Daily Kos: Another fiscal crisis? Paul Ryan’s answer: Medicare vouchers

Posted by:  :  Category: Medicare

Newsweek Magazine (February 16, 2009) ... Lenders Add Bigger Fannie, Freddie Fee – Thanks to Payroll Tax Cut (January 15, 2012) ...item 2.. Dupuy: GOP trying to sell pyrmaid scheme to voters (September 3, 2012) ... by marsmet526On March 4, 2008, McClintock announced his candidacy for the U.S. House of Representatives in California’s 4th congressional district, which is hundreds of miles away from the district McClintock represented in the state Senate. The district’s nine-term incumbent, fellow Republican John Doolittle, did not seek re-election In typical GOTP fashion, why bother with rules (involving taking Calif. state pay for legislators who do not live in/near Sacramento)?: McClintock maintained that the payments were justified because his legal residence was in Thousand Oaks, in his State Senate district. He stated, “Every legislator’s [Sacramento area] residence is close to the Capitol. My residential costs up here are much greater than the average legislator because my family is here.” However, Ose’s campaign commercials argued McClintock does not own or rent in home in the 19th district, but uses his mother’s address. These attacks prompted a response from McClintock’s wife, Lori, who said McClintock stays with his mother in order to better care for her after she fell ill and after the death of her husband. Just when I thought his time under a rock was taking hold, he popped up on local news with his “take” on the sequester of all things.  This guy is a radical with nothing other than his own pocket as his guiding light.  It is pathetic that he is once again being given a voice.
Source: dailykos.com

Video: Will Higher Tax Rates Balance the Budget?

New Boehner budget offer: Lower tax rate for rich, cut Medicare

“The Republican letter released today does not meet the test of balance. In fact, it actually promises to lower rates for the wealthy and sticks the middle class with the bill. Their plan includes nothing new and provides no details on which deductions they would eliminate, which loopholes they will close or which Medicare savings they would achieve. Independent analysts who have looked at plans like this one have concluded that middle class taxes will have to go up to pay for lower rates for millionaires and billionaires. While the President is willing to compromise to get a significant, balanced deal and believes that compromise is readily available to Congress, he is not willing to compromise on the principles of fairness and balance that include asking the wealthiest to pay higher rates. President Obama believes – and the American people agree – that the economy works best when it is grown from the middle out, not from the top down. Until the Republicans in Congress are willing to get serious about asking the wealthiest to pay slightly higher tax rates, we won’t be able to achieve a significant, balanced approach to reduce our deficit our nation needs.”
Source: americablog.com

Payroll Tax increases in 2013

All faculty and staff will notice an increase in the OASDI /EE taxes to a rate of 6.2% on earnings paid on or after January 1, 2013.  The temporary rate reduction to 4.2% in effect during 2011 and 2012 for the employee portion of OASDI taxes expired at the end of 2012.  The American Taxpayer Relief Act of 2012 did not extend this temporary tax cut for employees, so employees will pay the full rate of 6.2% for that portion of the Federal Insurance Contributions Act (FICA) tax.  The maximum earnings subject to OASDI taxes are capped at $113,700 in 2013.  In 2012, the cap was $110,100.
Source: umsystem.edu

Unearned Income Medicare Contribution Tax

Even if the high-income portions of the 2001 and 2003 tax cuts are fully extended, the unearned income Medicare contribution tax’s arrival next year will raise the top rates on interest, dividends and capital gains 3.8 percentage points above this year’s levels. Or, if the high-income provisions are allowed to expire, it will push the top rates on interest, dividends and capital gains 3.8 percentage points above Clinton- era levels.”
Source: businessinsider.com

Additional 0.9 percent Medicare tax on wages starts January 1st

For partners in a general partnership and shareholders in an S corporation, the tax applies to earned income that is paid as compensation to individuals holding an interest in the entity. Partnership income that passes through to a general partner is treated as self-employment income and is also subject to the tax, assuming the income exceeds the applicable thresholds. However, partnership income allocated to a limited partner is not treated as self-employment and would not be subject to the 0.9 percent tax. Furthermore, under current law, income that passes through to S corporation shareholders is not treated as earned income and would not be subject to the tax.
Source: cgmcpa.com

Proposed regs clarify the new 0.9% additional Medicare tax

Good news: The proposed regulations closely track FAQs the IRS issued last summer, so you don’t need to make many changes to your software to withhold this additional tax. And, since there’s no employer match, the regs follow the income tax withholding rules for adjusting over- or underwithholding of this tax. The regs also clarify the interplay between FICA and SECA. You may rely on these proposed regs until final regs are issued. (77 F.R. 72268, 12-5-12)
Source: businessmanagementdaily.com

New Medicare Tax Goes Into Effect January 2013: Year

Deferred compensation is not generally subject to Medicare until it is vested and ascertainable. For defined benefit plans, this means that Medicare tax often is not paid until an employee terminates employment, when the total value of the plan benefit is ascertainable. For defined benefit deferred compensation plans that currently have vested and accrued benefits, the employee can electively pay FICA taxes presently for vested, accrued benefits on an estimated basis. If such early elections are made in 2012, the additional Medicare tax can be avoided for amounts accrued and vested this year. Early FICA inclusion will also exempt the future value of that amount from any additional FICA tax, including the additional .9 percent rate applicable to years after 2012.
Source: jdsupra.com

HANYS Benefit Services: Questions and Answers on the Additional Medicare Tax

If a former employee receives group-term life insurance coverage in excess of $50,000 and the resulting income is in excess of $200,000, how does an employer report Additional Medicare Tax on this? The imputed cost of coverage in excess of $50,000 is subject to social security and Medicare taxes, and to the extent that in combination with other wages it exceeds $200,000, it is also subject to Additional Medicare Tax. When group-term life insurance over $50,000 is provided to an employee (including retirees) after his or her termination, the employee share of social security and Medicare taxes and Additional Medicare Tax on that period of coverage is paid by the former employee with his or her tax return, and is not collected by the employer. An employer should report this income as wages on Form 941, Employer’s Quarterly Federal Tax Return (or the employer’s applicable employment tax return), and make a current period adjustment to reflect any uncollected employee social security, Medicare, or Additional Medicare Tax on group-term life insurance. However, unlike the uncollected portion of the regular (1.45 percent) Medicare tax, an employer may not report the uncollected Additional Medicare Tax in box 12 of Form W-2 with code N.
Source: hanysbenefits.com

“Increasing the Social Security Payroll Tax Base: Options and Effects o” by Thomas L. Hungerford

The Social Security Trustees project that the assets in the two Social Security trust funds will be exhausted in 2033, and after that, Social Security payroll tax revenue will cover about three- quarters of promised benefits. To help close Social Security’s long-term financing gap, some analysts have proposed increasing the Social Security tax base by raising the maximum taxable limit so that 90% of aggregate covered earnings are taxable (the percentage in 1982). CBO estimated that the maximum taxable limit would have had to been $186,000 in 2008, almost double the actual limit, so that 90% of covered earnings are taxable. They estimated that this policy could have increased payroll tax revenues by $503.4 billion over the 2010-2019 period. The Urban Institute reports that the Social Security Administration estimates the 2012 maximum taxable limit would have had to been $214,500 so that 90% of covered earnings were taxable. Since 1982, the ratio of taxable earnings to covered earnings has fallen from 90%, reaching 82.7% in 2007. 82.7% in 2007.
Source: cornell.edu

