Viewpoints: Sen. Hatch’s Prescription For Safeguarding Entitlements; Medicare Crackdown On CVS Drug Program; JFK’s Mental Health Vision Failing

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 marsmet524Boston Globe: Hospital Fees Shouldn’t Apply For Treatments In Doctors’ Offices When health care providers send out confounding medical bills thick with mysterious fees, it’s stressful to patients, and it illustrates a troubling lack of transparency within the health care system. Consider the case of local patient Robert Reed, who had three pre-cancerous spots treated with liquid nitrogen at a suburban dermatologist’s office last year — and was billed not just for the doctor’s visit, but for $1,525 in operating room and hospital charges. Reed’s case, profiled in a recent Globe article, isn’t unusual. Amid widespread confusion about who’s paying whom and for what, it’s easy for costs to keep on going up. That’s why it’s important for medical bills to reflect the true price of the procedure — and avoid any add-ons that seem designed simply to take advantage of arcane insurance rules (2/5).
Source: kaiserhealthnews.org

Video: What is a Medicare health insurance exchange?

Slow Health Care Spending has Already Substantially Reduced the Deficit

Medicaid and Medicare. In recent years, health care spending has grown much more slowly both nationally and for federal programs than historical rates would have indicated. (For example, in 2012, federal spending for Medicare and Medicaid was about 5 percent below the amount that CBO had projected in March 2010.) In response to that slowdown, over the past several years, CBO has made a series of downward technical adjustments to its projections of spending for Medicaid and Medicare. From the March 2010 baseline to the current baseline, such technical revisions have lowered estimates of federal spending for the two programs in 2020 by about $200 billion—by $126 billion for Medicare and by $78 billion for Medicaid, or by roughly 15 percent for each program.
Source: firedoglake.com

Affordable Health Care Act can help push for Medicare portability

Lewis said that she is confident that Fil-Ams would soon enjoy the benefits of Medicare portability. She pointed out that the generation of Fil-Ams who are now in their “golden years” – those who immigrated to the US in the late 70s and early 80s – are now retiring one by one, and will soon need sustained medical care.
Source: asianjournal.com

Another ObamaCare Medicare Gimmick

ObamaCare supporters sometimes like to talk about the legislation’s “delivery system reforms,” which are supposed to change the way health care services are organized in ways that make health care less costly and more efficient. The bulk of these delivery system reforms are essentially payment reforms — restructuring the way medical providers are reimbursed in hopes of changing their incentives. But the sheer complexity of the way Medicare pays providers means that these sorts of payment games are not only commonplace, but key drivers of administrative decisions in medical facilities. Medicare’s size also means that its decisions often have ripple effects throughout the medical payment ecosystem.
Source: reason.com

health care solutions, Medicare FAQ, Questions about Medicare

As an alternative to Part A and B, beneficiaries can select a Part C plan, which is also referred to as a Medicare Advantage plan. Private companies contract with the federal government to offer these plans, which pay for everything covered by Original Medicare and often provide additional services.  Such as dental, hearing, vision benefits and maybe even a gym membership. Beneficiaries usually pay a monthly premium and some other fees, such as copayments and deductibles.
Source: ahealthiermichigan.org

Obamacare Health Insurance Tax: Making Medicare Advantage More Expensive

The health care reform law imposes a massive new sales tax on health insurance which will increase the cost of coverage for individuals, small businesses, and public program beneficiaries with private insurance. The tax begins at $8 billion in 2014 and rises to $14.3 billion in 2018, increasing annually thereafter based on premium growth. The Joint Committee on Taxation projects that between 2013 and 2022 the new tax will total $101.7 billion.
Source: amac.us

International health insurance, a necessity for Spring vacations, not covered by Medicare

A second option that should be considered by Medicare-covered international travelers is emergency medical evacuation insurance. This type of insurance will provide coverage for medically necessary evacuation and transportation to medical facilities. Without this type of insurance coverage, travelers could easily owe more than $10,000 worth of out-of-pocket medical expenses if they aren’t covered. The service would become extremely useful if policyholders became stranded in a remote rural area without easy access to needed facilities.
Source: benefitspecialists.biz

Left In Alabama:: Funding Alabama Medicaid in the meantime

Posted by:  :  Category: Medicare

African American Political Pundit AmericaBlog An Examination of Free Will Bartcop Blog for Rural America Balloon Juice Blue Gal Booman Tribune Borowitz Report Science Blogs Corrente Crooks and Liars Daily Kos Docudharma Eschaton Firedoglake First Draft FiveThirtyEight Hullabaloo Jack and Jill Juan Cole La Vida Locavore The Left Coaster MyDD My Left Wing NASA Watch Notion’s Capital Oliver Willis Paul Krugman Political Cortex Scoobie Davis Senate Guru Spocko’s Brain Elections@DailyKOS Suburban Guerilla Talk To Action Talking Points Memo The Field Negro The Oil Drum Think Progress US Politics News
Source: leftinalabama.com

Video: Medicare Supplements in Alabama by Medicare Pathways

Bipartisan Bill Would Repeal Medicare Hospital Payment Loophole

Sens. Claire McCaskill (D-Mo.) and Tom Coburn, MD (R-Okla.), have introduced a bill that would sunset Section 3141 of the Patient Protection and Affordable Care Act — a controversial provision that sets the Medicare hospital wage index floor for the entire country. Under Section 3141, the Medicare hospital wage index is adjusted so that a state’s urban hospitals must be reimbursed for wages paid to physicians and staff at least as much as rural hospitals. These reimbursements for hospital wages also come from a national pool of money, meaning that if one state receives higher Medicare wages, it will come at the expense of another state. In January, 20 state hospital associations — Alabama, Arkansas, Delaware, Georgia, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Nebraska, North Carolina, Ohio, Oklahoma, Oregon, South Carolina, South Dakota, Virginia, West Virginia and Wisconsin — as well as the National Rural Health Association wrote a letter (pdf) to the White House arguing this provision is decimating their Medicare reimbursements.   A Boston Globe report found that Massachusetts had received an estimated $367 million in additional Medicare funding due to Section 3141 because the state’s only rural hospital — Nantucket (Mass.) Cottage Hospital, based in an affluent area with a high cost of living — set an inordinately high floor for wage reimbursements. In total, nine states received higher Medicare wages under the provision, while the remaining 41 lost Medicare funds. Sens. McCaskill and Coburn called the provision “unfair” and said it only benefited hospitals in some states to the disadvantage of many others.
Source: beckershospitalreview.com

