SCHUMER: MEDICARE’S ‘OBSERVATION STATUS’ FORCES SENIORS TO PAY THOUSANDS EXTRA FOR REHAB THAT IS NOT REIMBURSED – NY’S OVER 3 MILLION MEDICARE RECIPIENTS COULD BE LEFT HIGH & DRY, UNABLE TO PAY FOR POST

Posted by:  :  Category: Medicare

Today, during a conference call, U.S. Senator Charles E. Schumer pushed his plan to change a flawed Medicare law, so that seniors with Medicare across Upstate New York are not charged unfairly for receiving needed nursing home care after being hospitalized. Schumer noted that “observation stay” cases in hospitals, when the elderly individual is not technically an inpatient, have been on the rise in recent years, costing America’s seniors thousands of dollars in medical bills for post-hospital therapy and rehab. Currently, Medicare will only cover post-acute care in a skilled nursing home facility if a beneficiary has three consecutive days of hospitalization as an inpatient. Schumer pushed his plan, the Improving Access to Medicare Coverage Act, which would allow “observation stays” to be counted toward the three-day mandatory inpatient stay for Medicare to cover rehabilitation post-hospital visit.
Source: ltpbazzo.com

Video: Proposed Changes to Medicare Observation Status Law

Daily Kos: Tennessee’s plan to privatize Medicaid doesn’t fly with administration

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Source: dailykos.com

Have the Tides Turned for Medicare Advantage Plans in New York? By Myco Dang

The Court then concluded that the New York statute is preempted as it applies to MAOs and that the Plaintiffs claims concerning MAOs reimbursement rights arise under the Medicare Act. (Potts, page 13). In its ruling, the Court looked at the Supremacy Clause of the Constitution, U.S.Const.Art. VI, cl.2, “[w]here a state statute conflicts with, or frustrates, federal law, the former must give way.” CSX Transp., Inc. v. Easterwood, 507 U.S. 658, 663 (1993). “If the statute contains an express preemption clause, the task of statutory construction must in the first instance focus on the plain wording of the clause, which necessarily contains the best evidence of Congress’ preemptive intent.” CSX Transp., 507 U.S. at 664. In turn, the Court ruled that the Medicare Act contains a very broad, express preemption clause. The statute provides that “[t]he Secretary shall establish by regulation other standards . . . for [MA organizations] and plans consistent with, and to carry out, this part.” 42 U.S.C. § 1395w-26(b)(1). The statute further provides, under a sub-paragraph headed “Relation to State Laws”: “The standards established under this part shall supersede any State law or regulation (other than Case 1:11-cv-09071-JPO Document 33 Filed 09/25/12 Page 13 of 22 14 See also 42 C.F.R. § 422.402. (Potts, page 13-14).
Source: xerox.com

DiNapoli Finds Errors in Medicare, Medicaid Billing Costing NY $26m

The audit looked at claims for patients who are both Medicare and Medicaid eligible, which are known as crossover claims. In December 2009, the Department of Health implemented a new payment mechanism in e-med NY to achieve greater control over Medicaid payments.
Source: cnynews.com

State Roundup: N.Y. GOP Readies Medicaid Probe After Allegations

San Francisco Chronicle: Long-Term Care Rate Hike Stuns Retirees When Marie Benedetto opened her mail last week and learned her long-term care premium was going up a stunning 85 percent, she did what a retired math teacher would do. She made a spreadsheet. Benedetto calculated she’d have to spend $1,328 a month or $15,936 a year for the policy after the increase goes into effect. That added up to a 415 percent increase in premiums since she first purchased the policy in 1997. For Benedetto, the rate increase makes her policy unaffordable. … The state pension fund’s board decided in October to increase rates for the policies, which help pay for nursing-home care, home health care and other expenses not covered by Medicare (Colliver, 2/24).
Source: kaiserhealthnews.org

Medicare Competitive Bid Coming soon….for better or for worse.

Section 302 of the Medicare Modernization Act of 2003 (MMA) established requirements for a new Competitive Bidding Program for certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS). Under the program, DMEPOS suppliers compete to become Medicare contract suppliers by submitting bids to furnish certain items in competitive bidding areas, and the Centers for Medicare & Medicaid Services (CMS) awards contracts to enough suppliers to meet beneficiary demand for the bid items. The new, lower payment amounts resulting from the competition replace the Medicare DMEPOS fee schedule amounts for the bid items in these areas. All contract suppliers must comply with Medicare enrollment rules, be licensed and accredited, and meet financial standards. The program sets more appropriate payment amounts for DMEPOS items while ensuring continued access to quality items and services, which will result in reduced beneficiary out-of-pocket expenses and savings to taxpayers and the Medicare program.
Source: timesunion.com

Administrator, Medicare CHHA

The position reports to a Sr. VP and will be responsible for the CHHA operation including supervision, recruiting staff, preparing a budget, growth projections, regulatory compliance, outreach, planning, development of policies and procedures, and supervision of staff.  BSN required, Master’s preferred, NYS RN license and prior experience directing and running a CHHA required.  Strong knowledge of CHHA operations and regulations as well as strong interpersonal skills, the ability to work with all levels of staff, creativity and flexibility a must.  Prior experience starting up a CHHA or ALP is preferred. Knowledge of Microsoft Office required.
Source: jobstofill.com

House Oversight Committee Release Report on NY Medicaid Program

Capital Tonight is also seen on our sister stations in Texas and North Carolina. In order to allow consistent website access to all three of our websites we will be adding a splash page at our old URL, capitaltonight.com. The splash page will allow users to select their state. If your browser allows cookies that state selection will be saved.
Source: ynn.com

Metro NYC “No Grand Bargain” Coalition Letter to Members of Congress

Together, these measures raise $4.172 trillion without placing the burden of our country’s economic struggles on those who are least able to bear them and who are in no way responsible for federal deficits or the economic downturn.  In addition, at the same time the military absorbed 57 percent of the entire federal discretionary budget, the people of New York City alone sent $4 billion to the U.S. government in 2012 that went to the war in Afghanistan.  For that money, we could have provided 726,913 college students Pell grants or hired 47,505 schoolteachers.
Source: jobs-not-wars.org

Privately Run Medicare Plans are Really Expensive

Posted by:  :  Category: Medicare

Bubbles? Take something like 'Not I! ...item 1.. Wakulla Republicans Protest Against Taxes in the County (September 06, 2011) ... by marsmet552Austin Frakt draws my attention today to a new article about the administrative costs of Medicare. Exciting stuff! Long story short, Kip Sullivan of the Minnesota chapter of Physicians for a National Health Program wants everyone to understand just what’s involved in figuring out the true administrative costs of Medicare. The cost of collecting payroll taxes is one frequently overlooked element, for example. More interestingly, though, there’s a large and growing gap between the overhead calculations of the Medicare Trustees and those of the National Health Expenditure Accounts. Why is that?
Source: motherjones.com

Video: Learn about the 2011 Medicare Open Enrollment Period: Get a Plan that Meets Your Needs