The Moment You Have All Been Waiting For: Payroll Tax Guidance for 2013

Additional Medicare Tax Withholding. In addition to withholding Medicare tax at 1.45%, employers must withhold a 0.9% Additional Medicare Tax from wages paid to an employee in excess of $200,000 in a calendar year. Employers are required to begin withholding Additional Medicare Tax in the pay period in which it pays wages in excess of $200,000 to an employee and must continue to withhold it each pay period until the end of the calendar year. Additional Medicare Tax is only imposed on the employee. There is no employer share of Additional Medicare Tax. All wages that are subject to Medicare tax are subject to Additional Medicare Tax withholding if paid in excess of the $200,000 withholding threshold.
Source: taxblawg.net

The American Taxpayer Relief Act of 2012

The Act did not affect the 3.8% Medicare tax which went into effect January 1, 2013. Thus, for single taxpayers with taxable income in excess of $200,000 and for joint filers with taxable income in excess of $250,000, the 3.8% Medicare tax applies to interest, dividends and other investment income as well as income from trades or businesses in which the taxpayer is a passive investor. For example, if a single taxpayer had $150,000 of W-2 income and $125,000 of net investment income, the tax would be assessed against $75,000 which is the excess of the $275,000 AGI over the $200,000 threshold amount for single taxpayers, and would result in an additional $2,850 tax liability.
Source: shuffieldlowman.com

Capital Gains and Dividend Income Tax Rates Scheduled to Increase in 2013: Added Impact of New Medicare Contribution Tax : Federal Taxation Developments Blog

The significant increase in capital gains rates and taxes on dividend income have already resulted in taxpayers attempting to realize gains or accelerated the receipt of dividends from closely held corporations before the end of this year. If the rates do increase, i.e., Congress does not resolve the fiscal tax cliff in a manner that reduces or eliminates the anticipated tax rate hikes, then the new tax rates will certainly have a widespread and dramatic effect on future tax planning for all taxpayers, including closely held businesses and investors. For example, many owners of appreciated real property may prefer to engage in tax-free exchanges instead of having a preference for cash sales. From a merger and acquisition standpoint, privately owned companies looking to sell out may want to either postpone the sale of its business or consider being acquire in a tax-free reorganization or perhaps engage in a joint venture which could be partially taxed to the extent cash is received. With higher rates also brings along a greater tax benefit from depreciation and other tax deductions, including tax credits. The change in rate structure may also affect the preferred entity form for many businesses particularly if the much talked about reduction in the corporate income tax rate occurs. There could be a wide disparity then in the rate of tax a regular or C corporation pays instead of a flow through entity used by individuals in operating a closely held business or professional service organization causing the entity owners to reassess the best tax form for doing business.
Source: foxrothschild.com

“Reading Your Medicare Summary Notice” Workshop

Posted by:  :  Category: Medicare

The Monmouth County Connection is located at 3544 State Highway 66 in Neptune, in the strip mall adjacent to the Home Depot and across the street from Walmart.  This new office of Monmouth County government offers a variety of services including passports, passport photos, free notary public, veterans’ IDs, election/voter information, senior and veterans’ services, public access computers and more.
Source: patch.com

Video: You Can Help Fight Medicare Fraud

Understanding Medicare Statements

You should compare the information on your MSN with bills, statements and receipts from your health care providers and suppliers. Do the dates, billing codes and the descriptions of services you received match? In some instances, your MSN may include valid charges for services or supplies you weren’t aware of having received — such as for medical consultations or tests. But, as a general rule, the dates and codes should match. If you don’t see codes on your provider’s paperwork, ask for copies that include them.
Source: aarp.org

Medicare Summary Notice Made Easy

This post was written by Jim Blazer, Executive V.P. of Bermel, Inc.  Since joining Bermel, Inc. 18 years ago, Blazer has led the company in its steady expansion. He is recognized for managing one of two major US hospital networks for Medicare Select. Bermel, Inc’s Medicare Select Supplements significantly reduce the premium outlay for policyholders.
Source: medicareecompare.com

Cutting the clutter – the newly designed Medicare Summary Notice

gives you faster access to your Medicare claims information—you can check it 24 hours a day, 7 days a week, 365 days a year. Customize your MSN to see procedures broken down by single claim, or by a time period you choose, and print out your own statement anytime. Reviewing your MSN online means a shorter wait to see what you were charged for health care services, medical supplies or equipment, and how much Medicare paid.
Source: medicare.gov

New Medicare Summary Notice Designed to Help Fight Fraud

“Consumer protection starts with making sure consumers not only get timely and accurate information, but that they understand what services they’re receiving from Medicare,” said Acting Administrator Marilyn Tavenner.  “The new Medicare Summary Notice empowers Medicare’s seniors and people with disabilities.  The statement is easier to understand and navigate, and makes clear what information to check and how to report potential fraud.  The new MSN also makes it easier for people with Medicare to understand their benefits and file appeals if a claim is denied.”
Source: wolterskluwerlb.com

CMS announces new Medicare Summary Notice (sometimes referred to as an Explanation of Benefits)

This MSN redesign is part of a new initiative, “Your Medicare Information: Clearer, Simpler, At Your Fingertips,” which aims to make Medicare information clearer, more accessible, and easier for beneficiaries and their caregivers to understand. CMS will take additional actions this year to make information about benefits, providers, and claims more accessible and easier to understand for seniors and people with disabilities who have Medicare. This MSN redesign reflects more than 18 months of research and feedback from beneficiaries to provide enhanced customer service and respond to suggestions and input.
Source: quinnscommentary.com

How To File A Medicare Appeal

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

6 Features of CMS’s Redesigned Medicare Summary Notice

In light of ongoing healthcare reform there is a push for clarity, as several of our stories illustrate this week. Medicare claims forms have been redesigned so that beneficiaries and their caregivers can better understand them, check for important facts and potential fraud. The subject of fraud is particularly timely given the story that has been circulating for the last week involving the arrest of a physician, the office manager of his medical practice, and five owners of home health agencies. They’ve been charged with allegedly participating in a nearly $375 million healthcare fraud scheme involving fraudulent claims for home health services.
Source: hin.com

Make 2013 a year for preventing Medicare fraud!

This might seem like too big of a resolution for just one person, but if we work together, we can accomplish anything we set our minds to. When it comes to protecting, detecting, and reporting Medicare fraud, the community is the best defense. The National Hispanic SMP (NHSMP) needs to the support and involvement of older adults, their families, and caregivers to help stop Medicare fraud in our community. The NHSMP is part of a whole network of leaders, agencies, and organizations working to fight Medicare fraud across the country:
Source: nhcoa.org

As More Baby Boomers Turn to Medicare, Helpful Tips : BoomerCafé.com

Posted by:  :  Category: Medicare

3.27.06 Los Angeles Times 1 by Korean Resource Center 민족학교Crazy ideas and trash talk seem so juvenile. If you go that way, expect to meet condescending smiles and frustrated head shaking. Don`t ruin your credibility. This is the time and place for reasonable conversation. Be wise and impressive, engaging in rational dialogue with those around you. You want them to share their theories and opinions and they`re happy when you add yours to the mix. Even if you have nothing earthshaking to say, your voice is welcome. Preaching to the converted makes everybody feel good. At least you all agree on issues that are important to you.
Source: boomercafe.com

Video: Medicare Part D Prescription Drug Coverage

Medicare Prescription Drug Coverage, Medicare Part D, Doughnut Hole

Medicare has an optional program — called Medicare Part D — that provides insurance to help you pay for prescription drugs. If you select to have the coverage, you pay a monthly premium. This guide explains how the program works and helps you make decisions in choosing a plan that’s right for you.
Source: aarp.org

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

What Is Covered By Insurance Medicare Part D?

Medicare Part D, covers a wide range of medical care which is not covered in the original Insurance Medicare Parts, A and B. However, in contrast to Medicare Part A and B, Part D coverage is not standardized. Plans are given the freedom to choose which drugs they will provide coverage for, to which degree they will provide coverage, and which drugs are to be excluded from coverage. Medicare Part D coverage may help lower the cost of prescription drugs. It may also help protect its beneficiaries from higher medication costs in the future. Another aspect of Part D coverage is that it provides a wider range of access to the drugs which beneficiaries required to stay healthy or treat an illness.
Source: seniorcorps.org

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

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

Part D Politics: Medicare Drug Rebates or Price Controls?

