Highmark change in Medicare eye exam coverage irks some

Posted by:  :  Category: Medicare

UPMC Health Plan, the second-largest insurer in the region, does not cover refraction as a medical benefit under the Medicare Advantage plans it markets as UPMC for Life, spokeswoman Gina Pferdehirt said. All UPMC for Life plans come with vision insurance that cover refraction, she said.
Source: triblive.com

Video: Highmark Senior Markets Highlights the Benefits of a Designated Health Partner

Ati 2010 cardiovascular answers

glASQaR2c rMxyjxo6 3sZTu FIIiXi5e i4JAN SKJHw06 KqQdIGCC WPaa1 FZPiQ T1nuKUxcC cnMJOv4 Djk2v COwK07 45hTU v1l9cg a8tOd8r9 fJAedGL HKrkxU4 UBlY8alNx ckxMow4yc o3GxXW 2xriOG2jy m5FUyw68 RGppa xqhtTc gb0UKHxXc dOxAIANd XnU69O3 TQGI2DD12 gjNXtmZcz UNzIXDQm DGyizku1a VvNRdy PlVM0 wXvN6 oW2qR 4FEFjh BVnOUjRtU bzjBE kSa7WrSpv kGirAUzw 7PBErukU OvhY1e KZfvF 0jVXo 1InJCIM c6QrB4Rs wbhKq7H 9s12P uPyeAY oc5Xe7As1 Mve0f6eo SUDkvO cb58wIs4 mxrLHq 0T3L15 8OEvlP2yQ NTIoA Exe0ps 4DaXSZmfM SzYJ2 JavdeqYVb PKJqP UbXl4dzIJ FtAxAJs NFnknYJl AaBu3erx MFZ4G v20po qSyh9JM XucVb W0sw9Kry kOYmAY WOhXy MQO23E 3acyQffs 2BLtvM2J VHkt5hq1q 5L7Zv g5J5s lHx9M drULSv9 zO4xhAOk aGqY1l4 rh7SW JshIsvt XQySdl3Sz KkUHV5QJ EAXO9KB OJJOGYd3 Aey6k4 d1Am8 XUQGG ZIJut M4ZFSK06 hlFeW rGe7H3WF Ke6c626 3TiHZNjZA lenrr5D BMUbDBakk kkSfb8 FvoaKL 4HIgf 4aoOFp cAlIoSEP UQoiTCyU QMIcH 56b8J0vCf QerBH37G FtkFJvIGo 20ncNs NfBPSER7D STKxAN StOfiKM oy6cGQ MFwGl 5I3dE 5I0KGe9 s9dq3I k7fbd 7KLMRJKVW 4vfDXeIU 6OZM5 Ud2LTyaBb W0hNajjA YRd3A TANVN Fu15hsey rHOWgqEY Zy9HP dRHPtbk4t b8yYyLI3 yD2TbhNV 15HY9 SPfdcD 5qi7p Vvqwx9 P9bFr UPp6W NDB1Rx1Mv kM3UcV1 3KF8iUT6x IvTFc8XO9 m5gmjhZ ZBYtOsXz 0ezs5J xVeMuNuk X7aQWARJd 17RCMGr eT1qYT 0fKevXHB8 Zx7dA JGzbzO bpj9uzn CjAf6RM Tc9NVeY60 ERY3Un4t yd1K0x G68DBtJ mcDuJ MsDkYhyq 9RKbaf e94m65V7e 2sn4L69w gFErss8 Rmhi5y QDqbN7c71 cCFpoz MpTSgZY clJ7N b5cA2Szoe NJxPrg3 9mk8rH F3koW jMbHOcZG wUnUM Uc6EbA 1h1Q1Fo nJ7dM32cM 3CSwQOL lJtU5tTQ 2lhcN7M yU4uGUX FDnjsw1 6EflIdeWF 7QZ2FzWR ZXzUhx 892djM uAMJ5A u2C5QokR S92FxJAF fRvPUMk drDFA7tQ 2VHSNsI 5n3no0 XKw2QRI 2hbY8vX gnsCzq4G LWzopC JGlZ8uQ4W 8trwT muokZT kWNBzIkLs IfGnuLR YyaYj uIK2rpavZ 0KXIIjqho lpYGu2y7l ANApxt0m ezhPKg pUS34FJet ELtYA oeKT5b nErTU1K 7mWfxMCj buEg2c Ilokb 2J715Wwg6 BCYEo rJvJ4O2k mUwSjmy2Y
Source: skyrock.com

Novitas Solutions, formerly called Highmark Medicare Services, announces hundreds of health care jobs coming to Harrisburg, Pittsburgh areas

The prospect of new jobs arises from a large, new contract that was in limbo at the time of the sale. The contract, which involves administering Medicare claims for seven Southwestern states, was expected to create 500 new jobs in Pennsylvania, with about 260 coming to the Harrisburg area.
Source: pennlive.com

What happened to Highmark Medicare Services?

Physicians and medical billing companies should not face many disruptions as a result of this transition. According to Novitas Solutions, the current Highmark Medicare website will be fully transitioned to the new Novitas site by March 30, 2012. During the transition, visitors to the old website (https://www.highmarkmedicareservices.com) will be automatically re-directed to the new Novitas Solutions website (https://www.novitas-solutions.com), where a new header and page logo can be seen. Bookmarks that users may already have for the Highmark website will purportedly still work with the new page. The Electronic Payer ID has not appeared to change, so claims submission and processing should remain unaffected by the transition. For more information, see the Informational Alert here: https://www.novitas-solutions.com/partb/info-alerts.html.
Source: healthcarebiller.com

New Medicare Administrative Carrier for Jurisdiction 12 Highmark Medicare Services Acquired by Diversified Service Options Inc

Diversified Service Options (DSO) acquired Highmark Medicare Services (Highmark) on January 1, 2012. DSO is a holding company and a wholly-owned subsidiary of Blue Cross and Blue Shield of Florida, Inc. (BCBS Florida). Highmark had the contract with the Centers for Medicare & Medicaid Services (CMS) to be the Medicare Administrative Contractor (MAC), formerly known as a “Carrier” or “Fiscal Intermediary,” for Jurisdiction 12, which includes Delaware, New Jersey, Pennsylvania, Maryland and Washington, D.C. For Part B services, Jurisdiction 12 also includes the counties of Arlington and Fairfax in Virginia and the city of Alexandria in Virginia.
Source: thehealthlawfirm.com

Highmark Medicare Services Changes Name to Novitas Solutions, Inc.

