Long Waits For Consumers When Medicare Is ‘Secondary Payer’

Posted by:  :  Category: Medicare

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

Video: Medicare Supplemental Insurance Plans

Medicare Secondary Payer: Conditional Payment Reimbursement Policies for Certain Liability Settlements

Beginning February 21, 2011, CMS implemented an option permitting certain Medicare beneficiaries the ability to self-calculate Medicare’s conditional payment amount prior to settlement. As with other recent policies, the option is available only to liability insurance (including self-insurance) settlements and not workers’ compensation or no-fault claims and only when involving a physical trauma based injury and not ingestion, implantation or exposure. The dollar threshold was established at $25,000 or less and the date of incident must have occurred at least six months prior to the submission of the self-calculated amount to Medicare for review. The beneficiary must demonstrate that treatment has been completed and that no further treatment is expected through written physician attestation or a written certification by the beneficiary that there was no treatment for at least the 90 days prior to submission and that there is no further care expected. The election of this option bars the beneficiary from appealing the amount or existence of this debt, but the right to pursue waiver of recovery will remain.
Source: lexisnexis.com

Statement to the Record on the Medicare Secondary Payer and Workers’ Compensation Settlement Agreement Act

HR 5284 creates a system of certainty and allows the workers’ compensation settlement process to move forward while eliminating millions of dollars in administrative costs.  It will help create clear and consistent standards, currently lacking in the process, to address workers’ compensation issues.  Most importantly, it will benefit all parties involved – injured workers, employers, insurers and CMS.  
Source: house.gov

SMART Act Amends Medicare Secondary Payer Statute, Creates Three

The SMART Act requires the Secretary of Health and Human Services (“Secretary”) to establish a process by which a claimant (or his or her authorized representative) can dispute discrepancies with the statement of reimbursement amount. A claimant or authorized representative must submit documentation of the potential discrepancy and a proposed resolution to the Secretary. The Act states that the Secretary must determine whether there is a reasonable basis for including or removing a claim and provide a response within eleven (11) business days. Lack of a response is a deemed acceptance of the claimant’s proposal. If the Secretary determines that there is not a reasonable basis to include or remove claims, the proposal will be rejected. If the Secretary concludes that there is a discrepancy, but rejects the proposed resolution, documentation showing good cause for why the Secretary has rejected the proposal and establishing an alternate discrepancy resolution must be provided to the claimant. This process does not create an appeals process, however, and the SMART Act expressly forecloses the possibility of administrative or judicial review of the Secretary’s determinations. Final regulations must be promulgated by October 10, 2013, nine (9) months after the date of enactment, the effective date of this provision.
Source: crowell.com

House Panel Approves Changes to Medicare Secondary Payer (MSP), Medical Loss Ratio Rules : Health Industry Washington Watch

On September 20, 2012, the House Energy and Commerce Committee approved by voice vote H.R. 1063, the Strengthening Medicare and Repaying Taxpayers (SMART) Act. The legislation would make a series of procedural changes to MSP rules intended to “speed up the process of returning money to the Medicare Trust Fund while reducing costly legal barriers for both large and small employers.” The panel also approved on a 16-14 vote H.R. 1206, the Access to Professional Health Insurance Advisors Act. The legislation would amend the Affordable Care Act’s (ACA) health insurance medical loss ratio (MLR) rules to exclude from the calculation of the MLR certain commissions paid to independent insurance brokers and agents. H.R. 1206 also would require HHS to defer to a state’s determinations as to whether enforcing the MLR requirement will destabilize their respective individual or small group health insurance markets. Neither bill has been considered by the full House to date.
Source: healthindustrywashingtonwatch.com

Obama Signs Medicare Secondary Payer Reforms

President Barack Obama signed a bill Thursday that will change the way Medicare recovers money for health care services from secondary payers, in a bid to speed up settlements to beneficiaries from other payers like car insurance companies. Read More…
Source: lexisnexis.com

Where Do We Stand On the Tenth Anniversary of the Medicare Secondary Payer Industry

The Patel memo resulted in a lot of frenzy and confusion, with attorneys and many others in the property and casualty industry coming to believe that CMS approval was required by law, while others, such as Jennifer C. Jordan, Esq., General Counsel at
Source: lexisnexis.com

Obama signs Medicare Secondary Payer Act

Obama signs Medicare Secondary Payer Act H.R. 1845, a bill that aims to simplify compliance with the Medicare Secondary Payer Act, has been signed into law by President Obama. http://www.businessinsurance.com/section/rss?feed=NEWS
Source: public-liability-insurances.com

The Rules of The Medicare Secondary Payer

6 ways to improve the orthopedics practice A Study in 5010 and Podiatry Q Codes Benefits of EMR/EHR billing and coding issues EHR electronic health records EMR EMR consultant emr dictation integration emr integrated medical billing services EMR revolution EMR software EMR support EMR support company EMR support services HITECH incentives icd9 to icd10 ICD 10 implementation Increasing Revenues Through Medical Billing iSource medical billing medical billing office medical coding medical rata Medical records medical reports medical transcription medical transcription and billing medical transcription service industry Orthopedic surgeons orthopedic transcription outsourcing medical billing patient records revamping the revenue management cycle services The Benefits of EMR The Hour Of Reckoning The integration of pacs into orthopedic emr tips Transcribers transcription provider trends for orthopedic tutorial US Healthcare
Source: medicaltranscriptionsservice.com

Medicare Secondary Payer and “Future Medicals” A Movement Toward a Standardized Process?

CMS states that its interests should be considered in every settlement where the claimant, “reasonably anticipates receiving, or should have reasonably anticipated receiving Medicare covered…services after the date of “settlement…”.  To accomplish this purpose, CMS proposes options  ranging from absolute exemptions on one end of the spectrum (i.e., CMS defined a set of circumstances in which no further action would be necessary / no “set aside” required) to alternatives on the other end of the spectrum that involve a) the beneficiary paying for all future injury-related care out of his/her settlement proceeds until they are exhausted or b) submitting a proposed Medicare Set Aside arrangement (similar to the current process in workers’ compensation).With regard to the latter options, it is important to note that CMS acknowledges that perhaps thresholds could be established (i.e., a dollar amount below which no action is necessary even if one of the other exemptions do not apply).
Source: dritoday.org

Medicare Supplement Phone Sales

Posted by:  :  Category: Medicare

I sell med supps exclusively by phone. What I can tell you is there is a crazy amount of companies offering medicare supplements, and a lot of companies only operate in certain states. 47 states would just hinder your production with out a team of agents, as opposed to just focusing on 3-4 states. Most states you’ll have two or three companies worth writing depending on their situation and you’ll just be replacing everything else for the most part.
Source: insurance-forums.net

Video: Medicare Supplement Plans (How to Find)

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

During open enrollment, your right to purchase a Medicare supplement policy is guaranteed, no matter your health condition or past medical history. Insurers cannot refuse to offer you a policy. You also cannot be asked to pay a higher premium because of insurance risks you may bring to the table. For example, a smoker will pay the same premiums as a non-smoker. There is no medical screening for applicants during the open enrollment.
Source: kurafire.net

Explaining Medigap Insurance

•Medigap policies are identified by letters A through N and insurance companies in most states can only sell you a standardized policy. What this means, for example, is that a Plan F policy will offer the same basic benefits, no matter which insurance company offers it. Therefore it pays to shop around, as cost is usually the main difference between Medigap policies sold by different insurance companies. However, when shopping around for coverage remember that the best medicare supplement for you is not just the cheapest one. You also want to factor in the reputation and service offered by the insurance carrier.
Source: themhnews.org

