CMS Announces PECOS Activation for May 1, 2013

Posted by:  :  Category: Medicare

The Affordable Care Act, Section 6405, “Physicians Who Order Items or Services are Required to be Medicare Enrolled Physicians or Eligible Professionals,” requires physicians or other eligible professionals to be enrolled in the Medicare Program to order or refer items or services for Medicare beneficiaries. Some physicians or other eligible professionals do not and will not send claims to a Medicare contractor for the services they furnish and therefore may not be enrolled in the Medicare program. Also, effective January 1, 1992, a physician or supplier that bills Medicare for a service or item must show the name and unique identifier of the attending physician on the claim if that service or item was the result of an order or referral. Effective May 23, 2008, the unique identifier was determined to be the National Provider Identifier (NPI). The Centers for Medicare & Medicaid Services (CMS) has implemented edits on ordering and referring providers when they are required to be identified in Part B, DME, and Part A HHA claims from Medicare providers or suppliers who furnished items or services as a result of orders or referrals.
Source: hcafnews.com

Video: Medicare Provider Enrollment 3.wmv

Implementation of Medicare Ordering/Referring Provider Edits (March 20 Call) : Health Industry Washington Watch

Effective May 1, 2013, Medicare contractors will activate edits that will deny claims for Medicare Part B (including imaging and lab services), DME, and Part A home health agency (HHA) services if the ordering/referring physician or other professional is not identified, is not in Medicare’s enrollment records, or is not of a specialty type that may order/refer the service/item being billed. Concerns have been raised by physicians and suppliers that they could experience claims denials and delays after May 1 based on discrepancies between the names of the ordering physician on the 1500 claim form and in Medicare’s enrollment records. CMS is holding a March 20, 2013 National Provider Call to discuss these new requirements.
Source: healthindustrywashingtonwatch.com

Health Insurers Launch TV Campaign Opposing Medicare Advantage Cuts

The Medicare NewsGroup: Medicare’s Middlemen Await Word From CMS To Put In Play Sequesration Cuts Medicare’s middlemen, the companies that will carry out the administrative work of the automatic budget cuts set to hit Medicare providers on April 1, are waiting for directions from the Centers for Medicare & Medicaid Services (CMS) to put in play provider payment reductions. The updates to the payment systems will ultimately lead to $11 billion in reduced payments to hospitals, doctors and other health care providers for the remainder of fiscal year 2013. These middlemen are Medicare Administrative Contractors (MACs), the private companies that handle the bulk of the entitlement program’s administrative claims processes. They will implement the 2 percent across-the-board payment reductions, mandated by sequestration, which is the result of the federal government’s inability to reach a deficit-reduction deal totaling $1.2 trillion. This means a .02 cent cut for every $1 paid to health care services providers, such as doctors, hospitals, skilled nursing facilities, insurers, medical device suppliers and home health companies (Sjoerdsma, 3/6).
Source: kaiserhealthnews.org

Lawmakers Might Have Time To Avert Medicare Payment Cuts

Call me American citizen. I first want to address Medicare I believe it is disrespectful that we would even consider cutting payments Doctors do not take plain Medicare patients due to payments being so low. We should never take our parents Social Security, Medicare, or the right to have quality medical care away. We should never have our Social Security or health care taken away or deceased.
Source: californiahealthline.org

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

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

SAI Global Compliance Survey Of Healthcare Providers Identifies Audit Awareness Compliance Effectiveness And Training As Top GRC Priorities For 2013

About SAI Global Compliance SAI Global Compliance provides organizations with a wide range of governance, risk and compliance (GRC) products, solutions and services that help build organizational integrity and meet overall business objectives. With more than twenty-five years experience and offices in more than 25 countries, SAI Global’s solutions include a wide range of GRC products and services including the Compliance 360 GRC Software Suite, best practice Code of Conduct program services and training, compliance and ethics training and awareness, risk and culture assessments, a full range of advisory services, whistleblowing hotline services, regulatory knowledge, policy management, case management, and third party compliance management including automated assessments and workflow. For more information, visit www.saiglobal.com/compliance
Source: healthcaretechnologyonline.com

Why does an MRI cost more with No Fault than Blue Cross or Medicaid?

Auto insurance providers also claim that they pay more for medical services than other providers such as Blue Cross and Medicare and further claim that they should pay the same rate.  Some simple facts are that Blue Cross and Medicaid represent a larger scale of business to the medical industry than auto insurance.  Also, Blue Cross and Medicare provide pre-approval for medical services, allow for electronic medical billing and provide payment within several days by direct deposit.  This gives the medical providers’ confidence that they will be paid in a timely manner and reduces the cost of doing business.
Source: michiganautolaw.com

Health Care Authority Prepares to Start Paying Medicaid Providers at Higher Rates Under Health Reform

The website includes an explanation of the current situation, the higher rates, a list of all the eligible codes involved in the rate changes and a Frequently-Asked Questions document to address other concerns. That FAQ and the Attestation Form have been recently updated to address “how to bill” issues as well as provider questions related to mid-level providers receiving the enhanced rates. The updated FAQ explains that eligible physicians who supervise mid-level practitioners and who have submitted the form will need to fill out and submit the second page of the form only.
Source: wa.gov

CMS Issues Final Rules on Medicaid, Medicare Provider Payment Rates

The payment increase applies to physicians practicing in family medicine, general internal medicine, pediatric medicine and related subspecialties, such as board certified pediatric cardiologists. The rule clarifies that primary care services delivered by medical professionals working under the personal supervision of a qualifying physician, such as nurse practitioners, also are eligible for the higher payment rate (Reichard,
Source: californiahealthline.org

Best Ways to Do Business with Social Security

Posted by:  :  Category: Medicare

GIMME SOME OF THAT GOOD 'OLE OBAMA DOUBLESPEAK by SS&SS• create a my Social Security account for quick access to your information; • get an instant, personalized estimate of your future Social Security benefits; • apply for retirement, disability, spouse’s, and Medicare benefits; • check the status of your benefit application; • change your address and phone number, if you receive monthly Social Security benefits; • sign-up for direct deposit of Social Security benefits; • use our benefit planners to help you better understand your Social Security options as you plan for your financial future; • request a replacement Medicare card; and • apply for Extra Help with your Medicare prescription drug costs.
Source: paramuspost.com

Video: Medicare Card Fraud: Protect Your Identity

Disability Evaluation Under Social Security

Disability Evaluation Under Social Security,(also known as the Blue Book), has been specially prepared to provide clients and other concerned professionals with an understanding of the disability programs administered by the Social Security Administration. It explains how each program works, and the kinds of information a health professional can furnish to help ensure sound and prompt decisions on disability claims. The Adult and Childhood Listings of Impairments are included in this publication. These listings are just part of how we decide if someone is disabled. We also consider past work experience, severity of medical conditions, age, education, and work skills.
Source: patch.com

How Do I Obtain A Replacement Medicare Card?

