Communities of Care Model Saves $5 Million In Hospital Costs

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSThe JAMA study focused on 14 communities around the country, where researchers found that interventions helped to avert about 6,800 hospitalizations and 1,800 re-hospitalizations per year. In a hypothetical average community of 50,000 fee-for-service Medicare beneficiaries, the collaborative effort would have saved Medicare more than $4 million per year in hospitalization costs, while costing less than $1 million to implement, the study authors said. However, the study found no change in the rate of re-hospitalizations as a percentage of all hospital discharges.
Source: courant.com

Video: What Does Medicare Cost?

CBO: Medicare, Medicaid Spending Growth Slowing by 15%

Healthcare spending on Medicare and Medicaid has grown slower than many have predicted, and the most recent report from the Congressional Budget Office (pdf) shows federal spending for the two programs was 5 percent lower than it estimated in March 2010. The CBO consequently lowered seven-year spending projections for Medicare and Medicaid in 2020 by $200 billion — $126 billion for Medicare and $78 billion for Medicaid, which is roughly a 15 percent decrease for each program. The CBO reduced its 10-year projection of outlays for Medicare by $137 billion, citing the third straight year of below-average growth. Federal spending for Medicare Part A and Part B has risen by an average of 2.9 percent per year since 2009 — far less than the 8.4 percent growth rate from 2002 to 2009 and far less than what the CBO has projected for the past several years. CBO analysts made changes to Medicaid spending outlays for the next 10 years, citing lower expected costs per person through the Medicaid expansion, which will go live in 2014. However, the CBO also said it expects Medicaid enrollment will not be as high as originally thought, saying more people will gain health coverage over the next decade through other sources, mostly employers.
Source: beckershospitalreview.com

CBO Updates Spending Projections for ACA, Medicare, Medicaid

According to CBO, the new estimate is the result of the American Tax Payer Relief Act, which maintained lower tax rates for U.S. residents with annual incomes below $450,000. The lower rates “reduce the relative attractiveness of employment-based insurance for low-income workers and for their employers.” In essence, offering health coverage as a tax-free form of compensation is less appealing when marginal tax rates are lower and a publicly subsidized option is available. CBO estimated that employers will pay $13 billion more in fines for non-compliance with the ACA’s employer mandate. 
Source: californiahealthline.org

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

Do we really know what is going on with health care spending?

#4:  “Looking ahead, Medicare spending is projected climb at a rate the country can’t afford.”  Probably true, but maybe the trajectory isn’t quite as worrisome as it used to be—or is it?  On one hand, the government report cited earlier, projects that, “The slow growth in spending per beneficiary from 2010 to 2012 combined with the projections of spending growth at GDP+0 for 2012-2022 is unprecedented in the history of the Medicare program. If sustained, the slower growth would improve Medicare’s ability to meet its commitments to seniors and persons with disabilities in future generations.”   But the qualifier “if sustained” leaves a lot of room for doubt. The Fiscal Times notes that, “ ‘Even though spending per beneficiary is projected to grow at or below the rate of per capita GDP, the number of Medicare beneficiaries is projected to grow at approximately 3 percent a year,’ the HHS report says. The 50 million beneficiaries today will grow to more than 85 million in 2035. ‘As a result, aggregate Medicare spending will account for a growing share of GDP over the next decade.’”
Source: kevinmd.com

Change in Billing Option Leads to an Increase in Medicare Spending

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

GAO Report Looks at Medicare Spending on Part B Drugs

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Source: ahipcoverage.com

Join the debate on “Reining in Medicare Costs without Hurting Seniors”

 Should we try to spend less on end-of life care? Many say “Yes,” but Zeke Emanuel (a medical ethicist and oncologist who was part of the Obama team during the president’s first term), says “No.” I link to a column where he notes that “It is conventional wisdom that end-of-life care is an increasingly huge proportion of health care spending. . . Wrong. Here are the real numbers: end-of-life care (not just for the elderly, but for all Americans) accounts for just 10% to 12% of  total health care spending. This figure has not changed significantly in decades.”
Source: healthbeatblog.com

Bundled payments, DMEPOS, regulatory reform, and ESRD

We also announced a major expansion of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program.  In its first year of operation, competitive bidding, where prices are based on suppliers’ bids, saved the Medicare program, and taxpayers, over $202 million, while maintaining access to quality products for Medicare beneficiaries in the nine areas of the country where the program launched.   It’s a great example of the Administration’s determination to put the brakes on runaway healthcare costs.  With this expansion in the program, Medicare beneficiaries in 91 major metropolitan areas will save an average of 45 percent on certain DMEPOS items beginning in July.  Between 2013 and 2022, we estimate that the expansion of the DMEPOS program will save Medicare $25.7 billion, while saving beneficiaries, who pay a percentage for medical equipment and supplies, $17.1 billion through lower prices.
Source: medicare.gov

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

GAO Report Examines Medicare Costs From Self

A recent GAO report examines the growing prevalence of physician self-referral (referral to the physician’s own practice) for advanced imaging services (e.g., magnetic resonance imaging (MRI) and computed tomography (CT) services) and its effect on Medicare spending. The GAO reports that while the number of both self-referred and non-self-referred advanced imaging services increased from 2004 through 2010, the growth rate was much higher for self-referred services. For instance, the number of self-referred MRI services increased by more than 80% during this period, compared to a 12% growth rate for non-self-referred MRI services. Self-referring providers referred about twice as many MRI and CT services as providers who did not self-refer in 2010, and these differences persisted even after accounting for practice size, specialty, geography, or patient characteristics. The GAO also found that providers’ referrals of MRI and CT services substantially increased the year after they purchased or leased imaging equipment or joined a group practice that self-referred. The GAO estimates that providers who self-referred likely made 400,000 more referrals for advanced imaging services in 2010 than they would have if they were not self-referring, increasing Medicare costs by about $109 million. The GAO points out that any unnecessary referrals “pose unacceptable risks for beneficiaries, particularly in the case of CT services, which involve the use of ionizing radiation that has been linked to an increased risk of developing cancer.” The GAO recommends that CMS take steps to improve its ability to identify self-referral of advanced imaging services and address increases in these services, including: inserting a self-referral flag on Medicare Part B claims form to indicate whether or not an advanced imaging service is self-referred; implementing a payment reduction for self-referred advanced imaging services to “recognize efficiencies when the same provider refers and performs a service”; and determining how to ensure the appropriateness of advanced imaging services referred by self-referring providers.
Source: healthindustrywashingtonwatch.com

Senior Research Associate/Health Economist: Medicaid and Medicare Program and Policy Analysis RQ# 005663

Posted by:  :  Category: Medicare

Sign at Occupy St Pete: "Hands Off Social Security, Medicaid Medicare"  "www.SayNoCuts.org" by Fifth World ArtAbility to perform quantitative analysis of Medicare data, cognizant of its policy environment and implications. The ideal candidate should be able to identify quantitative methods appropriate to apply to data to analyze a given policy question, and execute such analyses.
Source: ashecon.org

Video: Medicare and Medicaid: What’s it all mean?

