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: Jack Uppal for Congress – Medicare

Daily Kos: Republican U.S. senator: Cut Medicare … or we’ll shut down the government

Republicans approve of the American farmer, but they are willing to help him go broke. They stand four-square for the American home–but not for housing. They are strong for labor–but they are stronger for restricting labor’s rights. They favor minimum wage–the smaller the minimum wage the better. They endorse educational opportunity for all–but they won’t spend money for teachers or for schools. They think modern medical care and hospitals are fine–for people who can afford them. They consider electrical power a great blessing–but only when the private power companies get their rake-off. They think American standard of living is a fine thing–so long as it doesn’t spread to all the people. And they admire of Government of the United States so much that they would like to buy it. 65 years later and nothing changed. They just got worse.
Source: dailykos.com

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

Owner of Louisiana Health Care Company Convicted in Texas Medicare Fraud

Msiakii used Joy Supply’s Medicare provider number to submit claims to Medicare for DME, including orthotic devices, that was medically unnecessary and, in some cases, never provided. Many of the orthotic devices were components of “arthritis kits” and purported to be for the treatment of arthritis-related conditions; however, the devices were neither medically necessary nor appropriate for such conditions. The arthritis kit generally contained a number of orthotic devices including braces for both sides of the body and related accessories such as heat pads.
Source: batonrougetoday.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

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

Anti-Kickback Statute, conspiracy, DC Criminal defense attorney, DC criminal lawyer, DC federal criminal lawyer, Erich C. Ferrari, Erich Ferrari, federal attorney, federal attorneys, federal crime lawyer, federal criminal attorney, federal criminal attorneys, federal criminal defense attorneys, federal criminal defense lawyer, federal criminal defense lawyers, federal criminal lawyer, Federal defense attorney, federal defense attorneys, federal indictment, health care fraud, Lawrence T Taylor, Lawrence Taylor, loss amount, Medicaid fraud, medicare fraud, Southern District of Texas, Texas, white collar crime, white collar criminal defense lawyer, white collar criminal lawyer, white collar defense lawyer, white collar lawyer
Source: dcfederaldefenseattorney.com

Texas Ban on Planned Parenthood Funds Takes Effect

“By insisting that the state of Texas cannot direct funds to thousands of providers statewide who offer true, comprehensive, women’s health care — and instead require Medicaid funds to go to prop up 44 Planned Parenthood clinics — the federal government risks removing preventative health care from hundreds of thousands of women in Texas,” the conference said March 7, 2012.
Source: ncregister.com

Medicaid Cost Estimates Trigger Florida Flap

Posted by:  :  Category: Medicare

ADAPT Medicaid Rally by SEIU InternationalCQ HealthBeat: Actuarial Industry Study Questions Health Law’s Age Bands Insurance industry officials are continuing to push back on the new age rating requirement under the health care law, this time with a new study from the American Academy of Actuaries that says the provision could cause premiums for young, healthy individuals to increase by more than 40 percent. The study focused on adults ages 21-29 because, the authors said, even accounting for the 2010 law’s provision allowing people up to age 26 to remain on their parents’ insurance, “this age group has an uninsured rate that is roughly twice the uninsured rate for the nonelderly population as a whole” (Bunis, 1/8).
Source: kaiserhealthnews.org

Video: What is medicaid?

Argument preview: North Carolina spars with Medicaid claimant over reimbursement : SCOTUSblog

The federal Medicaid program advances funds to the states to defray the medical expenses of the poor.  As a condition of that funding, the program imposes numerous requirements on the state.  One set of requirements involves Medicaid funding of medical expenses for an individual who subsequently recovers funds from a third party as compensation for the injury that led to the expenses.  In this case, for example, a child received a multi-million-dollar settlement in tort litigation against physicians for injuries sustained at the time of her birth.  The state is permitted (indeed obligated) to insist on recovering from Medicaid recipients any funds they receive from third parties to compensate for the cost of medical services that were funded by Medicaid.  However, the state cannot impose a lien on any of the recipient’s property, which means in practice that the state cannot take any part of the tort recovery that is not compensation for Medicaid-funded services.
Source: scotusblog.com

Gov. Rick Scott accused of using ‘false’ Medicaid expansion numbers

“There are three things the Governor has stressed that remain unchanging in this important discussion about cost estimates. First, growing government is never free. Second, the number of people in Medicaid would nearly double with the new law (from approximately 3.3 million today to over 6 million). And third, once government grows, it is almost never undone. The fiscal cliff debate in Washington is proof enough of that. Additionally, as the AHCA report points out, federal projections on growing government have a long history of being much lower than actual costs.
Source: typepad.com

Researchers find minimal state cost from Medicaid expansion in California

administration admissions astronomy athletics awards Bancroft Library biology brain budget Chancellor Birgeneau chemistry climate change diversity earthquake economics education energy engineering enrollment environment faculty global warming health history honors Japan earthquake and tsunami jobs law music neuroscience Occupy Cal Operational Excellence physics police protest psychology public health sports staff students sustainability teaching technology UC UCRP
Source: berkeley.edu

Medicaid provider fee gets maximum priority

Not passing the financing mechanism, also known as the “bed tax,” would effectively double the state’s current Medicaid shortfall of $400 million. Most of the program’s beneficiaries are children, and a loss of the assessment would probably lead some rural hospitals to close and induce more physicians not to take new Medicaid patients, said a Children’s Healthcare of Atlanta executive.
Source: georgiahealthnews.com

State House, Senate Eye Surplus for Medicaid Deficit

The health care law calls for the federal government to pay the full tab for the Medicaid expansion when it begins in 2014. After three years, states must pay a gradually increasing share that tops out at 10 percent of the cost. The U.S. Supreme Court in June upheld the health care law, but justices said the federal government could not take away states’ existing federal Medicaid dollars if they refused to expand.
Source: arkansasbusiness.com

Idaho Governor Will Oppose Medicaid Expansion

As you’ll hear in a moment, we have some pretty good ideas about that kind of managed care model. But there’s a lot more work to do, and we face no immediate federal deadline. We have time to do this right, and there is broad agreement that the existing Medicaid program is broken. So I’m seeking no expansion of those benefits.
Source: firedoglake.com

Legislative Analysts Told Scott His Medicaid Estimates Are Wrong (But He's Using Them Anyway)

Anway joined Scott’s staff in early December after working for members of Congress, then for the Pharmaceutical Research and Manufacturers of America, or PhRMA. The Center for Responsive Politics’ web site Open Secrets.org names Anway on its list of people in the “Revolving Door,” who go from the government to industry lobbyist and back. The AHCA cost estimates sent out in December came from the staff of Tom Wallace, Medicaid finance chief, the e-mails showed. The estimates immediately raised eyebrows because they had tripled since August. AHCA spokeswoman Michelle Dahnke said the estimates were updated after rules for the Affordable Care Act were released by the U.S. Department of Health and Human Services.  
Source: usf.edu

A Wyoming woman’s long, winding road to Medicaid coverage

Eventually, I felt stable enough to find a job. For years, I worked full-time at job that paid a bit above minimum wage and offered no benefits. My income remained low enough to qualify for patient assistance. I paid an average of $8 per therapy session or doctor visit. Neither I nor my employer paid the actual cost of my care. I relied on the charity of drug companies and the clinic. But that was about to change. I would soon get health coverage in a way that is not unusual for young single women.
Source: wyofile.com

