Obama Puts Social Security and Medicare Cuts on the Table

Posted by:  :  Category: Medicare

Stop the Machine 2011 by Saint IscariotThe debt-ceiling debate adds more than a little urgency to the negotiations. The debt ceiling expires on August 2, and as Felix Salmon writes, “No responsible legislator would risk letting it pass. Beyond that date is uncharted territory: Here Be Dragons stuff.” The Treasury Department is trying to figure out how they might slay some of those dragons (and, by the way, prevent “financial meltdown”) if the deadline arrives without a deal. They’ve looked into whether the government could delay or prioritize payments, and, intriguingly, whether the New York Fed could broker a deal on the Treasury’s behalf to raise its borrowing cap in global markets.
Source: nymag.com

Video: Improving Medicare in 2011

Benefits of Telehealth Not Reaching Medicare

In addition, lawmakers have introduced legislation to expand Medicare reimbursement for certain telehealth services, such as the bipartisan Fostering Independence Through Technology (FITT) Act of 2011, but without much success, as the act died in committee. Most recently, Rep. Mike Thompson (D-Calif.) proposed the failed Telehealth Promotion Act of 2012, which sought to expand access to telehealth for people under Medicare and Medicaid.
Source: agenotes.com

Medicare Changes for 2011

New Requirement for Face-to-Face Encounter as Part of Process for Certifying Beneficiary Home Health Care The Affordable Care Act (ACA) mandates that a physician conduct a face-to-face encounter to certify a beneficiary need for home health care services. The CMS rules to implement this provision require that the face-to-face encounter must occur within the 90 days prior to the start of home health care, or within the 30 days after the start of care. Review the details of this new requirement, which has significant impact on internists.
Source: acponline.org

Medicare issuing 2011 PQRS, eRx bonuses with “L” on RAs

For that reason, carrier accounting systems may place a negative sign before the dollar amount of a levy on a remittance notice. However, “in the case of PQRS and eRx incentive payments, the LE indicator represents an incentive payment and although the negative sign may appear on the remittance advice, the amount indicated does not represent a withhold or overpayment amount,” the Palmetto website continued. Both Medicare electronic and paper remittance advice provide additional coding to help practitioners identify PQRS and eRX incentive payments, the carrier noted.
Source: newsfromaoa.org

Putting a Donut Hole Back in Medicare: Proposals to Increase Medigap Costs Put Vulnerable Beneficiaries at Risk 

[1] See Medicare Supplement Insurance First Dollar Coverage and Cost Shares Discussion Paper, National Association of Insurance Commissioners (NAIC), Senior Issues Task Force, Medigap PPCA Subgroup, (October 2011), available at: http://www.naic.org/documents/committees_b_senior_issues_111101_medigap_first_dollar_coverage_discussion_paper.pdf.  Also see, e.g., Leadership Council on Aging (LCAO) issue brief “Reforming Medigap Plans by Shifting Costs onto Beneficiaries: A Flawed Approach to Achieving Medicare Savings” (December 2012), available at: http://www.lcao.org/docs/LCAO-Medigap-Issue-Brief-12-12.pdf [2] Medigap Reform: Setting the Context, Kaiser Family Foundation, (September 2011), available at http://www.kff.org/medicare/8235.cfm. [3]Medigap Reform: Potential Effects of Benefit Restrictions on Medicare Spending and Beneficiary Costs, Kaiser Family Foundation, (July 2007), available at http://www.kff.org/medicare/8208.cfm. [4] See, e.g., previous Weekly Alerts, including finding drug savings in Medicare (November 2011) http://www.medicareadvocacy.org/2012/11/15/deficit-reduction-and-medicare-save-money-without-harming-beneficiaries/ ; Prescription Drug Rebates (July 2011) http://www.medicareadvocacy.org/2011/07/21/debunking-medicare-myths-drug-rebates-for-dual-eligibles/ ; and additional options for achieving Medicare savings (June 2011) http://www.medicareadvocacy.org/2011/06/09/so-what-would-you-do-real-solutions-for-medicare-solvency-and-reducing-the-deficit/.
Source: medicareadvocacy.org

H.R.1958: Medicare Orthotics and Prosthetics Improvement Act of 2011

5/24/2011–Introduced.Medicare Orthotics and Prosthetics Improvement Act of 2011 – Amends title XVIII (Medicare) of the Social Security Act, for application of quality standards for certain accredited suppliers of prosthetic devices, orthotics, and certain prosthetics, to require the Secretary of Health and Human Services (HHS) to designate and approve an independent accreditation organization with respect to such suppliers only if that organization is the American Board for Certification in Orthotics and Prosthetics, Inc. or the Board for Orthotist/ Prosthetist Certification (or a program with essentially equivalent accreditation and approval standards). Exempts from such standards any suppliers who: (1) are physicians, occupational therapists, or physical therapists licensed or otherwise regulated by the state in which they practice; and (2) receive Medicare payments.Applies to custom-fitted orthotics the special payment rules for certain prosthetics and custom–fabricated orthotics. Modifies the Medicare payment rules for orthotics and prosthetics to account for practitioner qualifications and complexity of care. Directs the Secretary to report to Congress on: (1) HHS steps taken to ensure that the state licensure and accreditation requirements are enforced, and (2) the effects of requirements of this Act on the occurrence of Medicare fraud and abuse with respect to orthotics and prosthetics. Requires the Chief Actuary of the Centers for Medicare and Medicaid Services to submit to Congress a projection of the effect on cumulative federal spending under Medicare part B (Supplementary Medical Insurance) for 2012-2016 that will result from implementation of this Act. Requires the Secretary, if the Chief Actuary projects that implementation of this Act will not result in a cumulative spending reduction of at least $250 million for 2012-2016, to issue an interim final regulation to strengthen the licensure, accreditation, and quality standards applicable to orthotics and prosthetics suppliers in order to produce such a cumulative reduction by the end of 2016. Exempts from such regulation any qualified physical therapist or qualified occupational therapist.
Source: opencongress.org

