NJ Doctors Face Significant Cuts to Medicare ReimbursementsUnless Congress acts by end of year, healthcare providers in the Garden State could see Medicare payments shrink by more than 25 percent

Posted by:  :  Category: Medicare

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Source: lwpolice.org

Video: Fat Arrogance: Rude-Hypocrite NJ Gov. Christie’s War on Medicare & The Poor

NJ health system pays millions to settle fraud allegations

“After more than three years of extended discussions with government lawyers, we decided, in the best interests of Cooper, to settle our dispute without the admission of wrongdoing to avoid the burdens and uncertainties of a protracted litigation,” the company said in a statement. “This allows us to focus our full energies on serving our community.”
Source: freebeacon.com

Senior Medicare Patrol Of New Jersey Receives Award

SMP is a federally funded endeavor created to help Medicare and Medicaid beneficiaries prevent, detect, and report health care fraud, waste, and abuse. Health care fraud is an enormous problem. According to the FBI, health care fraud costs the country an estimated $80 billion a year. The SMP of New Jersey is part of a network of 54 national SMPs educating seniors about Medicare fraud and presenting practical tips for becoming wise health care consumers such as safeguarding Medicare numbers, reviewing Medicare Summary Notices, and counting prescription pills.
Source: njtoday.net

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

Horizon NJ Health Slashes Medicaid Reimbursements for Home Healthcare

Thomas Vincz, spokesman for Horizon Blue Cross Blue Shield of New Jersey, the parent company of Horizon NJ Health, called the reimbursement reductions “difficult decisions,” but said that they “demonstrate the realities of today’s healthcare in having to do more with fewer resources.” Horizon is seeing a reduction in the rates it receives from the state to administer “various government health programs,” Vincz said, while “benefit utilization” and overall costs were growing.
Source: wnyc.org

Report Says Early Years of Medicaid Expansion in NJ Won’t Break the Bank

Every other advanced democracy (Israel, Sweden, Norway, Denmark, Finland, Australia, Japan, Taiwan, Canada, France, Austria, Switzerland, New Zealand, Germany, Holland, etc.) has some form or version of universal health care; everyone is covered and no one goes bankrupt from medical expenses as they do in the US. A national health care system was part of the 1912 campaign platform of Teddy Roosevelt. Truman tried to institute a national health care system throughout his presidency but was defeated by the GOP, the AMA and the one percenters. By some miracle, LBJ managed to enact Medicare and Medicaid in 1965. Without these programs, we would have about 100 million uninsured; we currently have 48.8 million uninsured according to the US Census. We have tens of millions more with inadequate crap insurance with high deductibles and many out of pocket expenses. When is enough enough in the US? We should have Medicare for all or a single payer health care system. Instead of that, we are talking about cutting and gutting Medicare and Medicaid. It’s just stupid and nuts.
Source: patch.com

Demystifying Medicare Part D enrollment

Once you’ve found a plan that fits your budget and medication needs, don’t forget about convenience when filling your prescriptions. A pharmacy accepted as “preferred” by a Medicare Part D Plan is a network pharmacy that offers covered drugs to plan members at lower out-of-pocket costs than what the member would pay at a non-preferred network pharmacy. For example, Walmart is a preferred pharmacy on multiple plans including the Humana-Walmart Preferred Rx Plan. People with high blood pressure or who are concerned about heart health also should know that Humana and Walmart just announced that members of the Humana Walmart-Preferred Rx Plan will have access to 10 hypertension drugs for a penny each when filled at one of the 4,400 Walmart or Sam’s Club pharmacy locations.
Source: lifeandleisurenj.com

Democrats Heart Medicare Fraudsters

Hey, remember when President Obama crusaded against Medicare fraud and vowed to crack down aggressively on scammers who’ve bilked the program out of an estimated $90 billion? Like Archie and Edith Bunker used to sing: Those were the daaaays. While Democrats pretend to protect the elderly and disabled, leaders of the People’s Party have pocketed gobs of campaign contributions from fat-cat donors tied to massive Medicare rip-off schemes. Let’s talk some more about Dr. Salomon Melgen, shall we? We now know that the jet-setting Florida eye doctor who flew beleaguered Sen. Bob Menendez (D-NJ), to several alleged sex romps in the Dominican Republic also overbilled the government by $8.9 million for care at his clinic. That’s according to Menendez’s own aides. They acknowledged last week that their boss met with federal health bureaucrats at least twice to lobby on Melgen’s behalf. “Federal investigators and health-care auditors have had concerns about Melgen’s billing practices at various times over the past decade,” according to two former federal officials who spoke to The Washington Post. “In part, they have examined the volume of eye injections, surgeries and laser treatments performed at his West Palm Beach clinic.” Now, brace yourselves. A Menendez aide says that while Sen. Sleaze-Bob intervened, he didn’t know nuttin’ about Melgen being under investigation. Just like he didn’t know nuttin’ about his longtime aide working for Melgen’s port security firm in the Dominican Republic, on whose behalf Sen. Sleaze-Bob also intervened. And just like he didn’t know nuttin’ about yet another ride on Melgen’s plane in 2008 (exposed this week by the conservative Daily Caller), which he forgot to disclose to the Senate. Senate Democrat leaders have done nuttin’ to prevent Menendez, who also sits on the Senate Finance Committee overseeing Medicare, from playing a prominent role in Medicare reform negotiations while Melgen’s Medicare fraud investigation unfolds. It’s all par for the Democrats’ conflict-of-interest course, of course. Recently departed Obama healthcare czar Nancy-Ann DeParle raked in millions from her positions on a handful of corporate boards under fire for various regulatory violations, whistleblower complaints and Medicare fraud. One of the companies for which DeParle served as a director, kidney dialysis empire DaVita, has been plagued by whistleblower fraud allegations for nearly 20 years. These include long-standing claims (many still under investigation or the subject of ongoing litigation) that the company overused the anemia drug Epogen and then billed Medicare for it; submitted fraudulent Medicare claims for dialysis drugs; and forged alleged kickback schemes between doctors and joint ventures. Another Medicare fraud suspect, the Stryker Corporation, paid nearly $17 million to settle allegations about false claims submissions in 2007. Pat Stryker, liberal heiress to the Stryker fortune, is an Obama bundler and one of the Democrat Party’s wealthiest progressives. She was also behind the now-bankrupt Obama green energy boondoggle in Colorado, Abound Solar. While the Obama campaign (aided and abetted by the lapdog media) viciously smeared Mitt Romney by tying him to Medicare fraud he had absolutely nothing to do with while at Bain Capital, this White House has escaped any scrutiny of its own ties to accused Medicare scammers. Instead, the administration was happy to powwow with Menendez and other Democrat leaders on policy strategy this week. What did they have to say about Menendez’s lobbying on behalf of Medicare exploiter Melgen and the conflict-of-interest cloud stretching from Capitol Hill to 1600 Pennsylvania? Nuttin’.
Source: newmediajournal.us

