CONNECTURE ACQUIRES DRX, A LEADING PROVIDER OF INFORMATION SYSTEMS FOR MEDICARE

Posted by:  :  Category: Medicare

New Online Rx System Makes UM Student 'Top Entrepreneur' Finalist by University of Maryland Press ReleasesConnecture is the leading provider of Web-based information systems used to create health insurance marketplaces and exchanges. Its industry-proven solutions enable consumers, employers and brokers to more easily shop for, purchase and renew health insurance while minimizing back-office administrative expenses for health plans.  Connecture’s solutions are provided to health plans, state insurance exchanges, private exchanges and insurance brokers.  More than 25 million Americans shop for their health insurance through systems built by Connecture, and more than half of the nation’s 20 largest plans rely on them to sell, administer and manage their plans and products effectively.  For more information, visit www.connecture.com.
Source: drx.com

Video: Medicare Benefits Made Clear: News, Reform & Obamacare Exposed!

Medicare Clawbacks Extended To 5 Years: What You Can Do About It

3. Incentives and Rebates: Multiple incentives and rebates for medical providers are available for implementing Meaningful Use requirements, Electronic Medical Record opportunities, and Physician Quality Reporting System reporting. Most of these CMS programs started as incentives, and turn into penalties if providers do not adhere to the guidelines within strict time limits. The PQRS bonus turns into a retroactive penalty if providers do not file in 2013, for example. Providers can partner with individual providers or with a complete medical distributor to help guide them through these processes, which will help them to increase revenues up front through the rebates and incentives available, and will also help to avoid penalties when CMS moves forward through their implementation plan. Furthermore, many of these incentives can help improve efficiencies and reduce expenses for physicians through improved workflow processes. For example, the PQRS reporting system used to take enormous resources (either in monetary or FTE terms) through its cumbersome, complicated and imposing volume of reporting requirements. The new registry-based reporting requires only 30 patients instead of 80% of all Medicare patients in the practice, dramatically expands the selection of disease states to report on, covers just about ANY medical practitioner, and only takes about 30 minutes.
Source: content4reprint.com

Drug and Device Law: When Did This Happen?

We first got wind of this when the decision, Michigan Spine & Brain Surgeons, PLLC, , v. State Farm Mutual Automobile Insurance Co., 2013 U.S. Dist. Lexis 17721 (E.D. Mich. Feb. 11, 2013), showed up, more or less by accident, in one of the ongoing searches we use to stay abreast of drug/device developments,  Apparently, however, the more important decision was over a year ago in Bio-Medical Applications, Inc. v. Central States Health & Welfare Fund, 656 F.3d 277 (6th Cir. 2011).
Source: blogspot.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

CMS angling to ease providers’ burdens from Medicare Administrative Contractors

CMS has called for provider contact information so the agency can survey a random sample of long-term care operators. This will help the agency determine just how satisfied providers are with the recently instituted Medicare Administrative Contractors (MACs). The Social Security Act names provider satisfaction as a MAC performance standard.
Source: mcknights.com

What’s New With Medicare?

Tags: advocate on aging, affordable care act, care manager for elderly, care manager news on Medicare, caregivers for elderly, caregiving and medicare changes, Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, changing Medicare, CMMI, CMS, deborah dolan, elderly Medicare, health care reform for seniors, improve Medicare quality, medical home, Medicare, Medicare benefits, Medicare news, Medicare reform, model of care, Obama Care, quality of care for seniors, reduce Medicare cost, senior life transitions
Source: advocateonaging.com

Health Care Authority Prepares Website to Answer Medicaid Providers’ Questions About Rate Increases

FOR MORE INFORMATION ON HEALTH CARE REFORM OR BACKGROUND: The Medicaid Expansion 2014 website: www.hca.wa.gov/hcr/me The Health Benefits Exchange website: www.hca.wa.gov/hcr/exchange The Provider Rates Change website: www.hca.wa.gov/acarates Provider questions about the rate increase can be emailed to prvrates@hca.wa.gov Jim Stevenson, Communications, HCA 360-725-1915 jim.stevenson@hca.wa.gov
Source: wa.gov

Settlement Agreement in the Medicare Improvement Standard case

The official approval of the settlement means the Centers for Medicare and Medicaid Services (CMS) must develop and implement an education campaign to ensure that Medicare providers are not denying coverage for vital maintenance services to those with any chronic illness who meet other qualifying Medicare requirements. These illnesses include, but are not limited to, Parkinson’s disease, Alzheimer’s or other dementia, strokes, heart disease, multiple sclerosis, diabetes or paralysis.
Source: theadaptables.com

Understanding Paul Ryan’s Medicare reform plan in three minutes

Posted by:  :  Category: Medicare

TWO YEARS OF RUIN by SS&SSThe federal government will determine the minimum level of benefits that all plans must offer. The premium-support payment is capped at the growth of GDP, plus 0.5 percent. The subsidy will be adjusted based on the income level of the consumer.
Source: constitutioncenter.org

Video: DeafLink ASL Update – Show 1 – Medicare Part D Rebate Checks June 15, 2010.wmv

$250 Medicare Rebate Checks a ‘Drop in the Bucket’ Compared to Rising Drug Prices

–> Sometime in August, Patricia Holland will drop into Medicare’s dreaded doughnut hole. She is already bracing for that financial wallop. Holland, 67, of Centreville, Md., regularly takes seven prescription medications. One of them — Entocort — is especially expensive. It prevents severe attacks of her colitis, an inflammatory bowel disease. Right now, with full Medicare drug coverage — before the doughnut hole — Holland pays $195 a month for Entocort. That’s her co-pay, nowhere near the full price of the medication. When she enters the doughnut hole, though, her Entocort cost will go up exponentially, consuming, she says, her entire state retirement check. The doughnut hole is the coverage gap in the Medicare prescription drug benefit, called Part D. Seniors get initial coverage until their total drug expenses exceed $2,830. Then Medicare covers nothing until total spending reaches $6,440, when catastrophic coverage starts. The doughnut hole is the $3,610 space between the two amounts, when seniors pay all costs for their drugs.Health care reform legislation will shrink that hole in Medicare drug costs. This year, seniors who fall into the doughnut hole will get a rebate check for $250. Last week, the federal government mailed the first of those checks. Next year, Medicare recipients will get a 50% discount on brand-name drugs while in the doughnut hole. The coverage will improve annually until the hole disappears in 2020. The extra $250 doesn’t impress Holland. “A drop in the bucket,” she says. She spends hundreds of dollars a month on prescriptions even before she reaches the gap. When she arrives in the doughnut hole, the retail price of Entocort (three 3 mg pills a day) could reach $1,200 a month. For one drug. Fortunately, her position as a volunteer at a nearby Maryland hospital offers her a price break. Holland began volunteering there in 1997. Two years ago, when her drug costs spiked with Entocort, she started taking advantage of the hospital program offering medications at the same price that the hospital pays. When in the doughnut hole last year, Holland paid $680 for Entocort through the hospital. This year, she says, it will cost her $300 more a month in the doughnut hole. The hospital’s cost has climbed to $988, she says. The price difference stunned her. “My pharmacist told me that all drug prices have gone up,” Holland says. A recent AARP study found that average prices for brand-name drugs that are widely used by Medicare beneficiaries rose almost 10% over a 12-month period ending in March — higher than the rate of increase in the previous eight years. That compares with a general inflation rate of 0.3% over that same period. Meanwhile, the price of widely used generic prescriptions fell by an average of nearly 10% during that same period, the study found. AARP has been tracking drug price increases since the enactment of Medicare Part D and the doughnut hole. “It’s no surprise that prices have gone up,” says John Rother, AARP executive vice president. “The surprise is they’ve gone up faster than before — and gone up during an economic downturn.” Responding to the AARP data, the brand-name drug industry said prescription drugs help control health care spending by reducing unnecessary hospitalizations and helping manage chronic diseases. “Prescription medicines represent a small and decreasing share of growth in overall health care costs in the U.S,” said a statement from PhRMA, which represents the brand drug industry. Entocort is manufactured by AstraZeneca, which referred questions about pricing to the company that markets the drug, Prometheus Laboratories. A Prometheus spokesman declined to comment. The drug is expected to face generic competition in early 2012. As drugs near the end of their patent exclusivity, prices sometimes rise — probably so the manufacturer can maximize its revenue before the drug goes generic, AARP says. Holland takes generics when she can. She says her family income is too high for her to qualify for the manufacturer’s drug assistance program for Entocort. So the doughnut hole awaits — along with the $988 per month tab. “I know people in the doughnut hole who don’t take their prescriptions” because of the cost, Holland says, adding that it’s a good thing that health reform will eventually close the doughnut hole. Her overall assessment of the hole? “It stinks.” And the price increase for her medication? “There’s no rhyme or reason for that. It’s already high enough. ”
Source: dailyfinance.com