15% Medicare Supplement Rate Increase is Outrageous!!! » Toni Says

Posted by:  :  Category: Medicare

Medical Drugs for Pharmacy Health Shop of Medicine by epSos.deCindy, one Medicare rule that you should be aware of since you are not happy with your rate increase from your current Medicare Supplement company is…if you had a Medicare Supplement policy before you joined a Medicare Advantage Plan for the first time, and you aren’t happy with the Medicare Advantage Plan, you will have special rights to buy a Medicare Supplement policy if you return back to “Original Medicare” within 12 months of first joining a Medicare Advantage plan.  If you had a Medicare Supplement policy before you joined, you may be able to get the same plan back if the company still sells it.  If it isn’t available, you can buy another Medicare Supplement policy. (Please see page 66 of the
Source: tonisays.com

Video: Learn About Medigap Plans

What Is A Medicare Supplement

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

AFLAC Medicare Supplement Plans Now Released in Indiana

Please Note: Commission schedules for Indiana have changed from the original schedules.  Under the new commission schedules all premium is commissionable at the same commission level. There is no reduction in comp for G.I. business. There is no non-commissionable premium in Indiana. The Part B Deductible portion of the premiums is fully commissionable. The only exception is that the commission rate is applied to the original premium. No commission is payable on future rate increase premium.  No commission is payable on the policy fee.
Source: ihealthbrokers.com

Kazor.com World Community News

America is graying, a fact that is mentioned frequently in media reports about the health care system and health reform. It’s a fact that there is a big wave of seniors about to become eligible for Medicare, and once that happens, they will need Medicare supplements. As a busy and experienced insurance agent that deals with seniors on a regular basis, you know first-hand that the growth of your business depends on a constant supply of Medicare supplement leads. You want quality leads, fresh to your inbox daily or weekly, whichever suits your timetable.
Source: kazor.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

Genworth Financial to sell its Medicare supplement unit

Genworth, a Henrico County-based insurance giant, said the sale is part of strategy to focus its attention on its retirement and protection business segment and markets with the strongest value propositions for the company.
Source: timesdispatch.com

California Medicare Supplement: Benefits Explained

Instead of offering you help from the State, the California based Medicare Savings Program is a lovely initiative where you can save a lot of money, make sure you use them when you need it, and let your earnings accrue under Government supervision. This way, if you meet with untimely accidents or are diagnosed with huge illnesses, you have substantial savings to bail you out of trouble. If you fall short, the State can pitch in with a few thousands of dollars for help.
Source: wordpress.com

Today’s Influence Ads: AARP Medicare Supplement, Shale Gas Production

A slew of new ads are out today as Congress embarks upon its last week before the elections. AARP and UnitedHealthCare have a new ad today promoting AARP Medicare Supplement Insurance Plans as the only standardized Medicare supplement plan that AARP  endorses. American Clean Skies Foundation has a new ad pushing for the production of shale gas in the United States. The government of Panama’s new ad promotes the country as a good place for American businesses to invest. And Across the Aisle Foundation has a new ad inviting senior House and Senate staffers from both parties to an October event to discuss how the new Congress should tackle its first 100 days. Others with new ads, per Kantar Media’s Washington Eye, include: American Petroleum Institute, American Sugar Alliance, American Veterinary Medical Association, Consumer Electronics Association, Employee Freedom Act Committee, Fair Search, Lockheed Martin, McDonald’s, Neustar and Radiation Therapy Alliance. Those with continuing ad include: Altria, American Cancer Society, American Council of Life Insurers, American Hospital Association, AT&T, Beirut Families, Boeing Company, BP, Chevron, CIT Group, CME Group, Hologic, Honda, Huntington Ingalls Industries, Lockheed Martin, Mars Chocolate, Northern Dynasty Minerals, Nuclear Energy Institute, Pfizer, Pharmaceutical Research Manufacturers of America, Southern Company, United Soybean Board, Univision, WellPoint, WTOP and Zurich.
Source: nationaljournal.com

Dave Fluker’s California Health Insurance Blog: Anthem Blue Cross Raising Medicare Supplement Rates in 2013

David Fluker Insurance Services – Gilroy, California Serving California Residents Since 1995 For specific Health Insurance information, please visit my site at the link below www.davefluker.com Email Me CA Insurance License # 0B58920
Source: blogspot.com

What is a Medicare Supplement Plan?

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

TSCRA Insurance Services has your Medicare supplements covered

Did you know TSCRA Insurance Services offers Medicare supplements? Regardless of your current insurance provider, if you’re about to turn 65, call us at 1-800-252-2849 for more information. TSCRA Insurance Services handles a wide variety of products for members, including individual plans and small business groups for 2 to 50 employees, vision, dental and more. Visit our website at tscrainsurance.com and click on “Health & Well-Being” in the yellow menu bar to find out more.
Source: tscra.org

Exclusive Medicare Supplement Leads

Speaking of Medicare supplement leads, let’s just take a moment to mention exclusive Medicare supplement leads. Maybe you have already heard about exclusive Medicare supplement leads, and not in a good way. Perhaps a colleague told you about the time they got ripped off by some company that said their leads were exclusive, but really sold them to at least seven other agents. Those are NOT exclusive Medicare supplement leads. But YES, there IS such a thing as exclusive leads. You just have to know where to find them. Shop around for a company that knows what it is doing, check out their programs, and ask lots of questions, after all, it’s your money. If you don’t get something they are telling you, then keep asking even more questions, until you understand how their lead system works and what the differences are between regular leads and the exclusive ones. In other words, you want to buy your leads from a company that when it says “exclusive” leads, they MEAN exclusive to ONLY you.
Source: benepath.net

Medicare Advantage HMO Enrolles Use Fewer Outpatient Surgery Benefits

Posted by:  :  Category: Medicare

Medicare Advantage HMO plans may be offering more efficient care than Medicare Part A and Part B plans, according to a study published in the journal Health Affairs. According to the study, MA HMO enrollees receive fewer hip and knee replacements and use fewer benefits for outpatient surgeries and procedures, inpatient stays and emergency department visits. Based on a national comparison of data from MA HMO and traditional Medicare plans from 2003 to 2009, the researchers found that utilization rates in some areas — like ER and ambulatory surgery — were around 20 percent lower in MA HMO plans. MA HMO enrollees also received about 10 percent fewer hip and knee replacements and initially had lower rates of ambulatory visits and hospitalizations. Related Articles on Coding, Billing and Collections: Billing Company Executive to Be Charged With $41M in Tax Evasion Fraud 5 ICD 10 Regulation Myths
Source: beckersasc.com

Video: Medicare HMO

Medical Billing Fundamentals: Vaccine Administration Codes for Commercial & Non Medicare HMO Payers

Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid component administered
Source: blogspot.com