When ordering a Medicare Card you have a few options. You can do this by internet, the telephone, or you can visit one of your local Social Security Offices. To order a Medicare Card by internet you can visit www.socialsecurity.gov/medicarecard, to complete the application. To order by telephone, the toll free number is 1-800-772-1213. If you prefer to order your card in person, you can call the toll free number to find the nearest Social Security Office or go to www.socialsecurity.gov/locator and type in your zip code to find the location nearest you.
Source: seniorcorps.org

Why Medicare Cards Still Show Social Security Numbers

In a report issued in 2006, C.M.S. said it would cost $300 million to remove SSNs from Medicare cards. Then, in an updated report last November, it said it would cost at least $803 million, and possibly as much as $845 million, depending on the option chosen. Much of the cost, the agency said, was for upgrading computer systems not only at the federal level, but also at the state level, for coordination with Medicaid systems.
Source: nytimes.com

Warning: Medicare Card Scam Afoot

Leigh Ann Otte is a freelance writer who specializes in health and aging issues. She covers finding and paying for senior care for OurParents. If you have any questions about this post or need help finding senior-care options for a loved one, call 1-866-483-4896 to speak with a care advisor in your area.
Source: ourparents.com

BEST WAYS TO DO BUSINESS WITH SOCIAL SECURITY

If you need to reach us by phone, you can call us toll-free at 1-800-772-1213. We treat all calls confidentially. We can answer specific questions from 7 a.m. to 7 p.m., Monday through Friday. Generally, you’ll have a shorter wait time if you call during the week after Tuesday. We can provide information by automated phone service 24 hours a day. (You can use our automated response system to tell us a new address or request a replacement Medicare card.) If you are deaf or hard of hearing, you may call our TTY number, 1-800-325-0778.
Source: patch.com

How to Prevent Medicare Card Identity Theft

Note: You’ll notice that your Medicare ID has one or two additional letters or numbers following the digits of the SSN. These identify what kind of beneficiary you are, according to the Social Security Administration. For example, the letter T mainly indicates that you are entitled to Medicare, but are not yet filed for Social Security retirement benefits; whereas W1 indicates that you are a widower who is eligible for Medicare through disability. For the purposes of your photocopy, it doesn’t matter whether you delete these final letters (or letter-number combinations) or leave them in. Also of interest: You can help fight health care fraud. 
Source: aarp.org

Guiding you in the right direction: Medicare and Hearing Aids

Posted by:  :  Category: Medicare

Medicare hearing aids by gregoryperezIf Medicare and hearing aids are of concern to you, you should become a wise consumer. Learn as much as you can about the Medicare HMO you plan to choose and make sure that they offer additional benefits such as vision care and hearing aids. These plans will generally offer services for auditory evaluations and fittings for the hearing aid. Medicare sometimes pays the full amount and other times you may be asked to meet a deductible. It depends on your specific coverage.
Source: eldercareresources.info

Video: Does Medicare Insurance Cover Hearing Aids? : Medicare Insurance Questions

10 things Medicare won’t tell you

According to the Center for Public Integrity investigation, doctors have increasingly abandoned the lower-level codes for the better paying ones, a practice known as “upcoding.” The study—which analyzed a representative 5% sample of Medicare patients and their claims, submitted by more than 400,000 medical practitioners and 7,000 hospitals and clinics starting in 2001—found no evidence that Medicare patients are sicker and older than in the past, which if true might have justified doctors billing at the higher rates. “Medicare is susceptible to fraud not only because of its size and complexity, but because the system itself makes it easy to defraud the government,” says Ken Nolan, a partner at Nolan & Auerbach, a health-care fraud law firm. “Most of the scrutiny, if any, is made after the payment is made—not before, as in traditional business transactions.” Dr. Jeremy A. Lazarus, president of the American Medical Association, said in a statement that more analysis was needed on the issue: “Attributing the trend solely to fraudulent and abusive behavior remains an unproven assumption.”
Source: marketwatch.com

Are Hearing Aids Covered By Medicare?

Most hearing problems are relatively easy to correct with hearing aids. The problem becomes that a large majority of the people that need the hearing aids are living on a fixed income and are unable to afford the $3,000 to $5,000 out of pocket. If medicare or medicaid would cover the hearing aids then these people would have the means to get them, resulting in a dramatic improvement in their quality of life. It is been proven over and over again that if you have a positive outlook on life and are happy then you are healthier. I wonder how much money would be saved on treatment of physical ailments if the insurance companies were to focus on improving peoples quality of life so that they are upbeat and happy. Providing hearing aids seems like an easy place to start.
Source: empowernetwork.com

Why Doesn’t Medicare Pay For Hearing Aids Or Eyeglasses?

Hearing aids are elective to, just like glasses. Patients are responsible for 100% of the bill. However Medicare, in certain circumstances, will cover the cost of a prosthetic device. Often though, the cost of prosthetics far outweigh the costs of a hearing aid. This elective also extends to routine hearing tests, which are also the responsibility of the Medicare patient. Regulations vary by the state however, so there may be some exceptions to the contrary. Though most states operate under the same mindset. One exception, though limited, is coverage based on an advantage plan; a secondary premium insurance add on.
Source: seniorcorps.org

Medicare and Listening to Aids

If Medicare insurance and listening to aids tend to be of concern for you, you should be a wise customer. Learn around you can concerning the Medicare HMO you intend to select and ensure that they provide additional benefits for example vision treatment and listening to aids. These programs will usually offer providers for oral evaluations as well as fittings for that hearing help. Medicare occasionally pays the entire amount along with other times you might be asked to satisfy an insurance deductible. It depends on your particular coverage.
Source: kidneycancersymposium.net

What Medicare doesn’t cover

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Source: bankrate.com

Medicare and Hearing Aids

Hearing loss is very common among aging adults. Your hearing loss may stem from several causes, though the most common is sensorineural. That means that the tiny hairs inside your ears have been damaged and are deteriorating, usually because of aging. You losing your hearing if you notice that straining to hear thing clearly makes you tired, or if you watch the mouths of people around you to understand what they are saying. Other troubling signs of hearing loss include having difficulty hearing people in public places where there is a lot of ambient sound, or if you often find yourself asking people to repeat themselves.
Source: totalmedicare.com

Expanding TennCare would hurt patients, taxpayers

Posted by:  :  Category: Medicare

Jessica Sundheim by On BeingBeacon Center budget business-friendly cities charter schools climate corporate welfare corporate welfare reform death tax dr. milton friedman education education reform energy policy entrepreneurs estate tax government government handouts government reform government waste Governor Bredesen Governor Haslam healthcare income tax inheritance tax jobs Justin Owen legislation mass transit nashville ObamaCare pork Pork Report property rights regulation school choice small business state budget stimulus taxation tax credits taxes taxpayers tenncare reform transparency transportation welfare
Source: beacontn.org

Video: ABC’s of Medicare – Tennessee Medicare Supplements and Advantage Plans

Lamar & Bob Talk Medicare Cuts and Other TN Fiscal Cliff Notes

DesJarlais, of Jasper, Tenn., was one of 234 members of his caucus who listened in on a conference call Thursday with House Speaker John Boehner of Ohio. Boehner said the House will return to work Sunday at 6:30 p.m. and remain in session in case lawmakers and President Barack Obama reach agreement on a deal to avoid more than $600 billion in tax increases and spending cuts that will otherwise take effect on Tuesday. Economists fear the combination could jar the nation’s economy back into recession.
Source: knoxnews.com

Whistlerblowers, state Medicare fraud investigators helps Tennessee recoup big bucks for bad drug deals

