Medicare Plan Finder for Health, Prescription Drug and Medigap plans

Posted by:  :  Category: Medicare

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

Video: Medicare Supplemental Insurance Comparison

Comparing Medicare Supplemental Insurance Benefits

These plans, called “Medigap” plans, each have different medical care coverage. Variable benefits of coverage to be considered are: • Coinsurance plus coverage that last 365 days after medicare benefits end (Medicare Part A) • Coinsurance/Copayment for medicare part B. • Pints of blood (transfusions, first three pints) • Hospice care copayments or coinsurance • Coinsurance for Skilled Nursing Facilities • Part A medicare deductible • Part B medicare deductible • Part B excess charges • Emergencies during foreign travel • Preventative care coinsurance, per Medicare Part B If any of these are important for you to have covered, comparing medicare supplemental plans that include benefits is the only way to ensure they are included.
Source: seniorcorps.org

Medigap: Sacramento, Placer Medicare Supplement Rates

Independent 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

Compare Medicare Supplements

When you compare Medicare Supplements you should also be aware that attained age-rated-rated plans are based on your age when you apply. Premiums are usually low when you are 65. After a decade, these plans may be the most expensive and if your health fails, you may not be able to change plans to lower your premiums.
Source: healthbhg.com

Medicare Supplement Plans Medicare Supplements Comparisons

Effective January 1, 2013: Individuals who own a Medicare supplement policy in the State of Oregon may change Medicare supplement plans once per year for a period of 60 days beginning 30 days before and ending 30 days after the individual’s birthday. The new policy must be guaranteed issue which means there are no health questions. This will allow traditionally uninsurable applicants to obtain the exact same coverage elsewhere for less premium.
Source: searchmyquote.com

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

Has Your Medicare Supplement Gone UP in Price?

During this time of year we can help you make sure you have the best price and coverage for your doctor and hospital care.  Many people think all they need is a Part D comparison, but why pay more for your Medicare Supplement than you have to?  Medicare only pays 80% of your doctor and hospital costs.  If you are turning 65 and in your open enrollment, you cannot get turned down for coverage during those months no matter what kind of health issues you may be experiencing.  That is why it is so important NOT to get a Medicare Advantage Plan!!!  Start off with the BEST coverage available!!
Source: mypartdusa.com

What Medigap Insurance Has That Medicare Advantage Doesn’t

Compare this to Medicare Advantage plans. Plans are not standardized and vary from company to company. The same named plan may even include different benefits depending on the County where it is offered. Because of the moving parts, shopping for and comparing Medicare Advantage plans is much more difficult and can result in less certainty that you have actually chosen the best plan for your circumstances.
Source: medicareprofs.com

Compare Medicare Supplement Insurance Plans

This is the basic plan. Its coverage includes: Medicare Part A coinsurance, Medigap coverage for hospital benefits, Medicare B coinsurance, Medicare B copayments, first three pints of blood, Part A hospice care coinsurance or copayments, and Medicare preventive care Part B insurance. By law, all Medicare Supplement insurance carries must offer this plan.
Source: ihealthcoalition.org

Sterling Medicare Supplemental Insurance Reviews

Posted by:  :  Category: Medicare

Sterling Option #1 is the first Medicare Advantage plan that allows holders to combine Medicare Supplemental Services and traditional Medicare. This ultimately translates into seeing your physician and allowing the bill to be sent to Sterling. Sterling will pay the bill and Medicaid will be notified of their portion, which then pays Sterling. This subsequently saves lots of time and headaches with filing claims with Medicaid and Sterling. Sterling basically handles everything while making the process as simple as possible for you. Your only concern will be paying the premiums for your Sterling Medicare Supplemental Insurance plan as well as for the Medicare Part B plan.
Source: ihealthcoalition.org

Video: Pat Creech Insurance – Mount Sterling, KY

Sterling Insurance providing Medicare Supplement Policies in California

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Source: medigap4seniors.com

Sterling Life Insurance Medicare Supps.

Has anyone heard of Sterling Life (captive company) reducing Medicare Supplement rates in PA. I talked to a man that claims that his insurance plan premium was reduced by around $40 per month without switching plans? Any Sterling agents on the forum? I am also interested in finding out what Sterling is going to do this year and next with their PFFS. If anyone has info, please post.
Source: insurance-forums.net

Medicare Insurance Fitness & Activity Sterling Heights

Some Nuvo Cleanse research has found that giving societies too much Nuvo Cleanse Ergänzung is bad. This would be dangerous moment if there was an alternative to Nuvo Cleanse. You need a quality Nuvo Cleanse. I barely scratched the surface. I wish everything was as simple as this. Better still, we wa…
Source: tuffclassified.com

Sterling Insurance announces new California Supplement policies for Medicare …

At the moment, only 7 percent of the Medicare-eligible population of the state is carrying a Medicare Supplement policy, which means that there is a large number of people who have health coverage, but who will also face notable out-of pocket expenses should they need to make a claim. In the case of more serious injuries or illnesses, this can become quite costly to the policyholder.
Source: medigap.ca

Medicare Plans That Broke Rules Include Familiar Names

Freedom Heath’s Chief Operating Officer Sidd Pagidipati said the company sends its agent-compensation plan to the Centers for Medicare and Medicaid Services (CMS) every year and has heard no objections. “In general, we, as a health plan, are very sensitive to protecting Medicare beneficiaries and their rights. In fact, we have secret shoppers attending 100% of our independent sales seminars.” Anyone who breaks rules goes through immediate retraining or gets fired, he said.
Source: kaiserhealthnews.org

