Medicare Plan Finder for Health, Prescription Drug and Medigap plans

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Source: medicare.gov

Video: Medicare vs Medicaid 612-309-9184 Minnesota Medical Assistance Minneapolis Elder Law Attorney

Deadline looms for Medicare enrollment

The Medicare Advantage disenrollment period runs Jan. 1 to Feb. 14. During that time you can leave your Medicare Advantage Plan to switch to original Medicare. If you switch to original Medicare during this period, you’ll have until Feb. 14 to join a Medicare Prescription Drug Plan to add drug coverage. Your coverage will begin the first day of the month after the plan gets your enrollment form. However, during this period, you cannot switch from original Medicare to an advantage plan or from one advantage plan to another; join, switch or drop a Medicare medical savings account; or change the prescription drug plan.
Source: superiortelegram.com

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

Medicare revalidation, DMEPOS fee still prompt questions among ODs

“Medicare covers post-op eyeglasses for cataract patients only if the glasses are provided by a DMEPOS supplier who is enrolled in Medicare,” Dr. Jordan said. “If the optometrist is not enrolled in Medicare for DMEPOS, then the glasses are not covered. Neither the doctor nor the patient can obtain reimbursement for the glasses from Medicare if the supplier is not enrolled. If a Medicare beneficiary wants to pay out-of-pocket for eyeglasses from a supplier who is not enrolled in Medicare, she or he may do so, but the doctor should be sure to explain to the patient that the glasses would be covered if they were obtained from another supplier who is enrolled in Medicare. In addition, the doctor should be certain to have an ABN form signed by the patient acknowledging that although she/he could have these glasses covered elsewhere she/he agrees to pay the doctor out-of-pocket and that he or she cannot get reimbursement from Medicare.”
Source: newsfromaoa.org

How Do I Resubmit Insurance Enrollment to Medicare?

You are eligible for medicare benefits when you are sixty five years or older. You can also be eligible for medicare benefits if you have a disability and are younger than sixty five. You are eligible to submit an insurance enrollment form to Medicare three months after you turn sixty five. This initial enrollment period will last for seven months. If you do not enroll during this period or if you were denied during this period, you can resubmit the insurance enrollment form for Medicare during the general enrollment period. The general enrollment period usually lasts from January 1st to March 31st. You can submit a Medicare 855R application if you wish to reassign your Medicare benefits.
Source: seniorcorps.org

Resource Center for Religious Institutes: Medicare Open Enrollment Period Closes Tomorrow!

Note that you can join a health or drug plan under Medicare when you first get Medicare (initial enrollment periods for Part C & D), such as when you turn age 65. Each year, you have a chance to make changes to your Medicare Advantage or Medicare prescription drug coverage for the following year. There are 2 separate enrollment periods each year. According to the Medicare website:
Source: blogspot.com

Medicare Enrollment Revalidation and the Revised CMS 855 Forms : Healthcare Integration Advisors : New York Attorneys & Lawyers for Health Care Providers, Hospitals, Insurers : Iseman, Cunningham, Riester & Hyde LLP

In July of this year, CMS published revised Medicare enrollment forms for all provider and supplier types.  CMS revised the enrollment forms in an effort to implement a more rigorous program of integrity standards.  CMS’s theory is that by keeping bad people out of the Medicare system, most of the fraudulent activity that has plagued federal health care programs can be halted before it even begins.  The most substantial revisions were made to the Form 855A for institutional providers and the new Form 855O, which is for physicians and non-physician practitioners who enroll in Medicare for the sole purpose of ordering or referring items for Medicare beneficiaries.
Source: healthcareintegrationadvisors.com

Email Scams: (your email address):: Your Medicare Enrollment form‏

Attention (your email address) Medicare Open Enrollment is Going on Now for a limited time All plans regulated by law. Get specific pricing from your area. One simple form takes just minutes Your medicare benefits Here To unsubscribe go here or write to: Medicare-Open-Enrollment PO Box 7022 New York NY 10116 You are subscribed to bonusslice.com with the email address (youremailaddress). To avoid receipt moving forward, please use this page 5042 Wilshire Blvd #14149- Los Angeles, CA 90036
Source: blogspot.com

Increased hospice enrollment would save Medicare millions each year, researchers find

Increasing hospice enrollment would improve care for beneficiaries while saving the Medicare program millions of dollars annually, according to a study in the March issue of Health Affairs. Researchers at the Icahn School of Medicine at Mount Sinai Medical Center in New York City looked at 2002-2008 survey data and Medicare claims of 3,069 people. Those who enrolled in hospice cost the Medicare program less than those who did not enroll in hospice, the researchers found. The most savings occurred for Medicare when patients entered hospice 15-30 days prior to death, according to the report. If 1,000 additional beneficiaries enrolled in hospice during this window of time, the Medicare program would save about $6.4 million annually. Medicare would save more than $2.5 million annually if 1,000 additional people enrolled in hospice 53-105 days before death. Increased hospice care would also lower 30-day hospital readmissions rates and positively impact quality of care measures, the researchers stated.
Source: mcknights.com

Draft Obamacare Application Asks About Voter Registration

The online application draft for healthcare insurance under Obamacare inquires if the applicant would like to register to vote and directs the applicant to a registration page if they answer in the affirmative. Page 59 of the 61 page draft application, “List of Questions in the Online Application to Support Eligibility Determinations for Enrollment” developed by the Centers for Medicare & Medicaid Services, and first reported by The Washington Examiner, asks applicants “Would you like to register to vote?” The “yes” answer linking to a blank registration form. On Monday, House Ways & Means Oversight Subcommittee Chairman Charles Boustany of Louisiana called on Health & Human Services Secretary Kathleen Sebelius to provide more information about the voter registration portion of the draft. “The healthcare law spans 974 pages and regulated nearly one fifth of our economy, yet nowhere in the law is voter registration mentioned,” Boustany wrote in a letter to the HHS secretary. “The Paperwork Reduction Act of 1995 (PRA) requires that federal agencies gather only appropriate information as required by legislation. While the healthcare law requires that government agencies collect vast information about Americans’ personal lives, it does not give your department an interest in whether individual Americans choose to vote.” Boustany surmised that the placement of the voter registration question, in the middle of questions to determine eligibility for insurance policies, could lead some to believe their potential eligibility is contingent on whether they are registered to vote. The Louisiana Republican requested that by April 8, Sebelius supply him with the department’s authorization to collect voter information under Obamacare and the Health Care & Education Reconciliation Act, the titles of those responsible for clearing the document, and other drafts of the application. READ FULL SOURCE ARTICLE: 03/25/2013
Source: newmediajournal.us

What You Have To Know About Medicare Supplement Plans

Posted by:  :  Category: Medicare

In the event you discover a program which you like and that functions effectively together with your spending budget, get a full copy of what your program will look like prior to you purchase it. Ensure to study by means of the whole point and look for clauses and exceptions that could deny you achievable necessary coverage. This could be aggravating in the search for a plan, but is is essential for making sure you obtain an excellent health insurance coverage program.
Source: apyc2011.org

Video: Choosing a Medicare Supplement Policy in 2011

New WordPress Medicare Supplement Site for Sale

Are you an Insurance Forums member yet ? To sign up for your FREE INSTANT account, please fill out the form below ! Username:     Password:   Confirm Password:     E-Mail:   Confirm E-Mail:     Question of the day:   Time is M*** Agree to forum rules 
Source: insurance-forums.net

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 – NONE 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 – Birthday Wyoming
Source: insurance-forums.net

Genworth Financial to sell its Medicare supplement unit

Genworth, a Henrico County-based insurance giant, said the sale is part of strategy to focus its attention on its retirement and protection business segment and markets with the strongest value propositions for the company.
Source: timesdispatch.com

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

The page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

6 things you should know about Medicare Supplements

Medicare Supplement plans are subject to periodic rate increases: Medicare Supplement plans A-N are standardized (except in states: MA, MN, WI), and all Medicare Supplement plans with the same letter offer the same benefits, regardless of the state you live in or the insurance carrier providing the coverage. Put another way, a Plan N from “insurer 1” must provide the same benefits as a Plan N from “insurer 2.” But, medical costs, medical inflation and innumerable other issues impact the cost of Medicare Supplement plans, which means the monthly fees you pay for a plan will increase over time. If a plan premium increases to a level you can no longer afford, beneficiaries do have the option to change to a Medicare Advantage plan during the Medicare Advantage annual enrollment period, which runs from October 15th to December 7th in 2011.
Source: ehealthinsurance.com