While health care was barely mentioned in the recent State of the Union address, President Obama generated some interest in his proposal to cut Medicare spending by reducing “taxpayer subsidies to prescription drug companies.” That’s code for requiring pharma marketers to pay rebates on medicines provided by Medicare Part D plans to low income “dual eligibles” who previously received prescription drugs through state Medicaid plans. Savings to Medicare are calculated at about $150 billion over ten years, and many Democrats and consumer advocates think it’s a great idea.  
Source: pharmexec.com

Changes in Medicare Part D for 2013

Open Enrollment ends Friday, December 7, 2013.  If you have not done so already, please take a few minutes to review your coverage information today. If you find your plan is not meeting your expectations, call me to set up an appointment to find a plan that offers better coverage. Call 440-255-5700.
Source: mutskoinsurance.com

Medicare part D coverage gap ?

Medicare Guidelines permit a yearly deductible of up to $320 before you receive full benefits. You are then in the "initial coverage period" and will pay approximately 25% for your medications. When both you and the insurance company has paid $2930 you go into the "donut hole" or coverage gap, where you pay 86% of the negotiated medication cost for generics and 50% of the negotiated medication cost for brand name medications (as long as those medications are on the formulary of the plan that you choose). After your out of pocket costs have reached $4700 will go into "catastrophic coverage" and will pay approximately 5%. There are several different plans. One with a deductible and donut hole. One without a deductible but has a donut hole, and one without a deductible and without a donut hole.
Source: zqas.net

Part D: Bending the Medicare Cost Curve

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

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

Seniors Need To Be Tenacious In Appeals To Medicare

Posted by:  :  Category: Medicare

Code Pink R-E-P-P-E-N' ENDS! by eyewashdesign: A. GoldenMedicare officials say appeals are rare, though they would not provide statistics on how many appeals came from beneficiaries rather than from health-care providers, such as hospitals, doctors and nursing homes.  The inspector general’s office in the Department of Health and Human Services reported last month, however, that 85 percent of appeals in 2010 that reached the third level of review, which are decided by an administrative law judge, were filed by health care providers.  And for those who persevere and do appeal a third a third time, the OIG found that the judges reversed 56 percent of all unfavorable decisions in 2010.
Source: kaiserhealthnews.org

Video: Medicare denial code

Medical Billing And Coding: Medicare common denials

Denial reason: Charges exceed your contracted/ legislated fee arrangement. This change to be effective 6/1/07: Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. (Use Group Codes PR or CO depending upon liability).
Source: blogspot.com

Payers Turning to Patients to Fight Denied Claims

I’ve seen it three times in the past week alone where benefits provided by an insurance company representative at a specified and documented time were grossly incorrect. Unfortunately by the time you are made aware that the benefits were incorrect, it is too late and claims have been denied. What is also new is that the insurance company is claiming that the patient is the only one allowed to call and attempt to get this resolved. Is this because we as professionals are all dialed into the insurance companies’ sneaky ways of doing business? That we know how to talk the talk, and walk the walk, and most patients are pushovers and can be intimidated by the insurance company?
Source: physicianspractice.com

How to Avoid Landing in Medicare Hot Water : Physiospot

ACL Acupuncture Adherence Anatomy Ankle Ankylosing Spondylitis Assessment Asthma Balance Biomechanics Cardiac Cardiac Rehab CBT Cerebral Palsy Cervical Chronic Pain CIMT Clinical Guidelines Clinical Prediction Rule clinic management software Contemporary Interventions COPD Critical Care Current Affairs Cystic Fibrosis Diabetes Eccentric Exercise education eHealth EIM Elbow Electrophysical Electrotherapy Evidence In Motion Exercise Performance Exercise Therapy Falls Fatigue Fibromyalgia Foot Gait Haemodynamics Hamstrings Hand Headache Head Injury Help Hip Hydrotherapy ICU Imaging Incontinence Injection Therapy Knee LBP Lumbar Manipulation Manual Techniques Manual Therapy Massage Therapy Metabolic Mobilisation Multiple Sclerosis Muscle Imbalance Neurodevelopmental Neurodynamics Neuromuscular Obesity online clinic management Orthopaedic Rehab Osteoarthritis Osteoporosis Outcome Measures Parkinsons Disease PFPS Pharmacology physical therapy Physiology Pregnancy Pulmonary Rehab Rehabilitation Respiratory Rheumatoid Arthritis Shoulder SIJ Soft Tissue Techniques Spinal Injury Spine Stretching Stroke Stroke Rehabilitation Suction Surgery Taping Telehealth Tendinopathy Thoracic Urgency WCPT Wrist
Source: physiospot.com

Denial of claims: Medicare does it most

An older woman whose doctor prescribed a diagnostic mammogram to detect breast cancer was 180 times more likely to have a claim denied in Southern California than in Northern California or in North Carolina, the auditors said. Likewise, for angioplasty, a technique for opening clogged blood vessels, Medicare denied 1,824 claims as unnecessary for every 10,000 approved in Southern California. Denial rates in North Carolina and Wisconsin were about 300 per 10,000. But in South Carolina and Illinois, Medicare did not reject any claims for this service in 1992.
Source: patientpowernow.org

Radiology Coding Challenge: Why is Medicare Denying a 38792, 78195 Claim

stdClass Object ( [term_id] => 207 [name] => Hot Coding Topics [slug] => hot-coding-topics [term_group] => 0 [term_order] => 0 [term_taxonomy_id] => 207 [taxonomy] => category [description] => The latest news [parent] => 0 [count] => 839 [cat_ID] => 207 [category_count] => 839 [category_description] => The latest news [cat_name] => Hot Coding Topics [category_nicename] => hot-coding-topics [category_parent] => 0 ) [1] => stdClass Object ( [term_id] => 312 [name] => ICD-10 [slug] => icd-10 [term_group] => 0 [term_order] => 0 [term_taxonomy_id] => 4475 [taxonomy] => category [description] => All About ICD-10 [parent] => 0 [count] => 40 [cat_ID] => 312 [category_count] => 40 [category_description] => All About ICD-10 [cat_name] => ICD-10 [category_nicename] => icd-10 [category_parent] => 0 ) [3] => stdClass Object ( [term_id] => 349 [name] => Provider News [slug] => provider-news [term_group] => 0 [term_order] => 2 [term_taxonomy_id] => 104 [taxonomy] => category [description] => Insurers, CMS, etc [parent] => 0 [count] => 278 [cat_ID] => 349 [category_count] => 278 [category_description] => Insurers, CMS, etc [cat_name] => Provider News [category_nicename] => provider-news [category_parent] => 0 ) [4] => stdClass Object ( [term_id] => 102 [name] => Coding Challenge [slug] => coding-challenge [term_group] => 0 [term_order] => 3 [term_taxonomy_id] => 102 [taxonomy] => category [description] => Test Your Skills [parent] => 0 [count] => 234 [cat_ID] => 102 [category_count] => 234 [category_description] => Test Your Skills [cat_name] => Coding Challenge [category_nicename] => coding-challenge [category_parent] => 0 ) [5] => stdClass Object ( [term_id] => 350 [name] => Toolkit [slug] => toolkit [term_group] => 0 [term_order] => 4 [term_taxonomy_id] => 110 [taxonomy] => category [description] => Coding & Billing Tools [parent] => 0 [count] => 133 [cat_ID] => 350 [category_count] => 133 [category_description] => Coding & Billing Tools [cat_name] => Toolkit [category_nicename] => toolkit [category_parent] => 0 ) ) –>
Source: inhealthcare.com

Who Denies the Highest Percent of Claims? Medicare.

