Medicare Supplement Plan G

Posted by:  :  Category: Medicare

Choose Love Over Fear by elycefelizMedicare Supplement Plan G offers a smart alternative to Plan F. When comparing plan benefits, the only difference is Plan G does not cover the Part B annual deductible of $147 per calendar year. In many instances, you would be saving money to take Plan G (with a much lower monthly premium) and pay the Part B deductible.
Source: searchmyquote.com

Video: Plan F and Plan G Comparison

Plan G Medicare Supplement Insurance Quotes

Prior to June 1 2010, Plan G only covered 80% of Part B Excess charges, but plans purchased after June 1 cover this benefit at a 100% level. If you live in or often travel to a state that allows doctors and/or hospitals to charge Part B excess, then it is wise to consider a Medicare supplement that covers Part B Excess charges completely. Both Plan G and Plan F cover this benefit in its entirety while no other supplements will provide benefits for this gap.
Source: ohioinsureplan.com

Texas Medicare Supplement Plan G

Plan G is also available in a money saving Medicare Select option. Basically, if you’re looking to save on premiums, you can receive the same benefits as the standard Plan G but for a reduced premium.  By agreeing to use Medicare Select hospitals and doctors, your monthly payment is reduced. Need emergency care? No problem, with Medicare Select, you can get treatment at any hospital for no extra charge. Plus, you can still choose your own doctor. Remember, to be eligible for Medicare Select Plan G, you must live within 30 miles of a Medicare Select participating hospital.
Source: medicareinsurancetexas.com

Robert Hansen’s Blog: Medicare Advantage auctions: Asking too much?

When I teach about auctions, I like to ask students:  What does an auction accomplish, or put differently, what social roles does an auction play? I point to two major roles:  An auction determines an allocation — who gets the good being sold, or who is chosen to produce — and it also determines a price.  Two very important things:  allocation and price. In Medicare — a confused and confusing policy area if there ever was one!– auctions are used in both Medicare Part D (prescription drug coverage) and Medicare Advantage (private Medicare plans). I am concerned that some policy proposals for Medicare Advantage (MA) are asking too much from an auction, for they add a third role:  determining the subsidy level for subscibers.  This is a complicated issue, requiring auction theory that is at the frontier.  But I think the intuition is pretty clear.  Also, while I will focus on MA here, similar issues arise with Part D plans, albeit somewhat less so because of the way those rules are set. In a nutshell, here is the way MA plans work now.  Private insurers submit bids to provide health coverage for those over 65, with bids submitted on a county basis.  Folks who qualify for Medicare can either take the standard government-issue Medicare or opt into one of the private MA plans. The private plans are paid by the government a subsidy amount equal to the average per person cost of that county’s standard Medicare plan.  If the plan bids more than that, the enrollees in that plan pay the difference between the subsidy and the bid.  If a plan bids less than the subsidy, then enrollees don’t pay anything but the plan has to rebate the difference to enrollees as either cash or extra benefits (I do need to verify the specifics of this, but for now I don’t think it is crucial).  Importantly, enrollees select which MA plan they want, so choice is a key part of the process. So this is fine.  The auctions do two things, as above.  They determine which of the private plans provide service (allocation) and they determine a price (the price paid by enrollees). Note that the subsidy is determined exogenously from the auction — the average per person cost of standard Medicare.  Granted, there might be some endogeneity here, as the cost of the local Medicare plan depends on who opts into MA plans…but that seems of second order importance. However, some policy proposals (see Alice Rivlin, for example) will add a third role to MA auctions, that of determining the subsidy.  The typical idea is to set the subsidy at the second-lowest bid of the private insurers. The first order logic of this is great.  Set the subsidy at that level, and you can be sure that at least two plans will be willing to offer coverage at that subsidy amount.  Even more important, instead of having the MA subsidy set through a political process, it is set in a market mechanism.  What could sound better than that? Here is my concern, arising from the effect that setting the subsidy in the auction will have on strategic bidding behavior. (Let’s be clear that strategic bidding behavior should be expected, that is, insurers will not just put bids in that equal their expected cost, even if that is what the government asks for.  Insurers will put in bids that maximize their expected profit.) The issue is that by putting in a higher bid, an insurer has a reasonable expectation that it will increase the subsidy (if the bidder happens to be the second lowest bid).  This will increase the subsidy to enrollees and make it less likely that the insurer’s bid will result in a net payment by the enrollees.  Also, as the subsidy increases, more people will opt into the MA plan arena.  Seems pretty clear to me that this will result in higher bids. Amplification of this problem arises because is in MA plans, there is not a standard package of benefits.  By adding benefits, and putting in a higher bid reflecting the higher cost of that expanded package, an insurer minimizes any competitive effect of being a high bidder in the auction while still having a reasonable expectation that the subsidy will be increased. As all bidders do this, the entire distribution of bids shifts higher.  Studies that have been done on the cost savings from basing the subsidy on the second lowest bid are obviously wrong, as that second lowest bid is going to be higher. The idea is not that different from shifting from a second-price sealed bid auction to a first-price selaed bid auction (standard auction where something is being SOLD to bidders).  It would seem that taking the highest bid as the price in an auction would clearly be better than taking the second highest.  But as the rules change from second-highest to highest, we have to expect that bidders will lower their bids.  I always ask students:  What do you think is greater — the second highest out of a distribution, or the first highest out of a lower distribution?
Source: blogspot.com

Exit Quick: The Advantages To Medicare

Medicare supplemental insurance was introduced to simply help seniors address the gaps left in the insurance from Medicare Part A and Part B. There are twenty Medicare supplement plans that may fill all or just a few of the coverage breaks, depending on which strategy you choose. While slightly higher priced, the Medicare supplement insurance coverage that load many or all the holes, like Medicare supplement plan Y and plan G, can make certain that you may not need certainly to spend such a thing moreover out of pocket. If you’ve any additional questions you should seek the assistance of a qualified Medicare supplement insurance broker.
Source: exitquick.com

Illinois Medicare Supplement Plan G: Is this your Best Option?