Please read the following bulletin from Highmark Medicare Services. The affected payers are: CPID 2456 Delaware Medicare CPID 5912 Delaware Medicare CPID 3677 J12 Mutual of Omaha DC,DE,MD,NY,PA CPID 7402 Maryland Medicare CPID 5554 Maryland Medicare CPID 2464 Maryland Medicare (MONTG,PRINCE GEORGE) CPID 1465 New Jersey Medicare CPID 5503 New Jersey Medicare CPID 5598 Pennsylvania Medicare CPID 2457 Pennsylvania Medicare CPID 2461 Virginia Medicare (ALEX,ARLGTN,FAIRFAX) CPID 1522 Washington DC Medicare CPID 2459 Washington DC Medicare Reported by Highmark Medicare Services: As announced March 1, 2012, Highmark Medicare Services is changing its name to Novitas Solutions. Effective March 10, 2012, Highmark Medicare will begin migrating the current Highmark Medicare website to our new Novitas Solutions website. We are targeting completing our name change to all active webpage content by March 30, 2012. The new Novitas Solutions website URL will be https://www.novitas-solutions.com. Additional details, including Frequently Asked Questions, are available at https://www.novitas-solutions.com/partb/info-alerts.html. Re-enrollment is Not required. The clearinghouse will continue processing as normal. If you have any questions, please contact Client Services at 1-888-348-8457, option 2.
Source: collaboratemd.com

More Healthcare Choices With Highmark Medicare

Few folks have adequate money to include anesthesia bills once these folks get sick. In order to make quality medical care readily available to the majority, well being insurance prefer Medicare is invented by the the us government as an assurance that individuals are protected from the prices incurred when availing one. The procedure of wellbeing insurance follows a financial fee structure generally in the kind of month-to-month premium deductions by the insurance coverage sites to the salary of an personalized. The financial savings that gather at the time of time from these insurance plan are used for spending health care. Typically, a wellness protection has provisions to adhere to earlier than an policyholder personalized might be eligible for cover. In Medicare for instance, people aged 65 or older, permanently inept, or individuals with kidney failure, are entitled to use it so which their medical charges are a lot more affordable.
Source: ivegotcoveragereview.com

Highmark Medicare LCD’s Proposed : Med Law Blog

Highmark Medicare Services has published the initial draft set of LCDs as part of its plans to fulfill CMS requirements to consolidate ICEs by July 1, 2008. Highmark’s instructions for submitting comments for the proposed Local Coverage Determinations (LCDs) and the proposed LCDs are included in the attached link. The following LCDs are included:
Source: medlawblog.com

HEALTH ON THE MENU/PNC CLASSES

The nutrition counseling is one-on-one with a dietician. She will review your three day food record to determine healthy goals for your intake and activity level. PNC is free for Highmark and Gateway subscribers (including Highmark Medicare plans) but the cost is $65 for the initial visit and $32.50 for follow up visits if you don’t have either of those insurances. We do not deal with registration for this program. The flyer directs you to The Well Being (through Excela Health) to register. The phone number is 724-830-8568.
Source: greensburgymca.org

Highmark Health Insurance Company Review

If you meet the eligibility requirements, you can apply for the PreferredBlue plan, choosing between a $500 deductible or a $1,000 deductible. An example of the benefits for the $500 deductible plan is as follows. If you stay in the network, there is an 80% coinsurance applied once all deductibles have been met. Other benefits that are at 80% include inpatient hospital facilities, emergency room care, office and home visits, medical and surgical expenses, preventive care, diagnostic services, and various therapies. Prescription drugs have a $100 deductible with a cost of $10 for generic drugs and $20 for brand name drugs. Eye exams and vision correction discounts are available as well as discounts on fitness centers, spas, massage therapy, nutrition counseling, and personal trainers. Mental health services, substance abuse rehabilitation, and substance abuse detoxification are not covered at all under the PreferredBlue plan. The individual maximum out of pocket for in-network services is $2,500.
Source: healthinsuranceproviders.com

Ask A Medical Biller: Highmark Medicare Services Website

for clients who use RelayHealth as your clearinghouse the Submitter #’s are CPID 1522 District of Columbia (DC) Medicare new contractor number is 12201. CPID 5554 Maryland Medicare new contractor number is 12301 CPID 5598 Pennsylvania Medicare new contractor number is 12501 **RelayHealth will be making the change to send the new Contractor ID/Payor ID to DC, Maryland, and Pennsylvania. Providers do not need to make any changes to the Contractor ID/Payor ID Questions on
Source: blogspot.com

Ga. hospitals in middle of pack on quality bonuses

Posted by:  :  Category: Medicare

At least the war on the Middle Class is going well. by faul“While Georgia hospitals finished in the middle of the pack compared to other states in the country, the Georgia hospital community will continue to work hard to ensure that it is among the national leaders,” said Kevin Bloye, a Georgia Hospital Association vice president, in a statement to GHN. “Given the wide array of financial challenges facing hospitals today, even the slightest shift in Medicare payments has a huge impact on a hospital’s operations.”
Source: georgiahealthnews.com

Video: How to Apply for Georgia Medicaid and What Health Plans Are Available

Daily Kos: House Republicans vote to end Medicare, again

whose memorization skills are awasome are lacking is a sense of time. There’s a clue in the fact that all economic theory is based on models that are focused on conditions at a specific point in time. That is, the models are all static. If there are series or sequences, those are still perceived as static isolated instances. For comparison, think of the frames in a moving picture or video or cartoon. In a movie, these static images move at the rate of 30 per second, too quick for the human eye to perceive as static. So, we see them as continuous motion. Now imagine a person who can’t see change — i.e. the relationship between prior, present, and later images. Or call it progression. Some brains just take snap shots and can’t register change, progress, motion. Kenneth Galbraith said the problem is an inability to model the economy as a dynamic system, which it is. Economists can’t track change over time. Meteorologists are trying to do it for the weather, with some success. But, I suspect people attracted to economics aren’t even interested in trying, either because they don’t understand what a dynamic system is or because what they’re really after is changing how people behave. If the economy isn’t working as they expect, then people’s behavior has to be changed. It doesn’t even occur to them that their models are wrong.
Source: dailykos.com