Melgen, Menendez throw spotlight on Medicare, Medicaid fraud

“Normally, federal searches of businesses occur during the day during normal business hours. The fact that this search began on Jan. 29 and lasted some thirty-plus hours and ended Jan. 30, tells us the scope of this search was major,” Ken Boehm, chairman and cofounder of the National Legal and Policy Center, said by email. “Also, the presence of crow bars and drills would seem to indicate that materials being sought were locked up. By any conventional yardstick, all of this activity tells us this is a very serious investigation.”
Source: freebeacon.com

Medicaid Expansion Puts Spotlight On Access To Primary Care

The authors of the Affordable Care Act foresaw that there would be a growing shortage of primary care doctors for Medicaid when expansion occurs January 1, 2014. That’s why the law includes a provision that raises the Medicaid fees paid to doctors practicing primary care medicine to the same levels Medicare pays for those services. The Medicare-Medicaid match went into effect January 1 this year and will remain in effect for two years. Best of all from the states’ point of view, in most cases the federal government will bear the entire cost of that increase. (Most other Medicaid costs involve both state and federal contributions.)
Source: kaiserhealthnews.org

Why we need Medicaid and Medicare

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Source: ncpolicywatch.org

Bundled payments, DMEPOS, regulatory reform, and ESRD

We also announced a major expansion of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program.  In its first year of operation, competitive bidding, where prices are based on suppliers’ bids, saved the Medicare program, and taxpayers, over $202 million, while maintaining access to quality products for Medicare beneficiaries in the nine areas of the country where the program launched.   It’s a great example of the Administration’s determination to put the brakes on runaway healthcare costs.  With this expansion in the program, Medicare beneficiaries in 91 major metropolitan areas will save an average of 45 percent on certain DMEPOS items beginning in July.  Between 2013 and 2022, we estimate that the expansion of the DMEPOS program will save Medicare $25.7 billion, while saving beneficiaries, who pay a percentage for medical equipment and supplies, $17.1 billion through lower prices.
Source: medicare.gov

16 Recent Medicare, Medicaid Issues

Here are 16 issues dealing with Medicare or Medicaid that occurred in the past week, starting with the most recent. 1. Last month, CMS unveiled the Bundled Payments for Care Improvement initiative, which is considered to be a bellwether on how bundled payments will work in the future. Because the program has such a large scope, hospital executives — regardless of whether their organization is participating in BPCI or not — need to familiarize themselves with the program, theories and pitfalls. 2. Republican senators reintroduced a bill to repeal Medicare’s Independent Payment Advisory Board. 3. For the 11th straight year, Rep. John Conyers Jr. (D-Mich.) proposed the Expanded and Improved Medicare for All Act, legislation that would establish a universal, single-payor healthcare program akin to Canada’s and other developed countries’ healthcare systems. 4. Wisconsin Gov. Scott Walker (R) refused the federal government’s offer to cover an expansion of the state’s Medicaid program if it met full criteria, but he said he would begin to include the poorest childless adults on the state-federal health plan. 5. A recent study found by expanding its Medicaid program with federal funding, Colorado could save $133.8 million by 2025. 6. House Energy and Commerce Committee Chairman Rep. Fred Upton (R-Mich.) and other representatives of his party released a framework of their plan to permanently replace the sustainable growth rate that would make drastic cuts to Medicare payments to physicians. 7. University of Maryland St. Joseph Medical Center in Towson failed a Medicare inspection after the University of Maryland Medical System acquired it late last year, and the hospital is likely losing millions in Medicare payments as a result. 8. Medicare dominated healthcare components of President Barack Obama’s State of the Union address and was one of the largest targets in the Republican response delivered by Sen. Marco Rubio of Florida. 9. Georgia Gov. Nathan Deal (R) signed the hospital provider fee bill into law, injecting millions of dollars in extra Medicaid reimbursement to the state’s distressed hospitals. 10. HHS and the Department of Justice announced the federal government recovered $7.90 for every dollar spent on Medicare and Medicaid fraud investigations over the past three years. 11. North Carolina Gov. Pat McCrory issued a statement, claiming a review of the state’s readiness to implement parts of the health law indicated North Carolina was not prepared to take on the financial risk of an expanded Medicaid program, nor was it prepared to build and run its own health insurance exchange. 12. A Robert Wood Johnson Foundation report found Medicare readmission rates in hospitals across the U.S. have not changed significantly from 2008 to 2010. 13. An audit found that Arkansas’ Medicaid program erroneously distributed $1.36 million in payments to ineligible recipients since 2009. 14. CMS clarified that critical access hospitals will not need to apply for special exemption when providing outpatient therapy treatments to Medicare patients who have exceeded their annual payment cap for such services. 15. New Mexico’s Human Services Department announced four health insurers will be the primary managed care organizations for New Mexico’s revamped Medicaid program. 16. U.S. District Judge David Campbell in Phoenix ordered that HHS re-review a waiver application for Arizona’s Medicaid copay demonstration project within 60 days, claiming the department’s original approval did not offer adequate explanation.
Source: beckershospitalreview.com

HCAN Partners: Tax Corporations, Protect Medicare, Medicaid, ACA

Citizen Action of Illinois held a press conference outside the office of Rep. Rodney Davis (R-13) in Champaign, Illinois to highlight the negative impact of budget cuts and joined the Chicago Federation of Labor at a gathering in Chicago to push back against cuts to Medicare, Medicaid, the Affordable Care Act, and Social Security. Leaders were joined by U.S. Reps. Jan Schakowsky (D-9) and Bill Foster (D-11).
Source: healthcareforamericanow.org

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

Massachusetts Medicare and Medicaid

asset management asset protection attorney stephanie konarski disability benefits Disability planning durable power of attorney elder care elder care attorney elder care law elder care management elder health care elder law elder law attorney estate plan estate planning estate planning attorney estate planning law firm estate planning massachusetts estate planning practice estate planning questionnaire estate planning seminar estate planning services estate planning trust estate taxes estate tax planning guardianship health care proxy irrevocable trust living will long term care LTC Massachusetts elder law and estate planning attorney masshealth nursing home nursing home care probate law real estate attorney revocable living trust social security Social Security Disability Insurance SSDI SSI Supplemental Security Income trustee wills and trusts
Source: massestatelawyer.com

CMS Releases FY2012 Medicaid and Medicare Error Rates

The FY2012 numbers reflect a one-year drop in improper payments rates for Medicare and Medicaid by 0.1% and 1.0%, respectively. CMS asserts that reducing the occurrence of improper payments with activities aimed at fighting fraud, waste, and abuse remains a high priority. The agency continues to be committed to programs and initiatives to reduce improper payments, including increased prepayment medical review, enhanced analytics, and expanded review of paid claims by recovery auditors.
Source: medicaid-rac.com

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

Guest opinion: Allow Medicaid, Medicare to bargain with pharmaceutical companies

In 2011, 12 Fortune 500 drug manufacturers pulled in combined profits of $49.3 billion. One company, Merck, saw its profit explode by more than 600 percent compared to 2010. Meanwhile, the top 10 pharmaceutical companies’ CEOs took in pay of almost $200 million in 2011. That is $20 million per CEO per year, a world away from the earnings of our men and women returning from Iraq and Afghanistan.
Source: spokesman.com

Medicaid (Mass Health) & Medicare, Do you have both?