Medicare and Medicare Supplemental Insurance

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

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

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

What Are My Medicare Options

Medicare supplement insurance will actually cover the 20% that original Medicare (parts A and B) doesn’t cover. So when you go to the doctor, for example, you show your Medicare card and your supplemental insurance card. Instead of the insurance carrier taking over your original Medicare and filling in the gaps, the supplement will leave your Medicare as is and add additional insurance. The benefit of this plan is that it allows you to see any doctor that takes Medicare as opposed to the Advantage plan that usually requires you to be in a network. The drawback of this plan is that it can be quite expensive and isn’t affordable for a lot of folks.
Source: jewishjournal.com

Medicare Supplement Insurance coverage

When you utilize a web site to obtain Medicare Supplement Insurance, all you have to do is complete a form that asks basic details such as your gender Prograde supplements and age.  You will see distinct insurance policies from varying providers and you will be able to assessment the costs and policy figures from each and every provider.  In the finish you can select the insurance coverage policies that give what you need to have and that are financially sound.
Source: pakchom.net

Comparing Medicare Supplemental Insurance Benefits

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

How To Know If You Need Medicare Supplemental Insurance

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

Part V: Medicare Supplemental Insurance

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

Protect your Family with Medicare Supplement Insurance

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Source: your-shopname.com

All About Medicare Supplement Insurance!

Yes to ensure that your health insurance is complete, you need to have a combination of both the Medicare services as well as the Medicare supplement insurance services. Do not just go about buying the maximum number of Medigap policies. There are 12 standardized policies there for you. Ascertain first of all, which services you really need. Go through all the plans and ascertain which one you will have the most and best coverage for you. Of course you must be sure of your decision. Most of the times, agents will try to take you to the more expensive plans. Make sure you have just that very standardized plan that you need. Get the best deal out of the health insurance industry.
Source: wordpress.com

The Official Medicare Set Aside Blog And Information Resource: Florida Court Refuses to Opine as to Whether an LMSA is Needed or Not

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 marsmet481So while unfortunate that we cannot get a judicial opinion on the matter, the outcome is the right one. An MSA is a risk management tool to prevent future potential Medicare recovery actions. It is not an express statutory or regulatory requirement at this time and may never become one given that we are trying to assess damages on something that hasn’t happened and may never happen. I have no doubt that the statute permits Medicare to make payments post-settlement for which it would be entitled to reimbursement, but there are several factors that could potentially limit the nature and extent of that occurrence. Only parties to the settlement have the ability to agree what do to in the event that the situation arises at some point in the future. And the sooner that everyone finally realizes that we hold the power to control this situation, the easier this issues will be to resolve in all settlements.
Source: medicaresetasideblog.com

Video: Paul Ryan Talking Medicare in Florida

Whistleblower Alleges Overbilling Of Medicare By Florida Hospice

Douglas Stone was an executive at the Hospice of the Comforter, based in Altamonte Springs, when he learned that the company was overbilling Medicare for patient stays. He filed a whistleblower lawsuit alleging Medicaid/Medicare fraud against the Florida nursing home a year ago; the U.S. Department of Justice recently intervened and will now be pursuing the Medicare fraud claims.
Source: federalwhistleblowerlawyers.com

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

Philip Greenspun's Weblog

The Carnival Triumph can cruise at about 22 knots, which means that it could cross the 90 miles of water that separate Florida from Cuba in about 4 hours. Why not set the ship up as an ambulatory care clinic staffed with Cuban doctors? The ship can sail every day from Florida to Cuba and back. Any Medicare patient who can be treated on board will enjoy the round-trip sail, the waterslide park, and the rest of the amenities on board. Any Medicare patient whom the doctors deem to require more extensive treatment can get off in Cuba and be admitted to a hospital there for a procedure to be performed at a tiny fraction of the cost to the U.S. taxpayer.
Source: harvard.edu

South Florida Pharmacy Owner Allegedly Used Dead Beneficiaries to Defraud Medicare

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

Is Florida Medicare Insurance Different From Other States?

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

Florida Pharmacy Owner Admits to $23 Million Health Care Fraud Scheme

The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.
Source: wordpress.com

Ryan Vows to Protect Medicare at Florida Retirement Community

Betty Ryan Douglas was on stage with her congressman son Saturday at the world’s largest retirement community as the Republican campaign tried to blunt withering criticism from President Barack Obama and his allies. The Democratic team charges that presidential candidate Mitt Romney and Ryan would gut programs for older people.
Source: theroot.com

Obama Pledges ‘Modest Reforms’ to Medicare in State of the Union

Medicare dominated healthcare components of President Barack Obama’s State of the Union address and was one of the largest targets in the Republican response delivered by Sen. Marco Rubio of Florida. Medicare President Obama said looming healthcare spending for the nation’s aging population will fuel the government’s long-term debt unless lawmakers “embrace the need for modest reforms.” “On Medicare, I’m prepared to enact reforms that will achieve the same amount of healthcare savings by the beginning of the next decade as the reforms proposed by the bipartisan Simpson-Bowles commission,” the president said. He also pledged reduced subsidies to pharmaceutical companies and increased Medicare contributions from wealthy beneficiaries. Sen. Rubio’s rebuttal simultaneously defended Medicare and called for larger reforms to it. “I would never support any changes to Medicare that would hurt seniors like my mother. But anyone who is in favor of leaving Medicare exactly the way it is right now, is in favor of bankrupting it,” he said. “Republicans have offered a detailed and credible plan that helps save Medicare without hurting today’s retirees. Instead of playing politics with Medicare, when is the president going to offer his plan to save it? Tonight would have been a good time for him to do it,” Sen. Rubio added. Healthcare reform The president’s signature Patient Protection and Affordable Care Act received a fraction of the airtime compared with Medicare and other topics. President Obama said the PPACA “is helping to slow the growth of healthcare costs,” though fact-checkers say the evidence to support that is unclear. Sen. Rubio kept with his party’s mantra and challenged the legislation. “Obamacare was supposed to help middle-class Americans afford health insurance. But now, some people are losing the health insurance they were happy with,” he said. He added the policy has constricted businesses’ ability to hire more employees or keep them full-time, and it has caused workers to lose their pay raises due to expensive health benefits and administrative overhead.
Source: beckershospitalreview.com

