Research Finds Link Between Poor Health And Seniors Switching Out Of Private Medicare Plans

Posted by:  :  Category: Medicare

Romney Ryan Plan for Student Loans by DonkeyHoteyA study released Thursday, by Gerald Riley, a researcher at the Centers for Medicare & Medicaid Services (CMS), adds to those concerns. The study looked at more than 240,000 people who dropped out of Medicare Advantage plans in 2007, and compared them with beneficiaries who remained in traditional Medicare the entire time. In the six months after leaving the private plans, the former Medicare Advantage patients used an average of $1,021 in medical services each month, while the patients in the control group cost Medicare $710 a month, the study found.
Source: kaiserhealthnews.org

Video: How to Understand Medicare Plans

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

Duluth billboard hits Cravaack on GOP Medicare plan

“Congressman [Chip] Cravaack owes Minnesota’s seniors a straight [answer] on where he stands on this misguided privatization scheme for Medicare that will leave them paying more and more out of pocket for their care. If he does support it, he must explain why he is seeking to dismantle Medicare as we know it and slash benefits for seniors at the same time he is protecting billions of dollars in needless subsidies for the oil industry. If he doesn’t support privatizing Medicare, is he doing everything in his power to discourage his Republican Party bosses from pursuing it?”
Source: minnpost.com

Administration Cuts Medicare Plans; Stock Prices Plunge

American 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

Daily Kos: A Medicare voucher by any other name, still a bad deal for seniors

Proposals floating around Congress these days call for privatizing Medicare via vouchers, but they don’t use the term. In general, the proposals would encourage insurance companies to bid against each other, to produce the lowest-cost policies in the private market. Customers would receive a sum of money—aka a voucher— to help defray the cost. Tennessee Sen. Bob Corker introduced his “Dollar for Dollar Act,” and a good chunk of it deals with what he calls structurally transforming Medicare by “keeping fee-for-service Medicare in place, competing side-by-side with private options that seniors can choose instead. Utah Sen. Orin Hatch used the term “competitive bidding” and said allowing health plans “to compete with traditional fee-for-service Medicare” would reduce costs and preserve the quality of care. The plans would allow people to choose between these voucherized plans and traditional Medicare, preserving the notion of choice. Foes of our social insurance programs have gotten savvy enough to realize that they can’t privatize Medicare in one fell swoop, as Ryan’s original budget (back before “vouchers” were a dirty word) envisioned. So in the next iteration, they employed the idea of “choice,” of competition with traditional Medicare. That allows them to chip away at it, pulling away younger, healthier patients who might be able to get good private insurance deals and leaving the older, sicker, more expensive patients in traditional Medicare to sap the program more quickly and make killing it off entirely that much easier.
Source: dailykos.com

Uwe E. Reinhardt: The Complexities of Comparing Medicare Choices

Each private plan would have had to offer a benefit package that covered at least the actuarial equivalent of the benefit package provided by the traditional fee-for-service Medicare. Medicare’s contribution (or “premium support”) to the full premium for any of these choices, including traditional Medicare, would have been equal to the “second-least-expensive approved plan or fee-for-service Medicare” in the beneficiary’s county, whichever was least expensive. That premium support payment would have been adjusted upward for the poor and the sick and downward for the wealthy.
Source: nytimes.com

Local Teacher Confused about Changes to TRS Medicare Plans » Toni Says

On page 31 of the 2013 Medicare & You handbook it  states that an inpatient hospital stay begins the day you’re formally admitted with a doctor’s order. You must have 3 full days past midnight stay “formally admitted” and doesn’t include the day you are discharged. So that makes 4 days.  I would determine the stay begins when the doctor has “formally” written the order not when you are in the ER waiting for a room.  Don’t confuse signing papers when you arrive at the hospital with being formally admitted. Your doctor has to do sign that order.
Source: tonisays.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

CMS Releases Proposed 2014 Payment Plan for Medicare Part D, Advantage

For the first time in Medicare Part D’s history, CMS would lower beneficiary’s deductibles and copays for covered prescription drugs as part of the agency’s proposed payment plan for 2014. Among other features of the proposed rule (pdf) are details regarding the health law’s 85 percent medical loss ratio requirement for Medicare Advantage and prescription drug plans. The proposed rule would also forbid plans from raising costs to members more than $30 per member per month, which is even more stringent than the previous cap of $36 per member per month. Another key element of the rule would be a new requirement on Part D pharmacies to require a beneficiary’s consent for each prescription drug delivery unless he or she personally requested the refill. That’s a move to help eliminate unwanted shipments to covered Medicare beneficiaries who could be billed for drug shipments they no longer required.
Source: beckershospitalreview.com

There Is A Plan to “Save” Medicare…But It’s Complicated

In the end, it isn’t just liberals and frightened senior citizens who oppose the across-the-board Medicare cuts that Rubio and his fellow austerity-obsessed friends are recommending. Health care stakeholders and policy experts in the public and private sectors know that it will require a lot of experimentation and patience to bring about systematic change. Prices for services need to come down and be more transparent to consumers. Better care coordination is necessary to prevent so many costly hospital readmissions. End-of-life planning needs to be a part of every Medicare patient’s treatment plan. We need more comparative effectiveness research and outcomes data to identify the most valuable care.
Source: reforminghealth.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

Ohio Health Policy Review: Ohio Medicare

Posted by:  :  Category: Medicare

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

Video: FOX NEWS: McConnell To Democrats Raise eligibility age for Medicare

What Raising the Medicare Eligibility Age Means

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

Ohio Gets Federal Approval for Dual

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

Medicare Eligibility Age Increase Rejected By Obama Allies

DURBIN: I do believe there should be means testing. and those of us with higher income in retirement should pay more. That could be part of the solution. But when you talk about raising the eligibility age, there’s one key question. what happens to the early retiree? What about that gap in coverage between workplace and Medicare? How will they be covered? I listened to Republicans say we can’t wait to repeal Obamacare, and the insurance exchanges. Well, where does a person turn if they are 65 years of age and the medicare eligibility age is 67? They have two years there where they may not have the best of health. They need accessible, affordable medical insurance during that period.
Source: firedoglake.com

Sequestration Set to Kick in, Cut Medicare by Billions

After two months of failed negotiations, the across-the-board spending cuts — better known as sequestration — will go into effect today pending a last-minute grand bargain, which many in Washington, D.C., do not expect. Yesterday, the U.S. Senate floated two proposals to avoid the sequester, but both flopped. Sen. Harry Reid (D-Nev.), the majority leader, proposed a deal that would have reduced the deficit through a 50-50 measure: 50 percent increased taxes, 50 percent spending cuts from defense and agricultural programs. Sen. Reid’s proposal, which lost on a 51-49 vote, would have exempted Medicare and Medicaid, according to an AHA News Now report. Sens. Jim Inhofe (R-Okla.) and Pat Toomey (R-Pa.) proposed a counter deal that would have required President Barack Obama to submit a “sequestration replacement plan” of $85 billion in spending cuts by March 15. Defense cuts would have been limited to $42.6 billion. The vote failed 62-38. Sequestration, which was postponed until today through the fiscal cliff bill at the end of last year, will cut $85 billion this fiscal year, which ends in October. According to a Congressional Budget Office (pdf) report released last month, Medicare will be reduced by 2 percent, resulting in $9.9 billion in cuts. Medicaid and Social Security are exempt from cuts. Hospitals, physicians and others were originally expected to see Medicare payment reductions of $11.1 billion, but the two-month delay from Congress lessened the impact slightly. Medicare reimbursement cuts to providers will not go into effect until April, “thereby delaying some of the effect on outlays until the following fiscal year,” according to the CBO report. Many hospital and health system executives have been preparing for the impacts of sequestration since the national deficit talks first began in the summer of 2011. Most hospitals will lose millions in Medicare reimbursements, with larger providers taking cuts up to eight figures. David Blom, president and CEO of OhioHealth, an 18-hospital system based in Columbus, Ohio, told Kaiser Health News his system expects to lose $12 million on $2.5 billion in revenue. “Let me say this about sequestration: I fully understand how the national debt reduction needs to be really high on our agenda,” Mr. Blom told KHN. “Sequestration is unfortunate, in my opinion, to be making across-the-board cuts without really redesigning the system or just reforming the system. Can we live with it? Yes. I think we’re able to live with it because we’ve anticipated it for some time. What I’m concerned about is even this sequestration won’t be enough. So what is the next thing we’ll be living with to deal with this national debt situation?” Medicare will remain a high-priority issue for hospital executives this year and into 2014, where some say adept budgeting will become paramount. “We budget very conservatively when it comes to projected [Medicare] reimbursements,” Dan Moncher, CFO of Firelands Regional Medical Center in Sandusky, Ohio, said earlier this year. “We try to make sure our budget reflects the operating margin of a high-performing hospital — that’s our goal. But that means we have to take a good, hard look at costs, staffing levels that are appropriate and maintaining the highest quality of care with [appropriate] staffing levels.”
Source: beckershospitalreview.com