It is important for you to understand these changes and be informed about how this new system will affect you and your family member.  One of the changes includes how (disability) community supports and services will be delivered.  There will also be changes in health care services.
Source: thecenterofhope.org

Medicare covers hospice & comfort care

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 marsmet526, your loved one can get the care and support they need. This can include doctor and nursing services, counseling, medical supplies, pain medications, and other services. And, most importantly, hospice can provide much needed comfort while at home.
Source: medicare.gov

Video: Supplemental Insurance Covers What Medicare Doesn’t

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

Medicare Myths » Toni Says

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

Medicare Now Covers Obesity Counseling

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Source: diabetesnews.com

Medicaid Expansion Puts Spotlight On Access To Primary Care

The authors of the Affordable Care Act foresaw that there would be a growing shortage of primary care doctors for Medicaid when expansion occurs January 1, 2014. That’s why the law includes a provision that raises the Medicaid fees paid to doctors practicing primary care medicine to the same levels Medicare pays for those services. The Medicare-Medicaid match went into effect January 1 this year and will remain in effect for two years. Best of all from the states’ point of view, in most cases the federal government will bear the entire cost of that increase. (Most other Medicaid costs involve both state and federal contributions.)
Source: kaiserhealthnews.org

Massachusetts Medicare and Medicaid

asset management asset protection attorney stephanie konarski disability benefits Disability planning durable power of attorney elder care elder care attorney elder care law elder care management elder health care elder law elder law attorney estate plan estate planning estate planning attorney estate planning law firm estate planning massachusetts estate planning practice estate planning questionnaire estate planning seminar estate planning services estate planning trust estate taxes estate tax planning guardianship health care proxy irrevocable trust living will long term care LTC Massachusetts elder law and estate planning attorney masshealth nursing home nursing home care probate law real estate attorney revocable living trust social security Social Security Disability Insurance SSDI SSI Supplemental Security Income trustee wills and trusts
Source: massestatelawyer.com

Does Medicare Pay for Long Term Care?

Our hospital social worker informed us that my father had stabilized; meaning he no longer had acute (short term) medical needs and had crossed the threshold into custodial care.  There was nothing more that could be done for him there. We were informed he was being released from the hospital and we had seven days to figure out our next steps. It was suggested that we put him in a skilled nursing facility for the remainder of his life, because his prognosis was not good and his medical needs were too great for someone like my 70 year old mother to handle.  We were told that if we chose to put him in a home that Medicare would pay for 20 days, and we would have a co-payment for the next 80 days.  After that, we would be responsible for all of the costs.
Source: thelongtermcarepro.com

What Medicare Part A Covers

It can be confusing at first to navigate the alphabet soup of Medicare, but basically each letter is for a different aspect of coverage. Medicare Part A, hospital insurance, is for when you have a disease or condition which needs treatment. You are eligible for Part A Medicare without cost if you are over 65 and you or your spouse has paid Medicare taxes for at least ten years; otherwise, even if you have reached the age limit, you have to pay a premium each month if you have not paid taxes long enough.
Source: medicareecompare.com

The ABCD’s of Medicare

Part D Tip: Each year since 2010, the donut hole amount has been reduced by 10%. It will continue to go down 10% each year until it disappears in 2020. Then, you will only pay your normal 25% coinsurance after you reach your deductible. Coinsurance means Medicare pays 75%, you pay 25%. Since it’s 2012, and you still have a donut hole, the government has negotiated with brand name drug manufacturers to offer 50% off some prescriptions. Check with your local pharmacy to see if the discount applies to your medications.
Source: hoopayz.com

What Medicare doesn’t cover

Once you have your Medicare in place you will quickly realize that there are gaps in the coverage that Medicare provides.  This means that people on a fixed income could be in a position where they have to deal with a large bill after an extended hospital stay or a series of out-patient services.  To help with this private insurance companies partnered with the government to provide Medicare supplemental insurance.  These Medigap plans are designed to fill the coverage gaps in Medicare Part A and Part B.  There are ten plans in all and each one covers a different number of the gaps. The same plans have been adopted by 47 of the 50 states, with the exceptions being Massachusetts, Wisconsin, and Minnesota, whom have adopted their own standardized plans. What that means is that the best Texas Medicare supplement is no better in coverage than the same California Medicare supplement. Source: lauragibson.net
Source: medicarehelpco.com

KS: Medicaid changes four weeks away still await federal decision

Posted by:  :  Category: Medicare

"I believe that banking institutions are more dangerous to our liberties than standing armies. ~ Thomas Jefferson. by eyewashdesign: A. Golden“We’re expecting a decision within days,” said Miranda Steele, press secretary for the Kansas Department of Health and Environment, which is supervising the companies. She and others in the administration have been saying the OK is just around the corner for many of the 13 months since Brownback announced the planned change.
Source: watchdog.org

Video: Kansas Medicare Supplements

Kansas seniors saved money on drugs, checkups

Last year 36,383 Kansans with Medicare who reached the Part D “doughnut hole” saved more than $24 million on prescription drugs as a result of discounts provided in the Affordable Care Act, according to the U.S. Department of Health and Human Services. In addition, 284,396 Kansans with traditional Medicare used one or more free preventive services in 2012, including 27,437 who each received an annual wellness checkup.
Source: kansas.com

VILLA v. KANSAS HEALTH POLICY AUTHORITY, No. 102,324., January 11, 2013

An equal protection analysis has three steps. First, a court must determine the nature of the statutory classifications and examine whether these classifications result in disparate treatment of arguably indistinguishable classes of individuals. Board of Miami County Comm’rs v. Kanza Rail–Trails Conservancy, Inc., 292 Kan. 285, 315, 255 P.3d 1186 (2011). If so, the Equal Protection Clause is implicated. In the second step, a court examines which rights the classifications affect because the nature of those rights dictates the scrutiny applied when the statute or regulation is reviewed. There are three levels of scrutiny: (1) the rational basis standard to determine whether a statutory classification bears some reasonable relationship to a valid legislative purpose; (2) the heightened or intermediate scrutiny standard to determine whether a statutory classification substantially furthers a legitimate legislative purpose; and (3) the strict scrutiny standard to determine whether a statutory classification is necessary to serve some compelling state interest. Miller v. Johnson, 295 Kan. 636, 2012 WL 4773559, at *21 (citing Kanza Rail–Trails Conservancy, 292 Kan. at 316). In the final step of analysis, a court determines whether the relationship between the classifications and the object desired to be obtained withstands the applicable level of scrutiny. Miller, 295 Kan. at ––––, 2012 WL 4773559, at *21 (citing Kanza Rail–Trails Conservancy, 292 Kan. at 316).
Source: findlaw.com