Medigap coverage sales rose by 9% in 2012, projections good for future

Humana Lives and Premiums Increase Again in Fourth Quarter 2012 Humana reported fourth quarter 2012 Medicare supplement policy in-force counts of 77,400, a 3% increase over 3rd quarter 2012 and 30% increase over fourth quarter 2011. Humana also reported fourth quarter 2012 Medicare supplement premium of $39 million, up 8% from 3rd quarter 2012 and 39% over fourth quarter 2011. Humana’s Medicare supplement sales rank in the top eight in the market.
Source: ifawebnews.com

FAQ: Seniors May See Changes in Medigap Policies

Advocacy groups like the Medicare Rights Center oppose restricting Medigap plans, saying it would simply shift more costs from the government to elderly and low-income people who can least afford it. “Some in government feel people in Medicare don’t have enough ‘skin in the game,’” says Ilene Stein, federal policy director for the center. In fact, she says, people on Medicare already pay 15 percent of their incomes for health care, well above the level paid by non-Medicare households. While the proposals would cap maximum annual spending per enrollee to $5,500 or $7,500, “that’s a lot of money for someone making $22,000,” the median household income for those on Medicare, she says. 
Source: kaiserhealthnews.org

Medicare Supplement Phone Sales

I sell med supps exclusively by phone. What I can tell you is there is a crazy amount of companies offering medicare supplements, and a lot of companies only operate in certain states. 47 states would just hinder your production with out a team of agents, as opposed to just focusing on 3-4 states. Most states you’ll have two or three companies worth writing depending on their situation and you’ll just be replacing everything else for the most part.
Source: insurance-forums.net

Guarantee Issue Medicare Supplements

Applicants must complete the Section F: Conditions of Application. While online applicants will need to complete the Health History in order to successfully navigate through the online system, as long as they are applying for an Anthem Blue Cross and Blue Shield Medicare Supplement policy of equal or lesser benefits, their application will not need underwriting and the Health History information will not be reviewed or considered.
Source: wordpress.com

Competitive Bidding Will Save Money For People With Medicare

Posted by:  :  Category: Medicare

Notre Dame des Bananes by Grant NeufeldIf you have Original Medicare, your permanent residence is in a ZIP code within a competitive bidding area, and you use one of the items in the categories above, you generally must use a Medicare contract supplier in order for Medicare to help pay for the item. If you currently receive oxygen or oxygen equipment, or rent certain items from a non-contract supplier, you may be able to continue renting these items from your current supplier after July 1 if the supplier chooses to become “grandfathered” into the competitive bidding program.
Source: patch.com

Video: Medicare HMO-POS Explained – Rob Merritt interviews Tony Prince in Laguna Woods, CA

Competitive Bidding for Medicare Can Save Money

I agree with you Frank, lowering costs with same service and products, the current bid system cannot do this. How many times have you bid and then said, no I was only kidding? The bids are non-binding. 167 Economist against current bid system. http://www.cramton.umd.edu/papers2010-2014/comments-of-concerned-auction-experts-on-medicare-bidding.pdf I am for Market Pricing Program which they are trying to run through legislation now. http://www.cramton.umd.edu/papers2010-2014/market-pricing-program-legislation.pdf The goals for this CB are to lower costs, provide excellent service, provide name brand quality products and eliminate fraud. Home care is the most cost effective way to care for Medicare beneficiaries; however product and services are going to suffer under the latest round of bidding using this flawed method.
Source: patch.com

Manning Conference III: The right's strategies for dominating cities and wrecking medicare

David Climenhaga, author of the Alberta Diary blog, is a journalist, author, journalism teacher, poet and trade union communicator who has worked in senior writing and editing positions with the Toronto Globe and Mail and the Calgary Herald. His 1995 book, A Poke in the Public Eye, explores the relationships among Canadian journalists, public relations people and politicians. He left journalism after the strike at the Calgary Herald in 1999 and 2000 to work for the trade union movement. Alberta Diary focuses on Alberta politics and social issues.
Source: rabble.ca

How Obamacare Will Affect Medicare Recipients in 2013

David, I sure wish you folks would come clean on the tough issues! Especially, now that you don’t have to worry about re-election again: More specifically, end-of-life treatment plans/living wills. A medicare financial expert on one of the financial news channels indicated that he suspected, "if everyone just documented their wishes for final care, we would save enough money to balance the federal budget". I believe there is fair consensus among experts that 25% of Medicare funds is spent on people in their final months of life. The suspicion is that most of us would say something to the effect: "When it’s my time just make me comfortable" versus the situation now which is, ‘without judgment, how can we keep this person alive?’. Would it be too much to ask every American to document their desires so that surviving family members don’t have feel like they are making life and death calls for a loved one?
Source: patch.com

Blog: How Medicare Works with Other Insurance

Medicaid and TRICARE (the healthcare program for U.S.armed service members, retirees, and their families) never pay first for services that are covered by Medicare. They only pay after Medicare, employer plans, and/or Medicare Supplement Insurance (Medigap) have paid.
Source: patch.com

State disability center forfeits funding over abuse

In particular, the Sonoma center had evidence of a dozen sexual assaults, but police investigators failed to order a single hospital-supervised examination for the alleged victims. Those reported assaults, all from the Corcoran unit, represent a third of the 36 documented cases of sexual abuse and molestation in the past four years at the state’s five developmental centers.
Source: californiawatch.org

Kaiser Permanente earns top 4

“Our physicians, nurses and staff provide care that is personalized, technologically advanced, and closely coordinated across both inpatient and outpatient settings. The gap between the excellence of care we provide and the rest of medicine is growing year by year. As a result,  Kaiser Permanente members in Northern California have lower mortality rates from heart attacks and strokes than the rest of the country, and our cancer-screening and sepsis-prevention efforts are looked to as models nationally,” said Dr. Robert Pearl, executive director and CEO of The Permanente Medical Group.
Source: patch.com

Florida Healthcare Lawyers

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 marsmet524GAO estimated that cumulative Medicare Advantage (MA) risk scores in 2010 were 4.2 percent higher than they likely would have been if the same beneficiaries had been enrolled continuously in Medicare fee-for-service (FFS). For 2011, GAO estimated that differences in diagnostic coding resulted in risk scores that were 4.6 to 5.3 percent higher than they likely would have been if the same beneficiaries had been continuously enrolled in FFS. This upward trend continued for 2012, with estimated risk scores 4.9 to 6.4 percent higher.
Source: flhealthlaw.com

Video: Medicare 101 – Top Things Regarding Medicare Advantage

What is the price of Florida Medicare Advantage Plans?

Mitt Romney declared that the insurers will leave the Medicare market or there will be some increased prices for the health plans. CSM officials declared that they will not leave the Medicare market because they will not be affected by the reductions of health plans. In Florida, 1 million of the 3.5 million Medicare beneficiaries decided to choose a plan from a private provider. Medicare Advantage Plans occupy a large amount of the market. The Medicare enrollment will be opened between October 15 and December 7. In that period of time seniors can choose health and prescription drug coverage. CMS stated that the average drug plan will cost $30 in 2013. Seniors that have heavy prescription drug costs will definitely get assistance in 2013. This year, the drugs will certainly see a decrease in price.
Source: tshp.info

Bayonet Point Florida Medicare Advantage Plan Members eligible for Free Gym Membership

I am a mom of three teenage boys. Our family has struggled with multiple chronic health issues for many years. It was for this reason that I became interested in Xocai healthy chocolate. Our entire family eats healthy chocolate every day as a supplement and I am currently losing weight with the Xocai X-protein meal shake. I have struggled with Fibromyalgia for over 10 years. If you are struggling with your health, you owe it to yourself to check this out. This is the best way I have found to incorporate significant antioxidants into our diet. Feel free to email me if you have any questions. I look forward to hearing from you!
Source: healthchocoholic.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

The Florida Medicare Advantage Plans

Everyone loves to be in good health at all times and enjoy life to the fullest time. We however know that we may have need for medical attention from time to time, either when seeking treatment or when having regular checkups. Have you been wondering where to turn to for all your answers related to your health? Here is your solution, and you can be assured that you cannot go wrong with the Florida Medicare Advantage Plans.
Source: anti-sociais.info