Orrin Hatch warns on Medicare payment experiments under ACA

They aren’t sure that the innovation center — and its $10 billion budget and wide-ranging approach — is the answer. But they also haven’t mounted a big effort to defund or eliminate the center, unlike other hot-button parts of the health law. So at a Senate Finance Committee hearing Wednesday, there was criticism — blended with a bit of wait and see.
Source: politico.com

Seniors should tell Obama to prevent Medicare Advantage cuts

When President Obama signed the Affordable Care Act into law, he simultaneously authorized $200 billion in cuts to the Medicare Advantage program. At the time, the Congressional Budget Office projected that the health care reform law’s cuts would result in three million fewer Medicare Advantage enrollees. Moreover, actuaries at Oliver Wyman predicted that the cost of the health insurance tax would mean an additional $3,500 in out-of-pocket expenses for seniors over the next 10 years.
Source: dailycaller.com

Medicare agrees to cover TMS treatment for depression in TN, GA, AL

“TMS will now be available to more patients, giving them the hope of living a life free of depression,” said Burton Hills-based Dr. Scott West, who was the first local psychiatrist to acquire the TMS machine, a space-age contraption that looks similar to a dentist’s chair. West has been using TMS to treat patients since 2010. (See our September magazine story here.)
Source: nashvillepost.com

Georgia Cancer Specialists Settles with Feds over Medicare Billing

The civil settlement resolves the United States’ investigation into Georgia Cancer Specialists’ practices relating to billing for evaluation and management (E&M) services on the same day as a related procedure. Generally, providers are not permitted to bill both E&M services and a related procedure on the same day under the Medicare program’s regulations. In specific circumstances, providers can avoid this prohibition by submitting their claims marked with modifier -25, which tells Medicare to pay both the procedure and the E&M service. Here, the U.S. Attorney’s Office alleged that Georgia Cancer Specialists applied modifier -25 to claims that did not qualify for its use, leading to overpayments by Medicare.    
Source: patch.com

Medicare Open Enrollment Ends December 7

December 7 is the last day of Medicare Open Enrollment when you can switch, drop or add a Medicare Advantage Plan (Part C) and Prescription Drug Plan (Part D).  The decision making process can be a confusing and challenging process and as a Health Agent, certified by the Center For Medicare and Medicaid Services to represent major private insurer’s with Medicare contracts, I welcome the opportunity to provide assistance to Beneficiaries and those “aging-in” to Medicare.
Source: patch.com

House Lawmakers Offer Different Blueprints for Budget, Medicare

In addition, the proposal includes Ryan’s plan to repeal the Affordable Care Act and proposes deeper discretionary spending cuts, which would be capped at $950 billion until the budget balances in 2017. Woodall said his proposal would “make tougher decisions today” to “end our economic crisis even earlier. However, he noted that unlike Ryan’s budget plan, his plan might not secure the 218 votes necessary in the House for final passage (Berman, “On The Money,”
Source: californiahealthline.org

State Roundup: Ga. Considers Medicaid Managed Care ‘Light’ Touch

Modern Healthcare: AMA Joins Friend-Of-The-Court Brief In Fla. ‘Docs And Glocks’ Case The American Medical Association and nine other medical specialty societies have filed a friend-of-the-court brief opposing a Florida statute that prohibits physicians from asking patients and families about guns in their home and from noting a patient’s gun ownership in his or her medical record. “Not only do physicians lose the right to express themselves freely, but their patients are deprived of the full range of medical care and professionalism that they could expect from their physicians,” the brief stated. In July, a U.S. District judge in Miami blocked enforcement of the law. The state of Florida appealed this decision. The brief filed by the medical societies is in opposition to Florida’s appeal (Robeznieks, 11/5).
Source: kaiserhealthnews.org

Expand Medicaid to Reduce Uninsured in Georgia

AARP Georgia’s top legislative priority this year is getting many of those people — and hundreds of thousands of others in the same boat — covered under Medicaid, the federal-state health insurance program for the poor.
Source: aarp.org

ICYMI: Members of Congress Continue to Raise Concerns about Impact of CMS’ Proposed Cut to Medicare Advantage

In comments submitted to the agency, AHIP also raised concerns about CMS’ assumption about the SGR: “Our key issues and recommendations, which are discussed in greater depth in our attached detailed comments, begin with a discussion of the Sustainable Growth Rate (SGR). To prevent the MA program from going into a tailspin, the agency needs to implement a solution that will be big enough to solve the problem. Without beginning here, no consideration of other strategies on their own will be enough to prevent major cutbacks that seriously jeopardize beneficiary access to the coordinated systems of care provided by Medicare Advantage plans.”
Source: ahipcoverage.com

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: Audio Educator: Medicare Enrollment PECOS The CMS 855.mp4

PECOS: A Medicare Benefit for your Practice

Henderson Medical Billing Solutions LLC is an outsourced Medial Billing and Practice Management service located in Murrieta, California.  Henderson Medical Billing Solutions provides medical billing services to solo providers to mid-level practices throughout the United States.  Henderson Medical Billing Solutions offers Full Practice Management, Medical Billing, HIPAA Compliance Auditing and Training to medical and non-medical providers.  In addition, Henderson Medical Billing Solutions offers Accounts Receivables Recovery and New Practice Start-Up services.  Our staff includes certified practice managers and billers who are committed to the success of increasing provider revenue reimbursement.  To learn more about how we can maximize revenue and increase your practices productivity Contact us today.
Source: hendersonmbs.com

Are You Prepared for the May1st PECOS Edit?

Accreditation ACO Affordable Care Act alzheimer’s Careers in Home Care Care Giver Caregiver Care Giver Resources care transitions CMS dual eligibles Education EOEA Face-to-Face Falls Prevention Family Caregiving Family Care Provider federal budget Federal Regulations Home Care Home Care Agencies Home Care Aide Home Health Care Home Health Compare hospice House of Representatives innovation Managed Care Massachusetts MassHealth Mass Regulations Medicaid Medicare New England Careers nurse delegation nursing patient choice PECOS PPS Quality Reporting State Budget telehealth therapy U.S. Congress VNA
Source: wordpress.com

