Whistlerblowers, state Medicare fraud investigators helps Tennessee recoup big bucks for bad drug deals

Posted by:  :  Category: Medicare

Jessica Sundheim by On BeingIn 2011 Tennessee’s MFCU’s 35 people had 132 fraud investigations, with 27 [20.5%] convictions and 44 Abuse/Neglect investigations with 13 [29.5%] convictions. Tennessee made 13 recoveries for $55,497,185 of Tennessee’s $7.8 billion Medicaid costs. Comparing recoveries with Tennessee’s $4.2 million MFCU budget shows a $13.21 to $1 return, 58% higher than the MFCU national $8.39 average. Tennessee’s MFCU is below average in size in a state whose Medicaid recipients are 25% of the population. Staffed with only 2 attorneys [one cross designated for federal court], only 2 auditors, 20 investigators and 11 support staff. They would recover more with more attorneys, fraud indictment rates higher than 8%, and focusing prosecution more on 8 Abuse/Neglect indictments costing more than they recovered. http://oig.hhs.gov/fraud/medicaid-fraud-control-units-mfcu/index.asp
Source: medcitynews.com

Video: ABC’s of Medicare – Tennessee Medicare Supplements and Advantage Plans

Medicare Secondary Payer Bill Summary

CMS is required to maintain a secure web portal with access to claims and reimbursement information. The web portal must meet the following requirements: • Payments for care made by CMS must be loaded into the portal within 15 days of the payment being made. • The portal must provide supplier or provider names, diagnosis codes, dates of service and conditional payment amounts. • The portal must accurately identify that a claim or payment is related to a potential settlement, judgment or award. • The portal must provide a method for receipt of secure electronic communications from the beneficiary, counsel, or the applicable plan. • Information transmitted from the portal must include an official time and date of transmission. • The portal must allow parties to download a statement of reimbursement amounts. The Reimbursement Process The SMART Act requires parties to notify CMS of when they reasonably anticipate settling a claim (any time beginning 120 days before the settlement date). CMS then has 65 days to ensure the portal is up to date with all of the appropriate claims data. CMS can have an additional 30 days on top of the 65 days to update the portal if necessary. At the expiration of the 65 and potentially the 30 day periods, the parties may download a final conditional payment amount from the website. The final conditional payment amount is reliable as long as the claim settles within 3 days of the download.
Source: wordpress.com

Medicare to Cover Paradigm Spine Coflex Technology in Select States

Paradigm received a favorable Medicare determination by Cahaba Government Benefit Administrators, a contractor with the Centers for Medicare and Medicaid Services, for the post-decompression and motion preserving interlaminar stabilization device. The Coflex received FDA PMA approval at the end of 2012, and reached a favorable Medicare determination for use as a non-fusion alternative for symptomatic spinal stenosis. More Articles on Devices: Drug-Device Combination Market to Reach $30.5B by 2017 InspireMD Names Alan Milinazzo President, CEO Soft Tissue Regeneration Receives Market Approval for Rotator Cuff Repair Device
Source: beckersspine.com

Tennessee senators support budget compromise

“The Medicare fiscal cliff is still ahead of us, which is why Sen. Corker and I have a proposal to deal with the out-of-control spending that will soon bankrupt the programs seniors rely on to pay their medical bills,” he said. “If we don’t deal with this during the debt ceiling debate, we are on the road to becoming Greece.” 
Source: nooga.com

Molina Healthcare to participate in Ohio’s integrated care system for dual eligibles

Posted by:  :  Category: Medicare

Molina Healthcare (NYSE: MOH) today announced that its health plan subsidiary, Molina Healthcare of Ohio, Inc., has been chosen to participate in the Southwest (Cincinnati), West Central (Dayton), and Central (Columbus) markets under the Ohio Integrated Care Delivery System (ICDS). The Ohio ICDS is intended to improve care coordination for individuals enrolled in both Medicaid and Medicare. The selection of Molina Healthcare of Ohio was made by the Ohio Department of Jobs and Family Services (ODJFS) pursuant to the request for applications for qualified health plans to serve in the ICDS issued in April 2012. The commencement of the ICDS is subject to the readiness review of the selected health plans, and the execution of three-way provider agreements between the health plans, ODJFS, and the Centers for Medicare and Medicaid Services (CMS). Enrollment of dual eligible members in the ICDS is expected to begin on April 1, 2013.
Source: medcitynews.com

Video: Newly Accepted Insurances & Current Services at American Indian Health & Family Services

Student Health Insurance Rates

today announced that U.S. News and World Report has ranked Molina’s subsidiary Medicaid insurance plans in New Mexico and Utah among. Molina Insurance is a multi-state managed care organization that has succeeded in providing needs to people that have not yet gotten the. Find out how Molina Healthcare Insurance differs from other plans; look into various affordable options. & wellness: quality: HIPAA: drug list: services: contact us. Welcome to Medicare in Texas! For 2011, Molina Medicare offers two (2) plans in Texas. Healthcare, a FORTUNE 500 company, has grown into one of the leaders in providing quality healthcare for financially vulnerable individuals and families. 120 listings of in on YP.com. Find reviews. Insurance; Email; Send to Mobile; Facebook; Twitter; Improve this listing Inaccurate result? 20. Healthcare has developed this website to help. including Medicaid and the State Children’s Program (SCHIP). Molina Healthcare offers. yourfreequotes is a free service that helps consumers compare prices on insurance plans in their area. Get quotes for individual insurance, family. Services in San Diego, CA; Health/Allied Services; Direct & Medical Insurance Carriers; Molina Healthcare in San Diego, CA is a private company. [USA] Provides managed healthcare in California, Washington, Utah, and Michigan, to individuals covered under Medicaid and related programs.
Source: individualmandatehealthcare.com

Molina Healthcare Management Discusses Q2 2012 Results

I think that’s a great question, Josh. And here, I think, is one of the differences. In California, we are operating in the existing markets. We do have data on the Medicare side. So we do have better, I think, utilization data. When we look at Texas, specifically in Hidalgo, the state gave us no utilization data despite our asking for it. They simply gave us a PMPM. So we made our estimates based on what was happening in the rest of the state in the markets that we had already been serving. And what we saw was the utilization, the number of beneficiaries utilizing long-term care service is — in our other markets, range from 11% on the low end to 20% on the high end. So when we look into the rates adequate, we thought they would be assuming that the same percentage of people in Hidalgo were using it in other areas, which led us to believe that it was really a overutilization of services. What we found once we got in there, was that 60% of the people in Hidalgo are utilizing long-term care services. It’s a much different issue that we have to tackle because we have to go out now on every one of those people and do a home visit. So you are absolutely right that data — our ability to see data, our ability to analyze the data will be critical, and in each of our discussions with the states, that’s what we’ve been talking to them about. We have experiencing in California. Ohio, we’re fortunate that they have probably the best rate setting experience of any state we’re in there, totally transparent. And then in Michigan, which is another duals state that we’re looking at, we currently have experienced because the state enrolled the Duals into Medicaid Health Plans for their Medicaid non-long-term care benefits. So again, it’s we’re getting actual experience which I think will help us.
Source: seekingalpha.com

Molina Healthcare appoints Richard Chambers as new President of its arm

Lisa Rubino, Senior Vice President of the Western Region for Molina Healthcare said, “Richard’s extensive knowledge and experience in managed care combined with his unwavering commitment to Medicaid and Medicare programs and to assisting vulnerable populations prepare him well for the opportunities ahead.” “We are excited to have him on our team and look forward to his contributions in growing our California health plan,” she said.
Source: healthcareglobal.com