Webinar: Employment as a Health Determinant for Medicaid Participants with Disabilities

Description: Working age people with disabilities are a health disparities population characterized by increased risk factors such as smoking and obesity, lower overall health status and greater health care costs. The objective of this NIDRR-funded study was to determine the moderating effects of employment on the health and health risk behaviors of a group of Kansans with disabilities dually-eligible for Medicare and Medicaid. Using primary and secondary data sources, we examined the relationship of employment and a) health, b) health risk factors and c) health care expenditures. Findings show that when compared to those who were not working, people with any level of paid, competitive employment:
Source: wordpress.com

Kansas’ Great Hope: Managed Care Will Tame Medicaid Costs

According to Michael Sparer, a Columbia University professor of health policy, “good research” is surprisingly thin, and reaches the same conclusion: Medicaid managed care hasn’t yet produced the hoped-for results of lowering costs and raising quality in states where the concept has been tried. That’s mostly because much of the existing research focuses on managed care programs that serve low-cost Medicaid populations such as women and children. But he notes there may be more potential to save significant amounts of money when high-cost populations’ care is managed. 
Source: kaiserhealthnews.org

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

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

Posted by:  :  Category: Medicare

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

Video: EHR: Medicare, Medicaid EHR Incentive Program Webinar for Eligible Professionals

9 Recent Medicare, Medicaid Issues

Here are nine issues dealing with Medicare or Medicaid that occurred in the past week, starting with the most recent. 1. Protecting Medicare and implementing online health insurance marketplaces were among Americans’ top priorities in a recent poll conducted by the Kaiser Family Foundation, Robert Woods Johnson Foundation and Harvard School of Public Health. 2. Medicare Recovery Auditors, also known as recovery audit contractors, set a new record for most overpayments collected in a quarter, as they recouped $744.8 million from hospitals and other providers in the first quarter of the federal government’s 2013 fiscal year. 3. A bill temporarily halting the nation’s $16.4 billion debt ceiling through mid-May passed the House 285-144, but automatic cuts to Medicare and other programs are still scheduled to take effect March 1. 4. Maryland found it may lose more than $1 billion in Medicare payments by losing its eligibility for a waiver that grants it full reimbursement from CMS, rather than the discounted rates all 49 other states receive unless the state can suppress its healthcare cost growth. 5. A Kaiser Family Foundation report showed many states have increased Medicaid access and eligibility over the past year, though a few have added restrictions to eligibility. 6. The U.S. Supreme Court issued a unanimous opinion that reversed and remanded a circuit court ruling that hospitals could appeal decisions by the Provider Reimbursement Review Board that are up to 25 years old. A group of 18 hospitals challenged their Medicare disproportionate share adjustments for 1987 through 1994. 7. A study found the number of all-cause 30-day rehospitalizations and all-cause hospitalizations decreased more in communities where quality improvement initiatives were led by Medicare Quality Improvement Organizations than in communities without these initiatives. 8. Hospital executives are on board with Arizona Gov. Jan Brewer’s plan to impose a provider fee to expand the state’s Medicaid program. 9. President Barack Obama gave airtime to the need to reform healthcare entitlements in his second inaugural address Monday, but he defended their existence and pushed back on calls to make drastic cuts to the Medicare and Medicaid programs.
Source: beckershospitalreview.com

Ohio Health Policy Review: Ohio Medicare

The federal Department of Health and Human Services announced last week that Ohio has been approved to undertake a pilot project to better coordinate care for 114,000 Ohioans who are eligible for both Medicare and Medicaid (Source: "State gets OK to alter Medicare, Medicaid," Columbus Dispatch, Dec. 13, 2012).
Source: healthpolicyreview.org

Digging in on entitlement reform

Protestors call for an increase of taxes on the wealthy and voice opposition to cuts in Social Security, Medicare, and Medicaid during a demonstration in the Federal Building Plaza on December 6, 2012 in Chicago, Illinois. About 300 protestors participated in the demonstration which resulted in three arrests. (Photo by Scott Olson/Getty Images)
Source: msnbc.com

Daily Kos: Are Democrats abandoning raising the Medicare eligibility age?

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Source: dailykos.com

GOP Counteroffer Would Raise Medicare’s Eligibility Age To 67

McClatchy: GOP Fiscal-Cliff Counter: Cut Tax Rates, Limit Deductions To Increase Revenue A Republican proposal Monday to shave $2.2 trillion off projected budget deficits sets up a fiscal-cliff showdown with the White House because the plan includes reductions in the very tax rates that Democrats seek to raise. The Obama administration’s opening offer sought to raise $1.6 trillion in taxes over 10 years, much of it from higher income-tax rates on the wealthy. Republican leaders in the House of Representatives countered Monday with their own offer, saying their plan would raise $800 billion in new tax revenues but basing that on cuts in tax rates coupled with limits on deductions that would make more income taxable. …The other $900 billion would come from so-called mandatory programs and health care, presumably Medicare, Medicaid and other programs in which spending is often subject to automatic formulas (Lightman and Hall, 12/3).
Source: kaiserhealthnews.org

CALL TO ACTION on Medicaid eligibility rule

While the new rule acknowledges the multiple ways that individuals may begin the process of gaining health coverage in post-ACA America, it reaffirms that final eligibility determination for Medicaid can only be conducted by a publicly operated entity. This construct has been a consistent legal interpretation for eight successive administrations. To unravel this important foundation would jeopardize benefits for vulnerable individuals and families; and would decimate good, middle-class jobs that our nation needs in order to remain strong.
Source: wfse.org

Massachusetts Medicare and Medicaid

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Source: massestatelawyer.com

Ohio Gets Federal Approval for Dual

Patients who qualify for two government health programs due to age or disability as well as a lack of financial resources often face a confusing system with overlapping rules and poor coordination, which can lead to diminished quality of care and poor health outcomes that increase costs for taxpayers.
Source: clevelandleader.com

What Raising the Medicare Eligibility Age Means

Raising the eligibility age saves very little money, on the order of a few billion dollars a year. That’s because the 65 and 66-year-olds will have to get insurance somewhere, and many of them are going to get it with the help of the federal government, either through Medicaid or through the insurance exchanges, where they’ll be eligible for subsidies. However, since many Republican-run states are refusing to expand Medicaid in accordance with the Affordable Care Act, lots of seniors who live in those states will just end up uninsured, which will end up leading to plenty of financial misery and more than a few premature deaths. Put this all together, and the Center on Budget and Policy Priorities estimates that while the federal government would save $5.7 billion a year from raising the eligibility age, costs would increase by more than twice in other parts of the system—for the seniors themselves, employers, other enrollees in exchanges who would pay higher premiums, and state governments.
Source: prospect.org