Obama Admin. to Cut Medicare Advantage Reimbursements

The Obama administration is planning new cuts to Medicare, a federal regulatory filing reveals, cuts that could mean higher premiums or seniors losing their coverage altogether. The 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. In a Feb. 15 regulatory filing, the Centers for Medicare and Medicaid Services (CMS) announced the surprise rate cuts of 2.3 percent – meaning it would pay health care providers 2.3 percent less for providing services to patients. CMS said it was cutting payments because it foresaw the overall costs of the Medicare Advantage program shrinking by 3.2 percent, despite the fact that healthcare costs – the driver of all federal health care program costs – are only rising. Medicare Advantage is like traditional Medicare except that its plans are administered by insurance companies, who are paid a per-enrollee reimbursement fee by the government. If insurance companies can provide care to seniors at less than what the government pays them for it, they make a profit. Medicare Advantage provides coverage for approximately 28 percent of all Medicare beneficiaries, offering them higher-quality services and additional benefits, such as vision and dental care, than the traditional government program at slightly higher cost. The Obama administration already plans to cut the Medicare Advantage program by $200 billion as part of Obamacare. However, the proposed reductions it announced in February are new, and will cut the program in addition to the planned $200 billion in Obamacare cuts, most of which are delayed in 2014. The new cuts are also scheduled to go into effect in 2014, but as a function of the normal rate-setting process for that year, not a political effort to delay financial pain for seniors past an important election, as apparently was the case with the original Medicare cuts that Obama signed. In its regulatory announcement, the CMS said it was assuming that reimbursement payments in traditional, government-run Medicare will be cut, and cited that as justification for cutting Medicare Advantage. However, while those cuts to traditional Medicare have been set into law for more than a decade, Congress has never allowed them to happen, instituting what is known as the Doc Fix every year, to keep reimbursement payments the same. Senator Marco Rubio (R-FL) wrote to the CMS urging them to consider political reality and reverse their planned Medicare Advantage cuts. “This assumption is highly problematic because – even though it almost certainly will turn out to be wrong – it translates into lower funding to support the health benefits of the 14 million Medicare beneficiaries who are currently enrolled in MA [Medicare Advantage] plans,” Rubio wrote on March 8. In other words, if the Obama administration continues with its proposed new Medicare cuts, some or all of the 14 million seniors who get health care through the MA program could be negatively affected, that is, paying higher premiums or possibly losing coverage. READ FULL SOURCE ARTICLE: 03/14/2013
Source: newmediajournal.us

WellCare names new Florida president

Starting April 1, McNichols will have responsibility for WellCare’s Medicaid and Medicare Advantage businesses in Florida and will lead statewide expansion initiatives, a statement from the company said.
Source: saintpetersblog.com

Goldhill: Medicare Is the Problem, Not the Solution

Posted by:  :  Category: Medicare

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Source: ncpa.org

Video: CATARACT SURGERY ASSOCIATED WITH LOWER ODDS OF HIP FRACTURE IN THE MEDICARE POPULATION

Medicare Costs More in 2013

If Mr. Smith broke the other hip (or the same hip) thirty days after leaving the nursing home and going home, he would not have a full 100 days of coverage.  The 100 days would be reduced by however many days Mr. Smith already utilized in the same spell of illness.  If, for instance, he was in the nursing home for fourteen days during his first stay, he would only have eighty-six days of rehabilitation remaining in this spell of illness, even though the second injury may be completely unrelated to the first injury.
Source: eldercarelawyer.com

Lab Soft News: Medicare Costs Rise as Knee Replacements Increase for Seniors

The popularity of total knee arthroplasty surgeries among Medicare patients has grown considerably as beneficiaries are living longer and seeking to increase their mobility, but the shift has led to fiscal concerns for the entitlement program….Overall volume growth has been driven both by the increased number of Medicare enrollees and by increased per capita utilization….The number of total knee replacements increased 161.5% between 1991 and 2010, when 243,802 such surgeries were performed. Per capita utilization nearly doubled during that period, to 62.1 procedures per 10,000 Medicare beneficiaries from 31.2 surgeries per 10,000 enrollees….For patients, knee replacements are relatively safe and have low rates for complications, mortalities and length of hospital stays. However, 30-day readmissions rates have risen to 5% in 2010 from 4.1% in 1991. Shorter hospital stays are causing the increase, a change that should have been expected by health policymakers….The volume of revision knee replacement surgeries has increased to 19,871 in 2010 from 9,650 in 1991….There were 243,802 knee replacement surgeries in 2010, a jump of 161.5% from 1991. More and more patients taking advantage of the surgeries will lead to higher Medicare program costs. The procedure itself costs about $15,000 to $30,000…The bundled Medicare payment for the procedure is spent on the device implants, facility fees, therapy providers and the surgeons. The surgeon probably will receive about $1,500 of the total….New Medicare payment models, such as the bundled payments used for knee replacements, aim to achieve lower costs while maintaining high quality to prevent patients from being readmitted.
Source: typepad.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

Brad DeLong : Remember, the Dormouse Says Medicare Is the Best

Disenrolled from fee for service Medicare – and unable to keep the surgical follow-up appointment from a surgeon who takes Medicare assignment but does not participate in Medicare Managed Care – and moved to a Medicare Managed Care rehab funded facility, Alice was advised that this was her problem to unravel. Her new Medicare Managed Care insurance plan vacillated between advising her she was not an enrollee in their plan and advising that, even were she an enrollee, no follow up post-surgical appointment was necessary….
Source: typepad.com

Hip Replacement Class Action Suits And How Medicare And Health Insurers Will Be Getting All The Money : Pennsylvania Injury Law Report

The most widespread medical implant failure in the United States in decades, involving thousands of all-metal artificial hips that need to be replaced prematurely, has entered the money phase. Medical and legal experts estimate the hip failures may cost taxpayers, insurers, employers and others billions of dollars in coming years, contributing to the soaring cost of health care. The financial fallout is expected to be unusually large and complex because the episode involves a class of products, not a single device or just one company. The case of Thomas Dougherty represents one particularly costly example. He spent five months this year without a left hip, largely stuck on a recliner watching his medical bills soar. In August, Mr. Dougherty underwent an operation to replace a failed artificial hip, but his pelvis fractured soon afterward. The replacement hip was abandoned and then a serious infection set in. Some of the bills: $400,776 in charges related to hospitalizations, and $28,081 in doctors’ bills….The so-called metal-on-metal hips like Mr. Dougherty’s, ones in which a device’s ball and joint are made of metal, are failing at high rates within a few years instead of lasting 15 years or more, as artificial joints normally do.The wear of metal parts against each other is generating debris that is damaging tissue and, in some cases, crippling patients.
Source: pennsylvaniainjurylawreport.com

Public hearings set to discuss Medicaid expansion, Healthy Indiana Plan

The hearings come on the heels of an exchange between Statehouse Democrats and the governor over an apparent oversight by the administration to meet appropriate deadlines for a waiver application. Democrats continue to push for an extension of health care coverage in Indiana, citing the potential for 30,000 new jobs, the injection of billions of dollars into local communities and the extension of health care services to an estimated 400,000 more Hoosiers. Read more>>
Source: wordpress.com

Research Roundup: Medicare Advantage Plan Beneficiaries May Get More Appropriate Services; CHIP Participation Grows

Urban Institute/Robert Wood Johnson Foundation: Medicaid/CHIP Participation Among Children And Parents – “Despite the economic downturn, most states have maintained or expanded Medicaid and CHIP for children, by expanding eligibility to higher income and immigrant children, undertaking enrollment and retention simplifications, and implementing new policy options,” the authors wrote about coverage rates between 2008 and 2010. The rate of eligible children participating in Medicaid or CHIP grew to 86 percent nationwide and the number of eligible children who were not insured fell by 500,000 in that time, the study found. Participation rates for eligible parents were lower, however. The authors conclude that the 2009 law designed to improve participation of children in the program “may have contributed to increased take-up for Medicaid/CHIP among children, but that additional efforts will be needed, particularly among parents, to achieve high levels of Medicaid enrollment under the Affordable Care Act ACA” (Kenney et al., 12/3).
Source: kaiserhealthnews.org

Report: Cuts to Social Security, Medicare could hurt NJ small business owners

Posted by:  :  Category: Medicare

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Source: leomoo.com

Video: NJ Hospital Association President Says Sequestration Could Hurt Medicare Reimbursement