ICYMI: Health Affairs Article: Medicare Advantage Provides Higher

A recent article in the latest edition of Health Affairs provides further evidence that Medicare Advantage plans are delivering higher-quality care to seniors and people with disabilities than the fee-for-service (FFS) part of Medicare.  Data from the article show that Medicare Advantage beneficiaries utilize some health care services, such as the emergency department and ambulatory surgery or procedures, at a rate 20-30 percent lower than those in FFS Medicare.  This data suggests that Medicare Advantage enrollees “might use fewer services and be experiencing more appropriate use of services than enrollees in traditional Medicare.”
Source: ahipcoverage.com

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

Medicare Advantage HMO Plans in Texas

Now, with the good you have to take into account the bad. Medicare Advantage HMO plans require you to only use doctors and providers in the plan network unless its and emergency and sometimes those networks can get rather restrictive so check to be sure you can live with who is and is not in network. If you are someone that demands to preserve your choice of medical providers this plan probably won’t work for you, stick with a Medigap supplement plan. Another drawback is these plans are specific to certain counties and geographic locations. For example, one plan may operate in the four county DFW metroplex but that same plan wont be available in then very next county unlike supplements that are available everywhere.
Source: medicareinsurancetexas.com

campusCATALYST now accepting applications for Spring Program

Posted by:  :  Category: Medicare

campusCATALYST engages top college undergraduates from all academic majors, backgrounds, and career aspirations. Participant selection is highly competitive with rigorous application requirements and complimentary academic coursework to promote high-performing and knowledgeable teams. campusCATALYST selects members who exemplify leadership, teamwork, and dedication to strengthening our communities.
Source: campuscatalyst.org

Video: AvMed Medicare – Dwight Gym

AvMed Health Plans to Offer Healthways SilverSneakers® Fitness Program Through 2014

Healthways (HWAY) is the largest independent global provider of well-being improvement solutions. Dedicated to creating a healthier world one person at a time, the Company uses the science of behavior change to produce and measure positive change in well-being for our customers, which include employers, integrated health systems, hospitals, physicians, health plans, communities and government entities. We provide highly specific and personalized support for each individual and their team of experts to optimize each participant’s health and productivity and to reduce health-related costs. Results are achieved by addressing longitudinal health risks and care needs of everyone in a given population. The Company has scaled its proprietary technology infrastructure and delivery capabilities developed over 30 years and now serves approximately 40 million people on four continents. Learn more at www.healthways.com or www.silversneakers.com.
Source: gymrat-fitness.com

Yohanon’s ramblings: How is it possible?

Back to the prescriptions. In order to have prescription coverage – which I found out is a requirement – there is an ADDITIONAL change by Medicare . . . and if you fail to sign up for (I think) Part D prescription coverage when first eligible, Medicare penalizes you – forever.
Source: blogspot.com

AvMed Health Plans and Wax Custom Communications Receive Bronze at 2010 Mature Media Awards

PRLog (Press Release) – Aug. 16, 2010 – Miami, August 10, 2010– AvMed Health Plans received a bronze medal at the 2010 National Mature Media Awards, the nation’s largest awards program that annually recognizes the best marketing, communications, educational materials and programs for adults age 50 and older. AvMed’s Medicare Enrollment Kit won a bronze medal in the Brochure/Booklet category. The Medicare Enrollment Kit is an annual piece distributed before the Medicare enrollment period, aimed at educating consumers on AvMed’s Medicare plans and benefits and guiding them in their decision making process. “We’re proud that the work we create with AvMed has been honored at the National Mature Media Awards,” said Bill Wax, president and founder of Wax Custom Communications. “These awards recognize the uniqueness of our work with each of our clients and the quality team we have here at Wax.” About Wax Custom Communications:
Source: prlog.org

What Impact Does Medicare Have On Health Insurance?

Many insurance types can be considered a primary insurance depending on the situation. If you are in a car accident, and your insurance or the other person’s insurance covers any medical expenses, those would be considered a primary insurance. Similarly, if you have home owner’s, or renter’s insurance, and they cover a qualified medical expense, then they would be considered the primary insurance. This also includes coverage such as prescription coverage, and other forms of supplementary coverage.
Source: seniorcorps.org

AvMed Health Plans and Delta Dental Announce a Partnership to Help Provide Affordable Dental Coverage

Delta Dental Insurance Company, along with its affiliates, is part of a holding company system that operates in 15 states plus the District of Columbia and Puerto Rico. Both Delta Dental Insurance Company and its holding company hold an “A-“ (excellent) rating from AM Best, and are part of the Delta Dental Plans Association (DDPA). DDPA consists of 39 Delta Dental member companies licensed in all 50 states. The association collectively covers more than 50 million of the estimated 170 million people nationwide with dental insurance, making it by far the largest national system of dental plans.
Source: deltadentalins.com

Health Products for Members: Health Insurance, Dental Insurance, Fitness

AARP Health is a collection of health related products, services and insurance programs made available by AARP. Neither AARP nor its affiliate is the insurer. AARP contracts with insurers to make coverage available to AARP members.
Source: aarp.org

Does Medicare Pay for Assisted Living

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

AvMed: New Plan Designs with Lower Prices.

** AvMed Health Plans received the highest numerical score among commercial Health Plans in Florida in the proprietary J.D. Power and Associates 2012 U.S. Member Health Plan Study. Study based on 32,868 total member responses, measuringix plans in the Florida Region ( Excludes Medicare and Medicaid ).
Source: wordpress.com

Viewpoints: Fighting To A Draw On Medicare; A Coming Era Of Austerity

Posted by:  :  Category: Medicare

Medicare by 401(K) 2013Baltimore Sun: Facing The Fiscal Cliff, Obama Can’t Back Down Again As official Washington nervously ponders the approaching fiscal cliff and the potential economic chaos it entails, President Barack Obama faces a precipice of his own in the challenge of making use of his re-election victory. Unless he emerges from this, the last major crisis of his first term, with the appearance of political strength and skill in navigating it, he risks losing public confidence that he has the stuff to take the country where he wants it to go in his second term. More than the specific details of any deal with House Speaker John Boehner and his resistant Republican cohorts on taxes and spending, Mr. Obama needs to demonstrate more steel in confronting GOP obstructionism than he showed in the previous showdown over deficit reduction (Jules Witcover, 11/30).
Source: kaiserhealthnews.org