Medicare Clawbacks Extended To 5 Years: What You Can Do About It

3. Incentives and Rebates: Multiple incentives and rebates for medical providers are available for implementing Meaningful Use requirements, Electronic Medical Record opportunities, and Physician Quality Reporting System reporting. Most of these CMS programs started as incentives, and turn into penalties if providers do not adhere to the guidelines within strict time limits. The PQRS bonus turns into a retroactive penalty if providers do not file in 2013, for example. Providers can partner with individual providers or with a complete medical distributor to help guide them through these processes, which will help them to increase revenues up front through the rebates and incentives available, and will also help to avoid penalties when CMS moves forward through their implementation plan. Furthermore, many of these incentives can help improve efficiencies and reduce expenses for physicians through improved workflow processes. For example, the PQRS reporting system used to take enormous resources (either in monetary or FTE terms) through its cumbersome, complicated and imposing volume of reporting requirements. The new registry-based reporting requires only 30 patients instead of 80% of all Medicare patients in the practice, dramatically expands the selection of disease states to report on, covers just about ANY medical practitioner, and only takes about 30 minutes.
Source: content4reprint.com

Please be aware of Medicare Scams as $250 rebate checks get sent out!

The recent mailing of $250 rebate checks to participants in Medicare’s drug program has given scammers a new opportunity to take advantage of seniors and other Medicare recipients. In this latest scam, Medicare recipient receive a call from a con artist claiming to be a Medicare representative. The scammer then tells each recipient that they need to provide personal information, such as their Social Security number and bank account number, in order to receive their rebate check. In reality, the scammers need this information to gain access to the recipient’s bank account and empty it.
Source: seniorlivingexperts.com

Avoid Medicare doughnut hole rebate check scams

The one-time rebate checks were mandated under the Affordable Care Act recently passed by Congress and signed by President Obama. They are the first step in fixing the coverage gap in Medicare Part D prescription drug coverage. Currently, Medicare beneficiaries whose prescription drug costs reach $2,830 must pay 100 percent of their additional costs until total out-of-pocket expenses reach $4,550.
Source: consumerreports.org

Doughnut Hole Rebate Checks Fuel Medicare Fraud & Insurance Scams

Missouri Attorney General Chris Koster (also the name of the website) comments on the types of Medicare scams taking place across the nation. The article can be found in the Attorney General’s News Release titled, “Attorney General Koster Warns Seniors About Medicare Rebate Fraud Schemes” (June, 2010). According to the author (name not given), “[Koster] said a common scam related to the $250 donut hole checks was for individuals to convince seniors that the rebate check needed to be transferred to a third party or used to cover specific prescription drug payments.”
Source: suite101.com

White House Touts Medicare Rebates

“You the American people have made it clear that you don’t want Obamacare,” Mr. Herger said on the video. “You told the president and Speaker Pelosi at town hall meetings, public rallies and at the ballot box. They rammed their government takeover of health care through anyway. But House Republicans are listening. That’s why we have introduced a bill that would fully repeal Obamacare and replace it with common-sense, incremental solutions that would actually help bring down skyrocketing health care premiums by up to 20 percent.”
Source: nytimes.com

VPR News: Governor Changes His Mind On Medicare Rebate Checks

(Sanders) "You’re looking at people who are old, who are sick, who are poor, and then the state is going to say ‘I’m sorry, you’re going to have to return it to the state’. I think it’s going to cause a lot of confusion, I think it’s going to cause pain and I just don’t think it’s the right thing to do."                                                                                      
Source: vpr.net

More Medicare Part D rebate checks are in the mail, Sebelius says

The next round of $250 rebate checks for seniors who have confronted the Medicare Port D coverage gap have been sent, Sebelius announced at the forum in Manchester, NH. This batch is expected to reach roughly 300,000 seniors who fell into the coverage gap during the second quarter of 2010. Seniors who are enrolled in a qualified retiree prescription drug plan, or who qualify for Medicare Extra Help, will not receive the checks, according to a press release from the Department of Health and Human Services.
Source: mcknights.com

Medicare ‘Doughnut Hole’ Rebate Checks Are In Mail, Obama Administration Announces