Senior Care in Mt. Laurel, NJ: Open Enrollment for Medicare –Now through Dec 7, 2012

Would a small increase in premiums result in a large reduction in health care costs you pay? Check, for example, what coverage is available for prescription drugs you take? Medicare representatives can create a report containing the costs and benefits of various insurance products if you supply them with a list of your drug prescriptions. Ask questions about participating doctors and clinics. Some Medicare Advantage plans limit which physicians a patient can visit.
Source: hometostayhc.com

Report: N.J. Medicaid patients are least likely in U.S. to find new doctor

A major factor in this issue is medical billing itself. The fact that hospitals and medical suppliers charge exorbitantly more for products and services than it costs them to provide means that the cost for any person or entity paying medical bills are likely experiencing extortion. Medicaid is not immune to this, even though it pays reduced rates. If controls were put in place to limit unreasonable billing practices, it would leave more money for medicaid to work with and spend on necessary costs like doctors for new patients.
Source: newjerseynewsroom.com

Fight against Dominican smugglers lands in N.J.

His interest has drawn public scrutiny since federal agents recently searched the Florida offices of his largest campaign contributor, Dr. Salomon Melgen, who in August 2011 had purchased a company with a contract to provide increased security at Dominican ports. The 10-year contract, valued at $500 million, was signed in 2002 but suspended two years later by the Dominican government and is tied up in the courts.
Source: triblive.com

Explaining Medigap Insurance

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SS•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

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

Medicare and Medicare Supplemental Insurance

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

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

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

Is United Healthcare Supplemental Medicare Insurance My Only Option?

Supplemental health insurance allows for you to pay for out-of pocket expenses that your insurance company refuses to pay. Out-of-pocket medical expenses such as deductibles, copayments, and coinsurance are taken care of through supplemental health insurance which is what makes having the right company by your side extremely important. There are many different supplemental health insurance companies like United HealthCare supplemental medicare insurance, that offer different to fit your needs.
Source: seniorcorps.org

Colonial Penn Medicare Supplement Insurance

• Long-term hospitalization. Medicare only covers a small portion if any of the cost for those people who need to be hospitalized. Colonial Life Medicare supplement insurance on the other hand, covers all or most of your hospitalization depending on the type of supplemental insurance you purchase. This is a huge benefit to most elderly people who simply do not have the income to pay those large hospital bills.
Source: lifeinsurancequotesnreviews.com

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

Understand the differences between Medicare Insurance Cape Coral Florida plans

There are also a number of publications and articles that offer people with very crucial information in this regard, but most people do not take much interest on this information simply because reading the information is boring. Furthermore, most people are attracted to the colorful brochures that they receive from various companies that offer Medicare Insurance Cape Coral Florida, but what they tend to ignore is that none of these brochures offer them a clear idea of what they will be getting, and what they will have to pay in return. This causes many individuals to waste plenty of money on insurance policies that eventually prove to be fruitless.
Source: seosubmitarticle.com

How To Know If You Need Medicare Supplemental Insurance

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

Newsroom – Blue Cross Blue Shield of Michigan broadens Medicare options with new Medicare Advantage PPO product

Posted by:  :  Category: Medicare

32.Detroit by Tomato GeezerOctober 1 is the first day BCBSM and Medicare Advantage carriers across the nation can market their Medicare Advantage products for 2010. Beneficiaries in BCBSM Medicare Advantage products will receive letters in the next 10 days about the new product line-up. "Blue Cross remains fully committed to providing products to Medicare beneficiaries and will continue to have the broadest array of Medicare Advantage products in the state," said Mark Owen, BCBSM vice president for federal and individual business. "It’s important for Medicare beneficiaries to know that there is no immediate change to their coverage. They have until the end of the year to make their selection for 2010." In addition to the three BCBSM products for 2010, seniors also can select from three Medicare Advantage products offered by Blue Care Network, the BCBSM-affiliated HMO. "We will be working with insurance agents and other groups across the state to reach out to Medicare beneficiaries to help them navigate these product and premium changes," said Owen. Seniors who meet low income guidelines can receive subsidies from the state and/or federal government to pay for all or part of their premiums. Medicare Advantage premiums vary by product and region. The new PPO product is expected to provide beneficiaries with value for their premium. For example, the BCBSM Medicare Plus Blue PPO, which includes Part D prescription drug coverage, will cost between $61 and $141 a month (premiums vary by geographic region), while traditional BCBSM Medicare Supplemental (Medigap) Plan C plans cost $183 when combined with a stand-alone Part D BCBSM prescription drug program. Medicare Advantage plans offer Medicare benefits through private health insurance plans and most include Part D prescription drug coverage. When you purchase a Medicare Advantage plan, you do not need to also purchase a Medigap policy. Medicare Advantage plans are regulated solely by the federal government, while Medigap plans are regulated by the state. The announced product changes are only for Medicare beneficiaries who directly purchase their Medicare Advantage products, not for beneficiaries enrolled in a group plan. Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.
Source: bcbsm.com

Video: Dan Benishek: A Troubling Record on Medicare

The Difference Between Medicaid and Medicare

The obvious downfall to Medicare is the limit on coverage. Rehabilitation oftentimes falls far short of the 100 day maximum. The other downfall to Medicare is that it only pays for skilled nursing and does not cover the treatment of all diseases. For example, a nursing home stay because of Alzheimer’s or Parkinson’s will not be covered under Medicare even though the patient is receiving medical care. If you are staying in a nursing home longer than 100 days or suffer from a debilitating disease like Alzheimer’s the best option to pay for long term or even permanent nursing home care is Medicaid.
Source: michiganelderlawyer.com