Brad DeLong : Aaron Carroll: Raising the Medicare Eligibility Age Is Really, Really, Really, Really Bad Policy

Washington would see $24 billion in Medicare savings. But it also would see a rise of about $9 billion in Medicaid spending and another $9 billion in subsidy spending, which would reduce the overall savings to about $5.7 billion. But all those 65- and 66-year-olds need insurance. Those who get it through their jobs would cost employers another $4.5 billion. Others would go to the exchanges. But, ironically, removing these people from the Medicare risk pool and adding them to the exchanges makes both groups less healthy, so everyone’s premiums would go up. This would cost all Americans another $2.5 billion. States have to cover a portion of the new Medicaid spending. That’s $700 million. Finally, there are the out-of-pocket costs to seniors, which may rise by $3.7 billion.
Source: typepad.com

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

Meteor Blades, skybluewater, SME in Seattle, bink, Renee, Angie in WA State, cslewis, Sylv, chuck utzman, Irfo, hester, slinkerwink, Gooserock, PeterHug, Andrew C White, eeff, willyr, TX Unmuzzled, Duncan Idaho, jancw, expatjourno, eyeswideopen, bronte17, cyberKosFan, Einsteinia, susakinovember, whenwego, pedrito, Nate Roberts, Eddie C, revsue, psnyder, figbash, 2laneIA, defluxion10, RebeccaG, grrr, lcrp, inclusiveheart, ybruti, lonespark, Wife of Bath, Sybil Liberty, Skennet Boch, drofx, radarlady, 3goldens, ichibon, irate, sc kitty, Alice Venturi, wallys son, Flint, dewtx, Dobber, Laurence Lewis, ratzo, bleeding blue, Sun Tzu, skyounkin, markdd, Ozzie, spunhard, xaxnar, Jim R, splashoil, Jim P, begone, Born in NOLA, velaski, Patriot Daily News Clearinghouse, vigilant meerkat, Kimball Cross, rl en france, martyc35, kestrel9000, DarkestHour, triv33, twigg, real world chick, el cid, sceptical observer, Timothy J, Clive all hat no horse Rodeo, bstotts, ms badger, sea note, BentLiberal, ammasdarling, Tamar, One Pissed Off Liberal, phonegery, fabucat, Habitat Vic, tgypsy, puakev, beth meacham, dclawyer06, deepeco, jedennis, leonard145b, madgranny, trueblueliberal, JDWolverton, MKinTN, CroneWit, mconvente, TruthFreedomKindness, also mom of 5, HappyinNM, wayoutinthestix, zerone, prettyobvious, Involuntary Exile, elwior, treesrock, KJG52, jamess, Therapy, Lujane, tofumagoo, petulans, venger, Tonga 23, JamieG from Md, Nica24, Mike Taylor, maggiejean, prettygirlxoxoxo, Rhysling, cybrestrike, J M F, Throw The Bums Out, Scott Wooledge, Alex Budarin, maryabein, Zotz, mkor7, papahaha, kevinpdx, sfarkash, Lacy LaPlante, emptythreatsfarm, FogCityJohn, flitedocnm, Crabby Abbey, Progressive Pen, Polly Syllabic, sunny skies, ATFILLINOIS, melpomene1, gulfgal98, Lady Libertine, ItsSimpleSimon, Puddytat, Egalitare, sharonsz, addisnana, Betty Pinson, ericlewis0, cocinero, Oh Mary Oh, fiercefilms, stevenaxelrod, Onomastic, mama jo, Liberal Capitalist, Mr MadAsHell, BlueJessamine, OhioNatureMom, smiley7, marleycat, thomask, Wolf10, whaddaya, ratcityreprobate, stlsophos, Willa Rogers, Mentatmark, SouthernLiberalinMD, allergywoman, SycamoreRich, wolf advocate, Cordyc, anodnhajo, SparkyGump, cwsmoke, pistolSO, Siri, Citizenpower, IndieGuy, rustypatina, S F Hippie, effervescent, Trotskyrepublican, JGibson, congenitalefty, Mr Robert, BobSoperJr, geojumper, radical simplicity, MartyM, pittie70, Vote4Obamain2012, avsp, marty marty, dotdash2u, George3, wasatch, Marjmar, fauve, Sue B, simple serf, Illinois IRV, jbob, Linda1961, Panama Pete, goodpractice, The Hamlet, alice kleeman, Jollie Ollie Orange, marcr22, chicklet, pragmaticidealist, MBishop1, Catkin, Chas 981
Source: dailykos.com

Which Are the Best Ohio MAPD’s and Med Supp’s?

In speaking with our agents, the majority of what they wrote in 2013 was UnitedHealthcare. A number of agents said that they felt forced to move their Anthem business based upon some of the benefit changes that were made between 2012 and 2013. Again, this differs by geography. We saw much higher sales numbers for UnitedHealthcare in the Columbus/Dayton/Cincinnati markets than we did in NE Ohio. That may be based upon network agreements as opposed to benefits. One carrier to keep in mind in NE Ohio is Coventry. They just released MA products in that market in 2013, and they also have Cleveland Clinic and University Health in their network. For a first year plan, we saw decent sales numbers from them out of that market. At the end of the day, though, it all does come down to a county by county look.
Source: insurance-forums.net

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: COO Sharon Grambow talks about living at Sun Health Senior Living

Universal’s Comp Plan for 2010 in Ga.

