Part D Formulary Medical Review Awarded to Strategic

Posted by:  :  Category: Medicare

319 | Tragedies of Medicine by The DoctrStrategic’s team of pharmacists and data analysts will work with CMS to monitor drug updates and evaluate Medicare Part D Plan formularies and benefits to ensure the Part D prescription drug program — offered through Medicare Advantage drug plans and stand-alone prescription drug plans — meets CMS formulary guidelines. These guidelines help to ensure that Medicare beneficiaries receive clinically appropriate medications at the lowest possible cost and that Part D plans do not have formularies that discriminate against beneficiaries.
Source: strategichs.com

Video: Medicare Part D Formulary

Medicare Part D and Dual Eligibles: Prescription Drug Formularies and Drugs Used by Dual Eligibles

Medicare drug plans may exclude drugs from formularies or may control drug use in an effort to contain costs, but they must meet certain criteria in doing so.  Each PDP and MA-PD drug formulary is reviewed by staff in the Centers for Medicare and Medicaid Services (CMS).  Generally, Part D plan formularies must cover at least two drugs in every theraputic class.  Under CMS rules, Part D formularies must also include all or substantially all drugs in six protected classes: immunosuppressant (for prophylaxis of organ transplant rejection), antidepressant, antipsychotic, anticonvulsant, antiretroviral, and antineoplastic drugs.
Source: piperreport.com

Medicare Part D Plans Expanding Five

A review of Part D plan design trends among the leading sponsors shows that Humana has switched to five-tier formularies, UnitedHealth is using a preferred pharmacy network and CVS Caremark is sponsoring plans that include community-based independents in its preferred network.
Source: elsevierbi.com

Medicare Information, Tips to Help You Choose the Right Medicare Plan

Navigating your Medicare prescription drug coverage options can be challenging, but with the right information, you can make the best decision based on your unique medical requirements and preferences. Every patient that is eligible for Medicare is also eligible for prescription drug coverage. There are several plans available, including Medicare Advantage and Medicare Part D plans, so it is imperative to understand your options before making a decision. It may also be helpful to talk to an expert in the field if you have questions or concerns about which plan is right for you. Here are a few tips to keep in mind while evaluating your options for Medicare prescription drug coverage:
Source: myowens.com

Q1Medicare.com Releases Updated Medicare Part D Prescription Drug Plan Formulary Browser

Q1Medicare.com has updated their Medicare Part D Formulary Browser with the latest prescription drug plan formulary data made available from the Centers for Medicare and Medicaid Services (CMS). Since January, the updated data includes the addition of over 70 medications and the deletion of 16 medications that impact all Medicare Part D prescription drug plans. The most recent released June formulary changes include the addition of 20 new medications. A detailed summary of the recent formulary changes impacting all Medicare Part D plans, along with corresponding links to specific formularies can be found within the Q1Medicare.com/Blog.In addition to the major additions and deletions to all Medicare Part D plans, most Medicare Part D plans have adjusted their drug lists with the addition of new medications, removal of medications, changes to drug cost-sharing tiers, and changes to specific drug usage management requirements. For example, since the beginning of 2012, over 250 formularies now include the newly introduced generic medication atorvastatin.To review a specific Medicare plans prescription coverage, Q1Medicare site users can access any stand-alone Medicare Part D prescription drug plan or Medicare Advantage plan formulary by using the Formulary Browser found at Q1Medicare.com/FormularyBrowser.The Q1Medicare.com Formulary Browser is designed so the Medicare community can quickly find a Medicare Part D plans drug list by just selecting the state or entering a ZIP Code, the name of the Medicare Part D plan carrier, and then selecting the name of the specific Medicare plan. Once a Medicare plan is selected, the user can then browse alphabetically for a specific medication. The Formulary Browser provides search results in a chart with the medication drug strengths and packaging; formulary drug tier details; preferred pharmacy and mail-order cost-sharing or co-payment amounts; and drug usage management restrictions. The formulary information also includes details about the Medicare prescription drug plans monthly premiums, initial deductible and whether the plan qualifies for the state-specific Low Income Subsidy $0 monthly premium.Pharmacists, prescribers, and healthcare professionals can also access Medicare prescription drug plan formularies by selecting the PlanID tab and search by plan Contract/Plan IDs or by selecting the FormularyID search tab and entering the plans unique eight-digit Formulary ID. As a convenience, both the Contract/Plan ID and the Formulary ID search results will return the geographical service area for the chosen Medicare plan along with the Medicare plans formulary details and the actual Medicare plan features.We developed our Formulary Browser so people could quickly see the details for the prescription drugs covered by a specific Medicare Part D plan, notes Dr. Susan Johnson, Technical Director and co-founder of Q1Group LLC. Aside from our recent drug data update, we have also enhanced our Formulary Browser by linking it with our Drug Finder so that with one click, users can see how all Medicare plans in the area cover a particular medication.The Q1Medicare Formulary Browser and Drug Finder are both available at no cost and designed for computer, smartphone and tablet platforms. The results of the Formulary Browser and Drug Finder are also formatted to be printed for offline use.About the Q1Medicare.com Website Q1Medicare.com is one of the largest independent online resources for Medicare Part D prescription drug plan and Medicare Advantage plan information. Q1Medicare offers a large selection of Frequently Asked Questions, online tools, and a free Medicare Part D Newsletter all designed to help Medicare beneficiaries, healthcare professionals, advocates, advisers, caregivers, and insurance agents better understand both the Medicare Part D prescription drug and Medicare Advantage programs. Q1Medicare.com is operated by Q1Group LLC (Saint Augustine, Florida).
Source: jcpenneygiftcarda.com

