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

Texas Medicare Supplement Insurance

You’d like to think all your medical services are covered, but unfortunately, even with Medicare supplement insurance, that is simply not the case. Most Medicare supplement policies pay only for services Medicare decides are “medically necessary”. If you are unsure what these exact services are, you can look in your Medicare Summary Notice. If you do receive a bill for services, you will need to review your notice statement to find out if you owe anything extra. All medical providers and doctors that accept Medicare should know beforehand if a procedure is approved by Medicare and the rule of thumb is if it’s an approved charge the supplement is required by law to start paying its share. Fairly simple and less worrisome., easy actually.
Source: medicareinsurancetexas.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

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

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

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

Obama’s Proposals for Medicare

Posted by:  :  Category: Medicare

Newsweek Magazine (February 16, 2009) ... Lenders Add Bigger Fannie, Freddie Fee – Thanks to Payroll Tax Cut (January 15, 2012) ...item 2.. Dupuy: GOP trying to sell pyrmaid scheme to voters (September 3, 2012) ... by marsmet526Why has Medicare been overpaying Advantage insurers? Under the Medicare Modernization Act (MMA) of 2003 Congress agreed to pay Advantage Insurers 13% more than it would cost traditional Medicare to cover the same seniors.  Since then research has shown that seniors themselves didn’t believe that Advantage is worth the premium.  A 2009 study published in the International Journal of Health Care Finance and Economics reveals that, when Advantage beneficiaries were asked how much they would pay, out of their own pocket, for the benefits provided by their insurer, they estimated the value of those benefits at just 14 cents for every extra dollar that Medicare was paying. The Incidental Economist’s Austin Frakt, a coauthor of the report, concluded: “This relatively poor return of value on taxpayer dollars is why I support reductions in Advantage payments.”
Source: healthbeatblog.com

Video: What is Medicare, What is Medicaid and What is the Difference? (50)

Daily Kos: Kaiser report details Medicare options

Medicare cost sharing is relatively high and, unlike most private health insurance policies, Medicare does not place an annual limit on the costs that people with Medicare pay out of their own pockets. Many Medicare beneficiaries have supplemental coverage to help pay for these costs, but with half of beneficiaries having an annual income of $22,500 or less in 2012, out-of-pocket spending represents a considerable financial burden for many people with Medicare.Cost sharing and premiums for Part B and Part D have consumed a larger share of average Social Security benefits over time, rising from 7 percent of the average monthly benefit in 1980 to 26  percent in 2010 (Exhibit I.3). Medicare beneficiaries spend roughly 15 percent of their household budgets on health expenses, including premiums, three times the share that younger households spend on health care costs. Finally, Medicare does not cover costly services that seniors and people with disabilities are likely to need, most notably, long-term services and supports and dental services. Putting the burden of saving Medicare on the beneficiaries, already paying a significant portion of their incomes on health care, isn’t a solution for saving this program, for keeping it’s promise to America’s seniors and disabled. That basic premise should be the starting point for reforms.
Source: dailykos.com

Are Medicare Insurance Premiums On The Rise?

A COLA increase in 2012 allowed CMS to close the gap between the standard premium and the amount that most beneficiaries pay. Crediting the ACA, CMS lowered the standard premium to $99.90 from a previously forecasted $106.60. Although the standard premium was lowered, the amount most beneficiaries paid increased by $3.50, and some beneficiaries who previously paid the high-income surcharge saw a decrease in their Medicare insurance premium.
Source: seniorcorps.org

Report: Raising Medicare Age Would Increase Insurance Costs by $2K

Mr. Simonian, we can find the funding, heck, we could go the Canadian route and put everyone into Medicare if we so desired AND save money doing it. Ask yourself why it is the Canadians cover EVERYONE, have way better outcome numbers than the U.S. and only spend 10% of their GDP on health care? Meanwhile, in the U.S. we have 50 million uninsured, another 50 million with essentially bogus insurance, lousy health statistics (e.g.,CIA: life expectancy in U.S. now 51st place) and we spend 17% of our GDP on health care. At the same time that that part of our population below the median income level has not seen and increase in life expectancy for 30 years. There was a study out earlier this year that for every dollar saved by raising the Medicare age would cost the private sector double.
Source: californiahealthline.org

State Trends: Per Person Costs of Private Insurance Rising Faster Than Medicare

Rising health care costs and stagnant incomes have pushed more families into poverty. As a result of the recession, the percentage of people with ESI dropped from 58.9% to 55.3% from 2008 to 2010. An estimated 9 million adults between 19-64 lost a job with health benefits and became uninsured. As Say Ahhh! readers know, a new alternative poverty measure from the Census Bureau finds that 16% of the population would have been counted as poor, compared to 12.7%, when medical spending is factored in to the calculation.
Source: georgetown.edu

Medicare Costs Going up in 2013

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 Premiums – Beware of Deceptive E

As is always the case in an election year, hot topics are regularly used as canon fodder. One such hot topic is Medicare. The deceptive letter below is making the rounds via e-mail on the letterhead of Blue Cross of Alabama, appearing official until you notice the political commentary. The information in the e-mail regarding premium increase to Medicare part B is 
Source: ostdiek.co

IRS Reverses Position on Deducting Medicare Premiums

The IRS Confirms the Deduction Until recently, there has been some confusion as to whether Medicare premiums paid by a self-employed individual, a partner in a partnership or a more than 2% shareholder of an S corporation qualified for this deduction.  The IRS recently confirmed in a Chief Counsel Advice (CCA) that if you otherwise qualify for the above-the-line deduction for health insurance premiums, you may be able to deduct your Medicare premiums.  The CCA concludes that all Medicare parts are insurance constituting medical care and that all Medicare premiums may be deductible – not just the supplemental medical insurance of Medicare Part B.
Source: herbein.com

Viewpoints: Bowles And Simpson Urge Obama To Seek Medicare Savings; Health Care Industry Helps Stabilize The Economy

