OSU testing ACO, pay for performance approach to employee health insurance

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"The single best augury is to fight for one's country." ~ Homer (800 BC - 700 BC), The Iliad. by eyewashdesign: A. GoldenIn return, those doctors will potentially be paid more if the health of those patients improves, said Dr. Richard Streck, the hospital system’s chief medical officer.Nationwide Children’s Hospital has had an accountable-care organization — Partners for Kids — since 1994. It’s billed as the nation’s largest pediatric ACO, positioning the hospital well for future shifts in how it’s paid for patient care, said Tim Robinson, the hospital’s chief financial officer.And Partners for Kids is getting bigger.
Source: medcitynews.com

Video: Kansas Children Drugged In Foster Care Medicaid Fraud

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


The City of Camden, New Jersey, is one of America’s poorest cities. For the last nine years, the Camden Coalition of Healthcare Providers has been working to build a citywide coalition to improve the quality, capacity, and accessibility of healthcare services while reducing costs. Driven by a homegrown patient-‐level database with nine years of longitudinal hospital claims records for every city resident, the Coalition has worked methodically to redesign how healthcare is delivered and target services to the most costly and complex patients. The Coalition efforts include a combination of primary care clinical redesign, a citywide Health Information Exchange, outreach projects targeted to the highest cost patients, patient education programs, and community organizing. The Camden Coalition worked with the NJ Chamber of Commerce, NJ Hospital Association, Citizen Action, and other partners to pass a Medicaid Accountable Care Organization (ACO) bill in August 2011. The bill will permit shared savings to be captured from reductions in ER and hospital use in Medicaid and the Camden Coalition will be the first Medicaid ACO in New Jersey. The Coalition was recently featured in an article by Dr. Atul Gawande in the New Yorker and on PBS Frontline. Dr. Jeffrey Brenner, MD is a family physician that has worked in Camden, NJ for the past twelve years. Dr Brenner owned and operated a solo-practice, urban family medicine office that provided full-spectrum family health services to a … views:
Source: wn.com

5 Affordable Health Insurance Options One Can Find in This Market

If you don’t qualify for the options listed above, you are still able to qualify for private health insurance. If you do not currently have health insurance coverage or if you have difficulty affording your currently health insurance plan, you may want to consider private insurance options. Some of these private insurance options may even provide you with low cost care. Using healthcare.gov will give you tools for it. This online tool, which is free of charge, will help you find health insurance policies in your location that offer the lowest premiums and the lowest out of pocket costs. Also, if you have a pre-existing health condition, this tool will help you find the coverage you need in addition to all other options you may qualify for. In conclusion, you will be able to find the most affordable health care option.
Source: emaxhealth.com

Haslam remains undecided on Medicaid expansion

Another hook is that after the first few years of implementation, federal subsidization of new TennCare enrollees would be reduced, leaving Tennessee to pay potentially upward of tens of millions of additional dollars on top of costs already outlined in the health care plan. In a budget presentation to Haslam last year, TennCare Chief Darin Gordon told the governor that implementation costs for the new law in Tennessee could be as much as $200 million over the next five and a half years. 
Source: nooga.com


In the fight to put a public option of the Affordable Care Act, many missed that the law contained a historic boost to Medicaid, our single-payer health insurance program that covers the poorest and most vulnerable Americans. Obamacare was set to cover 17 million additional Americans, as many as 670,000 in Michigan, who earn up to 133% of poverty level. Until 2020 the federal government pays for 100% of this expansion using tax increases on the richest 2% to fund it. After 2020, states will have to kick in a mere 10%. Unfortunately, when the Supreme Court ruled that ObamaCare was legal, it also gave states the right to opt out of the program. So far nearly a dozen states with Republican governors have turned down this coverage.
Source: eclectablog.com

Opinion: Medicaid cuts would harm children and families the most

The Affordable Care Act will build upon the success of Medicaid and the health care safety net to expand access to care to 19 million additional Americans by 2019, according to the Congressional Budget Office, reducing the number of uninsured by 50 percent.  The House Budget Plan advocated by the Romney-Ryan presidential ticket would decrease total Medicaid enrollment by approximately 50 percent or 37.5 million people, according to a recent Urban Institute study.
Source: healthpolicysolutions.org

GAO audit highlights increases in entitlement costs

Posted by:  :  Category: Medicare

BITCH .. beautiful individual that causes hardons ...item 1.. Allen West calls Wasserman Schultz ‘vile’ and ‘not a lady’  (7/20/2011) ... by marsmet522The GAO’s auditors “were unable to obtain sufficient evidence to support the amounts presented in the 2012, 2011, and 2010 Statements of Social Insurance and the 2012 and 2011 Statements of Changes in Social Insurance Amounts,” meaning that the Statement of Social Insurance was underestimating the cost of entitlement programs.
Source: freebeacon.com

Video: Medicare Fraud Costs American’s $90 Billon a Year 2/17/2011

Medicare Part B Premium Costs Likely To Cut Into Social Security’s Increase

The Wall Street Journal: Prices Rise 0.3%, Prompting Boost In Government Benefits The climb in prices means millions of Americans who rely on government programs such as Social Security will receive their first cost-of-living increase since 2009. It also will raise taxes on close to 10 million of the 161 million workers who pay Social Security taxes. That’s because in 2012, Americans will have to pay the payroll tax on their first $110,100 in earnings, up from the $106,800 in earnings in 2011. … Nearly 55 million Social Security beneficiaries will see their checks rise by 3.6 percent beginning in January. … The 3.6 percent increase could be partially or completely offset by a bump in the premiums that seniors pay for Medicare Part B benefits, which have been held flat for many beneficiaries because of low inflation in the last two years. … The Centers for Medicare & Medicaid Services could announce their premiums and copayments for 2012 as soon as next week. Because Medicare premiums are deducted directly from Social Security checks, many Americans may never see an increase (Paletta and Murray, 10/20).
Source: kaiserhealthnews.org

Insure The Uninsured Project (ITUP)

Private health insurance spending on hospitals accelerated in 2011 as plans’ enrollment increased. However, per beneficiary growth in these plans hospital spending slowed to 4.3% from 6.0% in the previous year, potentially a result of the enrollment of young adults age 26 and under through the ACA. Growth in Medicaid hospital spending declined appreciably from 7.6% in 2010 to 2.4% in 2011. This deceleration was as consequence of the expiration of temporary federal support for states’ Medicaid programs and the states’ persistent fiscal pressures. Individuals’ out-of-pocket spending on hospital services grew at a faster pace in 2011, as more individuals faced higher cost-sharing requirements in private health insurance plans.
Source: itup.org

What Part of My Medicare Costs Are Covered by My Tax Dollars?

