ICYMI: New York Times Economix Blog Highlights Higher Quality Care Medicare Advantage Plans Provide

Posted by:  :  Category: Medicare

Medicare for All by juhansonin3rd Party Studies ACOs Admin Costs affordability Age Rating Cadillac Tax cbo Cost-Shift Employers Essential Benefits Exchanges GRP Health Insurance Tax Health Plan Innovations Health Plan Satisfaction House hearings House legislation HSAs KI MA McCarran-Ferguson Medical Prices Medical Tests medicare medigap MedMal MLR Morning Headlines MT Patient Safety premiums Profits Provider Consolidation PWC Quality Rate Review Readmissions Reform RZ Senate hearings Senate legislation Small Business The Link Vilification Waste Fraud and Abuse
Source: ahipcoverage.com

Video: Centers for Medicare & Medicaid Services’ (CMS) Hospital Acquired Conditions

The DD News Blog: Important Medicare case settlement awaits final approval

  An agreement has been reached in a class action lawsuit that is especially important to people covered by Medicare who have chronic or debilitating medical conditions from which they may not recover or improve. In the final stage of the settlement process, a Fairness Hearing will be held on January 24, 2013 to determine whether the agreement is “fair, reasonable, and adequate”, after which a final judgment may be issued to approve the settlement. In  Jimmo v. Sebelius, No. 11-cv-17 (D.Vt.), the plaintiffs contend that Medicare has for years illegally restricted coverage of skilled nursing and therapy services  only to beneficiaries who showed improvement. Beneficiaries who needed services to maintain their status or to slow deterioration were denied services on the basis that they would not improve. A settlement that was signed by the Chief Judge for the District of Vermont on November 20, 2012 would overturn the “improvement standard” and require that skilled nursing and therapy services necessary to maintain a person’s condition can be covered by Medicare. [Visit the Web site for Center for Medicare Advocacy, Inc.  for the most complete information on the case that includes Frequently Asked Questions, personal stories, and links to important documents.] The federal Centers for Medicare and Medicaid Services (CMS) has agreed to revise the Medicare Benefit Policy Manual to include new policy provisions. Skilled Nursing Facilities, Home Health Services, and Outpatient Therapy Services, including outpatient physical and occupational therapy and speech pathology services, will be covered “to perform a maintenance program [that] does not turn on the presence or absence of a beneficiary’s potential for improvement from the therapy, but rather on the beneficiary’s need for skilled care.”
Source: blogspot.com

Centers for Medicare & Medicaid Services to launch ‘medical neighborhood’

In the wake of the Supreme Court’s ruling to uphold the Affordable Care Act, approximately 30 million uninsured Americans, under age 65, stand to gain coverage under the law. As decisions are made and plans put in place, one thing is certain: When the exchange population is combined with the new Medicaid beneficiaries, the result will be a distinctly different customer base for the health sector, bringing with it many new challenges and opportunities. Register now!
Source: fiercehealthit.com

Cops: Fugitive behind $1 million Medicare fraud nabbed in Canada

I personally know of 9 cases here in just one small area of Michigan that total almost 2 million, one defendant sentenced to 10 years and others have fled the country. Does anyone else thinks it time to stop screaming about cuts, and see what it would actually cost if it was administered correctly. Here its mostly Pakistani, Indian, and African doctors that operate for about three to five years before being indighted and then flee before trial. (these are just what I have seen and not a judgement on other well meaning doctors) My mother, for example, has retired from two jobs and has health care coverage for the rest of her life. She is the kind of person that looks at the bill, even if it is not hers. She had a little bit of a health scare and had to go to the hospital. When it was all said and done she found 5 different times that a service was double billed, billed without it being performed, or billed incorrectly. Most of those losses would have been to medicare, because private insurance denies first and pays second.
Source: nbcnews.com

Medicare preventive services: What’s free, what’s not

Medicare also offers several other preventive services that require some out-of-pocket cost-sharing. With these tests, you’ll have to pay 20 percent of the cost of the service (Medicare picks up the other 80 percent), after you’ve met your $147 Part B yearly deductible. The services that fall under this category include digital rectal exams for prostate cancer, glaucoma tests, and diabetes self-management training services.
Source: pomeradonews.com

Medicare Changes for 2013 and Beyond

Most notable for 2013 is Medicare’s new policy for Transitional Care Management services. Medicare will pay a patient’s physician or practitioner to coordinate their care, 30 days following a hospital or skilled nursing stay. Compensation to Medicare providers will be more directly tied to patient outcomes, which can include a reduced reimbursement for your doctor and hospital if you return to the hospital within 30 days for the same issue.
Source: centralcoastseniorservices.com

Center for Medicare & Medicaid Services: 106 Additional Medicare ACOs Announced

The Centers for Medicare and Medicaid Services (CMS) has announced the approval of an additional 106 accountable care organizations (ACOs) through the Medicare Shared Savings Program.  These newly approved ACOs bring the total number of ACOs approved by CMS to over 250 organizations. In total, Medicare’s ACO partners will serve more than 4 million beneficiaries nationwide.  Federal savings from this initiative could be up to $940 million over four years.
Source: ignatiusbau.com

Medicare to Cover More Home Health Services

Just in time for the New Year 2013! In the past, Medicare recipients were unable to receive home health services such as nursing care and therapies if they had a chronic condition. As a result of a court case that originated in Vermont, that is about to change. Vermont Chief Judge Christina Reiss will sign off on the settlement after a hearing on January 24, 2013. The settlement will apply nationally, and it will mean a big change from the current practice. At present, the Medicare recipients had to have had a reasonable chance of recovering from the condition before they could receive rehabilitative services in the home. Of course, sometimes it is difficult to make that prediction, so this ruling represents a giant step forward for patients. Now, they will be able to receive skilled nursing services as well as speech therapy and occupational therapy in the home, despite the fact that the patient may not fully recover. Those enrolled in both fee-for-service Medicare and private Medicare Advantage plans will also have this option.
Source: rothkofflaw.com

Are you ready for 2013? 4 questions to ask yourself

Don’t forget, if you have Medicare Part B and are in Original Medicare, you’ll have to meet your deductible before your Medicare coverage pays for services and supplies. Next year, the Medicare Part B deductible will be $147. Make sure to plan your health care budget to account for the increased cost of doctor visits for the time that it will take to cover your deductible.
Source: medicare.gov

Proposed Settlement May Expand Medicare Coverage for Important Services

According to a story in the New York Times, “Federal officials agreed to rewrite the Medicare manual to make clear that Medicare coverage of nursing had therapy services does not turn on the presence or absence of an individual’s potential for improvement, but is based on the beneficiary’s need for skilled care.”
Source: mindingoureldersblogs.com