Don’t Fall for Medicare Card Phone Scam

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: bbb.org

Sterling Health Insurance Company Review

Sterling Life prides itself on providing high quality personalized service to all its clients. The company motto is “Real People, Wise Choices.” The Sterling website provides a testimonial page featuring comments by current customers. Sterling members have access to an excellent interactive portal where they may file a claim, make a premium payment, download information and forms, or shop for a new insurance plan. Plans are available to fit the needs of any individual wherever they might live in the US.
Source: healthinsuranceproviders.com

SALEM, Ore.: Ore., Calif., require transgender health coverage

State regulators don’t have authority to force insurance companies to cover specific procedures, like hormone therapy or genital reconstruction. But they’ve told insurers that if they provide breast reduction for patients with back pain, they can’t deny it for a gender reassignment that’s been deemed medically necessary. Insurers could unilaterally exclude coverage of, say, breast implants, but it would have to apply to all policyholders equally, including breast-cancer patients.
Source: sunherald.com

Rep. Cummings wants federal workers comp insurer for overseas contractors

The federal government has been requiring government contractors to provide workers’ comp to their employees at overseas military bases going back to 1941’s Defense Base Act, which has since been expanded to require coverage for nearly all overseas contractors and subcontractors of any government agency. For decades, the DBA workers’ comp program was a tiny and insignificant one, with total premiums of just $18 million as recently as 2002. But with the enormous build-up of contractors in Iraq and Afghanistan over the past decade, premiums grew to more than $400 million by 2007.
Source: rstreet.org

91 Charged With $430 Million Medicare Billing Fraud

Posted by:  :  Category: Medicare

Healthcare solution >> more doctors by / // /Houston Chronicle: FBI Arrests Historic Houston Hospital’s CEO, Son, 5 Others After 30 years as CEO of one of Houston’s most historic hospitals, Earnest Gibson III, along with his son and five others, was arrested on Thursday — part a national Medicare fraud sweep involving $430 million in bogus billings and 91 health care providers in seven states. If the allegations against the 68-year-old Gibson are true, that he and others at the hospital bilked the Medicare program of $158 million over a period of more than seven years, it could prove lethal for Riverside, once the primary hospital for the city’s black population. Gibson and his son Earnest Gibson IV, 35, were charged with 13 counts: conspiracy to commit health care fraud; conspiracy to defraud the United States and pay and receive health care kickbacks; one count of money laundering and ten counts of violating the anti-kickback statute (Langford, 10/4).
Source: kaiserhealthnews.org

Video: Medical Billing Software – Capture Billing and Advanced Data Systems

False Medicare Billing Results in $15.3 Million Whistleblower Settlement

A whistleblower lawsuit alleging false Medicare billing by American Sleep Medicine has resulted in a $15.3 million settlement. Daniel Purnell, a technician formerly employed by American Sleep Medicine, filed the whistleblower suit under the federal False Claims Act disclosing that the company falsely billed Medicare Part B, Tricare and the Railroad Retirement Medicare Program for sleep disorder testing done by unqualified technicians.  
Source: robertabelllaw.com

Medicare Covering Orthotics?

AFO APMA CDFE Charcot Marie Tooth Coding Diabetic foot DME compliance DME Medicare compliance dme treatment protocols fall prevention in the news keys to success medicare Medicare billing medicare coding medicare compliance Medicare Diabetic Shoe Program Medicare DME compliance medicare fraud Medicare program moore balance brace podiatry PQRS shoe fitting what’s new
Source: safestepblog.net

Physical Therapy Software: Billing Medicare

Medicare is the standard setter for payers throughout the country and they seem to always be changing and evolving the way that they pay therapists. One question that comes to mind is how can you effectively bill Medicare while still keeping the flow of your system quick and easy to understand? As Medicare creates new rules and gets them set into place, other insurances are quick to follow, so it is necessary to understand how to bill Medicare in the early going or you risk the chance of being left behind. The big question that you need to ask is how can my practice management system help me bill Medicare properly?
Source: rehabsoftware.com

Hospices’ Medicare Billing Practices Under False Claims Act Scrutiny

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

Make 2013 a year for preventing Medicare fraud!

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

Who Knew? Patients’ Share Of Health Spending Is Shrinking

Posted by:  :  Category: Medicare

Economists measure three kinds of consumer health costs: insurance premiums paid through payroll deductions or for individual policies; out-of-pocket costs for deductibles and co-pays; and Medicare payroll taxes. Such outlays fell to 27.7 percent of the health care economy in 2011, down from 28 percent in 2010 and from 32 percent in 2000, according to the national health expenditures report issued by HHS last week.
Source: kaiserhealthnews.org

Video: Medicare Supplement plan F High Deductible Explanation

Medicare Home Health: Medicare Supplement Insurance

For all others, the standard Medicare Part B monthly premium will be $115.40 in 2011, which is a 4.4% increase over the 2010 premium. The Medicare Part B premium is increasing in 2011 due to possible increases in Part B costs. If your income is above $85,000 (single) or $170,000 (married couple), then your Medicare Part B premium may be higher than $115.40 per month. For additional details, see our FAQ titled: “2011 Part B Premium Amounts for Persons with Higher Income Levels”.
Source: blogspot.com