Michigan Liberal::: Medicaid expansion the latest thing to be obstructed for no real reason

For MI Bloggers: – MI Bloggers Facebook – MI Bloggers Myspace – MI Bloggers PartyBuilder – MI Bloggers Wiki Statewide: – Blogging for Michigan – Call of the Senate Dems – [Con]serving Michigan (Michigan LCV) – DailyKos (Michigan tag) – Enviro-Mich List Serve archives – Democratic Underground, Michigan Forum – Jack Lessenberry – JenniferGranholm.com – LeftyBlogs (Michigan) – MI Eye on Bishop – Michigan Coalition for Progress – Michigan Messenger – MI Idea (Michigan Equality) – Planned Parenthood Advocates of Michigan – Rainbow Mittens – The Upper Hand (Progress Michigan) Upper Peninsula: – Keweenaw Now – Lift Bridges and Mine Shafts – Save the Wild UP Western Michigan: – Great Lakes Guy – Great Lakes, Great Times, Great Scott – Mostly Sunny with a Chance of Gay – Public Pulse – West Michigan Politics – West Michigan Rising – Windmillin’ Mid-Michigan: – Among the Trees – Blue Chips (CMU College Democrats Blog) – Christine Barry – Conservative Media – Far Left Field – Graham Davis – Honest Errors – ICDP:Dispatch (Isabella County Democratic Party Blog) – Liberal, Loud and Proud – Livingston County Democratic Party Blog – MI Blog – Mid-Michigan DFA – Pohlitics – Random Ramblings of a Somewhat Common Man – Waffles of Compromise – YAF Watch Flint/Bay Area/Thumb: – Bay County Democratic Party – Blue November – East Michigan Blue – Genesee County Young Democrats – Greed, Eggs, and Ham – Jim Stamas Watch – Meddling Outsider – Saginaw County Democratic Party Blog – Stone Soup Musings – Voice of Mordor Southeast Michigan: – A2Politico – arblogger – Arbor Update – Congressman John Conyers (CD14) – Mayor Craig Covey – Councilman Ron Suarez – Democracy for Metro Detroit – Detroit Skeptic – Detroit Uncovered (formerly “Fire Jerry Oliver”) – Grosse Pointe Democrats – I Wish This Blog Was Louder – Kicking Ass Ann Arbor (UM College Democrats Blog) – LJ’s Blogorific – Mark Maynard – Michigan Progress – Motor City Liberal – North Oakland Dems – Oakland Democratic Politics – Our Michigan – Peters for Congress (CD09) – PhiKapBlog – Polygon, the Dancing Bear – Rust Belt Blues – Third City – Thunder Down Country – Trusty Getto – Unhinged MI Congressional District Watch Blogs: – Mr. Rogers’ Neighborhood (CD08)
Source: michiganliberal.com

Oregon May Provide Model For Restructuring Medicaid In Alabama

Last October, a commission established by Bentley began researching ways to restructure the state’s Medicaid program to make it more efficient. The group concluded that Alabama should follow Oregon’s path. “It will be a heavy, heavy lift,” says state health officer Don Williamson, who headed the group. But he said the overhaul is necessary if the state is ever going to expand Medicaid. Otherwise, he said, “we will find ourselves with a program that simply collapses under the weight of the expansion.”
Source: kaiserhealthnews.org

CARR ALLISON Medicare Compliance Group: Court Follows Sixth’s Circuit Decision that Providers May Assert a Private Cause of Action

, No. 12-CV-11329, 2013 U.S. Dist. LEXIS 17721 (E.D. Mich. Feb. 11, 2013), State Farm denied coverage of medical treatment provided by Michigan Spine on the basis that the treatment was related to preexisting conditions of the individual insured, and unrelated to the accident at issue.  As a result, Medicare paid for those medical expenses.  Michigan Spine filed a claim for recovery against State Farm, asserting that it had a private cause of action for double damages under the Medicare Secondary Payer Act.  In response, State Farm argued that Michigan Spine had no standing to bring a claim under the Medicare Secondary Payer Act because no court had determined that State Farm was liable for the medical services in question.
Source: blogspot.com

Medicaid expansion has skeptics in biz groups

Kahn, a physician, said Snyder failed to mention that Medicaid rates for primary care physicians will rise to equal Medicare rates for only two years. “The end result of that will be what? The physicians will stop seeing the patients,” Kahn said. “Because an insurance card is not access, it’s having someone take care of you — that’s access.” At that point, people may then go back to using the emergency room as their primary care provider, and then the uncompensated care costs rise again, negating some business savings, Kahn said. Over the last several months, Snyder had expressed concern that expanding Medicaid would flood hospital emergency departments with thousands of newly insured patients who could not find primary care doctors. But a survey last month by the Center for Healthcare Research found that more than 81 percent of doctors said they would be willing to accept Medicaid patients if the state expanded the program. Jack Billi, M.D., a board member of the Michigan State Medicaid Society and a physician executive at the University of Michigan Health System, said it is possible that some physicians could stop accepting Medicaid in 2016, when rates drop about 30 percent from Medicare levels. “We will have a temporary improvement in reimbursement for office visit codes for primary care physicians,” Billi said. “Medicaid rates do not cover costs now. Many doctors accept Medicaid because they see it as a duty for the underserved and for the community.” Some of the groups that support Medicaid expansion include AARP Michigan, Michigan Association of Community Mental Health Boards, Michigan Association of Health Plans, Michigan Health and Hospital Association, Michigan Osteopathic Association, Michigan Primary Care Association, Michigan State Medical Society, the Detroit Wayne County Health Authority and the Greater Detroit Area Health Council. Jay Greene: (313) 446-0325, jgreene@crain.com. Twitter: @jaybgreene
Source: crainsdetroit.com