The Los Angeles Times: “Senior citizens who hit the so-called doughnut hole in Medicare’s drug benefit will begin getting $250 rebate checks in two weeks, the Obama administration announced Thursday — providing one of the first tangible benefits of the recently enacted healthcare law. The rebates, designed in part to bolster support for the controversial law, are the first steps in a decade-long phase-out of the unpopular gap in Medicare Part D drug coverage. Seniors now enrolled in a Medicare Part D plan pay 25% of the cost of their prescription drugs until the total bill reaches $2,830. At that point, enrollees must pay the full cost of their prescriptions until their total out-of-pocket spending reaches $4,550. Catastrophic coverage then kicks in and enrollees pay 5% of drug costs for the rest of the year. Department of Health and Human Services officials said Thursday that the first 80,000 seniors who hit that coverage gap, or ‘doughnut hole,’ will be sent checks on June 10, five days before the deadline” (Levey, 5/27). NPR’s SHOTS blog: “Checks will then go out every 30 days or so after that. By year’s end, an estimated four million beneficiaries will get them. The rebates are a one-time benefit. Starting next year, beneficiaries will get a 50 percent discount on brand-name medications once they reach the coverage gap. Within a decade the gap will be closed altogether. … At a news conference on implementation efforts on the new health law, however, [HHS Secretary Kathleen] Sebelius warned that seniors not only need to do nothing in order to receive the rebate checks — they SHOULD do nothing” (Rovner, 5/27). The Associated Press: “Sebelius warned that scam artists are already taking advantage of rebate program to circulate bogus ‘application forms’ that solicit personal information such as Medicare numbers. ‘If anybody shows up asking for information … report it immediately,’ Sebelius said. ‘Nothing is required in order to get the check.’ … The Medicare coverage gap came about because of funding constraints, when in 2003 a Republican-led Congress created the prescription benefit under President George W. Bush’s administration” (Alonso-Zaldivar, 5/27). The Hill: “The announcement marks the latest example of ongoing efforts to persuade the public, and particularly seniors, of the new healthcare law’s benefits. Seniors disproportionately dislike the new law, and they’re also the group that’s most likely to vote in this year’s midterm elections. Two months after health reform was signed into law, Sebelius said, ‘it’s clear we’re headed in the right direction'” (Pecquet, 5/27). CQ HealthBeat: “Sebelius’ comments came as administration officials continue to stress the portions of the law that are going into effect right away, or even earlier than planned” (Norman, 5/27).
Source: kaiserhealthnews.org

Settlement Agreement in the Medicare Improvement Standard case

Posted by:  :  Category: Medicare

No doctor shopping here, buddy by Newtown grafittiThe official approval of the settlement means the Centers for Medicare and Medicaid Services (CMS) must develop and implement an education campaign to ensure that Medicare providers are not denying coverage for vital maintenance services to those with any chronic illness who meet other qualifying Medicare requirements. These illnesses include, but are not limited to, Parkinson’s disease, Alzheimer’s or other dementia, strokes, heart disease, multiple sclerosis, diabetes or paralysis.
Source: theadaptables.com

Video: Medicare Shared Savings Program Overview National Provider Call 12/7/11

Massachusetts Elder Law Attorney

The Medicare provisions in the Relief Act are not as harmful to the program as many of the dangerous proposals offered to Congress over the past few months.  There have been proposals made to double look back periods and decrease Medicare and Medicaid benefits.  Drastic cuts are still on the table as policy-makers seek to address the looming sequestration and debt ceiling with savings from health care programs. For real health savings that address the underlying problem of health care costs system wide, policy-makers and advocates should begin with solutions that improve the health and well-being of Medicare beneficiaries while preserving the Medicare program for those who depend on it now and in the future.
Source: estateplanandassetprotection.com

Daily Kos: Projected Medicare spending falls dramatically

ferg, Gooserock, emal, Shockwave, Pescadero Bill, eeff, elfling, hnichols, Creosote, susakinovember, whenwego, pedrito, oceanview, splashy, antirove, psnyder, Eyesbright, wdrath, dkmich, Matt Esler, lyvwyr101, Vyan, ExStr8, marina, auditor, chimene, Alice Venturi, juliesie, YucatanMan, majcmb1, Inland, Savvy813, Ginny in CO, Jim R, Jim P, begone, martini, irishwitch, vigilant meerkat, luckydog, kck, blueoasis, shrike, JVolvo, Spock36, Dreaming of Better Days, Little, BentLiberal, bear83, peagreen, deepeco, joedemocrat, GeorgeXVIII, JML9999, TomP, cynndara, GAS, elwior, jamess, tofumagoo, petulans, Diogenes2008, clent, maggiejean, greengemini, shopkeeper, bfitzinAR, sfarkash, RoCali, Tortmaster, Larsstephens, Railfan, Christy1947, marabout40, Captain Marty, elginblt, anonevent, nirbama, ericlewis0, slowbutsure, OhioNatureMom, smiley7, PorridgeGun, BarackStarObama, createpeace, enhydra lutris, Canuck in Ohio, peregrine kate, VTCC73, Vatexia, jolux, jadt65, Inkberries, cwsmoke, Siri, wordfiddler, S F Hippie, This old man, rivercard, Olkate, Brown Thrasher, countwebb, JayRaye, howabout, doraphasia, The Story Teller, LilithGardener, northcountry21st
Source: dailykos.com

Medicare Clawbacks Extended To 5 Years: What You Can Do About It

3. Incentives and Rebates: Multiple incentives and rebates for medical providers are available for implementing Meaningful Use requirements, Electronic Medical Record opportunities, and Physician Quality Reporting System reporting. Most of these CMS programs started as incentives, and turn into penalties if providers do not adhere to the guidelines within strict time limits. The PQRS bonus turns into a retroactive penalty if providers do not file in 2013, for example. Providers can partner with individual providers or with a complete medical distributor to help guide them through these processes, which will help them to increase revenues up front through the rebates and incentives available, and will also help to avoid penalties when CMS moves forward through their implementation plan. Furthermore, many of these incentives can help improve efficiencies and reduce expenses for physicians through improved workflow processes. For example, the PQRS reporting system used to take enormous resources (either in monetary or FTE terms) through its cumbersome, complicated and imposing volume of reporting requirements. The new registry-based reporting requires only 30 patients instead of 80% of all Medicare patients in the practice, dramatically expands the selection of disease states to report on, covers just about ANY medical practitioner, and only takes about 30 minutes.
Source: content4reprint.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

Hospitals: Medicare reforms preferable to cuts

The American Hospital Association has expressed support for several proposed structural reforms to Medicare as alternatives to reductions in healthcare provider payments, according to a letter from AHA Executive Vice President Rick Pollack to Sen. Orrin Hatch, R-Utah. The AHA and other provider representatives have voiced concern that negotiations to avoid the upcoming budget sequester and to reduce the federal deficit could lead to additional cuts in payments to providers. Such cuts may be more tenable politically than adjustments to benefit levels. Since 2010, according to the AHA, Congress has authorized $95 billion worth of reductions in hospital payments. “Simply ratcheting down provider payments is not real reform.

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

Posted by:  :  Category: Medicare

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

Video: Medicare and You – Resources for Open Enrollment

Medicare updates and workshops

For 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

OIG Report: Medicare Part B Overpaying for Infusion Medications

OIG recommended that CMS “seek legislative change” over reimbursement policies or include the devices used with such drugs in the next round of competitive bidding. According to “RegWatch,” CMS “partially” has agreed to ask Congress to change the rules and said it will go forward with the competitive bidding suggestion (Wilson, “RegWatch,”
Source: californiahealthline.org

Medicare Open Enrollment: last chance to review and compare plans

With the holiday season upon us, it’s easy to get busy this time of year. Some pretty important tasks can get left to the last minute. One of those important tasks is ensuring you are in the right health insurance plan in Medicare.  Selecting the right plan is a personal choice, and a lot of thoughtful consideration goes into finding the right match.  But just like the holidays, those key dates come whether or not you are ready.
Source: medicare.gov

Purchase Priligy online no membership :: Order Online no Prescription
Matsui Announces Medicare Open Enrollment