Medicare Part D, formularies, competition, pricing leverage and getting it all wrong

Medicare Part D has long presented a controversy because the law prevents direct negotiation by the government with drug companies for lower prices and rebates; something common in the private sector via pharmacy benefit managers (PBMs). Rather, each Part D provider must negotiate on its own, but with so many vendors offering Part D benefits their negotiating power is limited. In New Jersey for example there are eighteen different vendors offering Part D plans to 1,336,988 Medicare beneficiaries. That is an average of less than 74,277 individuals per vendor (some beneficiaries have private drug coverage through previous employers). How much more pricing leverage would there be if there were only three or four Part D insurers in NJ (or nationally)? In addition, these vendors are prevented from limiting their formulary drugs.
Source: quinnscommentary.com

Is There A Limit As To How Many Drugs A Medicare Plan Covers?

The United States Government mandates, by category, the number of drugs covered by each Medicare Plan. For example: If the mandated number for blood pressure medicines is 100, the insurance company must offer 100 different blood pressure medications. This formula applies for all drug categories. The company compiles a list of drugs offered, identified as a “Formulary.” Each insurance plan has its own Formulary. Formularies can, and do, change from year to year. Insured individuals are responsible for finding a plan with a Formulary that supplies the drugs needed.
Source: seniorcorps.org

Part D Formulary Is Key To Choosing The Right Plan

My dad had to move from Ky to GA so my sister and I could take care of him. Humana (his Part D) just terminted him for the month of Dec because he moved out of his service area. They mailed us a letter on 11/25/10(Thanksgiving) and it stated as of 11/30/10 he would no longer have Part D coverage. I spent almost all day last Friday talking to Humana and got no where. They did deduct his payment from his SS??? Any suggestions? Is there a plan that would cover him in GA and KY should he decide to move back and stay with my other sister???
Source: affordablemedicareplan.com

House of Light: Frequently Asked Questions About Hospice Care

Posted by:  :  Category: Medicare

1. How do we pay for hospice care? Hospice care is usually covered by your healthcare insurance. Individuals with Medicare can utilize the Medicare Hospice Benefit to cover the cost of care. The Hospice Benefit covers visits by the hospice care team as well as the cost of medical equipment and supplies and medications related to the hospice plan of care. Most private insurance plans will also pay for hospice care. To confirm, check with your insurance provider or with the hospice agency. 2. Will the Medicare Hospice Benefit pay for care in a facility? The Medicare Hospice Benefit will reimburse for hospice services that are provided in long-term care facilities, such as assisted living homes and skilled nursing facilities. However, the benefit does not cover expenses for room and board. Long-term care insurance can help shoulder the cost of room and board in a long-term care facility, or individuals can investigate options for long-term care assistance from their state Medicaid. 3. How long can a patient receive hospice care? A patient can continue receiving hospice care as long as the hospice physician continues to recertify the terminal illness. Patients receive two 90-day periods of care followed by an unlimited number of 60-day periods as long as the patient continues to meet Medicare criteria for eligibility. Hospice care is provided only to patients who have been certified by two doctors as terminally ill with a life expectancy of six months or less. 4. Can a hospice patient continue seeing his/her primary care physician? Some primary care providers or specialty physicians may choose to follow their patients’ care while the patient is on hospice. Others defer primary/attending physician care to the hospice physician. If the hospice physician serves as the attending physician, a patient may continue to see their PCP or specialist for care not related to the hospice diagnosis. 5. Will someone from the hospice be with the patient 24 hours a day? Hospice support is available 24 hours a day, but a hospice worker does not stay with the patient 24 hours a day. Hospice patients should have a primary caregiver, usually a loved one or a paid caregiver, and hospice workers will supplement the care and support the patient and the caregiver. The hospice can be contacted 24 hours a day, 7 days a week if you have questions or are in a crisis situation. If you have more questions about hospice services in the Pima County area, contact Casa de la Luz Hospice at 520-544-9890.
Source: houseoflightblog.com

Video: Health Insurance Information : About Hospice Medicare Benefits

Growing Pains for the Medicare Hospice Benefit

For 30 years, the Medicare hospice benefit has played a key role in shaping end-of-life care in the United States. Authorized by the Tax Equity and Fiscal Responsibility Act of 1982, the benefit was meant to improve the dying experience for terminally ill beneficiaries and to reduce the intensity and cost of health care services at the end of life. After a slow start, hospice became an integral part of Medicare, and nearly half of all people who die while covered by Medicare now use the benefit before death.
Source: globalhealthhub.org

