Medicare Advisory Group Recommends 1% Increase In Hospital Rates

Posted by:  :  Category: Medicare

Bubbles? Take something like 'Not I! ...item 1.. Wakulla Republicans Protest Against Taxes in the County (September 06, 2011) ... by marsmet552CQ HealthBeat: MedPAC Considers 1 Percent Payment Increase For Hospitals The Medicare Payment Advisory Commission on Thursday in a draft recommendation called for a modest 1 percent increase in inpatient and outpatient hospital payments in 2014, at a time when providers are dreading the impact of possible Medicare cuts under sequestration or as a result of budget negotiations. A staff analysis used for the draft recommendation found that Medicare paid two percent more to hospitals in 2011 compared to 2010, as well as a continued shift to services provided in an outpatient setting rather than in hospital beds. The quality of care is generally improving as well, the analysis said. But commissioners continued to chafe at a fee-for-service system that they say too often rewards volume over quality and efficiency. “I believe $117 billion in spending on acute care is too much,” said Scott Armstrong, president of Group Health Cooperative in Seattle, Wash., referring to total inpatient Medicare costs in 2011 (Norman, 12/6).
Source: kaiserhealthnews.org

Video: 2011- 4/19 MEDICARE PATIENTS HAVE SHORTER HOSPITAL STAY AFTER HIP REPLACEMENT BUT

Do you trust hospital readmission rates?

Amin and colleagues examined the records of 5,780 spine surgery patients treated at the University of California San Francisco Medical Center between October, 2007 and June, 2011. (Before joining Loyola, Amin did a clinical fellowship in complex spine surgery at UCSF under Dr. Praveen Mummaneni. Currently, Amin is an assistant professor in the Department of Neurological Surgery at Loyola University Chicago Stritch School of Medicine. His clinical expertise is in minimally invasive and complex spine surgery.)
Source: sciencecodex.com

Medicare Panel Calls for Repealing Sustainable Growth Rate Formula

Ten days after Congress voted to approve a temporary “doc fix,” the Medicare Payment Advisory Commission last week released a blueprint that calls for permanently repealing and replacing the sustainable growth rate formula — which is used to determine Medicare physician reimbursement rates,
Source: californiahealthline.org

CDC hospital infection report shows more effort needed

Nationally, hospitals reported 7 percent fewer CAUTIs in 2011 compared to 2009.  Most of this reduction was achieved in hospital wards, which showed a statistically significant reduction of 15 percent since 2009.  Changes in critical care units and neonatal care units were not statistically significant.  Little progress was made between 2010 and 2011.  According to the CDC, only 13 percent of hospitals reported a statistically significant decrease compared to the baseline.  However, about half of the hospitals in the report had a Standardized Infection Ratio for CAUTIs that was at least 33 percent lower than the baseline.
Source: safepatientproject.org

OIG Calls for Cuts in Medicare Rates for Back Orthoses : Health Industry Washington Watch

The OIG is calling on CMS to lower Medicare payment for certain back orthosis products, either by subjecting these products to the Medicare durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) competitive bidding program or by making an inherent reasonableness adjustment. This recommendation stems from the OIG’s findings that Medicare payment amounts far exceeded supplier acquisition costs for lumbar-sacral orthoses billed under L0631. Specifically, between July 2010 and June 2011, the average Medicare-allowed amount for L0631 was $919, compared to the average supplier acquisition cost of $191, resulting in Medicare paying an estimated $37 million more than supplier costs. Moreover, while the code descriptor for L0631 references fitting and adjustment services, the OIG found that for 33% of claims the supplier did not report providing such services, and only 7% of suppliers reported providing any additional services other than general instructions. CMS agreed that Medicare payments for back orthoses billed under HCPCS code L0631 “should be adjusted to more closely reflect the supplier’s acquisition costs for the device and the level of service provided when furnishing the device.” CMS indicated that it would be pursing competitive bidding rather than an inherent reasonableness adjustment, noting that it is working to finalize its classification of HCPCS codes that may be considered to be “off-the-shelf” orthotics and subject to DMEPOS competitive bidding (the preliminary classification list included HCPCS code L0631). 
Source: healthindustrywashingtonwatch.com

Medicare Is More Efficient Than Private Insurance

The CBO explicitly stated that its data on relative cost growth should not be used to make the argument that Goodman and Saving make, writing that the relatively low growth rate of all health care expenditures other than Medicare and Medicaid “should not be interpreted as meaning that Medicare or Medicaid is less able to control spending than private insurers.” Goodman and Saving mistakenly suggest that the growth rate of private insurance is the same as the growth rate of all health care expenditures other than Medicare and Medicaid; however, as CBO points out, the growth rate of all health care expenditures other than Medicare and Medicaid includes not just spending by private insurers, but also government programs and out-of-pocket costs paid by the uninsured.
Source: healthaffairs.org

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

Today’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

MITA Applauds Congress for Letter on Medicare Rates

“Recent data confirm that imaging is the slowest growing category in Medicare fee-for-service program, with two consecutive years of declining utilization,” Gail Rodriguez, executive director of MITA said in a statement. “MITA applauds Congressmen Gerlach and Green and their colleagues for recognizing the importance of making budget decisions based on the latest available data, and we thank them for their continued support in the fight to protect and preserve access to medical imaging services for Medicare beneficiaries.”
Source: healthcare-informatics.com