GAO finds CMS negligent in risk adjustment for Medicare Advantage plans

Risk adjustment is important to ensure that payments to MA plans adequately account for differences in beneficiaries’ health status and to maintain plans’ financial incentive to enroll and care for beneficiaries regardless of their health status. Our work confirms that differences in diagnostic coding caused risk scores for MA beneficiaries to be higher than those for comparable beneficiaries in Medicare FFS in 2010, 2011, and 2012. CMS’s decision to use a 3.4 percent adjustment to risk scores for 2010 through 2012 instead of the higher adjustments called for by our analysis resulted in excess payments to MA plans. The existence of such excess payments indicates that CMS’s adjustment does not accurately account for differences in treatment and diagnostic coding between MA plans and Medicare FFS—the stated goal of the statute that required CMS to develop a diagnostic coding adjustment. In our January 2012 report, we recommended that CMS take steps to improve the accuracy of the adjustment to account for excess payments due to differences in diagnostic coding. We noted that CMS could, for example, account for additional beneficiary characteristics, include the most recent data available, identify and account for all the years of coding differences that could affect the payment year for which an adjustment is made, and incorporate the trend of the impact of coding differences on risk scores. CMS’s adjustment for 2013 is the same as it used in 2010, 2011, and 2012. However, given our finding that this adjustment was too low and resulted in estimated excess payments to MA plans of at least $3.2 billion, we continue to believe that it is important for CMS to implement our recommendation that it update its methodology to more accurately account for differences in diagnostic coding.
Source: pnhp.org

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

In defense of Paul Ryan’s Medicare plan

The centerpiece of the Ryan manifesto is the radical new math it applies to Medicare benefits. In short, Ryan (R-Wis), chairman of the House Budget Committee, would transform the program for Americans ages 65 and older from an open-ended entitlement that threatens to swamp the budget into a system that makes fixed payments to participants each year — payments that would rise at a predetermined, predictable rate. In concept, it’s similar to the defined contribution plans most Americans now depend on for retirement: The government would provide a set dollar payment towards your health care premium, and you’d cover the balance of your health care costs, just as most Americans need to take extra savings from their paychecks for retirement.
Source: cnn.com

10 things Medicare won’t tell you

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

Medicare 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

Paying taxes, social security & medicare in WA, USA

Posted by:  :  Category: Medicare

What's In My Bag... by Amy DiannaIf you hired someone and had them work 12 to 18 hours a day, you most likely also owe them time and a half, overtime pay. If they qualify as employee and not independent contractor (the IRS test for employee vs. independent contractor is available online), then you were obligated to pay withholding; get W-4 form signed, withhold income taxes, medicare and social security deductions. Their gross income is reported together with the deductions. You as employer are obligated to deduct from them their share and ALSO pay your portion. My advice is to contact the IRS and pay the taxes you are required to. For not withholding from the employee, you may be required to pay the entire amount.
Source: worldlawdirect.com

Video: Preserve Social Security & Medicare – AARP WA Speaks Out

Senior Care in Bellevue WA: Open Enrollment for Medicare –Now through Dec 7, 2012

Would a small increase in premiums result in a large reduction in health care costs you pay? Check, for example, what coverage is available for prescription drugs you take. Medicare representatives can create a report containing the costs and benefits of various insurance products if you supply them with a list of your drug prescriptions. Ask questions about participating doctors and clinics. Some Medicare Advantage plans limit which physicians a patient can visit.
Source: andelcare.com

Medicare Product Manager II/SR (Seattle, WA)

Local Jobs in Portland: Medicare Product Manager II/SR Seattle, WA;Tacoma,WA;Portland, OR and Salt Lake City, UT Manages the development and ongoing oversight of innovative strategies to ensure profitable enrollment growth of various product categories. Responsible for a
Source: inportland.info

Analyzing The Budgets: How The House GOP And Senate Dems Treated Medicare

Medscape: Senate Democrats’ Budget Assumes SGR Repeal Senate Democrats released a budget proposal for fiscal 2014 yesterday that, unlike its House Republican counterpart, assumes the repeal of Medicare’s sustainable growth rate (SGR) formula and the 26.5% physician pay cut that it would trigger. The plan from Sen. Patty Murray (D-WA), chair of the Senate budget committee, factors in the $138 billion cost of maintaining Medicare rates at their current level for 10 years. Another assumption in Murray’s budget is the rollback of an additional 2% reduction to Medicare rates scheduled for April 1 that resulted from automatic, across-the-board cuts to military and domestic spending called sequestration. The budget allocates almost $1 trillion to replace the sequester cuts (Lowes, 3/14).
Source: kaiserhealthnews.org

Cutting Health Care Waste, Medicare Fraud

There are promising signs. Medical education is beginning to respond to these issues. "At bottom, the key agents are the physicians. They order the tests, prescribe the drugs and recommend the surgeries," said Darrell G. Kirch, M.D., president of the Association of American Medical Colleges. More physicians are weighing the cost of brand-name drugs against generics and questioning the effectiveness of commonly ordered tests. The American Board of Internal Medicine Foundation and 375,000 doctors are developing the "Choosing Wisely" campaign with a list of overused tests and procedures that starts with stress tests for healthy people, bone scans for those under 60 and diagnostic tests for common allergies.
Source: aarp.org

Social Security, Medicare and public investments have one thing in common: They make us richer

You’d have to look hard to find a bigger fan of public investments than me. But, the economic benefits of Social Security, Medicare, and Medicaid are absolutely enormous. They provide a service (insurance against risk, and people value insurance quite highly) much more efficiently than do private-sector providers. In the case of Social Security, this efficiency is mainly in low administrative costs and the government’s ability to provide actuarially fair insurance without needing the compensation that private-sector insurance providers would demand.
Source: ssworkswa.org

Nurse Pride, the Healthcare Law Anniversary and Congressman Ryan’s Disastrous Budget

Just think about all that this law has already delivered. Because of the Affordable Care Act, we are seeing patients for preventive care with no co-pays and young people are able to stay on their parent’s insurance until they are 26 years old. Insurance companies can no longer discriminate because of a pre-existing condition, arbitrarily raise premiums or cancel coverage for those who have reached some limit on care. The law is delivering real prescription drug savings to seniors and cracking down on waste, fraud and abuse in Medicare.
Source: seiu.org

Research Roundup: Comparing Medicare Budget Plans

Posted by:  :  Category: Medicare

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

Video: Jed Weissberg, MD, Talks About Medicare Advantage Health Plans and the Special Enrollment Period

Kaiser ranked highest Colorado health plan, says J.D. Power

Kaiser Permanente Colorado has been widely recognized within the health care industry for delivering top-quality care. According to the National Committee for Quality Assurance Health Insurance Plan Rankings 2012-2013, Kaiser Permanente Colorado is the highest-rated private health insurance plan in Colorado, and No. 6 in the nation for quality and member satisfaction. The Kaiser Permanente Medicare plan in Colorado also earned five stars from the Centers for Medicare & Medicaid Services, the highest overall rating for quality and service for 2013 plans.
Source: csbj.com

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

Kaiser Permanente Leads the Nation with Six 5

About Kaiser Permanente Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 9 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: www.kp.org/newscenter.
Source: kp.org

Kaiser Permanente Sets the Standard with 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