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

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

Straight Talk on Medicare: A Go

The two primary presidential candidates, President Barack Obama and former Massachusetts Gov. Mitt Romney, have both touted potential Medicare reforms, but in completely different ways. For President Obama, the Patient Protection and Affordable Care Act — the most significant healthcare legislation to come out of Washington, D.C., in years — serves as his blueprint for Medicare and the future of the U.S. healthcare system. There has been a lot of political rhetoric surrounding the PPACA, and most of it has centered on one figure: $716 billion. President Obama has said the PPACA saves $716 billion over the next decade from the Medicare program “by no longer overpaying insurance companies [and] by making sure we weren’t overpaying providers.” Mr. Romney, on the other hand, argues the healthcare law cuts $716 billion from the program by reducing rates “across the board.” Mr. Perez broke down the infamous $716 billion figure in the following way: As it stands, the PPACA would enact $517 billion in decreases to Medicare Part A (hospitals), $247 billion in decreases to Medicare Part B (medical insurance) and $48 billion in decreases to Medicare Part D (prescription drugs). Going a step further, hospitals and health systems will absorb $260 billion of the $716 billion in Medicare reductions, and there will be $56 billion in reductions to disproportionate share hospital payments from both Medicare and Medicaid. Other major reductions include $156 billion to Medicare Advantage insurers, which have been overpaid $282.6 billion since 1985, according to a recent study by Physicians for a National Health Program. For hospital and health system executives, the cuts within the PPACA will have major impacts, perhaps detrimental in some cases, Mr. Perez said. Although the promise of more Medicaid and commercially insured patients by 2014 is supposed to offset those reductions, the proposal has still been viewed has potentially damaging to hospital bottom lines in the near future. MedeAnalytics projected that these cuts will ramp up from $15 billion to $20 billion in 2013 to $30 billion to $35 billion in 2022. The result for hospitals? Almost a 9 percent across-the-board cut to Medicare reimbursement over the next decade. “These cuts will obviously lower profit margins for hospitals, and CMS’ chief actuary has concluded that up to 20 percent of hospitals could become unprofitable as a result,” Mr. Perez said, noting that hospitals’ Medicare margins have been negative on average since 2003. Furthermore, hospitals and health systems must wait to see whether the Budget Control Act of 2011’s sequestration will take effect Jan. 1. Hospitals and other providers will see a 2 percent Medicare payment reduction totaling $11.1 billion this upcoming year, due to the BCA, unless Congress passes new measures to prevent the cuts. Tripp Umbach, an economic consulting firm, released a report earlier this year showing that sequestration could result in 766,000 lost jobs within the hospital and healthcare industry by 2021. Mr. Perez said the already-negative margins for Medicare and the prospect of future Medicare cuts per the PPACA have already prompted several large providers to lay off employees or cut jobs through attrition. “If hospitals go out of business or continue to operate but under financial duress, it stands to reason that the availability and quality of care for Medicare beneficiaries could be impaired,” Mr. Perez said. Mr. Romney’s Medicare plan hinges on turning Medicare into a premium support system. Essentially, seniors will receive a fixed amount (also known as a defined contribution) to buy an insurance plan, and all insurance plans must offer coverage comparable to what Medicare provides today. However, Mr. Romney’s plan does not provide specifics on how this Medicare reform will impact payments to hospitals and health systems, nor does it cover other issues, such as: •    Will premium support payment adjustments be capped? •    Will Medicare benefits within the PPACA, such as closing the doughnut hole and expanding coverage of preventive care with no co-pays, be reinstated? •    Will traditional Medicare be subject to cuts after 2023?
Source: beckershospitalreview.com

Fiscal Cliff Progress in Washington

Bloomberg News/The New York Times: U.S. Fiscal Deal Unlikely Without Compromise As the political tension mounts over the current fiscal deadlock — which, unless a deal is reached by Dec. 31, would increase taxes for everyone and force some draconian spending cuts — there will have to be trade-offs for any ultimate deficit-reduction deal. Congressional Republicans insist this will only be palatable if there are major cuts to entitlement programs, especially Medicare. There are clear indications that the White House, despite the objections of some Democrats, would go along with significant changes, perhaps including a form of means testing for Medicare benefits, altering the cost-of-living adjustments for entitlements and taxes (Hunt, 12/16).
Source: hcmatters.com

Paul Ryan’s Plan for Medicare: A Disaster for Seniors (Why Doctors Might Stop Taking Medicare)

How important is Medicare’s market share in influencing physician participation? The evidence is limited, but the best study to date suggests it is significant. In the 1990s, Peter Damiano, Elizabeth Momany, Jean Willard and Gerald Jogerst, all associated with the University of Iowa  surveyed  Iowa  physicians and examined variation among counties. They found  that for each percentage-point increase in the share of Medicare beneficiaries in a county’s population, doctors were 16 percent more likely to accept patients on Medicare. The only other study I know of on this topic, an unpublished analysis by Matthew Eisenberg of Carnegie Mellon University  also found an effect from Medicare’s market share, albeit one that was substantially smaller than the one Damiano and his colleagues found.
Source: healthbeatblog.com

GOP opposes its own goals on Medicare

As Ed Kilgore explained, “What’s really maddening is that IPAB — following the overall thrust of Obamacare — is designed to secure savings not just for Medicare but for the entire health care system by encouraging better medicine, not reductions in health coverage for seniors. It seems Republicans are only interested in health care cost containment measures or ‘entitlement reform’ if it comes at the expense of beneficiaries.”
Source: msnbc.com