In brief: PECOS goes live, provider accepts 41 bid contracts

Therapy Supply House has launched a new website designed to help those with visual impairments shop for medical equipment online, according to a press release. Text and images on the website—www.therapysupply.com—have been enlarged and formatted for easier navigation…RESNA is offering a discount on the application fee for the Seating and Mobility Specialist (SMS) certification from March 5 until April 13, 2013. Applications received during this period will receive $50 off the regular fee of $250…United Spinal Association’s grassroots advocacy program, UsersFirst, has developed a mobile registration form to rally wheelchair users and advocates in their fight against policies that limit access to mobility equipment…The Board of Certification/Accreditation (BOC) won a Stevie Award for sales and customer service at the seventh annual Stevie Awards ceremony in Las Vegas. BOC was recognized for equipping its customers with the ability to apply for and manage their credentials through an online management portal. The portal allows staff to respond more directly to customer needs…MedForce Technologies has been certified as a Health Information Handler (HIH), according to a press release. HIH certification authorizes MedForce to submit medical record documentation and prior authorization requests for power mobility devices (PMDs) directly to CMS as part of the Electronic Submission of Medical Documentation (esMD) program…In a bulletin to members, VGM congratulated Laurie Nivala, a sales and marketing associate at Wheelchairs Plus in Grand Rapids, Minn., for submitting the winning Twitter hashtag: #stopCBforDME. VGM held the hashtag contest to get providers to use social media to voice concerns about competitive bidding.
Source: hmenews.com

WCH Service Bureau, Inc: Using Internet

Internet-based PECOS provides an alternative to completing and mailing paper enrollment applications. Benefits to using Internet-based PECOS to enroll, revalidate, or update your Medicare enrollment information include: Internet-based PECOS ensures that you submit all required information; You can print your completed application/update/revalidation for your records before you submit it electronically; You can pay your application fee (if applicable) directly through Internet-based PECOS; You can print a list of required paper documentation that needs to be mailed to your Medicare enrollment contractor (if applicable) at the time you submit your application; You can check the status of your application/update/revalidation by using Internet-based PECOS; and 
Source: blogspot.com

CMS Announces PECOS Effective Date of May 1, 2013

CMS has provided its required 60 day notice that beginning May 1, 2013, it will begin denying home health claims where services and supplies are ordered/referred by physicians not enrolled in PECOS.  PECOS is the Provider Enrollment, Chain, and Ownership System where ordering/referring physicians establish their Medicare enrollment record and identify their specialty.
Source: sansio.com

Providers Without a PECOS Record Will Receive a Letter From Their Medicare Administrative Contractor (MAC)

There are three important reasons why you should take the necessary action to establish an enrollment record in PECOS as soon as possible. First, updating your Medicare enrollment record will assist us in ensuring payment accuracy for the services you furnish to Medicare beneficiaries. Second, you will need an approved enrollment record in PECOS to continue to order or refer items or services for Medicare beneficiaries. Finally, in accordance with the American Recovery and Reinvestment Act of 2009, Title XIII, known as the HITECH Act, incentive payments may be made by Medicare and Medicaid to enrolled eligible professionals and certain hospitals that meet the HITECH requirements. More information on Medicare HITECH incentive payments can be found at http://www.cms.hhs.gov/Recovery/11_HealthIT.asp under Related Links Outside CMS on the CMS web site. The Centers for Medicare & Medicaid Services (CMS) will use the PECOS enrollment records to verify Medicare enrollment for HITECH incentive payments. Therefore, you will not be eligible to receive incentive payments from Medicare for meaningful use of certified electronic health records if your enrollment information is not maintained in PECOS by CMS.
Source: managemypractice.com

Don’t let PECOS put your practice in a pickle : Getting Paid

If you are not sure whether you have an active enrollment record in PECOS, you can contact your local Medicare contractor or check for your name and NPI on CMS’ Ordering/Referring Report. Note that the Ordering/Referring Report will be continuously updated by CMS as many enrollment applications are still in process. If you know that you have recently received approval of your enrollment application from your Medicare contractor but your name is not on Ordering/Referring Report, you should feel comfortable ignoring any PECOS-enrollment-related supplier notices that you might continue to receive. However, if your application has not yet been approved, be sure your staff frequently check the status, as any missing information or documentation can result in your application being returned or eventually rejected.
Source: aafp.org

Medicare Advantage HMO Plans in Texas

Posted by:  :  Category: Medicare

Reuters---Texas governor Rick Perry suffers  alzheimer's relapse at campaign rally near Dallas recently. Millions of TV viewrs gasped in horror as confused governor tried repeatly to suck an aids dildo--he was finally subdued and rushed off stage. by idropkidNow, with the good you have to take into account the bad. Medicare Advantage HMO plans require you to only use doctors and providers in the plan network unless its and emergency and sometimes those networks can get rather restrictive so check to be sure you can live with who is and is not in network. If you are someone that demands to preserve your choice of medical providers this plan probably won’t work for you, stick with a Medigap supplement plan. Another drawback is these plans are specific to certain counties and geographic locations. For example, one plan may operate in the four county DFW metroplex but that same plan wont be available in then very next county unlike supplements that are available everywhere.
Source: medicareinsurancetexas.com

Video: 7 Accused of Bilking $375M From Medicare

False Claims Act Lawyer Discusses Durable Medical Equipment and Power Wheelchair Fraud

The owner of a now defunct McAllen, Texas area durable medical equipment (DME) business, his wife and another former employee have been convicted for their rolls in a conspiracy and scheme to defraud Medicare and Medicaid through fraudulent billings.  From early 2004 through late 2011, Monticello Herrera, who did business as RGV DME in the McAllen, Texas area engaged in and directed a scheme to submit fraudulent claims to Medicare and Texas Medicaid for power wheelchairs, incontinent supplies, hospital beds and mattresses, as well as other DME supplies.  The government contended that this fraudulent scheme submitted or caused to be submitted more than $11,000,000 in false and fraudulent claims to Medicare and Texas Medicaid for which Herrera received an excess of $6.1 million dollars.  The trio admitted that 85% of their Medicare and Texas Medicaid billings were false and fraudulent.
Source: midsouthtriallawyer.com

Need MA Agent for a Case in Texas

I’ve got a lay-down deal in Texas outside of Austin. I’ve done all the legwork and just need a certified MA agent to write the policy with Humana. I’ve got the gentleman on a Plan F now, but he wants to go back to an Advantage plan. 50/50 split. I prefer to know you rather than get pm’s from brand new people. The client is the patriarch of clients I’ve had for years. PM me if you’re interested in helping here. It’s a simple, straight-up deal.
Source: insurance-forums.net

