Democrats Heart Medicare Fraudsters

Posted by:  :  Category: Medicare

Liver Transplant 1 by pennstatenews1. Bookmark us now! Enter Ctrl D to save our URL to your bookmarks 2. Don’t miss an article! Use the RSS feed above or the Email below to stay informed! 3.We look Best with a minimum Screen resolution of 1024×768 and Firefox Browser. It’s Free and Safer than Internet Explorer! Upgrade Now! 4.Below are our Archives and other News and Blog Feeds for your viewing pleasure. Also our Blog Rolls, etc., of other worthwhile contributors to Fair and Balanced News and Commentaries that you won’t find in the Leftist Media that dominates the TV, Radio and Newspapers. Stay Honestly Informed!
Source: wordpress.com

Video: Medicare & Medicaid Pittsburgh PA | (724) 934-5044

Medicare Takes Center Stage In Close Pennsylvania Races

The campaign jockeying over Medicare comes at a time when the program represents a huge fiscal challenge to both parties. With almost 50 million beneficiaries — and growing at the rate of 10,000 baby boomers every day — the entitlement program is one of the fastest-growing portions of the federal budget. Both parties acknowledge the need to curb its growth; both have also used the issue for political gain, casting themselves as the program’s protectors against what they portray as rivals’ threats.
Source: kaiserhealthnews.org

Appealing Medicare Denials of New Medical Technologies

In addition to filing reconsideration requests and supporting beneficiary challenges, Providers may appeal individual denied Medicare claims that are denied through the five-step Medicare appeal process (redetermination, reconsideration, ALJ, Medicare Appeals Council).  Providers or patients may also appeal denied claims through their insurer’s appeal process.  However, less than 10% of claims denied by commercial payers and less than 2% of claims denied by Medicare are appealed.  Every payer anticipates that most denied claims will not be appealed.  Nonetheless, reported statistics show that most parties that appeal denied claims up to the administrative law judge level are successful.  Thus, it behooves a provider or beneficiary to appeal the denied claim at least through the ALJ level.  Such claims are favorably reviewed even in the face of a non-coverage LCD because ALJ’s are not bound by a contractor’s LCD, although they must give deference to it.  This is particularly true when the LCD does not appear to reflect the literature or the consensus of medical opinion.
Source: wphealthcarenews.com

Ryan Takes to Pennsylvania to Push Medicare Message

Mr. Ryan was extrapolating from a 2010 report from Medicare’s Office of the Actuary. It analyzed the potential impact of lower premium supports paid to private companies that issue Medicare Advantage plans, popular alternatives to traditional Medicare with extra benefits such as gym memberships. To slow the growth of Medicare spending, the Affordable Care Act reduces support for the private plans, which Democrats consider inefficient. Beneficiaries would still be covered under traditional Medicare.
Source: nytimes.com

Daily Kos: Pennsylvania’s Gov. Corbett refuses Medicaid expansion

After the announcement Monday by Ohio Gov. John Kasich that he would accept Medicaid expansion funds under Obamacare, Pennsylvanians might have hoped that the sanity was spreading, and that their Republican governor too would see the light. No such luck. Pennsylvania Gov. Tom Corbett (R) announced Tuesday that his state will turn down the Medicaid expansion, becoming the first governor of a blue state to officially say no to the coverage provision of the Affordable Care Act that the Supreme Court made optional. “At this time, without serious reforms, it would be financially unsustainable for Pennsylvania taxpayers, and I cannot recommend a dramatic Medicaid expansion,” Corbett wrote in a letter to U.S. Health and Human Services Secretary Kathleen Sebelius. The Medicaid expansion would have provided coverage to 542,000 additional people in the state over the next decade, according to analysis from the Kaiser Family Foundation. That would have cost the state  $2.8 billion over a decade, with the federal government kicking in $37.8 billion to the state. More than 1.3 million Pennsylvanians are uninsured, nearly 13 percent of the state’s non-elderly population.
Source: dailykos.com

Legislation Would Up Medicare

Bills have been introduced in the House and Senate that would up add Medicare-supported physician residency positions to programs across the country, according to AHA News Now and Association of American Medical Colleges reports. The House bill, the “Training Tomorrow’s Doctors Today Act,” was introduced by Reps. Arron Shock (R-Ill.) and Allyson Schwartz (D-Pa.). It would increase the number of Medicare-supported graduate medical education residency positions by 15,000 over five years. It would also establish accountability and transparency measures, according to the AAMC. The bill in the Senate, S.577, was reintroduced by Sens. Bill Nelson (D-Fla.), Charles Schumer (D-N.Y.) and Harry Reid (D-Nev.). It would also up the number of GME positions by 15,000, according to AHA. The number of residency positions has been frozen at the 1996 level since 1997 due to The Balanced Budget Act of 1997, according to the reports.
Source: beckershospitalreview.com

Trolling for Insurance Prospects on Twitter

Posted by:  :  Category: Medicare

'tis I by McBethSelling health insurance on Twitter?’  Yes indeed. Not long ago a simple tweet about a blog called Medicare Made Clear alerted me to this new way to find sales prospects for Medicare Advantage Plans and Medigap policies ‘ just in time for the annual open enrollment that begins Oct 15. As someone who has spent a lot of time trying to simplify Medicare for the public, naturally, I was interested to see how the competition might be doing it ‘ perhaps even learning a few new tricks for breaking down the complexities of Part B and the allowable charge. I followed the Twitter link to Medicare Made Clear’s blog where I found several posts that looked interesting. ‘ Here’s a sample: ‘How to Evaluate Medicare Plan Costs,’ ‘Out-of-Pocket Medicare Costs: What’s the Limit?’, ‘What is a Medicare Medical Savings Account Plan?”  There were even posts called ‘Medicare Memos.”  Why for some time I have written Medicare Beat Memos for the Columbia Journalism Review website. ‘ There wasn’t much I could learn from that approach.’  I kept reading. At the end there was a picture of a smiling young woman next to this message: ‘Questions? To learn more about Medicare Made Clear, contact us at 1-877-619-5582.”  That sounded like 1-800-Medicare, the government’s toll-free help line, which beneficiaries can call with their questions. Would some readers think they were calling Medicare? At the very end of the blog site in teensy, weensy type was the revelation that this information came from United HealthCare, the largest seller of products to cover gaps in Medicare benefits. By this time I was suspecting I would find an insurance salesperson on the phone, so I called the number to see what they were selling.’  Sure enough, a sales agent said ‘Hello.”  ‘I’m a trained licensed agent,’ she added, and I asked ‘You sell insurance?’ The agent said she sold Medicare plans and that ‘The Centers for Medicare and Medicaid Services has given us permission to sell the plans.’ Okay. The government does sign off on Medicare Advantage plans. But how many readers would make it to the very bottom of Medicare Made Clear’s website to find out an insurance company is behind it? Would they call the toll-free number and hear a pitch even if they hadn’t planned on listening to one?’  Would they get hooked into a sale? Those are reasonable consumer questions, and they show how the boundaries between commercial information to generate sales and Medicare information from legitimate news organizations are blurring fast, especially given the ‘shorthand’ of 140 character limits and such of social media. I further examined the Medicare Made Clear site and concluded that some of the information, such as the description of what is a benefit period under Part A (the hospital coverage) or Medicare worksheets, was like the stuff I would have produced at Consumer Reports.’  But the site certainly was not Consumer Reports. It had more of the feel of those sites promoted by drug companies and disease groups that receive funding from Big Pharma.’  Their purpose: to build excitement and interest in whatever cure they are pushing. United Healthcare may be doing the very same thing ‘ ginning up excitement for their Medigap policies. The similarities between insurance company and drug marketing were striking when I clicked a button directing me to sign up for United’s ‘Medicare Made Clear Newsletter’ which promised I could ‘keep current with news and information from Medicare Made Clear.’ Of course, signing up would do more than that. It would give the insurer my contact details, including zip code, for its great database of future customers. In the insurance biz, that’s called lead generation, and getting sales leads this way is a snap. I recalled a similar newsletter a few years ago from a disease awareness group that was really promoting drugs for restless legs syndrome. It seemed like United may have borrowed other marketing tactics from drug and device makers. United Healthcare offered a Medicare quiz to help sales prospects see where they might need more information. An online offering by a for-profit company called Talk about Sleep with ties to medical device makers offers a “sleep self assessment quiz” to help people, perhaps leading them to think they may need sleep medications. This kind of marketing works; and United Healthcare shows it is spreading elsewhere in the growing health care marketplace. In the world of social media, it’s ‘buyer beware’ more than ever.
Source: cfah.org

