CMS Names 106 New Medicare ACOs

Posted by:  :  Category: Medicare

2009localidiots by lobstar28CMS 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

Video: Indiana Medicare Supplements

LeadingAge: PACE in VT Closes

The closure will affect about 60 seniors who go to the PACE in Colchester and another 73 seniors in the Rutland area. The Vermont PACE was part of the Rural PACE Pilot Grant Program, established under the Deficit Reduction Act of 2005 by Congress and administered by the Centers for Medicare and Medicaid Services (CMS). 
Source: leadingage.org

Medicare Supplement Insurance

In 2004, Jess and Sandra heard about some exciting options for Medicare. Jess and Sandra started to learn more about the different Medicare Advantage, Medicare Supplement, and Part D prescription plans. As Sandra puts it, “They dove into the senior market heavily; it just exploded.” Jess and Sandra have become experts in the Medicare marketplace. The demand was great back then and continues to be to this day. Sandra said, “We are certified with every company that does business here in Indiana. 80% of what we do is Medicare focused.” The annual election period is October 15 to December 7 for Medicare. “Every participant can change their current plan with Easy Street,” said Jess. Jess and Sandra look at many options to find the right plan to match each client’s needs.
Source: atcentergrove.com

Indiana Farm Bureau Offers New Medicare Supplement Plans Benefit

Indiana Farm Bureau has joined with Members Health Insurance Company to offer Medicare supplement plans to IFB members. MHI is an affiliate of the health organization that serves members of the Tennessee Farm Bureau, the largest Farm Bureau in the nation.
Source: hoosieragtoday.com

Saving The Most On Medicare

The original Medicare has two key basic parts; Part A and Part B. The part A component of the Medicare was established with the initial Medicare package. It’s an insurance financed by the government, and it offers coverage associated with health services at home, nursing home facilities, hospice, hospital stays categorized under inpatient, and Non-medical Health care facilities with religious attachment. If you pay medical taxes during the course of your work, there are no premiums for Medicare part A. If your spouse paid for these taxes, there are also no premiums. You can get Part A Medicare if you are over 65 years old and meet some citizenship requirements. Part B Medicare assists in the payment of outpatient hospital care, doctors’ visits, and some medical services not covered by part A. These include the services of occupational and physical therapists, and other related home health care.
Source: healthpartnersx.com

Eye Opening Report on Hospital and Physician Medicare Fraud 

According to the Center’s report, doctors and other healthcare providers have, over the last decade, steadily billed higher rates for treating elderly patients and thereby  increasing their fees by more than $11 billion.  While there was little evidence indicating that Medicare patients were sicker than in prior years, or that the healthcare providers were rendering more care, analysis of claims from 2001 through 2010 indicated that the health care providers were using more lucrative billing codes.  The process of billing for more expensive services than were actually provided is called “upcoding.”
Source: indiananursinghomewatch.org

Medicare Open Enrollment: last chance to review and compare plans

Posted by:  :  Category: Medicare

COMPARING THE ECONOMY OF YESTERYEAR WITH TODAY'S ECONOMY... by roberthuffstutterWith the holiday season upon us, it’s easy to get busy this time of year. Some pretty important tasks can get left to the last minute. One of those important tasks is ensuring you are in the right health insurance plan in Medicare.  Selecting the right plan is a personal choice, and a lot of thoughtful consideration goes into finding the right match.  But just like the holidays, those key dates come whether or not you are ready.
Source: medicare.gov

Video: Compare 2013 Medicare Advantage Plans – Tips

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

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

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

Comparing Medicare Supplemental Insurance Benefits

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

Medicare Spotlights Hospitals With Especially Costly Patients

The Medicare data indicated big spending differences in areas of the country that have not generally been thought of as high users of Medicare services. In Kansas City, Mo., the average patient admitted to St. Joseph Medical Center cost Medicare $19,247 during a stay and in the month afterward, 7 percent above the national median. Fifteen miles away, according to the data, an essentially similar patient admitted to Truman Medical Center-Lakewood cost Medicare $15,290, or 15 percent below the national median. The owner of St. Joseph, Corondelet Health, which is part of the nation’s largest Catholic nonprofit system, Ascension Health, declined to comment. Truman said in a written statement: “It is important that there be a comprehensive analysis of this data and its variables before final reimbursement conclusions are reached.”
Source: kaiserhealthnews.org

Medicare’s physician compare initiative gets all the basics wrong

Seth Bilazarian MD has been a Clinical and Interventional Cardiologist at Pentucket Medical Associates in Massachusetts since 1993. He is board certified in Internal Medicine, Cardiovascular Medicine, Nuclear Cardiology, Vascular Ultrasound, Interventional Cardiology, and Vascular and Endovascular Medicine. Dr Bilazarian performs coronary and peripheral interventions at Lahey Clinic and Massachusetts General Hospital. He has been an investigator in the interventional laboratory for new devices including drug-eluting stents, distal protection devices, imaging devices (OCT and InfraRed), and anticoagulant pharmacotherapy. Dr Bilazarian is an active participant in clinical trials in congestive heart failure, hypertension, coronary disease prevention, prediabetes management, anemia, atrial fibrillation, and anticoagulation/antiplatelet therapies in the outpatient setting. He has authored numerous papers and book chapters in clinical cardiology. He was appointed as a physician advisor to the circulatory device panel of the FDA in 2008.
Source: theheart.org

CONNECTURE ACQUIRES DRX, A LEADING PROVIDER OF INFORMATION SYSTEMS FOR MEDICARE

Connecture is the leading provider of Web-based information systems used to create health insurance marketplaces and exchanges. Its industry-proven solutions enable consumers, employers and brokers to more easily shop for, purchase and renew health insurance while minimizing back-office administrative expenses for health plans.  Connecture’s solutions are provided to health plans, state insurance exchanges, private exchanges and insurance brokers.  More than 25 million Americans shop for their health insurance through systems built by Connecture, and more than half of the nation’s 20 largest plans rely on them to sell, administer and manage their plans and products effectively.  For more information, visit www.connecture.com.
Source: drx.com

Medicare made clear: Compare Another advantage compared to

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

Medicare For Those With Disabilities

• If you have End-Stage Renal Disease you are not automatically enrolled in Medicare, but you can apply if you have worked the required amount of time according to Social Security or the Railroad Retirement Board, or if you are the spouse or dependent child of someone who has. Contact Social Security for details. You would need both Medicare A and B to cover certain dialysis and kidney transplant services. The coverage usually starts the fourth month of dialysis treatments.
Source: medicareecompare.com

Medicare Competitive Bid Coming soon….for better or for worse.

Posted by:  :  Category: Medicare

Section 302 of the Medicare Modernization Act of 2003 (MMA) established requirements for a new Competitive Bidding Program for certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS). Under the program, DMEPOS suppliers compete to become Medicare contract suppliers by submitting bids to furnish certain items in competitive bidding areas, and the Centers for Medicare & Medicaid Services (CMS) awards contracts to enough suppliers to meet beneficiary demand for the bid items. The new, lower payment amounts resulting from the competition replace the Medicare DMEPOS fee schedule amounts for the bid items in these areas. All contract suppliers must comply with Medicare enrollment rules, be licensed and accredited, and meet financial standards. The program sets more appropriate payment amounts for DMEPOS items while ensuring continued access to quality items and services, which will result in reduced beneficiary out-of-pocket expenses and savings to taxpayers and the Medicare program.
Source: timesunion.com

Video: Medicare Physician Fee Schedule; the Never Ending Debate

Will Obama’s Medicare Cuts Hurt Seniors?