Florida Physician to Pay $26.1 Million to Resolve False Claims Allegations

WASHINGTON—Steven J Wasserman, MD ., a dermatologist practicing in Venice, Florida, has agreed to pay $26.1 million to resolve allegations that he violated the False Claims Act by accepting illegal kickbacks from a pathology laboratory and by billing the Medicare program for medically unnecessary services, the Justice Department announced today. The settlement is the largest ever with an individual under the False Claims Act in the Middle District of Florida and one of the largest with an individual under the False Claims Act in United States history. The government alleged that, in or around 1997, Dr. Wasserman entered into an illegal kickback arrangement with Tampa Pathology Laboratory (TPL), a clinical laboratory in Tampa, Florida, and Dr. José SuarezHoyos, a pathologist and the owner of TPL, in an effort to increase the lab’s referral business. Under that agreement, Dr. Wasserman allegedly sent biopsy specimens for Medicare beneficiaries to TPL for testing and diagnosis. In return, TPL allegedly provided Dr. Wasserman a diagnosis on a pathology report that included a signature line for Dr. Wasserman to make it appear to Medicare that he had performed the diagnostic work that TPL had performed. The government alleged that Dr. Wasserman then billed the Medicare program for TPL’s work, passing it off as his own, for which he received more than $6 million in Medicare payments. In addition, the government asserted that, in furtherance of his agreement with TPL, Dr. Wasserman substantially increased the number of skin biopsies he performed on Medicare patients, thus increasing the referral business for TPL. The government further alleged that, in addition to his involvement in the alleged kickback scheme, Dr. Wasserman also performed thousands of unnecessary skin surgeries known as adjacent tissue transfers on Medicare beneficiaries. Adjacent tissue transfers are complicated and often time-consuming procedures physicians sometimes use to close a defect resulting from the removal of a growth on a patient’s skin. The government alleged that Dr. Wasserman performed many of these procedures in order to obtain the reimbursement for them and not because they were medically necessary. “Doctors who take illegal kickbacks and perform unnecessary procedures not only put their own financial self-interest over their duty to their patients, they raise the cost of health care for all of us as patients and as taxpayers,” said Stuart F Delery, Principal Deputy Assistant Attorney General for the Civil Division of the Department of Justice. “The Department of Justice will not tolerate those who abuse the public health care programs to which we all contribute and on which we all depend.” “This settlement represents a watershed achievement in our district’s civil healthcare fraud enforcement program,” said Robert O’Neill, United States Attorney for the Middle District of Florida. “Schemes of this magnitude require extraordinary remedies, and we are proud to have reached such an outstanding resolution for the taxpayers and their health programs.” The allegations resolved by today’s settlement were initiated by a lawsuit originally filed in the District Court for the Middle District of Florida by Alan Freedman, MD ., a pathologist who formerly worked at TPL. Dr. Freedman filed the lawsuit under the qui tam, or whistleblower, provisions of the False Claims Act. Under the False Claims Act, a private party may file suit on behalf of the United States for false claims and share in any recovery. The United States has the right to intervene in the action, which it did in this case, filing its own complaint in October 2010. Dr. Freedman will receive $4,046,000 of today’s settlement. The United States previously settled with TPL and Dr. SuarezHoyos for $950,000 to resolve the allegations asserted against them in the same lawsuit. “Anyone cheating patients and taxpayers should expect to pay a high price,” said Daniel R Levinson, Inspector General of the United States Department of Health and Human Services. “Besides paying more than $26 million, Dr. Wasserman is excluded from treating patients and being paid under Medicare, Medicaid, and all other federal health care programs.” This resolution is part of the government’s emphasis on combating health care fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced by Attorney General Eric Holder and Kathleen Sebelius, Secretary of the Department of Health and Human Services in May 2009. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover more than $10.2 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department’s total recoveries in False Claims Act cases since January 2009 are over $14 billion. Principal Deputy Assistant Attorney General Delery and United States Attorney O’Neill thanked the joint investigation team, which includes special agents with the Department of Health and Human Services-OIG and the FBI, for their efforts in the investigation of this matter. The claims settled by this agreement are allegations only; there has been no determination of liability. The lawsuit is captioned United States ex rel. Freedman v. SuarezHoyos et al ., No. 04-933 (M.D. Fla.). Reported by: FBI
Source: 7thspace.com

1 Drug, $1.3M Medicare Overpayment in FL

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

Florida Surgeon Under Scrutiny With Sen. Menendez

A South Florida eye surgeon who’s a friend of a U.S. senator is under federal criminal investigation for billing Medicare millions of dollars to treat elderly patients for services they may not have needed, The Miami Herald has learned. Federal agents began investigating Dr. Salomon Melgen last year, sources say, after investigators suspected he overbilled the taxpayer-funded health program by overprescribing a high-priced drug called Lucentis, which is injected into patients’ eyes. Several sources familiar with the doctor’s practice said he used the drug, which costs $2,000 a vial, to treat patients with macular degeneration more than any other ophthalmologist in Florida and possibly the country. His high patient volume also raised red flags for investigators, the sources said. Under Medicare policies, a doctor may only prescribe treatment that is “reasonable” and “necessary.” To make a case, federal prosecutors would have to prove that Melgen needlessly treated patients simply to run up sky-high Medicare bills. Melgen, whose lawyers have denied any wrongdoing, finds himself in the middle of two federal investigations: His Vitreo-Retinal eye clinics in West Palm Beach and two other South Florida sites were raided last week by agents with the FBI and the Department of Health and Human Services, who are investigating possible Medicare fraud. MENENDEZ PROBE A separate FBI investigation revolves around the doctor’s relationship with U.S. Sen. Robert Menendez, D-N.J., and the trips they took on his private plane to Melgen’s villa at a resort in the Dominican Republic. Melgen donated more than $750,000 last year to Menendez’s reelection campaign and other political committees and candidates. Menendez has insisted that he only took two personal trips on the doctor’s plane and recently reimbursed him $58,500 for the travel expense — but only after an ethics complaint was filed against him in New Jersey last year. Of late, Menendez also has drawn media coverage for contacting Medicare officials to help resolve Melgen’s nearly $9 million billing dispute stemming from a 2008 audit. The dispute revolves around claims filed by Melgen’s patients who received Lucentis. Menendez also advocated on his friend’s behalf to the U.S. State Department and at a Senate hearing, where he pushed for enforcement of a $500 million port security contract in the Dominican Republic that would directly benefit Melgen. The doctor owns half of a company that won the contract from the Dominican government a decade ago, but is now stalled. On Thursday, Menendez acknowledged that his office contacted Medicare officials to help Melgen, but the senator denied he sought to intervene improperly in billing disputes between the doctor and the government. Menendez said he contacted the U.S. Centers for Medicare & Medicaid Services to ask generally about billing practices and policies. “The bottom line is, we raised concerns with CMS over policy and over ambiguities that are difficult for medical providers to understand and to seek a clarification,” Menendez told The Associated Press. The senator called federal health officials in 2009 and met with them again in 2012, each time urging them to change what he called an unfair payment policy. Medicare ordered Melgen to repay the government program $8.9 million, and he complied, but he is appealing the decision.
Source: hispanicbusiness.com

Ryan's Medicare Plan: How Big a Factor in Florida?

As Obama for America’s Florida press secretary, Eric Jotkoff, put it: “If the headlines don’t tell the story, then certainly Floridians can say that Mitt Romney and Paul Ryan are simply out of touch and have no idea what’s important to the people of Florida. Whether it’s a budget that could end Medicare as we know it forcing Florida seniors to pay $6,350 a year out of their pockets or a tax hike which would burden hard-working middle-class families, Romney and Ryan’s campaign is toxic in the Sunshine State, and they will have a hard time convincing voters to choose them in November.”
Source: realclearpolitics.com

Hospital groups denounce Medicare cuts

Posted by:  :  Category: Medicare

peace by MBK (Marjie)In the new era of customer care, forward-thinking healthcare organizations are implementing care-focused SMS, voice, and email notifications programs as an integral part of their business operations and competitive strategy. Join OpenText EasyLink for an insightful look at how healthcare organizations can improve their customer service using interactive notifications. Register Today!
Source: fiercehealthfinance.com

Video: Missouri Medicaid and Missouri Medicare Recipients – Special Benefits For You Only

House Democrats Call On President Obama To Reject Benefit Cuts To Medicare, Medicaid, And Social Security Benefits

We write to affirm our vigorous opposition to cutting Social Security, Medicare, or Medicaid benefits in any final bill to replace sequestration. Earned Social Security and Medicare benefits provide the financial and health protections necessary to keep individuals and families out of poverty. Medicaid is not only a lifeline for low-income children, pregnant women, people with disabilities and families, it is the primary source of long-term care services and supports for 3.6 million individuals. We cannot overstate their importance for our constituents and our country.
Source: taylormarsh.com