Forced to Choose: Nursing Home vs. Hospice

The study, using data from the National Health and Retirement Study from 1994 through 2007, looked at more than 5,000 people who initially lived in the community – that is, not in a facility. About 30 percent used the skilled-nursing facility benefit during the final six months of life; those people were likely to be over 85 and family members said, after their deaths, that they had expected them to die soon. (The benefit is commonly referred to as S.N.F., which people in the field pronounce as “sniff”).
Source: nytimes.com

Is it time for another lawsuit? Advocating to change the Medicare Hospice Benefit eligibility requirements

I have decided that there is compelling evidence that the Medicare Hospice eligibility requirements are outdated and need to be re-written.  These policies are not driven by patient need and the evidence is mounting that limiting access to hospice and palliative services actually increases the cost of health care at the end of life.  Those with concerns about the rise in the cost of the Medicare Hospice Benefit appear to put undue focus on the increasing length of stay of a number of hospice patients without considering that hospice and palliative care can be more cost effective than usual care.  This cost reduction does not come from “irrationally rationing” health care but by facilitating conversations that allow patients and families to understand prognosis and verbalize preferences and goals about end-of-life care.  These conversations enable health care providers to guide patients away from costly treatments and interventions that do not facilitate attainment of patients’ goals or add to the quality or length of their lives. If you agree that it is time for a change to the eligibility requirements, what can we do as hospice and palliative medicine providers to advocate for our patients to receive high-quality palliative and end-of-life care in a manner that makes sense? Do we wait until the results of the concurrent care demonstration project are in? Do we ask AAHPM, NHPCO, and HPNA’s Public Policy and Advocacy Committees to weigh in on the matter?  Or do we wait until the lawyers file another class-action lawsuit against Medicare? by: Shaida Talebreza Brandon (all opinions expressed are my own)
Source: geripal.org

Understanding the Medicare hospice benefit

While attending a national hospice conference a few years back, I recall listening to Mary Labyak, one of the earliest pioneers of hospice care in our country. I’d heard Mary speak previously and, although I never had the honor of knowing her, she was a mentor for me throughout my career. Mary stated, “When you’ve seen one hospice, you’ve seen one hospice.” I was puzzled for a moment but quickly understood—and she was certainly correct in her declaration. Hospices across the country were continuing to find new and innovative ways to deliver services, developing programs that meet the unique needs of their communities. One is as different as the next. Some hospices are small, focused on providing care within a small geographic area, while others are large with a nationwide reach. Some service urban environments while others meet the challenges of servicing rural communities. Some are not-for-profit providers, some are for-profit, and others are government sponsored. It can be a challenge to navigate through the array of programs that may be available to you, and for this I refer you to my prior blog “Choosing a hospice: Finding the right program for you and your loved one.”
Source: wordpress.com

Pitching the Medicaid deal: e

Posted by:  :  Category: Medicare

Uninsured Direct-Care Workers by Geographical Region, 2007-2009 by PHInational.org• Medicaid Director Andy Allison confronts the cost question. My reading is that this confirms what we’ve said: this approach to providing coverage will likely be costlier; it will be a lot costlier to the feds; because of various savings and revenues, it will still likely be a net fiscal positive for the state. Here’s Allison: “We do expect the gross costs to be higher than expanding traditional Medicaid in the first years of the expansion. However, it isn’t clear that those higher costs mean that expansion turns from being a net saver to a net coster for the state in the out years (2017 and beyond)…In any event, I don’t view this option as committing the state to a more costly expansion.”
Source: arktimes.com

Video: Strengthening Medicaid is a Good Deal for Arkansas

UPDATED WITH HHS RESPONSE Is new Arkansas Medicaid expansion deal legal?

*UPDATE: Slate’s Matt Yglesias suggests one possible answer: Arkansas will get a 1915(b) waiver as part of the Medicaid expansion to use managed care to deliver coverage. This is the deal that Florida got. A little strange for Arkansas given that our state does not have a managed care system, but perhaps simply funding folks to buy insurance on the exchange counts. Of course, under this waiver, the state has to prove that the alternative system is cost effective, and everything we know suggests that it will cost more.
Source: arktimes.com

Arkansas Accepts Medicaid Expansion, But Not Via Medicaid

Ed Kilgore, once again directing his gimlet eye at goings-on in his native South, points us today to a report that Arkansas plans to accept the full expansion of Medicaid that’s part of Obamacare. The gotcha is that Arkansas’ Republican legislature is insisting that instead of receiving traditional Medicaid, all the new beneficiaries will get benefits via private insurance purchased on Obamacare’s exchanges. This will almost certainly be more expensive, but apparently Republicans are so enamored of a private solution that they’re willing to accept this.
Source: motherjones.com

Medicaid v. Private Insurance in Arkansas

The logic behind the proposed changes rests in the different needs of the “three programs” represented within Medicaid. Those covered by acute care Medicaid (45-50 million persons) most of them pregnant women and children, are relatively inexpensive to care for on a per capita basis. Increasingly, such beneficiaries have trouble finding providers who will care for them, due to a double whammy of stigma (it is insurance for persons who are poor) and the fact that it pays providers below what Medicare pays, which is less than what private insurers pay. This has lead to a systematic access problem for some Medicaid beneficiaries who have trouble finding a physician willing to treat them. There is nothing inherently wrong with the structure of Medicaid; we could decide to make it the best payer of care tomorrow, but that of course, is not going to happen. Buying them into private insurance policies will mainstream their care and remove a layer of cost shifting. [emphasis added]
Source: samefacts.com

