Research Roundup: Medicare Advantage Plan Beneficiaries May Get More Appropriate Services; CHIP Participation Grows

Posted by:  :  Category: Medicare

THE LITTLE MAN KILLED MEDICARE FOR EVERYONE by SS&SSUrban Institute/Robert Wood Johnson Foundation: Medicaid/CHIP Participation Among Children And Parents – “Despite the economic downturn, most states have maintained or expanded Medicaid and CHIP for children, by expanding eligibility to higher income and immigrant children, undertaking enrollment and retention simplifications, and implementing new policy options,” the authors wrote about coverage rates between 2008 and 2010. The rate of eligible children participating in Medicaid or CHIP grew to 86 percent nationwide and the number of eligible children who were not insured fell by 500,000 in that time, the study found. Participation rates for eligible parents were lower, however. The authors conclude that the 2009 law designed to improve participation of children in the program “may have contributed to increased take-up for Medicaid/CHIP among children, but that additional efforts will be needed, particularly among parents, to achieve high levels of Medicaid enrollment under the Affordable Care Act ACA” (Kenney et al., 12/3).
Source: kaiserhealthnews.org

Video: Medicare replacement vs. Supplement

The Trouble with Medicare Advantage

Fillman goes on to explain: “The new accounting rules issued by the Governmental Accounting Standards Board (GASB) place a tremendous strain on public retiree health benefits and add to the lure of these private Medicare plans.  The GASB rules require public employers to estimate future costs of their retiree health benefits – 35 years into the future – and publish them on their annual financial statements.  To reduce this paper liability, more public employers are proposing a switch from their own solid retiree health plans, which include traditional Medicare, to these private Medicare plans.  This is a major factor in public employers’ decisions to switch to Medicare Advantage private fee-for-service plans.
Source: healthbeatblog.com

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

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

Obama administration hides Medicare Advantage cuts in demonstration project

“Over the next few years the Affordable Care Act cuts about $156 billion worth of subsidies from Medicare Advantage plans,” Herrick said. “Nearly one in four seniors are enrolled in a Medicare Advantage plan. Half of these may lose their plans, as plans that are no longer profitable close due to the budget cuts. However, millions of seniors being thrown off their private Medicare plans in an election year is not something that’s welcome by the Administration.
Source: consumerinsuranceguide.com

Notes from the Cliff: The Deal and Its Impact on Medicare 

Cong. Tit. VI (2012) [2] Id. at  §§ 601, 603, 607, 608, 610, 621, 643 (2012) [3] For more information on the Sustainable Growth Rate See The Sustainable Growth Rate Formula and Health Reform, The Center on Budget and Policy Priorities, (April, 2010) http://www.cbpp.org/files/4-21-10health2.pdf & Mary Agnes Carey,  ‘Doc Fix’ In ‘Fiscal Cliff’ Plan Cuts Medicare Hospital Payments, Kaiser Health News, Jan. 1, 2013, http://capsules.kaiserhealthnews.org/index.php/2013/01/doc-fix-in-senate-fiscal-cliff-plan-cuts-medicare-hospital-payments/ [4] There is a separate $1,900 per year cap for occupational therapy [5] See also the Medicare Improvements for Patients and Providers Act of 2008, Pub. L. No 11-275, codified at 42 U.S.C. §§ 1320b-14, 1396u-5(a) (2010).
Source: medicareadvocacy.org

What Medicare Needs is a Consumer

Medicare’s cuts will be implemented by changing the way fees for the diagnostic procedures are calculated. Instead of reimbursing neurologists for each nerve analyzed, the new billing codes will henceforth bundle multiple nerve-conduction tests into a single fee. The Obama administration claims that under the current system Medicare has been paying too much for neurologists’ overhead costs. But the American Academy of Neurology, in an advisory to its members, warns that the cuts will devastate “neurology practices large and small, many of which rely on these services to meet their bottom line.” Patients will be hurt as well: As Medicare squeezes neurologists, seniors’ access to neurological care will dwindle.
Source: townhall.com

Cliff Averted: Medicare Fee Schedule Intact

Posted by:  :  Category: Medicare

Benefit Security Card .. HALF of the U.S live in households that receive government benefits (26 May 2012) ...item 2.. Brevard man gets 4 years in Social Security fraud case (Jun 1, 2012 ) ... by marsmet481As CMS reminded providers in its 12/19/2012 bulletin, clean electronic claims are never paid sooner than 14 calendar days after the date of receipt. CMS has promised to issue further notification before January 11, 2013 with an update on its progress in updating its fee schedule (remember, CMS was forced to load the 2013 fee schedule with the projected pay cuts, since Congress acted so late in averting the cuts). It is our hope that CMS will be able to work quickly enough within these next two weeks in order to avoid having to reprocess claims for 2013 dates of service.
Source: healthcarebiller.com

Video: Confronting New Medicare Payment Realities – How 2013 Reimbursement Changes Will Impact Pathologists

Medicare payment boost in Massachusetts prompts angry letter to Obama

From admission and discharge to billing and record keeping, today’s hospitals use technology along every point of the care continuum. But challenges remain, especially when so many clinicians and staff access patient records across multiple points, and often on different equipment. This webinar will examine how UC Irvine and other providers are simultaneously using multiple technologies to boost physician access while ensuring data security. Register now!
Source: fiercehealthcare.com

Medicare’s 2013 Fee Schedule Compared to 2012

On November 1, 2012, the Centers for Medicare & Medicaid Services (CMS) released the final 2013 Medicare Physician Fee Schedule (MPFS) and its updated conversion factor. Under current law, providers paid under the MPFS will face significant cuts to reimbursement rates. Within the law governing reimbursement rates, a mechanism known as the Sustainable Growth Rate (SGR) automatically would have resulted in a significant decrease in Medicare reimbursement rates over the past several years. However, Congress has intervened each year to override the SGR, meaning rates have been generally flat each subsequent year. For 2013, if Congress does not intervene, the SGR will result in a 26.5 percent cut to the Medicare Part B conversion factor from $34.0376 to $25.0008.
Source: healthcarereforminsights.com

Detailing Medicare’s 2013 Doc Pay Schedules: Home Health Flat, Primary Care Up

Medpage Today: Medicare Sets 2013 Physician Fee Schedule Family physicians will receive up to a 7 percent boost in Medicare payments in 2013, and other primary care providers will receive 3 percent to 5 percent more, under a final rule announced Thursday by the Centers for Medicare and Medicaid Services (CMS). Much of the increase in the physician fee schedule reimbursement will come from new added payments for coordinating a patient’s care in the 30 days following a hospital or skilled nursing facility stay. Under the rule, providers will for the first time receive a separate payment to help a patient transition back to the community following a discharge. The American Medical Association (AMA) said it was pleased that the transition payments — which were suggested by a work group that the association participated in — had been adopted (Pittman, 11/1).
Source: kaiserhealthnews.org