Medicaid Eligibility Laws in Missouri

Medicaid benefits are provided to those who meet the requirements as per the Medicaid Eligibility Laws in Missouri. Applicants can receive Medicaid benefits if they are citizens of United States or are eligible and qualified non-residents. They must be residents of Missouri and intend to maintain residency in Missouri. Applicants should be medically eligible in terms of age (65 or above) or diagnosed with permanent disabilities if aged below 65.
Source: medicaremissouri.com

Dean of University of Missouri

The radiologists, Dr. Kenneth Rall and Dr. Michael Richards, are alleged to have billed Medicare for radiologic studies that only residents read; the two attending radiologists did not over read the studies yet billed Medicare as if they had. It is unclear how much money the department accepted from Medicare as a result of these practices or how long ago the alleged fraudulent practices began. Dr. Rall was the chairman of the department of radiology until December 2011, when he resigned because of these issues. A month after his resignation, the Columbia Tribune also discovered that 62.5% of imaging studies within the department did not have legitimate physician orders.
Source: pathologyblawg.com

Tony’s Kansas City: MISSOURI GOP KILL MORE MEDICARE CASH

Meanwhile . . . Tough talk among GOP voters is convincing until Grandma gets unplugged. On the (not so) bright side, emboldened Republicans in Missouri seem eager to show the State the power of their bad ideas and how they plan to crack down everyone but the petty bourgeois and the elite . . . So it stands to reason that over time a great many of their new found influence will be wasted on a vendetta against the Prez Obama.
Source: tonyskansascity.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

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

Medicare, Health Law Are Common Themes In House And Senate Races

The Associated Press/Wall Street Journal: Spending By Outside Groups Rocks Many House Races Rep. Dan Lungren knows what it’s like to have a big bull’s eye plastered on his back. The Democratic Party and labor and environmental groups have spent $4.7 million on TV commercials and other efforts to unseat the nine-term Republican congressman from California. That makes him one of the biggest targets of outside groups, which are throwing unprecedented sums of money into House races this year. “I don’t recognize the person they’re portraying,” Lungren said about the ads that paint him as an ally of Wall Street and enemy of Medicare and abortion rights. He added, “Yeah, these ads have a considerable impact” (10/27).
Source: kaiserhealthnews.org

Anthem Blue Cross Medicare Supplement Plan F

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSAlso 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: Is Freedom Blue PPO a Medicare Supplement?

anthem medicare supplement 332

abacusrx.com Get New York Medicare plans and New York Medicare plan quotes. Talk to a licensed insurance agent in your area at GoMedicare. 1.Hughesnet Reviews and Complaints Hughesnet Reviews and Complaints – You could get direct answers to your … and I can say from experience that HughesNet has the 2009 All insurance plan list (summary) Plan Name PlanID Processor BIN PCN 340B CMS 6405 ARGUS  
Source: rediff.com

Anthem Medicare Preferred PPO Plan and Rates

Anthem Blue Cross Life and Health Insurance Company (Anthem) is the legal entity that has contracted with the Centers for Medicare and Medicaid Services (CMS) to offer the Medicare Advantage Local PPO Plan(s) (MAPD-LPPO) noted.  Anthem is the risk bearing entity licensed under applicable state law to offer the MAPD-LPPO plan(s) noted.  Anthem has retained the services of its related companies and the authorized agents/brokers/producers to provide administrative services and / or to make the MAPD-LPPO plan(s) available in this region.  Anthem Blue Cross Life and Health Insurance Company is an independent licensee of the Blue Cross Association.  Anthem is a registered trademark of Anthem Insurance Companies, Inc.  The Blue Cross name and symbol are registered marks of the Blue Cross Association.
Source: johnconner.com

Anthem Blue Cross Blue Shield Medicare Supplement Plans Are Affordable…

Based in beautiful Jackson Hole, Wyoming, we currently market health insurance in 18 different states from our website IndividualHealth.com. I have worked in the domestic and international markets for most of my adult life. Recently we launched a newly revamped website www.tetonmarketing.com which has a primary focus on music and Native American Flutes and hand crafted items made in Wyoming. Check it out! I want the Insurance Simplified Blog to be a place you can visit from time to time and read about real world issues that individuals and families face daily. Our parent website IndividualHealth.com we like to think of as a virtual brochure. But with the blog I want to talk about the topics behind the brochure. Also check out our blog www.JacksonHoleTim.com which is “All Things Wyoming, Everything Jackson Hole” . If you love the Yellowstone basin this is blog for you! Then when you are ready check out our new Social Network site Jacksonholetim.ning.com – this is a place you can connect with other who visit and live in Wyoming. And finally we have just launched another new blog. Jackson Hole Tim (www.jacksonholetim.com) is a new place to visit that talks about “All things Wyoming, Everything Jackson Hole”. I hope you find these blog helpful.
Source: wordpress.com

Anthem Medicare Supplement

The Apex Merchant Group scam has been viewed online for the past 2 years or so to the delight of those who enjoy discontent and disharmony rather than resolution and growth. The Apex Merchant Group, which has been in business since 2008 and with headquarters in Texas, went through some of the most tough times with these so-called rip off reports. With the Internet, it has been so easy to post comments and reviews irrespective of consequences. Many businesses like Apex Merchant Group have suffered tremendous losses in confidence and potential new clients because of baseless or incomplete negative feedback.
Source: scoop.it

Anthem Medicare Supplemental Insurance Reviews

With Anthem Medicare Supplemental Insurance you’ll have the freedom to rely upon coverage for deductibles and co-insurance that traditional Medicare coverage doesn’t cover. You will also have the liberty of enjoying the security of knowing these benefits will not change regardless of the changes in your health. Freedom to choose plans offering 100% coverage for the basic benefits is also standard and that includes preventative care service as well. You will also have the option of selecting plans that cover well-trained nursing facilities, Medicare Part B Excess fees, and even far-off travel emergencies while exploring the world.
Source: ihealthcoalition.org