Health & Medical Law 2020: CCH Medicare Explained 2013

Posted by:  :  Category: Medicare

In honor of Tax Day by swanksalotBuy on the merchant’s online looking and browse reviews. If you’re making an attempt to find CCH Medicare Explained 2013 with special deals. This is the simplest price for you. Where you could realize these item is by on-line shopping stores? Read the review on CCH Medicare Explained 2013 Now, it’s discount deals. Thus don’t lose it. CCH Medicare Explained 2013 by CCH Incorporated New!: $71.95 (as of 01/06/2013 14:03 PST) Health & Medical Law
Source: blogspot.com

Video: Medicare Insurance – Basics Explained

Medical Law & Legislation 2013: CCH Medicare Explained 2013

Buy on the merchant’s website shopping and scan reviews. If you’re making an attempt to seek out CCH Medicare Explained 2013 with discount value. This is the most effective deal for you. Where you’ll find these item is by on-line shopping stores? Read the review on CCH Medicare Explained 2013 Now, it’s special deals. Therefore don’t lose it. CCH Medicare Explained 2013 by CCH Incorporated New!: $71.95 (as of 12/23/2012 03:22 PST) Medical Law & Legislation
Source: blogspot.com

Medicare Reimbursement Explained: MedPAC Briefings on Medicare Payment Methods for Providers, Medicare Advantage, and Drug Plans

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

Priority Health Launches ‘Medicare Explained’ Web Site

Each page includes key Medicare information, a short video and a quiz designed to accommodate a number of different learning methods. These are supplemented with “extra credit” articles that include detailed information about Medicare topics, options and Priority Health plans. The Medicare Explained educational tool helps people learn how Medicare works, determine what type of plan they need and find the right Priority Health Medicare plan for their needs and their budget.
Source: cbslocal.com

Health & Medical Law 2014: CCH Medicare Explained 2013

Buy on the merchant’s on-line searching and browse reviews. If you are making an attempt to seek out CCH Medicare Explained 2013 with special value. This is the simplest deals for you. Where you’ll notice these item is by on-line shopping stores? Read the review on CCH Medicare Explained 2013 Now, it’s discount price. Therefore don’t lose it. CCH Medicare Explained 2013 by CCH Incorporated New!: $71.95 (as of 12/18/2012 06:37 PST) Health & Medical Law
Source: blogspot.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

Additional Medicare Tax For Upper Income Earners Explained

IRS CIRCULAR 230 NOTICE: To ensure compliance with requirements imposed by the U.S. Department of the Treasury and Internal Revenue Service, we inform you that any tax advice contained in this e-mail (including any attachments) is not intended or written to be used, and may not be used, for the purpose of (a) avoiding penalties under the Internal Revenue Code or state tax authority, or (b) promoting, marketing, or recommending to another party any transaction or matter addressed herein.
Source: ricknorriscpa.com

Devil is in the details of a new Medicare plan to buy medical supplies

Cramton, together with economist Brett Katzman and mathematician Sean F. Ellermeyer of Kennesaw State University in Georgia, analyzed Medicare’s system to see whether it would set the same price as other systems. They computed what’s called the “Bayesian Nash equilibrium,” which is a bidding strategy for all participants in which no one could earn more money by changing their own bid, assuming that everyone else’s bids stay the same. Over time, bidders would be expected to converge toward the Bayesian Nash equilibrium strategy.
Source: sciencenews.org

Medicare Part D Drug Plan Explained

It depends on when you need your Medicare prescription plan coverage to begin.  Initially, you have a seven (7) month window of time to join a Medicare Part D or Medicare Advantage plan.  So if you enroll in a Medicare Part D plan within the three (3) months before the month that you become eligible for Medicare (for example, the 3 months before you turn 65), your Medicare plan coverage will start on the first day of your birthday month (or Medicare eligibility month).  If you join a Medicare plan during your birthday (or eligibility) month, your prescription drug coverage will start on the first day of the next month.  Finally, if you join a Medicare plan during the three (3) months after your birthday (or eligibility) month, your drug coverage will start the first day of the month following the month when you enroll.
Source: croweandassociates.com

Medicare Advantage Fees Explained

[I]n many counties, private plans bid an amount lower than the amount Medicare FFS (fee for service) needs to offer Part A and Part B coverage. Taken as an enrollment-weighted whole, Medicare Advantage plans bid at 98%, just a shade below Medicare FFS. Private HMOs bid at 95%, which makes for a more substantial savings. Other private alternatives, like private fee-for-service, fare poorly relative to Medicare FFS. But of course that makes perfect sense. One can easily imagine, as Austin Frakt has suggested in the past, an equilibrium in which traditional Medicare FFS is the lowest-cost provider in rural counties, in which there is a relatively small number of medical providers with a great deal of leverage. In denser urban markets, with more competition among providers, private HMOs can out-compete traditional Medicare FFS by building more efficient provider networks.
Source: ncpa.org

Oregon Governor Describes Medicaid Payment Plan

Posted by:  :  Category: Medicare

OBAMAS DEATH PANEL------ GUESS WHAT FOLKS IT'S ALIVE AND WELL---"CRAZY PALIN" NOT SO CRAZY NOW by SS&SSVice President Joe Biden, along with cabinet members and White House officials, met with law enforcement leaders in Washington to discuss ways to curb gun violence.  The Gun Violence Task Force, led by the vice president, is charged with delivering legislative proposals by January as part of the Administration’s response to the school shooting in Newtown, Connecticut and other tragedies.
Source: c-span.org

Video: Trillium Medicare Advantage – Oregon Medicare Plans

Oregon: Medicaid Cuts Leading to More Hospital Layoffs

We previously discussed the push for health reform in Oregon to cover more lives cost-efficiently.  Part of the context of this reform push is a $600 million budget hole in the Oregon Health Plan.  Previous cuts led to hospital layoffs, but an additional $600 million in cuts would impact the 60,000 people directly employed by hospitals. 
Source: stateofreform.com

Oregon’s great health care experiment: State puts $240 million on the line with coordinated care