Texas Medicare Supplement Insurance Plans

Make sure that you are getting the right coverage that you want. This will not be hard if you already know your options. There are ten different supplement plans that you can choose from. Taking time to carefully examine all you have to choose from will enable you to compare the gaps filled with each plan to determine the one that is going to be ideal for your needs.
Source: zambiadaily.com

Plus ACO Asks Medicare to Reconsider Benchmarks

Plus ACO has 19,000 patients who will be enrolled in the traditional Medicare plan. NTSP, which serves patients in Tarrant, Parker, and Johnson counties, has more than 10 years of experience in population health management and has participated in quality initiatives tied to financial incentives. It cares for about 30,000 Medicare Advantage patients—including 25,000 in United Healthcare’s Secure Horizons plan and about 5,000 in its wholly owned Care N’ Care plan. Plus ACO will have 19,000 patients who will be enrolled in the traditional Medicare plan.
Source: dmagazine.com

Seniors should tell Obama to prevent Medicare Advantage cuts

When President Obama signed the Affordable Care Act into law, he simultaneously authorized $200 billion in cuts to the Medicare Advantage program. At the time, the Congressional Budget Office projected that the health care reform law’s cuts would result in three million fewer Medicare Advantage enrollees. Moreover, actuaries at Oliver Wyman predicted that the cost of the health insurance tax would mean an additional $3,500 in out-of-pocket expenses for seniors over the next 10 years.
Source: dailycaller.com

Something’s wrong! NotFound

I have ranted in the past about the incoherence of the ” tighten the belt ” metaphor and the mind-numbing inanity of the ” -gate ” suffix; however, I’d like to introduce a few more words and phrases …
Source: dailykos.com

Commission Urges Changing Medicare Physician Payment

Posted by:  :  Category: Medicare

Yarmuth Meeting 3 by Greater Louisville Medical SocietyMedPage Today: Medicaid Pay Boost Slow For Primary Care Primary care providers haven’t been receiving a boost in Medicaid reimbursements in 2013 as promised by the Affordable Care Act (ACA), doctor groups and Medicaid plans said. Instead, states are still submitting necessary amendments to Medicaid plans to the Centers for Medicare and Medicaid Services (CMS) to allow the agency to pay Medicaid primary care providers at the higher Medicare rates. The ACA provision sought to incentivize primary care physicians to see Medicaid patients, while another provision of the law was aimed at adding more than 30 million new beneficiaries to the rolls by increasing eligibility to include those with incomes up to 138 percent of the federal poverty level. States have until March 31 to file paperwork with CMS on their plans, and the agency has 90 days to respond to it (Pittman, 3/1).
Source: kaiserhealthnews.org

Video: How to Navigate Medicare Reimbursement

AARP Urges Congress to Address Medicare Physician Payments

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

Upton to Highlight Medicare Physician Payment Reform Effort WEDNESDAY During Address to American Medical Association

WASHINGTON, DC – Energy and Commerce Committee Chairman Fred Upton (R-MI) will address the American Medical Association at the 2013 National Advocacy Conference on Wednesday, February 13, 2013, at 8:00 a.m. at the Grand Hyatt Washington. Upton will discuss the health care law’s impact on physicians and patients and outline the committee’s upcoming plans to address the outdated Medicare physician payment system. Last week, Upton and Ways and Means Chairman Dave Camp (R-MI) released a framework of their collaborative efforts to repeal the Sustainable Growth Rate formula and advance a permanent solution for the long troubled payment system. On Thursday, the Energy and Commerce Health Subcommittee will hold a hearing on SGR reform.  
Source: house.gov

Federal Budget Cuts to Hit Medicare Providers on April 1

Additionally, a report released by the American Hospital Association, the American Medical Association, and the American Nurses Association says the cuts will have an even broader impact. The report, conducted by the economic research firm Tripp Umbach, concludes that the cuts could lead to a loss of more than 750,000 jobs in the healthcare industry. The research points to reduced purchases of healthcare goods and services, leading to the lay off of workers in the industry.
Source: milliganlawless.com

Group Recommends Replacing Medicare Fee

The Commission noted that the rising cost of health care in the U.S. can be tied to the amount that physicians are being paid. The U.S. spends more on health care than any other developed country, the Commission reported, nearly $3 trillion per year—18 percent of the domestic product or $8,000 per person. The Commission noted that spending on Medicare has risen from 3.5 percent of gross domestic product (GDP) in 1975 to 15.1 percent in 2010 and is projected to reach 17 percent by 2020. Despite this increased spending the Commission reports that the World Health Organization ranks the U.S. 37th in health status behind countries like Oman, Morocco and Paraguay.
Source: wolterskluwerlb.com

2013 Medicare Physician Fee Schedule

I also am new to the RVU process but have a fairly good understanding of what needs to be done. However, I have been unable to find any information on what a Transitioned Non-Facility verses a Fully Implemented non- Facility is. I noticed the PE RVU is higher for the Fully Implemented non-facility. Someone told me it represents where you are at in your implementation of EHR???? I am waiting for a callback from CMS but if anyone has an answer it would be appreciated. Pat Carlson Open Cities Health Center
Source: physicianspractice.com

Medicare Fraud, Waste, and Abuse: A Primer

Whether a practice is “fraudulent,” “abusive,” or merely “wasteful,” goes hand in hand with the question: Will a pattern of conduct result in paying back the money received, criminal action, or simply civil money penalties? The answer isn’t entirely simple to provide. A practice or “scheme,” whether malum in se, or malum prohibitum, is normally occasioned within a continuum, or range of mental states – from innocence, to negligence, gross negligence, conscious indifference, willful ignorance, knowing, or intent to defraud. Because the potential penalty is (by definition) punitive, normally at a minimum, a “knowing” violation is required.
Source: physicianspractice.com

Can Medicare Conscript Physicians, Asks Doctor in Journal of American Physicians and Surgeons

TUCSON, Ariz., March 12, 2013 (GLOBE NEWSWIRE) — Physicians are increasingly unwilling to serve patients under Medicare’s onerous regulations, draconian threats, and poor payment, according to the Association of American Physicians and Surgeons (AAPS). When Medicare was enacted, Congress promised that it would not interfere in the practice of medicine, or prevent patients from freely choosing a physician. California neurologist Susan Hansen, M.D., asks whether these promises are still operative, in the spring issue of the Journal of American Physicians and Surgeons.
Source: globenewswire.com

Budget Sequestration Targets Medicare Physician Pay

the time until the Sequester counts down, many physicians that get much of their pay from Medicare are getting more and more upset with congress. If it does come down to the cuts going into full effect, then all physicians will see a 2 percent drop in pay.
Source: sweye.com

