Registration for Medicare EHR Incentives To Open on Jan. 3

Posted by:  :  Category: Medicare

San Diego, CA by Oggie DogMany of the states that are ready to begin registration in the next few months plan to issue their first incentive payments by late January or early February 2011 (Modern Healthcare, 12/23). Other states might not launch their incentive programs until spring or summer of 2011 (Kraynak, HealthLeaders Media, 12/23).
Source: ihealthbeat.org

Video: EHR: Medicare and Medicaid Incentive Program Registration Webinar for Eligible Hospitals

CVS Caremark Corporation (CVS) To Help Pharmacy Patients Who Are Registering In Medicare Part D

Endo Health Solutions Inc (ENDP) Lowers Its Outlooks For Year 2013 – Stage Stores Inc (SSI) 5 Weeks Total Sales Surged 5% – Sonic Corporation (SONC) Will Be Presenting At The 15th Annual ICR Xchange Investor Conference – Ruth’s Hospitality Group, Inc. (RUTH)’s Team Will Join 15th Annual ICR XChange Investor Conference – A. Schulman Inc (SHLM) Reports a Drop of Almost 13% in Earnings during Fiscal First-Quarter – Warren Buffett’s MidAmerican Energy Reserved A Deal Of $2.5 Billion Holdings SunPower Corporation (SPWR) – Rovi Corporation (ROVI) Plans To Sell Rovi Entertainment Store – Progress Software Corporation (PRGS) Profit Surged During Fiscal Fourth-Quarter – Eli Lilly & Co. (LLY) Reported Top Line Results Of Empagliflozin – NuVasive, Inc. (NUVA) Reports an Upbeat Revenue Forecast for Year 2013
Source: stockmarketvideo.com

Registration Opens for the Medicare and Medicaid Electronic Health Records (EHR) Incentive Programs

While the Medicare EHR Incentive Program is administered by CMS, the Medicaid EHR Incentive Program is voluntarily offered and administered by the states. California, Missouri, and North Dakota are expected to open registration for the Medicaid Incentive Program in February 2011, with other states likely to offer the program during the spring and summer of 2011. Registration marks a major step for providers in the process of obtaining incentive payments under the EHR Incentive Programs. Under these programs, Medicare and Medicaid incentive payments totaling as much as $27 billion from 2011 to 2021 will be available for payment to eligible professionals (EPs) and eligible hospitals for the “meaningful use of certified EHR technology.” Providers are encouraged by CMS to register and participate early to obtain the maximum incentive payments.
Source: lexisnexis.com

Registration for CMS EHR Incentive Programs

On your mark: Determining your eligibility Before you register, you need to determine if you are eligible. Eligibility differs for eligible hospitals and professionals — criteria that you should review as soon as possible. Those who’d prefer a more interactive experience can use CMS’s Eligibility Wizard to reveal what program(s) they qualify for. It’s crucial to know that EPs qualifying for both Medicare and Medicaid Incentive Programs have to choose one or the other prior to registration. (Hospitals can receive payments from both.) Moreover, EPs can only change programs once before 2015 after receiving their first incentive payment. The major difference between the programs is money, nearly $20,000 (Medicare’s 44,000 to Medicaid’s $63,750), but there are plenty more. Choose your own adventure.
Source: ehrintelligence.com

Even if you don’t take Medicare, Medicare may have created a marketing and growth opportunity for your business

Medicare has approved two new billing codes designed to encourage doctors to connect with patients promptly after hospital or nursing home discharge, to assess their needs, and to coordinate their in-home and outpatient care.  Both the codes are titled Transitional Care Management (TCM).  Medicare-certified home health agencies remember what a great marketing tool it was when Medicare started paying doctors for certifying plans of care more than a decade ago.  At the time, the advantage only applied to certified home health.  A handful of certified agencies now recognize that Medicare is handing them another opportunity.  In addition, these new codes apply to any care or services the patient needs (e.g. non-medical home care, home improvement, ambulation devices, lift chairs, home infusion, etc.).  Private duty and HME providers should take note that CMSs final rule for these news billing codes twice specifies that doctors need to assess patients for ADL needs and refer to the services that help with ADLs.
Source: bma-advisor.com

Tips to Demystify Medicare Open Enrollment

Once you’ve found a plan that fits your budget and medication needs, don’t forget about convenience when filling your prescriptions. A pharmacy accepted as “preferred” by a Medicare Part D Plan is a network pharmacy that offers covered drugs to plan members at lower out-of-pocket costs than what the member would pay at a non-preferred network pharmacy. For example, Walmart is a preferred pharmacy on multiple plans including the Humana Walmart-Preferred Rx Plan. (Incidentally, people who have high blood pressure or who are concerned about heart health should also know that Humana and Walmart just announced that members of the Humana Walmart-Preferred Rx Plan will have access to 10 hypertension drugs for a penny each when filled at one of the 4,400 Walmart or Sam’s Club pharmacy locations).
Source: alexisabramson.com

Medicaid expansion could create 12,000 jobs in state

Posted by:  :  Category: Medicare

Colorado Public News asked Clark, CEO of Metro Denver Economic Development Corp., to calculate the number of jobs created by such a large influx of funds. In a rough estimate with pen, lined paper and long division, Clark figured that half the money would go to jobs and half to buildings and equipment, to provide health care to all these newly insured people. Using an average $50,000 Colorado salary on the remainder, he came up with more than 12,000 jobs from the other half of the money.
Source: gazette.com

Video: Linda Gorman on Colorado’s Medicaid Expansion

Colorado Moves Forward with Obamacare by Expanding Medicaid

Expanding Medicaid is a critical piece of Obamacare, but last year’s Supreme Court ruling said the expansion is voluntary for states, not mandatory. Fifteen states and the District of Columbia have indicated they will proceed with the expansion, while governors in nine states have said they will decline to do so, according to the Advisory Board Company.
Source: thecoloradoobserver.com

Colorado Medicaid Expansion May Create 12,000 Jobs

“We are focusing on transforming our health system to ensure all Medicaid recipients have access to the right services, at the right time, in the right setting and at the right price,” said Susan E. Birch, executive director of the Department of Health Care Policy and Financing (HCPF). “We will reset the cost trajectory of Medicaid by building on the successful work we’ve started with our Accountable Care Collaborative.”
Source: economicdevelopmenthq.com

Colorado to Expand Medicaid

Colorado Gov. John Hickenlooper (D) announced his state would expand its Medicaid program to an estimated 161,000 more people and expense the added costs to the U.S. government through 2016. The U.S. Supreme Court previously ruled the Patient Protection and Affordable Care Act could not require states to raise their Medicaid eligibility income threshold to 138 percent of the poverty line, but states can voluntarily opt in to access the extra federal funding for three years. Most Republican-governed states have opted out of the expansion, Nevada being an exception. The Colorado Hospital Association released a statement in favor of the move, saying it hoped it would reduce the $1 billion of annual uncompensated care. By 2020, Colorado will pay 10 percent of the expanded Medicaid program cost using a provider fee it instituted in 2009, according to a report from the Denver Post.
Source: beckershospitalreview.com

Legislature seeks health care reform prescription

Another fight over health care expansion is likely to be generated by universal health care. Aguilar has proposed a referred initiative that would ask voters to back a constitutional amendment to create a health care cooperative. The co-op would provide health insurance to all Coloradans. She must receive two-thirds support from both the House and Senate to place the question on the ballot. Aguilar acknowledged she has an uphill battle, but she still plans on introducing the bill in the next few weeks.
Source: coloradostatesman.com

Instead of expanding Medicaid ghetto, Colorado should emulate Florida’s Medicaid premium support program

The program has achieved results. According to the Florida Agency for Health Care Administration, the health outcomes are 64 percent better than under a managed care system, with 83 percent higher satisfaction from those in the program. Florida is currently saving roughly $118 million a year on Medicaid in the five counties, with better outcomes for the people in it.
Source: patientpowernow.org

Colorado Governor Proposes Medicaid Expansion

KKTV firmly believes in freedom of speech for all and we are happy to provide this forum for the community to share opinions and facts. We ask that commenters keep it clean, keep it truthful, stay on topic and be responsible. Comments left here do not necessarily represent the viewpoint of KKTV 11 News.
Source: kktv.com

Health Care in the Next Colorado Legislative Session

Simplification of Colorado’s health insurance laws is another piece of unfinished business. Obamacare eliminates health status as a factor getting health care coverage. The federal law also standardizes health benefit plans and establishes benchmarks for the amount of out of pocket expenses paid by an enrollee. As a result, Colorado has a number of unnecessary laws on the books. The legislature will consider a bill to simplify and clean up health insurance laws.
Source: rmhp.org

Medicare Part B Premium 2011 and 2012: Are Costs On The Rise?