The patients began writing and calling and pressuring CMS. CMS offices accused us of fraud, and were dishonest to our patients by telling them it was our problem, not theirs. With help from Senator Pat Roberts, we were finally able to receive payment for these improperly denied claims. Our bariatric office staff spent 60% of their time for several months trying to resolve these issues. This was time away from processing new patients, and running the rest of our practice. This is one example of the horror stories that await all physicians when the government has absolute power of the purse.
Source: ncpa.org

RRCA Roads Scholar Wins Bupa Edinburgh Cross Country

Posted by:  :  Category: Medicare

BUPA-NHS Reversion by imjustcreativeFresh off of her win at the USA Club Cross Country Championships, Mattie Suver finished on the podium in the senior women’s 6 km as she finished third in 21:00. Full Team USA Senior Women’s results: 7th Ladia Albertson-Junkans (21:08); 11th Brianne Nelson (21:14); 16th Addie Bracy (21:33); 18th Meghan Peyton (RRCA Roads Scholar – 2011) (21:38); 20th Jamie Cheever (21:41); 21st Stephanie Price (21:43); 24th Sarah Boyle (21:59); 29th McKenzie Melander (22:58).
Source: rrca.org

Video: The Bupa story

Bupa Westminster Mile to be held May 26, 2013, release, note by Larry Eder

It is hoped the competition will attract more than 5,000 entrants in its first year with a view to it becoming a regular fixture in the national sporting calendar. The Bupa Westminster Mile will also act as the official UK Road Mile Age Group Championship and sponsorship contracts from adidas will be awarded to the winners of the junior and senior races. 
Source: runblogrun.com

Bupa to be Australia’s biggest

“We have spent a significant amount of time considering the available businesses on the market and believe that the Innovative Care portfolio represents the best strategic fit given its high quality and leading reputation for care services in the communities where it operates,” Mr Gregersen said.
Source: com.au

BUPA cut ‘Domicillary Only’ providers from their UK Network.

Unbelievable, how does this bare any relation to ‘treating physiotherapists fairly’? When are we all going to wake up and start a non-BUPA provide network. I have been suggesting this for years but it seems there are only about 3-4 other who get it. Maybe we have to be totally crushed as a profession by the health insurance companies before a fire might rise from the ashes. Unfortunately it seems in Britain this is an unlikely possibility. Similar Threads:
Source: physiobob.com

BUPA Great South Run – register now for just £1

The RNLI have a strong presence in Hampshire and the Isle of Wight with local stations working to keep the waters of the Solent as safe as possible for all users. Portsmouth Lifeboat Station is one of the busiest in the country and in 2011 launched 104 times in response to distress calls. It was also recently announced that Calshot was the third busiest coastal lifeboat station in the whole of the UK and Republic of Ireland this summer.
Source: co.uk

Tour Down Under 2013 Stage 4 BUPA Challenge

In addition if you want enlargements of your photos we can supply them. Please contact Tim at sales@dreamsportphotography.com for pricing. We also have a price structure for royalty free images. Please contact us for details if interested.
Source: dreamsportphotography.com

JustGiving chosen as online fundraising partner for Bupa Great North Run event series

Clare Jones-Leake, Head of Giving Something Back, Vodafone UK said: “This will be the first time for many, as they add text to their fundraising efforts and see the benefits of quick, easy spur of the moment donations which are free to send with 100% of the donation being passed to their charity.”
Source: co.uk

Bupa Foundation: annual prizes in sport, exercise and health

The Bupa Foundation invites applications for its annual prizes. These recognise excellence in medical research and health care. £60,000 will be allocated for completed research or development that has been conducted over the past three years into each of the following research themes:
Source: ac.uk

Medicare payment rate for hospices should not rise in 2014, MedPAC says

Posted by:  :  Category: Medicare

The final recommendation reflects what was in a December draft. That recommendation pointed out that 10.2% of hospice facilities exceeded the 2010 payment cap, which was a lower number than in previous years, indicating adjustment to the cap, according to the Bureau of National Affairs. Additionally, MedPAC said strong growth in the hospice sector showed capital is available.
Source: mcknights.com

Video: Medicare Hospice, American Journal Of Palliative Care

Medicare covers hospice & comfort care

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

New Research Validates That Hospice Saves Medicare Dollars

Led by Amy S. Kelley, MD, MSHS, from the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mt. Sinai, researchers looked at the most common hospice enrollment periods: 1 to 7 days, 8 to 14 days, 15 to 30 days, and 53 to 105 days. Within all enrollment periods studied, hospice patients had significantly lower rates of hospital and intensive care use, hospital readmissions, and in-hospital death when compared to the matched non-hospice patients.
Source: angelleshpc.com

On the Way to Hospice, Surprising Hurdles

This probably explains why the researchers found that smaller hospices were more likely than large ones to say no to patients receiving such treatments. “If you’re a small hospice caring for someone with many medical issues and the reimbursement doesn’t even cover the care – and then Medicare comes to take it back – that’s a big hit,” Dr. Aldridge Carlson said. Larger organizations with more patients and bigger budgets can better absorb the costs.
Source: nytimes.com

How to Choose a Medicare Hospice Service Provider

Medicare beneficiaries have the right to choose the hospice that best fits their individual needs. Medicare hospices, and there are many in the Phoenix area, must all follow the same regulations as set forth by Medicare in the hospice Conditions of Participation (www.cms.gov) and each is paid the same amount for hospice services, also set by Medicare. In interviewing different hospices, you should hear about the same answers to your questions from each one.
Source: allegianthospice.org

New Research Validates That Hospice Saves Medicare Dollars

A Hospice Chaplain? No Alleviating Fear An Outstanding Hospice Volunteer Building Relationships with Families carol louden Carol Louden – A Vigilant Volunteer cottage in the meadow Dia de los Muertos Dia de los Muertos in Yakima Funeral Planning Grief Support Groups Grieving Now or Later—It’s Up to You (Part 1) Grieving Now or Later—It’s Up to You (Part 2) Helping Your Kids Cope with Loss—Part II Holiday Sadness Hospice Groundbreaking hospice in yakima hospice volunteers Hospice Volunteer Training How to Help the Kids Cope with Loss—Part I I Can’t Believe They Said THAT!! I need something to distract me from my grief. It’ll Calm Me journaling tips Last Days Learn to have patience with yourself national hospice month National Hospice Month Events in Yakima News & Events Archive Now Where Shall I Go? Preparing For End of Life Event Real Living Safeway managers check out Cottage in the Meadow Talking with Kids about Loss Thanks the chruch blues The Craziness Of The Season The Funeral’s Over The Letter Unsure How to Handle a Loved One’s Grief What Should We Do at the Bedside? Why is This Taking So Long? yakima hospice Yakima Volunteer training “Hands On” Volunteer
Source: memfound.org

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

San Diego Hospice Files For Bankruptcy

The financial woes facing San Diego Hospice, which has slashed its workforce and patient load, might not be isolated. Hospices nationwide are under intense scrutiny from Medicare, and facing lower growth in their reimbursement levels. “There’s a bit of a squeeze going on. Hospices have to do more with less, and you can see how that could take its toll over time,” said Theresa M. Forster, vice president for hospice policy and programs at the National Association for Home Care & Hospice, a trade group.
Source: kaiserhealthnews.org

Seniors Face Higher Medicare Deductibles, Part B Premiums

Posted by:  :  Category: Medicare

"Associate yourself with men of good quality if you esteem your own reputation, for 'tis better to be alone than in bad company." ~ George Washington. by eyewashdesign: A. GoldenLiving on a fixed income can be very challenging, and Social Security alone is really not enough for most people.  And even if you could get by on Social Security on the day that you retire costs inevitably go up and cost-of-living adjustments are very modest to say the least.
Source: frankkraft.com

Video: Medicare Part B_1.wmv

Hearing aids and health insurance: are you covered?