UMHS signs with Priority Health HMO/PPO effective March 1

Posted by:  :  Category: Medicare

Newsweek Magazine (February 16, 2009) ... Lenders Add Bigger Fannie, Freddie Fee – Thanks to Payroll Tax Cut (January 15, 2012) ...item 2.. Dupuy: GOP trying to sell pyrmaid scheme to voters (September 3, 2012) ... by marsmet526Effective March 1, 2013, UMHS will become a participating provider with Priority Health for their commercial HMO and PPO plans. Priority Health is a subsidiary health plan of Spectrum Health System. Priority Health HMO and PPO members may be seen at UMHS for both primary and specialty care at an in-network benefit level beginning March 1, 2013. Additionally, UMHS has been a participating provider with Priority Health’s Medicare Advantage plans since September 2012. UMHS remains a non-contracted provider for Priority Health’s Medicaid and MIChild plans. Staff should continue to follow the Medicaid Specialty Access process for Priority Health Medicaid members.
Source: umhsheadlines.org

Video: 2009 Medicare TV spot for Priority Health Medicare plans – couple RV’ing

BCBS, Priority Health rank highest in state for Medicaid, Medicare

If you enjoy the content on the Crain’s Detroit Business Web site and want to see more, try 8 issues of our print edition risk-free. If you wish to continue, you will receive 44 more issues (for a total of 52 in all), including the annual Book of Lists for just $59. That’s over 55% off the cover price. If you decide Crain’s is not for you, just write “Cancel” on the invoice, return it and owe nothing. The 8 issues are yours to keep with no further obligation to us. Sign up below.
Source: crainsdetroit.com

Priority Health Adds Medicare Advantage Plan and Seven Counties.

Medicare is available to individuals age 65 and older as well as to some people with disabilities. Medicare recipients may enroll between November 15 and December 31, 2010. To learn more about Priority Health’s Medicare plans, premiums by county and participating health care providers, call Priority Health toll-free at 888 389-6676, visit a Priority Health Medicare Information Center in Holland, Grand Rapids, Kalamazoo or Traverse City (opening November 1) or go to prioritymedicare.com. Priority Health’s Medicare Advantage health plans are available in 38 counties: Allegan, Antrim, Barry, Benzie, Cass, Charlevoix, Clare, Crawford, Emmet, Grand Traverse, Hillsdale, Ionia, Jackson, Kalamazoo, Kalkaska, Kent, Lake, Leelanau, Livingston, Manistee, Macomb, Mason, Mecosta, Missaukee, Monroe, Montcalm, Muskegon, Newaygo, Oakland, Oceana, Osceola, Otsego, Ottawa, Roscommon, St. Clair, Washtenaw, Wayne and Wexford.
Source: blogspot.com

House GOP Seeks To Change Medicare Doctor Payment Formula

Medpage Today: Bill Near To Repeal SGR? House Republicans are launching a renewed effort to repeal Medicare’s sustainable growth rate (SGR) reimbursement formula, reaching out to Democrats and the medical community in favor of replacing yearly “fixes” with a permanent change in the system. Repealing and replacing the SGR is a priority for the law’s two authorizing committees in the House — the Energy and Commerce Committee and the Ways and Means Committee, an Energy and Commerce aide said Thursday. In a sign of how important this issue is, the Energy and Commerce Health Subcommitee’s first hearing this year will be on the SGR. It’s slated for Feb. 14, although a witness list hasn’t yet been finalized (Pittman, 2/7).
Source: kaiserhealthnews.org

Priority Health members will now have full access to UMHS careClass Action Dispatch

Priority Health is an award-winning health plan nationally recognized for creating innovative solutions that impact health care costs while maximizing customer experience. It offers a broad portfolio of products for employer groups and individuals including Medicare and Medicaid beneficiaries. As a nonprofit company, Priority Health serves more than 600,000 people and continues to be rated among the best health plans in the nation by the National Committee for Quality Assurance.
Source: invisibleagentrecords.com

Priority Health Expands Its Medicare Offerings

2012 2013 about after attack Bill Blog Business care case Celebrity China court Dead death economy First from Health House Iran jobs killed more News Obama Over Police politics Poll post President report Romney says Senate Sports Syria Syrian Technology Times U.S. update Video World
Source: thenewsroom.info

U.S. recovers $4.2 billion from healthcare fraud probes: report

The Obama administration has stepped up investigations under the program, making the prevention of fraud and waste in healthcare a top priority. The Patient Protection and Affordable Care Act authorized additional tools to fight fraud, including tougher eligibility screening for Medicare providers, increased data sharing among government agencies and greater oversight of private insurance abuses.
Source: medcitynews.com

Americans Prioritize State Insurance Exchanges, Oppose Medicare Cuts, Poll Finds

Fifty-five percent of the public, including majorities of Republicans and Democrats, say that establishing the exchanges —a key element of the Affordable Care Act (ACA) and one whose implementation has divided states along partisan political lines—is a “top priority” for their governor and legislature. So far 18 states and the District of Columbia have declared that they will create their own state-based exchanges, seven other states have opted to establish exchanges in partnership with the federal government and 25 others—some driven by resistance to the ACA—appear set to default to a federally-run exchange. The survey did not make a distinction as to whether the exchange was run by the state or the federal government.
Source: healthcare-informatics.com