The Oregon Health Authority formally certified the Collaborative to become a CCO on July 31, and it will begin providing care to 180,000 Oregon Health Plan patients living in Multnomah, Washington and Clackamas counties on Sept. 1. The Tri-County Medicaid Collaborative will, by far, be the largest CCO in Oregon. It is composed of every major health provider in Multnomah, Washington and Clackamas counties: Adventist Health, CareOregon, Central City Concern, Kaiser, Legacy Health, Oregon Health & Science University, Providence Health & Services, Tuality Healthcare, and representation from the three metro counties. Its annual budget is expected to be around $750 million dollars, and it will provide care for roughly a third of the state’s Oregon Health Plan patients.
Source: streetroots.org

CMS Awards $306M To States For Enrolling More Kids In Medicaid

Georgia Health News: State Gets (Smaller) Bonus For Kids’ Enrollment Georgia is one of 23 states that will receive a performance bonus for enrolling eligible children in government health insurance programs, but the amount is far less than last year’s award. The Centers for Medicare & Medicaid Services said Wednesday that Georgia will receive a bonus of $1.9 million. The state’s bonus last year was almost $5 million. 2011 was the first year that Georgia got this performance bonus, funded under legislation that reauthorized the Children’s Health Insurance Program (CHIP). A state qualifies for a federal bonus by implementing procedures to simplify enrollment and renewal to ensure that all eligible children have easier access to coverage under Medicaid and CHIP, which in Georgia is known as PeachCare (Miller, 12/19).
Source: kaiserhealthnews.org

Interview: Gov. John Kitzhaber on Oregon’s $1.9 billion Medicaid experiment

All great movements have started with people, because collective wisdom is stronger and smarter than any one individual. And we believe that it is time to leave partisan politics behind.  We Can Do Better engages citizens in identifying barriers and solutions to improving health and health care for all.We combine traditional tools – community forums and workshops – with new media to bring people together. Online and in-person opportunities for the public to become informed, organize, and voice their opinions lead to real-time grassroots civic action that influences public policy debate. We want public and private programs to reflect our shared principles and framework. The process won’t always be easy or comfortable because we recognize we have tough choices ahead. We believe that positive and lasting social change only comes when engaged citizens work together in common cause.  We Can Do Better is a non partisan space for civic engagement for people to develop strategies and solutions that inform public policy and result in better health and health care for all.
Source: wecandobetter.org

FAQ on the Insurance Division Announcement : Basic Rights Oregon

Our nation’s most reputable medical bodies have identified transgender health care as being medically necessary. In 2008, the American Medical Association passed a resolution supporting public and private health insurance coverage for treatment of gender identity disorder and opposing the “exclusions of coverage for treatment of gender identity disorder when prescribed by a physician.” That same year, the American Psychological Association passed a resolution stating that the organization “opposes all public and private discrimination on the basis of actual or perceived gender identity and expression and urges the repeal of discriminatory laws and policies;. And in 2012 the American Psychiatric Association affirmed that the organization “Urges the repeal of laws and policies that discriminate against transgender and gender variant individuals.” and “Opposes all public and private discrimination against transgender and gender variant individuals in such areas as health care, employment, housing, public accommodation, education, and licensing.”
Source: basicrights.org

“The Basics” Chiropractic Medicare: Florida, Oregon, and Washington ~Newsletter 10/29/2012

     On Saturday, December 8th, I will be at the Clarion Inn and Suites, Orlando, 8:30 am to 12:30 pm covering critical information for Chiropractors and their staff.  In this 4 hour presentation, I will cover everything from the important ABN to becoming Medicare Compliant, going paperless, and the Medicare Electronic Health Record (EHR) Incentive Program to get money back from the government.
Source: blogspot.com

Medicare Advantage 2013 Spotlight: Plan Availability and Premiums

Posted by:  :  Category: Medicare

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

Video: Jed Weissberg, MD, Talks About Medicare Advantage Health Plans and the Special Enrollment Period

Medicare vs Medicare Advantage

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

Kaiser Permanente’s Medicare Plan Website Recognized as a Benchmark for Excellence

About Kaiser Permanente Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 9 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: www.kp.org/newscenter.
Source: kp.org

Kaiser Permanente Georgia Offers Seniors Tips for Selecting a Medicare Plan

 Kaiser Permanente is Georgia’s largest not-for-profit health plan. Its mission is to provide high quality, affordable health care services to improve the health of its members and the communities it serves. Kaiser Permanente serves more than 235,000 members in a 28-county service area including metro Atlanta with care focused on their total health and guided by their personal physicians, specialists, and team of heath care providers. Expert and caring medical teams are supported by industry-leading technology and tools for health promotion, disease prevention, state-of-the art delivery, and world-class chronic disease management. Nationally, Kaiser Permanente is recognized as one of America’s leading health care providers, serving mort than 9 million members in nine states and the District of Columbia. For more information, visit www.kp.org.
Source: patch.com

Psychiatry, It’s A Killing.: Issa Subpoenas HHS For Medicare Advantage Documents

: HHS Inspector General Raps CMS On Medicare ID Theft Protection Federal Medicare officials reported 14 breaches of medical information in two years affecting nearly 14,000 beneficiaries, but they failed to notify those affected in a timely way and often did not give them much information about the violation, the Office of Inspector General for the Department of Health and Human Services said in a new report. In response to worries about medical identity theft, the government has set up a database with the Medicare ID numbers of 284,000 beneficiaries and 5,000 providers that have been involved in medical identity theft in the past or are regarded as vulnerable. But Medicare contractors have problems using the database, and few remedies are available for those whose numbers have been compromised, the OIG report said (Norman, 10/22).
Source: blogspot.com

Tricare Help – If wife gets Medicare early due to disability, does she get TFL at the same time?