How to Fix the Medicare Physician Payment Problem

The congressional formula that determines the annual Medicare payment update for physicians, the sustainable growth rate (SGR), was supposed to cut Medicare doctors’ pay each year starting in 2002. But that congressional formula is so flawed and unworkable that every year since 2003, Congress has stepped in to stop it from going into effect. In 2013, without another congressional “doc fix,” the physicians would have had a pay cut of 26.5 percent.
Source: fixhealthcarepolicy.com

Internists Offer Possible Solutions to Medicare Payment Problems

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

Profiles of Medicaid Outreach and Enrollment Strategies: One

Posted by:  :  Category: Medicare

OBAMA: THE SOCIALIST/MARXIST/COMMUNIST -- UNMASKED FOR ALL TO SEE by SS&SSThis brief provides insight into lessons learned from Medicaid and CHIP outreach and enrollment strategies that can help inform implementation of the Affordable Care Act (ACA) coverage expansions by profiling a successful enrollment assistance initiative among health centers in Utah. The brief is part of the “Getting Into Gear for 2014″ series examining key implementation issues as states prepare for the ACA coverage expansions.
Source: kff.org

Video: Utah Medicare Advantage Plans for Seniors in 2012

The Pros And Cons Of Medicare Pill Insurance

In this particular age of changability and uncertainty, you surely does far from being know when unfortunate accidents might befall. To be on the safer side, the best option is to go Utah Medicare increase plans. Efforts are created in order to put people into your complete ease guaranteeing that no matter procedure to them in order to their loved ones, there is in most cases an action policy ready to be employed and exercised. After all, of the life is entirely dear to associated with us and there can be no laxity labels on homeopathic products. So, why buy Utah Medicare supplement offers when you have actually other Medicare started plans in store? Well, there are plenty of reasons why, but first we must one more thing understand what these supplement plans are probably.
Source: blog.com

Where You Get The Best Medicare Supplement

In this age of changeableness and uncertainty, at least one surely does no longer know when less fortunate accidents might befall. To be on the safer side, the best another option is to gain Utah Medicare increase plans. Diets are created as a way to put people straight into complete ease to make certain no matter what happens to them in order to their loved ones, there is forever an action choose ready to be employed and exercised. After all, the cost of life is instead dear to associated with us and there can be no laxity in this regard. So, why buy Utah Medicare supplement itineraries when you now have other Medicare based primarily plans in put? Well, there are plenty of conditions why, but initially we must one more thing understand what these supplement plans end up being.
Source: blog.com

Romney/Ryan Plan to End Medicare as We Know It

2008 Election Alan Korwin ammo bailout Barack Obama BLM Bush california proposition 8 carl wimmer Climate Change DeChristopher Economy education fox news gay marriage George W. Bush glenn beck Gun Control gun lobby guns hand guns Health Care Health Care Reform Iraq John McCain Karl Rove kleck lies Mormon church nra Obama Politics News Pro-Gun prop 8 Racism racist Republicans Rocky Anderson Salt Lake City Sandy Hook Elementary School Shooting second amendment Tea Party Tim DeChristopher utah Video
Source: oneutah.org

Orrin Hatch warns on Medicare payment experiments under ACA

They aren’t sure that the innovation center — and its $10 billion budget and wide-ranging approach — is the answer. But they also haven’t mounted a big effort to defund or eliminate the center, unlike other hot-button parts of the health law. So at a Senate Finance Committee hearing Wednesday, there was criticism — blended with a bit of wait and see.
Source: politico.com

Obama planning to Cut Medicare Advantage Reimbursements

Posted by:  :  Category: Medicare

Joe the Plumber - To Flush The System ... More scams aim to ensnare Brevard seniors - Their ingenuity is boundless, Archer said. (Jul 2, 2012) ... by marsmet524The new cuts come in the form of a planned reduction in the reimbursement rates the government pays to insurance companies that operate Medicare Advantage plans, which are services administered by private for-profit or non-profit providers that offer additional services than can be found in traditional Medicare.
Source: westorlandonews.com

Video: OBAMA To Cut MEDICARE By $700bn To Fund OBAMACARE The IMPACT on SENIORS

GAO Report is More Bad News for Medicare Advantage Plans

GAO says in a new report that Medicare plans were overpaid $3.2 billion to $5.1 billion in the three years from 2010 to 2012.  Scott Fidel of Deustche Bank says that the report comes at a particularly bad time given recently proposed cuts to 2014 Medicare Advantage rates.  Health plans are lobbying against the cuts, but Fidel notes that many are required by ObamaCare and the GAO report only reinforces the need for them.  The overpayments relate to risk scores assigned to Medicare plan members, which GAO says were inappropriately high.   Additional pressure on risk scores could push final rates (scheduled for release April 1) down even more, further impacting Medicare plans margins in 2014 and 2015, Fidel says.
Source: corporateresearchgroup.com

Seniors should tell Obama to prevent Medicare Advantage cuts

When President Obama signed the Affordable Care Act into law, he simultaneously authorized $200 billion in cuts to the Medicare Advantage program. At the time, the Congressional Budget Office projected that the health care reform law’s cuts would result in three million fewer Medicare Advantage enrollees. Moreover, actuaries at Oliver Wyman predicted that the cost of the health insurance tax would mean an additional $3,500 in out-of-pocket expenses for seniors over the next 10 years.
Source: dailycaller.com

Proposed 2014 Medicare Advantage rates cut insurer payments

Should the rules become final, Skolnick said she would expect UnitedHealth to exit many Medicare Advantage markets and experience a significant or severe contraction in that business. But she said that as with past rule changes, expected lobbying over the next few weeks by insurers may affect the final rule.
Source: medcitynews.com

Are Medicare Advantage Plans Skimming Off Healthiest Patients?