2011 Medicare Deductibles and Premiums

 “Part A premiums are decreasing because spending in 2010 was lower than expected and the Affordable Care Act implemented policies that lower Part A spending due to payment efficiencies and efforts related to waste, fraud and abuse. Part B premiums are increasing because of growth in the use of services like outpatient hospital care, home health and physician-administered drugs. In addition, the premium accounts for a likely Congressional action to avert a precipitous decrease in physician payments, which the Administration supports, and has occurred every year since 2003. The Administration is committed to permanent reform of the physician payment formula.”
Source: wordpress.com

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

Medicare Premiums and Deductibles for 2012 Mostly Sweet

However, some enrollees age 65 and over and certain persons with disabilities who have fewer than 30 “quarters of coverage” obtain Part A coverage by paying a monthly premium set according to a statutory formula. This premium will be $451 for 2012, an increase of $1 from 2011. Those who have between 30 and 39 “quarters of coverage” may buy into Part A at a reduced monthly premium rate which is $248 for 2012, the same amount as in 2011. The Part A deductible paid by a beneficiary when admitted as a hospital inpatient will be $1,156 in 2012, an increase of $24 from this year’s $1,132 deductible. The Part A deductible is the beneficiary’s cost for up to 60 days of Medicare covered inpatient hospital care in a benefit period. Beneficiaries must pay an additional $289 per day for days 61 through 90 in 2012, and $578 per day for hospital stays beyond the 90th day in a benefit period. For 2011, per day payment for days 61 through 90 was $283, and $566 for beyond 90 days.
Source: indoamerican-news.com

2011 Medicare Deductibles Shocking News

The Centers for Medicare and Medicaid Services (CMS) has set the Medicare premiums, deductibles and coinsurance amounts to be paid by Medicare beneficiaries in 2011. For Medicare Part A, which pays for inpatient hospital, skilled nursing facility, and some home health care, the deductible paid by the beneficiary when admitted as a hospital inpatient will be $1,132 in 2011, an increase of $32 from this year’s $1,100 deductible. The Part A deductible is the beneficiary’s cost for up to 60 days of Medicare-covered inpatient hospital care in a benefit period. Beneficiaries must pay an additional $283 per day for days 61 through 90 in 2011, and $566 per day for hospital stays beyond the 90th day in a benefit period. For 2010, the per-day payment for days 61 through 90 was $275, and $550 for beyond 90 days. For beneficiaries in skilled nursing facilities, the daily co-insurance for days 21 through 100 in a benefit period will be $141.50 in 2011, compared to $137.50 in 2010. Those who enroll in Medicare Advantage plans may have different cost-sharing arrangements. All of these Part A program payment changes are determined in accordance with a statutory formula. About 99 percent of Medicare beneficiaries do not pay a premium for Medicare Part A services since they have at least 40 quarters of Medicare-covered employment. However, some enrollees age 65 and over and certain persons with disabilities who have fewer than 30 quarters of coverage obtain Part A coverage by paying a monthly premium established according to a statutory formula. This premium will be $450 for 2011, a decrease of $11 from 2010. Individuals who have between 30 and 39

Understanding the Medicare Advantage Disenrollment Period

Posted by:  :  Category: Medicare

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

Video: BSN Headline News for February 14, 2011

CPIDs 2161 and 1620 Guardian Healthcare No Longer Accepting Electronic Claims Effective 01/01/2012

Effective immediately, t he following payer will no longer accept electronic claims with dates of service on or after 01/01/2012: CPID 2161 Guardian Healthcare – Professional CPID 5975 Guardian Healthcare – Institutional Electronic claims with dates of service on or after 01/01/2012 must now be submitted to the following payer: CPID 6111 Sterling Medicare Advantage – Professional CPID 1620 Sterling Medicare Advantage – Institutional If you have already submitted electronic claims to Guardian Healthcare this year, those claims may have been rejected and will need to be submitted to Sterling Medicare Advantage. Please be sure to submit electronic claims to the correct payer. If you have any questions, please contact Client Services at 1-888-348-8457, option 2.
Source: collaboratemd.com

Health Dept. IG Says Six Medicare Advantage Insurers Broke Rules

Health New Florida: “A multinational company and two members of the Fortune 500 were named among six insurers found in violation of Medicare marketing rules when federal inspectors checked their books and sat in on presentations as ‘secret shoppers,’ documents show.” The three big firms were Aetna, Universal American Corp and Munich American Holding Corp.’s Sterling Insurance. The six plans insure more than 1 million beneficiaries through the Medicare Advantage program. The Office of the Inspector General for the federal health department targeted these and three other firms because of complaints. The six firms’ violations include paying sales agents more than is allowed and offering “inappropriate” incentives to outside marketing firms. Sterling allegedly used “unqualified” sales agents, the company’s only listed violation. The report says other companies that were not examined are likely behaving in the same ways (Gentry, 3/31).
Source: kaiserhealthnews.org

Munich Re agrees to terms for acquisition of Windsor Health Group, Inc.