Posted by:  :  Category: Medicare

Your Medicare Part B Premium is taken out of your social security check, usually on a monthly basis. If you can not afford to carry Medicare Part B agencies are available to assist you. They are: Medicaid, Supplemental Security Income, Qualified Medicare Beneficiary (QMB) Program, Specified Low-Income Medicare Beneficiary (SLMB) Program or theQualifying Individual (QI) Program. You can still be accepted even if your income is above the qualifying income limits.
Source: seniorcorps.org

Video: Medicare Part B_1.wmv

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

Medicare fees rise for 2013

I see attacks on our president for problems wth our social security and medicare and am amazed how few people ignore the fact that congress is the major force behind plans to cripple and cut the programs each of us rely on. Over the last few years it is the GOP who have been hucking these programs under the buss they view the program that most of us will use to survive our senior years as a charity supported by rich people wrong it is a fund we have paid into all our working lives and i am offended every time i hear the word entitlement.
Source: bankrate.com

Medicare open enrollment: Did Obamacare secretly increase Part B premiums?

Here’s what’s happening. The 2003 law that set up these high-income premium surcharges also stated that the income thresholds were to increase every year to account for general inflation. But the Affordable Care Act freezes the thresholds at their current level through 2019, which will over the next six years snare more and more beneficiaries as incomes in general rise (or at least we hope they do). The Kaiser Family Foundation estimates that by 2019, about 14 percent of Medicare beneficiaries will be paying these higher premiums.
Source: consumerreports.org

Medicare Coverage Gaps 2013: Deductibles and CoInsurance

Just like your Part B premium, your Part D premium surcharge will be based on your modified adjusted gross income. Most people will pay the amount billed by their insurance company. But, if you filed an individual tax return for 2011 and your modified adjusted gross income was more than $85,000, your Part D premium surcharge for 2013 is shown in the table below. If you filed a joint tax return for 2011 and your modified adjusted gross income was more than $170,000, your Part D premium surcharge for 2013 is also shown in the table below. The Social Security Administration will compute your premium for you. However, we recommend that you double-check their computation against your 2011 tax return.
Source: asourparentsgrowolder.com

Your Health: “I can’t afford Medicare Part B premiums”

Barnhart, at Senior Connections, said if a person applies for the low-income subsidy (the “extra help” promoted by a twisting Chubby Checker on TV commercials) to cover prescription drugs, they can have an application automatically sent to Social Services for the premium assistance.
Source: timesdispatch.com

Finally the Medicare Part B Premium for 2013 is announced!

Since the Social Security Cost of Living Adjustment is 1.7% for 2013, this should be less than anyone’s increase in their monthly Social Security retirement benefit.  If you receive only $700 a month from Social Security (one of the lowest amounts), your Social Security benefit should increase $11.90, leaving you a small increase in monthly income after the Medicare Part B premium has been deducted from your check.   
Source: retirementeducationplus.com

Information on Medicare part b premiums for 2013

The standard Medicare Part B premium is determined by a formula contained in the 1997 Balanced Budget Act, which set the premium at 25 percent of total program costs.  The remaining 75 percent of program costs are financed through general revenues. The Medicare Modernization Act of 2003 (MMA) requires higher-income beneficiaries to pay a higher percentage of program costs, resulting in multiple tiers of premiums based on income. The 2013 and 2014 Part B premiums haven’t been decided yet. Also note: There has been lots of confusion about Medicare Part B premium rates in recent years, because Medicare beneficiaries who receive Social Security were protected from premium increases in 2010 and 2011 under what is called the “hold harmless” provision, which freezes Medicare Part B premiums if there is no Social Security cost-of-living adjustment.
Source: medicareplansstcharles.com

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

Posted by:  :  Category: Medicare

'The election of Obama would, at a stroke, refresh our country's spirit' by Renegade98Both 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: It’s Easy to Compare Medicare Plans at Joppel

What Is The Best Method For Making A Medicare Supplement Plans Comparison?

A list of physicians and healthcare professionals, by geographical location, can be found on the official Medicare website: https://questions.medicare.gov/find-a-doctor . This is an easy and convenient method to find participants in local areas. Every year there is an open season when individuals have the opportunity to make a Medicare supplement plans comparison to ensure both providers and services will continue. As with the original Medicare Parts A and B, the monthly fees for Medicare supplement plans are reviewed and adjusted on an annual basis. The Medicare monthly costs for Parts A, B, and D can be found at www.medicare.gov/costs/ . Supplemental insurance carriers will notify participants of any changes in annual fees or altered services during the November to December timeframe. Anyone who wants to change or drop a current insurance carrier can do so during the annual open season, January through March. Comparing costs today will lower individual expenses tomorrow.
Source: seniorcorps.org

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

Comparing Medicare prescription drug plans

Also, be aware that if you’re a low-income beneficiary and your annual income is under $16,755 or $22,695 for married couples living together, and your assets are below $13,070 or $26,120 for married couples, you may be eligible for the federal Low Income Subsidy known as “Extra Help” that pays Part D premiums, deductibles and copayments. For more information or to apply, call Social Security at 800-772-1213 or visit socialsecurity.gov/prescriptionhelp.
Source: pomeradonews.com

Moneycation: Medicare Part D: Plans and price comparison

You are likely to find several plans offered to you from several private insurance companies that seem to meet your needs. By using Medicare.gov’s Medicare Plan Finder before you make a change, you will be able to see which plans provide coverage for your state and town. You will see which are likely to have a low cost when the monthly premium, deductible and copayments are all considered. By contacting the various company’s websites or agents you can learn what is required of you in regards to using their network. Following these steps should make it easier for you to select the right prescription drug plan for you needs.
Source: blogspot.com

A (Very Brief) Comparison of Romney and Obama on Medicare

So which do you like better? A plan that reduces reimbursement levels and relies on top-down control/encouragement to produce more cost-effective medical care? Or a plan that relies on competitive bidding to keep costs under control? The choice, for both liberals and conservatives, is not as simple as you might think. Conservatives need to acknowledge that, like it or not, cost controls have a proven track record and that Obamacare’s top-down programs really might help improve the efficiency of healthcare delivery. Liberals need to acknowledge that those top-down controls aren’t a sure thing and that competitive bidding might make a real difference.
Source: motherjones.com

Annual Enrollment for Medicare Advantage (Part C) & Part D: October 15 – December 7 