The New England Journal of Medicine: The Oregon ACO Experiment — Bold Design, Challenging Execution (Accountable Care Organizations) are expected to contain costs through improvements in health care delivery and realignment of financial incentives, but their effectiveness remains unproved, and there are reasons for concern that they may fail. Oregon has embarked on an ambitious program centered on the ACO model, which aims to change Medicaid financing and health care delivery. The Oregon experiment highlights both the bold vision of ACO-based health care reform and the potential challenges to executing that vision. Failure of the Oregon experiment would not only jeopardize health care for vulnerable Oregonians but also call into question the viability of central tenets of the ACA (Dr. Eric C. Stecker, 2/13).
Source: kaiserhealthnews.org

Medicare Is Doomed The Future of Freedom Foundation

Leaving aside the fatal moral defect of Medicare — that it coerces innocent people through taxation and permits no one to opt out — the program is doomed. (Some time can be bought through changes such as advancing the eligibility age to 67.) It has tens of trillions of dollars in unfunded liabilities, meaning it has made promises to future retirees that Congress has made no provision for keeping. If nothing changes, the working generations will have to be crushed with a far higher tax burden than they have today — which hardly could be seen as fair even by conventional standards, since (for obvious reasons) the elderly tend to be wealthier than younger people. Because of the relative size of the Baby Boom generation, 10,000 members of which are turning 65 each day and going on Medicare, there will be many fewer workers per beneficiary than there were in the past. Two workers will be forced to pay each retiree’s medical bills. Those younger people might have other plans for their money.
Source: fff.org

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

Posted by:  :  Category: Medicare

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

Video: Learn About Medigap Plans

Assessing Risk: Medicare Advantage vs. Medigap vs. Drug Coverage Only

As Medicare’s open enrollment season draws to a close, it’s a good bet that seniors are still sifting through all those brochures and flyers that have come in the mail the last several weeks.’  My husband received 22.’  Some used tried-and-true scare tactics that Medicare insurance sellers have relied on forever to get him to open the envelope and bite.’  Others simply designed ways to gauge his interest in hopes that a salesperson could get in the door. Under current government rules, health insurance agents must make an appointment before coming to a senior’s home.’  That’s the government’s way of protecting them from pushy salespeople making cold calls.’  The theory is that an agent who is invited in will help seniors compare plans and choose the best one; though, the ‘best’ may very likely be what helps the agent or insurance company the most.’  Flyers are mere appetizers for the main course served by an agent.’ ‘  The first solicitation from First United American blared on the envelope:’  ATTENTION: NEW 2011 MEDICARE PRESCRIPTION DRUG COVERAGE INFORMATION HAS ARRIVED.’  The next one said:’  SECOND NOTICE:’  PLEASE REVIEW MEDICARE PRESCRIPTION DRUG COVERAGE FOR 2011.’  The second notice bit, of course, was to make the envelope look like something official from the government. Both were pushing a prescription drug plan, called a PDP in Medicare-speak.’  It’s meant to be used along with an old-fashioned Medigap policy that does not cover prescription drugs.’  I spotted some scary fine print.’  It said that if you sign up for the drug benefit, your membership in a Medicare Advantage (MA) plan may end.’  No more doctor, hospital, or drug coverage from that plan.’  I wonder how many seniors missed that warning. Emblem Health sent three messages.’  Two pushed plans using scary language highlighting changes in the law to get people interested in their brand of MA plan.’  One said:’  ‘ACTION REQUIRED’ and noted that’  ‘due to the recent changes in health care legislation, you will no longer be able to switch Medicare Advantage Plans after December 31.”  Another warned my husband ‘may not have a second chance to get the right Medicare Advantage coverage,’ and urged him to get the facts to make the right choice by calling for a free Medicare decision guide.’  Another of Emblem’s solicitations contained a short survey to fill out and return.’  The company would then send along a copy of the decision guide. What was missing from most of these solicitations was real information.’  The AARP-UnitedHealthcare solicitation for Medigap policies gave the table of standard benefits and premiums for New York.’  That’s kind of helpful.’  Their solicitation for Medicare Advantage plans was more explicit.’  The envelope enticed with ‘Looking for a plan with a monthly premium starting at $0?’ ‘ The flyer for United’s MedicareComplete plan gave a brief summary of benefits: zero monthly premium, zero annual medical deductible, zero copayments for routine physicals, immunizations and preventive screenings.’  What a deal!’  But a good consumer needs to know more. First of all, the new heath law allows all of those services without copayments whether you have a Medicare Advantage plan or not, so United wasn’t offering anything special here.’  There were other caveats.’  What about staying in a network and the lack of freedom to go to any doctor?’  What about coinsurance (a percentage of a medical bill that you are required to pay) that you might have to pay: for chemotherapy drugs, for example?’  To find out more, a shopper would need to call the company, visit with a sales agent or use Medicare’s website, not a simple task. So I suggest a simple rule no matter whether you use an agent or the government website: the Medicare option you choose boils down to your risk vs. premium calculation.’  A combination Medigap policy with a stand-alone drug benefit may cost more upfront than a Medicare Advantage plan with no monthly premiums and deductibles.’  But if you are seriously ill, the combo plan may be cheaper in the end when you consider the hidden costs of an MA plan that may not be disclosed when you sign up. ‘ In our ZIP code alone there are 84 options.’  Mindboggling!’  There’s no way anyone can choose “the best” from that kind of crowd, which raises a point I have made before ‘ do we really need all that choice in health care?
Source: cfah.org

Medigap: Providing Financial Security and Peace of Mind for Medicare Beneficiaries

Proponents of limiting first-dollar coverage in Medigap often cite the findings from a 1970’s RAND experiment to make the case zero cost-sharing leads to higher health care spending.  AHIP commissioned a white paper to examine the relevance of this study to current Medicare beneficiaries. The white paper found that the RAND study “was set in a reimbursement environment far different from today’s Medicare,” and noted that “a higher proportion of Medicare beneficiaries are low income (and low wealth), and so the impact of higher cost-sharing may be magnified for this population.” The authors conclude that “an across-the-board ban on first-dollar coverage Medigap plans is an overly blunt tool for lowering healthcare expenditures and invites adverse, unintended consequences.”
Source: ahipcoverage.com

Medicare open enrollment: What’s the best Medigap policy?