Munich Re stands for exceptional solution-based expertise, consistent risk management, financial stability and client proximity. This is how Munich Re creates value for clients, shareholders and staff. In the financial year 2009, the Group – which pursues an integrated business model consisting of insurance and reinsurance – achieved a profit of €2.56bn on premium income of around €41bn. It operates in all lines of insurance, with around 47,000 employees throughout the world. With premium income of around €25bn from reinsurance alone, it is one of the world’s leading reinsurers. Especially when clients require solutions for complex risks, Munich Re is a much sought-after risk carrier. The primary insurance operations are mainly concentrated in the ERGO Insurance Group. With premium income of over €17bn, ERGO is one of the largest insurance groups in Germany and Europe. 40 million clients in over 30 countries place their trust in the services and security it provides. In international healthcare business, Munich Re pools its insurance and reinsurance operations, as well as related services, under the Munich Health brand. Munich Re’s global investments amounting to €182bn are managed by MEAG, which also makes its competence available to private and institutional investors outside the Group.
Source: munichre.com

Sterling Health Plans 2011

Does anyone know if Sterling Life is partnering up with FMO’s to offer plans for 2011? They have been a captive company for years. Also, are they pulling all of their plans out of Pennsylvania? I received this email today. (I left out the agency name that made the announcement) Thanks for any info you can give me.
Source: insurance-forums.net

Dallas Morning News Article

Soon after enrolling, the 73-year-old Dallas woman learned that doctors she had had for years didn’t participate in the plan. What most upset her, though, was that her prescription drug costs jumped by a couple of hundred dollars a month.
Source: medicaresupplementcenter.com

Medicare Advantage coverage to end soon

The 2008 Medicare Improvements for Patients and Providers Act goes into full effect next year. It sets a private fee for companies who had to pay for a network of physicians. However, Humana, Sterling Life, Pyramid Life and United Health Care decided to opt out on the expenses.
Source: seeleymedical.com

Munich Re has agreed to acquire Windsor Health Group, Inc.

The acquisition is expected to close by December 31st, subject to customary closing conditions and regulatory approvals. Going forward, the combined companies will serve more than 200,000 members across the United States, with a more complete range of products to meet their needs. The companies will leverage each other’s strengths to enhance the outstanding service we both provide to our members and healthcare providers. The acquisition is totally consistent with our efforts to build a financially strong, competitive company that balances the needs of our members, providers and other stakeholders.
Source: wordpress.com

Medicare Insurance Fitness & Activity Sterling Heights

Some Nuvo Cleanse research has found that giving societies too much Nuvo Cleanse Ergänzung is bad. This would be dangerous moment if there was an alternative to Nuvo Cleanse. You need a quality Nuvo Cleanse. I barely scratched the surface. I wish everything was as simple as this. Better still, we wa…
Source: tuffclassified.com

Medicare Advantage Enrollment Up, But Participation Varies by State, Carrier

A new analysis by the Kaiser Family Foundation finds a small number of firms dominate Medicare Advantage enrollment both nationally and in most states; for example, in 14 states and the District of Columbia, a single firm accounts for more than half of all Medicare Advantage enrollment. This is true despite the fact that the average Medicare beneficiary has 33 Medicare Advantage plans available in their area, with the average enrollee paying a monthly premium of $44 per month, a 22 percent increase since 2009 ($36 per month). The health reform legislation of 2010 gradually phases down payments to Medicare Advantage plans over time, which is expected to ultimately affect plan participation, enrollment, premiums, and extra benefits. Yet, even with these changes, Medicare Advantage plans can be expected to remain an important option for many beneficiaries. By using this information, agents can understand what clients in their area might be interested in purchasing, and make educated decisions based on buying habits.
Source: lifehealthpro.com

The Story of Medicare: A Timeline

Posted by:  :  Category: Medicare

ILGWU senior female members and retirees holding placards urging "fair play for the aged", "hands off social security", "don't mess with medicare", "keep your promises Mr. President", and more. by Kheel Center, Cornell UniversityWritten and produced by Foundation staff, The Story of Medicare: A Timeline serves as a visual timeline of Medicare’s history, including the debate that led to its creation in 1965 and subsequent changes, such as the passage and repeal of the Medicare Catastrophic Coverage Act in the 1980s, the Medicare Modernization Act in 2003, and the Affordable Care Act in 2012. The seven-minute video also highlights the program’s impact on the 50 million elderly and disabled Americans it serves today, as well as the fiscal challenges it faces to ensure its long-term sustainability. Watch the video and share the story of Medicare with your colleagues, friends and family. Organizations are welcome to show the video at events and meetings.  Request  a download or DVD of the video at no charge. Additional resources on Medicare from the Kaiser Family Foundation can be found at www.kff.org/medicare.
Source: kff.org

Video: President Harry S.Truman gets Medicare

Reform Law Helped Slow Growth in Medicare Spending, HHS Finds

Study authors Richard Kronick and Rosa Po, with the HHS Office of the Assistant Secretary for Planning and Evaluation, noted that per capita spending is estimated to grow “at or below the rate of GDP per capita [and that] the number of Medicare beneficiaries is projected to increase by approximately 3% annually.” They added, “As a result, aggregate Medicare spending will account for a growing share of GDP over the next decade.”
Source: californiahealthline.org

At risk for glaucoma? Find out before it’s too late

Do you have diabetes, a family history of glaucoma, or are you African American and age 50 or older? If so, your risk of getting glaucoma may be higher. With the start of a new year, it’s the perfect time to schedule a regular eye exam to check for glaucoma. You can prevent vision loss by finding and treating problems early.
Source: medicare.gov

Potentially the Largest Claim of Medicare Fraud in US History : Nursing Home Law Blog

A large dialysis company, DaVita, Inc, has been accused by a physician of defrauding the US government  – and ultimately, taxpayers, by intentionally wasting huge amounts of medication in order to increase their bills.  If true, this may prove to be the largest case of its kind in US history.  DaVita is already reported to have paid a $54,000,000 settlement for a similar claim made in Texas.  
Source: stark-stark.com