Clear thinking needed on election health priorities

Thank you to all who commented, expanding the conversation well beyond the article I had written. Sandra Bradley, Margo Saunders and Sue Ieraci all raise questions about the ethics of how we make individual and collective choices about health care. In the past we have ducked questions about prolonging life with a pragmatic rule based on opportunity costs – expensive life-support resources should be allocated to those who can gain the greatest benefits. That rule accords with most utilitarian and faith-based ethical frameworks, but we are now in an era where, for many conditions, life can be prolonged at low cost. We don’t necessarily have to turn off A’s life support to save B – we can keep both going. The ethical questions are now much harder. Another question, made by Tim Niven and Margo Saunders, is about people’s lifestyle choices. If people are making what others see as “bad choices”, how should others respond – with liberal indifference or with strong paternalism, with gentle persuasion or with strong sanctions? The contrast between our strong intervention on smoking and our laissez faire attitude to poker-machine harm suggests we are far from a consistent set of policy principles. Then there are basic questions about governments and interest groups raised by Bruce Tabor, Chris O’Neill and Sue Ieraci. The idea that governments in democracies are guided by appeasement of interest groups has a great deal of explanatory value, but it does not always hold. Moral philosophers such as Isaiah Berlin through to practical politicians such as Robert Reich point out the power of ideas in shaping public policy. Even within the interest group framework, a situation in which peace reigns, as at present, is an optimum only according to some policy models. Other models based on game theory show that here can be much better outcomes for all concerned, but to get there we must open our minds to new possibilities and be prepared to make big moves. The Hawke-Keating Government move on tariff reform and the Howard Government move on indirect taxes and state finances are cases in point. Can we make such moves in health policy?
Source: edu.au

Daily Kos: Poll finds majority support for exchanges, Medicaid, Medicare

Consider if one or more of these tags fits your diary: Civil Rights, community, Congress, Culture, Economy, Education, Elections, Energy, Environment, Health Care, International, Labor, Law, media, Meta, National Security, Science, Transportation, or White House. If your diary is specific to a state, consider adding the state (California, Texas, etc). Keep in mind, though, that there are many wonderful and important diaries that don’t fit in any of these tags. Don’t worry if yours doesn’t.
Source: dailykos.com

What’s Up with Meaningful Use Stage 3? : Schwartz MSL PRx

According to a letter by EHRA: “The EHRA strongly recommends that Stage 3 focus primarily on encouraging and assisting providers to take advantage of the substantial capabilities established in Stage 1 and especially Stage 2, rather than adding new meaningful use requirements and product certification criteria. In particular, we believe that any meaningful use and functionality changes should focus primarily on interoperability and building on accelerated momentum and more extensive use of Stage 2 capabilities and clinical quality measurement.”
Source: schwartzmsl.com

Medicare Myths » Toni Says

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 marsmet481Myth #1:  Most baby boomers think Medicare is just like regular health insurance plans…FALSE!!  Only 2 in 5 or 40% of the baby boomers surveyed know that Medicare is totally different than traditional group or individual health insurance.  Medicare has 2 Parts A & B.  Part A has a $1,184 deductible 6 times a year for an in hospital stay.  Part B of Medicare includes doctor’s services such as office visits and doctor performing surgery, outpatient services and surgery, scans, x-rays, chemotherapy and radiation, and the list goes on.  There is a 1 time deductible for Part B of $147.00 once a year with Medicare picking up 80% and you pay 20% of the Medicare approved amount with no co-insurance or stopping.  Not like the typical 80/20 to $5,000 with a stop lost. The 20% just keeps on going!! Toni Says: Medicare is completely different than health insurance. Your out of pocket can be huge if you only have Medicare or the red, white and blue card. Learn what Medicare offers.
Source: tonisays.com

Video: Enrolling in Medicare

Ask The Experts: Retirement

Q. I’m 74 and have been retired for 5½ years. During that time, my medical coverage has been through my working wife’s FEHB family plan and Medicare Part A. I’ve never enrolled for Medicare Part B. My wife has just retired, retaining the FEHB family plan. She will also enroll (SEP) for Medicare Part B. If I enroll for Medicare Part B, will I be penalized for late enrollment?
Source: federaltimes.com

Affordable Health Insurance: What You Need To Know About Enrolling in Medicare When You Turn 65