Medicare Part A is free to most Americans who have had the Medicare payroll tax deducted from their income for at least ten years. Medicare Part A covers hospital costs, hospice care, home health care and skilled nursing facility stays. The tax rate for Medicare’s Hospital Insurance (HI) is currently 1.45% for both employer and employee. The US government spent $486 billion on Medicare costs in 2011.
Source: seniorcorps.org

State Trends: Per Person Costs of Private Insurance Rising Faster Than Medicare

Rising health care costs and stagnant incomes have pushed more families into poverty. As a result of the recession, the percentage of people with ESI dropped from 58.9% to 55.3% from 2008 to 2010. An estimated 9 million adults between 19-64 lost a job with health benefits and became uninsured. As Say Ahhh! readers know, a new alternative poverty measure from the Census Bureau finds that 16% of the population would have been counted as poor, compared to 12.7%, when medical spending is factored in to the calculation.
Source: georgetown.edu

Medicare Drugs Should Cost A Little Less Next Year – The Consumerist

According to Reuters, the Department of Health and Human Services projects the average monthly premium for Medicare Part D should slide to $30 from $30.76. The drop is thanks in part to more generic drugs on the market.
Source: consumerist.com

Growth of national health expenditures, 2011

In 2011 US health care spending grew 3.9 percent to reach $2.7 trillion, marking the third consecutive year of relatively slow growth. Growth in national health spending closely tracked growth in nominal gross domestic product (GDP) in 2010 and 2011, and health spending as a share of GDP remained stable from 2009 through 2011, at 17.9 percent. Even as growth in spending at the national level has remained stable, personal health care spending growth accelerated in 2011 (from 3.7 percent to 4.1 percent), in part because of faster growth in spending for prescription drugs and physician and clinical services. There were also divergent trends in spending growth in 2011 depending on the payment source: Medicaid spending growth slowed, while growth in Medicare, private health insurance, and out-of-pocket spending accelerated. Overall, there was relatively slow growth in incomes, jobs, and GDP in 2011, which raises questions about whether US health care spending will rebound over the next few years as it typically has after past economic downturns.
Source: pnhp.org

How much does Medicare Advantage cost?

Plans with $0 Monthly Premiums: Among the 43,306 plans available in 2013, 13,741 plans (32 percent) will be offered at a cost of $0 above what a Medicare beneficiary already pays for Medicare Part B. By comparison, 14,297 plans (33 percent) were available with a $0 monthly premium in 2012 and 13,821 plans (35%) were available in 2011.
Source: ehealthinsurance.com

Regence and Healthways Partner to Offer SilverSneakers® Fitness Program to Regence Medicare Advantage PPO Plans …

Posted by:  :  Category: Medicare

Healthways (HWAY) is the largest independent global provider of well-being improvement solutions. Dedicated to creating a healthier world one person at a time, the Company uses the science of behavior change to produce and measure positive change in well-being for our customers, which include employers, integrated health systems, hospitals, physicians, health plans, communities and government entities. We provide highly specific and personalized support for each individual and their team of experts to optimize each participant’s health and productivity and to reduce health-related costs. Results are achieved by addressing longitudinal health risks and care needs of everyone in a given population. The Company has scaled its proprietary technology infrastructure and delivery capabilities developed over 30 years and now serves approximately 40 million people on four continents. Learn more at www.healthways.com or www.silversneakers.com.
Source: gymrat-fitness.com

Video: Regence Medicare Advantage insurance – Compare to 180+ Comp

Regence BlueCross BlueShield to drop its Portland

The change reflects a growing trend among health insurers to nip and tuck at escalating costs to rein in premium hikes. For Regence, representatives say, the move is necessary to allow it to remain competitive in the Portland area. The change follows years of declining membership and financial losses in Oregon for Regence, Oregon’s largest insurer in the private health insurance market.
Source: oregonlive.com

Medicare Updates for 2011

What article on Medicare Part D would be complete without mentioning Humana.  There I have just mentioned it. Just kidding, Humana has good news also.   The Humana Value plan which was priced at $18.60 in 2010 has been rebranded and repriced for 2011.  It is now the Humana Walmart Preferred Rx Plan with a reduced price of $14.80. I guess the little yellow price slasher at Walmart has been at work once again. The plan ID numbers are the same, so technically it is the same plan but the benefits are totally different from 2010. For example, it has a $310 deductible for all drug tiers, but then many generics are priced at only $2 for a 30 day supply at Walmart or $10 at any other local pharmacy. When I first saw that I thought “What, that is a huge advantage for Walmart.” Then I read the fine print. The $2 co-pay is only for the generics on the Walmart $4 drug list, and other stores either have their own $4 list like QFC, or will match prices. But I still applaud Humana and Walmart for innovative thinking.
Source: wordpress.com

The Red Electric: Regence returns my call

ecounted my experiences with Regence MedAdvantage customer support . Because I wasn’t satisfied, I decided to track down one of three Regence executives I happened to be seated with at a recent Community Health Partnership honors banquet. I phoned and left a message for one to call back. All three did, on a pre-arranged conference call. I was impressed. We talked for about a half hour about the surprising jump in the premium from $45/mo. to $75/mo. You may recall that the customer service representative told me that premiums for the non-profit are based on claims from the previous year. Last year was not a good year, insurance-wise. My executive trio told me that there’s some discretion in setting premiums, and they readily admitted that the hike for next year is hard to swallow, but necessary. I joined the program early this year when, at reaching 65, I became eligible for Medicare. If I had joined in 2005, the year the Medicare Advantage programs began, I would have a different perspective on next year’s increase. Amanda, my customer service rep, told me that premiums could drop, but, because she had only been on the job a year and a half, she didn’t have a clue whether they ever had. Fat chance, I thought. I was wrong. My conferees informed me that indeed the rates had dropped. My $45 premium was the low over four years. In 2005, the premium was $79, in 2006 it was $72. It turns out that 2006 was a very good year, as Frank Sinatra used to say, so management decided to pass the savings on in 2007, hence my $45 premium, which I took to be the norm. So my advice to this august group was to level out the peaks and valleys of the premiums to avoid the appearance of a bait and switch. In the highly competitive health insurance industry, low rates are a selling point. That $45 snared me. “We don’t like to whipsaw our members,” said Mike Becker, Regence vice president of public policy and community affairs. “Leveling out the premiums is exactly what we’ve been talking about,” chimed in Alison Nicholson, manager for individual sales. Good, I replied. I had a few other ideas, which I won’t bore you with and which you probably won’t be interested in, at least until you turn 65. Suffice to say, I feel better about Regence Blue Cross — for now.
Source: blogspot.com

The Power Of Alternatives For Your Health Issues

Medical doctors report that they are not writing as many prescriptions as they once did mostly because many of the high grade medications that once were only available with a prescription are not considered OTC medications allowing most anyone to simple go in and buy them off the shelve without the expensive prescription paper from a doctor. If you are still concerned with what you are buying you can always seek out the counsel of a doctor, or you can simply ask the pharmacist about what your needs are what they would recommend which is most always free advice for the asking. Why not take advantage of this before you spend money on something that could be free.
Source: regencemedicareinfo.com

Kathie Bracy’s Blog: Is the STRS Medicare Advantage program really an ‘Advantage’? Susan doesn’t think so!