Hitting hard on Medicare: Romney, Obama go at it

In the days leading to Ryan’s selection, opinion polls generally showed a close race with Obama holding a modest advantage despite a sluggish economy and unemployment of 8.3 percent. Romney’s pick for a running mate drew enthusiastic support from conservatives pleased that he had tapped a lawmaker known as an intellectual leader of the effort to rein in big government benefit programs and reduce future deficits.
Source: al.com

Senate GOP Probes Lew’s Failure to Comply with Medicare Law

Senate Republicans are demanding the administration hand over all documents related to Jack Lew’s failure, when he was head of the Office of Management & Budget, to comply with a law aimed at ensuring Medicare’s solvency. The demand, led by Senate Budget Committee ranking member Jeff Sessions (R-AL), is the latest sign the GOP may be intent on building a case against Lew, who was tapped by President Obama earlier this month to replace Treasury Secretary Timothy Geithner. Lew has served most recently as Obama’s chief of staff. Most GOP senators haven’t said how they would vote, but those who have are expressing reservations about Lew, who irritated Republicans during last summer’s debt talks. Sessions has said Lew “must never” be Treasury secretary and has criticized the former top Obama aide for submitting budgets that failed to receive any votes in Congress. Sessions has also accused Lew of misrepresenting Obama’s 2012 budget by saying that it would not add to the debt, a claim the Alabama senator pegged as the “greatest financial misrepresentation in history.” A Senate GOP aide said Lew’s failure to comply with the Medicare law could stiffen opposition to Lew even further. This aide said there is a “growing sense” among Republicans that unless the administration adheres to this law, Obama will not find it easy to move Lew’s nomination along. Under current law, the president must submit a legislative proposal to Congress that resolves Medicare funding issues whenever the Medicare Trustees release a warning that the program is in financial trouble. Funding warnings have been issued in each of the last four years, but Obama has not sent such proposals. When he was director of OMB, Lew was responsible for meeting this requirement. “The administration has failed each of the last four years to respond to these funding warnings despite receiving several communications from Congress urging them to comply with his unambiguous legal requirement,” the senators wrote to acting OMB Director Jeff Zients in a letter sent over the weekend. “In two of those four years, 2010 and 2011, Mr. Lew was the Director of the Office of Management & Budget, the entity directly responsible for drafting and submitting fiscal proposals to Congress and complying with federal budget law.” Republicans also noted that if Lew was to become the next Treasury secretary, he would be in charge of issuing Medicare solvency warnings. The Treasury secretary acts as the Chair of the Board of Medicare Trustees. As a result, Republicans asked for all documents related to the administration’s response to the “Medicare trigger” so that they may “properly consider Mr. Lew’s nomination.” The letter also asked the administration to comply immediately with the law by submitting a “detailed legislative proposal responsible to the latest Medicare funding warning to bring the administration into compliance with federal law.” The letter was signed by Sessions, Sens. Kelly Ayotte (R-NH), Mike Crapo (R-ID), Mike Enzi (R-WY), Lindsey Graham (R-SC), Chuck Grassley (R-IA), Ron Johnson (R-WI) and Roger Wicker (R-MS). Crapo, Enzi and Grassley serve on the Senate Finance Committee, which will have to approve Lew’s nomination. READ FULL SOURCE ARTICLE: 02/04/2013
Source: newmediajournal.us

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Source: blogspot.com

Sen. Menendez intervened twice in federal audit of key donor

Sen. Robert Menendez raised concerns with top federal health-care officials twice in recent years about their finding that a Florida eye doctor — a close friend and major campaign donor — had overbilled the government by $8.9 million for care at his clinic, Menendez aides said Wednesday.
Source: dailycaller.com

As 23 states get even fatter, heavy costs loom

Health economists once made the harsh financial calculation that the obese would save money by dying sooner. But more recent research instead suggests that better treatments are keeping them alive nearly as long — but they’re much sicker for longer, requiring such costly interventions as knee replacements and diabetes care and dialysis. Medicare spends anywhere from $1,400 to $6,000 more annually on health care for an obese senior than for the non-obese, Levi said.
Source: nbcnews.com

Viewpoints: Pelosi Says Higher Medicare Age ‘Doesn’t Work;’ Marketplace’s Clout Could Lower Seniors’ Drug Costs

Baltimore Sun: The Other, More Dangerous, Cliffs The “fiscal cliff” isn’t nearly the biggest cliff we face — if we’re talking about dangerous precipices looming on the horizon. Here are three: The child poverty cliff. A staggering number of our children are impoverished. Between 2007 and 2011, the percentage of American school-age children living in poor households grew from 17 percent to 21 percent. Last year, according to the Agriculture Department, nearly 1 in 4 young children lived in a family that had difficulty affording sufficient food at some point in the year. Yet federal programs to help children and lower-income families — such as food stamps, federal aid for poor school districts, Pell grants, child health care, subsidized lunches, child nutrition, prenatal and postnatal care, Head Start and Medicaid — are being targeted for cuts by deficit hawks who insist we can no longer afford them (Robert Reich, 12/12).
Source: kaiserhealthnews.org