Volunteer Medicare Counselor: HICAP Services of Northern California Opportunity

Assist Senior Citizens in your community by helping them to navigate the Medicare maze. Become a Registered Volunteer HICAP Counselor and join a group of energetic, well-trained, computer-literate retirees who counsel individuals, on a one-to-one basis, about Medicare. HICAP provides extensive training & mentorship. Our next training session begins in February, 2013. Opportunities in these counties: Nevada, Yuba/Sutter, San Joaquin, Yolo, Sacramento, El Dorado, Placer.
Source: volunteermatch.org

Despite Potential Benefits, Medicare Slow to Utilize Telehealth

Health, Person Location, Person Career, Quotation, Telehealth, Health informatics, Medicare, EHealth, American Telemedicine Association, Medicine, Technology, Medical informatics, Videotelephony, telemedicine, Presidency of Lyndon B. Johnson, telehealth services, USD, Jonathan Linkous, Chicago, Institute of Medicine, Mike Thompson, California, stroke, stroke care, bipartisan Fostering Independence Through Technology, Richard Brennan Jr., telehealth technologies, dozen services, certain telehealth services, chief executive officer, John Thune, practicing neurologist, Lee H. Schwamm, American Heart Association, Harvard Medical School, acute stroke, bypass, video conferencing, National Association for Home Care & Hospice, chronic care management, Medicare Payment Advisory Commission, cessation services, reimbursable telehealth services
Source: reportingonhealth.org

Settlement May Bring Easier Qualifications for Medicare Saginaw Michigan

Posted by:  :  Category: Medicare

DC Voting Rights by dbkingThe result of a nationwide class-action suit and an agreement from the administration may change the course of Medicare qualifications, which is hopeful news for those who previously had been left without coverage. As it stands, beneficiaries must show a probability of improvement before Medicare will approve therapy and skilled nursing care. Ditching this age-old practice could mean huge relief to those with chronic or long-term conditions. For a perspective on the proposed settlement, turn to a recent article in The New York Times titled “Settlement Eases Rules for Some Medicare Patients.” The Medicare board has had a longstanding practice to require a likelihood of medical or functional improvement before a beneficiary could receive coverage for skilled nursing or therapy services, whether institutional or home-based. That left many care recipients in a lurch. If this settlement goes through and becomes practice, then the requirement is no longer “improvement” but “maintenance.” Accordingly, Medicare will provide services if they are needed to “maintain the patient’s current condition or prevent or slow further deterioration.” Not only would this be beneficial for those who have chronic conditions such as Alzheimer’s and Parkinson’s disease, but also for the families who are financially overextended from providing care to their loved ones.
Source: jerryreiflawyer.com

Video: Medicare vs Medicaid 612-309-9184 Minnesota Medical Assistance Minneapolis Elder Law Attorney


Today, there are more than 60 million Americans enrolled in Medicaid—but what is Medicaid and how is it financed? This video explains how Medicaid is funded and how it will change under the Patient Protection and Affordable Care Act (PPACA). Video transcript Medicaid is a US healthcare program that finances the care of low-income and certain high-risk populations, including low-income children and families, people with developmental or physical disabilities, low-income nursing home residents, and others. Unlike Medicare—which is a federally funded and administered health insurance program available to everyone over 65, regardless of income—Medicaid is a need-based program funded jointly by the federal and state governments and administered at the state level. In 2009, Medicaid financed the care for nearly 20% of all Americans, making it the largest source of medical coverage for the country’s low-income population. In the coming years, under the Patient Protection and Affordable Care Act, Medicaid will expand to cover a much larger proportion of the population in certain states. And yet, despite the growing importance of Medicaid, most Americans do not understand how it is funded. Medicaid begins with a mix of federal and state funding. The federal government makes annual Medicaid payments to states based on their Federal Medical Assistance Percentages, or FMAPs. Each state’s FMAP—which is determined by a formula that looks at state per capita income relative to the US … views:
Source: wn.com

Medicare to Cover More Home Health Services

Just in time for the New Year 2013! In the past, Medicare recipients were unable to receive home health services such as nursing care and therapies if they had a chronic condition. As a result of a court case that originated in Vermont, that is about to change. Vermont Chief Judge Christina Reiss will sign off on the settlement after a hearing on January 24, 2013. The settlement will apply nationally, and it will mean a big change from the current practice. At present, the Medicare recipients had to have had a reasonable chance of recovering from the condition before they could receive rehabilitative services in the home. Of course, sometimes it is difficult to make that prediction, so this ruling represents a giant step forward for patients. Now, they will be able to receive skilled nursing services as well as speech therapy and occupational therapy in the home, despite the fact that the patient may not fully recover. Those enrolled in both fee-for-service Medicare and private Medicare Advantage plans will also have this option.
Source: rothkofflaw.com

Refresher: Medicare’s Accreditation Requirements for Advanced Imaging Services

At the risk of oversimplification, the Anti-Markup Rule prohibits a practice from billing Medicare for the technical and professional components of diagnostic tests unless the practice complies with one of two tests, which will be difficult for most practices to comply with when the accreditation requirement goes into effect. Further, the IOAS exception to the Stark Law is the main exception to the Stark Law that permits practices to bill Medicare and Medicaid for ancillary services, including diagnostic imaging tests and nuclear medicine. Compliance with the IOAS exception’s physician supervision requirement is more difficult with this accreditation requirement.
Source: milliganlawless.com

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

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

How Do I Qualify for an EHR Grant?

The government wants to make your practice better. Electronic health records (EHR) will revolutionize medical data management over the next several years, saving the government billions of dollars. In order to improve the efficiency of Medicare and Medicaid, they are offering a grant to medical and dental practices willing to make the switch to EHR. Your practice will be streamlined, and everyone will save money. It’s difficult to see a downside.
Source: totalehr.com

New Medicare Tax for High

Posted by:  :  Category: Medicare

HERES YOUR TOP TEN by SS&SSIt’s actually two separate taxes, depending on the source of income.  There will be a 3.8 percent tax on investment income for individuals with adjusted gross income above $200,000, or $250,000 for married couples filing jointly.  The same high-income taxpayers will pay an additional Medicare tax of 0.9 percent on wages and self-employment income above the income thresholds.
Source: bennettlaw.com

Video: Best Democrats’ Debate Yet -Clearest, Quickest Answers-Pt J

Medicare Part B Premiums Up $5 Per Month Next Year

CQ HealthBeat: Medicare Part B Premium Increase Modest For 2013 With health care inflation relatively stable, officials at the Centers for Medicare and Medicaid Services released rules Friday that include a $5-per-month increase in Medicare Part B premiums and a $28 hike in the hospital inpatient deductible. The Part B premium will reach a milestone, however, topping $100 a month. The monthly payment for Part B, which covers doctor visits, outpatient hospital services, home health care and other items, will be $104.90 next year, compared to the current $99.90. And the deductible for inpatient hospital stays will go to $1,184 in 2013 from $1,156 this year. One item will be decreasing: the Part A monthly premium, which pays for inpatient hospital stays, skilled nursing facilities and some home care for about 1 percent of Medicare beneficiaries who do not automatically qualify for the program. That premium will be $441 a month, down $10 a month from this year (11/16).
Source: kaiserhealthnews.org

Brad DeLong : Boehner Breaks the Money

House Republicans signaled Thursday they will not follow rules in President Obama’s healthcare law that were designed to speed Medicare cuts through Congress…. The rules package says the House won’t comply with fast-track procedures for the Independent Payment Advisory Board (IPAB)…. House Republicans have tried unsuccessfully to repeal the IPAB, the central cost-cutting feature in the Affordable Care Act. The IPAB was designed to take Medicare payments largely out of Congress’s hands, similar to the independent panel that recommends closing military bases, because lawmakers would rarely sign off on such politically risky moves….
Source: typepad.com

Medicare Part D: A First Look at Part D Plan Offerings in 2013

NOTE: Originally released in October 2012, this data spotlight was updated in November 2012 to reflect revised data from the Centers for Medicare and Medicaid Services. 
Source: kff.org

Where is that Trust Fund?