Video: How to Understand Medicare Plans

Middlesex YMCA: Medicare Made Clear

Determining which insurance coverage is best for you can be confusing, and its even more so when you add in all of the Medicare options. To help you sort through all of the information and get answers to your questions, the Middelsex YMCA is proud to host two FREE information sessions called “Medicare Made Clear”. Choose the one session that is most convenient for you. And please invite a friend. Session A- Wednesday, November 10th 11:00 am in the Hazen Room of the YMCA Session B- Friday, November 12th 9:30 am in the Hazen Room of the YMCA Each session will be approx 1 hour and we will provide coffee. To reserve your seat please stop by the Front Desk of the YMCA or contact Helen at (860) 343-6230 or hpeaslee@midymca.org
Source: blogspot.com

Why today's seniors object to the dissolution of Medicare

Privatization / corporatization of health care in the U.S. is the reason why our health care is prohibitively expensive, and can boast of only mediocre outcomes, at best. Nowhere else in the industrial world do citizens find themselves going bankrupt over medical care, and most industrial countries achieve substantially better health outcomes, and at lower cost, than we do. All Mr. Ryan’s plan will do is perpetuate our current dysfunctional system, with CEOs of health insurance companies being paid 7-figure salaries while nameless clerks deny coverage and the people they ostensibly “serve” find themselves having to choose between paying for food, or the mortgage, or clothing on the one hand, and paying off that hospital or doctor bill on the other, knowing that the “non-profit” hospital or physician may well take them to court if they choose to eat rather than pay for medical care.
Source: minnpost.com

Medicare HMOs reduce utilization, researchers say

Posted by:  :  Category: Medicare

“Although we could not assess the appropriateness of services, some of our findings suggest that the use of services may be more appropriate within Medicare Advantage HMOs,” the researchers said. “For instance, relative to beneficiaries in traditional Medicare, Medicare Advantage HMO enrollees are more commonly treated with cardiac bypass surgery, in accord with current guidelines. Additionally, lower rates of emergency department use suggest that Medicare Advantage HMOs may be treating patients in less costly primary care or urgent care settings.”
Source: lifehealthpro.com

Video: Differences between Medicare PPO & HMO Plans

Medicare Advantage HMO Plans in Texas

Now, 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

Medicare Advantage HMO Enrolles Use Fewer Outpatient Surgery Benefits

Medicare Advantage HMO plans may be offering more efficient care than Medicare Part A and Part B plans, according to a study published in the journal Health Affairs. According to the study, MA HMO enrollees receive fewer hip and knee replacements and use fewer benefits for outpatient surgeries and procedures, inpatient stays and emergency department visits. Based on a national comparison of data from MA HMO and traditional Medicare plans from 2003 to 2009, the researchers found that utilization rates in some areas — like ER and ambulatory surgery — were around 20 percent lower in MA HMO plans. MA HMO enrollees also received about 10 percent fewer hip and knee replacements and initially had lower rates of ambulatory visits and hospitalizations. Related Articles on Coding, Billing and Collections: Billing Company Executive to Be Charged With $41M in Tax Evasion Fraud 5 ICD 10 Regulation Myths
Source: beckersasc.com

Think Medicare HMO Advantage Covers Everything? Think Again!

Consumer’s Guide to Hospice Care in Florida – It’s Much More Than You Think. Most people never get the true benefit from this fully Medicare covered service. In addition to bursting the myths and legends about Hospice, our guide will walk you through the legal steps a family should take as soon as the Hospice decision is made to protect assets and provide for an orderly transition after the passing. Includes an all-new Bonus Section on Long Term Care Needs and Incapacity Planning.
Source: florida-elderlaw.com

Research Finds Link Between Poor Health And Seniors Switching Out Of Private Medicare Plans

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: kaiserhealthnews.org

State gives high marks to North Bay health plans and providers

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Source: northbaybusinessjournal.com

Do I Need To Supplement My Medicare Ins?

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSInsurance companies that offer Medicare Supplement Insurance will need to provide Plan A. Insurance companies will also need to offer Plan C and Plan F. You have the option to choose from plans ranging from A through N. However, plans E, H, I, and J are no longer available. Insurance companies in your state may not offer all Medigap plans for purchase. They also cannot deny you a policy for any type of pre-existing health issue.
Source: seniorcorps.org

Video: Medicare Advantage vs. Medicare Supplement Insurance

Medicare Supplemental Insurance

We also offer a Plan F High Deductible Medicare Supplement Insurance plan* that is designed to save you money if you stay healthy and keeps the cost of insurance affordable. There is a one-time deduction that must be met each year with this plan. With a Medicare Supplement Insurance plan from Pekin Life Insurance Company you will also have access to discounts on eye exams, eyeglasses, contact lenses, LASIK correction surgery, hearing aids, hearing exams, and more at NO CHARGE.
Source: pekininsurance.com