Waiver Approval Clears Way for Massive Medicaid Reform in NJ

Paul Langevin, president of the Health Care Associates of New Jersey, the industry nursing home association said he was relieved to hear Velez’s statement that she did not expect to move large numbers of current nursing home residents out into the community. The waiver will have a major impact on his members, and he said the state has been taking an inventory of nursing home residents, with an eye to finding out how many might be able to move back into the community. Langevin estimates very few — about 100 — of the 29,000 Medicaid patients now residing in New Jersey nursing homes could qualify. “The facts are, most people have sold their houses. There are no homes to go back to.”
Source: wnyc.org

Nonpartisan Public Policy Group Reports Medicaid Expansion Would Save New Jersey $2.45 Billion

“Expanding Medicaid in New Jersey just makes sense. As laid out in this non-partisan study, the Medicaid expansion in the Affordable Care Act will save New Jersey billions of dollars,” said Congressman Pallone. “Even some of the Affordable Care Act’s harshest critics, including conservative governors throughout the nation, are beginning to recognize the importance of these savings and how critical expanding coverage to New Jerseyans will be. The Medicaid expansions under the Affordable Care Act will improve the health of many throughout the state with the added benefit of extraordinary cost savings.”
Source: paramuspost.com

First Edition: February 27, 2013

The New York Times: Austerity Kills Government Jobs As Cuts To Budgets Loom But this time is different. Growth has remained sluggish and millions remain unemployed even as the federal government, riven by partisan differences, has largely turned its attention to deficit reduction. Mr. Bernanke, like many critics of sequestration, said the government could not ignore the need to reduce its annual deficits and curtail the growth of its debt. But he said short-term cuts would worsen those problems by slowing the economy. Moreover, sequestration mostly spares Medicare and Medicaid, the health care programs that are the primary reason federal spending is projected to increase. Congress and the administration, he said, should “introduce these cuts more gradually and compensate with larger and more sustained cuts in the future” (Appelbaum, 2/26).
Source: kaiserhealthnews.org

Christie Seeks Medicaid Expansion in $32.9 Billion NJ Budget

While the negotiations between President Barack Obama and House Speaker John Boehner are still ongoing there is little indication we will see a deal in the short term. Recently Boehner has made an offer and Obama has made a counteroffer, but there is little actual movement. The two new offers are only slightly different from their initial offers and still very far apart. There is no agreement on the size of the revenue increases or the size of cuts. As a result, Boehner is warning his caucus to expect to work through Christmas.
Source: birchindigo.com

NJ health system pays millions to settle fraud allegations

“After more than three years of extended discussions with government lawyers, we decided, in the best interests of Cooper, to settle our dispute without the admission of wrongdoing to avoid the burdens and uncertainties of a protracted litigation,” the company said in a statement. “This allows us to focus our full energies on serving our community.”
Source: freebeacon.com

Health coverage for many in Martinez’s hands

Posted by:  :  Category: Medicare

KNOW WHO YOUR CZARS ARE --ENOUGH TO MAKE YOU SICK ---ONLY OBAMA COULD CREATE POSITIONS FOR THESE INCOMPENTENT COMMUNISTS AND SOCIALISTS by SS&SSThe New Mexico Health Policy Commission, a state agency that provided independent research and policy recommendations until its budget was eliminated in 2010, wrote a report that year detailing recommendations for addressing the health workforce shortage. Here are some of the commission’s proposals: • Increase funding for loan-repayment programs that attract providers to rural areas • Support legislation to expand the scope of practice for potential mid-level oral health providers, amend dental licensure examination requirements, and allow University of New Mexico dental residents to obtain temporary licenses • Study the feasibility of expanding New Mexico physician assistant training programs and other mid-level training programs in the state • Support legislation to create 60 lottery scholarship slots for individuals to become certified nurse practitioners or physician assistants and agree to work in New Mexico for at least three years • Seek funding for programs that create a more diverse workforce that better reflects and represents New Mexico’s population • Support legislation that would levy excise taxes on alcohol, tobacco and/or sugared soft drinks to pay for loan forgiveness, debt repayment and scholarship programs for health professionals
Source: nmindepth.com