Lawsuit Challenges Medicaid Managed Care Decision In Missouri

For the first time, the state has limited the number of managed care contracts it awarded to just three, instead of granting a contract to any company that meets certain requirements. Having a cap could save the state $16 million over two years, according to officials with the state, through reduced administrative costs from having to work with fewer companies. The state also expects money to be saved from better rates that companies will be able to negotiate with providers because each company will have more members and more leverage.
Source: kaiserhealthnews.org

FMO for Molina Medicare in FL

MedicarePlanSolutions – you are correct. Street level for FL is 450, but CMS allows reimbursement of expenses above and beyond the 450, plus overrides to managing agents for business written by their subagents. As I was saying before, if you are interested in a 473 or 493 contract level (depending on your production level and number of sub-agents), feel free to contact me at the above phone number. I also immediately vest ALL of my contracts.
Source: insurance-forums.net

Physicians want permanent fix for long

Posted by:  :  Category: Medicare

Historic Moment: the Fall of an Empire - 25 SEP. 2008. by eyewashdesign: A. GoldenThe 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

Video: Medicare for All – MoKan demonstration at Blue Cross/Blue Shield offices in Kansas City, Missouri

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

The 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

Less hospital access could be rural Kansas’ future with cuts to Medicare

Dave Ranney KHI News Service LEOTI — In small towns like this across Kansas, hospital administrators are paying close attention to federal deficit-reduction talks in Washington, D.C. that could lead to a 2 percent cut in Medicare spending, starting Jan. 1. “Two percent may not sound like much,” said Vicki Hahn, who runs the Wichita County Health Center in Leoti. “But we’re a ‘critical access hospital,’ which means we’re reimbursed for 101 percent of our Medicare costs. If 2 percent gets taken away, it would put us in the red on our Medicare patients. That wouldn’t be good.” Leoti is about 40 miles from Colorado and 110 miles from Oklahoma in a county where about 18 percent of the population is age 65 or older. Total county population is 2,276 people according to most recent U.S. Census estimates. “We’re a frontier county,” Hahn said. Medicare patients account for about 78 percent of the patients seen by the publicly owned hospital. A cut in Medicare reimbursement, Hahn said, would force the hospital to ask the Wichita County Commission for help in offsetting the loss of federal support. “That would be a big concern,” Hahn said. “If we end up losing revenue that doesn’t get replaced, we would have to come up with a much different business model than the one we have now.” Many Medicare patients Wichita County Health Center’s situation is not unique. Because of the disproportionate number of rural and small-town Kansans who are elderly, most of the state’s small hospitals treat a relatively high percentage of Medicare patients. Medicare is the federal health program for persons age 65 and older. Roger Masse, chief executive officer at Ellsworth County Medical Center, said a 2 percent cut in Medicare reimbursement would result in a $200,000 loss for the public hospital he manages. “In Ellsworth County, that’s a lot of money,” he said, noting that a three-mill property tax currently generates about $225,000 for the hospital. “So far, operationally, we’ve been able to just about break even,” Masse said. “We haven’t had to ask the county for more than the three mills. But if we end up taking a $200,000 hit, how long can that be sustained? I don’t know.” About 55 percent of the hospital’s patients, he said, are on Medicare. Blaine Miller has a similar story. He runs the Republic County Hospital in Belleville. He said a 2 percent reduction in Medicare reimbursement would lower hospital revenues by about $110,000. “That would be big for us,” Miller said. “At the same time, our charity care had gone up substantially. Last year, we had about $200,000 in charity care; this year we’re looking at about $300,000.” Miller attributed the increase to the hospital’s non-Medicare patients either losing or not being able to afford their health insurance. 101 percent Kansas has 83 federally designated “critical access” hospitals, the most of any state in the nation. Among other things, the designation allows the hospitals to bill Medicare for 101 percent of their outpatient, inpatient, laboratory, physical therapy, and post-acute care costs. The hospitals, in turn, agree to have no more than 25 beds, limit their inpatient stays to no more than 96 hours per patient annually, and provide 24-hour emergency room care. The critical access program was started in 1997 with the goal of ensuring access to emergency, primary and acute care in the nation’s rural areas. In Kansas, nine counties — Linn, Woodson, Osage, Wabaunsee, Elk, Wallace, Gray, Chase and Doniphan — do not have a hospital. But 10 counties — Barber, Harper, McPherson, Marion, Dickinson, Washington, Pottawatomie, Nemaha, Brown, Wilson — have two hospitals with 25 beds or less. A future with fewer hospitals? “There is so much required of hospitals nowadays, I don’t know that all of them can survive,” said Dennis Franks, chief executive office at Neosho Memorial Regional Medical Center in Chanute. “The requirements are the same for all of us, but our resources for meeting those requirements are different.” Many of the state’s rural communities, he said, also are having a hard time recruiting medical staff, a situation that’s likely to worsen with implementation of the Affordable Care Act on Jan. 1, 2014, which could mean thousands of additional Kansans gaining access to health insurance either through the new subsidies provided for them to purchase private coverage or perhaps through Medicaid should state policymakers choose to expand the program. “There simply aren’t enough primary docs to go around,” Franks said. “We’re all competing for them now. But after the Affordable Care Act kicks in, everybody’s going to need them and we’re going to find ourselves competing with some very, very nice places to live. It’s going to be very difficult.” Charity care and Medicaid On the other hand, Franks also said he was concerned by reports that Gov. Sam Brownback may decide not to expand the state’s Medicaid program to include adults with incomes below 133 of the federal poverty level. Currently, the Kansas Medicaid program is restricted mostly to poor children, pregnant women, the disabled and the elderly. A non-disabled adult rearing children is currently eligible for Medicaid, if his or her income is below 32 percent of the poverty level — about $5,200 a year for a young mother with two children. Childless adults are not eligible for Medicaid regardless of their income. Many of these adults now rely on hospital emergency rooms for routine medical care, resulting in the hospitals providing millions of dollars in uncompensated care. To offset the costs of expanding Medicaid eligibility, the Affordable Care Act calls for phasing out federal payments to hospitals that care for disproportionately high numbers of uninsured patients who can’t pay their bills. Hospitals, Franks said, cannot afford to lose the “disproportionate share” payments without a corresponding reduction in charity care. “That would really hurt a lot of hospitals,” he said. Currently, Kansas hospitals receive about $41 million in disproportionate share payments annually. KanCare changes Hospital administrators also are waiting to see how they will be affected by KanCare, the governor’s plan to move virtually all of the state’s Medicaid enrollees into managed care plans run by private insurance companies. “At this point, we don’t know how that’s going to work out,” said Denny Hachenberg, chief executive officer at Anderson County Hospital in Garnett. “But it’s like I tell my board, ‘There’s nobody out there looking for ways to pay us more for what we do.” Losing proposition According to the National Rural Health Association, 41 percent of the nation’s critical access hospitals are losing money. If the White House and Congress allow a reduction in Medicare reimbursement, the percentage of rural hospitals operating in the red is sure to increase, said Brock Slabach, a senior vice president at the association. “As of this moment, this (reduction) is real,” he said. “It’s in the law, it’s part of the Budget Control Act of 2011, and it will happen on Jan. 1. “That’s not to say there won’t be an act of Congress between now and Dec. 31 to reverse some of what’s in the act,” he said. “But that’s going to require quite a bit of negotiation on the part of the president and Congress. It’s possible, certainly, but it’s also possible that it won’t happen.” In addition to the 2 percent reduction in Medicare reimbursement, the Obama administration has twice proposed lowering payments to critical access hospitals by 1 percent. Both times, Slabach said, the president’s proposals were considered “dead on arrival” and were soon dropped. But there is no telling what lies ahead. “What’s happened is that the president has let it be known that he’s open to the notion of using CAH (Critical Access Hospital) payments as a ‘pay for’ for other programs,” Slabach said. “He’s ‘put it in the water,’ if you will.”
Source: gardnernews.com