Remember, simply because providers must offer the same plans does not mean they are all reputable or dependable. And when it comes time to collect on your benefits, a low cost will not help you if the insurance company cannot deliver. Stay with the major names and get peace of mind in knowing you’re insured with a stable, reliable provider. Blue Cross Blue Shield of Illinois, for example, has been providing Medicare supplement insurance to folks just like you for years. Because they are dependable, they will continue to offer competitive prices and great benefits for years to come.
Source: ssiinsure.com

Medicare Supplement Plan G

Plan G coverage is fantastic for those individuals looking for a slightly lower premium who do not mind having a small out of pocket cost. Plan G does not cover your part B deductible. For 2011 this deductible is $162. So what that means is the first couple of times you visit your doctor you will pay out of pocket until your costs reach $162. At that point your Medicare and your supplement kick in. After this point, your Plan G Medicare Supplement Policy covers you fully. You will have no further co-pays, or deductibles, only that initial $162.
Source: e-medigap.com

What is the Cadillac Medicare Advantage plan

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

How To File A Medicare Appeal

Posted by:  :  Category: Medicare

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

Video: Medicfusion Custom Forms – Medicare ABN Form

Understanding Paul Ryan’s Medicare reform plan in three minutes

The 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

Daily Kos: Projected Medicare spending falls dramatically

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Source: dailykos.com

Doctors Fleeing Medicare, Moving to Direct Primary Care

Neil Sapin, a Glendale, Arizona, physician, charges less, about $1,500, but has a larger practice. He used to run himself ragged trying to keep up with the flow of patients necessary to cover all the expenses of his practice: “I used to see 18 patients per day, but [over time] I’m up to 24 or 25. It [became] difficult to give people as much time as I’d like to.” So he went private, dropping his workload from 1,600 patients to just 500. His patients have access to him any time of day or night and they can access their medical records from a home computer at any time and send him questions about their health via e-mail. Sapin says this allows him to spend more time with those who need him, and he also has time “to stress preventive health and dietary counseling.”
Source: thenewamerican.com

Explaining Medigap Insurance

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

Medicare Terminology To Know

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

IRS Issues Guidance On Additional Medicare Tax : ADP Compliance Insights

Background Effective for wages paid on or after January 1, 2013, the Medicare tax rate increases from 1.45 percent to 2.35 percent on wages earned above $200,000 for single filers and $250,000 for joint filers ($125,000 for a married individual filing separately).   This increase only applies to the employee portion of the Medicare tax. Employers do not have to match the increased Medicare tax amount. However, employers are still responsible for the withholding and reporting obligations with respect to the increased employee Medicare tax.  If an employer fails to withhold and deposit the additional Medicare tax amount AND the employee pays it with their tax return, the employer will not be required to pay the amount not deducted, but the employer will be subject to penalties for the failure to withhold the tax.   The employer is required to withhold the increased amount from all workers with wages exceeding $200,000 regardless of the marital status claimed on the employee’s Form W-4. Over- and under-withholding for the employee will be reconciled upon the filing of his/her individual tax return.
Source: adpcomplianceinsights.com

Medicare fees rise for 2013

Posted by:  :  Category: Medicare

Deputy Administrator and Director for the Center of Medicare at CMS Jonathan Blum visits Christiana Care to speak about accountable care organizations by Christiana CareI see attacks on our president for problems wth our social security and medicare and am amazed how few people ignore the fact that congress is the major force behind plans to cripple and cut the programs each of us rely on. Over the last few years it is the GOP who have been hucking these programs under the buss they view the program that most of us will use to survive our senior years as a charity supported by rich people wrong it is a fund we have paid into all our working lives and i am offended every time i hear the word entitlement.
Source: bankrate.com

Video: Diagnostic Ultrasound Medicare fee change Petition

Lab Soft News: Medicare Costs Rise as Knee Replacements Increase for Seniors

The popularity of total knee arthroplasty surgeries among Medicare patients has grown considerably as beneficiaries are living longer and seeking to increase their mobility, but the shift has led to fiscal concerns for the entitlement program….Overall volume growth has been driven both by the increased number of Medicare enrollees and by increased per capita utilization….The number of total knee replacements increased 161.5% between 1991 and 2010, when 243,802 such surgeries were performed. Per capita utilization nearly doubled during that period, to 62.1 procedures per 10,000 Medicare beneficiaries from 31.2 surgeries per 10,000 enrollees….For patients, knee replacements are relatively safe and have low rates for complications, mortalities and length of hospital stays. However, 30-day readmissions rates have risen to 5% in 2010 from 4.1% in 1991. Shorter hospital stays are causing the increase, a change that should have been expected by health policymakers….The volume of revision knee replacement surgeries has increased to 19,871 in 2010 from 9,650 in 1991….There were 243,802 knee replacement surgeries in 2010, a jump of 161.5% from 1991. More and more patients taking advantage of the surgeries will lead to higher Medicare program costs. The procedure itself costs about $15,000 to $30,000…The bundled Medicare payment for the procedure is spent on the device implants, facility fees, therapy providers and the surgeons. The surgeon probably will receive about $1,500 of the total….New Medicare payment models, such as the bundled payments used for knee replacements, aim to achieve lower costs while maintaining high quality to prevent patients from being readmitted.
Source: typepad.com