This Compensation Schedule pertains to all Representatives of the FMO, for Enrollments effective for the period starting January 1, 2010 thru December 1, 2010, specifically for those individuals who become Medicare eligible during this period. Representatives understand that this document is for your information only and the actual terms and conditions for any Compensation or other duties is as more fully set forth in the FMO Agreement between UHC and the FMO. UHC agrees to compensate Representatives for Enrollments accepted by CMS as follows: 1. Commission Payments for Tier 1 Counties (see details at Schedule A herein). For each individual who is newly enrolled in one of the following UHC Medicare Advantage products: Medicare Masterpiece HMO, PPO, POS and SNP Plans, Universal HMO of Texas, and Any, Any, Any PFFS Plans, UHC will pay an Initial Rate of $403.00 in all states excluding Pennsylvania, which is $454.00, and a "Renewal Rate" of $202.00 in all states excluding Pennsylvania, which is $227.00 based upon applications accepted by CMS. Beginning in January, 2010, commission payments will be paid to the FMO as outlined in Section 3 herein. 2. Commission Payments for Tier 2 Counties (see details at Schedule A herein). For each individual who is newly enrolled in one of the following UHC Medicare Advantage products: Medicare Masterpiece HMO, PPO, POS and SNP Plans, Universal HMO of Texas, and Any, Any, Any PFFS Plans, UHC will pay an Initial Rate of $200.00 (all states) and a "Renewal Rate" of $100.00 (all states) based upon applications accepted by CMS. Beginning in January, 2010, commission payments will be paid to the FMO as outlined in Section 3 herein. 3. Payment Terms. Beginning January 8, 2010, commissions will be paid out twice a month. For those individuals who were newly entitled or enrolled from traditional Medicare, as determined by CMS, FMO will be paid at the Initial Rate. Compensation is earned in months four (4) through twelve (12) of the enrollment year as long as the member is active with the plan. If an enrollee leaves the plan prior to month four (4), no compensation is earned. If enrollee leaves the plan after month three (3), compensation is paid on a pro-rated basis for the months in which the enrollee actually was a member of the plan. 4. Renewal Payments for Tier 1 Counties. Representative will receive renewal compensation in the amount of $16.66 per member per month in all states excluding Pennsylvania, which is $18.91, for the five (5) year renewal period (year’s two through six) as long as the member remains enrolled in the plan or enrolled by FMO in a like replacement plan with UHC. Compensation is earned in months four (4) through twelve (12) of the enrollment year as long as the member is active with the plan. If an enrollee leaves the plan prior to month four (4), no compensation is earned. If enrollee leaves the plan after month three (3), compensation is paid on a pro-rated basis for the months in which the enrollee actually was a member of the plan. 5. Renewal Payments for Tier 2 Counties. Representative will receive renewal compensation in the amount of $8.33 per member per month in all states for the five (5) year renewal period (year’s two through six) as long as the member remains enrolled in the plan or enrolled by FMO in a like replacement plan with UHC. Compensation is earned in months four (4) through twelve (12) of the enrollment year as long as the member is active with the plan. If an enrollee leaves the plan prior to month four (4), no compensation is earned. If enrollee leaves the plan after month three (3), compensation is paid on a pro-rated basis for the months in which the enrollee actually was a member of the plan.
Source: insurance-forums.net

Michael Gerson Pens a Modern Masterpiece

In cliff negotiations, Obama had one overriding goal: to make Republicans vote for rate increases on the wealthy. For 20 years the refusal to raise taxes has been one of the core issues that held together the disparate groups of the GOP. If Obama saw his job as bringing together a broad coalition to fix the long-term debt problem, he would have maneuvered Democrats to take on some of their core issues as part of a package, just as Republicans had to do. But Obama did not view his job this way. He wanted Republicans to swallow their humiliation pure.
Source: motherjones.com

What Information Does The Medicare Website Provide?

The Medicare website is also useful resource in locating state organized sections of the Medicare program. Medicare is not the same in every state; however they are represented by many regional firms. This requires phone numbers and access, which Medicare provides as well as how often they do it. In this case from 7am to 7pm, Monday through Friday. There is also an automated 24 hour system in two languages, English and Spanish. Even when telephone help isn’t concerned, there is also an incredible amount of PDF’s to consult online.
Source: seniorcorps.org

Daily Kos: Mitt’s morphing Medicare lie

The diary says that it is a Romney “lie”  that doctors are turning away medicare patients.   You say its been going on for years.  I actually agree with you  and have experienced what Romney is claiming with my own aging family members.   It has been getting harder to get doctors you want under medicare  and frankly  its hard to see how the problem would not increase under the Obamacare scenario.  Medicare is in the process of being slammed  by the baby boom generation right at the time Obama wants to cut payments.   It really doesn’t matter whether you parse the definition of who gets cut-  doctors need hospitals for many procedures so cutting hospital payments  can affect doctors in an indirect manner.  As seniorhood approaches for  me and my wife, alarm bells go off when a program  for the elderly we paid into for years expecting decent services after retirement looks like it could be diminished by transferring funds to a new program for healthier younger people.     Senior or soon to be senior voters need to consider this carefully  and Obama supporters need to present better arguments than “Romney is a lying liar”.
Source: dailykos.com

DownWithTyranny!: Both Sides Now

With the political demise of the Blue Dogs, the New Dems are the corporate cat’s paw inside the House Democratic Caucus. And they are, conveniently and opportunistically, the ultimate “blame both sides” band of sell-outs, creeps who use working class voters to help them move corporate agendas. Yesterday their p.r. person got them a lovely and nicely transcribed spread in one of the DC trade rags. It’s all about how the New Dems Coalition has “high hopes that it will seize the political power that’s largely eluded the group.” The Hill misses the whole point when it describes them as “an odd band featuring lawmakers from both the conservative Blue Dog Coalition and the liberal Congressional Progressive Caucus.” I know they’re not going to use a more accurate term like “corporate shills” or “Big Business whores” but lets be a little more accurate in describing who they really are– essentially an odd band of economic conservatives, some of whom are also social conservatives and some of whom aren’t. There are only two members of the Progressive Caucus among the New Dems, Jared Polis and Jim Moran, who are primarily committed to a progressive social agenda. There are 6 outright Blue Dogs, one Blue Dog who just quit (Adam Schiff) because his new district is too progressive and a whole bunch who are Blue Dogs in all but name, like Bill Owens and Rick Larsen. According to the Progressive Punch crucial vote scores so far this year, New Dem leaders Ron Kind (37.50) and Allyson Schwartz (42.86) are clocking in with more conservative voting records than half a dozen Republicans.
Source: blogspot.com

Walking On Fire: The Rate And A Masterpiece

each Medicare RUG score. Our Director of Therapy and I work very well together to maximize our facility’s reimbursement rate – as our Medicare reimbursement rate testifies. The rate trend consistently continues upward. Second, yesterday one of our Corporate Support Specialists came to our daily stand-up meeting. She made a comment to all those present regarding the clinical care plans (like clinical action plans, sort of) I write (I also am the Care Plan Coordinator as well as the MDS Coordinator), calling one in particular “a masterpiece.” She requested that I print off a hardcopy of it for her. She also requested that I do a special in-service on the clinical issue the care plan addressed. I really appreciated her comment and public recognition on behalf of the corporation of my hard work and ability. I hope my approaching first yearly evaluation reflects these two good things that happened to me last week.
Source: blogspot.com

House Panel Examines Nuts & Bolts Of Changing Traditional Medicare

Posted by:  :  Category: Medicare

Senate Dems Protest Medicare Cuts by Talk Radio News ServiceMARY AGNES CAREY: I got a strong sense today that members on both sides of the aisle were trying to get what they could from the witness panel – that were all Medicare experts – about what would be some of the impacts if you tried to change the design of traditional Medicare. Again, this is Medicare fee-for-service, where 75 percent of the beneficiaries get their coverage. Kevin Brady, as you mention, the subcommittee chairman, he’s a big fan of the Medicare Advantage program. He thinks traditional fee-for-service [Medicare] could learn some lessons from Medicare Advantage. Not everyone necessarily agrees with that, but it was a real kind of a nuts-and-bolts session looking at the benefits or the consequences of changes to fee-for-service.
Source: kaiserhealthnews.org

Video: United Healthcare Oxford Medicare Advantage Denies Coverage

Senate Hearing on Modernization Efforts for Medicare and Medicaid

Medicare and policy experts discussed the basics of how Medicare works at an event hosted by the Alliance for Health Reform (AHR). The federal government currently devotes 15 percent of its budget to Medicare, which provides health care coverage to 50 million individuals ages 65 and over, and to younger people with permanent disabilities, according to AHR.
Source: c-span.org

Report: Medicare Funding Dangerous Nursing Homes

But one out of every three was placed in a home that failed to follow basic care requirements, resulting in dangerous and neglectful conditions. Investigators estimated the homes failed to address patients’ health problems in one out of five stays.
Source: cbn.com

After Supreme Court Decision and the effect on Expanding Medicaid

The Affordable Care Act required states to expand their Medicaid programs to cover more low-income people, including mid-life adults. However, a recent U.S. Supreme Court decision, while upholding the rest of the health reform law, effectively turned the mandate into a state option. This Insight on the Issues examines the Court’s decision and how uninsured midlife adults in states that take up this option can benefit.
Source: aarp.org