Eyes Turn To Arkansas’ Bold Effort To Cut Medicaid Costs, Add Transparency

First, the three entities analyzed historical billing data to determine the state’s highest-volume and most costly medical conditions. Then, they each individually targeted three conditions for which they would track the costs for “episodes of care” — meaning the total charges of treating patients for that specific illness, everything from office visits, to medications and specialty care. The conditions included perinatal care, upper respiratory infections, attention deficit/hyperactivity disorder, hip and knee replacements, and congestive heart failure.
Source: kaiserhealthnews.org

Arkansas: Medicaid Magnet?

Medicaid is a federally mandated program intended to serve as a safety-net for very low-income Americans in need of necessary medical care.  But Medicaid’s low reimbursement rates have resulted in 40 percent of physicians restricting access to patients in the program.  So Medicaid patients often end up in the emergency room for basic health services. In fact, Medicaid patients use the ERs more than the uninsured.  And there is growing documentation demonstrating that being enrolled in Medicaid is actually worse than having no health coverage at all.
Source: netsolhost.com

Arkansas Medicaid Faces $138M Deficit Next Year

The Arkansas Medicaid program is facing a $138 million shortfall next year, and Gov. Mike Beebe (D) has said expanding Medicaid under the Patient Protection and Affordable Care Act would help fight that deficit, according to a Seattle Post-Intelligencer/Associated Press report. Earlier this week, Arkansas state officials proposed countering the Medicaid deficit through rate freezes for hospitals and other providers as well as elimination of the lowest level of nursing home care. The nursing home cuts would potentially save $35 million, but up to 15,000 low-income seniors would lose access to nursing care, according to the report.
Source: beckershospitalreview.com

Proposed Arkansas Medicaid Cuts On the Table

The Arkansas Medicaid Program faces a budget shortfall of up to $4 million. Even with the Governor’s proposal to add $90 million in state general revenue and $70 million in general improvement funds, it still leaves a $138 million shortfall. The Department of Human Services says that would mean 75,000 adults would be cut from medicaid services. Arkansas Advocates For Children and Families said one way to help these families is by extending Medicaid coverage. “Up to 138 percent of the poverty level, which is about 31,000 for a family of four, those families served by the Arkansas Health Networks Programs that is on the list of potential cuts, they could be covered through the medicaid expansion,” said Anna Strong. DHS suggest a three-pronged approach to cutting $130 million out of its budget: The big ones include cutting provider payment rates by 3 percent, eliminating adult dental care, dropping ArHealthNetworks coverage for working adults, freezing eligibility for home and community based waiver services for the aged and those with disabilities, and cutting level 3 nursing care for those not wholly dependent on help for activities of daily living. The final determination will be made during the 2013 regular session.
Source: arkansasmatters.com

Researchers Expose Insurance Industry Fearmongering About Future Health Plan Premiums

Posted by:  :  Category: Medicare

Massachusetts Association of Health Plans’ Annual Conference by Office of Governor PatrickHealth insurance companies have been spreading propaganda about the phenomenon of “rate shock,” which they describe as the surprise their customers will experiences when they see how much insurance companies want to charge them for coverage under new rules contained in the ACA. Ironically, the warnings have been coming loudest from health insurance company CEOs, who exert the most direct control over rates their companies set and who extract the biggest paychecks of any executives in the health care industry .
Source: healthcareforamericanow.org

Video: Zensar Tech bets big on organic growth in 2013

Brown University’s student health plan will cover sex changes

The LGBTQ Center does not keep any sort of statistics on the number of transgender students at Brown, or the number who would like to change their sexual characteristics. Nevertheless, Garrett said, the LGBTQ Center has promoted the added health care coverage for many years, on the theory that the high costs of sex changes have prevented transgender students from seeking surgeries and hormone treatments.
Source: dailycaller.com

FAQ: Grandfathered Health Plans

Nonetheless, consumers should know the status of their plans since that may determine whether they are eligible for certain protections and benefits created by the health law.  For example, an employee at a large company may wonder why his job-based insurance doesn’t include the free preventive services he’s heard about. Or someone who purchases her own coverage may wonder whether she will be eligible for broader benefits when new insurance marketplaces open next fall. To answer those questions, you must understand the status of your plan and how grandfathering works.  Here are the basics:
Source: kaiserhealthnews.org

WellCare Health Plans’ CEO Discusses Q4 2012 Results

Sure, Mike. There are a number of different things that seemingly have the same definition of the technical scores that everything on the accreditations that we mentioned earlier of NCQA and (inaudible) that we’ve achieved historically to the different components of the stars system, be it (inaudible), caps, various other things. So, broadly, early indemnification of care gaps and finding that through our clinical work and our claims harvesting and indemnification initiatives to close those care gaps, improving the service experience, meeting our customers’ expectations are the broad set of initiatives across our clinical programs, our customer service programs, our network, making sure that we have the appropriate network and the right set of aligned incentives and our reimbursement for pay-for-performance, pay-for-quality, those sorts of things. And then as Tom mentioned, significant investment in our infrastructure, upgrading care management and quality systems capabilities in our shared service infrastructure as well.
Source: seekingalpha.com