Medicare and coding update for 2013

Conduct internal self-audits of each doctor’s charts periodically; for example five charts each three months; checking for the quality of the record-keeping. This includes a clear reason for visit, legible record of elements of case history, physical examination, and medical decision-making, record of all diagnoses and management options that are related to the visit. Each record must include orders for any additional testing that is done or recommended, referrals, etc., as well as interpretations and reports of all special ophthalmological services performed during each visit, and appropriate initials, dates, and signatures throughout each chart.
Source: newsfromaoa.org

Daily Kos: Government Shutdown: What It Is, and What It Isn’t

Is what drives me up the wall with this lack of governing. We are aware that Republicans are willing to go all Chuck Norris if that’s what it takes to “defend their principles”. But when in the FUCK are they obligated to DEFINE them? And why won’t the beltway media point this out each time, or the President or Dems for that matter? IF they “loyal opposition” had any better response than “look, see how awful they are”, or “here is OUR line in the sand” maybe we could get to the point that Republicans would be forced to start naming sacrifices (and no I don’t want to hear what people assume it will be, or what is obvious but hasn’t been declared by the Republicans, that’s just enabling them to let other people be scapegoats later).
Source: dailykos.com

Senators Urge CMS To Reform Medicare Fraud Prevention Program

Posted by:  :  Category: Medicare

Cynthia Markus, Ingrid McDonald, and Diana Birkett discuss Medicare at the KUOW Studios by kuow949The OIG report looked into activities from April 2010 to March 2011 and found that the Medicare Drug Integrity Contractor, or MEDIC, program identified most of the few cases referred to law enforcement through passive and external means, such as a fraud hotline, rather than proactive, internal means, such as research and investigation. Specifically, the report found that:
Source: californiahealthline.org

Video: Romney’s Medicare Program = Disaster

Medicare Shared Savings Program Grows by 106 ACOs in 2013

Yesterday the Centers for Medicare & Medicaid Services formally announced the 106 new Accountable Care Organizations (ACOs) participating in the 2013 Medicare Shared Savings Program (MSSP) cycle.  CMS also announced that 15 of the new ACOs qualified to participate in the Advance Payment ACO Model.  This brings the total count of MSSP ACOs to more than 250:  215 in the traditional MSSP and 35 participating in the Advance Payment program.
Source: jdsupra.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

Viewpoints: Health Law’s ‘Sticker Shock;’ Changing Medicare Eligibility Age Is Not A Simple Solution

San Jose Mercury News: Pancreatic Cancer Finally Gets Federal Attention Pancreatic cancer is a devastating and unforgiving disease. My husband, Patrick Swayze, was diagnosed with this terrible cancer in January of 2008. … Of the top five cancer killers, pancreatic cancer is the only one with a five-year survival rate in the single digits — just 6 percent. Patrick fought valiantly before passing away almost 22 months later. While pancreatic cancer may have taken him in the end, it never beat him. And for me, just because he’s gone doesn’t mean this fight is over. Due in part to the lack of federal resources, scientific advances against this disease, whose statistics are shocking, have been minimal at best. No early-detection tools exist, and few effective treatment options are available. Further, despite its being one of the most deadly cancers, there has been no national plan to address pancreatic cancer (Lisa Niemi Swayze, 1/11).
Source: kaiserhealthnews.org

Uwe E. Reinhard: The Complexities of Comparing Medicare Choices

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

The Rural Blog: Cliff deal revives rural hospitals’ Medicare program

Even though most of the hospital industry wasn’t happy with the fiscal-cliff deal that will only pay half the $30 billion needed to avoid a 27 percent Medicare fee cut for doctors, the deal gave about 200 rural hospitals reason to celebrate. It extends a program that pays hospitals up to several millions of dollars a year because they have fewer than 100 beds, are located in rural areas and have a high percentage of Medicare patients, Phil Galewitz of Kaiser Health News reports. The Medicare Dependent Hospital Program was created in 1990 and is one of several payment programs designed to help small, rural hospitals deal with financial challenges that larger hospitals don’t face. The program is based on the idea that “some rural hospitals have such a high percentage of Medicare patients they are unable to get enough money from higher paying privately insured patients to make up for the lower government reimbursements,” health lawyer Eric Zimmerman told Galewitz. The program has come under scrutiny. Congress allowed it to expire in September 2012, but two senators from New York and Iowa made sure $100 million for the program made it into the budget deal. The Medicare Payment Advisory Commission said hospitals in the program will receive about 25 percent higher reimbursements as a result of the funding. (Read more) For a list of the hospitals in the program, click here.
Source: blogspot.com

Saving money on health costs: Extra Help program

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

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

Important: We have the wrong Medicare program

Second, Canadian hospitals receive prospectively determined global operating budgets, removing incentives to provide unnecessary care while simplifying billing and administration. However, unlike accountable care organization payment schemes in the United States, capital costs are not folded into the global budgets but distributed separately through an explicit health-planning process. Canadian hospitals cannot use operating surpluses to fund new buildings or equipment but must request separate capital appropriations. Hence, they cannot expand by overproviding lucrative services, gaming the payment system through upcoding, avoiding unprofitable patients, or cost shifting.
Source: pnhp.org

Medicare and coding update for 2013

Conduct internal self-audits of each doctor’s charts periodically; for example five charts each three months; checking for the quality of the record-keeping. This includes a clear reason for visit, legible record of elements of case history, physical examination, and medical decision-making, record of all diagnoses and management options that are related to the visit. Each record must include orders for any additional testing that is done or recommended, referrals, etc., as well as interpretations and reports of all special ophthalmological services performed during each visit, and appropriate initials, dates, and signatures throughout each chart.
Source: newsfromaoa.org