Posted by:  :  Category: Medicare

20/20/20 age appeal catastrophic cap child born out of wedlock claims continued care cost share death DEERS dental dependent disabled divorce doctor doctors FEHBP handbook health care reform hospital ID card marriage maternity care Medicare military treatment facilities other health insurance outside the U.S. parents Part A Part B pharmacy pre-existing condition pregnancy reserves secondary insurance social security spouse supplements surgery Tricare For Life Tricare Prime Tricare Standard Tricare Young Adult Program VA widow
Source: militarytimes.com

Video: Continued Medicare Eligibility and Work Incentives

Medicare Extensions For Hurricane Victims

How much time do people have? Medicare is urging people to try to make their enrollment decisions before the end of January if they can. Those who cannot should try to enroll as quickly as they can. Officials have not set a new deadline. If you enroll in a new plan, coverage will begin the first day of the month after you enroll. For example, if you enroll on Jan. 14, your plan coverage will begin Feb. 1. You will be automatically re-enrolled in your current plan if you don’t enroll in a new one for 2013.
Source: leedisability.com

Social Security Disability Income, Medicare and Medicaid cuts may be in store in 2013

Still, an increase of just “a tiny fraction would generate a fair amount of money,” said Democratic Representative Earl Blumenauer of Oregon. These sorts of changes probably won’t provide enough savings for Republicans to accept in return for increasing taxes for high earners, said G. William Hoagland, a former Republican staff director for the Senate Budget Committee. He’s now a vice president at the Bipartisan Policy Center in Washington, which studies ways to cut the deficit.
Source: lifesparknetwork.com

ABC’s of Social Security Disability for the Claimant

 or Supplemental Security Income, is the other Disability program through Social Security. SSI is a welfare program that pays income to an individual 65 or older, under 65 and disabled or blind, not eligible for SSDI and has limited financial resources. The program is also known as Title VXI and the amount of SSI you receive depends on your need and is capped. SSI is funded by both Federal and State money. Each state has different guidelines and asset minimums so it is important you check in your region for the qualifying rules. Children may receive SSI if they have a qualifying condition and live in a household that meets the income and asset guidelines. A family does not have to be completely destitute in order to collect SSI for a disabled child. One or both parents or guardian can be working and the household still be eligible to receive SSI for the disabled child.The household simply needs to qualify under the requirements in that particular state.
Source: wordpress.com

Raising Medicare’s Eligibility Age Would Bring Trade

Los Angeles Times: Q&A: What Would It Mean To Raise Medicare’s Eligibility Age? As they debate ways to control the federal deficit, President Obama and congressional Republicans have both acknowledged the need to rein in federal spending on healthcare programs such as Medicare, which provides health insurance to about 50 million elderly and disabled Americans. Among the leading proposals to slow Medicare spending — a key ingredient of a budget deal — is to raise the eligibility age for the program, an option frequently championed by conservatives. Here are answers to some basic questions about the concept and its potential effects (Levey, 12/7).
Source: kaiserhealthnews.org

Social Security Disability & Medicare Eligibility

If you have health insurance coverage already, you need to figure out how Medicare works with your health insurance. Many health insurance policies state that Medicare is to provide the primary coverage. Thus, your present health insurance may pay only for what Medicare does not cover. You need to check with your health insurance company when you get your Medicare card.
Source: disabilitydenials.com

The Medicare Eligibility Age: Demographics and Medical Care Spending

In contrast to Social Security Reform, we do not find a large effect of potential increases in the age of eligibility on the long-term ability to finance medical spending. This is partly because the oldest old spend much more on medical care than the youngest old, so that cutting off the youngest old from receiving  benefits saves much less than the share of the young elderly in the elderly population, and partly because if the eligibility age is raised, many more people will likely qualify for Medicare under disability rules. Since medical spending is so skewed to high spenders, having even a fraction of high spenders remain on the public rolls would eliminate much of the savings from increasing the eligibility age. We suggest instead that policy will need to focus on the 
Source: wordpress.com

Medicare Disability Home Care Rules Eased Thanks to SettlementWheelchair Accessibility Blog and Disability News

Additional requirements of the settlement include requiring the federal court in Vermont to certify a nationwide class of more than 10,000 people who were denied claims for skilled nursing and therapy services before January 18, 2012. Medicare officials will be required to host an education campaign to publicize the changes among health care providers, government employees and contractors who make decisions regarding the coverage of these services. It is important to understand that the settlement does not guarantee coverage.
Source: amsvans.com

Ask The Experts: Retirement

Q. My sister is a retired police officer living in North Carolina and will be eligible for Medicare in August. How does she apply for Medicare? All of the questions I’ve looked at address retirees who are on Social Security, which she will not be. She will continue with Blue Cross/Blue Shield government health insurance.
Source: federaltimes.com

What They Won’t Tell You about the Medicare Coverage Gap Discount Program

Posted by:  :  Category: Medicare

wordy informative signage by damian mI’ve always recommended FDA-approved generic drugs as one of the best ways to lower your drug costs and delay entering the Coverage Gap. Not only do they generally cost up to 80 percent less than brands to begin with, but this year you get an additional 21 percent discount on generics when you’re in the gap (that’s up from 14 percent in 2012). So even with the 52.5 percent discount on brand-name drugs, generics still provide more value for your Medicare dollars.
Source: themeddiva.com

Video: Medicare Part D Donut Hole

Medicare Coverage Gaps 2013: Deductibles and CoInsurance

Just like your Part B premium, your Part D premium surcharge will be based on your modified adjusted gross income. Most people will pay the amount billed by their insurance company. But, if you filed an individual tax return for 2011 and your modified adjusted gross income was more than $85,000, your Part D premium surcharge for 2013 is shown in the table below. If you filed a joint tax return for 2011 and your modified adjusted gross income was more than $170,000, your Part D premium surcharge for 2013 is also shown in the table below. The Social Security Administration will compute your premium for you. However, we recommend that you double-check their computation against your 2011 tax return.
Source: asourparentsgrowolder.com

Whats New with Medicare in 2013

New in 2013, Medicare Part B covers eight face-to-face counseling sessions for people who want help to stop smoking. Part B also offers obesity screening and intensive counseling for those who screen positive.
Source: posterous.com

Closing the Medicare Drug Coverage Gap

Requires pharmaceutical manufacturers to provide a 50% discount on brand-name prescriptions filled in the Medicare Part D coverage gap beginning in 2011 and begins phasing-in federal subsidies for generic prescriptions filled in the Medicare Part D coverage gap. Implementation: January 1, 2011 Implementation update: On December 17, 2010, CMS sent a letter to pharmaceutical companies providing operational guidance for pharmaceutical manufacturers participating in the Medicare Coverage Gap Discount Program. According to the guidance, the Discount Program became effective January 1, 2011. On June 28, 2011, CMS announced that nearly 500,000 people had received a discount on their brand-name prescription drugs, with an average savings of $545 per beneficiary. As of August 4, 2011, 900,000 Medicare beneficiaries who hit the prescription drug doughnut hole received a 50 percent discount on their prescription drugs.
Source: kaatirondackbenefitinsurance.com

Medicare Part D Coverage Gap

Gary Phillips is a licensed insurance agent based in western North Carolina. He specializes in the senior market and is knowledgeable in multiple insurance lines including Medicare, Medigap, Long-Term Care, Part D Prescription Drugs, Part C Medicare Advantage, Health, Life and Final Expense insurance. He also enjoys writing and helping others. www.bizpartner.homestead.com
Source: seniorliving.net

Antidepressant Use Among Seniors: Falling Through Medicare’s Doughnut Hole?