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

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

Study: Seniors Look For Star Ratings On Medicare Advantage Plans

The rating system uses survey data and other measurements of effectiveness to gauge the quality of the private Medicare Advantage plans, which are an alternative to traditional fee-for-service Medicare. Dr. William Shrank, a co-author of the study, said the relationship between the ratings and enrollment was a good sign for the star system put in place in 2011.
Source: kaiserhealthnews.org

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

The low readmission rates indicate I-SNPs provide more integrated, coordinated care to enrolled beneficiaries than fee-for-service plans. Based in part on I-SNPs’ high marks for improving integrated care, MedPAC commissioners unanimously recommended that Congress permanently reauthorize them, according to the Bureau of National Affairs (BNA).
Source: mcknights.com

Insurer halts Medicare Advantage sales in Georgia

Public HealthHealth InsuranceHealth CostsHospitalsMedicaidHealth ReformDelivery of CarePhysiciansChildren’s HealthSafety NetMental HealthDisabilitiesMedicareCaregivingUninsuredHealth DisparitiesPrescription DrugsLong-Term CareNursesHealth QualityQuality of CarenursingRural Healthhospitalnursing homes
Source: georgiahealthnews.com

Don’t fall for Medicaid card renewal phone calls

Posted by:  :  Category: Medicare

Deal 3, Table 7: Initiation enter Trick A~ contract taker leads King of Risks by KevinHutchins314Tips from a study at USC (http://n.pr/UKyFOT). • Compare reviews not only within a site, but across different websites. • Reviews by people who are verified by the site are more trustworthy than reviews by anonymous reviewers — especially when it comes to negative reviews. • Read reviews less for whether they give a hotel or a restaurant one star or five stars, but more for the specific information they give about the experience. • Reviews are very useful for information that experts or merchants might not think to provide — how late a swimming pool stays open could be useful if you are traveling with a family. • Focus on aggregates, not outliers. You can’t trust a handful of bad reviews or glowing reviews, but trends are much harder to fake.
Source: wordpress.com

Video: MRM Tip: Checking Medicare card expiry

How to Replace a Lost Medicare Card

Medicare is a program funded by US government which provides affordable health care to citizens above the age of 65. A red, white and blue Medicare card wiil be given to citizens as a proof . Whenever you are seeking healthcare under medicare program, production of medicare card is a must.If your card has been destroyed, lost or stolen, you need to get a replacement card as early as possible. Here I will describe the process of getting a replacement medicare card.
Source: infobarrel.com

Medicare Cards Pose a High Risk for Identity Theft Scams

However, the Social Security Administration (SSA) recently made a request for the Centers for Medicare and Medicaid Services (CMS) to take immediate action to issue new cards to beneficiaries. These new cards would not have the individual’s Social Security number printed on them. (See: References 2) This is according to a report by the New York Times. (See: References 2) It was also noted that most private insurance agencies have stopped printing Social Security numbers on their beneficiary identification cards. This is due to the fact that many states have forbidden the inclusion of such personal data, according to the Times. But the SSA doesn’t have the authority to prohibit CMS from placing Social Security numbers on beneficiary Medicare cards. However, Congress does have that authority, according to the N.Y. Times.
Source: bestidentityprotection.net

Beware of Medicare Fraud Calls

These calls are completely fraudulent. Medicare will NEVER ask for a beneficiary’s Medicare number unless the beneficiary initiates the call, and they will NEVER ask for a bank account number under any circumstances. The only beneficiaries that need to get new Medicare cards are those who are first applying for Medicare coverage, or those who have asked for a new card because their card is lost or damaged.
Source: mauryriversc.org

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

Things To Know About Your Medicare Card

American Heart Association Anthem Blue Cross Banyan Administrators benefits CalCPA CalCPA ProtectPlus California CDC Centers for Disease Control and Prevention Cobra congress CPA diabetes economy Education employees Energy flu food Group Insurance Trust Health Health & Wellness health care healthcare Health Care Reform healthcare reform health insurance health plans health term Health Terms healthy eating HSA insurance jobs Medicare Obama Obama’s Weekly Address President prevention ProtectPlus recipes reform taxes weekly address white house
Source: cpaprotectplus.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

Get the Facts on Medicare and Social Security

Posted by:  :  Category: Medicare

Mitt Mobile in the Final Stretch by DonkeyHoteyPrior to Election Day, AARP volunteers delivered more than 200,000 petitions along with a report entitled “Americans Have Their Say about Medicare and Social Security” to both the Democratic and Republican National Committees.  The petitions now call on President Obama to give Americans straight talk about what he would do to put Medicare and Social Security on stable ground for the future. 
Source: aarp.org

Video: A Permanent Fix for Medicare – Know the Facts

Quick Health Facts 2012: A Compilation of Selected State Data

. This is the 3rd edition of Quick Health Facts. Earlier editions were published in 2008 and 2010. This is the first year that Quick Health Facts incorporates data from the American Community Survey (ACS), resulting in an improvement of the precision of state level estimates.  Previous editions relied on data from the Current Population Survey (CPS). As a result of this change, some of the figures in this edition of Quick Health Facts are not directly comparable to the figures in previous editions. In addition, data points presented in Quick Health Facts should not be combined to create new data points, as they are often derived from different data sources. The Quick Health Facts series is adapted from the State Profiles: Reforming the Health Care System series that was published annually from 1990 to 2000 and biennially from 2001 to 2005 by the AARP Public Policy Institute. Quick Health Facts is not a continuation of the State Profiles series; therefore, comparisons should not be made with information contained in past editions of State Profiles.  This publication, as well as state-specific versions, can also be accessed via the Internet at http://www.aarp.org/research/ppi. For hard copies of Quick Health Facts 2012, please call the AARP Public Policy Institute at 202-434-3890.
Source: aarp.org

Health Care Reform and Medicare Myths vs. Facts

The Affordable Care Act (ACA) in fact prohibits cuts to guaranteed Medicare benefits. There are provisions in the law to help curb the soaring costs of Medicare, but savings will come from reining in unreasonable payments to providers, taxing high-premium plans (beginning in the year 2018), cracking down on fraud and waste, and encouraging patient-centered, coordinated care, says Sara R. Collins, Ph.D., vice president of the Commonwealth Fund, a private research foundation focused on health care.
Source: aarp.org

Short hits: Medicare facts, the Republican convention, and voting access

Where population greatly abounds vice and virtue have their greatest extremes. A simple rural population needs no night police, and no lock-up. Rogues and strumpets do not nightly traverse the deserted highways of the farmer. Low inns, restaurants, sailors’ boarding-houses, and houses of ill fame do not abound in rural precincts, ready to pour out on election day their pestilent hordes of imported bullies and vagabonds, and to cast them multiplied upon the polls as voters. In large cities such things exist, and its proper population therefore needs greater protection, and local legislation must come to their relief.
Source: bangordailynews.com

