Business Roundtable attacks Medicare and Social Security

Posted by:  :  Category: Medicare

• Expand Competitive Models of Care: By 2015, Medicare should offer seniors the opportunity to choose among competing and comprehensive private plans and traditional Medicare. The private plans would offer a benefit similar to the existing Medicare program with the flexibility to innovate, sell across state lines, and create greater value strategies. Plans would be required to accept all applicants and would risk adjust the premium to take into account age and health status. The traditional fee-for-service program would compete for enrollment with private plans on cost, quality and a more innovative benefit structure. We believe that competition in the provision of health care to America’s seniors will bring substantial benefits, as it has to most all other categories of personal expenditure. The recent experience of competition in the Medicare Part D program serves as a persuasive indication of the potential savings and improvement in care available through the provision of choice to well-informed seniors.
Source: pnhp.org

Video: Inova LifeChoice Portable Oxygen Concentrator Featured on Good Morning Texas

Raising Medicare age would hurt seniors and the economy

The much-touted Republican plan to raise the eligibility age of Medicare would raise health care costs for seniors, hurt the overall economy, and put increasing pressure on older Americans, a study by the Kaiser Family Foundation found. “This is a policy change that seems straightforward, but has surprising ripple effects,” Tricia Neuman, Medicare specialist with Kaiser, said. “It’s a simple thing to describe … but I don’t think people have thought through the indirect effects.” The idea of raising Medicare’s eligibility age became a national demand of Republicans after House Budget Chair and vice-presidential candidate Paul Ryan put forward his budget, which called for massive cuts to Medicare, Social Security, Medicaid and other federal programs that help poor and working Americans, while pushing continued huge tax cuts for the wealthy. Among the indirect cost shifts the Kaiser study identified are the following; * Higher Medicare premiums for those on Medicare because younger (and healthier) 65- and 66-year-olds would be kept out of the program, raising Medicare’s insurance costs.  Kaiser said the cost increases for seniors could top three percent due to this change. * An increase in costs for companies providing health care to their workers due to older workers staying on company health care plans instead of going onto Medicare at that age. * Higher premiums for those on private insurance programs across the board as older, and less healthy, workers are forced to stay with private insurance rather than moving onto Medicare, as they now do. * Much higher out-of-pocket expenses for more than two-thirds of older adults, as they are forced to wait two years longer to be Medicare-eligible. * Kaiser and the nonpartisan Congressional Budget Office (CBO) projected a huge increase in uninsured Americans if Medicare eligibility is raised by two years. Texas and other states where Republican administrations have said they will refuse the federal increase in Medicaid under the Affordable Care Act are expected to be particularly hard hit. Republicans, led by House Speaker John Boehner of Ohio, continue, even after suffering a historic defeat in the recent elections, to make the change in Medicare eligibility a centerpiece in their campaign to slash federal spending for poor and working Americans while keeping major tax cuts for the wealthy. While President Obama is taking a tougher post-election position in budget talks, some Democrats appear ready to accept raising the Medicare eligibility age. Steny Hoyer, leading Democrat from Maryland, said last week that the Medicare eligibility shift is “clearly on the table.” The AFL-CIO, AARP, Alliance for Retired Americans and other organizations representing working and retired Americans are working hard at mobilizing their grassroots base, demanding “No cuts to Medicare, Medicaid, and Social Security – have the wealthy pay their fair share.” “These vital programs have not caused the deficit,” ARA President Barbara Easterling said in a recent public letter. “Instead, reckless tax cuts and loopholes for the wealthy and greedy Wall Street behavior have. Make those who caused the deficit pay for it.” Tim Burga, president of the Ohio AFL-CIO, in a radio interview last week, compared the so-called “fiscal cliff” to the Mayan Cclendar, which some alarmists have stated sets this year as the “end of the world.”   “I think we’ll be here the day after both of these phony, made up, so-called ‘crises’,” he said. ” The point is that we can’t let self-promoting corporate snake oil salesmen stampede us off of a real cliff, destroying real programs that really help real people and our real economy.”
Source: peoplesworld.org

Daily Kos: Ed Rendell: Obama “must deliver” on raising Medicare eligibility age & chained CPI

just the continuous claims I hear over and over again.  I can’t really give you an answer about why he does the things he does because I’m not sure either but even when he shows willingness to give Republicans what they want they still bitch and yell “No”.  In fact when I talk to people who are misinformed and yell, “both sides do it!  Obama is always fighting with Republicans” I always point out what he tries to do to get the other side on board.  After I explain that they go, “Oh, ok.  Some of those things he shouldn’t have agreed to but you’re right, he at least is trying to be the adult in the room and it is the Republicans who are the problem.”  I also hear this answer from moderate Republicans or moderates in general “I wish Bill Clinton was President again because he got shit done with the congress he had” but then I usually come back with, “That would be nice except that these Republicans are not the Republicans from the 90s and a lot of those racist tea baggers who represent racist voters would rather eat shit and die than be caught working with the black guy.”  They then respond, “Yeah, I guess you’re right.”
Source: dailykos.com

Daily Kos: Open thread for night owls: Raising Medicare eligibility age would hurt minorities most

un-Constitutional, since illness and injury are not age-dependent. Separating populations by age and income is little more than a sop to segregationist sentiments — sentiments which, in turn, merely satisfy an ideological commitment to hierarchy as a fundamental principle of society. Ranking humans in order to give some more or less authority over others is not natural. If humans are equal, admittedly an ideological commitment, but one that is enshrined in our organizing document, then hierarchy is in basic conflict. Insisting on it merely serves to undermine our democracy. Of course, we have a long history of not living up to our aspirations. But, that’s what moving forward is about. If we are going to make progress, then irrelevant distinctions have to be removed. Medicare should be an option for all, especially now that all income earners are paying into it. Money, btw, is a social utility. People who use it incur some obligations for our communal certification that their IOUs are good. If some people get along with handshakes, more power to them. We won’t expect them to pay in.
Source: dailykos.com

Viewpoints: $4,000 A Night For A ‘Cozy’ Hospital Room; Texas Effort To Provide Women’s Health Care Falls Short

Los Angeles Times: First The Cat, Now The Health System Puts The Bit On Me Call it the $55,000 cat bite. That’s the rough total in medical costs (so far) for a cat bite on my hand that turned into an infection that turned into surgery that turned into a week in the hospital. … But the bill has finally arrived, and I’m a good deal less impressed with the money side of our medical system. Put simply, it’s nuts. Case in point: My cozy hospital room at UCLA Medical Center in Santa Monica was priced at $4,000 a night. Four thousand. You can book a 1,400-square-foot Premier Suite at the Beverly Hills Hotel for less than that. Another case in point: Sixteen bucks for a Tylenol. Actually, not even a proper Tylenol. That’s for the generic equivalent. “It’s totally crazy,” admitted Dr. David Feinberg, who isn’t just some innocent bystander when it comes to UCLA’s medical pricing. He’s the president of UCLA Health System. He runs the place (David Lazarus, 1/15).
Source: kaiserhealthnews.org

Raised Medicare Eligibility Age, and Other Links

American Medical Association cancer CBO consumer driven health care diabetes doctors drugs electronic medical records email emergency room EMR ER exercise FDA genetics Health Care Access Health Care Costs health care quality health insurance health IT health policy Health Reform Health Savings Accounts heart disease hospital HSA insurance life expectancy Massachusetts Medicaid Medicare medicare advantage NHS ObamaCare obesity pay for performance public option SCHIP seniors socialized health care Social Security stimulus tax unemployment Uninsured
Source: ncpa.org

Listen Up, White House! Take Medicare Eligibility Age Off The Table NOW.