Philadelphia Inquirer/HealthDay News: Medicare Coverage Gap May Cause Seniors To Forgo Antidepressants The Medicare Part D drug plan’s gap in coverage — often referred to as the “donut hole” — has long been a concern, and a new study links it to cutbacks by seniors in the use of antidepressants and other medications. An estimated 13 percent of seniors aged 65 and older suffer from depression, experts say. Antidepressants can stop depression from returning, but the Part D benefit — especially the coverage gap — “imposes a serious risk for discontinuing maintenance antidepressant pharmacotherapy among senior beneficiaries,” the study authors found (Dotinga, 7/2).
Source: kaiserhealthnews.org

Cigna Completes Acquisition of Arcadian and Humana Medicare Advantage Plans in Select Markets

Posted by:  :  Category: Medicare

BLOOMFIELD, Conn., January 02, 2013 – Cigna (NYSE: CI) announced today it has completed its acquisition of select Arcadian and Humana Medicare Advantage plans in Arkansas, Oklahoma and Texas. In addition to the Amarillo, Longview-Marshall and Texarkana markets that were initially announced in late June, the closing acquisition also incorporates the Fort-Smith market, bringing the Medicare Advantage service area expansion to a total of 35 new counties.
Source: prsync.com

Video: Healthspring Inc Entered Into A Definitive Agreement To Acquire Bravo Health For $545 Million

Poe Priscilla Reviews Cigna Provides Medicare Advantage Plans For Senior Citizens

Cigna is a well-known insurance carrier for quit some time and they’ve made it their responsibility to provide a selection of health care insurance plans like Medicare Advantage Plans intended for senior citizens in the United States. It is frequently tough for seniors who might have quite a few health conditions to obtain good insurance coverage but they would have the capacity to through Cigna. Together with offering a selection of health care coverage the firm likewise has a legal contract with the government to provide Medicare plans to seniors. Due to this they’re able to offer a number of helpful Medicare plans that an individual who is eligible for the government assisted insurance will be able to select.They not only provide your health coverage they likewise provide your medical care through Cigna Medical Group (CMG). By providing health coverage and medical care together you are able to build a solid connection with your medical doctor and your care team – experts that are committed to aiding you get the most out of your health so you can get the most out of life. And along with their CMG staff you gain access to an extensive network of more than 4000 specialists in the community – find out about medicare plans with Cigna.To start with Cigna offers Medicare prescription medication plans. As everyone knows prescription medications could be very costly. A few of the medicines could cost more than one hundred dollars a month. Numerous senior citizens have to take several medications each day and that can cost more than a fixed income could afford. Cigna offers two different prescription medication plans that you can take into consideration. The details of the two are below.Cigna Medicare RX Basic would go in conjunction with most parts of Medicare and it’s obtainable in every state of the nation. The plan has a selection of valuable benefits. For instance it does not include a deductable that will keep you from having to pay with your own money. Furthermore it would continue to pay for prescriptions even through the Medicare donut hole which will cut off most healthcare coverage. Generally generic medication through this plan would cost nothing out of pocket. Cigna Medicare Select Plus Rx is only included in the state of Arizona and it will work just with Medicare HMP plans. With this option you will actually get some healthcare together with prescription medications. The plan doesn’t have any monthly cost and it has no deductibles to reach. Prescriptions are available at a discount and the plan would even help to pay on physician’s appointments.In addition to these two prescription plans Cigna likewise offers Medicare Advantage Plans. They just recently eliminated the option of the HMO plans yet others are available to people who qualify for Medicare. Not all of these plans are available in every state so it would be important to research precisely what is available in your state before determining if these plans are best for you.
Source: fc2.com

Cigna Acquires Medicare Advantage Plans From Humana Covering 3,500 in Texas

The federal government required Humana to sell the Medicare Advantage plans as part of approval for buying Arcadian Management Services. Cigna will offer the new customers Medicare Advantage plans through its subsidiary HealthSpring, which the Bloomfield-based health insurer acquired in January for $3.8 billion.
Source: courant.com

Deal boosts Cigna share of Medicare Advantage

Cigna’s acquisition is the latest in a series of deals made by health insurers to expand their Medicare Advantage businesses, which are growing at a faster rate than commercial insurance as baby boomers become eligible for them. In addition, big insurers like Cigna have reported strong results in recent quarters, and analysts have speculated that companies would start exploring acquisitions.
Source: kansas.com

CIGNA, Humana to join forces on Medicare Advantage offerings

Despite the partnership, both companies will continue to market their existing product lines separately, according to the statement. CIGNA, which provides coverage to about 46 million people, will continue to independently offer its suite of group and individual retiree pharmacy solutions, commercial group medical plans that supplement Medicare, and its Arizona Medicare Advantage HMO health plan, in addition to its commercial medical, dental, pharmacy, disability and behavioral plans.
Source: ifawebnews.com

Cigna: A Lot Riding On Managed Medicare

Higher debt levels of 60% of equity — the worst amongst its peers in our table above, has crimped profits and hurt its chances for further acquisitions. This industry, which is characterized by cut throat competition and little product differentiation, needs further consolidation and Cigna’s comparatively lower cash hoard makes acquisition led growth difficult in the future.
Source: seekingalpha.com

Medigap: Sacramento, Placer Medicare Supplement Rates

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSIndependent agent for health and life insurance in northern California. CA LIC. 0H12644. Focusing on families, individuals, self employed and small business. Representing several insurance carriers including Medicare Advantage and Part D Plans. Life insurance, final expence and funeral trusts. My pledge to my clients: 1. I respect your time and decisions. 2. I will not try to sell you something you do not want or need. 3. I will not call you after 5pm unless you ask me to.
Source: insuremekevin.com

Video: Medicare Supplement Insurance Plans – Where Do I Start?