KS: Rising obesity weighs on public health

The recent obesity study released by the Robert Wood Johnson Foundation, “F as in Fat,” ranked Kansas 13th overall with an obesity rate of 29.6 percent, tied with Ohio, and just behind Missouri. The ranking is three slots higher than last year when Kansas came in at 16th, with a 29 percent obesity rate. Kansas was only 18th for obesity in 2009.
Source: watchdog.org


Meanwhile . . . Tough talk among GOP voters is convincing until Grandma gets unplugged. On the (not so) bright side, emboldened Republicans in Missouri seem eager to show the State the power of their bad ideas and how they plan to crack down everyone but the petty bourgeois and the elite . . . So it stands to reason that over time a great many of their new found influence will be wasted on a vendetta against the Prez Obama.
Source: tonyskansascity.com

The Message Rang Loud and Clear in Kansas City…

Overland Park, Kansas: Congressional staff from both senate offices in Kansas and Missouri, along with staff from Congressman Yoder’s office, Medicare beneficiaries, and health care professionals gathered Thursday, November 1 at an event hosted by the Midwest Association for Medical Equipment Services (MAMES), VGM Group, Inc., and People for Quality Care, at the MidAmerica Rehabilitation Hospital, in Overland Park, Kansas  to discuss a government mandate that is affecting Medicare beneficiaries and disabled individuals in the Kansas City region.
Source: vgm.com

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)

Posted by:  :  Category: Medicare

DAMN!! -- I THINK WE'RE F*%KED by SS&SSSo, 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

Video: Medicare Part D | How to Apply for Medicare Part D

My Experience Applying for Medicare Online

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

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

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

Social Security and You: Signing up for Medicare

However, WEP does not affect benefits paid to your wife as a widow in the event of your death. For example, a worker and spouse both claim their benefits at full retirement age. Because the worker receives a pension based on work not covered by Social Security, the benefit amount under the WEP benefit formula is $700. Based on the WEP benefit amount, the spouse’s benefit is $350 (one-half of the worker’s WEP benefit amount). When the worker dies, the WEP reduction is removed. The surviving spouse’s benefit is refigured using the regular benefit formula.
Source: mysanantonio.com

H.R. 6719, To promote and expand the application of telehealth under Medicare and other Federal health care programs, and for other purposes

Latest Major Action: 12/30/2012: Referred to House committee. Status: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Oversight and Government Reform, Armed Services, and Veterans’ Affairs, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Source: washingtonwatch.com

What is the Cadillac Medicare Advantage plan

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. GoldenA 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

Video: Medicare Part F

What you don’t know about Medicare Part B

3) Medicare does not pay for most preventative care : except in certain circumstances, Part B does not pay for preventative care. The physician must demonstrate in their documentation of the visit that the visit was “medically necessary” or they will not be paid. So under Part B “routine follow-ups” are not covered, and physicians are not paid to see patients unless it is “necessary”. It is notable that there is little guidance from Medicare on the definition of what is “medically necessary” and that this is a prime target for auditors looking to recover funds. For a list of Medicare-covered preventative care, see http://www.medicare.gov/navigation/manage-your-health/preventive-services/preventive-service-overview.aspx
Source: cognitive-psychiatry.com

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

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

Medicare Part D Notice Required Before October 15

This is a reminder that the deadline to distribute the Annual Notice of Creditable Coverage required under Medicare Part D is less than a week away. This notice informs participants whether the prescription drug coverage offered under your health plan constitutes creditable or noncreditable coverage. As the Medicare Part D annual enrollment period now runs from October 15 to December 7, you must distribute the notices before October 15. Employers who sponsor a health plan offering prescription drug benefits must provide an annual notice to all Medicare-eligible participants that explains whether the prescription drug benefits offered under the plan are at least as good as the benefits offered under the Medicare Part D plan. The only employers exempt from this requirement are those that establish their own Part D plan or contract with a Part D plan. The Centers for Medicare and Medicaid Services (CMS) has posted forms and instructions for providing this notice. The forms were last updated in 2011. They are available, both in English and Spanish, through the following links:
Source: jdsupra.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

Cigna Medicare Access Not Renewing For 2011

Posted by:  :  Category: Medicare

Cigna Medicare Access Advantage plan ends 12/31/2010 Cigna announced in June that they would not be renewing their national Medicare Advantage contract for Private Fee-For-Service (PFFS) plans. PFFS Medicare Advantage plans are plans that do not ?
Source: posterous.com

Video: Udall Bennet

CIGNA to Pull Out of PFFS Business in 2011.

Medicare Advantage has, over the past few years, been harder and harder to sell and become such a pain – with all of the regulations, Scope of Appointment form scrutiny, commission reductions, replacement prohibitions, etc. This has now been topped off by a president who wants to eliminate the medicare advantage altogether. See the video of President Obama saying so here. We are already starting to see the effects in one of the major carriers, CIGNA, pulling out of the 2011 Medicare Advantage bidding process. The Department of Health and Human Services fired off a letter to CIGNA and others, telling them that they must avoid raising rates on their members if they want to stay in the Medicare Advantage market. This, while they’re simultaneously cutting the subsidies to the carriers for providing the same service. CIGNA responded by declining to participate in national Medicare Advantage going forward. This is a trend that will continue. To the extent that they can get away with it – to remain profitable, the insurers will have to increase monthly premiums to their Medicare Advantage clients. They will also have to increase co-payments and other internal costs passed on to the members. HHS has made it clear, however, that they will not be approving such changes. So, backed into a corner, more will be making their exit from the marketplace. This will be a horrible blow to the seniors, as I predicted in this video that got rave reviews from all except for AARP – who wrote me a Cease & Desist letter for mentioning what they were up to. They got their bill, and now the results that I predicted are coming true. YouTube – Medicare News You Need to Know This will be a huge opportunity for those agents wanting to help potential clients with medicare supplement choices, as the Medicare Advantage market will begin to dwindle starting in November with thousands of members getting letters explaining that they have 1) Guaranteed issue into any medicare supplement provider for 1/1/11 and 2) They MUST pick a new plan/provider by 1/1/11 or the government will pick one for them. This happened last year when Coventry left the Medicare Advantage market and it was a huge boost to our enrollment in medicare supplements. That was just the first break, and the tidal wave is coming. Will it be hard for low income seniors? Absolutely. Somebody will have to write applications for seniors going onto medicare supplements, though, and it might as well be you. —- Agents wanting to take advantage of the new opportunities should visit: www.sellmedicarebyphone.com
Source: insurance-forums.net