Most people believe that enrolling in Medicare when you reach the age of 65 is straight forward and uncomplicated. However, depending upon one’s circumstances this may not be the case. For example if someone is continuing to work when they reach the age of 65 or if he or she has health insurance under his or her spouse this could complicate matters. Listed below are some things to consider if you are nearing the age of 65 and wondering about Medicare enrollment. 1. If you are already receiving Social Security retirement benefits you will be automatically sent a Medicare card in the mail three months prior to your 65th birthday.You will be enrolled in Medicare Part A and Medicare Part B. If you don’t want the Part B right now, follow the instructions sent to you and send the card back to Social Security. 2. If you are still working you will not be automatically enrolled in Medicare when you turn 65. If you want Medicare you must contact Social Security Administration to enroll. 3. You have a seven month window to enroll in Medicare starting three months prior to your birthday month and three months following your birthday month. 4. If you are still working and your employer employs more than 20 people, you may not need the Medicare B right away. Contact your Human Resources. representative for more information. 5. If you stop working and have a retiree plan through your employer you will still need to enroll with the Medicare Part B. 6. Medicare A and Medicare B do not cover all services at 100%. You will normally need a Medicare supplemental plan or Medicare Advantage Plan to help cover some of those costs not covered by Medicare. Medicare Supplemental plans and Advantage Plans are private insurance plans. 7. Medicare Advantage Plans are also known as Medicare Part C. You are eligible to choose and enroll in a Medicare Advantage Plan at the time you are eligible for Medicare. You can join during the seven month window period which begins three months prior to your birthday month and three months following your birthday month. 8. You are also eligible to sign up with a Medicare supplemental plan at the time you are eligible for Medicare. You have a six month period to sign up with a Supplemental plan, beginning from the month of your 65th birthday and/or when you are eligible for Medicare Part B. 9. You should not have both a Medicare Supplemental Plan and a Medicare Advantage Plan at the same time. You will need to choose one or the other. 10. Medicare Part D is the prescription drug plan. You will not be automatically enrolled in a Medicare Part D plan. You must either sign up with a Medicare Advantage Plan (which includes the drug coverage) or a stand alone plan which just offers the Medicare Part D. As you can see there is a lot to consider when you get closer to that age of eligibility for Medicare. If you are confused about enrollment you can receive free Medicare counseling through the State Health Insurance Assistance Program or SHIP. Contact the Department of Aging in your county for more information or go to http://www.SHIPtalk.org. Karen Porterfield, MA, MSW, is a hospital social worker who works with Susan Hartfield, PharmD, RPA-C to assist people with understanding Medicare and their insurance options. Visit their website http://www.understandmedicare.org for more information.
Source: blogspot.com

3 Tips for Avoiding Pitfalls in Medicare Enrollment

IAM is an SEC registered investment adviser with its principal place of business in the State of Texas.  IAM and its representatives are in compliance with the current registration and notice filing requirements imposed upon registered investment advisers by those states in which IAM maintains clients.  IAM may only transact business in those states in which it is noticed filed, or qualifies for an exemption or exclusion from notice filing requirements.  Any subsequent, direct communication by IAM with a prospective client shall be conducted by a representative that is either registered or qualifies for an exemption or exclusion from registration in the state where the prospective client resides.  For information pertaining to the registration status of IAM, please contact IAM or refer to the Investment Adviser Public Disclosure web site (www.adviserinfo.sec.gov).  For additional information about IAM, including fees and services, send for our disclosure brochure as set forth on Form ADV using the contact information herein.
Source: iaminvest.com

Medicare confusing, but don’t put off enrolling

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Source: fredericksburg.com

Supreme Court Forces Government Healthcare on Citizens

“When the government stopped tracking EAJA payments in 1995, it was a dream come true for radical environmental groups. Lack of oversight has fueled the fire for these groups to grind the work of land management and other federal agencies to a halt — and it does so on the taxpayer’s dime. Americans have unwittingly funded these obstructionist political agendas for far too long at the expense of individuals, small businesses, energy producers, farmers and ranchers who must pay out of their own pocket to defend the federal government against relentless litigation,” Lummis said. “This common sense legislation would help restore integrity to EAJA and return the program to the original intent of Congress.”
Source: ruralliberty.org

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

Posted by:  :  Category: Medicare

The page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

Video: Medicare Plan Finder Lesson 5: Comparing Plans

Medicare Targets Health Plans With Low Ratings

Medicare officials are encouraging 525,000 beneficiaries to switch out of these 26 Medicare Advantage and drug plans that have received low ratings for three consecutive years and enroll in better plans for next year. The poor performing plans will have this warning symbol next to their names on Medicare’s plan finder website to steer shoppers to other plans.
Source: kaiserhealthnews.org

Medicare Open Enrollment: More is better

For 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

5 mistakes retirees make choosing a Medicare plan

About 1 in 4 Medicare beneficiaries chooses a Medicare Advantage plan, which sometimes offers benefits beyond what’s included in traditional Medicare. If you’re considering a Medicare Advantage plan, remember that this model means seeing out-of-network providers can quickly become a costly proposition for you. Before signing up for this option, call your preferred doctors, specialists and hospitals to verify that they participate in the plan’s network. This can get tricky if you travel a lot, spend winters in a different location, or get a referral from your primary-care doctor to a specialist who’s out of network.
Source: sltrib.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

Medicare Open Enrollment Period through Dec. 7

With more benefits, better choices and lower costs, the Centers for Medicare & Medicaid Services (CMS) is encouraging people with Medicare and their families to begin reviewing drug and health plan coverage options for 2012. The Medicare Open Enrollment Period – which began earlier this year on Oct. 15 – has been expanded to last seven weeks and will end on Dec, 7. This will give seniors and people with disabilities more time to compare and find the best plan that meets their unique needs. Across the country, HHS officials will hold 150 events in the days leading up to Medicare’s Open Enrollment Period to inform and educate people with Medicare.
Source: sundancetimes.com

AARP Urges Congress to Address Medicare Physician Payments

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 marsmet481“As you know, physicians and other health care providers are scheduled to receive a 27 percent cut on January 1, 2013, as a result of the flawed sustainable growth rate (SGR) formula.  This is in addition to the 2 percent reduction included in the planned sequestration.  Failure to adopt legislation to address the “doc fix” would create considerable instability in the Medicare program.  Such a significant reduction in reimbursement could cause providers to stop seeing Medicare beneficiaries or prevent them from accepting new ones.  We are disappointed that Congress has thus far been unable to develop a long-term solution to this perpetual problem.  However, even in the absence of a longer-term solution, the SGR cuts must not be allowed to occur.  Under current law, the Centers for Medicare and Medicaid Services may begin issuing the reduced payments on January 1.  A reduction for even a short time in reimbursement rates could disrupt access to care, as providers may delay seeing Medicare patients until updated rates go into effect. 
Source: aarp.org