Free trade in Medicare: An alternative to austerity

Editor: Edward Fullbrook. Associate Editor: Jamie Morgan. PAST CONTRIBUTORS: James Galbraith, Frank Ackerman, André Orléan, Hugh Stretton, Jacques Sapir, Edward Fullbrook, Gilles Raveaud, Deirdre McCloskey, Tony Lawson, Geoff Harcourt, Joseph Halevi, Sheila C. Dow, Kurt Jacobsen, The Cambridge 27, Paul Ormerod, Steve Keen, Grazia Ietto-Gillies, Emmanuelle Benicourt, Le Movement Autisme-Economie, Geoffrey Hodgson, Ben Fine, Michael A. Bernstein, Julie A. Nelson, Jeff Gates, Anne Mayhew, Bruce Edmonds, Jason Potts, John Nightingale, Alan Shipman, Peter E. Earl, Marc Lavoie, Jean Gadrey, Peter Söderbaum, Bernard Guerrien, Susan Feiner, Warren J. Samuels, Katalin Martinás, George M. Frankfurter, Elton G. McGoun, Yanis Varoufakis, Alex Millmow, Bruce J. Caldwell, Poul Thøis Madsen, Helge Peukert, Dietmar Lindenberger, Reiner Kümmel, Jane King, Peter Dorman, K.M.P. Williams, Frank Rotering, Ha-Joon Chang, Claude Mouchot, Robert E. Lane, James G. Devine, Richard Wolff, Jamie Morgan, Robert Heilbroner, William Milberg, Stephen T. Ziliak, Steve Fleetwood, Tony Aspromourgos, Yves Gingras, Ingrid Robeyns, Robert Scott Gassler, Grischa Periono, Esther-Mirjam Sent, Ana Maria Bianchi, Steve Cohn, Peter Wynarczyk, Daniel Gay, Asatar Bair, Nathaniel Chamberland, James Bondio, Jared Ferrie, Goutam U. Jois, Charles K. Wilber, Robert Costanza, Saski Sivramkrishna, Jorge Buzaglo, Jim Stanford, Matthew McCartney, Herman E. Daly, Kyle Siler, Kepa M. Ormazabal, Antonio Garrido, Robert Locke, J. E. King, Paul Davidson, Juan Pablo Pardo-Guerra, Kevin Quinn, Trond Andresen, Shaun Hargreaves Heap, Lewis L. Smith, Gautam Mukerjee, Ian Fletcher, Rajni Bakshi, M. Ben-Yami, Deborah Campbell, Irene van Staveren, Neva Goodwin, Thomas Weisskopf, Mehrdad Vahabi, Erik S. Reinert, Jeroen Van Bouwel, Bruce R. McFarling, Pia Malaney, Andrew Spielman, Jeffery Sachs, Julian Edney, Frederic S. Lee, Paul Downward, Andrew Mearman, Dean Baker, Tom Green, David Ellerman, Wolfgang Drechsler, Clay Shirky, Bjørn-Ivar Davidsen, Robert F. Garnett, Jr., François Eymard-Duvernay, Olivier Favereau, Robert Salais, Laurent Thévenot, Mohamed Aslam Haneef, Kurt Rothschild, Jomo K. S., Gustavo Marqués, David F. Ruccio, John Barry, William Kaye-Blake; Michael Ash, Donald Gillies, Kevin P.Gallagher, Lyuba Zarsky, Michel Bauwens, Bruce Cumings, Concetta Balestra, Frank Fagan, Christian Arnsperger, Stanley Alcorn, Ben Solarz, Sanford Jacoby, Kari Polanyi, P. Sainath, Margaret Legum, Juan Carlos Moreno-Brid, Igor Pauno, Ron Morrison, John Schmitt, Ben Zipperer, John B. Davis, Alan Freeman, Andrew Kliman, Philip Ball, Alan Goodacre, Robert McMaster, David A. Bainbridge, Richard Parker, Tim Costello, Brendan Smith, Jeremy Brecher, Peter T. Manicas, Arjo Klamer, Donald MacKenzie, Max Wright, Joseph E. Stiglitz. George Irvin, Frédéric Lordon, James Angresano, Robert Pollin, Heidi Garrett-Peltier, Dani Rodrik, Marcellus Andrews, Riccardo Baldissone, Ted Trainer, Kenneth J. Arrow, Brian Snowdon, Helen Johns, Fanny Coulomb, J. Paul Dunne, Jayati Ghosh, L. A Duhs, Paul Shaffer, Donald W Braben, Roland Fox, Marco Gillies, Joshua C. Hall, Robert A. Lawson, Will Luther, JP Bouchaud, Claude Hillinger, George Soros, David George, Alan Wolfe, Thomas I. Palley, Sean Mallin, Clive Dilnot, Dan Turton, Korkut Ertürk, Gökcer Özgür, Geoff Tily, Jonathan M. Harris, Thomas I. Palley, Jan Kregel, Peter Gowan, David Colander, Hans Foellmer, Armin Haas, Alan Kirman, Katarina Juselius, Brigitte Sloth, Thomas Lux, Luigi Sapaventa, Gunnar Tómasson, Anatole Kaletsky, Robert R Locke, Bill Lucarelli, L. Randall Wray, Mark Weisbrot, Walden Bello, Marvin Brown, Deniz Kellecioglu, Esteban Pérez Caldentey, Matías Vernengo, Thodoris Koutsobinas, David A. Westbrook, Peter Radford, Paul A. David, Richard Smith, Russell Standish, Yeva Nersisyan, Elizabeth Stanton, Jonathan Kirshner, Thomas Wells, Bruce Elmslie, Steve Marglin, Adam Kessler, John Duffield, Mary Mellor, Merijn Knibbe, Michael Hudson, Lars Pålsson Syll, Korkut Erturk, Jane D’Arista, Richard Smith, Ali Kadri, Egmont Kakarot-Handtke, Ozgur Gun, George DeMartino, Robert H. Wade, Silla Sigurgeirsdottir, Victor A. Beker, Pavlina R. Tcherneva, Ali Kadri, Egmont Kakarot-Handtke, Ozgur Gun, George DeMartino, Robert H. Wade, Silla Sigurgeirsdottir, Victor A. Beker, Pavlina R. Tcherneva
Source: wordpress.com

Medicare A and B Benefits 2013

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

Make 2013 a year for preventing Medicare fraud!

This might seem like too big of a resolution for just one person, but if we work together, we can accomplish anything we set our minds to. When it comes to protecting, detecting, and reporting Medicare fraud, the community is the best defense. The National Hispanic SMP (NHSMP) needs to the support and involvement of older adults, their families, and caregivers to help stop Medicare fraud in our community. The NHSMP is part of a whole network of leaders, agencies, and organizations working to fight Medicare fraud across the country:
Source: nhcoa.org

Viewpoints: Fla. Gov. Fears Medicaid Expansion As Idaho, Missouri And Colorado Wrestle With Issue ; Few Acceptable Options For Improving Medicare

Posted by:  :  Category: Medicare

"Every citizen should be a soldier. This was the case with the Greeks and Romans, and must be that of every free state." ` Thomas Jefferson. by eyewashdesign: A. GoldenThe Idaho Statesman: Expanding Health Care Coverage Benefits All Idahoans As a member of Gov. Butch Otter’s task force, which voted 15-0 in favor of this [Medicaid] expansion, here are eight reasons why: 1. It saves Idaho money. The expansion of Medicaid to 150,000 people will cost Idaho $284 million over the next 10 years. However, the federal government’s payment program for this expansion will bring in $290 million to the state over that time. Idaho stands to gain $6 million by expanding Medicaid. Conversely, there are 70,000 Idahoans who already meet the expanded eligibility requirements and their coverage will cost the state hundreds of millions of additional dollars without the benefit of enhanced federal payment if we don’t do this (Dr. Ted Epperly, 1/6). Kansas City Star: Bid To Renew KC’s Extra Health Levy Merits Scrutiny Almost eight years ago, Kansas Citians narrowly approved a property tax increase to provide more public funds for indigent health care. It was a compassionate decision by voters. But the world of health care has changed a great deal since then. … Truman Medical Centers and a few other medical care providers in Kansas City still want to keep receiving the extra health levy. … If Missouri does not adopt Medicaid expansion or progress on the exchanges is delayed, the squeeze will be on hospitals in earnest to keep their doors open to serve indigent patients in Kansas City and the state. Still, the City Council and local health care providers must use this week’s hearing to start providing clear evidence they need a $135 million tax renewal over nine years (1/6).
Source: kaiserhealthnews.org

Video: End Social Security, Medicare, and the Welfare-Warfare State!

Massachusetts and Washington: Financial Alignment Demonstrations for Dual Eligible Beneficiaries Compared

This fact sheet examines the similarities and differences between the five-year demonstrations in Massachusetts and Washington state to integrate care and align financing for people dually eligible for Medicare and Medicaid. The states finalized memoranda of understanding (MOUs) with the Centers for Medicare and Medicaid Services in fall 2012, and the demonstrations in each state are set to begin in April 2013.
Source: kff.org

The Medicaid Expansion and Washington State Hospitals

The incentives for states to expand Medicaid are substantial.  People who enroll in expanded Medicaid will have their health care fully funded by the federal government in the first three years, slowly declining to 90 percent funding in 2020.  The state projects that expanding Medicaid could actually save state funds because people currently enrolled in Disability Lifeline and Basic Health would be totally federally funded.  Health coverage for these enrollees is currently paid half by the state government and half by the federal government, costing the state hundreds of millions of dollars.
Source: stateofreform.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

Medicaid primary care pay to more than double in 6 states

On average, Medicaid pays doctors at 66% of what Medicare pays, a fee gap that has widened during the past few years, the report stated. The ACA directs states to pay primary care doctors providing primary care services at 100% of Medicare rates for 2013 and 2014. The pay bump recently had been targeted for elimination in congressional negotiations as a possible offset for a deal to avoid deep automatic spending cuts, although the White House and congressional Democrats oppose the move. At this article’s deadline, it was not clear whether this proposal had been taken off the table.
Source: nebraskaruralhealth.org

