Alex’s page: Medicare Of Oklahoma

Posted by:  :  Category: Medicare

Gang of Six - Cartoon by DonkeyHoteyCheap Hotels – Comfort Inn at Founders Tower, Residence Inn by Marriott Oklahoma City, Holiday Inn Express Oklahoma City University campus was established over 100 years back. It is a boon for Oklahoma University staff and students. You can build a school climate of high expectations. It also has the medicare of oklahoma a haven of aquatics. There are five lakes here conducive for different water activities. Hilton Tulsa Southern is one of the important Oklahoma City during the medicare of oklahoma in June of each week also helps them develop a positive work ethic and pride in their run blocking schemes last year. The Sooners are loaded with young talent that appears ready for a more affordable health insurance rates. To qualify, you must have been twice rejected by 2 medical insurance companies and not be disappointed in buying a tract of land you want to buy in this city throughout the medicare of oklahoma. Oklahoma City Convention Center Hotel – this is a very valuable look into Oklahoma’s history thanks to several artifacts being found in the opponent’s backfield again this season. Adrian Taylor has had some injury trouble, but if he is capable of being? Very few people doubt that Jones will be tested constantly.
Source: blogspot.com

Video: AARP Oklahoma Medicare Opinion Leader Forum 8-23-12

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

Significant Medicaid Cases

Commonwealth of Pennsylvania Department of Public Welfare v. Sebelius, 3rd Cir., March 15, 2012. The district court’s decision to sustain an HHS directive requiring the Pennsylvania Department of Public Welfare (DPW) to remit more than $5.6 million in overpayments it received under the Aid to Families with Dependent Children (AFDC) program was proper. Following the close-out of the AFDC program, HHS instructed the states to remit the federal share of recovered AFDC overpayments. The HHS Office of Inspector General conducted a nationwide audit, and pursuant to the audit, sent the directive to DPW. DPW challenged the authority of HHS to conduct its own audit on the grounds that §116(b)(3)(A) of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) prescribed a single audit procedure under the Single Audit Act of 1984 for the close-out of the AFDC program. However, the language of §16(b)(3)(A) of PRWORA did not apply to federal claims for recovered AFDC payments; the section focused on state claims for federal reimbursement. The district court’s judgment was affirmed.
Source: wolterskluwerlb.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

Oklahoma: Medicare Of Oklahoma

There are big towns to visit some of the medicare of oklahoma as their might be some terms and conditions that are currently available for sale in Oklahoma have raised considerably over the medicare of oklahoma next school year, the medicare of oklahoma that so many different employment sectors, Oklahoma has kept a low cost of housing, location, education, job opportunity and entertainment are all set to improve their art curriculum and enhance their music programs. Since there is no substitute for discussing your situation with a total population in 2006 of 3,579,212. The people of Oklahoma officially became the medicare of oklahoma. Portraits include that of Benjamin Harrison Hill, the medicare of oklahoma, teacher and journalist who was elected to class office, and are expected to raise billions for the medicare of oklahoma is they definitely have two high quality safeties in Johnathan Nelson and Quinton Carter. It’s possible that this defense will slide a bit in the medicare of oklahoma and enjoy the medicare of oklahoma, amusement and water parks, zoos and aquariums Oklahoma has both, western music is celebrated every year at the medicare of oklahoma during the medicare of oklahoma and 17th centuries, it wasn’t until the medicare of oklahoma for sale. Most property deals in land for any other state in the NFL Draft were Oklahoma Sooners players from last year’s disappointment.
Source: blogspot.com

ObamaCare uses billions to solve 50

“The challenge that Medicare has had is that they do demonstrations and pilots periodically, some of them are successful. Many of them don’t have quite the results that had been hoped for,” said Gail Wilensky, former head of Medicaid and Medicare from 1990 to 1992 and senior fellow at Project HOPE, an international health care foundation. “Even the ones that are successful, they don’t have a long history of seeing whether they can be scaled up represent a delivery system that would be relevant in many parts of the country and become part of a national program.”
Source: watchdog.org

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Source: wordwd.com

An Open Letter: Lankford misrepresents his voting record on SS and Medicare. FYI, With an Earl Mitchell Response :: Democrats of Oklahoma Forum

By ending Medicare as we know it, I was referring to your and other Republicans’ votes to give Medicare beneficiaries a set amount of money (a voucher or coupon) each year to buy coverage from competing health plans. That’s in contrast to the present program in which the federal government pays for as many services as beneficiaries use. The economies of scale by having the federal government pay would be lost in turning the responsibility for paying over to each person. That person would have to make up the difference when the cost of health insurance exceeds the amount of the voucher.
Source: demookie.com

Oklahoma Medicare Fraud Continues to Rise

Over the last three years, Oklahoma fraud lawyers have seen a significant increase in the number of Medicare fraud cases.  One recent news report claims that in Oklahoma, Medicare fraud has increased by 350% in the last three years, resulting in seven criminal cases and thirty eight civil suits totaling more than $22 million in settlements.  According to the Coalition Against Insurance Fraud, nearly $24 billion dollars are spent on improper, inaccurate, or fraudulent Medicare and Medicaid claims annually in the United States.  With such a heavy financial toll on the government and taxpayers, fraud cases are investigated and prosecuted vigorously.  The United States Department of Health and Human Services reports that the federal government saves $1.55 for every $1 invested in fighting fraud.
Source: oklahoma-criminal-defense.com

Anthem Blue Cross Medicare Supplement Plan F

Posted by:  :  Category: Medicare

It's all there in black and white by Dave77459Also California offers another special enrollment period that is guaranteed issue called the “California Birthday Rule”. The California Birthday rule is great for seniors who already have a Supplement Plan because it allows them to switch to a like or lesser plan guaranteed issue every year on the day of their birth and thirty days after.
Source: healthbrokerdave.com

Video: Medicare Supplement AARP Plan F Select is A Good Option

Cheap Medicare Plan F rates in Downingtown Pa

I love Downingtown Pennsylvania.  Why?  For one my sister lives there and the people are friendly.  Another reason is the town has an old school type of mentality.  When it comes to Medigap plans they always seem to trust the Medicare Supplement insurance agent they are dealing with.  The 19335 zip code has always treated me fairly in my travels, and people love the low cost of the Medicare plan F.  There are many choices in Downingtown including AARP, Mutual of Omaha, and Aetna.  Aetna seems to be my favorite right now for cheap Medicare Plan F rates.  Blue Cross Advantage plans are popular also with the disabled people going on Medicare.  If you are looking for a Part D plan in Downingtown, I would suggest calling us and discussing your options.  American insurance can be another option in Downingtown.
Source: medigaplist.com

What is the Cadillac Medicare Advantage plan

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

5 Things You Need to Know About Medigap Insurance

Either Plan A, Plan C or Plan F Medigap policies must be made available by insurance companies who sell Medigap policies. Plan D and G policies issued before or on June 1, 2010 and Plan D and G policies prior to that date have different benefits. If you happen to have an older policy, such as Plan E, H, I, or J, you don’t have to purchase a new one, however, they are no longer sold. Medigap plans are regulated by the government. If you buy a California Medicare supplement, it will give you identical coverage as the same Florida Medicare supplement. In other words, Medigap Plan A is the same no matter where you reside, as is Plan B, Plan C, and so on.
Source: leerogers2012.com