Daily Kos: Kaiser report details Medicare options

Medicare cost sharing is relatively high and, unlike most private health insurance policies, Medicare does not place an annual limit on the costs that people with Medicare pay out of their own pockets. Many Medicare beneficiaries have supplemental coverage to help pay for these costs, but with half of beneficiaries having an annual income of $22,500 or less in 2012, out-of-pocket spending represents a considerable financial burden for many people with Medicare.Cost sharing and premiums for Part B and Part D have consumed a larger share of average Social Security benefits over time, rising from 7 percent of the average monthly benefit in 1980 to 26  percent in 2010 (Exhibit I.3). Medicare beneficiaries spend roughly 15 percent of their household budgets on health expenses, including premiums, three times the share that younger households spend on health care costs. Finally, Medicare does not cover costly services that seniors and people with disabilities are likely to need, most notably, long-term services and supports and dental services. Putting the burden of saving Medicare on the beneficiaries, already paying a significant portion of their incomes on health care, isn’t a solution for saving this program, for keeping it’s promise to America’s seniors and disabled. That basic premise should be the starting point for reforms.
Source: dailykos.com

Kaiser study: Romney’s Medicare plan raises costs

What’s more, as Sahil Kapur added, the study “does not project the longer-term implications for traditional Medicare. Many analysts warn that over time, sicker and older patients would choose traditional Medicare over private plans as private insurers tailored their plans to younger, healthier beneficiaries. Without strict rules and adequate risk adjustment, this would put traditional Medicare premiums on a ‘death spiral’ and the public plan would collapse.”
Source: msnbc.com

Kaiser Permanente’s Medicare Plans Get Top Ratings in Nation for Second Straight Year

“Kaiser Permanente is a model for health care in this country and this Medicare 5-Star rating confirms the value we provide to patients,” said Robert Pearl, MD, executive director and CEO of The Permanente Medical Group. “The combination of superb physicians and the most advanced information technology systems leads to excellence in quality and service. By providing coordinated medical care and greater ease of access, we are able to achieve outstanding outcomes both in prevention of disease and management of the most complex medical conditions. I applaud the U.S. Centers for Medicare and Medicaid Services for helping shift the focus of our country from rewarding volume to recognizing superior outcomes. If the whole nation could match this 5-star performance, thousands of lives could be saved each year.”
Source: patch.com

Kaiser Permanente Georgia Offers Seniors Tips for Selecting a Medicare Plan

 Kaiser Permanente is Georgia’s largest not-for-profit health plan. Its mission is to provide high quality, affordable health care services to improve the health of its members and the communities it serves. Kaiser Permanente serves more than 235,000 members in a 28-county service area including metro Atlanta with care focused on their total health and guided by their personal physicians, specialists, and team of heath care providers. Expert and caring medical teams are supported by industry-leading technology and tools for health promotion, disease prevention, state-of-the art delivery, and world-class chronic disease management. Nationally, Kaiser Permanente is recognized as one of America’s leading health care providers, serving mort than 9 million members in nine states and the District of Columbia. For more information, visit www.kp.org.
Source: patch.com

Kaiser Permanente’s Medicare Plans In California Get Top Ratings In The Nation For The Second Straight Year

Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to   improve the health of our members and the communities we serve. We currently serve more than 9 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery   and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: kp.org/newscenter.
Source: patch.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

Kaiser Permanente Receives Highest Rating for Medicare Plan in Mid

About Kaiser Permanente Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health careproviders and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 9 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health.
Source: seniorlivingcare.com

KAISER PERMANENTE SETS THE STANDARD WITH 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

Kaiser: Medicare Reform Ideas

American Medical Association cancer CBO consumer driven health care diabetes doctors drugs electronic medical records email emergency room EMR ER exercise FDA genetics Health Care Access Health Care Costs health care quality health insurance health IT health policy Health Reform Health Savings Accounts heart disease hospital HSA insurance life expectancy Massachusetts Medicaid Medicare medicare advantage NHS ObamaCare obesity pay for performance public option SCHIP seniors socialized health care Social Security stimulus tax unemployment Uninsured
Source: ncpa.org

Uwe E. Reinhardt: Comparing the Quality of Care in Medicare Options

Posted by:  :  Category: Medicare

'The election of Obama would, at a stroke, refresh our country's spirit' by Renegade98Both traditional Medicare and Medicare Advantage plans are monitored annually through surveys of patients, using the Consumer Assessment of Health Care Providers and Systems, known in the trade as Cahps. The findings from this survey make it possible to compare traditional Medicare with Medicare Advantage plans on quality. As Medpac reports in Table 12-8 of Chapter 12 of the March 2012 report, the commission found little difference in the relatively few quality-performance scores of the traditional Medicare and Medicare Advantage plans.
Source: nytimes.com

Video: Medicare Supplemental Insurance Comparison

Have The Medicare Supplemental Health Insurance Policies ImmediatelyWorld Order of Forest Watchers

Acknowledge that there is in fact more to a new actual cost akin to Medicare than an initial premiums when it comes to Medicare Part An actual and B. You will have co-pays and subjected office visits to meet. This is where the different products in Medicare supplement insurances come straight to play. Medicare health insurance supplemental plans while policies help to cover deductible and additionally co-pays. Any single policy offers very different coverage options. You will yearn to determine exactly what policy will give good results best for your situation.
Source: forestwatch.org

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

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

What is the Cadillac Medicare Advantage plan

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

What Is The Best Method For Making A Medicare Supplement Plans Comparison?

A list of physicians and healthcare professionals, by geographical location, can be found on the official Medicare website: https://questions.medicare.gov/find-a-doctor . This is an easy and convenient method to find participants in local areas. Every year there is an open season when individuals have the opportunity to make a Medicare supplement plans comparison to ensure both providers and services will continue. As with the original Medicare Parts A and B, the monthly fees for Medicare supplement plans are reviewed and adjusted on an annual basis. The Medicare monthly costs for Parts A, B, and D can be found at www.medicare.gov/costs/ . Supplemental insurance carriers will notify participants of any changes in annual fees or altered services during the November to December timeframe. Anyone who wants to change or drop a current insurance carrier can do so during the annual open season, January through March. Comparing costs today will lower individual expenses tomorrow.
Source: seniorcorps.org

A Call for Mandatory Disclosure of Corporate Political Spending

Second, over the years, this issue has been caught, legislatively speaking, in a weird deadlock between Democrats and Republicans that involves, oddly enough, corporate philanthropic grantmaking. As readers know, corporate grantmaking through 501(c)(3) corporate foundations that file 990s gets disclosed, but direct grants from companies’ executive offices, marketing and PR arms, community relations divisions, etc. can be, and frequently are, done without disclosure. For some years, a Republican member of Congress would introduce a bill calling on disclosure of corporate charitable giving. Democrats (and leading nonprofit associations) have consistently opposed corporate charitable disclosure, saying that disclosure would make corporations apprehensive about supporting some causes and charities. Democrats would instead counter that if Republicans wanted disclosure of corporate philanthropic spending, they should be willing to require the disclosure of corporate political spending. And that’s where the debate would always grind to a halt.
Source: nonprofitquarterly.org