Even beneficiaries who were satisfied with their 2012 plans need to review their plan options for 2013.  Part D and MA plans may have made changes to their coverage, provider networks and other plan features.[3] Plan information for 2013 will be available on the Medicare Plan Finder at www.medicare.gov.[4]  For the computer-savvy, the Medicare Plan Finder is an excellent plan comparison tool, allowing users to enter all their drugs and drug dosages, compare up to three plans at a time, save their drug information for later use, and actually enroll in a plan on-line.  This is the best – if not only – way to truly compare the many plans available to choose from.  People who cannot use the Plan Finder themselves may contact 1-800-Medicare, or their State Health Insurance Assistance Program (SHIP), for assistance with evaluating, selecting, and enrolling in a Part D plan.
Source: medicareadvocacy.org

Medicare vs Medicare Advantage

For Part A and Part B of Medicare, members must pay 20% of costs out-of-pocket. For inpatient hospital visits, members must pay a $1,184 deductible for the first 60 days, and then $296 coinsurance per day until day 90. After day 90, members can have another 60 days at $578 per day in their lifetimes, after which they must pay all costs. The Part B deductible is $140 per year. Those who have Part D (prescription coverage) must also pay an average deductable of $325. After the deductible has been paid, members may either have a co-pay program, where they pay a flat fee for each drug, or co-insurance program, where they pay a percentage of the cost. However, members may face the “doughnut hole”: after the total cost of drugs exceeds $2,970, members must pay 47.5% of the cost of brand-name drugs and 79% of the cost of generic drugs. Once the cost of drugs has exceeded $4750, Medicare kicks in again, with 95% of drug costs covered.
Source: diffen.com

Comparison Friction: Experimental Evidence from Medicare Drug Plans

Consumers need information to compare alternatives for markets to function efficiently. Recognizing this, public policies often pair competition with easy access to comparative information. The implicit assumption is that comparison friction—the wedge between the availability of comparative information and consumers’ use of it—is inconsequential because information is readily available and consumers will access this information and make effective choices. We examine the extent of comparison friction in the market for Medicare Part D prescription drug plans in the United States. In a randomized field experiment, an intervention group received a letter with personalized cost information. That information was readily available for free and widely advertised. However, this additional step—providing the information rather than having consumers actively access it—had an impact. Plan switching was 28 percent in the intervention group, versus 17 percent in the comparison group, and the intervention caused an average decline in predicted consumer cost of about $100 per year among letter recipients—roughly 5 percent of the cost in the comparison group. Our results suggest that comparison friction can be large even when the cost of acquiring information is small, and may be relevant for a wide range of public policies that incorporate consumer choice.
Source: nber.org

Medicare Open Enrollment: What’s your back

Nobody likes to think of back-up plans when it comes to our health, but health can be as unpredictable as the weather. It’s hard to know what you’ll feel like next week, much less what health care you’ll need next year. But that’s exactly what you need to think about when you’re shopping for health coverage during Medicare Open Enrollment – which ends on December 7.
Source: medicare.gov

Not Happy with Your Medicare Advantage Plan? Change it!

Posted by:  :  Category: Medicare

Cassandra Q. Butts by Center for American ProgressThe 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

Video: Medicare supplement Insurance Plans VS Medicare Advantage plans

Reader Response: Medicare Options and Quality of Care

Medicare beneficiaries self-select into traditional Medicare or Medicare Advantage plans. They may differ systematically in characteristics that could indirectly affect readmission rates. Age and health status are two characteristics that can usually be measured and might be included in the available data set; but there may be others not included. Researchers try as best they can to make statistical adjustments for differences in the characteristics among self-selecting beneficiaries, as the authors of all of the studies cited in my previous post did. But the adequacy of these adjustments depends on the available data. Typically researchers acknowledge such limitation of their studies forthrightly in their reports.
Source: nytimes.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

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

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

3rd Party Studies ACOs Admin Costs affordability Age Rating Cadillac Tax cbo Cost-Shift Employers Essential Benefits Exchanges GRP Health Insurance Tax Health Plan Innovations Health Plan Satisfaction House hearings House legislation HSAs KI MA McCarran-Ferguson Medical Prices Medical Tests medicare medigap MedMal MLR Morning Headlines MT Patient Safety premiums Profits Provider Consolidation PWC Quality Rate Review Readmissions Reform RZ Senate hearings Senate legislation Small Business The Link Vilification Waste Fraud and Abuse
Source: ahipcoverage.com

Medicare Advantage 2013 Spotlight: Plan Availability and Premiums

This data spotlight report examines trends in the Medicare Advantage marketplace, including the choices available to Medicare beneficiaries in 2013, premium levels and other plan features. It finds almost all plans offered this year will be available again in 2013, despite concerns that reductions in payments to plans under the Affordable Care Act would result in widespread pullouts from Medicare Advantage plans. If all beneficiaries choose to remain in their current plans, monthly premiums would increase about 10 percent, or $4, on average. The analysis also examines the types of plans available (HMOs, PPOs, etc.), changes in out-of-pocket limits, and the availability of special needs plans.
Source: kff.org

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

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

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

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

Truven Health Analytics Healthcare Blog: Comparing the Quality of Care in Medicare Options

While the results of studies comparing quality outcomes in Medicare Advantage (MA) programs to those in traditional Medicare programs are variable, they do tend to show that patient outcomes in Medicare Advantage are in general better than in traditional Medicare. For example, hospital readmission rates, considered an excellent barometer of hospital quality are substantially lower in MA than under traditional Medicare; the evidence is clear that Medicare Advantage programs are better for special needs populations, such as those suffering from chronic diseases like end-stage renal disease and diabetes; and another study has shown that Medicare Advantage patients have fewer avoidable hospital admissions than those in traditional Medicare.
Source: truvenhealth.com

Medicare Trying To Nudge Seniors Out Of Plans With Low Ratings

Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, an industry trade group, said the letter to beneficiaries is “premature” because the ratings system is flawed.  It is based on measures that do not sufficiently take into account, for example, plans serving a disproportionate number of beneficiaries with multiple chronic conditions or special needs, or who live in medically underserved areas.  “These are unique challenges to providing care to those populations,” he said.
Source: kaiserhealthnews.org

Higher quality rating for Medicare Advantage plan linked with increased likelihood of enrollment

“To inform enrollment decisions and spur improvement in the Medicare Advantage marketplace, the U.S. Centers for Medicare & Medicaid Services (CMS) provides star ratings reflecting Medicare Advantage plan quality. A combined Part C and D overall rating was created in 2011 for Medicare Advantage and prescription drug (MAPD) plans,” according to background information in the article. The star ratings incorporate data from several sources. “In 2011, MAPD star ratings ranged from 2.5 to 5 stars. Only 3 MAPD contracts received 5 stars; some were unrated because they were too new or small,” the authors write. “While star ratings clearly matter to insurers, it is unclear whether they matter to beneficiaries.”
Source: sciencecodex.com

Cancel Medicare Advantage

Because of their flexibility, the ability to move states and the fact that the insurance company cannot change the plan are just a few of the reasons we prefer Medicare Supplement Insurance Plans to MAPD. If you would like to hear more about the reasons a Medicare Supplement can be a better fit for your insurance, please fill out the short form at the top of the page and one of our experts will get you a new medicare supplement quote and help explain how you can save the most off your medicare cost.
Source: medicarecost.net

Medicare Part C, Medicare Advantage Plans, What Does It Cover, Who Is Eligible

Before you enroll in a Medicare Part C plan you will have to enroll in Medicare Parts A and B. Generally, individuals are automatically enrolled in both if they are already receiving Social Security. Otherwise you will need to contact your local Social Security office to enroll. Once you are enrolled in Parts A and B you can select a Medicare Advantage Plan. For most people, this can all be done at the same time, when they turn 65 years of age. There is a seven month window to enroll which starts three months before your birthday month and ends three months after.
Source: bradeninsurance.com