A key player in this CORE group, Dr. Dennis Leone, initiated the investigation (2002-2004) against STRS that led to the dismissal of the Executive Director and the conviction of six Board members for ethics violations. Eventually elected to the Board, Dr. Leone was the only member to vote against the forced ‘move’ discussed in my paper. On the CORE website, click on ‘history’ to see the results of this group‟s vigilance and perseverance. To protect your pension and quality health care, follow this group and help them create a direct line to educators.
Source: blogspot.com

Annual Enrollment Workshops for Medicare Advantage Plans 2011

If you have Medicare with only part A and B you might want to participate in one of the Medicare Advantage plans that are accepted at this clinic. The plans accepted are Regence Blue Cross, Humana, HealthNet, United Healthcare and Providence.
Source: hudsonsbaymed.com

More advantage in Medicare plans

Premium costs, on the whole, are not increasing much, especially compared with last year’s average 22 percent jump, experts say. Health reform also will provide some relief on prescription drug costs and — for the first time — free preventive care. Other improvements will come next year, including an open-enrollment period that will start before Halloween and end before Thanksgiving. The plan search engine on Medicare.gov has become more powerful and helpful. But not everyone will be happy. A number of fee-for-service plan providers — including Cigna — withdrew from the market rather than comply with a 2008 law that required them to set up provider networks. That’s left about 25,000 Medicare recipients, mostly in rural counties, hunting for a new plan. Many have only one Medicare Advantage provider in their area. In an effort to keep premiums down, plans are increasing co-pays for hospitalizations or altering what drugs they cover. That means just about anyone with a supplemental Medicare plan will need to check his or her Annual Notice of Change. “Even if they’re satisfied with their plan this year, they should review what their plan is offering next year, look at the changes and see if the plan still meets their medical needs,” said Gretchen Jacobson, a principal policy analyst with the Kaiser Family Foundation in Washington, D.C. Confused? You’re not alone. “I’m so ignorant, I don’t even know what questions to ask,” said Gayle al-Kaisy, 68, during a meeting last week with Multnomah County senior health officials in North Portland. Al-Kaisy joined a Kaiser Permanente plan late last year after her employer-provided plan dropped coverage. She loves her current doctor but dislikes having to leave Portland city limits to go to a Kaiser hospital. Choosing an alternative, however, seems intimidating. Jim Hutchins, meanwhile, found his Providence Health Plans’ premiums increased 22 percent, or about $150 a year. “As much as I like the people at Providence, I simply want to make sure this is still my best bet,” the 70-year-old Durham resident said. There are plenty of free resources to help you choose, many of which I’ve listed in the accompanying box. Last year, I explained the differences between all the basic plans. I’m talking Part A, Part B, Part D, Medigap and Medicare Advantage. Just know that some of the figures might have changed. For now, let’s focus on the most important things to keep in mind this year.
Source: oregonlive.com

Los Angeles Medicare Supplement

Posted by:  :  Category: Medicare

I recommend seniors turning 65 to enroll in a Plan F because the rates are relatively good at that age, and they can always switch to a lower coverage plan, every year on their birthday. Another popular plan to consider is Plan N. Plan N has great rates, but you will have some cost sharing on this plan. You will have to pay co-pays, deductibles and co-insurance with Plan N.
Source: healthbrokerdave.com

Video: Medicare Supplement plan F High Deductible Explanation

Medicare Supplement Plan F

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

Summit Medigap: What Is Medicare Supplement Plan F?

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

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

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

What is a Medicare Supplement Plan?

AARP AARP Connecticut AARP Medicare AARP Medicare Complete AARP Medigap AARP Medigap 2013 AARP Rates 2013 AARP Supplement AARP Supplement 2013 Anthem Anthem High F plan Anthem Medicare Anthem Medigap Anthem Supplement Coverage Gap Donut Hole Drug Help High Deductible F supplement LIS Connecticut Medicare Medicare Advantage Medicare Advantage plans Medicare Complete Medicare Complete connecticut Medicare Connecticut Medicare for Dummies Medicare part B Medicare part D Medicare prescription drug plans Medicare Rx Medicare Saving program Medicare Supplement Medicare Supplement Connecticut Medigap Medigap rates 2013 Medigap rates NY 2013 MSP Connecticut Original Medicare Part D Part D Drug help Rx Help Rx help connecticut united healthcare United Healthcare AARP United Medicare complete 2013
Source: croweandassociates.com

What Is A Medicare Supplement

There are ten different Medicare supplement plans.  Each one is given a different letter.  The letters skip a few here and there because plans that were once available have been retired and the labeled the new plans with the next letter in the alphabet so as not to create confusion for people who were grandfathered in on the old plans.  The plans themselves cover a varying number of combinations of the nine different coverage gaps that were left by the coverage you get with Medicare Part A and Medicare part B.  The Gaps include: the deductible, coinsurance, first three pints of blood and hospice care from Medicare Part A, The deductible and coinsurance for Medicare Part B, skilled nursing facility care, and expenses for foreign travel emergencies. Which plan you select dictates how many or what combination of these coverage gaps are covered.  Plan A covers only four of the gaps while Plan F covers all nine.
Source: seanbrock.com

What Medigap Insurance Has That Medicare Advantage Doesn’t

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

Puritan Financial Group on Facebook

Choosing Medigap Provider:Name Recognition vs. Lowest Price Traveling Abroad? Medicare Supplement G, Plan N & Plan F 5 Questions to Ask Yourself About Medicare Supplement F About Medicare Plan G Supplemental Insurance Medicare Supplement for Women The Trifecta: Medicare Plan G, Medigap Plan N & Medicare Supplement F Medigap Plan N Benefits Chart Comparison True or False? Plan N Medicare Supplemental Insurance Facts
Source: wordpress.com

What is the Cadillac Medicare Advantage plan

A plan’s network of providers: People often think Medicare Advantage plans are only offered as part of healthcare management organizations (HMOs), but many are also preferred provider organizations (PPOs). With HMOs and PPOs, insurance companies typically have a list doctors, specialists and hospitals that are preferred so when you go to those providers, you presumably pay a lower price for care. Either that, or the insurer covers more of your out of pocket costs, or both. Your costs typically differ if you get “in network” care versus “out of network” care. You’re more likely to think of a plan that includes your doctors, specialists and hospitals at a lower price to be a Cadillac plan.
Source: ehealthinsurance.com

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

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

AARP Medicare Supplement Plan F

2012 AARP about Advantage Auto Beautiful BENEFITS Best bill care companies Company Cool DEMO Find from Good Hartford health Healthcare images Insurance Join know Life many Medicare members membership Michigan Nice Obama Part photos pictures Plan Plans reform senior Seniors Should Supplement Supplemental there they
Source: wordwd.com

Feds approve some LePage cuts to health care for low

Posted by:  :  Category: Medicare

KNOW WHO YOUR CZARS ARE --ENOUGH TO MAKE YOU SICK ---ONLY OBAMA COULD CREATE POSITIONS FOR THESE INCOMPENTENT COMMUNISTS AND SOCIALISTS by SS&SS“I don’t want to minimize the difficulty of this decision, but these cuts were legislatively authorized policy changes that were presented in the budget that was submitted by the governor,” Mayhew said. “We have to look comprehensively at managing the size and scope of the state’s Medicaid program to get it on a stable and sustainable path.”
Source: mainesenate.org