Medigap vs. Medicare Advantage Plan

Medicare Advantage comprises a variety of private health plans — most often HMOs and PPOs — that Medicare offers as a coverage alternative to the traditional program. Every plan must cover all the same benefits that traditional Medicare covers. But the plans can charge different copayments (often lower than the traditional program but not always) and offer extra benefits. Most charge a monthly premium in addition to the Part B premium, but some don’t. Most include prescription drug coverage at no additional cost. Some cover routine hearing and vision services, usually as a separate package for an additional premium. Another difference from the traditional program is that most plans require you to go to doctors and other providers within their service network or pay higher copays for going out of network.
Source: aarp.org

Medigap Covers Some of Medicare’s Out

You can buy one of 10 standardized Medigap policies. Each policy is labeled with a letter of the alphabet — A, B, C, D, F, G, K, L, M, N — and offers a different range of benefits from the others. All policies include coverage for certain core benefits, such as copays for Part B services and extended stays in the hospital. For example: Medicare pays 80 percent of a doctor’s bill and your share is 20 percent. Medigap pays your share and you pay nothing.  Some policies provide more benefits — for example, covering additional out-of-pocket costs in Medicare and emergency medical treatment abroad.  Generally: the greater the coverage, the higher the premium. If you’re age 65 or older and buy a Medigap policy within six months of enrolling in Part B, you get full federal guarantees and protections.  This means that a Medigap insurer cannot turn you down or charge a higher premium because of current or past health problems and must cover preexisting medical conditions. (However, an insurer may delay coverage of treatment for a preexisting condition for a period, typically six months, after purchase. Some state laws give additional consumer protections in this regard.)   There are several other situations in which you’re entitled to these protections — such as losing employer health coverage, COBRA or retiree benefits that serve as secondary coverage to Medicare, or if you’re enrolled in a Medicare Advantage plan that closes down or you move out of its service area.  In these circumstances, the time frame for buying a Medigap policy is about two months. If you’re under 65 and have Medicare due to disability, these federal guarantees do not apply, although some states have similar protections. See related article: “Getting Medigap Insurance Under Age 65.” Things to remember when considering Medigap insurance
Source: aarp.org

Medigap: Medicare Supplemental Insurance

What is Medigap or Medicare Supplemental Insurance? A Medigap policy is health insurance sold by private insurance companies to fill the “gaps” in your Medicare Part A and Part B coverage: it helps pay some of the health care costs that Medicare doesn’t cover. If you have Medicare and a Medigap policy, then Medicare and your Medigap policy will each pay its share of covered health care costs. Some Medigap policies also cover other extra benefits that aren’t covered by Medicare. Generally, you must have both Medicare Part A and Part B to purchase a Medigap plan.
Source: alzinfo.org

[WATCH]: Medicare Supplement Ins Video answers your Ohio ins quest.

http://www.OhioMedicareSupplementInsurance.com 888-225-2323 email info@healthinsuranceforohio.com If you are turning 65 or are unhappy with your Medicare Supplement Insurance and want to change you can now during Open
Source: wordpress.com

Here We Go Again! Cuts to Medicare/TRICARE Physician Payments Begin January 1 Unless Congress Acts

Posted by:  :  Category: Medicare

Getting a so-called “Doc Fix,” which would end scheduled cuts in Medicare reimbursement rates, is a recurring issue. Congress temporarily stopped the scheduled payment cuts in February 2012 as part of the Middle Class Tax Relief and Job Creation Act of 2012  (P.L. 112-96). Unfortunately, that fix is due to expire on January 1, 2013, which means that without further Congressional action the 26.5% physician payment cut will go into effect. The timing of the expiration also means the issue has been caught up in the negotiations over the pending fiscal cliff. This makes fixing it that more difficult.
Source: militaryfamily.org

Video: (Part 1) Using TRICARE and Medicare

Ask The Experts: Retirement

Q. On Jan. 18, there was question about which is primary between these two programs, and the answer ended with “whether you keep both [Federal Employees Health Benefits] and Tricare is something you’ll have to decide.” How do you decide? Where can I find a clear, side-by-side comparison of my FEHB (BC/BS standard in my case) and Tricare for Life — one that is not comparing apples to oranges? I have been told I don’t really need FEHB because TFL is “very comprehensive,” but how can I find out exactly what, if anything, FEHB would cover that TFL wouldn’t. P.S. I’m in excellent health and am also covered by Medicare Parts A and B.
Source: federaltimes.com

TRICARE Moving to Medicare Type Methodology for SCHs

Medicare reimburses SCHs for inpatient care at the greater of the Medicare DRG for all Medicare discharges, or the amount the SCH would have been paid if it were paid the average cost per discharge at that SCH in fiscal years 1982, 1987, 1992, 1996 or 2006, updated to the current year, for all Medicare discharges. DOD noted, however, that establishing a methodology exactly like Medicare is not practical. While the aggregate DRG reimbursement for all TRICARE discharges can be calculated, using the Medicare cost per discharge would not be appropriate for TRICARE because of differences in the TRICARE and Medicare beneficiary case mix. Also, applying an annual update to a TRICARE base-year average doesn’t make sense because of the relatively low number of TRICARE discharges in any given year—fewer than 20 at nearly half of SCHs. The average cost per discharge in any one year may not be a good measure of the average cost in future years.
Source: healthcarereforminsights.com

Tricare and Medicare Patch

I know I have quite a few readers who have tricare or medicare so if you are a military family, senior, disabled, or you just want to help then here is an easy one-click way to contact your congress to ask them to permanently fix the payment cut for Medicare/Tricare. The fix they have in place right now will expire in December.
Source: littlepeoplewealth.com

TRICARE to MEDICARE Transition

On 8-31-2008 Friar 1610 posting in a separate thread, wrote: "What worries me about TRICARE Standard (and also about MEDICARE as I get within spittin’ distance of it) is this: It seems like every year there’s a drill to reduce the fees paid to providers. At the eleventh hour they always seem to restore (or slightly increase) the fees and kick the decision into the next FY when even deeper reductions are proposed. The potential – and in some cases actual – problem: fewer and fewer civilian providers wanting to accept new patients under TRICARE/MEDICARE." Friar, do you have an update on this? I have had Medicare/Tricare for Life for some time and have not one complaint about it. As far as I know, it is currently the best senior medical insurance available. (But – we earned it, didn’t we?!) I’d be concerned if I thought it would be hard to be accepted though. One thing to be aware of – not a big deal – Medicare premiums are now means tested to a top level of around $250/month that will kick in if you sell highly appreciated assets and have a big capital gain – at least for that year.
Source: early-retirement.org

How Tricare, Medicare work in retirement

Yes it’s gen­er­ally a good deal in the states but not so good over­seas where one gets to pay for medicare but gets none of the ben­e­fits. In addi­tion if one lives in the Philip­pines they will find the Tri­care Stan­dard has been reduced to a sec­ond class ben­e­fit with lim­ited access to providers. Very often retirees find they get to pay 100% of the cost of their care. On aver­age for inpa­tient care they can look for­ward to pay­ing 50% or more of the pro­fes­sional fees and even then they have to learn med­ical cod­ing and pro­ce­dures to con­vert local global bills into a form accept­able to TMA. Any­where else in the world they accept the local global bill and pay the full 75% they should. Local providers and hos­pi­tals tend to avoid Tri­care because of its bad rep­u­ta­tion and past actions. So also expect to keep $10,000 plus lay­ing around to pay for your hos­pi­tal­iza­tion up front and then hope to get 50% back.
Source: military.com