The difficulty for consumers is that the nature of Medigap makes it a lot harder to shop for than Medicare Advantage. Here’s why. Medicare Advantage plans are regulated and overseen on a national level. Medicare routinely collects all kinds of information on them about customer satisfaction and quality of care. In addition, the premium of a specific Medicare Advantage plan is the same for each customer. As a result, it’s possible (as I explained yesterday) to go to Medicare.gov and compare Medicare Advantage plans in detail, including quality ratings and price. It’s also why we can publish rankings of Medicare Advantage HMOs and PPOs through our partnership with the National Committee on Quality Assurance.
Source: consumerreports.org

Insurance Commissioners Reject Calls To Limit Seniors’ Medigap Policies

Medigap policies are popular with seniors because Medicare does not cap out-of-pocket expenses. The policies are not cheap — the average premium nationwide was $178 a month in 2010 — but they protect subscribers from unexpected high medical bills, which is important to people on fixed incomes. The C and F Medigap plans cover nearly all of the out-of-pocket costs that beneficiaries would usually pay.  Two thirds of people who buy Medigap plans have incomes below $40,000 a year — about the same income levels for all Medicare beneficiaries.
Source: kaiserhealthnews.org

Medicare Vs Medigap in Medical Healthcare Insurance

                                                     Medicare Vs Medigap Medicare is the federal (national) health insurance program for Americans age 65 and older and for certain disabled Americans. If you are eligible for Social Security or Railroad Retirement benefits and are age 65, you and your spouse automatically qualify for Medicare. Medicare has two parts: Hospital insurance, known as Part A, and Supplementary medical insurance, known as Part B, which provides payments for doctors and related services and supplies ordered by the doctor. If you are eligible for Medicare, Part A is free, but you must pay a premium for Part B. Medicare will pay for many of your health care expenses, but not all of them. In particular, Medicare does not cover most nursing home care, long-term care services in the home, or prescription drugs. There are also special rules when Medicare pays your bills that apply if you have employer group health insurance coverage through your own job or the employment of a spouse. Medicare usually operates on a fee-for-service basis. HMOs and similar forms of prepaid health care plans are now available to Medicare enrollees in some locations. The best sources of information on the Medicare program are the handbook Medicare & You , and the Medicare website. You may also contact your local Social Security office for information and materials. Some people who are covered by Medicare buy private insurance, called “Medigap” policies, to pay the medical bills that Medicare does not cover. Some Medigap policies cover Medicare’s deductibles; most Medigap policies pay the coinsurance amount. Some Medigap policies also pay for health services not covered by Medicare. There are 10 standard medical healthcare insurance plans from which you can choose but some States may have fewer than 10. If you buy a Medigap policy, make sure you do not purchase more than one. You need to shop carefully before deciding on the best Medigap policy to fit your needs. Disability Insurance Disability insurance replaces income you lose if you have a long-term illness or injury and cannot work. Disability coverage is an important type of insurance for working-age people to consider. Disability insurance does not cover the cost of rehabilitation if you are injured. Check your major medical insurance to see if it is covered there. Some employers offer group disability insurance and this may be one of the benefits where you work. Or you might be eligible for some government-sponsored programs that provide disability benefits. Many different kinds of individual disability policies are also available. Hospital Indemnity Insurance Hospital indemnity insurance offers limited coverage. It pays a fixed amount for each day, up to a maximum number of days. You may use it for medical or other health care expenses. Usually, the amount you receive will be less than the cost of a hospital stay. Some hospital indemnity policies will pay the specified daily amount even if you have other health insurance. Other hospital indemnity insurance plans may coordinate benefits, so that the money you receive does not equal more than 100 percent of the hospital bill. Long-Term Care Insurance Long-term care insurance is designed to cover the costs of nursing home care, which can be several thousand dollars each month. Long-term care is usually not covered by health insurance except in a very limited way. Medicare covers very few long-term care expenses. There are many long-term care insurance plans and they vary in costs and services covered, each with its own limits.
Source: blogspot.com

Why Do You Need Medigap Insurance?

There are several types of Medigap plans available. Each depends of the benefits that are required. Although the prices that insurance carriers offer may vary widely in different areas, the coverage provided by each plan is the same. In other words, if you buy Medicare supplemental insurance in Florida, you would be afforded the same coverage as someone who bought the same plan in Ohio.
Source: alissapajer.org

Is it too late to change my Medigap/Medicare Supplement for 2013?

If you are 65 or older and have been on Medicare Part B for longer than 6 months, you will most likely have to answer some health questions as part of the application process for a new Medicare Supplement/Medigap policy.  The majority of people have no trouble qualifying for a new policy, and usually an agent or broker can tell in the first conversation whether or not you will qualify.  Illinois also has a few companies that have guaranteed issue Medicare Supplements.  These companies never ask health questions of any applicants and will issue a policy to everyone who applies.
Source: bcmil.com

Margy Wenham Insurance Services

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Source: globalhealthcareprofessional.com

What Medigap Insurance Has That Medicare Advantage Doesn’t

Compare this to Medicare Advantage plans. Plans are not standardized and vary from company to company. The same named plan may even include different benefits depending on the County where it is offered. Because of the moving parts, shopping for and comparing Medicare Advantage plans is much more difficult and can result in less certainty that you have actually chosen the best plan for your circumstances.
Source: medicareprofs.com

Myths and Realities of Ryan and Medicare

Posted by:  :  Category: Medicare

ROBERT L. HUFFSTUTTER'S HEALTHCARE PLAN FOR AMERICA by roberthuffstutterHis insincerity in dealing with the problems facing Medicare is every bit as brazen. In contrast to Ryan, who admits that tough choices and significant revisions in its structure and management must be made, Obama postures as if it will continue forever in its present state, with funding magically available from unlimited economic sources. This is particularly egregious since it was his own establishment of socialized medicine (Obamacare) that has inflicted the worst damage to Medicare. In order to balance the books on Obamacare, the current medical coverage for seniors would be forced to forfeit $700 billion from its coffers. Yet we are told that no reduction would be experienced by recipients. No need to do the math, just take his word for it. The worst aspect of this situation is that liberals do not care if Medicare eventually implodes, as long as it waits until after November 6 to do so.
Source: hawaiireporter.com