Coughlan’s division was created 18 months ago and now works with TennCare, the Office of Inspector General and the Tennessee Bureau of Investigation’s Medicaid Fraud Control Unit in the TennCare provider Fraud Task Force. Together, the groups find health care fraud that rips off the taxpayer-funded TennCare program, recoups the money for the health insurance program and the rest of the funds go back to the state.
Source: medcitynews.com

Tennessee Federal Judge Dismisses Medicare Qui Tam Suit For Lack Of Specificity

NASHVILLE, Tenn. – A federal judge in the U.S. District Court for the Middle District of Tennessee, Nashville Division, on Jan. 14 dismissed without prejudice a False Claims Act qui tam cause of action against Health Management Associates Inc. and the University Medical Center, saying the relator lacked specificity of actual fraudulent acts (United States of America, ex rel. Kevin Dennis, State of Tennessee, ex rel. Kevin Dennis; Kevin Dennis v. Health Management Associates Inc., et al., No. 3:09cv00484, M.D. Tenn., Nashville Div.; 2013 U.S. Dist. LEXIS 5212).Full story on lexis.com
Source: lexisnexis.com

Haslam remains undecided on Medicaid expansion

Another hook is that after the first few years of implementation, federal subsidization of new TennCare enrollees would be reduced, leaving Tennessee to pay potentially upward of tens of millions of additional dollars on top of costs already outlined in the health care plan. In a budget presentation to Haslam last year, TennCare Chief Darin Gordon told the governor that implementation costs for the new law in Tennessee could be as much as $200 million over the next five and a half years. 
Source: nooga.com

Exactly How The Tennessee Program For Medicare Supplemental Policies

Medicare supplemental plan F ree p approved by the middle for Medicare Providers (CMS), which shifts every company must provide the exact same real benefits when selling this in order to seniors. They cannot add extensional benefits, nor can they’ll clear away in addition modify any extra benefits. Knowing Medicare Supplement Software programs F is the only problem similar unconcerned of which company is so long as this option, might be wise to shop for a plan from the actual company who is giving the lowest price. 011 is quickly attaining here, and with that brings new transitions to your http://www.medigapplansguide.com field. Therefore, the first phase is to search an expert broker whom specializes in the Medicare Supplement Insurance cover market. When using the advent of the online world this task much simpler. By simply going to Google or yahoo and entering the term Medicare Supplement Insurance or Medigap, you can easily find many resources of commentator information. Although there are 12 very different plans, not they are offered nationwide. Despite the indisputable fact providers can sell all plans, these items very often do not. This makes selecting a agenda more complicated laptop or computer could be. You may seem wondering how to decide a plan the actual to consider when going though your alternatives. It is important to note that all companies deliver you similar, standardized schemes. The best Medicare Supplemental insurance coverage also known whereas “Medigap” and it is private health insurance, which designs that will help supplement original Treatment. It helps you to pay a number of health care costs, which original Medicare doesn’t cover resembling co-payments, co-insurance, with deductibles etc. Medicare supplemental Insurance plans also cover several certain things which unfortunately Medicare doesn’t. Medicare supplemental organizations can only sell your plan through identified letters. Each modernized Medicare supplemental plan deliver the same basic extra benefits but it doesn’t matter which insurance supplier sells it. You can on top of that find some essentially guaranteed coverage that has a policy, while contract is guaranteed renovation.
Source: typepad.com

Molina Healthcare brings new jobs to The Crossings in Oak Brook 

Posted by:  :  Category: Medicare

“The recent renovations and building improvements at The Crossings were key in Molina Healthcare’s decision to move here,” said Dan O’Neill, executive vice president of NAI Hiffman, who represented The Davis Companies in the transaction. “The Davis Companies’ commitment to its investment is obvious with a new HVAC system, lobby enhancements, common corridor and restroom upgrades and the addition of a 50-person conference room.”
Source: rejournals.com

Video: 2009 Taste of Tuscany

Health Insurers See Big Opportunities In Health Law’s Medicaid Expansion

The clinic, affiliated with Molina Health Care, one of the nation’s largest Medicaid managed care plans, is one of  about a dozen facilities the company is opening across the country to handle a tidal wave of new customers in 2014.  That’s when about 10 million more people are expected to sign up for Medicaid managed care as a result of expanded enrollment under the federal health law known as Obamacare, and states shifting enrollees into private plans, according to Medicaid Health Plans of America, a trade group.
Source: kaiserhealthnews.org

Molina Healthcare to participate in Ohio’s integrated care system for dual eligibles

Molina Healthcare (NYSE: MOH) today announced that its health plan subsidiary, Molina Healthcare of Ohio, Inc., has been chosen to participate in the Southwest (Cincinnati), West Central (Dayton), and Central (Columbus) markets under the Ohio Integrated Care Delivery System (ICDS). The Ohio ICDS is intended to improve care coordination for individuals enrolled in both Medicaid and Medicare. The selection of Molina Healthcare of Ohio was made by the Ohio Department of Jobs and Family Services (ODJFS) pursuant to the request for applications for qualified health plans to serve in the ICDS issued in April 2012. The commencement of the ICDS is subject to the readiness review of the selected health plans, and the execution of three-way provider agreements between the health plans, ODJFS, and the Centers for Medicare and Medicaid Services (CMS). Enrollment of dual eligible members in the ICDS is expected to begin on April 1, 2013.
Source: medcitynews.com

Molina Healthcare’s CEO Discusses Q4 2011 Results

Carl, it’s John. There are a number of moving pieces in Texas, but we were able to make what we believe are some improvements in the fourth quarter, largely because some of the care requirements — the sum of [ph] care requirements that began to move away on the population that came in, in the Jefferson Service Area. The mix that’s shifting a little bit for — a little bit more towards the STAR membership. We also don’t have the same profit sharing that we had in 2011. And we think that we have done a pretty good job of making sure that we’re staffed up and prepared for the influx of membership. Now having said all of that, we are expecting that across the entirety of the state, the medical care ratio will be 90% for the entire year. We’re also adding pharmacy and inpatient responsibility, and we generally tend to do pretty well on the pharmacy piece. So while 90% is nothing to write home about, we think that we have put some mechanisms in place to help with the utilization, and we’ve done some nice work on recontracting some of the challenging hospital contracts. Long answer, but that’s what we said in January, and we’re sticking to it.
Source: seekingalpha.com

FMO for Molina Medicare in FL

MedicarePlanSolutions – you are correct. Street level for FL is 450, but CMS allows reimbursement of expenses above and beyond the 450, plus overrides to managing agents for business written by their subagents. As I was saying before, if you are interested in a 473 or 493 contract level (depending on your production level and number of sub-agents), feel free to contact me at the above phone number. I also immediately vest ALL of my contracts.
Source: insurance-forums.net

Molina Healthcare Medicaid Plans Ranked among ''America's Best''

“Molina Healthcare is continually focused on providing access to high quality health care services for individuals and families that are among society’s most vulnerable. We are extremely proud that our plans are among America’s best, but even more importantly, we are delighted that all of our eligible plans possess NCQA’s highest accreditation of ‘Excellent’ and have earned rankings that favorably reflect the quality and value that Molina Healthcare provides to the Medicaid program and the states we serve,” said J. Mario Molina, M.D., president and chief executive officer of Molina Healthcare, Inc. “I want to thank our employees and providers and congratulate our health plan leaders for their contributions toward achieving this important and valuable recognition.”
Source: emaxhealth.com

Molina Healthcare Inc. Q2 2008 Earnings Call Transcript

I also would like to remind you that our comments today contain numerous forward-looking statements under the safe harbor provisions of the Private Securities Litigation Reform Act. All of our forward-looking statements are based on our current expectations and assumptions that are subject to numerous risks, uncertainties and other factors that could cause our actual results to differ materially. A description of such risk factors can be found in our press release, our 10-K annual report and our 10-Q quarterly reports filed with the Securities and Exchange Commission. These reports can be accessed under the Investor Relations tab of our company website or on the SEC’s website. All forward-looking statements made during today’s call represent our judgment as of July 23, 2008, and we disclaim any obligation to update such statements.
Source: seekingalpha.com

VIDEO: World Likud Evangelical dept.