Daily Kos: Don’t let sequester ax scholarships for children of American troops killed in Iraq and Afghanistan

Following World War II, the “Servicemen’s Readjustment Act of 1944” – better known as the G.I. Bill – helped returning veterans earn college degrees, train for vocations, support young families, and purchase homes, farms and businesses. [snip] Education and training benefits were the most popular parts of the G.I. Bill, claimed by 51 percent of veterans. Some 2.2 million attended college or graduate school, and 5.6 million prepared for vocations in fields such as auto mechanics, electrical wiring, and construction. Veterans could attend any institution that admitted them, using benefits that covered even the costliest tuition and helped support spouses and children. Nearly three of every ten veterans used low-interest mortgages to buy homes, farms or businesses. The economic impact was huge. In 1955, for example, the Veterans Administration backed close to a third of housing starts. This should be a no-brainer decision. These cuts are antithetical to just about everything the matters in rebuilding todays middle class imo
Source: dailykos.com

Medicare Open Enrollment: More is better

Posted by:  :  Category: Medicare

Martin Place 1 by Greens MPsFor those choosing Original Medicare, the benefit package continues to grow stronger and provide greater value. For example, EVERYONE with Medicare has access to a variety of preventive services and screenings, most at no cost to them when furnished by qualified and participating health care professionals. This includes things like diabetes and cancer screenings, and a yearly “wellness” visit. During the first 9 months of this year, over 20 million people with Original Medicare received at least one preventive service at no cost.
Source: medicare.gov

Video: Medicare Dental Plans | Medicare supplemental Plans dental plans

What is Medicare Supplement and What you should know about it?

A Medicare supplement, also called as Medigap, is a type of insurance usually sold by private insurance companies. Such policies help paying for healthcare services like coinsurance, copayments and deductibles that are not covered by traditional Medicare. Some Medicare supplement plans provide coverage for medical care when the policyholder is traveling outside the United States.
Source: ezinemark.com

Dental Coverage under Medicare

Should you choose to get your health insurance through Original Medicare, you can still get coverage for your teeth. You can supplement your coverage with a private dental insurance policy. Before purchasing one of these policies you should be sure that you understand the limits of the coverage.
Source: medicare-supplement-quotes.com

Medicare Eligibility and Senior Health Care

Medicare Advantage popularly known as MA refers to a health insurance program which offers an eligible individual with the US Medicare benefits. MA differs from the previous Medicare model that offered a standard plan offered directly by the United States. In contrast, MA is program that is normally provided by private providers.
Source: eazyretirement.com

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

Medicare open enrollment: How can I find a better plan?

What about doctor availability? On the Medicare site you can directly compare up to three plans, and when I selected your current plan and these other two plans, I saw that your current plan says it has 1001-1500 “physicians and providers,” compared to 4001-5000 for the other two plans. For each plan you can click on “View provider and physician network website,” which takes you away from Medicare.gov and onto the plan’s own website, where you can search its provider directory to judge for yourself whether it has enough doctors to meet your needs.
Source: consumerreports.org

Medicare Part D, Prescription Drug Plan Coverage, PDP

Posted by:  :  Category: Medicare

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

Video: Humana and Walmart Announce Innovative Medicare Part D Prescription Drug Plan

Top Medicare Part D Plan Costs Spike in 2013

The opinions expressed in WebMD User-generated content areas like communities, reviews, ratings, or blogs are solely those of the User, who may or may not have medical or scientific training. These opinions do not represent the opinions of WebMD. User-generated content areas are not reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other reason except for compliance with our Terms and Conditions. Some of these opinions may contain information about treatments or uses of drug products that have not been approved by the U.S. Food and Drug Administration. WebMD does not endorse any specific product, service or treatment.
Source: webmd.com

CMS AND CALIFORNIA PARTNER TO COORDINATE CARE FOR MEDICARE

Medicare Part D went into effect on January 1, 2006. Anyone with Part A or B is eligible for Part D. It was made possible by the passage of the Medicare Modernization Act. In order to receive this benefit, a person with Medicare must enroll in a stand-alone Prescription Drug Plan (PDP) or Medicare Advantage plan with prescription drug coverage (MA-PD). These plans are approved and regulated by the Medicare program, but are actually designed and administered by private health insurance companies. Unlike Original Medicare (Part A and B), Part D coverage is not standardized. Plans choose which drugs (or even classes of drugs) they wish to cover, at what level (or tier) they wish to cover it, and are free to choose not to cover some drugs at all. The exception to this is drugs that Medicare specifically excludes from coverage, including but not limited to benzodiazepines, cough suppressant and barbiturates.[41][42] Plans that cover excluded drugs are not allowed to pass those costs on to Medicare, and plans are required to repay CMS if they are found to have billed Medicare in these cases.[43] It should be noted again for beneficiaries who are dual-eligible (Medicare and Medicaid eligible) Medicaid may pay for drugs not covered by part D of Medicare, such as benzodiazepines, and other restricted controlled substances. The Patient Protection and Affordable Care Act (“ACA”) of 2010 made a number of changes to the Medicare program. Several provisions of the law were designed to reduce the cost of Medicare. Congress reduced payments to privately managed Medicare Advantage plans to align more closely with rates paid for comparable care under traditional Medicare. Congress also slightly reduced annual increases in payments to physicians and to hospitals that serve a disproportionate share of low-income patients. Along with other minor adjustments, these changes reduced Medicare’s projected cost over the next decade by $455 billion. Additionally, the ACA created the Independent Payment Advisory Board (“IPAB”), which will be empowered to submit legislative proposals to reduce the cost of Medicare if the program’s per-capita spending grows faster than per-capita GDP plus one percent. While the IPAB would be barred from rationing care, raising revenue, changing benefits or eligibility, increasing cost sharing, or cutting payments to hospitals, its creation has been one of the more controversial aspects of health reform. The ACA also made some changes to Medicare enrollee’s’ benefits. By 2020, it will close the so-called “donut hole” between Part D plans’ coverage limits and the catastrophic cap on out-of-pocket spending, reducing a Part D enrollee’s’ exposure to the cost of prescription drugs by an average of $2,000 a year.[116] Limits were also placed on out-of-pocket costs for in-network care for Medicare Advantage enrollees. Meanwhile, Medicare Part B and D premiums were restructured in ways that reduced costs for most people while raising contributions from the wealthiest people with Medicare. The law also expanded coverage of preventive services. The ACA instituted a number of measures to control Medicare fraud and abuse, such as longer oversight periods, provider screenings, stronger standards for certain providers, the creation of databases to share data between federal and state agencies, and stiffer penalties for violators. The law also created mechanisms, such as the Center for Medicare and Medicaid Innovation to fund experiments to identify new payment and delivery models that could conceivably be expanded to reduce the cost of health care while improving quality. http://en.wikipedia.org/wiki/Medicare_%28United_States%29
Source: wn.com