AARP Urges Congress to Address Medicare Physician Payments

“As you know, physicians and other health care providers are scheduled to receive a 27 percent cut on January 1, 2013, as a result of the flawed sustainable growth rate (SGR) formula.  This is in addition to the 2 percent reduction included in the planned sequestration.  Failure to adopt legislation to address the “doc fix” would create considerable instability in the Medicare program.  Such a significant reduction in reimbursement could cause providers to stop seeing Medicare beneficiaries or prevent them from accepting new ones.  We are disappointed that Congress has thus far been unable to develop a long-term solution to this perpetual problem.  However, even in the absence of a longer-term solution, the SGR cuts must not be allowed to occur.  Under current law, the Centers for Medicare and Medicaid Services may begin issuing the reduced payments on January 1.  A reduction for even a short time in reimbursement rates could disrupt access to care, as providers may delay seeing Medicare patients until updated rates go into effect. 
Source: aarp.org

Uwe E. Reinhard: The Complexities of Comparing Medicare Choices

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

Avoiding Medicare cliff still has initial consequences for payment : Getting Paid

Finally, the 2013 Annual Participation Enrollment Program allowed eligible physicians, practitioners, and suppliers an opportunity to change their Medicare participation status by Dec. 31, 2012. Given the new legislation, CMS is extending the 2013 annual participation enrollment period through Feb. 15, 2013. Therefore, you have until Feb. 15, 2013, to postmark any participation changes (both elections and withdrawals) that you want to make. The effective date for any participation status changes during the extension remains Jan. 1, 2013, and will be binding for the rest of the year.
Source: aafp.org

2013 Medicare pay hike for ODs back on track under Washington’s last

While the immediate Medicare pay crisis has been averted for now, the one-year SGR fix and the two-month sequester delay signal the start of a new effort to prevent future Medicare pay cuts and finally fix Medicare’s broken SGR payment formula. A growing concern, the two-month delay in sequester cuts directly aligns with the date on which the nation is expected to reach its borrowing limit, providing yet another opportunity to potentially target Medicare payments to doctors of optometry.
Source: newsfromaoa.org

Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline, CPT Code Billing: Office visit CPT, E&M code fee schedule

CPT Code Medicare Allowed Amount 99201 Office visit new level 1 $43.80 99202 Office visit new level 2 $74.53 99203 Office visit new level 3 $109.06 99204 Office visit new level 4 $166.63 99205 Office visit new level 5 $206.10 99211 Office visit est. level 1 $20.16 99212 Office visit est. level 2 $43.80 99213 Office visit est. level 3 $72.93 99214 Office visit est. level 4 $107.04 99215 Office visit est. level 5 $143.41 99241 Office Consult 15 min minor $47.21 99242 Office Consult 30 min low $89.22 99243 Office Consult 40 min moderate $121.56 99244 Office Consult 60 min mod/high $178.92 99245 Office Consult 80 min mod/low $219.34 99223 Hospital care initial level 3 $201.65 99231 Hospital care subsequent level 1 $38.71 99232 Hospital care subsequent level 2 $70.95 99233 Hospital care subequent level 3 $102.38 99235 Observ or inpatient hosp care $166.98 99238 Hosp discharge day mgmt;30 min or less $71.29 99251 I/P consult 20 min $48.26 99252 I/P consult 40 min low $74.50 99253 I/P consult 55 min moderate $112.82 99254 I/P consult 80 min moderate/high $161.96 99255 I/P consult 110 min moderate/high $202.13 99291 Critical care first hour $275.14 99374 Home hlth supervision 15 29 m $69.45 99395 Preventive checkup est 18 39 $117.19 99396 Preventive checkup est 40 64 $125.33 99397 Preventive checkup est 65 y $135.18 90471 Vaccine only $25.41 90658 Flu vac split 3 years intr 90732 Pneumococcal vaccine -0.5 ml $65.77 90749 Immunization procedure nec 90935 Hemodialysis one evaluation $72.04 90945 Dialysis one evaluation $85.30 90960 ESRD – 4 or more visits per month $284.51 90961 ESRD – for 2 to 3 visits per month $239.69 90962 ESRD – Per visit per month $185.58 90966 PD Home dialysis $239.36 90970 ESRD less than a month 20 yrs and old $7.93 93000 Electrocardiogram complete $18.37 93005 Electrocardiogram tracing onl $10.08 94640 Airway inhalation treatment $18.97 94664 Aerosol or vapor inhalations $18.31 96372 Injection admin code $25.41 G0008 Flu vaccine $23.78 G0009 Admin of pneumococcal vaccine $23.78 G0179 Phys Recertification For Medicare Cov $41.27 G0180 Home health certification $52.90 G0438 Short descriptor – Annual wellness first $169.05 G0439 Short descriptor – Annual wellness subsequent $110.58 G0101 Female examination/medicare $37.97 G0102 Prostat Cancer Screening $19.82 10040 Acne surgery $104.69 10060 Incision/drainage of abscess;simple $118.00 11042 Surgical cleansing of skin tis $119.95 11100 Biopsy of skin lesion $106.16 11302 Shave skin lesion trunk arm l $144.56 11400 Remove lesion trunk arm leg $126.21 17110 Destroy flat wart up to 14 le $113.01 69210 Remove impacted ear wax $53.43 81002 Urinalysis nonauto w/o scope $3.52 82270 Test for blood feces $4.48 82947 Assay of glucose quant $5.39 85610 Prothrombin time $5.40 86580 Tb intradermal test $8.10 88142 CYTOPATH C/V THIN LAYER $27.75 J0696 Rocephin 1 gram $0.72 J0881 Aranesp 5 mcg $3.44 J1080 Testosterone shot $5.78 J1815 Insulin Injection $0.53 J3301 Kenalog $1.79 J3420 B12 inj. $0.56 Q0091 Pap smear, sample retrieval $45.46 Q2037 Fluvirin vacc, 3 yrs & >, im $14.05
Source: medicarepaymentandreimbursement.com

Odds and Ends: 2013 Medicare Physician Fee Schedule

, 2012. This policy and payment update sets the Medicare therapy cap amount for outpatient therapy services and payment. According to the American Physical Therapy Association (APTA), this fee schedule established the 2013 therapy cap exception at $1,900 but this exception will only last till December 31, 2012 unless the Congress extends it. In addition, the APTA notes that this rule also “includes a 26.5% reduction to Medicare payment rates for physicians, physical therapists, and other professionals due to the flawed sustainable growth rate formula.” They also mentioned that this reduction can be avoided if the Congress acts by the end of the year (as it repeatedly has done since 2003) and change the growth rate formula such that the “aggregate impact on payment for outpatient physical therapy would be a positive 4% in 2013.”
Source: mtbc.com

Medicare Reimbursement for Outpatient Therapy

Effective in 1999, there are two outpatient therapy caps: 1) a PT/SLP services combined cap, and 2) a separate OT services cap. The cap limits are adjusted annually per Congressional formula. In 2012, the cap for each service was $1,880. For most of 2000-2006, however, the caps were not enforced as a result of legislation. Since 2006, there has been an exceptions process permitted by Congress that allows beneficiaries to receive services beyond the cap limits in non-hospital settings, if the clinician attests the services are medically necessary, and places a KX modifier on claim lines for services furnished beyond the annual cap limits.
Source: healthcare-economist.com