Arguing for raising the federal debt ceiling, CNNMoney says today (1/16), “The standoff over the debt ceiling…threatens to stiff a lot of people owed money by the government. Among them: more than 55 million Social Security recipients.” The answer it gives to its own headline, “Debt ceiling: Is Social Security at risk?” is: Yes, Social Security is at risk.
Source: aei-ideas.org

Your Money Matters: Healthcare in Retirement

Medigap In general Medigap is supplemental insurance specifically designed to cover some of the gaps in Medicare coverage. Although the name might lead you to believe otherwise, Medigap is provided by private health insurance companies, not the government. However, Medigap is strictly regulated by the federal government. There are 10 standard Medigap policies available (Plans E, H, I, and J are no longer available for sale, however, if you already have one of these plans you can keep that plan). All plans may not be offered in your state, yet all are standardized and certified by the U.S. Department of Health and Human Services so that each plan provides exactly the same kind of coverage no matter what state you live in (except for Massachusetts, Minnesota, and Wisconsin, which have their own standardized plans). Every Medigap policy offers certain basic core benefits, such as coverage of certain Medicare Part A and B coinsurance and co-payments. Other plans offer additional benefits, such as coverage of Medicare Part A and B deductibles, and charges that result when a provider bills more than the Medicare-approved amount for a service. Medicaid
Source: wgntv.com

Mother/Daughter Team: On Working Together & Making Medicare Easy

Previously, Diane (mother) and her husband owned a company that serviced home health agencies for over 23 years. Having navigated the changes in Medicare in 1998-1999 that eliminated over 30% of their customer base overnight, she was well aware of how complex and changeable the Medicare space is. Frustrated by the lack of unbiased education for consumers (much of the education out there is provided or sponsored by insurers), Diane and her daughter Melinda started 65 Incorporated, officially launching it in October 2012 following a non-compete period from previous company relationships. Melinda’s unbridled enthusiasm for capitalizing on the huge opportunity was very evident in our conversation. After all, she shared that 10,000 Baby Boomers a day will turn 65 through 2030. That’s a lot of consumers trying to navigate the complex, confusing maze of Medicare.
Source: blogher.com


“Eligibility and Take-up of the Medicare Part D Low-Income Subsidy,” by J. Samantha Shoemaker, Amy J. Davidoff, Bruce Stuart, Ilene Zuckerman, Eberechukwu Onukwugha, and Christopher Powers – Concern exists that many people eligible for the Medicare Part D low-income subsidy (LIS) are not enrolled in the assistance program, which can reduce prescription drug plan premiums and cost-sharing. This study found that published literature tends to over represent the LIS-eligible population and thus the portion not receiving the subsidy, while a third of potentially eligible people remain unenrolled. Incorporating supplementary data on income and assets into information from the Medicare Current Beneficiary Survey (MCBS) enhances “the ability to draw appropriate conclusions about eligibility and take-up of the LIS,” the authors write.
Source: readmedia.com

Proposed Regulations Explain 3.8 Percent Medicare Tax on Net Investment Income : The Venture Alley : Entrepreneurs, Startups, Venture Capital, Angel Investors

Posted by:  :  Category: Medicare

In honor of Tax Day by swanksalotThese proposed regulations, released at the end of November along with accompanying frequently asked questions, provide taxpayers and their advisors much needed guidance in interpreting the statutory provisions imposing this tax. Despite application of the tax beginning in 2013, the effective date of the proposed regulations has been delayed until January 1, 2014. To assist taxpayers, the IRS has stated that taxpayers may rely on the proposed regulations for compliance purposes until publication of final regulations under Section 1411, which is anticipated to occur during 2013. The proposed regulations indicate that the IRS will closely review transactions that manipulate a taxpayer’s “net investment income” to reduce or eliminate the amount of tax imposed by Section 1411 and will challenge such transactions based on applicable statutes and judicial doctrines. Therefore, careful tax planning to accommodate this new tax is essential. Among other things, these proposed regulations provide definitions of operative phrases and terminology in the statute, indicate where definitions used elsewhere in the Code should be incorporated into the statute, identify how certain entities are treated under Section 1411, expand income categories potentially subject to the tax, allow taxpayers to regroup activities with respect to the passive activity grouping rules and describe how the tax applies to dispositions of interests in passthrough entities and income/distributions from certain foreign entities.
Source: theventurealley.com

Video: Medicare

Denver Debate: The Candidates Discuss Medicare

So, I don’t think vouchers are the right way to go. And this is not only my opinion. AARP thinks that the savings that we obtained from Medicare bolster the system, lengthen the Medicare trust fund by eight years. Benefits were not affected at all. And ironically, if you repeal Obamacare, and I have become fond of this term, “Obamacare,” if you repeal it, what happens is those seniors right away are going to be paying $600 more in prescription care. They’re now going to have to be paying copays for basic checkups that can keep them healthier.
Source: kaiserhealthnews.org

Politico: Mitt Romney tries to explain Medicare stance

Those were the words he scrawled on a whiteboard at a last-minute news conference in Greer, S.C. this afternoon as he attempted to address questions about whether his plan is identical to that of Paul Ryan’s. Romney chose Ryan as his running mate last weekend, and the Wisconsin lawmaker is best known for a budget-slashing effort that would convert Medicare into a voucher program for some future seniors.
Source: laaacoalition.org

Romney holds press conference, uses whiteboard to explain Medicare

The Black Panthers have already implied they will do violence to whites & tea party patriots. The DOJ let Black Panthers off after they intimidated voters on tape in 2008. Obama is counting on their help to cheat again & stay in office. The DOJ & DHS will not protect us at polls and they want to make us afraid to come out for R & R rallies and to vote. Stand up now or we will become eternal slaves of the crime syndicate in control. Google Robert Holmes, FICO, Libor bank scandal, NY Fed Reserve. ANYTHING the paid off liberal media says DO NOT BELIEVE. NoMoreFakeNews.com http://www.theblaze.com/stories/why-is-homeland-security-buying-450-million-rounds-of-hollow-point-bullets/
Source: therightscoop.com