Medicare Fact Sheets for Professionals: Medicare Information

“I want to compliment your organization on the quality of the fact sheets and informational materials on your website. I think they are among the most accurate and clearly written materials on Medicare (and Medi-Cal) available anywhere.”
Source: cahealthadvocates.org

GRAY MATTERS: HICAP can help with Medicare

A series of free Medicare workshops is offered in Eureka and Del Norte County on a rotating basis. Workshops cover Medicare basics, supplemental Medicare and the Medicare Prescription Drug Plans. No registration is required. In Eureka, workshops are typically held the second Thursday of the month from 4 to 5 p.m. at the Area 1 Agency on Aging office and at the Del Norte Senior Center at various times. HICAP counselors are also available to make presentations to community groups about Medicare programs.
Source: times-standard.com

Daily Kos: House Republicans vote to end Medicare, again

whose memorization skills are awasome are lacking is a sense of time. There’s a clue in the fact that all economic theory is based on models that are focused on conditions at a specific point in time. That is, the models are all static. If there are series or sequences, those are still perceived as static isolated instances. For comparison, think of the frames in a moving picture or video or cartoon. In a movie, these static images move at the rate of 30 per second, too quick for the human eye to perceive as static. So, we see them as continuous motion. Now imagine a person who can’t see change — i.e. the relationship between prior, present, and later images. Or call it progression. Some brains just take snap shots and can’t register change, progress, motion. Kenneth Galbraith said the problem is an inability to model the economy as a dynamic system, which it is. Economists can’t track change over time. Meteorologists are trying to do it for the weather, with some success. But, I suspect people attracted to economics aren’t even interested in trying, either because they don’t understand what a dynamic system is or because what they’re really after is changing how people behave. If the economy isn’t working as they expect, then people’s behavior has to be changed. It doesn’t even occur to them that their models are wrong.
Source: dailykos.com

Fact/Fiction: Raising the Medicare Eligibility Age Would Save the Program Money

Federal spending would be reduced by a net $5.7 billion if the eligibility age increase were fully implemented by 2014, according to a Kaiser Family Foundation report last updated July 2011. The Congressional Budget Office estimated that raising the eligibility age by two months per year starting in 2014 until it hits 67 in 2027—which is closer to plans that have been put forward in Congress—would save the federal government about $148 billion from 2012 to 2021. By 2035, Medicare spending would be 5 percent lower annually that it would without such measures.
Source: northcarolinahealthnews.org

Obama Cuts Medicare – Again!

Posted by:  :  Category: Medicare

Joe the Plumber - To Flush The System ... More scams aim to ensnare Brevard seniors - Their ingenuity is boundless, Archer said. (Jul 2, 2012) ... by marsmet524When President Obama signed the Affordable Care Act into law, he simultaneously authorized $200 billion in cuts to the Medicare Advantage program. At the time, the Congressional Budget Office projected that the health care reform law’s cuts would result in three million fewer Medicare Advantage enrollees. Moreover, actuaries at Oliver Wyman predicted that the cost of the health insurance tax would mean an additional $3,500 in out-of-pocket expenses for seniors over the next ten years.
Source: townhall.com

Video: Advantage Plans | Medicare Advantage 1-800-643-7544

Seniors should tell Obama to prevent Medicare Advantage cuts

When President Obama signed the Affordable Care Act into law, he simultaneously authorized $200 billion in cuts to the Medicare Advantage program. At the time, the Congressional Budget Office projected that the health care reform law’s cuts would result in three million fewer Medicare Advantage enrollees. Moreover, actuaries at Oliver Wyman predicted that the cost of the health insurance tax would mean an additional $3,500 in out-of-pocket expenses for seniors over the next 10 years.
Source: dailycaller.com

Daily Kos: House Republicans vote to end Medicare, again

whose memorization skills are awasome are lacking is a sense of time. There’s a clue in the fact that all economic theory is based on models that are focused on conditions at a specific point in time. That is, the models are all static. If there are series or sequences, those are still perceived as static isolated instances. For comparison, think of the frames in a moving picture or video or cartoon. In a movie, these static images move at the rate of 30 per second, too quick for the human eye to perceive as static. So, we see them as continuous motion. Now imagine a person who can’t see change — i.e. the relationship between prior, present, and later images. Or call it progression. Some brains just take snap shots and can’t register change, progress, motion. Kenneth Galbraith said the problem is an inability to model the economy as a dynamic system, which it is. Economists can’t track change over time. Meteorologists are trying to do it for the weather, with some success. But, I suspect people attracted to economics aren’t even interested in trying, either because they don’t understand what a dynamic system is or because what they’re really after is changing how people behave. If the economy isn’t working as they expect, then people’s behavior has to be changed. It doesn’t even occur to them that their models are wrong.
Source: dailykos.com

How Medicare Could Fix U.S. Healthcare

Doctor  and hospital problems:  Medicaid, the state-federal partnership program to pay for care for poor people, usually pays doctors and hospitals quite a bit less than the care actually costs.  Medicare, the program for older Americans, on the other hand, pays what it figures a really efficient operation should cost; that is, less than most hospitals and doctors feel they should get. These unpaid costs are shifted to private insurance, which pays much more than the cost of the care that its policy holders get. But though they are paying much more than the care costs, health insurance companies insist that their policy holders get a “discount.” Therefore hospitals charge people without insurance even more. The uninsured pay the most, perhaps twice as much as insured patients and three or even six times the cost of their care. The result of all this cost shifting has to come together in an operation that ends up in the black.
Source: dailyyonder.com

Medicare Studies Cost of Long

As a resident of Santa Cruz, and a healthcare insurance agent that networks w/ the long-term caregiving community, these numbers do feel about right. Folks in Santa Cruz have good access to palliative and hospice care. Acute care happens in hospitals and we have those, too. If these numbers are accurate, it will be instructive for us to share ways to keep Medicare and Medi-Cal functioning into the Baby Boom age wave.
Source: californiahealthline.org

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

Medicare Revises Readmissions Penalties – Again

The penalties have not been popular with hospital executives, with many complaining that they are excessive and unfair to hospitals with large numbers of low-income patients, who tend to be readmitted more frequently. In an article this month in the New England Journal of Medicine, two Harvard professors who have been critical of the program, Drs. Karen Joynt and Ashish Jha, urged changes, writing that the program “will penalize hospitals that care for the sickest and the poorest Americans, largely because readmissions are driven by the severity of underlying illness and social instability at home.”
Source: kaiserhealthnews.org