“Our hearts are broken today for the parents and grandparents, sisters and brothers of these children and the families of the adults we lost. As a country, we have been through this too many times. This evening Michelle and I will do whah every parent in America will do – hug our children a little tighter and tell them that we love them. There are families in Connecticut that cannot do that tonight and they need all of us tonight. May god bless the memory of the victims and in the words of scripture heal the broken hearted and bind up their wounds,” said the President as he closed his remarks.
Source: birchindigo.com

Find Pharmacist Jobs in Utah: Pharmacist

For detail informations about this position opportunity kindly read the description below. The licensed pharmacist will perform a variety of duties; including but not limited to, performing literature review for the development of criteria for management of the Medicare Pharmacy Benefit, administer the pharmacy benefit in conjunction with the pharmacy technicians to deliver continuous, high quality member care while maximizing member satisfaction and managing appropriate utilization, coordinating disease specific therapeutic interventions with the members and providers where appropriate to assist with the Medication Therapy Management Program (MTMP). ESSENTIAL FUNCTIONS Duties and Responsibilities
Source: blogspot.com

Health Net, Molina Healthcare To Benefit From California’s Dual

Under these circumstances, the analyst expects HNT, MOH and WLP could gain incremental EPS of roughly 15 cents, 10 cents and 1 cent respectively. The State Assembly and Senate Subcommittee hearings are expected to be held on March 7 and March 8, respectively, to evaluate the Medicaid budget proposal, and a revised budget should be available in mid-May. The final enacted budget will be available in the summer.
Source: istockanalyst.com

Medicare Sales Agent Manager

Posted by:  :  Category: Medicare

"I believe that banking institutions are more dangerous to our liberties than standing armies. ~ Thomas Jefferson. by eyewashdesign: A. GoldenThe purpose of this job is to supervise Independent Career Agents (ICA’s) who sell the UnitedHealth Group (UHG) portfolio of products offered to Medicare beneficiaries and individuals age 50 . The ICA Supervisor is responsible for achieving assigned sales/membership growth targets through ICA’s in his/her territory/territories. ICA’s are not employees of UHG but rather independent sales agents who contract exclusively with UHG to sell this portfolio of products. ICA’s may sell additional/alternative products that do not compete with this UHG product portfolio (e.g.; life insurance, home insurance).
Source: insurancesalesweb.com

Video: Legislative Round Table: Impacts of Medicare Competitive Bidding Program in Kansas City

Tony’s Kansas City: MISSOURI GOP KILL MORE MEDICARE CASH

Meanwhile . . . Tough talk among GOP voters is convincing until Grandma gets unplugged. On the (not so) bright side, emboldened Republicans in Missouri seem eager to show the State the power of their bad ideas and how they plan to crack down everyone but the petty bourgeois and the elite . . . So it stands to reason that over time a great many of their new found influence will be wasted on a vendetta against the Prez Obama.
Source: tonyskansascity.com

VILLA v. KANSAS HEALTH POLICY AUTHORITY, No. 102,324., January 11, 2013

An equal protection analysis has three steps. First, a court must determine the nature of the statutory classifications and examine whether these classifications result in disparate treatment of arguably indistinguishable classes of individuals. Board of Miami County Comm’rs v. Kanza Rail–Trails Conservancy, Inc., 292 Kan. 285, 315, 255 P.3d 1186 (2011). If so, the Equal Protection Clause is implicated. In the second step, a court examines which rights the classifications affect because the nature of those rights dictates the scrutiny applied when the statute or regulation is reviewed. There are three levels of scrutiny: (1) the rational basis standard to determine whether a statutory classification bears some reasonable relationship to a valid legislative purpose; (2) the heightened or intermediate scrutiny standard to determine whether a statutory classification substantially furthers a legitimate legislative purpose; and (3) the strict scrutiny standard to determine whether a statutory classification is necessary to serve some compelling state interest. Miller v. Johnson, 295 Kan. 636, 2012 WL 4773559, at *21 (citing Kanza Rail–Trails Conservancy, 292 Kan. at 316). In the final step of analysis, a court determines whether the relationship between the classifications and the object desired to be obtained withstands the applicable level of scrutiny. Miller, 295 Kan. at ––––, 2012 WL 4773559, at *21 (citing Kanza Rail–Trails Conservancy, 292 Kan. at 316).
Source: findlaw.com

Medicare Supplement GI Thread

Rather than search all through the forums and internet collecting this data, I figure I would start a thread about state GI periods. Please feel free to reply if your state has a GI period based on the client’s birthday or anniversary date. I will update this top thread as answers or changes come in. Alabama Alaska Arizona Arkansas California – 30 Days after birthday Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas – NONE Kentucky – NONE Louisiana Maine – GI at any time provided you move to plan of like or lessor value (no more than 90 break in coverage) Maryland Massachusetts Michigan – NONE Minnesota Mississippi Missouri – Annually on the Anniversary date of the supplement Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York – GI All year North Carolina North Dakota Ohio – NONE Oklahoma Oregon – 30 days after birthday Pennsylvania – NONE Rhode Island South Carolina South Dakota Tennessee – NONE Texas – NONE Utah – NONE Vermont Virginia – NONE Washington – Washington, is odd, You can change medicare supplements at any time as long as you currently have coverage. You can also switch from MA to supp. West Virginia Wisconsin Wyoming
Source: insurance-forums.net

Hospital groups use economics to defend Medicaid expansion

However, the sentiment of Alabama Gov. Robert Bentley on expanding Medicaid and participating in the state-run healthcare insurance exchanges was succinct: "We need to stand together on Medicaid as long as we possibly can, because those two things are necessary in order to implement the Patient Protection and Affordable Care Act," he told the Advertiser. "My goal is to make some changes in that law."
Source: fiercehealthfinance.com

CMS Announces 2013 Application Fee for Medicare, Medicaid and CHIP

Posted by:  :  Category: Medicare

DAMN!! -- I THINK WE'RE F*%KED by SS&SSOn November 30, 2012, CMS announced the 2013 application fee for those providers initially enrolling in Medicare, Medicaid, or CHIP or revalidating an enrollment or adding a new location.  This application fee applies to those providers submitting an 855A application form, which is the form that health centers use to enroll in the Medicare program. The 2013 fee will be $532.00, effective January 1, 2013.  This is a $9.00 increase over the 2012 fee.
Source: nachc.com