HEALTHY IOWA: Branstad Talks Healthcare Plan

“The Healthy Iowa Plan is a modern health plan that will pay providers to care for their whole population and based on the quality of care they deliver, while rewarding positive health outcomes,” said Branstad. “Under our Healthy Iowa Plan, more Iowans will be served by the private insurance market, with access to affordable plans available through health benefits exchanges.”
Source: whotv.com

Medicare Locals to face chop by Coalition? Primary healthcare concern

Posted by:  :  Category: Medicare

He says there are already several Medicare Locals seeking active links with public hospitals to explore ways of shifting care, where medically appropriate, from hospitals to services organised by the scheme. The highest priority of the Medicare Local Alliance is to gather evidence showing how better co-ordinated services in the community reduced demand for hospital beds.
Source: com.au

Video: Medicare Levy Surcharge 2011/2012: nib Health Insurance Explained

NEW MEDICARE ELIGIBLE MRI FOR BARTON

At the same time as the additional MRI licences come into effect, the Government will allow GPs to refer patients under the age of 16 to Medicare-eligible MRIs for specific conditions without the need to first see a specialist.
Source: com.au

Medicare Fact Sheet for Clients

On 1 November 2006, the Australian Government introduced new Medicare items for psychological treatment by registered psychologists. This service provides considerable assistance to people living with mental heath problems, allowing them greater access to psychologists and providing more affordable mental healthcare.
Source: com.au

3 Tips for Avoiding Pitfalls in Medicare Enrollment

Posted by:  :  Category: Medicare

HERES YOUR TOP TEN by SS&SSIAM is an SEC registered investment adviser with its principal place of business in the State of Texas.  IAM and its representatives are in compliance with the current registration and notice filing requirements imposed upon registered investment advisers by those states in which IAM maintains clients.  IAM may only transact business in those states in which it is noticed filed, or qualifies for an exemption or exclusion from notice filing requirements.  Any subsequent, direct communication by IAM with a prospective client shall be conducted by a representative that is either registered or qualifies for an exemption or exclusion from registration in the state where the prospective client resides.  For information pertaining to the registration status of IAM, please contact IAM or refer to the Investment Adviser Public Disclosure web site (www.adviserinfo.sec.gov).  For additional information about IAM, including fees and services, send for our disclosure brochure as set forth on Form ADV using the contact information herein.
Source: iaminvest.com

Video: EHR: Medicare Incentive Program Attestation Webinar for Eligible Professionals

Open Enrollment 2013: Medicare Part D Benefits Improve but Premiums an…

While Medicare Part D prescription drug plan premiums are generally expected to remain steady in 2013, this PPI Fact Sheet by Leigh Purvis and Lee Rucker finds that premiums for many popular plans will actually be considerably higher than they were in 2012. Many plans are also increasing cost-sharing and their reliance on utilization management tools for covered prescription drugs. Medicare beneficiaries should closely examine their 2013 prescription drug plan choices during open enrollment for Part D.
Source: aarp.org

Your Health: Medicare open enrollment under way

A: All Medicare enrollees should have gotten notice by now that the Medicare open enrollment season has begun. Medicare beneficiaries have through Dec. 7 to decide whether they want to stay with their current plan — whether it’s a Medicare Advantage managed-care plan or original Medicare — or switch coverage to something else.
Source: timesdispatch.com

Registration Due for Medicare Seminar

The program, titles “Welcome to Medicare” will be presented by Crossroads’ SHIPP volunteers. The program will cover Medicare Parts A, B, and D, as well as Medicare Advantage plans and Medicare supplemental insurance. Registration for the September 22nd program is required by next Tuesday.
Source: kniakrls.com

Modern Aging: Understanding Medicare’s annual enrollment

As in previous years, Medicare beneficiaries have the option of making no change during the AEP, and they automatically will be re-enrolled in their existing plan for another year, along with any changes that their current Medicare plan may have made for 2013. To inform members how their plans are changing, Medicare plan carriers are required to send each member an Annual Notice of Change letter.
Source: timesdispatch.com

Deadline approaching to "Get Paid for 2012: Medicare EPs Must Attest by February 28, 2013"

Eligible professionals (EPs) who participated in the Medicare Electronic Health Record (EHR) Incentive Program in 2012 must complete attestation for the 2012 program year by February 28, 2013. In order to be eligible to attest you must have completed your 2012 reporting period by December 31, 2012.
Source: medicalmastermind.com

Upcoming events (posted March 7, 2013)