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

Phone Presentation Medicare Advantage

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

Jon Stewart Paraphrases Marco Rubio: ‘Medicare Helps MY Mom, But F _ _ k You’

We encourage users to engage in a respectful discussion of this post, below. Comments are not necessarily representative of MoveOn.org’s views or beliefs, nor are commenters necessarily MoveOn members. This is a community-moderated forum: If you see something offensive, please flag it. If a comment receives enough flags, it will be removed.
Source: moveon.org

Get Ready For Enrolled Agent Education on New Medicare Tax on Investment Income

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Source: fastforwardacademy.com

Are Medicare Advantage Plans Skimming Off Healthiest Patients?

Posted by:  :  Category: Medicare

Cassandra Q. Butts by Center for American ProgressA 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

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

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

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

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

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

The page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

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

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

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

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

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

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 Delivery System Reform Employers Essential Benefits Exchanges GRP Health Insurance Tax Health Plan Innovations Health Plan Satisfaction House hearings House legislation KI MA Medical Prices Medical Tests medicare medigap MLR Morning Headlines Patient Safety premiums Profits Provider Consolidation Quality Rate Review Reform RZ Senate hearings Senate legislation Small Business The Link Vilification Waste Fraud and Abuse
Source: ahipcoverage.com

Last Chance to Disenroll from Your Medicare Private Health Plan

Beneficiaries who disenroll from their private plan may need to join a stand-alone Medicare prescription drug plan in order to maintain drug coverage. Medicare Rights advises beneficiaries who are choosing a plan to consider not only premium and copayment costs, but also whether the drugs they take are on the plan’s formulary (list of covered drugs) and whether they can use the pharmacies they prefer. Beneficiaries should also check to see whether the plan places any restrictions on the drugs they take. Restrictions can take the form of quantity limits, prior authorization and step therapy. To learn more about choosing a Medicare prescription drug plan that best meets your needs, visit Medicare Interactive.
Source: utahboomersmagazine.com

91 Charged With $430 Million Medicare Billing Fraud

Posted by:  :  Category: Medicare

White House Medicare Presentation by National Institutes of Health LibraryHouston Chronicle: FBI Arrests Historic Houston Hospital’s CEO, Son, 5 Others After 30 years as CEO of one of Houston’s most historic hospitals, Earnest Gibson III, along with his son and five others, was arrested on Thursday — part a national Medicare fraud sweep involving $430 million in bogus billings and 91 health care providers in seven states. If the allegations against the 68-year-old Gibson are true, that he and others at the hospital bilked the Medicare program of $158 million over a period of more than seven years, it could prove lethal for Riverside, once the primary hospital for the city’s black population. Gibson and his son Earnest Gibson IV, 35, were charged with 13 counts: conspiracy to commit health care fraud; conspiracy to defraud the United States and pay and receive health care kickbacks; one count of money laundering and ten counts of violating the anti-kickback statute (Langford, 10/4).
Source: kaiserhealthnews.org

Video: Cheryl Bradley lectures on Medicare Billing

Loopholes to help you track Medicare Part B therapy billing

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

Prime Acknowledges Federal Probes Over Billing, Data Disclosure

In addition, the Service Employees International Union-United Healthcare Workers West — which is involved in a labor dispute with Prime — conducted research in 2008 and 2009 and found that Prime hospitals reported some of the highest rates of the bloodstream infection septicemia in the U.S. (California Healthline, 6/6/12).
Source: californiahealthline.org

Judge may issue own order for WakeMed settlement over Medicare billing violations

The government said that the order would hold WakeMed publicly accountable for its actions and force the hospital to pay back money to the Federal government. Prosecutors say if WakeMed was taken to court on a criminal charge, it would put the hospital out of business and thousands of workers would be left unemployed.
Source: news14.com

Doctors billing Medicare patients at higher rates, report finds

“This is an urgent problem,” Dr. Mark McClellan, who directs the Engelberg Center for Health Care Reform at the Brookings Institution in Washington, told the CPI. McClellan, a former director of the Centers for Medicare and Medicaid Services, or CMS, said the agency must send a message that it “won’t stand by and do nothing … that they are paying attention to this.”
Source: nbcnews.com

Change in Billing Option Leads to an Increase in Medicare Spending

The authors of the study caution that their findings do not make any broad statements about the effects of coding changes in general. It is important to realize that the spike in Medicare spending during the year of 2010 could in fact be a one-off anomaly as opposed to a trend. But the researchers were able to conclude that in this particular case of Medicare billing structure alteration, the projected results of the change were out of alignment with the actual real-world repercussions.
Source: questns.com