Anthem Blue Cross of California Medicare Supplement

Anthem Blue Cross of California has a been a dominant fixture in the California health insurance market for decades now and their participation in the California Medigap market is no exception. One of the key concerns when shopping for Medicare supplement plans is a carrier’s strength and stability in the market since the purchase can echo decades into the future. Anthem Blue Cross definitely looks good in this light since they are one of the original providers of Medigap plans and can be considered as a leader in the market. Let’s dig a little deeper into their participation, pricing, and plan design in the California market. In most states, Blue Cross and Blue Shield are the same company. California, as always, is very unique in that the two are separate companies for the individual, family, small group, and Senior medigap markets. They each offer their own plans and options for supplements. Once that’s cleared, let’s look at Blue Cross of California which is part of the Anthem nationwide company. Anthem Blue Cross is one of the first companies in California to offer Medicare supplement plans to the Senior market which makes sense in that Medigap plans are the senior equivalent to PPO plans and Cross has a strong presence in the PPO marketplace among all segments of health insurance. The alternative to PPO’s would be HMO and the alternative to Medigap plans (used interchangeably with Medicare supplement) would be Advantage plans which are the new derivatives of old senior HMO’s from a decade ago. Let’s get back to California Medicare supplement plans. Blue Cross of California has offered many of the available standardized plans allowed by Medicare. They were even one of the first to offer a high deductible F plan under the branding of Smart Choice which is still around. Currently (1/1/2012), Anthem Blue Cross of California offers the F high deductible, N, A, G, and Standard F Medicare supplement plans. This offering may change over the course of time as it does with all carriers although the A, F, and F high deductible are standards for Anthem Blue Cross California Medigap. As with most carriers across the country, the F plan (not high deductible option) continues to be the most popular California Medigap plan and for good reason since it covers all major gaps of traditional Medicare and at a good premium to benefit comparison. The key comparison is with the F high deductible option in our view since this plan still covers all the important holes in original Medicare but uses a deductible to reduce the premium. How do you go about comparing the two plans? First, take the monthly premium difference over a year’s time. We can run those quotes for you. Next, compare this annualized premium difference against the potential deductible amount you would pay under the California F high deductible plan. That gives you a baseline. If you do not have sizeable medical expenses now (outside of medication), the savings in premium looks pretty attractive. Keep in mind that your decision will likely travel with you for a long time especially if health changes so it’s best to assume worst case (you reach full deductible) to know what the potential risk is for a bad year. You now have the best case of the California high deductible F plan (full savings on the premium side) and the worst case (meet full deductible minus the premium savings). This gives you the the opposite extremes and you can expect many years to be in between depending on your health status. Now, it’s a question of your risk comfort level. Also, if you have large health issues, the California high deductible F plan will probably not be the right choice. Either way, Anthem Blue Cross of California offers both Medigap options and we feel comfortable with them as a strong carrier in the senior California medigap market for years to come.

Medicare to Cut Payments for Not Meeting Reporting Requirements

Posted by:  :  Category: Medicare

Joe the Plumber - To Flush The System ... More scams aim to ensnare Brevard seniors - Their ingenuity is boundless, Archer said. (Jul 2, 2012) ... by marsmet524According to the website on PQRS from the Center for Medicare and Medicaid Services (CMS), “Beginning in 2015, if the eligible profes-sional or group prac-tice does not satisfactorily submit data on Physician Quality Reporting System quality measures, a 1.5 percent payment adjustment will apply. To avoid the 2015 adjustment, an eligible professional must satisfactorily report Physician Quality Reporting System quality measures during the 2013 reporting period (Jan. 1-Dec. 31, 2013).”
Source: nationalpsychologist.com

Video: Canvas-CMS1500-HEALTH-INSURANCE-CLAIM-FORM Black Berry.mp4 – Mobile App – GoCanvas.com

Medicare revalidation, DMEPOS fee still prompt questions among ODs

“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

2013 Brings Many Changes for Therapists in the Medicare Program

Tagged as: Bells And Whistles, Bill Medicare, Bonus Payment, Cmrs, Corf, Functional Limitation, Healthcare Reimbursement, Home Health Agencies, Medicare Patients, Medicare Program, Outpatient Therapy, Party Hats, Private Practice Settings, Private Practices, Quality Measures, Reimbursement Services, Ringing In The New Year, Skilled Nursing Facilities, Therapy Providers, Therapy Settings
Source: cherifreeman.com

Home Health Medicare Claims / Eventish

Learn To Submit A Compliant Claim To Medicare For proper reimbursement, the home health agencies need to submit a clean claim for to Medicare. But in our haste to “get the bill out the door” and reimbursement “in the door” are red flags in coding and OASIS inadvertently triggering selection of our records for review and possible denials? Not only the codes and OASIS M items can result in a denial of payment but also the failure to adequately document the physician face to face, skilled services, homebound status, and the focus of the plan of care put our claims at risk and are areas of increased scrutiny by RACs and the OIG in 2013.
Source: eventish.com

Dru Writes: Medicare Mandatory Reporting Requirements

party administrator. The Center for Medicare and Medicate Services (CMS) requires this information to be submitted electronically. The data that the CMS is after is your Medicare Health Insurance Claim Number (HICN) or your Social Security Number (SSN). This may become a problem for RREs because of the recent wave of identity theft and the caution people have towards it. The CMS has issued communication about this issue saying that the participant may instead use a model collection form for reporting. The RRE must have the participant re-sign the model collection form every 12 months to keep it valid. While the reporting obligations fall to the RREs, the RREs will often ask the employers as the plan sponsors to collect this data. RREs should emphasize the importance of obtaining the HICN or the SSN of the participants, it simply makes the paper work easier.
Source: blogspot.com

Article > Medicare drug price negotiations “could save US $541B by 2022″

The proposal’s advocates say they are expecting strong opposition. “The GOP [Republican Party) would rather cut life-saving benefits for seniors than bring some of the most profitable companies on earth to the negotiating table,” said Ethan Rome, executive director of the group Health Care for America Now (HCAN), which is coordinating legislative and field activities for the campaign in states across the US. The campaigners also say that while opponents could claim that lower prices would sap much of the revenues and incentives for financing R&D for new drugs, they would also disincentivise improper marketing of medicines and misrepresentation of the quality and safety of drugs. “There is a strong argument for developing a more efficient mechanism for financing drug research, and there is little reason for people in the United States to continue to overpay for a system that serves us poorly,” says CEPR.
Source: pharmatimes.com

Hospice and Caregiving Blog: Changes to Medicare Hospice Claim Form

The Centers for Medicare & Medicaid Services (CMS) recently issued CR6791 which requires hospice agencies to report a separate line item for each time the levelof care changes.For hospice claimssubmitted on or after April 29, 2010, hospices should report separate line itemsfor the level of care each time the level of care changes. This includes revenuecodes 0651 (Routine Home Care), 0655 (Inpatient Respite Care) and 0656 (General Inpatient Care).Read the complete release on the CMS website.
Source: hospicefoundation.org

GAO: Additional Imaging Self

Additional imaging service referrals by providers who self-referred cost Medicare approximately $109 million, according to a U.S. Government Accountability Office report. The report, “Higher Use of Advanced Imaging Services by Providers Who Self-Refer Costing Medicare Millions,” examined the rate of imaging referrals among providers who self-referred and those who did not, and the accompanying costs. Results showed that from 2004 through 2010, the number of self-referred MRI services increased by more than 80 percent, while the number of non-self-referred MRI services increased by only 12 percent. Overall, self-referring providers referred roughly twice as many imaging services in 2010 as providers who did not self-refer, according to the report. GAO estimates self-referring providers likely made 400,000 more referrals for advanced imaging services in 2010 than they would have if they were not self-referring, resulting in an approximate cost of $109 million to Medicare. Moreover, these additional referrals pose a risk to patient safety due to increased radiation exposure, according to the GAO report. The differences in referral rates between self-referring and non-self-referring providers remained after accounting for practice size, specialty, geography and patient characteristics, according to the report. To address the high rate of imaging service referrals among self-referring physicians, GAO made three recommendations to the administrator of CMS: 1. Insert a self-referral flag on its Medicare Part B claims form and require providers to indicate whether the advanced imaging services for which a provider bills Medicare are self-referred or not. 2. Determine and implement a payment reduction for self-referred advanced imaging services to recognize efficiencies when the same provider refers and performs a service. 3. Determine and implement an approach to ensure the appropriateness of advanced imaging services referred by self-referring providers. While HHS said it would consider the third recommendation, it did not concur with the first two. For the first recommendation, HHS said CMS believes a new checkbox on the claim form would be complex to administer and may not characterize referrals accurately. For the second recommendation, CMS commented that an additional payment reduction may cause providers to refer more services in an effort to maintain their income, according to the report.
Source: beckershospitalreview.com