A NAMI Connection peer support group for adults recovering from mental illness meets weekly in Cambridge. The free group is sponsored by the National Alliance on Mental Illness of Minnesota. Trained facilitators who are also in recovery lead NAMI Connection groups. The group meets Thursdays, 6:30 p.m., at Cambridge Medical Center, 701 S. Dellwood Street, in the administrative conference room. For more information, contact Louise at 651-592-6989. A family support group also meets at the same time and location to help families develop better coping skills and find strength through sharing their experiences. For information, call Sarah 320-396-0443.
Source: ecmpostreview.com

The Clock is Ticking for Meaningful Use Attestation

Unfortunately, the notion of being fashionably late does not apply to EHR incentive programs. It pays to be on time for this party.  If you haven’t yet attested for the Medicare or Medicaid EHR Incentive Programs, you’ve still got some time.  Eligible professionals must begin their consecutive 90-day reporting period by October 3rd in order to attest to meeting meaningful use and be qualified to receive an incentive payment for 2012. Nuesoft has prepared a video guide to help walk you through some of the program’s more complex meaningful use requirements.  Don’t let this opportunity pass you by. Follow our guide and prepare your practice to receive the maximum incentive payments available. Full Video:
Source: nuesoft.com

Whats New with Medicare, Medicaid and Health Care Reform 2013

Register Below or Contact the Philadelphia Office with questions pertaining to this event: (215) 546-5800. If you would like to register for multiple events save time in the registration process by updating your eventbrite profile. Next time you RSVP make sure you are logged in and it will auto fill the fields for you! We look forward to seeing you at the next event.
Source: rothkofflaw.com

Oral cancer patient fights Medicare for coverage 

Posted by:  :  Category: Medicare

Denied coverage because of a pap smear by Paul Schreiberalcohol cancer CDC Cervarix cervical cancer cetuximab chemotherapy chewing tobacco cigarettes cisplatin DNA early detection erbitux FDA Food and Drug Administration Gardasil head and neck cancer HPV HPV-16 human papillomavirus human papilloma virus lung cancer mouth cancer National Cancer Institute nicotine oral cancer oral cancer foundation oral sex oropharyngeal cancer radiation radiation therapy radiotherapy smokeless tobacco smokers smoking snus squamous cell carcinoma surgery survival The Oral Cancer Foundation throat cancer tobacco vaccination vaccine xerostomia
Source: oralcancernews.org

Video: Medicare Drug Coverage

Official: Sequestration To Affect Medicare EHR Incentive Payments

The ACA, which was signed into law by Obama in 2010, contains more than 40 tax changes, including penalties on individuals who do not purchase health coverage. The IRS also is charged with administering tax credits to the estimated 15 million individuals who are expected to qualify for federal subsidies to purchase coverage through the law’s health insurance exchanges.
Source: californiahealthline.org

The campaign to save medicare is in full swing. Next up: April Lobby Week!

The 2014 Health Accord gives our leaders an opportunity to share best practices in public health care, discuss evidence-based and innovative solutions, set national standards on care to ensure that every person in Canada receives quality care, and look at areas that are under-served or not covered by medicare — like home and community care, long-term care, mental health, dental care, and pharmacare — and find ways to expand the medicare umbrella.
Source: rabble.ca

Nine Health Care: Medicare Boosting Coverage For Mental Health Issues

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter’s name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.
Source: blogspot.com

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

Important Information to Know About Medicare Coverage of Hospital Stays & Skilled Nursing Care

Most people assume that when they are admitted into a hospital they are automatically considered an inpatient. However, this is untrue. The physician or practitioner decides whether to list the patient as an inpatient or put them on “observation status.” CMS defines observation status as, “a well-defined set of specific, clinically appropriate services, which include ongoing short term treatment, assessment, and reassessment before a decision can be made regarding whether patients will require further treatment as hospital inpatients or if they are able to be discharged from the hospital.” The problem with observation status is that Medicare Part A will only pay for hospital inpatient care. If you are listed as on observation status Medicare Part B will pay for care provided by the hospital physicians, and normally supplemental insurance policies will pay for the additional costs such as hospital deductibles, copayments, and Part B cost sharing. This is an issue for beneficiaries who opted out of Medicare Part B and also for those who require care in a skilled nursing facility upon discharge from the hospital. Medicare Part A will only cover skilled nursing care in a facility if the patient had been admitted to a hospital as an inpatient for three days prior – this is called a “qualified stay.” This means that if you were on observation status, even if you stayed at the hospital for three days, Medicare will not pay for the skilled nursing facility rehabilitation you need as that was not a qualified stay..
Source: newyorkelderlawblog.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 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

The Medical Minute: Colon cancer prevention Penn State Hershey Newsroom

breast cancer cancer Cancer Institute cardiology children Childrens Hospital Childrens Miracle Network College of Medicine colon cancer colorectal cancer diabetes emergency medicine EMS endocrinology fitness flu heart Heart and Vascular Humanities Life Lion Medical Center Medical Minute medicine melanoma neurology neurosurgery nurse nursing obesity oncology orthopedics patient centered medical home PCMH personalized medicine primary care public health research sleep stroke surgery technology telemedicine THON thyroid cancer weight loss
Source: psu.edu

Therapy Plateau No Longer Ends Coverage

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

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 Open Enrollment: More is better