The American Political Handbook: Medicare and other extensions for health are not permanent

Posted by:  :  Category: Medicare

OBAMA: THE SOCIALIST/MARXIST/COMMUNIST -- UNMASKED FOR ALL TO SEE by SS&SSWe hope you have followed our previous posts on the laws behind the new American Taxpayer Relief Act and the Unemployment Extensions under the Act (H. R. 8).  We hope to cover the extensions to Medicare and other health provisions under Title VI of the Act.  The scope and length of the Title VI extensions is sweeping but does not appear to be permanent.  Only one of the Sections of Title VI is extended until “2015” (Section 607 – which is a very worthwhile provision).  The rest are extended until “the end of the year/beginning of the new year” or until fiscal year 2013. We searched for a video from Medicare.gov or the Administration on the new Medicare extension/s but could only find a Medicare YouTube video on their Physician Compare Website redesign.
Source: blogspot.com

Video: Law Book Review: Medicare Handbook 2012 Edition by Judith A Stein, Alfred J. Chiplin Jr.

The Social Security and Medicare Handbook: What You Need to Know Explained Simply

The Social Security and Medicare Handbook includes the provisions of the Social Security Act, regulations issued under the Act, and recent case decisions (rulings). It is a readable, easy to understand resource for the extremely complex Social Security and Medicare programs and services. Here in this new, groundbreaking, and exhaustively researched book you will learn an overview of the Social Security and Medicare system, how Social Security benefits are currently computed, how to become insured, and how to file a claim. You also will learn about retirement and auxiliary benefits, survivor benefits, disability benefits and protection, evaluating disability, cash benefit rates, employees, employer responsibilities, special coverage provisions, state and local employment, earnings records and tax reports, the administrative review process, supplemental income, other benefit programs, hospital insurance (Part A), medical insurance (Part B), Medicare Advantage plans (Part C), prescription drug coverage (Part D), prescription programs, and special veteran benefits. This book will explain how current Social Security benefits are computed and provide insight into your Social Security benefits.
Source: blogspot.com

Fiscal Cliff Deal Avoids Cuts in Medicare Payments to Doctors…but Hurts Hospital!! » Toni Says

3)  Look for a doctor or specialist that does take Medicare assignment and will bill Medicare.  There are still plenty of fantastic doctors that do accept Medicare.  Even the top specialists in their field still take Medicare. More doctors and specialists are taking Medicare than those that don’t.  Ask your grandmother’s doctor for more than one doctor or specialist that he/she can refer for your grandmother.
Source: tonisays.com

“Medicare & You” goes paperless

and 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

Raiding Medicare: How seniors will pay for Obamacare

Other hospitals will be forced to operate in an environment of scarcity, with as many as 40 percent in the red, according to Foster. That will mean fewer nurses on the floor, fewer cleaners, and longer waits for high-tech diagnostic tests. It will affect all patients. Obamacare’s defenders say that cutting Medicare payments to hospitals will knock out waste and excessive profits. Untrue. Medicare already pays hospitals less than the actual cost of caring for a senior, on average 91 cents for every dollar of care. No profit there. Pushing down the reimbursement rate further, as the Obama health law does, will force hospitals to spread nurses thinner. When Medicare reduced payment rates to hospitals as part of the Balanced Budget Act of 1997, hospitals incurring the largest cuts laid off nurses. Eventually patients at these hospitals had a 6 to 8 percent worse chance of surviving a heart attack and going home, according to a National Bureau of Economic Research report.
Source: dailycaller.com

This is the official U.S. government Medicare handbook: Open …

Acer Aspire Manual Apple iPhone Apple iPod Apple Store Apple the Fruit Asus Eee PC Asus Laptop Review Blackberry Accessories Blackberry Bold Blackberry Curve BlackBerry Curve User Guide Blackberry Pearl Blackberry Software Blackberry Storm Download Kenmore Owners Manuals Free Blackberry Themes Free Car Owner Manuals Free Owner’s Manual Free Owner Manuals Database Free Sewing Machine Manuals Free User Manuals Instruction Manual Instruction Manual Download iPhone 5 Download iPhone Applications iPhone Features iPhone for Sale iPhone Price iPhone Reviews Kindle User Guide Lexmark X4270 Online User Guide LG Cell Phone Users Manual Motorola Razor User Guide Motorola Razr V3 User Guide Nortel T7316 User Guide Owners Manual Red Apple Sony User Manuals Template User Manual Toshiba Laptops Toshiba Laptop User Manuals Toshiba Support Toshiba TV Manuals Toshiba Users Manuals User Guide Templates
Source: monsieurbome.com

The Social Security and Medicare Handbook: What You Need to Know Explained Simply

The Social Security and Medicare Handbook includes the provisions of the Social Security Act, regulations issued under the Act, and recent case decisions (rulings). It is a readable, easy to understand resource for the extremely complex Social Security and Medicare programs and services. Here in this new, groundbreaking, and exhaustively researched book you will learn an overview of the Social Security and Medicare system, how Social Security benefits are currently computed, how to become insured, and how to file a claim. You also will learn about retirement and auxiliary benefits, survivor benefits, disability benefits and protection, evaluating disability, cash benefit rates, employees, employer responsibilities, special coverage provisions, state and local employment, earnings records and tax reports, the administrative review process, supplemental income, other benefit programs, hospital insurance (Part A), medical insurance (Part B), Medicare Advantage plans (Part C), prescription drug coverage (Part D), prescription programs, and special veteran benefits. This book will explain how current Social Security benefits are computed and provide insight into your Social Security benefits.
Source: dolittleretirement.com