Medicare agrees to cover TMS treatment for depression in TN, GA, AL

“TMS will now be available to more patients, giving them the hope of living a life free of depression,” said Burton Hills-based Dr. Scott West, who was the first local psychiatrist to acquire the TMS machine, a space-age contraption that looks similar to a dentist’s chair. West has been using TMS to treat patients since 2010. (See our September magazine story here.)
Source: nashvillepost.com

Newly Created Alabama Medicaid Commission to Recommend Legislation

The commission will comprise about 25 members. State Health Office Dr. Don Williamson will serve as chair. Other members will include the chair and vice-chair of the state’s Joint Legislative Committee on Medicaid Policy, representatives of the agencies mental health and senior services agencies, and appointees of the Speaker of the state’s House of Representatives and the President of the Senate. Representatives will be appointed to represent hospitals, physicians, nurse practitioners, dentists, clinics, hospices, pharmacists, insurers, and consumers.
Source: wolterskluwerlb.com

Ohio Health Policy Review: Ohio Medicare

Posted by:  :  Category: Medicare

Double-Parked by elycefelizThe federal Department of Health and Human Services announced last week that Ohio has been approved to undertake a pilot project to better coordinate care for 114,000 Ohioans who are eligible for both Medicare and Medicaid (Source: "State gets OK to alter Medicare, Medicaid," Columbus Dispatch, Dec. 13, 2012).
Source: healthpolicyreview.org

Video: Ohio Medicare Advantage Vs Ohio Medicare Supplement Plans

Ross family events: Medicare In Ohio

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Source: blogspot.com

Medicare Changes for Seniors in Ohio

Governor John Kasich of Ohio announced a medicare medicaid transformation plan with cost saving measures to consolidation of care for  Seniors on Medicare. Kaisch and the State of Ohio had their plan approved the the Centers for Medicare and Medicaid. What the plan  does is coordinate care for Seniors qualify for medicare that are on Medicaid meet low income guidelines.
Source: wordpress.com

Ohio Hospital Settles in Medicare Overbilling Whistleblower Case

From our offices in San Francisco, California, New York, New York, and Nashville, Tennessee, Lieff Cabraser’s whistleblower attorneys represent whistle blowers in False Claims Act, SEC/CFTC, and IRS/tax cases nationwide. Our whistleblower lawyers practice in federal court throughout the United States. Members of the firm are also licensed to practice in local courts in California, New York, Massachusetts, Tennessee, New Jersey, and Pennsylvania, as well as Washington, DC. We have affiliations in particular cases with attorneys licensed to practice in almost every state court in the United States. For a free, confidential prompt evaluation of your whistleblower case, please contact us.
Source: uswhistleblowerlaw.com

HCAN Partners: Tax Corporations, Protect Medicare, Medicaid, ACA

Citizen Action of Illinois held a press conference outside the office of Rep. Rodney Davis (R-13) in Champaign, Illinois to highlight the negative impact of budget cuts and joined the Chicago Federation of Labor at a gathering in Chicago to push back against cuts to Medicare, Medicaid, the Affordable Care Act, and Social Security. Leaders were joined by U.S. Reps. Jan Schakowsky (D-9) and Bill Foster (D-11).
Source: healthcareforamericanow.org

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

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

Bipartisan Bill Would Repeal Medicare Hospital Payment Loophole

Sens. Claire McCaskill (D-Mo.) and Tom Coburn, MD (R-Okla.), have introduced a bill that would sunset Section 3141 of the Patient Protection and Affordable Care Act — a controversial provision that sets the Medicare hospital wage index floor for the entire country. Under Section 3141, the Medicare hospital wage index is adjusted so that a state’s urban hospitals must be reimbursed for wages paid to physicians and staff at least as much as rural hospitals. These reimbursements for hospital wages also come from a national pool of money, meaning that if one state receives higher Medicare wages, it will come at the expense of another state. In January, 20 state hospital associations — Alabama, Arkansas, Delaware, Georgia, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Nebraska, North Carolina, Ohio, Oklahoma, Oregon, South Carolina, South Dakota, Virginia, West Virginia and Wisconsin — as well as the National Rural Health Association wrote a letter (pdf) to the White House arguing this provision is decimating their Medicare reimbursements.   A Boston Globe report found that Massachusetts had received an estimated $367 million in additional Medicare funding due to Section 3141 because the state’s only rural hospital — Nantucket (Mass.) Cottage Hospital, based in an affluent area with a high cost of living — set an inordinately high floor for wage reimbursements. In total, nine states received higher Medicare wages under the provision, while the remaining 41 lost Medicare funds. Sens. McCaskill and Coburn called the provision “unfair” and said it only benefited hospitals in some states to the disadvantage of many others.
Source: beckershospitalreview.com

FactCheck.org : Ryan Revises History on Medicare Reform

Posted by:  :  Category: Medicare

32.Detroit by Tomato GeezerThe commission was created by Congress as part of the Balanced Budget Act of 1997. The New York Times reported that Clinton appointed just four of the 17 commission members, and all four of them voted against the report. Clinton himself opposed the final draft report. He issued a statement on the day of the vote that criticized the plan for, among other things, potentially increasing premiums for seniors who remain in the traditional government-run Medicare plan. Why? Clinton and other Democrats feared the subsidies would not keep pace with inflation. 
Source: factcheck.org