Video: New Mexico and Medicare Supplements

3 Years of PPACA: The 5 Biggest Changes in Healthcare Since the Law’s Passage

Saturday, March 23, marked the three-year anniversary of President Barack Obama’s Patient Protection and Affordable Care Act. The legislation has undergone and continues to experience a bevy of challenges since its enaction, but it’s recently gained broader acceptance as the law of the land. Just minutes after President Obama signed the bill in 2010, officials from 14 states went to court and asked a judge to block enforcement of the law. They claimed the PPACA, especially the individual mandate, infringed upon sovereignty of the states. This event merely foreshadowed the longstanding political opposition PPACA would face. The challenges started day one and only persisted, from the Supreme Court’s 5-4 decision in June 2012 that upheld the individual mandate, to House Speaker John Boehner (R-Ohio) saying the House would “continue working to scrap the law in its entirety” just last week. It’s been a long road, but most state lawmakers have recently come to accept healthcare reform as the “law of the land.” Florida Gov. Rick Scott (R) took the industry by surprise this February when he accepted the Medicaid expansion under the PPACA. He’s been one of the most vocal opponents of the PPACA, as evidenced by his state spearheading State of Florida, et al v. Department of Health and Human Services, which landed in the Supreme Court. To mark the law’s third year, Becker’s Hospital Review compiled a list of the five largest changes for hospitals under the PPACA. Doing so is a little like identifying the largest wave in an ocean — there has been so much change in the past three years. But these specific events, provisions and programs have created ripple effects that will undoubtedly continue shaping healthcare delivery in the years to come. 1. Payment reform tied to quality measures. One of the biggest concepts inherent in President Obama’s health law has been the “triple aim:” improving patient quality and experience, improving the health of populations and reducing the per capita cost of healthcare. Within the PPACA is the Value-Based Purchasing program for Medicare — a program that encourages hospitals to move toward a quality-based business model. VBP started October 2012 and redistributed roughly $850 million in incentives to hospitals based on their overall performance on a set of quality measures, such as clinical processes of care and patient satisfaction from the Hospital Consumer Assessment of Healthcare Providers and Systems survey. Examples of the care processes included in the measures are how quickly heart attack patients receive potentially life-saving surgery on their arteries and how often patients with heart failure get proper discharge instructions. CMS’ Bundled Payments for Care Improvement program, in which hundreds of hospitals have signed up to try their hand at bundled payments for select DRGs, is another payment reform that has made its way to the forefront of the business office. BPCI is based on the idea that hospitals, physicians and other parties will collaborate to better coordinate care, improve health outcomes, reduce readmissions, diminish duplicative care and lower Medicare costs. CMS will dole out a discounted payment for an episode of care, and in return, everyone gets to share in the savings if the care is delivered efficiently and well. These value-based payments have forced hospitals to rethink how they develop three- and five-year and long-term strategic plans, as the goal is no longer to have “heads in beds.” 2. Accountable care organizations. In 2010, it wasn’t unusual to hear ACOs referred to as “the unicorns of healthcare.” Many hospital leaders said they had heard about ACOs, but had never seen one. Furthermore, many industry experts likened the concept of ACOs to managed care in the 1990s, or “HMO redux.” A 2012 study from Health Affairs analyzed the differences between HMOs and ACOs, finding the roles of health information technology, data analytics and clinical decision support to be some of the largest distinctions. Recent data has shown a proliferation of ACOs, with 428 of them throughout 49 states as of January 2013. At that time, Delaware was the only state without an ACO, while California led the way with 46, Florida followed with 42 and Texas trailed with 33. Private payors’ interest in coordinated care management helped spur this growth. Cigna, for example, announced plans to have one million people enrolled in ACOs by 2014. CMS’ unveiling of the 32 Pioneer ACOs in December 2011 and first 27 Medicare Shared Savings Program ACOs in April 2012 also helped make what was once called a “unicorn” into a reality. Given their relative youth, few ACOs have yet released their quality outcomes or cost savings. Oak Brook, Ill.-based Advocate Health Care is one of the few systems that has reported some results, including reduced readmission rates, from its ACO. The system launched AdvocateCare in partnership with Blue Cross Blue Shield of Illinois in 2011. Year-one data showed a 26 percent decline in readmission rates for ACO patients with chronic illnesses. It also released data showing a 10.6 percent decrease in its hospital admissions per ACO member and a 5.4 percent drop in emergency department visits. More recently, officials from CMS said results for Medicare ACOs could be expected sometime this summer. Repercussions of ACOs have spread far and wide, as the model is one of the forces driving hospital-provider integration. ACOs also emphasize the role of preventive care and providing care delivery in low-cost settings. This has sparked an even more robust demand for primary care physicians, who are already in high demand due to a nationwide shortage.   3. New provider-payor partnership models. Partly driven by the proliferation of ACOs, many more hospitals and health systems began striking value-based reimbursement agreements with commercial payors since the PPACA was signed into law. This has been a change from the traditional relationship between providers and payors, which was often tinged with mistrust. Armed with sophisticated analytics, payors can provide clinicians with coded data that connects patients’ and broader populations’ health patterns. Providers can then incorporate this longitudinal information into their population health strategy and outcomes-based care. Many agreements are structured around the principles of preventive care, improved care coordination and chronic condition management. Both payors and providers also take on more risk. Generally, in most value-based deals, payors offer incentives or penalties tied to providers’ ability to meet specific quality metrics while delivering care within a projected cost. The payor-provider deals vary in breadth and scope. Some health systems and insurers have pursued these goals in full-on ACO agreements, while others scaled back their value-based reimbursement contracts to tackle a few specific conditions or metrics at a time. Some payors have designed pay-for-performance contracts for specific types of clinicians, as well. For instance, in January 2012, WellPoint agreed to boost reimbursement for primary care physicians and pay them up to 50 percent more if they maintained or improved care quality. The insurer said it would begin paying PCPs for “non-visit” services that were previously not reimbursed, and it would also enhance information sharing with clinicians. Providers are also facing pressures to demonstrate payor-like efficiencies from businesses and employers, many of which seek a provider partner to trim costs and better manage employees’ health outcomes. This has spurred some health systems to form direct contracting relationships with self-insured employers, such as bundled payments. Cleveland Clinic has been a pioneer in this regard, striking direct-to-employer deals with Lowe’s, Wal-Mart and Boeing. Under those deals, the company’s employees and their dependents can travel to Cleveland Clinic for certain procedures at a fixed price. The deals are driven by Cleveland Clinic’s ability to link quality of care to outcomes and cost, which many large employers find attractive. 4. More robust fraud-fighting efforts. The PPACA included new tools that have made the Obama administration’s fraud-fighting efforts much more robust. These defense mechanisms include tougher sentences for healthcare fraud. A crime involving more than $1 million in losses will earn the convicted party a 20 percent to 50 percent longer sentence than he or she would receive prior to the PPACA. The law also introduced Medicare and Medicaid Recovery Auditor Contractors, or RACs. These auditors, which are divided among four regions across the U.S., scrutinize hospitals’ expense records for any improper payments, including incorrect payment amounts, incorrectly coded services, non-covered services and duplicate services. In fourth quarter of 2012, 90 percent of hospitals participating in the American Hospital Association’s RACTrac survey (approximately 2,335 hospitals) reported that they had experienced RAC activity through December 2012. Federal agencies have also picked up steam in the fight against healthcare fraud through the False Claims Act. From January 2009 through the end of the 2012 fiscal year, the DOJ used the False Claims Act to recover more than $9.5 billion in federal healthcare dollars, mostly Medicare and Medicaid. That figure is a record for any four-year period. Actions against pharmaceutical companies represented some of the largest recoveries. For instance, GlaxoSmithKline paid $1.5 billion to resolve FCA allegations of off-label marketing for five of its medications. 5. Uncertainty around Medicare and Medicaid. Hospitals and health systems knew Medicare and Medicaid funds would be impacted with the implementation of the PPACA, but perhaps not to this degree. Medicare and Medicaid disproportionate share hospital payments, which subsidize hospitals that treat large numbers of elderly and poor patients, will be cut significantly by 2020 under the law, and Medicare DSH payments will be cut by roughly 75 percent this October. Hospitals also knew Medicare reimbursements would be on the line with VBP. However, hospitals knew the individual mandate and the Medicaid expansion imbedded within the law would provide a flurry of new covered patients, which would help offset the loss of other federal funds and rising uncompensated care costs. The Supreme Court’s decision on the individual mandate was the most highly watched aspect, but the decision on Medicaid may have had a bigger impact. Chief Justice Roberts and the majority saved the Medicaid expansion, in general, but they gave states the option to reject the expansion. They ruled that “nothing in our opinion precludes Congress from offering funds under the ACA to expand the availability of healthcare…what Congress is not free to do is to penalize States that choose not to participate in that new program by taking away their existing Medicaid funding.” This has resulted in many states toying with the idea of passing on the Medicaid expansion, which will be fully funded by the federal government for the first three years and 90 percent after that. Several states, including Texas, the state with the nation’s highest uninsured rate, have already said they would not expand the program for the poor, leaving hospitals in mostly Republican states with the potential for higher uncompensated care in addition to other Medicare cuts. However, GOP governors from Arizona, Michigan, New Mexico, North Dakota, Ohio, Nevada and New Jersey accepted Medicaid expansions under the law, giving hope to some hospitals in red states.
Source: beckersasc.com

Medicaid Expansion Puts Spotlight On Access To Primary Care

The authors of the Affordable Care Act foresaw that there would be a growing shortage of primary care doctors for Medicaid when expansion occurs January 1, 2014. That’s why the law includes a provision that raises the Medicaid fees paid to doctors practicing primary care medicine to the same levels Medicare pays for those services. The Medicare-Medicaid match went into effect January 1 this year and will remain in effect for two years. Best of all from the states’ point of view, in most cases the federal government will bear the entire cost of that increase. (Most other Medicaid costs involve both state and federal contributions.)
Source: kaiserhealthnews.org

Seniors Speak Out Against Medicare Advantage Cuts in AHIP’s New TV Ad

Current discussions about the impact on seniors of the ACA’s $200 billion in cuts to Medicare Advantage have largely ignored the fact that only four percent of those cuts have gone into effect through the end of 2012. The Congressional Budget Office (CBO) projects that, when fully phased in, these cuts alone will result in three million fewer people enrolled in the program. In addition, Medicare Advantage enrollees also will be impacted by the new health insurance tax established by the ACA that starts in 2014. Oliver Wyman previously estimated that this tax alone will result in seniors facing $220 in higher out-of-pocket costs and reduced benefits next year and $3,500 in additional costs over the next ten years.
Source: ahipcoverage.com

Zone 4 Program Integrity Contractor (ZPIC) for Medicare and Medicaid Programs is Health Integrity, LCC

When a physician, medical group or other health care provider receives a notice of an audit and site visit from a ZPIC, things happen fast with little opportunity to prepare. A ZPIC will routinely fax a letter to the practice shortly before the end of a business day the day before a site visit/audit to that practice. Auditors will request to inspect the premises, will photograph all rooms, equipment, furniture, and diplomas on walls. They will usually request copies of several patient records to review later. They will request copies of practice policies and procedures, treatment protocols, all staff licenses and certifications, drug formularies, medications prescribed, and medications used in the office. ZPIC auditors will inspect any medication/narcotic lockers or storage cabinets and will request drug/medication invoices and inventories. You will usually be contacted for follow-up information and documentation after the audit and will eventually be provided a report and, possibly, a demand for repayment of any detected overpayments.
Source: wordpress.com