Medicare Discloses Hospitals’ Bonuses, Penalties Based On Quality

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

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

Doctors Fleeing Medicare, Moving to Direct Primary Care

Neil Sapin, a Glendale, Arizona, physician, charges less, about $1,500, but has a larger practice. He used to run himself ragged trying to keep up with the flow of patients necessary to cover all the expenses of his practice: “I used to see 18 patients per day, but [over time] I’m up to 24 or 25. It [became] difficult to give people as much time as I’d like to.” So he went private, dropping his workload from 1,600 patients to just 500. His patients have access to him any time of day or night and they can access their medical records from a home computer at any time and send him questions about their health via e-mail. Sapin says this allows him to spend more time with those who need him, and he also has time “to stress preventive health and dietary counseling.”
Source: thenewamerican.com

Doctors billing Medicare patients at higher rates, report finds

“This is an urgent problem,” Dr. Mark McClellan, who directs the Engelberg Center for Health Care Reform at the Brookings Institution in Washington, told the CPI. McClellan, a former director of the Centers for Medicare and Medicaid Services, or CMS, said the agency must send a message that it “won’t stand by and do nothing … that they are paying attention to this.”
Source: nbcnews.com

CMS to Cut Physicians’ Medicare Payments 26.5% in 2013 Unless SGR Bypassed

CMS has issued its final rule on the Medicare physician fee schedule (pdf) for 2013, saying Medicare reimbursement rates for physicians will be slashed by 26.5 percent on Jan. 1, 2013, unless Congress bypasses the sustainable growth rate. Here are six primary points from CMS’ final rule, many of which carried over from the proposed rule in July. •    Sustainable growth rate. The SGR, which is the formula used to adjust Medicare physician payment rates, is currently expected to cut physician rates by 26.5 percent. However, every year since 2003, Congress has temporarily bypassed the SGR to ensure there would be no cuts to physician Medicare payments, and another temporary “doc-fix” is likely this year during a lame duck session. •    Primary care emphasis will stand. Primary care physicians and extenders will see increased payments next year, assuming there is an SGR fix, as the final rule solidified new policies in total allowed charges. Family practice physicians will see the largest Medicare payment increases at 7 percent, and several other primary care providers — such as internal medicine physicians, pediatricians, and nurse practitioners — will see payment boosts ranging from 3 to 5 percent. The total allowed charges figures are similar to those that were in the proposed rule. As stated in the proposed rule, CMS also said a new policy will pay a patient’s physician or practitioner to coordinate care in the 30 days following a hospital or skilled nursing facility stay. •    Specialists will still see reduced charge rates. The proposed rule stated that many specialty physicians will see their Medicare rates decrease, and that carried forward in the final rule as well. Here are some of following specialties that will see the biggest decreases in Medicare total charge rates/payments: independent laboratory providers (14 percent), neurologists (7 percent), radiation oncologists (7 percent), pathologists (6 percent), interventional radiologists (3 percent) and cardiologists (2 percent). •    Physician value-based payment modifier and Physician Quality Reporting System. CMS said it will apply the value-based payment modifier — which is a tool that provides different Medicare payments to physicians based on quality of care and cost of care comparisons — to groups that have 100 or more physicians in 2015 instead of groups of 25 or more in the proposed rule. •    Information technology. The final rule also expanded Medicare telehealth services and simplified reporting within the Medicare Electronic Health Records Incentive Pilot Program for physicians. •    Certified registered nurse anesthetists. Medicare will now pay CRNAs for providing all services that are allowable under state law and within the full extent of their state’s scope of practice.
Source: beckershospitalreview.com

AARP Urges Congress to Address Medicare Physician Payments

“As you know, physicians and other health care providers are scheduled to receive a 27 percent cut on January 1, 2013, as a result of the flawed sustainable growth rate (SGR) formula.  This is in addition to the 2 percent reduction included in the planned sequestration.  Failure to adopt legislation to address the “doc fix” would create considerable instability in the Medicare program.  Such a significant reduction in reimbursement could cause providers to stop seeing Medicare beneficiaries or prevent them from accepting new ones.  We are disappointed that Congress has thus far been unable to develop a long-term solution to this perpetual problem.  However, even in the absence of a longer-term solution, the SGR cuts must not be allowed to occur.  Under current law, the Centers for Medicare and Medicaid Services may begin issuing the reduced payments on January 1.  A reduction for even a short time in reimbursement rates could disrupt access to care, as providers may delay seeing Medicare patients until updated rates go into effect. 
Source: aarp.org

Medicare Payments & the Sustainable Growth Rate (SGR)

To reduce cost, health policy experts have recommended a number of actions: better coordination of patient care among providers; the use of electronic medical records;  increased patient accountability; the elimination of duplicative or unnecessary tests; and, the replacement of the fee-for-service method of reimbursement with models that do not reward physicians based on the number of services they perform.
Source: rmhp.org