Daily Kos: Politico: Liberals want to save Social Security with the chained CPI

Posted by:  :  Category: Medicare

"I'm George Washington and I approve this message." by eyewashdesign: A. GoldenFor the record: I don’t want Chained CPI.  I would rather have a logical COLA, which would be possible if the cap on FICA was taken off, and it would extend the number of years Social Security would remain solvent – provided our arsehole Congress Critters and the president don’t start any more stupid, expensive wars and borrow against it.  I also want everyone to be able to buy into Medicare, a not-for-profit single-payer government-run program (actually being managed efficiently; surprise!) without interfering corporations who need profits we will be paying for, thanks to Obamacare and corporate interference in government.  For a Medicare buy-in to run efficiently, new employees would need to be hired to handle the paperwork (instant impact on the economy, job creation), and cost limits would need to be imposed on the skyrocketing greedy medical institutions who keep raising their prices which necessitates expensive supplemental insurance that SSI and SSDI recipients can’t afford since they’re already paying for Medicare Part A and Part B, and were forced to buy private prescription insurance for Part D.
Source: dailykos.com

Video: Changes to Medicare Supplements – Plans M and N

Increased Risk of RAC Audits when Reporting High Level E&M Codes

Evaluation and management (E&M) services are provided on the basis of the physician’s knowledge of the patient’s medical history, medication review, physical examination, and a medical decision. Charles Fidel of AMedNews.com reports that Medicare paid a huge amount of $33.5 billion alone for E&M services in the year 2010. When reviewed, it was found that out of the 442,000 physicians that billed for E&M services, 1,669 providers consistently billed using high-level E&M codes such as 99215. The important fact here is that a claim for a low-level visit by an established patient paid only $20 in 2010. On the other hand, for a high-level new patient it amounted to $190.
Source: workoninternet.com

Study: Medicare Part D “donut hole” does not linked to increase in heart attacks

After a small deductible, Part D drug plans typically cover 75 percent of drug costs up to a certain dollar figure, which was $2,400 in 2007. After a beneficiary reaches that level, there is no coverage until the person has spent potentially thousands of dollars out of pocket, then coverage kicks back in.
Source: medcitynews.com

What If I’m Not Covered By Medicare Part A?

Not qualifying for Medicare Part A is not as hard of a problem as it might seem. Plenty of insurance companies offer hospitalization insurance. As long as a person subscribes to the policy fairly young and keeps paying the premiums, he can prevent himself from falling into financial ruin by preparing. Some conditions may reverse his lack of qualifications, such as going through end stage renal failure. A person with limited income may qualify for coverage under the Medicaid program administered by his state. The Department of Public Welfare can process a person’s Medicaid application.
Source: seniorcorps.org

Medicare ‘Part D’ Pays $3.1M For Viagra

The OIG has recommended that CMS recoup payment for the drugs and “strengthen internal controls to help ensure that drugs covered by Medicare Part D comply with federal requirements.” This can be accomplished by maintaining an up-to-date list of all ED drugs, making sure that Part D plans have that list and periodically updating the software employed to deny payment for those drugs.
Source: sweetness-light.com

Making Medicare Profitable for Chiropractors (Part 6 of 13 Things Series)

What is perfectly legal AND reimbursable, however, is the fact that a chiropractor may act as supplier of durable medical equipment (DME).  To do this, chiropractors must have a valid supplier number assigned by the National Supplier Clearinghouse.  And yes, this means that you have to wade through the monstrosity of Medicare red tape (i.e. their application to become a supplier) and wait with bated breath for CMS to approve your status.
Source: strategicdc.com

Exclusive Medicare supplement leads are a vital investment in the growth of your agency

Posted by:  :  Category: Medicare

Medical Drugs for Pharmacy Health Shop of Medicine by epSos.deAmerica is graying, a fact that is mentioned frequently in media reports about the health care system and health reform. It’s a fact that there is a big wave of seniors about to become eligible for Medicare, and once that happens, they will need Medicare supplements. As a busy and experienced insurance agent that deals with seniors on a regular basis, you know first-hand that the growth of your business depends on a constant supply of Medicare supplement leads. You want quality leads, fresh to your inbox daily or weekly, whichever suits your timetable.
Source: benepath.net

Video: FREE MEDICARE LEADS/ MEDICARE SUPPLEMENT LEADS/ INSURANCE SALES LEADS

A way to remain tension free – Medicare Supplement Leads

There is no denying the fact that all of us require insurance. Chances are that one can face health related problems after 65 years of age or even before that. So taking a chance in not opting for an insurance cover can only prove fatal. These days however people are aware of costs related to helth issues and do not want to take them lightly. Medicare supplement leads in this regard can really come to your rescue in the form of financial security According to many elderly people having a proper Medicare is more than enough to cover up their medical expenses as and when need arises. However this is not true. Merely relaying on Medicare can be risky especially in the later years of life. Buying Medicare supplement leads can fill in gaps that Medicare failed to cover up. People will then no longer consider these leads as a burden to them and will accept them readily. It is however very important to understand these leads correctly and see if they meet all your needs. In having such leads all your medical expenses can easily be covered. This can happen even without any additional financial assistance. In opting for supplement leads you need to be aware of rules that govern them and their coverage areas. In fact, a Medicare can often be compared to a government program. Depending upon the level of Medicare coverage the rules associated with them can vary a great deal. Their levels of complexities can also vary a lot. It is worthwhile to note that there exist four different levels of Medicare that can come to your rescue albeit in different ways. For example, using type A Medicare can help you pay off hospital bills that you would have incurred during your stay there overnight. The type B Medicare coverage will help you pay doctor’s fees for routine tests and checkups. Type C Medicare coverage can be used optionally. Type D Medicare coverage will be of help in buying prescribed drugs. All the above types have their own sets of limitations that can get exhausted anytime. And hence can not be fully relied upon. In this regard, you need the help of Medicare supplement leads. They will help you cover those areas that Medicare couldn’t. All the extra funds needed by you would be kept ready by these supplement needs. So having these supplement leads along with the general insurance cover will assure you that you will never fall short of any funds during your stay in the hospital and during your entire treatment days. These leads can be your perfect gift to your parents or grand parents so as to enable them to spend their last years peacefully and not worry unnecessary about the mounting medical expenses. It is thus very important to have them irrespective of your age group and your present condition. These leads can render your life stress free and you can relax and spend quality time with your near and dear ones.
Source: workoninternet.com

Coming Out As Gay Leads To Reduced Stress

AIDS anal cancer bear flu Bear New Zealand cancer coming out depression diabetes drink spiking drug interactions erectile dysfunction exercise first aid flu gay marriage health healthy eating heart attack HIV HIV Education HIV treatments homophobia HPV Virus it gets better media melanoma Men’s Health mens health mental health oral sex prostate health rape rapid hiv testing reader of the week safe sex sexual health skin cancer suicide tattoo testicular cancer volunteering volunteer work weight loss World Aids Day youth suicide
Source: thehealthybear.com

Patterico's Pontifications

No one is suggesting that what we call are ‘earned entitlements’, entitlements you pay for, you know, like payroll taxes for Medicare and Social Security, are putting you in a ‘taker’ category. No one suggests that whatsoever. The concern that people like me have been raising is we do not want to encourage a dependency culture. This is why we called for welfare reform. This is what welfare reform in 1996 was. This was what the new rounds for welfare reform we’re calling for do, which is to increase social mobility, economic opportunity, self-responsibility, those kinds of things. But earned entitlements, where you pay your payroll taxes to get a benefit when you retire, like Social Security and Medicare, are not taker programs. And I think when the president does kind of a switcheroo like that, what he’s trying to say is we are maligning these programs, that people have earned throughout their working lives. And so it’s kind of a convenient twist of terms to try and shadowbox a straw man in order to win an argument by default, is essentially what that rhetorical device is that he uses over and over and over.
Source: patterico.com