…with the electorate. Act 1. A disaster scenario (created by the WH & Congress) aptly named a ‘fiscal cliff’ MUST be solved by Dec. or we’ll all die. Both parties posture and pose and pretend to hold out for a deal their base supports. Act 2. Media run non-stop stories about the fiscal cliff ‘disaster’. Theme: If no compromise is reached before (artificial) deadline life will end for us all. Good cop, bad cop drama ensues. Act 3.The WH/Congress leak Pete Peterson’s plan to a couple of insiders to float. Outrage from both bases. Media frenzy. WH/Congress wait out the storm. Act 4. Float a slightly more palpable plan with “tweaks”. Media insiders in both parties give it a tepid thumbs up claiming it was the best they could do given the intransigence of the other party. Act 5. Tweaked entitlement “reform” bill gets bipartisan support. Act 6: The public finds out 9 mos later about the poison pills lobbyists for Pete Peterson wrote into the bill. Act 7. Medicare age raised to 67. SS cola ‘tweaked’. Taxes raised 2% on millionaires. Captial Gains tax untouched. Defense cuts- not so much.
Source: crooksandliars.com

Medicare Experts Discuss Proposal to Raise Eligibility Age

Juliette Cubanski, associate director for the Program on Medicare Policy at the Kaiser Family Foundation; Gail Wilensky, senior fellow at Project HOPE, and a former Medicare and Medicaid administrator; David Certner, federal policy director at AARP, who previously served as chairman of the ERISA Advisory Council at the Department of Labor; and Paul Dennett, senior vice president for health reform at the American Benefits Council, which represents Fortune 500 companies, and a congressional staff veteran; discussed the costs and benefits of raising the eligibility age.
Source: c-span.org

OIG Cites Lax Oversight of Texas Medicare Mental Health Centers

Private contractors tasked with finding fraud and abuse in Medicare community mental health centers have been ineffective in Texas and other states prone to such activity, according to an audit by the Office of the Inspector General (OIG) for the U.S. Department of Health and Human Services.
Source: dmagazine.com

Texas Medicare Advantage Disenrollment : Learn Your Options

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

High court rejects Medicare challenge

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

In Iowa’s Interest: Taking Advantage of Medicare Open Enrollment

Posted by:  :  Category: Medicare

Double-Parked by elycefelizThe options for choosing a plan can be daunting, but the Medicare website – www.medicare.gov – is a good resource for seniors to select a plan and answer questions about their options.   The site also includes The Medicare Plan Finder, a unique tool that allows seniors to compare numerous drug and health plans simultaneously.  The Plan Finder breaks down monthly premiums, deductibles, co-pay levels, and prescription drug coverage.
Source: northiowatoday.com

Video: New Iowa Frontrunner Thinks Medicare, Paper Money And Nearly Everything Else Is Unconstitutional

More independently owned drugstores closing in Iowa, nation

Gainer said gross margins on prescriptions covered by Medicare Part D tend to be lower than those covered by Medicaid, commercial health insurers or cash customers. While prescription volume among Medicare beneficiaries has increased under Medicare Part D, the size of the increase at some pharmacies has been less than projected.
Source: thegazette.com

Bleeding Heartland:: Iowa Hospital Association backs Medicaid expansion

- County chairs list at IDP site – Iowa 4th District Democrats (includes contact info for county chairs) – Iowa 5th District Democrats (includes contact info for county officers) – Allamakee County Democrats – Appanoose County Democrats – Black Hawk County Democrats – Boone County Democrats – Bremer County Democrats – Buena Vista County Democrats – Carroll County Democrats – Cedar County Democrats – Clinton County Democrats – Dubuque County Democrats – Emmet County Democrats – Fayette County Democrats – Hardin County Democrats – Harrison County Democrats – Henry County Democrats – Jackson County Democrats – Jefferson County Democrats – Johnson County Democrats – Linn County Democrats – Marion County Democrats – Monona County Democrats – Muscatine County Democrats – Page County Democrats – Pocahontas County Democrats – Polk County Democrats – Scott County Democrats – Story County Democrats – Tama County Democrats – Wapello County Democrats – Warren County Democrats – Washington County Democrats – Woodbury County Democrats
Source: bleedingheartland.com

Iowa Nursing Home Sues Kindred Healthcare over Medicare Fraud : South Carolina Nursing Home Blog

Now, Bethany has filed a lawsuit against its parent company, Kindred Healthcare, for its involvement in the scheme. Kindred Healthcare is the parent company of RehabCare Group, which became Bethany Lutheran Home’s insurer in 2006, at the same time that billings for “ultra high” therapy care skyrocketed. According to the federal prosecutors who conducted their suit against Bethany, RehabCare had provided Bethany with assurances that its profits would increase dramatically as a result of doing business with the insurer during the negotiation phase of its contract talks. The timing of the increase in payments, as well as the alleged assurances on the part of the insurer lend credence to Bethany’s lawsuit claiming damages for negligence and breach of contract.
Source: scnursinghomelaw.com

Steve King’s Voting Record On Medicare And Social Security

The 4th District of Iowa is the smallest district with the number of residents in it but the largest number of seniors in it. 21.2 percent of the residents in the 4th receive Social Security benefits. The 4th District is rated fifth in the nation with the number of seniors by percent in a district; yet Congressman King seems to vote against seniors more than for them.
Source: blogforiowa.com

Medicare ad hit IA03, IA04 airwaves

Both Congressman King Latham voted twice for the Ryan plan, which would end the current Medicare system and instead give seniors a voucher to get private health insurance. Non-partisan experts have said ultimately this would cost individuals $6,000 per year.
Source: cciaction.org

HHS Names 106 New Participants in Medicare Shared Savings Program

In addition, 15 organizations in the latest ACO cohort are Advanced Payment Model ACOs, which are physician-based or rural providers granted capital to invest in electronic health record systems, staff and other infrastructure improvements. CMS will recoup the advanced payments through future shared savings (CMS release, 1/10). Another 15 Advanced Payment Model ACOs were announced in the second round of ACOs.
Source: californiahealthline.org