Posted by:  :  Category: Medicare

Medical Drugs for Pharmacy Health Shop of Medicine by epSos.deFor those choosing Original Medicare, the benefit package continues to grow stronger and provide greater value. For example, EVERYONE with Medicare has access to a variety of preventive services and screenings, most at no cost to them when furnished by qualified and participating health care professionals. This includes things like diabetes and cancer screenings, and a yearly “wellness” visit. During the first 9 months of this year, over 20 million people with Original Medicare received at least one preventive service at no cost.
Source: medicare.gov

Video: Guide to Medicare Part A and Part B

Switching from Medicare Advantage to Original Medicare & Supplement

Individuals are guaranteed to be issued Medicare Supplements if they apply for one within six months of the date they turn 65 and are enrolled in Part B. After that period expires, individuals must go through underwriting before a policy will be issued.  There is a wide variety in underwriting guidelines among the companies offering supplemental insurance. Some may be very difficult while others may only ask a couple of questions. Those couple questions are generally, (1) has the applicant been discharged from a hospital within 90 days and, (2) has the applicant been told that they need some sort of surgery or procedure (waiting to have surgery). If an applicant can answer those two questions honestly in the negative, he or she can qualify for a supplement.  If one company turns down an individual, they would do well to try others. This means that even people in a nursing home and on Medicaid can get a Medicare Supplement.
Source: parrilaw.com

Doctor’s Advice…Get Traditional Medicare…What’s That? » Toni Says

(In-patient Hospital Insurance) pays for your medical care while you have a hospital stay. Part A also pays some of the costs if you stay in a skilled nursing facility which has 100 day benefit, hospice, or if you receive home health care.  The Part A deductible for 2013 is $1,184.00 and can be used 6 times or 6 deductibles in a year.  Yes, Part A has a benefit period of 60 days, so every 60 days; there is a new deductible of $1184.00. If you go back in the hospital after a 60 day period, then you can have another deductible of $1,184.00.  Skilled nursing has a $0 co pay for days 1-20, but from days 21-100, there is $148.00 co pay per day.  After day 100, you pay all of the cost for each additional day. And yes they do bill you the additional cost.
Source: tonisays.com

A WORD TO WISE… Admission vs. Observation

A patient under observation in a hospital setting is covered by Part B of Medicare, because this service is outpatient. If you are held for observation and then released to a skilled nursing facility, you will be Private Pay and Medicare will pay NOTHING.  Most people with Original Medicare also have a Medicare Supplement.  The Medicare Supplement plans pay after Original Medicare, so if Medicare does not approve charges for care, the supplement plan will not pay either.
Source: medicaremazeadvisors.com

Daily Kos: Projected Medicare spending falls dramatically

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Source: dailykos.com

Stephen L Morgan’s Personal Blog

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Source: worldvillage.com

Panel: Fix SGR by Cutting Increased Medicare Payments for Hospital Services

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 marsmet481The National Commission on Physician Payment Reform, a panel of physicians and healthcare experts assembled by the Society of General Internal Medicine, made bold recommendations to fix Medicare’s sustainable growth rate by saving money through ending the increased payments hospitals receive for outpatient services and incorporating quality metrics in all physician reimbursement within five years. The panel also recommended the American Medical Association diversify the membership of its Relative Value Scale Update Committee, which advises Medicare on how to reimburse physicians, and make its decisions more transparent. The panel argued Medicare doesn’t need additional funding to come up with the $138 billion over the next decade needed to stop the sharp cuts to physicians from the SGR. Instead, it listed 12 recommendations to keep the program solvent while rewarding cost-effective and high-quality care practices. Among those recommendations: •    Largely eliminate fee-for-service payments, and incorporate value- and quality-based payments over the next five years in testing sites, with broad adoption within the next 10 years. •    All payors should increase annual updates for evaluation and management codes, which the panel called “currently undervalued,” while freezing updates for most procedural diagnosis codes for the next three years. •    End the practice of paying hospitals more for procedures that could be performed in lower-cost facilities. •    Encourage practices with fewer than five physicians to form virtual relationships and share resources.
Source: beckershospitalreview.com

Video: Preserving – Obama for America TV Ad

Internists Offer Possible Solutions to Medicare Payment Problems

ACP supports a two-phased approach to eliminate the SGR and transition to better payment and delivery systems that are aligned with value. During phase one, repeal the SGR formula, provide at least five years of stable physician payments, with positive increases for all physician services, and higher payments for primary care, preventive and care coordination services; and in phase two establish a process for practices to transition to new, more effective, models of care by a date certain. ACP is encouraged that this committee

Health Insurance: Medicare Rebates and Private Health Insurance Cover for Osteopathic Treatment in Australia