Of the $716 billion in cuts, $415 billion come in the form of “updates to fee-for-service payment rates,” a euphemism for reducing Medicare’s payments to doctors and hospitals. But what happens when you reduce payments to doctors? Doctors stop being willing to see Medicare patients. And if you can’t actually get a doctor’s appointment, what does it really matter what your insurance plan covers on paper?
Source: andrewsullivan.com

Cliff Averted: Medicare Fee Schedule Intact

As CMS reminded providers in its 12/19/2012 bulletin, clean electronic claims are never paid sooner than 14 calendar days after the date of receipt. CMS has promised to issue further notification before January 11, 2013 with an update on its progress in updating its fee schedule (remember, CMS was forced to load the 2013 fee schedule with the projected pay cuts, since Congress acted so late in averting the cuts). It is our hope that CMS will be able to work quickly enough within these next two weeks in order to avoid having to reprocess claims for 2013 dates of service.
Source: healthcarebiller.com

Medicare’s 2013 Fee Schedule Compared to 2012

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

Medicare's 2013 Proposed Fee Schedule: The Physician Impact

4. Multiple procedure payment reductions are proposed on the technical component of second and subsequent cardiovascular and ophthalmology diagnostic services furnished by the same doctor, to the same patient, on the same day. The professional component from any doctor in a practice performing second and subsequent CT, MRI, or ultrasound scans on the same patient on the same day will be reduced by 25 percent. Since patients receiving multiple scans are often the most ill, this modification could significantly impact patient care as well as the reimbursement of those groups that care for them. Although it’s likely this rule was intended to prevent excessive and unnecessary testing, without additional qualification it is likely to create hardship for patients legitimately requiring multiple same-day diagnostic tests.
Source: physicianspractice.com

Suppliers, experts dispute savings claims from Medicare competitive bid program

Shirvinsky and Cramton dispute the savings touted by Medicare, saying that lower costs have come from reductions in use of medical equipment by seniors who can no longer buy medical equipment from their neighborhood supplier. That could lead to higher hospitalizations from seniors who are not using walkers or wheelchairs and end up in the emergency room after a fall.
Source: triblive.com

Congress Passes Bill to Avoid “Fiscal Cliff,” With Medicare Doc Fix, Other Medicare/Medicaid Extensions

The legislation requires CMS, for services furnished on or after January 1, 2014, to adjust payments relating to the end stage renal disease (ESRD) bundled payment rate to reflect changes in utilization of certain drugs and biologicals. In making reductions, CMS must take into account the most recently available data on average sales prices and changes in prices for drugs and biological reflected in the ESRD market basket percentage increase factor. The legislation also delays until January 1, 2016, implementation of oral-only ESRD-related drugs in the ESRD prospective payment system. HHS also must conduct an analysis by January 1, 2016, of the case mix payment adjustments relating to ESRD bundled payments, and make appropriate revisions to such case mix payment adjustments. The Government Accountability Office (GAO), no later than December 31, 2015, must prepare a report to Congress on how HHS has addressed implementation of payments for oral-only ESRD-related drugs in the bundled ESRD prospective payment system.
Source: wolterskluwerlb.com

Medicare releases its final rule on the 2013 physician fee schedule : Getting Paid

CMS delayed to July 1, 2013, the effective date of its requirement that a face-to-face visit be a condition of payment for certain high-cost durable medical equipment (DME) covered items. The list included many items that have historically been targets of Medicare fraud as identified by various program integrity experts. The encounter must occur within six months before the written order for the DME. CMS is not mandating additional documentation beyond what the physician or other qualified health professional would normally document during the actual face-to-face encounter.
Source: aafp.org

10 Statistics on Medicare Spending for Physician Fee Schedule Services

2001 Aged: $1,374 Disabled: $1,160 2003 Aged: $1,485 Disabled: $1,274 2005 Aged: $1,837 Disabled: $1,404 2007 Aged: $1,964 Disabled: $1,650 2011 Aged: $2,181 Disabled: $1,883 More Articles on Medicare: CMS Proposed Rule Drops Neurosurgical Reimbursement 1% 10 Statistics on Average Percent of Medicare Rates for Best Payors Dr. Peter Mandell Testifies in Congress on Making Medicare Payments Sustainable
Source: beckersspine.com

U.S. expects big Medicare savings from competitive bid program

Wednesday’s announcement illustrates the savings that traditional fee-for-service Medicare could achieve at a time when analysts, policymakers and lawmakers are considering ways to reduce spending as part of deficit reduction. Some have recommended broad use of the competitive bidding process for a host of private operators that do business with Medicare, including private insurers.
Source: medcitynews.com

CMS Issues Final 2013 Medicare Physician Fee Schedule Rule, Including Other Part B Policy Updates : Health Industry Washington Watch

Under the final rule, the 2013 MPFS conversion factor will be $25.0008, compared to $34.0376 in 2012. As noted, Congress could override the 26.5% SGR cut on either a temporary or permanent basis. Other provisions of the rule impact reimbursement for different types of services. For instance, the final rule seeks to benefit primary care physicians by authorizing separate payment to a patient’s community physician or practitioner to coordinate the patient’s care in the 30 days following a hospital or skilled nursing facility (SNF) stay. On the other hand, certain specialists, like diagnostic radiologists, would be negatively impacted by CMS’s continued expansion of the multiple procedure payment reduction (MPPR) policy. Under the final rule, on January 1, 2013 CMS will implement its policy, discussed in the CY 2012 final rule, applying the MPPR when one or more physicians in the same group practice furnish the interpretation of advance imaging services to the same patient, in the same session, on the same day. CMS also will apply the MPPR to the technical component of certain cardiovascular and ophthalmology diagnostic services for 2013. Under this policy, CMS will make full payment for the highest paid cardiovascular or ophthalmology diagnostic service and reduce the technical component payment for subsequent cardiovascular or ophthalmologic diagnostic services furnished by the same physician or group practice to the same patient on the same day by 25% for cardiovascular diagnostic services or 20% for ophthalmologic diagnostic services.
Source: healthindustrywashingtonwatch.com

Proposed Medicare Fee Schedule Includes Pay Increase For Primary Care, Family Docs

Medscape:  CMS Proposes Primary Care Raises Funded With Specialist Cuts Medicare would reduce reimbursement for many types of specialists to fund sizable raises for primary care physicians in 2013, according to a proposed fee schedule that the Centers for Medicare and Medicaid Services (CMS) released today.  These reductions and raises are apart from the huge pay cut — now put at 27% — set for January 1, 2013, that is triggered by Medicare’s sustainable growth rate formula, and likely to be postponed by Congress (Lowes, 7/6).
Source: kaiserhealthnews.org

Are Medicare Advantage Plans Skimming Off Healthiest Patients?

Posted by:  :  Category: Medicare

TWO YEARS OF RUIN by SS&SSA study released Thursday, by Gerald Riley, a researcher at the Centers for Medicare & Medicaid Services (CMS), adds to those concerns. The study looked at more than 240,000 people who dropped out of Medicare Advantage plans in 2007, and compared them with beneficiaries who remained in traditional Medicare the entire time. In the six months after leaving the private plans, the former Medicare Advantage patients used an average of $1,021 in medical services each month, while the patients in the control group cost Medicare $710 a month, the study found.
Source: kqed.org

Video: Medicare supplement Insurance Plans VS Medicare Advantage plans

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

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

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

Not Happy with Your Medicare Advantage Plan? Change it!