While an adults’ struggle with hearing loss and the costs involved seems unfair, the situation is even more irritating when it comes to hearing aids for children.  Hearing is essential for a child’s development of speech, language, and social skills.  Children can feel even more isolated and depressed if their hearing loss goes unaided or unaddressed.  While generally as expensive as adult hearing aids, children’s hearing aids may require more adjustment and replacement as they grow and develop.  This only makes the price higher and places hearing aids further out of reach for more families.
Source: wordpress.com

Medicare Part B Premiums Up $5 Per Month Next Year

CQ HealthBeat: Medicare Part B Premium Increase Modest For 2013 With health care inflation relatively stable, officials at the Centers for Medicare and Medicaid Services released rules Friday that include a $5-per-month increase in Medicare Part B premiums and a $28 hike in the hospital inpatient deductible. The Part B premium will reach a milestone, however, topping $100 a month. The monthly payment for Part B, which covers doctor visits, outpatient hospital services, home health care and other items, will be $104.90 next year, compared to the current $99.90. And the deductible for inpatient hospital stays will go to $1,184 in 2013 from $1,156 this year. One item will be decreasing: the Part A monthly premium, which pays for inpatient hospital stays, skilled nursing facilities and some home care for about 1 percent of Medicare beneficiaries who do not automatically qualify for the program. That premium will be $441 a month, down $10 a month from this year (11/16).
Source: kaiserhealthnews.org

AARP Statement on 2013 Medicare Part B Premium Increase

AARP is a nonprofit, nonpartisan organization, with a membership of more than 37 million, that helps people 50+ have independence, choice and control in ways that are beneficial to them and society as a whole. AARP does not endorse candidates for public office or make contributions to either political campaigns or candidates. We produce AARP The Magazine, the definitive voice for Americans 50+ and the world’s largest-circulation magazine; AARP Bulletin, the go-to news source for the 50+ audience; AARP VIVA, a bilingual lifestyle multimedia platform addressing the interests and needs of Hispanic Americans; and national television and radio programming including My Generation and Inside E Street. The AARP Foundation is an affiliated charity that provides security, protection, and empowerment to older persons in need with support from thousands of volunteers, donors, and sponsors. AARP has staffed offices in all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. Learn more at www.aarp.org.
Source: aarp.org

Medical Imaging Not Driving Escalating Medicare Costs

“This study confirms that medical imaging costs are down significantly in recent years and runs counter to the misconceptions that imaging scans serve a primary role in rising medical costs,” said Levin. “This study should provide lawmakers and regulators with more current information on which to base medical imaging policies and allow them to correctly focus on other areas of medicine that may be seeing rising costs.”
Source: diagnosticimaging.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

ABCs of Medicare: What is Part B?

What does Part B cover? Part B covers medical and preventive services. Coverage rules can differ depending on whether a beneficiary has a Medicare Advantage Plan or other Medicare plan. However,  your plan must give you at least the same coverage as Original Medicare. (Original Medicare is fee-for-service coverage under which the government pays your health care providers directly for your Part A and/or Part B benefits.) Additionally, some services may only be covered in certain settings or for patients with certain conditions.
Source: nhcoa.org

OIG Report: Medicare Part B Overpaying for Infusion Medications

Posted by:  :  Category: Medicare

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

Video: Do I need to enroll in Medicare part B if I have VA benefits

WCH Service Bureau, Inc: Get great experience Medicare Part B Enrollment and receive 10% for any credentialing packages

WCH Medical billing, coding and credentialing blog. Don’t Miss the Latest Healthcare Industry News. WCH will provide you with the daily breaking news . WCH is proud to offer complimentary, unique and educational publications to all clients and visitors of our blog.
Source: blogspot.com

Office of Statewide Benefits provides information on Medicare Parts A, B enrollment

Failure to enroll and maintain enrollment in Medicare Parts A and B upon eligibility may result in the subscriber being held financially responsible for the cost of all claims incurred, including prescription costs. Retirees and spouses enrolled in Medicare Parts A and B must provide a copy of their Medicare Identification Card to be enrolled in the state of Delaware Special Medicfill plan.
Source: udel.edu

Schumer and Pierluisi Introduce Puerto Rico Medicare Equity Legislation

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

Is Medicare Part B Enrollment Necessary?

Part B covers several medical needs that Part A does not. It helps cover many outpatient services you may need including doctor visits, clinical laboratory services, as well as some preventive services including examinations. Maybe this will clarify the situation better. The Original Medicare Part A is pretty black and white about coverage, leaving you to add Part B for any other medical coverage.
Source: seniorcorps.org

Illinois Medicare Enrollment Process

Medicare Part A and Part B will not pay all of your health care costs and in many cases, you will need to supplement coverage with additional insurance. If you are planning on continuing to work and receive group coverage through an employer, you may not need to add coverage and you should check your plan for details. If you are retired or plan on retiring, like many Illinois residents, you may want to choose to supplement Original Medicare with Medicare supplement or Medigap coverage.  As an Illinois resident, you must be enrolled in both Medicare Part A and Part B to be eligible to purchase Medicare supplement insurance, but you cannot be denied coverage if you purchase A Medigap policy during your “open enrollment period” (6 month period after enrolling in Part B).
Source: ssiinsure.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 Advantage Question

Initial Coverage Election Period (ICEP)The period where individuals newly eligible for Medicare can join a Medicare Advantage plan. This period is 7 months: 3 months before Medicare eligibility, the month when both Part A and Part B benefits start, and 3 months after. If a person delays enrolling in Part B because he or she is covered by an employer group health plan, the ICEP is 3 months; the 3 months before both Part A and Part B benefits are effective. For example, if both Part A and Part B benefits start December 1, the 3-month ICEP starts September 1 and ends November 31
Source: insurance-forums.net

Financial Stakes for Chicagoland: Medicare Part B Payment

There are exceptions to this rule. As an example, you can delay your Medicare Part B enrollment without having to pay higher premiums if you are covered under a group health plan based on your own current employment or the current employment of any family member. If this situation applies to you, you have a “Special Enrollment Period” in which to sign up for Medicare Part B, without paying the premium surcharge for late enrollment. 
Source: blogspot.com

Medicare Part B Enrollment When Working Beyond 65

By law, people who continue to work beyond age 65 still must be offered the same health insurance benefits (for themselves and their dependents) as younger people working for the same employer. So your employer cannot require you to take Medicare when you turn 65 or offer you a different kind of insurance — for example, by paying the premiums for Medicare supplemental insurance or a Medicare Advantage plan — as an inducement to enroll in Medicare and drop your employer plan. However, this law (known as ERISA) applies only to employers with 20 or more workers.  So if you work for a smaller business or organization, you may be required to enroll in Part B at age 65. Do I need to do anything about Part B at age 65 if I continue to be insured at work? It depends on whether you’re already receiving Social Security retirement benefits.  If you are, Social Security will automatically enroll you in Part A and Part B just before your 65th birthday.  The letter sent to you with your Medicare card explains your right to opt out of Part B if you have employer insurance.  To opt out, follow the instructions included in that letter within the specified deadline.
Source: aarp.org

3 Tips for Avoiding Pitfalls in Medicare Enrollment

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Source: iaminvest.com

US Proposes Scrapping Some Obsolete Medicare Regulations

Posted by:  :  Category: Medicare

OBAMAS DEATH PANEL------ GUESS WHAT FOLKS IT'S ALIVE AND WELL---"CRAZY PALIN" NOT SO CRAZY NOW by SS&SSComments are not pre-screened before they post. Charisma Media reserves the right to modify or remove any comment that does not comply with the above guidelines and to deny access of your Disqus account to make additional comments to the website without any notice. If you have been denied access to comment due to a violation of these terms please do not create multiple accounts in an attempt to circumvent the system. The correct course of action is to request a review of your account status by contacting webmaster@charismamedia.com.
Source: charismamag.com