Choosing Your Outlook on Functional Limitation Reporting : Physiospot

ACL Acupuncture Adherence Anatomy Ankle Ankylosing Spondylitis Assessment Asthma Balance Biomechanics Cardiac Cardiac Rehab CBT Cerebral Palsy Cervical Chronic Pain CIMT Clinical Guidelines Clinical Prediction Rule clinic management software Contemporary Interventions COPD Critical Care CSP Current Affairs Cystic Fibrosis Diabetes Eccentric Exercise education eHealth EIM Elbow Electrophysical Electrotherapy Evidence In Motion Exercise Performance Exercise Therapy Falls Fatigue Fibromyalgia Foot Gait Haemodynamics Hamstrings Hand Headache Head Injury Help Hip Hydrotherapy ICU Imaging Incontinence Injection Therapy Knee LBP Lumbar Manipulation Manual Techniques Manual Therapy Massage Therapy Metabolic Mobilisation Multiple Sclerosis Muscle Imbalance Neurodevelopmental Neurodynamics Neuromuscular Obesity online clinic management Orthopaedic Rehab Osteoarthritis Osteoporosis Outcome Measures Parkinsons Disease PFPS Pharmacology Physiology Pregnancy Pulmonary Rehab Rehabilitation Respiratory Rheumatoid Arthritis Shoulder SIJ Soft Tissue Techniques Spinal Injury Spine Stretching Stroke Stroke Rehabilitation Suction Surgery Taping Telehealth Tendinopathy Thoracic Urgency WCPT Wrist
Source: physiospot.com

Medicare Terminology To Know

Medicare summary notice (MSN) deals directly with the beneficiary or the person covered  under Medicare. The MSN replaced the Explanation of Medicare Benefits form in 2001.[1] This is an easy to read document sent to the Medicare holder every month that allows them to see their Part A and Part B claims. The MSN also holds the deductible status. Basically it is an information sheet. Often when a patient receives the MSN they think it is a bill. It is important to understand that this is not a bill but rather an explanation of what has transpired the previous month under their Medicare coverage.
Source: codingcertification.org

Blog: How Medicare Works with Other Insurance

Posted by:  :  Category: Medicare

Rogue Magazine (October 1964)  Volume 9 Number 5 - Water Balloons ...item 1.. routinely use devious devices -- wears us down like rabid trial lawyers until we give in (August 15, 2011 / 15 Av 5771) ... by marsmet542Medicaid 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

Video: How Medicare Works

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

Medicare: can we protect what works and still fix delivery, financing?

So here’s my take: Medicare is a popular program but its cost is not sustainable. Cost shifting by providers borne by the privately insured is not a long-term solution to the $105 trillion obligation owed current and future beneficiaries. And solutions that incrementally modify the program’s funding—higher premiums, delayed eligibility, required co-payments in MediGap coverage, changes to its annual cost formula using the Chain Consumer Price Index (CPI), a voucher-type alternative and others—without fundamentally restructuring the delivery of services will fall short. While possibly effective in changing what the Medicare program spends, these might not solve the larger issues of costs and cost shifting, or the fundamental challenge of overtreatment and unnecessary care. So the issue is not just what to do with Medicare costs; it’s what to do with health costs! For seniors today, cost is the problem. Tragically, 46% die with virtually no financial assets, largely because their out-of-pocket health costs exceeded their savings.
Source: deloitte.com

How Medicare Works With My Other Insurance

The supplemental insurance agent we use at work joined Columbia River Insurance Services over a year ago. We got some great rates on our new personal life insurance policies. Chrys suggested we get a quote on our home and auto policies. Another employee advised she had CR take a look at her policies and she saved a ton so we finally checked it out. With farm, home, residential rental, and multiple vehicles it wasn’t the easiest policy to review. This was no 15 minutes and you’re done! As it turns out we didn’t really save much if any money, but gained A LOT of necessary coverage – much of which we didn’t realize was missing under our old policy!! We couldn’t be happier. We’re recommending Columbia River to all our friends and family. Thanks Chastain & Chrys!
Source: columbiariverinsuranceservices.com

Medicare Advantage Works As Long As You’re Healthy, But Boots Off Neediest Patients

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Source: flaglerlive.com

How Medicare Advantage Works

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

Why Won’t Medicare Cover An Abdominal Panniculectomy?

A: It certainly sounds like your mother would benefit greatly by a combined abdominal panniculectomy and hernia repair. But I believe you may have a misconception about how Medicare works. Medicare, a federal program, does not preauthorize or preapprove any surgical procedure. They never have. A surgeon must do the procedure and then wait and see if Medicare will actually approve (pay) for the procedure. When it comes to an abdominal panniculectomy, no matter how medically indicated it might be (and your mother certainly fulfills that criteria), Medicare will almost certainly deny it after it is done. This leaves the patient with the benefit but the doctor will rarely ever get paid and if they do it is pennies on the dollar. An abdominal panniculectomy is a lot of work, risk and after care for little if any reimbursement. A patient may say that this is not their problem but the doctor’s…but it influences the options for many  prospective patients. This is because very few plastic surgeons are willing anymore to do such procedures under Medicare. Thus the origin of the $7,000 fee to which you refer must be a cosmetic fee quote to do the procedure, allowing Medicare to pay for the hospital, operating room and anesthesia fess which they are obligated to do. Short of doing it under this fee for service basis, you will have to seek a plastic surgeon who accepts Medicare coverage.
Source: eppleyplasticsurgery.com

Treasury Nominee Jack Lew Accused of Breaking Medicare Law

Both the House and Senate Budget Committees, along with the Senate Republican Conference at large, have previously corresponded with the administration regarding its continued violation of federal law with respect to the so-called Medicare Trigger.  The Senate will soon consider the nomination of Jacob Lew, who served as the Director of Office [of] Management and Budget during this period of noncompliance and who, if confirmed as Secretary of the Treasury, will also hold the position of Chairman of the Board of Medicare Trustees.  Pursuant to our committee’s oversight responsibilities, we are therefore writing to request documents pertaining to the Medicare Trigger to better ascertain Mr. Lew’s role in this matter during his time as budget director.
Source: freedomworks.org

How Do Medicare And Health Insurance Work Together?

Medicare works with employer insurance in a few different ways. Most people with employer insurance enroll in Medicare Part A because it requires no premium. Medicare Part B requires a premium. The part(s) of Medicare you need will depend on your employer. If your employer has fewer than twenty employees then you will need both Parts A and B for adequate coverage. If your employer has more than twenty employees then your employer would be the first payer. This means that you should enroll in Part A (at no cost to you). For specifics of your employer coverage and how it works with Medicare contact the proper administrator at your job.
Source: seniorcorps.org

Experts Discuss Basics of the Medicare Program

Posted by:  :  Category: Medicare

KNOW WHO YOUR CZARS ARE --ENOUGH TO MAKE YOU SICK ---ONLY OBAMA COULD CREATE POSITIONS FOR THESE INCOMPENTENT COMMUNISTS AND SOCIALISTS by SS&SSPanelists 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

Video: Medicare physical therapy patient testimonial bowie maryland.avi

Study by Federal Regulators Finds Higher Rate of Medicare Fraud Among For

A report by Bloomberg News found that the number of civil and criminal claims brought against nursing homes between 2008 to 2012 was more than twice the number of similar claims brought during the prior five-year period. While the companies profiled by Bloomberg denied any wrongdoing, the report includes multiple allegedly unnecessary treatments connected to inappropriate Medicare claims. An eighty year-old resident of a South Carolina nursing home, owned by the third-largest nursing home chain in the country, reportedly died two days after spending eighty-four minutes in a standing frame for occupational and physical therapy. The resident allegedly received this treatment despite being unable to control her head or hold her eyes open. At a Florida facility, a ninety-two year-old male patient allegedly received more than two hours of occupational and physical therapy, according to Medicare billing records, despite having just coughed up blood due to lung cancer. He also died several days later.
Source: marylandnursinghomelawyerblog.com