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

Turning 65: Finding a Medicare Advantage Plan

This is the fifth in a series of posts that examine the process of signing up for Medicare, navigating its rules, choosing supplemental coverage and planning for health care in a program with a very uncertain future. Here are the first, second and third posts and fourth posts in this series. Ah, those Medicare Advantage (MA) plans!’  The government can’t seem to decide if it loves or hates them.’  On the one hand, when I tried to learn about my options, there was much more MA plan information available from the government than for traditional Medigap policies. ‘ So it seemed like I was being encouraged to select an MA plan. ‘ ‘ ‘ On the other hand, Congress with a big nudge from the president, whacked reimbursements to MA plans, cutting out the overpayments they’d been receiving for years.’  It was costing the government far more to fund the benefits to seniors who picked them than it cost to provide the traditional program.’  Lower payments, experts believe, could cause some MA plans to disappear. While government is betwixt and between on MA plans, I am not.’  I know I would not feel comfortable in a restricted provider network, which is the crux of most of these MA plan arrangements.’ ‘  But I approached the selection process with an open mind, taking a careful look at what’s available and evaluating the advice for selecting one.’  As with Medigap policies and the prescription drug plans that go with them, there were too many choices and too many data points for the average senior to comprehend, let alone make the ‘right’ decision that the marketplace model says will appear, like magic. I understand why seniors fall for misleading or deceptive sales pitches.’  We need a helping hand but all too often whoever is extending it doesn’t have our best interests at heart.’  I had heard lots of these pitches before’the kind where a seller invites seniors to a local restaurant, then glosses over the negatives and highlights insurance deals for a very low or no monthly premium with drug coverage, gym memberships, and vision and dental care thrown in to boot.’  Appealing, no? Now it was time for me to cut through the hype. First, I started my review with the sales brochures I received for MA plans.’ ‘  The giant in this universe, UnitedHealthcare/AARP, sent its brochure in an enticing envelope.’  A big red banner screamed ‘$0 premium Medicare health plans’ ‘enough to make me rip it open.’  The insurer’s Medicare Advantage Guide said that although costs vary by plan, all of United’s MA plans have annual limits on out-of-pocket expenses ‘so you can budget for health care expenses and limit your out-of-pocket costs each year.”  That didn’t mean much since I don’t know what illnesses might befall me.’  Marketing jargon, really, but apparently it works. Another sales piece in the mailing gave concrete info about United-AARP’s MedicareComplete Plan 1 (an HMO) with its out-of-pocket limit of $5,900.’  And the other United-AARP offerings?’  For those I had to turn to the government’s Medicare & You handbook where I ran smack into the bizarre world of MA plans.’  It turned out there were also two PPO plans offered through United-AARP.’  Since PPOs are less restrictive than HMOs, I wouldn’t lose my Medicare benefits by going out of network as I would with an HMO. I learned that there were also three other AARP’  HMO choices’the MedicareComplete Essential HMO with an out-of-pocket limit of $5,900; the MedicareComplete Plan 2 which carried an out-of-pocket limit of $4,200; and the MedicareComplete Mosaic with its limit of $2,900.’ ‘  It’s not uncommon for one insurance company to offer several different Medicare plans with fanciful names, which further confuses consumers. All had no monthly premiums, but they paid different amounts for what’s called durable medical equipment, like oxygen, and for critical treatments like chemotherapy drugs.’ ‘  I also discovered that the United-AARP MedicareComplete Essential HMO did not cover drugs, which would force me into shopping for a drug plan, another headache I didn’t need. The United-AARP MedicareComplete Mosaic seemed ideal with its low out-of-pocket maximum, low copayments for doctor visits, and low coinsurance for the expensive stuff like chemo drugs and medical equipment.’  But based on the sales brochure they mailed to me, which were all about Plan 1, it was not the plan United-AARP was encouraging me to buy.’ ‘  With Plan 1, I would be on the hook for more out-of-pocket expenses’meaning that the carrier would pay less and profit more.’  No wonder they were pushing it.’  A second United-AARP mailing also pushed Plan 1. However, both brochures did disclose a significant variable to look at when choosing an MA plan’the copayments for inpatient hospital stays.’  I knew these copays are often hidden in the fine print, and consumers frequently don’t learn of them until they land in the hospital.’  They are clearly a negative for MA plans.’  FYI:’  Medigap policies pay the copayments for hospital stays, which give them an edge in this department.’ ‘  The copay for Plan 1 was fairly hefty’$175 each day up to $1,400 per stay.’  These could add up for a sick person who had multiple admissions. Emblem Health also sent some Medicare insurance mailers, mostly trying to get me to access their website with my own personal password, which was good for a limited time only.’  They were looking for sales prospects, and I didn’t want to become one, especially since I wasn’t interested in watching some NBA hall of famer on a how-to video telling me how easy it is to choose Emblem’s Medicare options.’  But acting like an average senior who had heard of Emblem Health might, I thought I better take a look at the Emblem plans for New York City. It turns out Emblem offers three HMOs and four PPOs.’  The penalty for being able to go out of network in a PPO is steep. They came with high out-of-pocket maximums’$2,500 for going out of network and $6,700 for staying in network, or a’  $10,000 combined maximum.’  Even though two had no monthly premiums, and two had premiums of less than $100, I didn’t go further with Emblem. While sales people push MA plans with low or no monthly premiums, the premium is not the only thing to consider.’  It’s the mix of policy elements that ultimately determine whether a plan is a good or bad deal.’  And then of course, there’s the unknown of your future health status to consider.’  You need to know how the combination of premiums, in- and out-of-network hospital copays, out-of-pocket limits, drug copays, coinsurance for chemotherapy drugs, and copays for doctor visits interact to determine what a plan will really cost.’  The trade-off for a no-premium plan may be hidden’and high’hospital copays, very high out-of-pocket limits, or the obligation to pay 20 percent of chemotherapy bills.’  It boils down to a game of ‘name your poison.’ I also looked for MA plan information on the Medicare.gov website but did not find it helpful.’  Both the handbook and website gave star ratings for MA plans but they seemed to measure different things, further confusing shoppers who might want to use them.’  The government handbook gave the United-AARP CompleteMosaic plan one star for Member Satisfaction.’  That might be important to know.’  At the same time the government website gave the same plan an overall rating of three stars.’  This certainly raised some questions for me about the usefulness of these stars as a shopping tool. Having done lots of homework, it was time to select a plan to cover Medicare’s gaps.’  Was I going to try one of those Medicare Advantage PPO plans that seemed to offer flexibility and let me keep the doctors that I like?
Source: cfah.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

What is a Medicare Advantage Plan?

Seniors looking for a Medicare Advantage plan have a lot of options to choose from. When you’re trying to decide, it’s best to have someone who knows what plans are available in your area and what they cover. Contact the experts at Benefit Packages, today, if you’re shopping for a Medicare advantage plan. We can help you sort out all of your options, such as Blue Cross, Blue Shield, Secure Horizons, and Scan. With our experience in the insurance field, we can help you select the best California Medicare coverage for your situation.
Source: benefitpackages.com

2013 Medicare Advantage Plan Enrollment

While the political pundits argue that privatized Medicare insurance doesn’t work, the numbers tell a different story.  With ObamaCare focused on Medicare quality over quantity metrics to drive down insurance and healthcare provider costs, the gap between Original Medicare costs and Advantage Plan costs is narrowing.  The gap will close further in 2014. That’s when Medicare Advantage insurance carriers are required to spend no less than 85 percent of their insurance premium revenue on direct healthcare benefits.
Source: medicarewire.com

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

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

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

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

Medicare Competitive Bid Coming soon….for better or for worse.