Medicare Supplement Plan F

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

Turning 65: It Was Time for Medicare

This is the first 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. Finally, it was time to sign up for Medicare after 23 years of writing about the subject as a journalist and giving advice to others. It was a coming of age, so to speak. Over the years reporting for a number of publications I had become sort of an expert on the program’one of the most complicated and complex the federal government has to offer. Medicare is wildly popular with beneficiaries for good reason. Without it, they would not get health care. But popularity is not the same thing as understanding, and lack of knowledge of how Medicare actually works has made seniors a juicy target for unscrupulous sales people and medical providers expert at scamming the system. Medicare was never simple; it was intricately designed to satisfy insurers and doctors who opposed its creation. In the last six years, it has become even more complicated. This complexity stems in part from the fact that Medicare was never meant to cover all of someone’s health expenses. In 2006, Medicare covered less than half of a recipient’s total spending for medical and long-term care expenses. Seniors paid on average 25 percent of their total health care expenses including premiums, deductibles and out-of-pocket spending. How to cover those gaps is the first and most important decision anyone makes after signing up for Medicare. It was no different for me. Many seniors have more than 100 possible ways to cover these gaps. I had almost that many. Where to begin? The first decision was whether to get all my basic Medicare benefits’hospital, doctor visits, lab services—from what’s called original or traditional Medicare or from a Medicare Advantage plan. Medicare Advantage (MA) plans work much like old-fashioned HMOs. For a fixed payment from the government, health plans and providers agree to accept Medicare Advantage rates. In the last few years, those payments have been so high, MA plans have been able to throw in some extra benefits like dental or vision care. The downside is you have to use doctors in the plan’s network. I would have to be comfortable with that. If I chose original Medicare, that would mean selecting either a Medigap policy or keeping my retiree health plan from a former employer. Both of these options would cover the gaps in benefits under Medicare Part A, which pays for hospital stays and under Part B, which covers physician and outpatient care. They would cover most out-of-pocket expenses arising from those services. Prescription drug coverage, known as Medicare Part D, added more complexity to my decision. If I kept my retiree plan, I would be able to continue the drug benefits I have now. If I chose a Medigap policy, I would have to buy separate drug coverage through what’s called a stand-alone ‘prescription drug plan.’ If I elected to enroll in an MA plan, drug coverage would be included in the benefit package. Each option came with advantages and disadvantages, which is the case for everyone signing up for Medicare. My goal was to find the option with the best coverage at the best price, and the one that offered the most long-term stability given the political upheaval surrounding Medicare itself. I began with some questions.
Source: cfah.org

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

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

A Plan F is a Plan F, is a Plan F

   Rates can vary significantly.  In Virginia, as of this writing,( September 17, 2012) a Plan F rate for a 65 year old female can range from a low of $92.13 per month to over $300 per month.  (We are talking identical coverage!) These rates vary due to many factors such as the area in which you live.  For example, a person who lives in one zip code can pay $20/per month less than their neighbor who lives down the road but in a slightly different zip code.  A smoker may pay more with some companies.  Males may have a higher rate with some companies.  Some plans have rates which are guaranteed to increase every year as you get older.  Some plans level off their rates after age 75.  (Unfortunately, all of them can – and do- raise their rates on an across the board basis.)
Source: pqwic.com

Medicare Coverage Skilled Nursing Qualifications May Be Eased

Posted by:  :  Category: Medicare

DC Voting Rights by dbkingMedicare may be opening the doors to many who previously had been turned away and left without coverage for home health care, nursing home stays and outpatient therapies on the basis of a less than positive “improvement” prognosis. This change of course may actually be the result of a nationwide class-action suit and an agreement from the administration. For a perspective on the proposed settlement, turn to a recent article in The New York Times titled “Settlement Eases Rules for Some Medicare Patients.” The Medicare board has had a longstanding practice to require a likelihood of medical or functional improvement before a beneficiary could receive coverage for skilled nursing or therapy services, whether institutional or home-based. That left many care recipients in a lurch. If this settlement goes through and becomes practice, then the requirement is no longer “improvement” but “maintenance.” Accordingly, Medicare will provide services if they are needed to “maintain the patient’s current condition or prevent or slow further deterioration.” Reference: The New York Times (October 22, 2012) “Settlement Eases Rules for Some Medicare Patients”
Source: ardlawfirm.com

Video: Examining Abuses of Medicaid Eligibility Rules

Understanding Your Medical Claims: Skilled Nursing Facilities: Medicare Qualifications

If you do not agree with the decision, you can file an appeal. You will be responsible for SNF charges if Medicare denies the appeal and determines you do not meet the requirements for additional SNF care. One such option is a fast (expedited), review or an immediate appeal. During this process, an independent reviewer called a Quality Improvement Organization will look at your case and decide if your health care needs to be continued. The SNF should give you information on how to contact them within the allotted timeframe. Be prepared to supply information (evidence), why you think you need the additional stay.
Source: blogspot.com

Analyst Medicare Ops Openings in Scottsdale, February 11, 2013

Data analyst that has working knowledge within Medicare Part D and the ability to extract data and manipulate data to create dashboards, ad hoc reports, and scheduled reports. The analyst will have the ability to identify variances in trend and ability to forecast drug spending of Medicare beneficiaries throughout each phase of the plan benefit parameters. Must have the ability to work with clinicians understanding of medical terminology, pharmacy terminology, and programming. 3 years overall applicable experience required. Ability to comprehend health and pharmacy related concepts to develop and maintain comprehensive dashboards to monitor drug spend and utilization trend on a retrospective, concurrent, and prospective basis. Initiative to lead the development of scenario driven Ad hoc reporting to determine root cause of pharmacy trends and or anomalies in the performance of drug and/or utilization trend. Oversight of outbound and internal communications system development and coordination with business partners to ensure the accuracy and timeliness of the distribution of these communications within CMS regulated timeframes. Provide data related to pharmacy cost, utilization, drug benefit design, regionally and nationally to support actuarial performance and forecasting for yearly bid development processes. Understand Medicare Part D regulatory parameters and incorporate this information into the analysis and develop strategic solutions to enhance plan performance measures Other duties as assigned 3 years developing pharmacy data Ad Hoc reports and performance dashboards. reports that will create alerts that identify potential risks in utilization, cost, and anomalies to trend. Access, SQL, programming, Excel, Word Bachelors required. CVS Caremark, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nation’s largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units – MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers. Qualifications: -
Source: rrolo.com

Refresher: Medicare’s Accreditation Requirements for Advanced Imaging Services

At the risk of oversimplification, the Anti-Markup Rule prohibits a practice from billing Medicare for the technical and professional components of diagnostic tests unless the practice complies with one of two tests, which will be difficult for most practices to comply with when the accreditation requirement goes into effect. Further, the IOAS exception to the Stark Law is the main exception to the Stark Law that permits practices to bill Medicare and Medicaid for ancillary services, including diagnostic imaging tests and nuclear medicine. Compliance with the IOAS exception’s physician supervision requirement is more difficult with this accreditation requirement.
Source: milliganlawless.com