Medicare Advantage: Providing Quality Care to More than 14 Million Beneficiaries

Medicare Advantage plans are a valuable resource in protecting beneficiaries from unpredictable out-of-pocket costs. In 2012, all Medicare Advantage plans offered an out-of-pocket maximum limit for beneficiary costs, and about 78 percent of Medicare Advantage enrollees are in plans that have annual out-of-pocket maximums of $5,000 or less. These out-of-pocket maximums – which are not offered by the Medicare FFS program – help protect Medicare beneficiaries from catastrophic health care expenses that otherwise might pose a serious threat to their financial security.  Medicare Advantage plans also help reduce out-of-pocket costs for enrollees by reducing premiums for Part B and Part D, and by limiting cost-sharing for Medicare-covered services, including primary care physician visits and inpatient hospital stays.
Source: ahipcoverage.com

Minnesota scores big win with new Medicare language in health care bill

Today, Klobuchar said that senators on the Finance Committee from states that have lower quality care “seemed to be coming around.” “They realize they need our support to get this done,” said Klobuchar. Language would link payments to quality, not volume Thus, the new language in the Senate Finance bill would finally connect Medicare reimbursements to quality, as opposed to volume. The measure gives the secretary of Health and Human Services, working with the Centers for Medicare and Medicaid Services, the power to develop quality measurements and a payment structure that would be based on quality of care relative to the cost of care. The secretary would have to account for variables that include geographic variations, demographic characteristics of a region, and the baseline health status of a given provider’s Medicare beneficiaries. The secretary would also be required to account for special conditions of providers in rural and underserved communities. Additionally, the quality assessments would be done on a group-practice level, as opposed to a statewide level. Thus, the amendment would reward physicians who deliver quality health care even if they are in a relatively low quality region. The secretary of Health and Human Services would begin to implement the new payment structure in 2015. By 2017, all physician payments would need to be based on quality. “The change included today will help control costs and get the most from our health care dollars. This will strengthen the strong safety net of Medicare by ensuring funds are there to pay for our seniors’ health care,” Klobuchar said in a statement. The Mayo Clinic applauded the measure. “It’s great,” said Bruce Kelly, director of government relations for the Mayo Clinic, adding: “It is starting to move Medicare in the direction of incorporating value into how they pay.” Mayo also has supported the agreement that the House reached earlier this summer on Medicare payment reform. Senate, House versions differ Under the House agreement, the Institute of Medicine would have the responsibility of conducting two studies, one on geographic variations in payments and the other on how to reflect quality of care through reimbursements. Based on the study results, the secretary of Health and Human Services would have to implement a new payment rate and submit the plan to Congress, which then would have the opportunity to veto the new payment model. On Tuesday, Kelly said he did not favor one proposal over the other. “At this point, I would say it is premature for us to pick sides,” said Kelly, adding, “The fact that both bills have this concept in there is a great success.” In the Senate, however, proponents of payment reform have said that the language included in the Finance Committee bill is stronger than the House proposal. “We would say no study, no delay,” Klobuchar said. “It would not give veto power to Congress later on and it would be a straight rewarding of cost efficiency as opposed to putting in some money for the inefficient states.” Though the measure made it over a major hurdle today when Baucus decided to include the language, there is still the likelihood that details will change. The bill that is ultimately passed out of the Finance Committee will need to be merged with the bill that the Health Committee passed. Then, the resulting legislation will need to be passed by the Senate. Likewise, the health care bills on the House side also need to be merged and passed. At the end of all of that, the bills will go to conference committee to reach final agreement. And, at each stage, changes to the measure could be made. Cynthia Dizikes covers Minnesota’s congressional delegation and reports on issues and developments in Washington, D.C. She can be reached at cdizikes[at]minnpost[dot]com.
Source: minnpost.com

Lawmakers Might Have Time To Avert Medicare Payment Cuts

The mandated cuts involve nearly $1 trillion in across-the-board reductions, including a 2% reduction to Medicare reimbursement rates. In January, President Obama signed legislation — negotiated by Vice President Biden and Senate Minority Leader Mitch McConnell (R-Ky.) — that delayed the cuts until March 1 (California Healthline, 2/26).
Source: californiahealthline.org

Medicare Part A Deductibles & Benefit Periods

Posted by:  :  Category: Medicare

Wall Street by elycefelizThere is some cost sharing with Medicare Part A, which includes deductibles. Medicare Part A deductibles are different from a typical deductible in health insurance for people under 65.  You pay a deductible for each “benefit period,” rather than for the calendar year. A benefit period starts the day you go into a hospital or skilled nursing facility. It ends when you have been out of the facility for 60 consecutive days.
Source: medicareecompare.com

Video: Jed Weissberg, MD, Talks About Medicare Advantage Health Plans and the Special Enrollment Period

Understanding Medicare Benefit Periods

Under Part A the patient must pay a deductible for every "hospital benefit period." Unlike most health insurance, where deductibles must be satisfied once every year, usually between January and December, there can be several Medicare hospital benefit periods in a calendar year. In 2010 the Part A deductible per benefit period is $1,100. A benefit period begins on the day a patient enters the hospital and ends after there has not been any hospital or skilled nursing care for 60 days. If the patient is discharged from the hospital or a skilled nursing facility and returns to either within 60 days of discharge, it is considered to be the same benefit period and there is no need to pay another deductible. However, if the patient remains out of skilled medical care (either hospital or skilled nursing facility) for more than 60 days and then goes back to the hospital, a new benefit period begins and another Part A deductible of $1,100 is required.
Source: texasagingnetwork.com

Improving Healthcare Costs Through Smarter Utilization of Hospice Care

There is also a common set of misconceptions about hospice that contributes to late referrals including the belief that once a patient forgoes curative treatment, they cannot return if their medical condition improves.  In fact, if a patient’s condition does improve, they can be discharged and return to their daily lives as well as curative treatment.  Another common misconception is the thought that hospice care is only limited to six months.  Under Medicare’s current policy, the initial benefit period is 90 days.  If the patient’s illness continues and it remains likely that the patient has a life expectancy of less than six months, the patient can be recertified for another 90 days.  After the second period, the patient can be recertified for an unlimited number of 60 day periods, as long as he or she remains eligible.
Source: healthworkscollective.com

What Options Do I Have After Exhausting My Medicare Benefits?

Medicare only provides a certain number of hospitalization days for a person’s life time. It also places yearly limits on what a person can receive for certain services. For some people, there is no limit to what a person can receive in a year or a lifetime. When a person exceeds the amount of services that Medicare provides, the options available to him depend on the situation. In some cases, he can use a Medigap plan to extend the services covered. In some cases, he may want to wait until he receives a new benefit period. People who require long time nursing care may be forced onto the Medicaid program.
Source: seniorcorps.org

Medicare Explained: The Skilled Benefit Period

As an example, my father, who did get his qualifying hospital stay at Christmas time, was placed in a skilled nursing facility for rehabilitation.  He received Physical Therapy, Occupational Therapy and Speech Therapy for about 6 weeks.  At that point, though he had not used 100 days of his benefit period, he no longer was receiving services that qualified him under Medicare.  My mother was notified by the facility before the Medicare benefits ended.  He continues to stay in this facility as a resident but now pays privately for his care.  Due to the nature of his needs, he will also qualify to access his long-term care benefits after reaching the 100 day exclusion period.
Source: wordpress.com

Three Midnight Rule For Medicare SNF Explained: How To Get CMS To Pay for a Nursing Home Stay.