Free Insurance Agent Websites And Medicare Quote Engine For Professionals

A new alliance dedicated to insurance agents is all set to revolutionize the insurance industry, by offering a first of its kind networking website solely dedicated to insurance agents where they will have access to a free Medicare supplement quote engine, along with real leads. In essence, a platform where they can build their consumer network socially.
Source: trailer-trash.tv

Palmview Siblings Sentenced for Health Care Fraud Conspiracy

Posted by:  :  Category: Medicare

At their plea hearing in December 2011, Velma and Valente Alaniz admitted to conspiring to submit false and fraudulent claims to the Medicare and Medicaid programs related to Ace Medical’s purported sale of power wheelchairs to Medicare and Medicaid patients. In numerous claims for a power wheelchairs, the defendants represented to Medicare and Medicaid that the items were prescribed by the patients’ physicians and had been delivered to the patients when, in fact, the defendants knew that both of these representations were false. In other instances, the defendants submitted false claims to Medicare and Medicaid that represented that power wheelchairs had been delivered to patients when, instead, less expensive scooters were delivered to the patients. The defendants also billed for incontinent and other medical supplies which had not been prescribed by the patients doctors.
Source: geyergorey.com

Video: About Shield Healthcare – Medical Supplies for Care at Home

Medicare Incontinence Supplies

Urinary incontinence and unexpected bowel problems are no longer whispered about subjects among medical professionals, patients and caregivers. However, these conditions are still private matters for many people. Increasing life span averages and progressive medical advances allow patients to use simple solutions such as Diapers for Adults, disposable garments such as Depends Adults Diapers and Adult Cloth Diaper products rather than complicated, expensive and embarrassing waste bags and catheter tubing. The demand for convenience, and the increased medical necessity for these products has dramatically increased the market for privately purchased disposable protection and billed Medicare incontinence supplies requested by hospitals, nursing homes and assisted living facilities. Individual consumers and facility purchasing managers will not only find product use to be easier, but purchase and delivery methods are streamlined when buying online.
Source: forincontinence.com

Legislators Propose Tax Credits Up to $675 for At

Cloudy. A slight chance of showers this morning…then a chance of showers with isolated thunderstorms this afternoon. Areas of dense fog this morning…then patchy fog this afternoon. Visibility one quarter mile or less at times this morning. Highs in the upper 50s. South winds 10 to 15 mph. Chance of rain 50 percent.
Source: patch.com

hmedata.com on Social Media

Posted by:  :  Category: Medicare

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Source: coolsocial.net

Video: NPIDS eDirectory – NPI Lookup (PDF Directory of US Healthcare Providers from NPI Data Services)