360 Vantage Expands Board to Support Continued Growth

Dr. David Lorber brings an extensive healthcare background in prescriber programs, e-business initiatives, and government relations. Dr. Lorber currently serves as vice president of clinical affairs for Walgreen Co. Previously, he served as vice president of medical affairs at CVS Caremark where he was responsible for the development and implementation of formulary and clinical programs for their Medicare PDP. Dr. Lorber is a member of the USP Pulmonology Expert Committee, Therapeutic Decision Making Expert Committee, and the Medicare Model Guidelines Committee. He has served on the Stakeholder’s Committee for AHRQ (Agency for Healthcare Research and Quality) and the Medical Advisory Board of the National Rural Electrical Cooperatives. He is a board-certified internist and pulmonologist.
Source: 360vantage.com

Medicare Part D Prescription Drug Plan Availability in 2012

This fact sheet contains 2013 state-specific summary data about available Medicare drug benefit options, including premium ranges and the number of plans available at no cost to qualifying beneficiaries.
Source: kff.org

CMS Proposed 2014 Payment and Policy Updates for Medicare Health & Drug Plans & Draft Call Letter | Crowell & Moring

The Advance Notice discusses changing CMS’s actuarial calculation and risk score models for Medicare Advantage plans to comply with the requirements of the Affordable Care Act. CMS also proposes data collection and analysis for Health Risk Assessments (HRAs), which are enrollee risk assessments done by Medicare Advantage plans. MA plans must flag any diagnoses collected in MA enrollee risk assessments, which CMS believes will encourage adequate follow-up by plans for these conditions. The Advance Notice also updates many statistical factors used for payment calculation. Updated statistical payment factors include: normalization factors for its Part C plans, normalization factors for Part D plans, and frailty factors. CMS also proposes recalibration of its prescription drug risk adjustment model (RxHCC).
Source: crowell.com

Most Medicare Part D beneficiaries not in low

An analysis of more than 100,000 user sessions on PlanPrescriber.com found only 5 percent of customers were in the Medicare prescription drug plan (PDP) with the lowest total out-of-pocket costs available to them. Only 24 percent of customers were in the Medicare Advantage prescription drug (MAPD) plan with the lowest total out-of pocket costs.
Source: lifehealthpro.com

Reminder: Medicare Advantage Disenrollment Period (MADP) Ends February 14th 

During the MADP, an individual using the MADP to disenroll from an MA plan is eligible for a special enrollment period (SEP) to enroll in a stand-alone Part D prescription drug plan, regardless of whether the MA plan from which the individual disenrolled included the Part D drug benefit. The old OEP did not allow a beneficiary to add Part D coverage if he or she did not previously have such coverage at the beginning of the calendar year.
Source: medicareadvocacy.org

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

How the government keeps the poor in their place

Posted by:  :  Category: Medicare

"Never spend your money before you have it." ~ Thomas Jefferson. by eyewashdesign: A. GoldenDisability is not a lot of money, there is no need for a savings account to hold excess income. Disability teaches humility and frugality. The Social Security Administration attorney put me on permanent disability and approved my Medicaid in the autumn of 2012. I received medical benefits for about 90 days. And then in January 2013 my world radically changed…the government changed the Medicaid rules. I ran the numbers that the DHS indicated as my deductible amount: my Spend Down deductible for medical expenses must be 75% of my disability check (that’s right 75%) before I will be reimbursed.  If it’s, say, 72%…oops, so sorry, you’re not getting any medical reimbursement and you’re out that amount to pay for your living expenses. So, let’s imagine my SSA monthly income is on the higher end at $1000 a month. This must pay for mortgage, utilities, food, clothing, laundry soap, and, well, all other personal hygiene stuff. And now imagine my medical and prescription expenses are at the low end at $720 for the month. That is only 72%, three points below my required 75% Spend Down deductible. Do the numbers ($1000 SSA income – $720 un-reimbursable medical). That leaves me with $280 per month to pay my mortgage, utilities, and groceries. Oh, and DHS added to my income my qualifying amount of $20 a month in food assistance. $20 a month for food?!
Source: wizbangblog.com

Video: Medicaid spend down

New Court of Appeals Decision Provides Guidance on Medicaid Spenddown Requirements

The MN program assists low-income families with medical costs.  A family can qualify for the MN program if its income is less than a certain amount during a specific base period.  A family that exceeds the maximum income level can still qualify for the program if it pays medical expenses in an amount equal to or over the excess income.  For example, if a family’s income is $500 over the maximum level, it can still qualify for the MN program if it spends $500 on medical expenses.  This process of using excess income is called the “spenddown.”
Source: omwhealthlaw.com

With the Loss of Illinois Cares Rx, Where Can People Turn? : The Shriver Brief

The elimination of Illinois Cares RX is effective on July 1, if the Governor signs the bill as is. As you can tell from this blog, that leaves precious little time for seniors to make the complicated choices and actions necessary to rearrange their drug purchasing and transition to the new system. Advocates have asked that Governor Quinn amendatorily veto the bill to keep Illinois Cares Rx on the books, or, at a minimum, to delay the effective date to January 1, 2013, to allow for a smoother transition—let’s keep our fingers crossed. Of course, we will keep you updated on any developments.  
Source: theshriverbrief.org

Medicaid Nursing Home Spend

The Medicare / Medicaid programs are dual eligibilities government programs for the aged, the blind, and disabled, and heavy long term care users for the poor of the poorest. Medicaid is the largest liability in state budgets having topped elementary and secondary education. For 2003, total Medicaid expenditures in most states were $267 billion. Of this, Medicaid financed nursing home care accounted for approximately $51 billion and home care $9.9billion.*
Source: blogspot.com

State Roundup: Medicaid Causes Budget Headache In Wash. State

Posted by:  :  Category: Medicare

Racism by elycefelizMPR News: DFL’s Plan To Cut Health, Human Services Spending Comes As A Surprised With Minnesota House and Senate Democrats proposing $2 billion in new taxes to erase the budget deficit and spend more on schools, economic development and other state services, one area — health and human services — is getting left out. In fact, DFLers propose a spending cut. But some advocates for the poor say they can’t handle any more spending reductions. Democrats in the House and Senate want to cut $150 million in spending from health and human services programs. After education, health and human services is the second-largest portion of the state’s two-year budget at $11 billion in general fund spending. But it is increasing at a fast rate, and that worries DFL House Speaker Paul Thissen (Scheck, 3/21).
Source: kaiserhealthnews.org

Video: Medicare in Arizona- 1.800.643.7544

Can Florida Medicaid Learn from Arizona?