Video: Apply for Medicare | Medicare Sign Up

CMS Announces PECOS Activation for May 1, 2013

The Affordable Care Act, Section 6405, “Physicians Who Order Items or Services are Required to be Medicare Enrolled Physicians or Eligible Professionals,” requires physicians or other eligible professionals to be enrolled in the Medicare Program to order or refer items or services for Medicare beneficiaries. Some physicians or other eligible professionals do not and will not send claims to a Medicare contractor for the services they furnish and therefore may not be enrolled in the Medicare program. Also, effective January 1, 1992, a physician or supplier that bills Medicare for a service or item must show the name and unique identifier of the attending physician on the claim if that service or item was the result of an order or referral. Effective May 23, 2008, the unique identifier was determined to be the National Provider Identifier (NPI). The Centers for Medicare & Medicaid Services (CMS) has implemented edits on ordering and referring providers when they are required to be identified in Part B, DME, and Part A HHA claims from Medicare providers or suppliers who furnished items or services as a result of orders or referrals.
Source: hcafnews.com

Low Volume Adjustment & Medicare Dependent Hospital Extension Rules

A number of MDHs that requested SCH status or dropped their rural classification did so with the proviso that if MDH status was reinstated, they wanted to remain MDHs. This question was raised in the FY 2013 final IPPS rules. A comment was made to CMS that hospitals should be allowed to retroactively rescind their request for SCH status and have MDH status seamlessly reinstated. CMS responded that if the MDH program was extended, it would “develop policy to implement the specific provisions of such legislation.” Many read that to mean CMS would allow MDHs to retroactively rescind SCH status. However, CMS does not state this in the final IPPS rules; it leaves the matter open to “the specific provisions” of the legislation that is passed. The taxpayer relief act simply changed dates, so in CMS’ interpretation there are no specific provisions in the law allowing hospitals now carrying the SCH or urban designations to be seamlessly returned to MDH status.
Source: healthcarereforminsights.com

Medicare Advantage Plans grow amid pay cuts by the Obama Administration

“The Medicare Advantage program is stronger thanks to the health care law, with estimated premiums down 10 percent and enrollment up 28 percent since the law was enacted,” a spokeswoman for the Centers for Medicare & Medicaid Services said. “We are reducing taxpayer-funded overpayments to insurance companies, and giving more incentives for them to provide quality care for seniors.”
Source: medicarewire.com

The Official Medicare Set Aside Blog And Information Resource: Standing Under 42 USC 1395y(b)(3)(A)

Now I was deposed on this very issue for two hours yesterday, so let me tell you a few things about how a conditional payment comes into existence if you don’t already know. Pursuant to the Medicare statute, any provider that accepts Medicare must first determine if any other form of payment is available. If another source is available, it should be billed first, then if the  payment is not made in a timely fashion (defined as within 120 days), Medicare may by statute make a conditional payment. In this case, the provider has to make the election to accept the Medicare payment, settling for payment at the Medicare fee schedule. This payment is typically the lowest available, but it is guaranteed and has no contingency on the legal outcome of the insurance claim. If, however, a provider is risk tolerant and patient, he or she may instead elect to assert a lien against any potential insurance proceeds. (Most states have statutes that control that course of action.) Litigation takes a long time, so it is very likely that the Medicare billing window (365 days) will close during that process and the opportunity to accept a Medicare payment lost.  Nevertheless, if an insurance payment is made, the provider stands the chance to recover more than the Medicare fee schedule would have provided because he or she is not governed by pre-negotiated insurance rates. All this being said, the provider has no obligation to continue to chase down payment once the Medicare election has been made. The only way he or she would have a reimbursement obligation is in the event that someone else makes payment for  the same service after the Medicare payment has been accepted. So where exactly is the injury to the provider to achieve standing if they’ve already been paid???
Source: medicaresetasideblog.com

How Do I Apply For Medicare Part B While Working?

Your still working but you need Medicare Part B. If this describes you then you should know that Medicare Part B covers your physicians services and some other medical expenses while Part A covers 80% of your hospital expenses but you need to know what steps to take to apply for Medicare part B while working. First of all, you will need to follow the steps exactly to ensure that the process is being done accordingly. This is very important! For a person to be eligible for Medicare Part B, he must at least be 65 years old and the steps for applying must be followed properly. You should always keep record of your enrollment dates of Medicare Part A. They will be needed to make certain determinations and find information that is required before applying for Medicare Part B.
Source: seniorcorps.org

To promote and expand the application of telehealth under Medicare and other Federal health care programs, and for other purposes. (2012; 112th Congress H.R. 6719)

So, yes, we display the House Republican Conference’s summaries when available even if we do not have a Democratic summary available. That’s because we feel it is better to give you as much information as possible, even if we cannot provide every viewpoint.
Source: govtrack.us

Medicare Supplement Plan F

Posted by:  :  Category: Medicare

"Every citizen should be a soldier. This was the case with the Greeks and Romans, and must be that of every free state." ` Thomas Jefferson. by eyewashdesign: A. GoldenPlan F also pays for outpatient deductibles as well, so seeing the family doctor or specialist is no problem. Medicare Part A and Part B coinsurance and copayments are covered, as are hospital costs after Part A benefits have been exhausted. Plan F also covers up to three pints of blood if transfusions are given, skilled nursing facility care, hospice care coinsurance and copayments and any Part B excess charges incurred. These can happen if a doctor refuses assignment and charges more than Medicare approves. The remainder, or excess charge, is paid by the supplemental insurance. For those looking for a good supplemental policy, Plan F will fit the bill.
Source: alissapajer.org

Video: Medicare Supplement AARP Plan F Select is A Good Option

What is the Cadillac Medicare Advantage plan

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

Cut Medicare Advantage plans and save money

To the group supporting keeping Medicare Advantage plans: Your group wants to continue a program spending taxpayer monies faster than regular Medicare. Each person on an Advantage plan costs the tax payer 14 to 15 percent more than one on Medicare as it was originally designed.
Source: dallasnews.com

jandasavoy: Medicare Health Insurance Supplemental Insurance With Respect To Seniors