Video: Maine medigap insurance aka medicare supplement

10 Recent Medicare, Medicaid Issues

Here are 10 issues dealing with Medicare or Medicaid that occurred in the past week, starting with the most recent. 1. The average per capita costs of hospital services covered by Medicare and commercial insurance increased 3.57 percent in the 12-month period ended November 2012 — a historic low since the S&P Healthcare Economic Indices started tracking the data. 2. A bill that would extend a 1.45 percent fee on Georgia’s hospitals to help fund a deficit in the Medicaid program passed the state’s Senate and is expected to go before the state House Jan. 28. 3. South Carolina Gov. Nikki Haley (R) announced during her State of the State address that 19 Medicaid-designated rural hospitals in the state will receive 100 percent funding for any uncompensated care, starting this October. 4. Several groups, not just those in healthcare, lost something financially in the fiscal cliff deal, but do hospitals have a legitimate gripe? Was this year’s Medicare SGR patch an illusory solution? 5. Legislation to reauthorize the Children’s Hospitals Graduate Medical Education program was reintroduced in the House Energy and Commerce Committee’s Health Subcommittee. 6. The Business Roundtable, a group of CEOs representing the largest U.S. companies, recommended the retirement age at which beneficiaries become eligible for Medicare and Social Security should be raised from 65 to 70. 7. Maine Gov. Paul LePage (R) announced the state will repay roughly $186 million in Medicaid payments owed to 39 hospitals through a revenue bond and the state reclaiming control over liquor sales. 8. Seniors tended to choose Medicare Advantage plans with higher quality ratings on CMS’ five-star scale, according to a study published in the Journal of the American Medical Association. 9. Arizona Gov. Jan Brewer recommended state lawmakers expand the Medicaid program in her state of the state address Monday, becoming only the third Republican governor to do so. 10. Twenty-one states demanded the government change a rural hospital Medicare loophole embedded with the Patient Protection and Affordable Care Act that has given Massachusetts hundreds of millions of dollars in extra Medicare funding at the expense of other states.
Source: beckershospitalreview.com

Congress should keep promise, protect Medicare, Social Security

How many 55-year-old gasmen, drywall hangers, construction workers, farmers and fisherman do you know who are hanging on until they can call it a day and hopefully have a few good years to enjoy retirement, spend time with their grandkids, fish a little or just tinker around the house?
Source: bangordailynews.com

Maine Clashes with Feds Over Medicaid

Access Andrew Cuomo Avik Roy Barack Obama Block Grant Bob McDonnell Cato Institute Costs Costs to the States Cutbacks Dental Care Eligibility Enrollment Final Notice: Medicaid Crisis Flexibility GAO Gary Alexander Grace-Marie Turner Haley Barbour Innovative Ideas Jagadeesh Gokhale John Barrasso John Graham Kaiser Family Foundation Kathleen Sebelius Legislation Medicaid Expansion Medicaid Ghetto Medicaid waiver Michael Cannon MISEA National Center for Policy Analysis Opt Out PPACA Richard Burr Richard Foster Rick Perry Saxby Chambliss SCHIP SCOTUS Studies Texas Texas Public Policy Foundation Tom Coburn Waste Fraud and Abuse
Source: reformmedicaid.org

LePage administration files plan for Medicaid cuts with feds; federal permission remains uncertain — Politics — Bangor Daily News — BDN Maine

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Source: bangordailynews.com

Using FSA funds for Medicare premiums

Yes, you can pay your Medicare Part B or Part D premiums using funds from your Flexible Spending Account (FSA).   Yours is an unusual situation.  Most people who have an FSA would not need Medicare Part B and Part D, since the employer plan covers hospital services and prescription drugs. Nevertheless, it is an allowable expense.  See IRS Publication 502 for a complete list of expenses that an FSA can pay.
Source: bangordailynews.com

Growth of Government Assistance Adds to National Debt

Many of those who receive benefits from the federal government could live well without them, so they do not count as truly dependent on the federal government. Warren Buffett is the beneficiary of a federal program—Social Security—but, since he does not rely on that income for his livelihood, he should not be considered dependent on government programs. Others depend on the programs for nearly all of their income, housing, health care, food, and other needs and so fall under the classification of truly dependent on the government. Still others are somewhere in between, depending on government financing for, say, college, but little else. Consequently, it is important to note that stating that 128.8 million people receive benefits from a government program does not mean that all of them are dependent on the government.
Source: themainewire.com

New England Innovation: Collaborative IT Foundations for Accountable Care

David Wennberg, M.D., M.P.H., is CEO of the Northern New England Accountable Care Collaborative, a Portland, Maine-based collaborative organization founded by four hospital-based organizations in New England: Eastern Maine Medical Center (Bangor, Me.), MaineHealth (Portland, Me.), the Dartmouth-Hitchcock healthcare system (Lebanon, N.H.), and Fletcher Allen Health Care (Burlington, Vt.). Of those organizations, Eastern Maine and Dartmouth-Hitchcock are  Pioneer ACOs [accountable care organizations] under the Medicare Shared Savings Program, while Maine Health is a participant in the regular Medicare Shared Savings Program for ACOs; and the executives at Fletcher Allen Health Care are considering participation in one of those programs.
Source: healthcare-informatics.com

Medicare Billing Data Available for Market Analysis

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 marsmet471Advertising Branding Brand Relationships Brochure Design Brochure Printing Domain Names Drug Companies Effective Fonts Frequency Health Care Health Care Marketing Home Care Sales Home Health Care Home Health Care Brochures Hospice Care Internet Marketing Leadership Logos Marketing marketing reps Memory Motivation Name Recognition Office of the Inspector General OIG Orthopedic Surgeons Orthopedic Surgery Personal Relationships Physical Therapy Physical Therapy Brochures Pre-Surgical Visits Print Print Advertising Referral Sources Sales Sales and Marketing Sales Coaching Sales Management Sales People Sales Training Target Audience Top of Mind Awareness Website Websites
Source: bma-advisor.com