Ford’s house is busy today. Dave Oxford, the case manager from his health plan Mercy Care is here, too, peppering Ford with questions about the nagging wound on his foot and whether he needs to change any of his many medications. Oxford visits the homes of all of his clients in the Phoenix area who are old or disabled enough to qualify for Medicare and poor enough to qualify for Medicaid. Oxford’s visits every three months are part of a coordinated and concerted effort to keep patients like Ford out of pricey nursing homes and emergency rooms. Mercy Care is a contractor of the insurance giant Aetna, and like all health plans that compete for Arizona’s combined Medicare-Medicaid patients, it receives a monthly fee per person that it must use to cover all of a patient’s needs.
Source: hcafnews.com

Medicaid Expansion: Not Just An Arizona Problem

Arizona is not alone in trying to decide whether to expand health-care insurance for the poor. Talking Points Memo today looks at how Republican governors in various swing states are wrestling with the question: Rejecting the Medicaid expansion, as many fellow Republican governors from red states have done, would endear them to the conservative base, which detests the Affordable Care Act.
Source: tucsonweekly.com

Medicaid Math Trumps Ideology for GOP Governors

Even if the exchanges function as intended, there will be holes in the safety net for the poor in states that opt not to expand Medicaid. In recognition of this problem, the Obama administration has relaxed rules on states in an effort to coax them into compliance. On Tuesday, a day after Obama declined in his second inaugural address to offer an olive branch to Republicans in Congress, the Department of Health and Human Services issued a regulation that extends a helping hand to states by allowing them to charge higher co-payments for some medical services and prescription drugs.
Source: realclearpolitics.com

Hospice Company Agrees to $12 Million to Settle Medicare Fraud Case

AAHomecare AARP Addus HomeCare Corp. Alliance for Home Health Quality and Innovation Almost Family Amedisys Inc. American Association for Homecare American Association for Long Term Care Insurance Apria Healthcare Group Brookdale Senior Living Care.com Center for Medicare Advocacy Centers for Medicar & Medicaid Services Centers for Medicare & Medicaid Services CMS Ensign Group featured First Care Home Health Care Gentiva Health Services Gentiva Health Services Inc. Health Care Fraud Prevention and Enforcement Team HHS Home Health Depot Home Health International Humana IntegraCare Intel-GE Care Innovations Jordan Health Services Kindred Healthcare LHC Group Inc MedPAC NAHC National Association for Home Care & Hospice National Hospice and Palliative Care Organization New York Times Paraprofessional Healthcare Institute Partnership for Quality Home Healthcare PHI ResCare HomeCare Scripps Health Sentara Healthcare The Ensign Group VA Visiting Nurse Association Visiting Nurses Association
Source: homehealthcarenews.com

Medicaid Expansion Is Delicate Maneuver for Arizona Governor

Ms. Brewer, who has become something of a conservative icon for her aggressive opposition to Mr. Obama’s policies, surprised many Legislature watchers at her State of the State address last week by saying she wanted to expand the state’s Medicaid program to include anyone who makes up to 133 percent of the federal poverty level, or $14,856 for an individual. The risk if Arizona does otherwise, she said, is losing the federal funds and the health care jobs that come with the changes.
Source: protectingmedicare.org

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

Sun and Shield: Letting private insurance companies run Medicaid and Medicare: Arizona’s good experience

I confess that I have had grave doubts about turning our nation’s healthcare “system” completely over to private companies. My Medicare works well for me, and seems to be inexpensive to run, compared to the high salaries and bloated bureaucracy of some private insurance companies, and their desire to turn a profit, no matter what, as their primary reason for existence, rather than patient care being primary. (I know — Medicare expenses have to be brought more under control. But the increasing expenses aren’t because it’s a government-run program. They are because more and more people are becoming eligible for Medicare, and living longer while on it.)
Source: blogspot.com

The Rural Blog: Rural Georgia hospital closing, blames Medicare

Posted by:  :  Category: Medicare

Gang of Six - Cartoon by DonkeyHoteypopulation 1,400, about 30 miles west of Americus, will suspend operations tomorrow. The 25-bed hospital, named for the two rural counties it serves but owned by Accord Health Care Corp., says it is closing partly because high unemployment in the area means the hospital is seeing more people who are not paying for services. Also, “Medicaid and Medicare are not paying what they used to,” and the hospital simply ran out of money, report Sydney Cameron and Liz Buckthorpe of WRBL of Columbus. And, in changing top electronic health records, “The hospital had to pay for the costs up front and because of a mix-up with Medicare they have not received $1 million in incentive money for the changeover.” Stewart-Webster is the largest employer in Richland at nearly 80 employees. The hospital sees around 10 patients a day and performs about five surgeries a week, the station reports.
Source: blogspot.com

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

Medicaid expansion: An irresistible tide?

Cheryl Smith of Leavitt Partners, former director of the Utah health insurance exchange for small businesses, and MIT’s Jonathan Gruber, a key architect of the Massachusetts health reform law, also told health care journalists Friday to get ready for a bumpy debut when the Affordable Care Act launches health insurance exchanges in January.
Source: georgiahealthnews.com