Comparing Medicare prescription drug plans

Also, be aware that if you’re a low-income beneficiary and your annual income is under $16,755 or $22,695 for married couples living together, and your assets are below $13,070 or $26,120 for married couples, you may be eligible for the federal Low Income Subsidy known as “Extra Help” that pays Part D premiums, deductibles and copayments. For more information or to apply, call Social Security at 800-772-1213 or visit socialsecurity.gov/prescriptionhelp.
Source: pomeradonews.com

AARP Medicare Complete Connecticut (review) « Insurance News from Crowe & Associates

AARP Medicare Complete Regional PPO- The regional PPO is a United Healthcare plans that has the AARP branding.  This plan has in network benefits that are similar to the HMO 2 but it has slightly higher copays, offers out of network coverage and costs $24.00 a month.  The main reason someone would select this plan instead of the HMO 2 is to have the out of network coverage.  This plan will still provide coverage when you visit non participating providers.   This plan should not be confused with the AARP Medicare Supplement plans.  For more info on Medicare Supplement plans CLICK HERE
Source: croweandassociates.com

Annual Enrollment for Medicare Advantage (Part C) & Part D: October 15 – December 7 

Even beneficiaries who were satisfied with their 2012 plans need to review their plan options for 2013.  Part D and MA plans may have made changes to their coverage, provider networks and other plan features.[3] Plan information for 2013 will be available on the Medicare Plan Finder at www.medicare.gov.[4]  For the computer-savvy, the Medicare Plan Finder is an excellent plan comparison tool, allowing users to enter all their drugs and drug dosages, compare up to three plans at a time, save their drug information for later use, and actually enroll in a plan on-line.  This is the best – if not only – way to truly compare the many plans available to choose from.  People who cannot use the Plan Finder themselves may contact 1-800-Medicare, or their State Health Insurance Assistance Program (SHIP), for assistance with evaluating, selecting, and enrolling in a Part D plan.
Source: medicareadvocacy.org

Medicare Open Enrollment: What’s your back

Nobody likes to think of back-up plans when it comes to our health, but health can be as unpredictable as the weather. It’s hard to know what you’ll feel like next week, much less what health care you’ll need next year. But that’s exactly what you need to think about when you’re shopping for health coverage during Medicare Open Enrollment – which ends on December 7.
Source: medicare.gov

Comparison Friction: Experimental Evidence from Medicare Drug Plans

Consumers need information to compare alternatives for markets to function efficiently. Recognizing this, public policies often pair competition with easy access to comparative information. The implicit assumption is that comparison friction—the wedge between the availability of comparative information and consumers’ use of it—is inconsequential because information is readily available and consumers will access this information and make effective choices. We examine the extent of comparison friction in the market for Medicare Part D prescription drug plans in the United States. In a randomized field experiment, an intervention group received a letter with personalized cost information. That information was readily available for free and widely advertised. However, this additional step—providing the information rather than having consumers actively access it—had an impact. Plan switching was 28 percent in the intervention group, versus 17 percent in the comparison group, and the intervention caused an average decline in predicted consumer cost of about $100 per year among letter recipients—roughly 5 percent of the cost in the comparison group. Our results suggest that comparison friction can be large even when the cost of acquiring information is small, and may be relevant for a wide range of public policies that incorporate consumer choice.
Source: nber.org

Medicare vs Medicare Advantage

For Part A and Part B of Medicare, members must pay 20% of costs out-of-pocket. For inpatient hospital visits, members must pay a $1,184 deductible for the first 60 days, and then $296 coinsurance per day until day 90. After day 90, members can have another 60 days at $578 per day in their lifetimes, after which they must pay all costs. The Part B deductible is $140 per year. Those who have Part D (prescription coverage) must also pay an average deductable of $325. After the deductible has been paid, members may either have a co-pay program, where they pay a flat fee for each drug, or co-insurance program, where they pay a percentage of the cost. However, members may face the “doughnut hole”: after the total cost of drugs exceeds $2,970, members must pay 47.5% of the cost of brand-name drugs and 79% of the cost of generic drugs. Once the cost of drugs has exceeded $4750, Medicare kicks in again, with 95% of drug costs covered.
Source: diffen.com

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

Social Security & Medicare for Adult Disabled Children

Posted by:  :  Category: Medicare

"The single best augury is to fight for one's country." ~ Homer (800 BC - 700 BC), The Iliad. by eyewashdesign: A. GoldenIf you or your spouse are retired or disabled and receiving Social Security benefits and have a disabled adult child who has been denied the SSDI benefits, the experienced attorneys at Littman Krooks, LLP can assist you in filing an appeal, so that your child can obtain the benefits they are entitled to. Our firm represents adult children with disabilities in SSDI appeals on a contingent fee basis, which means that there is no out of pocket legal costs for filing the appeal.
Source: specialneedsnewyork.com

Video: May 12, 2011 – Health Markup on “H.R. 5 (Medicaid, Medicare, and Children’s Health Insurance)”

Daily Kos: Abbreviated pundit roundup: Deficit hawks are cheating our children

The New York Times editorial board brings attention to the Republican’s “malicious obstruction” in the Senate: There is no historical precedent for the number of cabinet-level nominees that Republicans have blocked or delayed in the Obama administration. […] Republicans clearly have no interest in dropping their favorite pastime, but Democrats could put a stop to this malicious behavior by changing the Senate rules and prohibiting, at long last, all filibusters on nominations. Here’s an interesting piece from a “free enterprise” perspective. Art Kellermann at The Los Angeles Times looks at how Congress is intent on having beneficiaries bear the burden of Medicare reform while the pharmaceutical industry gets giveaways: … Congress publicly criticizes growth of Medicare costs while privately restraining the Centers for Medicare and Medicaid Services, or CMS, from getting a better deal for Medicare patients and U.S. taxpayers.
Source: dailykos.com

3 charts on sequestration, healthcare innovation and the Affordable Care Act

The National Institutes of Health has said that cuts will likely trickle down to grantees who have been awarded research funding. Keckley anticipates that could, in turn, create a riskier environment for private investors. Coupled with the potential for a slower regulatory approval process, that may push medical device and drug companies even more in the direction of streamlining their R&D, refocusing on emerging markets and seeking collaborations, he wrote.
Source: medcitynews.com

Stop Stealing From Our Kids

Steven Rattner, a long-time Wall Street financier, led the restructuring of the auto industry in 2009 as counselor to the Treasury secretary under the Obama administration. His book “Overhaul: An Insider’s Account of the Obama Administration’s Emergency Rescue of the Auto Industry” was published in 2010. He is the chairman of Willett Advisors, the investment arm for Mayor Michael R. Bloomberg’s personal and philanthropic assets, and the economic analyst for MSNBC’s “Morning Joe.” Follow Steven Rattner at twitter.com/SteveRattner
Source: nytimes.com

Webinar: Translating The Medicaid Expansion Into Increased Coverage: The Role Of Application Assistance