Video: Medical Billing Tips – Coding for Medicare Flu Shots

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

5 Medicare Trends for Surgery Centers to Watch

1. Quality program reporting requirements for ASCs. As of October 2012, ambulatory surgery centers are required to participate in a quality reporting program for Medicare if they accept Medicare patients. Non-compliance will see a 2 percent reduction in reimbursement rates in the future. To maximize reimbursement from Medicare, make sure you are capturing all eight quality measures and any additional measures added in the future. “ASCs should consider appointing a point person who will be responsible for ensuring that the ASC will be able to comply with the new reporting requirements,” says Ms. Carney. “If they fail to implement and report these quality reporting measures, they will see their rates cut in 2014.  Surgery centers are better off now than in 2008, but they still receive less reimbursement than hospitals and we are still seeing a migration from inpatient procedures to ASCs.” The designated leader for quality reporting in each center should attend training to become familiar with the codes that need to be documented. If the codes aren’t documented and the center is selected for an audit, they will lose money. “There may be some financial considerations involved for the ASC to invest in an individual’s training,” says Ms. Carney. “If you outsource billing, you should speak to your IT vendors, billing companies or both to ensure that they will be able to add the quality data codes to claims.” 2. Value-based purchasing programs. While surgery centers aren’t required to meet the standards of value-based purchasing yet, it’s something that could come down the pipe in the near future. Hospitals are already implementing value-based programs, and Congress has discussed requiring these programs in ASCs as well. “There are pros and cons to value based purchasing for ASCs,” says Ms. Carney. “The ASC could support their argument for bringing more cases into their setting if their data is good, or they will be punished if their data is bad.” Value-based purchasing relies on rewarding providers with high patient satisfaction, clinical outcomes and quality with higher reimbursement; those that don’t meet these standards will receive a lower rate. “CMS doesn’t have the authority to reduce payments yet based on quality reports, but it is a recommendation for a report to Congress,” says Ms. Carney. “For now, it appears the commissions belief is that value based purchasing programs for ASCs should include a relatively small set of measures that primarily focus on clinical outcomes, with some process, structural and patient experience measures.” 3. Punishment for provider complications. It will be important going forward to make sure patients don’t acquire additional injuries or conditions during their time at the surgery center. This means minimizing complications like wrong-site surgery and maximizing infection control. “If someone comes in with a wound on their leg and leaves with another issue, that’s evidence that something was missed and that’s a hit against you,” says Ms. Carney. “There is a potential for an adjustment downward in payment going forward. You want to make sure you are capturing as much Medicare payment as possible.” Look at a small set of measures, such as primary clinical outcomes, processes, structure and patient experience measures, to make sure you are efficient and effective. Implementing an electronic medical record could make reporting and workflow easier. “You have to be extremely efficient and effective,” says Mr. Macies. “If the CMS continues on the path they are on, you are going to be penalized if you are not using EMR to report quality. Maintain efficiency and get an EMR in place so you don’t experience those penalties. An EMR will also help you with patient safety by warning you of such events as patient fall risks, allergies, drug to drug  interactions and fire risk” 4. More ASC utilization in the future. Medicare, as well as commercial payors and providers participating in accountable care organizations, will be directing patients to the high quality, low cost provider in their community, which is often the surgery center. “Medicare wants to utilize ASCs because they are so much more cost effective,” says Ms. Carney. “ASC growth has slowed down substantially over the past few years, along with ASC reimbursement rates and the economy as a whole. When people are comfortable, we will see an upswing again. We can still get financing and resources for new ASCs, and they need to be prepared for Medicare patients.” Become attractive to Medicare and other providers, as well as cash-pay patients who are looking for a high quality surgical setting. These cases can help your center become more financially secure. “Prepare for value based purchasing and quality reporting,” says Ms. Carney. “You want to have the Rock Star ASC people wanting to come to your center and you will get reimbursed financially depending on what regulations come out.” 5. Treating Medicare patients is viable for ASCs in the future. While Medicare has historically low reimbursements, rates are increasing in some areas. The rates are tied to CPI, but under the Patient Protection and Affordable Care Act, you reduce CPI growth by productivity growth. “For Medicare, provided you are doing quality reporting, I would say it’s a viable option for ASCs in the future,” says Ms. Carney. “Do what you have to do to capture the maximized Medicare dollar. That’s the way you are going to lose or gain revenue.” As more people become Medicare-eligible, a large portion of an ASC’s patient base will be covered by Medicare. It may not be possible to do without those patients, so focus on maximizing potential reimbursement. “The margins for Medicare and Medicaid patients in ASCs are pretty thin these days, and have  always been less than hospitals,” says Mr. Macies. “The challenge that most ASCs have is with the aging population, with around 10,000 people becoming Medicare eligible every day. It’s a growing population and it’s difficult to conceive how you can run your business without treating Medicare patients.”   Maximizing reimbursement through high quality care delivery and maximizing efficiency in your operations through systems like an EMR will make treating Medicare patients viable and profitable. More Articles on Surgery Centers: How Will Obama’s Re-Election Impact Healthcare? ASC Industry Leaders Respond 8 Steps for Profitable Materials Management at Orthopedics ASCs 8 Steps to Re-Negotiate Profitable Payor Contracts in 2013
Source: beckersasc.com

Fenton Doctor Sentenced to Prison for $1.6 Million Medical Billing Scheme and More Big News Around You

5. Teachers and school staff from across Oakland County will receive expert training in the next two months on how to react in an active school shooter situation conducted by the Oakland County Sheriff’s Office and the county’s Homeland Security Division. In addition, Sheriff Michael Bouchard will give active shooter presentations on site at various schools in the county, reported White Lake-Highland Patch.
Source: patch.com

How doctors and hospitals have collected billions in questionable Medicare fees

Medicare has emerged as a potent campaign issue, with both Barack Obama and Mitt Romney vowing to tame its spending growth while protecting seniors. But there’s been little talk about some of the arcane factors that drive up costs, such as billing and coding practices, and what to do about them.  Our 21-month investigation documents for the first time how some medical professionals have billed at sharply higher rates than their peers and collected billions of dollars of questionable fees as a result. 
Source: publicintegrity.org

Fraud & Abuse Training required for Medicare Advantage Plans

The comment period on proposed changes to this very rule just ended December 8, 2009. See page 54644 of http://edocket.access.gpo.gov/2009/E9-24756.htm in which CMS actually admits this and proposes that providers enrolled in Medicare are deemed to have met the training requirement of MA plans. Of course, the final, final rule has not come out yet, but you should expect that healthcare providers will be exempt from this and that MA plans CAN NOT terminate a provider for failure to participate in that plan’s [required] training. Even at this time, MA plans cannot withhold monies owed or terminate a provider for not having completed this “training.”
Source: wordpress.com

Healthways Partners ConnectiCare

Posted by:  :  Category: Medicare

The Healthways model encourages people to make favorable lifestyle changes that lead to enhanced well-being, reduced healthcare costs, improved performance and economic value for customers. The company has invested in technology platforms that provide scalable support for large populations. It has tie-ups with a large proportion of U.S. health plans and counts many millions of lives in its customer base.
Source: gamutnews.com

Video: CBIA Webinar on ConnectiCare’s Medicare Advantage Program for 2013

ConnectiCare and Healthways Partner to Offer SilverSneakers® Fitness Program Through 2015

Healthways (HWAY) is the largest independent global provider of well-being improvement solutions. Dedicated to creating a healthier world one person at a time, the Company uses the science of behavior change to produce and measure positive change in well-being for our customers, which include employers, integrated health systems, hospitals, physicians, health plans, communities and government entities. We provide highly specific and personalized support for each individual and their team of experts to optimize each participant’s health and productivity and to reduce health-related costs. Results are achieved by addressing longitudinal health risks and care needs of everyone in a given population. The Company has scaled its proprietary technology infrastructure and delivery capabilities developed over 30 years and now serves approximately 40 million people on four continents. Learn more at www.healthways.com or www.silversneakers.com.
Source: buyersdirectory.net

Connecticare signs deal to offer new fitness program

The SilverSneakers Fitness Program engages participants in more frequent strength training and aerobic and flexibility exercises through access to a variety of venues and programming designed specifically for older adults. It incorporates both physical fitness and social experiences
Source: com.au

Aetna, ConnectiCare Push Collaborations With Health Providers In Private Medicare Plans

Treatment of some Medicare patients presents unique challenges, the insurers say. Patients who require more than basic care often have several doctors or other points of contact in the medical care system, which means coordinating treatments can be more difficult. For instance: ConnectiCare said a typical Medicare patient sees more than seven doctors in a year and uses nine different medications, so a key piece of its pilot program will be identifying high-risk patients and providing data to help coordinate their care.
Source: courant.com

ConnectiCare Enters Medicare Advantage Market

Consumers looking for a Medicare Advantage product will find many options to match their health insurance needs from ConnectiCare. Individuals, who enroll in our Medicare Advantage plans, will receive all the benefits of original Medicare plus benefits such as disease management programs, health and wellness support, limited dental benefits and more.
Source: wordpress.com

CT Medicare Advantage, Medicare Supplement, Prescription Drug Plans

Our agency is expanding! Shortly we will be Medicare Advantage and Medicare Supplement brokers. (We will continue to help Connecticut residents buy medical insurance.) We will be offering Zero Premium Policies (that right, some of the policies require none of your money be sent to the insurance company!) as well as other policies with premiums and enhanced benefits.
Source: 1800insurancect.com