Eligible Georgia Retirees Switching to Medicare Advantage Plans

What Does the Change Really Mean for My Doctors? It was detailed in July 15th letter that your doctor (provider) would need to accept the changes in the plan to accept the MA terms. From all the research and discussions that I have had with both doctors and insurance vendors, it does not seem like there will be many changes they believe (view the letter with all enclosures by clicking here). There are no networks. You may see any provider that accepts Medicare and is willing to accept CIGNA/UHC’s terms and conditions. The really important point to make is to have your provider agree to accept the new plan changes (information on the plan was given in the July 15 letter). Along those lines, I have received a few emails talking about the problems with finding Medicare Advantage doctors. Numerous articles have said that the vast majority of doctors will not refuse Medicare or Medicare Advantage from current patients – they wish to continue the relationship. Some doctors may or may not accept new patients, but a study by the Center for Studying Health System Change found that nearly 75% of doctors accepted all or most new Medicare patients in 2008 (Study: Most Physicians Still Accepting Medicare Patients, Fierce Health Finance). How Much Will This Cost Me? First, remember that the State of Georgia is subsidizing your coverage by nearly 75% of the total costs. This is one of the benefits that was “given” to you, so if you were to opt out of the MA plan, it will cost you hundreds of dollars per month for the same coverage. In other words, unless you feel like you have no other option and money to burn, opting out is not an option… (who has money to burn??) The good news about the changes is that it will actually save you money every single month for your coverage. Currently, a PPO covered participant pays $32.90 for single coverage ($142.40 for family). The standard option MAPD PFFS plan will cost $19.30 for single coverage and $38.60 for family coverage (all dependents eligible for MA plan). A mix of eligible and non-eligible Medicare participants in family coverage will have higher costs, but that is to be expected. The premium coverage option for the MAPD PFFS plan will cost $59.30 for a single and $118.60 for a family (all dependents eligible for MA plan). The benefits here are a lower out-of-pocket maximum, lower hospital costs, reduced co-pays, and a better prescription drug benefit. The choice is yours, but weigh the costs by looking at your 2008 and 2009 medical expenditures. The standard plan could cost you more based on your needs… (Check the July 15 letter above to compare the coverages on the Plan Summary enclosure) If you want to check out the retiree rates as set by the SHBP, please click this link to open the PDF. What If I Don’t Choose? According to the information sent with the July 15 letter, “If you are not enrolled in a MAPD PFFS option and do not make an election during the ROCP, your coverage will roll to the MAPD PFFS option of the healthcare vendor you are currently covered. Kaiser members who do not make an election will default to the CIGNA Medicare Access Plus Rx (PFFS) – Standard Plan.” Conclusion Any change is tough to accept in anything… especially medical coverage. The unknown is more of a worry than the known even when it may be better. In five years, few people may even remember this change unless there are real problems. If that starts to happen though, you can almost be assured that the SHBP and its vendors will try to make things right. The State Health Benefit Plan covered 693,716 people as of September 1, 2009, and that is far too big a number to think that they will just accept mediocre results. Try to work with your doctors and try to work with the insurance vendors. The vendors are there to help, so let them help. Both CIGNA and UHC told me that if a doctor is not accepting the plan after you discuss it with them, get the vendor involved. They may be able to help explain it from an ease of use and payment perspective. Just a hint the vendors gave me.
Source: theeducatorsretirement.com

I have a Cigna plan, now what?

What does this mean to you? There is no change for customers during calendar year 2010. ·          There is no visible impact  in 2010. ·          There is no change in benefits or premiums; no one is losing coverage. ·          CIGNA will continue to provide all individual PFFS administration, such as processing enrollments, issuing ID cards and paying claims. ·          No change to contact information. Continue to use the same phone numbers, fax numbers, websites and land addresses to reach the same CIGNA teams as before. So there is nothing for you to do differently yet.
Source: ohiomedicaresupplementcompanies.com


Medicare Advantage/Medicare Health Plans SHIIP Publications: Frequently Asked Questions About Medicare Advantage PFFS Plans Is A Medicare Advantage Private-fee-for-service Plan Right For Me Medicare Advantage Comparison Guide (2008) Your Guide To Medicare Private-fee-for-service Plans Medicare Advantage Summaries of Benefits SHIIP Publications: Aarp Medicarecomplete Choice Aarp Medicarecomplete Plus Plan 1 Aarp Medicarecomplete Plus Plan 2 Advantra Freedom – Plan 1, Plan 2 (005), Plan 5 (001) Advantra Freedom – Plan 2 (010),plan 3 (006-013), Plan 5 (002) Advantra Savings (msa) – Plan 1 Aetna Medicare Open Plans America’s 1st Choice – Patriot Plus And Presidential Plus America’s 1st Choice – Patriot-presidential Blue Medicare HMO Plans Blue Medicare PPO Plans Cigna Medicare Access Plans One, Two And Three – Version A Cigna Medicare Access Plans One, Two And Three – Version B Cigna Medicare Access Plans One, Two And Three – Version C Cigna Medicare Access Plans One, Two And Three – Version D Evercare – Dh – Special Needs Plan Evercare – Ih – Special Needs Plan Evercare – Mh – Special Needs Plan Fidelis – Secure Comfort – Special Needs Plan Fidelis – Secure Comfort Plus – Special Needs Plan Fidelis – Secure Independence – Special Needs Plan Health Net Pearl – Plans 009-014-015 Healthmarkets Care Assured Plans Humana – Special Needs Plan Humana Goldchoice – H1804 -216 Sb08 Humana Goldchoice – H1804-007 Sb08 Humana Goldchoice – H1804-016 Sb08 Humana Goldchoice – H1804-217 Sb08 Humana Goldchoice – H1804-278 Sb08 Humana Goldchoice – H1804-279 Sb08 Humanachoiceppo – H3405-001 Sb08 Humanachoiceppo – H3405-002 Sb08 Humanachoiceppo – Regional – R5826-003 Sb08 Securehorizons Medicaredirect Plan 3 Securehorizons Medicaredirect Plan 3a Securehorizons Medicaredirect Rx Plan 51 Securehorizons Medicaredirect Rx Plan 51a Securehorizons Medicaredirect Rx Plan 54 Securitychoice Classic-enhanced-plus-enhance Plus – Area A – Securitychoice Classic-enhanced-plus-enhanced Plus – Area B Securitychoice Essential-essential Plus Southeast Community Care – Dual Plus Plan – Special Need Plan Southeast Community Care – Plus Plan Sterling Option I Sterling Option Ii Sterling Option Iii Sterling Option Iv Today’s Options – Basic Plus, Value Plus, Premier Plus Today’s Options – Basic, Value, Premier Today’s Options Powered By Ccrx Unicare 2008 Msa Summary Benefits WelLCare Benefit Summary A WelLCare Benefit Summary B WelLCare Benefit Summary C WelLCare Benefit Summary D WelLCare Benefit Summary E
Source: blogspot.com

The Sullivan Independent News

The Visiting Nurses Association will hold a flu shot clinic at the Sullivan Senior Center on Tues., Oct. 13 from 12 p.m.- 3 p.m. In order to be sure a vaccine is available for you, you must call or stop by the Senior Center and have your name put on the vaccine list. The VNA will be bringing 150 vaccines, but more will be available if we see more people are signing up. This will be a one-time clinic. Those planning to receive their vaccine may show up anytime from 12 p.m.-3 p.m. To avoid the congestion and long waiting periods, you may wish to wait a little later and not all show up at 12 p.m. Insurances accepted by the VNA for this clinic include: Medicare Advantage Plans, Essence, Coventry Advantra Freedom, GHP, Advantra, GHP Advantra Freedom, GHP Gold Advantage, Humana Choice PPO, Humana Gold Choice PFFS, Humanna Gold Plus HMO and Mercy Medicare Advantage. Other insurances that did not contract with the VNA and will not be accepted are: Medicare Advantage Plans, Secure Horizons, Aetna Medicare, Anthem Senior Advantage, Cigna Medicare Access, Sterling Option, Wellcare, Evercare or any other Medicare Advantage or out-of-state plans. Medicaid is not accepted. If you have another primary insurance, you may not use Medicare or Medicare Advantage. Those wishing to pay “out of pocket” for the vaccine may do so. The cost is $30. Visiting Nurses Association is a non-profit community based organization dedicated to serving the healthcare needs of your community. Please help us by giving us your correct insurance at the time of service.
Source: mysullivannews.com