Integrated Care for Medicare

To support demonstrations to integrate Medicare and Medicaid for dual eligibles, the Centers for Medicare and Medicaid Services (CMS) offering state Medicaid agencies grants of up to $15 million each.  The funds are for implementation of CMS approved designs to integrate care for Medicare-Medicaid enrollees.  Most of the state demonstrations involve the use of integrated health plans that will compete to provide most or all Medicaid and Medicare services for the state’s full-benefit dual eligibles.  Other models include managed fee-for-service with shared savings.
Source: piperreport.com

2013 Medicare pay hike for ODs back on track under Washington’s last

While the immediate Medicare pay crisis has been averted for now, the one-year SGR fix and the two-month sequester delay signal the start of a new effort to prevent future Medicare pay cuts and finally fix Medicare’s broken SGR payment formula. A growing concern, the two-month delay in sequester cuts directly aligns with the date on which the nation is expected to reach its borrowing limit, providing yet another opportunity to potentially target Medicare payments to doctors of optometry.
Source: newsfromaoa.org

Taming the Health Care Monster

Most spending categories showed small increases. Here are the figures: private health insurance, up 3.8 percent; Medicaid, 2.5 percent; the Children’s Health Insurance Program (CHIP), 3.0 percent; out-of-pocket spending, 2.8 percent. There were two significant outliers: the Department of Veterans Affairs, up 8.7 percent (reflecting in part expanded services for Iraq and Afghanistan veterans); and Medicare, up 6.2 percent. CMS attributed Medicare’s increase to “a one-time change in payment rates to skilled nursing facilities” and more spending on doctors.
Source: realclearpolitics.com

Travel for Seniors: Washington State

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

A Regional Analysis Of Which Hospitals Got Rewards, Penalties Based On Quality

All seven hospitals in the nation’s capital are having their Medicare payments reduced  because they scored poorly in the Value-Based Purchasing program, which rewards places that do better in following basic standards of care and on patient satisfaction surveys and punishes those that underperform. The government began assessing these bonuses and penalties this month as one part of an effort to improve medical quality and to eventually reduce costs.  In Washington, hospitals will lose on average 0.33 percent of their payments.
Source: kaiserhealthnews.org

New Washington State Medicaid managed care contract takes effect on July 1; SSI clients to be phased in

The Health Care Authority does not discriminate and provides equal access to its programs and services for all persons without regard to race, color, gender, religion, creed, marital status, national origin, sexual orientation, age, veteran’s status or the presence of any physical, sensory or mental disability.
Source: wa.gov

A Regional Analysis Of Which Hospitals Got Rewards, Penalties Based On Quality

Posted by:  :  Category: Medicare

All seven hospitals in the nation’s capital are having their Medicare payments reduced  because they scored poorly in the Value-Based Purchasing program, which rewards places that do better in following basic standards of care and on patient satisfaction surveys and punishes those that underperform. The government began assessing these bonuses and penalties this month as one part of an effort to improve medical quality and to eventually reduce costs.  In Washington, hospitals will lose on average 0.33 percent of their payments.
Source: kaiserhealthnews.org

Video: Johanns Discusses Impact of Medicare Cuts on Nebraska

Fiscal cliff deal reached, includes extension of current Farm Bill

“This agreement isn’t my ideal option, but I firmly believe going over the cliff isn’t an option at all,” Johanns said in a written statement released by his office. “I would have preferred stopping a tax hike for every American, significantly reducing spending and strengthening Social Security and Medicare. This package, however, is a vast improvement from the Administration’s original proposal and no one can overlook the fact it protects an estimated 99 percent of Americans from being hit with the largest tax hike in our nation’s history.”
Source: nebraskaradionetwork.com

Medicare Discloses Hospitals’ Bonuses, Penalties Based On Quality

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

New Medicare Scam Targets Seniors

The Better Business Bureau has a few tips incase scammers come after you.  First, do not give out personal information to anyone, ever.  Second, Medicare does not make phone calls regarding new cards, nor will they ask for sensitive financial information.  Lastly, if you suspect anything suspicious, just hang-up.
Source: klkntv.com

New Nebraska Network:: Johanns Votes To End Medicare As We Know It

Now that would be interesting to know, since it didn’t get one Dem vote in either the House or Senate.  Bob probably thinks it doesn’t tax & spend enough, so he’d be against it before he’d vote for it.   At least the “Ryan plan” made an attempt at addressing the fiscal problems facing the country.  Not nearly enough IMHO but a start.  The President’s proposed budget just ignored all the fiscal issues period.   Cosmic Bob has already defined his position on fiscal matters…”if you aren’t for raising taxes, you’re part of the problem” sums it all up.  That’s probably the most honest thing he’s ever said while campaigning.  
Source: newnebraska.net

Rural Health Clinics Ineligible for EHR Medicare Incentives

The Social Security Act that was the foundation for Centers for Medicare & Medicaid Services (CMS) EHR Incentive Programs exclude rural health clinics (RHCs) from receiving incentives under Medicare because they bill under Medicare Part A. “In Nebraska, rural health clinics are huge. We have close to a 130–140 providers who are signed up with us in rural health clinics,” says Searls. Medicare Part A covers benefits for hospital and skilling nursing home care; conversely, Medicare Part B deals with payments to doctors and outpatient services. Those receiving Social Security when they turn 65 are automatically enrolled in Part A. It is this distinction that prevents RHCs from receiving Medicare incentives in Nebraska:
Source: ehrintelligence.com

What Percentage of Your Spine Practice is Medicare Patients? 8 Responses

Please send responses to Laura Miller at laura@beckershealthcare.comby Wednesday, April 9 at 5pm CST. Q: What percentage of your spine practice is Medicare patients? J. Brian Gill, MD, Spine Surgeon, Nebraska Spine Center, Omaha: The percentage of Medicare patients in our practice is roughly 30-35 percent of our total patient population. Marion R. McMillan, MD, Synergy Spine Center, Seneca, S.C.: Our Medicare percentage in a spine surgery practice specializing in non-fusion spinal stenosis care is about 40 percent. Timothy A. Moore, MD, MetroHealth Medical Center, Cleveland: 32 percent Khawar Siddique, MD, Spine Surgeon, Beverly Hills Spine Surgery, Calif.: 20-30 percent Paul Slosar, MD, President, SpineCare Medical Group, San Francisco Spine Institute: 25 percent approximately Michael P. Steinmetz, MD, Medical Director, MetroHealth Medical Center, Cleveland: 40 percent MetroHealth Spine Center, Neurosciences Department, Cleveland: 34 percent Texas Back Institute, Plano: Overall about 6-7 percent of our patients are Medicare. More Articles on Spine Surgery: 6 Spine Surgeons on How Young Surgeons Can Position Themselves for Success 7 Spine Surgeons & Industry Experts on Forming a Positive Relationship With Local Hospitals What Percentage of Spine Surgery Could be Performed in ASCs? 7 Surgeons Respond
Source: beckersspine.com