Video: Healthcare: Plain & Simple “Medicare” – Hawaii News Now, KGMB and KHNL

IRS Unveils Proposed Rules, FAQs on Additional Medicare Tax

The FAQs address a number of issues. In addition to adding a set of FAQs for individuals, IRS expanded on the existing set of FAQs it had released earlier in the year for employers and payroll service providers, adding 13 new FAQs (questions 7, 24, 30, 36, 38, and 40-47), and modifying existing guidance in questions 32 and 34 to include Form 941 reporting information.
Source: wordpress.com

Coming Soon: A New Way to Buy Health Insurance

When key parts of the health care law take effect in 2014, you’ll have a new way to buy health insurance for yourself, your family, or your small business: the Health Insurance Marketplace. The Marketplace is designed to help you find health insurance that fits your budget, with less hassle. Every health insurance plan in the new Marketplace will offer comprehensive coverage, from doctors to medications to hospital visits. You can compare all your insurance options based on price, benefits, quality, and other features that may be important to you, in plain language that makes sense.
Source: hawaiinewscenter.com

Arkansas Medicare part d plans

There are many prescribed drugs that are covered under this plan. Each drug has a different price based on the formulary category it belongs to making it easy for calculation of monthly drug expense for the insurer. The various categories of drugs that are covered under this plan are antidepressants, antipsychotics, anti-consulvants, anti-retrovirals (AIDS treatment), immune-suppressants and anti-cancer drugs. The premium that needs to be paid for the plan depends greatly on many factors such as the drugs used, the type of plan opted, network pharmacy, drugs part of Formulary and lastly additional coverage required by insurer for specific treatment of illnesses. This Medicare Pat D plan is available to those already enrolled for Part A and Part B plans.
Source: medicarearkansas.com

Can accountable care organizations reign in health

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

Travel for Seniors: Hawaii

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

American Counseling Association Weblog

Work Conditions: * The work conditions and physical demands listed below are representative of those that must be met by an associate to successfully perform the essential functions of this job. Associates are expected to follow the proper work safety practices and procedures for their personal safety and to prevent possible injuries. * Computer usage may be required up to 50 percent of the time, including heavy typing, keyboarding, data entry, repetitive motion, and/or eye strain. * May be exposed to confidential information and expected to maintain confidentiality at all times; must adhere to HIPAA rules and regulations. * May be required to work outside of normally scheduled hours as mandated by the client, project and/or workload (e.g. evenings, weekends, and/or holidays). * Phone usage may be required up to 15 percent of the time; headsets may be required. * May be required to maintain established work pace, meet deadlines; may have last minute urgent requests. * May be required to travel 25 percent of the time. * May be required to lift, carry and/or move equipment/supplies weighing up to 50 pounds. * May operate personal computers, printers, facsimile, telephones, copy machines and other commonly used office accessories/equipment. * Frequent interruptions/distractions; environment may be loud. * Physical activity may include: twisting, reaching, kneeling, bending, stooping, squatting, crawling, grasping, grabbing, pushing, pulling, repetitive motion, climbing, etc. * Significant reading required via internet and/or bound regulatory volumes. * Work may be sedentary, desk bound or seated up to 8 hours per day. * May be required to walk or stand up to 4 hour per day; walking and/or transporting supplies and equipment between buildings/parking lots and structures may be required
Source: counseling.org

Coming in 2014: Health Insurance Marketplace

It’s an easier way to shop for health insurance. The Health Insurance Marketplace simplifies your search for insurance by gathering all your options in one place. One application, one time, and you and your family can explore every qualified insurance plan in your area — including any free or low-cost insurance programs you may qualify for, such as Medi-Cal or the Children’s Health Insurance Program. 
Source: patch.com

Impact of Federal Affordable Care Act on Hawaii’s Medicaid Buy

2012 Legislative Session Act 48 Act 130 appointed Board of Education Art at the Capitol Ask Your Senator Department of Land and Natural Resources Education Week Governor Neil Abercrombie Hawaii State Budget Hawaii State Capitol Hawaii State Senate House Bill 2012 Senate Bill 1174 Senate Bill 2012 Senate Committee on Education Senate Committee on Ways and Means Senate President Shan Tsutsui Senate Special Committee on Accountability Senator Brian Taniguchi Senator Brickwood Galuteria Senator Carol Fukunaga Senator Clarence Nishihara Senator Clayton Hee Senator Colleen Hanabusa Senator David Ige Senator David Y. Ige Senator Donna Mercado Kim Senator Donovan Dela Cruz Senator Gilbert Kahele Senator Jill Tokuda Senator J Kalani English Senator Maile Shimabukuro Senator Malama Solomon Senator Michelle Kidani Senator Mike Gabbard Senator Pohai Ryan Senator Ronald D. Kouchi Senator Ronald Kouchi Senator Roz Baker Senator Shan Tsutsui Senator Suzanne Chun Oakland Senator Will Espero Twitter Town Hall University of Hawaii
Source: hawaiisenatemajority.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

Susan Tompor: Medicare fraudsters reach out to seniors

Posted by:  :  Category: Medicare

Jessica Sundheim by On Being- Contact your bank or other financial institution immediately if you do make a mistake and give out personal information, such as your Social Security number or bank account information. Think twice about disclosing to a stranger where you go to church or shop. A fraudster might start going to the store or church that you mention to try to take further advantage of you. – Watch all financial statements carefully. Go online to check on recent activity. – Write down any details of calls that seem like a scam and report to local law enforcement, said Dianne Shovely, vice president of fraud services for Comerica Bank in Auburn Hills, Mich. Report any unauthorized transactions promptly. Do not send or give anyone money if you receive a telemarketing call or e-mail. – Obtain a free copy of your annual credit report at www.annualcreditreport.com. Or call (877) 322-8228. – You can ask nationwide consumer credit-reporting companies to place a fraud alert on your file if you’re a victim of identity theft. You may place a fraud alert in your file by calling just one of the three credit-reporting companies. The agencies are: Equifax: (877) 576-5734; www.alerts.equifax.com. Experian: (888) 397-3742; www.experian.com/fraud. TransUnion: (800) 680-7289; www.transunion.com.
Source: goerie.com