Daily Kos: Barney Frank wants to be in the Senate for all the right reasons

Posted by:  :  Category: Medicare

Romney Ryan Plan for Medicare and SSI by DonkeyHoteyGainesT1958, Bill in Portland Maine, Sean Robertson, mwm341, Subterranean, Gooserock, nicolemm, Richard Cranium, exNYinTX, hnichols, jackspace, bronte17, cyberKosFan, mkfarkus, Aquarius40, abs0628, menodoc, NYFM, Diana in NoVa, schuylkill, lyvwyr101, Limelite, Longwing, sawgrass727, Los Diablo, radarlady, jrooth, democracy inaction, craigkg, citizenx, myeye, orson, Dobber, Kevskos, FindingMyVoice, Dolphin99, detroitmechworks, flying shams, technomage, IL clb, Texdude50, Statusquomustgo, AllanTBG, bmcphail, BeninSC, ColoTim, yoduuuh do or do not, Mary Mike, Dave in Northridge, sfbob, JML9999, gizmo59, MKinTN, olo, JeffW, bill warnick, NewDealer, mofembot, No Exit, Parthenia, Nica24, artmartin, divineorder, LinSea, Ohiodem1, aunt blabby, followyourbliss, kevinpdx, Railfan, blueyescryinintherain, Polly Syllabic, ericlewis0, CA Berkeley WV, annieli, allenjo, jardin32, IllanoyGal, thomask, DRo, allergywoman, sunnyr, fenway49, TheLizardKing, a2nite, 2thanks, JGibson, Glen The Plumber, Sue B, hillbrook green, poopdogcomedy, EliWery, Icicle68, Kendra Marr Chaikind, H E Pennypacker, OldSoldier99
Source: dailykos.com

Video: Sen. John Kerry (D-MA): “We Cut $550 Billion In The Health Care Act From Medicare”

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

Blog: Medicare begins readmission cuts; Mass. Medicaid set to raise them

Hospitals in Massachusetts object to the penalty, said Tim Gens, executive vice president of the Massachusetts Hospital Association. The readmission policy holds hospitals financially accountable for patients’ outcomes when other providers and patients themselves also shoulder some responsibility for patient health, he said. He also criticized the policy’s methodology as flawed and cautioned that penalties could jeopardize efforts at financially strained hospitals to invest in efforts that will boost quality and reduce readmissions.
Source: modernhealthcare.com

2013 Social Security and Medicare Information | Financial Planning Association of Massachusetts

To help you in answering questions which you might receive from clients and prospects about these changes, I have prepared the following Fact Sheet which summarizes the major program features for both Social Security and Medicare. (Click to view Fact Sheet, as well.) Please feel free to give me a call if you have questions about any of the information in the Fact Sheet. And, please be sure to let me know if you are interested in having me participate in an educational event for you in the months ahead. Winter and spring dates are filling up fast.
Source: fpama.org

Jehlen: Review Your Medicare Options, Save Money

The full implementation of Obamacare over the next couple of years makes reevaluating your Medicare options even more important.  You will notice many positive changes and reviewing options will maximize your savings.  Most notably, Obamacare will close the Medicare Part D “donut hole.”  Currently, if your yearly prescription drug costs exceed a certain amount ($2,930 in 2012), but your out-of-pocket costs have not reached the point where you qualify for “catastrophic coverage” ($4,700 in 2012), you fall into the donut hole.  Starting in 2012, seniors got a 50% discount on brand-name prescription drugs and 14% discount on generic prescriptions.  These discounts will increase incrementally until 2020, when 75% of prescription drug costs for people in the donut hole will be covered by Medicare.
Source: patch.com

Where Medicare Stands: A Discussion With Dr. Oliver Fein of Weill Cornell Medical College