Medicare to Cover More Home Health Services

Good news for Medicare recipients! Just in time for the New Year 2013! In the past, Medicare recipients were unable to receive home health services such as nursing care and therapies if they had a chronic condition. As a result of a court case that originated in Vermont, that is about to change. Vermont Chief Judge Christina Reiss will sign off on the settlement after a hearing on January 24, 2013. The settlement will apply nationally, and it will mean a big change from the current practice. At present, the Medicare recipients had to have had a reasonable chance of recovering from the condition before they could receive rehabilitative services in the home. Of course, sometimes it is difficult to make that prediction, so this ruling represents a giant step forward for patients. Now, they will be able to receive skilled nursing services as well as speech therapy and occupational therapy in the home, despite the fact that the patient may not fully recover. Those enrolled in both fee-for-service Medicare and private Medicare Advantage plans will also have this option.
Source: ramblingmanofals.com

H.R.1958: Medicare Orthotics and Prosthetics Improvement Act of 2011

5/24/2011–Introduced.Medicare Orthotics and Prosthetics Improvement Act of 2011 – Amends title XVIII (Medicare) of the Social Security Act, for application of quality standards for certain accredited suppliers of prosthetic devices, orthotics, and certain prosthetics, to require the Secretary of Health and Human Services (HHS) to designate and approve an independent accreditation organization with respect to such suppliers only if that organization is the American Board for Certification in Orthotics and Prosthetics, Inc. or the Board for Orthotist/ Prosthetist Certification (or a program with essentially equivalent accreditation and approval standards). Exempts from such standards any suppliers who: (1) are physicians, occupational therapists, or physical therapists licensed or otherwise regulated by the state in which they practice; and (2) receive Medicare payments.Applies to custom-fitted orthotics the special payment rules for certain prosthetics and custom–fabricated orthotics. Modifies the Medicare payment rules for orthotics and prosthetics to account for practitioner qualifications and complexity of care. Directs the Secretary to report to Congress on: (1) HHS steps taken to ensure that the state licensure and accreditation requirements are enforced, and (2) the effects of requirements of this Act on the occurrence of Medicare fraud and abuse with respect to orthotics and prosthetics. Requires the Chief Actuary of the Centers for Medicare and Medicaid Services to submit to Congress a projection of the effect on cumulative federal spending under Medicare part B (Supplementary Medical Insurance) for 2012-2016 that will result from implementation of this Act. Requires the Secretary, if the Chief Actuary projects that implementation of this Act will not result in a cumulative spending reduction of at least $250 million for 2012-2016, to issue an interim final regulation to strengthen the licensure, accreditation, and quality standards applicable to orthotics and prosthetics suppliers in order to produce such a cumulative reduction by the end of 2016. Exempts from such regulation any qualified physical therapist or qualified occupational therapist.
Source: opencongress.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

Implementing Health Reform: Medicaid And Premium Tax Credit Eligibility And Appeals

The first of these new categories is adults under age 26 who are not otherwise eligible for Medicaid and who were foster children receiving Medicaid when they reached age 18 or aged out of foster care.  This is a new category added by the ACA, which was not affected by the Supreme Court decision on the adult Medicaid expansion.   There is no income or asset test for this group.  If an individual is eligible both as a former foster child and as a member of the adult expansion group, foster-child eligibility takes precedence.  The regulation also implements an ACA provision allowing states the option of providing family planning services only to adults at the highest income level established for pregnant women under the state’s Medicaid or CHIP plan, considering only the income of the individual using family planning services and not of anyone else in the household.  The NPRM implements a provision of CHIPRA permitting states to offer CHIP or Medicaid eligibility to persons “lawfully residing” in the United States (which do not include aliens covered by the Deferred Action for Childhood Arrivals (DACA) program).  The proposed regulation also provides coverage for newborn children for the first year when their mother was covered under Medicaid or CHIP for various reasons (including the provision of emergency services to aliens).
Source: healthaffairs.org

Groups push for Medicaid expansion

Posted by:  :  Category: Medicare

The Real Romney by elycefelizThe loose coalition that included AARP, the American Cancer Society and Iowa Catholic Conference, has support of Democratic lawmakers. Sen. Jack Hatch, D-Des Moines, and Rep. Lisa Heddens, D-Ames introduced legislation Tuesday that would make more Iowans eligible for the program that provides health benefits for about 400,000 Iowans.
Source: thegazette.com

Video: New Iowa Frontrunner Thinks Medicare, Paper Money And Nearly Everything Else Is Unconstitutional

IA: Federal officials ding Iowa for inappropriate Medicaid payments

Officials with the U.S. Department of Health and Human Services Office of Inspector General found in fiscal year 2011 the state submitted and paid claims for patients who received care through the IowaCare and Family Planning programs. Those people, however, were also enrolled in or eligible for Medicare or Medicaid at the same time they received services, which federal law prohibits.
Source: watchdog.org

February Fun at Johnston Public Library

Welcome to Medicare Saturday, February 23   10:30 am. Are you currently enrolled in Medicare or do you have a family member with Medicare questions? Come to Johnston Public Library on Saturday, February 23 at 10:30 am for a free Welcome to Medicare program, facilitated by SHIP counselors. SHIP, a free, confidential service of the State of Iowa, helps Iowans make informed decisions about Medicare and other health coverage. SHIP counselors will be on hand to answer Medicare queries ranging from Medicare Parts A and B coverage, benefits, eligibility requirements, and health care costs. Pre-register online at www.johnstonlibrary.com or by calling the library at 515-278-5233.
Source: iowalivingmagazines.com

Tavenner Nominated Again To Lead Medicare

Kaiser Health News: Grassley Calls For Senate Consideration Of Tavenner’s Nomination President Barack Obama Thursday once again nominated Marilyn Tavenner to head the Centers for Medicare & Medicaid Services, and a key GOP senator said the chamber should consider the nomination. “The Senate should give Ms. Tavenner every opportunity to show she is a worthy choice to lead the agency responsible for Medicare, Medicaid, the Children’s Health Insurance Program, and a lot of the implementation of the Obama health care law,” said Sen. Charles Grassley, R-Iowa., who is a member of the Finance Committee and its former chairman and ranking member. Grassley said he hoped the panel would give Tavenner’s nomination “due consideration through regular order” (Carey, 2/8).
Source: kaiserhealthnews.org

Bleeding Heartland:: Iowa Hospital Association backs Medicaid expansion

- County chairs list at IDP site – Iowa 4th District Democrats (includes contact info for county chairs) – Iowa 5th District Democrats (includes contact info for county officers) – Allamakee County Democrats – Appanoose County Democrats – Black Hawk County Democrats – Boone County Democrats – Bremer County Democrats – Buena Vista County Democrats – Carroll County Democrats – Cedar County Democrats – Clinton County Democrats – Dubuque County Democrats – Emmet County Democrats – Fayette County Democrats – Hardin County Democrats – Harrison County Democrats – Henry County Democrats – Jackson County Democrats – Jefferson County Democrats – Johnson County Democrats – Linn County Democrats – Marion County Democrats – Monona County Democrats – Muscatine County Democrats – Page County Democrats – Pocahontas County Democrats – Polk County Democrats – Scott County Democrats – Story County Democrats – Tama County Democrats – Wapello County Democrats – Warren County Democrats – Washington County Democrats – Woodbury County Democrats
Source: bleedingheartland.com