Medicare Drug Costs Going Down for Seniors

For the first time since the inception of the program the 2014 defined standard Part D prescription drug benefit will have lower co-payments and a lower deductible than in 2013. These costs are decreasing at the same time that coverage for Medicare beneficiaries in the Part D prescription drug coverage gap, or “donut hole” will continue to increase in 2014. As a result of the Affordable Care Act, in 2014, enrollees with liability in the donut hole will receive coverage and discounts of 52.5 percent on covered brand name drugs and 28 percent on covered generic drugs.
Source: moneytalksnews.com

MedPAC calls for permanent reauthorization of Medicare Advantage plan covering nursing home residents

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSThe low readmission rates indicate I-SNPs provide more integrated, coordinated care to enrolled beneficiaries than fee-for-service plans. Based in part on I-SNPs’ high marks for improving integrated care, MedPAC commissioners unanimously recommended that Congress permanently reauthorize them, according to the Bureau of National Affairs (BNA).
Source: mcknights.com

Video: Best Medicare Advantage Plan

Turning 65: Finding a Medicare Advantage Plan

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

2013 Medicare Advantage Plan Enrollment

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

What is the Cadillac Medicare Advantage plan

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

Uwe E. Reinhardt: Comparing the Quality of Care in Medicare Options

Both traditional Medicare and Medicare Advantage plans are monitored annually through surveys of patients, using the Consumer Assessment of Health Care Providers and Systems, known in the trade as Cahps. The findings from this survey make it possible to compare traditional Medicare with Medicare Advantage plans on quality. As Medpac reports in Table 12-8 of Chapter 12 of the March 2012 report, the commission found little difference in the relatively few quality-performance scores of the traditional Medicare and Medicare Advantage plans.
Source: nytimes.com

Insurer stocks slip over possible Medicare cuts

Medicare Advantage plans could see payment reductions topping 5 percent, considering they also face cuts from the health care overhaul and from the steep federal budget cuts known as sequestration that are slated to start next month. Plus, their profits also are expected to be pressured by a premium tax imposed to help fund the overhaul, which aims to cover millions of uninsured people.
Source: seattlepi.com

HHS IG: Still Not Many Medicare Advantage Fraud Probes Despite 2007 Investigation

Modern Healthcare: Amid Concerns About Overpayments, HHS Notes Small Number Of Medicare Advantage Probes HHS’ inspector general’s office says the $124 billion Medicare Advantage program is the focus of very few investigations from fraud-hunters — a conclusion that comes on the heels of a string of audits alleging hundreds of millions of dollars of questionable payments in the program. HHS officials last year published the results of long-running investigations into four Medicare Advantage plans, concluding that the plans had received nearly $600 million more than they should have in 2007 by claiming that patients were more medically complex than they were. All four companies denied the allegations, but the inspector general’s office is continuing with probes of an untold number of the other 170 or so Medicare Advantage companies working for the CMS (Carlson, 1/10).
Source: kaiserhealthnews.org

ICYMI: Health Affairs Article: Medicare Advantage Provides Higher

A recent article in the latest edition of Health Affairs provides further evidence that Medicare Advantage plans are delivering higher-quality care to seniors and people with disabilities than the fee-for-service (FFS) part of Medicare.  Data from the article show that Medicare Advantage beneficiaries utilize some health care services, such as the emergency department and ambulatory surgery or procedures, at a rate 20-30 percent lower than those in FFS Medicare.  This data suggests that Medicare Advantage enrollees “might use fewer services and be experiencing more appropriate use of services than enrollees in traditional Medicare.”
Source: ahipcoverage.com

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

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

Daily Kos: Projected Medicare spending falls dramatically

Posted by:  :  Category: Medicare

Healthcare Costs by Images_of_Moneyferg, 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

Video: What Does Medicare Cost?

Part D: Bending the Medicare Cost Curve

Part D’s 10-year projection has now been reduced by over $100 billion the past three years, and these projections are almost half of their initial estimated cost when the program was enacted seven years ago.  Through market-based competition, Part D is successfully able to offer a mix of plans to help seniors access medicines which, in turn, helps them adhere to doctors’ orders. This improved use of medicines helps lower other health costs, such as hospitalizations and expensive procedures.
Source: phrma.org

Projected Medicare Spending Already Came Down by Half a Trillion

That’s important to remember because it was in late 2010 — and based on CBO’s August 2010 projections — when Fiscal Commission co-chairs Erskine Bowles and Alan Simpson issued their original budget proposal, calling for slightly more than $300 billion in Medicare spending cuts through 2020. The original Bowles-Simpson proposal is often considered an appropriate starting point in evaluating whether other deficit-reduction proposals should be viewed as responsible approaches to the deficit problem.
Source: firedoglake.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