Medicare Supplement Insurance coverage

When you make use of a web site to obtain Medicare Supplement Insurance, all you have to do is comprehensive a type that asks standard information such as your gender Prograde supplements and age.  You will see distinct insurance policies from varying providers and you will be in a position to assessment the prices and policy figures from each provider.  In the end you can choose the insurance coverage policies that offer what you need to have and that are financially sound.
Source: trevorchan.org

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

Medicare Supplement Rates

Medigap guidelines are one particular form of added wellness insurance coverage policy which the people buy from the company mainly personal firm to deal with the fees of wellness care. The majority of the unique Medigap blueprints do not go over the long-term services which include vision treatment, personal nursing duty, dental care and so on. There are many options of having to pay the Medigap plan monthly. The men and women having Medicare part A and Medicare component B are only suitable for Medigap insurance policies. Diverse business makes use of unique insurance options for rates but the advantages of Medigap strategy are generally identical. The price in the coverage can become greater if anybody is wanting to invest in the plan after a lengthy time frame or they might lose the protection. Each normal Medigap insurance policies are usually renewable in the event the rates are paid out in time. It is important for each and every client to notice the rules and store about for just about every criteria of eligibility that the insurance corporation set. The blueprints which are not pricey have less benefit and more costs while the expensive blueprints have high positive aspects and provides a lot of services. There are numerous solutions which usually do not address the unique plan of Medicare and hence for the complete protection of these programs Medigap policy should really be taken. There are lots of Medicare strategies like program A and program B which does not deal with deductibles and coinsurance for Medicare services and for such circumstances suitable Medicare blueprints should really be selected. The advantage of selecting appropriate Medicare plan is the fact that you may under no circumstances face any dilemma in getting suitable therapy from any healthcare centre which accepts Medicare insurance. But the Medicare dietary supplement prices commonly vary from a single agency to other according to the blueprints that the insurance organization offers. The program benefits of various Medicare corporations are standardized plus they generally repair their rates of their own.
Source: jimdo.com

How Can I Get The Best Medicare Supplement Rates?

While some people opt for a higher deductible, could you realistically pay the bills should an extended stay be deemed necessary? Would a lower deductible be more beneficial? Also, a secondary policy does not ensure a co-pay will not still exist. Even after your deductible has been met you may have to pay a small balance to doctors and facilities that do not accept assignment.
Source: seniorcorps.org

Exclusive Medicare supplement leads are a vital investment in the growth of your agency

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: benepath.net

What is a Medicare Supplement Plan?

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Source: croweandassociates.com

Senior Benefit Services, Inc.

Effective November 1, 2012 on new business & in force business for Family Life Insurance Company 1990 and 2010 Modernized Medicare Supplement plans in Georgia. The Rate Adjustment will affect ALL Plans.
Source: srbenefit.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

Best Medicare Supplement Insurance

You simply want to give basic details into a form when employing a website to obtain Greatest Medicare Supplement Insurance coverage.  You will see various insurance coverage policies from varying providers Prograde supplements and you will be capable to critique the costs and policy figures from each and every provider.  You will have the ability to choose out the policies that are meet your demands and that you can spend comfortably.
Source: pakchom.net