Video: Tennessee Medicare Supplement

Lamar & Bob Talk Medicare Cuts and Other TN Fiscal Cliff Notes

DesJarlais, of Jasper, Tenn., was one of 234 members of his caucus who listened in on a conference call Thursday with House Speaker John Boehner of Ohio. Boehner said the House will return to work Sunday at 6:30 p.m. and remain in session in case lawmakers and President Barack Obama reach agreement on a deal to avoid more than $600 billion in tax increases and spending cuts that will otherwise take effect on Tuesday. Economists fear the combination could jar the nation’s economy back into recession.
Source: knoxnews.com

Tennessee Federal Judge Dismisses Medicare Qui Tam Suit For Lack Of Specificity

NASHVILLE, Tenn. – A federal judge in the U.S. District Court for the Middle District of Tennessee, Nashville Division, on Jan. 14 dismissed without prejudice a False Claims Act qui tam cause of action against Health Management Associates Inc. and the University Medical Center, saying the relator lacked specificity of actual fraudulent acts (United States of America, ex rel. Kevin Dennis, State of Tennessee, ex rel. Kevin Dennis; Kevin Dennis v. Health Management Associates Inc., et al., No. 3:09cv00484, M.D. Tenn., Nashville Div.; 2013 U.S. Dist. LEXIS 5212).Full story on lexis.com
Source: lexisnexis.com

Whistlerblowers, state Medicare fraud investigators helps Tennessee recoup big bucks for bad drug deals

In 2011 Tennessee’s MFCU’s 35 people had 132 fraud investigations, with 27 [20.5%] convictions and 44 Abuse/Neglect investigations with 13 [29.5%] convictions. Tennessee made 13 recoveries for $55,497,185 of Tennessee’s $7.8 billion Medicaid costs. Comparing recoveries with Tennessee’s $4.2 million MFCU budget shows a $13.21 to $1 return, 58% higher than the MFCU national $8.39 average. Tennessee’s MFCU is below average in size in a state whose Medicaid recipients are 25% of the population. Staffed with only 2 attorneys [one cross designated for federal court], only 2 auditors, 20 investigators and 11 support staff. They would recover more with more attorneys, fraud indictment rates higher than 8%, and focusing prosecution more on 8 Abuse/Neglect indictments costing more than they recovered. http://oig.hhs.gov/fraud/medicaid-fraud-control-units-mfcu/index.asp
Source: medcitynews.com

Whistleblower Case Against Tennessee

The Health Law Firm’s President and Managing Partner George F. Indest III wrote a two-part blog on the increased number of Medicare and Medicaid audits being initiated against health professionals who treat assisted living facility (ALF) and SNF residents. Most often these are audits by the Medicare Administrative Contractor (MAC), because this area of medical practice has been identified as one fraught with fraud and abuse. To learn more on the areas being targeted and how to respond to different types of audits, click here for the first blog and here for the second.
Source: wordpress.com

Electronic medical records probed for over

Posted by:  :  Category: Medicare

Bubbles? Take something like 'Not I! ...item 1.. Wakulla Republicans Protest Against Taxes in the County (September 06, 2011) ... by marsmet552Michelle Dougherty, director of research and development from the American Health Information Management Association, said in prepared testimony that digital records can produce “volumes of redundant data” that are “very difficult to use and understand.” She said policy makers need to be aware of “red flags” that could produce inaccurate records — for instance, software that allows doctors with a single mouse click to check a box indicating that all body systems were examined and found to be normal, even though that not all were actually examined. Since doctors are compensated for the total amount of service they provide, these systems can improperly generate higher fees.
Source: publicintegrity.org

Video: Medical Billing Minute – Elimination of Medicare Consultation Codes

Democrats Heart Medicare Fraudsters

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.
Source: rightwingnews.com

Loopholes to help you track Medicare Part B therapy billing

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

91 Charged With $430 Million Medicare Billing Fraud

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

Medicare Billing Housekeeping during the Holidays

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

Schneiderman catches top NYC hospital overbilling Medicare and Medicaid

According to the Complaints and Settlements filed in this case, the hospital double-dipped by billing New York and the federal government for psychiatric services provided by its physicians.  St. Luke’s-Roosevelt billed out-patient psychiatric services to Medicaid as a rate-based service, which included the care provided by the physician and all other related costs. At the same time, SLR billed the state and federal governments on a fee-for-service basis for the same care provided by the physician. Also, St. Luke’s-Roosevelt sought and received reimbursement from Medicare for non-reimbursable costs for outpatient psychiatric visits. As a result, the Hospital received Medicare and Medicaid payments that it was not entitled to receive.
Source: seniorlivingcare.com

CMS Issues FY 2011 Medicare RAC Report to Congress

The report was the second official Medicare RAC report. CMS concluded that after accounting for RAC contingency fees, appeals and other RAC-related costs, the RAC program saved Medicare more than $488 million in 2011. The FY 2011 collections figures pale in comparison to the RAC program’s projected FY 2012 results. In December, CMS said RACs recouped $2.29 billion in overpayments from providers and returned $109.4 million in underpayments in 2012. Here are some other major takeaways from CMS’ RAC report to Congress. Note: All figures are based on FY 2011. •    CMS spent $129.4 million to operate the RAC program. Of that total, roughly $82 million were paid to the private, for-profit RACs as contingency fees. (RAC contingency fees ranged from 9 to 12.5 percent for all claims except durable medical equipment.) •    Medicare hospitals and other providers appeal almost 61,000 RAC claims, which represent 6.7 percent of all overpayment claims. Of those claims, more than 26,000 claims — or 43.6 percent — were overturned in favor of the provider. •    HealthDataInsights, which is the HHS Region D RAC, collected the most in overpayments in 2011 — $318 million. •    RAC corrections were highest in California, New York, Illinois and Florida. •    The top overpayment denial reasons were medical necessity reviews for renal and urinary tract disorders and medical necessity reviews for acute inpatient admissions for neurological disorders. •    The top underpayment issues were providers using the incorrect MS-DRGs for severe sepsis and lysis of adhesions.
Source: beckersspine.com

For every silver lining, a cloud: The reality of Medicare incentive payments, audits