Lab Soft News: Medicare Costs Rise as Knee Replacements Increase for Seniors

The popularity of total knee arthroplasty surgeries among Medicare patients has grown considerably as beneficiaries are living longer and seeking to increase their mobility, but the shift has led to fiscal concerns for the entitlement program….Overall volume growth has been driven both by the increased number of Medicare enrollees and by increased per capita utilization….The number of total knee replacements increased 161.5% between 1991 and 2010, when 243,802 such surgeries were performed. Per capita utilization nearly doubled during that period, to 62.1 procedures per 10,000 Medicare beneficiaries from 31.2 surgeries per 10,000 enrollees….For patients, knee replacements are relatively safe and have low rates for complications, mortalities and length of hospital stays. However, 30-day readmissions rates have risen to 5% in 2010 from 4.1% in 1991. Shorter hospital stays are causing the increase, a change that should have been expected by health policymakers….The volume of revision knee replacement surgeries has increased to 19,871 in 2010 from 9,650 in 1991….There were 243,802 knee replacement surgeries in 2010, a jump of 161.5% from 1991. More and more patients taking advantage of the surgeries will lead to higher Medicare program costs. The procedure itself costs about $15,000 to $30,000…The bundled Medicare payment for the procedure is spent on the device implants, facility fees, therapy providers and the surgeons. The surgeon probably will receive about $1,500 of the total….New Medicare payment models, such as the bundled payments used for knee replacements, aim to achieve lower costs while maintaining high quality to prevent patients from being readmitted.
Source: typepad.com

Seniors’ Medicare Costs Will Be Reduced For Medicine

“Historically low growth” in health-care spending for the nation’s 50 million Medicare beneficiaries also led to a proposed 2.2 percent reduction in payments from the federal government to private Medicare Advantage plans offered by insurers including UnitedHealth Group Inc., the agency said in a statement. About one-quarter of Medicare’s participants choose Advantage plans, which provide extra benefits such as fitness programs and eye glasses compared with the traditional program.
Source: ctwatchdog.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

Best Bets for Reducing Medicare Costs for Dual Eligible Beneficiaries: Assessing the Evidence

With pressure mounting to slow the growth in federal health care spending, policymakers are exploring ways to reform the way care is delivered to the 9 million low-income Medicare beneficiaries who also receive Medicaid – a group that on average is sicker and frailer than other Medicare beneficiaries, and therefore receive significantly more care at greater cost. Major efforts are underway at the federal and state level to better coordinate care for this population and lower health care costs – with some estimates projecting hundreds of billions of dollars in savings over the next decade.
Source: kff.org

Peter Orszag Chart Shows Medicare Costs Slowing

“Presumably, the weak state of the economy is a factor, but given the magnitude of the slowdown in national health spending and the timing of that slowdown, which seems to have started before the recession, we and most analysts think there are probably structural factors at work as well,” he said. Those structural factors could include slower growth of spending on prescription drugs, changes in the health care delivery and payment system, and higher out-of-pocket spending for consumers, according to Elmendorf.
Source: businessinsider.com

Viewpoints: ‘Bad Idea’ About Repealing Medicare Cost Board; Conservatives Say Health Law Repeal Fight Is Not Over

The New York Times: A Bad Idea Resurfaces House Republicans like to talk about the need to find common ground with President Obama to make progress on important national issues, especially after the election. Yet within days, they were setting an agenda to eliminate an important element of his signature domestic achievement, the Affordable Care Act. Representative Eric Cantor of Virginia, the majority leader, recently proposed that House Republicans set their sights on repealing the part of the law that creates an independent board that is supposed to help limit growth in Medicare spending (11/17).
Source: kaiserhealthnews.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

Medicare Drug Costs Going Down for Seniors

For the first time since the inception of the program the 2014 defined standard Part D prescription drug benefit will have lower co-payments and a lower deductible than in 2013. These costs are decreasing at the same time that coverage for Medicare beneficiaries in the Part D prescription drug coverage gap, or “donut hole” will continue to increase in 2014. As a result of the Affordable Care Act, in 2014, enrollees with liability in the donut hole will receive coverage and discounts of 52.5 percent on covered brand name drugs and 28 percent on covered generic drugs.
Source: moneytalksnews.com

Medicare Fraud News: Services Not Eligible For Reimbursement Result in Whistleblower Lawsuit

Posted by:  :  Category: Medicare

From our offices in San Francisco, California, New York, New York, and Nashville, Tennessee, Lieff Cabraser’s whistleblower attorneys represent whistle blowers in False Claims Act, SEC/CFTC, and IRS/tax cases nationwide. Our whistleblower lawyers practice in federal court throughout the United States. Members of the firm are also licensed to practice in local courts in California, New York, Massachusetts, Tennessee, New Jersey, and Pennsylvania, as well as Washington, DC. We have affiliations in particular cases with attorneys licensed to practice in almost every state court in the United States. For a free, confidential prompt evaluation of your whistleblower case, please contact us.
Source: uswhistleblowerlaw.com

Video: Medicare Fraud Whistleblowers

Jury in nursing home whistleblower suit hands down $28M in fines

Two nurses formerly employed at the Momence Meadows Nursing Center (MMNC) in Kankakee, IL, launched the whistleblower case. They alleged the facility provided substandard care to residents and inappropriately billed Medicare and Medicaid for treatments during the time it was owned and operated by defendant Jacob Graff. The nurses also said MMNC terminated their employment in 2003 to silence their complaints.
Source: mcknights.com

Texas Lawyers Blog: Medicare Fraud Whistleblowers: Probate Lawyers and Executors Are Seeing More Medicare Fraud That Can Be The Basis of Medicare Fraud Whistleblower Reward Lawsuits by Medicare Fraud Whistleblower Lawyer Jason S. Coomer