Section 302 of the Medicare Modernization Act of 2003 (MMA) established requirements for a new Competitive Bidding Program for certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS). Under the program, DMEPOS suppliers compete to become Medicare contract suppliers by submitting bids to furnish certain items in competitive bidding areas, and the Centers for Medicare & Medicaid Services (CMS) awards contracts to enough suppliers to meet beneficiary demand for the bid items. The new, lower payment amounts resulting from the competition replace the Medicare DMEPOS fee schedule amounts for the bid items in these areas. All contract suppliers must comply with Medicare enrollment rules, be licensed and accredited, and meet financial standards. The program sets more appropriate payment amounts for DMEPOS items while ensuring continued access to quality items and services, which will result in reduced beneficiary out-of-pocket expenses and savings to taxpayers and the Medicare program.
Source: timesunion.com

Bayonet Point Florida Medicare Advantage Plan Members eligible for Free Gym Membership

I am a mom of three teenage boys. Our family has struggled with multiple chronic health issues for many years. It was for this reason that I became interested in Xocai healthy chocolate. Our entire family eats healthy chocolate every day as a supplement and I am currently losing weight with the Xocai X-protein meal shake. I have struggled with Fibromyalgia for over 10 years. If you are struggling with your health, you owe it to yourself to check this out. This is the best way I have found to incorporate significant antioxidants into our diet. Feel free to email me if you have any questions. I look forward to hearing from you!
Source: healthchocoholic.com

Medicare Open Enrollment: More is better

Posted by:  :  Category: Medicare

Martin Place 1 by Greens MPsFor those choosing Original Medicare, the benefit package continues to grow stronger and provide greater value. For example, EVERYONE with Medicare has access to a variety of preventive services and screenings, most at no cost to them when furnished by qualified and participating health care professionals. This includes things like diabetes and cancer screenings, and a yearly “wellness” visit. During the first 9 months of this year, over 20 million people with Original Medicare received at least one preventive service at no cost.
Source: medicare.gov

Video: Medicare dental coverage Dallas

Can I get dental coverage from a Medigap policy?

Medigap does not pay for everything. It is meant to supplement Medicare, not replace it. Medicare pays the defined portion, and then your Medigap policy kicks in to pay for costs it covers. Unlike Medicare Advantage, Medigap is not part of your Medicare coverage, but is instead a supplemental policy which makes your existing Medicare coverage more useful and less expensive. Medigap has separate premiums that must be paid in addition to the premiums for your Medicare Part A and Part B insurance.
Source: usinsurancenet.com

Medicare Eligibility and Senior Health Care

Medicare Advantage popularly known as MA refers to a health insurance program which offers an eligible individual with the US Medicare benefits. MA differs from the previous Medicare model that offered a standard plan offered directly by the United States. In contrast, MA is program that is normally provided by private providers.
Source: eazyretirement.com

medicare fee schedule 2011: The cost of dental prämienverbilligung care can be high

since prophylactic cleaning, fluoride applications and oral x-rays, allowing you to take advantage of them for free. However, there are a lot of dental insurance providers in the market offering a wide variety of products. prämienverbilligung Which one should you choose? prämienverbilligung Before beginning to choose between dental insurance companies, first decide what kind of dental prämienverbilligung coverage insurance you need. The most typical types of dental insurance plans are Preferred Provider Organization prämienverbilligung (PPO) and Health Maintenance Organization (HMO) packages. prämienverbilligung In an Health Maintenance Organization plan, you may be asked to select a practitioner prämienverbilligung belonging to the HMO’s provider network, who provides you with primary dental and refer you to a professional if you need specialized treatment. A PPO plan allows you to visit virtually
Source: blogspot.com

What Medicare doesn’t cover

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Source: bankrate.com

In Pennsylvania, Medicaid Cuts Reduce Options For Dental Care

Medicaid, a program funded jointly by the federal government and the states, covers the the poor and disabled, and coverage varies by state.  Most states don’t pay for any dental care. Now, in Pennsylvania, Republican Gov. Tom Corbett has reduced Pennsylvania’s 2 million adult Medicaid patients to basic dental care – eliminating root canals, periodontal disease work and limiting the number of dentures a patient can receive. The plan now covers little more than cleanings, fillings — and extractions.
Source: kaiserhealthnews.org

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

The Medicare Sales Season Begins: As Always, Buyer Beware!

It happens every fall’sellers bombarding seniors with pitches for Medigap policies and Medicare Advantage plans’some legit and some not.’  Having watched this rite for years, I was intrigued by an envelope that arrived in the mail announcing on the front:’ ‘  ‘The U.S. Government has APPROVED new benefits not available in your current Medicare plan.”  Why, I am not even eligible for Medicare, let alone Medigap coverage.’  Presumably, that big, bold, enticing statement referred to the new preventive care benefits tucked into the health reform law passed last March. A letter inside began with this pitch in large, black letters: ‘Get free information about a new lower-cost health coverage option only for seniors’ and gave a number to call.’ ‘  Who doesn’t like something for nothing?’  I read on and learned that I was ‘eligible for several new health plans,’ some of which the letter said would save me money.’  The letter went on.’  An outfit called SafePath Benefits, or SBI, was ‘uniquely qualified’ to help me ‘understand and appraise these changes.” ‘  The letter said that SBI is not an insurance company.’  They are ‘Benefit Advisors who analyze health plans and recommend the ones that suit you best.”  Once a decision is made, advisers are available to answer questions and ‘provide solutions’ when ‘new options become available.”  Solutions?’  Sure sounded like they would be selling insurance.’  The envelope and letter were lead generators as they are called in the insurance biz’ways to snag sales prospects.’ ‘  The letter advised that there was no charge for the consultation service.’  That raised an immediate red flag.’  What business can afford to offer a completely free service without being paid by someone? The envelope also contained a small flyer noting that SafePath was ‘Your advocate in health care’ and an affiliate of a 100-year-old not-for-profit health services provider serving the five boroughs of New York City.’ ‘  But which provider?’  The flyer didn’t say.’  There was also a form to return indicating that I wanted a free consultation about my health care choices.’  It offered the phone number of a Benefits Advisor. When I called, a customer service rep explained that SBI was a benefits adviser for health plans.’  ‘We are not an insurance company,’ she said.’  ‘We do not touch your Medicare or Medicaid insurance.”  She said SBI had what she called ‘licensed advisers who explain any supplemental plans you may need.”  She mentioned prescription drug plans, dental, and eye glasses.’  ‘We just give advice to elders,’ she said and pointed out the free consultation, adding that advisers could meet me in a library or in an apartment building rec. room since people didn’t like strangers coming into their homes. ‘If you need a new plan, we’d refer you to Mutual of Omaha, AARP, Nationwide.’  It’s supplemental insurance,’ she said.’  At the end of our conversation she said they were a ‘sales agency licensed by the state.’ Wanting to know more, I checked with Google and found three sites that made it clear SafePath was recruiting sales people.’  One site said that ‘SafePath Benefits Inc. (SBI) is a newly formed wholly owned for-profit subsidiary of Metropolitan Jewish Health System.’  SBI is licensed in New York to provide accident, life and health insurance products to the senior market.”  Another site revealed that’  ‘SafePath Benefits Inc. is an insurance agency focused on the senior market in New York City.”  It also noted that the firm ‘has built a robust product portfolio’ and that there were immediate openings for Benefits Advisors/Producers.’  In insurance lingo, producers usually means sales agents. A third site gave a job description for a ‘Benefits Adviser.”  It said: ‘As a Benefits Advisor, you will present various lines of insurance from Medicare Supplements and Medicare Advantage, to life, disability, dental and more.’  SBI’s seasoned management team will work with you on strategies yielding high close ratios and high paying commissions.” ‘  In other words, they expect their advisers to sell.’  One requirement for the job was the ability ‘to conduct a consultative sale.’ Seniors can be forgiven if they don’t understand what’s going on.’  I don’t understand either.’  The bottom of the letter said:’ ‘  ‘SafePath Benefits, Inc. is a New York State licensed sales agency.”  But what are they licensed to sell?’  The letter didn’t say or disclose any license number so I phoned the New York State Department of Insurance, where officials told me they had issued no insurance license to SafePath Benefits, SBI, or Metropolitan Jewish Health System. Spokesman Andy Mais said the department had just checked the websites I looked at and ‘based on the websites they are soliciting for insurance in which case they should be licensed as an insurance agency.”  Said Mais:’  ‘We are opening an investigation as of today.’
Source: cfah.org

What is Medicare Supplemental Insurance Open Enrollment, And Why Is It Important For Me?