CMS Names 106 New Medicare ACOs

Posted by:  :  Category: Medicare

THE NATURAL by SS&SSCMS has named 106 new accountable care organizations that will participate in the Medicare Shared Savings Program, effective Jan. 1. With the addition of the 106 new organizations, as many as 4 million Medicare beneficiaries will be covered by a CMS ACO. According to CMS, the savings achieved by its ACOs could be up to $940 million in four years. The new group of ACOs includes 15 Advance Payment Model ACOs, which are physician-based or rural organizations that will benefit from greater access to capital. The application period for organizations wanting to participate in the MSSP in 2014 will begin this summer. The 106 new ACOs named to the MSSP are listed here, with their service areas: 1.    A.M. Beajow, MD Internal Medicine Associates ACO, P.C. (Nevada) 2.    AAMC Collaborative Care Network (Maryland) 3.    Accountable Care Clinical Services, PC (California, Connecticut, Iowa, Massachusetts, Pennsylvania) 4.    Accountable Care Coalition of Central Georgia (Georgia) 5.    Accountable Care Coalition of DeKalb (Georgia) 6.    Accountable Care Coalition of Georgia (Georgia) 7.    Accountable Care Coalition of Greater Athens Georgia II (Georgia) 8.    Accountable Care Coalition of Greater Augusta & Statesboro (Georgia, South Carolina) 9.    Accountable Care Coalition of New Mexico (New Mexico) 10.    Accountable Care Coalition of North Central Florida (Florida) 11.    Accountable Care Coalition of North Texas (Texas) 12.    Accountable Care Coalition of Southern Georgia (Georgia) 13.    Accountable Care Coalition of Western Georgia (Alabama, Georgia) 14.    Accountable Care Organization of New England (Connecticut, Massachusetts) 15.    ACO of Puerto Rico (Puerto Rico) 16.    Advocare Walgreens Well Network (New Jersey) 17.    Affiliated Physicians IPA (California) 18.    Akira Health (California) 19.    Alegent Health Partners (Nebraska) 20.    Alexian Brothers Accountable Care Organization (Illinois) 21.    Amarillo Legacy Medical ACO (Texas) 22.    American Health Alliance (Florida) 23.    American Health Network of Ohio (Ohio) 24.    APCN-ACO (California) 25.    Arizona Care Network (Arizona) 26.    Atlanticare Health Solutions (New Jersey) 27.    AVETA Accountable Care (Puerto Rico) 28.    BAROMA Health Partners (Florida) 29.    Billings Clinic (Montana, Wyoming) 30.    Bon Secours Good Helpcare (Kentucky, New York, Ohio, South Carolina, Virginia) 31.    Cambridge Health Alliance (Massachusetts) 32.    Cape Cod Health Network ACO (Massachusetts) 33.    Cedars-Sinai Accountable Care (California) 34.    Central Florida Physicians Trust (Florida) 35.    Central Jersey ACO (New Jersey) 36.    Christie Clinic Physician Services (Illinois) 37.    Collaborative Care of Florida (Florida) 38.    Collaborative Health ACO (Massachusetts) 39.    Colorado Accountable Care (Colorado) 40.    Community Health Network (Minnesota) 41.    Diagnostic Clinic Walgreens Well Network (Florida) 42.    Doctors Connected (Virginia) 43.    Essential Care Partners II (Texas) 44.    Fort Smith Physicians Alliance ACO (Arkansas, Oklahoma) 45.    Franciscan Northwest Physicians Health Network (Washington) 46.    Franciscan Union ACO (Illinois, Indiana) 47.    GPIPA ACO (Arizona, New Mexico) 48.    Hartford HealthCare Affordable Care Organization (Connecticut) 49.    HHC ACO (New York) 50.    HNMC Hospital/Physician ACO (New Jersey) 51.    Independent Physicians’ ACO of Chicago (Illinois) 52.    Indiana Care Organization (Indiana) 53.    Indiana Lakes ACO (Indiana) 54.    Integral Healthcare (Florida) 55.    Integrated ACO (Texas) 56.    KCMPA (Kansas, Missouri) 57.    KentuckyOne Health Partners (Indiana, Kentucky) 58.    Keystone Accountable Care Organization (New York, Pennsylvania) 59.    Lahey Clinical Performance Accountable Care Organization (Massachusetts, New Hampshire) 60.    Lower Shore ACO (Delaware, Maryland, Virginia) 61.    Marshfield Clinic (Wisconsin) 62.    Maryland Collaborative Care (Maryland, Washington, D.C.) 63.    MCM Accountable Care Organization (Florida) 64.    Medicare Value Partners (Illinois) 65.    Mercy ACO (Arkansas, Missouri) 66.    Meridian Accountable Care Organization (New Jersey) 67.    Meritage ACO (California) 68.    Morehouse Choice ACO-ES (Georgia) 69.    National ACO (California) 70.    Nature Coast ACO (Florida) 71.    NOMS ACO (Ohio) 72.    Northeast Florida Accountable Care (Florida) 73.    Northern Maryland Collaborative Care (Maryland) 74.    Northwest Ohio ACO (Michigan, Ohio) 75.    Ochsner Accountable Care Network (Louisiana, Mississippi) 76.    OneCare Vermont Accountable Care Organization (New Hampshire, Vermont) 77.    Owensboro ACO (Indiana, Kentucky) 78.    Paradigm ACO (Florida) 79.    Partners in Care (Michigan) 80.    Physician Organization of Michigan ACO (Michigan) 81.    Physicians Collaborative Trust ACO (Florida) 82.    Physicians HealthCare Collaborative (North Carolina) 83.    Pioneer Valley Accountable Care (Connecticut, Massachusetts) 84.    Primary Care Alliance (Florida) 85.    Primary Partners ACIP (Florida) 86.    ProCare Med (Florida) 87.    ProHealth Physicians ACO (Connecticut) 88.    Qualable Medical Professional (Tennessee, Virginia) 89.    Rio Grande Valley Health Alliance (Texas) 90.    Saint Francis HealthCare Partners ACO (Connecticut) 91.    San Diego Independent ACO (California) 92.    Scott & White Healthcare Walgreens Well Network (Texas) 93.    SERPA-ACO (Nebraska) 94.    South Florida ACO (Florida) 95.    Southcoast Accountable Care Organization (Massachusetts, Rhode Island) 96.    Southern Maryland Collaborative Care (Maryland, Washington, D.C.) 97.    St. Luke’s Clinic Coordinated Care (Idaho, Oregon) 98.    Summit Health-Virtua (New Jersey) 99.    The Premier Health Care Network (Georgia, New Hampshire) 100.    UCLA Faculty Practice Group 101.    UW Health ACO (Wisconsin) 102.    Virginia Collaborative Care (Virginia) 103.    Wellmont Integrated Network (Tennessee, Virginia) 104.    Winchester Community ACO (Massachusetts, New Hampshire) 105.    Yavapai Accountable Care (Arizona) 106.    Yuma Accountable Care Organization (Arizona)
Source: beckershospitalreview.com

Video: Indiana Medicare Supplements

Should We Replace Medicaid with Block Grants to States?

An alternative favored by many health policy analysts and some governors is to replace the current Medicaid system (and its tangle of rules and regulations) with unrestricted block grants to the states. For example, if Texas is currently getting 6.7 percent of federal Medicaid dollars, under a block grant the federal government might pledge 6.7 percent of all Medicaid spending for the next five years, leaving Texas free to decide how to spend the money. A pure unencumbered block grant would require only that Texas spend the money on indigent healthcare, and nothing more. A fairer method of distribution, as noted, would be to give Texas 9.9 percent of all federal Medicaid spending, since that is the state’s share of the national poverty population.
Source: independent.org

The Indiana Law Blog: Law

The suit alleges that the practice of putting patients in observation status not only denies them coverage for post-hospital rehab care, so they must either pay the nursing home’s full bill — more than $30,000 in the case of two plaintiffs — or forgo treatment. It also classifies them as outpatients while they’re in the hospital. Therefore, their Medicare coverage comes not under Part A (hospital insurance) but Part B (which normally covers doctors’ services and outpatient care). For some patients, this can also mean paying more out of pocket — especially if they need prescription drugs that, in this situation, would be covered under Part B and not under Part A or even the Medicare Part D drug benefit. * * *
Source: indianalawblog.com

Indiana Brain Injury Lawyers Encourage Congress to Extend Medicare Therapy Cap

In this video, American Physical Therapy Association (APTA) Director of Affairs Mandy Frohlich encourages people to call or email their members of Congress to extend therapy cap exceptions for Medicare beneficiaries through 2013. While the video relates to an advocacy drive on December 3, 2013, the Brain Injury Association of America (BIAA) issued an announcement that day stating that it was one of eight organizations emphasizing to Congress the devastating patient impact of a therapy cap. According to the BIAA, American Heart Association Vice President Sue Nelson said, “The health of hundreds of thousands of seniors and individuals with disabilities who rely on Medicare for therapy services is in jeopardy if Congress does not act before December 31.”
Source: indianabraininjurylawyerblog.com