The Kaiser Family Foundation’s Commission on Medicaid and the Uninsured held a webinar on March 19, 2013 to examine the role of application assistance in ensuring eligible individuals successfully enroll in health coverage. The webinar featured an overview of the importance of application assistance drawing on lessons learned from Medicaid and CHIP and insight into states’ planning efforts to provide such assistance under the ACA. The Foundation also released a case study highlighting the experience of providing in-person application assistance for Medicaid through community health centers in Utah. The webinar is part of the Getting into Gear for 2014 series examining key implementation issues as states prepare for the ACA coverage expansions.
Source: kff.org

Bill To Close a Gap in Children’s Health Insurance Stalls as Tallahassee Dawdles

12-15 year old category barack obama barbara revels bunnell city commission corruption don fleming economic development elections 2012 Flagler Beach flagler beach city commission Flagler County Commission flagler county crime flagler county school board flagler county schools flagler county sheriff’s office Flagler Palm Coast High School florida education Florida Legislature gop gov. rick scott health care health care reform ideology janet valentine jim landon jobs jon netts l’infame little miss junior flagler county pageant local government budgets milissa holland Miss Flagler County Pageant miss flagler county scholarship pageant obama administration Palm Coast palm coast city council palm coast crime police state republicans rick scott small government taxes traffic accidents unemployment us economy
Source: flaglerlive.com

Obama Cuts Medicare – Again!

 The combined impact of these administrative actions will force millions of seniors into the government run Medicare they already chose to reject. According to the CMS’ own numbers, enrollment in Medicare Advantage fell for several years after the program was faced with significant cuts in the Balanced Budget Act of 1997. And between December 2001 and December 2002, enrollment dropped by more than 900,000. Those who stayed in the program saw higher premiums and reduced benefits and coverage.
Source: townhall.com

Children’s Health Insurance Coverage in 2013: eHealth Releases Updated State Market Data

Availability of Child-only Health insurance in 2013 STATE OPEN ENROLLMENT PERIODS AND CONDITIONS —————————————————————————- Availability of child-only plans varies by insurance Alaska company but some insurers offer child-only coverage year-round. —————————————————————————- Availability of child-only plans and enrollment periods Arkansas may vary by insurance company. —————————————————————————- Open enrollment occurs during child’s birth month — Applications submitted at other times may be approved California with a higher premium due to pre-existing conditions or if submitted without a qualifying event. Some insurers offer child-only coverage year-round. —————————————————————————- Open enrollment occurs in January and July 2013. Some Colorado insurers may accept applications year-round. —————————————————————————- Availability of child-only plans and enrollment periods Connecticut may vary by insurance company. —————————————————————————- Availability of child-only plans and enrollment periods Delaware may vary by insurance company. —————————————————————————- Open enrollment periods occur in January and July but District of Columbia insurer participation may vary. —————————————————————————- Availability of child-only plans and enrollment periods Hawaii may vary by insurance company. —————————————————————————- Availability of child-only plans and enrollment periods Idaho may vary by insurance company. —————————————————————————- Open enrollment occurs July 1 through August 14, 2013 Iowa — though some insurers may accept child-only applications year-round. —————————————————————————- Illinois Open enrollment occurs in January and July 2013. —————————————————————————- Availability of child-only plans and enrollment periods Kansas may vary by insurance company and by locale within the state. —————————————————————————- Kentucky Open enrollment occurs in January 2013. —————————————————————————- Child-only health insurance policies available year- Maine round. —————————————————————————- Maryland Open enrollment in January and July 2013. —————————————————————————- Open enrollment occurs from July 1 through August 15, Massachusetts 2013. —————————————————————————- Availability of child-only plans and enrollment periods Missouri may vary by insurance company and by locale. —————————————————————————- Availability of child-only plans and enrollment periods Montana may vary by insurance company, though qualifying event may be required. —————————————————————————- Child-only health insurance policies available year- New Hampshire round. —————————————————————————- Child-only health insurance policies available year- New Jersey round. —————————————————————————- Availability of child-only plans and enrollment periods New Mexico may vary by insurance company. —————————————————————————- Child-only health insurance policies available year- New York round. —————————————————————————- Open enrollment occurs in March 2013 but insurer Ohio participation may vary. —————————————————————————- Open enrollment occurs in June and July 2013 but Oklahoma insurer participation may vary. —————————————————————————- Child-only health insurance policies available year- Oregon round. —————————————————————————- Availability of child-only plans and enrollment periods Pennsylvania may vary by insurance company. —————————————————————————- Child-only health insurance policies available year- Rhode Island round. —————————————————————————- Availability of child-only plans and enrollment periods South Dakota may vary by insurance company. —————————————————————————- Availability of child-only plans and enrollment periods may vary by insurance company — A certificate of Utah insurability is required and can be obtained by applying and being denied coverage under the state’s high-risk pool, HIPUtah. —————————————————————————- Child-only health insurance policies available year- Vermont round. —————————————————————————- Open enrollment from March 15 – April 30, 2013 and Washington September 15 to October 31, 2013. —————————————————————————-
Source: andhranews.net

An Economic and Policy Analysis of Florida Medicaid Expansion

French economist Frédéric Bastiat introduced the concept of the “fallacy of the broken window.” Economics instructors use this classic parable to explain opportunity costs and alternative uses for resources. In the parable, a shopkeeper’s son accidently breaks a shop window pane. As a result, the store owner will have to pay someone to haul the broken glass away; then order a new glass pane, hire a craftsman to install it and possibly someone else to clean up afterward. This is an example of “economic activity” created by a simple broken window. The broken window pane will create work and wages for the glassmaker, carpenter and anyone involved in the repair; but the shop owner will suffer a loss of disposable income. Moreover, society is worse off by one pane of glass that was needlessly broken. The resources employed to remove the broken glass and install a new pane could have been employed to produce something else that would please the shopkeeper more and possibly make society richer.
Source: ncpa.org

Important: What are Medicare’s true administrative costs?

Posted by:  :  Category: Medicare

BITCH .. beautiful individual that causes hardons ...item 1.. Allen West calls Wasserman Schultz ‘vile’ and ‘not a lady’  (7/20/2011) ... by marsmet522The Centers for Medicare and Medicaid Services (CMS) annually publishes two measures of Medicare’s administrative expenditures. One of these appears in the reports of the Medicare Boards of Trustees and the other in the National Health Expenditure Accounts (NHEA). The latest trustees’ report indicates Medicare’s administrative expenditures are 1 percent of total Medicare spending, while the latest NHEA indicates the figure is 6 percent. The debate about Medicare’s administrative expenditures, which emerged several years ago, reflects widespread confusion about these data. Critics of Medicare argue that the official reports on Medicare’s overhead ignore or hide numerous types of administrative spending, such as the cost of collecting taxes and Part B premiums. Defenders of Medicare claim the official statistics are accurate. But participants on both sides of this debate fail to cite the official documents and do not analyze CMS’s methodology. This article examines controversy over the methodology CMS uses to calculate the trustees’ and NHEA’s measures and the sources of confusion and ignorance about them. It concludes with a discussion of how the two measures should be used.
Source: pnhp.org

Video: What Does Medicare Cost?