Medicare Supplement Phone Sales

Posted by:  :  Category: Medicare

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

Video: Best Medicare Supplement Plan

Hot Stuff Supplements: Finding the Best Medicare Supplement Insurance

Finding the Best Medicare Supplement Insurance The best Medicare supplement insurance offers several benefits in every plan option including hospitalization, medical expenses, hospice and blood. There are also additional benefits of every plan in Medicare supplement insurance. As mentioned above, before you purchase Medicare supplemental insurance, you need to find the best Medicare supplement policy provider which is reliable and offers the best benefits for you because there is no such thing as important as your health.
Source: blogspot.com

Deal with a Reputable Lead Generation Company for Exclusive Medicare Supplement Leads

Exclusive Medicare supplement leads are best purchased from a reputable online lead generation company. “There are many online lead generation companies out there that tell you they sell exclusive Medicare supplement leads. Define exclusive. To benepath.net, exclusive means exclusive, and the leads you order only go directly to you. Other companies call their leads exclusive, but as it turns out, you end up working them with at least seven other agents. What a waste of time and money, not to mention the irritation factor – both for you and the harassed potential client,” said Clelland Green, RHU, CEO, and president of benepath.net, Pennsylvania The idea behind exclusive Medicare supplement leads is that only one person gets them and works them. Unfortunately, there are lead generation companies who do not do what their advertising suggests. “Call it misleading if you will, but there are companies that will sell leads as being exclusive when they are not. This costs the insurance agent money they could have spent on buying genuine exclusive leads,” Green added. While it is “buyer beware” in the online world of lead sourcing, it should be automatic for the agent to check the veracity of what that lead generation company states in its advertising. Check with other agents to find out their experiences with various lead generation companies and ask a lot of questions before investing any money into exclusive Medicare supplement leads. If they are not genuinely exclusive, there is no sense in buying them, as they are a waste of time and money – both commodities are a precious resource when running an insurance agency. Without solid, pre-screened leads, the job of running an insurance agency just got that much more difficult. Certainly, there are other ways to generate leads, with direct mail marketing being one of them, but the real decision to be made is what method will provide leads that convert quickly? “If you’re looking to convert leads on a regular basis, then you want to invest in exclusive Medicare supplement leads. Hands down, they are the best source to build your business, rapidly. You want leads that want and need your product. You don’t want to take the time to convince someone they need what you are selling. That is the beauty of pre-qualified exclusive Medicare supplement leads. Call the lead, book the appointment, discuss the products they are considering, outline other options, discuss pricing to budget and close the sale. It’s pretty easy,” Green remarked. To learn more, visit http://www.benepath.net
Source: sbwire.com

What benefits are offered by Oregon Medicare supplement plan?

State and federal regulatory our body is responsible for managing Medicare supplement plans in Oregon. Same benefits are offered to the beneficiaries whatever the insurer. The only difference in the policies will be in the cost, kind of plan chosen from the insurers and administration who manages the program. You can contact and buy insurance plan through the health insurer that offer best benefits you can also simply shop around to find the best suitable Medicare supplement Oregon. One of the better and most suitable insurance plans is SELECT policy. This can be Oregon Medicare supplement plan in which beneficiaries can be found a complete network of hospitals, doctors and medical medical care services.
Source: wordpress.com

15% Medicare Supplement Rate Increase is Outrageous!!! » Toni Says

Cindy, one Medicare rule that you should be aware of since you are not happy with your rate increase from your current Medicare Supplement company is…if you had a Medicare Supplement policy before you joined a Medicare Advantage Plan for the first time, and you aren’t happy with the Medicare Advantage Plan, you will have special rights to buy a Medicare Supplement policy if you return back to “Original Medicare” within 12 months of first joining a Medicare Advantage plan.  If you had a Medicare Supplement policy before you joined, you may be able to get the same plan back if the company still sells it.  If it isn’t available, you can buy another Medicare Supplement policy. (Please see page 66 of the
Source: tonisays.com

Medicare Supplement Insurance coverage

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

Policy Store Top 5 Medicare Supplemental Insurance Picks!

3.) Supplementtomedicare.com– A website designed to fulfill your every Medicaresupplemental insurance needs! Supplement to Medicare is certain that they are able to support you in finding the best Medicare Supplemental insurance policy for you. Not to mention, they are there for you 7 days a week. Should you have a question or concern, you have the option of calling an agent to help you. Supplementtomedicare.com is a website who is proud to be there for their customers.
Source: globenewswire.com

Health Care Systems: Tips for Getting the Best Medicare Supplemental Insurance

When seeking the ideal Medicare insurance, you need to get more information on Medicare supplement plans. Usually, these plans will give you the rates of payment as charged by Medicare supplement companies. This means you can use the various information about your preferred plans to establish the insurance plan that will meet your all your needs in the most affordable manner. The main reason why many people subscribe to Medicare supplemental insurance or these plans is to be able to find the easiest way of meeting all Medicare costs. Given that many individuals have varied needs, many companies offer different supplemental plans to suit different customer needs and preferences. The varied plans cater for different Medicare services meaning you can settle for a plan or package that suits your needs best. Medicare supplemental insurance is a recommendable way of meeting various medical needs, many companies target the older people mostly aged 65 years and above. However, this does not mean that the insurance only caters for older people as it is perfect when you cannot afford the medical bills of your household. As offered by different insurance organizations, the supplement plan gives the subscribers access to more qualified, affordable, and personalised medical services. Usually, all the medical needs of the subscribers are summarized into one and treated together. Helpful information on choosing the best supplemental plans When choosing the best Medicare plans, know that there are plans that offer more advantages than others. When you choose such a plan, you will be able to get more value for your money. The plans also vary from one company to another. The plans may also have different supplement rates. So, regardless of the rate gap that may have been created by the companies, you can still find the best rates and package with a little research on your end. Helpful research tips The first factor that you should consider when conducting your research is your monthly medical expenses. Determine the number of people you would like to cover and the type of existing illnesses or the ones likely to come your way. With this information at hand, you will be able to make a better choice when choosing the most suitable Medicare supplemental insurance. It is also best to check your current insurance and its coverage. Then, settle for a plan that is not covered in your current insurance plan. Get factual information from your insurance agent in regards to what the Medicare supplemental plans offer. If you are looking for a fast delivery of services, choose an insurance firm that you have worked with before as they usually have most of the documents needed. Compare different companies offering Medicare insurance services and settle for a firm that will offer adequate coverage for all your needs. When making the company comparisons, ask the companies to give you Medicare supplement quotes so that you are able to choose the ideal Medicare supplement rates. You can make a more informed choice by asking the supplement insurance agent to provide you with all the information you need. Find out if the company has what it takes to meet your insurance needs, know about its financial stability and ability to meet your claim needs, the application procedures and timeline for having your claims approved. About this Author Selina Cantu is the author of this article on Medicare Supplement Rates. Find more information, about Medicare Supplemental Insurance here.
Source: blogspot.com