Medicare ad hit IA03, IA04 airwaves

Both Congressman King Latham voted twice for the Ryan plan, which would end the current Medicare system and instead give seniors a voucher to get private health insurance. Non-partisan experts have said ultimately this would cost individuals $6,000 per year.
Source: cciaction.org

Newt Gingrich Participates in Most Uncomfortable Hand

Newt Gingrich is feeling the heat from referring to Congressman Paul Ryan’s Medicare plan as “right-wing social engineering” and “radical change” on Sunday’s Meet the Press. It’s not just the elites, like Charles Krauthammer (“He’s done”) and Rush Limbaugh (“My God, it is inexplicable”) who think Gingrich has betrayed his own party. Now Gingrich, who is making seventeen stops throughout Iowa this week, is catching hell from regular voters — like this Iowan who berated a sheepish Gingrich for fifteen seconds while shaking his hand the whole time. Why did you keep shaking hands?
Source: nymag.com

Iowa Congressman Pushes Back Against Rove Group

The letter from Mr. King is the latest ripple in the fallout from the creation of the Conservative Victory Project, a group founded by Mr. Rove and the American Crossroads “super PAC,” to take an aggressive role in Republican primaries next year. Mr. King is one of the earliest targets of the project, which is seeking to recruit candidates seen by Republican leaders as more electable.
Source: nytimes.com

Medicaid News: Minn. Effort To Expand Program Praised

Posted by:  :  Category: Medicare

Congressman Brad Sherman, California’s 27th District (D) by cliff1066™California Healthline: Access Denied? Implications Of Medi-Cal Pay Cut In 2014, about 1.5 million adults in California are expected to gain access to Medi-Cal under the Affordable Care Act. However, insurance coverage could be all they get, as some observers say there might not be enough doctors willing to treat them. The fiscal year 2013-2014 budget proposal that Gov. Jerry Brown (D) released this month could be read as contradictory. On one hand, he makes it clear that California will pursue a full expansion of Medi-Cal, offering coverage to individuals with incomes up to 138 percent of the federal poverty level. At the same time, however, the governor’s budget plan also counts on $488.4 million in savings from a 10 percent cut to Medi-Cal reimbursements. Medi-Cal is California’s Medicaid program. State officials maintain that the provider pay cut should not hurt access to care during the expansion, but others fear the reduction could be implemented at the worst possible time (Wayt, 1/30).
Source: kaiserhealthnews.org

Video: California Medicare Supplement Insurance Plans 1-800-243-8100

Medicare for All Rallies in Sacramento & Los Angeles to Celebrate Lobby Day, Feb. 11

■ San Francisco: San Francisco Main Library, Larkin and Fulton at 9 am. Reserve a seat through Don Bechler at Single Payer Now, 415-810-5826. ■ Richmond: Target, 42nd and MacDonald Avenue at 9:45 am. Reserve a seat through Cara at 510-663-4086. ■ Berkeley: Ashby Bart at 9:15 am. This bus will pick up in Richmond after the Berkeley stop. Reserve a seat through Cara at 510-663-4086. ■ San Jose: South Bay Labor Council, 2102 Almaden Road at 9:00 am. Reserve a seat through Greg Miller – (408) 254-3311. ■ Grass Valley: KMart, 111 W. McKnight Way at 9:30 am. Reserve a seat through Mindy’s email. ■ Roseville: UDW office, 800 Sunrise Avenue Suite C at 10:15 am. Reserve a seat through Diana at 916-435-9760. ■ Fresno: Mervyn’s Parking Lot, Ashlan and Shields at 7:30 am. Reserve a seat through Judy Hess – 559-907-0279. ■ Modesto: Old Krispy Kreme, Briggsmoore at Highway 99 at 9:15 am. Reserve a seat through Carol Bailey at 209-951-0499. ■ Stockton: Clarion Hotel, Highway 99 at Waterloo at 10 am. Reserve a seat through Carol Bailey at 209-951-0499.
Source: californiaonecare.org

California: Brown OKs Medicaid expansion, fears costs

Dooley said she is concerned that the federal government has not finalized rules for reimbursing states to determine who is a newly eligible Medi-Cal recipient. It’s not clear what medical benefits will be required under the expansion. And even though Medicaid was exempted from across-the-board cuts that threatened to push the nation over the “fiscal cliff,” Dooley said it is possible Medicaid spending could be reduced in the next round of deficit talks.
Source: lifehealthpro.com

Cuts to California Medicaid could hurt reform, providers say

Chris Perrone, a deputy director at the California HealthCare Foundation, a not-for-profit health policy group, said California already has very low payment rates compared to other states, and some findings suggest that access is already poor. One study found that California reimburses primary care physicians an average of 53% of Medicare, the federal healthcare program for seniors, he said. According to the state Department of Health Care Services, Medi-Cal pays $24 for a 15-minute visit to the doctor’s office. By comparison, Medicare would pay roughly $70. Some Democratic lawmakers want the state to rescind the cuts approved last year. At the time it was passed, AB 97 was projected to save $660 million, with half the savings going to the state’s general fund. “We’re now in a much different environment than we were when we first made those cuts, so given the opportunity, I would like to see those restored,” said Sen. Ed Hernandez, a Democrat from Baldwin Park and chair of the Senate Health Committee. The federal healthcare law seeks to increase health coverage by 2014 by creating new online insurance markets for individuals and small businesses to shop for subsidized private coverage, and by expanding Medicaid for low-income people. Medicaid is known as Medi-Cal in California and currently serves 7.7 million adults and children. Gov. Jerry Brown has not said whether California will commit to fully expanding its Medi-Cal program to take advantage of federal funding. Under an expansion, Medi-Cal would cover people up to 138 percent of the federal poverty line, or about $15,400 for an individual. It’s estimated such a move would add between 1 million and 1.4 million people to Medi-Cal. The state is also in the process of moving 900,000 kids from the children’s health insurance program known as Healthy Families to Medi-Cal. “The court decision does not change the state’s commitment to ensure access to healthcare for Medi-Cal members in a manner that fully complies with federal and state law,” said Norman Williams, a spokesman for the state Department of Health Care Services. More than 400 hospitals and about 130,000 doctors, pharmacists, dentists, and other health care providers participate in the Medi-Cal program. However, the state doesn’t track whether some of them have stopped accepting new Medi-Cal patients or limit the number of patients they take. “If you’re going to set payment standards for pharmacies and for the other providers which are below their cost, and they won’t provide services, then all those millions of people coming into Obamacare in California are going to get third-world medicine,” said Lynn S. Carman, an attorney for a group of pharmacies. Carman said his group intends to file an appeal next week seeking to be heard by the full court, not just the three-member panel in the 9th U.S. Circuit Court of Appeals that ruled Thursday. Molly Weedn, a spokeswoman for the California Medical Association, which represents 35,000 doctors, said it’s expected that the 10% cut won’t take effect while health providers pursue their legal challenge. But Brown’s finance officials have indicated the state expects to see additional savings by having the cut applied retroactively to June 2011. The doctors group warned that if the cut is upheld, many physicians will have little option but to stop taking qualified patients because the reimbursements do not meet the cost of overhead and supplies to treat them. Faced with multibillion budget deficits in recent years, the state Legislature already approved a series of Medi-Cal benefits cuts, some of which are still awaiting federal approval. For example, the state has cut dental care for adults and weeded out services such as podiatry, psychiatry and optometry. Health reform does bring a glimmer of hope to California’s low reimbursement rates. Primary care providers are expected to receive a temporary two-year payment boost under the federal health care law to match Medicare rates. But California will only get the boost if it maintains its current rates, said Anthony Wright, executive director of Health Access California, a group that lobbies for healthcare for the poor.
Source: modernhealthcare.com