Mitt Romney Uses White Board to Explain Medicare Plan

Mitt Romney pulled out a white board on the campaign trail to prove how smart he is and over-simplify the difference between his and President Obama’s Medicare plans. ThinkProgress quickly responded with their own white board presentation showing what will actually happen.
Source: gotchamediablog.com

Daily Kos: I Hate Explaining the Medicare “Donut Hole” (Updated with explanation of donut hole)

I had a chance to talk to Tom Scully, the head of HMS at the time and the creator of Plan D and the donut hole about why he did it. There were two reasons. First, he had a budget of $400 billion over ten years for the program so he had to design something that hit his budget target and he did a great job on that. Medicare Part D is the only government health program where the ten year cost was actually under the budget estimate. I think it came in at $380 billion. The second reason was to make seniors really think about generics and switching from higher priced brand name drugs to lower cost generic substitutes. And that part worked as well. You need to remember that before Part D all prescriptions were out of pocket expenses for seniors on Medicare, so even with the donut hole Part D was a big benefit.
Source: dailykos.com

New York Times Wages War on Medicare and Social Security

Visit his blog site at sjlendman.blogspot.com and listen to cutting-edge discussions with distinguished guests on the Progressive Radio News Hour on the Progressive Radio Network Thursdays at 10AM US Central time and Saturdays and Sundays at noon. All programs are archived for easy listening.
Source: warisacrime.org

Awesome: Mitt Romney Uses White Board To Explain Medicare to Press (video)

This entry was posted in 2012 Primary, Budget, Elite Media, Mitt Romney, Obama, Paul Ryan, True Talking Points and tagged elite media, media journalists, occupy-wall-street, politics. Bookmark the permalink.
Source: politicalarena.org

Romney Tries to Explain Medicare Stance Vis

But after the 10-minute and 11-second news conference, Romney shed no new light on how he would overhaul the 47-year-old federal health care program for senior citizens and how (or if) his program differs from that of his running mate’s much-maligned proposal that is part of an effort to slash the federal budget deficit.
Source: sayitaintsoalready.com

FAQ: Decoding The $716 Billion In Medicare Reductions

Posted by:  :  Category: Medicare

Ryan’s plan also calls for an overhaul of the program, offering beneficiaries a set amount of money that they would use toward buying a private plan or traditional Medicare. Democrats have argued that such a fundamental change could undermine the traditional Medicare program, because private plans might tailor their coverage to attract healthier beneficiaries, leaving sicker beneficiaries in traditional Medicare. Critics of Ryan’s plan also predict it will force seniors to eventually pay more for their health care because the federal payments will be capped at the rate of gross domestic product plus half a percentage point, an amount that may not keep up with the increase in medical costs. Under Ryan’s plan, insurers would have to provide benefits that are at least equal the value of those offered in traditional Medicare. 
Source: kaiserhealthnews.org

Video: Medicare Advantage vs. Medicare Supplement Insurance

Proposed regs clarify the new 0.9% additional Medicare tax

Good news: The proposed regulations closely track FAQs the IRS issued last summer, so you don’t need to make many changes to your software to withhold this additional tax. And, since there’s no employer match, the regs follow the income tax withholding rules for adjusting over- or underwithholding of this tax. The regs also clarify the interplay between FICA and SECA. You may rely on these proposed regs until final regs are issued. (77 F.R. 72268, 12-5-12)
Source: businessmanagementdaily.com

Despite Potential Benefits, Medicare Slow to Utilize Telehealth

Health, Person Location, Person Career, Quotation, Telehealth, Health informatics, Medicare, EHealth, American Telemedicine Association, Medicine, Technology, Medical informatics, Videotelephony, telemedicine, Presidency of Lyndon B. Johnson, telehealth services, USD, Jonathan Linkous, Chicago, Institute of Medicine, Mike Thompson, California, stroke, stroke care, bipartisan Fostering Independence Through Technology, Richard Brennan Jr., telehealth technologies, dozen services, certain telehealth services, chief executive officer, John Thune, practicing neurologist, Lee H. Schwamm, American Heart Association, Harvard Medical School, acute stroke, bypass, video conferencing, National Association for Home Care & Hospice, chronic care management, Medicare Payment Advisory Commission, cessation services, reimbursable telehealth services
Source: reportingonhealth.org

Medicare Tax on High Wage Earners

When must an employer withhold Additional Medicare Tax? The statute requires an employer to withhold Additional Medicare Tax on wages or compensation it pays to an employee in excess of $200,000 in a calendar year. An employer has this withholding obligation even though an employee may not be liable for the Additional Medicare Tax because, for example, the employee’s wages or other compensation together with that of his or her spouse (when filing a joint return) does not exceed the $250,000 liability threshold. (See Q&A-3.) Any withheld Additional Medicare Tax will be credited against the total tax liability shown on the individual’s income tax return (Form 1040).
Source: holdenagency.com

FAQ on additional Medicare tax effective 1/1/13 now available

The IRS recently published a new FAQ on the new Medicare taxes that will impact taxpayers with incomes over $250k if filing jointly, $125k if filing separate, and $200k for all others. Read through the details of this new tax here.
Source: andersontaxgroup.com

Health Informatrix: New Medicare FAQ for CAHs

We want to help keep you updated with information on the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. CMS has recently revised an FAQ with new guidance that discusses whether critical access hospitals (CAHs) in the Medicare EHR Incentive Program can include costs for capital leases of certified EHR technology. Take a minute and review the new FAQ below.
Source: healthinformatrix.com

LSU doctors and Peoples Health look to improve treatment of chronic diseases

Solomon said the physician-owned plan is working to put in place teams of medical professionals to assist physicians across south Louisiana in helping patients tackle their health problems. Solomon said that means, for example, making available a social worker that physicians can call to go to a patient’s home if that person can’t go to the doctor’s office. Teams will also include nurse practitioners, nurses and dieticians.
Source: nola.com

Fiscal cliff provision spells huge Medicare payment cuts for SNFs, analysis shows

At issue is the Multiple Procedure Payment Reduction provision of ATRA. The provision cuts the Medicare Part B payment rate for beneficiaries who receive multiple therapy procedures during a single day. The ATRA reduction, effective April 1, 2013, came on the heels of a previous 2012 payment cut of 25% for those who receive multiple same-day therapies in inpatient settings such as SNFs.
Source: mcknights.com

FAQ: The Medicare EHR Incentive Program

Before dispensing incentive funds, the government wants to verify that eligible medical professionals are actively using EHR technology, not just purchasing it to avoid penalties. There is a list of minimum of criterion that medical professionals must meet to prove they will “meaningfully use” certain features of their EHRs. These requirements specify that an EHR must support 10 mandatory features, in addition to five optional features out of a list of 10. Medical practitioners must be actively using these features on their EHR for at least 90 days to meet government requirements for the incentive.
Source: softwareadvice.com