Video: clinical chart documentation review crosswalking CMS Medicare 2010 regulations.mov

Obama Administration Proposes Eliminating ‘Obsolete’ Medicare Regs

The Medicare NewsGroup: Troubling Trends On Disability As A Back Door Into Medicare No publicly presented Medicare reform proposal has addressed the growing problem of those younger than age 65 who are finding their way into the program through permanent disability. Those who qualify for Social Security Disability Insurance (SSDI) and who have been disabled for at least two years are automatically enrolled in Medicare, no matter their age. That means a growing number of those under age 65 — at least five million people — are qualifying for lifetime benefits, according to a recent tally published in the journal Health Affairs. Policymakers are concerned about the rise in disabled adults because they often require expensive care, putting even more pressure on the health care system (Wasik, 2/4).
Source: kaiserhealthnews.org

CMS proposes removal of burdensome Medicare regulations

The proposed rule would relax several physician supervision requirements, especially for small critical access hospitals, rural health clinics and federally qualified health centers. For example, those facilities would no longer need a physician onsite once every two weeks. The administration recognizes that geographical location makes this difficult and that advances in telemedicine allow physicians to provide care without being physically present.
Source: bartonassociates.com

CMS Proposes Medicare Reforms to Save Hospitals $676M Per Year

HHS and CMS have issued a proposed rule (pdf) that would modify or eliminate Medicare regulations deemed to be unnecessary or obsolete — reforms the government expects will save hospitals and healthcare providers up to $676 million per year and $3.4 billion over five years. “We are committed to cutting the red tape for healthcare facilities, including rural providers,” HHS Secretary Kathleen Sebelius said in a news release. “By eliminating outdated or overly burdensome requirements, hospitals and healthcare professionals can focus on treating patients.” The following provisions were included within the proposed rule: •    Qualified dietitians would be able to order patient diets and meals at hospitals without requiring the supervision of a physician or other practitioner, which will “free up time for physicians and other practitioners to care for patients,” according to HHS. •    Critical access hospitals would no longer need to develop patient care policies with the guidance of at least one member who is not a member of the CAH staff. The government said the old policy resulted in too much turnover, unnecessary pay for outside personnel and lost time. •    CAHs would not have to require a physician to be onsite once every two weeks. •    Ambulatory surgery centers currently must meet full hospital requirements for radiology services even though they are only allowed to provide limited radiology services. The rule proposes that ASCs only meet radiological requirements for services they actually perform. •    Hospitals would no longer have to require a pharmacist or physician be present during off-hour deliveries of nuclear medicine tests. Overall, CMS estimates one-time savings of $22 million and annual recurring savings of $654 million. “Several of the proposed changes would create measurable monetary savings for providers and suppliers, while others would create less tangible savings of time and administrative burden,” according to the rule. Public comments are due April 8.
Source: beckershospitalreview.com

Medicare Surtax Regulations Are Out

to help employers implement the additional .9% Medicare surtax for wages, self-employment income and other compensation. Effective January 1, 2013, employers must begin withholding this additional .9% Medicare tax for employees with wages in excess of $200,000. For a joint return on which neither spouse earns more than $200,000 but, when combined, results in earnings of more than $250,000, the tax is due but the employer will not be responsible for the added withholdings.
Source: wscpa.org

Comments on proposed IRS regulations on additional Medicare tax due March 5

With regard to specific matters discussed in the proposed regulations, taxpayers may rely on the proposed regulations for tax periods beginning before the date that the final regulations are published in the Federal Register. If any requirements change in the final regulations, taxpayers will only be responsible for complying with the new requirements from the date of their publication. ■
Source: cbia.com

Medicare Reform Proposal Could Save Providers $676 Million Annually

“We are committed to cutting the red tape for healthcare facilities, including rural providers,” said Health and Human Services Secretary Kathleen Sebelius. “By eliminating outdated or overly burdensome requirements, hospitals and healthcare professionals can focus on treating patients.”  The proposed rule is designed to help healthcare providers operate more efficiently by eliminating regulations that are out of date or no longer needed. Many of the rule’s provisions streamline the standards healthcare providers must meet in order to participate in the Medicare and Medicaid programs without jeopardizing beneficiary safety.  For example, a key provision reduces the burden on very small critical access hospitals, as well as rural health clinics and federally qualified health centers, by eliminating the requirement that a physician be held to an excessively prescriptive schedule for being onsite once every two weeks.  This provision seeks to address the geographic barriers and remoteness of many rural facilities, and recognize telemedicine improvements and expansions that allow physicians to provide many types of care at lower costs, while maintaining high-quality care.    Among other provisions, the proposed rule would:
Source: nutraceuticalsworld.com

Proposed Regulations Explain 3.8 Percent Medicare Tax on Net Investment Income : The Venture Alley : Entrepreneurs, Startups, Venture Capital, Angel Investors

These proposed regulations, released at the end of November along with accompanying frequently asked questions, provide taxpayers and their advisors much needed guidance in interpreting the statutory provisions imposing this tax. Despite application of the tax beginning in 2013, the effective date of the proposed regulations has been delayed until January 1, 2014. To assist taxpayers, the IRS has stated that taxpayers may rely on the proposed regulations for compliance purposes until publication of final regulations under Section 1411, which is anticipated to occur during 2013. The proposed regulations indicate that the IRS will closely review transactions that manipulate a taxpayer’s “net investment income” to reduce or eliminate the amount of tax imposed by Section 1411 and will challenge such transactions based on applicable statutes and judicial doctrines. Therefore, careful tax planning to accommodate this new tax is essential. Among other things, these proposed regulations provide definitions of operative phrases and terminology in the statute, indicate where definitions used elsewhere in the Code should be incorporated into the statute, identify how certain entities are treated under Section 1411, expand income categories potentially subject to the tax, allow taxpayers to regroup activities with respect to the passive activity grouping rules and describe how the tax applies to dispositions of interests in passthrough entities and income/distributions from certain foreign entities.
Source: theventurealley.com

U.S. proposes scrapping some obsolete Medicare regulations

The Department of Health and Human Services described the targeted regulations as unnecessary or excessively burdensome and said their proposed elimination would allow greater efficiency without jeopardizing safety for the Medicare program’s elderly and disabled beneficiaries.
Source: audishusarart.com

Medicare and Medicaid Statistical Analyst, Integrity Management Services, LLC

The analyst will possess strong analytical skills and able to use statistical software including SAS, SQL, Business Objects, MS Excel, and MS Access. Specifically, the analyst should possess SAS programming knowledge and intermediate level experience with SAS macros, PROC REPORT, SAS/GRAPH procedures, SAS ODS, PROC UNIVERIATE, PROC TTEST, PROC MEANS, and PROC FREQ, SAS/GIS. The analyst should also have experience applying statistical concepts including t-tests and chi-square, to large datasets. The analyst should have experience with analyzing and interpreting data, maintaining and manipulating large datasets, ensuring integrity of the data, performing quality assurance, and formally writing results for submission in final reports. Additionally, the analyst may research specific regulatory and industry information regarding Medicare and Medicaid to support statistical analysis.
Source: caucusforwomeninstatistics.com

CMS Proposes Medicare Advantage, Part D Drug Plan Medical Loss Ratio Rule and Advance 2014 Rate Information : Health Industry Washington Watch