Michigan’s Rick Snyder Becomes 6th GOP Governor to Expand Medicaid

Michigan Gov. Rick Snyder became the sixth GOP governor to recommend an expansion of the state’s Medicaid program to include individuals slightly above the poverty line, marking the second time in recent years he’s branched away from his party’s staunch resistance to the federal health law, according to a report by the Washington Post. The move would cover 470,000 previously uninsured poor Michigan residents in the long term, while saving the state an estimated $200 million annually by shifting the cost of various state-funded mental health and medical services to the federal government. Under the Patient Protection and Affordable Care Act, the feds will pay 100 percent of the expansion cost for three years and 90 percent after that. Snyder proposed reserving half of the savings in the first three years to cover Michigan’s share of the tab until 2035, according to the report. Gov. Snyder joins Ohio, Arizona, New Mexico, Nevada and North Dakota on the list of GOP-governed states that have urged embracing the expansion. The governor supported a state-run health insurance marketplace that was shot down in his Republican-controlled legislature and is now working toward a partnership exchange that would share control with federal regulators.
Source: beckershospitalreview.com

Michigan Home Health Providers Fend Off Unionization, Hold onto Medicare Funding

AAHomecare AARP Alliance for Home Health Quality and Innovation Almost Family Amedisys Amedisys Inc. American Association for Homecare American Association for Long Term Care Insurance Apria Healthcare Group Brookdale Senior Living Care.com Center for Medicare Advocacy Centers for Medicar & Medicaid Services Centers for Medicare & Medicaid Services CMS Ensign Group featured First Care Home Health Care Gentiva Health Services Gentiva Health Services Inc. HHS Home Health Depot Home Health International Houston Compassionate Care Humana IntegraCare Intel-GE Care Innovations Jordan Health Services Kindred Healthcare LHC Group Inc MedPAC NAHC National Association for Home Care & Hospice National Hospice and Palliative Care Organization New York Times Paraprofessional Healthcare Institute Partnership for Quality Home Healthcare PHI Scripps Health Sentara Healthcare The Ensign Group Univita VA Veterans Health Administration Visiting Nurse Association
Source: homehealthcarenews.com

Michigan Medicare Patients Risk Losing Essential Health Care Federal Government Urged to Resolve Flawed Physician Payment Formula by Year’s End

The cuts will stem from the SGR, a flawed formula created by Congress 15 years ago to determine how much physicians get paid for treating Medicare patients. It has cost billions of government dollars to adjust the rate over the last 15 years to prevent drastic payment cuts to physicians, as
Source: broadcasteverywhere.com

New Ad From Democrats Attacks Michigan Lawmaker on Medicare

The attack ad represents part of a larger strategy by Democrats to make a prominent issue of Medicare, which they perceive as a major political weakness of Mr. Ryan’s budget plan. That tack has already extended to some Congressional races, including ones in Montana and Florida.
Source: nytimes.com

Medicare Part D Notice Required Before October 15

This is a reminder that the deadline to distribute the Annual Notice of Creditable Coverage required under Medicare Part D is less than a week away. This notice informs participants whether the prescription drug coverage offered under your health plan constitutes creditable or noncreditable coverage. As the Medicare Part D annual enrollment period now runs from October 15 to December 7, you must distribute the notices before October 15. Employers who sponsor a health plan offering prescription drug benefits must provide an annual notice to all Medicare-eligible participants that explains whether the prescription drug benefits offered under the plan are at least as good as the benefits offered under the Medicare Part D plan. The only employers exempt from this requirement are those that establish their own Part D plan or contract with a Part D plan. The Centers for Medicare and Medicaid Services (CMS) has posted forms and instructions for providing this notice. The forms were last updated in 2011. They are available, both in English and Spanish, through the following links:
Source: jdsupra.com

House Republican aims to repeal Medicare doctor pay cuts

The 16-year-old “sustainable growth rate” (SGR) provision calls for reductions in doctor pay as a way to control spending by Medicare. Congress has prevented the SGR from taking effect through temporary measures, but that has run up the fiscal and political costs of finding a permanent solution.
Source: medcitynews.com

Anthem Medicare Preferred PPO Plan and Rates

Posted by:  :  Category: Medicare

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

Video: Differences between Medicare PPO & HMO Plans

Newsroom – Blue Cross Blue Shield of Michigan broadens Medicare options with new Medicare Advantage PPO product

October 1 is the first day BCBSM and Medicare Advantage carriers across the nation can market their Medicare Advantage products for 2010. Beneficiaries in BCBSM Medicare Advantage products will receive letters in the next 10 days about the new product line-up. "Blue Cross remains fully committed to providing products to Medicare beneficiaries and will continue to have the broadest array of Medicare Advantage products in the state," said Mark Owen, BCBSM vice president for federal and individual business. "It’s important for Medicare beneficiaries to know that there is no immediate change to their coverage. They have until the end of the year to make their selection for 2010." In addition to the three BCBSM products for 2010, seniors also can select from three Medicare Advantage products offered by Blue Care Network, the BCBSM-affiliated HMO. "We will be working with insurance agents and other groups across the state to reach out to Medicare beneficiaries to help them navigate these product and premium changes," said Owen. Seniors who meet low income guidelines can receive subsidies from the state and/or federal government to pay for all or part of their premiums. Medicare Advantage premiums vary by product and region. The new PPO product is expected to provide beneficiaries with value for their premium. For example, the BCBSM Medicare Plus Blue PPO, which includes Part D prescription drug coverage, will cost between $61 and $141 a month (premiums vary by geographic region), while traditional BCBSM Medicare Supplemental (Medigap) Plan C plans cost $183 when combined with a stand-alone Part D BCBSM prescription drug program. Medicare Advantage plans offer Medicare benefits through private health insurance plans and most include Part D prescription drug coverage. When you purchase a Medicare Advantage plan, you do not need to also purchase a Medigap policy. Medicare Advantage plans are regulated solely by the federal government, while Medigap plans are regulated by the state. The announced product changes are only for Medicare beneficiaries who directly purchase their Medicare Advantage products, not for beneficiaries enrolled in a group plan. Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.
Source: bcbsm.com

Medicare Advantage PPO Plans

These plans may or may not have a plan premium whereas several more of the HMO types hove none other than your normal Part B premium to Medicare. Also there will be both an in network out of pocket and an out of network out of pocket if you choose a provider not in network. The out of network providers must agree to accept the terms and conditions of the plan in order to get covered treatment; generally look for providers that accept Medicare on assignment.
Source: medicareinsurancetexas.com