Posted by:  :  Category: Medicare

SCOTUS Obamacare Decision Makes Individual Mandate A Fact & Universal Healthcare Coverage A Fiction by watchingfrogsboilIf you want to commit an osteopathic treatment in Australia, it is important to know how your treatment will be covered by Medicare, the scheme of the government universal health care or private health insurance funds. Medicare One patient in Australia with a chronic disease (eg, a condition long musculoskeletal system), which is overseen by a family physician, is entitled to Medicare for up to five sessions of osteopathic treatment in a calendar year, such as by an osteopath with the Osteopathy Board of Australia are registered. However, there are certain conditions that can be applied in the order for a patient to be eligible for the rebate. First, the treatment must be an osteopath from a chronic disease management MBS physician services provided to the patient and the patient’s GP Management Plan (GPMP) and the detention orders are recommended. Team (ATC) A reference GP is necessary for a referral form, which is provided by the Australian Department of Health and Ageing, this form must be submitted to the osteopaths the first treatment. After all five sessions have been committed, if further treatment is necessary, a new benchmark GP is required. Second, if more than five sessions of osteopathic treatment is undertaken, the following sessions are not covered by Medicare. Third, the osteopath needed a reference GP written report. Usually at the end of treatment that provide detail the proposed treatment, tests or analyzes and plans for the future management of the patient A patient who has private health insurance, chose not to seek a guarantee that their osteopathic treatment, but to their Medicare claims is also entitled to the cost of five treatments each year civil claim above conditions are provided fulfilled. Private health insurance Osteopaths in Australia as allied health professionals are a patient with osteopathic treatment required by their private health insurance does not start treating doctor’s recommendation. Generally have a private health insurance either a form of collateral or Extras: right of a patient to a specific number of sessions of osteopathy during the calendar year, depending on the amount of coverage, or to pay a contribution towards the cost of osteopathic treatment, to for an agreed amount. However, it is important that patients check with their health insurance, that osteopathic treatment is covered in her special diet, and other expenses that they can be held accountable. It is also important that patients who decided to have not claim the cost of osteopathic treatment on their private health insurance, know, and instead to claim their Medicare rebate can not use their private health insurance for Any shortfalls between Medicare and fees to pay for the processing.
Source: blogspot.com

Video: Medicare rebate – Nick Xenophon

OPINION: drug firms say no to rebates, despite billions in new revenue from Part D

Before the Medicare Part D drug program was created in 2006, the pharmaceutical industry paid rebates to the government to help pay for those folks’ medications. The rebate program ended when Part D went into effect and the dual eligibles’ drug coverage was switched from Medicaid to Medicare. As a result, taxpayers are paying more now than before, even though drug companies are getting billions of dollars in revenue they never had before Part D was created. So the President will be asking Congress to reinstate the rebates, which the nonpartisan Congressional Budget Office says would save billions of dollars in government spending every year. That’s because even though dual eligibles comprise only 20 percent of the total number of people enrolled in Medicare, they account for almost a third of total Medicare spending.
Source: publicintegrity.org

White House Touts Medicare Rebates

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

Medicare Fact Sheet for Clients

On 1 November 2006, the Australian Government introduced new Medicare items for psychological treatment by registered psychologists. This service provides considerable assistance to people living with mental heath problems, allowing them greater access to psychologists and providing more affordable mental healthcare.
Source: com.au

Claiming a Medicare rebate: :: Centred MGP

Every woman is entitled to have a midwife, unfortunately if you see your GP you don’t get to see a midwife until you go for your hospital visit at 19/20 weeks. This means you have missed out on vital information and building a valued relationship. This is regretable because it is beneficial for women to see a midwife from the moment she is pregnant or at least between 8 – 10 weeks. A midwife gives the woman unbiased information allowing the woman to choose different options of care, rather than the straight route to an obstetrician because she has private cover. Now with midwives having a Medicare provider number, this means that a pregnant woman can see a private midwife to discuss options of care and claim for a refund just like going to the doctors. Midwives work in collaboration with doctors and midwives are all to happy to refer the woman when it is required and the woman wishes to do so.
Source: centredmgp.com

PhRMA Will Fight Rebates for Low Income Drug Beneficiaries

During his State of the Union speech on Feb. 12, President Obama said he planned to “reduce taxpayer subsidies to prescription drug companies” as a way to reduce Medicare spending. His staff later explained that the president seeks to reinstate a drug industry rebate for drugs the Medicare program pays for about 10 million seniors on Medicaid, the federal and state funded healthcare program for the poor. That rebate went away when the Medicare Part D program was passed by Congress and signed into law by President Bush in 2006. Since then, Medicare has picked up the tab for seniors on Medicaid — about $137 billion, according to the Congressional Budget Office.
Source: about.com

Medicaid Pays less for Drugs than Medicare

The program requires a drug manufacturer to enter into, and have in effect, a national rebate agreement with the Secretary of the Department of Health and Human Services (HHS) in exchange for State Medicaid coverage of most of the manufacturer’s drugs. Manufacturers are then responsible for paying a rebate on those drugs each time that they are dispensed to Medicaid patients. These rebates are paid by drug manufacturers on a quarterly basis and are shared between the States and the Federal government to offset the overall cost of prescription drugs under the Medicaid Program.
Source: healthcare-economist.com

BOOST FOR ST GEORGE HEALTH SERVICES WITH NEW MRI LICENCES

It will be easier to get an MRI in St George after the Gillard Government confirmed MRI units at two sites (previously one) will be granted Medicare eligibility from November for certain types of scans of some patients, Mr McClelland said today.
Source: com.au