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSDuring open enrollment, your right to purchase a Medicare supplement policy is guaranteed, no matter your health condition or past medical history. Insurers cannot refuse to offer you a policy. You also cannot be asked to pay a higher premium because of insurance risks you may bring to the table. For example, a smoker will pay the same premiums as a non-smoker. There is no medical screening for applicants during the open enrollment.
Source: kurafire.net

Video: Medicare Supplement Insurance Plans – Where Do I Start?

Medicare and Medicare Supplemental Insurance

Medicare supplemental insurance is the easiest way to bridge the coverage gaps in traditional Medicare coverage.  The Medicare supplement plans will cover varying numbers and combinations of the nine gaps.  The most popular and expensive of the plans is plan F because it covers the all of the gaps, while plan A tends to be the least expensive because it only covers the minimum of four gaps.  Each plan has its merits but knowing which one to get can only be based off of your individual needs and budget. You can get a free quote of medicare supplement rates here.
Source: tablib.org

Medicare Supplemental Insurance Comparison Website Created by Senior Citizen Announces 25,000th Customer Helped

Medicare Supplemental Insurance Comparison (MSIC) announced today that they have successfully assisted their 25,000th customer. For anyone who has searched for Medicare supplemental insurance they know it can be a challenging process. The advent of the internet has certainly made the process easier, but only until recently clients still had to part with sensitive information such as their name, age and home address. Medicare Supplemental Insurance Comparison was created with the researcher’s privacy in mind, and is one of the first comparison websites of its kind to give insurance quotes while only requiring a zip code. “This is what allowed us to take our website to the next level,” said Steven Pewter, creator of the MSIC. “I’m a senior citizen myself and I wanted to create something that anyone could be comfortable using. The majority of our clients just aren’t OK with giving personal information up front. Our goal was to allow people to search for supplemental insurance anonymously, and I think our success with that has made us so popular.” “Hitting the 25,000th visitor helped is indeed a fine achievement,” said David Bartholomew, director of marketing. “We’ve found that as soon as anything ‘personal’ is requested people immediately click away. They just don’t want that, it feels completely invasive. With our site people can search all the most reputable Medicare supplemental insurance providers in their area and do so 100% anonymously. They can contact the companies on their own terms, and the fact that they get competing price quotes puts them in the place of power during negotiations.” MSIC also recently announced that they have added 250,000 companies to their database, all of them vetted according to reputation and years in business. To learn more, or to get a fast comparison of all the highest rated insurance companies in a specific area, please visit: http://medicaresupplementalinsurancecomparison.net/ About MSIC Medicaresupplementalinsurancecomparison.net (MSIC) was created in September of 2012 to help shoppers get the best rates for Medicare supplemental insurance. The website utilizes the absolute latest in price quote technology, and has already received rave reviews from the industry.
Source: sbwire.com

How To Know If You Need Medicare Supplemental Insurance

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

California Birthday Rule Medicare Supplement

Because of the “equal or lesser value” restriction in the California Birthday Rule for Medicare Supplements, it is often best for new enrollees to choose the highest level plan they can afford. You can always keep this plan for a year, and then downgrade later to save money if needed. However, if your health is adversely affected and you find you are using your supplemental insurance more and more, you’ll be glad you have access to the higher coverage plan.
Source: healthbrokerdave.com

Adding Medicare Supplement Insurance to Your Primary Medicare Coverage

Health Insurance can be a confusing mess if you don’t have someone who can help you sort through eligibility, policy differences and red tape. While you certainly don’t have to have an insurance agent and can sign up for insurance on your own, it can be very helpful to have someone break it down for you into easy terms. This can be especially true for Medicare Supplemental Insurance plans, simply because there are twelve different Medigap plans, and even those are different from state to state. Medicare simply doesn’t always cover all of your healthcare needs, however, and you may need additional coverage.
Source: medicaremedics.com

Do I Need A Medicare Supplemental Insurance Policy?

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

Part V: Medicare Supplemental Insurance

You can only obtain Medicare supplemental insurance, or Medigap, if you enroll in Traditional Medicare. While Medigap covers the out of pocket costs that arise under Medicare Parts A and B, it does not usually pay for any costs under Part C, Part D or private health insurance plans. Many private insurers offer Medicare supplemental insurance, and coverage comes in 10 different options: A, B, C, D, F, G, K, L, M and N. Some of these options do provide prescription drug coverage through Part D.
Source: wordpress.com

Protect your Family with Medicare Supplement Insurance

auto based benefit business car care claim commercial companies company cost cover coverage customer education entertainment financial group health home industry information insurance insurer law life management market million news & politics people percent policies policy premium program property rate risk service state strong video visit year
Source: your-shopname.com

Comparing Medicare Supplemental Insurance Benefits

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

Medicare Supplement Insurance › Medicare Supplement Insurance

So I decided to check into different types of Medicare insurance and how much they cost. I found that many insurance companies that offer regular insurance also offer the supplement plans. I also read testimonials from people who had Medicare supplement plans. Some people found them to help and others said they don’t help enough. After finding a plan that fit my budget I found that it did help cover some costs but there was still some left over that I still had to cover. I feel that some months when I have more bills the insurance is a lifesaver and other months when I don’t I feel as if I’m putting out more money than is necessary. I still have mixes emotions about the supplement plans and being that I have only invested in them for the past 3 years I will continue to purchase Medicare supplement insurance. The best advice I can give is to research the different plans, they are very similar but there is always the fine print that needs to be read and understood.
Source: savestvictors.org

Do You Need Medicare Supplemental Insurance?