Hospices’ Medicare Billing Practices Under False Claims Act Scrutiny

Recent actions by the Department of Justice (DOJ) in False Claims Act (FCA) whistleblower cases highlight one of the types of Medicare fraud that can occur in hospice care facilities. Hospices provide palliative care – medical treatment that concentrates on reducing the severity of a disease’s symptoms – to patients who decide to forego curative care of their illness. Medicare beneficiaries are entitled to hospice care if they have a terminal prognosis and are certified by a hospice physician as having six months or less to live. In one recent whistleblower case, South Carolina-based Harmony Care Hospice Inc. and CEO/Owner Daniel J. Burton paid the U.S. $1.287 million to resolve allegations that they knowingly submitted or caused to be submitted false claims for patients who did not have such a prognosis and thus were not eligible for hospice care. The qui tam case brought by two former Harmony employees is captioned United States ex rel. Singletary, et al. v. Harmony Care Hospice, Inc., et al., Case No. 2:10-cv-01404-PMD (D.S.C.). In another recent case, DOJ intervened in a whistleblower’s case against the Altamonte Springs, Florida-based Hospice of the Comforter, alleging that the nonprofit routinely over-billed Medicare for patients who didn’t qualify as terminally ill, sometimes keeping them in hospice care for as long as five years. The whistleblower in that case is a former nursing-home administrator who became the hospice’s vice president of finance in February 2008, and was later fired in retaliation for urging the hospice CEO and several board members to repay Medicare for the overbillings.
Source: bostonwhistleblowerlawyerblog.com

Sen. Menendez contacted top officials in friend

2011 Medicare Deductibles and Premiums

Posted by:  :  Category: Medicare

Healthcare in America: Who's Paying Who? And Who's Getting What? (g1a2d0014c1) by watchingfrogsboil “Part A premiums are decreasing because spending in 2010 was lower than expected and the Affordable Care Act implemented policies that lower Part A spending due to payment efficiencies and efforts related to waste, fraud and abuse. Part B premiums are increasing because of growth in the use of services like outpatient hospital care, home health and physician-administered drugs. In addition, the premium accounts for a likely Congressional action to avert a precipitous decrease in physician payments, which the Administration supports, and has occurred every year since 2003. The Administration is committed to permanent reform of the physician payment formula.”
Source: wordpress.com

Video: Medicare & the Affordable Care Act in 2011

Medicare Part B Premium Costs Likely To Cut Into Social Security’s Increase

The Wall Street Journal: Prices Rise 0.3%, Prompting Boost In Government Benefits The climb in prices means millions of Americans who rely on government programs such as Social Security will receive their first cost-of-living increase since 2009. It also will raise taxes on close to 10 million of the 161 million workers who pay Social Security taxes. That’s because in 2012, Americans will have to pay the payroll tax on their first $110,100 in earnings, up from the $106,800 in earnings in 2011. … Nearly 55 million Social Security beneficiaries will see their checks rise by 3.6 percent beginning in January. … The 3.6 percent increase could be partially or completely offset by a bump in the premiums that seniors pay for Medicare Part B benefits, which have been held flat for many beneficiaries because of low inflation in the last two years. … The Centers for Medicare & Medicaid Services could announce their premiums and copayments for 2012 as soon as next week. Because Medicare premiums are deducted directly from Social Security checks, many Americans may never see an increase (Paletta and Murray, 10/20).
Source: kaiserhealthnews.org

Daily Kos: Cantor’s big relaunch of the GOP on health care a lead balloon

grytpype, DeminNewJ, filkertom, hnichols, lippythelion69, kitebro, litigatormom, menodoc, Lilith, lyvwyr101, reflectionsv37, Gordon20024, noweasels, gpoutney, Clive all hat no horse Rodeo, NancyWH, FlamingoGrrl, john07801, offgrid, paz3, jayden, Fireshadow, TomP, Sixty Something, jamess, Gemina13, Magick Maven, Zotz, followyourbliss, stevenwag, Railfan, Just Bob, Its the Supreme Court Stupid, Puddytat, BlueFranco, cocinero, slowbutsure, Mr MadAsHell, poorbuster, OhioNatureMom, NormAl1792, thomask, BarackStarObama, Vatexia, stlsophos, Sister Inspired Revolver of Freedom, IndieGuy, a2nite, Buckeye54, avsp, Canis Aureus, remembrance, Says Who, aresea, LaraJones, Icicle68, TheDuckManCometh, Ticorules, Betterthansoap, wyckoff
Source: dailykos.com

How to Transform Medicare into a Modern Premium Support System

In the FEHBP, the capped amount of the government’s contribution to employees’ health plans is based on 72 percent of the weighted average premium of health plans competing in the program. This formula, allowing for changes in the market, also provides that the government’s contribution cannot exceed 75 percent of the cost of any given plan. If federal workers or retirees buy a plan that is more expensive than the government contribution, they pay the extra costs. OPM determines “reasonable minimal standards” for plans, ensures that the health plans are fiscally solvent, and enforces rules for consumer protection. It does not set prices, standardize health benefit packages, or apply detailed guidelines for doctors or hospitals. Compared to Medicare’s rules, OPM’s regulatory role in FEHBP is light, and it is focused on providing a level playing field for health plans to compete. Walton Francis, a prominent Washington-based health care economist, writes that “the FEHBP has outperformed original Medicare in every dimension of its performance. It has better benefits, better service, catastrophic limits on what enrollees must pay, and far better premium cost control.”[11] 
Source: heritage.org