Medicare Advantage, Medicare « Insurance News from Crowe & Associates

Medicare Advantage plan designs are set for 2010.  The general trend was that everyone lowered benefits and raised premiums.  Some of the change can be attributed to the cut in funding for Advantage programs (approximate 4% decrease in funding vs. the traditional 4%-6% increase in funding) but some of it most surely be due to utilization and frequency.
Source: croweandassociates.com

Connecticare Sets The Stage For Fun In 2010

PRLog (Press Release) – May 25, 2010 – Inspired by timeless adages such as “Laughter is the Best Medicine” and “An Active Mind is a Healthy Mind,” ConnectiCare has created the 2010 “Setting the Stage” program for its VIP Medicare members. The program will provide free admission to events such as trivia game shows, dance classes, museums, movies, comedy shows and more to give members incentive to stay active and healthy. “Our ‘Setting the Stage’ program will provide free admission to a number of fun events around the state for our VIP Medicare members. It’s a great way to help keep our members feeling vital, fit and always smiling,,” says Tony Tedeschi, Director of Medicare Program Management with ConnectiCare. “Additionally, we are hosting four trivia competitions at locations around the state to see who knows the most about the 1950s through the 1980s. The top three contestants will advance to a final challenge in September in Cromwell hosted by Scot Haney of WFSB TV 3 and Better Connecticut, where the top finisher will be crowned the ‘Know it by Heart’ trivia king or queen. It should be lots of fun and an event-filled summer for all of our members.” Details about all of the ConnectiCare VIP Member exclusive events can be found on ConnectiCare’
Source: prlog.org

Insurer Teams With Medical Group To Improve Patient Care

The second part of the program involves end-of-life care, a term that invokes stigmas after debate about federal health care reform. In this instance, the term means that patients will meet with their doctors and health insurer to talk about treatment options before it’s a last-minute decision in an intensive-care unit, said Dr. Paul Bluestein, ConnectiCare’s chief medical officer.
Source: courant.com

Medicare Advantage Plans Connecticut 2012 « Insurance News from Crowe & Associates

There are a limited number of Medicare Advantage plans available in Connecticut for 2012.  The list includes plans from Connecticare, AARP/United, Aetna, Anthem BlueCross BlueShield and Wellcare.   Our agency has clients with all companies and plan types in Connecticut and we are happy to share the good and bad of them with you.
Source: croweandassociates.com

Flu shots available Tuesday in Fairfield

Insurance plans accepted for flu shots and/or pneumonia shots include: Aetna, Medicare Part B; Connecticare — commercial plans and Medicare Advantage plans; Anthem Blue Cross and Blue Shield — commercial plans and Medicare Advantage Plans. Without that specific insurance coverage plans, the cost for the flu shot is $25 and for the pneumonia vaccine it is $45. People getting inoculations should bring their insurance cards to the clinic.
Source: ctnews.com

What Is A Medicare Supplement

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSThere are ten different Medicare supplement plans.  Each one is given a different letter.  The letters skip a few here and there because plans that were once available have been retired and the labeled the new plans with the next letter in the alphabet so as not to create confusion for people who were grandfathered in on the old plans.  The plans themselves cover a varying number of combinations of the nine different coverage gaps that were left by the coverage you get with Medicare Part A and Medicare part B.  The Gaps include: the deductible, coinsurance, first three pints of blood and hospice care from Medicare Part A, The deductible and coinsurance for Medicare Part B, skilled nursing facility care, and expenses for foreign travel emergencies. Which plan you select dictates how many or what combination of these coverage gaps are covered.  Plan A covers only four of the gaps while Plan F covers all nine.
Source: seanbrock.com

Video: Medicare Made Clear: Compare Supplemental vs. Advantage

Medicare Supplemental Insurance

Canadian Underwriter37% of US respondents report spending more on insurance over the past yearCanadian UnderwriterThe next most popular response was because they bought a new home, car, boat or recreational vehicle (12%), notes the company statement. Results reflect total spending on all types of insurance, including auto, homeowners, renters, health and lif […]
Source: unitel.cc

Do I Need A Medicare Supplemental Insurance Policy?

The cost of each plan will be based on the age, gender, overall health, and location of the individual to be insured. Anyone just turning 65 or going on Medicare Part B for the first time can enter into a plan during the Open Enrollment. Open enrollment means that for 6 months, individuals have the opportunity to enroll in a Medicare supplemental insurance plan without having to go through a health examination. Anyone with a serious health condition or lifestyle that normally would result in an increased premium for their health insurance, for example smokers, can enroll during this period and pay the exact same rates that any other insured individual would pay.
Source: skepticwiki.org

Website is currently unreachable (1)

The website that you are trying to access is in Offline Mode, which means the server is not currently responding. To browse the site from cache, click the button below. (Cookies and Javascript must be enabled.)
Source: wesupplements.com

Looking Into Different Aspects Of Medicare Supplemental Insurance

One issue that is near and dear to our hearts when considering health insurance is prescription drug coverage.  It is notable to understand that any Medicare Supplemental Policy you currently purchase will not come with prescription drug coverage.  This is something that needs to be purchased through separately and is referred to as Medicare Part D prescription drug coverage.
Source: seniorhealthdirect.com

How To Know If You Need Medicare Supplemental Insurance

If you require a lot of medical attention, getting the most coverage you can afford makes sense. Whether you have cancer, chronic illnesses, a major health condition, or regular visits to hospitals and specialists, supplemental insurance will help ensure that everything you need is covered and affordable. Getting Medicare supplemental insurance is also a good idea if your regular Medicare policy does not cover something specific that you need, such as a prescription medication, a certain type of service, or additional medical care that you need. Talk to your doctors and healthcare providers about your current health and the steps you will need to take in order to stay healthy. This will give you a good idea of what you need, and whether Medicare will cover it. If not, seek out a supplemental insurance plan.
Source: dzida.org

Comparing Medicare Supplemental Insurance Benefits

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

Medicare Supplemental Insurance Website Server Starts Data Center Fire, Authorities Say