California Medicare Insurance: 2013 Anthem Medicare PPO

This plan is also offered in other states but here in California it is now a Local PPO as opposed to a Regional PPO, which means its limited to particular counties The plan used to cover the entire state of California and now only a handful of counties will be able to have access to Medicare Advantage PPO network. In addition. only 3 of the counties will continue to receive the “Zero Cost” option; Los Angeles, San Diego and Ventura. All other counties will now have a monthly premium for this plan ranging from $40-131/mo. For some this is no problem but for many Medicare beneficiaries who are dependent upon Social Security or on a fixed income, this raises huge issues. 
Source: blogspot.com

AARP Medicare Complete « Insurance News from Crowe & Associates

United has an AARP Medicare Complete branded product in most states.  In some states they have multiple plans.  The AARP branded Medicare Complete plans come in three types: HMO, POS and PPO.  The plans all have the same basic copay structure and more or less operate in the same manner with the only real difference being that the POS and PPO plans have out of network coverage.
Source: croweandassociates.com

Turning 65: Finding a Medicare Advantage Plan

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

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 in Las Vegas, NV: Anthem Preferred PPO Is Leaving Las Vegas in 2013

In 2013, the Anthem Preferred PPO Medicare Advantage (MA) Plan will no longer be available in Clark County.  If you are a member of the Anthem PPO, you must choose another option before December 31, 2012, or you will go back to original Medicare on January 1, 2013. The fact that this plan is not continuing may be disconcerting, but it may also be a good opportunity.  If you have been denied a Medicare Supplement in the past due to health reasons, you can no longer be denied.  In other words, if you are on Anthem PPO right now, you have a guarantee issue right for a Medicare Supplement in 2013. As an Anthem member, you have two options:
Source: suncityfinancial.com

Community Health Plan: Fallon Community Health Plan Ppo

Please note that the termination by Fallon Community Health Plan of the Senior Plan contract with Athol MEDEX, Indemnity, PPO, HMO Blue) BMC HealthNet Plan CBA CeltiCare Health Plan CHAMPVA Cigna Cigna Healthsource Commonwealth Indemnity Comprehensive Benefits (CBC) Fallon Community Health Plan
Source: blogspot.com

Medicaid Eligibility Laws in Missouri

Posted by:  :  Category: Medicare

peace by MBK (Marjie)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

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

Missouri Residents Weigh In on Medicare, Social Security Changes

When the new Congress convenes next month, policymakers are likely to consider changes to the programs, including an increase in the amount of income subject to the payroll tax that finances most of Social Security and some of Medicare, benefit reductions, an increase in the eligibility age for both programs, a curb in the cost-of-living increases for Social Security beneficiaries and higher Medicare premiums for higher-income enrollees.
Source: aarp.org

Don’t Let Missouri’s Businesspeople Become Prostitutes in Business Suits

Here’s the simple truth: the Missouri Chamber of Commerce is not conservative. It does not exist to advance limited government and fiscal responsibility and free enterprise capitalism. The Missouri Chamber of Commerce has become convinced that it must lie down before government and beg for scraps from the federal table. Like good men and women who go astray once elected to Congress, many business leaders need our help in reminding them that government is not the solution to their problems; government is their problem.
Source: hennessysview.com

seMissourian.com: Blog: Should Missouri Expand the Medicaid Program?

State Representative Donna Lichtenegger is currently serving the 157th District of the Missouri House of Representative. Born July 26, 1950, in St. Louis, MO. A 1969 graduate of Normandy High School. She received an A.S. in Dental Hygiene in 1973 from St. Louis Community College — Forest Park. Rep. Lichtenegger has 37 years of experience as a dental hygienist. She resides in Jackson with her husband, John. They have two children, Brent and Leigh Ann. Current and past memberships: Missouri Dental Hygiene Association; American Dental Hygienist Association; Southeast Missouri Dental Hygienist Association. St. Paul Lutheran Church — Ladies Guild; Jackson Noon Optimist Club; Cape Girardeau Boys and Girls Club, board member; Cape County Black and Gold Club; Lutherans For Life; University of Missouri Alumni Association; and the Regional Samaritan Clinic, board member; and former memberships with JC Wives and the Lutheran Family Children Services’ Cape Girardeau board. Public Service: 20 years Republican Central Committee; the Republican State Committeewoman from 1998 to 2010 for the 25th Senatorial District; Chair of the 32nd Judicial District for six years; ten years Chair for the Eighth Congressional District.
Source: semissourian.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

Medicaid expansion in Missouri would create jobs, study says

The report says the spending and coverage would generate 22,000 Missouri jobs during the period, including nursing, hospitals, payroll workers, and others. Taxes generated by those jobs, and other economic growth, might provide enough money to cover the state’s share, the group argues.
Source: midwestdemocracy.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

Alex’s page: Medicare Of Oklahoma

Posted by:  :  Category: Medicare

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

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

Another ObamaCare Medicare Gimmick

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

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

If offered bidding contracts, 68% of providers say they wouldn't accept

“We’ve been focusing on cash sales since 2004,” said Joseph Magill, warehouse manager at Aston Pharmacy Home Health Center, based in Aston, Pa. “In 2004, insurance was about 85% of our revenue, now it is about 50-50, and we’re striving for an even higher ratio of cash sales.” 
Source: hmenews.com

2013 Medicare Physician Fee Schedule

I also am new to the RVU process but have a fairly good understanding of what needs to be done. However, I have been unable to find any information on what a Transitioned Non-Facility verses a Fully Implemented non- Facility is. I noticed the PE RVU is higher for the Fully Implemented non-facility. Someone told me it represents where you are at in your implementation of EHR???? I am waiting for a callback from CMS but if anyone has an answer it would be appreciated. Pat Carlson Open Cities Health Center
Source: physicianspractice.com

Medicare Discloses Hospitals’ Bonuses, Penalties Based On Quality

The program is one of several Medicare is launching to make hospitals and doctors accountable for quality and more careful stewards of public money. In October, Medicare also began reducing payments to 2,217 hospitals because too many of their patients ended up back in their care within a month. Medicare already gives bonuses to the private Medicare Advantage insurance plans that score well on quality metrics. In 2015, the health law calls for the government to begin a quality payment program for physician groups of 100 professionals or more, and that is to be expanded to all doctors by 2017.
Source: kaiserhealthnews.org

Significant Medicaid Cases

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

Cash and carry: Is this OKC surgery center the future of health care?