BioCentury this week looks at Medicare

Posted by:  :  Category: Medicare

Racism by elycefeliz360 Vantage 2011 AZBIO AWARDS AND EXPO advamed AdvaMed 2012 Advocacy Arizona BioIndustry Arizona BioIndustry Association Arizona BioScience Companies Arizona BioScience Industry Arizona BioSciences Arizona Commerce Authority ASU ASU Biodesign AZBio AZBio Awards AZBio Expo AZBio Fast Lane AZBio In the Loop AZbio Members AZBio Resource Library BioAccel BIO DC Biodesign Institute BIO International Convention Bioscience educational opportunities Brain State Technologies C-Path EmpowHER Flagship Biosciences Flinn Foundation Government Affairs Blog innovation Joan Koerber-Walker NAU PADT Regenesis BioMedical SBIR STTR Syncardia TGen Total Artificial Heart UA UA College of Medicine University of Arizona U of A
Source: azbio.org

Video: Arizona Medicare Supplement Plans- 1.800.643.7544

GAO 2013 releases High Risk List for fraud and waste

GAO designated Medicaid as a high-risk program due to its size, growth, diversity of programs, and concerns about the adequacy of fiscal oversight, which is necessary to prevent inappropriate program spending. This federal and state program covered acute health care, long-term care, and other services for about 70 million low-income people in fiscal year 2011; it is one of the largest sources of funding for medical and health-related services for America’s most vulnerable populations. Medicaid consists of more than 50 distinct state-based programs. The federal government matches state expenditures for most Medicaid services using the Federal Medical Assistance Percentage, a statutory formula based in part on each state’s per capita income. Medicaid is a significant expenditure for the federal government and the states, with total expenditures of $436 billion in 2011. The Centers for Medicare & Medicaid Services (CMS) in the Department of Health and Human Services (HHS) is responsible for overseeing the program at the federal level, while states administer their respective programs’ day-to-day operations.
Source: arizonadailyindependent.com

Medicaid Math Trumps Ideology for GOP Governors

Even if the exchanges function as intended, there will be holes in the safety net for the poor in states that opt not to expand Medicaid. In recognition of this problem, the Obama administration has relaxed rules on states in an effort to coax them into compliance. On Tuesday, a day after Obama declined in his second inaugural address to offer an olive branch to Republicans in Congress, the Department of Health and Human Services issued a regulation that extends a helping hand to states by allowing them to charge higher co-payments for some medical services and prescription drugs.
Source: realclearpolitics.com

Seniors Need To Be Tenacious In Appeals To Medicare

Posted by:  :  Category: Medicare

The PARTY Is OVER ...item 4.. Today, Mitt Romney Lost the Election (Sep 17, 2012 6:02 PM ET) ...item 5.. James Brown - Get On The Good Foot, Soul Power, Make It Funky Soul Train 1973 ... by marsmet471Medicare officials say appeals are rare, though they would not provide statistics on how many appeals came from beneficiaries rather than from health-care providers, such as hospitals, doctors and nursing homes.  The inspector general’s office in the Department of Health and Human Services reported last month, however, that 85 percent of appeals in 2010 that reached the third level of review, which are decided by an administrative law judge, were filed by health care providers.  And for those who persevere and do appeal a third a third time, the OIG found that the judges reversed 56 percent of all unfavorable decisions in 2010.
Source: kaiserhealthnews.org

Video: AT Network Training on AT and Medicare

In brief: Appeals process, acquisitions and readmissions

Pride Mobility Productsand Specialty Equipment Market Association (SEMA) recently unveiled the Victory ES 10, a mobility scooter customized by car designer Chip Foose. Foose, best known for his television show “Overhaulin’,” drew up the hot rod modifications for the scooter, adding a roadster grill, pinstriping and color-keyed upholstery for a vintage look…Breathe IDTF now allows its HME provider customers to receive text message alerts when their patients have qualified for oxygen using the Breathe Oximetry System. Receiving text messages in the field helps the provider’s sales reps know when to follow up with physicians and get patients on oxygen faster, the company stated…PDG Drives Technology, a manufacturer of motor control systems for industrial and mobility electrics vehicles, including power wheelchairs, has been acquired by Curtiss-Wright, an engineering company…The Braff Group closed its 200th transaction on its 17th deal this year, the Pittsburgh-based M&A firm has announced. Since launching in 1998, The Braff Group has completed an average of 14 deals per year.
Source: hmenews.com

Providers Filed 85% of Medicare Appeals in 2010

A study from the HHS Office of Inspector General (pdf) found that hospitals and other Medicare providers filed 85 percent of payment appeals at the administrative law judge level, 56 percent of which went in favor of providers, and the OIG concluded that serious improvements are needed to clarify Medicare policies. Medicare providers and beneficiaries may appeal certain decisions regarding claims for healthcare services. For example, hospitals may appeal payment recoupments from Recovery Auditors, or RACs, if they believe their actions were consistent with Medicare law and standards. There are four general levels of appeal: Level One goes to CMS Medicare Administrative Contractors, Level Two goes to CMS Qualified Independent Contractors, Level Three goes to ALJs and Level Four goes to the Medicare Appeals Council. The ALJ level is the most common platform of the four. The OIG looked at the 40,682 Medicare appeals filed to ALJs in fiscal year 2010. It found that hospitals, physicians and other providers filed 34,542 of those appeals, or roughly 85 percent. In addition, a small number of providers accounted for nearly one-third of all appeals. The OIG tagged 96 providers as “frequent filers,” meaning they filed at least 50 appeals each. One provider filed 1,046 appeals alone. For 56 percent of appeals that made it to level three, ALJs also reversed 56 percent in favor of appellants, indicating a “number of inconsistencies and inefficiencies in the Medicare appeals process,” according to the OIG’s report. The OIG had 10 recommendations for CMS and the Office of Medicare Hearings and Appeals, including more coordinated training on Medicare policies to ALJs and QICs, better identification and clarification of Medicare policies that are unclear, and digitization of appeal case files. CMS and OMHA concurred fully or in part with all of the OIG’s recommendations.
Source: beckershospitalreview.com

Court: You Can Appeal Medicare Decisions About Hospice Services

That’s a victory of sorts, because it makes it clear that beneficiaries have the right to challenge a hospice provider’s refusal to provide a service that a doctor deems necessary, Mr. Deford said. But it’s disappointing because it doesn’t ensure that people receive a notice of their right to appeal when they enter hospice care, or that any mechanism exists for expedited appeals – an important protection for people who are dying.
Source: nytimes.com