CPT code 43235, 43236, 43237, 43238, 43239 and covered DX

LCD for Diagnostic and Therapeutic Esophagogastroduodenoscopy (L29167) Coding Information for CPT/HCPCS Codes Bill Type Codes: Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service.Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims. Revenue Codes: Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes. 99999 Not Applicable 43235 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE) 43236 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE 43237 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH ENDOSCOPIC ULTRASOUND EXAMINATION LIMITED TO THE ESOPHAGUS 43238 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH TRANSENDOSCOPIC ULTRASOUND-GUIDED INTRAMURAL OR TRANSMURAL FINE NEEDLE ASPIRATION/BIOPSY(S), ESOPHAGUS (INCLUDES ENDOSCOPIC ULTRASOUND EXAMINATION LIMITED TO THE ESOPHAGUS) 43239 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH BIOPSY, SINGLE OR MULTIPLE 43241 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH TRANSENDOSCOPIC INTRALUMINAL TUBE OR CATHETER PLACEMENT 43243 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH INJECTION SCLEROSIS OF ESOPHAGEAL AND/OR GASTRIC VARICES 43244 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH BAND LIGATION OF ESOPHAGEAL AND/OR GASTRIC VARICES 43245 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH DILATION OF GASTRIC OUTLET FOR OBSTRUCTION (EG, BALLOON, GUIDE WIRE, BOUGIE) 43246 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH DIRECTED PLACEMENT OF PERCUTANEOUS GASTROSTOMY TUBE 43247 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH REMOVAL OF FOREIGN BODY 43248 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH INSERTION OF GUIDE WIRE FOLLOWED BY DILATION OF ESOPHAGUS OVER GUIDE WIRE 43249 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH BALLOON DILATION OF ESOPHAGUS (LESS THAN 30 MM DIAMETER) 43250 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT BIOPSY FORCEPS OR BIPOLAR CAUTERY 43251 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE 43255 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH CONTROL OF BLEEDING, ANY METHOD 43258 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) NOT AMENABLE TO REMOVAL BY HOT BIOPSY FORCEPS, BIPOLAR CAUTERY OR SNARE TECHNIQUE ICD-9 Codes that Support Medical Necessity 040.2 WHIPPLE’S DISEASE 112.84 CANDIDAL ESOPHAGITIS 150.0 – 152.9 opens in new window MALIGNANT NEOPLASM OF CERVICAL ESOPHAGUS – MALIGNANT NEOPLASM OF SMALL INTESTINE UNSPECIFIED SITE 155.0 MALIGNANT NEOPLASM OF LIVER PRIMARY 156.0 – 156.9 opens in new window MALIGNANT NEOPLASM OF GALLBLADDER – MALIGNANT NEOPLASM OF BILIARY TRACT PART UNSPECIFIED SITE 157.0 – 157.9 opens in new window MALIGNANT NEOPLASM OF HEAD OF PANCREAS – MALIGNANT NEOPLASM OF PANCREAS PART UNSPECIFIED 159.8 MALIGNANT NEOPLASM OF OTHER SITES OF DIGESTIVE SYSTEM AND INTRA-ABDOMINAL ORGANS 176.3 KAPOSI’S SARCOMA GASTROINTESTINAL SITES 197.4 SECONDARY MALIGNANT NEOPLASM OF SMALL INTESTINE INCLUDING DUODENUM 197.6 SECONDARY MALIGNANT NEOPLASM OF RETROPERITONEUM AND PERITONEUM 198.89 SECONDARY MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES 202.80 OTHER MALIGNANT LYMPHOMAS UNSPECIFIED SITE 211.0 – 211.9 opens in new window BENIGN NEOPLASM OF ESOPHAGUS – BENIGN NEOPLASM OF OTHER AND UNSPECIFIED SITE IN THE DIGESTIVE SYSTEM 214.3 LIPOMA OF INTRA-ABDOMINAL ORGANS 214.9 LIPOMA UNSPECIFIED SITE 215.9 OTHER BENIGN NEOPLASM OF CONNECTIVE AND OTHER SOFT TISSUE SITE UNSPECIFIED 228.04 HEMANGIOMA OF INTRA-ABDOMINAL STRUCTURES 230.1 – 230.8 opens in new window CARCINOMA IN SITU OF ESOPHAGUS – CARCINOMA IN SITU OF LIVER AND BILIARY SYSTEM 235.2 – 235.4 opens in new window NEOPLASM OF UNCERTAIN BEHAVIOR OF STOMACH INTESTINES AND RECTUM – NEOPLASM OF UNCERTAIN BEHAVIOR OF RETROPERITONEUM AND PERITONEUM 239.0 NEOPLASM OF UNSPECIFIED NATURE OF DIGESTIVE SYSTEM 251.5 ABNORMALITY OF SECRETION OF GASTRIN 261 NUTRITIONAL MARASMUS 263.0 – 263.9 opens in new window MALNUTRITION OF MODERATE DEGREE – UNSPECIFIED PROTEIN-CALORIE MALNUTRITION 280.0 – 280.9 opens in new window IRON DEFICIENCY ANEMIA SECONDARY TO BLOOD LOSS (CHRONIC) – IRON DEFICIENCY ANEMIA UNSPECIFIED 285.1 ACUTE POSTHEMORRHAGIC ANEMIA 300.11 CONVERSION DISORDER 306.4 GASTROINTESTINAL MALFUNCTION ARISING FROM MENTAL FACTORS 307.1 ANOREXIA NERVOSA 307.50 EATING DISORDER UNSPECIFIED 307.51 BULIMIA NERVOSA 307.52 PICA 307.53 RUMINATION DISORDER 307.54 PSYCHOGENIC VOMITING 438.82 DYSPHAGIA CEREBROVASCULAR DISEASE 447.2 RUPTURE OF ARTERY 448.0 HEREDITARY HEMORRHAGIC TELANGIECTASIA 456.0 ESOPHAGEAL VARICES WITH BLEEDING 456.1 ESOPHAGEAL VARICES WITHOUT BLEEDING 456.20 – 456.21 opens in new window ESOPHAGEAL VARICES IN DISEASES CLASSIFIED ELSEWHERE WITH BLEEDING – ESOPHAGEAL VARICES IN DISEASES CLASSIFIED ELSEWHERE WITHOUT BLEEDING 507.0 PNEUMONITIS DUE TO INHALATION OF FOOD OR VOMITUS 530.0 – 530.89 opens in new window ACHALASIA AND CARDIOSPASM – OTHER DISEASES OF ESOPHAGUS 531.00 – 531.91 opens in new window ACUTE GASTRIC ULCER WITH HEMORRHAGE WITHOUT OBSTRUCTION – GASTRIC ULCER UNSPECIFIED AS ACUTE OR CHRONIC WITHOUT HEMORRHAGE OR PERFORATION WITH OBSTRUCTION 532.00 – 532.91 opens in new window ACUTE DUODENAL ULCER WITH HEMORRHAGE WITHOUT OBSTRUCTION – DUODENAL ULCER UNSPECIFIED AS ACUTE OR CHRONIC WITHOUT HEMORRHAGE OR PERFORATION WITH OBSTRUCTION 533.00 – 533.91 opens in new window ACUTE PEPTIC ULCER OF UNSPECIFIED SITE WITH HEMORRHAGE WITHOUT OBSTRUCTION – PEPTIC ULCER OF UNSPECIFIED SITE UNSPECIFIED AS ACUTE OR CHRONIC WITHOUT HEMORRHAGE OR PERFORATION WITH OBSTRUCTION 534.00 – 534.91 opens in new window ACUTE GASTROJEJUNAL ULCER WITH HEMORRHAGE WITHOUT OBSTRUCTION – GASTROJEJUNAL ULCER UNSPECIFIED AS ACUTE OR CHRONIC WITHOUT HEMORRHAGE OR PERFORATION WITH OBSTRUCTION 535.00 – 535.71 opens in new window ACUTE GASTRITIS (WITHOUT HEMORRHAGE) – EOSINOPHILIC GASTRITIS, WITH HEMORRHAGE 536.1 ACUTE DILATATION OF STOMACH 536.2 PERSISTENT VOMITING 536.3 GASTROPARESIS 536.40 – 536.49 opens in new window GASTROSTOMY COMPLICATION UNSPECIFIED – OTHER GASTROSTOMY COMPLICATIONS 536.8 DYSPEPSIA AND OTHER SPECIFIED DISORDERS OF FUNCTION OF STOMACH 537.0 – 537.89 opens in new window ACQUIRED HYPERTROPHIC PYLORIC STENOSIS – OTHER SPECIFIED DISORDERS OF STOMACH AND DUODENUM 538 GASTROINTESTINAL MUCOSITIS (ULCERATIVE) 551.3 DIAPHRAGMATIC HERNIA WITH GANGRENE 552.3 – 552.8 opens in new window DIAPHRAGMATIC HERNIA WITH OBSTRUCTION – HERNIA OF OTHER SPECIFIED SITES WITH OBSTRUCTION 553.3 DIAPHRAGMATIC HERNIA WITHOUT OBSTRUCTION OR GANGRENE 555.0 – 555.9 opens in new window REGIONAL ENTERITIS OF SMALL INTESTINE – REGIONAL ENTERITIS OF UNSPECIFIED SITE 560.9 UNSPECIFIED INTESTINAL OBSTRUCTION 562.01 DIVERTICULITIS OF SMALL INTESTINE (WITHOUT HEMORRHAGE) 562.02 DIVERTICULOSIS OF SMALL INTESTINE WITH HEMORRHAGE 562.03 DIVERTICULITIS OF SMALL INTESTINE WITH HEMORRHAGE 569.62 MECHANICAL COMPLICATION OF COLOSTOMY AND ENTEROSTOMY 569.71 – 569.79 opens in new window POUCHITIS – OTHER COMPLICATIONS OF INTESTINAL POUCH 569.82 ULCERATION OF INTESTINE 569.87 VOMITING OF FECAL MATTER 571.1 ACUTE ALCOHOLIC HEPATITIS 571.2 ALCOHOLIC CIRRHOSIS OF LIVER 571.3 ALCOHOLIC LIVER DAMAGE UNSPECIFIED 571.40 CHRONIC HEPATITIS UNSPECIFIED 571.41 CHRONIC PERSISTENT HEPATITIS 571.42 AUTOIMMUNE HEPATITIS 571.49 OTHER CHRONIC HEPATITIS 571.5 CIRRHOSIS OF LIVER WITHOUT ALCOHOL 571.6 BILIARY CIRRHOSIS 572.3 PORTAL HYPERTENSION 574.00 – 574.01 opens in new window CALCULUS OF GALLBLADDER WITH ACUTE CHOLECYSTITIS WITHOUT OBSTRUCTION – CALCULUS OF GALLBLADDER WITH ACUTE CHOLECYSTITIS WITH OBSTRUCTION 574.10 – 574.11 opens in new window CALCULUS OF GALLBLADDER WITH OTHER CHOLECYSTITIS WITHOUT OBSTRUCTION – CALCULUS OF GALLBLADDER WITH OTHER CHOLECYSTITIS WITH OBSTRUCTION 574.20 – 574.21 opens in new window CALCULUS OF GALLBLADDER WITHOUT CHOLECYSTITIS WITHOUT OBSTRUCTION – CALCULUS OF GALLBLADDER WITHOUT CHOLECYSTITIS WITH OBSTRUCTION 574.30 – 574.31 opens in new window CALCULUS OF BILE DUCT WITH ACUTE CHOLECYSTITIS WITHOUT OBSTRUCTION – CALCULUS OF BILE DUCT WITH ACUTE CHOLECYSTITIS WITH OBSTRUCTION 574.40 – 574.41 opens in new window CALCULUS OF BILE DUCT WITH OTHER CHOLECYSTITIS WITHOUT OBSTRUCTION – CALCULUS OF BILE DUCT WITH OTHER CHOLECYSTITIS WITH OBSTRUCTION 575.0 ACUTE CHOLECYSTITIS 575.5 FISTULA OF GALLBLADDER 576.0 POSTCHOLECYSTECTOMY SYNDROME 576.4 FISTULA OF BILE DUCT 577.0 ACUTE PANCREATITIS 577.1 CHRONIC PANCREATITIS 577.2 CYST AND PSEUDOCYST OF PANCREAS 578.0 – 578.9 opens in new window HEMATEMESIS – HEMORRHAGE OF GASTROINTESTINAL TRACT UNSPECIFIED 579.0 – 579.9 opens in new window CELIAC DISEASE – UNSPECIFIED INTESTINAL MALABSORPTION 694.0 DERMATITIS HERPETIFORMIS 710.1 SYSTEMIC SCLEROSIS 747.61 GASTROINTESTINAL VESSEL ANOMALY 750.3 CONGENITAL TRACHEOESOPHAGEAL FISTULA ESOPHAGEAL ATRESIA AND STENOSIS 750.4 OTHER SPECIFIED CONGENITAL ANOMALIES OF ESOPHAGUS 750.5 CONGENITAL HYPERTROPHIC PYLORIC STENOSIS 750.6 CONGENITAL HIATUS HERNIA 750.7 OTHER SPECIFIED CONGENITAL ANOMALIES OF STOMACH 783.0 ANOREXIA 783.21 – 783.3 opens in new window LOSS OF WEIGHT – FEEDING DIFFICULTIES AND MISMANAGEMENT 784.42 DYSPHONIA 784.43 HYPERNASALITY 784.44 HYPONASALITY 784.49 OTHER VOICE AND RESONANCE DISORDERS 784.52 FLUENCY DISORDER IN CONDITIONS CLASSIFIED ELSEWHERE 784.91 – 784.99 opens in new window POSTNASAL DRIP – OTHER SYMPTOMS INVOLVING HEAD AND NECK 786.2 COUGH 786.50 – 786.59 opens in new window UNSPECIFIED CHEST PAIN – OTHER CHEST PAIN 786.6 SWELLING MASS OR LUMP IN CHEST 787.01 – 787.91 opens in new window NAUSEA WITH VOMITING – DIARRHEA 789.00 – 789.09 opens in new window ABDOMINAL PAIN UNSPECIFIED SITE – ABDOMINAL PAIN OTHER SPECIFIED SITE 789.30 – 789.39 opens in new window ABDOMINAL OR PELVIC SWELLING MASS OR LUMP UNSPECIFIED SITE – ABDOMINAL OR PELVIC SWELLING MASS OR LUMP OTHER SPECIFIED SITE 789.51 – 789.59 opens in new window MALIGNANT ASCITES – OTHER ASCITES 789.60 – 789.69 opens in new window ABDOMINAL TENDERNESS UNSPECIFIED SITE – ABDOMINAL TENDERNESS OTHER SPECIFIED SITE 790.5 OTHER NONSPECIFIC ABNORMAL SERUM ENZYME LEVELS 790.99 OTHER ABNORMAL FINDINGS ON EXAMINATION OF BLOOD 792.1 NONSPECIFIC ABNORMAL FINDINGS IN STOOL CONTENTS 793.4 NONSPECIFIC (ABNORMAL) FINDINGS ON RADIOLOGICAL AND OTHER EXAMINATION OF GASTROINTESTINAL TRACT 793.6 NONSPECIFIC (ABNORMAL) FINDINGS ON RADIOLOGICAL AND OTHER EXAMINATION OF ABDOMINAL AREA, INCLUDING RETROPERITONEUM 799.4 CACHEXIA 862.22 INJURY TO ESOPHAGUS WITHOUT OPEN WOUND INTO CAVITY 874.4 – 874.5 opens in new window OPEN WOUND OF PHARYNX WITHOUT COMPLICATION – OPEN WOUND OF PHARYNX COMPLICATED 935.1 – 935.2 opens in new window FOREIGN BODY IN ESOPHAGUS – FOREIGN BODY IN STOMACH 936 FOREIGN BODY IN INTESTINE AND COLON 938 FOREIGN BODY IN DIGESTIVE SYSTEM UNSPECIFIED 947.0 BURN OF MOUTH AND PHARYNX 947.2 – Diagnoses that Support Medical Necessity N/A ICD-9 Codes that DO NOT Support Medical Necessity ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation * According to the ICD-9-CM book, diagnosis codes E864.1, E864.2, E864.3, E864.4 and E961 are secondary diagnosis codes and should not be billed as the primary diagnosis. 947.3 opens in new window BURN OF ESOPHAGUS – BURN OF GASTROINTESTINAL TRACT 959.01 – 959.09 opens in new window OTHER AND UNSPECIFIED INJURY TO HEAD – OTHER AND UNSPECIFIED INJURY TO FACE AND NECK 983.2 – 983.9 opens in new window TOXIC EFFECT OF CAUSTIC ALKALIS – TOXIC EFFECT OF CAUSTIC UNSPECIFIED 990 EFFECTS OF RADIATION UNSPECIFIED 996.82 COMPLICATIONS OF TRANSPLANTED LIVER 997.4 DIGESTIVE SYSTEM COMPLICATIONS NOT ELSEWHERE CLASSIFIED E864.1* ACCIDENTAL POISONING BY ACIDS NOT ELSEWHERE CLASSIFIED E864.2* ACCIDENTAL POISONING BY CAUSTIC ALKALIS NOT ELSEWHERE CLASSIFIED E864.3* ACCIDENTAL POISONING BY OTHER SPECIFIED CORROSIVES AND CAUSTICS NOT ELSEWHERE CLASSIFIED E864.4* ACCIDENTAL POISONING BY UNSPECIFIED CORROSIVES AND CAUSTICS NOT ELSEWHERE CLASSIFIED E961* ASSAULT BY CORROSIVE OR CAUSTIC SUBSTANCE EXCEPT POISONING V10.00 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF UNSPECIFIED SITE IN GASTROINTESTINAL TRACT V10.03 – V10.04 opens in new window PERSONAL HISTORY OF MALIGNANT NEOPLASM OF ESOPHAGUS – PERSONAL HISTORY OF MALIGNANT NEOPLASM OF STOMACH V10.09 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF OTHER SITES IN GASTROINTESTINAL TRACT V12.71 PERSONAL HISTORY OF PEPTIC ULCER DISEASE V12.72 PERSONAL HISTORY OF COLONIC POLYPS V12.79 PERSONAL HISTORY OF OTHER SPECIFIED DIGESTIVE SYSTEM DISEASES V18.51 – V18.59 opens in new window FAMILY HISTORY, COLONIC POLYPS – FAMILY HISTORY, OTHER DIGESTIVE DISORDERS V55.1 ATTENTION TO GASTROSTOMY V58.61 LONG-TERM (CURRENT) USE OF ANTICOAGULANTS V58.64 LONG-TERM (CURRENT) USE OF NONSTEROIDAL ANTIINFLAMMATORIES V58.69 LONG-TERM (CURRENT) USE OF OTHER MEDICATIONS V69.1 INAPPROPRIATE DIET AND EATING HABITS N/A XX000 Not Applicable Diagnoses that DO NOT Support Medical Necessity N/A Back
Source: medicalbillingcptmodifiers.com