Medicare Advantage Grows; But Not Without Government Help

The net result, encouraging more plans to compete in the Medicare market, is not actually in the best interest of seniors. In a study published last month in Health Affairs, researchers found that too many choices with too little guidance can be overwhelming for Medicare enrollees, especially the growing proportion that is experiencing cognitive difficulties. “Our study suggests that the Medicare Advantage program presents an overabundance of choices for many elderly beneficiaries,” the researchers write. “Medicare Advantage plans currently compete for enrollees through the benefits they offer and the premiums they charge, but elderly beneficiaries with low cognitive function were not responsive to changes in these features.” The implication, according to Health Affairs, is that these “unresponsive” seniors may buy into plans not well suited to their needs, allowing private insurers to profit “by offering less-generous coverage or reducing benefits while still attracting or retaining enrollees with limited cognitive abilities.”
Source: healthbeatblog.com

Beware of Medicare Fraud Calls

Posted by:  :  Category: Medicare

Congressman Kendrick B. Meek by cliff1066™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

Video: Medicare Tax ~ HiltonHeadReal EstateNews.com

flu medicare hcpcs 2011 crosswalk

                                          New HCPCS Codes for Medicare 2010-2011. G8482 INFLUENZA IMMUNIZATION ADMINISTERED OR PREVIOUSLY RECEIVED – HCPCS Procedure & Supply Codes – FindACode.com For dates of service on or after October 1, 2010, HCPCS codes Q2035, Q2036, Q2037, Q2038 and Q2039 will replace the CPT Code 90658 for Medicare payment purposes 2011 Medicare Codes for Flu Shots: Q2035, Q2036, Q2037, Q2038 Effective January 1, 2011 the Centers for Medicare & Medicaid Services (CMS) will no longer Medicare has released new flu vaccine codes that are specific to the vaccine manufacturer, and will pay using the new codes (replacing 90658) after January 1, 2011.
Source: rediff.com

Police: New Medicare Scams Target Seniors

Officer Tammie Colling of Northfield Township said in some instances the caller contacts a senior and claims to be with Medicare, informing the senior that they will be receiving a new Medicare card in the mail. The caller advises that a direct deposit system needs to be set up so the Medicare funds can be deposited into the victim’s bank account. The caller then requests the senior’s banking information. Another variation of the scam, according to Colling, involves callers asking the senior to verify his or her identity in order to receive the new card. The caller requests the current Medicare card number, which is the same as the victim’s Social Security number. After a few more questions regarding personal information, the caller is able to steal an individual’s identity.
Source: patch.com

Medicare Recipients Targeted in Phone Scam

The caller apparently attempts to retrieve personal information from the victims by various forms of tactics, even stating to some individuals that their benefits will be cancelled if they do not assist completely. In most of these cases, the suspect appears to sound as though they have a Hispanic accent.
Source: staceypageonline.com

Medicare Part D off to rocky start

Although the program officially launched on New Year’s Day, the real Part D rush didn’t hit the nation’s retail pharmacies until Jan. 2, when tens of thousands of seniors began to present millions of prescriptions. The system broke down because too many of them did not have proof of their enrollment in a Medicare Rx plan. Pharmacists were stymied when they tried to tap into NDCHealth’s overloaded E1 electronic eligibility system. Trying to pin down Rx plan details, staffers dialed up insurers’ help desks only to encounter busy signals or harried operators unable to cope with the volume of calls. Some pharmacists spent up to two hours on hold, and others were disconnected or told to phone back later. Adding to the chaos was the fact that the phone lines set up by the Centers for Medicare & Medicaid Services were also understaffed.
Source: modernmedicine.com

Officials warn Wisconsin seniors to be on the lookout for scam involving Medicare cards

The sad truth is that elderly people are often targeted by those committing fraud and other types of white collar crimes due to their trusting nature. For instance, we discussed back in November how grandparents throughout the country, including right here in Wisconsin, were still being victimized by the long-standing telephone scam involving a phone call from a fictional grandchild who is supposedly in need of emergency funds.
Source: milwaukeecriminallawyerblog.com

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 revalidation, DMEPOS fee still prompt questions among ODs

Posted by:  :  Category: Medicare

Jessica Sundheim by On Being“Medicare covers post-op eyeglasses for cataract patients only if the glasses are provided by a DMEPOS supplier who is enrolled in Medicare,” Dr. Jordan said. “If the optometrist is not enrolled in Medicare for DMEPOS, then the glasses are not covered. Neither the doctor nor the patient can obtain reimbursement for the glasses from Medicare if the supplier is not enrolled. If a Medicare beneficiary wants to pay out-of-pocket for eyeglasses from a supplier who is not enrolled in Medicare, she or he may do so, but the doctor should be sure to explain to the patient that the glasses would be covered if they were obtained from another supplier who is enrolled in Medicare. In addition, the doctor should be certain to have an ABN form signed by the patient acknowledging that although she/he could have these glasses covered elsewhere she/he agrees to pay the doctor out-of-pocket and that he or she cannot get reimbursement from Medicare.”
Source: newsfromaoa.org

Video: Medicare Shared Savings Program and Advance Payment Model Application Process

New insights into the 3.8% Medicare surtax

Here’s the whole story: Effective Jan. 1, 2013, the 3.8% Medicare surtax applies to the lesser of “net investment income” (NII) or the amount by which modified adjusted gross income (MAGI) exceeds a threshold of $200,000 for single filers and $250,000 for joint filers. For example, if you’re a joint filer and have annual NII of $100,000 and a MAGI of $300,000 in 2013, you must pay a surtax of $1,900 (3.8% of the $50,000 above the MAGI threshold of $250,000). For estates and trusts, the surtax applies to the lesser of undistributed NII or adjusted gross income (AGI) above the taxable income threshold for the highest tax bracket.
Source: businessmanagementdaily.com