The second significant commitment every provider must make is to keeping an excellent record of each patient encounter: focused, thorough, and legible. The record will clearly show the reason for each visit while providing clear evidence that each element of the encounter was relevant to the needs of the patient and, in the words of the insurers, “reasonable and necessary.” Each patient is unique, and each patient encounter is unique, so the doctor may need to help the auditor understand why a specific question was asked or test performed. That will require some careful thought on the part of the doctor, but it often will be effective in convincing the auditor that the doctor did what was appropriate and therefore “reasonable and necessary.”
Source: newsfromaoa.org

Prime Acknowledges Federal Probes Over Billing, Data Disclosure

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

Medicare Fraud Strike Force Charges 91 Individuals for Approximately $430 Million in False Billing

Seven individuals are charged in Houston for their participation in a fraud scheme at a hospital which led to $158 million in fraudulent billing for community mental health center services. According to court documents, the defendants who served as administrators at the hospital paid kickbacks – in the form of cigarettes, food and coupons redeemable for items available at the hospital’s “country stores” – to Medicare beneficiaries in exchange for those beneficiaries’ attendance at the hospital’s partial hospitalization programs (PHP). Allegedly, beneficiaries watched television, played games and engaged in other non-PHP activities rather than receiving the services for which the hospital billed Medicare. Previously, on Feb. 22, 2012, the assistant administrator of the hospital, Mohammad Kahn, pleaded guilty to conspiracy to commit health care fraud and paying kickbacks related to $116 million worth of fraudulent claims submitted to Medicare. After his guilty plea, an additional $42 million in fraudulent claims were discovered that are included in today’s totals.
Source: redsticknow.com

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

Posted by:  :  Category: Medicare

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

Video: Medicare Competitive Bidding Fiasco

Suppliers, experts dispute savings claims from Medicare competitive bid program

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

CMS: Medicare competitive bidding program for durable medical equipment expanding after successful first year

CMS hailed the first round as a success during a call with reporters Wednesday. By replacing fee schedules with prices determined through competition, the bidding process resulted in savings for beneficiaries, taxpayers and the Medicare program, said Jonathan Blum, deputy CMS administrator and director of the CMS Center for Medicare.
Source: mcknights.com

CMS Competitive Bidding Program Demands Attention : NC SPIN Balanced Debate for the Old North State

The North Carolina Association for Medical Equipment Services (NCAMES) is focused on preserving access to safe, affordable, and therapeutic home medical equipment. We provide advocacy and education to home medical equipment (HME) providers statewide dedicated to helping North Carolina’s growing senior population and patients of all ages gain more mobility and experience a high quality of life in the comfort and privacy of their own homes.
Source: ncspin.com

CMS announces payment amounts for Round 2

CMS starts the announcement by mentioning the 27 billion dollars in savings in medicare between now and 2022, so this sets the tone to the great majority of the patients, because throughtout all the public publications CMS had created the idea that DME providers are not partners but rivals. For many, we had made too much money and we shuld afford this unreasonable large cuts in the fee schedule. This is the perfect song to play for the large majority of patients out there that supports the idea that governmment intervention is good because it will take from the DME suppliers and will distribute among the users. We are just 100,000 DME providers but we need to get united to be able to show the people that this is the path to an enviroment of very few providers left to provide to a very large number of consumers. Quality of service and quality of products will deminish to sad levels and those whom had contributed to the Medicare system for years, will be experiencing a sorry service and poor quality supplies. 
Source: hmenews.com

DMEPOS Round 2 Competitive Bidding and National Mail

CMS will now begin mailing contract offers to winning bidders.  14,654 contract offers will be made to 867 Round 2 bidders.  The winning suppliers have 3,109 locations to serve Medicare beneficiaries in the competitive bidding areas.  CMS will offer 15 contracts for the national mail-order program; the national mail-order program winners have 48 locations.  CMS expects to complete the contracting process in time to announce the contract suppliers in the spring of 2013.  Bidders that are not offered contracts will be notified of the reasons why they did not qualify for the program when the contracting process is complete. Suppliers that are not contract suppliers for this round of the DMEPOS Competitive Bidding Program may bid in future rounds.
Source: hallrender.com

CMS Sees Substantial Savings On Medical Equipment From Competitive Bidding Program

To reduce costs and the fraud resulting from excessive prices, CMS introduced a competitive bidding program in nine areas of the country in 2011. Under the DME competitive bidding program, Medicare beneficiaries with Original Medicare who live in competitive bidding areas will pay less for certain items and services such as wheelchairs, oxygen, mail order diabetic supplies, and more. Competitive bidding for DME is proven to save money for taxpayers and Medicare beneficiaries while maintaining access to quality items and services.
Source: medicarewire.com

Deforming Medicare into a Competitive Bidding System (part 1)

FEHBP requires that all plans cover the same medical services. In spite of this, some plans offer more dental and vision coverage than others. However, the primary “choice” is whether to pay now or pay later. Those who choose plans with lower premiums (taken out of biweekly or monthly pay-checks) face higher deductibles and co-payments when they actually need medical care. Often this results in higher overall cost to those who choose what looks like a less-expensive plan. Seeing physicians “out of network” costs more in a “basic”plan than in a “standard” or “high option” plan. We know from many studies that higher co-payments lead low- and even middle-income people to postpone needed medical care. Since FEHBP premiums are independent of the employee’s income, lower-wage workers are likely to choose a “basic” plan and thus face the barrier of higher costs when they have to seek care. And many, of course, will not be able to afford to pay for any plan.
Source: correntewire.com

Competitive Bidding CMS MPP HME Medicare DME

If a Medicare beneficiary chooses to switch suppliers and obtain rental equipment from a new contract supplier instead of a grandfathered supplier, OR if a non-contract supplier decides not to grandfather items that were rented at the time the program is implemented, the current supplier and the new contract supplier must coordinate the pick-up and delivery of the equipment so that service to the beneficiary is not disrupted. The current supplier should provide all supporting documentation, such as the physician order or Certificate of Medical Necessity (CMN) when applicable, to the new contract supplier.
Source: greatlakesmedicalbilling.com

CMS Slashes Medicare Reimbursement under Round 2 of the Medicare DMEPOS Competitive Bidding Program/National Mail Order Competition for Diabetic Testing Supplies : Health Industry Washington Watch