On February 15, 2013, CMS released a proposed rule implementing the ACA’s medical loss ratio (MLR) requirements for Medicare Advantage (MA) and prescription drug (Part C and Part D) plans. Under these provisions, which are intended to limit plan spending on marketing, overhead, and profit, MA organizations and Part D plan sponsors will be required to report their MLR, reflecting the percentage of contract revenue spent on clinical services, prescription drugs, quality improving activities, and direct benefits to beneficiaries in the form of reduced Part B premiums. CMS has generally aligned the Medicare MLR rules with commercial MLR regulations that went into effect January 1, 2011.  Plan sponsors that do not have an MLR of at least 85% will be subject to payment remittance; if a plan sponsor fails to meet MLR requirements for more than 3 consecutive years, it also will be subject to enrollment sanctions and, after 5 consecutive years, to contract termination. CMS expects the first year of MLR reporting to occur in 2015 for the 2014 contract year. Comments on the proposed rule will be accepted for 60 days. The official version of the proposed rule will be published in the Federal Register on February 22, 2013.
Source: healthindustrywashingtonwatch.com

Emdeon Current: New Payer Transactions

Posted by:  :  Category: Medicare

Claims Management Services, Payer ID: 39141 Clarian Health Plans Inc., Payer ID: 95444 Connecticare – Medicare, Payer ID: 78375 CoreSource Little Rock, Payer ID: 75136 DiaTri LLC, Payer ID: 36439 Employee Benefit Systems, Payer ID: 42149 Fallon Community Health Plan, Payer ID: 22254 GHI – Medicare Private Fee for Service, Payer ID: 22937 GHI – New York (Group Health Inc.), Payer ID: 13551 GHI HMO, Payer ID: 25531 Geisinger Health Plan, Payer ID: 75273 Group Health Cooperative of South Central Wisconsin, Payer ID: 39167 Group Health Inc., Payer ID: 22937 HIP – Health Insurance Plan of Greater New York, Payer ID: 55247 Harrington Health-Kansas (formerly known as Fiserv Health-Kansas), Payer ID: 62061 Harvard Pilgrim Health Care, Payer ID: 4271 ISLAND HOME INSURANCE COMPANY, Payer ID: IU Medical Group Primary Care, Payer ID: SX172 Integra Group, Payer ID: 31127 LIFE Pittsburgh, Payer ID: 25181 Landmark Healthcare Inc, Payer ID: LNDMK MED PAY, Payer ID: 88058 MEDICA HEALTH CARE PLAN INC., Payer ID: 78857 March Vision Care Inc., Payer ID: Call Meritain Health / Agency Services, Payer ID: 64158 Meritain Health/North American Administrators, Payer ID: 64157 Metropolitan Health Plan, Payer ID: 10850 Montefiore Contract Management Organization, Payer ID: 13174 Network Health, Payer ID: 4332 Network Health Insurance Corp-Medicare, Payer ID: 77076 North American Administrators Inc., Payer ID: 64157 North American Health Plan, Payer ID: 64157 North American Preferred, Payer ID: 64157 Northstar Advantage, Payer ID: 60058 ODS Health Plan, Payer ID: 13350 PacificSource Health Plans, Payer ID: 93029 Paragon Benefits Inc., Payer ID: 58174 Prism-First Health, Payer ID: 37303 Screen Actors Guild, Payer ID: 99289 Touchstone Health PSO, Payer ID: 23856 Trellis Health Partners, Payer ID: 36397 Vytra Healthcare, Payer ID: 22264 Weyco Inc., Payer ID: 38232 Wisconsin Department of Corrections, Payer ID: 74101 Anthem Blue Cross, Payer ID: 47198 Associated Benefits, Payer ID: 50266 Blue Cross Blue Shield of New Mexico, Payer ID: SB790 Blue Cross Blue Shield of Oklahoma, Payer ID: SB840 Illinois Medicaid, Payer ID: SKIL0 Nebraska Medicaid, Payer ID: SKNE0 New Hampshire Medicaid, Payer ID: SKNH0 Eligibility Inquiry and Response Ameritas Group, Payer ID: AMERITAS Ameritas Life Insurance Company, Payer ID: 425 CoreSource – FMH, Payer ID: CORSE00204 CoreSource – FMH, Payer ID: CRSKC CoreSource – Little Rock, Payer ID: CORSE00205 CoreSource Little Rock, Payer ID: CRSAR Coresource – FMH, Payer ID: 204 Coresource Little Rock, Payer ID: 205 First Ameritas of New York, Payer ID: 426 First Ameritas of New York, Payer ID: AMTAS00426 First Reliance Standard Life Ins Co., Payer ID: 428 First Reliance Standard Life Insurance Company, Payer ID: AMTAS428 MMSI, Payer ID: 85 MMSI, Payer ID: MMSI Medica, Payer ID: 404 Medica, Payer ID: MEDIC Medical Mutual of Ohio, Payer ID: 211 Medical Mutual of Ohio, Payer ID: MMO00211 Nippon Life Benefits, Payer ID: NIPON Peoples Health, Payer ID: PPLSH Reliance Standard Life Insurance Company, Payer ID: 427 Reliance Standard Life Insurance Company, Payer ID: AMTAS00427 SAMBA Health Benefit Plan, Payer ID: SAMBA Standard Insurance Company, Payer ID: 429 Standard Insurance Company, Payer ID: AMTAS00429 Standard Life Insurance Company of New York, Payer ID: 430 Standard Life Insurance Company of New York, Payer ID: AMTAS00430 ameritas, Payer ID: AMTAS00425 Blue Cross Blue Shield of Pennsylvania (Highmark), Payer ID: BCPAC Blue Cross Blue Shield of Pennsylvania – Highmark, Payer ID: 440 Mountain State, Payer ID: MTNST Affinity Health Plan, Payer ID: AFNTY New Jersey Medicaid, Payer ID: AID19 New Jersy Medicaid, Payer ID: NJ South Dakota Medicaid, Payer ID: AID28 South Dakota Medicaid, Payer ID: SD Claim Status And Response: Ameritas Group, Payer ID: AMERITAS Ameritas Life Insurance Company, Payer ID: 425 CoreSource – FMH, Payer ID: CORSE00204 CoreSource – FMH, Payer ID: CRSKC CoreSource – Little Rock, Payer ID: CORSE00205 CoreSource Little Rock, Payer ID: CRSAR Coresource – FMH, Payer ID: 204 Coresource Little Rock, Payer ID: 205 First Ameritas of New York, Payer ID: 426 First Ameritas of New York, Payer ID: AMTAS00426 First Reliance Standard Life Ins Co., Payer ID: 428 First Reliance Standard Life Insurance Company, Payer ID: AMTAS428 MMSI, Payer ID: 85 MMSI, Payer ID: MMSI Medica, Payer ID: 404 Medica, Payer ID: MEDIC Nippon Life Benefits, Payer ID: NIPON Peoples Health, Payer ID: PPLSH Reliance Standard Life Insurance Company, Payer ID: 427 Reliance Standard Life Insurance Company, Payer ID: AMTAS00427 SAMBA Health Benefit Plan, Payer ID: SAMBA Standard Insurance Company, Payer ID: 429 Standard Insurance Company, Payer ID: AMTAS00429 Standard Life Insurance Company of New York, Payer ID: 430 Standard Life Insurance Company of New York, Payer ID: AMTAS00430 For all payers, visit https://access.emdeon.com/PayerLists/
Source: blogspot.com

Video: Standard of Living in the United States and China, Medicare Prescription Drug Benefit (2012)

835 (ERN) FILES FROM MEDICARE

If your files have stopped coming, you need to complete the form. CLICK HERE and complete the 5010 Production Transition form online. It can take 5 to 10 business days to process the form. Once it is processed, you will receive a confirmation email from NGS. There is nothing else to set up or do once confirmed and you should start receiving your 835 ERN files thereafter.
Source: wordpress.com