CMS Names 106 New Medicare ACOs

CMS has named 106 new accountable care organizations that will participate in the Medicare Shared Savings Program, effective Jan. 1. With the addition of the 106 new organizations, as many as 4 million Medicare beneficiaries will be covered by a CMS ACO. According to CMS, the savings achieved by its ACOs could be up to $940 million in four years. The new group of ACOs includes 15 Advance Payment Model ACOs, which are physician-based or rural organizations that will benefit from greater access to capital. The application period for organizations wanting to participate in the MSSP in 2014 will begin this summer. The 106 new ACOs named to the MSSP are listed here, with their service areas: 1.    A.M. Beajow, MD Internal Medicine Associates ACO, P.C. (Nevada) 2.    AAMC Collaborative Care Network (Maryland) 3.    Accountable Care Clinical Services, PC (California, Connecticut, Iowa, Massachusetts, Pennsylvania) 4.    Accountable Care Coalition of Central Georgia (Georgia) 5.    Accountable Care Coalition of DeKalb (Georgia) 6.    Accountable Care Coalition of Georgia (Georgia) 7.    Accountable Care Coalition of Greater Athens Georgia II (Georgia) 8.    Accountable Care Coalition of Greater Augusta & Statesboro (Georgia, South Carolina) 9.    Accountable Care Coalition of New Mexico (New Mexico) 10.    Accountable Care Coalition of North Central Florida (Florida) 11.    Accountable Care Coalition of North Texas (Texas) 12.    Accountable Care Coalition of Southern Georgia (Georgia) 13.    Accountable Care Coalition of Western Georgia (Alabama, Georgia) 14.    Accountable Care Organization of New England (Connecticut, Massachusetts) 15.    ACO of Puerto Rico (Puerto Rico) 16.    Advocare Walgreens Well Network (New Jersey) 17.    Affiliated Physicians IPA (California) 18.    Akira Health (California) 19.    Alegent Health Partners (Nebraska) 20.    Alexian Brothers Accountable Care Organization (Illinois) 21.    Amarillo Legacy Medical ACO (Texas) 22.    American Health Alliance (Florida) 23.    American Health Network of Ohio (Ohio) 24.    APCN-ACO (California) 25.    Arizona Care Network (Arizona) 26.    Atlanticare Health Solutions (New Jersey) 27.    AVETA Accountable Care (Puerto Rico) 28.    BAROMA Health Partners (Florida) 29.    Billings Clinic (Montana, Wyoming) 30.    Bon Secours Good Helpcare (Kentucky, New York, Ohio, South Carolina, Virginia) 31.    Cambridge Health Alliance (Massachusetts) 32.    Cape Cod Health Network ACO (Massachusetts) 33.    Cedars-Sinai Accountable Care (California) 34.    Central Florida Physicians Trust (Florida) 35.    Central Jersey ACO (New Jersey) 36.    Christie Clinic Physician Services (Illinois) 37.    Collaborative Care of Florida (Florida) 38.    Collaborative Health ACO (Massachusetts) 39.    Colorado Accountable Care (Colorado) 40.    Community Health Network (Minnesota) 41.    Diagnostic Clinic Walgreens Well Network (Florida) 42.    Doctors Connected (Virginia) 43.    Essential Care Partners II (Texas) 44.    Fort Smith Physicians Alliance ACO (Arkansas, Oklahoma) 45.    Franciscan Northwest Physicians Health Network (Washington) 46.    Franciscan Union ACO (Illinois, Indiana) 47.    GPIPA ACO (Arizona, New Mexico) 48.    Hartford HealthCare Affordable Care Organization (Connecticut) 49.    HHC ACO (New York) 50.    HNMC Hospital/Physician ACO (New Jersey) 51.    Independent Physicians’ ACO of Chicago (Illinois) 52.    Indiana Care Organization (Indiana) 53.    Indiana Lakes ACO (Indiana) 54.    Integral Healthcare (Florida) 55.    Integrated ACO (Texas) 56.    KCMPA (Kansas, Missouri) 57.    KentuckyOne Health Partners (Indiana, Kentucky) 58.    Keystone Accountable Care Organization (New York, Pennsylvania) 59.    Lahey Clinical Performance Accountable Care Organization (Massachusetts, New Hampshire) 60.    Lower Shore ACO (Delaware, Maryland, Virginia) 61.    Marshfield Clinic (Wisconsin) 62.    Maryland Collaborative Care (Maryland, Washington, D.C.) 63.    MCM Accountable Care Organization (Florida) 64.    Medicare Value Partners (Illinois) 65.    Mercy ACO (Arkansas, Missouri) 66.    Meridian Accountable Care Organization (New Jersey) 67.    Meritage ACO (California) 68.    Morehouse Choice ACO-ES (Georgia) 69.    National ACO (California) 70.    Nature Coast ACO (Florida) 71.    NOMS ACO (Ohio) 72.    Northeast Florida Accountable Care (Florida) 73.    Northern Maryland Collaborative Care (Maryland) 74.    Northwest Ohio ACO (Michigan, Ohio) 75.    Ochsner Accountable Care Network (Louisiana, Mississippi) 76.    OneCare Vermont Accountable Care Organization (New Hampshire, Vermont) 77.    Owensboro ACO (Indiana, Kentucky) 78.    Paradigm ACO (Florida) 79.    Partners in Care (Michigan) 80.    Physician Organization of Michigan ACO (Michigan) 81.    Physicians Collaborative Trust ACO (Florida) 82.    Physicians HealthCare Collaborative (North Carolina) 83.    Pioneer Valley Accountable Care (Connecticut, Massachusetts) 84.    Primary Care Alliance (Florida) 85.    Primary Partners ACIP (Florida) 86.    ProCare Med (Florida) 87.    ProHealth Physicians ACO (Connecticut) 88.    Qualable Medical Professional (Tennessee, Virginia) 89.    Rio Grande Valley Health Alliance (Texas) 90.    Saint Francis HealthCare Partners ACO (Connecticut) 91.    San Diego Independent ACO (California) 92.    Scott & White Healthcare Walgreens Well Network (Texas) 93.    SERPA-ACO (Nebraska) 94.    South Florida ACO (Florida) 95.    Southcoast Accountable Care Organization (Massachusetts, Rhode Island) 96.    Southern Maryland Collaborative Care (Maryland, Washington, D.C.) 97.    St. Luke’s Clinic Coordinated Care (Idaho, Oregon) 98.    Summit Health-Virtua (New Jersey) 99.    The Premier Health Care Network (Georgia, New Hampshire) 100.    UCLA Faculty Practice Group 101.    UW Health ACO (Wisconsin) 102.    Virginia Collaborative Care (Virginia) 103.    Wellmont Integrated Network (Tennessee, Virginia) 104.    Winchester Community ACO (Massachusetts, New Hampshire) 105.    Yavapai Accountable Care (Arizona) 106.    Yuma Accountable Care Organization (Arizona)
Source: beckershospitalreview.com

MEDICARE PROGRAM; PART B INPATIENT BILLING IN HOSPITALS (CMS

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Source: wn.com

New Mexico Medicare Part D Plans

In New Mexico, the first $2,830 is paid as drug costs per annum. Once the said amount is received, there’s no further coverage till $4,550. Any amount in this range has to be borne by the patient. If the annual cost towards prescription drugs in the state exceeds $4,550, the patient will again be entitled to 95 per cent of the total amount incurred. The patient, then, has to pay only 5 per cent of the amount.
Source: medicarenewmexico.com

Paul Ryan’s Fix For Medicare Cuts Elder

If Ryan does need to find significant new cuts to achieve balance, his options are all problematic. Proposing Social Security cuts now would create new political headaches for the GOP. Defense spending is likely off limits, too — Ryan’s budget last year raised military spending. And that budget already contained massive cuts to popular domestic programs like education, health care for the poor, and research. That leaves Medicare — an issue on which the GOP is already on the record and taken the hits. Between these choices, enacting the voucher plan sooner may potentially be the least painful of the bad options. But that would require straying from the promise the GOP has made repeatedly to seniors 55 and older over the past two years.
Source: businessinsider.com

Medicare Supplement in New Mexico by Senior Supplemental

Medicare Supplement in New Mexico by Senior Supplemental Going into retirement? You may be asking yourself &will I enjoy not having to wake up early every morning to venture off to work or Will I miss my job and my co-workers?& The answer? Well, as individuals, we may feel something totally different from one another. Some of us may miss the routine of going to work while others may enjoy the much earned time to themselves. And who knows, maybe that will change too. Perhaps for the first month, you love retiremenent, but then once retirement settles in, you may find yourself asking &What now?& Well one thing we know for sure is that you want to feel secure and taken care of in your retirement. Once you turn 65 you automatically qualify for Original Medicare, or Medicare Part A and B. Original Medicare only covers up to %80 of your medical costs in most cases. That is why finding the right Medicare Supplement can make a big difference in your medical security during retirement. Medicare Supplement covers the out of pocket expenses not covered by Original Medicare. For free quotes and more information from a medicare professional call 1-800-MEDIGAP Video, publisher, and owners are not associated, endorsed or authorized by the Social Security Administration, the Centers for Medicare and Medicaid Services, or the Department of Health and Human Services nor do we claim to be. Medicare has neither reviewed nor endorsed this information. This site contains basic information about Medicare, services related to Medicare and services &From:Senior SupplementalViews:0 0ratingsTime:02:11More inEducation
Source: tcei.org

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

Posted by:  :  Category: Medicare

meds: it's obscene by fallsroadThe page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

Video: Medicare Part D Prescription Drug Plan Basics

Medicare Prescription Drug Coverage, Medicare Part D, Doughnut Hole

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

Opinion: Medicare Part D helps seniors, keeps costs down

Part D empowers consumers to make choices in the marketplace, stimulating cost-containing competition. The program does that by working exclusively through private plans, whether they be standalone prescription drug plans or comprehensive health plans that offer prescription drugs and are covered under the Part C Medicare Advantage program. Different plans offer different options for coverage, co-payments and premiums, enabling beneficiaries to pick what will work best for them.
Source: healthpolicysolutions.org