One huge benefit of a Medicare supplemental insurance plan is that it will not be nearly as expensive as a traditional plan. After all, the supplemental insurance will not have to cover all of your bills. This reduces the risk by reducing the total amount of money that you will need. Even though you will feel like you are getting a high level of coverage, the insurance company will not feel the same pressure. For example, perhaps you have $10,000 worth of bills and Medicare will only pay for $8,000. The insurance plan merely has to pick up the extra $2,000. Therefore, you can pay as much as you would for low level coverage, but you will get a much better service.
Source: loneframe.com

Looking Into Different Aspects Of Medicare Supplemental Insurance

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

Nearly 600 WPS Health Insurance Jobs Could be Cut in Madison …

Posted by:  :  Category: Medicare

About WPS Health Insurance Founded in 1946, WPS is Wisconsin?s leading not-for-profit health insurer, offering affordable individual health insurance, family health insurance, high-deductible health insurance, and short-term health plans, as well as flexible and affordable group plans and cost-effective benefit plan administration for businesses. The WPS Medicare division administers Part A and B benefits for millions of seniors in multiple states, and the WPS TRICARE division serves millions more members of the U.S. military and their families. In 2012, the international Ethisphere? Institute named WPS one of the World?s Most Ethical Companies for the third straight year. WPS is the only health insurance company to earn this distinction multiple times. For more information about WPS Health Insurance, visit www.wpsic.com.
Source: typepad.com

Video: WPS Medicare

Important Medicare Updates

Providers who are currently participating and choose not to participate in CY 2013 must write to each Medicare contractor, to which they submit claims, advising of the termination of their participation agreement effective January 1, 2013. This written notice must be postmarked prior to January 1, 2013.
Source: wordpress.com

Flash of Genius: Medical Matters: URGENT: WPS J8 MAC Medicare change starts at 2:00 Thursday 7/12/2012

. WPS officially starts payor id 08202 on Monday July 16, however they have announced “Dark Days” of Friday July 13 through Tuesday July 17. A dark day is a business day during the cut-over period when the Medicare claims processing system is not available for normal business operations. System dark days may occur between the time the outgoing claims administration contractor ends its regular claims processing activities and the incoming claims administrative contractor begins its first day of normal business operations. Genius is not certain what would happen if you sent Medicare claims with the new payor id between 2:01pm Thursday through 12:00am Monday.It is possible that BCBSM or WPS might hold them until they finish their dark days and process them normally, but we do not have any confirmation from BCBSM or WPS that this actually will happen. Therefore Genius recommends you do all of your Medicare billing before 2pm on Thursday July 12.Then do no Medicare billing until July 16 or later.On July 16 go to your Insurance Code Files and change payor id 00953 to 08202. Don’t change anything else and don’t change it before July 16. Click here for step-by-step instructions for changing the payor id in THOMAS. After you have changed your payor id on July 16 or later you should be able to resume sending your Medicare claims.
Source: blogspot.com

AOA, state affiliates pressure Medicare contractor to withdraw restrictive policy

After building support on Capitol Hill, AOA and affiliates then met with top Center for Medicare and Medicaid Services (CMS) officials at the agency’s headquarters in Washington, D.C. At the meeting, AOA and affiliates expressed concern that WPS has, as a matter of policy, substituted its own opinion about what constitutes the appropriate scope of practice of an optometrist, rather than deferring to interpretations of state scope of practice law by appropriate state authorities, such as legislatures, courts, and optometry boards.
Source: newsfromaoa.org

WPS Health Insurance, a Leading Provider of Individual Health Insurance, Begins American Heart Month with Go Red for Women

About WPS Health Insurance Founded in 1946, WPS is Wisconsin’s leading not-for-profit health insurer, offering affordable individual health insurance, family health insurance, high-deductible health insurance, and short-term health plans, as well as flexible and affordable group plans and cost-effective benefit plan administration for businesses. The WPS Medicare division administers Part A and B benefits for millions of seniors in multiple states, and the WPS TRICARE division serves millions more members of the U.S. military and their families. In 2012, the international Ethisphere® Institute named WPS one of the World’s Most Ethical Companies for the third straight year. WPS is the only health insurance company to earn this distinction multiple times. For more information about WPS Health Insurance, visit http://www.wpsic.com.
Source: rawhealthfacts.com

WPS Health Insurance, Wisconsins Largest Not

Founded in 1946, WPS is Wisconsin?s heading not-for-profit health insurer, charity affordable particular health insurance, family health insurance, high-deductible health plans, and short-term health insurance, as good as stretchable and affordable organisation skeleton and cost-effective advantage devise administration for businesses. In addition, a WPS Medicare multiplication administers Part A and B advantages for millions of seniors in mixed states, and a WPS TRICARE multiplication serves millions some-more members of a U.S. troops and their families. In 2010 and 2011, WPS was famous by a general Ethisphere? Institute as one of a World?s Most Ethical Companies, and is a usually health word association to acquire this distinction. For some-more information about WPS Health Insurance, revisit http://www.wpsic.com.
Source: typepad.com

CMS clarifies 2013 Therapy Caps and Manual Medical Review Impacts from Fiscial Cliff Legistation

Section 603 – Extension Related to Payments for Medicare Outpatient Therapy Services -Section 603 extends the exceptions process for outpatient therapy caps through December 31, 2013. Providers of outpatient therapy services are required to submit the KX modifier on their therapy claims, when an exception to the cap is requested for medically necessary services furnished through December 31, 2013. In addition, the new law extends the application of the cap and threshold to therapy services furnished in a hospital outpatient department (OPD), and counts outpatient therapy services furnished in a Critical Access Hospital towards the cap and threshold.Additional information about the exception process for therapy services may be found in the Medicare Claims Processing Manual, Pub.100-04, Chapter 5, Section 10.3:http://www.cms.gov/manuals/dow
Source: mediserve.com

The Medicare Sales Season Begins: As Always, Buyer Beware!

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 marsmet524It happens every fall’sellers bombarding seniors with pitches for Medigap policies and Medicare Advantage plans’some legit and some not.’  Having watched this rite for years, I was intrigued by an envelope that arrived in the mail announcing on the front:’ ‘  ‘The U.S. Government has APPROVED new benefits not available in your current Medicare plan.”  Why, I am not even eligible for Medicare, let alone Medigap coverage.’  Presumably, that big, bold, enticing statement referred to the new preventive care benefits tucked into the health reform law passed last March. A letter inside began with this pitch in large, black letters: ‘Get free information about a new lower-cost health coverage option only for seniors’ and gave a number to call.’ ‘  Who doesn’t like something for nothing?’  I read on and learned that I was ‘eligible for several new health plans,’ some of which the letter said would save me money.’  The letter went on.’  An outfit called SafePath Benefits, or SBI, was ‘uniquely qualified’ to help me ‘understand and appraise these changes.” ‘  The letter said that SBI is not an insurance company.’  They are ‘Benefit Advisors who analyze health plans and recommend the ones that suit you best.”  Once a decision is made, advisers are available to answer questions and ‘provide solutions’ when ‘new options become available.”  Solutions?’  Sure sounded like they would be selling insurance.’  The envelope and letter were lead generators as they are called in the insurance biz’ways to snag sales prospects.’ ‘  The letter advised that there was no charge for the consultation service.’  That raised an immediate red flag.’  What business can afford to offer a completely free service without being paid by someone? The envelope also contained a small flyer noting that SafePath was ‘Your advocate in health care’ and an affiliate of a 100-year-old not-for-profit health services provider serving the five boroughs of New York City.’ ‘  But which provider?’  The flyer didn’t say.’  There was also a form to return indicating that I wanted a free consultation about my health care choices.’  It offered the phone number of a Benefits Advisor. When I called, a customer service rep explained that SBI was a benefits adviser for health plans.’  ‘We are not an insurance company,’ she said.’  ‘We do not touch your Medicare or Medicaid insurance.”  She said SBI had what she called ‘licensed advisers who explain any supplemental plans you may need.”  She mentioned prescription drug plans, dental, and eye glasses.’  ‘We just give advice to elders,’ she said and pointed out the free consultation, adding that advisers could meet me in a library or in an apartment building rec. room since people didn’t like strangers coming into their homes. ‘If you need a new plan, we’d refer you to Mutual of Omaha, AARP, Nationwide.’  It’s supplemental insurance,’ she said.’  At the end of our conversation she said they were a ‘sales agency licensed by the state.’ Wanting to know more, I checked with Google and found three sites that made it clear SafePath was recruiting sales people.’  One site said that ‘SafePath Benefits Inc. (SBI) is a newly formed wholly owned for-profit subsidiary of Metropolitan Jewish Health System.’  SBI is licensed in New York to provide accident, life and health insurance products to the senior market.”  Another site revealed that’  ‘SafePath Benefits Inc. is an insurance agency focused on the senior market in New York City.”  It also noted that the firm ‘has built a robust product portfolio’ and that there were immediate openings for Benefits Advisors/Producers.’  In insurance lingo, producers usually means sales agents. A third site gave a job description for a ‘Benefits Adviser.”  It said: ‘As a Benefits Advisor, you will present various lines of insurance from Medicare Supplements and Medicare Advantage, to life, disability, dental and more.’  SBI’s seasoned management team will work with you on strategies yielding high close ratios and high paying commissions.” ‘  In other words, they expect their advisers to sell.’  One requirement for the job was the ability ‘to conduct a consultative sale.’ Seniors can be forgiven if they don’t understand what’s going on.’  I don’t understand either.’  The bottom of the letter said:’ ‘  ‘SafePath Benefits, Inc. is a New York State licensed sales agency.”  But what are they licensed to sell?’  The letter didn’t say or disclose any license number so I phoned the New York State Department of Insurance, where officials told me they had issued no insurance license to SafePath Benefits, SBI, or Metropolitan Jewish Health System. Spokesman Andy Mais said the department had just checked the websites I looked at and ‘based on the websites they are soliciting for insurance in which case they should be licensed as an insurance agency.”  Said Mais:’  ‘We are opening an investigation as of today.’
Source: cfah.org