Deal again says Georgia can’t afford Medicaid expansion

Members of the Georgia Chamber, Lieutenant Governor Cagle, Speaker Ralston, state legislators, elected officials, judges, justices, ladies and gentlemen: Let me begin by congratulating you. We have had one of the best years of economic development in quite some time. A few notable companies that have chosen Georgia include Baxter, General Motors, and Caterpillar, along with numerous others. We did this with your help, with both the private and the public sector doing their parts! Several weeks ago, the lieutenant governor, along with Sandra and I hosted a reception at the Governor’s Mansion to honor Georgia’s Olympic and Paralympic athletes who competed at the London Olympic Games. This was an outstanding group of young people of whom we are extremely proud. One of the men in the group was Aries Merritt, a native of Atlanta and a graduate of Wheeler High School in Marietta. Aries won an Olympic Gold Medal in the 110 meter hurdles. Unlike sprinters who travel in a straight line with no obstacles other than the lane markers assigned to them, hurdlers, as the name implies, must jump over obstacles that are placed in their path. Making analogies between sports and government is always risky, but I want to suggest to you that the business of governing our state is somewhat similar to running the hurdles. As governor, my goal is to see Georgia become the No. 1 state in the nation in which to do business. I have made that clear from the beginning, because I believe that is the best path to economic growth and the quickest way to get Georgians into jobs. And we are not all that far off from reaching our target: For two years in a row, we have ranked in the top five for business climate by Site Selection Magazine, and we ranked No. 3 for doing business in 2012 by Area Development Magazine. But we certainly still have some hurdles that we must overcome before we get there. This morning I will focus my remarks on one of the highest hurdles facing state government, that of healthcare. In Georgia, we have had many successes in the realm of healthcare. With rising healthcare costs, we have worked to keep Georgians healthy so that they can avoid some of these expenses rather than react to them when they become ill. We have launched the Georgia SHAPE program as a way to combat childhood obesity, a growing problem in our state. I proclaimed this past September “Georgia SHAPE Month,” during which we emphasized physical activity and proper nutrition for our state’s children. In its inaugural year, the Governor’s SHAPE Honor Roll had 39 schools achieve Gold Medal status for their dedicated work in making our state’s youth healthier. These healthier young people generally perform better in the classroom, and many will continue their healthy lifestyles into later years, making these programs an investment in the economic and cultural well being of our state. The State Health Benefit Plan just finished the first year of its Wellness Program – the largest such program in the country, with more than 245,000 enrollees. We would like to take the next step by growing and developing it; we want to see employees taking responsibility for their own health through preventative action … and receiving lower premiums as a reward. Even with all of these cost-saving approaches, it still costs approximately $10 million per day in claims to provide health benefits to active and retired employees and teachers. Those costs have and will increase because of Obamacare’s mandated benefits; in FY2014, the State Health Benefit Plan is projected to incur $106M of additional costs due to Obamacare. And because our State Health Benefit Plan is classified as a Self-Insured Plan, it is subject to the three-year Obamacare reinsurance tax. This means we would pay an additional $35M in 2015. Of course, even among the healthy, not all illness can be prevented; so last year, we grew graduate medical education by adding funding in the budget for the development of 400 new residency slots in hospitals throughout the state, helping keep Georgia’s doctors in Georgia. These are just a few of the great things we have going for us in healthcare. But we also face hurdles that we must overcome, like how to fund the state’s responsibility for Medicaid. Right now, the federal government pays a little under 66 cents for every dollar of Medicaid expenditure, leaving the state with the remaining 34 cents per dollar, which in 2012 amounted to $2.5B as the state share. For the past three years, hospitals have been contributing their part to help generate funds to pay for medical costs of the Medicaid program. Every dollar they have given has essentially resulted in two additional dollars from the federal government that in part can be used to increase Medicaid payments to the hospitals. But the time has come to determine whether they will continue their contribution through the provider fee. I have been informed that 10 to 14 hospitals will be faced with possible closure if the provider fee does not continue. These are hospitals that serve a large number of Medicaid patients. I propose giving the Department of Community Health board authority over the hospital provider fee, with the stipulation that reauthorization be required every four years by legislation. They have experience in this area, having had authority over a similar fee for the nursing home industry since around 2004. Of course, these fees are not new. In fact, we are one of 47 states that have either a nursing home or hospital provider fee – or both. It makes sense to me that, in Georgia, given the similarity of these two fees, we should house the authority and management of both of them under one roof for maximum efficiency and effectiveness. Sometimes it feels like when we have nearly conquered all of our hurdles, the federal government begins to place even more hurdles in our path. I am, of course, referring to the various mandates of Obamacare that put a strain on our state, its businesses and its citizens. As most of you are well aware, the United States Supreme Court upheld the individual mandate as a tax. Therefore, most Georgians, beginning in 2014, will be forced to get insurance coverage or else pay a minimum of $95 (and potentially far more) in penalties. So what does this mean for us? It means that Georgians must pay out dollars to either an insurance company or the federal government – whether they want to or not. But ultimately there still is a choice, albeit a rock-and-a-hard-place kind of choice. As more individuals enter the marketplace, younger, healthier Georgians might begin deciding they would rather pay the penalty than deal with the potentially much higher cost of coverage, causing the price of insurance for everyone to climb; this increase will drive even more healthy individuals out of the market, further swelling the cost. This potential cycle is one of the inherent flaws in the federal law. The employer mandate means that businesses with 50 or more employees must provide affordable health insurance to their workers or else pay the rather large penalties. Costs can increase here, as well, as the pool of insured becomes less healthy. These costs stand to hurt our state’s private sector. Because as all businessmen and women know, the higher your input costs, the lower your profits; the lower your profits, the less you operate, expand or employ. But whether it’s through fewer employees and less equipment purchases or higher costs, this mandate will negatively impact many of our state’s businesses and, of course, the would-be employees themselves. Georgians who have already received a paycheck this January have no doubt noticed that their payroll taxes went up and their take-home salary went down. This is the cost of entitlements. If you think your taxes went up a lot this month, just wait till we have to pay for “free health care.” Free never cost so much. The individual mandate has a second tier of impact involving Medicaid and its cost to the state. I have said clearly that Georgia will not expand Medicaid under the federal government’s guidelines. Even so, in Fiscal Years 2013 and 2014, Medicaid and SCHIP funding will be the second largest portion of the state funds budget with more than 13 cents of every dollar going straight to one of these programs. And with just the portions that our state must do, Obamacare is expected to add more than 100,000 new individuals to our Medicaid rolls and mandate other requirements, costing our state nearly $1.7B over the course of 10 years – and that’s on top of the $2.5 B we already pay annually. The reason: These Georgians qualify for Medicaid under the current system but have yet to enroll in it. With the individual mandate requiring either insurance or a hefty fee, they will likely think that Medicaid looks like a pretty good option. And since they fall under the current system, the state of Georgia and its taxpayers must pay the current rate of 34% and not the 0 to 10% rate proposed for the expanded population group. We constitutionally must balance our state budget – a wise requirement instituted by those who have come before us. This increase in costs to the state means we have to find that money somewhere in our already tight budget; we cannot simply create more. As such, I have instructed the Department of Community Health to reduce its budget by at least three percent in Amended Fiscal Year 2013 and by five percent in Fiscal Year 2014 – a difficult but necessary task. They have already identified $109M in cost-saving measures between the two years. But this hardly covers the additional nearly $500M in needed funds caused by growth in Medicaid expenses during the same time frame. That means we must make necessary cuts in other agencies and core functions of government since raising taxes is not an option I will accept! As I have indicated, I have rejected the Medicaid expansion in Georgia already, but let me emphasize that the expansion would have put our additional costs over 10 years closer to $4.5B – and that’s operating under the dubious assumption that the federal government, with its ever-growing national debt, would have fulfilled their promised share. The 620,000 new enrollees would have stretched our resources and our state to the limit. But whether the cost to our state would have been $2B, $4B or $6B, it does not make much sense to ask for more hurdles when you are already utilizing every muscle in your state’s body to overcome the ones you currently have before you and that you must face. So unless the federal government changes it to a block-grant program and allows Georgia to design the benefit plan, I cannot justify expanding Medicaid. The irony to me is that there are those in the medical community who are urging the expansion of the Medicaid program while at the same time, we are seeing more and more medical providers refusing to accept Medicaid patients. Their reason for doing so is that they claim the reimbursements for their services are below their costs. It is for that reason that the previously discussed provider fee is so important since that revenue is used to pay providers. If providers are already having difficulty covering their costs for care to Medicaid patients, how will they accommodate 34% more people on the Medicaid rolls? If you are losing money now, how do you reconcile the number of patients on whom you will lose even more money? Add to that the fact that the new enrollees would be higher on the economic scale, and some will be leaving their higher-paying, employer-provided health insurance plans to enter the taxpayer-funded Medicaid program with its lower reimbursements for the providers. If we have to depend on provider fees now to keep our reimbursements to Medicaid providers at a “tolerable” level, just imagine the pressure that will come when hospitals and doctors are losing more money on a larger portion of their patient base. Expansion of the Medicaid rolls does not solve the problem, it only exacerbates the one we already have. As many of you know, I also turned down the federal government’s offer to let us put our name on their insurance exchange program. I have no interest in seeing our state’s name, or its taxpayer dollars, used on something that we would have very little input in designing. If the purpose is to let those closest to and most knowledgeable about the population design the program, then we should be allowed to do so. It does not appear that is the pattern for the exchanges. I see no benefit to our citizens to have a program bearing the name of the State of Georgia over which our elected or appointed officials have little if any say so. While many federal programs come with strings attached, these strings turn states into marionettes to be manipulated by federal bureaucrats. If there is one thing we don’t need, it is another puppet show directed from Washington, D.C.! We cannot always determine what obstacles will be laid in front of us, but we can decide how we deal with them, and whether we approach them with anger, indifference or decisive action. The first two provide very little in productivity, but the latter offers opportunity to grow our state (and our businesses) in spite of newfound hurdles. Therefore, we must choose to work diligently. We must choose discernment over acquiescence, which is what I have aimed to do in my decision-making. And we must choose to confront these hurdles together, because discussion and determination, without bitterness, lead to the greatest forward progress. Despite all that is in front of us, we will still make Georgia the No. 1 state in which to do business. One last note: For those of you not attending in person, tune in tomorrow at 11 a.m. as I outline the rest of my plan for Georgia in this year’s State of the State Address, or go to my Twitter account, where my staff will be live Tweeting my remarks or at least the good parts.
Source: clatl.com

