Source: nbcnews.com

Medicare Reimbursements and Health Insurance for Scooters and Wheelchairs: No Guaranties of Payment!

If you are in the market for a scooter or wheelchair, you’ve probably quickly come to the understanding that these modes of personal transportation are not inexpensive and come in a variety of styles. You’ve probably also come to the conclusion that unlike other types of medical equipment, a scooter or wheelchair is a must have for a person with a mobility impairment. So, purchasing one isn’t really an option, it’s a need. Medicare has new strict medical criteria which must be met o qualify for reimbursement. Most people do not qualify and if you risk trying to get the scooter paid for then you risk being charged a high price by a Medicare medical equipment company if denied.
Source: wordpress.com