Facing an Audit? Here’s What You Need to Know

When you get notice, Kraus said, “do not take these audits lightly.” “They are very serious. They need to be treated with the utmost respect, and reviewed. Don’t wait to respond.” Kraus said the audit should be handled by a high level administrator, someone who knows billing. He and/or the CEO spend a lot of time and energy researching every audit before responding. Indeed there are timelines associated with the audit, and if you don’t comply, the payer will start issuing denials for them. You’ll get overpayment demands for the entire claim amount, said Gustafson. What started out as a minor issue can turn into a major one. Here’s how Kraus deals with an audit. He is first alerted because an electronic remittance file will end a remark code in 432, which indicates an audit. His staff puts him on notice, and when the paper request arrives, he reviews it and logs onto his RAC auditor’s website. The audits are listed there, with the letters posted. He said the nature of the issue in the mailed letter isn’t always clear, and “sometimes the letter and the website vary,” with the website often being more accurate.
Source: diagnosticimaging.com

Hospitals urge OIG to investigate RACs

Moreover, Pollack noted in his letter that overlapping and duplicative efforts among RACs and other CMS contractors overwhelm providers. "For example, RACs, MACs and ZPICs are all charged with reviewing hospital Medicare claims, and hospitals may be required to respond to simultaneous audits of the same claims or to duplicative record requests. These redundant audits drain time, funding and attention that could more effectively be focused on patient care," he wrote.
Source: fiercehealthfinance.com

Does the Medicare Appeal Process Take Too Long?

Paula Oertel used an unapproved drugs for nine years to treat a brain tumor, and Medicare paid for it. When Oertel moved in 2007, she temporarily lost her Medicare coverage, and she went without treatment. During that time, two different drugs were approved to treat her condition. Once Oertel regained her Medicare coverage, both drugs were used, but neither worked. When the doctors tried to prescribe interferon, her claim was rejected by Medicare.
Source: elderparenthelp.com

Medicare and Appeal Rights for Hospice Care Patients

Much can be learned through the unfortunate case of Howard and Emily Back. Emily, now deceased, was a California hospice patient covered by Medicare. Howard appealed his wife’s lack of treatment through the court process. However, the court was quick to point out that there is an administrative appeals process through Medicare regarding its hospice care decisions.
Source: kenvanway.com

The Current Medicare Debate Will Not Solve The Program’s Problems

Posted by:  :  Category: Medicare

TWO YEARS OF RUIN by SS&SSWe believe that this debate is both needed and possible.  As mentioned, there has been a bright spot in the past few years with the recent surge in innovation across both the public and private sectors.  The public sector is seeking to make great strides with the development of the CMMI.  As enacted under the ACA, CMMI is charged with testing innovative payment and service delivery models to promote methods that are proven to work, and to begin the transition towards a more integrated, coordinated delivery system.  The private sector, including Medicare Advantage plans, continues to offer health plans that provide greater coordinated care, medical homes, expanded benefits, and new methods for reimbursement.  These types of innovative models are precisely what we need if Medicare is to truly develop into a program that provides seamless care, improves beneficiary health, and lowers costs.
Source: healthaffairs.org

Video: Start Selling Medicare Advantage – Great Opportunity

No more Medicare Advantage leads

The carriers will love all of this because it puts everyone on an equal playing field and drives everyone in through their telemarketing and bypasses the agents which they also love to do. Some zamboni of the phone slams them into an MA and an hour later they dont know what the hell they have or who to call about it. I suppose it is also a windfall for captive agents who get some feed off the tv ads and mailings and not have to compete with the independents at the local buffet. However, after next enrollment season, the entire field looks grim for them too. This bill only address how to market. Other legislation will address whether they will be offered at all. The PFFS piece has already taken a fatal hit. As with the PFFS plans, congress will probably not kill MA’s but cut their subsidies and then tell the carriers to do what they want. Then when the carriers raise their rates to cover costs or failure to realize savings then the public will just say "what the hell, I can get a full med supp without the smoke and mirrors of an MA for another fifty bucks a month beyond what the MA would cost me." Winter
Source: insurance-forums.net

Medicare Advantage Leads for Sale

Over the past month we have been mailing for medicare advantage and have received thousands of medicare advantage leads all of them are in upstate new york. Unfortunately the parter in our company that had the NY license is no longer working for us and we are STUCK with leads we can’t sell medicare advantage to. These are real leads – you’ll get a copy of the response card 95% of them have phone numbers on them permitting you to call them to setup an appointment. These leads cost us tens of thousands of dollars and I need to get rid of them. Please PM me if you are interested. I’ll only sell them in blocks: 5 leads as a sample $75 25 = $12/ea 50 = $10/ea 100= $9/ea 250=$8.50/ea 1000+=$6/ea You can pay for the samples with paypal, all others must be via company check. I’ll even credit back the $75 for a bulk order. This isn’t a scam, I’m desperate to get rid of these hot leads. I hate to see them go but I would hate to have the respondents not get anyone sending them information. I’ve called around to lead companies but I keep getting disconnected numbers! So I am only selling them here and will only sell them once. Please PM me with the companies you represent and the amount of leads you are interested in.
Source: insurance-forums.net

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

RealTime Medicare Advantage Insurance Leads

Competition is tougher when you know that every other agent is clamoring to seal the deal with the same clients that you go after to. But if are a goal-driven entrepreneur who is ready to face any challenges along the way, you would be surprised to know that there is a new set of online users that is making waves in the insurance market today.
Source: realtime-insuranceleads.com

Reductions in Medicare Advantage Payments: Impact on Seniors

[35]This is slightly different conceptually from the elasticities explained in elementary economics textbooks. Those elasticities are typically the “price elasticity of supply” and the “price elasticity of demand,” which measure the effect of a change in price on either supply or demand in isolation from the other. The price elasticity of demand is the ratio of the percent change in the quantity demanded to the percentage change in the price, assuming the supply function stays the same. Likewise, the elasticity of supply assumes the demand function remains unchanged. However, this study follows the example of the CMS actuary and calculates a “benchmark elasticity of enrollment,” a combined elasticity that is the ratio of the percent change in the MA benchmark to the percent change in MA enrollment. This elasticity captures both the supply effect and the demand effect. The supply effect results from lower revenue to MA plan providers, and the demand effect results from MA plans having to provide less generous benefits.
Source: heritage.org

Medicare Advantage & Medicaid

I have a few members on a Dual plan because they like the gym membership and it works nicely with their Medicare and full dual medicaid. Another of my Dual SNPs is dropping this gym benefit in 2013. :( I don’t have any other options except to put these ppl on a regular MA to keep a gym membership. If they enroll into one of these, can I count on each provider to waive the copay or coinsurance when they present their medicaid card along with the MA card? The PCP has already verified that they would, but I’m concerned about the other providers. What have been your experiences with this?
Source: insurance-forums.net

Pitts Kicks Off 113th Congress with Hearing on Reforming the Medicare Physician Payment System