10 things Medicare won’t tell you

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

The Affordable Care Act At Three: Paying For Quality Saves Health Care Dollars

The health care law creates new Accountable Care Organizations (ACOs) that incentivize doctors and other providers to work together to provide more coordinated care to their patients.  ACOs agree to take responsibility for the cost and quality of their patients’ care, to improve care coordination and safety, and to promote appropriate use of preventive health services.  And when this new care model saves the Medicare program money, that savings is shared with the ACO. Over 250 organizations are participating in Medicare ACOs, giving more than 4 million Medicare beneficiaries access to high-quality coordinated care throughout the nation.  ACOs are estimated to save the Medicare program up to $940 million in the first four years.
Source: healthaffairs.org

Cost of long term acute care for Medicare patients in Santa Cruz among lowest in U.S.

Quinn has a patient in his 40s who is on a ventilator, he said, and his 80-year-old parents care for him. Other patients disabled by a spinal cord injury or stroke may need a ventilator, bowel and bladder care and feeding tubes, he added, but most of them don’t require 24-hour professional help. They need a limited amount of nursing care and physician oversight, but they could remain at home if a family member were able to do around-the-clock care. In-Home Support Services of Santa Cruz County pays family members just above minimum wage to do that, he said.
Source: healthycal.org

Center for Medicare Advocacy Testifies on Medicare Redesign 

[1] National Association of Insurance Commissioners letter to Secretary Sebelius (December 2012), available at: http://www.naic.org/documents/committees_b_sitf_medigap_ppaca_sg_121219_sebelius_letter_final.pdf. [2] National Association of Insurance Commissioners, Senior Issues Task Force, Medigap PPACA Subgroup, “Medicare Supplemental First Dollar Coverage and Cost Shares Discussion Paper” (October 2011), available at: http://www.naic.org/documents/committees_b_senior_issues_111101_medigap_first_dollar_coverage_discussion_paper.pdf.  [3] MedPAC, “Report to the Congress: Medicare and the Health Care Delivery System” (June 2012), available at: http://www.medpac.gov/documents/Jun12_EntireReport.pdf; Congressional Budget Office, “Budget Options Volume 1: Health Care” (December 2008), page 155, available at: http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/99xx/doc9925/12-18-healthoptions.pdf. [4] AARP Public Policy Institute, “The Medicare Program: A Brief Overview” (March 2012), available at: http://www.aarp.org/content/dam/aarp/research/public_policy_institute/health/medicare-program-brief-overview-fs-AARP-ppi-health.pdf. [5] Kaiser Family Foundation, “Projecting Income and Assets: What Might the Future Hold for the Next Generation of Medicare Beneficiaries?” (June 2011), available at:  http://www.kff.org/medicare/upload/8172.pdf. [6] General Accounting Office (GAO), “Medicare Savings Programs: Implementation of Requirements Aimed at Increasing Enrollment” (September 2012), available at: http://www.gao.gov/assets/650/648370.pdf . [7] Kaiser Family Foundation, “Health Care on a Budget: The Financial Burden of Health Care Spending by Medicare Households. An Updated Analysis of Health Care Spending as a Share of Total Household Spending” (March 2012), available at http://www.kff.org/medicare/upload/8171-02.pdf. [8] Kaiser Family Foundation, “Key Issues in Understanding the Economic and Health Security of Current and Future Generations of Seniors” (March 2012), available at: http://www.kff.org/medicare/upload/8289.pdf. [9] MedPAC, “A Data Book: Health Care Spending and the Medicare Program” charts 5-6 (June 2012), available at:  http://www.medpac.gov/documents/Jun12DataBookEntireReport.pdf. [10] U.S. Department of Health and Human Services, Assistant Secretary for Planning and Evaluation (ASPE), “Variations and Trends in Medigap Premiums” (December 2011), available at: http://aspe.hhs.gov/health/reports/2011/medigappremiums/index.pdf. [11] MedPAC, “Report to the Congress: Medicare and the Health Care Delivery System” (June 2012), available at: http://www.medpac.gov/documents/Jun12_EntireReport.pdf. [12] Kaiser Family Foundation, “Policy Options to Sustain Medicare’s Future” (January 2013), available at: http://www.kff.org/medicare/upload/8402.pdf. [13] Kaiser Family Foundation, “Medigap: Spotlight on Enrollment, Premiums and Recent Trends” (February 2013), available at: http://www.kff.org/medicare/upload/8412.pdf. [14] MedPAC, “Report to the Congress: Medicare and the Health Care Delivery System” (June 2012), available at: http://www.medpac.gov/documents/Jun12_EntireReport.pdf. [15]Kaiser Family Foundation, “Restructuring Medicare’s Benefit Design: Implications for Beneficiaries and Spending” (November 2011), available at: http://www.kff.org/medicare/upload/8256.pdf. [16] Kaiser Family Foundation, “Restructuring Medicare’s Benefit Design: Implications for Beneficiaries and Spending” (November 2011), available at: http://www.kff.org/medicare/upload/8256.pdf. [17] MedPAC Presentation, “Reforming Medicare’s Benefit Design” (March 2012), slide 10, available at: http://www.medpac.gov/transcripts/benefit%20design%20mar2012%20public.pdf . [18] U.S. Department of Health and Human Services, Assistant Secretary for Planning and Evaluation (ASPE), “Variations and Trends in Medigap Premiums” (December 2011), available at: http://aspe.hhs.gov/health/reports/2011/medigappremiums/index.pdf. [19] Patient Protection and Affordable Care Act, §3210. [20] National Association of Insurance Commissioners, “Medigap PPACA (B) Subgroup” webpage, available at: http://www.naic.org/committees_b_sitf_medigap_ppaca_sg.htm; See under heading “Cost-sharing Research and Literature” for summary of much of this literature (as of June 2011) available at: http://www.naic.org/documents/committees_b_senior_issues_110628_summary_dist_research.pdf. [21] National Association of Insurance Commissioners, Senior Issues Task Force, Medigap PPACA Subgroup, “Medicare Supplemental First Dollar Coverage and Cost Shares Discussion Paper” (October 2011), available at: http://www.naic.org/documents/committees_b_senior_issues_111101_medigap_first_dollar_coverage_discussion_paper.pdf.  [22] Katherine Swartz, “Cost-Sharing: Effects on Spending and Outcomes” (December 2010), Robert Wood Johnson Foundation Research Synthesis Report No. 20, available at: http://www.naic.org/documents/committees_b_senior_issues_110628_rwjf_brief.pdf [23] Congressional Budget Office, “Budget Options Volume 1: Health Care” (December 2008), page 155, available at: http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/99xx/doc9925/12-18-healthoptions.pdf. [24] National Association of Insurance Commissioners letter to Secretary Sebelius (December 2012), available at: http://www.naic.org/documents/committees_b_sitf_medigap_ppaca_sg_121219_sebelius_letter_final.pdf.
Source: medicareadvocacy.org

Privately Run Medicare Plans are Really Expensive

Austin Frakt draws my attention today to a new article about the administrative costs of Medicare. Exciting stuff! Long story short, Kip Sullivan of the Minnesota chapter of Physicians for a National Health Program wants everyone to understand just what’s involved in figuring out the true administrative costs of Medicare. The cost of collecting payroll taxes is one frequently overlooked element, for example. More interestingly, though, there’s a large and growing gap between the overhead calculations of the Medicare Trustees and those of the National Health Expenditure Accounts. Why is that?
Source: motherjones.com