Raiding Medicare: How seniors will pay for Obamacare

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

Claiming a Medicare rebate: :: Centred MGP

Posted by:  :  Category: Medicare

SCOTUS Obamacare Decision Makes Individual Mandate A Fact & Universal Healthcare Coverage A Fiction by watchingfrogsboilEvery woman is entitled to have a midwife, unfortunately if you see your GP you don’t get to see a midwife until you go for your hospital visit at 19/20 weeks. This means you have missed out on vital information and building a valued relationship. This is regretable because it is beneficial for women to see a midwife from the moment she is pregnant or at least between 8 – 10 weeks. A midwife gives the woman unbiased information allowing the woman to choose different options of care, rather than the straight route to an obstetrician because she has private cover. Now with midwives having a Medicare provider number, this means that a pregnant woman can see a private midwife to discuss options of care and claim for a refund just like going to the doctors. Midwives work in collaboration with doctors and midwives are all to happy to refer the woman when it is required and the woman wishes to do so.
Source: centredmgp.com

Video: Medicare Rebate [1998]

Physiotherapy Medicare Rebates

Clients can either choose to claim the rebate onsite after their treatment or by going into Medicare. For clients who choose to claim onsite we require an eftpos card (linked to a savings or cheque account) and your Medicare card. We will charge $61.10 to your account, then swipe your Medicare card to attain the rebate then reswipe your eftpos card to place the $51.95 back into your account. If clients to choose to go into Medicare we can print them a receipt with all the necessary details to claim the rebate.
Source: com.au

John Hunter’s Blog: Medicare Rebate at November 2010

JOHN HUNTER, provides Medicare rebatable counselling in the Melbourne CBD at 253 Lonsdale Street, Melbourne and in Burwood East near the K-Mart complex. Please call Mobile 0405 107 476 or 9539 2200 for appointments and enquiries. Voice messages will be answered as promptly as possible. John Hunter, BSW, MAASW (Accredited), Mobile 0405 107 476, Landline (03) 9539 2200 Visit: www.johnhunter.net.au
Source: blogspot.com

White House Touts Medicare Rebates

“You the American people have made it clear that you don’t want Obamacare,” Mr. Herger said on the video. “You told the president and Speaker Pelosi at town hall meetings, public rallies and at the ballot box. They rammed their government takeover of health care through anyway. But House Republicans are listening. That’s why we have introduced a bill that would fully repeal Obamacare and replace it with common-sense, incremental solutions that would actually help bring down skyrocketing health care premiums by up to 20 percent.”
Source: nytimes.com

Uwe E. Reinhard: The Complexities of Comparing Medicare Choices

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

Means Test for Private Health Insurance Rebate [Video]

[…] $600 carer payment $900 $950 ATO BAS Bookkeeping/MYOB branding budget budget 2010 Business Management business plan business plans centrelink client retention concessional contributions customer service data matching debtors family tax benefit FTB household stimulus package insurance Jobs & Education Lifestyle marketing myob naming a business new company name one-off payment Online Services Planning & Growth Reminders Resources Service & Marketing Small Business SMSF Superannuation superannuation Taxation tax bonus tax deduction tax offset taxpayer alert tax return understanding benefitsSource: com.au […]
Source: com.au

State Hospitals Face 2nd Highest Rate Of Federal Penalties Nationwide

Posted by:  :  Category: Medicare

HERES YOUR TOP TEN by SS&SSUnder the value-based program, hospitals receive penalties or incentives based on how well they perform on 12 clinical measures, such as controlling surgery patients’ blood sugar levels or giving them antibiotics, and on eight patient experience measures, including how well doctors and nurses communicate with them and how clean and quiet the hospital is during their stays. Middlesex, like most other hospitals, has a number of committees dedicated to encouraging “patient-centered care,” and has put in place new policies to improve safety for surgical patients.
Source: courant.com

Video: Medicare Anniversary CEO Jeff Flaks FOX CT

New Benefits, Taxes Under The Affordable Care Act

Expanded Medicaid Coverage: Connecticut was the first state to receive federal approval to expand Medicaid enrollment even before the Affordable Care Act takes effect. States must decide whether to expand Medicaid by 2014, with the federal government paying 90 to 100 percent of the costs. The number of low-income adults receiving Medicaid has grown from an estimated 47,000 to about 86,800 from July 2010 to December 2012, reports the state Department of Social Services. Some lawmakers question whether the increase stems from a bad economy or if people are deliberately moving to Connecticut to receive benefits. For now, the Centers for Medicare & Medicaid Services is reviewing a request by Connecticut to institute a $10,000 asset test and parental income reporting for applicants.
Source: ctwatchdog.com

CMS Names 106 New Medicare ACOs

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

McMahon spitballs ideas for Medicare, Social Security reform

“I think we have to put every single thing on the table and work it out between Democrats and Republicans and then have our CBO, the Congressional Budget Office, put the economics or the scoring next to that to see what really does make sense so we’re not kicking this can down the road,” McMahon said. “I want a permanent solution so I can make sure we protect both of these programs.”
Source: nhregister.com

McMahon Favors Medicare/Medicaid and Social Security Cuts

If Linda McMahon’s “Balanced Budget” Plan Was Enacted This Year, It Would Potentially Mandate Hundreds of Billions of Dollars in Medicare/Medicaid and Social Security Cuts.  Linda McMahon proclaims support for a so-called Balanced Budget Amendment, which is a constitutional amendment mandating that federal outlays not exceed total tax receipts.  This year, the federal budget deficit is $1.5 trillion.  Linda McMahon has said on the campaign trail that she opposes any tax increases to balance the budget and that she would exempt Defense spending ($714 billion), Homeland Security ($41 billion), and Veterans Benefits ($162 billion) from her proposed spending cuts in order to reach her goal.  Including debt service ($196 billion), this leaves just $917 billion left, meaning Congress would have to cut 57% of the rest of government spending—including Medicare, Medicaid (currently $736 billion) and Social Security ($749 billion).  Even if you shut down funding for highways, ended small business and education loans, and cut the entire Department of Justice, this plan would still serious consequences for the entitlement programs, if enacted.  [Washington Post, 7/24/10; Congressional Research Service Summary, H.J.Res78, 3/2/10; Linda McMahon Editorial Board Interview (Hartford Courant), 7/20/10; OMB U.S. Budget, Mid-Session Review, 8/25/09; Congressional Research Service, “Mandatory spending Since 1962,” 9/15/10; LM at Conservative Women’s Luncheon PT 2, 9/23/1; LM Remarks at Gun Enthusiasts Meeting, 9/22/10; LM Common Sense CT Interview, 8/30/10; LM at Taste of Mystic, 9/10/10; Linda McMahon, Chaz & AJ Show FM 99.1, 8/3/10]
Source: ctnews.com

5th District debate focuses on Medicare, Social Security

“I’m not embracing any one of their particular recommendations, but I think they should be considered,” he said. Both candidates accused the other of fear-mongering — Esty accusing Roraback of using “scare tactics” culled from the U.S. Chamber of Commerce’s website and telling seniors that Social Security benefits are in danger, Roraback accusing Esty of promoting incorrect information in her advertisements.
Source: ct5thdistrict.com

AARP Medigap Rates 2013 Connecticut

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

Travel for Seniors: Connecticut

This post is a guest post by John Walters who is a freelance writer who attended the 1973 Clarion West science fiction writing workshop and is a member of Science Fiction Writers of America.  He writes mainstream fiction, science fiction and fantasy, and memoirs of his wanderings around the world.  For many years he lived in Greece with his Greek wife and five sons and taught English as a second language to help pay the bills, but he has recently moved back to the United States and now lives in San Diego. 
Source: medicareecompare.com