Medicare will pay a portion of these SNF costs (the rest of which are picked up by patient’s supplemental policies) for a up to 100 days for every benefit period.   Once these days are used up,  the patient will be financially responsible for any other skilled nursing benefits until the next benefit period begins.  How does Medicare define a benefit period?   A benefit period ends when you have not been in a hospital or in a  SNF for 60 consecutive days.  Once a new benefit period begins you will need another three midnight stay to qualify for additional SNF days (up to 100 days every benefit period).  If Medicare won’t pay for additional days, neither will the supplemental policy as these policies will usually only cover the portion of approved days that Medicare doesn’t cover. Most patients who use up 100 days of SNF benefits would never go another 60 days in a row without being admitted to the hospital.  They use up their 100 days for a reason. They cannot avoid living at home without avoiding frequent hospital level care.  Clinically, what I see is that most patients who have used up their 100 days in a benefit period will are palliative care candidates or require long term care in a nursing home.
Source: blogspot.com

Trolling for Insurance Prospects on Twitter

Selling health insurance on Twitter?’  Yes indeed. Not long ago a simple tweet about a blog called Medicare Made Clear alerted me to this new way to find sales prospects for Medicare Advantage Plans and Medigap policies ‘ just in time for the annual open enrollment that begins Oct 15. As someone who has spent a lot of time trying to simplify Medicare for the public, naturally, I was interested to see how the competition might be doing it ‘ perhaps even learning a few new tricks for breaking down the complexities of Part B and the allowable charge. I followed the Twitter link to Medicare Made Clear’s blog where I found several posts that looked interesting. ‘ Here’s a sample: ‘How to Evaluate Medicare Plan Costs,’ ‘Out-of-Pocket Medicare Costs: What’s the Limit?’, ‘What is a Medicare Medical Savings Account Plan?”  There were even posts called ‘Medicare Memos.”  Why for some time I have written Medicare Beat Memos for the Columbia Journalism Review website. ‘ There wasn’t much I could learn from that approach.’  I kept reading. At the end there was a picture of a smiling young woman next to this message: ‘Questions? To learn more about Medicare Made Clear, contact us at 1-877-619-5582.”  That sounded like 1-800-Medicare, the government’s toll-free help line, which beneficiaries can call with their questions. Would some readers think they were calling Medicare? At the very end of the blog site in teensy, weensy type was the revelation that this information came from United HealthCare, the largest seller of products to cover gaps in Medicare benefits. By this time I was suspecting I would find an insurance salesperson on the phone, so I called the number to see what they were selling.’  Sure enough, a sales agent said ‘Hello.”  ‘I’m a trained licensed agent,’ she added, and I asked ‘You sell insurance?’ The agent said she sold Medicare plans and that ‘The Centers for Medicare and Medicaid Services has given us permission to sell the plans.’ Okay. The government does sign off on Medicare Advantage plans. But how many readers would make it to the very bottom of Medicare Made Clear’s website to find out an insurance company is behind it? Would they call the toll-free number and hear a pitch even if they hadn’t planned on listening to one?’  Would they get hooked into a sale? Those are reasonable consumer questions, and they show how the boundaries between commercial information to generate sales and Medicare information from legitimate news organizations are blurring fast, especially given the ‘shorthand’ of 140 character limits and such of social media. I further examined the Medicare Made Clear site and concluded that some of the information, such as the description of what is a benefit period under Part A (the hospital coverage) or Medicare worksheets, was like the stuff I would have produced at Consumer Reports.’  But the site certainly was not Consumer Reports. It had more of the feel of those sites promoted by drug companies and disease groups that receive funding from Big Pharma.’  Their purpose: to build excitement and interest in whatever cure they are pushing. United Healthcare may be doing the very same thing ‘ ginning up excitement for their Medigap policies. The similarities between insurance company and drug marketing were striking when I clicked a button directing me to sign up for United’s ‘Medicare Made Clear Newsletter’ which promised I could ‘keep current with news and information from Medicare Made Clear.’ Of course, signing up would do more than that. It would give the insurer my contact details, including zip code, for its great database of future customers. In the insurance biz, that’s called lead generation, and getting sales leads this way is a snap. I recalled a similar newsletter a few years ago from a disease awareness group that was really promoting drugs for restless legs syndrome. It seemed like United may have borrowed other marketing tactics from drug and device makers. United Healthcare offered a Medicare quiz to help sales prospects see where they might need more information. An online offering by a for-profit company called Talk about Sleep with ties to medical device makers offers a “sleep self assessment quiz” to help people, perhaps leading them to think they may need sleep medications. This kind of marketing works; and United Healthcare shows it is spreading elsewhere in the growing health care marketplace. In the world of social media, it’s ‘buyer beware’ more than ever.
Source: cfah.org

PRESS RELEASE: South Carolina Ambulance Company, Williston Rescue Squad Inc. to Pay U.S $800,000 to Resolve False Claims Allegations

Posted by:  :  Category: Medicare

The Pfelons of Pfizer: Too Crooked to Fail and Don't Go to Jail (g1a2d0052c1) by watchingfrogsboilThe fellow that can only see a week ahead is always the popular fellow, for he is looking with the crowd. But the one that can see years ahead, he has a telescope but he can’t make anybody believe that he has it. ~~~~Will Rogers __The woman who follows the crowd will usually go no further than the crowd. The woman who walks alone is likely to find herself in places no one has ever been before.~ Albert Einstein _________________________________________I’m a Citizen that takes Politics seriously. I Research and try to Blog or Post things you don’t normally hear. Do we want Politics involving Smoke and Mirrors or the Truth? fredericacade@gmail.com_______________________________________________ ~”I never work better than when I am inspired by anger; for when I am angry, I can write, pray, and preach well, for then my whole temperament is quickened, my understandingsharpen​ed, and all mundane vexations and temptations depart.” ~Dr. Martin Luther King Jr. _________________________________________________________________________________________ ~”The bosom of America is open to receive not only the Opulent and respectable Stranger, but the oppressed and persecuted of all Nations and Religions; whom we shall welcome to a participation of all our rights and privileges, if by decency and propriety of conduct they appear to merit the enjoyment”.~___________________________________ George Washington, Address to the Members of the Volunteer Association of Ireland, December 2, 1783
Source: wordpress.com

Video: Three SC Quotes Make Yale’s Top 10 List

Lifeline Direct Insurance Introduces South Carolina Medicare Supplement Insurance

Lifeline Direct Insurance Services provides clients transparency in their insurance options by finding the appropriate insurance plan for their specific situation at the most competitive prices on the market. Lifeline Direct released a post this week titled South Carolina Medicare Supplement Insurance. When acquiring a South Carolina Medicare supplement insurance policy, you could be wondering how much coverage you really want. The best way to understand the amount of South Carolina Medicare supplement insurance you will require is to usually work out how much you have to pay monthly on your medical bills. Take a close look at your funds and see what kind of money goes toward hospital bills on a monthly basis that your particular Medicare wont cover, stated by Matthew Loughran, from Lifeline Direct Insurance Services. To get an instant Medicare supplement insurance quote visit http://www.lifelinedirectinsurance.com/medicare-supplement-insuranceAbout Lifeline Direct Insurance Direct Insurance Services was founded to assist clients in finding the right life insurance plan for their specific situation at the most competitive prices on the market. Lifeline Direct Insurance remains diligent in their goal to deconstruct and speed up the process of acquiring insurance for their clients. To obtain more information please contact Lifeline Direct Insurance Services at 877-805-9624 or http://www.lifelinedirectinsurance.com
Source: jcpenneygiftcarda.com

Medicare Targets Health Plans With Low Ratings

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

Travel for Seniors: South Carolina

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

How to effectively manage Medicare enrollments

Posted by:  :  Category: Medicare

Jessica Sundheim by On BeingPlans should reconcile all payments types for Part C and/or Part D to ensure compliance with CMS procedures and determine if they may have been underpaid. In developing the wherewithal to reconcile payments, plans can opt for one of two approaches: internal IT infrastructure and processing or contracted services from an external vendor. The current trend is toward contracted services for reasons, such as operating efficiency and return on investment.
Source: modernmedicine.com

Video: eHealth Technology: Broker Exchange Software as a Service platform

Application of Medicare Contribution Tax of 3.8% to Certain U.S. Persons Owning Stock in A Controlled Foreign Corporation or Passive Foreign Investment Company : Federal Taxation Developments Blog