In dialogue with CapitolBeatOK, Dr. Smith said the center’s approach is helping to restore an old-fashioned medical ethic for provision of charity care. Many referrals to the hospital come from churches and other groups helping the poor. Patients are encouraged in those cases to pay what they can, while physicians and anesthesiologists can (and often do) waive their fees for individuals in need.
Source: watchdog.org

Letter to the Editor: Wanda Jo Stapleton says, “WAKE UP OKLAHOMA” :: Democrats of Oklahoma Forum

Then, she opposed House Resolution 4 which gave Medicare authority to negotiate with drug manufacturers for lower prescription drug prices. In other words, she voted to turn pricing of our prescription drugs over to pharmaceutical companies and order Medicare to pay whatever was asked. For those advocating reduction of Medicare costs, here’s the place to start.
Source: demookie.com

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

Posted by:  :  Category: Medicare

Harry Reid, Health Care narrow by Truthout.org“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

Video: NC Medicare | NC Medicare Supplement

PAs: It’s Time to Consider Medicaid Enrollment

 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: msochealth.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

North Carolina Medical Society

To help promote primary care physician participation, the Affordable Care Act (ACA) increases Medicaid reimbursements for evaluation and management and immunization services to 100 percent of Medicare reimbursement in 2013 and 2014. The increase will apply to both fee-for-service and managed care Medicaid plans. Under the new rule, which was finalized by the Centers for Medicare & Medicaid Services in November, Medicaid is federally required to pay up to the Medicare rate for certain primary care services and to reimburse 100 percent of the Medicare Cost Share for services rendered and paid in calendar years 2013 and 2014.
Source: ncmedsoc.org

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

Trudy Lieberman: Is Obama Going To Cut Medicare? Probably

Simpson-Bowles also restricts the amount that insurance companies can reimburse a beneficiary for medical expenses under a Medigap policy—the “skin-in-the-game” method of controlling medical costs, meaning that if seniors have to pay more they will use fewer medical services. Indeed, the Simpson-Bowles document asserts that Medicare’s “benefit structure encourages over-utilization of health-care,” a point state insurance commissioners have found dubious. So to fix this “problem” and make seniors pay more, Medigap policies would be prohibited from covering the first $500 of expenses and only 50 percent of the next $5,000 of expenses a beneficiary racks up.
Source: crooksandliars.com

Trudy Lieberman: Is Obama Going To Cut Medicare? Probably

Posted by:  :  Category: Medicare

Choose Love Over Fear by elycefelizSimpson-Bowles also restricts the amount that insurance companies can reimburse a beneficiary for medical expenses under a Medigap policy—the “skin-in-the-game” method of controlling medical costs, meaning that if seniors have to pay more they will use fewer medical services. Indeed, the Simpson-Bowles document asserts that Medicare’s “benefit structure encourages over-utilization of health-care,” a point state insurance commissioners have found dubious. So to fix this “problem” and make seniors pay more, Medigap policies would be prohibited from covering the first $500 of expenses and only 50 percent of the next $5,000 of expenses a beneficiary racks up.
Source: crooksandliars.com

Video: The Romney/Ryan Medicare Plan: Boo!

Brad DeLong : Remember, the Dormouse Says Medicare Is the Best

Disenrolled from fee for service Medicare – and unable to keep the surgical follow-up appointment from a surgeon who takes Medicare assignment but does not participate in Medicare Managed Care – and moved to a Medicare Managed Care rehab funded facility, Alice was advised that this was her problem to unravel. Her new Medicare Managed Care insurance plan vacillated between advising her she was not an enrollee in their plan and advising that, even were she an enrollee, no follow up post-surgical appointment was necessary….
Source: typepad.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

Brad DeLong : John Cogan, Tobias Cwik, John Taylor, and Volker Wieland’s Reputational Bet on Fiscal Policy Is Due, and They Are Bankrupt

This matters when interest rates on assets like Treasury Bills get very low, like zero, like they are now. If you hold your money in a six-month Treasury Bill you get essentially no interest—0.3% per year Monday afternoon—and you run the small risk that interest rates might rise over the next month and your Bill might lose a little value. If you hold your money in cash you get exactly no interest and it is safe—FDIC insured. Thus there is no economic incentive pushing you to spend your cash when interest rates are very low. And so there is no economic reason for the velocity of money to be any particular value. When the central bank tries to boost nominal spending through standard monetary expansion it might prove ineffective: interest rates will drop even closer to zero as the ratio of money to bonds rises, and the velocity of money might well drop to offset the boost to the money stock.
Source: typepad.com

Are US Retirement Accounts at Risk?

Will tax increases solve these fiscal problems? According to data from the Internal Revenue Service, in 2009 (the latest year for which data has been provided), the top one percent of earners paid more than 36 percent of all federal tax revenues collected, the top five percent paid more than 58 percent, and the top 10 percent paid more than 70 percent of income taxes [National Taxpayers Union]. What are the odds that the feds will be able to successfully squeeze even more money out of the business owners and others who create and manage the wealth? At the other end of the spectrum, roughly half of all Americans paid no income tax [The Heritage Foundation], and that is unlikely to change given the current political environment. We now have only 115 million Americans paying income taxes, but 120 million receiving government entitlements, and it is growing at a rate of more than six percent every year [Richard Russell].
Source: financialsense.com