Outside of Social Security, no other domestic program has been scrutinized as much as Medicare as of late. Medicare represents 21 cents for every dollar spent on healthcare in the United States, according to CMS, and it also represents 49 cents for every dollar received by hospitals. Some lawmakers called for massive cuts to the program during the fiscal cliff showdown. Others argued cuts to Medicare would lead to an even bigger healthcare financial nightmare. Medicare will continue to be debated fiercely over the next two months as Congress attempts to find a way to avoid sequestration, or automatic spending cuts to domestic programs. If Congress cannot figure out a solution, Medicare providers stand to lose more than $11 billion this year alone under the sequestration plan. For Oliver Fein, MD, Medicare and other public healthcare policies have been a major part of his life since he left Case Western Reserve University School of Medicine in 1967. Currently, Dr. Fein is a general internist at NewYork-Presbyterian Hospital in New York City, a professor of clinical medicine and public health at Weill Cornell Medical College and chair of the New York Metro Chapter of Physicians for a National Health Program. Dr. Fein says he has always been interested in the delivery of healthcare to vulnerable populations, especially the poor and elderly. He spent his residency in public hospitals, and his clinical practice was based in academic medical centers where he could continue to see Medicaid and Medicare patients. When it comes to Medicare, Dr. Fein explains it is “not a perfect program,” but it will continue to be tremendously important for hospitals and physicians alike. Here, he shares his thoughts on where Medicare stands today, if the program is really as insolvent, as some say it is, and what he would do if he helmed CMS. Question: Medicare is, for all intents and purposes, one of the most important payors in the country. What are some of the fundamental problems with it, and what does it do well? Is it really as insolvent as some public policy leaders say it is? Dr. Oliver Fein: Let’s start with what Medicare does well. [Medicare] is a situation where when you turn 65 and have worked 40 quarters, or 10 years, in this country, you’re eligible. The simple eligibility of Medicare is just wonderful, and I think people really appreciate that. From a physician’s point of view, the sense I have is, there are some that believe Medicare doesn’t pay them enough. So, therefore, they don’t take Medicare patients. I think that’s been highly exaggerated. There was a study from the Archives of Internal Medicine in 2011 that argues, in fact, the number of physicians that accept Medicare is much larger than acknowledged in the anecdotal literature. That may change if this whole [sustainable growth rate] issue isn’t solved. The other thing to say is many [physicians] who are in private practice have told me they like Medicare because they can count on getting the check each month. There’s no hassle of claims being denied that occurs with private health insurance. What has happened is most insurers are for-profit entities. Any way they can delay payment means they can make money on premiums they’ve collected. Well, since there is no for-profit motive in Medicare, claims denials are rare. I think overall, beneficiaries like Medicare, and it’s a program that physicians overwhelmingly think is an important program for them. For hospitals, Medicare is kind of their intermediate payor. It may not be as good as contracts they’ve been able to negotiate with private insurers, but it’s better than contracts with Medicaid insurers. The result is even specialized places like Memorial Sloan-Kettering Cancer Center take Medicare whereas they may deny certain for-profit private insurers because they feel they don’t get adequate reimbursement from them. In terms of Medicare’s solvency, Medicare’s trustees and most economists will say the money that has been collected from people’s payroll checks makes the program solvent through 2024. So what does that mean? The money is there to pay projected payouts that will be needed in those years for Part A. Some people are talking about Medicare going broke after that. It is perhaps that the monies collected won’t equal what’s paid out — but that assumes there’s no change in the payroll tax. Currently, [payroll tax contributions to Medicare] are 1.45 percent from you and 1.45 percent from your employer. Let’s increase that by a little bit to 1.5 or 1.55 percent of salary, and we could extend the life of this program on the Part A side to perhaps 2040 or 2050. I think that’s one dimension. The other thing to realize is that on the Part B side, Medicare is a 25-75 program. The beneficiary, on average, contributes 25 percent of cost of the program, and the government takes the rest out of current tax revenues. Does that mean program is broke? Well, if we continue to have wars in Afghanistan and Iraq and have military costs that are so substantial, we’re not going to collect enough tax revenue to cover it. [However], if you just shrink [the military budget] a little bit, we’ll have plenty of money to cover Part B contributions. Part C, or Medicare Advantage, is also designed in such a way where beneficiaries are able to elect a private health insurance company to mange their benefits. And when that happens, the doctor and the hospital are dealing with a private insurance company, not Medicare. What has been shown is private [Medicare Advantage] companies are getting 11 to 14 percent more money than if the beneficiary stayed in the public program. The program is designed to reimburse the private insurance companies more generously. They also risk select, and one of the classic ways they do that is by offering a free gym club membership, for example. So if we really paid private insurers less [Medicare] money, there would be more money in program, and again one wouldn’t be talking about us going broke. Q: There’s been a consistent refrain in the hospital sector that raising the eligibility age of Medicare from 65 to 67 or higher would help control costs as well. What do you think would result from that plan? OF: It will deal with the government costs. If you don’t cover a whole sector of the population, sure, Part A costs will be less, Part B costs will be less, Part C and D costs will be less. But it is enormously unfair, and the hospital sector will ultimately get very hurt by this. This works for people of upper incomes because many of them actually do work past age 67. It’s the laboring class — the coal miners, steelworkers, garbage collectors, people who have to do real, physical labor who frankly ought to retire at age 65 who are the ones really adversely affected by this. If those older, low-income folks are laid off by their employers, they lose their insurance — and that will come back to slap hospitals in the face. When contrasted with 30-year-olds with no insurance, hospitals will find themselves swimming in a new form of debt. Q: What about the inverse? What if Medicare’s age was lowered to add in younger, healthier people? OF: That’s where we should be going, it seems to me. Incorporate younger people in Medicare, who will cost the program much less on a per capita basis. One could decide to cover children. Children are a great example. They require relatively cheap care even though they do have immunizations in the first year of life. But on a per capita basis, they are much cheaper. Let’s incorporate them in the Medicare program, and as they get older, keep them in the program. Q: What about reducing the number of health insurers? Would that make financial planning at hospitals, for example, easier? OF: The studies we’ve looked at show that since administrative costs of multiple health insurers are on average 20 percent to the insurance company and up to 40 percent to the physician because they have to hire extra staff to deal with multiple insurers and challenge unjustly denied claims. [Physicians for a National Health Program] decided to compare Toronto General in single-payor Canada with Massachusetts General Hospital in Boston, since they are similarly sized. At Toronto General, there were three billers in the billing office; Massachusetts General had over 300. Frankly, every single-payor bill that exists in Congress includes jobs retraining, so if we went to single-payor, there wouldn’t be this concern. We haven’t actually seen a good economic study of how many fewer employees you would need in the insurance sector. Some people have looked at the issue in terms of the amount of time a primary care physician has to spend dealing with prior approval, denial of claims, so on and so forth. Larry Casalino, MD, PhD, [chief of the division of outcomes and effectiveness research at Weill Cornell Medical College] shows that in terms of income, practicing primary care physicians are probably spending an enormous amount of money having to deal with multiple insurers. Q: If you were in charge of CMS, what would be some of your main initiatives? OF: Initially, I would try to figure out a good strategy to reduce payments to the private health insurers who take Part C and see if we couldn’t get that down to a more reasonable amount of money. CMS doesn’t control the percentage of payroll tax, and CMS doesn’t control how to get more money into the system. All that it could control is how to spend less and do it efficiently. Medicare’s deductable for Part A has become quite substantial. It’s now over $1,100. Part B’s deductible is $140. Part D’s is $335. These are major barriers to low-income patients’ access to care. I would like to see them reduced or eliminated. I also would like get rid of the doughnut hole, and the proposal in the ACA will eliminate it later in 2020. I would propose a lot of things Don Berwick, MD, [former CMS administrator] was doing to boost quality and reduce cost, but they would not be adequate. For instance, penalties for readmissions — yeah sure. But hospitals are paid on a DRG basis, and physicians are paid on a fee-for-service basis. The physician has an incentive to keep patient in hospital longer, and the hospital has an incentive to get the patient out. To the degree the physician has patients’ interest in mind, it may be good for physicians to resist the hospitals’ pressures to discharge early. I’m not sure I want to give physicians a financial incentive to do that, but it may make sense that the physician who is close to the patient feels this patient really can’t go home, is not medically stable, the home situation isn’t ideal to go to yet — I respect that. That’s important.
Source: beckershospitalreview.com

How Massachusetts hospitals increased Medicare reimbursement rates by 20 percent

Prior to 2012, the Nantucket Cottage Hospital was classified as a critical access hospital and therefore did not figure into the computations for the states’ IPPS [Inpatient Prospective Payment System] HWI [Hospital Wage Index] rural floor. However, as a result of being acquired by a large health system, the Nantucket Cottage Hospital converted to IPPS status, becoming the only rural IPPS hospital in the state of Massachusetts. This change resulted in the rural floor wage index being applied to 60 urban hospitals in the state of Massachusetts, increasing wage indexes for these hospitals from an average of 1.16 in FY2011 to 1.35 in FY2012.
Source: healthcare-economist.com

Massachusetts Passes New Law to Protect Long Term Care Insurance Consumers

The Massachusetts State Legislature recently passed a Bill entitled “An Act Establishing Standards for Long-Term Care Insurance” in order to better protect LTCI consumers. Massachusetts has pioneered a Long-Term Care exemption, which allows Medicaid recipients with private Long Term Care Insurance policies to insulate their homes from Medicaid liens, and the new act enhances consumer protection under that law. Another protection that the Massachusetts law provides is the adoption of the National Association of Insurance Commissioners’ Long-Term Care Insurance Model Act, which provides various protections including prohibitions on deceptive sales practices and the cancellation of policies due to age or medical deterioration, disclosure requirements, and limitations on pre-existing condition exclusions. 46 other states, including New Jersey, have already passed legislation adopting all or part of the Model Act. New Jersey has incorporated the Act in its own Act on Long Term Care Insurance, N.J.S.A. § 17B:27E-1, et. seq., which regulates issues such as sales of policies, rescission, and grounds for denial.
Source: newjerseydisabilitylawyerblog.com

High court rejects Medicare challenge

WASHINGTON (AP) – The Supreme Court has turned away a challenge from former House Majority Leader Dick Armey and other Social Security recipients who say they have the right to reject Medicare in favor of continuing health coverage from private insurers.
Source: 8newsnow.com

Medicare Open Enrollment Ends Soon

One question seniors need to start thinking about is whether this is the year to drop their Part C Medicare Advantage health plan and go to Medigap/Part D because of the coming changes to Part C Medicare Advantage caused by Obamacare. Or whether to wait a few more years, put the likely savings in your pocket, and see how bad the Obamacare-related changes are. The Medicare actuary projects either or both major premium increases and major benefit reductions to Part C Medicare Advantage because of Obamacare over the next five years.
Source: patch.com

Don’t Fall for Medicare Card Phone Scam

Posted by:  :  Category: Medicare

You answer the phone, and the unknown caller claims to be with Medicare or another government office. He informs you that your new Medicare card is in the mail, and you will receive it in a few days.  In the meantime, you need to set up your direct deposit so your Medicare funds can be deposited into your bank account. To do this, you just need to tell the caller your banking information. He will take care of the rest. 
Source: patch.com