Video: Medicare Covered Power Chair – Do You Qualify? – Toll Free Phone Hotline

Medicare: why no app for that?

The second prong of my being emotionally wounded that day was looking down at the change in my hand, as I walked away. I realized that my dignity had suffered a severe hit and that the extra change only amounted to roughly 30 cents.  Should I insist on paying the standard price or simply put the extra change in my pocket and walk away gracefully?  At the end of this exercise, I realized I discovered that my dignity was only worth 30 cents. I pocketed the extra change and have been enjoying rather nice senior coffee for cheap ever since. I have never been carded over it. I guess the cute young girl was right.
Source: appledailyreport.com

Jon Chait’s Miserable Endorsement of Raising the Medicare Eligibility Age

What’s more, raising the Medicare retirement age would help strengthen the fight to preserve the Affordable Care Act […] The political basis for the right’s opposition to universal health insurance has always been that the uninsured are politically disorganized and weak. But a side effect of raising the Medicare retirement age would be that a large cohort of 65- and 66-year-olds would suddenly find themselves needing the Affordable Care Act to buy their health insurance. Which is to say, Republicans attacking the Affordable Care Act would no longer be attacking the usual band of very poor or desperate people they can afford to ignore but a significant chunk of middle-class voters who have grown accustomed to the assumption that they will be able to afford health care. Strengthening the political coalition for universal coverage seems like a helpful side benefit — possibly even one conservatives come to regret, and liberals, to feel relief they accepted.
Source: firedoglake.com

Phone scam targets Medicare users

Consumers have reported a cold caller tells them to expect a new Medicare card in January. But before getting the new card, you have to verify your social security number or supply a bank account number.
Source: wmbfnews.com

Medicare Billing Housekeeping during the Holidays

The holiday season is coming with food, fun and family time ahead. However, billing must continue and claims must be sent as part of supporting the overall health of home health organizations.  The general decrease in workload due to lighter patient loads and absences from the office provides a little extra time to catch up on “housekeeping.”  Now is a good time to review old claims that have not been sent and adjustments that have not been completed or any other claim problems that have not been resolved. Clearing these problems up as well as continuing with current billing are enough to keep one busy, and keep everything current. Keep in mind to review claims for timely filing deadlines and get those claims completed and sent. The timely filing deadline for all claims is one year from the end of episode date for each claim.
Source: axxessweb.com

Beware of Medicare Fraud Calls

These calls are completely fraudulent. Medicare will NEVER ask for a beneficiary’s Medicare number unless the beneficiary initiates the call, and they will NEVER ask for a bank account number under any circumstances. The only beneficiaries that need to get new Medicare cards are those who are first applying for Medicare coverage, or those who have asked for a new card because their card is lost or damaged.
Source: mauryriversc.org

Connecticut BBB Issues Alert about ID Theft Scams Related to Medicare and Medical Insurance

The crime takes many forms. Identity thieves may rent an apartment, obtain a credit card, or establish a telephone account in your name. You may not find out about the theft until you review your credit report or a credit card statement and notice charges you didn’t make—or until you’re contacted by a debt collector. Identity theft is serious. While some identity theft victims can resolve their problems quickly, others spend hundreds of dollars and many days repairing damage to their good name and credit record. Protect yourself. Keep your personal information safe. Don’t give your information out over the Internet, or to anyone who comes to your home (or calls you) uninvited. Give personal information only to doctors or other Medicare approved providers. Quick Tips: Has anyone approached you in a public area and offered FREE services, groceries, or other items in exchange for your Medicare number? Just walk away!
Source: patch.com

Medicare phone scam targets elderly South Carolinians

WMBF reports that the phone calls are coming from 409-579-1214 and entice the recipient with a new card coming in January and free medical supplies. You can read the full article and get tips for keeping your or your loved one’s personal information safe.
Source: thedigitel.com

Contacting Railroad Medicare when a beneficiary dies

Posted by:  :  Category: Medicare

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

Video: GBMC Primary Care – Debbie Jones, CRNP

Medical Billing Fundamentals: Railroad Medicare OPS

We can use this service if your provider had Electronic Data Interchange (EDI) agreement with Palmetto GBA. If we are submitting claims electronically for a provider then no need to submit the new EDI agreement. For providers we are submitting their claims through paper those need to complete the EDI agreement with Palmetto GBA to use this service.
Source: blogspot.com

Secret 101 to Medicare: Railroad Medicare

If you are wondering about the traditional Medicare program and Railroad Medicare insurance program, then you may be asking what the difference between the two is. You might even ask about what’s special about Railroad coverage where the people enrolled in this kind of health insurance preferred it rather than going with the traditional Medicare.
Source: blogspot.com

Comments on proposed IRS regulations on additional Medicare tax due March 5

With regard to specific matters discussed in the proposed regulations, taxpayers may rely on the proposed regulations for tax periods beginning before the date that the final regulations are published in the Federal Register. If any requirements change in the final regulations, taxpayers will only be responsible for complying with the new requirements from the date of their publication. ■
Source: cbia.com

Audit Proof Income: New Fax Service for RailRoad Medicare to Submit Documentation

Palmetto GBA Railroad Medicare now offers the availability of a fax service for electronic submitters to submit additional documentation with the claim. Certain services require a fax be submitted as acceptable documentation.
Source: blogspot.com

Are Medicare And The Railroad Retirement Act Related?

The Medicare tax gets deducted from all employees’ paychecks or is paid directly to the federal government by self-employed people. Railroad employees paid an additional tax that covers survivors’ benefits, retirement benefits, and unemployment compensation. The benefits amount for people who qualified for the programs offered through the Railroad Retirement board currently averages at about $800.
Source: seniorcorps.org

PHYLLIS CARTER’S JOURNAL: WHAT IS CANADA BUT THE RAILROAD, MEDICARE AND THE CBC ?