The Government Wants Seniors Out of Bad Medicare Plans

Time will tell whether the half million Medicare beneficiaries will leave their poor performing plans or will stay put until the government closes them down—if it does. Earlier this year, a report from the National Bureau of Economic Research, a private nonprofit group, showed that seniors rarely switch plans even when they might get one with a cheaper premium. Other factors like restrictions on drugs or whether their doctors are in the plan may trump price, meaningless satisfaction ratings, and yes, the government’s stars. Perhaps the shopping process CMS has set up is just too darn hard.
Source: preparedpatientforum.org

Medicare & You Handbook 2013 for Medicare Open Enrollment

To start your enrollment, you should a Medicare & You 2013 handbook. If you have not received your handbook, you should go to the website Medicare.gov to learn where the handbook is available to read or download an PDF version of the 2013 Medicare & You Handbook. You can also get by calling 1-800-MEDICARE to request a paper booklet to your mailing address.
Source: hotbuzz4u.com

Medicare handbooks short on helpful info

The CMS website does include more quality information than the handbook, such as right to appeal, drug pricing information and management of long-term conditions, but the availability of that data is also spotty. Also, it is estimated only about 60 to 70 percent of seniors have used the Internet. “Because of the insurers’ failure to report data, the Medicare handbook on which many seniors rely has nothing meaningful about such things as customer service and price stability,” said Vaughan. “What’s even more troubling is that the one subjective quality indicator they do have is provided for only a third of all the available plans.”
Source: consumersunion.org

Download the Medicare and You 2010 Medicare Handbook

The federal Department of Health and Human Services has released the 2010 Medicare and You consumer handbook. This is the official government benefit description manual issued to Medicare members. The handbook contains information on the following:
Source: elderguru.com

News/Events @ Your Library: Getting the Facts on Medicare @ Your Library

At the close of their presentation, the floor was then opened to the audience where many asked questions relating to the changing state of Medicare.  Concern and frustration could be felt by many who discussed problems including finding a doctor, dealing with the task of finding the correct plan when considering the prescription medications one needs to be covered for, understanding the star-level ratings for drug coverage, and more.  This portion of the program became just as important as the presentation as it opened up a line of dialogue amongst the audience and the presenters to highlight and discuss areas relevant to what they have or may experience.
Source: blogspot.com

Florida man sentenced in Medicare fraud case

Posted by:  :  Category: Medicare

George W. Bush by cliff1066™Being accused of having been involved in a Medicare fraud scheme can be a very serious allegation. Major criminal charges can be brought against an individual in connection to such an allegation. If a person is convicted of Medicare fraud-related charges, he or she can be given serious criminal punishments. Such punishments can be very impactful on an individual.
Source: criminallawsarasotafl.com

Video: Medicare certified home health care Port Charlotte Florida

Medicare to Cover More Home Care

To secure coverage for home health care, Medicare requires a patient to be homebound, which typically means the individual needs help moving about from a device (like a wheelchair) or a person. A doctor must approve a “plan of care” every 60 days that includes the services of a nurse or physical or speech therapist. In addition, the patient must contract with a home health agency certified by Medicare.
Source: floridahomecare.net

The Health Law Firm Blog: Florida Pharmacy Owner Admits to Multi

The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.
Source: blogspot.com

Daily Kos: Poll: Medicare Propels Obama Into the Lead in Florida

Biden’s father had been very well-off earlier in his life, but had suffered several business reverses by the time Biden was born, and for several years the family had to live with Biden’s maternal grandparents, the Finnegans. When the Scranton area went into economic decline during the 1950s, Biden’s father could not find enough work. In 1953, the Biden family moved to an apartment in Claymont, Delaware, where they lived for a few years before moving to a house in Wilmington, Delaware. Joe Biden Sr. then did better as a used car salesman, and the family’s circumstances were middle class. He took a stand against injustice at an early age. Biden attended the Archmere Academy in Claymont…During these years, he participated in an anti-segregation sit-in at a Wilmington theatre. People like to portray him as a bumbling avuncular man, but he’s had one hell of a career, too. When Biden took office on January 3, 1973, at age 30 (the minimum age to become a U.S. Senator), he became the sixth-youngest senator in U.S. history…
Source: dailykos.com

Daily Kos: Rick Scott lies about cost of expanding Medicaid

is said to be a liar, a thief, a criminal scammer and a total nutcase.  I have never met a Floridian who admits to having voted for him(I live in Tampa).  There were strong allegations that the vote was fixed and that, like the rest of the miserable life of this miserable man, that it was a fraud.  It was common knowledge that Scott had left his corporation with a sizable golden parachute and that the corp had paid the highest fines ever for Medicaid/Medicate fraud.  Why no one went to jail for that only the State Attorney can say.  Then he became governor.  Astonishing!  It has been downhill ever since.  His polling numbers have tanked.  He is the most disliked politician/governor since I moved to Florida in 1978.  We have had some great ones over the years (Democrats, of course), Bob Graham who later became our great, progressive Senator & Lawton Chiles who was loved by the people of Florida.
Source: dailykos.com

FL Gov. Scott: ‘Growing government is never free’