Video: A Short History on Medicare

Critical Analysis Essay: History of Medicare

History of Medi divvy up HCS 530 Professor Michele Fletcher December 4, 2006 Background The social Security system, which was created as an economic safety net for older Americans, was failing to harbor them against the greatest single cause of economic dependency in old age which was the high cost of medical tutelage. The impoverishment for a social insurance program to provide older Americans with reliable health care coverage started within the kind Security Administration and in Congress. In July 1965, the House and Senate passed the consign which established Medicare, a social insurance program designed to provide all older adults with comprehensive health care coverage at an affordable cost. Findings Since its inception in 1965, Medicare has been one of the fastest growing federal programs. When the program began on Jul 1, 1965, 19.1 million persons were enrolled. In 2004, approximately 42 million persons were enrolled. In its first 30 years, the programs costs grew at an average rate of 15% a year. As a percentage of the federal bud father, Medicare accounted for just over 1% in 1967, increased to 12% by 1997, was budgeted at 11.6% for 2004, and is projected at 15.2% for 2010. In 2003, Medicare represented 19. 1% of all personal health care pending in the United States. (The Health Care Manger, 2005). The Medicare regulation established a health insurance program for recovered persons to complement the retirement, survivors, and disability insurance benefits under opposite titles of the Social Security Act. When first implanted in 1966, Medicare covered or so persons aged 65 years or older. Since then, legislation has added other beneficiaries such as persons on disability payments from social certification or the Railroad Retirement Board and persons with end-stage renal illness requiring continuing dialysis or kidney transplant. (The Health Care Manager, 2005). Medicare originally consisted of 2 primary parts: hospital insurance (HI) and… If you want to get a full essay, order it on our website: Orderessay Order your essay at Orderessay and get a 100% original and high-quality custom paper within the required time frame.
Source: blogspot.com

The history of Medicare and its influence on American health care

Several months ago, it appeared that Congress would tackle the issue of correcting the formula in its healthcare reform legislation, but then senators announced they were going to bring up a standalone bill that would overhaul the formula, replace it with a new one, and erase the accumulated cuts in pay. But that bill failed a procedural vote in the Senate, indicating that an SGR bill that offers no way to pay for itself would not be able to earn support from senators who were on the verge of passing trillion-dollar healthcare legislation in the midst of an economic recession.
Source: kevinmd.com

Obama Says Medicare and Social Security Cuts Still on the Table

No bad idea supported by President Obama is ever permanently defeated, it is at best simply stopped temporarily. In a statement today about the sequestration cuts Obama wanted to make it clear that the proposed entitlements cuts that he has previously backed are still on the table. In fact Obama made sure to repeat this point. From the transcript:
Source: firedoglake.com

Sen. Menendez intervened twice in federal audit of key donor

Sen. Robert Menendez raised concerns with top federal health-care officials twice in recent years about their finding that a Florida eye doctor — a close friend and major campaign donor — had overbilled the government by $8.9 million for care at his clinic, Menendez aides said Wednesday.
Source: dailycaller.com

Daily Kos: Republicans trying to rewrite history on Medicare vote

The Ryan Plan was very vague. Despite all the supposed details in the press, it included only a policy statement on Medicare that said that Medicare was to be “reformed” into a program of “premium support” so that seniors would have a “choice” of insurance plans. Extremely vague and benign sounding.   Had it become law, the Congress and the executive branch would had to flesh out the details, by which time the initial vote would be long forgotten and future officeholders would get the blame. Or, if the future officeholders were to be Rs, then they would point out that it happened under Obama.
Source: dailykos.com

Open Enrollment For Medicare Part C & D

Posted by:  :  Category: Medicare

ROBERT L. HUFFSTUTTER'S HEALTHCARE PLAN FOR AMERICA by roberthuffstutterWhy shop around? Like any other insurance policy that renews annually, it’s important to see if your current options still best fit your needs. For example, what may have been the most efficiently priced policy last year could be significantly higher this year. Pricing for most Medicare Advantage Plans are expected to increase moderately this coming this year. However many Medicare Part D Plans are expecting double digit increases in premiums. Second, your current plans provisions and benefits may have changed and may not best fit your needs anymore. Finally, you may have had a change in your personal circumstances where another option may be more efficient. When shopping around for Medicare Advantage, just make sure that any new plan that you are considering has your primary care physician, specialists and care facilities that you are likely to use are on the plans network of providers.
Source: figuide.com

Video: What Is Medicare Part-C and Part-D?

Your Money Matters Healthcare in Retirement

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

How to Decipher the ABCDs of Medicare: Part C

Medicare Part C is also referred to as Medicare Advantage Plans. Medicare Advantage Plans are a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with Part A and B benefits and may additional provide Part D. Medicare Advantage Plans may include organizations such as: HMOs, PPOs, private fee for service plans, special needs plans, and Medicare Medical Savings Account plans.
Source: bhmpc.com

health care solutions, Medicare FAQ, Questions about Medicare

As an alternative to Part A and B, beneficiaries can select a Part C plan, which is also referred to as a Medicare Advantage plan. Private companies contract with the federal government to offer these plans, which pay for everything covered by Original Medicare and often provide additional services.  Such as dental, hearing, vision benefits and maybe even a gym membership. Beneficiaries usually pay a monthly premium and some other fees, such as copayments and deductibles.
Source: ahealthiermichigan.org

OIG Calls for Improvements to Medicare Parts C & D Benefit Integrity Activities : Health Industry Washington Watch

The OIG recently identified barriers to the effectiveness of the Medicare Drug Integrity Contractor (MEDIC) in performing Medicare Parts C and D benefit integrity activities between April 2010 and March 2011. For instance, the MEDIC reported that it does not have access to centralized Part C data, it lacks access to certain prescription drug event data, and there is no mechanism to recover payments from Part C or Part D plan sponsors when law enforcement agencies do not accept these cases for further action. Moreover, while the MEDIC has benefit integrity responsibility for both Medicare Parts C and D, the OIG determined that Part C investigations and case referrals represented a small percentage of its activities (only 8% of investigations and referrals involved Part C only; the majority were Part D only). The OIG makes a series of recommendations to, among other things: improve the data available to the MEDIC (including information from pharmacies, physicians, and pharmacy benefit managers); expand the ability of the MEDIC to recover payments from Part C and Part D plan sponsors; and require Part C and Part D plan sponsors to refer potential fraud and abuse incidents to the MEDIC. For details, see the full report, MEDIC Benefit Integrity Activities in Medicare Parts C and D.
Source: healthindustrywashingtonwatch.com