Connecticut rallies issue call to tax the rich; no cuts to Social Security

Public support for increasing taxes on the rich was strong in Hartford, where  bystanders at the bus stop near the rally eagerly signed postcards calling for an end to the Bush tax cuts for the wealthiest 2%,  no cuts to Social Security, Medicare and Medicaid, maintaining unemployment benefits, putting Americans back to work rebuilding infrastructure, renewable energy and public safety, and transferring pentagon funds and converting military production and jobs.
Source: peoplesworld.org

Medicare spends $1 billion on mammograms

Medicare, which provides health insurance to the elderly and disabled, spent $523 billion in 2010. During the time studied, 2006-2007, Medicare spent $1.36 billion on breast cancer treatments and $1.08 billion on screening. About $410 million of that was spent on screening women who were over 74.
Source: nbcnews.com

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

Posted by:  :  Category: Medicare

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

Video: Excellus BCBS Medicare: What’s included in my Medicare Advantage Plan?

Blue Medicare Advantage: Blue Cross Blue Shield of Illinois

“Greetings, My name is Nannie Burrell. The purpose for emailing you is to tell share how wonderful Jordan Kohanim has been in helping me to understand the policies, terms, conditions, and premiums related to the enrollment in the BCBS Medicare program. As many people may experience, the amount of mail, letters, and phone calls about Medicare coming to any individual can be, and is, very overwhelming. From the beginning, Jordan has made it a point to help me through the whole process. Without hesitation, Jordan has been there for me and my daughter in answering any questions we have and actually spending time, day or night, talking to us about the products that not only BCBS provides, but even to help me understand the government’s Medicare program. Because of her personal touch, caring nature, and focus on customer service, Jordan has relieved me of my hesitations, concerns, and apprehensions about joining the Medicare program. There have been times she’s answered emails and phone calls during non traditional work hours, which I truly appreciate it. Her flexibility has enabled me to get my questions answered and increased my comfort level. Again, I thank Jordan for her customer service and passion about her job and customers. I would highly recommend Jordan to anyone who is interested in BCBS or simply wants to understand Medicare. If you have any question or concerns about this feedback, please let me know. Thanks! “
Source: ssiinsure.com

BCBS Medicare Advantage Plans

I would just cut your losses. Sitting around waiting for med advantage commish will destroy your focus. If it comes, then it comes. I would recommend never, ever selling that junk again and moving on. Sell a real insurance policy. If you don’t cut it off in your mind it will kill your focus, your sanity, and ultimately your business. There is nothing more insane then waiting to get paid by the govt’. Fool me once…
Source: insurance-forums.net

Blue Cross Blue Shield of Texas Health Insurance Quotes and Plan Review

For Texas residents looking for health care, Blue Cross Blue Shield of Texas is one of the top health insurance companies to consider in the state. Learning about Blue Cross Blue Shield of Texas medical insurance plans is even more important when one realizes that within the Unites States there cost of health care keeps rising and with it the uninsured rate keeps rising steadily. It is estimated that about 47 million Americans are living without Health Insurance coverage, when in 2006 there were about 46.4 million without Health Insurance. Middle class citizens are having trouble paying their bills and some people just cannot afford health insurance coverage at the moment. As the nation tries to do something about it, private insurance companies have tried to lower the rates to attract more customers and make it easier for people to sign up for the so long wished health insurance.
Source: c-tides.org

Phone Presentation Medicare Advantage

Hi everyone, I am trying to better understand if it is possible to sell Medicare Advantage plans by phone? I know there has to be a consent to contact before it is okay to contact the client. I also understand that a scope of appointment form is necessary before any Medicare Advantage products can be discussed. Once this information is received, what can the agent discuss with the client about Medicare Advantage? What are the rules? Does the presentation have to be recorded and stored for 10 years? I understand that the consent to contact and actual enrollment has to be recorded, but does the presentation? What can the phone presentation actually consist of? Can a scope of appointment be obtained by phone and recorded? How can I get a hold of the scripts for the consent to contact and the script for the enrollment? Can I send a standardized letter out to a bunch of prospects asking them to sign the consent to contact letter if they are interested in learning about Medicare Advantage?
Source: insurance-forums.net

What Raising the Medicare Eligibility Age Means

Posted by:  :  Category: Medicare

State of the World - May 7 2006 by yonghokimRaising the eligibility age saves very little money, on the order of a few billion dollars a year. That’s because the 65 and 66-year-olds will have to get insurance somewhere, and many of them are going to get it with the help of the federal government, either through Medicaid or through the insurance exchanges, where they’ll be eligible for subsidies. However, since many Republican-run states are refusing to expand Medicaid in accordance with the Affordable Care Act, lots of seniors who live in those states will just end up uninsured, which will end up leading to plenty of financial misery and more than a few premature deaths. Put this all together, and the Center on Budget and Policy Priorities estimates that while the federal government would save $5.7 billion a year from raising the eligibility age, costs would increase by more than twice in other parts of the system—for the seniors themselves, employers, other enrollees in exchanges who would pay higher premiums, and state governments.
Source: prospect.org

Video: Medicare Part 1: Eligibility and Enrollment

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

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

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

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

Daily Kos: Are Democrats abandoning raising the Medicare eligibility age?

Meteor Blades, skybluewater, SME in Seattle, bink, Renee, Angie in WA State, cslewis, Sylv, chuck utzman, Irfo, hester, slinkerwink, Gooserock, PeterHug, Andrew C White, eeff, willyr, TX Unmuzzled, Duncan Idaho, jancw, expatjourno, eyeswideopen, bronte17, cyberKosFan, Einsteinia, susakinovember, whenwego, pedrito, Nate Roberts, Eddie C, revsue, psnyder, figbash, 2laneIA, defluxion10, RebeccaG, grrr, lcrp, inclusiveheart, ybruti, lonespark, Wife of Bath, Sybil Liberty, Skennet Boch, drofx, radarlady, 3goldens, ichibon, irate, sc kitty, Alice Venturi, wallys son, Flint, dewtx, Dobber, Laurence Lewis, ratzo, bleeding blue, Sun Tzu, skyounkin, markdd, Ozzie, spunhard, xaxnar, Jim R, splashoil, Jim P, begone, Born in NOLA, velaski, Patriot Daily News Clearinghouse, vigilant meerkat, Kimball Cross, rl en france, martyc35, kestrel9000, DarkestHour, triv33, twigg, real world chick, el cid, sceptical observer, Timothy J, Clive all hat no horse Rodeo, bstotts, ms badger, sea note, BentLiberal, ammasdarling, Tamar, One Pissed Off Liberal, phonegery, fabucat, Habitat Vic, tgypsy, puakev, beth meacham, dclawyer06, deepeco, jedennis, leonard145b, madgranny, trueblueliberal, JDWolverton, MKinTN, CroneWit, mconvente, TruthFreedomKindness, also mom of 5, HappyinNM, wayoutinthestix, zerone, prettyobvious, Involuntary Exile, elwior, treesrock, KJG52, jamess, Therapy, Lujane, tofumagoo, petulans, venger, Tonga 23, JamieG from Md, Nica24, Mike Taylor, maggiejean, prettygirlxoxoxo, Rhysling, cybrestrike, J M F, Throw The Bums Out, Scott Wooledge, Alex Budarin, maryabein, Zotz, mkor7, papahaha, kevinpdx, sfarkash, Lacy LaPlante, emptythreatsfarm, FogCityJohn, flitedocnm, Crabby Abbey, Progressive Pen, Polly Syllabic, sunny skies, ATFILLINOIS, melpomene1, gulfgal98, Lady Libertine, ItsSimpleSimon, Puddytat, Egalitare, sharonsz, addisnana, Betty Pinson, ericlewis0, cocinero, Oh Mary Oh, fiercefilms, stevenaxelrod, Onomastic, mama jo, Liberal Capitalist, Mr MadAsHell, BlueJessamine, OhioNatureMom, smiley7, marleycat, thomask, Wolf10, whaddaya, ratcityreprobate, stlsophos, Willa Rogers, Mentatmark, SouthernLiberalinMD, allergywoman, SycamoreRich, wolf advocate, Cordyc, anodnhajo, SparkyGump, cwsmoke, pistolSO, Siri, Citizenpower, IndieGuy, rustypatina, S F Hippie, effervescent, Trotskyrepublican, JGibson, congenitalefty, Mr Robert, BobSoperJr, geojumper, radical simplicity, MartyM, pittie70, Vote4Obamain2012, avsp, marty marty, dotdash2u, George3, wasatch, Marjmar, fauve, Sue B, simple serf, Illinois IRV, jbob, Linda1961, Panama Pete, goodpractice, The Hamlet, alice kleeman, Jollie Ollie Orange, marcr22, chicklet, pragmaticidealist, MBishop1, Catkin, Chas 981
Source: dailykos.com