Medicare to penalize hospitals for readmitted patients

Excessive rates of readmission are only part of the problem of high costs and uneven quality in the U.S. health care system. While some estimates put readmission rates as high as 20 percent, a congressional agency says the level of preventable readmissions is much lower. About 12 percent of Medicare beneficiaries who are hospitalized are later readmitted for a potentially preventable problem, said the Medicare Payment Advisory Commission, known as MedPAC.
Source: publicradio.org

Mother/Daughter Team: On Working Together & Making Medicare Easy

Previously, Diane (mother) and her husband owned a company that serviced home health agencies for over 23 years. Having navigated the changes in Medicare in 1998-1999 that eliminated over 30% of their customer base overnight, she was well aware of how complex and changeable the Medicare space is. Frustrated by the lack of unbiased education for consumers (much of the education out there is provided or sponsored by insurers), Diane and her daughter Melinda started 65 Incorporated, officially launching it in October 2012 following a non-compete period from previous company relationships. Melinda’s unbridled enthusiasm for capitalizing on the huge opportunity was very evident in our conversation. After all, she shared that 10,000 Baby Boomers a day will turn 65 through 2030. That’s a lot of consumers trying to navigate the complex, confusing maze of Medicare.
Source: blogher.com

IRS Releases New Information About Medicare Tax Surcharges

The IRS released a lovely FAQ today about the 0.9% surcharge that applies wages, self-employment earnings and other compensation above $200,000 (single filers) / $250,000 (joint filers). When this surcharge applies to wages, employers are required to withhold it, but the withholding rules are a bit strange. Taxes won’t be withheld until you receive that first dollar in compensation in excess of $200,000; taxes might be withheld even if the surcharge won’t ultimately apply to you because your spouse is not employed; and taxes might not be withheld even if the surcharge will apply to you, because you and your spouse together earn more than the threshold. The FAQ explains these peculiar rules, both from the employee’s and the employer’s perspective.
Source: perkinsaccounting.com

Cigna Announces New Medicare Supplement Product

Posted by:  :  Category: Medicare

Cigna Corporation (NYSE: CI) is a global health service company dedicated to helping people improve their health, well-being and sense of security. All products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including American Retirement Life Insurance Company. Such products and services include an integrated suite of health services, such as medical, dental, behavioral health, pharmacy, vision, supplemental benefits and other related products including group life, accident and disability insurance. Cigna maintains sales capabilities in 30 countries and jurisdictions, and has approximately 71 million customer relationships throughout the world. To learn more about Cigna
Source: dlvr.it

Video: Lucid Insurance Services | Individual Health Insurance, Health Plans, Medicare Advantage, Folsom, CA

Government Issues CIGNA Government Services Federal Medicare Contracts Awarded Prestigious Quality Management Certification

CIGNA Government Services today announced it has again achieved the prestigious International Organization for Standardization (ISO) 9001:2008 certification, an internationally accepted quality management system. Certification includes all CGS Part B and Durable Medical Equipment Medicare Administrative Contractor (DME MAC) Program Management functions under contract with The Centers for Medicare and Medicaid Services (CMS). ISO 9001:2008 certification requires organizations to develop and adhere to stringent quality management standards and to have controls and mechanisms in place to comply with all regulatory requirements. The ISO 9001:2008 certification also requires processes that enhance customer satisfaction and ensure continual improvements. Companies are required to pass an exhaustive audit of all quality management processes prior to receiving certification. ‘This award recognizes CIGNA’s dedication to continuous quality improvement. Achieving this level of certification underscores the commitment we’ve made to our customers to continually raise the bar on performance,’ said Jean Rush, president of CIGNA Government Services. ‘We take very seriously our responsibility as a Medicare contractor and the positive impact we can have on the lives of millions of Medicare beneficiaries, providers of durable medical equipment and health care professionals. I am proud of our employees’ continued commitment to quality and performance excellence demonstrated by this certification.’ CIGNA Government Services has provided services to Medicare since 1991. In June 2007, CIGNA was awarded the largest of four DME MAC contracts to provide claims processing, customer service and administrative services to over 55,000 durable medical equipment, prosthetics, and orthotics suppliers in 15 states, including: Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia as well as the territories of Puerto Rico and the U.S. Virgin Islands. CIGNA also holds federal Medicare Part B contracts for North Carolina and Idaho.
Source: dmagovernment.com

Cigna Adds 10 Partners to Collaborative Accountable Care Program

Already in 2013, Cigna has added 10 members to its collaborative accountable care program, bringing the total number of members to 52. Cigna’s CAC program strives to achieve improved health outcomes, affordability and patient satisfaction. The program now covers about 510,000 customers in 22 states. As of Jan. 1, 2013, the following members joined Cigna’s program: BayCare Physician Partners (Clearwater, Fla.) Orlando (Fla.) Health Physician Partners Franciscan Alliance (Mishawaka, Indiana) Ochsner Clinic (Jefferson, La.) Central and Western Maine Regional PHO (Lewiston, Maine) Derry (N.H.) Medical Center Mt. Kisko (N.Y.) Medical Group Central Ohio Primary Care Physicians (Columbus) Palmetto Primary Care Physicians (Charleston, S.C.) Village Health Partners (Plano, Texas)
Source: beckershospitalreview.com

As new ACOs launch, CMS digs in for savings

Among the crop of ACOs launching this year, 15 are following the advanced payment model, which helps bring physician-based and rural providers a form of capital investment for infrastructure needed for care coordination, like electronic health record systems and information exchange capabilities.
Source: lawscribes.com

Top Medicare Part D Plan Costs Spike in 2013

The opinions expressed in WebMD User-generated content areas like communities, reviews, ratings, or blogs are solely those of the User, who may or may not have medical or scientific training. These opinions do not represent the opinions of WebMD. User-generated content areas are not reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other reason except for compliance with our Terms and Conditions. Some of these opinions may contain information about treatments or uses of drug products that have not been approved by the U.S. Food and Drug Administration. WebMD does not endorse any specific product, service or treatment.
Source: webmd.com

CIGNA Wins $243 Million Medicare Contract

The award is for Jurisdiction 15 Medicare Parts A and B Administrative Contract by the federal Centers for Medicare & Medicaid Services. It includes administration, processing and paying Medicare physician and hospital claims for the states of Kentucky and Ohio. It also includes home health and hospice claim processing services for Colorado, Delaware, Iowa, Kansas, Maryland, Missouri, Montana, Nebraska, North Dakota, Pennsylvania, South Dakota, Utah, Virginia, West Virginia, Wyoming and Washington, D.C.
Source: courant.com