Are you ready for 2013? 4 questions to ask yourself

Posted by:  :  Category: Medicare

Lyndon B. Johnson by cliff1066™Don’t forget, if you have Medicare Part B and are in Original Medicare, you’ll have to meet your deductible before your Medicare coverage pays for services and supplies. Next year, the Medicare Part B deductible will be $147. Make sure to plan your health care budget to account for the increased cost of doctor visits for the time that it will take to cover your deductible.
Source: medicare.gov

Video: Guide to Medicare Part A and Part B

Medicare Myths » Toni Says

Myth #1:  Most baby boomers think Medicare is just like regular health insurance plans…FALSE!!  Only 2 in 5 or 40% of the baby boomers surveyed know that Medicare is totally different than traditional group or individual health insurance.  Medicare has 2 Parts A & B.  Part A has a $1,184 deductible 6 times a year for an in hospital stay.  Part B of Medicare includes doctor’s services such as office visits and doctor performing surgery, outpatient services and surgery, scans, x-rays, chemotherapy and radiation, and the list goes on.  There is a 1 time deductible for Part B of $147.00 once a year with Medicare picking up 80% and you pay 20% of the Medicare approved amount with no co-insurance or stopping.  Not like the typical 80/20 to $5,000 with a stop lost. The 20% just keeps on going!! Toni Says: Medicare is completely different than health insurance. Your out of pocket can be huge if you only have Medicare or the red, white and blue card. Learn what Medicare offers.
Source: tonisays.com

Medicare Part B Premiums Up $5 Per Month Next Year

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

Kaiser: Medicare Reform Ideas

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

Medicare breast cancer screening costs top $1B

A total of 43.5 percent of women had a mammogram during the study period. Gross and colleagues extrapolated screening and suspicious lesion work-up costs to the entire Medicare population and calculated screening costs of $723.1 million and work-up costs of $359 million. This screening-related total cost of $1.08 billion accounts for more than 45 percent of the $2.42 billion that Medicare spends on breast cancer screening and treatment.
Source: healthimaging.com

AARP Statement on 2013 Medicare Part B Premium Increase

AARP is a nonprofit, nonpartisan organization, with a membership of more than 37 million, that helps people 50+ have independence, choice and control in ways that are beneficial to them and society as a whole. AARP does not endorse candidates for public office or make contributions to either political campaigns or candidates. We produce AARP The Magazine, the definitive voice for Americans 50+ and the world’s largest-circulation magazine; AARP Bulletin, the go-to news source for the 50+ audience; AARP VIVA, a bilingual lifestyle multimedia platform addressing the interests and needs of Hispanic Americans; and national television and radio programming including My Generation and Inside E Street. The AARP Foundation is an affiliated charity that provides security, protection, and empowerment to older persons in need with support from thousands of volunteers, donors, and sponsors. AARP has staffed offices in all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. Learn more at www.aarp.org.
Source: aarp.org

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

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

Critiquing The Medicare Part D Low

Posted by:  :  Category: Medicare

Raging Grannies: No Private Parts by Grant NeufeldAt the outset, however, it is important to note that we agree on the basic goal: a Part D program that displays effective cost containment in a very tight federal budgetary environment.  The good news is that the existing program is quite successful in this regard. Since 2007 per capita costs in Part D have grown at a compound annual rate of 1.8 percent, while costs in Part A and B have grown at 3.6 percent and 3.7 percent, respectively. The program’s negotiated rebates between large purchasers and drug manufacturers, and the ability for consumers to compare plan prices and benefits, have resulted in lower than expected Part D spending overall.  (In contrast, note that from 1990 to 2005, average annual drug cost growth in the Medicaid program was about 13.1 percent per year.)
Source: healthaffairs.org

Video: Guide to Medicare Part A and Part B

Loopholes to help you track Medicare Part B therapy billing

Unfortunately, there is no easy solution to this problem. But I have a few ideas. The current process of updating a resident’s cap amount is through checking the “Common Working File” (CWF). This file is a master list of all Medicare Part B therapy services billed for the year to date. It’s a good system, but it’s not always accurate. If another provider, such as another SNF, outpatient clinic, hospital, etc. is delayed in its billing of services, the Common Working File has no current record of these services. In terms of reimbursement, Medicare Part B pays whichever provider submits the claims first.
Source: mcknights.com

Medicare Part B Premiums Up $5 Per Month Next Year

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

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

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

CBO: Medicare, Medicaid Spending Growth Slowing by 15%

Healthcare spending on Medicare and Medicaid has grown slower than many have predicted, and the most recent report from the Congressional Budget Office (pdf) shows federal spending for the two programs was 5 percent lower than it estimated in March 2010. The CBO consequently lowered seven-year spending projections for Medicare and Medicaid in 2020 by $200 billion — $126 billion for Medicare and $78 billion for Medicaid, which is roughly a 15 percent decrease for each program. The CBO reduced its 10-year projection of outlays for Medicare by $137 billion, citing the third straight year of below-average growth. Federal spending for Medicare Part A and Part B has risen by an average of 2.9 percent per year since 2009 — far less than the 8.4 percent growth rate from 2002 to 2009 and far less than what the CBO has projected for the past several years. CBO analysts made changes to Medicaid spending outlays for the next 10 years, citing lower expected costs per person through the Medicaid expansion, which will go live in 2014. However, the CBO also said it expects Medicaid enrollment will not be as high as originally thought, saying more people will gain health coverage over the next decade through other sources, mostly employers.
Source: beckershospitalreview.com