Medicare Drug Benefit: Formulary Oversight in Medicare Part D

An expert on Medicaid, Medicare, and health reform, Kip Piper, MA, FACHE, is a consultant, speaker, and author. Kip Piper advises health plans, hospitals and health systems, states, and pharma, biotech, medical device, HIT, and investment firms. With 30 years’ experience, Kip is a senior consultant with Sellers Dorsey, top specialists in Medicaid and health reform. He is also a senior advisor with Fleishman-Hillard and TogoRun. For more, visit KipPiper.com. Follow on Twitter @KipPiper, Google +, Facebook and connect on LinkedIn.
Source: piperreport.com

What on Earth is the Donut Hole? A Brief Explanation of Medicare Part D and the “Donut Hole” » The NeedyMeds Blog

In 2013, you get out of the coverage gap when you have paid $4,750 out-of-pocket for covered drugs since the start of the year. When you reach this out-of-pocket limit, you get catastrophic coverage. The costs that help you reach catastrophic coverage include what you spent on drugs while in the donut hole and most of the discount on brand-name drugs you received in the coverage gap. If someone else pays for your drugs on your behalf, this will also count toward getting you out of the coverage gap. This includes drug costs paid for you by family members, most charities, State Pharmaceutical Assistance Programs, AIDS Drug Assistance Programs and the Indian Health Service. You continue to pay your drug plan’s monthly premium during the gap, but the premium does not count toward the $4,750 out-of-pocket limit. The amount your drug plan paid for your drugs in your initial coverage period also does not count.
Source: needymeds.org

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

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

Medicare Part D, Prescription Drug Plan Coverage, PDP

It is best to sign up for a Part D plan as soon as you become eligible. In some circumstances, members may be charged a penalty or face higher premiums if they sign up after their initial eligibility. If necessary, you can make changes to your plan in the fall when providers announce upcoming changes during the Annual Election Period (AEP). Few exceptions allow enrollments outside of an enrollment period, but it is important to enroll as soon as possible to avoid potential penalty fees.
Source: bradeninsurance.com

Happy Anniversary, Affordable Care Act 

[1]  Health Care Reform consists of two separate laws, the Patient Protection and Affordability Care Act of 2010 (PPACA), Pub.L. 111-148  (March 23, 2010),  and the Health Care and Education Reconciliation Act of 2010 (HCERA), Pub. L. 111-152 (March 30, 2010).  The laws often are collectively referred to as the Affordable Care Act (ACA). [2] Centers for Medicare and Medicaid Services, available at http://www.cms.gov/apps/files/MedicareReport2012.pdf. [3] Department of Health and Human Services, available at http://www.healthcare.gov/blog/2013/03/anniversary-consumer-protections.html. [4] See, e.g., MedPAC Report to Congress: Medicare Payment Policy (March 2010) noting that in 2010, overall payments to plans average an estimated 113 percent of original Medicare fee-for-service (
Source: medicareadvocacy.org

Part D Politics: Medicare Drug Rebates or Price Controls?

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

Free Zone Media Center News: Report: Premium hikes for top Medicare drug plans

President Barack Obama’s health care law does not appear to be the cause of the increases. Indeed, the law is improving the prescription benefit by gradually closing a coverage gap called the “doughnut hole,” which catches people with high drug costs. Instead, the price hikes appear to be driven by market dynamics, and some insurers are introducing new low-premium options to gain a competitive advantage on plans that are raising their prices.
Source: freezonemediacenternews.com

How Medicare Could Fix U.S. Healthcare

Posted by:  :  Category: Medicare

New Online Rx System Makes UM Student 'Top Entrepreneur' Finalist by University of Maryland Press ReleasesDoctor  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

Video: Turning 65 Becoming Eligible for Medicare – 2011

Who is Eligible for Medicare?

While most people do not have to pay a premium for Part A, everyone must pay for Part B if they want it. This monthly premium is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you do not get any of these payments, Medicare sends you a bill for your Part B premium every 3 months. If you have questions about your eligibility for Medicare Part A or Part B, or if you want to apply for Medicare, call the Social Security Administration or visit their web site. The toll-free telephone number is: 1-800-772-1213. The TTY-TDD number for the hearing impaired is 1-800-325-0778. You can also get information about buying Part A as well as Part B if you do not qualify for premium-free Part A.
Source: seniorsguideonline.com

When Will YOU Be Eligible For Medicare?

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Source: epilepsytalk.com

Oklahoma Medicare Eligibility Requirements

You’re not alone if the term “Medicare eligibility” leaves you scratching your head, wondering if you qualify for the full package of benefits. It’s true, there are a few restrictions, but for the most part, as long as you’re 65 or older and a permanent citizen, you should be qualified for health care benefits through Medicare. In some cases, it’s possible to be eligible for Medicare even if you’re younger than 65. If you have End-Stage Renal disease or have been on Social Security disability benefits for over 24 months, you’re eligible at any age.
Source: oklahomamedicarehealth.com

Social Security Disability Insurance and Medicare

: Once the applicant qualifies as disabled, the recent work test and duration of work tests are administered. The recent work test is based on age; according to the Social Security administration, the age of the applicant at the time of the disability determines how long the applicant needs to have worked in order to qualify. The duration of work test is meant to prove that the applicant worked under Social Security (and paid Social Security taxes) for long enough to qualify. SSDI eligibility is based on “work quarters”, or three month periods during which the applicant needs to have worked.  Please click here to view the specific guidelines that the Social Security administration has outlined in regards to the duration of work and the recent work test.
Source: specialneedsplanning.net

Research Roundup: Comparing Medicare Budget Plans

JAMA Pediatrics: Nurse Staffing And NICU Infection Rates –Neonatal intensive care units (NICU) – which provide care for infants who are critically ill – are costly and require a significant amount of nursing services. Little is known, however, about the adequacy of nurse staffing at these units. Using data from 2008 and 2009, researchers analyzed the relationship between adherence to national staffing guidelines and hospitals-associated infections among very low birth-weight (VLBW) infants. “Our results document widespread understaffing relative to guidelines: one-third of NICU infants were understaffed… ,” the authors write. “In VLBW infants, NICU nurse understaffing relative to guidelines was associated with a sizable increase in infection risk.” They conclude that their findings “suggest that the most vulnerable hospitalized patients, unstable newborns require complex critical care, do not received recommended levels of nursing care. Even in some of the nation’s best NICUs, nurse staffing does not match guidelines” (Rogowski et al., 3/18).
Source: kaiserhealthnews.org

Jon Chait’s Miserable Endorsement of Raising the Medicare Eligibility Age

What’s more, raising the Medicare retirement age would help strengthen the fight to preserve the Affordable Care Act […] The political basis for the right’s opposition to universal health insurance has always been that the uninsured are politically disorganized and weak. But a side effect of raising the Medicare retirement age would be that a large cohort of 65- and 66-year-olds would suddenly find themselves needing the Affordable Care Act to buy their health insurance. Which is to say, Republicans attacking the Affordable Care Act would no longer be attacking the usual band of very poor or desperate people they can afford to ignore but a significant chunk of middle-class voters who have grown accustomed to the assumption that they will be able to afford health care. Strengthening the political coalition for universal coverage seems like a helpful side benefit — possibly even one conservatives come to regret, and liberals, to feel relief they accepted.
Source: firedoglake.com

What is Medicare? Will It Cover All My Medical Bills? Q & A

A. Probably not. The program was designed to meet the medical needs of people sixty-five years or older, though there are defined exceptions. Specifically, if you can show that you have been on social security disability for a period of 24 months or longer. Or have worked long enough in a federal, state, or local government job to be insured for Medicare. Or have a defined medical condition as discussed below.
Source: gottrouble.com

UM Health System Joins Priority Health Healthcare Network

Posted by:  :  Category: Medicare

Newsweek Magazine (February 16, 2009) ... Lenders Add Bigger Fannie, Freddie Fee – Thanks to Payroll Tax Cut (January 15, 2012) ...item 2.. Dupuy: GOP trying to sell pyrmaid scheme to voters (September 3, 2012) ... by marsmet526Priority Health is an award-winning health plan nationally recognized for creating innovative solutions that impact health care costs while maximizing customer experience. It offers a broad portfolio of products for employer groups and individuals including Medicare and Medicaid beneficiaries. As a nonprofit company, Priority Health serves more than 600,000 people, has the largest individual Medicare Advantage plans in the state and has the highest Medicare quality rating for a health plan in Michigan. To learn more visit priorityhealth.com.
Source: cbslocal.com