The Centers for Medicare and Medicaid Services (CMS) recently released the purchase Priligy online no membership 2013 quality ratings for Medicare health and drug plans on their web-based tool “Medicare Plan Finder.” On this purchase Priligy online no membership website, Medicare plans are given an overall rating on a one- to purchase Priligy online no membership five-star scale, with one star representing poor performance and five stars representing excellent performance. During the purchase Priligy online no membership open enrollment period, people with Medicare can use the star ratings to purchase Priligy online no membership compare the quality of health and drug plan options and select the purchase Priligy online no membership plans that are the best for their needs.
Source: rafu.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

Medicare Open Enrollment Begins October 15th This Year

In addition, a recording of our recent webinar explaining the Fall Open Enrollment Period is now available on our online training service, Medicare Rights University, free of charge. You can view the webinar any time here: www.medicarerightsuniversity.org/webinars/fall-open-enrollment-period
Source: hemophiliafed.org

Privately Run Medicare Plans are Really Expensive

Austin Frakt draws my attention today to a new article about the administrative costs of Medicare. Exciting stuff! Long story short, Kip Sullivan of the Minnesota chapter of Physicians for a National Health Program wants everyone to understand just what’s involved in figuring out the true administrative costs of Medicare. The cost of collecting payroll taxes is one frequently overlooked element, for example. More interestingly, though, there’s a large and growing gap between the overhead calculations of the Medicare Trustees and those of the National Health Expenditure Accounts. Why is that?
Source: motherjones.com

Tips for Navigating Medicare Part D Open Enrollment

Yesterday kicked off the 2013 Medicare Part D open enrollment period, during which millions of Medicare-eligible Americans over 65 and persons with disabilities can choose a new Part D plan that best fits their needs. As Medicare Today recently highlighted in a survey, 90 percent of seniors are satisfied with their Part D plan, with more than six in 10 seniors reporting that they would not be able to fill all of their prescriptions without Part D. But if you aren’t one of those satisfied people, shop around. In the coming weeks, our hope is that we can assist in pointing people to helpful tools that enable comparing and evaluating options.
Source: phrma.org

Schumer and Pierluisi Introduce Puerto Rico Medicare Equity Legislation

Over the years, the responsible federal agencies have done a poor job informing beneficiaries in Puerto Rico about the opt-in requirement and the consequences of late enrollment.  Therefore, many of my constituents fail to realize they lack Part B until they get sick and need to visit a doctor, by which point significant time may have elapsed.  To illustrate the repercussions, consider the standard Medicare Part B monthly premium of $105 dollars.  An individual who enrolls two years late must pay a 20 percent surcharge—an additional $21 dollars per month.  Over one year, that is $252 dollars.  Over 20 years, it is $5,000 dollars.
Source: puertoricoreport.org

Anthem Medicare Preferred PPO Plan and Rates

Posted by:  :  Category: Medicare

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

Video: Is Freedom Blue PPO a Medicare Supplement?

Anthem blue cross ppo, mri

Anthem Blue Cross Dental Plans – Domestic. Blue Cross – Amazon.de Niedrige Preise, Riesen-Auswahl und kostenlose Lieferung ab nur € 20 Receive affordable California health insurance and health care coverage with Anthem Blue Cross. Visit and design a personalized health care plan today. Anthem Medicare Preferred Standard PPO, Blue Cross Senior Secure Plan hmo,blue cross freedom blue , Freedom Blue application . freedom blue Rx, freedom ppo , freedom 2012 Plan (Non-Medicare) This document is not a guarantee of benefits. It is a summary intended for communication purposes. rev 4/12 UCSB Health Care Facilitator 893 Anthem Medicare Preferred Standard PPO ,.
Source: rediff.com

Blue Cross Blue Shield of Michigan Offers New Medicare Plans

HMO’s (health maintenance Organizations) let you select a primary care physician from the BCBS provider network and this PCP manages your overall care. He or she will refer you to a specialist or to a selected hospital for care should you need additional services beyond his scope of practice. Referring yourself to an outside provider will cause a forfeit of benefits and out-of-pocket costs. The four BCBSM HMO products, formerly known as Options 1, 2, and 3, will now be known as BCN Advantage Elements, Classic , and Prestige. The Blues Care Network will also continue to offer the BCN Advantage Basic Plan.
Source: emaxhealth.com

California Medicare Insurance: Anthem Medicare Preferred PPO Replaces Freedom Blue for 2012

One of the newest Medicare Advantage plan in California for 2012 is the Anthem Medicare Preferred Standard PPO or AMP. The Anthem Medicare Preferred is the newest successor to the Freedom Blue Regional PPO plan that became very popular over the past few years. The plan offers significant freedom of choice in regards to your medical service providers. The AMP PPO plan is only available in select counties throughout California and the benefits are different from county to the next. The plans are grouped below by counties that share the same benefits:
Source: blogspot.com

Community Health Plan: Fallon Community Health Plan Ppo

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

How Does Blue Cross Medicare Crossover Work?

Blue Cross offers the following program choices: Blue Cross Plus, Blue Cross PPO, High Option Supplement to Medicare and Core. Blue Cross Medicare Crossover is an option for all Blue Cross programs. The Blue Cross Medicare Crossover system allows Medicare to directly provide Blue Cross access to a person’s explanation of benefits (EOB), so that neither the individual nor the provider needs to file a separate claim with the insurance carrier after sending a claim to Medicare. The Blue Cross Medicare Crossover system simplifies the procedure. Under the new Blue Cross Medicare Crossover system, most claims are automatically sent to Blue Cross.
Source: seniorcorps.org

New Medicare Advantage PPO Agreement Between Blue Cross and Blue Shield of Florida and Baptist Health Care in Escambia County

Baptist Health Care is a community-owned, not-for-profit health care organization committed to improving the quality of life for people and communities in northwest Florida and south Alabama. A 2003 Malcolm Baldrige recipient, Baptist continuously strives to be a national leader in quality and service. Baptist Health Care includes four hospitals, two medical parks, Baptist Manor, Baptist Leadership Group, Andrews Institute for Orthopedic & Sports Medicine, Lakeview Center and Baptist Medical Group. With more than 6,000 employees and employed physicians, Baptist Health Care is the largest non-governmental employer in northwest Florida. For more information, please visit 
Source: northsantarosa.com

Are you ready for 2013? 4 questions to ask yourself

Don’t forget, if you have Medicare Part B and are in Original Medicare, you’ll have to meet your deductible before your Medicare coverage pays for services and supplies. Next year, the Medicare Part B deductible will be $147. Make sure to plan your health care budget to account for the increased cost of doctor visits for the time that it will take to cover your deductible.
Source: medicare.gov