Can accountable care organizations reign in health

AB 32 AB 109 aging aging with dignity Ashby Wolfe Bay Area breast cancer bridge to reform budget children City Heights diesel Every Woman Counts global warming Greater Sacramento greenhouse gas health insurance health reform Healthy San Francisco Housing in-home care Medi-Cal nutrition oakland obesity pesticides pollution prevention prison realignment regulation Richmond San Francisco San Joaquin Valley SB 375 Schwarzenegger single-payer smoking Southern Boarder Southern California taxes tobacco transit unemployment wellness youth
Source: healthycal.org

Vermont Medicaid Provider Enrollment Agreement

 Medicaid is a health insurance program run jointly by theUSfederal government and the respective states. It’s a program mainly aimed for the needy and low income group people. It also provides coverage to children, senior citizens, people with disabilities like blindness and others. Each of the states runs its own Medicaid program. It’s monitored by the Center for Medicare and Medicaid Services (CMS). Individual states set out individual benchmarks for the program regarding how it’ll be financed and managed.
Source: medicarevermont.com

Pelosi Again Rejects Proposal To Change Medicare

The Hill: Obama: Sequester Would Deal ‘Huge Blow To Middle-Class Families’ The president devoted a significant amount of his (weekly Saturday) address to outlining the real-world consequences that would result if the sequester was implemented. On Friday, top administrative aides warned the cuts would hamper law enforcement, hurt federal education programs, withhold mental health services and furlough thousands of workers. “If the sequester is allowed to go forward, thousands of Americans who work in fields like national security, education or clean energy are likely to be laid off,” Obama said. “Firefighters and food inspectors could also find themselves out of work – leaving our communities vulnerable. Programs like Head Start would be cut, and lifesaving research into diseases like cancer and Alzheimer’s could be scaled back” (Sink, 2/9). 
Source: kaiserhealthnews.org

Tell the Centers for Medicare & Medicaid Services to Provide Language Access

The federally facilitated exchange (FFE) must comply with both Title VI of the Civil Rights Act and Section 1557 of the ACA. To prevent discrimination against LEP individuals, the FFE must ensure access and understanding for LEP consumers. In addition to the legal requirements, federal translation of the application would benefit all entities engaged in enrollment, outreach and education. Translated applications will assist in ensuring effective communication by creating a baseline for standardizing ACA-related enrollment terminology and creating translation “glossaries” that can be used by other entities for outreach, education and training, saving costs of re-translating the same terms. Translated applications can also help train bilingual staff and interpreters who will assist LEP individuals to ensure consistency and accuracy, thus aiding effective enrollment and information dissemination.
Source: asiaohio.org

Last Chance to Disenroll from Your Medicare Private Health Plan

Beneficiaries who disenroll from their private plan may need to join a stand-alone Medicare prescription drug plan in order to maintain drug coverage. Medicare Rights advises beneficiaries who are choosing a plan to consider not only premium and copayment costs, but also whether the drugs they take are on the plan’s formulary (list of covered drugs) and whether they can use the pharmacies they prefer. Beneficiaries should also check to see whether the plan places any restrictions on the drugs they take. Restrictions can take the form of quantity limits, prior authorization and step therapy. To learn more about choosing a Medicare prescription drug plan that best meets your needs, visit Medicare Interactive.
Source: utahboomersmagazine.com

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

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

Application of Medicare Contribution Tax of 3.8% to Certain U.S. Persons Owning Stock in A Controlled Foreign Corporation or Passive Foreign Investment Company : Federal Taxation Developments Blog

As mentioned, a U.S. shareholder of a CFC is required to include certain amounts in income, i.e., Subpart F income to the extent of earnings and profits, under Section 951(a). The Preamble to the Section 1411 proposed regulations states that constructive or pass through income includible under Section 951 will generally not be treated as dividends in computing NII as dividend income unless expressly provided for in the Code. Still NII treatment will result to the extent the Subpart F income is derived from a trade or business to which the tax applies as provided in Section 1411(c)(1)(A)(ii)(trading trading in financial instruments or commodities) and Prop. Treas. Reg. § 1.1411-4(a)(1)(ii)). As to PFICs, a U.S. person is required to income in income amounts described under Section 193 if the taxpayer makes a QEF election under Section 1295.. Section 1293 inclusions also are not treated as dividends unless expressly provided for in the Code, and, therefore, also are not taken into account for purposes of calculating net investment income (unless the amount is derived from a trade or business to which the tax applies as provided in Section 1411(c)(1)(A)(ii) and Prop. Treas. Reg. §1.1411-4(a)(1)(ii)).  This difference in timing for reporting income for chapter 1 (regular income tax) and chapter 2A (Section 1411), as well as other overlapping provisions, will require a taxpayer to compute separate stock basis for chapter 1 and chapter 2A, subject to making an election under Prop. Reg. §1.1411-10(g) which seems to only be available after 2013 although the Preamble to the regulations when read with the proposed regulations is not entirely clear on this point, i.e., whether such election can be made for a taxable year beginning in 2013.
Source: foxrothschild.com