Republicans debate Medicaid expansion

I used medicaid when it was in its infancy 50 years ago. I went to a dentist for a filling. The filling would have cost $10.00. The dentist said, why have a filling, I will give you a crown[made out of gold]. He said, why not have the best, the state is paying for it? I knew then, medicaid would be a collasal issue for funding as the years went by. Even now, people on social security as their ownly income, have multiple hip replacements, and soforth. Now, I hear society is judged by how it acts towards the least of its citizens. Very true, however, citizens should take some of the responsiblity for their health by living healthy lives rather than thinking government will solve all their problems. I voluntere in a church serving meals to the poor as well as others, I find it enormously rewarding, if Drs, served the needy without expecting gargantuan payment they would find it even more rewarding.
Source: ajc.com

GHA recognizes medical center as patient safety leader

Medical College of Georgia College of Nursing National Institutes of Health College of Allied Health Sciences Georgia Regents University Ricardo Azziz Cancer Childrens Hospital of Georgia Medical College of Georgia at Georgia Regents University Georgia Regents Medical Center Sheldon Litwin Joe Tsien Psychiatry and Health Behavior Georgia Regents Medical Associates Physicians Practice Group Foundation W. Vaughn McCall James Rawson Alumni Weekend Walter Evans American Heart Association GRU Cancer Center MEGAi Days Health Informatics Council of Education in Public Health Health Management
Source: gru.edu

Senior Benefit Services, Inc.

Continental Life Insurance Company of Brentwood, Tennessee (CLI) previously announced a rate increase (effective April 1, 2013) on its Medicare Supplement policies issued in Georgia. The date on which the new rates will apply to new Georgia Medicare Supplement applications underwritten by Continental Life Insurance Company of Brentwood, Tennessee (CLI) has been revised. The new application cut-off date is March 1, 2013 and applies to policies that will become effective on or after April 1, 2013.
Source: srbenefit.com

Medicare agrees to pick up the tab for obesity counseling — Health — Bangor Daily News — BDN Maine

Unfortunately, those best prepared to provide obesity counseling will not be able to bill directly to do so. CMS has limited who is able to bill for those services to primary care physicians and practitioners, including nurse practitioners, clinical nurse specialists and physician assistants. Those with expertise in the field, such as registered dietitians, are not eligible to bill directly. Medicare will cover services from “auxiliary” providers only if the service is provided in a physician’s office suite and the physician is immediately available to provide assistance and direction.
Source: bangordailynews.com

Medicare Payments to Providers Are Carved, Sliced and Chopped by Sequestration

CHOPPED – Sequestration will have a huge impact on healthcare chopping up reimbursements. Now more than ever before, providers must look for every dollar of reimbursement they can find. In most cases, the low-hanging fruit has already been picked. Today, forward thinking healthcare executives must move quickly to make the decisions which will positively affect reimbursements. Investments in brand new technologies and reinvented processes, which offer an ROI of less than 12 months will be the most attractive moves executives can make. There are several “Blue Diamond” technologies entering the marketplace every day. These new avenues for reimbursement recovery are available to help offset the reimbursements that has been carved up, sliced off and hacked to pieces by sequestration.
Source: healthworkscollective.com

Georgia nursing home fire leaves 1 person deadseveral injured www.privateofficer.com

The victim was identified late Tuesday morning as 64-year-old Laura Barrett. The fire, which broke out at around 3 a.m., was reported to be in one room of the Meadow Brook Nursing Home located at 4608 Lawrenceville Highway in Tucker.
Source: wordpress.com

FBI — Doctor Pleads Guilty to Billing Medicare and Medicaid for Counseling Sessions with Dead Patients

According to United States Attorney Yates, the charges, and other information presented in court: WILLIAMS was a licensed physician, practicing in the Atlanta area. From approximately July 2007 through October 2009, he contracted with a medical services company to provide group psychological therapy to nursing home patients in a variety of nursing homes. Under his signature, thousands of claims were submitted to Medicare and Georgia Medicaid seeking reimbursement for group psychological therapy that WILLIAMS purportedly provided to beneficiaries at several nursing homes in the Atlanta area. In many instances, however, WILLIAMS did not actually provide the therapy.
Source: fbi.gov

Medicare Fraud and Nursing Home Abuse is Not Tolerated in Georgia

Look for signs of malnutrition or dehydration, as well as bruises or unexplained bleeding. Broken bones and fractures may indicate pushing, rough handling, or hazardous conditions within the building itself. Any sign of bed sores needs to be questioned and documented. Talk to your loved one and gently try to discern if he or she is being bullied, sexually harassed, or physically or verbally abused. If you see signs of over or under medication, question it until you receive satisfactory answers. If the person you care about has been injured either by neglect or outright abuse, call the police and call a skilled Atlanta nursing home abuse lawyer to preserve the victim’s rights.
Source: goldmanlawatlanta.com