Kick Silver Script out of Medicare part D

Today I have tried to get TWO prescriptions filled under my other coverage, and Silver Script; this is going to cost me over $400.00. The Co-pays with Silver Script are questionable. When I checked the retail cost of these prescriptions and was able to question someone from Silver Script (The Associate Who Works in There Complaint Department), to find the amount they used to calculate my Co-pay amount; I found they were the same. My other prescription coverage Ins. is primary, because I am disabled.
Source: complaintslist.com

Doctor’s Advice…Get Traditional Medicare…What’s That? » Toni Says

(In-patient Hospital Insurance) pays for your medical care while you have a hospital stay. Part A also pays some of the costs if you stay in a skilled nursing facility which has 100 day benefit, hospice, or if you receive home health care.  The Part A deductible for 2013 is $1,184.00 and can be used 6 times or 6 deductibles in a year.  Yes, Part A has a benefit period of 60 days, so every 60 days; there is a new deductible of $1184.00. If you go back in the hospital after a 60 day period, then you can have another deductible of $1,184.00.  Skilled nursing has a $0 co pay for days 1-20, but from days 21-100, there is $148.00 co pay per day.  After day 100, you pay all of the cost for each additional day. And yes they do bill you the additional cost.
Source: tonisays.com

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

Webinar: Medicare Part D in 2013: Addressing Client Issues

Adult Day Health Care Affordable Care Act Assisted Living Chained CPI Clark v Astrue Court Access Dual Eligibles Health Care Reform Home and Community-based Services IHSS Language Access LGBT long term care Medi-Cal Medicaid Medicare Medicare Part D Nursing Homes Olmstead Pickle Amendment Preemption Same Sex Marriage Social Security SSI Supreme Court
Source: nsclc.org

What is Medicare Part A, What Does It Cover, Who Is Eligible

: Medicare Part A covers certain skilled nursing care services needed daily in a skilled nursing facility for up to 100 days. In order to have the nursing facility covered, your doctor must decide that you need daily skilled care given by, or under the direct supervision of, skilled nursing or rehabilitation staff. It is important to note that this is in-home care only. For patients who go to a nursing facility 5 or 6 days a week for rehabilitation services only, the care is considered daily care.
Source: bradeninsurance.com

Maximize Your Medicare: The Blog: Observation Status and Medicare Part A

Medicare Part A Includes Hospitalization If you are admitted inpatient into a hospital, then you are covered by Medicare Part A.  In 2013, this is subject to a $1184 deductible per benefit period.  In other words, you need to pay the first $1184, before receiving any Medicare benefits under Medicare Part A.   There’s more, however. Observation Status Doesn’t Count If you admitted to the hospital under “Observation” status, then this does NOT qualify for Medicare Part A benefits.  You will be charged the entire amount.  In addition, your Medicare Advantage and your Medigap policy will NOT cover you.  That is because Medicare must be the primary payer before you receive benefits under either of these. You Need to Check It is understandable that this is the furthest thing from your mind.  Nevertheless, you (or the person that is caring for you) need to be careful, or else you may be in for an unwelcome surprise.   Unfortunately, It Gets Worse There are two additional points to know. First, your status can be changed after the fact.  The reason for this is that there is someone at the Medicare system reviewing your file before paying benefits.  You may have been originally under inpatient status, but then have your status changed to Observation status. Second, the Affordable Care Act encourages hospitals to admit patients under Observation status.  The reason is, in an attempt to curb excessive hospitalization, that hospitals are fined if there are an excessive number of patients who are readmitted to the hospital for the same reason within 30 days.  However, those admitted under Observation Status do not count towards this number.  It is logical, then, that hospitals would want to admit someone under Observation Status, rather than inpatient, because that reduces the chance of paying this penalty to the federal government. Maximize Your Medicare Maximize Your Medicare is written to point out these subtle points.  Many people do not know these points, and don’t become aware of them, until it is too late.  The objective of the book is to provide the information before the fact.  You are then in greater control of the risks that you are accepting.  We cannot predict the future, but you can consider your own situation and your own priorities, so that you can choose for yourself.
Source: blogspot.com

Sen. Menendez contacted top officials in friend

Posted by:  :  Category: Medicare

George W. Bush by cliff1066™by MIKE FLYNN 7 Feb 2013 According the developing accounts, NJ Sen. Bob Menendez has a special relationship with mega-donor Dr. Salomon Melgen. In addition to campaign contributions, Dr. Melgen allegedly flew Sen. Menendez to the Dominican Republic on his private plane and may have provided the Senator with prostitutes. That soap opera, though, obscures a more troubling connection. According to areport in the Washington Post, Sen. Menendez intervened at least twice on behalf of Melgen in a billing dispute he had with Medicare. Since at least 2009, Dr. Melgen, a Florida eye surgeon has been in a billing dispute with Medicare. At issue is billing over a vial of medicine used in surgery to treat macular degeneration. Under Medicare billing practices, the system reimburses medical offices $2,000 for each vial. Dr. Melgen broke the vial into 3-4 individual doses, billing Medicare $6-8,000 for each vial. Medicare’s original complaint alleged that Dr. Melgen had improperly billed Medicare $8.9 million. Medicare billing is notoriously complicated. It is also entirely possible that Melgen’s dilution of the medicinal vial was medically appropriate. At any given moment, there are likely dozens of billing disputes being debated between Medicare and doctors’ offices. It is unusual, however, that a US Senator weighs in. According to the Post, Sen. Menendez pressed HHS officials on the matter on at least two occasions. The first was a phone call in 2009 to Jonathan Blum, the Medicare director for HHS. The second was in 2012, in a meeting ostensibly to discuss implementation of ObamaCare. It is important to note that Dr. Melgen is not a constituent of Sen. Menendez. He does not practice medicine in New Jersey. Outside of campaign contributions, he has no ties to the Senator that might in other cases trigger a Senator’s intervention on behalf of a constituent. Yet, according to officials, Dr. Melgen frequently cited his ties to Menendez.
Source: alipac.us