See, it doesn’t matter if CBC’s funding is cut by 5 per cent or 10 per cent today. The CBC must take a hit because CBC represents the Canada that is “a northern European welfare state in the worst sense of the term,” as OGL famously described Canada in a 1997 speech. Fifteen years later, a reduced CBC will be presented, like a head on a bayonet, another small but viciously achieved victory in the war against all that northern-European-welfare-state stuff. More important, there will be cheering among government supporters, those braying for the crushing of the CBC for years. The braying mob will get what it wants.
Source: blogspot.com

Medicare Compliance & the Railroad Industry

As of January 1, 2010, there will be new rules pertaining to Medicare compliance.  In this edition of Ringler Radio, host Larry Cohen welcomes Attorney Benjamin M. Basista from the law firm of Burns, White & Hickton, to look at the new rules regarding Medicare compliance and how they relate to the railroad industry. Larry and Ben will explore the Medicare reporting process, the issue of medical liens and how it all relates to the railroad industry.
Source: legaltalknetwork.com

Utah Governor Discusses Health Policy Reform

Posted by:  :  Category: Medicare

OBAMA: THE SOCIALIST/MARXIST/COMMUNIST -- UNMASKED FOR ALL TO SEE by SS&SSLast December, the state of Utah asked the federal government to allow Utah to maintain control of a health insurance exchange for small businesses while releasing control of the individual consumer market to Washington, but that hasn’t been fully resolved. 
Source: c-span.org

Video: About Medicare Supplement Plans Utah

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

Boston 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

Utah works on ACO tenets in Medicaid overhaul

The Utah Medicaid reform proposal says that the state now wants to improve Medicaid by adding more ACOs while tweaking the model to “implement payment reforms and more appropriately aligns financial incentives in the health care system.” As part of the Medicaid overhaul, the Central Utah Clinic and the proposed ACOs will handle 70 percent of Utahn Medicaid patients and, according to the Salt Lake Tribune, will have the goal of saving $770 million in tax payer money over seven years. But this process is in a state of flux at the moment as both the Utah Health Policy Project (UHPP) and Utah Medicaid Inspector General agree that Utah needs to thoroughly examine how it defines accountable care while keeping the patients in mind.  The UHPP is 501-C-3 nonprofit organization that is trying to work with both insurance payers and healthcare providers to offer quality, affordable healthcare.
Source: ehrintelligence.com

Another Breach for Utah DOH

“There were no Social Security numbers or financial information included in the data, so we believe the potential risk for identity theft is minimal.  Further, we have no reason to believe the data were targeted by anyone to be used for malicious purposes,” UDOH Deputy Director and state Medicaid Director Michael Hales, said in a statement.  “Nevertheless, we understand the anxiety this will likely cause, and want clients to know we are taking all reasonable precautions to ensure the missing data cannot be used to harm individual clients or defraud the Medicaid program.”
Source: healthcare-informatics.com

Medicare and the Meaningless Market Mantra

Ideas that boost market competition are the same ideas that have been recycled repeatedly for many years. There is one major problem with them. They always end up increasing cost by decreasing quality and efficiency. IT IS TIME TO STOP THE AMERICAN HEALTH CARE BUSINESS AS USUAL NONSENSE. Health care is not a commodity and market forces do not shape health care delivery for the better. The pretense of market forces is the cover for the extraction of windfall profits from the American taxpayer/patient.
Source: utahhealthcareinitiative.com

DAR File No. 37122 (Section R414

Section R414-1-5 is changed to update the incorporation of the State Plan by reference to 01/01/2013 which includes any approved State Plan Amendments (SPAs). SPAs that became effective during the fourth quarter of Calendar Year 2012 include SPA 12-011-UT, Nursing Facility Evacuation Payments, which adds wording to define how payments to facilities will be administered and what payment limits will be in place during a time of a declared disaster; SPA 12-013-UT, Reimbursement for Optometry Services, which clarifies reimbursement methodology and changes the effective date of rates for optometry from 07/01/2007, to 07/01/2012; SPA 12-014-UT, Reimbursement for Speech Pathology Services, which clarifies reimbursement methodology and changes the effective date of rates for speech pathology from 11/01/2008 to 07/01/2012; SPA 12-015-UT, Reimbursement for Audiology Services, which clarifies reimbursement methodology and changes the effective date of rates for audiology from 11/01/2008, to 07/01/2012; SPA 12-016-UT, Reimbursement for Chiropractic Services, which clarifies reimbursement methodology and changes the effective date of rates for chiropractic services from 11/01/2008, to 07/01/2012; SPA 12-017-UT, Reimbursement for Eyeglasses Services, which clarifies reimbursement methodology and changes the effective date of rates for eyeglasses from 07/01/2007 to 07/01/2012; SPA 12-018-UT, Reimbursement for Clinic Services, which clarifies reimbursement methodology and changes the effective date of rates for clinic services from 05/25/2010 to 07/01/2012. This SPA also clarifies services and limitations in freestanding birth centers; SPA 12-019-UT, Reimbursement for Physical and Occupational Therapy, which changes the effective date of rates for physical therapy and occupational therapy from 07/01/2009 to 07/01/2012; and SPA 12-020-UT, Reimbursement for Rehabilitative Mental Health Services, which clarifies reimbursement methodology and changes the effective date of rates for rehabilitative mental health services from 01/01/2002 to 07/01/2012. This rule change also incorporates by reference the Medical Supplies Manual and List and the hospital services provider manual, effective 01/01/2013; incorporates by reference both the definitions and the attachment for the Private Duty Nursing Acuity Grid found in the Home Health Agencies Provider Manual, effective 01/01/2013; incorporates by reference the Speech-Language Services Provider Manual, effective 01/01/2013; incorporates by reference the Audiology Services Provider Manual, effective 01/01/2013; incorporates by reference the Hospice Care Provider Manual, effective 01/01/2013; incorporates by reference the Long Term Care Services in Nursing Facilities Provider Manual, with its attachments, effective 01/01/2013; incorporates by reference the Utah Home and Community-Based Waiver Services for Individuals 65 or Older Provider Manual, effective 01/01/2013; incorporates by reference the Personal Care Provider Manual, with its attachments, effective 01/01/2013; incorporates by reference the Utah Home and Community-Based Waiver Services for Individuals with Acquired Brain Injury Age 18 and Older Provider Manual, effective 01/01/2013; incorporates by reference the Utah Home and Community-Based Waiver Services for Individuals with Intellectual Disabilities or Other Related Conditions Provider Manual, effective 01/01/2013; incorporates by reference the Utah Home and Community-Based Waiver Services for Individuals with Physical Disabilities Provider Manual, effective 01/01/2013; incorporates by reference the Utah Home and Community-Based Waiver Services New Choices Waiver Provider Manual, effective 01/01/2013; incorporates by reference the Utah Home and Community-Based Waiver Services for Technology Dependent, Medically Fragile Individuals Provider Manual, effective 01/01/2013; the Office of Inspector General Administrative Hearings Procedures Manual, effective 01/01/2013; the Pharmacy Services Provider Manual with its attachments, effective 01/01/2013; and the Coverage and Reimbursement Code Look-up Tool, effective 01/01/2013.
Source: utah.gov

DAR File No. 37174 (Rule R414

(b) Eligibility for coverage of home and community-based services under a Medicaid waiver cannot begin before the first day of the month the client is determined by the case management agency to meet the level of care criteria and home and community-based services are scheduled to begin within the month. The case management agency must verify that the individual meets the level of care criteria for waiver services. Medicaid eligibility for waiver services does not begin earlier than the first day of the month that is three months before the month of application for Medicaid coverage of waiver services.
Source: utah.gov