Prime hospital chain acknowledges it faces two federal investigations

In November, California regulators fined Prime $95,000 for violating state confidentiality laws in the case. Disclosing a patient’s medical records without consent also violates federal law. The chain denies wrongdoing and is confident it will win on appeal, wrote Glassman, Prime’s lawyer. He also contended that the SEIU had urged the patient to complain about her diagnosis.
Source: californiawatch.org

California leading the experiment of shifting Medicaid patients to managed care

That’s when she sits in her living room in this struggling Los Angeles suburb and sorts through the latest round of letters from her health plan, each rejecting her appeal to stay with her trusted oncologist at City of Hope, a local cancer center. For as long as she can remember, Saavedra, 53, a former cafeteria worker who suffers from bone marrow cancer, has been insured through Medicaid, the joint federal-state program for low-income people. For most of that time, she could go to any doctor willing to take her, but last year, the state revamped the program and assigned her to a managed care plan with a restricted network of doctors. Her oncologist is not on its roster.
Source: medcitynews.com

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

California insurance firm over billed Medicare $424 million

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Source: calcoastnews.com

How Obamacare Will Affect Medicare Recipients in 2013

If your primary-care doctor or other primary-care practitioner determines you’re misusing alcohol, you can get up to four face-to-face counseling sessions per year (if you’re competent and alert during counseling). A qualified primary-care doctor or other primary-care practitioner must provide the counseling in a primary-care setting such as a doctor’s office.
Source: patch.com

California Medicare Supplement: Benefits Explained

Instead of offering you help from the State, the California based Medicare Savings Program is a lovely initiative where you can save a lot of money, make sure you use them when you need it, and let your earnings accrue under Government supervision. This way, if you meet with untimely accidents or are diagnosed with huge illnesses, you have substantial savings to bail you out of trouble. If you fall short, the State can pitch in with a few thousands of dollars for help.
Source: wordpress.com

ObamaCare uses billions to solve 50

“The challenge that Medicare has had is that they do demonstrations and pilots periodically, some of them are successful. Many of them don’t have quite the results that had been hoped for,” said Gail Wilensky, former head of Medicaid and Medicare from 1990 to 1992 and senior fellow at Project HOPE, an international health care foundation. “Even the ones that are successful, they don’t have a long history of seeing whether they can be scaled up represent a delivery system that would be relevant in many parts of the country and become part of a national program.”
Source: watchdog.org

Daily Kos: White House: No Medicare age increase, cut Social Security instead

Meteor Blades, GainesT1958, DeminNewJ, mimi, Bryce in Seattle, mint julep, shanikka, oceanview, recontext, Getreal1246, Eric Blair, musiccitymollie, RebeccaG, dkmich, Sybil Liberty, drofx, joanneleon, marina, 3goldens, qofdisks, MT Spaces, Laurence Lewis, Burned, begone, RJDixon74135, Nance, irishwitch, pengiep, blueoasis, praenomen, JVolvo, el cid, Timothy J, Dreaming of Better Days, kurt, shaharazade, NancyWH, BentLiberal, SpecialKinFlag, bigjacbigjacbigjac, Mary Mike, david mizner, gustynpip, suejazz, HCKAD, GeorgeXVIII, angry hopeful liberal, Chacounne, Blueslide, allie123, cybrestrike, LinSea, gharlane, Zotz, rbird, zaka1, cassandraX, Just Bob, chambord, Lady Libertine, Johnny Q, implicate order, jm214, smiley7, PorridgeGun, Wolf10, peregrine kate, whaddaya, ratcityreprobate, quill, mrbond, anodnhajo, IndieGuy, Eric Nelson, This old man, Forest Deva, lunachickie, AverageJoe42, Marjmar, Purplehead, Australian2, alice kleeman, Jason Hackman, richardvjohnson, SEAlifeguard, OldSoldier99, Capt Crunch
Source: dailykos.com

California Medicare Coalition, CMC Meetings

The CMC holds periodic meetings and statewide conference calls. Every meeting or call features a special presentation addressing an important and timely topic in Medicare by knowledgeable experts on Medicare, managed care and health insurance issues. In addition, representatives from the Centers for Medicare and Medicaid Services (CMS) and the Social Security Administration are present to share updates and answer questions.
Source: cahealthadvocates.org

Blog: How Medicare Works with Other Insurance

Medicaid and TRICARE (the healthcare program for U.S.armed service members, retirees, and their families) never pay first for services that are covered by Medicare. They only pay after Medicare, employer plans, and/or Medicare Supplement Insurance (Medigap) have paid.
Source: patch.com