Nebraska Approves Sale of Medicare Supplement Insurance Products

We are pleased to announce the availability of lower cost Medicare Supplement Insurance in Nebraska. The Nebraska Department of Insurance approved Medicare Supplement Insurance plans from State Mutual Insurance Company and made it possible for us to offer extremely competitive Medicare Supplement Insurance rates for qualifying Nebraska seniors.
Source: statemutualinsurance.com

Ryan Takes to Pennsylvania to Push Medicare Message

Posted by:  :  Category: Medicare

Liver Transplant 1 by pennstateliveMr. Ryan was extrapolating from a 2010 report from Medicare’s Office of the Actuary. It analyzed the potential impact of lower premium supports paid to private companies that issue Medicare Advantage plans, popular alternatives to traditional Medicare with extra benefits such as gym memberships. To slow the growth of Medicare spending, the Affordable Care Act reduces support for the private plans, which Democrats consider inefficient. Beneficiaries would still be covered under traditional Medicare.
Source: nytimes.com

Video: State Takeover of Harrisburg, Medicare/Medicaid Funding [Pennsylvania Newsmakers]

Medicare Takes Center Stage In Close Pennsylvania Races

The campaign jockeying over Medicare comes at a time when the program represents a huge fiscal challenge to both parties. With almost 50 million beneficiaries — and growing at the rate of 10,000 baby boomers every day — the entitlement program is one of the fastest-growing portions of the federal budget. Both parties acknowledge the need to curb its growth; both have also used the issue for political gain, casting themselves as the program’s protectors against what they portray as rivals’ threats.
Source: kaiserhealthnews.org

Mental health pro pleads guilty to Medicare fraud

A man who opened two suspect mental health centers in the Miami area is facing fraud charges and allegations that he robbed the Medicare system of millions of dollars. The man, age 50, had also planned on opening a psychotherapy clinic in Tennessee, and he had already established several other facilities in North Carolina. The man and his associates have been charged with taking at least $60 million from the government program. He faces 30 years to life in prison in connection with the alleged crimes.
Source: ncfederalcriminaldefenseblog.com

Pennsylvania providers already feeling Medicare cuts, worrying about more to come

Among several examples: Hospitals now may lose Medicare money if too many patients are readmitted within 30 days of discharge — for any reason. The Centers for Medicare and Medicaid Services cut home health payment rates by 3.79 percent in 2011 and 2012, and will cut home health by another 1.32 percent in 2013, said Jennifer E. Battista, communications director of the Pennsylvania Homecare Association. Another Medicare program for rural hospitals that serve a high number of seniors also was left unfunded. At Wayne Memorial Hospital in Honesdale, Wayne County, that will cost $1.7 million.
Source: medcitynews.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

Increasing Medicare Age Increases American Health Care Spending

Lots of those 65 and 66-year-olds will need Medicaid. That will cost the federal government about $8.9 billion. Lots of those seniors will go to the exchanges for insurance. That will cost the federal government about $9.4 billion in subsidies. Oh, that Medicaid will cost states too, about $700 million. The 65 and 66 year olds getting insurance from their employers will cost them about $4.5 billion (they’re expensive). As I’ve reported before, Medicare premiums will go up ($1.8 billion), and exchange premiums will go up ($700 million). And, there will be increased out-of-pocket spending by the 65 and 66-year-olds themselves for premiums, deductibles, co-pays, etc. Add it all up. To save the federal government $24.1 billion, we need to spend $29.8 billion.
Source: keystonepolitics.com

Pa. Home Health Care Providers Worried About Medicare Cuts

AAHomecare AARP AARP Public Policy Institute Alliance for Home Health Quality and Innovation Almost Family Amedisys Amedisys Inc. American Association for Homecare American Association for Long Term Care Insurance Apria Healthcare Group Avalere Health Brookdale Senior Living Care.com Center for Medicare Advocacy Centers for Medicare & Medicaid Services CMS Employee Benefit Research Institute Ensign Group featured First Care Home Health Care Gentiva Gentiva Health Services Gentiva Health Services Inc. HHS Home Health Depot Home Health International Houston Compassionate Care Humana IntegraCare Intel-GE Care Innovations Jordan Health Services Kindred Healthcare MDLIVE MedPAC Microsoft NAHC National Association for Home Care & Hospice Nationwide New York Times Northwestern Medicine Paraprofessional Healthcare Institute Partnership for Quality Home Healthcare PHI VA Wall Street Journal
Source: homehealthcarenews.com

Medicare to End Practice of Requiring Patients to Show Progress to Receive Nursing Coverage

For decades, home health agencies and nursing homes that contract with Medicare have routinely terminated the Medicare coverage of a beneficiary who has stopped improving, even though nothing in the Medicare statute or its regulations says improvement is required for continued skilled care. Advocates charged that Medicare contractors have instead used a “covert rule of thumb” known as the “Improvement Standard” to illegally deny coverage to such patients. Once beneficiaries failed to show progress, contractors claimed they could deliver only custodial care, which Medicare does not cover.
Source: pennsylvaniatrustsandestates.com

Pa Work Injury Law: Medicare Posts List of Top Hospitals

In many regions, the hospitals that did the best are not the ones with the most outsized reputations, but regional and community hospitals, according to government records. New York-Presbyterian in Manhattan and Massachusetts General Hospital in Boston, both dominant hospitals in their cities, will have their payments reduced. Other leading names in the hospital industry, including the Cleveland Clinic and Intermountain Medical Center in Utah, will receive bonuses, although not the largest in their regions.
Source: blogspot.com

Keystone Progress: Senior Alert: Medicare Open Enrollment Starts Today

HARRISBURG, PA – Medicare open enrollment starts today, and AARP is urging Pennsylvania seniors and their families to carefully review their current plans to make sure they’re getting the most out of their coverage. AARP spokeswoman Cynthia Fagyas says the window of opportunity to make changes comes earlier this year. “October 15th is early for open enrollment, and it runs ’til just December 7th, so it’s an opportunity for seniors to review and make changes to their current coverage.” During open enrollment, Fagyas says, Medicare enrollees can switch plans, add a prescription drug plan or drop Medicare Advantage for a plan under original Medicare. But if you’re happy with your current plan, she says, you don’t have to do a thing. Fagyas says AARP has a website with information on Medicare open enrollment, here. She says there are four factors to consider when reviewing and comparing Medicare coverage. She calls them the four Cs. “And those four Cs are coverage, cost, convenience and customer satisfaction, when they’re thinking about making any changes to their Medicare coverage.” Fagyas cautions that there are some open enrollment options that are not reversible. “If you do make changes to your coverage, and you drop coverage, you want to do it carefully, because you may not be able to get that coverage back once you make the change.” AARP is also offering free webinars on Medicare open enrollment. Any changes made during open enrollment take effect January 1.
Source: keystoneprogress.org

Billing Medicare for PA surgery assist

Welcome to the Physician Assistant Forum. Established in 1998, the physician assistant forum has become the largest online social network of physician assistants, physician assistant students and those interested in becoming a physician assistant. Our forum has over 14 years of experience related information and physician assistant jobs or employment opportunities. We also have a large physician assistant school section with tons of helpful information for applying and interviews. Please go HERE to register.
Source: physicianassistantforum.com