FREE Website NPINumber.org Enables NPI lookup

USA(SANEPR.com) October 9, 2007 — ICS Software Ltd. has recently published a website that allows anyone to look up the NPI number of health care professionals at no charge. The information on this website also includes mailing address, practice location, credential information, UPIN number, taxonomy number, and provider number. The information retrieved from this website is provided by NPPES. NPINumber.org allows the user to receive automatic updates when Doctors in your state update their information. The user is encouraged to create an account in order to save their individual user preferences to expedite the searching process. The account user will also receive information and special offers from ICS Software, Ltd. periodically if requested. Currently, creating an account on NPINumber.org provides the user with 25 free clicks on CheckMedicare.com whether they are a current subscriber or not. Checkmedicare.com is a website that allows providers to look up Medicare eligibility and benefit status. This website will even tell the provider how much of the deductible is left so it can be collected at the time of the visit. If the patient opted out of Medicare and is now with an HMO this website will give that information as well. More benefits of creating an account on NPINumber.org will be revealed in the coming weeks. ICS Software is the developer of checkmedicare.com and the practice management software, The Sammy Systems. For CheckMedicare.com users, their username and password for CheckMedicare.com will work for NPINumber.org. All user information entered when the CheckMedicare.com account was created will automatically be linked to NPINumber.org.
Source: sanepr.com