CIGNA Government Services Awarded Medicare Contract

CIGNA Government Services (CGS) is a Durable Medical Equipment Medicare Administrative Contractor and Medicare Part B contractor for the Centers for Medicare & Medicaid Services (CMS). Headquartered in Nashville, Tennessee, CGS provides a variety of services for the federal Medicare program including claims processing, customer service, and claims payment for over 16 million Medicare beneficiaries, providers, and suppliers in 17 U.S. states and territories. For more information, please visit our web site at www.cignagovernmentservices.com. CIGNA Government Services, LLC is a subsidiary of Connecticut General Life Insurance Company.
Source: co.uk

Page not found : Stop The ACLU

Posted by:  :  Category: Medicare

Racism by elycefelizany idea when the new FTP access, and then they the same server (or a list of features for inclusion when you have some time file was submitted, rather than a poll have 66 of that remote server. I already have a downloader linked into my IPB – but I would like to see what this one offers, time i switch the numbers do most of the work renewal fee for which is. viagra emails viagra
Source: stoptheaclu.com

Video: 1/4/10 Arizona Mayo Clinic says cash only to Medicare

Arizona Federal Judge Affirms Denial Of Drug Coverage Under Medicare Part D

PHOENIX – An Arizona federal court judge on Dec. 11 affirmed a health plan’s denial of a prescription drug, agreeing that the drug is not covered under Medicare Part D (Penny Rickhoff v. United States Secretary for the Department of Health and Human Services, No. 11-2189, D. Ariz.; 2012 U.S. Dist. LEXIS 175206).Full story on lexis.com
Source: lexisnexis.com

Options for Medicare Beneficiaries discussed by an Arizona Broker

PRLog (Press Release) – Dec. 12, 2012 – Options available to Medicare Beneficiaries besides Original Medicare Medicare Part A which covers inpatient treatment for Medicare Beneficiaries and Medicare Part B which provides for outpatient services are both available to seniors and some people on disability under age 65 and is referred to as original Medicare.  However, original Medicare by itself can leave the senior with significant out of pocket expense. “As an Independent Insurance Broker in Arizona” states Ralph Bredahl with Arizona Medicare Advisors, “I find a lot of confusion among seniors on what is available to them to help with medical costs. I trust this list will help to answer some of the questions that I hear”   http://www.ArizonaMedicareAdvisors.com Medicare Supplement also called a Medigap plan; a supplement pays for many of the costs that are not covered by Medicare.  It is a separate plan and the company providing the coverage may ask health questions. There are certain times and situations where a beneficiary is guaranteed issue.  Also, there are several Medicare supplement plans available. Plan A, B, C, F, G, K, L, M and N.  Not all companies carry all plans. I won’t go into the differences here but it is important to point out that all plan types are the same with every company. In other words Plan F with company A will be the same basic coverage as Plan F with company B.  Arizona Medicare Advisors can answer your questions on plans in Arizona but consult a broker licensed in your state for particulars. http://ArizonaMedicareAdvisors.com Part D Prescription Drug Plan provides coverage for prescription drugs and has copays for various tiers of drugs. In addition, it has a premium that is paid by the beneficiary. Low income seniors can apply for assistance with the premiums and copays through social security. There is an open enrollment and special enrollment periods. If a senior declines to enroll when eligible they will have a penalty if enrolled later. As with Medigap Arizona Medicare Advisors can answer your questions on plans in Arizona but consult a broker licensed in your state for particulars Medicare Advantage is also known as part C. These plans are available in Arizona and in many other areas as well. Once again, check with your local broker. With a Medicare Advantage plan the beneficiaries opts to receive their medical coverage from a private company. The company must provide coverage as good as or better than original Medicare. The plans provide coverage for Part A and for Part B and often incorporate Part D into the plan. Like the Part D plans, Medicare Advantage plans are guaranteed issue and have open enrollment. There is also a disenrollment period if the senior wants to return to original Medicare. http://ArizonaMedicareAdvisors.com Ralph Bredahl Arizona Medicare Advisors.com 602-390-8573
Source: prlog.org

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

Medicare Advisory Specifies A Height Requirement For Custom AFOs

Arizona Extended L1960, L2330, L2820 Arizona Partial Foot L1940, L2330, L2820, L5000 Arizona Standard Short L1940, L2330, L2820 Arizona Standard Tall L1940, L2330, L2820 Arizona Unweighting L1960, L2330, L2820 Arizona Breeze L1940, L2330, L2820 Arizona Sporty L1940, L2330, L2820 Arizona Closed Toe Walker L1960, L2330, L2820, L3230, L3400 Arizona Neurowalker L1960, L2330, L2820, L3230, L3400 Moore Balance Brace L1940, L2330, L2820 Open Toe Walker L1960, L2330, L2820, L3230, L3400 Partial Foot Walker L1940, L2330, L2820, L3230, L3400, L5000 Thermoplastic AFO L1960 Thermoplastic Articulated AFO L1970 Thermoplastic Articulated AFO, Dorsi-Assist L1970, L2210 Split Upright AFO L2999 Split Upright AFO, Dorsi-Assist L2999
Source: safestepblog.net

Medicare Removes the “Improvement Standard”

As a result of this settlement, Medicare beneficiaries with chronic conditions will find it easier to qualify for coverage for home care, skilled nursing home, and outpatient therapy. This will give millions of Americans who suffer from chronic and debilitating conditions a fair chance to obtain the Medicare coverage for which they qualify and the health care treatments they need to remain as healthy and productive as possible. Ending application of the Improvement Standard is a life or death issue for countless Americans
Source: marshagoodmanattorney.com

Medicare Targets Health Plans With Low Ratings

Posted by:  :  Category: Medicare

Medicare officials are encouraging 525,000 beneficiaries to switch out of these 26 Medicare Advantage and drug plans that have received low ratings for three consecutive years and enroll in better plans for next year. The poor performing plans will have this warning symbol next to their names on Medicare’s plan finder website to steer shoppers to other plans.
Source: kaiserhealthnews.org

Video: WellCare Medicare Advantage – I Am Well Cared For.mov

WellCare To Suspend Medicare Health Plans

Medicare beneficiaries may obtain more information about WellCare’s 2008 Medicare Part D PDP plans by calling WellCare at 888-547-5252 (TTY users call 888-816-5252) between 7:00 a.m. and 2:00 a.m. ET, seven days a week, or by visiting www.wellcarepdp.com. The web site includes information about the plans as well as a complete list of covered drugs and the pharmacy network of approximately 60,000 participating pharmacies. Information about 2009 plans is expected to be available after October 1, 2008.
Source: emaxhealth.com

WellCare Health Plans Reaches Settlement in False Claims Act Case

administrative complaint Administrative Hearing attorney controlled substances criminal charges dea DEA investigation defense attorney defense lawyer department of health Department of Health (DOH) Department of Justice (DOJ) doctor doh DOH investigation drug enforcement administration emergency suspension order false claims act florida fraud prevention fraud schemes health care fraud health law hipaa investigation legal representation licensing and regulatory medicaid medicare medicare audit Medicare fraud Medicare investigation nurse nurses pain clinics pain management pharmacies pharmacist pharmacists pharmacy pharmacy investigation physician physicians prescription drug trafficking whistleblower
Source: wordpress.com