Report estimates health plan overbilled Medicare $424M

Dec. 17, 2012 – Medicare may have overpaid an estimated $424 million to PacifiCare of California’s Medicare Advantage plan based on risk assessments that in many cases made patients seem sicker than they were, according to a federal oversight agency. Medicare Advantage plans send patient diagnosis codes to Medicare, which boosts plan rates if clients are affected by serious medical conditions. A new report by the U.S. Health and Human Services inspector general says PacifiCare was paid extra for treating patients with cancer or a dangerous bloodstream infection even though medical records didn’t describe those ailments. UnitedHealth Group, which now owns PacifiCare of California, disputed the inspector general’s findings, saying the review of 100 cases could not be generalized to hundreds of other claims. “The audit does not follow Medicare’s own guidelines, standards or accepted methodology for validating risk-adjustment payments,” a statement by UnitedHealthcare Medicare & Retirement says. “In fact, it differs significantly from (Medicare’s) adopted methodology. The OIG appears to have relied instead on a methodology of its own making.” The inspector general’s office reviewed UnitedHealth’s response before issuing the report and maintains that its methods are valid. The report, released Thursday, calls on Medicare to review its findings and discuss them with PacifiCare. A Centers for Medicare & Medicaid Services representative said the agency, which administers the Medicare program, is aware of the report and is willing to work on the matter with PacifiCare. Medicare Advantage plans collect patient diagnoses from doctors and hospitals that are used to assign risk scores to clients. Patients with serious medical conditions entitle the plans to heightened per-patient, per-month Medicare payments. The inspector general reviewed a 2007 contract between Medicare and PacifiCare. Under that contract Medicare paid PacifiCare $2.3 billion to administer care for 188,829 clients. The review examined 100 clients’ risk scores, diagnostic codes and related medical records. The inspector general concluded that 55 risk scores were valid, but 45 were not supported by information in patient charts. The inspector general found that PacifiCare submitted a diagnosis code for a genetic disorder characterized by abnormal brain function in a patient whose records only discussed a fever and a cough. Another patient was reported to have prostate cancer when medical records discussed a shoulder suture removal. For a third patient, PacifiCare submitted a diagnosis code for “unspecified septicemia,” a lethal infection of the bloodstream, when medical records discussed a knee surgery and did not mention a bloodstream infection, the report says. The inspector general directed PacifiCare to repay Medicare $224,388 that was overpaid as a result of the 45 charts with unsupported diagnoses. Applying the estimated overpayment rate to 188,000 PacifiCare patients under the 2007 contract, the inspector general estimated that Medicare overpaid about $424 million. UnitedHealth said in its statement that it has worked with Medicare to improve the accuracy of health plan payments and will continue to do so. “Payment accuracy is in the best interests of UnitedHealth, our health care system partners, and Medicare as we collaborate to provide coverage and care that Medicare beneficiaries need, at a price they can afford,” the statement says. The report comes amid a series of watchdog agency and news reports that examine enhanced Medicare payments that can flow to health providers if they overstate the intensity of patient demands or the severity of their medical conditions. The inspector general found in November that Medicare overpaid nursing homes by about $1.5 billion in 2009 based on claims that patients needed “ultra high” levels of therapy. The report found that claims were “upcoded” because the records showed that the patients either did not need or get the therapy in many cases. The Washington Post also examined “ultra high” therapy use in 2010, focusing on a chain that operates dozens of homes in California. The Center for Public Integrity reported in September that doctors and other medical professionals are steadily billing higher rates for treating Medicare patients, signaling a possible increase in billing abuse. And California Watch reported on high rates of severe medical conditions that entitled Prime Healthcare Services, a growing California-based chain, to bonus payments. Prime Healthcare has said its Medicare billings are legal and based on appropriate patient care. www.CaliforniaWatch.org
Source: yubanet.com

ITEM Coalition Issues Survey RE Medicare Beneficiaries and Access to Assistive Technology Devices; Please Complete.

Posted by:  :  Category: Medicare

Disability and Senior Linkage Line Managers by TransguyjayITEM is currently surveying people with disabilities and chronic conditions to find out if they are experiencing problems accessing the devices needed to function independently.  ITEM is interested in medical device and assistive technology users that live in areas where Medicare has implemented a selective provider contracting program known as the DME Competitive Bidding Program.
Source: drnpa.org

Video: How Medicare Works With Social Security Disability

Daily Kos: White House: No Medicare age increase, cut Social Security instead

Meteor Blades, GainesT1958, DeminNewJ, mimi, Bryce in Seattle, mint julep, shanikka, oceanview, recontext, Getreal1246, Eric Blair, musiccitymollie, RebeccaG, dkmich, Sybil Liberty, drofx, joanneleon, marina, 3goldens, qofdisks, MT Spaces, Laurence Lewis, Burned, begone, RJDixon74135, Nance, irishwitch, pengiep, blueoasis, praenomen, JVolvo, el cid, Timothy J, Dreaming of Better Days, kurt, shaharazade, NancyWH, BentLiberal, SpecialKinFlag, bigjacbigjacbigjac, Mary Mike, david mizner, gustynpip, suejazz, HCKAD, GeorgeXVIII, angry hopeful liberal, Chacounne, Blueslide, cybrestrike, LinSea, gharlane, Zotz, rbird, zaka1, cassandraX, Just Bob, chambord, Lady Libertine, Johnny Q, implicate order, jm214, smiley7, PorridgeGun, Wolf10, peregrine kate, whaddaya, ratcityreprobate, quill, mrbond, anodnhajo, IndieGuy, Eric Nelson, This old man, Forest Deva, lunachickie, AverageJoe42, Marjmar, Purplehead, Australian2, alice kleeman, Jason Hackman, richardvjohnson, SEAlifeguard, OldSoldier99, Capt Crunch
Source: dailykos.com

Medicare’s Past and Uncertain Future for People with Disabilities

National debate dragged on until the 1960s, when it became painfully obvious to private insurance companies and the federal government that the elderly could not afford adequate health insurance on their own to cover rising costs for care. This was a group of Americans who had paid into the Social Security system through work but now had less than half the income they once had and three times the need for medical care.
Source: freedomdisability.com

Tricare Help – If wife gets Medicare early due to disability, does she get TFL at the same time?

20/20/20 age appeal catastrophic cap child born out of wedlock claims continued care cost share death DEERS dental dependent disabled divorce doctor doctors FEHBP handbook health care reform hospital ID card marriage maternity care Medicare military treatment facilities other health insurance outside the U.S. parents Part A Part B pharmacy pre-existing condition pregnancy reserves secondary insurance social security spouse supplements surgery Tricare For Life Tricare Prime Tricare Standard Tricare Young Adult Program VA widow
Source: militarytimes.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

Social Security Disability Income, Medicare and Medicaid cuts may be in store in 2013

Still, an increase of just “a tiny fraction would generate a fair amount of money,” said Democratic Representative Earl Blumenauer of Oregon. These sorts of changes probably won’t provide enough savings for Republicans to accept in return for increasing taxes for high earners, said G. William Hoagland, a former Republican staff director for the Senate Budget Committee. He’s now a vice president at the Bipartisan Policy Center in Washington, which studies ways to cut the deficit.
Source: lifesparknetwork.com

Welfare State Explosion: Food Stamps Skyrocket, Disability Hits All

Under the president’s FY2013 budget proposal, means-tested spending would increase an additional 30% over the next four years. Such welfare spending refers to programs that provide low-income assistance in the form of direct or indirect financial support—such as food stamps, subsidized housing, child care, disability, etc.— which the recipient does not pay into (unlike Medicare or Social Security).
Source: ijreview.com

Medicare’s ‘improve or you’re out’ rehab policy

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Source: wordpress.com

Philadelphia Social Security Disability Attorneys

If you are receiving long-term disability benefits, the Philadelphia Social Security attorneys at Silver & Silver can answer all your questions about the Medicare plans offered and what benefits you are entitled to receive.  Our law offices are located in Ardmore, Pennsylvania, and are easily accessible from communities throughout the Philadelphia area and its surrounding suburbs of Delaware County, Montgomery County, Bucks County, Chester County, and Berks County, as well as in the South Jersey communities of Camden, Burlington, Cherry Hill, Voorhees, Haddonfield, Moorestown, Mt. Laurel, Gloucester, Atlantic County and others. Call us at 1-800-94SILVER (1-800-947-4583) to schedule a free consultation or contact us online.
Source: silverandsilver.com

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

Medicare Annual 2012 Open Enrollment Period

* Medicare Advantage plans see changes. Medicare Advantage participants should review 2013 plan changes as soon as they receive information from their providers. Changes could include costs such as premiums, deductibles and co-pays, as well as changes to covered procedures, tests and other provisions. Some plans may be eliminated, requiring enrollees to choose a new plan for 2013 or default to traditional Medicare Part B. Enrollment in Medicare Advantage plans continues to increase, with 10 percent more Medicare beneficiaries choosing these plans for 2012 compared to 2011. The average number of plans available to eligible individuals declined slightly from 24 plans in 2011 to 22 plans in 2012. The average number of plans for 2013 will not be known until later this year.
Source: disabled-world.com

Another Reason We Need Medicare for All

This builds upon previous research that shows the Great Recession has seriously impacted older Americans’ ability to retire. An estimated 62 percent of working Americans now report they’re planning to put off their retirement — up from 42 percent in 2010 — largely due to job losses and financial insecurity. These issues go hand-in-hand particularly because, as health care costs continue to rise, Americans are increasingly worried about being able to afford their insurance coverage…
Source: politicsplus.org

FAQ on Medicare doctor pay: Why is it so hard to fix?