Pharmacy Technician Schools

Pharmacists are assisted by pharmacy technicians who enable them to perform their duties thoroughly as well as efficiently. Pharmacy technicians ensure smooth handling of a pharmacy. Apart from attending to the medical needs of the customers, pharmacy technicians count tablets and bottle prescriptions. Some certified pharmacy technicians work under the supervision of pharmacists for a couple of years and then head back to school to become pharmacists. These pharmacy technician-turned-pharmacists have more career opportunities.
Source: techpharmtraining.info

Random Ramblings: National Certification test today

It is also a major pain. I haven’t been in school for over 5 years, an this test is entirely on “what the book says to do” rather than on “what actually works in real life.” I’ve been in practice long enough that the later is what I actually use. I’ve also worked in ortho for 5 years – I’ve had to really study to be able to remember what serology test turns positive first in hepatitis B infection (Hep B surface antigen), or that acute myelogenous leukemia (AML) is the most common leukemia in adults. I deal with bones and joints. Not primary care. Wish me luck.
Source: blogspot.com

Senators Urge CMS To Reform Medicare Fraud Prevention Program

Posted by:  :  Category: Medicare

THE LITTLE MAN KILLED MEDICARE FOR EVERYONE by SS&SSLast week, a bipartisan group of senators urged the Obama administration to reform a program designed to identify and deter Medicare fraud following an HHS Office of Inspector General report that found the program to be ineffective, The Hill’s “Floor Action Blog” reports (Cox, “Floor Action Blog,” The Hill, 1/11).
Source: ihealthbeat.org

Video: Medicare Supplement vs. Medicare Advantage Plans – A Doctor’s Perspective

ICYMI: Health Affairs Article: Medicare Advantage Provides Higher

A recent article in the latest edition of Health Affairs provides further evidence that Medicare Advantage plans are delivering higher-quality care to seniors and people with disabilities than the fee-for-service (FFS) part of Medicare.  Data from the article show that Medicare Advantage beneficiaries utilize some health care services, such as the emergency department and ambulatory surgery or procedures, at a rate 20-30 percent lower than those in FFS Medicare.  This data suggests that Medicare Advantage enrollees “might use fewer services and be experiencing more appropriate use of services than enrollees in traditional Medicare.”
Source: ahipcoverage.com

Long waits for consumers when Medicare is ‘secondary payer’

In one case involving an 80-year-old man who was injured in a car accident in Kentucky in November 2011, it took more than a year to get a final figure from CMS detailing how much the agency was owed, says Linda Magruder, an attorney in Louisville who was the victim’s co-counsel in the case. That amount, for treatment for soft-tissue injuries to the man’s right hip, left foot, back and neck, was $2,640. But the agency first claimed it was owed more than $26,000, she says, because it included bills for care not related to the accident.
Source: medcitynews.com

Medicare. Medicaid. What’s the Difference?

Medicare is a federal government program, and offers basically the same benefits, limitations and administration everywhere in the nation. Medicaid is administered by state and local governments under federal guidelines. As a result, benefits and limitations vary widely depending upon where its beneficiaries reside.
Source: westminstervillagenorth.com

WellPoint Profits Up 38% As Insurer Girds For Big Changes In 2013

The Wall Street Journal: WellPoint Earnings Rise 38% Amid Light Commercial Costs Health insurers are preparing for the planned opening of state-based exchanges for individuals and small businesses. People will be able to seek plans there for coverage starting in 2014, potentially putting millions of new members in play for health insurers. Meantime, the industry is also aiming to add business as states expand Medicaid coverage under the health law and create new plans to cover high-cost people on Medicaid and Medicare, known as dual eligibles. WellPoint recently closed on a $4.46 billion purchase of Medicaid insurer Amerigroup to help chase the emerging dual-eligible market while lessening its tilt toward individual and small-group markets, which are considered most exposed to the exchanges (Kamp, 1/23).
Source: kaiserhealthnews.org

Medicare Advantage 2013 Spotlight: Plan Availability and Premiums

This data spotlight report examines trends in the Medicare Advantage marketplace, including the choices available to Medicare beneficiaries in 2013, premium levels and other plan features. It finds almost all plans offered this year will be available again in 2013, despite concerns that reductions in payments to plans under the Affordable Care Act would result in widespread pullouts from Medicare Advantage plans. If all beneficiaries choose to remain in their current plans, monthly premiums would increase about 10 percent, or $4, on average. The analysis also examines the types of plans available (HMOs, PPOs, etc.), changes in out-of-pocket limits, and the availability of special needs plans.
Source: kff.org

Kramer Chiropractic & Massage: Medicare Replacement Policies

Here are the most common plans that have replaced Medicare policies: Health Partners Freedom- these plans DO need to be prior auth. Medica-Prime Solutions -PA as req by Medica U-Care- Medicare Advantage Blue Cross Blue Shield-Medicare Advantage All these plans require medicare diagnosis and follow medicare guidelines (only adjustments covered/ no exams, therapies or x-rays) . These patients should still sign the ABN for these services. Also, regarding the new fee slips: please make sure Patient name is ledgible and that a date is being put on the top- if not by the patient, then by whoever is checking them in- this is our only signed record by the patient that they were in the office that day. Thanks :) Kathy S.
Source: blogspot.com

Medigap vs. Medicare Advantage Plan

Medicare Advantage comprises a variety of private health plans — most often HMOs and PPOs — that Medicare offers as a coverage alternative to the traditional program. Every plan must cover all the same benefits that traditional Medicare covers. But the plans can charge different copayments (often lower than the traditional program but not always) and offer extra benefits. Most charge a monthly premium in addition to the Part B premium, but some don’t. Most include prescription drug coverage at no additional cost. Some cover routine hearing and vision services, usually as a separate package for an additional premium. Another difference from the traditional program is that most plans require you to go to doctors and other providers within their service network or pay higher copays for going out of network.
Source: aarp.org

Medigap vs Medicare Advantage Policies

Switching to a Medicare Advantage policy may mean that you have to switch doctors. You may need to go to a different drug store or hospital also. Your health insurance company will have a network of providers that they want you to use. Except where the information in the contract says otherwise, you will need to go to those providers for your routine care if you want them to pay for the care you receive.
Source: medicare-supplement-quotes.com

Democrats and Republicans May Be Closer Than We Think: An Interview With Alice M. Rivlin

A: All of them are viable, but in combination. We did some combination of changes in 1983. The most straightforward way to increase revenues is to raise the cap on payroll taxes. On the benefits side, one proposal is to change the formula so benefits are even less generous to people with high incomes than they are now. It seems superficially attractive to raise the retirement age again, but far in the future. The problem is that people with higher educational levels and incomes are living longer, but low earners with physically tough jobs are not. So you have to allow for that. Our plan indexed benefits for longevity, which has the same effect arithmetically and is not so hard on the people who can’t work as long.
Source: gailfosler.com

Medicare Advantage Outperforms Medicare

We found that utilization rates in some major categories, including emergency departments and ambulatory surgery or procedures, generally were 20-30 percent lower in Medicare Advantage HMOs in all years. Medicare Advantage HMO enrollees initially had lower rates of ambulatory visits and hospitalizations, although these rates converged by 2008; they also received about 10 percent fewer hip or knee replacements. In contrast, HMO enrollees underwent more coronary bypass surgery than patients in traditional Medicare. These findings suggest that overall, Medicare Advantage HMO enrollees might use fewer services and be experiencing more appropriate use of services than enrollees in traditional Medicare.
Source: ncpa.org