Blue Cross, Blue Care Network expand service areas, add plan options

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

Blue Shield of California Medicare Supplement

California is a very unique State in terms of the options afforded its residents. In the same day, you can visit the beach, the snow, and the desert. We tend to expect this range of options in most things and Californian’s are very fortunate in your options for Medigap coverage. One of the main players in this availability is Blue Shield of California and it’s Medicare plans. Let’s take a closer look at Blue Shield of California Medigap offerings and how it competes in the market. First, we need a little explanation on the Blue Shield of California and it’s relationship with the Blue Cross Blue Shield parent and it’s competitor, Blue Cross of California. For individual and family plans (including California Medicare supplement plans for seniors), Blue Shield is a competitor of Blue Cross of California. They do not work together which is quite different than most (if not all) other States in the U.S. where they traditionally are one company and share costs with each other. Blue Shield of California has its own California Medigap plans separate from Blue Cross of California but both are still part of the BCBS association and participate in the Blue Card network. Now that we address that uniquely Californian wrinkle, let’s take a look at BS of California directly. Blue Shield has a strong presence in the PPO California market and Medicare supplements are the senior equivalent to PPO plans in terms of how they function. What does this mean exactly? First, California Medigap plans afford a great deal of flexibility in terms of which medical providers you can use and how that is accessed. You generally refer yourself out and you’re also not locked into a geographic region. These are all hallmarks of a PPO plan. Blue Shield has a long history of working both with PPO plans and with Medicare supplements which is important. The PPO or Medigap model is very different from HMO and a company generally needs a track record or period of time to wrap their heads around how to make the product stable in terms of pricing over the long run. This can be seen with Blue Shield of California’s general Medigap rate stability and competitiveness on the market. We feel confident with them as a California Medicare supplement provider for years to come. What California Medigap plans does Blue Shield of California currently offer on the market? The current plans offered are the A, C, D, F and K plan. The K plan provides more cost sharing but at a lower priced premium and this is the equivalent of a high deductible option (although different from the high deductible F plan in some key respects). The California F Medigap plan is by far the most popular not only with Blue Shield of California but across the State and the U.S. A is the bare-bones Medigap plan and C and D offer extra benefits above the A plan but not quite as rich as the F plan. In most cases, the premium savings is not sufficient enough to justify getting less than the F plan due to potential holes in coverage (primarily California Medicare Excess). Blue Shield also allows senior dental and Part D coverage to bundle with the California Medigap coverage for a complete protection package.

Moodys Roger Stein: For Those Who Are Preparing To Take An Insurance Then This Medicare Supplement Plans Texas Is Going To Be Very Helpful

Posted by:  :  Category: Medicare

Are you finding old as well as the will need for healthcare can also be obtaining enhanced so it’s important that you just ought to have coverage of it so that it will be particularly beneficial for you personally for the duration of enough time any time you possess a have to have. To become a aspect of it you must be above sixty five a long time of age and you will receive the compensation as eighty percent discount from your real bills. Within this they provide the right consumer support and the many prospects individuals that search for their assistance are very a great deal benefited and they also tell that their policy prices are very affordable and valuable, along with the most astonishing factor that is certainly provided by them are additionally they present 100 % free quotes and assistance so that persons people who are certainly not conscious of their polices will know about it improved. You can find a large number of ideas which have been offered with them and a single among them is Texas Medigap Plans to know it superior and more in regards to the other plans it’s possible to stop by their web site during which they have uploaded each of the advice. These plans will satisfy all your desires and it can be confident that all of your expenses might be saved for your greatest. One can find distinctive types of medigap ideas are also accessible you could pick the best a single in accordance with your compensation as well as your need to have, whatever could possibly be the strategy you choose it is going to be useful for you. To know a great deal more relating to this Texas Medigap Plans you’re able to contact them straight and inquire your desires in order that they’re going to give you the top ideas to select the plan. It is possible to receive the quotes from them conveniently merely by filling the fundamental information that is certainly asked. All of the advice that you just offer them is much secured and they produce hundred percent privacy for you. Each one of these Medicare Supplement Texas can be useful for your consumers those who take them and be benefited.
Source: blogspot.com

Video: Texas Medicare Supplements 2010: How to Choose a Plan.wmv

Apply For Medicare Supplement Plans In Texas At The Lowest Rates

Just decision Texas MediGap Advisors at 1.866.894.3258 (512.341.3222) to induce the answers you would like and notice the simplest Medicare Supplement plans. MediGap Advisors will assist you type through the ten Medicare Supplement set ups currently obtainable by comparison your scenario and desires to the advantages of every plan. They’ll take a glance at your biggest health care expenses and show you the simplest Medicare Supplement plans to safeguard you from charges that Medicare doesn’t cowl.
Source: wordpress.com

On Line Community Of Medicare Supplement Plans Texas For Know About Rewards Of Wellness Coverage Alongside Security Attributes

Insurance coverage schemes and added rewards of schemes are topic to alter based mostly on the country and corporation. It was essential to compare each and every and every single scheme ahead of getting any variety of insurance coverage plan like health, car, home and daily life. Approaches to ascertain very best scheme was briefed in on line web page with illustrations and on the net videos. Wellness complications, accidents, disasters may come up with out any indications to check the existence with financial help, insurance policy was practical. Primarily based on interest of individuals, Texas Medigap ideas developers give support and adequate data of distinct policy. Following certain age absolutely everyone suffers lot of issues due to pressure, perform stress and residing surroundings. So that you can overcome challenges caused by over factors people have to spend certain medical amount but when they take right insurance coverage it helps to keep free of charge from economic disaster. General facts about Medicare Supplement Texas reviewed by health researchers supports to explain the wellness problems alongside procedures to avail the insurance coverage at proper period. Coinsurance insurance policies give large amount of advantages with cost savings to consumer. By mentioning the title, deal with, message and wellness challenges a single can communicate the well being supporters belong to Medigap health supplement team. Prescription medication brochures translated by authors in various languages also in solitary look visitors get particular interest on topics coated beneath Medicare complement Texas. By creating chart or table with columns like Medicare parts, excessive charges and deductible variety on can have an understanding of the advantages of this policy. Aside from United states, persons from global nations also prefer Medicare complement due to its supports and simplicity. Response of client executives plays an important role for enlarging consumer support. Scores offered by patients about Medigap ideas tends to make simple to understand the positive aspects and use in the course of crisis time period. Tips provided by experts are supportive to satisfy reps at shorter span and resolve from wellness concerns.
Source: blog.com

Medicare Supplement Insurance Texas Agencies Offer Is Helpful To Certain Clients

The federal government allows private agencies to sell supplemental policies to customers. These policies help individuals to pay for the things that their original insurance does not cover. Companies that sell such policies must comply with very strict federal and state laws and regulations. They are standardized according to guidelines created by the United States government and all such policies must provide the same coverage, regardless of the agency from which the coverage is obtained. However, each agency is allowed to charge different rates for the coverage.
Source: myglobalseattle.org

Blue Cross Blue Shield of Texas Medicare Supplement Plan

Medicare Supplement Insurance in Texas, like all other traditional forms of coverage does have rate increases and I dislike them as much as you do. BCBS seems to have some of the most stable rates in the industry, where some carriers have pounded the rates some 10 and 12% these guys have not exhibited that type of behavior. They actually experienced a rate decrease this last October which was a pleasant surprise to most seniors. Of course there is no way of knowing what may or may not happen from one year to the next so yes, they could raise rates soon, but so far so good.
Source: medicareinsurancetexas.com