As mentioned, a U.S. shareholder of a CFC is required to include certain amounts in income, i.e., Subpart F income to the extent of earnings and profits, under Section 951(a). The Preamble to the Section 1411 proposed regulations states that constructive or pass through income includible under Section 951 will generally not be treated as dividends in computing NII as dividend income unless expressly provided for in the Code. Still NII treatment will result to the extent the Subpart F income is derived from a trade or business to which the tax applies as provided in Section 1411(c)(1)(A)(ii)(trading trading in financial instruments or commodities) and Prop. Treas. Reg. § 1.1411-4(a)(1)(ii)). As to PFICs, a U.S. person is required to income in income amounts described under Section 193 if the taxpayer makes a QEF election under Section 1295.. Section 1293 inclusions also are not treated as dividends unless expressly provided for in the Code, and, therefore, also are not taken into account for purposes of calculating net investment income (unless the amount is derived from a trade or business to which the tax applies as provided in Section 1411(c)(1)(A)(ii) and Prop. Treas. Reg. §1.1411-4(a)(1)(ii)).  This difference in timing for reporting income for chapter 1 (regular income tax) and chapter 2A (Section 1411), as well as other overlapping provisions, will require a taxpayer to compute separate stock basis for chapter 1 and chapter 2A, subject to making an election under Prop. Reg. §1.1411-10(g) which seems to only be available after 2013 although the Preamble to the regulations when read with the proposed regulations is not entirely clear on this point, i.e., whether such election can be made for a taxable year beginning in 2013.
Source: foxrothschild.com

10 Things to Know When Applying for Individual Health Insurance

Help may be available if you are turned down for individual coverage due to a medical or pre-existing condition, or find the policy is approved, but the premiums are too high. The state risk pool, HIPAA plans, Medicaid, the Children’s Health insurance Program (CHIP) and Medicare may be resources.
Source: typepad.com

Missouri DIFP: Enrollment in the federal health insurance pool ends March 2

The Centers for Medicare and Medicaid Services announced last week that enrollment in MHIP’s federal pool will end on March 2. Any applications received after this date will not be processed for the federal pool, but MHIP will continue to accept applications for enrollment in the state pool.
Source: mohealthalliance.org

State Innovation Models Initiative: Model Pre

New York submitted a Pre-Testing Assistance Award request also to support activities related to organizing collaboration with statewide and regional stakeholders; quantifying and describing the current health care environment in New York; and completing legal, regulatory and policy and cost analyses relating to implementation of new payment and service delivery models.  The state plans to convene a series of stakeholder meetings in various regions across the state including meetings in: Buffalo, Rochester, Syracuse, New York city and Albany.  Working with a consultant, the state will also collect and analyze health care pattern utilization data for public and private payers; conduct business process and systems analyses; and develop quality improvement systems, performance standards and related metrics.  The proposal meets the requirements set forth in the Funding Opportunity Announcement and the Centers for Medicare & Medicaid Services recommends this applicant for a Pre-Testing Assistance Award.
Source: coloradomedicalhome.org

CMS Announces Medicare Advantage and Prescription Drug Program MLR Proposed Rule

Unlike the commercial MLR statutory requirement, the Medicare MLR statutory provision does not include language regarding expenditures on quality improvement activities. Nevertheless, the proposed rule provides that MAOs and Part D sponsors may include certain quality improvement expenses in the numerator of the MLR. Like the commercial MLR rules, the proposed rule would permit MAOs and Part D sponsors to count a non-claims expense as a quality improvement activity if it is designed to improve health outcomes, prevent readmissions to hospitals, improve patient safety, promote health and wellness, or enhance the use of health care information technology. In addition to fitting within one of those broad categories, the activity must be designed to meet all of the following criteria: (1) improve health quality; (2) increase likelihood of desired health outcomes in ways that are capable of objective measurement and producing verifiable results; (3) target individual enrollees or specified segments of enrollees or provide benefits beyond the population of enrollees without increasing costs to enrollees; and (4) be grounded in evidence-based medicine. Quality improvement activities may satisfy more than one category, but may not be double-counted. Moreover, any shared quality improvement expenses must be apportioned among entities and lines of business or products.
Source: crowell.com

Mathematica Policy Research

Disability  Early Childhood  Education   Family Support     Health      International      Labor         Nutrition   
Source: mathematica-mpr.com

H.R. 6719, To promote and expand the application of telehealth under Medicare and other Federal health care programs, and for other purposes

Latest Major Action: 12/30/2012: Referred to House committee. Status: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Oversight and Government Reform, Armed Services, and Veterans’ Affairs, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Source: washingtonwatch.com

PAs: It’s Time to Consider Medicaid Enrollment

 Enhanced PCP Payments.  Coming soon, Medicaid will implement the Affordable Care Act’s PCP Payment Parity rule.  Under this program, eligible primary care providers, including PAs, can receive Medicare rates when providing certain primary care services to Medicaid patients.  While this detail has not yet been determined by NC Medicaid, it is foreseeable that PAs will need to register/attest for the enhanced rates by using their own Medicaid provider numbers, which will first require direct enrollment. You can read more about the status of PCP payment parity here.
Source: msochealth.com

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

Therapy Plateau No Longer Ends Coverage

Posted by:  :  Category: Medicare

Beneficiaries also often lose Medicare coverage for outpatient therapy because they hit the payment limit. But under the exceptions process Congress continued for another year, the health care provider can put an additional code on the claim that indicates further treatment above the $1,900 limit is medically necessary. When treatment costs reach $3,700, the provider can submit medical documentation to support a request for another exception to cover 20 more sessions. (A Medicare fact sheet provides some additional details, but has not been updated for 2013.)
Source: nytimes.com

Video: United Healthcare Oxford Medicare Advantage Denies Coverage

Medicare’s Decision on Whether to Cover Amyloid Brain PET Scans

As a clinician, I see great benefits not only in being able to accurately inform my patients about the cause of their cognitive impairment, but also being able to tell a patient with MCI that he or she does not have amyloid in the brain—that is, not on the path towards Alzheimer’s dementia. In these cases, we would initiate other studies as part of the work up to evaluate the cause of the patient’s cognitive impairment. In fact, just one day prior to the Medicare advisory panel meeting, the Alzheimer’s Association and the Society for Nuclear Medicine published guidelines specifying in which patients amyloid scans would have the greatest impact on outcome.
Source: alz.org

Medicare cuts benefits to pay for Obamacare

The most common vitamin deficiency in the world is D3, and elevating our blood level through supplementation and testing can provide extra protection from a number of major diseases and conditions. Also, we are learning how to increase immunity by improving gut flora and decreasing our dependency on antibiotics. And new forms of vitamin C hold promise against a number of maladies. For more information along these lines, see http://www.howtostopcolds.com/resources .
Source: wordpress.com

Medicare Coverage Changes

I see wal mart is stepping in and filling the gap where insurance is leaving people hanging. It takes one company to step in and drive cost down. I sometimes don’t like how wal-mart operates to drive prices down but I give them credit on low cost diabetic supplies. The relion prime test strips are 9 dollars for 50. I have compared them against accu-check and other expensive test strips and the results were very accurate. I think other companies will have to bring cost down and get rid of those insane markups since Walmart now sees a way to bring testing cost down. Here is the link. http://www.walmart.com/ip/ReliOn-Prime-Blood-Glucose-Test-Strips-50…
Source: tudiabetes.org

Ask your Senators to support Medicare’s immunosuppressive drug coverage extension!