Medicare Eligibility Age Increase Rejected By Obama Allies

DURBIN: I do believe there should be means testing. and those of us with higher income in retirement should pay more. That could be part of the solution. But when you talk about raising the eligibility age, there’s one key question. what happens to the early retiree? What about that gap in coverage between workplace and Medicare? How will they be covered? I listened to Republicans say we can’t wait to repeal Obamacare, and the insurance exchanges. Well, where does a person turn if they are 65 years of age and the medicare eligibility age is 67? They have two years there where they may not have the best of health. They need accessible, affordable medical insurance during that period.
Source: firedoglake.com

Brad DeLong : Aaron Carroll: Raising the Medicare Eligibility Age Is Really, Really, Really, Really Bad Policy

Washington would see $24 billion in Medicare savings. But it also would see a rise of about $9 billion in Medicaid spending and another $9 billion in subsidy spending, which would reduce the overall savings to about $5.7 billion. But all those 65- and 66-year-olds need insurance. Those who get it through their jobs would cost employers another $4.5 billion. Others would go to the exchanges. But, ironically, removing these people from the Medicare risk pool and adding them to the exchanges makes both groups less healthy, so everyone’s premiums would go up. This would cost all Americans another $2.5 billion. States have to cover a portion of the new Medicaid spending. That’s $700 million. Finally, there are the out-of-pocket costs to seniors, which may rise by $3.7 billion.
Source: typepad.com

Raising the Medicare Eligibility Age: A Costly and Dangerous Proposal 

[1] Congressional Budget Office: Raising the Ages of Eligibility for Medicare and Social Security, January 2012. Available at http://www.cbo.gov/publication/42683. [2]Center for Budget and Policy Priorities: Raising Medicare’s Eligibility Age would Increase Overall Health Spending and Shift Costs to Seniors, States, and Employers, August 2011.  Available at http://www.cbpp.org/cms/?fa=view&id=3564. [3] Henry J. Aaron, Ph. D, The Brookings Institution for AARP Public Policy Institute, Perspectives: Reforming Medicare: Option-Raise the Medicare Eligibility Age, available at http://www.aarp.org/content/dam/aarp/research/public_policy_institute/health/option-raise-the-medicare-eligibility-age-AARP-ppi-health.pdf. [4] Center for American Progress, The Senior Protection Plan, available at http://www.americanprogress.org/wp-content/uploads/2012/11/SeniorProtectionPlan.pdf. [5] Kaiser Family Foundation: Raising the Age of Medicare Eligibility: A Fresh Look Following the Implementation of Health Reform, July 2011, available at http://www.kff.org/medicare/8169.cfm. [6] Ibid. [7] Kaiser Family Foundation, Health Reform Subsidy Calculator, available at http://healthreform.kff.org/subsidycalculator.axpx [8] Ibid. [9] United States National Vital Statistics System. Available at http://www.cdc.gov/nchs/nvss.htm. [10] Health Affairs, Raising the Medicare Eligibility Age: Effects on The Young Elderly, July/August 2003, available at http://content.healthaffairs.org/content/22/4/198.full. [11] Medicare Rights Center, Paying More for Less: Raising the Eligibility Age, available at http://www.medicarerights.org/pdf/Paying-More-For-Less-Raising-Medicare-Age.pdf. [12] ABC News/WashingtonPost Poll, Langer Research Associates, November 2012, available at http://abcnews.go.com/blogs/politics/2012/11/among-cliff-avoidance-options-most-favor-targeting-the-wealthy/. [13] Center for Medicare Advocacy, Deficit Reduction and Medicare: Saving Money without Harming Beneficiaries, available at http://www.medicareadvocacy.org/2012/11/15/deficit-reduction-and-medicare-save-money-without-harming-beneficiaries/ [14] MRC. [15] Center for Medicare Advocacy, Investing in Our Future: Strengthening Medicare in 2012 and Beyond, available at http://www.medicareadvocacy.org/2012/02/09/investing-in-our-future-strengthening-medicare-for-2012-and-beyond/.
Source: medicareadvocacy.org

HCAN Fact Sheet: Raising the Medicare Eligibility Age Would Shift Costs to Seniors, States and Employers

The Congressional Budget Office (CBO) estimated the effects of delaying Medicare eligibility by two months for every year beginning in 2014. The Kaiser Family Foundation (KFF) took a more comprehensive look at the impact of the proposal if implemented immediately. KFF found that the proposal would generate $5.7 billion in net federal savings in 2014 alone but would shift costs of twice that amount ($11.4 billion) to individuals, employers and states.
Source: healthcareforamericanow.org

The Medicare Eligibility Age: Impacts on Health Behavior and Outcomes

The impact of Medicare eligibility on health outcomes is harder to assess, both because of difficulties in measuring health, and because health is less likely to change discretely in response to insurance coverage. Perhaps surprisingly, we find a statistically significant impact of reaching age 65 on self-reported health, with the largest gains among the education and race groups that experience the largest increases in insurance coverage at age 65. On the other hand, we find no evidence of a discrete change in mortality rates at 65, nor do we see any shift in the rate of growth of mortality after 65. These findings have to interpreted cautiously since it is difficult to identify a plausible comparison group for post-65 mortality rates in the absence of Medicare. Taken as a whole, we believe our findings point to a significant but relatively modest impact of health insurance coverage on health. 
Source: wordpress.com