CMS also conducted a national mail-order competition for diabetic testing supplies concurrent with the Round 2 competition. CMS announced that Medicare payment for diabetic testing supplies (100 lancets and test strips) under competitive bidding will be reduced from $77.90 to a national rate of $22.47. While the competition for diabetic testing supplies was intended to apply only to mail-order suppliers, it is important to note that the American Taxpayer Relief Act of 2012 (ATRA), which was signed into law on January 2, 2013, sets Medicare payment amounts for retail diabetic supplies at the national mail order competitive bidding single-payment amounts, effective July 1, 2013.  In other words, as a result of the ATRA, the competitive bidding process is being used to reduce pricing for DMEPOS other than items that actually were subject to competitive bidding. This policy was adopted despite CMS’s previous acknowledgment that "there are pricing differences between mail order and non-mail order diabetic testing supplies because of the delivery methods for these supplies."  Even though under competitive bidding program rules, only successful bidders that sign a contract with CMS will be eligible to furnish mail order diabetes supplies to Medicare beneficiaries as of July 1, 2013, Medicare beneficiaries will not be limited to using contract suppliers to obtain retail/storefront diabetes supplies. In sum, a Medicare beneficiary must use a contract supplier to obtain mail order diabetic testing supplies, but can pick up diabetic testing supplies from any local retailer; the payment to the supplier and the beneficiary copayment will be the same in either setting. (The ATRA also temporarily reduces fee schedule amounts for retail diabetic testing supplies to mail order amounts from April 1, 2013 until the national mail-order program single payment amounts start on July 1, 2013.)
Source: healthindustrywashingtonwatch.com

Competitive Bidding Saves Medicare Money

Today the Seattle Times reports that after a year-long experiment in 9 U.S. cities, government officials are saying competitive bidding for power wheelchairs, diabetic supplies and other medical equipment has resulted in $200 million in savings for Medicare. According to the article, written by Ricardo Alonso-Zaldivar:
Source: stateofreform.com

House rules aim to block controversial healthcare board’s Medicare cuts

Posted by:  :  Category: Medicare

OBAMAS DEATH PANEL------ GUESS WHAT FOLKS IT'S ALIVE AND WELL---"CRAZY PALIN" NOT SO CRAZY NOW by SS&SSHouse Republicans have tried unsuccessfully to repeal the IPAB, the central cost-cutting feature in the Affordable Care Act. The IPAB was designed to take Medicare payments largely out of Congress’s hands, similar to the independent panel that recommends closing military bases, because lawmakers would rarely sign off on such politically risky moves.
Source: thehill.com

Video: Examining Abuses of Medicaid Eligibility Rules

Obama Administration To Relax Medicare Benefit Rules

Modern Healthcare: Class-Action Settlement Would Widen Medicare Chronic-Care Benefits A federal judge in Vermont may approve a proposed legal settlement intended to guarantee Medicare benefits for people with chronic health conditions who need nursing and therapy services at home or in skilled-nursing and outpatient facilities. The settlement would resolve (PDF) a national class-action lawsuit that alleges HHS, Medicare contractors and administrative review boards across the country have rolled out a “clandestine” policy to limit Medicare coverage for nursing and therapy services even though official CMS rules say those benefits should be covered (Carlson, 10/23).
Source: kaiserhealthnews.org

New House Rules Aim To Block IPAB’s Medicare Recommendations

On Thursday, the House voted 228-196 to adopt a package of rules (H. Res. 5) put forth by the GOP for the 113th Congress, which includes a measure stating that the House will not have to follow through on any Medicare cost-cutting recommendations by the Independent Payment Advisory Board created under the Affordable Care Act,
Source: californiahealthline.org

New Medicare Rules Draw National Attention

I was shocked when I read this article on NPR.org the other day. I didn’t know that this problem had become big enough to warrant their notice. Their example case is not dissimilar to cases we’ve had. Medicare certainly does take their sweet time getting a final lien amount to us. And the discrepancies between the Conditional Payment Summaries that come to our office somewhat regular and the Final Lien Amount can be huge. I had a case go from about $5,000.00 to $20,000.00. It can throw a huge wrench in the case because when a client settles, they settle for a certain amount they will receive after all their bills are paid. When lien amounts change, that number changes, and suddenly, they aren’t getting what they agreed to accept. It puts the law office in a very difficult position. Especially since we cannot request a final Medicare lien amount until AFTER we have a settlement with the insurance company.
Source: travisblacklaw.com

Many Years Young: Obama rules out raising Medicare eligibility age to cut spending

(Reuters) President Barack Obama has ruled out raising the age that Americans become eligible for Medicare, the government health insurance program for seniors, as a way to reduce the government’s deficit, a White House spokesman said on Monday.
Source: manyyearsyoung.com

Different payer, different rules, different audit

That’s why providers want to be “100% familiar” with Medicaid guidelines, particularly as they relate to what documentation they need to submit and when, says Sylvia Toscano, owner of Professional Medical Administrators in Boca Raton, Fla.
Source: hmenews.com

GOP opposes its own goals on Medicare

As Ed Kilgore explained, “What’s really maddening is that IPAB — following the overall thrust of Obamacare — is designed to secure savings not just for Medicare but for the entire health care system by encouraging better medicine, not reductions in health coverage for seniors. It seems Republicans are only interested in health care cost containment measures or ‘entitlement reform’ if it comes at the expense of beneficiaries.”
Source: msnbc.com

Not Happy with Your Medicare Advantage Plan? Change it!

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 marsmet524The opinions expressed in WebMD User-generated content areas like communities, reviews, ratings, or blogs are solely those of the User, who may or may not have medical or scientific training. These opinions do not represent the opinions of WebMD. User-generated content areas are not reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other reason except for compliance with our Terms and Conditions. Some of these opinions may contain information about treatments or uses of drug products that have not been approved by the U.S. Food and Drug Administration. WebMD does not endorse any specific product, service or treatment.
Source: webmd.com

Video: Medicare supplement Insurance Plans VS Medicare Advantage plans

2013 Medicare Advantage Plan Enrollment

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

What Is Medicare Advantage Insurance?