“Growing government is never free. Under the new healthcare law, Florida would nearly double the people in our Medicaid program over 10 years. AHCA estimates that this would result in a total cost to taxpayers of more than $63 billion over 10 years, including $26 billion in costs to Florida taxpayers. We also know that adding people to Medicaid will affect our state for generations to come because government growth is almost never reversed. The current fiscal cliff debate here in Washington is proof of that.
Source: bizpacreview.com

Medicare changes: What seniors need to know

Co-pays can change This expanded drug coverage, along with the screenings that will be covered now for mental health, alcohol misuse and sexually transmitted diseases, are the sort of services that not only thread through a senior’s daily quality of life, they have deep impact on long-term mental and physical health, said Dr. Gwendolyn Graddy-Dansby, a geriatrician and the medical director of the Henry Ford Center for Senior Independence, a Medicare- and Medicaid-funded center that helps seniors avoid nursing homes and remain in their homes as long as possible.
Source: flcourier.com

Video: Home Care Jupiter FL

Home Care Services in Jupiter, Palm Beach Gardens, North Palm Beach, Tequesta, West Palm Beach, Jupiter Island, Palm Beach, Hobe Sound, Lake Park, Jupiter Inlet Colony, Stuart, Palm Beach Shores, Palm City, Wellington, Singer Island and the surrounding areas.
Source: amomentsnoticehealthcare.com

Medicare Battle Heats Up California House Race

Posted by:  :  Category: Medicare

Congressman Brad Sherman, California’s 27th District (D) by cliff1066™Bera was a newcomer to politics in 2010 when he ran a surprisingly strong campaign against Lungren, losing by 7 percentage points in a year in which Republicans made record gains in the House. But in this year’s rematch, Bera is placing greater emphasis on his medical background: he served as chief medical officer for a large California hospital chain and later in the Sacramento County public health department, tasked with providing medical care for some 225,000 uninsured people.
Source: kaiserhealthnews.org

Video: California Medicare Supplement Insurance Plans 1-800-243-8100

Insure The Uninsured Project (ITUP)

Director Douglas also discussed that the implementation of the dual eligible demonstrations in certain counties (Coordinated Care Initiative) would be delayed. The previous budget assumed that all counties would enroll all beneficiaries over 12 months, beginning in March 2013. This proposal assumes that enrollment in managed care will begin for Medi-Cal benefits in September 2013. Los Angeles County will conduct enrollment over 18 months, while San Mateo will enroll all beneficiaries at once. Orange, San Diego, San Bernardino, Riverside, Alameda, and Santa Clara counties will enroll beneficiaries over 12 months. These pilots would integrate and coordinate Medicare and Medicaid benefits in one managed care plan. Beneficiaries would be passively enrolled with the ability to subsequently opt-out of managed care for their Medicare benefits only.
Source: itup.org

William Henning: Medicare cuts bad medicine for vulnerable California communities

Meanwhile, Part D has been a singular fiscal success, posting what is nothing short of an astonishing record for a federal program. The Washington-based think tank Heritage Foundation found that Part D’s cost growth has come in 41.8 percent below its original cost estimate — a total savings projected at $264.6 billion for taxpayers. Additionally, according to the Journal of the American Medical Association, improved access and adherence to medicines through Part D saves Medicare about $1,200 per year in hospital, nursing home and other costs for each senior who previously lacked comprehensive drug coverage — a $12 billion-per-year savings for Medicare.
Source: santacruzsentinel.com

CMS Names 106 New Medicare ACOs

CMS 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

Analysis: Obama may turn Medicare reform into wider health debate

(Reuters) – President Barack Obama could seek common ground with Republicans in the looming battle over Medicare spending by broadening the debate over entitlement reform to encompass the spiraling healthcare costs that confront a wide range of Americans.
Source: pnhpcalifornia.org

Report estimates health plan overbilled Medicare $424M

The inspector general found in November that Medicare overpaid nursing homes by about $1.5 billion in 2009 based on claims that patients needed "ultra high" levels of therapy. The report found that claims were "upcoded" because the records showed that the patients either did not need or get the therapy in many cases. The Washington Post also examined "ultra high" therapy use in 2010, focusing on a chain that operates dozens of homes in California.
Source: californiawatch.org

Officials Tell Insurers To Stop Denying Coverage for Transgender Patients

The changes apply to insurers covering about 7% of state residents through plans regulated by the state Department of Insurance, such as PPOs, but they do not affect Medicare or Medi-Cal beneficiaries or the majority of residents who are insured through an HMO. Medi-Cal is California’s Medicaid program.
Source: californiahealthline.org

California insurance firm over billed Medicare $424 million

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Source: calcoastnews.com

How Obamacare Will Affect Medicare Recipients in 2013

If your primary-care doctor or other primary-care practitioner determines you’re misusing alcohol, you can get up to four face-to-face counseling sessions per year (if you’re competent and alert during counseling). A qualified primary-care doctor or other primary-care practitioner must provide the counseling in a primary-care setting such as a doctor’s office.
Source: patch.com

California leading the experiment of shifting Medicaid patients to managed care

That’s when she sits in her living room in this struggling Los Angeles suburb and sorts through the latest round of letters from her health plan, each rejecting her appeal to stay with her trusted oncologist at City of Hope, a local cancer center. For as long as she can remember, Saavedra, 53, a former cafeteria worker who suffers from bone marrow cancer, has been insured through Medicaid, the joint federal-state program for low-income people. For most of that time, she could go to any doctor willing to take her, but last year, the state revamped the program and assigned her to a managed care plan with a restricted network of doctors. Her oncologist is not on its roster.
Source: medcitynews.com