In Iowa, Obama Hits Back on Medicare

On the last day of his three-day bus tour of Iowa, sensing an opening to paint a contrast with his opponents, Mr. Obama sharply attacked Mr. Romney and his running mate, Representative Paul D. Ryan, for advocating budget cuts that he said would curtail Medicare benefits.
Source: realclearpolitics.com

Iowa crowd heckles Paul Ryan over Medicare cuts

Our whole system is a war on all the classes. Those fighting FOR the Middle Class are fighting AGAINST the top class. God’s ways are voluntary with one even “tax” called a tithe of !0% for all people. (Malachi 3:8-12) Malachi says that we are a cursed nation because we do not bring all the tithes into the storehouse. He calls us to prove Him and see if He will not open the windows of heaven and pour out a blessing we will not have room enough to receive it. We pay Medicare because we EXPECT to get sick or injured. Our lifestyle is dangerous to our health. Mitt Romney, Ryan Paul, Ron Paul, the Socialist candidate or even President Obama cannot solve our problems with jobs, equal wages, insurance and taxes for government payrolls and forced helps that should be done locally by family and community God warned against debt, interest, insurance, seeking riches and honors; we are polluting ourselves to death and extinction. ONLY turning back to living off the land brings all things in proper arrangement and solves our personal, national and world problems we created by ignoring God’s wisdom. It quickly becomes a garden paradise with abundance, good health and families together in love and helpfulness. God wants us to have an abundant life with no sorrow added. We can have it IF we pray and tell our leaders before they decide our fate for us.
Source: allvoices.com

Obama In Iowa: ‘I Have Strengthened Medicare’

In a statement, Romney campaign spokesman Ryan Williams said: “President Obama has a long history of launching shameful political attacks on Medicare – but he’s the only person in the race who has actually cut Medicare. President Obama cut $716 billion from Medicare to pay for Obamacare and our nation’s seniors will pay the price with higher costs and fewer benefits. As president, Mitt Romney will always protect this vital program for seniors and strengthen it for future generations.”
Source: news92fm.com

MedPAC calls for permanent reauthorization of Medicare Advantage plan covering nursing home residents

Posted by:  :  Category: Medicare

Healthcare Is A Human Right! by DonkeyHoteyThe Medicare Advantage special needs plan that enrolls nursing home residents, set to expire at the end of 2014, will be permanently reauthorized if Congress acts on recommendations proposed by the Medicare Payment Advisory Commission (MedPAC).
Source: naap.info

Video: CBO Director Douglas Elmendorf on Medicare Advantage

Medicare Office Urged to Take More Security Measures

Kathleen King, the GAO Health Care Director, testified to the House Committee on Energy and Subcommittee on Health that fraudulent activity in federal health programs such as upcoding, physician kickbacks and identity theft continue to proliferate. King reported that the GAO had urged CMS to take the following steps to reduce these incidents:
Source: choiceadminexchanges.com

Voice For Medicare, Medicaid Retiring

In a statement Friday, President Barack Obama hailed Rockefeller’s service. “From his time in the state legislature to the Governor’s office to the Senate floor, Jay has built an impressive legacy, one that can be found in the children who have better schools, the miners who have safer working conditions, the seniors who have retired with greater dignity, and the new industries that he helped bring to West Virginia,” Obama said. “A long-time champion of health care reform, Jay was also instrumental in the fight to make sure that nobody in America has to go broke because they get sick.”
Source: kaiserhealthnews.org

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

CMS: Method II Physicians Eligible For Medicare EHR Incentives

Certain physicians who provide services in the outpatient departments of critical access hospitals are eligible to participate in the Medicare Electronic Health Record Incentive Program beginning this year, according to the Centers for Medicare & Medicaid Services. However, due to CMS system changes that will be implemented over the coming year, these physicians will not be able to submit attestations until January 2014. They will not be able to receive incentives for 2012.  (Source: AHA News)  [Read article]
Source: worh.org

Office of Statewide Benefits provides information on Medicare Parts A, B enrollment

Failure to enroll and maintain enrollment in Medicare Parts A and B upon eligibility may result in the subscriber being held financially responsible for the cost of all claims incurred, including prescription costs. Retirees and spouses enrolled in Medicare Parts A and B must provide a copy of their Medicare Identification Card to be enrolled in the state of Delaware Special Medicfill plan.
Source: udel.edu

Policy consequences of low growth in Medicare spending

Medicare spending per beneficiary grew just 0.4% per capita in fiscal year 2012, continuing a pattern of very low growth in 2010 and 2011. Together with historically low projections of per capita growth from both the Congressional Budget Office and the Centers for Medicare and Medicaid Services (CMS) Office of the Actuary, these statistics show that the Affordable Care Act has helped to set Medicare on a more sustainable path to keep its commitment to seniors and persons with disabilities today and well into the future. The success in reducing the rate of spending growth has been achieved without any reduction in benefits for beneficiaries. To the contrary, Medicare beneficiaries have gained access to additional benefits, such as increased coverage of preventive services and lower cost-sharing for prescription drugs.
Source: pnhp.org

Medicare Spending Per Beneficiary Grew Just 0.4% in 2012

Accelerating a three-year trend, spending per Medicare beneficiary rose just 0.4 percent in fiscal year 2012, far slower than the 3.4 percent increase in gross domestic product per capita, according to a report released by the HHS Office of the Assistant Secretary for Planning and Evaluation. Since fiscal 2010, Medicare spending has averaged 1.9 percent annual growth per beneficiary, more than one percentage point under GDP’s average annual per capita growth of 3.2 percent in the same three-year period, according to the ASPE report. Over the next decade, projections from the Congressional Budget Office and the CMS Office of the Actuary put Medicare spending growth per beneficiary at roughly the same rate as per capita GDP. The Patient Protection and Affordable Care Act is partly responsible for putting the brakes on spending growth through its restrictions on payment increases for Medicare Advantage plans, beefed up fraud measures and value-based spending tactics. The CBO said those parts of the PPACA will save $10 billion from the Medicare program in 2012. CMS actuaries estimated a higher $13.5 billion in 2012 savings, equivalent to a more than 2 percent reduction per beneficiary that year. Both the CBO and the Office of the Actuary said the law will slow spending growth per beneficiary by about 1 percentage point each year for the next decade.
Source: beckershospitalreview.com

Elder Care: Healthcare Fraud and Abuse: What Should You Look For?