Video: Romney Takes Medicare Message to Florida

1 Drug, $1.3M Medicare Overpayment in FL

The report says audits were performed nationally on Herceptin payments after a pilot audit indicated the overpayments were a potential problem. The drug, also known as trastuzumab, is sold in a multiuse vial that contains more than one dose and is good for four weeks.
Source: nefhma.org

South Florida Pharmacy Owner Allegedly Used Dead Beneficiaries to Defraud Medicare

A family that owns a number of South Florida pharmacies is allegedly under investigation for Medicare fraud, according to a number of sources. On January 17, 2013, federal authorities raided one pharmacy location in Naples, Florida. Drug Enforcement Administration (DEA) agents removed boxes of documents and computers from the pharmacy, according to Naples News. The pharmacy owner and his mother are allegedly being investigated by the U.S. Office of Inspector General (OIG) of the Department of Health and Human Services (HHS).
Source: thehealthlawfirm.com

Sen. Menendez intervened twice in federal audit of key donor

Sen. Robert Menendez raised concerns with top federal health-care officials twice in recent years about their finding that a Florida eye doctor — a close friend and major campaign donor — had overbilled the government by $8.9 million for care at his clinic, Menendez aides said Wednesday.
Source: dailycaller.com

Is Florida Medicare Insurance Different From Other States?

Florida Medicare Insurance differs because many seniors have trouble paying out-of-pocket co-pays and deductibles after their Florida Medicare Insurance Part A and B pays their share. Currently, Floridians have the highest insurance rates in the country. And, the amount they pay for their Florida Medicare Insurance depends on the county they live in.
Source: seniorcorps.org

HCAN Partners: Tax Corporations, Protect Medicare, Medicaid, ACA

Citizen Action of Illinois held a press conference outside the office of Rep. Rodney Davis (R-13) in Champaign, Illinois to highlight the negative impact of budget cuts and joined the Chicago Federation of Labor at a gathering in Chicago to push back against cuts to Medicare, Medicaid, the Affordable Care Act, and Social Security. Leaders were joined by U.S. Reps. Jan Schakowsky (D-9) and Bill Foster (D-11).
Source: healthcareforamericanow.org

Rubio: Ryan’s Medicare Plan Helps Romney in Florida

When Mitt Romney tapped Paul Ryan to be his vice presidential running mate, conventional wisdom dictated that Romney had put himself at a distinct disadvantage in the key battleground state of Florida, where Ryan’s controversial plan to reform Medicare wouldn’t sit well with millions of government-dependent seniors. Florida Sen. Marco Rubio isn’t buying it. In an interview with National Journal, Rubio argued that Ryan’s proposal will help — not harm — Romney’s chances of winning the Sunshine State. He predicted that older voters will support Romney and Ryan because they are trying to “save Medicare” instead of pretending that nothing is wrong with the fiscally unsustainable program. “Look, you have three million people in the state who are on Medicare — one of whom is my mom, one of whom is Paul Ryan’s mom,” Rubio said. “These are people who understand the reality of Medicare: that it’s spending more money than it takes in; that anyone who’s in favor of leaving it the way it is is in favor of bankrupting it.” Rubio praised the GOP ticket for tackling the hot-button topic of entitlement reform at a time when many politicians won’t acknowledge the problems facing the Medicare program. “They’re looking for real solutions on how to solve this,” Rubio said. “Mitt Romney and Paul Ryan are offering a way to save Medicare that doesn’t change it at all for current beneficiaries. And I think people here are going to be excited about that.”
Source: nationaljournal.com

In Florida, Biden Attacks Romney on Social Security and Medicare

Mr. Romney has said that he will pay for his across-the-board cuts in income taxes and other taxes by eliminating deductions, but he has never specified which ones. The analysis, by the Tax Policy Center, concluded that making up all the revenue lost by Mr. Romney’s tax cuts would require eliminating tax breaks, as Mr. Romney has said he would do, but not just for high earners. Households earning below $200,000 would lose 58 percent of their tax deductions – like the one for mortgage interest – the Tax Policy Center said. That would lead to higher total taxes for such households.
Source: nytimes.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

In Florida, Obama Talks Medicare

CNN: Medicare Takes Center Stage For Obama Campaign In Florida  In the senior-heavy coastal city of Melbourne on Sunday, President Barack Obama, armed with a new study, continued to hammer the Republican plan to reform Medicare. He highlighted a Harvard analysis, conducted by a former Obama adviser, that found seniors would pay more under the “Romney-Ryan plan,” compared to his plan, which he said will strengthen the entitlement program. Obama said GOP nominee Mitt Romney wants to “give money back to insurance companies and put them in charge of Medicare.” “Their voucher plan for Medicare would bankrupt Medicare. Our plan strengthens Medicare,” Obama told a crowd of 3,050 gathered at a sports and recreation center. “No American should have to spend their golden years at the mercy of insurance companies.” The focus on Medicare on Sunday was the latest effort by the president and his campaign to turn up the noise around the program and throw Romney off his message on jobs and the economy, especially important as the president continues to make a play for the senior vote ahead of the November election (9/9).
Source: kaiserhealthnews.org

Obama Says Medicare and Social Security Cuts Still on the Table

Posted by:  :  Category: Medicare

What's In My Bag... by Amy DiannaNo bad idea supported by President Obama is ever permanently defeated, it is at best simply stopped temporarily. In a statement today about the sequestration cuts Obama wanted to make it clear that the proposed entitlements cuts that he has previously backed are still on the table. In fact Obama made sure to repeat this point. From the transcript:
Source: firedoglake.com

Video: What Is Medicare Advantage?