American Financial (AFG) Closes Sale Of Medicare Supplement And Critical Illness Businesses

AFG’s balance supplemental insurance operations consist solely of its run-off long-term care business, which has a book value of approximately $170 million, and which will continue to be based in Austin, Texas. AFG’s Austin-based life and annuity operations will transition to its home office in Cincinnati, Ohio before the end of the year.
Source: istockanalyst.com

Medicare Supplements in Texas

Yeah, because THAT’S a direct contract. Truth is that most carriers do not offer a true direct to home office contract. Old Surety does, I think. But getting them to send you one is seemingly impossible. The closest you can get to "direct" is by contracting through an FMO that is truly direct. That way there is no other upline in the hierarchy; just you and your FMO. As far as good, competitive supp companies here in Texas I sell United of Omaha, Forethought, Woodmen and Sentinel. Beating United of Omaha here in Texas is tough. They are unisex rated so they have the best rates for males and they’re one of very few carriers that offer a household discount. Plus everyone knows who United of Omaha is. Old Surety is competitive, but as I mentioned, getting a contract is nearly impossible. I have the majority of my med supp contracts through Precision Senior Marketing mostly because they’re local for me and I know the guys. Good crew. Additionally, they are direct to the carrier so I don’t get locked up under the Evil Empire. Premier Senior Marketing in Nebraska is another good outfit I use for Life products that Precision doesn’t offer. What I can’t get from either of those I generally go through Eldercare in Little Rock. Steve Brooks there is a really cool guy. I generally pick up anything that AIMS does through them. Using the Texas DOI to compare rates isn’t a bad idea but the rates they display are generally not up to date or accurate, so don’t quote it as gospel.
Source: insurance-forums.net

Texas Medicare Supplement Quotes

The easiest, most reliable way to ensure the quotes you are receiving are accurate and current is to go directly to the source. Stay with major carriers and visit their websites for quality information. After all, who better than the company themselves to quote you a price? With Blue Cross Blue Cross Shield of Texas, it’s possible to get an accurate quote, compare plans to one another and customize your own coverage. The site is informative, easy to navigate and a valuable source for finding the most reliable Medicare Supplement plan at a price you can afford. .
Source: texasmedicarehealth.com

Changes in Texas Medicare Supplements Since PPACA

Texas Medicare supplements as well as those paid out in other states will be on the county quartile basis. If you live in a rural or suburban area, your county quartile will receive 115% of the Medicare monies paid out. If you live in an urban area, your county quartile will receive 95% of what it usually receives. Currently, only 34% of Medicare Advantage participants live in the rural and suburban areas. This means that the increases are going to the fewer people, a move about which some people have attempted to question the Obama administration.,
Source: mclaininsurancegroup.com

How Good is Medicare’s Risk Adjustment?

Posted by:  :  Category: Medicare

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

Video: Risk Adjustment / Data Extraction and Coding Services video for Medical Ofiices

Nutrition and Diet for Weight Loss: Medicare And Risk Adjustment

When it comes to determining the number and the amount of payments to be provided to members of the Medicare Advantage plan, the Centers for Medicare and Medicaid have instated the risk adjustment program. The Medicare Advantage program uses an equation that looks into a number of different kinds of diagnostic data as well as the client’s health history in order to determine the number of risk factors a specific member has. To look at it more simply, the risk adjustment calculation uses the member’s health issues and determines the monetary amount each issue will end up costing over a certain time period. One of the most important parts of a productive Medicare risk adjustment is being able to correctly predict the care costs of a client connected to a particular disease. Currently Medicare gets its information from the client’s health plan in the form of claims data as the method for determining the payment for risk adjustment. This means that from the data gathered through the information given to Medicare by private health insurance companies is the foremost source of determining how much payment these private plans should receive to cover their member’s likely health care costs. Since the foremost portion of Medicare risk adjustment is calculated based on claims reporting it puts a big significance on precise and careful reporting between the health care suppliers to the health insurance plan. When it comes to reporting client health care and claims information, there are a number of areas that can be cause for calculation mistakes causing improper risk adjustment. Much of the mistakes that have taken place are centered around the problems of recording client visits and activity as well as the sharing of information from supplier, health insurer and Medicare. A common mistake that has been found is not completely listing all of the applicable diagnostic codes to a specific patient who is suffering from multiple health conditions. If codes are not applied to patient’s charts then they will also not be compensated through the Medicare program. Proper recording of patient encounters and paying attention to detail in patient health issues and concerns is essential in proper risk adjustment calculations. To know more about Medicare risk adjustment go to Altegra Health.
Source: blogspot.com

Medical Encounter Reporting Ripple Effects

Encounter reporting starts at gathering encounter data. This is all information that is collected and logged onto a patient charts at the time of interaction between healthcare facility or provider and patient. The more extensive and comprehensive this patient medical data is, the more beneficial it can be not only to the patient and their healthcare treatment, but also to the healthcare provider and the medical facility. Encounter data is reported to health insurance firms as well as other government payers as a way to calculate proper reimbursement for services rendered.
Source: medicare-risk-adjustment.com

CENSEOHEALTH ANNOUNCES SUBSTANTIAL INVESTMENT BY HEALTH EVOLUTION PARTNERS

“We have evaluated the Medicare Advantage space and its patient evaluation and care management tools for some time. We are enthusiastic about Medicare Advantage and believe that the tools developed there will spread across the health care industry,” said David Brailer, Ph.D, M.D., Chairman of Health Evolution Partners. “We are impressed by the depth of the CenseoHealth management team and the value they bring to their customers. We look forward to working with the CenseoHealth team to continue their robust, profitable growth.” Risk adjustment was initially designed to use financial incentives to effectively drive the quality of care for chronically-ill beneficiaries. CenseoHealth partners with Medicare Advantage health plans to make good on that promise by once again putting the patient first. To help meet their needs, CenseoHealth’s dedicated nationwide network of mobile physicians specializes in in-home evaluations, carefully documented and compliant medical record-keeping, and expert professional services in risk adjustment management. Learn more here.
Source: cision.com

Medicare Part D: A Flashpoint In Florida GOP Primary Debate

Posted by:  :  Category: Medicare

FactCheck/iWatch News: Flubs In Florida Romney continued his attacks on the federal health care law, saying that the country has $15 trillion in debt and President Obama “adds another trillion on top for Obamacare and for his stimulus plan that didn’t create private-sector jobs.” But the nonpartisan Congressional Budget Office has estimated that the Patient Protection and Affordable Care Act will reduce yearly deficits — by $119 billion over the 2012-2019 period — not add to them (Kiely, Jackson, Gore and Robertson, 1/24). 
Source: kaiserhealthnews.org

Video: How to Apply For Medicaid in Florida Online

Bayonet Point Florida Medicare Advantage Plan Members eligible for Free Gym Membership

I am a mom of three teenage boys. Our family has struggled with multiple chronic health issues for many years. It was for this reason that I became interested in Xocai healthy chocolate. Our entire family eats healthy chocolate every day as a supplement and I am currently losing weight with the Xocai X-protein meal shake. I have struggled with Fibromyalgia for over 10 years. If you are struggling with your health, you owe it to yourself to check this out. This is the best way I have found to incorporate significant antioxidants into our diet. Feel free to email me if you have any questions. I look forward to hearing from you!
Source: healthchocoholic.com