James knows that Medicare fraud is a more prevalent issue than you might first assume. As such, he encourages you to be on the lookout for signs of fraudulent activity and report anything that you detect to the proper authorities. By reviewing your senior’s claims, comparing doctor’s records with Medicare documentation, and going over your senior’s Medicare Summary Notice, you can ensure that your elderly loved one is receiving the services for which their doctor’s office is charging.
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

Special Report – Independence of Medicare Administrative Law Judges Threatened by Office of Inspector General’s Recommendations 

Cir. 1974). [5] “ALJs and the MAC are not bound by LCDs, LMRPs, or CMS program guidance, such as program memoranda and manual instructions, but will give substantial deference to these policies if they are applicable to a particular case.”  42 C.F.R. § 405.1062(a).  [6] 42 C.F.R. § 405.968  [7] For more information about the improvement myth and recent historic settlement, Jimmo v. Sebelisus, see http://www.medicareadvocacy.org/hidden/highlight-improvement-standard/.  [8] In a recent district Court case, the Judge held “an ALJ may not substitute his or her own unsupported judgment for that of a physician.”    Office of Vermont Health Access v Sebelius, 698 F.Supp.2d 436, 453(D.Vt.),  2010 WL 997386,  Med & Med GD (CCH) P 303,313 (March 15, 2010) citing Kertesz v. Crescent Hills Coal Co.,  788 F.2d 158, 163 (3d Cir. 1986).  This recent decision states unequivocally, “it is clear that Second Circuit case law requires ALJs to give some extra weight to the opinion of a treating physician’s opinion, or supply a reasoned basis for declining to do so.”  Id., at 453 citing Bergeron v. Shalala, 855 F. Supp. 665, 668, (D.Vt, 1994) Smith ex rel. McDonald v. Shalala, 855 F.Supp. 658, 664 (D.Vt 1994). [9] Id. [10] “When a request for an ALJ hearing is filed after a QIC has issued a Reconsideration, the ALJ must issue a decision, dismissal order, or remand to the QIC, as appropriate, no later than the end of the 90-day period beginning on the date the request for hearing is received by the entity specified in the QIC’s notice of Reconsideration…”  42 C.F.R. § 405.1016(a)
Source: medicareadvocacy.org

Efforts to Combat Fraud Continue to Yield Positive Results in Wisconsin 

badgercare plus Better Business Bureau charity scams credit card fraud credit card scams election fraud false claims act fraud fraud alert newsletter Frauds healthcare reform identity theft job scams medicaid fraud Medicare medicare fraud medicare overbilling medicare part D medicare reform medicare reimbursement mortgage fraud phishing scams podcasts prevent medicare fraud scams storm chasers storm scams telephone scams Training volunteer voter fraud wisconsin bbb wisconsin check fraud wisconsin child care fraud wisconsin election fraud wisconsin fraud wisconsin head start fraud wisconsin medicaid fraud wisconsin mortgage fraud wisconsin scam wisconsin scams wisconsin smp wisconsin smp training wisconsin unemployment benefits wisconsin unemployment fraud
Source: wisconsinsmp.org

Horizon Medicare Advantage Blue Value with Rx

Posted by:  :  Category: Medicare

THE PEOPLES LEADER by SS&SSPlease read through the full Horizon Medicare Blue Value with Rx HMO Summary of Benefits attached here for a more thorough review of the plan. I am also available to review this plan with you in a meeting if you wish. Due to marketing regulations, I have decided to list just the basics of the plan and but welcome appointments to discuss your full needs. Contact Mike at NewJerseyInsurancePlans
Source: newjerseyinsuranceplans.com

Video: Airport Assistence – New Horizon Medicare India

Medicare Marketing on the Horizon

Many thanks to the Council on Aging of Greater Nashville for this alert:  The Open Enrollment Period for Medicare, including Medicare Part D (Prescription Drug Benefits) and Medicare Advantage Plans, has started. That means that seniors will be receiving information on the many available plans.  Seniors should stay alert for information that will be mailed about possible changes to their current Medicare plan. 
Source: wholecareconnections.com

The Petition Response Strikes Back

The Administration does, however, have the rights to Birdman and the Galaxy Trio. We know a lot of you probably haven’t heard of this super team. But the Administration would like you to seriously consider YouTubeing some clips from the animated television show, which ran on Saturday mornings on NBC from Sept. 9, 1967, until Sept. 6, 1969. It’s a tour de force. Then you’ll know why we’ve invested over 350,000,000 of your tax dollars into making a reality of Vapor Man, Gravity Girl, Birdman, and the rest of the gang. Vice President Biden’s internal review strongly suggests that you, the American People, are going to love them. And, more importantly, they’re going to absolutely destroy Al Qaeda.
Source: themorningnews.org

One Fiscal Cliff Down and Three To Go––But No Real Solution On the Horizon

Affordable Care Act cancer diabetes doctor-patient relationship doctors doctors and patients Educate the Young electronic health records exercise health health care costs health care reform health care technology health insurance Health Populi health reform hospitals innovation Jane Sarasohn-Kahn Klepper Lisa Suennen Medicaid medical education Medicare Merrill Goozner mHealth Michaeli Mobile health New York Times Not Running a Hospital nutrition Obamacare obesity other patient engagement patient safety Paul Levy physicians politics PPACA primary care Salber Social Media Venture Valkyrie weight loss
Source: thedoctorweighsin.com

Daily Kos: White House might use Medicare reform momentum to push further health care reform

No, he has waited for the American people to get smart enough to see your bullshit for what is.  Very much the same tactic he’s used on entitlement cuts.  He lays out the bait, they start telling the truth, it hurts them.   They’ve finally figured that out.  You’ll notice they won’t say a word about WHAT they want cut?  Here’s some entitlements that need cutting:  subsidies and tax cuts for oil and gas companies enjoying record profits; subsidies to factory farms that pollute the water and the soil; tax breaks to companies that outsource jobs; tax breaks to companies that move to your town, provide a few jobs, pay nothing for infrastructure they need; continued payment to defense contractors who miss deadlines and fail to perform; payments to outside contractors who are twice as expensive and half as competent to provide government services.  Short list, there are dozens more.  Obama uses their language, twists it a bit, gets what he wants.  When Progressives miss the big picture and go nuts about his language they reveal an inability to shift to 21st Century politics.  The main complaint I’m reading is he doesn’t talk tough enough.  Hmmmm. Maybe people with conviction and a plan don’t need to engage in macho bullshit?  Maybe Obama gets it that Americans are sick of posturing and just want action?  Why is that so hard to grasp?
Source: dailykos.com

The Official Medicare Set Aside Blog And Information Resource: BP Spill Medical Benefits Class Action Settlement Includes MSAs

The MSP “expert” on this case, the Garrettson Resolution Group, is not generally know for its support of the concept of LMSAs; regardless, in a class action situation like this, there would never be sufficient funding after attorneys’ fees and expenses to fully fund MSAs by their or anyone else’s calculations. In the many MDLs Garretson has been involved in since Zyprexa, it has developed a system in which plaintiffs are grouped by the nature and extent of their condition and their share determined that way rather than on an individual basis – efficient if nothing else. We can only assume the same strategy was applied here.
Source: medicaresetasideblog.com

Horizon Care Services is a Proud Sponsor of the Hospice of Palm Beach County Foundation