Video: Miami: Medicare Fraud Summit Remarks (HHS Secretary & Attorney General)

Hotline Being Used to Combat Medicare Fraud

The hotline was created in 2008 and was largely ineffective due to under staffing. Many complaints regarding fraud went unanswered and phone call were unlikely to be returned. At the cost of millions of dollars, the hotline expanded the operation to include 15 telephone operators and 15 investigators. The operators at the hot line speak both English and Spanish. They are responsible for taking down the beneficiaries information and billing history. Once the information has been collected, the information is passed on to the investigative team for follow-up. The majority of the phone calls are regarding billing mistakes while about 15% are related to unprovided services. If the information is considered related to fraud, it is sent to the investigative team that is headed up by a retired FBI agent.
Source: miamicriminaldefenselawyerblog.com

How to Report Medicare Fraud

Silver Planet® helps Boomers guide their parents to age in place by offering services and products related to aging at home and housing options. Its Silver Advisors™ are professional geriatric care managers who provide phone consultations to resolve Boomers’ parents aging issues,  such as preventing falls, navigating  Medicare, and assessing seniors’ ability to drive safely, Silver Advisors clarify concerns, help prioritize next steps, and provide personalized written plans and recommendations.
Source: agewiseliving.com

Computers Key to Fighting Medicare Fraud

These kinds of schemes cost the U.S. government billions of dollars each year—there was an estimated $47 billion in improper Medicare payments in 2009 alone—so it should come as no surprise that cracking down on fraud has become a key part of the White House’s health-care reform efforts. The goal is to reduce improper payments by half by 2012. The biggest challenge facing Medicare fraud investigators is the sheer size of the system. Sorting through all the data can take months. Phony clinics, such as the ones the FBI shut down in October, often have collected their money and moved on to new locations by the time investigators discover the fraud.
Source: ieee.org

Seniors Blow the Whistle on Medicare Fraud

A federal report Tuesday spelled out the results of the South Florida calls: $58.6 million in overpayments recovered, $10.7 million in questionable bills not paid, $3 million seized from fraudulent firms, 103 companies booted from Medicare, 106 companies flagged for extra scrutiny, 835 fraud investigations started, and 30 cases referred for prosecution.
Source: hcafnews.com

Medicare Fraud in Home Health Care?

RELATED PAGES: Discover how to Prevent Home Health Care the Wise Way! Medicare may not pay if you are not homebound What are my patient rights and patient responsibilities? Senior Health Care Insurance Options For Home Care How does a Physical Therapist Pay Structure Affect My Quality of Care? Do I Need Home Health Care? Brag About Your Agency! Thank Your PT! How does a home care agency get paid? Home care business and Medicare fraud
Source: home-health-care-physical-therapy.com

Protect Yourself from Medicare Fraud

Guard personal information: To commit Medicare fraud, a person must have access to Medicare and Social Security numbers. Seniors shouldn’t share this information with anyone who is offering free goods or services in exchange for a Medicare number. If your Medicare card is lost or stolen, immediately contact Social Security at 1-800-772-1213.
Source: sequoiaseniorsolutionsblog.com

13 Indicted For Medicare Fraud In Puerto Rico; Federal Officials Use Hotline To Find Medicaid Fraud

This is part of Kaiser Health News’ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.
Source: kaiserhealthnews.org

Eye Opening Report on Hospital and Physician Medicare Fraud 

According to the Center’s report, doctors and other healthcare providers have, over the last decade, steadily billed higher rates for treating elderly patients and thereby  increasing their fees by more than $11 billion.  While there was little evidence indicating that Medicare patients were sicker than in prior years, or that the healthcare providers were rendering more care, analysis of claims from 2001 through 2010 indicated that the health care providers were using more lucrative billing codes.  The process of billing for more expensive services than were actually provided is called “upcoding.”
Source: indiananursinghomewatch.org

Work by Blues investigators helps stop pharmacy health care fraud ring in Michigan

After a six-week trial, Patel and his cohorts were found guilty of operating a network of 25 Detroit-area pharmacies that gave cash kickbacks and other illegal payments to physicians who agreed to prescribe expensive drugs—regardless of medical necessity—and illegally bill Medicaid, Medicare and private insurers. The prescriptions were to be filled at Patel’s pharmacies, but authorities said the pharmacists also billed payers for drugs that were returned to wholesalers to maximize profits.
Source: mibluesperspectives.com

Please be aware of Medicare Scams as $250 rebate checks get sent out!

The recent mailing of $250 rebate checks to participants in Medicare’s drug program has given scammers a new opportunity to take advantage of seniors and other Medicare recipients. In this latest scam, Medicare recipient receive a call from a con artist claiming to be a Medicare representative. The scammer then tells each recipient that they need to provide personal information, such as their Social Security number and bank account number, in order to receive their rebate check. In reality, the scammers need this information to gain access to the recipient’s bank account and empty it.
Source: seniorlivingexperts.com

“Medicare & You” goes paperless

Posted by:  :  Category: Medicare

Medicare for All by juhansoninand access all the same information found in your printed handbook. You can learn what’s new for the year, how Medicare works with your other insurance, get Medicare costs, and find out what Medicare covers. Even better, the handbook information on the web is updated regularly, so you can instantly find the most up-to-date Medicare information.
Source: medicare.gov

Video: NEW Romney-Ryan LIES about Medicare & Welfare reform! – Last Word

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

Social Security and You: Signing up for Medicare

However, WEP does not affect benefits paid to your wife as a widow in the event of your death. For example, a worker and spouse both claim their benefits at full retirement age. Because the worker receives a pension based on work not covered by Social Security, the benefit amount under the WEP benefit formula is $700. Based on the WEP benefit amount, the spouse’s benefit is $350 (one-half of the worker’s WEP benefit amount). When the worker dies, the WEP reduction is removed. The surviving spouse’s benefit is refigured using the regular benefit formula.
Source: mysanantonio.com

Medicare and Social Security Policies Based on Needs, Not Numbers

Decreasing the federal deficit at the expense of current and future Medicare and Social Security beneficiaries ignores the public’s overwhelming support for these programs. President Obama and Congress must think about what future generations will need for a secure retirement. They must work together and focus on our larger national goals of economic growth, health and financial security, and enacting affordable policies to meet those goals. Yes, we do need to make adjustments to Medicare and Social Security, but we need to do so without compromising the health and well-being of the nation or undermining the values that Americans cherish.
Source: aarp.org

Medicare Won’t Pay Your Claim? Appeal It!

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

Viewpoints: ‘Accepted Wisdom’ About Cutting Entitlements Disputed; Profit Motive Doesn’t Lead To Good Health Care

Bloomberg: Smart Health-Care Strategies Hidden In ‘Cliff’ Deal One little-noted provision I was encouraged to see tucked in last week’s fiscal-cliff legislation is Section 601(b): an incentive for doctors to expand their use of something called clinical data registries. These registries collect information on patient characteristics, patterns of care and outcomes that can be crucial to evaluating what medical techniques and strategies work and which ones don’t. Unfortunately, registries are not as widespread as they should be … Medicare costs are driven disproportionately by a small number of very expensive patients, most of whom are heavy users of specialty treatment. So early promotion of registries in those areas could yield ideas for lowering the cost of some of the most expensive care (Peter Orszag, 1/8).
Source: kaiserhealthnews.org

Lynn Parramore: 6 Reasons Joseph Stiglitz and Other Top Economists Think Means

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

A Simple Primer on Medicare Benefits Written for Patients and YOU!