Because of the growing number of Medicare eligible recipients, more and more people will pay for their health care including nursing homes, hospice, home health care, physical therapy, pharmacies, and medical equipment through Medicare.  The nursing homes and associated health care providers that accept Medicare payments too often find that it is more profitable to use fraudulent billing practices to increase their income from Medicare.  These nursing homes and elder care providers sometimes begin to use systematic Medicare Fraud including upcoding, manipulation of outlier payments to Medicare, illegal kickbacks, charging for unnecessary services, double billing for services, and falsely certifying goods or services that were not provided are all forms of Medicare fraud that cost United States taxpayers billions of dollars each year.  These forms of Medicare fraud can often be difficult to detect and often require the family of a senior or the administrator of the person’s estate to detect the fraud.  In these situations, it is important to determine if there is significant billing fraud taking place and if it may be systematic.  If this is the case, it can often be beneficial to work with a Medicare fraud whistleblower lawyer to determine the extent of the fraud and help build a whistleblower reward lawsuit that can expose the fraud as well as potentially result in a large financial recovery.
Source: texaslawyers.com

Hospices’ Medicare Billing Practices Under False Claims Act Scrutiny

Recent actions by the Department of Justice (DOJ) in False Claims Act (FCA) whistleblower cases highlight one of the types of Medicare fraud that can occur in hospice care facilities. Hospices provide palliative care – medical treatment that concentrates on reducing the severity of a disease’s symptoms – to patients who decide to forego curative care of their illness. Medicare beneficiaries are entitled to hospice care if they have a terminal prognosis and are certified by a hospice physician as having six months or less to live. In one recent whistleblower case, South Carolina-based Harmony Care Hospice Inc. and CEO/Owner Daniel J. Burton paid the U.S. $1.287 million to resolve allegations that they knowingly submitted or caused to be submitted false claims for patients who did not have such a prognosis and thus were not eligible for hospice care. The qui tam case brought by two former Harmony employees is captioned United States ex rel. Singletary, et al. v. Harmony Care Hospice, Inc., et al., Case No. 2:10-cv-01404-PMD (D.S.C.). In another recent case, DOJ intervened in a whistleblower’s case against the Altamonte Springs, Florida-based Hospice of the Comforter, alleging that the nonprofit routinely over-billed Medicare for patients who didn’t qualify as terminally ill, sometimes keeping them in hospice care for as long as five years. The whistleblower in that case is a former nursing-home administrator who became the hospice’s vice president of finance in February 2008, and was later fired in retaliation for urging the hospice CEO and several board members to repay Medicare for the overbillings.
Source: bostonwhistleblowerlawyerblog.com

Florida Hospital group facing a whistle blower lawsuit over Medicare Fraud. (Adventist Health Systems)

The Defendant, Adventist Health Systems recently sought  to have the case dismissed by filing a Motion to Dismiss based on a the government failing to state a claim on which relief can be granted and not pleading the “right elements of fraud”, well they lost this motion and will not be able dodge justice, they will have convince a jury that they have done no wrong.  U.S. Federal District Judge  John Antoon II denied Adventist Health Systems Motion to Dismiss
Source: insurancejusticelawyer.com

Illinois Jury Found Nursing Home Liable For $28.1 Million In Whistleblower Case Alleging Substandard Care And Resident Abuse

Past employees of Momence Meadows Nursing Center brought this whistleblower action alleging that the nursing home defrauded Medicare and Medicaid by providing substandard care that left residents neglected and abused. The plaintiffs provided evidence of noncompliance with normal nursing home procedures, which caused, for example, resident burns, failure to contain a scabies outbreak, and failure to follow proper procedures regarding the prevention and care of pressure ulcers. In addition, the plaintiffs alleged that the nursing home retaliated against them after complaining about inadequate care and manipulated records to show residents received appropriate care.
Source: jdsupra.com

Tampa doctor gets $4M from blowing whistle on Medicare fraud

Actos ASR Bayer Birth Defects Birth Injury BP Oil Spill Business Loss car accident Chantix compensation Damages DaVita Defective/Dangerous Products DePuy Dialysis Advocates Drugs Eli Lilly & Co. False Claims Act Fresenius Granuflo Hip Implant IUD Johnson & Johnson Kidney Dialysis Medical Device Medtronic Infuse Bone Graft Mirena NaturaLyte negligence Pelvic Mesh Pelvic Sling personal injury Pfizer Press Release Qui Tam Spinal Surgery Stryker Takeda Pharmaceuticals Whistleblower
Source: uptonfirm.com

Schneiderman catches top NYC hospital overbilling Medicare and Medicaid

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

Senior Care Plus Offers Daily Meetings During medicare Enrollment Period

Posted by:  :  Category: Medicare

This entry was posted in Press-Media Releases and tagged advantage plan, annual enrollment, answ, benefit, carson city, churchill, convenience, eligible beneficiaries, enrollment period, government programs, health, health care, health care reform, home appointments, hometown health, informational group, informational meetings, insurance carrier, insurance plan, lyon, medical prescription, medicare, medicare enrollment, medicare managed care, medicare part b, prescription drug plans, private health insurance, reno, reno nev, right insurance, senior, sparks, supplemental benefits, wh. Bookmark the permalink.
Source: nvseniorguide.com

Video: Learn about changes to Medicare from Matt Ladich of Senior Care Plus

workinflorida: CarePlus Medicare Enrollment Specialist

As a CarePlus Medicare Enrollment Specialist you will: be responsible for researching, documenting, evaluating and executing all requested member enrollment… From Humana – 21 Mar 2012 23:35:07 GMT – View all Tampa jobs Tampa, FL Jobs
Source: blogspot.com