In response to a question from the Health Subcommittee’s Vice Chairman, Michael C. Burgess, M.D. (R-TX), Chairman Glenn Hackbarth cited positive examples from Medicare Advantage that could be applied. Hackbarth said, “Some Medicare Advantage plans, as you know, perform extremely well on both quality of care measures and costs. Among the plans that perform well are a variety of different models. Some are pre-paid group practice model like Kaiser Permanente, but there are other plans that contract with individual independent practices and don’t rest entirely on large, multi-specialty groups.” Burgess added, “It’s not just satisfaction of the agencies and the people who measure those things, but it’s also satisfaction of patients and satisfaction of physicians. Certainly my experience with a group like Scott and White in Temple, Texas, this has worked reasonably well and we certainly want to be careful that we don’t damage with whatever we do going forward.”
Source: house.gov

Highmark change in Medicare eye exam coverage irks some

Posted by:  :  Category: Medicare

UPMC Health Plan, the second-largest insurer in the region, does not cover refraction as a medical benefit under the Medicare Advantage plans it markets as UPMC for Life, spokeswoman Gina Pferdehirt said. All UPMC for Life plans come with vision insurance that cover refraction, she said.
Source: triblive.com

Video: Pittsburgh Celebrates Medicare’s Anniversary

Novitas Solutions, formerly called Highmark Medicare Services, announces hundreds of health care jobs coming to Harrisburg, Pittsburgh areas

The prospect of new jobs arises from a large, new contract that was in limbo at the time of the sale. The contract, which involves administering Medicare claims for seven Southwestern states, was expected to create 500 new jobs in Pennsylvania, with about 260 coming to the Harrisburg area.
Source: pennlive.com

New Medicare Administrative Carrier for Jurisdiction 12 Highmark Medicare Services Acquired by Diversified Service Options Inc

Diversified Service Options (DSO) acquired Highmark Medicare Services (Highmark) on January 1, 2012. DSO is a holding company and a wholly-owned subsidiary of Blue Cross and Blue Shield of Florida, Inc. (BCBS Florida). Highmark had the contract with the Centers for Medicare & Medicaid Services (CMS) to be the Medicare Administrative Contractor (MAC), formerly known as a “Carrier” or “Fiscal Intermediary,” for Jurisdiction 12, which includes Delaware, New Jersey, Pennsylvania, Maryland and Washington, D.C. For Part B services, Jurisdiction 12 also includes the counties of Arlington and Fairfax in Virginia and the city of Alexandria in Virginia.
Source: thehealthlawfirm.com

Highmark Medicare Services Teleconference On Billing Of Time Units For Physical And Occupational Therapy Services : Med Law Blog

Highmark Medicare Services will be hosting a teleconference on May 15, 2009 at 12:00 p.m. Eastern to discuss the billing of time units for physical and occupational therapy services. The teleconference may reference issues such as CMS Online Manual, Pub. 100-2, Chapter 15, Sections 220 and 230; Change Request CR6321; Frequently Asked Questions; Social Security Act, Section 1862(a)(1)(A) of the Social Security Act, Exclusions from Coverage; and PT/OT modalities is Local Coverage Determination (LCD) L27513, Physical Medicine and Rehabilitation Services, PT and OT. To participate in the teleconference, the dial-in number is 1-888-276-8689 and the Access Code is 487794. Highmark Medicare Services has indicated that the teleconference does have limited capacity.
Source: medlawblog.com

More Healthcare Choices With Highmark Medicare

Few folks have adequate money to include anesthesia bills once these folks get sick. In order to make quality medical care readily available to the majority, well being insurance prefer Medicare is invented by the the us government as an assurance that individuals are protected from the prices incurred when availing one. The procedure of wellbeing insurance follows a financial fee structure generally in the kind of month-to-month premium deductions by the insurance coverage sites to the salary of an personalized. The financial savings that gather at the time of time from these insurance plan are used for spending health care. Typically, a wellness protection has provisions to adhere to earlier than an policyholder personalized might be eligible for cover. In Medicare for instance, people aged 65 or older, permanently inept, or individuals with kidney failure, are entitled to use it so which their medical charges are a lot more affordable.
Source: ivegotcoveragereview.com

Highmark gets Medicare contract for seven more states

Under the five-year contract, the company will handle both Medicare Part A and Part B fee-for-service claims for hospitals, physicians and other healthcare practitioners in Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma and Texas, according to a Highmark Medicare Services news release. It already serves as the Medicare administrative contractor for Delaware, Maryland, New Jersey, Pennsylvania and Washington, D.C. Highmark Medicare Services has offices in Camp Hill, Pittsburgh and Williamsport, Pa., and in Hunt Valley, Md., and is a wholly owned subsidiary of Highmark, which is a Pittsburgh-based licensee of the Blue Cross and Blue Shield Association. The company recently reached an agreement to acquire West Penn Allegheny Health System, a struggling five-hospital system based in Pittsburgh.
Source: modernhealthcare.com

Healthcare BPO News: Highmark Medicare Services to Begin Processing Claims in New Jersey

In fiscal year 2007, Highmark Medicare Services processed about 48.8 million claims and served approximately 2.3 million beneficiaries and 57,000 providers. As the MAC for J12, Highmark Medicare Services is expected to process approximately 131 million claims annually, accounting for more than 11 percent of the national Medicare fee-for-service workload. Highmark Medicare Services will be working on behalf of approximately 4.2 million beneficiaries and 137,000 physicians and practitioners.
Source: blogspot.com

Saint Vincent, Highmark talks still on track (VIDEO)

Merger talks between Saint Vincent Health System and Highmark Inc. aren’t expected to be finished until March, but the two groups are close enough to a definitive agreement that they gathered at Saint Vincent on Tuesday to discuss potential changes in the way the Erie hospital treats patients.
Source: goerie.com

Highmark Health Insurance Company Review

If you meet the eligibility requirements, you can apply for the PreferredBlue plan, choosing between a $500 deductible or a $1,000 deductible. An example of the benefits for the $500 deductible plan is as follows. If you stay in the network, there is an 80% coinsurance applied once all deductibles have been met. Other benefits that are at 80% include inpatient hospital facilities, emergency room care, office and home visits, medical and surgical expenses, preventive care, diagnostic services, and various therapies. Prescription drugs have a $100 deductible with a cost of $10 for generic drugs and $20 for brand name drugs. Eye exams and vision correction discounts are available as well as discounts on fitness centers, spas, massage therapy, nutrition counseling, and personal trainers. Mental health services, substance abuse rehabilitation, and substance abuse detoxification are not covered at all under the PreferredBlue plan. The individual maximum out of pocket for in-network services is $2,500.
Source: healthinsuranceproviders.com

Ask A Medical Biller: Highmark Medicare Services Website

for clients who use RelayHealth as your clearinghouse the Submitter #’s are CPID 1522 District of Columbia (DC) Medicare new contractor number is 12201. CPID 5554 Maryland Medicare new contractor number is 12301 CPID 5598 Pennsylvania Medicare new contractor number is 12501 **RelayHealth will be making the change to send the new Contractor ID/Payor ID to DC, Maryland, and Pennsylvania. Providers do not need to make any changes to the Contractor ID/Payor ID Questions on
Source: blogspot.com