IRS Releases New Information About Medicare Tax Surcharges

Posted by:  :  Category: Medicare

Joe the Plumber - To Flush The System ... More scams aim to ensnare Brevard seniors - Their ingenuity is boundless, Archer said. (Jul 2, 2012) ... by marsmet524The 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

Video: Medicare Retiree Information Session Presentation

Biden offers senior Floridians misguided information on Medicare

Under President Obama, that coverage for the screening procedures was expanded as a result of new directives forcing insurers to cover only those preventive services recommended by the United States Preventive Services Task Force. These mandates are another symptom of the centralized control that Obamacare exerts over the practice of medicine. But under Mr. Obama, the colonoscopies have faced offsetting new restrictions that mostly make it harder for seniors to access many of the tests.
Source: aei-ideas.org

Information for Medicare Beneficiaries

This week, open enrollment began for Medicare and runs through December 7, 2012. It is important for current Medicare beneficiaries to review their plans on an annual basis to ensure satisfaction with their current coverage. Some of the optional changes to your coverage you may wish to make during this period, which would take effect in 2013, are:
Source: texasgopvote.com

Senators Urge CMS to Provide Information about Medicare and Medicaid Reimbursement for Compounded Drugs

Public Citizen, a consumer advocacy group, has written a letter to HHS Secretary Kathleen Sebelius, asking her to direct the HHS Office of the Inspector General (OIG) to conduct an investigation into CMS’ policies with respect to reimbursement for compounded drugs. Public Citizen cited conflicting provisions of the Medicare Benefit Policy Manual that, on the one hand, instruct carriers to deny coverage for drugs that have not been approved by the FDA and, on the other hand, direct carriers not to deny coverage for such drugs unless directed to by CMS. Public Citizen also noted that CMS is aware of the dangers posed by compounded drugs. In 2007, its four regional Durable Medical Equipment (DME) Medicare Administrative Contractors (MACs) denied coverage for compounded inhalation drugs administrated via nebulizers, noting that the drugs were not FDA-approved and citing safety concerns. The senators, Public Citizen, and the public await the agencies’ response.
Source: wolterskluwerlb.com

Opinion Piece Calls for Increased Access to Medicare Claims Data

Lane notes that Dow Jones, the publisher of the Wall Street Journal, is asking a federal court in Florida to lift the 1979 injunction. He writes that when Dow Jones and the Center for Public Integrity obtained access to limited information from the Medicare database, they produced articles “documenting many millions of dollars’ worth” of excessive and questionable treatments.
Source: ihealthbeat.org

Don’t Fall for Medicare Card Phone Scam

You answer the phone, and the unknown caller claims to be with Medicare or another government office. He informs you that your new Medicare card is in the mail, and you will receive it in a few days.  In the meantime, you need to set up your direct deposit so your Medicare funds can be deposited into your bank account. To do this, you just need to tell the caller your banking information. He will take care of the rest.
Source: bbb.org

MHANJ Offers Free Medicare Benefits Counseling through “SHIP”

Counseling is free, objective and confidential and encompasses assistance with questions about Medicare, Medigap, Medicare Advantage, Medicare Part D, Long-Term Care Insurance and Dual-Eligibility. Sessions are conducted by telephone so that travel is not necessary.       
Source: mhanj.org

Contacting Railroad Medicare when a beneficiary dies

If you have received a Medicare Summary Notice (MSN), Palmetto can discuss the claims on that notice. If you have not received an MSN, a representative can order an MSN to be sent to the beneficiary’s address. Their representatives can also tell you whether or not we have received or processed a claim for a specific date of service.
Source: utu.org

Uwe E. Reinhardt: Comparing the Quality of Care in Medicare Options

Both traditional Medicare and Medicare Advantage plans are monitored annually through surveys of patients, using the Consumer Assessment of Health Care Providers and Systems, known in the trade as Cahps. The findings from this survey make it possible to compare traditional Medicare with Medicare Advantage plans on quality. As Medpac reports in Table 12-8 of Chapter 12 of the March 2012 report, the commission found little difference in the relatively few quality-performance scores of the traditional Medicare and Medicare Advantage plans.
Source: nytimes.com

Medicare: Assume Good Intentions

The procedure codes that we use to indicate the services we provide (CPT) were developed by physicians.  Many of the 97xxx CPT codes used by PT and OT are 15 minute time based codes. So, to accurately charge for services provided for a visit longer than 15 minutes, multiple procedure codes must be used. Consequently, the MPPR process greatly affects our reimbursement. We tend to get paid for how much we do (multiple procedures), not what we know (complex decision making).
Source: clinicient.com

Uwe E. Reinhardt: Comparing the Quality of Care in Medicare Options

Posted by:  :  Category: Medicare

Press Conference on Benefits of Health Insurance Reform to Seniors by Leader Nancy PelosiBoth traditional Medicare and Medicare Advantage plans are monitored annually through surveys of patients, using the Consumer Assessment of Health Care Providers and Systems, known in the trade as Cahps. The findings from this survey make it possible to compare traditional Medicare with Medicare Advantage plans on quality. As Medpac reports in Table 12-8 of Chapter 12 of the March 2012 report, the commission found little difference in the relatively few quality-performance scores of the traditional Medicare and Medicare Advantage plans.
Source: nytimes.com

Video: What is a Medicare health insurance exchange?

Goldman, Other Welfare Queens Tell Us Forget Social Security

Most seniors lack these necessities.  Half of those 65 or older make  $45,000 a year ($3,750 a month) or less.  If you have to wait until 70 for Medicare, you can either pay monthly health insurance premiums of $1,000 to $3,000 a month (if you can get it) or you can learn pain and suffering up close without coverage.  You can eat much less and downsize to substandard shelter to pay your health care costs (premiums and out-of-pocket expenses).  Perhaps the combination of restricted health care, substandard diet, and inadequate shelter may even kill you, in which case the problem is solved.
Source: warisacrime.org

Brad DeLong : Remember, the Dormouse Says Medicare Is the Best

Disenrolled from fee for service Medicare – and unable to keep the surgical follow-up appointment from a surgeon who takes Medicare assignment but does not participate in Medicare Managed Care – and moved to a Medicare Managed Care rehab funded facility, Alice was advised that this was her problem to unravel. Her new Medicare Managed Care insurance plan vacillated between advising her she was not an enrollee in their plan and advising that, even were she an enrollee, no follow up post-surgical appointment was necessary….
Source: typepad.com

Patterico's Pontifications

The twisted irony of Obama’s presidency, particularly in light of his emulation of Lincoln and Reagan, is that, like them, he does face a momentous crisis that requires leadership commensurate to the moment. He just doesn’t have it in him to lead on it, or maybe he’s too busy with other priorities. An economic rebound in his second term will delay the reckoning with entitlements for a few years longer so his legacy is probably safe in the near term, but if he doesn’t do something wildly unexpected in the next four years to deal seriously with mandatory spending, then his place in history is secure. He’s the guy who expanded health-care entitlements at a moment when Medicare spending was starting to go haywire, the guy who doubled down on the welfare state as the bill was coming due, the guy whose second-term agenda was even more aggressively liberal than his first despite trillions more in debt over four years. You wanted him, America, you got him. Good luck.
Source: patterico.com

Daily Kos: Politico has a sad because it doesn’t think Obama has done enough to cut Medicare or Social Security

The fiscal cliff deal, which raised $600 billion in new revenue, may have actually made it more difficult to strike a grand bargain. That’s because Republicans aren’t willing to consider further tax hikes — a White House prerequisite to weighing any controversial cuts to entitlements. Well, I guess that settles that. As we all know, if Republicans say no to something, then it’s off the table. It should never be considered. Why? Because Republicans said no, that’s why. And when they say no, they mean it. Except: A senior Republican tax aide confirmed that Representative Dave Camp of Michigan, the Ways and Means chairman, planned to push forward this year with “revenue-neutral” tax reform, with the revenue target adjusted upward to the amount raised by the higher tax rates on the wealthy approved this month to resolve most of the so-called fiscal cliff.
Source: dailykos.com

Not Happy with Your Medicare Advantage Plan? Change it!