As a 501(c)(3) non-profit organization, Hospice of Palm Beach County greatly depends on the generosity of the community to cover uncompensated expenses for patient care and specialized programs. The foundation is dedicated to raising funds to support the unfunded patient programs and services offered by Hospice of Palm Beach County which are not covered by Medicare, Medicaid or private insurance.  Hospice of Palm Beach County Foundation relies on the support of individuals and corporate partners who generously support the mission of Hospice of Palm Beach County.
Source: horizoncareservices.com

Horizon Blues chooses family friend for non

Horizon Blue Cross Blue Shield of New Jersey, the state’s oldest and largest health insurer, is a not-for-profit health services corporation, providing medical, dental, and prescription insurance products and services. Horizon BCBSNJ is an independent licensee of the Blue Cross and Blue Shield Association, serving 3.6 million members with offices in Wall, Mt. Laurel, and West Trenton, N.J.
Source: ifawebnews.com

Medicare Enrollment Season on the horizon…

This is the time of the year when senior citizens get inundated with advertisements for all the various Medicare Options they have available to them.  The sheer numbers of options can be very intimidating to anyone.  While Medicare Supplements, Medicare Advantage programs, and Part D Prescription Plans are the three most common, their are also PFFS, Dual option, Special Needs, Cost plans, Medicare Savings accounts and more.
Source: reevewillknow.com

Utah Medicare Plans….changes on the horizon?

Are there really changes on the horizon, did the recent legislation upheld by the Supreme  Court affect you. These are questions that I am afraid there are no current answers to at the moment, but I feel any and all changes to Utah Medicare rules and procedures will occur after the elections. As always we recommend you have a competent agent who specializes in Utah Medicare coverage to help answer your questions as they arise. Of course we are biased, but a good agent is always better than no agent.
Source: utahseniorservices.com

Daily Kos: Medicare also going over the “cliff”

Single-payer financing models, in which one government entity is the sole third-party payer of health care costs, can achieve universal access to health care without barriers based on ability to pay. Single-payer systems generally have the advantage of being more equitable, with lower administrative costs than systems using private health insurance, lower per capita health care expenditures, high levels of consumer and patient satisfaction, and high performance on measures of quality and access. They may require a higher tax burden to support and maintain such systems, particularly as demographic changes reduce the number of younger workers paying into the system. Such systems typically rely on global budgets and price negotiation to help restrain health care expenditures, which may result in shortages of services and delays in obtaining elective procedures and limit individuals’ freedom to make their own health care choices. Pluralistic systems, which involve government entities as well as multiple for-profit or not-for-profit private organizations, can assure universal access, while allowing individuals the freedom to purchase private supplemental coverage, but are more likely to result in inequities in coverage and higher administrative costs (Australia and New Zealand). Pluralistic financing models must provide 1) a legal guarantee that all individuals have access to coverage and 2) sufficient government subsidies and funded coverage for those who cannot afford to purchase coverage through the private sector. http://www.annals.org/…
Source: dailykos.com

Business Roundtable Offers Medicare Plan To Increase Eligibility Age To 70

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSCNN Money: The High Cost Of Raising The Medicare Age If seniors were not allowed to enroll in Medicare until 67 starting next year, federal spending would drop by $5.7 billion in 2014, according to the Kaiser Family Foundation. But Americans enrolled both in private health insurance plans and Medicare, as well as employers and states, would see expenses jump by $11.4 billion. “Raising the age doesn’t address the larger concern of reducing health care spending overall,” said Juliette Cubanski, associate director of Kaiser’s Program on Medicare Policy. “It just shifts costs from the federal government to other payers in the system.” Medicare reform is back in the spotlight as the White House and Congress gear up for another deficit reduction battle in coming weeks (Luhby, 1/17).
Source: kaiserhealthnews.org

Video: What Does Medicare Cost?

Why Private Medicare Plans Don't Cost Less

Many contend that the government “overpays” for people enrolled in private plans, since traditional Medicare could have covered these patients for less money. But the reason it would have cost less is partly that the government has done a woeful job in figuring out how much to pay the private plans. The government compensates insurers based on the health of their enrollees at the start of the year. Plans with healthier patients receive less money than those with sicker ones to reflect the likelihood that healthier people will use less care. Healthier patients enroll in Medicare Advantage plans, so in, principle, plans should be reimbursed less by the government for enrolling these patients (the technical term for this process is “risk adjustment”). But for decades, the government has failed to determine who is healthy and who is sick with any precision, with the result that private plans receive larger payments to cover their patients’ costs than necessary. This botched payment system gives insurers an incentive to spend more time selecting the healthiest patients, and less time treating them more efficiently.
Source: nytimes.com

Cravaack, Nolan battle over Medicare

Referring to Medicare’s low administrative costs relative to what private insurers spend on overhead, Nolan said, "It costs roughly 3 or 4 percent to administer Medicare. Private insurance on average runs somewhere between 27 and 30 percent administrative costs. So once you turn Medicare back over to the insurance industry, you know, right out of the chute you are dramatically increasing the administrative costs."
Source: publicradio.org

Obama's Medicare Cost

“They’ve planted a thousand seeds and are hoping one or two of them will bloom,” said Marc Goldwein, senior policy director for the Committee for a Responsible Federal Budget, a nonprofit Washington group. To contact the reporter on this story: Mike …
Source: newamerica.net

Transforming Medicare into a Premium Support System: Implications for Beneficiary Premiums

The analysis does not attempt to model any specific proposal, but is generally based on an approach included in House Budget Chairman Paul Ryan’s fiscal year 2013 budget plan, the proposal Chairman Ryan co-sponsored with Senator Ron Wyden of Oregon, and; in the plan put forward by former Senator Pete Domenici and Dr. Alice Rivlin. In the first two proposals, people who are at least 55 years old, including current beneficiaries, would be exempt from the new system. Republican presidential nominee Gov. Mitt Romney has supported a premium-support system along these lines.
Source: kff.org

Medicare cost control in action

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Source: marginalrevolution.com

Medicare, Medicaid, and Other Health Provisions in American Taxpayer Relief Act of 2012 (Updated)

Extension of Family-to-Family Health Information Centers:  This provision continues the Family to Family Health Information Centers (F2F HIC) to assist families of children and youth with special health care needs in making informed choices about health care in order to promote good treatment decisions, cost-effectiveness and improved health outcomes.  The centers are intended to help families navigate the health care system so that their children can get the benefits they need through Medicaid, CHIP, SSI, early intervention services, other government programs, and private insurance.  F2F HICs also train health care providers and policymakers and advocate for a family-centered “medical home” for every child. There is one F2F HIC in every state and the District of Columbia.
Source: piperreport.com

Opinion: New strategy tackles growing obesity problem

As with any attempt to address obesity, the challenges are many. Obesity requires multiple treatment options and a patient who is ready to make a personal commitment. Today’s health system and payment models aren’t necessarily structured to provide effective interventions. The new guidelines cover only those who are already obese rather than those who are overweight and could be prevented from crossing the line into obesity. And Colorado may not have enough qualified providers to deliver or coordinate multi-component behavioral interventions.
Source: healthpolicysolutions.org