A blaze which started at a Denver data center on Wednesday night has been contained with no one hurt, authorities say. The fire was reportedly started by an overheated server utilized by local Medicare Supplemental Insurance comparison website: http://medicaresupplementalinsurancecomparison.net. The fire started roughly two hours after the website’s initial launch. As the server heated up from the initial rush of traffic the CPU cooling system malfunctioned causing a chain reaction that led to the fire starting. The fire rapidly consumed a corner of the first floor in the data center. “This isn’t the first time a website’s launch has caused a server to overheat,” says Marcus Stevenson, director of operations at FSPServerDirect. “Overheating servers are common with websites that underestimate the demand they’ll receive at any given time. Though a fire would not have started if the system had not malfunctioned in the way that it did.” The fire reportedly caused significant damage to the host building but none of the neighboring structures were affected. Experts say the most expensive loss will likely come from the damaged server racks- Each one costing up to $10,000. The Medicare website owners would not comment, but according to a company spokesman the website is back up and running and was only down for 3 hours. “Admittedly we underestimated the sheer demand for this type of website,” says a company spokesperson. “We received 18 thousand visits in our first 2 hours online, most of which came from people searching for Medicare supplemental insurance through Google. As we entered our second hour after launch our site was suddenly kicked offline. Only the next morning were we told that our website might have caused the fire, but since hosting is an outside service we were not held accountable. The data center admitted to us that their own negligence was a major contributor to the fire. Needless to say we have upgraded to a brand new server and had it checked over thoroughly. We will now be able to handle as much traffic as we can get.” Experts say the demand for the site was so high because it’s one of the first websites of its kind to provide side by side comparisons of Medicare supplemental insurance companies by only entering a zip code. “This is rare for these types of sites,” says a company spokesman. “Most sites like this require personal info before they provide quotes, and the non-invasiveness of our site has definitely contributed to its popularity.” To learn more about the fire, or to get free side by side comparisons of the most reputable Medicare supplemental insurance providers in an area, please visit: http://medicaresupplementalinsurancecomparison.net/ About medicaresupplementalinsurancecomparison.net Medicaresupplementalinsurancecomparison.net was created in December of 2012 to help shoppers get the best rates for Medicare supplemental insurance. The website utilizes the absolute latest in price quote technology, and has already received rave reviews from the industry.
Source: sbwire.com

The importance of Medicare Supplemental Insurance

Today’s senior citizens are faced with many options when it comes to health care after age 65.The health of your body is very essential and must not be gambled with. Since sickness can happen anytime, is sensible to prepare adequately beforehand to avoid getting into serious financial problems when seeking treatment.  It can be a very hard situation if you fall sick to the point of long term hospitalization without enough money to pay. Medical Insurance coverage is meant to pay for such unforeseen events enabling you to enjoy quality medical care in your hospital of choice.
Source: imms.com

SummaCare Selects Burgess Software As Its Comprehensive Medicare Pricin… ( ALEXANDRIA Va. Jan. 6

Posted by:  :  Category: Medicare

Related medicine news : 1. INTEGRIS Health Selects Allscripts Care Management for Its 13 Hospitals 2. Berkshire Medical Center Selects Desktop Alert for Mass Notification Solutions 3. Jefferson Regional Medical Center Selects iSirona DeviceConX for Medical Device Integration 4. Park Avenue Nursing and Rehabilitation Center Selects PatientPlacement.com Web-based Long-Term Care Software to Automate Admissions and Boost Census Performance 5. Atrius Health Selects rL Solutions for Improved Patient Safety and Quality of Care 6. Kimball Health Services Selects HMS to Provide Information Technology Infrastructure 7. American Well Selects First DataBanks Drug Data for Use in Online Physician-Patient Care Consultations 8. Berkshire Medical Center Selects Desktop Alert for Mass Notification Solutions 9. National Cancer Institute Selects Ogilvy Public Relations Worldwide for Comprehensive Multi-Year Communications Support 10. Simon Property Group Selects New York Merchants Protective Co., Inc. for Fire-alarm Services 11. Nonin Medical Selects nParallel to Design and Craft its New Tradeshow Exhibit
Source: bio-medicine.org

Video: SummaCare Secure saves you money in so many ways.

Physicians at Akron's Summa Health Move Forward Boldly on an ACO

Like anything, it was all over the place. But most of the physicians were very excited, excited at the idea that we could improve care, could communicate among ourselves in a better way. In the past, everyone’s done their own thing in their own way. But this has been physician-led; the board has a physician majority. So this has very much been a physician-driven model, and the physicians are very excited. Of course, there’s always some skepticism; but the physicians have been very involved and have been working hard on this. And I’m very proud of them—the docs I get to work with, they’ve really done a wonderful job of embracing it and getting into it.
Source: healthcare-informatics.com

Medicare Buz ? Blog Archive ? Tom Strauss leads a new vision for …

I want my representatives to start representing. Members of Congress get a much better retirement plan than you and I do. They can even collect after being convicted of a crime while still in office and they take a lot more days off than our employers would allow for us little people. So I think we should begin holding our representatives to a higher standard or at least one equal to what is expected of us by our employers. The system for paying all of our elected representatives should be changed to a salary plus bonus plan. The bonus would only be paid when a representative leaves office or is re-elected. When we go to the ballots there should be a new question on every ballot in every state which would determine whether or not our representatives collected their bonus; Did Mr. /Ms (Insert name here) represent your interests to the best of his/her ability? If the majority feels that the representative did their best then the bonus is paid as soon as the current term expires. However, if the people feel that they were not properly represented then there is no bonus. I think that a system like this would force our elected officials to keep in touch and understand how we are feeling about the issues. Oh Yeah, from now on when someone running for office says that they are going to change this or change that, I for one want to see the plan. If someone says they can do better than the current elected officials we should have the right to know how they intend to do it before we vote for them. Source: arkansasmedicarepros.com
Source: posterous.com

Local hospital plans healthy: SummaCare, AultCare serving communities, eye growth in future.

Jun. 18–Hospitals nationwide are pulling the plug on their hospital-owned health insurance plans. But a handful — including at least two in Northeast Ohio — are sticking it out and helping maintain competition within the communities they serve. Leaders from Summa Health System’s SummaCare in Akron and Aultman Health Foundation’s AultCare in Canton say they’re committed to remaining a locally owned option for the thousands of area businesses and consumers. SummaCare is a vital part of Summa Health System, said Thomas J. Strauss, Summa’s president and chief executive. About 15 percent of Summa’s hospital revenues come from SummaCare, making the health plan the system’s largest payer aside from Medicare and Medicaid, he said. ‘If you’re just a hospital, you only get paid when patients are sick,’ he said. ‘There’s no incentive for you to keep that patient well and out of the hospital. If you’re an integrated system, you can actually work on true wellness and generate benefit financially to keep patients out of the hospital. ‘I’m absolutely convinced this is part of the future.’ Likewise, Aultman Health Foundation views AultCare as a vehicle to pass on lower charges at Aultman Hospital to the community, said Joe Novak, AultCare’s vice president for provider services. The hospital only contracts with AultCare, Novak said. ‘The goal was to not have a profit and keep the money in town,’ he said. Both local insurers operate with razor-thin margins. SummaCare has an operating margin of 2 percent to 3 percent each year, while AultCare’s averages less than 1 percent. In comparison, the health insurance industry posts an average operating margin of 6 percent, with some publicly traded companies approaching double-digit margins, said Rick Byrne, Ohio market analyst for HealthLeaders InterStudy, an industry research firm in Nashville. Unlike their larger competitors, hospital-owned insurers aren’t looking to make big bucks, said Cathy Eddy, president of the Health Plan Alliance, a group based in Texas that represents 37 provider-owned health plans. ‘The plan helps support the overall objectives of the system,’ she said. During the 1980s and into the mid-1990s, many hospitals were looking to diversify and develop strategies to get more patients, Eddy said. AultCare started in 1985, and SummaCare started five years later. Many hospitals also got into the insurance business because of potential changes in the way hospitals were paid, said Alan Bleyer, Akron General Health System’s president and chief executive. Akron General acquired HomeTown Health Network in 1999 when it purchased Massillon Community Hospital. Back then, he said, it appeared the industry was moving toward paying hospitals capitated rates. Under that scenario, insurers pay contracted hospitals a set amount of money per enrollee per month regardless of the amount of care provided. Evolving strategy
Source: blogspot.com