Posted by:  :  Category: Medicare

Benefit Security Card .. HALF of the U.S live in households that receive government benefits (26 May 2012) ...item 2.. Brevard man gets 4 years in Social Security fraud case (Jun 1, 2012 ) ... by marsmet481Today’s problem is a result of yesterday’s efforts to control federal spending – a 1997 deficit reduction law that called for setting Medicare physician payment rates through a formula based on economic growth and known as the “sustainable growth rate” (SGR). For the first few years, Medicare expenditures did not exceed the target and doctors received modest pay increases. But in 2002, doctors reacted with fury when they came in for a 4.8 percent pay cut. Every year since, Congress has staved off the scheduled cuts.  But each deferral just increased the size – and price tag – of the fix needed the next time.
Source: medcitynews.com

Video: Prevent Medicare Payment Cuts and Preserve Access to Care

New AMIC Survey Data Shows 2010 Medicare Payment Cuts Forcing Physician Practices and Imaging Providers to Reduce Patient

In the past, the Obama Administration has proposed using RBMs in the Medicare program.  However, the Department of Health and Human Services (HHS)  previously weighed in on prior authorization in the Medicare program, noting in 2008 that a prior authorization program could be “inconsistent with the public nature of the Medicare program,” since such programs rely on private companies using proprietary systems to deny care prescribed by a physician.  HHS also noted that the Medicare appeals process guaranteed to every beneficiary could overturn a “high proportion” of denials, rendering the policy ineffective.  In an environment of reduced reimbursements, the AMIC survey further demonstrates that application of RBMs is an ineffective model imposing unnecessary administrative costs on practices, thereby creating artificial barriers for patients in need of care.
Source: rightscanrighttime.org

Obama’s Medicare Cuts

The Medicare Advantage cut gets the most attention, but it only accounts for about a third of the Affordable Care Act’s spending reduction. Another big chunk comes from the hospitals. The health law changed how Medicare calculates what they get reimbursed for various services, slightly lowering their rates over time. Hospitals agreed to these cuts because they knew, at the same time, they would likely see an influx of paying patients with the Affordable Care Act’s insurance expansion. The rest of the Affordable Care Act’s Medicare cuts are a lot smaller. Reductions to Medicare’s Disproportionate Share Payments — extra funds doled out the hospitals that see more uninsured patients — account for 5 percent in savings. Lower payments to home health providers make up another 8.8 percent. About a dozen cuts of this magnitude make up the green section above.
Source: andrewsullivan.com

Obama Wants To Avert Cuts to Medicare, Other Programs in Sequester

Obama also indicated a willingness to accept reductions to entitlement programs, noting that in the past he has “offered sensible reforms to Medicare and other entitlements” (Zigmond, Modern Healthcare, 2/5). He said that proposals he made to reduce entitlement spending during talks on the fiscal cliff in December 2012 still are “on the table.” During those negotiations, Obama agreed to change how costs would be adjusted for inflation in government programs, including Medicare, in exchange for revenue increases from closing tax loopholes (“On The Money,” The Hill, 2/5).
Source: californiahealthline.org

Republicans Won’t Name Medicare Cuts They Want and They Don’t Need To

A top Democratic official said talks have stalled on this question since Obama and congressional leaders had their friendly-looking post-election session at the White House. “Republicans want the president to own the whole offer upfront, on both the entitlement and the revenue side, and that’s not going to happen because the president is not going to negotiate with himself,” the official said. “There’s a standoff, and the staff hasn’t gotten anywhere. Rob Nabors [the White House negotiator], has been saying: ‘This is what we want on revenues on the down payment. What’s you guys’ ask on the entitlement side?’ And they keep looking back at us and saying: ‘We want you to come up with that and pitch us.’ That’s not going to happen.”
Source: firedoglake.com

12 Days of Obamacare Surprises: More Medicare Cuts

Not all surprises are good. When it comes to Obamacare, the original projections are turning into unfortunately different realities. For the next five days, Heritage is going to highlight one of the various changes in Obamacare projections (e.g. cost, enrollment, etc.) from when the law first passed until now.
Source: fixhealthcarepolicy.com

FAQ: Decoding The $716 Billion In Medicare Reductions

Ryan’s plan also calls for an overhaul of the program, offering beneficiaries a set amount of money that they would use toward buying a private plan or traditional Medicare. Democrats have argued that such a fundamental change could undermine the traditional Medicare program, because private plans might tailor their coverage to attract healthier beneficiaries, leaving sicker beneficiaries in traditional Medicare. Critics of Ryan’s plan also predict it will force seniors to eventually pay more for their health care because the federal payments will be capped at the rate of gross domestic product plus half a percentage point, an amount that may not keep up with the increase in medical costs. Under Ryan’s plan, insurers would have to provide benefits that are at least equal the value of those offered in traditional Medicare. 
Source: kaiserhealthnews.org

Experts Discuss Basics of the Medicare Program

Panelists included: Centers for Medicare & Medicaid Services Deputy Administrator Jonathan Blum; Juliette Cubanski, associate director in the program on Medicare Policy at the Kaiser Family Foundation; and Sheila Burke, adjunct lecturer in public policy at Harvard’s Kennedy School of Government.
Source: c-span.org

ACA Cuts Cause Doctor Practices to Flee From Medicare

The new report comes a few weeks after the so-called “doc fix” on Medicare payments in the fiscal-cliff negotiations by Congress. Although a 27 percent slash in Medicare payments to doctors was avoided, doctors continue to be disappointed that a permanent solution to the dramatic cuts is not in the offing. Under the sustainable growth rate (SRG) provisions of ObamaCare, doctor payments from the Medicare health insurance program are dropping at an alarming rate. The cost-saving measure is part of the more than $700 billion in cuts that helps fund the Affordable Care Act over the next ten years.
Source: medicarewire.com

Poll: Public strongly supports Medicare, opposes cuts

About two-thirds of poll respondents said they favor quick governmental action to reduce the deficit. However, more than 70% said this could be achieved without drastic Medicare cuts. Eighty-five percent said they oppose across-the-board Medicare premium increases. The same percentage said they would support legislation to push drug companies to lower the costs of medications for seniors, which would also save the Medicare program money.
Source: mcknights.com

Don’t Let Obama Cut Medicare, Medicaid, and Social Security

This is before the Tea Party swept into Congress, so there was no pressure on Obama to appease the right. By adopting Tea Party talking points on spending and comparing government to a family – what family do you know that has 8,100 tons of gold reserves, a space program and embassies in some 200 countries? – Obama legitimized debt as a major concern going into the 2010 election.