Researcher: Older Medicare drug plans cost more

Medicare Part D program rules prohibit insurers from offering introductory discounts to gain market share, but Ericson says an insurer still has an incentive to find ways to use a subtle “invest then harvest” marketing strategy: setting initial rates low to attract first-time enrollees, then raising prices substantially once the insurer has a base of enrollees who are “stuck in place.”
Source: lifehealthpro.com

United Healthcare Acknowledges Payment Shortcomings : AAFP Leader Voices

Posted by:  :  Category: Medicare

Honestly, Dr. Cain, does United think we’ll swallow this load of hooey? They ask us to believe that: “United’s leaders” had no idea that for over two decades they’ve been forcing take-it-or-leave-it sub-Medicare contracts on family physicians (“Gambling in Casablanca? I’m shocked”); that, with all the resources of the country’s largest insurer, they’ve been unable during the past 14 months to identify physicians with those contracts; that they’re “developing solutions” while doing absolutely nothing; and that, icing on the cake, they “recognize the value of primary care” but, in the linked article say they will pay “incentive payments and fees GROWING (my caps) to a range of $0.45 to $3.30 PMPM” for medical home services. Dr. Cain, these are not decent, honorable people. They are con men: their words are lies, and their actions show nothing but contempt for the AAFP and family physicians. Every year, we read of these meetings, and every year things get worse. This approach does not work. Let me repeat: this approach DOES NOT WORK. The AAFP must take a strong adversarial approach if it wants to adaquately represent its members. A couple of suggestions: a major publicity campaign aimed at patients and employers outlining the actions/inactions of United and other insurers; a hot-line so physicians with these contracts can identify themselves, with the AAFP forwarding this information to United (along with the suggestion that, since their “leaders” didn’t know about these contracts, they re-process all claims from the last 10 years!); a blog in which physicians can report their experiences in renegociating their contracts; and, most importantly, the AAFP must walk out of the PCPCC, with a simple, public statement that we can no longer work in any capacity with organizations that are so hostile to our members and so damaging to our speciality. No family physicians, no medical home: this would carry some weight! We must refuse to allow our good name and reputation to be used as cover by these groups. The AAFP HAS to draw a line beyond which they will no longer tolerate this abuse of their membership. Thank you.
Source: aafp.org

Video: Medicare Basic Overview by United Healthcare Medicare Solutions

AARP/UHC Medicare Advantage

I was training a new agent in Florida today, the appointment we had was set from a mailer we sent to T-65. The client showed us a envelope from an Agency in Tarpon Springs, FL. They had sent an AARP/UHC Medicare Advantage with yellow highlights for the customer to sign including the scope of appointment and a returned envelope. What would you do?
Source: insurance-forums.net

Backed By New Partnerships With Humana, Aetna & Verizon, Blueprint Health Debuts Its Third Class Of Healthcare Disruptors http://khac.es/2744111

Primary Address 9 Schilling Road Hunt Valley, MD 21031 Phone: (410) 771-9220 Fax: (410) 771-9301 Specialty Family Practice Greater Baltimore Medical Center GBMA-Mark Lamos & Associates Insurance Accepted (GENERAL): AETNA AETNA GOLDEN CHOICE MEDICARE AETNA GOLDEN MEDICARE AMERIGROUP AMERIGROUP AMERIVANTAGE (MEDICARE) BCE EMERGIS BEECHSTREET BRAVO BY ELDER HEALTH CARE COORDINATION PLUS (XL HEALTH) CAREFIRST BCBS OF MD CAREFIRST BLUE PRECISION CAREFIRST BLUECHOICE CAREFIRST BLUEPREFERRED CCN CHOICECARE/HUMANA CIGNA COVENTRY DIAMOND PLAN (MEDICAID) COVENTRY HEALTHCARE OF DELAWARE FIRST HEALTH GREAT-WEST HEALTHCARE INFORMED JOHNS HOPKINS EMPLOYEE HEALTH PLAN JOHNS HOPKINS PRIORITY PARTNERS KAISER PERMANENTE MARYLAND MEDICAL ASSISTANCE MHIP (MARYLAND HEALTH INS PLAN) MULTIPLAN NCAS NCPPO NPN (NATIONAL PROVIDER NETWORK) PHCS PREFERRED PLAN RAILROAD MEDICARE TRICARE/CHAMPUS UHC AMERICHOICE UHC MDIPA UHC MEDICARE (EVERCARE MEDICARE) UHC ONENET PPO UHC OPTIMUM CHOICE UHC PRIMARY ADULT CARE UNITED HEALTHCARE UNITED HEALTHCARE GOLDEN RULE USA MCO INC
Source: alltrendingtopics.com

Medicare Advantage Medicare Supplement Long Term Care Insurance in Phoenix Arizona by Western Asset Protection

is a family owned and operated insurance brokerage firm specializing in Medicare Advantage andMedicare Supplement products. We are able to assist independent insurance professionals by providing a portfolio of strong Medicare Advantage or Medicare Supplement products to meet your clients needs.
Source: westernasset-us.com

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Source: cipunce.net

UHC Announces Changes to its Medicare Advantage Audits

UHC will no longer use MedAssurrant, the contractor that previously conducted its payment integrity audits. UHC will also make changes in the way that it conducts its Risk Adjustment Date Validation (RADV) audits. These audit request letters will be more clear about the reason for the audit and provide consistent information on follow-up medical record review, audit requests, and post-audit claim payment determinations. UHC will also update its payment integrity and recovery practices. Currently, UHC asks physicians to refund the full amount paid on the original claim and then resubmit the claim using the recommended coding. In the first quarter of 2012 physicians will only need to resubmit the claim with the recommended coding and refund only the difference between the amount UHC originally paid and the amount that should have been paid using the new coding. Physicians who disagree with UHC’s recommended coding should appeal the claims.
Source: wordpress.com

Any UHC Medicare Producers?