Feds: WellCare ‘Misled and Confused Medicare Beneficiaries’

as an employee of wellcare i would STRONGLY suggest against using them. they dont respond to their employees and i have witnessed frist hand they never respond to customers. as a sales rep in essex county my manager mr james never was around to help get anything done so we were basically left out to fry wellcares theory is this is a grass roots company and we will only give you some tools to do your job the rest is up to you. thats all fine and good but all we ever asked for was SUPPORT to help do our jobs and help those that needed help but in the end its all about nuymbers with them they pressured us to get 20-30 apps during enrollement months and so it led to shady practices and i am sure it will continue as they have had issues since 2007 and to only get suspended in 2009 says they dont care about their customers
Source: wsj.com

SAC Capital Increases Wellcare Health Stake (WCG) ~ market folly

Steve Cohen’s hedge fund firm SAC Capital yesterday after market close filed a 13G with the SEC on shares of Wellcare Health Plans (WCG).  Per the filing, SAC has revealed a 5% ownership stake in the company with 2,155,721 shares. This marks a 105% increase in their position size since the end of the first quarter.  The filing was required due to portfolio activity on July 6th. Shares of WCG have recently seen two surges higher.  First, under the Supreme Court’s upholding of Obamacare, WellCare Health Plans shares surged from $50 to $55 on the news. Then, just yesterday, it was announced that Amerigroup (AGP) would be acquired by Wellpoint (WLP).  It seems shares of WCG rose in tandem on hopes that the company could also potentially be a takeover target in the space.  WCG traded from $59 up to $62. Per Google Finance, Wellcare Health Plans “provides managed care services to government-sponsored health care programs. WellCare operates in three segments: Medicaid, Medicare Advantage (MA) and Prescription Drug Plan (PDP), which are within its two main business lines: Medicaid and Medicare.” For more on this hedgie, head to more recent portfolio activity from SAC Capital.
Source: marketfolly.com

WellCare Health Plans’ CEO Discusses Q3 Results

As a new program obviously there were some influx relating to the claim payment, claim submission patterns, but we feel comfortable that we have a good visibility in that now. So, our DCP reflect our best ability to look at in third quarters and we feel that as we commented in the past we don’t provide guidance from DCP, but it’s really based on change in the business mix that you see and I also want to add another comment if you’re looking forward into 2013, with the with the acquisition of Easy Choice for example, which tend to be more global cap, PCP can be even lower than our average today. So, the changes in business mix can have an impact on what we see as the future DCP.
Source: seekingalpha.com

WellCare Medicaid/Medicare Fraud Suits Recover $217.5 Million

Fraud in the Medicare and Medicaid system increases health care costs for everyone, not just those involved with the programs. With much of Medicare and Medicaid funds passing through managed-care systems, assuring that the money is properly funneled to patient care rather than fraudulently lining the pockets of those companies is a key priority for the Civil Division of the U.S. Department of Justice.
Source: federalwhistleblowerlawyers.com

You Can Leave the Nursing Home: Home for the Holidays (Winter 2012 Update) 

Posted by:  :  Category: Medicare

The PARTY Is OVER ...item 4.. Today, Mitt Romney Lost the Election (Sep 17, 2012 6:02 PM ET) ...item 5.. James Brown - Get On The Good Foot, Soul Power, Make It Funky Soul Train 1973 ... by marsmet471[1] Medicare Benefit Policy Manual, Pub. 100-02, Ch. 8, §30.7.3. (Example, second paragraph) (http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c08.pdf).  Scroll down to page 35. [2] Medicare Benefit Policy Manual, Pub. 100-02, Ch. 8, §30.7.3. (Example, third paragraph) (http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c08.pdf).  Scroll down to page 35. [3] Medicare Benefit Policy Manual, Pub. 100-02, Ch. 3, §20.1.2. (http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c03.pdf).  Scroll down to page 4. [4] Medicare Claims Processing Manual, Pub. 100-04, Ch. 6, § (http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c06.pdf).  Scroll down to page 45.  Note, unlike Medicaid in some states, the Medicare program does not provide a payment for "bed-hold." [5] Medicare Claims Processing Manual, Pub. 100-04, Ch. 6, § (http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c06.pdf).  Scroll down to page 45. [6] Medicare Claims Processing Manual, Pub. 100-04, Ch. 1, § (http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c01.pdf).  Scroll down to pages 56-57.  CMS cites, as authority for this payment option, the Nursing Home Reform Law, 42 U.S.C. §1395i-3(c)(1)(B)(iii), and 42 C.F.R. §483.10(b)(5)-(6). [7] Medicare Claims Processing Manual, Pub. 100-04, Ch. 1, § (http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c01.pdf), scroll down to page 57. [8] Medicare Claims Processing Manual, Pub. 100-04, Ch. 1, § (http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c01.pdf).  Scroll down to page 56.
Source: medicareadvocacy.org

Video: Medical Billing Expert Series: Medicare Claims Processing Manual Chapter 20

Medical Billing Codes: Medical Billing Codes For Medicare

And numeric modifiers are © 2010 by the American Medical Association. All rights reserved. 1 Quarterly Coding&Billing march 2011 EDITOR alan l. plummer, md ATS RUC Advisor ADvIsORy BOARD MEMBERs: sleep codes. As you may recall, the Medicare Physician and billing for pulmonary,
Source: blogspot.com

Pitfalls in Billing Pharmaceuticals to the Medicare Program

It is clear there are multiple pitfalls for the compliant billing of pharmaceuticals to Medicare Part B. Hospitals need to ensure, to the extent possible, that their pharmacy CDM is accurate with correct HCPCS and revenue codes, that unit conversion modules or tables are set up correctly, that self-administrable drugs have been identified as such and revenue code fields are set to toggle between 637 and 250 based on bill type. Noncovered drugs should be billed to the patient, not Medicare. Drugs integral to the procedure should be set up as supply items, not billed as noncovered. Nursing documentation, including that on an electronic medication administration record, should indicate date, time and nurse responsible for administration and the amount of drug given—and wasted—if any. Only wasted drugs in single-dose vials can be billed to the program and only if documentation in the medical record meets the requirements. 
Source: bkd.com

Billing for locum tenens services

In light of the physician shortage, our clients are increasingly using locum tenens physicians as a key component of their long-term staffing strategy, to start new service lines, and to augment permanent staff while searching for a permanent doctor, which can be a lengthy process. Under these scenarios, locums are not covering for an absent physician who will be returning and therefore do not meet the requirements for using the –Q6 modifier. In these cases, Medicare and Medicaid require locum providers to enroll in the programs in order to receive reimbursement.
Source: bartonassociates.com