In addition to the supplemental policies there are more health insurance practices in the involving plans. The Medicare supplemental programs are easily manufactured and are designed to meet the specific needs of somebody. Some of these plans include medical Maintenance Organization (HMO), the Preferred Physician Organization (PPO), Medicare insurance Special Needs Plans, Programs of All-inclusive Care for the elderly (PACE) and Secluded Fee for Company (PFFS). For quick identification, the first four are identified in the levels section. Through the types section, built commonly referred so that you can as the Treatment Advantage Plans. These plans usually are managed by in which you companies but governed by the Govt. The most common plans are the HMO and specific PPO. Designs that you will vary in the types of benefits they provide. The benefits can be putted under the ensuing categories: Basic benefits, professional Nursing Care, Medicare Part Any inferable, Part F inferable, Part Y simply higher Charges, Abroad Trip and stability Services. The actual normal advantages provided under several plans and blueprints distinguish from one to another. Suitable for instance, the Process A provides just exactly general benefits, but is expensive over F inferable, gives basic benefits all through extension to several more benefits. You could do this as plan One specific has more fundamental benefits. Multiple health insurance goals offer discounts or decreasing premiums when enroll in preventive maintenance programs. Medicare does no longer offer this to its recipients. The government a discount when going to the gym or for setting aside nutritional classes. Medicare Part Some and Part K are a one-stop shop. It is defined and that is it. Some A on the standard level gives customers hospital insurance and as a consequence part B makes participants medical assurance. The comparable coverage for every last individual within the Medicare program; getting this done is evident the this plans one size fits practically attitude is certainly going to share for every many need. This amazing is where Medicare insurance Supplement Insurance courses come into play. One of the many main reasons with which the excessive perspiring occurs is unpredictable functioning of typically the nerves. Most nerves are smeared all over you have to that sends currently the signal to human brain when body temperature is high and result in your the sweating. As they part abnormally it suggests the brain in order to sweat due to your wrong stimuli. Thus, it earnings into the hyperhidrosis. Sometimes hyperhidrosis is noted to be happening due to the most important abnormal functioning among the brain. There’s is controlled your hypothalamus part belonging to the brain. Due to some abnormalities inside of brain the hypothalamus part starts operating abnormally. Now this later on leads to the improper undertaking of the sweating regulatory functions this makes the person perspiration excessively. Generally, a Medigap rule covers a quantity key gaps involving original Medicare intend. Coinsurance, co-payments, deductibles, short-term care facilities and desperate travel insurance are normally covered by how the Medigap policy along with plans (they may well not all be constantly covered by model plan). There are many health insurance insurance companies in the market, which provide good insurance plans into secure your lifetime successfully. Any of these insurance companies provide to set guidelines and regulations and price and the four weekly premium, therefore millions of people attract towards efforts. Consequently, the What does Medicare Supplement Plan F Cover? plans can be purchased by the private student insurance companies with plenty good benefits to shield your life confidently. These plans are getting a involving popularity in everywhere around the world because these desires have good security, reliability and benefits. Therefore, these plans are the most successful for old matured people from military services so far. Of course! Your choice the Medicare Supplemental packages. Very good question! No, California Medicare supplemental insurance policy is not secured via federal government. As a substitute, ask on Medicare HMO insurance policy quotations from websites that market top quality strategies this associated with as Blue Cross of California. Currently there is no doubt seniors will waste it, and likely spend it for health care has that would feature medications and sugar off their Medicare insurance supplements for considerably health coverage. If you check out the news, may possibly likely appreciate the idea this kind of an economic bump for seniors will surely be a allowed relief as Medicare health insurance Part B amounts are slated to allow them to increase as greatly as 9% in just 2010 with Component D costs proper along with an effective increase of about 11.1% for year. How about we start off when it comes to some of this basics… Medicare “gap” insurance policies are designed past Medicare. This means that every single one of Medicare Medigap schematics are required a law to offer the same safety and same results when compared with assorted companies. For instance stated–all companies present the same exact plans, the only change is price.
Source: blogspot.com

Definition Of HMO Insurance, PPO Health Insurance, HMO Vs PPO, : Aetna Health Aetna Health Inc. (HMO)

Posted by:  :  Category: Medicare

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Source: projectedu.com

Video: COWEL’s Mountain San Diego Active Chiropractic #2

Cigna’s Management Presents at Barclays Global Healthcare Conference (Transcript)

Well, there’s a lot of resource and effort put into it. At the end of the day though, what you’re fundamentally talking about is changing the business operations of the primary care physician’s office to focus on a totally different set of metrics and incentives than they have in fee-for-service, and it’s extremely helpful. Here in Miami, the Leons only do business — the only patients they see are Medicare Advantage patients. So it’s not easy, but it’s at least a lot more practical to change those business operating models to focus on the right kinds of incentives. In most network models, you have a range of offices. You might have thousands of primary care doctors in some of these networks, some of whom only have 5% or 10% of their business in Medicare Advantage. And it’s a lot more challenging to get the kinds of changes it takes. The other thing for us that’s been a challenge — we’ve actually made pretty good progress on the Part C side. A couple of years ago, CMS changed the measures and more heavily weighted a lot of Part B measures on the pharmacy side. And we’ve been slower than I’d like to react to that. I hope we’re focused and have the right tools in place to improve our scores on Part D, but that’s really been more of what’s kept us below 4 stars in a lot of our markets.
Source: seekingalpha.com

Insurance Agent Websites Blog: Cigna Medicare Advantage plans

CIGNA Medicare supplement plans have been an integral part of the insurance industry with having served customers for over 220 years. This kind of insurance plan can be very beneficial for all people including senior citizens who may be suffering from constant medical issues due to their advanced ages. The company enjoys a lot of goodwill among the community and here are some of the benefits that come with buying this plan.
Source: blogspot.com

CIGNA to Pull Out of PFFS Business in 2011.

Medicare Advantage has, over the past few years, been harder and harder to sell and become such a pain – with all of the regulations, Scope of Appointment form scrutiny, commission reductions, replacement prohibitions, etc. This has now been topped off by a president who wants to eliminate the medicare advantage altogether. See the video of President Obama saying so here. We are already starting to see the effects in one of the major carriers, CIGNA, pulling out of the 2011 Medicare Advantage bidding process. The Department of Health and Human Services fired off a letter to CIGNA and others, telling them that they must avoid raising rates on their members if they want to stay in the Medicare Advantage market. This, while they’re simultaneously cutting the subsidies to the carriers for providing the same service. CIGNA responded by declining to participate in national Medicare Advantage going forward. This is a trend that will continue. To the extent that they can get away with it – to remain profitable, the insurers will have to increase monthly premiums to their Medicare Advantage clients. They will also have to increase co-payments and other internal costs passed on to the members. HHS has made it clear, however, that they will not be approving such changes. So, backed into a corner, more will be making their exit from the marketplace. This will be a horrible blow to the seniors, as I predicted in this video that got rave reviews from all except for AARP – who wrote me a Cease & Desist letter for mentioning what they were up to. They got their bill, and now the results that I predicted are coming true. YouTube – Medicare News You Need to Know This will be a huge opportunity for those agents wanting to help potential clients with medicare supplement choices, as the Medicare Advantage market will begin to dwindle starting in November with thousands of members getting letters explaining that they have 1) Guaranteed issue into any medicare supplement provider for 1/1/11 and 2) They MUST pick a new plan/provider by 1/1/11 or the government will pick one for them. This happened last year when Coventry left the Medicare Advantage market and it was a huge boost to our enrollment in medicare supplements. That was just the first break, and the tidal wave is coming. Will it be hard for low income seniors? Absolutely. Somebody will have to write applications for seniors going onto medicare supplements, though, and it might as well be you. —- Agents wanting to take advantage of the new opportunities should visit: www.sellmedicarebyphone.com
Source: insurance-forums.net