Turning 65: Finding a Medigap Policy

The first step after reading my collection of Medicare Advantage, prescription drug, and Medigap sales brochures was to find a way to fill in core Medicare coverage gaps’the deductibles for hospital stays and doctor care and the coinsurance for physician visits, lab tests, and hospital outpatient treatment that could really leave me with an unwelcome bill.’  I would have to pay 20 percent of those bills if I didn’t have supplemental coverage. The option I considered first was traditional Medicare supplement insurance, commonly known as Medigap policies, products I knew a lot about having reported on them for years at Consumer Reports. These policies have been around since the beginning of Medicare, but they have a blemished history because insurers used misleading and deceptive tactics to sell them. Congress ended those practices 20 years ago when it standardized the benefits for 10 different kinds of Medigap plans and designated them by using letters of the alphabet. That meant that all consumers had to compare were the premiums and how they were calculated. The idea then was to simplify shopping and end deceptive selling practices. Today shopping for a Medigap plan is anything but simple. Congress has taken away some of the standardized plans and added new ones with very skimpy coverage’a potential landmine for consumers on fixed incomes who choose them. The push to give consumers more information has actually made the job of picking a Medigap plan so much harder. The government’s website tells me that I can choose from among 96 Medigap different policies offered by sellers in New York City. Do I really need that many on top of some 43 choices for Medicare Advantage plans and 30 for prescription drug plans? Alphabet Soup Like any reasonable shopper, I checked out what the government’s handbook Medicare & You had to say about Medigap plans. Not much, it turned out. It said there were two new plans, M and N, and that plans E, H, I, and J are no longer available. It didn’t say what those plans covered. For an explanation of the coverage provided by any of the standardized plans’either old or new’I had to visit www. Medicare.gov or phone 1-800-Medicare, the New York insurance department, or contact the state health insurance counseling and assistance program. It almost seemed like the government does not want seniors to choose Medigap policies but rather steers them toward Medicare Advantage plans, for which there was far more information in the handbook. (I will discuss those in a later post.) I tackled the government website, which was confusing from the get-go. The first page of all the Medigap policies available in New York had columns listing the benefits with green checks and red x’s showing what was and was not covered.’  Okay, I got that, but what were the question marks that appeared next to the benefits?’  Take Policy A, for example, the page showed there was no coverage for the Part A hospital deductible’this year $1,132.’  But a blue question mark raised the question: was it covered or not? ‘ From that page, I was supposed to choose which combination of benefits and coverage I wanted and find out what policies were sold in my Zip code. Plan F was my choice, and the website advised that there were 14 policies for sale in my Zip code.’  Plan F is the most comprehensive and would cover me in case doctors don’t take Medicare’s payment as payment in full, sticking me with what’s called an ‘excess charge.”  In the past, most docs have accepted Medicare’s ‘ payment levels, but that may be less likely in the future as doctors get more persnickety about not taking Medicare patients.’  I wouldn’t take that risk.’  Others might, since Plan F is the most expensive.’  It’s a risk benefit calculation’higher monthly premiums versus the possibility of a large bill down the road uncovered by insurance. Since all insurers selling Plan F must offer the same benefits, I needed to know only two things’the monthly premium and how companies figure premium increases each year.’  Medicare’s website was not very helpful. ‘ It gave only a price range for Plan F policies’$197 to $422 and contact information for the 14 companies. I guess I was supposed to call them.’  When it came to how premiums would be calculated, I would give the website a grade of C.’ ‘  A section called ‘Additional Tools & Information,’ gave a clear explanation of the three ways to determine premium increases, but crucial information was missing. Pricing by Age? In general, community-rated policies are best because premiums don’t change just because you get older.’  Issue-age policies are cheaper for younger buyers, and their premiums don’t increase with age.’  However, they are not common.’  Attained age-rated policies become the most expensive in the long run because premiums do rise as you get older.’ ‘  In all cases, premiums will go up each year because health care will only get more expensive.’ ‘  That’s a good reason to avoid policies that might pile on extra costs just because your biological clock is ticking.’ ‘  Since income often shrinks in the later retirement years, this is ‘need-to-know’ stuff, but the government apparently believes that insurers don’t have to tell you.’ ‘  Only five Plan F sellers disclosed their pricing methods: they all used community rating.’  Were the others mum because their methods are unfavorable to consumers?’  I would not buy a policy from a company that failed to reveal its pricing method. Still, I needed actual premiums so I called the Health Insurance Information Counseling and Assistance Program.’ ‘  HIICAPs, as they are called, can be found all over the country.’  The one for New York City was lodged at the city’s Department for the Aging.’  I wanted to know more about how premiums would be calculated in the future, but the counselor I talked to didn’t know much.’  When I asked what community rating was, she replied, ‘Every state has a different rating depending on where you live.” ‘  As for attained-age rating, ‘I don’t know what that is,’ she admitted.’  The department offered a booklet that listed prices for only eleven companies selling Plan F.’ ‘  There was no plan with a premium of $197 as the website suggested.’ ‘ ‘  I did learn that all Medigap plans sold in New York were community rated, a protection unavailable in most other states. As the booklet directed, I visited the website of the New York State Department of Insurance for more current information.’  Eleven sellers offered premiums ranging from $251 to $409.’  State Farm, one of the sellers that sent a marketing brochure, had the highest premium; United Healthcare, the other marketer contacting me, had the lowest.’  I ruled out State Farm; it was too expensive.’  The UnitedHealthcare/AARP policy seemed ideal.’  I still had questions so I called the company’s toll-free number seeking answers. Can I always buy a Medigap policy even if my health changes?’  ‘A qualified yes,’ said a customer service rep.’  If I am outside of my open enrollment period’the six months that begins in the month I turn 65 and enroll in Part B’ and outside the 63-day period for previous coverage, then there is a pre-existing condition waiting period, he explained.’  Does an insurer have the right to refuse me coverage if I get sick in the future?’  If I stay on my previous employer’s retiree plan and the employer drops the coverage as many have been doing, then I might need a Medigap plan someday.’  Yes they can refuse, he said, but not in New York.’  If I moved to another state, I could be out of luck. Having picked a Medigap policy, it was time to choose a prescription drug plan to go with it.’  Congress won’t let insurers sell drug coverage as a benefit included in a Medigap plan.’  Picking the right prescription plan adds a whole new layer of difficulty to an already-complicated task. I’ll tackle that challenge in next week’s post.
Source: cfah.org

Medicare Supplement Plan J

When Medigap Plan J was introduced the addition of home health care and preventative care benefits made sense because neither benefit was included in Medicare. These were the two benefits that distinguished Plan J from Medicare supplement Plan F. For most companies Plan F was more popular due to lower premiums and many people denying that they would ever require home health care benefits.
Source: affordablemedicareplan.com