Attorney Charles Ware’s Blog: MARYLAND MEDICARE TIPS: ATTY. CHARLES JEROME WARE

www.CharlesJeromeWare.com NATIONAL ELDER LAW MEDICARE TIP: For Maryland And The Nation (August 2012) The national law firm of Charles Jerome Ware, P.A., Attorneys and Counsellors, is headquartered conveniently in the Baltimore-Washington, D.C. metropolitan area, in Columbia, Howard County, Maryland. The firm’s motto is: “Still working. Still committed. Still here to make a difference.” Attorney Charles Jerome Ware, founder and president of the firm, is renowned and consistently ranked among the best attorneys and legal counsellors in the United States. [GQ Magazine, The Washington Post, The Baltimore Sun, The Columbia Flier, USA TODAY, The Howard County Sun, The Anniston Star, The New York Times, et al.]
Source: blogspot.com

Maryland Has a Four Part Medicaid Program Insurance Families.com

Medicaid can cover people who fit into the following groups: low income families, children, pregnant women, and aged, blind, or disabled adults. The specific benefits that are offered, and the details about the eligibility requirements, are standard across the state of Maryland. A person can be covered by another form of health insurance and still be eligible for coverage through Medicaid.
Source: families.com

Maryland Seeks A New Balance In Its Unique Hospital Payment System

The debate is part of a larger discussion about saving Maryland’s oft-praised price-setting regime while maintaining the state’s leadership in developing an insurance exchange and other components of the health act. One idea is to have HHS judge Maryland according to the total cost of care for Medicare and not just inpatient cases, according to a presentation given by a top HHS official to the hospital association earlier this summer, according to people who were there. That raises the possibility of cost controls (although not necessarily rate setting) on physicians. “Obviously, it’s something we’re watching closely,” said Gene Ransom, chief executive of MedChi, Maryland’s state medical society.
Source: kaiserhealthnews.org

Maryland misses latest Medicare waiver goal

Maryland health care leaders have blown past another deadline they set for themselves to submit a proposal for a revised Medicare waiver. And this time they’re not bothering with a new deadline. The state has been working on a plan for revising its Medicare waiver for months and along the way setting — and passing — goals for completing the task. Most recently health officials said they planned to submit a proposal to the Centers for Medicare and Medicaid Services on Dec. 17. The date appeared…
Source: ewallstreeter.com

Ethics Opinions Underscore Problems That Medicare Liens Create when Negotiating Settlements

In the absence of an agreement to indemnify from the plaintiff’s attorney, another alternative would be that the defendant/insurer would distribute the money to the plaintiff’s attorney, and the plaintiff’s attorney would agree to maintain an amount equal to or greater than the full amount of the lien until the final lien amount is negotiated.  In this scenario, the attorney is not taking on the client’s obligations, but rather is being held to his word that the lien will be protected, assuming the plaintiff consents to the withholding of some funds.  The plaintiff can receive some of the settlement funds immediately, but the defendant/insurer is assured that a sufficient amount will be held back to guarantee that the asserted lien is protected.  It is seemingly a better solution to the problem.  However, as may be evident, similar ethical concerns are raised by this scenario as well, and the MD Committee on Ethics has also had occasion to address it.  According to the Committee, it is questionable whether the plaintiff’s attorney can ethically agree to such an arrangement.  The Committee, in reviewing this practice, has expressed concerns that the plaintiff’s attorney would be violating the aforementioned ethical rules regarding the safekeeping of property of the client and/or a third party.  Under these ethical rules, the settlement funds belonging to a party may be placed in an interest bearing account, where the interest must be provided to the party.  However, the funds belonging to one person may not be placed in an interest bearing account where the interest will be credited to someone else.  The question, then, as the Committee sees it, is who do the funds belong to at the time they are given to the plaintiff’s attorney: the plaintiff, the third-party, or both?  Keeping in mind that the assertion of a lien is not the same thing as a ruling that the lien is valid, the Committee has decided that the plaintiff’s attorney must consider the legal question of when a lien holder has “ownership” of the funds.  Given the Committee’s Opinion on this matter, plaintiff’s attorneys are left to analyze when and whether the lien holder becomes the owner of the funds.  If it is the owner of the funds, then the attorney cannot ethically hold it.  Given this dilemma, and absent a controlling opinion from Maryland appellate courts, one would think that most plaintiff’s attorneys will be cautious and decline to agree to maintain the funds for “safe keeping” in order to avoid the risk of committing an ethical violation.
Source: mdliability.com

AARP Medigap Plan N Maryland

AARP AARP Connecticut AARP Medicare AARP Medicare Complete AARP Medigap AARP Medigap 2013 AARP Rates 2013 AARP Supplement AARP Supplement 2013 Anthem Anthem High F plan Anthem Medicare Anthem Medigap Anthem Supplement Coverage Gap Donut Hole Drug Help High Deductible F supplement LIS Connecticut Medicare Medicare Advantage Medicare Advantage plans Medicare Complete Medicare Complete connecticut Medicare Connecticut Medicare part B Medicare part D Medicare prescription drug plans Medicare Rx Medicare Saving program Medicare Supplement Medicare Supplement Connecticut Medigap Medigap rates 2013 Medigap rates NY 2013 MSP Connecticut Original Medicare Part D Part D Drug help Rx Help Rx help connecticut united healthcare United Healthcare AARP United medicare complete United Medicare complete 2013
Source: croweandassociates.com

Report: $2 billion spent annually for Medicaid emergencies, largely for illegal immigrant baby delivery

Posted by:  :  Category: Medicare

'The election of Obama would, at a stroke, refresh our country's spirit' by Renegade98In this Wednesday, Jan. 27, 2010 photo, Carmelita Alejandria of the Philippines receives a dialysis treatment at University Medical Center in Las Vegas. Because of her immigrant status, Alejandria receives her dialysis through emergency care rather than going to a dialysis center. (AP Photo/Laura Rauch)
Source: dailycaller.com

Video: North Carolina Medicare Enrollment.wmv

North Carolina legislator’s ‘BrandonCare’ bill a response to GOP

“Obamacare’s changes to Medicaid would cost North Carolinians close to a billion dollars through 2019,” Berger said in a news release earlier this week. “The federal government is trying to bait us in with ‘free’ federal money that switches to state money after a few years, leaving our taxpayers holding the bag.”
Source: medcitynews.com

Medicaid runs $1.4B over budget in North Carolina

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Source: fiercehealthfinance.com

Awesome: Newly elected N.C. Governor says NO to Obamacare state medicaid exchange

For this reason, the state of Vermont is designing an insurance exchange system under the ACA that will serve as a prelude to a single-payer, universal, statewide health care system. It is estimated that this will reduce health care spending in Vermont by 25 percent while insuring all residents.
Source: therightscoop.com

For Good Public Policy Health : NC SPIN Balanced Debate for the Old North State

• Medicare has been a great deal for previous generations of Americans who paid relatively little into the system via taxes and premiums and then benefitted from the rapid improvement in medical technologies, treatments, and pharmaceuticals over the past three decades. Current recipients aged 85 and older have “gotten back” more than $2.50 in benefits for every dollar put into Medicare during their working lives. If you are 65 today, expect to get $1.26 back for every $1 spent. If you are 45 today, Medicare will end up costing you more than you get back. If you are 25 today, expect to get only 75 cents on the dollar.
Source: ncspin.com