Eligible Georgia Retirees Switching to Medicare Advantage Plans

What Does the Change Really Mean for My Doctors? It was detailed in July 15th letter that your doctor (provider) would need to accept the changes in the plan to accept the MA terms. From all the research and discussions that I have had with both doctors and insurance vendors, it does not seem like there will be many changes they believe (view the letter with all enclosures by clicking here). There are no networks. You may see any provider that accepts Medicare and is willing to accept CIGNA/UHC’s terms and conditions. The really important point to make is to have your provider agree to accept the new plan changes (information on the plan was given in the July 15 letter). Along those lines, I have received a few emails talking about the problems with finding Medicare Advantage doctors. Numerous articles have said that the vast majority of doctors will not refuse Medicare or Medicare Advantage from current patients – they wish to continue the relationship. Some doctors may or may not accept new patients, but a study by the Center for Studying Health System Change found that nearly 75% of doctors accepted all or most new Medicare patients in 2008 (Study: Most Physicians Still Accepting Medicare Patients, Fierce Health Finance). How Much Will This Cost Me? First, remember that the State of Georgia is subsidizing your coverage by nearly 75% of the total costs. This is one of the benefits that was “given” to you, so if you were to opt out of the MA plan, it will cost you hundreds of dollars per month for the same coverage. In other words, unless you feel like you have no other option and money to burn, opting out is not an option… (who has money to burn??) The good news about the changes is that it will actually save you money every single month for your coverage. Currently, a PPO covered participant pays $32.90 for single coverage ($142.40 for family). The standard option MAPD PFFS plan will cost $19.30 for single coverage and $38.60 for family coverage (all dependents eligible for MA plan). A mix of eligible and non-eligible Medicare participants in family coverage will have higher costs, but that is to be expected. The premium coverage option for the MAPD PFFS plan will cost $59.30 for a single and $118.60 for a family (all dependents eligible for MA plan). The benefits here are a lower out-of-pocket maximum, lower hospital costs, reduced co-pays, and a better prescription drug benefit. The choice is yours, but weigh the costs by looking at your 2008 and 2009 medical expenditures. The standard plan could cost you more based on your needs… (Check the July 15 letter above to compare the coverages on the Plan Summary enclosure) If you want to check out the retiree rates as set by the SHBP, please click this link to open the PDF. What If I Don’t Choose? According to the information sent with the July 15 letter, “If you are not enrolled in a MAPD PFFS option and do not make an election during the ROCP, your coverage will roll to the MAPD PFFS option of the healthcare vendor you are currently covered. Kaiser members who do not make an election will default to the CIGNA Medicare Access Plus Rx (PFFS) – Standard Plan.” Conclusion Any change is tough to accept in anything… especially medical coverage. The unknown is more of a worry than the known even when it may be better. In five years, few people may even remember this change unless there are real problems. If that starts to happen though, you can almost be assured that the SHBP and its vendors will try to make things right. The State Health Benefit Plan covered 693,716 people as of September 1, 2009, and that is far too big a number to think that they will just accept mediocre results. Try to work with your doctors and try to work with the insurance vendors. The vendors are there to help, so let them help. Both CIGNA and UHC told me that if a doctor is not accepting the plan after you discuss it with them, get the vendor involved. They may be able to help explain it from an ease of use and payment perspective. Just a hint the vendors gave me.
Source: theeducatorsretirement.com

I have a Cigna plan, now what?

What does this mean to you? There is no change for customers during calendar year 2010. ·          There is no visible impact  in 2010. ·          There is no change in benefits or premiums; no one is losing coverage. ·          CIGNA will continue to provide all individual PFFS administration, such as processing enrollments, issuing ID cards and paying claims. ·          No change to contact information. Continue to use the same phone numbers, fax numbers, websites and land addresses to reach the same CIGNA teams as before. So there is nothing for you to do differently yet.
Source: ohiomedicaresupplementcompanies.com

insurance: MEDICARE ADVANTAGE/MEDICARE HEALTH PLANS

Medicare Advantage/Medicare Health Plans SHIIP Publications: Frequently Asked Questions About Medicare Advantage PFFS Plans Is A Medicare Advantage Private-fee-for-service Plan Right For Me Medicare Advantage Comparison Guide (2008) Your Guide To Medicare Private-fee-for-service Plans Medicare Advantage Summaries of Benefits SHIIP Publications: Aarp Medicarecomplete Choice Aarp Medicarecomplete Plus Plan 1 Aarp Medicarecomplete Plus Plan 2 Advantra Freedom – Plan 1, Plan 2 (005), Plan 5 (001) Advantra Freedom – Plan 2 (010),plan 3 (006-013), Plan 5 (002) Advantra Savings (msa) – Plan 1 Aetna Medicare Open Plans America’s 1st Choice – Patriot Plus And Presidential Plus America’s 1st Choice – Patriot-presidential Blue Medicare HMO Plans Blue Medicare PPO Plans Cigna Medicare Access Plans One, Two And Three – Version A Cigna Medicare Access Plans One, Two And Three – Version B Cigna Medicare Access Plans One, Two And Three – Version C Cigna Medicare Access Plans One, Two And Three – Version D Evercare – Dh – Special Needs Plan Evercare – Ih – Special Needs Plan Evercare – Mh – Special Needs Plan Fidelis – Secure Comfort – Special Needs Plan Fidelis – Secure Comfort Plus – Special Needs Plan Fidelis – Secure Independence – Special Needs Plan Health Net Pearl – Plans 009-014-015 Healthmarkets Care Assured Plans Humana – Special Needs Plan Humana Goldchoice – H1804 -216 Sb08 Humana Goldchoice – H1804-007 Sb08 Humana Goldchoice – H1804-016 Sb08 Humana Goldchoice – H1804-217 Sb08 Humana Goldchoice – H1804-278 Sb08 Humana Goldchoice – H1804-279 Sb08 Humanachoiceppo – H3405-001 Sb08 Humanachoiceppo – H3405-002 Sb08 Humanachoiceppo – Regional – R5826-003 Sb08 Securehorizons Medicaredirect Plan 3 Securehorizons Medicaredirect Plan 3a Securehorizons Medicaredirect Rx Plan 51 Securehorizons Medicaredirect Rx Plan 51a Securehorizons Medicaredirect Rx Plan 54 Securitychoice Classic-enhanced-plus-enhance Plus – Area A – Securitychoice Classic-enhanced-plus-enhanced Plus – Area B Securitychoice Essential-essential Plus Southeast Community Care – Dual Plus Plan – Special Need Plan Southeast Community Care – Plus Plan Sterling Option I Sterling Option Ii Sterling Option Iii Sterling Option Iv Today’s Options – Basic Plus, Value Plus, Premier Plus Today’s Options – Basic, Value, Premier Today’s Options Powered By Ccrx Unicare 2008 Msa Summary Benefits WelLCare Benefit Summary A WelLCare Benefit Summary B WelLCare Benefit Summary C WelLCare Benefit Summary D WelLCare Benefit Summary E
Source: blogspot.com