Regence BlueCross BlueShield to drop its Portland

Posted by:  :  Category: Medicare

The change reflects a growing trend among health insurers to nip and tuck at escalating costs to rein in premium hikes. For Regence, representatives say, the move is necessary to allow it to remain competitive in the Portland area. The change follows years of declining membership and financial losses in Oregon for Regence, Oregon’s largest insurer in the private health insurance market.
Source: oregonlive.com

Video: Regence Medicare Advantage insurance – Compare to 180+ Comp

The Red Electric: Regence returns my call

ecounted my experiences with Regence MedAdvantage customer support . Because I wasn’t satisfied, I decided to track down one of three Regence executives I happened to be seated with at a recent Community Health Partnership honors banquet. I phoned and left a message for one to call back. All three did, on a pre-arranged conference call. I was impressed. We talked for about a half hour about the surprising jump in the premium from $45/mo. to $75/mo. You may recall that the customer service representative told me that premiums for the non-profit are based on claims from the previous year. Last year was not a good year, insurance-wise. My executive trio told me that there’s some discretion in setting premiums, and they readily admitted that the hike for next year is hard to swallow, but necessary. I joined the program early this year when, at reaching 65, I became eligible for Medicare. If I had joined in 2005, the year the Medicare Advantage programs began, I would have a different perspective on next year’s increase. Amanda, my customer service rep, told me that premiums could drop, but, because she had only been on the job a year and a half, she didn’t have a clue whether they ever had. Fat chance, I thought. I was wrong. My conferees informed me that indeed the rates had dropped. My $45 premium was the low over four years. In 2005, the premium was $79, in 2006 it was $72. It turns out that 2006 was a very good year, as Frank Sinatra used to say, so management decided to pass the savings on in 2007, hence my $45 premium, which I took to be the norm. So my advice to this august group was to level out the peaks and valleys of the premiums to avoid the appearance of a bait and switch. In the highly competitive health insurance industry, low rates are a selling point. That $45 snared me. “We don’t like to whipsaw our members,” said Mike Becker, Regence vice president of public policy and community affairs. “Leveling out the premiums is exactly what we’ve been talking about,” chimed in Alison Nicholson, manager for individual sales. Good, I replied. I had a few other ideas, which I won’t bore you with and which you probably won’t be interested in, at least until you turn 65. Suffice to say, I feel better about Regence Blue Cross — for now.
Source: blogspot.com

Kathie Bracy’s Blog: Is the STRS Medicare Advantage program really an ‘Advantage’? Susan doesn’t think so!

A key player in this CORE group, Dr. Dennis Leone, initiated the investigation (2002-2004) against STRS that led to the dismissal of the Executive Director and the conviction of six Board members for ethics violations. Eventually elected to the Board, Dr. Leone was the only member to vote against the forced ‘move’ discussed in my paper. On the CORE website, click on ‘history’ to see the results of this group‟s vigilance and perseverance. To protect your pension and quality health care, follow this group and help them create a direct line to educators.
Source: blogspot.com

Annual Enrollment Workshops for Medicare Advantage Plans 2011

If you have Medicare with only part A and B you might want to participate in one of the Medicare Advantage plans that are accepted at this clinic. The plans accepted are Regence Blue Cross, Humana, HealthNet, United Healthcare and Providence.
Source: hudsonsbaymed.com

Medicare Updates for 2011

What article on Medicare Part D would be complete without mentioning Humana.  There I have just mentioned it. Just kidding, Humana has good news also.   The Humana Value plan which was priced at $18.60 in 2010 has been rebranded and repriced for 2011.  It is now the Humana Walmart Preferred Rx Plan with a reduced price of $14.80. I guess the little yellow price slasher at Walmart has been at work once again. The plan ID numbers are the same, so technically it is the same plan but the benefits are totally different from 2010. For example, it has a $310 deductible for all drug tiers, but then many generics are priced at only $2 for a 30 day supply at Walmart or $10 at any other local pharmacy. When I first saw that I thought “What, that is a huge advantage for Walmart.” Then I read the fine print. The $2 co-pay is only for the generics on the Walmart $4 drug list, and other stores either have their own $4 list like QFC, or will match prices. But I still applaud Humana and Walmart for innovative thinking.
Source: wordpress.com

More advantage in Medicare plans

Slightly more than 600,000 Oregonians are eligible for Medicare, the federal health care program for citizens 65 and older. Four in 10 of them have coverage through Medicare Advantage, where the feds pay private health plans to provide benefits. That’s the highest ratio of any state in the nation, Medicare says. Seniors also can pay extra for standalone prescription drug plans, called Part D, offered by private insurers. They also can choose to pay for private Medigap plans, which generally cover the 20 percent of costs that basic Medicare does not. But their monthly premiums usually are higher.
Source: oregonlive.com

Maine’s GOP governor stands firm against Medicaid expansion

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&SSThat’s because Maine is one of a handful of states that have already extended Medicaid coverage to many of the people who would otherwise be eligible for the first time under the Affordable Care Act. Medicaid enrollment in the state rose 78 percent between 2002 and 2011 to about 361,000 people, according to the Maine Department of Health and Human Services. Maine now ranks fourth for the percentage of its population covered by Medicaid, according to the Kaiser Family Foundation: 27 percent, compared to 20 percent nationwide.
Source: medcitynews.com

Video: Medicare Supplemental Insurance in Maine by Medicare Pathways

Protect yourself against Medicare/Medicaid fraud — Business — Bangor Daily News — BDN Maine

The site will still be viewable but certain elements might display incorrectly. In order to enjoy all the features of our site, we recommended you upgrade to a newer, more secure browser. Read more ». If you don’t have administrator privileges for your computer, you can still take action. Google has developed a free plugin for Internet Explorer called Google Chrome Frame. You can install it on any computer, even if you can’t install applications, and it will ensure your computer stays secure and that you can still visit our website. Enable Google Chrome Frame now »
Source: bangordailynews.com

Letter to the Editor: Maine needs to participate in Medicaid expansion

1.On his own, the Governor is refusing to allow Maine to participate in the Medicaid expansion that is part of the Affordable Care Act (ACA). According to Maine Equal Justice Partners, a low-income advocacy group, “The ACA …increases the amount of money Maine receives from the federal government to pay for Medicaid. The federal government will pay 100 percent of the costs of covering ‘newly eligible’ individuals in Maine from January 1, 2014 through December 31, 2016.” By his refusal, the Governor is leaving $100 million per year “on the table” where it will be redistributed to other states, many of which, by the way, have Republican governors – New Jersey, Florida, Arizona and Ohio for instance. In the 28 states that have agreed to expansion, the most convincing cases have often been made by hospitals who will directly benefit from having more patients covered by insurance.
Source: dailybulldog.com