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

Health Department Holds Tibetan Medicare System Review Meeting

The Tibetan Medicare System (TMS) experience sharing meeting started on 21s January at Micro Insurance Academy (MIA) conference hall with a welcome speech by the chairman of MIA, Prof. David Dror and a keynote address by Health Kalon Dr. Tsering Wangchuk. It was later followed by presentations by various health executive officers from numerous Tibetan settlements.
Source: tibet.net

David Gregory Tells Morning Joe That President Obama Must Gut Medicare To Succeed

Unfortunately for America, President Obama has already indicated a willingness to move in that direction, having already placed raising the Medicare eligibility age on the table. Raising the age will only shift those costs, at higher rates, and only partially away from the federal government. Those two extra years will either be paid for by the seniors themselves, who will be charged up to 3 times as much for health insurance on the individual market, or by the government in the form of Medicaid for those who can’t afford private insurance, or by private insurance companies.
Source: mediaite.com

The South End :: Mich. medical school deans sound off on Obamacare

We know that cuts to providers are likely to be part of any discussion about the future of Medicare and Medicaid,” the document says, according to The Detroit News. “We do not expect that health systems will be spared while all other sectors are cut. However, we hope that Congress can foresee that disproportionate cuts to health systems, asking them to take more than their share of the budget reduction, will result in fewer doctors, less access to care and layoffs.” Michigan, as well as other states, is at the forefront of what many are calling the nation’s most important legislation since Franklin D. Roosevelt’s expansive New Deal: The Affordable Care Act.
Source: wayne.edu

Media distorts Obama on seniors issues

Posted by:  :  Category: Medicare

Joe the Plumber - To Flush The System ... More scams aim to ensnare Brevard seniors - Their ingenuity is boundless, Archer said. (Jul 2, 2012) ... by marsmet524Since the remarks were not uttered in public, it seems likely Romney was not as careful with his words as he would have been under other circumstances. Ironically, in 2008 Obama was also embarrassed by comments he made at a private fundraiser in San Francisco that became public. To Nather’s credit, he did acknowledge, “Romney and Ryan easily won among seniors even though Obama attacked their Medicare plan at every turn.”  And he admitted that Obama has entertained the possibility of increasing the age for Medicare eligibility and means testing benefits. Another inaccurate article was written by Rachelle Younglai of Reuters, who claimed that Obama’s speech “did not sit well with Republican lawmakers, who noted that healthcare is one of the biggest drivers of the country’s $16.4 Trillion debt.” Now, having made a statement like that, you’d think Younglai would have quoted a Republican lawmaker or two about Medicare’s contribution to the national debt. But she did not.  She did quote Senator Jeff Flake (R-AZ), who said, “In order to protect them, we’ve got to reform them.”  Of course, Flake is correct. His statement is not controversial. The fact is that much of the national debt is owed to the Medicare and Social Security trust funds.  For decades, Congress has “borrowed” from Medicare and Social Security for the general operations of the federal government. At the end of December 2012, the Financial Management Service of the Treasury Department reported that the federal government owed $287.199 Billion to the Medicare trust funds (hospital and supplemental medical) and owed $2.733 Trillion to the Social Security trust funds (old age and disability). Together, the $3.020 Trillion that is owed to Social Security and Medicare makes up 18.4% of the $16.432 Trillion national debt. What Obama said in his speech on seniors’ issues was completely different from what the news media reported. These blatant distortions of fact appear to be intended to harm conservatives.   The previous issue of What’s Happening with Seniors Benefits: Obamacare Increasing Health Insurance Costs and Unemployment The previous issue What’s Happening with Conservatives and the Tea Party: There should be NO increase in the debt ceiling UNLESS…   Previous issues of both newsletters. Follow Art Kelly on Twitter @ArthurKellyJr
Source: 60secondactivist.com

Video: VP Biden Talks Medicare with Seniors

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

Left Behind: Will Cutting Medicare Hurt Seniors?

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

12 On Your Side: Medicare scam targets seniors in Augusta

“What they well tell them is that they are from Medicare and that the card is in the mail and in order to make sure their funding is going into their account, they need to verify their account information,” Turner said.
Source: wrdw.com

Study: Star Rating System Resonating With Seniors

Medpage Today: Seniors Favor Higher-Rated Medicare Plans First-time enrollees in Medicare Advantage plans and those switching plans were more likely to enroll in ones with a higher star rating, a study of nearly 1.3 million Medicare beneficiaries found. An increase of one star in the ratings made it 9.5 percent more likely a first-time Medicare Advantage enrollee would choose a given plan, the study published in Tuesday’s Journal of the American Medical Association found. Similarly, for those switching plans, a higher star rating was associated with a 4.4 percent greater chance of enrollment. … But awareness and use of Medicare Advantage’s star-rating system has been mixed, Jack Hoadley, PhD, of the Health Policy Institute at Georgetown University, in Washington, wrote in an accompanying editorial (Pittman, 1/15).
Source: kaiserhealthnews.org

Obama’s Medicare Plan: Seniors Will Pay More

Obama’s latest budgetary scheme for cost-shifting to seniors is just another indication that the Administration and its allies on Capitol Hill are running out of options. They have already cut the Medicare provider payments to achieve a 10-year “savings” estimated at $716 billion, but most of those “savings” will finance Obamacare. In a letter to Senator Jeff Sessions (R–AL), ranking member of the Senate Finance Committee, the CBO writes, “Unified budget accounting shows that the majority of the HI trust fund savings under PPACA would be used to pay for other spending and therefore would not enhance the ability of the government to pay for future Medicare benefits.”
Source: amac.us

Gov. Kaine Talks Social Security, Medicare With Senior Residents

Kaine, a Democrat, told the audience at Birmingham Green, located just outside of Manassas Park, that he doesn’t support privatizing Social Security, which he says requires the working to set money aside in an account for themselves instead of using it to support older ones.
Source: patch.com

MedicareIsSimple: Seniors Favor Higher

“One interpretation of these findings suggests that publicly reported star ratings could be achieving one of their intended purposes of guiding beneficiaries toward higher-quality plans,” Rachel Reid from the the Centers for Medicare and Medicaid Services’ (CMS) Innovation Center, in Baltimore, and colleagues wrote. “Consequently, CMS may consider continued evolution of the rating methods to ensure that the quality information conveyed continues to reflect attributes important to both the agency and beneficiaries.”
Source: blogspot.com