Shingles Vaccinations Not Covered For Some Medicare Beneficiaries

A. Shingles is a painful rash caused by a virus that can lead to long-term nerve damage called postherpetic neuralgia. All Medicare Part D prescription drug plans cover the shingles vaccine, which is recommended by the Centers for Disease Control and Prevention for people age 60 and older. But Medigap plans, which may cover the deductible and coinsurance amounts for services provided under Medicare Parts A and B (hospitalization and outpatient care), don’t offer any financial help on the co-payments for vaccines and other drugs covered under Part D.
Source: kaiserhealthnews.org

Akron General offers free Medicare counseling to community

account articles-per business button-type california child children church city college counseling counselor country daughter department director education facebook family financial health kids life limited-number medical mental-health national office password people personal president program school shared social state student students study time university will-send work your-shared
Source: zxl6666.com

Choosing the right Medicare plan during open enrollment

Review your services and benefits: You or your caregiver should list the medical services you used this year. Were your benefits a good match for those services? How much did you pay for deductibles and co-payments? Are the premiums or co-pays of your existing medical insurance expected to increase next year? If yes, by how much?
Source: cleveland.com

SummaCare Health Insurance

Recognized nationally for its coverage of health insurance plan and Medicare health SummaCare has become one of the health insurance companies first in northern Ohio. Its members range from a service area of ??18 counties in northeast Ohio, and maintain a network of over 6,000 providers and hospitals 30. To accommodate members who travel outside the coverage area, have also established relationships with other national provider networks to ensure the best possible coverage for their members.
Source: typepad.com

SilverSneakers Medicare Programs

So, what exactly is SilverSneakers?  SilverSneakers is essentially a gym membership or fitness club membership to participating centers across the country.  You can find participating gyms by going to www.silversneakers.com and typing in your zip code.  You can find out if your Medicare plan offers Silver Sneakers by calling 1-888-423-4632.  Here are some of the features offered by SilverSneakers.
Source: medicare-plans.net

Sanctions Blocking Medicare Sales Lifted

Aetna Inc. has admitted interest in acquisitions that would increase the presence of Medicare. Recently, the company announced the purchase of Genworth Financial Inc., which is a Medicare supplement company, for just under $300 million. Unaffected by the restrictive sanctions, Medicare supplement plans were bought by individuals that held coverage under traditional Medicare. Medicare supplement plans offer beneficiaries with protection against paying any out-of-pocket expenses that may not be covered by Medicare. According to Aetna Inc., the Genworth unit featured almost 150,000 members.
Source: medhealthinsurance.com

Tom Strauss leads a new vision for patient care at Summa Health System

The first thing you’ve got to realize is that you can’t make everybody happy. That’s the hard one, especially for somebody like me who really prefers to have people holding hands singing ‘Kumbaya.’ The other area is trying to micromanage. You cannot in this environment micromanage. You’ve got to empower your people and let them go. They will make mistakes and that’s OK as long as they learn from their mistakes. I would think trying to stay in the old system, trying to stay in the old ways was a mistake that got us starting to transform toward population health and population management.
Source: sbnonline.com

Who Denies the Highest Percent of Claims? Medicare.

The patients began writing and calling and pressuring CMS. CMS offices accused us of fraud, and were dishonest to our patients by telling them it was our problem, not theirs. With help from Senator Pat Roberts, we were finally able to receive payment for these improperly denied claims. Our bariatric office staff spent 60% of their time for several months trying to resolve these issues. This was time away from processing new patients, and running the rest of our practice. This is one example of the horror stories that await all physicians when the government has absolute power of the purse.
Source: ncpa.org


Posted by:  :  Category: Medicare

Appellants assert that 42 C.F.R. § 423.509, pursuant to which CMS may terminate a contract with a Medicare sponsor that fails to comply with the applicable marketing guidelines, demonstrates “[t]he relevancy and materiality of compliance” with the marketing guidelines. Appellants’ br. at 23. Indeed, section 423.509 states that “CMS may at any time terminate a contract if CMS determines that the Part D plan sponsor ․ [s]ubstantially fails to comply with ․ [m]arketing requirements in subpart V of this part.” 42 C.F.R. § 423.509(a)(8)(i); 42 C.F.R. § 422.510(a)(11) (same for MA organization). The same regulation, however, provides that before CMS may issue a notice of intent to terminate a Medicare contract it will provide a plan sponsor “a reasonable opportunity of at least 30 calendar days to develop and implement a corrective action plan to correct the deficiencies.” 42 C.F.R. § 423.509(c)(1)(i); 42 C.F.R. § 422.510(c)(1)(i). The regulation further provides, in section (c)(2)(iii), an exception for the 30–day correction period if the termination is based on “credible evidence, [that the Plan Sponsor] has committed or participated in false, fraudulent, or abusive activities affecting the Medicare, Medicaid, or other State or Federal health care programs, including submission of false or fraudulent data.” 42 C.F.R. § 423.509(a)(4); 42 C.F.R. § 422.510(c)(2)(iii) (referring to 42 C.F.R. § 422.510(a)(4)). The regulation also contains an exception to the requirement that a sponsor be allowed a 30–day correction period where CMS’s delay in termination, or the financial difficulties of the Plan Sponsor, pose an imminent and serious risk to the health of the individuals enrolled in the sponsor’s plan. 42 C.F.R. § 423.509(c)(2)(i)-(ii); 42 C.F.R. § 422.510(c)(2)(i)-(ii). Thus, sections 423.509 and 422.510 clearly demonstrate that compliance with the marketing regulations is a condition of participation and not a condition of payment as the regulations draw a line between the type of violations which are correctible and, if corrected, will allow the sponsor to continue as a Medicare program participant and the type of violations which lead to immediate termination of a CMS contract.
Source: findlaw.com

Video: GBMC Primary Care – Debbie Jones, CRNP

Tax Evasion and Medicaid/Medicare Fraud : South Carolina Nursing Home Blog

Since all Ameri-Choice checks come from the United Health’s home office they should be held equally responsible for any bribes, kickbacks, Stark, Fraud and inducements violations that may have occured. Federal and State Governments have developed such a depended position with this company, guess the laws and rules no longer apply for them. Protected vendor status sure, politics sure, limited government budgets sure, Federal and State officals looking the other way sure, and rather then stop these activities a strong desire not to rock the boat exists. The Government created this monster and now they don’t know what to do about it, like shooting yourself in your own foot etc. Tons of money to advance their national growth, its market positions, tons of money for political donations, tons of money to send 75 millon back to its home office from New York state alone, tons of money to suppot National TV shows, tons of money to pay hugh State fines, tons of money to hire the very best law firms, tons of money for hugh salarys and bonuses, all done on the back of the American taxpayor, you see this company receives all its money from the Federal State governments.
Source: scnursinghomelaw.com

Medicare Targets Health Plans With Low Ratings

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

AmeriChoice Health Plans Team with Cover the Uninsured Week

“Cover the Uninsured Week is the nation’s largest mobilization on behalf of America’s 46 million uninsured people,” said Dr. Eric Yoder, AmeriChoice chief medical officer. “As a facilitator of programs in Medicaid, Children’s Health Insurance, Special Needs Plans and other government-sponsored health care programs, we are committed to improving access to quality, affordable health care for the most vulnerable populations in America.”
Source: istockanalyst.com

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

Source: alltrendingtopics.com