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

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

South Florida Pharmacy Owner Allegedly Used Dead Beneficiaries to Defraud Medicare

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

Medicare You Can Believe In

“In many states, a few private insurance companies control the market, restricting consumer choice and driving up the cost of care. Although the Patient Protection and Affordable Health Care Act attempts to address this problem, more could be done,” Grayson explained. “Why should the insurance companies get all of the options, while we get none? The people deserve a choice. The people deserve a public option. Opening up the Medicare system increases competition and provides more options to consumers.”
Source: westorlandonews.com

Florida Medicare 2013 Open Enrollment

For example, suppose after running a search-providing zip code of your county in a southwestern state and you find that your current plan does not cover any vision or dental coverage, and then plans can be changed. There are other two available plans, which cover both the aspects plus limited hearing coverage. This sort of Medicare plans are of high quality ratings such as 4.5 out 5stars. This also means that Medicare is giving them an extra quality bonus which are use to augment benefits like vision-dental coverage or results in overall cost reduction of the plan, to the members.
Source: medicare-supplement-advisor.org

CMS Names 106 New Medicare ACOs

CMS has named 106 new accountable care organizations that will participate in the Medicare Shared Savings Program, effective Jan. 1. With the addition of the 106 new organizations, as many as 4 million Medicare beneficiaries will be covered by a CMS ACO. According to CMS, the savings achieved by its ACOs could be up to $940 million in four years. The new group of ACOs includes 15 Advance Payment Model ACOs, which are physician-based or rural organizations that will benefit from greater access to capital. The application period for organizations wanting to participate in the MSSP in 2014 will begin this summer. The 106 new ACOs named to the MSSP are listed here, with their service areas: 1.    A.M. Beajow, MD Internal Medicine Associates ACO, P.C. (Nevada) 2.    AAMC Collaborative Care Network (Maryland) 3.    Accountable Care Clinical Services, PC (California, Connecticut, Iowa, Massachusetts, Pennsylvania) 4.    Accountable Care Coalition of Central Georgia (Georgia) 5.    Accountable Care Coalition of DeKalb (Georgia) 6.    Accountable Care Coalition of Georgia (Georgia) 7.    Accountable Care Coalition of Greater Athens Georgia II (Georgia) 8.    Accountable Care Coalition of Greater Augusta & Statesboro (Georgia, South Carolina) 9.    Accountable Care Coalition of New Mexico (New Mexico) 10.    Accountable Care Coalition of North Central Florida (Florida) 11.    Accountable Care Coalition of North Texas (Texas) 12.    Accountable Care Coalition of Southern Georgia (Georgia) 13.    Accountable Care Coalition of Western Georgia (Alabama, Georgia) 14.    Accountable Care Organization of New England (Connecticut, Massachusetts) 15.    ACO of Puerto Rico (Puerto Rico) 16.    Advocare Walgreens Well Network (New Jersey) 17.    Affiliated Physicians IPA (California) 18.    Akira Health (California) 19.    Alegent Health Partners (Nebraska) 20.    Alexian Brothers Accountable Care Organization (Illinois) 21.    Amarillo Legacy Medical ACO (Texas) 22.    American Health Alliance (Florida) 23.    American Health Network of Ohio (Ohio) 24.    APCN-ACO (California) 25.    Arizona Care Network (Arizona) 26.    Atlanticare Health Solutions (New Jersey) 27.    AVETA Accountable Care (Puerto Rico) 28.    BAROMA Health Partners (Florida) 29.    Billings Clinic (Montana, Wyoming) 30.    Bon Secours Good Helpcare (Kentucky, New York, Ohio, South Carolina, Virginia) 31.    Cambridge Health Alliance (Massachusetts) 32.    Cape Cod Health Network ACO (Massachusetts) 33.    Cedars-Sinai Accountable Care (California) 34.    Central Florida Physicians Trust (Florida) 35.    Central Jersey ACO (New Jersey) 36.    Christie Clinic Physician Services (Illinois) 37.    Collaborative Care of Florida (Florida) 38.    Collaborative Health ACO (Massachusetts) 39.    Colorado Accountable Care (Colorado) 40.    Community Health Network (Minnesota) 41.    Diagnostic Clinic Walgreens Well Network (Florida) 42.    Doctors Connected (Virginia) 43.    Essential Care Partners II (Texas) 44.    Fort Smith Physicians Alliance ACO (Arkansas, Oklahoma) 45.    Franciscan Northwest Physicians Health Network (Washington) 46.    Franciscan Union ACO (Illinois, Indiana) 47.    GPIPA ACO (Arizona, New Mexico) 48.    Hartford HealthCare Affordable Care Organization (Connecticut) 49.    HHC ACO (New York) 50.    HNMC Hospital/Physician ACO (New Jersey) 51.    Independent Physicians’ ACO of Chicago (Illinois) 52.    Indiana Care Organization (Indiana) 53.    Indiana Lakes ACO (Indiana) 54.    Integral Healthcare (Florida) 55.    Integrated ACO (Texas) 56.    KCMPA (Kansas, Missouri) 57.    KentuckyOne Health Partners (Indiana, Kentucky) 58.    Keystone Accountable Care Organization (New York, Pennsylvania) 59.    Lahey Clinical Performance Accountable Care Organization (Massachusetts, New Hampshire) 60.    Lower Shore ACO (Delaware, Maryland, Virginia) 61.    Marshfield Clinic (Wisconsin) 62.    Maryland Collaborative Care (Maryland, Washington, D.C.) 63.    MCM Accountable Care Organization (Florida) 64.    Medicare Value Partners (Illinois) 65.    Mercy ACO (Arkansas, Missouri) 66.    Meridian Accountable Care Organization (New Jersey) 67.    Meritage ACO (California) 68.    Morehouse Choice ACO-ES (Georgia) 69.    National ACO (California) 70.    Nature Coast ACO (Florida) 71.    NOMS ACO (Ohio) 72.    Northeast Florida Accountable Care (Florida) 73.    Northern Maryland Collaborative Care (Maryland) 74.    Northwest Ohio ACO (Michigan, Ohio) 75.    Ochsner Accountable Care Network (Louisiana, Mississippi) 76.    OneCare Vermont Accountable Care Organization (New Hampshire, Vermont) 77.    Owensboro ACO (Indiana, Kentucky) 78.    Paradigm ACO (Florida) 79.    Partners in Care (Michigan) 80.    Physician Organization of Michigan ACO (Michigan) 81.    Physicians Collaborative Trust ACO (Florida) 82.    Physicians HealthCare Collaborative (North Carolina) 83.    Pioneer Valley Accountable Care (Connecticut, Massachusetts) 84.    Primary Care Alliance (Florida) 85.    Primary Partners ACIP (Florida) 86.    ProCare Med (Florida) 87.    ProHealth Physicians ACO (Connecticut) 88.    Qualable Medical Professional (Tennessee, Virginia) 89.    Rio Grande Valley Health Alliance (Texas) 90.    Saint Francis HealthCare Partners ACO (Connecticut) 91.    San Diego Independent ACO (California) 92.    Scott & White Healthcare Walgreens Well Network (Texas) 93.    SERPA-ACO (Nebraska) 94.    South Florida ACO (Florida) 95.    Southcoast Accountable Care Organization (Massachusetts, Rhode Island) 96.    Southern Maryland Collaborative Care (Maryland, Washington, D.C.) 97.    St. Luke’s Clinic Coordinated Care (Idaho, Oregon) 98.    Summit Health-Virtua (New Jersey) 99.    The Premier Health Care Network (Georgia, New Hampshire) 100.    UCLA Faculty Practice Group 101.    UW Health ACO (Wisconsin) 102.    Virginia Collaborative Care (Virginia) 103.    Wellmont Integrated Network (Tennessee, Virginia) 104.    Winchester Community ACO (Massachusetts, New Hampshire) 105.    Yavapai Accountable Care (Arizona) 106.    Yuma Accountable Care Organization (Arizona)
Source: beckershospitalreview.com