Sens. Durbin (D-IL) and Cochran (R-MS) introduced S. 323 on February 13, 2013, to extend Medicare coverage of immunosuppressive drugs for kidney transplant recipients.  Medicare covers dialysis for most Americans, regardless of their age, with no time limit. However, if they are under age 65 or are not Medicare-disabled (receiving Social Security Disability Income), their eligibility ends 36 months after receiving a transplant.  S. 323 eliminates the 36 month time limit to provide continued Medicare coverage for life-saving immunosuppressive medications. All other Medicare would end after three years for kidney recipients, as under current law.  Please contact your Senators and urge them to cosponsor S. 323 to help transplant recipients access the medications they need to maintain their new kidney.
Source: wordpress.com

Disease Management Care Blog: The Dilemma of Medicare Coverage of “Reasonable and Necessary” Care and Why It’s Important

If you get sick, health insurance should cover all the “stuff” necessary to make you better, right? While that sounds good in principle, Uncle Sam has made it a lot more complicated than that.  As we continue to struggle with health reform, this New England Journal article on “Medicare’s Enduring Struggle to Define Reasonable and Necessary Care” is very timely. According to Drs. Neumann and Chambers, Medicare has always covered medical services that are “reasonable and necessary.” As new approaches, drugs and medical technologies have been released, you’d think coverage would be based on an objective analysis of outcomes and cost effectiveness. You’d be wrong. Years of differing interpretations, patient advocacy, Congressional meddling, regulatory carve-outs and case law have generated a miasma of bureaucratic complexity that will guarantee the incomes of thousands of lawyers for years to come. Not that CMS hasn’t tried to be reasonable about “reasonable and necessary.” According to the article, in 1989 CMS specifically proposed that the words “cost effective” could be used to assess new technology. That proved too controversial. It later tried “least costly alternative language” for coverage of durable medical equipment and Part B medications.  This too was dismantled by the courts when plaintiffs argued that the term “reasonable and necessary” could only be applied to medical services, not to the costs of those services. How ironic. Even though CMS is making “value-based purchasing” judgements for hospital payments and costs can be factored in the coverage of preventive services, that still doesn’t apply to new technologies and drugs. The latest dysfunction is CMS’ pretzel logic of “coverage with evidence  development” approach to medical devices, essentially agreeing to coverage that is conditional on CMS’ evaluation of additional outcomes data.  Unfortunately, CMS’ ability to collect and interpret these kinds of data in the current political environment remains an open question. Outside of Medicare’s cost travails, why is all of this important? 1) Medicare’s price tag was $509 billion in 2010, taking 12% of the federal budget. While there are other drivers of cost, such as aging, coverage arrangements, income, pricing, administrative costs and defensive medicine, technology could account from 38% to more than 65% of the current growth (inflation) in spending.  Medicare’s historic inability to control this does not bode well for future cost projections. 2) This is not a partisan issue and there are no partisan solutions. 3) Commercial insurers generally use Medicare’s coverage criteria to define their own benefit structure.  Medicare’s problems are everyone else’s. 4) This is another reason why Medicare is banking on ACOs.  By delegating management and the associated risk of all these thorny coverage issues, they’re hoping ACOs can do within three years what CMS couldn’t do in three decades. We’ll see.
Source: blogspot.com

Future for New Braunfels Scooter Store Workers Unclear

The company has been the target of Medicare fraud investigations in the past. The U.S. Justice Department sued the company in 2005 for allegedly making false Medicare claims and defrauding the government. The company settled agreeing to pay the government $4 million and forgo $13 million in Medicare payments.
Source: news92fm.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

UHC Announces Changes to its Medicare Advantage Audits

Posted by:  :  Category: Medicare

UHC will no longer use MedAssurrant, the contractor that previously conducted its payment integrity audits. UHC will also make changes in the way that it conducts its Risk Adjustment Date Validation (RADV) audits. These audit request letters will be more clear about the reason for the audit and provide consistent information on follow-up medical record review, audit requests, and post-audit claim payment determinations. UHC will also update its payment integrity and recovery practices. Currently, UHC asks physicians to refund the full amount paid on the original claim and then resubmit the claim using the recommended coding. In the first quarter of 2012 physicians will only need to resubmit the claim with the recommended coding and refund only the difference between the amount UHC originally paid and the amount that should have been paid using the new coding. Physicians who disagree with UHC’s recommended coding should appeal the claims.
Source: wordpress.com

Video: Medicare Part C Defined: Medicare Advantage Plans — UHC TV

AARP Medicare Complete « Insurance News from Crowe & Associates

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

United Healthcare Medicare Advantage Changes Brand in 2012

No, the Secure Horizons Medicare Advantage plan is not going away, but the branding for Secure Horizons is.  The plan is to start by branding the Medicare Advantage plan as AARP Secure Horizons by United Healthcare so that anywhere you see the Secure Horizons brand you will also see by United Healthcare.  Starting in 2012 you will see AARP United Healthcare without the Secure Horizons.  This is because most seniors are familiar with the United Healthcare branding as they probably had or knew someone who had United Healthcare medical insurance at some time in the past.  The Secure Horizons branding was not familiar to most seniors, and was just causing confusion. See my post reviewing their plans:
Source: medicare-plans.net

United HealthCare Medicare Advantage Dental Coverage

The team here at Stateline Senior Services in Somers, CT 06071 has been getting a lot of questions recently in regards to dental coverage.    Usually, you can only add options to your medical plan when you sign up for the coverage.  For our clients that have United Healthcare Medicare Advantage, you are in luck-if you want to add dental.  They allow their existing members to add the dental coverage at anytime during the year.  You can call them today and the coverage would start on July first.  The coverage has a $1000 maximum benefit that all basic, major and restorative work would apply to.  The preventative care that you would have done does not go towards the maximum benefit.  That means you can still get your cleanings, exams and x-rays done every six months and not have that count towards that total maximum benefit.  You do have the option of staying in-network and having the preventative care covered 100%, or if you go out of  network, it will be covered at 100% of the allowable plan charge.  You could be charged the extra amount that the plan would not pay for.  You can have fillings, crowns and major restorative work done and it would all be covered at 50% of the cost.  This coverage is offered at $32.00 per month, per person.  You can call the customer service number on the back of your membership card to add this coverage at anytime if you would like. All of this information can also be found in you Summary of Benefits book that you received when you joined the plan.  If you should have any other questions or need additional information, you may always call our office.
Source: statelineseniorservices.net

Madame Defarge: Avoid Working w/ United HealthCare, Medicare Advantage Plan, unless you are an IN

Well, I’ve got nothing better to do than to organize a bunch of paperwork to send to United HealthCare Appeals Department which entails printing out all of the patients’ outpatient psychotherapy notes, creating a face page, sending a copy of it to the NC Insurance Commissioner as the client did not understand that a Medicare Advantage company can be an oxymoronic term.  Almost one-half year’s worth of weekly billing had been rejected x2 (it takes time to wind thru their system while I continue to honor my relationship w/ the client and see her) on the basis of:                           Error Code: 0979: Member Self Directed Out of Network So, for United Healthcare, if the Medicare provider is not ‘in network’ to that company, if the client picks that company as their Medicare Provider, you will not be paid.  The woman on the line at United HealthCare, as she tried to talk the client out of switching back to Medicare insisted, “You could have seen oe of the providers we have” to which the client stated, “But I’ve been seeing Dr. Hammond since my husband died”—–indicating that the administration of United Healthcare has no idea of the nature of outpatient therapy.  Hey: just switch over to that fella down the road.  Right. She called them the other day to switch back to regular Medicare—–where I recommend ALL my clients to stay.  I haven’t had any recent trouble w/ Humana but two years ago they insisted I send all of my patients’ session notes in order to pay me.  And by the way, that reminds me that the company that Humana had outsourced the outpatient mental health care only authorized until mid-year. Whoopee!  More paperwork to create for Humana.  WE NEED A ONE PAYER SYSTEM THAT IS CENTRALLY ADMINISTERED.
Source: blogspot.com

Outsource Marketing Solutions blog: UHC Single brand for Medicare Advantage

While most popular attention over Medicare this year has focused on new plans that cover prescription drugs, analysts view Medicare Advantage plans as critical profit opportunities for health insurance companies. Read on….
Source: typepad.com

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

Posted by:  :  Category: Medicare

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

Video: Introduction to Medicare – Strengths, Weaknesses, and Applications of Medicare Data