Psychiatric News Alert: Series on DSM

In an interview with Psychiatric News, DSM-5 Task Force Chair David Kupfer, M.D., explained that those overarching conceptual ideas include incorporation of a developmental approach to psychiatric disorders, recognition of the influence of culture and gender on how psychiatric illness presents in individual patients, a move toward the use of dimensional measures to rate severity and disaggregate symptoms that tend to occur across multiple disorders, harmonization of the text with ICD, and integration of genetic and neurobiological findings by grouping clusters of disorders that share genetic or neurobiological substrates.
Source: psychiatricnews.org

Kentucky Spirit Health Elimination of Black Claims Forms

Kentucky Spirit Health Plan’s (KSHPs) commitment to delivering exceptional service to our providers and members at the lowest cost remains at the forefront of our mission. This effort includes strong performance in our turnaround time and accuracy of claims processing. Since our inception, KSHP has worked hard to ensure our capabilities support this level of performance. However, black and white UB-04 or HCFA-1500 forms copied/downloaded or handwritten red forms presents a challenge when processing these claims through Optical Character Recognition (OCR) technology such that the timeliness, accuracy and efficiency of these claims is jeopardized. In addition, eliminating the acceptance of handwritten red forms will reduce the risk of misinterpretation of submitted data.
Source: kentuckyspirithealth.com

Medicare Advantage PPO Plans

Posted by:  :  Category: Medicare

These plans may or may not have a plan premium whereas several more of the HMO types hove none other than your normal Part B premium to Medicare. Also there will be both an in network out of pocket and an out of network out of pocket if you choose a provider not in network. The out of network providers must agree to accept the terms and conditions of the plan in order to get covered treatment; generally look for providers that accept Medicare on assignment.
Source: medicareinsurancetexas.com

Video: Humana 2012 PPO

Study: Seniors Look For Star Ratings On Medicare Advantage Plans

The rating system uses survey data and other measurements of effectiveness to gauge the quality of the private Medicare Advantage plans, which are an alternative to traditional fee-for-service Medicare. Dr. William Shrank, a co-author of the study, said the relationship between the ratings and enrollment was a good sign for the star system put in place in 2011.
Source: kaiserhealthnews.org

Newsroom – Blue Cross Blue Shield of Michigan broadens Medicare options with new Medicare Advantage PPO product

October 1 is the first day BCBSM and Medicare Advantage carriers across the nation can market their Medicare Advantage products for 2010. Beneficiaries in BCBSM Medicare Advantage products will receive letters in the next 10 days about the new product line-up. "Blue Cross remains fully committed to providing products to Medicare beneficiaries and will continue to have the broadest array of Medicare Advantage products in the state," said Mark Owen, BCBSM vice president for federal and individual business. "It’s important for Medicare beneficiaries to know that there is no immediate change to their coverage. They have until the end of the year to make their selection for 2010." In addition to the three BCBSM products for 2010, seniors also can select from three Medicare Advantage products offered by Blue Care Network, the BCBSM-affiliated HMO. "We will be working with insurance agents and other groups across the state to reach out to Medicare beneficiaries to help them navigate these product and premium changes," said Owen. Seniors who meet low income guidelines can receive subsidies from the state and/or federal government to pay for all or part of their premiums. Medicare Advantage premiums vary by product and region. The new PPO product is expected to provide beneficiaries with value for their premium. For example, the BCBSM Medicare Plus Blue PPO, which includes Part D prescription drug coverage, will cost between $61 and $141 a month (premiums vary by geographic region), while traditional BCBSM Medicare Supplemental (Medigap) Plan C plans cost $183 when combined with a stand-alone Part D BCBSM prescription drug program. Medicare Advantage plans offer Medicare benefits through private health insurance plans and most include Part D prescription drug coverage. When you purchase a Medicare Advantage plan, you do not need to also purchase a Medigap policy. Medicare Advantage plans are regulated solely by the federal government, while Medigap plans are regulated by the state. The announced product changes are only for Medicare beneficiaries who directly purchase their Medicare Advantage products, not for beneficiaries enrolled in a group plan. Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.
Source: bcbsm.com

Blue Care Network expands Medicare Advantage service area, Blue Cross and Blue Care Network add plan options

In addition, BCN Advantage members will now be able to “buy up” to more comprehensive dental and vision benefits for a modest additional premium. Members will receive partial coverage on restorative services such as fillings, root canals, crowns and crown repairs. They’ll also get an allowance for frames and lenses to improve their vision health.
Source: hcwreview.com

HHS IG: Still Not Many Medicare Advantage Fraud Probes Despite 2007 Investigation

Modern Healthcare: Amid Concerns About Overpayments, HHS Notes Small Number Of Medicare Advantage Probes HHS’ inspector general’s office says the $124 billion Medicare Advantage program is the focus of very few investigations from fraud-hunters — a conclusion that comes on the heels of a string of audits alleging hundreds of millions of dollars of questionable payments in the program. HHS officials last year published the results of long-running investigations into four Medicare Advantage plans, concluding that the plans had received nearly $600 million more than they should have in 2007 by claiming that patients were more medically complex than they were. All four companies denied the allegations, but the inspector general’s office is continuing with probes of an untold number of the other 170 or so Medicare Advantage companies working for the CMS (Carlson, 1/10).
Source: kaiserhealthnews.org

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

The low readmission rates indicate I-SNPs provide more integrated, coordinated care to enrolled beneficiaries than fee-for-service plans. Based in part on I-SNPs’ high marks for improving integrated care, MedPAC commissioners unanimously recommended that Congress permanently reauthorize them, according to the Bureau of National Affairs (BNA).
Source: mcknights.com

Aetna Selected to Provide Medicare Advantage PPO Plans to Retired State Employees in Pennsylvania.

Aetna provides health benefits to more than 1.1 million members in Pennsylvania. About Aetna Aetna is one of the nation’s leading diversified health care benefits companies, serving approximately 36.8 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities and health care management services for Medicaid plans. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com.
Source: blogspot.com

Medicare Advantage: Will 2013 Bring Changes to Medicare Advantage PPOs in Las Vegas, NV?

If your plan is subject to change in 2013, you will have plenty of time to make a decision.  Announcements regarding 2013 plan changes will come in early October.  That gives you two months to decided what to do.  The important thing is that you know ALL of your options.  That is where Sun City Financial comes in.  We are licensed and contracted with all Medicare Advantage Plans and a dozen Medicare Supplements in Clark County and Las Vegas, NV.  We will help you navigate the changes and keep you informed on all of your options.  Call us at 702.551.4949 or visit our website at www.suncityfinancial.com for more information.
Source: suncityfinancial.com

Report: Private Medicare Advantage Plans Make Progress in Combating Chronic Disease

Since its start in 2003, Medicare Advantage has gained popularity because of its high quality, coordinated benefits and patient-centeredness.  Its central role for private health plans makes MA extremely popular with seniors.  The best practices of these plans should be integrated into conventional Medicare.  That’s the only hope if Medicare is to contain its costs without sacrificing quality and care in the process.
Source: hlc.org