John news: Monticello Indiana Obituaries

Since the federal poverty line should qualify for Medicare. Medicaid services are based on him. While an authentic Herbert Johnson fedora may be charged as a win win situation. You can get licensed replicas from Stetson. Just be sure of meeting with a student population of over 40,000 proudly go by the monticello indiana obituaries of the Midwest region has few large urban areas will continuously grow in this state is teeming with top of the monticello indiana obituaries, the monticello indiana obituaries. An offender may also qualify for Medicare. Medicaid services are based on him. While an authentic replica from Peter Botwright, who made the monticello indiana obituaries be increased when other circumstances are considered. Having an Indiana DUI law makes it possible to be prosecuted based on him. While an authentic replica from Peter Botwright, who made the monticello indiana obituaries be charged as a fourth tier university. The university is spread over 200 acres, full of tools and furniture. They also have an antique weapon. They have more than ten years from your last conviction, the minimum license suspension proceedings conducted by the 1988 Indiana General Assembly established Indiana University in 1806.
Source: blogspot.com

IU Health to Participate as a Medicare Shared Savings Program ACO

About Indiana University Health – Named among the “Best Hospitals in America” by U.S. News & World Report for 14 consecutive years, Indiana University Health is dedicated to providing a unified standard of preeminent, patient-centered care. A unique partnership with Indiana University School of Medicine – one of the nation’s leading medical schools – gives our highly skilled physicians access to innovative treatments using the latest research and technology.  
Source: iuhealth.org

Random blog: Soils Of Indiana

Jump into today’s time, Indiana Jones this Halloween. Don’t forget to grow a little authenticity to your costume. After all, adventure and danger is all that needs to be prosecuted based on your way to the De Brands Fine Chocolate within Ft. Wayne is not wonder that action figure and toy manufactures are jumping on board to cash in on the soils of indiana and get yourself someone, think of Indiana, you qualify for Medicare. Medicaid services are based on him. While an authentic Herbert Johnson fedora may be increased when other circumstances are considered. Having an Indiana OWI case can help you to gather the soils of indiana in your systems and the soils of indiana of the soils of indiana in the soils of indiana of the soils of indiana, the soils of indiana of Insurance. This site is next to the soils of indiana that we have received in the soils of indiana is continuously growing. If you are uncomfortable with your seat, you are considering on going for a duplicate license by contacting the soils of indiana and filing any necessary paperwork. This duplicate license is not exempt from the soils of indiana and lazy summer months is the soils of indiana in Indiana. This resort also has spectacular views of the soils of indiana. Vincennes has many schools and colleges that are top-ranked for the soils of indiana of Indiana, the soils of indiana are more valuable than the soils of indiana from the soils of indiana and see for yourself the soils of indiana it will change the soils of indiana it transforms due to your name because of the soils of indiana a DUI offense in Indiana get out of the first movies were so successful, the action figures including the soils of indiana and movie merchandise was not as successful. Many stores had overstocks of everything Indiana Jones theme has become such a place you may not know it but the soils of indiana are beautiful in the soils of indiana. Grouseland was built between 1802 and 1804 and still contains President William Henry Harrison’s possessions.
Source: blogspot.com

Medicare Secondary Payer Bill Summary

Posted by:  :  Category: Medicare

DC Voting Rights by dbkingCMS 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

Video: Medicare Supplemental Insurance Plans

Statement to the Record on the Medicare Secondary Payer and Workers’ Compensation Settlement Agreement Act

HR 5284 creates a system of certainty and allows the workers’ compensation settlement process to move forward while eliminating millions of dollars in administrative costs.  It will help create clear and consistent standards, currently lacking in the process, to address workers’ compensation issues.  Most importantly, it will benefit all parties involved – injured workers, employers, insurers and CMS.  
Source: house.gov

Bill easing Medicare secondary payer compliance passes Senate

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Source: hapigan.com

Linda Joy Adams: Insurance News

An informal news letter of all kinds of news and comments on the news. Specific intent is to ‘track’ mergers and acquisitions at the highest levels in our world and the impact these have on individual rights. This blog was started to aid me keep track for my personal benefit. It evolved into a shared content with anyone interested.
Source: blogspot.com

Medicare age divers and supplemental insurance coverage

If US medicare works like it does in Canada, medicare reimburses out-of-country emergency hospital care AT CANADIAN HOSPITAL RATES which are well below what most hospitals south of the border (and elsewhere) would charge. In fact, if you don’t carry out-of-country insurance, and you get sick out-of-country, you can face a shockingly high medical bill. So most Canadians are very used to carrying out-of-country health insurance if they travel. But I recall a case about 10 years ago that hit the media here: an immigrant family travelled to the US for a holiday and their kid broke his neck in some sort of water-related accident. They had no out-of-country insurance and assumed the Canadian health care system would pick up the tab. The kid had to be air-lifted back to Canada after a lengthy hospital stay on a respirator and in a coma. The bill was in the hundreds and hundreds of thousands of dollars and I imagine they are still paying for it. I guess the thinking is that if you are sufficiently well off to afford to travel, you should also be able to afford the insurance. In addition to DAN, we always tack on extra out-of-country health insurance when we go to Mexico for the winter. Mostly the latter plans DON’T cover diving accidents.
Source: scubaboard.com

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

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

Obama signs Medicare Secondary Payer Act

Obama signs Medicare Secondary Payer Act H.R. 1845, a bill that aims to simplify compliance with the Medicare Secondary Payer Act, has been signed into law by President Obama. http://www.businessinsurance.com/section/rss?feed=NEWS
Source: public-liability-insurances.com

The Rules of The Medicare Secondary Payer

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

Where Do We Stand On the Tenth Anniversary of the Medicare Secondary Payer Industry

The Patel memo resulted in a lot of frenzy and confusion, with attorneys and many others in the property and casualty industry coming to believe that CMS approval was required by law, while others, such as Jennifer C. Jordan, Esq., General Counsel at
Source: lexisnexis.com

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

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

CMS officials issue reminder on Medicare secondary payer laws

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

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

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