S.C. Hospice Firm Busted for Alleged Medicare Fraud

Posted by:  :  Category: Medicare

'The election of Obama would, at a stroke, refresh our country's spirit' by Renegade98“As budget pressures increase it is more important than ever to protect Medicare dollars and vigilantly guard against needless health spending,” Daniel R. Levinson, Inspector General of the U.S. Department of Health and Human Services, said in a statement. “The company and its owner have agreed to federal monitoring and reporting requirements designed to avoid such problems in the future.”  The investigation was jointly handled by the U.S. Attorney’s Office for the District of South Carolina, the Justice Department’s Civil Division and the Office of the Inspector General of the Department of Health and Human Services. The claims resolved by this settlement are allegations only, and there has been no determination of liability, the Justice Department noted.
Source: patch.com

Video: “Confederate ancestors” weigh in on SC Medicare battle

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

Travel for Seniors: South Carolina

This post is a guest post by John Walters who is a freelance writer who attended the 1973 Clarion West science fiction writing workshop and is a member of Science Fiction Writers of America.  He writes mainstream fiction, science fiction and fantasy, and memoirs of his wanderings around the world.  For many years he lived in Greece with his Greek wife and five sons and taught English as a second language to help pay the bills, but he has recently moved back to the United States and now lives in San Diego. 
Source: medicareecompare.com

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

Phone scam targets Medicare users

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

Oregon Governor Describes Medicaid Payment Plan

Posted by:  :  Category: Medicare

OBAMAS DEATH PANEL------ GUESS WHAT FOLKS IT'S ALIVE AND WELL---"CRAZY PALIN" NOT SO CRAZY NOW by SS&SSGuests Charles Evans Jr. and Victor DeNoble discuss the documentary film that chronicles DeNoble’s unexpected discovery of an ingredient in tobacco which, the data revealed, when coupled with nicotine makes cigarettes more addictive. The research and the company’s attempts to keep it private lead to Congressional testimony before a subcommittee of the House Energy and Commerce Committee. The movie details how this public revelation of DeNoble’s findings led journalists, politicians, attorneys and scientists to join forces against the tobacco industry,  which ultimately resulted in the first ever federal regulation of the tobacco industry. Evans discusses how and why he went about making the film, which began when he first watched Dr. DeNoble’s testimony on
Source: c-span.org

Video: Medicare 4: Straight Talk on Medicare and Social Security from AARP Oregon

AARP riles progressive Evangelical group

Local Oregon foresters and craftsmen offer Woodturning Blanks for woodworking projects. Display your skills with a lathe by starting from pen blanks or bowl blanks and creating beautiful artwork. Your options expand even more when you consider the options with burl wood and wood slabs.
Source: oregonfaithreport.com

Is Medicare Really Working in Oregon?

One certain reason enrollees are continually satisfied is that 2012 premiums are lower on average than 2011 premiums.  In 2011, the Centers for Medicare and Medicaid Services (CMS)  found that the Medicare Part D program saved enrollees $2.1 billion in 2011 because of the Gap Discount program, which requires drug manufacturers to provide discounts on brand-name and generic drugs to seniors in the gap or “donut hole.”  About 3.6 million enrollees nationwide benefitted from these discounts, at an average of $604 each.
Source: northcoastoregon.com

Details Emerge on Asante Health, Ashland Hospital Merger in Oregon

A decision is expected Tuesday from the Ashland (Ore.) City Council on whether to approve a letter of intent to merge Ashland Community Hospital with Medford, Ore.-based Asante Health System, according to a report by the Ashland Daily Tidings. If approved, the city-owned hospital will work to create a definitive agreement within two to three months, according to the report. Among the terms of the agreement would be $10 million in capital improvements from Asante. Asante would also be required to run the hospital as a general hospital for a set number of years or pay a fine between $4 million and $8 million. Asante would be expected to attempt to employ all current hospital employees, if possible, but would not need to guarantee employing all of them as part of the agreement, according to the report. Ashland Community Hospital lost $2.5 million last fiscal year due to a high Medicare and Medicaid payor mix and uncompensated care. Previous merger talks with San Francisco-based Dignity Health failed after the public decried would-be restrictions on contraception and end-of-life services, according to the report.
Source: beckershospitalreview.com

Interview: Gov. John Kitzhaber on Oregon’s $1.9 billion Medicaid experiment

All great movements have started with people, because collective wisdom is stronger and smarter than any one individual. And we believe that it is time to leave partisan politics behind.  We Can Do Better engages citizens in identifying barriers and solutions to improving health and health care for all.We combine traditional tools – community forums and workshops – with new media to bring people together. Online and in-person opportunities for the public to become informed, organize, and voice their opinions lead to real-time grassroots civic action that influences public policy debate. We want public and private programs to reflect our shared principles and framework. The process won’t always be easy or comfortable because we recognize we have tough choices ahead. We believe that positive and lasting social change only comes when engaged citizens work together in common cause.  We Can Do Better is a non partisan space for civic engagement for people to develop strategies and solutions that inform public policy and result in better health and health care for all.
Source: wecandobetter.org

Oregon’s great health care experiment: State puts $240 million on the line with coordinated care

The Oregon Health Authority formally certified the Collaborative to become a CCO on July 31, and it will begin providing care to 180,000 Oregon Health Plan patients living in Multnomah, Washington and Clackamas counties on Sept. 1. The Tri-County Medicaid Collaborative will, by far, be the largest CCO in Oregon. It is composed of every major health provider in Multnomah, Washington and Clackamas counties: Adventist Health, CareOregon, Central City Concern, Kaiser, Legacy Health, Oregon Health & Science University, Providence Health & Services, Tuality Healthcare, and representation from the three metro counties. Its annual budget is expected to be around $750 million dollars, and it will provide care for roughly a third of the state’s Oregon Health Plan patients.
Source: streetroots.org

Citivend: How will you enroll in Medicare supplement Oregon plans?

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Source: citivend.com

Raising Medicare Age Would Hurt Seniors

U.S. Sen. Jeff Merkley, D-Ore., visits the Multicultural Senior Center on Northeast Martin Luther King Jr. Boulevard to express his opposition to any proposal in Congress that would raise the age of Medicare. The Urban League of Portland’s Bonnie Jones (center) and southeast Portland senior Ann Sorlie (right) also spoke against Medicare cuts. Photo by Cari Hachmann/The Portland Observer
Source: portlandobserver.com