Ohio Health Policy Review: CMS approves MetroHealth Medicaid waiver

The Care Plus program covers uninsured adults who earn $14,856 or less (133 percent of the federal poverty level) and who are not eligible for regular Medicaid or Medicare. To pay for the Care Plus program, MetroHealth is using $36 million that it gets each year from county taxpayers to qualify for $64 million in federal Medicaid matching funds. No state money is being used for this expansion program.
Source: healthpolicyreview.org

Foot Care Plus: Medicare approved diabetic shoes and inserts

Did you know that Medicare will help pay most of the cost of diabetic shoes with or without inserts per calendar year?  The goal is to help prevent limb loss due to diabetes.  With diabetes, your body’s defense is not up to par like it used to be.  If you or somebody you know has diabetes, tell them about this program set up by Medicare.  As a foot specialist, Foot Care Plus, LLC can help.  Call us at (816) 434-5906.
Source: blogspot.com

Clinic Manager and Recruiter Plead Guilty in $2M Medicare Fraud Scheme

Detroit-area residents Carlos Grana and Dwight Armstrong pleaded guilty for their roles in a $2 million Medicare fraud scheme taking place between Feb. 2008 and Oct. 2009, according to a joint news release by the Departments of Justice and Health and Human Services. According to the plea documents, Mr. Grana managed the day-to-day operations of Careplus LLC, a medical clinic in Livonia, Mich. Mr. Grana admitted that while he managed Careplus, he paid patient recruiters for Medicare beneficiary referrals. He admitted he paid the recruiters between $100 and $150 per patient referral, and instructed the recruiters to pay the patients $50 from that amount. According to court documents, nearly all of the patients treated at Careplus were secured through the payment of kickbacks. Mr. Grana also admitted that in exchange for the payments, he and his co-conspirators expected the Medicare beneficiaries who received kickbacks to subject themselves to a medical examination and to medically unnecessary tests. Mr. Grana told the recruiters to instruct the patients to feign certain symptoms when they arrived at Careplus, which ultimately led to the patients’ medical records containing information about false symptoms. The falsified records then helped Careplus deceive Medicare about the legitimacy and medical necessity of the tests it performed, according to the release. Mr. Armstrong was one of the patient recruiters for Careplus, according to plea documents. Mr. Armstrong admitted that beginning in approximately June 2008 he began recruiting patients for the owners and/or operators of Careplus and that he paid kickbacks to the Medicare beneficiaries he recruited and later transported to Careplus using money provided by the owners/operators. He admitted he kept part of the funds he received as a kickback for referring the Medicare beneficiaries he recruited. The two are scheduled to be sentenced in July. Read the DOJ/HHS release on Carlos Grana and Dwight Armstrong.
Source: beckersasc.com

PHC4 Report Misses True Story of Ambulatory Surgery Centers’ Value

“The PHC4 report acknowledges that ASC and hospital profit margin rates available from the state cannot be compared directly because of the different methods used to calculate those statistics. For example, the disbursements (or salaries) that are paid to the physician owners of ASCs are not counted as overhead. This would be similar to removing all physician compensation from the operating costs of the hospitals before calculating their margins, which would increase significantly using that methodology. Also, the total margin for most for-profit ASCs does not reflect income tax expenses. By comparison, total margins for Pennsylvania’s for-profit general acute care hospitals are calculated after the tax expense is deducted.
Source: careplusmp.com

Lovelace’s Care Plus Brings Nurse Practitioners to Patients’ Homes

    Presbyterian Home Healthcare Services offers Hospital at Home, which it describes as hospital-level care in a home setting with doctors nurses or home health aides visiting people at home. It also offers a Home Care program with Medicare-certified skilled care for homebound patients post surgery or hospitalization, and its Medical House Calls program offers in-home care to patients as a means of circumventing the need for ER visits, urgent care visits and unnecessary hospitalizations.
Source: lovelace.com

Hearing Raises Questions About How To Replace Medicare’s SGR Formula

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 marsmet471Medpage Today: Repealing SGR Raises Questions For Congress Opinions on what to replace Medicare’s sustainable growth rate (SGR) formula with and how to get there vary greatly, comments during a Thursday hearing showed. Lawmakers looking to pull the trigger on finally doing away with the SGR, which is used to determine physician payments, must iron out many of the details that came to light during a hearing Thursday before the House Energy and Commerce Health Subcommittee. An outline of a Republican-offered plan to repeal and replace the SGR released last week by the House Energy and Commerce Committee and House Ways and Means Committee looked remarkably similar to that of bipartisan bills offered in the past. The plan would repeal the SGR and provide statutorily defined payment rates for a period of years before moving to a payment model that rewards quality and efficiency (Pittman, 2/14).
Source: kaiserhealthnews.org

Video: Medicare Supplement Plans | Questions about Medicare Supplement Plans

health care solutions, Medicare FAQ, Questions about Medicare

As an alternative to Part A and B, beneficiaries can select a Part C plan, which is also referred to as a Medicare Advantage plan. Private companies contract with the federal government to offer these plans, which pay for everything covered by Original Medicare and often provide additional services.  Such as dental, hearing, vision benefits and maybe even a gym membership. Beneficiaries usually pay a monthly premium and some other fees, such as copayments and deductibles.
Source: ahealthiermichigan.org

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

Who to Reach Out to For Your Medicare Related Questions

As you might imagine, the correct answers to these questions vary widely depending on very personal, complex and unique circumstances. Realistically, the only source for answers to these types of questions is through Medicare directly or through your Personal Care Physician. Our responses to these questions invariably advise you to call Medicare or your PCP, and, where applicable, point you to an official Medicare publication.
Source: medicarebenefits.com

Questions for Medicare in meningitis outbreak

The health insurance program for seniors long ago flagged compounded drugs manufactured without Food and Drug Administration oversight as safety risks. The outbreak that has sickened more than 250 people nationally has been linked to an injectable steroid from a Massachusetts compounding pharmacy.
Source: thedailyrecord.com

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

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

Medicare open enrollment: How can I find a better plan?