USDOJ: Former Registered Nurse Sentenced in Miami to 111 Months in Prison in Connection with $63 Million Mental Health Care Fraud Scheme

A former registered nurse was sentenced today to serve 111 months in prison for his role in a health care fraud scheme involving defunct health provider Health Care Solutions Network Inc. (HCSN), announced Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; United States Attorney Wifredo A. Ferrer of the Southern District of Florida; Michael B. Steinbach, Special Agent in Charge of the FBI’s Miami Field Office; and Special Agent in Charge Christopher B. Dennis of the United States Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami office. John Thoen, 53, of Miami, was sentenced by United States District Judge Cecilia M. Altonaga in the Southern District of Florida.  In addition to his prison term, Thoen was sentenced to serve three years of supervised release. On November 20, 2012, Thoen pleaded guilty in the Southern District of Florida to one count of conspiracy to commit health care fraud and one count of conspiracy to commit money laundering.  According to court documents, HCSN operated community mental health centers (CMHC) at three locations in Miami-Dade County, Fla ., and one location in Hendersonville, N.C.  HCSN purported to provide partial hospitalization program (PHP) services to individuals suffering from mental illness.  A PHP is a form of intensive treatment for severe mental illness.  According to court documents, HCSN obtained Medicare beneficiaries to attend HCSN for purported PHP treatment that was unnecessary and, in many instances, not even provided.  HCSN obtained those beneficiaries in Miami by paying kickbacks to owners and operators of assisted living facilities. According to court documents, Thoen was a licensed registered nurse in both Florida and North Carolina.  In Florida, Thoen participated in the admission to HCSN of patients who were ineligible for PHP services.  Thoen participated in the routine fabrication of patient medical records that were utilized to support false and fraudulent billing to government sponsored health care benefit programs, including Medicare and Medicaid. In North Carolina, Thoen, according to court documents, routinely submitted fraudulent PHP claims for Medicare patients who were not even present at the CMHC on days PHP services were purportedly rendered.  Thoen also caused the submission of fraudulent Medicare claims on days the CMHC was closed due to snow. Thoen also admitted to his role in a money laundering scheme, involving Psychiatric Consulting Network Inc. (PCN), a Florida corporation that was utilized by HCSN as a shell corporation to launder health care fraud proceeds.  According to court documents, Thoen was president of PCN. According to court documents, from 2004 through 2011, HCSN billed Medicare and the Florida Medicaid program approximately $63 million for purported mental health services. Fifteen defendants have been charged for their alleged roles in the HCSN health care fraud scheme, and nine defendants have pleaded guilty.  Alleged co-conspirators Wondera Eason and Paul Layman are scheduled for trial on March 11, 2013, before Judge Altonaga in Miami.  And alleged co-conspirators Alina Feas, Dana Gonzalez, Gema Pampin and Lisset Palmero are scheduled for trial on June 3, 2013.  Defendants are presumed innocent until proven guilty at trial. The cases are being prosecuted by Special Trial Attorney William Parente and Trial Attorney Allan J. Medina of the Criminal Division’s Fraud Section. This case was investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the United States Attorney’s Office for the Southern District of Florida.  In support of the Medicare Fraud Strike Force, the FBI Criminal Investigative Division’s Financial Crimes Section has funded the Special Trial Attorney position. Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,480 defendants who have collectively billed the Medicare program for more than $4.8 billion.  In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers. To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.  Contact: Department of Justice Main Switchboard – 202-514-2000 Reported by: US Department of Justice
Source: 7thspace.com

NC Healthcare service costs soar, Hospitals buy out doctors, Medicare rules let hospitals charge more than independent doctors, Indigent care cost shifting

Why would Muslim oil billionaires finance and develop controlling relationships with black college students? Well, like anyone else, they would do it for self-interest. And what would their self-interest be? We all know the top two answers to that question: 1. a Palestinian state and 2. the advancement of Islam in America. The idea then was to advance blacks who would facilitate these two goals to positions of power in the Federal government, preferably, of course, the Presidency. And why would the Arabs target blacks in particular for this job? Well, for the same reason the early communists chose them as their vanguard for revolution (which literally means “change”) in America. Allow me to quote Trotsky, in 1939: “The American Negroes, for centuries the most oppressed section of American society and the most discriminated against, are potentially the most revolutionary element of the population. They are designated by their historical past to be, under adequate leadership, the very vanguard of the proletarian revolution.” Substitute the word “Islam” for the words “the proletarian revolution,” and you most clearly get the picture, as Islam is a revolutionary movement just like communism is. (Trivia: it is from this very quote that Van Jones takes his name. Van is short for vanguard. He was born “Anthony”). In addition, long before 1979, blacks had become the vanguard of the spread of Islam in America, especially in prisons.
Source: wordpress.com

North Carolina Medical Society

 Enhanced PCP Payments.  Coming soon, Medicaid will implement the Affordable Care Act’s PCP Payment Parity rule.  Under this program, eligible primary care providers, including PAs, can receive Medicare rates when providing certain primary care services to Medicaid patients.  While this detail has not yet been determined by NC Medicaid, it is foreseeable that PAs will need to register/attest for the enhanced rates by using their own Medicaid provider numbers, which will first require direct enrollment.  You can read more about the status of PCP payment parity here. 
Source: ncmedsoc.org

Medicare Targets Health Plans With Low Ratings

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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

Video: Windsor Medicare Extra – Dually Eligible- Medicare and Medicaid.mp4

Windsor Medicare Extra Hosts Behavioral …

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Source: neurophysiologyblog.com

Windsor Health PlanSM Announces Partnership with Healthways SilverSneakers® Fitness Program

Healthways (HWAY) is the largest independent global provider of well-being improvement solutions. Dedicated to creating a healthier world one person at a time, the Company uses the science of behavior change to produce and measure positive change in well-being for our customers, which include employers, integrated health systems, hospitals, physicians, health plans, communities and government entities. We provide highly specific and personalized support for each individual and their team of experts to optimize each participant’s health and productivity and to reduce health-related costs. Results are achieved by addressing longitudinal health risks and care needs of everyone in a given population. The Company has scaled its proprietary technology infrastructure and delivery capabilities developed over 30 years and now serves approximately 40 million people on four continents. Learn more at www.healthways.com or www.silversneakers.com.
Source: buyersdirectory.net

Windsor Health Group Selects MedHOK’s Single Platform for Care, Quality and Compliance for Clinical and Compliance Programs

Tampa, Fla.-based MedHOK has more than 18 million lives in production and expects to double that number in 2012, making it one of the healthcare industry’s fastest-growing software companies. It offers a cloud-based integrated software platform for care management, quality and compliance that enables physicians, ACOs, PCMHs, payers and TPAs to manage and measure care against national quality standards for optimal outcomes. Its innovative modular software helps healthcare organizations meet quality, care and compliance objectives across business lines by facilitating real-time information sharing with all stakeholders to address disease management and care coordination, clinical quality and utilization review, and quality and financial measures. ICD-10 compliant, HIE-ready and securely accessible on any device, the MedHOK platform is user-friendly, rapidly deployed and easily configurable for a low total cost of ownership and rapid return on investment. It holds 2012 HEDIS®, Pay for Performance and Disease Management performance measures certification.
Source: emrandehrnews.com