Maine AG Warns of Medicare Scam

          Morning Classical           Maine Things Considered           Maine Calling           Speaking in Maine           Down Memory Lane           Friday Night Jazz           In Tune by Ten           Prime Cuts           Something Else           Additional MPBN Programs        Morning Classical Music with Suzanne Nance        PLAYLISTS           Classical 24        Radio & TV Stations        Car Talk Vehicle Donation Program        Down Memory Lane Television        TV Schedule        Sustainable Maine        Video On-Demand        Local Television Programs           Maine Watch           Basketball              Basketball Schedule              Tournament Scores              Basketball DVDs              Tournament Brackets                 Class A Boys Bracket                 Class A Girls Bracket                 Class B Boys Bracket                 Class B Girls Bracket                 Class C Boys Bracket                 Class C Girls Bracket                 Class D Boys Bracket                 Class D Girls Bracket              Basketball FAQ           Maine Arts!            Sustainable Maine              Archived Programs              Saving Our Lakes              Basket Trees              Pools, Policies and People           Making Our Way: Autism (Featuring Temple Grandin)              What is Autism?              Making Our Way:Autism Resources                 Occupational Therapy                 Autism Screening Tools                 Speech Therapy & Augmentative Communication                 Read Articles on Autism              Reach Out & Find Support              About “Making Our Way: Autism”           Conversations with Maine           Maine Experience               Maine Experience Full Programs           Making $ense New England           Broken Trust           Easing the Burden: Parkinson’s Disease           Caring for the Caregiver/Dementia and Alzheimer’s               Dementia & Alzheimer’s Disease Basics              Resources for Caregivers              If You Have Dementia              Quality Care              Safety Issues for Caregivers              Financial/Legal Topics                 Starting the Search for Long Term Care Insurance              Find a Support Group               Caring for the Cargiver: Contact Information              Share Your Story                 Losing my father a piece at a time.                 All Shared Stories                 Being a Caregiver for a Loved One with Alzheimer’s                 It’s the simple things that matter                 Our Journey with Early On-Set Alzheimer’s Disease              Watch Caring for the Caregiver Online           A Downeast Smile-In           Incredible Maine           Fresh to Flavorful           Sixteenth Maine at Gettysburg        MPBN Community Films           The Films           Contact MPBN Community Films        “Natural Maine Minute”        TV Programs A-Z        Kids’ TV Schedule        TV & Radio Stations        PBS Digtal Studios Remixes
Source: mpbn.net

Maine Medical equipment suppliers Return Congress to repeal Bill offered defective Medicare

On November 1, 2010 letter, 167 economists and experts in the auction, including two Nobel laureates, warned Congress that the design of auctions Medicare for medical equipment will fail. Those experts found that the program offered and designed by the Centers for Medicare Services has irreparable flaws that prevent it from achieving its objectives of low cost and high quality equipment and services. CMS designed the system, candidates are not bound by their bids, which undermines the credibility of the process and encourages low-ball bids that create a process unsustainable and threaten the sustainability of the program.
Source: hauberrealtors.com

The Lisbon Reporter: The Maine Wire: “Media Watch: Liberal Group Pretends To Be Small Biz Coalition, Media Falls For It” plus 4 more

WELCOME TO THE LISBON REPORTER. In an effort to keep our community informed of what is going on at the local level of government and in our community, we decided to create this on-line newspaper. It is our hope that this on-line newspaper will help you stay informed so that you can get involved and take action for the benefit of our ENTIRE community. Thank you for visiting and please check back frequently for information about what is happening in OUR TOWN. LISBON/LISBON FALLS, MAINE USA
Source: lisbonreporter.com

Advocacy group files suit to stop Medicaid cuts set to take effect March 1 — Health — Bangor Daily News — BDN Maine

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Source: bangordailynews.com

Maine Seeks To Cut Medicaid Eligibility

LePage argues that that the Affordable Care Act’s so-called “maintenance of effort” requirement went out the window with June’s Supreme Court decision. The provision prevented states from changing Medicaid eligibility levels before the Medicaid expansion occurred in 2014. (The concern was that states would remove beneficiaries from the Medicaid rolls knowing that when expansion occurred, those people would be allowed back on but the federal government would pay a much larger share of their expenses under the new law.) Now that the court has made that Medicaid expansion optional, LePage argues, Maine is no longer locked into the state’s Medicaid eligibility levels that were in effect when the federal health law was passed in 2010.
Source: kaiserhealthnews.org

Maine wins $33 million to test health care innovations — Health — Bangor Daily News — BDN Maine

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Source: bangordailynews.com

Rockport Maine Community Seniors Eligible for Free Medicare Health Club 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

Medicare Fraud Claims, A New Challenge Even For Honest US Physicians – is Competent Billing and Coding A Way Out?

Posted by:  :  Category: Medicare

The PARTY Is OVER ...item 4.. Today, Mitt Romney Lost the Election (Sep 17, 2012 6:02 PM ET) ...item 5.. James Brown - Get On The Good Foot, Soul Power, Make It Funky Soul Train 1973 ... by marsmet471The problems physician practices face today are in the subjective areas. Their in-house billers and coders mostly contend with ineffective in-house coordination between billing and coding and medical processes leading to inadequate medical information based on which coding judgments are made. Even if medical information is available, billers and coders are sometimes beset by lack of sound-enough familiarity with complex medical procedures where diagnoses may often overlap making it difficult to decipher where one ends and another starts leading to wrong assignment of codes and overbilling through coding of diagnoses not covered by Medicare.
Source: medicalbillersandcodersblog.com

Video: Mastering Medicare Coding, Billing, and Compliance — ContexoMedia.com eLearning

Medical Billing and Coding Training

Since 1981 JoAnne Sheehan, CPC, CPC-I, owner of Lomar Associates, Inc. has provided medical practice management expertise as a medical biller and coder, chart auditor, A/R manager , author, and consultant. She has worked on high profile fraud and abuse cases in the Boston area and is also an AAPC Licensed PMCC Coding Instructor. She has recently joined Laureen Jandroep, CPC, CPC-I, owner of www.codingcertification.org, as an affiliate and independent support representative for CCO’s online physician medical coding program. JoAnne believes CCO offers the most comprehensive approach to becoming a proficient medical coder and is excited to be part of Laureen’s team. She looks forward to working with Laureen and her CCO team and offering students the best education and resources available for the coding profession.
Source: codingcertification.org

Federal Liberals to shut down Medicare Locals and cut healthcare services

Responding to a question asked by in Parliament by Mr Husic, Health Minister Tanya Plibersek confirmed that the “bureaucrats” the Liberal Party would sack from Medicare Locals include frontline health workers such as doctors, nurses, psychologists, and speech pathologists.
Source: edhusic.com

MEDICARE PROGRAM; PART B INPATIENT BILLING IN HOSPITALS (CMS

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Source: wn.com

Medical Billing Codes: Medical Billing Codes

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Source: blogspot.com

MD education key to curbing $30B in Medicare errors

With healthcare costs projected to climb to 20 percent of the U.S. gross domestic product by 2020, controlling spending has become a national imperative. Although physicians influence at least 60 percent of healthcare costs, there is a dramatic disconnect between physicians’ fiscal responsibility and their knowledge of healthcare resource management, according to a viewpoint published March 20 in the Journal of the American Medical Association .
Source: healthimaging.com