The Sullivan Independent News

The Visiting Nurses Association will hold a flu shot clinic at the Sullivan Senior Center on Tues., Oct. 13 from 12 p.m.- 3 p.m. In order to be sure a vaccine is available for you, you must call or stop by the Senior Center and have your name put on the vaccine list. The VNA will be bringing 150 vaccines, but more will be available if we see more people are signing up. This will be a one-time clinic. Those planning to receive their vaccine may show up anytime from 12 p.m.-3 p.m. To avoid the congestion and long waiting periods, you may wish to wait a little later and not all show up at 12 p.m. Insurances accepted by the VNA for this clinic include: Medicare Advantage Plans, Essence, Coventry Advantra Freedom, GHP, Advantra, GHP Advantra Freedom, GHP Gold Advantage, Humana Choice PPO, Humana Gold Choice PFFS, Humanna Gold Plus HMO and Mercy Medicare Advantage. Other insurances that did not contract with the VNA and will not be accepted are: Medicare Advantage Plans, Secure Horizons, Aetna Medicare, Anthem Senior Advantage, Cigna Medicare Access, Sterling Option, Wellcare, Evercare or any other Medicare Advantage or out-of-state plans. Medicaid is not accepted. If you have another primary insurance, you may not use Medicare or Medicare Advantage. Those wishing to pay “out of pocket” for the vaccine may do so. The cost is $30. Visiting Nurses Association is a non-profit community based organization dedicated to serving the healthcare needs of your community. Please help us by giving us your correct insurance at the time of service.
Source: mysullivannews.com

medicare and cigna rx prior authorization forms

The CIGNA Medicare Rx Customer Center provides a summary of benefits. access to forms and additional information on rewards. discounts. and prescription drug costs. PRIOR AUTHORIZATION FORM Phone: (877)-2GHI HMO (877-244-4466) Fax and is only valid for eligible health plan received the services outside of the Medicare Advantage. Learn more about Prior authorization – MedicareBlue Rx at yourmedicaresolutions.com
Source: blog.cz

Massachusetts and Ohio: Capitated Financial Alignment Demonstrations for Dual Eligible Beneficiaries Compared

Posted by:  :  Category: Medicare

Romney Ryan Plan for Medicare and SSI by DonkeyHoteyThe Centers for Medicare and Medicaid Services (CMS) has finalized memoranda of understanding (MOUs) with Massachusetts and Ohio to test a capitated financial alignment model to integrate care and align financing for people who are dually eligible for Medicare and Medicaid in 2013. CMS also has signed an MOU with Washington to test a managed fee-for-service model. These three year demonstrations will introduce changes in the care delivery systems through which beneficiaries presently receive services and in the financing arrangements among CMS, the state, and providers.
Source: kff.org

Video: Medicare and Medigap Insurance in Massachusetts by 1-800-MEDIGAP®

Medicare payment boost in Massachusetts prompts angry letter to Obama

Imran A. Andrabi, M.D. Senior Vice President Mercy Health Partners Imran A. Andrabi, M.D., is a family physician and senior vice president and chief physician executive officer for Mercy Health Partners, a seven-hospital system in Toledo, Ohio. He oversees an employed physician group of more than 300 doctors and other providers, research and academics, clinical quality and safety, and clinical integration.
Source: fiercehealthcare.com

Massachusetts Elder Law Attorney

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

Research Roundup: Insurance Coverage And Access To Care In Massachusetts

Health Affairs: Insurance Expansion In Massachusetts Did Not Reduce Access Among Previously Insured Medicare Patients – In 2006 Massachusetts passed health overhaul legislation that sought to get universal coverage in the state. Opponents suggested it could have a negative impact on people who already had insurance. They said that the sudden increase in the number of people with insurance might overwhelm doctors and other health care providers, creating shortages and poor health care for some people who were already in the system, especially Medicare beneficiaries who are older and often need more medical care. In this study, researchers analyzed Medicare data from 2004 to 2009 to determine how insurance expansion under the Massachusetts’ health reform law affected beneficiaries. “We found no evidence that Massachusetts’ health care reform, with its resulting insurance expansion and consequent threat of negative spillover on the previously insured, led to an increase in preventable hospitalization among Medicare patients,” the authors write. Their study found that preventable hospitalizations among beneficiaries in Massachusetts dropped slightly more than rates in comparison New England states (Joynt, Chan, Orav, and Jha, 3/2013).  
Source: kaiserhealthnews.org

21 States Demand Extinction of Massachusetts’ Rural Hospital Medicare Loophole

A tiny 19-bed island hospital in Nantucket, Mass., has caused ire among 21 other states for allowing all other Massachusetts hospitals to benefit from extra Medicare money at other states’ expense, and those states want legislation to rectify the matter, according to a report by the Boston Globe. Medicare adjusts payments to hospitals and other providers based on where they are located geographically. In essence, rural hospitals set the floor for Medicare payments within a state, as urban hospitals must be paid at least as much as rural hospitals for wages paid to physicians and staff. A July report from the Institute of Medicine found this system lacked “accuracy” and needed several changes. Nantucket Cottage Hospital, owned by Boston-based Partners HealthCare, is located on an island where property values exceed $1 million. It pays above-average wages in an area with high living costs, but because it is the only rural hospital in Massachusetts, it sets minimum wages for the 81 other hospitals across the state due to Medicare’s geographic payment adjustments. For Massachusetts, that has led to an extra $256.6 million and $367 million annually in Medicare funding over the past two years — at the expense of other states, according to the report. Nine states, including Massachusetts and California, are paid the extra Medicare money out of a national pool by decreasing payments to other states as part of an amendment enacted in 2011 to the national health law. According to the report, Texas, New York, Michigan, Florida and Illinois are hurt the most by the rural funding structure at the cost of tens of millions each year. The American Hospital Association and CMS have pointed out flaws in the payment structure, and 21 states are urging Congress to change the payment model in February during discussions on the federal debt ceiling, according to the report.
Source: beckershospitalreview.com

Did Massachusetts Healthcare Reform Hurt Access To Care For the Previously Insured?

To determine if Massachusetts residents were negatively affected, we examined rates of preventable hospitalizations, those that result directly from diminished access to effective primary care, before and after health reform kicked in.  We focused on older adults, the Medicare fee-for-service population, who rely on primary care, hypothesizing that if their access to primary was curtailed, they would be susceptible to these preventable admissions.  We studied Massachusetts from 2005 through 2010, and used the rest of the New England states as controls.  We figured any effect would be particularly pronounced among those over 80 years of age, who might be particularly vulnerable to disruptions.  Finally, we thought that the counties within Massachusetts where the insurance uptake was the greatest, and therefore where the biggest surge of new patients to PCPs might occur, would see the biggest negative effects.
Source: harvard.edu

Massachusetts Medicare and Medicaid

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Source: massestatelawyer.com

Another ObamaCare Medicare Gimmick

ObamaCare supporters sometimes like to talk about the legislation’s “delivery system reforms,” which are supposed to change the way health care services are organized in ways that make health care less costly and more efficient. The bulk of these delivery system reforms are essentially payment reforms — restructuring the way medical providers are reimbursed in hopes of changing their incentives. But the sheer complexity of the way Medicare pays providers means that these sorts of payment games are not only commonplace, but key drivers of administrative decisions in medical facilities. Medicare’s size also means that its decisions often have ripple effects throughout the medical payment ecosystem.
Source: reason.com

8 charged for defrauding Massachusetts. Medicaid program

“MassHealth is a critical program that provides health insurance for some of our most vulnerable residents,” said Mass. Attorney Gen. Martha Coakley in a press release. “The brazenness of the fraud committed in these cases is particularly troubling. The defendants allegedly stole more than $260,000 from taxpayers, diverting resources from those who truly need it.”
Source: dailyfreepress.com

Massachusetts charges two laboratories with health care fraud

In just the last year, the state of Massachusetts was reported to be investigating Quest and LabCorp for possible Medicare fraud, settled with Calloway Labs for $20 million (again involving urine drug screen shenanigans), is dealing with the compounding pharmacy at the center of the fungal meningitis outbreak, is host to a federal grand jury investigating Millennium Laboratories, and settled with four pathology groups for $140,000 over allegations of improper medical record disposal.
Source: pathologyblawg.com