Patient Help Applications In Location of Medicare Element D###

Some of the huge pharmaceutical firms offer you an assistance system to those who can not afford the price of medication and have no insurance coverage or government assist. This is genuinely a blessing for these who get this assist. This is an option to medicare component d The process needs filling out forms, proving your income (or lack there of) and your physician signing the form and submitting a prescription. The approach can take several months for your medication to be authorized and shipped to you. You will also have to reapply periodically how often you must reapply depends on the policies of that medication organization. There is a group in Utah who specializes in filling out the paperwork for you for a little fee. Find Out If You Qualify Some PAPs demand these with a slightly more substantial revenue to make a co-payment for a portion of the expense of their drugs. Other individuals charge no co-payment to any individual. Every single drug firm is free to set their personal guidelines on whom and how significantly they will assist low-earnings and uninsured patients. This is equivalent to the medicare element d "Additional Assist reporting medicare fraud" system. Due to the fact it can take quite a bit of time to be authorized for these applications, what can be accomplished in the meantime to obtain affordable medication? If your physician occurs to have samples, you might be in a position to get some or all of the medication you need till your PAP medicines arrive. Nonetheless, this is not usually the case. If you locate yourself un-insured although awaiting approval of a PAP, you will need to uncover the really lowest prices accessible although making specific you are obtaining top rated-good quality drugs. The new medicare portion d government program can be helpful, but has month-to-month fees and an annual deductible. A Very good Option Canadian mail order sources are possibly a greater alternative. To make certain that you are dealing with a legal and trustworthy supply, pick a business that calls for confirmation of your prescription by your U.S. medical doctor as nicely as sign off by a Canadian medical doctor. Just be cautious though, any business that advertises "no prescription necessary" is operating illegally as properly as without having regular pharmacy ethics. Most of these businesses have been shut down, but beware if you locate a company offering this type of service. Hopefully, you can get aid via PAPs if you need to have this assistance. However, several folks are turned down every year. To help you even though you are applying, search for and assessment Canadian mail order prescription services to locate the very best costs available. To locate the Utah group talked about above go here and click on the correct hand link that says "Free Prescriptions (Fee For Service)" Submitted by Darwin Corby Professional Services Canada 1-800-946-4820 Specializing in Canadian Pharmacy Services
Source: blogigo.com

CMS prepares to take exchange applications

A typical small business might need an average of about 13 minutes to submit a paper application for the Small Business Health Options Program (SHOP) exchanges, and an employee at a small business that uses a SHOP exchange might need an average of about 9.5 minutes to submit an employee SHOP application, officials said.
Source: lifehealthpro.com

State Innovation Models Initiative: Model Pre

New York submitted a Pre-Testing Assistance Award request also to support activities related to organizing collaboration with statewide and regional stakeholders; quantifying and describing the current health care environment in New York; and completing legal, regulatory and policy and cost analyses relating to implementation of new payment and service delivery models.  The state plans to convene a series of stakeholder meetings in various regions across the state including meetings in: Buffalo, Rochester, Syracuse, New York city and Albany.  Working with a consultant, the state will also collect and analyze health care pattern utilization data for public and private payers; conduct business process and systems analyses; and develop quality improvement systems, performance standards and related metrics.  The proposal meets the requirements set forth in the Funding Opportunity Announcement and the Centers for Medicare & Medicaid Services recommends this applicant for a Pre-Testing Assistance Award.
Source: coloradomedicalhome.org

STATE INNOVATION MODELS INITIATIVE (CMS

This video features three presentations focusing on SAMHSA’s Recovery Support Strategic Initiative, the Co-Occurring Mental Health and Substance Abuse Disorders Knowledge Synthesis, Product Development & Technical Assistance (CODI) contract, and finally concludes with a presentation on the alignment of PATH data with the US Housing and Urban Development’s Homeless Management Information System (HMIS). A. Kathryn Power, M.Ed. is the Director of the Center for Mental Health Services (CMHS), Substance Abuse and Mental Health Services Administration (SAMHSA), an operating division of the US Department of Health and Human Services (DHHS). CMHS provides national leadership in mental health promotion, mental illness prevention, and the development and dissemination of effective mental health services. Director Power leads a staff of professionals in facilitating the transformation of our nation’s mental health care system into one that is recovery-oriented and consumer-centered, and serves as the lead for the Recovery Support Initiative. (visit this PATH Resource to find out more about SAMHSA’s Eight Strategic Initiatives: pathprogram.samhsa.gov Next, Deborah Stone, Ph.D., Social Science Analyst, Center for Mental Health Services (CMHS), SAMHSA and Onaje Salim, LPC, MAC, CCS, Public Health Advisor, Center for Substance Abuse Treatment (CSAT), SAMHSA provide an overview of the CSAT/CMHS Co-Occurring Mental Health and Substance Abuse Disorders Knowledge Synthesis, Product …
Source: wn.com

Medicare to test new approach to ESRD care

The Centers for Medicare & Medicaid Services has announced an initiative designed to identify, test and evaluate new ways to improve care for Medicare beneficiaries with end-stage renal disease. Through the Comprehensive ESRD Care initiative, CMS will partner with healthcare providers and suppliers to test the effectiveness of a new payment and service delivery model in providing these beneficiaries with patient-centered, high-quality care. “This initiative puts Medicare beneficiaries living with end-stage renal disease at the center of their care,” CMS Acting Administrator Marilyn Tavenner, RN, BSN, MHA, said in a news release. “Through enhanced care coordination, these beneficiaries will have a more patient-centered care experience, which will ultimately improve health outcomes.” In 2010, patients with ESRD constituted 1.3% of the Medicare population but accounted for an estimated 7.5% of Medicare spending, totaling over $20 billion. These high costs often are the result of underlying disease complications and multiple co-morbidities, such as coronary artery disease and hypertension, which can lead to high rates of hospital admission and readmissions and a mortality rate that is significantly higher than that of the general Medicare population. Through the Comprehensive ESRD Care Initiative, CMS will enter into agreements with ESRD Seamless Care Organizations, which are groups of healthcare providers and suppliers that will work together to provide beneficiaries with a more patient-centered, coordinated care experience. Participating organizations must include a dialysis facility, a nephrologist and one other Medicare provider or supplier, and must have at least 500 beneficiaries matched to their organization. Participating organizations will assume clinical and financial responsibility for a group of beneficiaries with ESRD, based on where these beneficiaries receive services. Beneficiaries will retain the right to see any Medicare provider they choose. The organizations will be evaluated based on their performance on quality measures, which fall under five broad categories: preventive health, chronic disease management, care coordination and patient safety, patient and caregiver experience, and patient quality of life. Organizations that are successful in improving beneficiary health outcomes and lowering the per capita cost of care for beneficiaries will have an opportunity to share in Medicare savings with CMS. This initiative was developed through consultation with advocates and beneficiaries living with ESRD, healthcare providers and nonprofit organizations, among others. Interested applicants must file non-binding letters of intent by March 15. Applications to participate in the model are due May 1. For more information, and to see the request for application, visit http://innovation.cms.gov/initiatives/comprehensive-ESRD-care. The initiative is being run through the CMS Innovation Center, which was created by the Affordable Care Act to test new models of delivering healthcare that may lower costs and improve patient care.
Source: nurse.com

CMS releases Medicare Shared Savings application

Following its announcement of the Oct. 20 final rule, the Centers for Medicare & Medicaid Services (CMS) yesterday released the 2012 application for its Medicare Shared Savings Program. Interested accountable care organizations (ACO) have the option for two start dates of April 1, 2012 and July 1, 2012. Before generally cheering for the final rule’s revisions, providers had blasted CMS for the short timeline in its proposed draft in the spring. Under the application guidelines, CMS now will accept applications for the two start dates. It will take applications from Dec. 1. to Jan. 20, 2012 for the April 1, 2012 start date and from March 1 to March 30, 2012 for the later July 1, 2012 start date, according to the CMS website.
Source: fiercehealthcare.com