I was recently denied commissions on seven enrollments for the Evercare Dual Eligible Mapd because they say I wasn’t certified to sell it .The website they use to take and track certification called Learnshare showed that I had completed the course and the friendly PHD reps had on more than one occassion told on the phone that all my certifications where up to date but in fact i had failed to go through the last 4 slides when I originally taken the course The whole module could be done in about three minutes and there was no test to take.I didn’t find out about this until recently when I audited my commissions and called the producer help line who told me the reason I was denied commisiions was because I had to go through the last 4 slides on the module.. I then sent a service request to appeal this decision but was denied so as it it stands right now iam SOL My question is what is the next step I could take to try to get paid or file a complaint.How is it that I am not certified to sell this plan yet these customers are actively enrolled on the plan and calling me constantly with questions like dual eligible customers always do.I am obligated to spend time servicing these clients if I an mot the agent of record as far as commissions go? Usually I would help these people but I am feeling very spiteful here.
Source: insurance-forums.net

Pennsylvania Federal Judge Declines To Dismiss Medicare Fraudulent Claims Case

Posted by:  :  Category: Medicare

Mitt Mobile in the Final Stretch by DonkeyHoteyPHILADELPHIA – A Pennsylvania federal judge on Dec. 20 denied the defendants’ motion to dismiss a Medicare false and/or fraudulent records case (United States of America, ex rel. Anthony R. Spay v. CVS Caremark Corp., et al., No. 09-4672, E.D. Pa.; 2012 U.S. Dist. LEXIS 180602).Full story on lexis.com
Source: lexisnexis.com

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

Ryan Takes to Pennsylvania to Push Medicare Message

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

Medicare Takes Center Stage In Close Pennsylvania Races

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

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

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

Medicare Key Issue in Close Pennsylvania Races

In the week since Romney’s announcement, Medicare has been catapulted from an issue that political strategists said could make a difference in close races to a central component of congressional campaigns nationwide — especially in states like Pennsylvania, Florida, Minnesota and Ohio with large numbers of older voters.
Source: aarp.org

President Signs Committee Bill that Creates Efficiencies in Medicare and Saves Taxpayer Dollars

“Four years ago, one of my constituents suffered severe injuries in a terrible car accident,” said Murphy. “After coming to a settlement with the insurer, 73-year-old Lorraine Babich of Washington County was unable to get a straight answer from the Centers for Medicare and Medicaid Services about the amount of her medical bills, which had to be repaid to the Medicare Trust Fund. As a result of unnecessary bureaucratic hurdles, Lorraine waited years to get the proper settlement due to her. Unfortunately, Lorraine’s heartbreaking story isn’t an isolated case because there are thousands of senior citizens just like her who continue to await settlements, see their Social Security checks garnished, and Medicare coverage denied through no fault of their own. With the SMART Act now signed into law, Lorraine and thousands of other senior citizens will no longer needlessly suffer due to bureaucratic red tape.”
Source: house.gov

Pa. Home Health Care Providers Worried About Medicare Cuts

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

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

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

Pennsylvania Medicaid earning its stripes

Also, the provider must either be in the process of adopting, implementing, upgrading to or meaningfully using a federally-certified EHR system. If all qualifications are met, the providers have a standard incentive amount that is available to them each year they participate and the incentive amount for the hospitals is based on factors including their discharges and bed days. Medicaid provides up to $63,750 over six years (started in 2011). The payments are evenly distributed ($8,500 per year) after the first-year payment of $21,250.
Source: ehrintelligence.com

Louisiana Law Blog: Recent Developments in Medicare Set Aside

Posted by:  :  Category: Medicare

Running Amok Again by elycefelizSpecifically, the District Court held that no federal law requires an MSA in personal injury settlements for future medical expenses. The District Court held that while MSA’s are prudent in settlements for future medical expenditures in the workers’ compensation context, they are not required outside that context. The District Court further commented that to require personal injury settlements to specifically apportion future medical expenses would prove burdensome to the settlement process and, in turn, discourage personal injury settlements. Finally, the District Court dismissed the September 29, 2011 advices of the CMMS described above by pointing out that “interpretation such as those in opinion letters, like interpretations containing policy statements, agency manuals, and enforcement guidelines lack the force of law.” Christensen v. Harris County, 529 U.S. 576, 587 (2000).
Source: louisianalawblog.com

Video: Structured Medicare Set Aside

COURT AFFIRMS NEED FOR MEDICARE SET ASIDE IN LIABILITY SETTLEMENT

, No. 4:09-CV-141, 2012 U.S. Dist. LEXIS 134900 (E.D.N.C. Sept. 5, 2012), the plaintiff, a Medicare recipient, received a settlement in a personal injury lawsuit. Plaintiff filed an unopposed motion for court approval of the settlement and a determination of the need for and amount of an MSA. The court examined documents submitted by the plaintiff’s physician, who estimated future medical costs of $4,500.00. The court approved an MSA in that amount to be paid from plaintiff’s settlement proceeds. The court also held that, to the extent the plaintiff received confirmation from Medicare of any previous conditional payments, he was required to promptly reimburse Medicare from his settlement funds.
Source: themedicarespa.com

Dawson Disantis & Myers, LLC: Ohio BWC Implements New Medicare Set

As most Ohio self-insured employers know, one of the most difficult hurdles in settling a workers’ compensation claim is the Medicare Set-Aside.  On November 5, 2012, BWC Administrator Stephen Buehrer announced a new BWC policy which addresses the MSA threshold for state funded settlements.  BWC will issue a Medicare set-aside letter only if 1.) the settlement is $100,000 and over or 2.) if the settlement is over $10,000 and the injured worker is already on Medicare or has a reasonable expectation of receiving Medicare within 30 months. While Buehrer’s policy announcement appears to address settlement of state fund claims, self-insured employers can look to the BWC’s MSA thresholds for guidance.  Of course, Dawson Disantis & Myers, LLC encourages SI employers to discuss MSA for Ohio workers’ compensation settlements further with legal counsel. Buehrer’s MSA policy letter is below:
Source: blogspot.com

What Is The Medicare Set Aside?

There are three main situations where the government gets involved with the settlement. In all three cases, funds must be allocated for use in payment of expenses that would otherwise pass to the government insurance program. This is referred to as a set aside, and requires appropriate Medicare set aside administration. This is required in three situations. If the individual is currently benefitting from Medicare, the fund must be established and will be the initial source of funding for all payments that would regularly have been paid by the government organization. If the individual is expected to become a beneficiary within 30 months from the date of settlement (not the date of injury) then money must be set aside. Finally, if the amount is over $250,000, MSA administration and creation will be necessary.
Source: webjason.com

How I became a health policy wonk, my favorite policy charts, and what’s ahead for health reform

Posted by:  :  Category: Medicare

Senate Dems Protest Medicare Cuts by Talk Radio News ServiceHarold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago and a nonresident fellow of the Century Foundation. He has written about health policy for the Washington Post, New York Times, New Republic, The Huffington Post and many other publications. In previous editions of Curbside Consult, Pollack interviewed blogger Austin Frakt (The Incidental Economist), health policy historian Paul Starr and economist Jonathan Gruber.
Source: healthinsurance.org

Video: Compare Medicare Supplement Plans | Supplemental Medicare Insurance

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

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

Daily Kos: Insurers hoping for billions in Medicare profits back Paul Ryan budget supporters

Health insurers love the idea of the Romney/Ryan plan to turn Medicare into a voucher system. They love it so much that they are rewarding all of the Republicans who voted for it, according to new analysis by Public Campaign Action Fund (PCAF) and Health Care for America Now (HCAN). A Romney-Ryan victory coupled with a Republican takeover of the Senate would boost health insurance company stock prices by 10 to 20 percent, according to Citigroup analyst Carl McDonald. Based on share prices on Aug. 18, the day McDonald published his report, a GOP sweep in Washington would quickly jack up the total market value of the 10 largest health insurers by $12 billion to $25 billion. […]
Source: dailykos.com