Why Medicare Costs Are Exploding In 2013

Posted by:  :  Category: Medicare

Record shop Ithaca, NY by exaktaAfter three years of declines, enrollment in private insurance plans grew by 1 million, or 0.5 percent in 2011. Medicare’s actuaries say one of the main reasons for that increase was increased coverage of dependents younger than 26 mandated by the Affordable Care Act. (The addition of those younger, healthier beneficiaries did help to drive down growth in private insurers’ spending on benefits per enrollee to 3.2 percent in 2011 from 4.6 percent in 2010.)
Source: businessinsider.com

Video: Medicare for All – MoKan demonstration at Blue Cross/Blue Shield offices in Kansas City, Missouri

UCLA Health System chosen as a Medicare Shared Savings Program accountable care organization / UCLA Newsroom

The UCLA Health System, which comprises the UCLA Hospital System and the UCLA Medical Group and its affiliates, has provided a high quality of health care and the most advanced treatment options to the people of Los Angeles and the world for more than half a century. Ronald Reagan UCLA Medical Center, the Resnick Neuropsychiatric Hospital at UCLA, Mattel Children’s Hospital UCLA, and UCLA Medical Center, Santa Monica (which includes the Los Angeles Orthopaedic Hospital) deliver hospital care that is unparalleled in California. Ronald Reagan UCLA Medical Center is consistently ranked one of the top five hospitals in the nation and the best in the western United States by U.S. News & World Report. UCLA physicians and hospitals continue to be world leaders in the full range of care, from maintaining the health of families to the diagnosis and treatment of complex illnesses.
Source: ucla.edu

How Likely Are Physician Offices to Accept Medicare and Medicaid?

SK&A released its report titled, “Physician Office Acceptance Government Insurance Programs,” which showed 83.6 percent of medical providers accept Medicare and 67 percent accept Medicaid, though a decline may be imminent. The Patient Protection & Affordable Care Act will give 30 million Americans access to healthcare, many on Medicaid. But 31 percent of physicians said they would not accept new Medicaid patients, according to a National Ambulatory Medical Care survey. SK&A’s survey of 271,451 office-based physicians found larger, affiliated practices have higher Medicare and Medicaid acceptance rates, while smaller, non-affiliated practices have lower rates. Offices with daily volumes greater than 31 cases had an acceptance rate of 85.5 percent for Medicare and 69.6 percent for Medicaid. Also, healthcare system-owned and hospital-owned practices are more likely to accept Medicare, at 89.1 percent, compared with non-hospital or healthcare system-owned practices, at 82.7 percent. Medicaid acceptance is about 83 percent for hospital or healthcare-owned practices and only 64 percent for non-hospital or system owned. The top specialties accepting Medicaid are dialysis, critical care medicine and nephrology. The lowest acceptances rates come from bariatrics, occupational medicine and holistic medicine. More Articles on Revenue Cycle: Fitch: Non-Profit Hospitals May See Some Stability in 2013 Physician Groups Gear Up to Fight for SGR Repeal University Hospitals’ Fundraising Campaign Reaches $1B Goal
Source: beckershospitalreview.com

Impact of Medicare surtax on trusts and estates

A new 3.8 percent Medicare surtax that took effect on Jan. 1, 2013, applies both to individuals and to trusts and estates that are required to file income tax returns. However, there are important differences between individual taxpayers and non-exempt trusts and estates in the way the new surtax is calculated and in the threshold income amounts to which it applies. These differences will require careful estate planning to minimize the applicability of the surtax. For individual taxpayers, the new surtax applies to the lesser of the taxpayer’s net investment income, which is income from interest, dividends, and other return on investments received by the taxpayer during the year, or the amount by which the taxpayer’s modified adjusted gross income (MAGI) exceeds the threshold amount. The threshold amount depends on filing status: $200,000 for those filing singly and $250,000 for couples filing jointly. Because net investment income is included in MAGI, the amount of investment income subject to the tax is limited by the amount MAGI exceeds the threshold.
Source: jacilaw.com

IRS Releases Proposed Regulations for Medicare Taxes Under Affordable Care Act

0.9% FICA Tax: Beginning in 2013, the Medicare portion of FICA will increase .9% for taxpayers who earn more than $200 thousand ($250 thousand for taxpayers filing married filing jointly). The .9% tax applies only to the employee’s share of FICA. Regardless of the employee’s filing status, an employer will withhold the .9% on any wages paid over $200 thousand in a calendar year. Employees with excess withholding can take a credit against their tax liability. Employees who may owe more than the amount withheld should make estimated tax payments or request additional income tax withholding. An employer who does not meet the appropriate withholding, deposit, reporting, and payment responsibilities may be subject to applicable penalties even though not liable for the tax itself.
Source: givnerkaye.com

Voice For Medicare, Medicaid Retiring

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

Health Department Holds Tibetan Medicare System Review Meeting

The Tibetan Medicare System (TMS) experience sharing meeting started on 21s January at Micro Insurance Academy (MIA) conference hall with a welcome speech by the chairman of MIA, Prof. David Dror and a keynote address by Health Kalon Dr. Tsering Wangchuk. It was later followed by presentations by various health executive officers from numerous Tibetan settlements.
Source: tibet.net

Media release announces co

Aboriginal and Torres Strait Islander people Australia Canada Case studies Centrelink Children Customer experience Data Department of Human Services Disabilities Disability services Egovernment Employment Error and Fraud Europe Evaluation Families Gov 2.0 Health Homelessness Housing Information and Communications Technology Innovation Internet Law and Legislation Local government Mental health Mobile Open Government Participation Privacy Public administration Public Sector Remote Seniors Service delivery Social inclusion Social media Statistics Surveys United Kingdom United States Vulnerable welfare Youth
Source: gov.au

Vacant Offices That Bill Medicare

I’ll remind the reader that I’m focusing only on Medicare fraud. This doesn’t get into the inefficiencies throughout the entire health care sector, consisting of many industries, that Medicare causes. There are always many associated costs. If resources are diverted to monitoring and enforcing Medicare, that means fewer resources going to activities that could use them profitably, even those that government supposedly is there to do.
Source: lewrockwell.com

Medicare and coding update for 2013

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

Study: Only 23% of Orthopedic Offices Accept Pediatric Patients With Medicare

The study included 250 general orthopedic practices — five from each state. Each office was called with a private cell phone using the following script: “My 10-year-old son broke his arm while out of the country last week. He was splinted and told to see an orthopedic surgeon within one week. His fracture does not involve the growth plate.” Only 23.2 percent of the practices across the country agreed to schedule an appointment for a pediatric fracture patient with Medicaid. Of the offices that declined an appointment request, 38 percent said that they do not accept Medicaid patients. Meanwhile, 82 percent of the offices nationwide agreed to see a patient with private PPO insurance. Nine states were identified where all five offices refused the Medicaid patient, but all five accepted the PPO patient (Connecticut, Illinois, Louisiana, New Jersey, North Carolina, Oklahoma, Rhode Island, South Dakota and Texas). Compared to data published in 2006, the number of offices in 2012 willing to see a child with private insurance has declined from 92 percent to 82 percent. The number of offices willing to see a child with a fracture and Medicaid insurance has decreased from 62 percent to 23 percent, a 39 percentage-point decline.
Source: beckersspine.com