What Is Medicare D Insurance?

There are several ways in which a person can sign up for Medicare D insurance coverage once they have been approved to receive Medicare insurance coverage. The first option for enrollment is to complete a paper enrollment form. Paper enrollment forms can be obtained through your local Social Security office, online, or by contacting the Medicare administration that has processed your basic Medicare application. The second option for signing up for Medicare Part D coverage is to call the number listed on your Medicare approval letter. The customer care professionals that answer your call will be able to provide the assistance necessary to get your application processed. The third option for applying for Medicare Part D insurance is to call 1-800-MEDICARE (1-800-633-4227). The representatives will either be able to begin the process of filling out your application for you over the phone or send you a form if you choose to do so in this manner.
Source: seniorcorps.org

Join the debate on “Reining in Medicare Costs without Hurting Seniors”

 Should we try to spend less on end-of life care? Many say “Yes,” but Zeke Emanuel (a medical ethicist and oncologist who was part of the Obama team during the president’s first term), says “No.” I link to a column where he notes that “It is conventional wisdom that end-of-life care is an increasingly huge proportion of health care spending. . . Wrong. Here are the real numbers: end-of-life care (not just for the elderly, but for all Americans) accounts for just 10% to 12% of  total health care spending. This figure has not changed significantly in decades.”
Source: healthbeatblog.com

Fiscal Cliff: What Is At Stake For Medicare And Medicaid?

MARY AGNES CAREY: Right. That is definitely the balance that’s in the works. If you ask beneficiaries to contribute more, what do you ask the providers to do? For example, some ideas that are out there, they’ve been around for a while: Do you look at the fee-for-service Medicare structure on co-payments and deductibles?  Combine those into one deductible, for example, but add a catastrophic cap, which doesn’t exist in fee-for-service Medicare.  On providers: As we know, their payments will continue to increase over the next ten years, but under the health care law they’re going to do so at a slower rate.  So do you go back to providers, to hospitals, to the nursing homes, to home health care agencies, and take more from them?  And how do you balance that pain to get an equal result?
Source: kaiserhealthnews.org

Congressional Accord Preserves Medicare Doctor Pay

Posted by:  :  Category: Medicare

Deputy Administrator and Director for the Center of Medicare at CMS Jonathan Blum visits Christiana Care to speak about accountable care organizations by Christiana CarePolitico Pro: Health Care Cuts Send Ripple Through The Industry The potential fiscal cliff deal … squeezes health savings from a variety of places. But spreading the pain around didn’t prevent complaints from rippling through the industry and Congress. Hospitals are protesting the loudest, since about half of the agreement’s $30 billion in health care cuts would fall on their backs — and most of that $30 billion would go to preventing doctor Medicare pay cuts from kicking in under SGR this month. But insurers and pharmacies are irked as well, since some of the savings would come from trimming payments to Medicare Advantage plans and reimbursements for diabetes tests (Cunningham, 1/1).
Source: kaiserhealthnews.org

Video: Medicare Provider Enrollment 3.wmv

The Physician Compare website

CMS is planning to include updated administrative information on an EP’s page as well as information regarding physician performance. CMS plans to enhance the administrative data by adding information on whether a physician or other health care professional is accepting new Medicare patients, board certification information, improved foreign language, and hospital affiliation data. CMS also intends to include the names of EPs who are successfully participating in the PQRS, the PQRS Maintenance of Certification bonus program, and the eRx Incentive Program. When feasible, CMS will post the names of EPs who are successfully participating in the Electronic Health Record (EHR) Incentive Program. As noted in the 2013 MPFS final rule, CMS will display an indicator on the profile Web page of an EP to acknowledge satisfactory participation in the incentive programs.
Source: facs.org

Doctor’s Advice…Get Traditional Medicare…What’s That? » Toni Says

(In-patient Hospital Insurance) pays for your medical care while you have a hospital stay. Part A also pays some of the costs if you stay in a skilled nursing facility which has 100 day benefit, hospice, or if you receive home health care.  The Part A deductible for 2013 is $1,184.00 and can be used 6 times or 6 deductibles in a year.  Yes, Part A has a benefit period of 60 days, so every 60 days; there is a new deductible of $1184.00. If you go back in the hospital after a 60 day period, then you can have another deductible of $1,184.00.  Skilled nursing has a $0 co pay for days 1-20, but from days 21-100, there is $148.00 co pay per day.  After day 100, you pay all of the cost for each additional day. And yes they do bill you the additional cost.
Source: tonisays.com

Health Care Authority Prepares Website to Answer Medicaid Providers’ Questions About Rate Increases

FOR MORE INFORMATION ON HEALTH CARE REFORM OR BACKGROUND: The Medicaid Expansion 2014 website: www.hca.wa.gov/hcr/me The Health Benefits Exchange website: www.hca.wa.gov/hcr/exchange The Provider Rates Change website: www.hca.wa.gov/acarates Provider questions about the rate increase can be emailed to prvrates@hca.wa.gov Jim Stevenson, Communications, HCA 360-725-1915 jim.stevenson@hca.wa.gov
Source: wa.gov

CMS angling to ease providers’ burdens from Medicare Administrative Contractors

CMS has called for provider contact information so the agency can survey a random sample of long-term care operators. This will help the agency determine just how satisfied providers are with the recently instituted Medicare Administrative Contractors (MACs). The Social Security Act names provider satisfaction as a MAC performance standard.
Source: mcknights.com