Revisiting Those Explanations of Benefits

Trudy Lieberman, a journalist for more than 40 years, is an adjunct associate professor of public health at Hunter College in New York City. She had a long career at Consumer Reports specializing in insurance, health care, health care financing and long-term care. She is a longtime contributor to the Columbia Journalism Review and blogs for its website, CJR.org, about media coverage of health care, Social Security and retirement. As a William Ziff ‘ fellow at the Center for Advancing Health, she contributes regularly to the Prepared Patient Forum blog. More’ Katie Ryan-Anderson, a health reporter at the Jamestown Sun in Jamestown, North Dakota, had a question.’  What did all that gobbledygook on the Explanation of Benefits (EOBs) from Blue Cross Blue Shield of North Dakota mean?’  Her infant son had been sick and the bills were coming in along with those indecipherable statements from her insurance company. Ideally, an EOB should in clear language identify the medical services provided, what the insurer paid, and what the patient still owes, if anything.’  But as I have reported before, too many EOBs miss the mark; they are confusing rather than illuminating.’  Ryan-Anderson’s EOBs were no exception.’  One showed that Blue Cross had made five payments to Medcenter One Health System.’  It listed the total charge, covered amount, and the amount Ryan-Anderson had to pay on her own.’ ‘  That was straightforward enough.’  On another page, the insurer gave a breakdown of charges and benefits.’  Here’s where clarity fell apart. The amounts of the charges submitted by providers were clear enough ‘ there was a $9 charge for an office laboratory service.’  But the columns called ‘covered amounts’ began to muddy Ryan-Anderson’s understanding.’ ‘  The covered amounts included a ‘provider discount’ ‘ the rate the provider agreed to accept from the insurer ‘ and an amount that Blue Cross would pay.’ ‘  It took a few minutes to figure it all out.’  The insurer had negotiated a discount with the provider, which was $2.28.’  So Blue Cross would pay just $6.05 of the $9 charge. ‘ ‘ She would have to pay the difference remaining, sixty-seven cents, which was added to her yearly coinsurance tally. ‘ At least Blue Cross had used the term ‘provider discount.”  Some EOBs use the term ‘insurance disallowance.”  That one stops me cold and would for anyone trying to grasp insurance company jargon. But what exactly were the services Ryan-Anderson’s child received?’  ‘ The EOB identified one service as ‘office laboratory.”  In the same breakdown, there was also a charge for an ‘independent laboratory’ service.’  How could Ryan-Anderson figure out which specimens were sent to which labs without more information?’  How could she shop for a lab that might analyze the sample for less cost? Or plan for future expenses without knowing what tests were provided by whom? If patients are to be transformed into consumers, they need to understand how their insurance coverage works, know what they are paying for, and have access to simple pricing and relevant provider information. EOBs that use vague or opaque terms or fail to identify a service make the job impossible.’ ‘  A Medicare beneficiary I know received an EOB from GHI, a subsidiary of Emblem Health in New York City, advising him he had to pay $533 for ‘durable medical equipment’ supplied by DEGC Enterprises.’  What equipment?’  He had never heard of DEGC Enterprises.’ ‘  He called GHI and learned that Medicare covers test strips and glucose meters for testing blood, but it doesn’t cover the needles.’  GHI, his Medigap carrier, picks up the difference between what Medicare pays and the cost.’  But since Medicare does not cover needles, he’s stuck with the bill.’  How many seniors think of insulin needs as durable medical equipment? Blue Cross did indicate on Ryan-Anderson’s EOB that customers could obtain a step-by-step brochure on how to read its EOB or they could consult an online guide.’  That’s a move in the right direction, but it adds a layer of complexity to the tasks that patients who are sick already face.’  Unless you know what services are given and what they cost, you’re buying a pig in a poke for health care. ‘ Related Posts from Trudy Lieberman:
Source: cfah.org

Deforming Medicare into a Competitive Bidding System (interlude)

Medicare is a fee-for-service insurance program in which the federal government serves as an insurance agent for the nation’s retired population (Oberlander 2003). Medicare Part A, financed through payroll tax contributions, covers hospital care for seniors. Medicare Part B is a voluntary program that pays for doctors’ visits and outpatient services; nearly 98 percent of those eligible take up this benefit, and currently monthly premiums on seniors cover 25 percent of costs, with general revenues paying the rest. Complex cost-sharing arrangements characterize the program, with annual deductibles and co-payments for hospital visits and doctors’ visits on top of the monthly premiums for Part B. There is no cap on out-of-pocket expenses for beneficiaries, and all together, beneficiaries are liable for about half the cost of acute care (Moon 2001). Also, Medicare was not designed to cover all needs, as most long-term care and prescription drugs were excluded from coverage.
Source: correntewire.com

Lý Tưởng Người Việt: UỐNG NHIỀU THUỐC QUÁ!

Medicare muốn các bác sĩ đừng lười, thường xuyên xem xét các thuốc dùng của người bệnh, bỏ bớt được thuốc nào hay thuốc nấy, và trước khi đặt bút biên toa một thuốc mới, suy tính, cân phân, tránh dùng những thuốc có thể gây hại cho các vị cao niên. (Quả có một số bác sĩ lười thực, thăm khám qua quít chỉ vài phút, thuốc men toàn cho thêm chứ không bao giờ bớt để cho nhanh, khỏi nhức đầu suy tính!). Rồi đây Medicare sẽ chuyển từ hệ thống chi trả fee-for-service (người bệnh cứ ghi tên vào khám là bác sĩ được trả tiền, trong phòng khám bác sĩ khám lâu mau, có chăm sóc cho người bệnh đàng hoàng hay không chẳng ai biết) sang hệ thống pay-per-performance (chi trả dựa theo dịch vụ của bác sĩ có tốt hay không). Cụ thể là vào tháng 9/2013 tới đây, theo dự định, 520.000 vị cao niên Medi-Medi (vừa có Medicare vừa có Medi-Cal) ở California sẽ buộc phải gia nhập một tổ hợp y tế, chỉ một bác sĩ trong tổ hợp sẽ chịu trách nhiệm chữa trị. Nếu nhiều bác sĩ trong tổ hợp lười, không làm “good job”, không chăm sóc cho người bệnh trong tổ hợp đàng hoàng, Medicare sẽ cắt bớt tiền trả tổ hợp, và tất nhiên, bác sĩ sẽ bị cắt bớt tiền trả mỗi đầu tháng. Trong các điều kiện Medicare đưa ra để một tổ hợp được xem là tốt, có điều kiện buộc các bác sĩ trong tổ hợp phải tránh dùng những thuốc có hại cho người bệnh cao niên. Trong hệ thống tổ hợp y tế, các bác sĩ phải làm việc đàng hoàng hơn, người bệnh được chăm sóc cẩn thận hơn.
Source: blogspot.com

Medicare Part B Enrollment When Working Beyond 65

By law, people who continue to work beyond age 65 still must be offered the same health insurance benefits (for themselves and their dependents) as younger people working for the same employer. So your employer cannot require you to take Medicare when you turn 65 or offer you a different kind of insurance — for example, by paying the premiums for Medicare supplemental insurance or a Medicare Advantage plan — as an inducement to enroll in Medicare and drop your employer plan. However, this law (known as ERISA) applies only to employers with 20 or more workers.  So if you work for a smaller business or organization, you may be required to enroll in Part B at age 65. Do I need to do anything about Part B at age 65 if I continue to be insured at work? It depends on whether you’re already receiving Social Security retirement benefits.  If you are, Social Security will automatically enroll you in Part A and Part B just before your 65th birthday.  The letter sent to you with your Medicare card explains your right to opt out of Part B if you have employer insurance.  To opt out, follow the instructions included in that letter within the specified deadline.
Source: aarp.org