Video: Priority Health Medicare — Understanding Medicare Video

16 Top Priorities for Healthcare Compliance Programs in 2013

Thirty-seven percent of compliance professionals in the healthcare provider industry ranked Medicare Recovery Auditors, or RACs, as their top priority for compliance programs in 2013, according to a survey from SAI Global and Compliance 360. The survey is based on responses from 1,056 healthcare compliance professionals. Survey respondents were provided with a list of the top compliance program areas and were asked to indicate priority levels for each. Here are the 16 issues, ranked by the percentage of respondents who identified them as “top priority.” Note: Respondents could also rank these issues as high, medium or low priority. Those priority levels weighted the rankings. 1. Medicare RACs — 37 percent 2. Demonstrating compliance effectiveness — 37 percent 3. Employee compliance training and education — 37 percent 4. Documenting and investigating incidents — 32 percent 5. Medicaid RACs — 31 percent 6. Meaningful use requirements — 28 percent 7. HIPAA and Office for Civil Rights audits — 26 percent 8. Other medical claims audits (government) — 26 percent 9. Stark law compliance — 25 percent 10. Managing and/or revising policies — 24 percent 11. Governance and board reporting — 21 percent 12. Medicaid Integrity Contractor audits — 20 percent 13. Ensuring compliance of vendors/business associates — 15 percent 14. Tracking and/or reporting conflicts of interest — 12 percent 15. Tracking and/or reporting gifts and entertainments — 9 percent 16. Tracking and/or reporting payments to public officials — 6 percent
Source: beckershospitalreview.com

David Brooks, Obama, and Medicare:

David Brooks is both a liar and an idiot. Speaking of idiocy, there is the idiotic repetition, ad nauseum, of the need to "reduce the size of government" as if this were self-evident. Actually, it is both backward and ass-backward. Government financing, transfer payments, are not part of the "size of government" as they do not represent a government service or expenditure. It is of no importance whatsoever whether financing for an activity is public or private so long as we adopt the most efficient and equitable means and in neither case is the "size of government" affected except as to the relatively de minimis costs of administration (a mere fraction of what is spent by the private sector for analogous functions). That way, we have the lowest overall share of GDP devoted to the particular service. In the case of retirement, education, and especially in the case of medical care, government financing is far preferable, both more efficient and more equitable. If private medical costs over the last 40 years had increased at only the rate of Medicare cost increases, the economy would now be saving roughly a trillion dollars a year. Moreover, in an advanced industrial economy, growth is not supply-constrained — we always have idle capacity — but demand-constrained. The private sector is not able to generate sufficient demand fully to employ productive resources, labor or capital. Therefore, the more efficient our economy becomes through technological innovation, the MORE government has to grow, the more government has to spend, in order to maintain output at or near its maximum. Thus, for three reasons, efficiency, equity, and aggregate demand, we need more government, not less. Does that stop the idiotic insistence that we shrink government? No, it does not. The ignorant and the ideological fanatics will repeat the same idiocy forever, regardless of the economic reality.
Source: newrepublic.com

Priority Health Joins Michigan Health Connect

Priority Health is an award-winning health plan nationally recognized for creating innovative solutions that impact healthcare costs while maximizing customer experience. It offers a broad portfolio of products for employer groups and individuals including Medicare and Medicaid beneficiaries. As a nonprofit company, Priority Health serves more than 600,000 people and continues to be rated among the best health plans in the nation by the National Committee for Quality Assurance. For more information see www.PriorityHealth.com.
Source: michiganhealthconnect.org

Deficit Reduction Rises on Public’s Agenda for Obama’s Second Term

The current survey finds that views of the importance of strengthening gun laws are correlated with gun ownership and opinions about whether it is more important to control gun ownership or to protect gun rights. Nearly half (47%) of those who do not have a gun in their household view strengthening gun laws as a top priority, compared with 24% of those who do. And while 61% of those who say gun control is more important than gun rights prioritize stronger gun laws, just 12% of those who say it is more important to protect gun rights do so. For more on opinions about gun control, see “In Gun Control Debate, Several Options Draw Majority Support,” Jan. 14, 2013.
Source: people-press.org

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

New KHN Poll Shows Americans Support ACA and Medicare Expansion

A new public opinion survey on the Affordable Care Act (ACA), Medicare and Medicaid, by the Kaiser Family Foundation, is packed with new findings. Americans overwhelmingly support the ACA and its proposed build out of health exchanges. The following points highlight the report from the survey.
Source: medicarewire.com

Fiscal Restraint Top Priority, Congressman Lance Promises

No, Congressman. With all due respect, your most important job is to address the unemployment issue. Fix that, and the economy will grow. But you don’t solve unemployment by cutting back on spending. The deficit is NOT a crisis. Yes, it’s got to come down eventually, but there’s no need to aggressively tackle it now. Government needs to spend to boost employment. Need convincing? How are all the European countries that adopted severe austerity measures doing? Their economies worsened. Look at the UK for a perfect example — heading for a triple recession. Unfortunately, Congressman, you, like most of your colleagues, refuse to act based on facts. There’s a party line that has to be walked with no regard for reality. All in the interest of self-preservation.
Source: patch.com

If Entitlement Programs Are Your Top Priority, the Fiscal Cliff Is Your Friend

Everyone knows that Ronald Reagan reduced income taxes (more than one half for the wealthy); what is less commonly understood is that he extensively offset this by raising payroll taxes(more than double for most self-employed). Today, most American families pay more in payroll taxes than they do in income taxes. Between 1946 and 1981, income taxes averaged 12(+/-1)% of normalized GDP. Reagan reduced income taxes to near 9%. Clinton increased them back to 12%; and Bush/Obama reduced them again to 9 %( and below). However, on budget expenses (which exclude Medicare and Social Security) have remained 12(+/-1)% of normalized GDP throughout. The deficit in income taxes has been financed by borrowing, largely from the Social Security and Medicare trust funds. When Clinton raised income taxes back to 12%, this eliminated the on budget deficit. The CBO projected that this, plus the Social Security and Medicare surpluses, was enough to pay off the entire US debt before the Social Security/Medicare trust funds would have to be amortized for beneficiary payments, all without having to raise any taxes to pay for the amortization of those trust funds. Like Reagan before him, Bush took those excess payroll tax receipts and gave them “back” as income tax reductions, heavily weighted to the wealthy–who didn’t create those surpluses in the first place. By doing this, Bush guaranteed that income taxes would have to be raised in order to amortize the trust funds. Although the Republicans like to talk about those “47%” who in large part pay only payroll taxes as being supported and subsidized by those who pay income taxes, the truth is the opposite; ever since Reagan, income taxes have been subsidized by payroll taxes; and the failure to raise income taxes to pay back that subsidy, is to steal the money that middle-class workers have had taken out of their income to pay for their retirement.
Source: baselinescenario.com

Canadians want Parliament to make medicare top priority, poll finds

But several months after winning the election, the Harper government announced there would be no negotiations. Instead, federal health-care transfers will continue to increase by six per cent until 2016-17. After that, increases will only be tied to economic growth including inflation – currently roughly four per cent – and never fall below three per cent.
Source: canada.com

Priority Health Adds Medicare Advantage Plan and Seven Counties.

Medicare is available to individuals age 65 and older as well as to some people with disabilities. Medicare recipients may enroll between November 15 and December 31, 2010. To learn more about Priority Health’s Medicare plans, premiums by county and participating health care providers, call Priority Health toll-free at 888 389-6676, visit a Priority Health Medicare Information Center in Holland, Grand Rapids, Kalamazoo or Traverse City (opening November 1) or go to prioritymedicare.com. Priority Health’s Medicare Advantage health plans are available in 38 counties: Allegan, Antrim, Barry, Benzie, Cass, Charlevoix, Clare, Crawford, Emmet, Grand Traverse, Hillsdale, Ionia, Jackson, Kalamazoo, Kalkaska, Kent, Lake, Leelanau, Livingston, Manistee, Macomb, Mason, Mecosta, Missaukee, Monroe, Montcalm, Muskegon, Newaygo, Oakland, Oceana, Osceola, Otsego, Ottawa, Roscommon, St. Clair, Washtenaw, Wayne and Wexford.
Source: blogspot.com