Strategist, Rehabilitation Management, MediServe a Mediware Company; Darlene is a PT with an MBA in Healthcare Management, in her role, as a Rehab Mgmt Strategist she brings information to leadership that help guide practice strategy. Her focus is to assist clients nationally in the use of charting data to drive clinical and financial performance in support of decisions for best practices in meeting rehabilitation compliance, outcomes, revenue and efficiency. Since February 2011, Darlene has visited more than 30 IRF locations to assist in guiding C.O.R.E. (Compliance, Outcomes, Revenue, Efficiency/Effectiveness), performance improvement plans. Working in rehab medicine for greater than 30 years, Darlene spent 12 years in executive leadership as a Director of Rehabilitation and Operations. Therapy oversight included three post-acute service lines: acute inpatient rehabilitation (IRF), skilled and outpatient hospital-based services and is LEAN trained in healthcare. At various points in her career, Darlene had oversight of rehabilitation admissions, marketing, quality improvement, dietary & maintenance. Her responsibilities have included compliance toward Federal Regulations and leading CARF and Joint Commission standards of practice. Her experience includes Quality Improvement Chair, Lean Healthcare Trainer Certification and Vice President of the Board of Directors for the Ohio Association of Rehabilitation Facilities (OARF). Darlene lectures and writes blogs on post acute care topics that include federal guidelines, post acute admissions, managing outcomes, documentation, and rehabilitation marketing. www.mediserve.com/blog
Source: mediserve.com

The ABCs (and D) of Medicare

Medicare helps pay for health care, but it does not cover all medical expenses. Medicare is divided into four parts: Part A, generally called hospital insurance, covers services associated with inpatient hospital care (including an overnight stay in a hospital, skilled nursing facility, or psychiatric hospital). Part A also covers hospice care, home health care and medications received while in the hospital. Part B covers your doctor bills and other outpatient services. Some of the bills covered include medical equipment, lab tests and rehab. Doctor’s services are paid by Part B whether received in the hospital or in the doctor’s office. While Part A covers medicines received while in the hospital, medicines administered in a doctor’s office are covered by Part B. Other services covered under Part B include ambulance service, preventive care and annual wellness visits. Part C is a different creature altogether. Instead of covering specific benefits, Part C offers you a different way to receive your Medicare benefits. Basically, Part C is an insurance package that covers Part A, Part B and sometimes even Part D benefits. Part C is often referred to as Medicare Advantage. Part D covers prescription drugs, including insulin supplies and some vaccines. The only way to get prescription coverage is to enroll in a Part D drug plan or to join a Medicare Advantage plan that includes prescription coverage. Services not covered by Medicare: Medicare covers services that it deems "medically necessary". Not included in this definition are vision, hearing and dental care. Also, nursing home care and medical services received outside the United States are not covered. Example of how Medicare coverage works: Assume you break your hip and go into the hospital for four days for treatment. Medicare Part B covers the cost of taking an ambulance to the hospital. Medicare Part A covers your expenses while in the hospital, such as your room, meals, and nursing care. Part A also covers the cost of the emergency room and medications received while you are in the hospital. Medicare Part B pays for your doctor bills, physical therapy and the cost of using a wheelchair. Note that your doctor bills are covered whether you see your doctor while in the hospital or at the doctor’s office.
Source: squidoo.com

Tying Medicare Payment to Quality

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

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

Cindy, 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

My Own Way to Earn Money Online: What Is Medicare Supplement Plan F?

Posted by:  :  Category: Medicare

DAMN!! -- I THINK WE'RE F*%KED by SS&SSThe basic and original coverages provided by Medicare are Part A (hospitalization) and Part B (doctor visits and required medical equipment). Currently, there are at least 11 supplement plans referred to as Medigap policies that fill any coverage gaps involved with Parts A and B. One of these is Plan F. It’s important to know that not every company offers all 11 supplement plans. However, if they do offer at least 2 of them, they are required to offer Plans C and F. Plan F premiums typically cost between $65 and $295 per month. The premium will vary depending on the insurance carrier and the state you live in. Coverage Provided By F The coverage required of Medigap coverage plans is mandated and regulated by the Centers for Medicaid and Medicare. Plan F also has a “high deductible” plan because it will not pay for any type of services covered by Medicare until the plan beneficiary has paid an out-of-pocket minimum of $2,000. Once that deductible has been met, Plan F will cover 100% of the co-insurances, co-pays, and deductibles of Parts A and B including hospice care co-insurance as well as preventative services. If you get the regular Plan F you will have no deductibles or coinsurance. When speaking to an insurance professional it’s important to make sure which Plan F you are being quoted. Comparisons There are only two supplements that covers any deductible expense of Part B, one of which is Medicare supplement Plan F. Additionally, this is the only supplementary plan that covers excess Part B charges. These charges typically accrue if doctors can legally charge more than what Medicare considers as reasonable service charges. Other supplement plans will usually pay for expenses that Medicare classifies as allowable. Finally, the excess amount that is allowable according to Medicare is covered by F. Is Plan F Right For You? Medicare supplement Plan F is viewed as one of the most popular plans because it covers 100% of the gaps encountered with Plans A and B meaning that it provides the highest amount of coverage of any of the Medigap insurance plans. For many individuals, the plan may seem a bit confusing initially. However, if you answer a few questions, it will not only explain the plan more thoroughly, you will be able to decide whether or not it is right for you.
Source: blogspot.com

Video: Medicare Supplement AARP Plan F Select is A Good Option

Medigap Plan F Discontinuance For 2014

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Source: croweandassociates.com

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 Supplement Plan F

At first glance this doesn’t make any sense at all since I just told you that it was more expensive on a monthly basis, but when you break down what it covers and the risk involved the Medicare supplement plan f will save you money in the long run.  With the coverage gaps left by Medicare Part A and Part B you can choose any of the ten Medicare supplement plans.  The problem is that each plan covers a different amount or combination of those coverage gaps.  So if you choose plan A you are still open to extra costs from a need for skilled nursing care, the Medicare part A deductible of $1,156, the Medicare part B deductible of $140 annually, any foreign travel expenses, and an charges that fall under Medicare Part B that are above the Medicare approved amount.  In this example if you went into your doctor’s office he would charge you $140 before any of your coverage comes into play.  If that same doctor decided you need to be admitted to the hospital you would then owe the $1,156 for being admitted.  After that you would be subject to additional charges if they moved you to a skilled nursing facility.  Just one quick incident can add up fast and instead of worrying about all this you can moderate your life by just getting a Medicare supplement plan F.
Source: dzida.org

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

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

Medigap Plan F Discontinuance for 2014? « Insurance News from Crowe & Associates

Utilization for people with plan F has trended much higher than that of other supplements.  If someone is paying for a plan that will cover all of their Medical expenses, they are probably going to be more inclined to go to the doctor or get a test than someone who has a cost share.   Given that Medicare is primary when using a supplement, people with a plan F supplement are utilizing more than someone without a plan F supplement.
Source: croweandassociates.com

A Plan F is a Plan F, is a Plan F

   Rates can vary significantly.  In Virginia, as of this writing,( September 17, 2012) a Plan F rate for a 65 year old female can range from a low of $92.13 per month to over $300 per month.  (We are talking identical coverage!) These rates vary due to many factors such as the area in which you live.  For example, a person who lives in one zip code can pay $20/per month less than their neighbor who lives down the road but in a slightly different zip code.  A smoker may pay more with some companies.  Males may have a higher rate with some companies.  Some plans have rates which are guaranteed to increase every year as you get older.  Some plans level off their rates after age 75.  (Unfortunately, all of them can – and do- raise their rates on an across the board basis.)
Source: pqwic.com