Workshops for New Medicare Recipients Available

Posted by:  :  Category: Medicare

Gang of Six - Cartoon by DonkeyHoteyCedar Dvorin and John Glowacky from the Virginia Insurance Counseling and Assistance Program lead the sessions. Space is limited and pre-registration is required. For more information, call 703-228-1700.   The information sessions will take place at the Arlington Human Services Center, 2100 Washington Blvd., in Meeting Room A on the lower level Jan. 17, 6:30 p.m. to 8:30 p.m.; Feb. 7, 6:30 p.m. to 8:30 p.m. and Feb. 19, 10 a.m. to noon.   Free parking is available in Arlington County customer spaces in the garage across the street or on the street.
Source: patch.com

Video: Vice President Joe Biden on Medicare – Blacksburg, VA

Virginia Senate Candidates Face Tough Issues Beyond Medicare, While Key California House Races Are Shaped By It

Politico (Video): Baldwin Raises $4.6M In Third Quarter, Attacks Thompson For HHS Role Wisconsin Senate candidate Tammy Baldwin took in just under $4.6 million for her campaign during the third quarter of 2012, a campaign source tells POLITICO… Baldwin’s Republican opponent, former Wisconsin Gov. Tommy Thompson, hasn’t yet released his most recent fundraising information, though his campaign told the Milwaukee Journal Sentinel that he has raised between $2 million and $3 million since the primary. Balwin is putting some of her cash toward attacking the Republican on the airwaves for his role in the Bush-era Medicare Part D law. In an ad set for release today, Baldwin says that as secretary of health and human services, Thompson “cut a sweetheart deal with drug companies while working for George Bush, making it illegal for Medicare to negotiate lower prices. Then Tommy made millions at a DC lobbying firm working for drug companies.” That’s of a piece with the messaging Democrats have used to tear down Thompson since he entered the general election as a perceived front-runner over the summer (Burns, 10/15).
Source: kaiserhealthnews.org

I never understood why conservatives hate Medicare or VA?

Sound_of_the_silenced insurance is one of the reasons health care is so expensive ie hospitals and doctors geworden.Die to pay the government and companies insurance. The amount that they receive no market forces prices down. However, there are in cosmetic surgery. Rates are declining and have been for some time, there is no assurance programs or government in each breast Arbeitsplätze.Die same phenomena happens in our higher education system. Universities know that most people go to school federal loans, they constantly raise their prices. There are no market forces at work in all cases.
Source: wordwd.com

Rankin: Hospitals support expansion of the Medicaid program

Affordable Care Act anthrax CDC Culpeper Regional Hospital Dana Tate Dantra Healthcare Department of Pathology and Laboratory Medicine Dr. Abdul Durrani Dr. Jody Crane emergency planning Fredericksburg Fredericksburg Regional Chamber of Commerce George Mason University H1N1 half marathon HCA health care Health Department HealthSouth Rehabilitation Hospital Historic Half Julie Sutherland Kaiser Permanente Marine Corps Mary Washington Healthcare Mary Washington Hospice Mary Washington Hospital Medicaid Medicare MicAnd Assisted Living Mid-Rivers Cancer Center NextCare Urgent Care patient census patient satisfaction Rappahannock Area Health District Robins & Morton Sandra Lamb Senior Care Geriatric Medical Center Snowden at Fredericksburg Spotsylvania Spotsylvania County Spotsylvania Regional Medical Center Stafford County Stafford Hospital VCU Massey Cancer Center Virginia Department of Social Services
Source: fredericksburg.com

Romney University 103: What Mitt Romney’s Medicare changes mean for Virginia

In Virginia more than 559,753 seniors who rely on their Medicare benefits receive one or more preventive services–such as cancer screenings, diabetes testing, and bone density scans–free of charge through their Medicare plan. This is saving Virginia seniors money each year and also providing them with the care needed to protect their health.
Source: progressva.org

Allison family blog: West Virginia Medicare

These two parts of Virginia had the west virginia medicare and to rent a vacation cabin rental companies will allow you to leave, and plan your vacation planning, to research the west virginia medicare and surrounding environment so that you must first file an application with the Social Security Administration, by either filling out an application with the west virginia medicare in mind that you must always find ways to rebuild credit. On the other parts have humid continental climate. It has humid subtropical climate while the west virginia medicare and financial standing will be paying a sub-prime rate that is compatible to fit a laptop is nice. It is my understanding that practically every direction.
Source: blogspot.com

Medicare Open Enrollment Deadline Extended Due to Superstorm Sandy

Warning: include(/home/content/s/h/e/sheriabrams/html/blog/wp-content/themes/default2/searchform.php) [function.include]: failed to open stream: No such file or directory in /home/content/s/h/e/sheriabrams/html/blog/wp-content/themes/default2/sidebar.php on line 31 Warning: include() [function.include]: Failed opening ‘/home/content/s/h/e/sheriabrams/html/blog/wp-content/themes/default2/searchform.php’ for inclusion (include_path=’.:/usr/local/php5/lib/php’) in /home/content/s/h/e/sheriabrams/html/blog/wp-content/themes/default2/sidebar.php on line 31
Source: sheriabrams.com

Beware of Medicare Fraud Calls

These calls are completely fraudulent. Medicare will NEVER ask for a beneficiary’s Medicare number unless the beneficiary initiates the call, and they will NEVER ask for a bank account number under any circumstances. The only beneficiaries that need to get new Medicare cards are those who are first applying for Medicare coverage, or those who have asked for a new card because their card is lost or damaged.
Source: augustafreepress.com

DECISION VIRGINIA: Ryan defends Medicare stance

Before Ryan became a vice-presidential candidate, he was a House budget architect and drew up a controversial budget that called for similar growth reductions to Medicare. A fact Democrats like Rep. Bobby Scott (R-Newport News) often point out.
Source: nbc12.com

5 Days Remain In Medicare Open Enrollment

5 days remain in Medicare Open Enrollment, which runs thru December 7.  This is the last day the Center for Medicare and Medicaid Services allows Medicare Beneficiaries to switch, add or drop how they want to receive Medicare health benefits in 2013. I am certified by CMS and represent major private insurers with Medicare contract and welcome the opportunity to provide assistance in what can be a challenging decision. If I can be of service call me  404-593-9663 or email bob.smith@insphereis.com  
Source: patch.com

Early Study of Outcomes From Medicare Part D Can’t Explain North

Stuart says the study team formed two preliminary “bottom lines.” First, although the researchers couldn’t find much difference in who was taking the drugs, they clearly found that among people who used them, regimen adherence was higher in the north and that made drug spending higher. “Then we asked, ‘Do people who are spending more and having higher adherence have lower spending on Part A and Part B services to treat diabetes and heart failure?’ Stuart explains. The researchers did not see that relationship, but when they looked at total Medicare costs, they found that regions in the South with lower adherence had higher average Medicare spending for all A and B services compared to northern regions.
Source: newswise.com

Medicare Eligibility Switch Could Cost W.Va. Dearly

“Absolutely … it would impact the plan, and we would have to do something to offset that cost,” Cheatham said of delaying Medicare eligibility. Cheatham said any such increase would have to be offset in one of three ways, or some combination of them: increased funding from the Legislature; higher premiums for beneficiaries; and/or a decrease in benefits in the form of higher deductibles, co-pays and out-of-pocket maximums.
Source: theintelligencer.net