What is Medicare Advantage insurance? Now that you can answer that basic question, let’s explore Medicare Advantage further so you can see how well it can go above traditional Medicare. The types of additional benefits offered may include vision care, health and wellness programs, hearing and dental. The dental benefit cannot be underestimated as traditional Medicare only covers dental services when they are deemed essential to the maintenance of your health or critical to the success of a non-dental operation. However, things such as prescription drug coverage, routine dental checks, fillings, cleaning or basic preventative maintenance are not covered under traditional Medicare. Some Medicare Advantage plans do offer that benefit. In fact, some Medicare Advantage plans offer coverage which competes directly with the combined coverage of traditional Medicare plus a Medicare Supplemental Insurance policy.
Source: seniorcorps.org

What is the Cadillac Medicare Advantage plan

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

Medicare Advantage Insurance Explained

The American Healthcare Education Coalition is a national, non-profit, public interest organization that pushes for free Market solutions to our healthcare issues.  According to the AHEC the affect of The Affordable Care Act (commonly known as Obamacare) is detrimental to Medicare Advantage, and their study of its negative impact shows the following:  Cuts to Medicare Advantage started right away in 2010 after the passing of The Affordable Care Act, with payment rates in 2011 being frozen at the 2010 levels. Medicare Advantage payment rates for doctors are being slashed from 2012-2017 and hospitals and medical providers will be cut in the government-managed, fee-for-service Medicare program. A portion of these cuts automatically get passed to Medicare Advantage Plans in the form of lower maximum rates.
Source: capeinthesand.com

Phone Presentation Medicare Advantage

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

What Medigap Insurance Has That Medicare Advantage Doesn’t

Compare this to Medicare Advantage plans. Plans are not standardized and vary from company to company. The same named plan may even include different benefits depending on the County where it is offered. Because of the moving parts, shopping for and comparing Medicare Advantage plans is much more difficult and can result in less certainty that you have actually chosen the best plan for your circumstances.
Source: medicareprofs.com

Cancel Medicare Advantage

Because of their flexibility, the ability to move states and the fact that the insurance company cannot change the plan are just a few of the reasons we prefer Medicare Supplement Insurance Plans to MAPD. If you would like to hear more about the reasons a Medicare Supplement can be a better fit for your insurance, please fill out the short form at the top of the page and one of our experts will get you a new medicare supplement quote and help explain how you can save the most off your medicare cost.
Source: medicarecost.net

Medicare updates and workshops

Posted by:  :  Category: Medicare

Newsweek Magazine (February 16, 2009) ... Lenders Add Bigger Fannie, Freddie Fee – Thanks to Payroll Tax Cut (January 15, 2012) ...item 2.. Dupuy: GOP trying to sell pyrmaid scheme to voters (September 3, 2012) ... by marsmet526For help and information about all things Medicare, call HICAP. In addition to individual appointments, HICAP offers monthly workshops on a variety of Medicare subjects. The next workshop will be held Thursday from 4-5 p.m. at the Area 1 Agency on Aging, 434 Seventh St. in Eureka. The one after that will be held March 28. No reservations are required. For more information or to schedule an appointment, call 444-3000 in Humboldt or 464-7876 in Del Norte.
Source: times-standard.com

Video: Medicare Online

Obama’s Proposals for Medicare

Why has Medicare been overpaying Advantage insurers? Under the Medicare Modernization Act (MMA) of 2003 Congress agreed to pay Advantage Insurers 13% more than it would cost traditional Medicare to cover the same seniors.  Since then research has shown that seniors themselves didn’t believe that Advantage is worth the premium.  A 2009 study published in the International Journal of Health Care Finance and Economics reveals that, when Advantage beneficiaries were asked how much they would pay, out of their own pocket, for the benefits provided by their insurer, they estimated the value of those benefits at just 14 cents for every extra dollar that Medicare was paying. The Incidental Economist’s Austin Frakt, a coauthor of the report, concluded: “This relatively poor return of value on taxpayer dollars is why I support reductions in Advantage payments.”
Source: healthbeatblog.com

Odd hours norm at Lacey clinic

The new clinic, called Sunday Clinic, was opened last month by Dr. Brandon Elrod and his wife, Amanda, at The Marston Center in Lacey, 677 Woodland Square Loop SE. It was created to provide more convenient hours for patients — it’s open Saturdays and Sundays and evenings by appointment during the week — as well as cater to uninsured patients.
Source: theolympian.com

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

Helping Parents with Medicare Payment Errors

I will add that I had helped mom complete this form before the online form was available. I made several copies before I mailed it in. Several times I had to send it again. Medicare keeps only computerized records, so they seemed to lose the form periodically. I believe this is because I was working with a third-party vendor as I mentioned before. The third-party vendor covered a large metropolitan area and seemed to have several computers in different offices in different geographic locations. Sometimes when I called they insisted they did NOT have the form on file and refused to talk to me. I insisted and usually asked to speak to a supervisor. As I went up the chain, eventually someone would locate the computer that showed that they really had the form completed and they could talk to me and then we could proceed to talk about the billing problems.
Source: wordpress.com

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

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

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

More Doctors Hospitals Partner To Coordinate Care For People With Medicare

Also recently HHS issued a new report showing Affordable Care Act provisions are already having a substantial effect on reducing the growth rate of Medicare spending.  Growth in Medicare spending per beneficiary hit historic lows during the 2010 to 2012 period, according to the report. Projections by both the Office of the Actuary at CMS and by the Congressional Budget Office estimate that Medicare spending per beneficiary will grow at approximately the rate of growth of the economy for the next decade, breaking a decades-old pattern of spending growth outstripping economic growth.  
Source: healthcaretechnologyonline.com

How To File A Medicare Appeal

Beneficiaries in Medicare Advantage plans follow similar appeals procedures, except the initial appeal must be made within 60 days of the denial. Information can be found at http://www.medicare.gov/claims-and-appeals/file-an-appeal/medicare-health-plan/medicare-health-plan-appeals.html. If a service or treatment has been denied, an expedited appeal can be requested from the plan if waiting for a regular appeal decision could jeopardize the member’s health. Expedited appeals are not permitted solely for payment denials. For more details about expedited Medicare Advantage appeals, see section 50 of the Medicare Managed Care Manual at http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/mc86c13.pdf .
Source: kaiserhealthnews.org

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Source: scaredmonkeys.com

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

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