GOP opposes its own goals on Medicare

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

Obamacare ‘Surprise’ Threatens Access to Medicare Advantage Coverage, AMAC Charges

The Association of Mature American Citizens [http://www.amac.us] is a vibrant, vital and conservative alternative to those traditional organizations, such as AARP, that dominate the choices for mature Americans who want a say in the future of the nation.  Where those other organizations may boast of their power to set the agendas for their memberships, AMAC takes its marching orders from its members.  We act and speak on their behalf, protecting their interests, and offering a conservative insight on how to best solve the problems they face today.
Source: amac.us

Ins & Outs of Medicare

Our presenter, David Smith, served for 20 years as the attorney of the New York State Department of Health, was the CFO of a New York acute-care hospital, and currently sits on the Board of Directors for the Southern Maine Agency on Aging.
Source: oceanviewrc.com

The Ins and Outs of Medicare

Next is the step involving supplemental plans.  In order to purchase a Medigap policy you must be enrolled in Medicare coverage.  Enrolling in Medigap begins on the first day of the first full month that you are sixty five or have enrolled in Part B Medicare and ends after six months.  This is the period in which an insurance company must waive all exclusions such as pre-existing conditions and accept all participants.  The must also allow your coverage to begin immediately.  After the six months insurers have the right to deny selling you a particular Medigap Supplemental Plan.
Source: 123medigap.com

Medicare Battle Heats Up California House Race

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

Poll: Americans Overwhelmingly Oppose Raising the Medicare Retirement Age

Hopefully the combination of the idea being both unpopular and unsound will prevent it from being part of any fiscal cliff deal, but the fact that the idea is still being discussed is a perfect symbol of what is wrong with the current dialog in Washington. Politicians promoting bad and unpopular ideas are treated as serious thinkers instead of psychopaths, because advocating for needlessly hurting poor people is somehow seen as a badge of courage.
Source: firedoglake.com

High court rejects Medicare challenge

Posted by:  :  Category: Medicare

New Online Rx System Makes UM Student 'Top Entrepreneur' Finalist by University of Maryland Press ReleasesWASHINGTON— The Supreme Court has turned away a challenge from former House Majority Leader Dick Armey and other Social Security recipients who say they have the right to reject Medicare in favor of continuing health coverage from private insurers.
Source: thedailyrecord.com

Video: Activists Advocate for Medicare-for-All as a Human Right

Maryland misses latest Medicare waiver goal

Maryland health care leaders have blown past another deadline they set for themselves to submit a proposal for a revised Medicare waiver. And this time they’re not bothering with a new deadline. The state has been working on a plan for revising its Medicare waiver for months and along the way setting — and passing — goals for completing the task. Most recently health officials said they planned to submit a proposal to the Centers for Medicare and Medicaid Services on Dec. 17. The date appeared…
Source: ewallstreeter.com

Hospital News: Nantucket’s Paradox; Maryland Overbilling; Calif. Fee Complication

California Healthline: Hospital Tax May Go To Reserve The state budget proposed by Gov. Jerry Brown extends the Hospital Quality Assurance fee, which is due to expire at the end of 2013. The complicated fee structure was originally planned to gather about $2.8 billion from private hospitals over the 30-month life of the fee. Some of the money is used to tap federal matching money, which benefits both hospitals and the state. … The issue for private hospitals, [Jan Emerson-Shea, of the California Hospital Association] said, is that the state wants to use the fee money to salt away a general fund reserve — and the hospitals want it to go to health care services (Gorn, 1/14).
Source: kaiserhealthnews.org

Northrop Grumman's New Maryland Facility to Support Social Security and Medicare NYSE:NOC

“Our new facility is a commitment by the company to SSA and CMS’s home base in the Woodlawn area, and will bring new jobs and economic growth to the area,” said Amy Caro, vice president for Health IT, Northrop Grumman Information Systems. “We hope to expand our current support of both agencies through continuing technological improvements and leveraging Northrop Grumman’s unique IT capabilities. We have approximately 600 people in the area supporting these customers and we expect this support to expand, along with our other health IT programs, in the coming contract years.”
Source: globenewswire.com

Ethics Opinions Underscore Problems That Medicare Liens Create when Negotiating Settlements

In the absence of an agreement to indemnify from the plaintiff’s attorney, another alternative would be that the defendant/insurer would distribute the money to the plaintiff’s attorney, and the plaintiff’s attorney would agree to maintain an amount equal to or greater than the full amount of the lien until the final lien amount is negotiated.  In this scenario, the attorney is not taking on the client’s obligations, but rather is being held to his word that the lien will be protected, assuming the plaintiff consents to the withholding of some funds.  The plaintiff can receive some of the settlement funds immediately, but the defendant/insurer is assured that a sufficient amount will be held back to guarantee that the asserted lien is protected.  It is seemingly a better solution to the problem.  However, as may be evident, similar ethical concerns are raised by this scenario as well, and the MD Committee on Ethics has also had occasion to address it.  According to the Committee, it is questionable whether the plaintiff’s attorney can ethically agree to such an arrangement.  The Committee, in reviewing this practice, has expressed concerns that the plaintiff’s attorney would be violating the aforementioned ethical rules regarding the safekeeping of property of the client and/or a third party.  Under these ethical rules, the settlement funds belonging to a party may be placed in an interest bearing account, where the interest must be provided to the party.  However, the funds belonging to one person may not be placed in an interest bearing account where the interest will be credited to someone else.  The question, then, as the Committee sees it, is who do the funds belong to at the time they are given to the plaintiff’s attorney: the plaintiff, the third-party, or both?  Keeping in mind that the assertion of a lien is not the same thing as a ruling that the lien is valid, the Committee has decided that the plaintiff’s attorney must consider the legal question of when a lien holder has “ownership” of the funds.  Given the Committee’s Opinion on this matter, plaintiff’s attorneys are left to analyze when and whether the lien holder becomes the owner of the funds.  If it is the owner of the funds, then the attorney cannot ethically hold it.  Given this dilemma, and absent a controlling opinion from Maryland appellate courts, one would think that most plaintiff’s attorneys will be cautious and decline to agree to maintain the funds for “safe keeping” in order to avoid the risk of committing an ethical violation.
Source: mdliability.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

Maryland’s health insurance exchange gets green light from feds

“Today’s approval by the Centers for Medicare & Medicaid Services is an important milestone for our state and for the Maryland Health Benefit Exchange,” said Lt. Gov. Anthony Brown, who leads the O’Malley-Brown Administration’s health care reform efforts. “Our progress has been the result of insurance producers, carriers, third-party administrators, health care providers, advocates, and consumers coming together to build a marketplace that will best meet the needs of individuals and small businesses throughout Maryland.”
Source: ifawebnews.com