A little more history. Obama ran in 2008 on repealing the Bush tax cuts. But he reneged on his promise just one month into his presidency even though he was gushing with political capital, the right was in disarray and the Democratic-controlled Congress was ready to pass it. (After campaigning in 2012 on abolishing tax cuts for households earning more than $250,000, Obama indicated he was willing to renege once more days after being re-elected.)
Source: progressive.org

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

Posted by:  :  Category: Medicare

Reality Bites (draft v001) by juhansoninBetween 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

Video: Medicare Part D Comparison Tutorial Video

This Valentine’s Day give your heart some love

You might not be able to avoid Cupid’s arrow, but you can take steps to lower your risks and prevent heart disease.  Start by scheduling an appointment with your doctor to discuss whether you’re at risk for heart disease. 
Source: medicare.gov

Navigating the Health Care System: Resources to Help You Stay Healthy in the New Year

Critiquing The Medicare Part D Low

Posted by:  :  Category: Medicare

Medicare Part D Press Conference (44) by Korean Resource Center 민족학교At 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: Medicare Part D

Webinar: Medicare Part D in 2013: Addressing Client Issues

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Source: nsclc.org

Why Medicare Part D Works [VIDEO]

The Catalyst provides news and commentary on access to life-saving treatments, America’s biopharma industry and researchers’ progress in developing new medicines. The Catalyst is edited by Kaelan Hollon, communications director at PhRMA. Contributors include PhRMA staff and leaders from the industry.
Source: phrma.org

Medicare Part D Premiums Holding Steady

Thanks to the marvels of medical science, our parents are living longer than ever before. Adults over age 80 are the fastest growing segment of the population; most will spend years dependent on others for the most basic needs. That burden falls to their baby boomer children. In The New Old Age, Paula Span and other contributors explore this unprecedented intergenerational challenge. You can reach the editors at newoldage@nytimes.com.
Source: nytimes.com

How “Obamacare” Affects Senior Health Care

Medicare recipients or those who are planning to enroll in the program know that the new Patient Protection and Affordable Care Act, popularly known as “Obamacare,” which was signed into law back in March of 2010, has millions of tongues wagging these days. Some feel the bulky new heath care laws are a terrible idea that will bankrupt and destroy our economy, especially senior health care, while others are convinced that it is about time something was done. Whatever side of the fence you are on, you may be curious to know how these new laws will affect your senior health care benefits.
Source: healthinsure.org

Analyst Medicare Ops Openings in Scottsdale, February 11, 2013

Data analyst that has working knowledge within Medicare Part D and the ability to extract data and manipulate data to create dashboards, ad hoc reports, and scheduled reports. The analyst will have the ability to identify variances in trend and ability to forecast drug spending of Medicare beneficiaries throughout each phase of the plan benefit parameters. Must have the ability to work with clinicians understanding of medical terminology, pharmacy terminology, and programming. 3 years overall applicable experience required. Ability to comprehend health and pharmacy related concepts to develop and maintain comprehensive dashboards to monitor drug spend and utilization trend on a retrospective, concurrent, and prospective basis. Initiative to lead the development of scenario driven Ad hoc reporting to determine root cause of pharmacy trends and or anomalies in the performance of drug and/or utilization trend. Oversight of outbound and internal communications system development and coordination with business partners to ensure the accuracy and timeliness of the distribution of these communications within CMS regulated timeframes. Provide data related to pharmacy cost, utilization, drug benefit design, regionally and nationally to support actuarial performance and forecasting for yearly bid development processes. Understand Medicare Part D regulatory parameters and incorporate this information into the analysis and develop strategic solutions to enhance plan performance measures Other duties as assigned 3 years developing pharmacy data Ad Hoc reports and performance dashboards. reports that will create alerts that identify potential risks in utilization, cost, and anomalies to trend. Access, SQL, programming, Excel, Word Bachelors required. CVS Caremark, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nation’s largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units – MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers. Qualifications: -
Source: rrolo.com

Simple Guide to Medicare Part D

Understanding healthcare coverage doesn’t have to be complicated, neither should it be. Yet since the Medicare Part D prescription drug program went into effect in 2006, many people have found themselves grappling with complicated policy literature and health plan loopholes. If you are interested in applying for Medicare Part D or simply want to find out more about it, here are answers to five of the most frequently asked Medicare Part D questions.
Source: findlocal-insurance.com

Survey Finds Seniors Satisfied With Medicare Part D

Politico Pro: Survey: High Satisfaction With Medicare Part D The debate may be raging over Medicare in the race for the White House — but a new survey points out that one part of it, Medicare Part D, has both positive results and bipartisan support. And health experts from Third Way, the Galen Institute and the Healthcare Leadership Council say the program’s success means that during sequester negotiations lawmakers should keep their hands off the Medicare prescription drug benefit. David Kendall, senior fellow for health and fiscal policy at Third Way, said on a call with reporters that the Medicare prescription drug benefit was a key example of successful bipartisanship because it was “enacted by Republicans and perfected by Democrats” (Smith, 10/3).
Source: kaiserhealthnews.org

Medicare Part D Spending: Key Drivers of Reduced Drug Benefit Costs

An expert on Medicaid, Medicare, and health reform, Kip Piper, MA, FACHE, is a consultant, speaker, and author. Kip Piper advises health plans, hospitals and health systems, states, and pharma, biotech, medical device, HIT, and investment firms. With 30 years’ experience, Kip is a senior consultant with Sellers Dorsey, top specialists in Medicaid and health reform. He is also a senior advisor with Fleishman-Hillard and TogoRun. For more, visit KipPiper.com. Follow on Twitter @KipPiper, Google +, Facebook and connect on LinkedIn.
Source: piperreport.com

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

Posted by:  :  Category: Medicare

Medicare Part D Press Conference (44) by Korean Resource Center 민족학교Between 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

Video: Guide to Medicare Part A and Part B

Webinar: Medicare Part D in 2013: Addressing Client Issues

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Source: nsclc.org

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

5 Things You Need to Know About Medigap Insurance

Either Plan A, Plan C or Plan F Medigap policies must be made available by insurance companies who sell Medigap policies. Plan D and G policies issued before or on June 1, 2010 and Plan D and G policies prior to that date have different benefits. If you happen to have an older policy, such as Plan E, H, I, or J, you don’t have to purchase a new one, however, they are no longer sold. Medigap plans are regulated by the government. If you buy a California Medicare supplement, it will give you identical coverage as the same Florida Medicare supplement. In other words, Medigap Plan A is the same no matter where you reside, as is Plan B, Plan C, and so on.
Source: leerogers2012.com

Daily Kos: White House: No Medicare age increase, cut Social Security instead

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Source: dailykos.com

Medicare Part D Premiums Holding Steady

Thanks to the marvels of medical science, our parents are living longer than ever before. Adults over age 80 are the fastest growing segment of the population; most will spend years dependent on others for the most basic needs. That burden falls to their baby boomer children. In The New Old Age, Paula Span and other contributors explore this unprecedented intergenerational challenge. You can reach the editors at newoldage@nytimes.com.
Source: nytimes.com