What about doctor availability? On the Medicare site you can directly compare up to three plans, and when I selected your current plan and these other two plans, I saw that your current plan says it has 1001-1500 “physicians and providers,” compared to 4001-5000 for the other two plans. For each plan you can click on “View provider and physician network website,” which takes you away from Medicare.gov and onto the plan’s own website, where you can search its provider directory to judge for yourself whether it has enough doctors to meet your needs.
Source: consumerreports.org

Seniors Need To Be Tenacious In Appeals To Medicare

Posted by:  :  Category: Medicare

Benefit Security Card .. HALF of the U.S live in households that receive government benefits (26 May 2012) ...item 2.. Brevard man gets 4 years in Social Security fraud case (Jun 1, 2012 ) ... by marsmet481Medicare 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: Introduction to Medicare – Data to Supplement Medicare Claims and Enrollment Information

CMS Implements 0% Medicare Payment Update: Hold Claims for 10 Day : Med Law Blog

In order to allow sufficient time to develop, test, and implement the revised MPFS, Medicare claims administration contractors may hold MPFS claims with January 2013 dates of service for up to 10 business days (i.e., through January 15, 2013). We expect these claims to be released into processing no later than January 16, 2013. The claim hold should have minimal impact on physician/practitioner cash flow because, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 for paper claims) after the date of receipt. Claims with dates of service prior to January 1, 2013, are unaffected. Medicare claims administration contractors will be posting the MPFS payment rates on their websites no later than January 23, 2013.
Source: medlawblog.com

The Smart Act Addresses Medicare Conditional Payments : Personal Injury Law Journal : New Jersey Product Liability Lawyers & Attorneys : Stark & Stark Law Firm

What does this mean to a workers’ compensation claimant?  If their case settles and they receive their Workers’ Compensation Award during this 120 day period then the last statement of conditional payments made by Medicare that was downloaded during this period shall constitute the final amount subject to recovery by Medicare.  This is a joy to behold.  Before this law was made, we would have to wait months for a statement of conditional payments.  Even after we received the statement there was no guarantee that Medicare would then not issue another statement after the settlement asking for more money to be reimbursed to Medicare than was requested prior to settlement.  The process as it stands now is a nightmare for workers and their attorneys.  The Secretary of Health and Human Services has until September 10, 2013 to implement these regulations. Congratulations to Congress for passing this SMART Act.
Source: personalinjurylawjournal.com

Rep. Allen West “Another False Obama Medicare Claim: The $6,400 Myth”

That structure ensures that seniors would have at least two choices (and likely far more) that they are guaranteed to do better than they do now. The amount of the premium-support subsidy would also be tied to underlying health-care costs, so it would not shift costs to beneficiaries, as Democrats also falsely claim. The very reasonable Romney-Ryan policy bet is that costs could nonetheless fall over time because seniors would have the incentive to switch to the most competitively priced Medicare plan.
Source: allenwestrepublic.com

SMART Act Amends Medicare Secondary Payer Statute, Creates Three

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

Democrats Heart Medicare Fraudsters

Posted by:  :  Category: Medicare

20090418jb_EFCAcanvassingPA_30 by SEIU International1. Bookmark us now! Enter Ctrl D to save our URL to your bookmarks 2. Don’t miss an article! Use the RSS feed above or the Email below to stay informed! 3.We look Best with a minimum Screen resolution of 1024×768 and Firefox Browser. It’s Free and Safer than Internet Explorer! Upgrade Now! 4.Below are our Archives and other News and Blog Feeds for your viewing pleasure. Also our Blog Rolls, etc., of other worthwhile contributors to Fair and Balanced News and Commentaries that you won’t find in the Leftist Media that dominates the TV, Radio and Newspapers. Stay Honestly Informed!
Source: wordpress.com

Video: State Takeover of Harrisburg, Medicare/Medicaid Funding [Pennsylvania Newsmakers]

Medicare Takes Center Stage In Close Pennsylvania Races

The campaign jockeying over Medicare comes at a time when the program represents a huge fiscal challenge to both parties. With almost 50 million beneficiaries — and growing at the rate of 10,000 baby boomers every day — the entitlement program is one of the fastest-growing portions of the federal budget. Both parties acknowledge the need to curb its growth; both have also used the issue for political gain, casting themselves as the program’s protectors against what they portray as rivals’ threats.
Source: kaiserhealthnews.org

Ryan Takes to Pennsylvania to Push Medicare Message

Mr. Ryan was extrapolating from a 2010 report from Medicare’s Office of the Actuary. It analyzed the potential impact of lower premium supports paid to private companies that issue Medicare Advantage plans, popular alternatives to traditional Medicare with extra benefits such as gym memberships. To slow the growth of Medicare spending, the Affordable Care Act reduces support for the private plans, which Democrats consider inefficient. Beneficiaries would still be covered under traditional Medicare.
Source: nytimes.com

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

Pa. Home Health Care Providers Worried About Medicare Cuts

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