Medicare Targets Health Plans With Low Ratings

Posted by:  :  Category: Medicare

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

Video: Unicare Medicare Advantage Plans – Compare to 180+ Companie

UniCare MedicareRx Rewards Part D

Alabama, Alaska, Arizona, Arkansas, Connecticut, Delaware, Florida, Hawaii, Idaho, Illinois, Iowa, Kansas, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Montana, Nebraska, New Jersey, New Mexico, New York, North Carolina, North Dakota, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Washington, Washington D.C., West Virginia and Wyoming.
Source: affordablemedicareplan.com

Salina Public Flu Vaccine Clinic To Be Held Wednesday

A drive-thru clinic for adults only will be conducted from 11:00AM-2:00PM in the east driveway behind the 4-H Building and Agriculture Hall.  Vehicle entry will be from the south in the dirt parking area across from the entrance to Kenwood Cove.  Participants at the drive-thru must be 18 years of age or older and are asked to wear short-sleeve shirts.
Source: todayinkansas.com

Lady is Unhappy with Medicare Advantage

I am pretty new to selling health insurance in general and particularly green at senior market. I have a lay who bought what looks to be a medicare advantage plan with Secured Horizons in Texas. She does not like it and wants me to suggest an alternative. she likes BCBS. I told her that I would take the certification training on Medicare advantage and Part D, but both BCBS and Unicare are no longer offering it and it sounds like they are out of the business. If I were to write her a plan F and she dropped the medicare advantage plan would she lose coverage? I know enough to know, I don’t want to mess her up on prescription coverage. Or can you tell me how I can go about how these different options coordinate with each other. I know from other posts that there are lots of problems with Medicare Advantage. I need some basic training to know how to advise people properly. I would appreciate any help. Thanks
Source: insurance-forums.net

CMS Letter on Poor Performing Medicare Advantage Plans

CMS has also created an SEP allowing beneficiaries one chance to move from a “poor” performing plan to one that is rated 3-Star or higher after January 1, 2013.  This SEP is not agent driven however, so in order for someone to take advantage of this, the individual must call 1-800-MEDICARE. There are no timeframes, end dates, etc. associated with this SEP and CMS will be granting the SEP on a case-by-case basis. Beneficiaries will be receiving letters regarding this as well.
Source: agentpipeline.com

WellPoint To Transfer UniCare Blocks

The old WellPoint Health Networks Inc., Woodland Hills, Calif., one of the companies that merged to form WellPoint Inc., created the UniCare business in 1995 to hold health insurance operations outside of California. Much of the business in the unit was acquired from Massachusetts Life Insurance Company, Springfield, Mass., in 1996 and from John Hancock Mutual Life Insurance Company, Boston, in 1997. Also today, WellPoint:
Source: lifehealthpro.com

Getting Insured at Home & World

Many companies offer CIGNA insurance as part of their group coverage. This is because the company is widely accepted throughout the United States and has a variety of different coverage available. CIGNA offers both a HMO and a PPO by way of coverage. The PPO coverage allows the insured to choose their own doctor and not have to rely on doctors that are in the network. HMO coverage only allows the insured to choose doctors that are in their own network.
Source: 4healthinsurance.com

UniCare Helps To Combat West Virginia Obesity Epidemic

“We know that physicians play an important role in the fight against obesity,” said Dr. Harvinder Sareen, director of clinical programs for UniCare. “Our goal is to provide training to physicians and clinical staff and equip their practices with tools to facilitate standard screening for members with this condition or those at risk. Early identification will allow physicians to provide directed anticipatory guidance and management services to children and families who need it the most.”
Source: emaxhealth.com

Medicare Open Enrollment: last chance to review and compare plans

Posted by:  :  Category: Medicare

With the holiday season upon us, it’s easy to get busy this time of year. Some pretty important tasks can get left to the last minute. One of those important tasks is ensuring you are in the right health insurance plan in Medicare.  Selecting the right plan is a personal choice, and a lot of thoughtful consideration goes into finding the right match.  But just like the holidays, those key dates come whether or not you are ready.
Source: medicare.gov

Video: SHIIP Medicare Enrollment Basics.flv

OIG Report: Medicare Part B Overpaying for Infusion Medications

OIG recommended that CMS “seek legislative change” over reimbursement policies or include the devices used with such drugs in the next round of competitive bidding. According to “RegWatch,” CMS “partially” has agreed to ask Congress to change the rules and said it will go forward with the competitive bidding suggestion (Wilson, “RegWatch,”
Source: californiahealthline.org

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

Resource Center for Religious Institutes: Medicare Open Enrollment Period Closes Tomorrow!

Note that you can join a health or drug plan under Medicare when you first get Medicare (initial enrollment periods for Part C & D), such as when you turn age 65. Each year, you have a chance to make changes to your Medicare Advantage or Medicare prescription drug coverage for the following year. There are 2 separate enrollment periods each year. According to the Medicare website:
Source: blogspot.com

More Time to Enroll in Medicare If You Live in Storm Areas

Thanks to the marvels of medical science, our parents are living longer than ever before. Adults over age 80 are the fastest growing segment of the population; most will spend years dependent on others for the most basic needs. That burden falls to their baby boomer children. In The New Old Age, Paula Span and other contributors explore this unprecedented intergenerational challenge. You can reach the editors at newoldage@nytimes.com.
Source: nytimes.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 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

Privately Run Medicare Plans are Really Expensive

Austin Frakt draws my attention today to a new article about the administrative costs of Medicare. Exciting stuff! Long story short, Kip Sullivan of the Minnesota chapter of Physicians for a National Health Program wants everyone to understand just what’s involved in figuring out the true administrative costs of Medicare. The cost of collecting payroll taxes is one frequently overlooked element, for example. More interestingly, though, there’s a large and growing gap between the overhead calculations of the Medicare Trustees and those of the National Health Expenditure Accounts. Why is that?
Source: motherjones.com