Medicare Targets Health Plans With Low Ratings

Posted by:  :  Category: Medicare

Medicare officials are encouraging 525,000 beneficiaries to switch out of these 26 Medicare Advantage and drug plans that have received low ratings for three consecutive years and enroll in better plans for next year. The poor performing plans will have this warning symbol next to their names on Medicare’s plan finder website to steer shoppers to other plans.
Source: kaiserhealthnews.org

Video: Anthem PPO – Health Quotes

California Medicare Insurance: Anthem Medicare Preferred PPO Replaces Freedom Blue for 2012

One of the newest Medicare Advantage plan in California for 2012 is the Anthem Medicare Preferred Standard PPO or AMP. The Anthem Medicare Preferred is the newest successor to the Freedom Blue Regional PPO plan that became very popular over the past few years. The plan offers significant freedom of choice in regards to your medical service providers. The AMP PPO plan is only available in select counties throughout California and the benefits are different from county to the next. The plans are grouped below by counties that share the same benefits:
Source: blogspot.com

Medicare Advantage: Anthem Medicare PPO Alternative in Las Vegas, NV

The second option is to upgrade to a Medicare Supplement.  Because your plan is not renewing, you have the guarantee issue right to a supplement.  You cannot be denied for health history.  The monthly cost will be higher than that of the PPOs, but a supplement will give you freedom to see any doctor that accepts Medicare and you will no longer have co-payments if you select a Medicare Supplemental Plan F.
Source: suncityfinancial.com

Medicare Advantage Plans From Anthem Blue Cross

An Anthem Medicare Advantage HMO offers low or no monthly premiums, so your dollars can really stretch. You’ll be using doctors and hospitals that are within the Anthem network, so you’ll find that the savings are substantial. You will also have access to hundreds of preventive and wellness programs, discounts on products and services, and tools and kits that can help educate and guide you about ways to live a healthier lifestyle. Part D Prescription Drug Coverage is included.
Source: medicareoptionsnow.com

Anthem blue cross ppo, mri

Anthem Blue Cross Dental Plans – Domestic. Blue Cross – Amazon.de Niedrige Preise, Riesen-Auswahl und kostenlose Lieferung ab nur € 20 Receive affordable California health insurance and health care coverage with Anthem Blue Cross. Visit and design a personalized health care plan today. Anthem Medicare Preferred Standard PPO, Blue Cross Senior Secure Plan hmo,blue cross freedom blue , Freedom Blue application . freedom blue Rx, freedom ppo , freedom 2012 Plan (Non-Medicare) This document is not a guarantee of benefits. It is a summary intended for communication purposes. rev 4/12 UCSB Health Care Facilitator 893 Anthem Medicare Preferred Standard PPO ,.
Source: rediff.com

‘Zero, Zero, Zero’ Medicare Advantage Plan

In Missouri (excluding 30 counties in the Kansas City area) Anthem Blue Cross and Blue Shield is the trade name for RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. Independent licensees of the Blue Cross and Blue Shield Association. ®ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross Blue Shield Association. Additional information about Anthem Blue Cross and Blue Shield in Missouri is available at www.anthem.com.
Source: springfieldmonews.com

Anthem Blue Cross Helath Insurance Latest Posts

San Diego residents have a wide range of choices with Medicare Supplement plans, rates and companies which provide Medicare options. Is a Medicare Supplement right for your situation? Or maybe a Medicare Advantage HMO fits your needs and budget. If you would like to compare Medicare Supplement rates in San Diego County be sure to include; Blue Shield, Anthem Blue Cross, Health Net and Gerber. They are currently some of the more competitive companies in California.
Source: blogcatalog.com

How to Choose the Medicare Advantage Plan that’s Best for You

Medicare Advantage plans can be attractive because of the low or $0 monthly premiums insurers charge.  Like anything in life, there are trade offs and sacrifices we all have to make.  When it comes to Medicare Advantage plans, the trade offs are usually less freedom when it comes to which doctors and hospitals you can use as well as more restrictions or red tape when it comes to getting services covered.  In order to choose a Medicare Advantage plan wisely, I’ve come up with an easy guideline to follow.  Following these steps should hopefully ease the potential frustrations within Medicare Advantage.
Source: medicareplansstcharles.com

Dave Fluker’s California Health Insurance Blog: Anthem Medicare Advantage LPPO and Sutter Health Group

Sutter Health Group and Anthem Blue Cross MAPD LPPO (Medicare Preferred PPO and Medicare Preferred Select LPPO) have been unable to reach agreement on a new contract. As of February 1, 2012, Sutter will no longer be a participating provider for Anthem Blue Cross CA hospital and professional network. The ancillary services for Sutter will continue to be a participating provider. Again, this contract issue affects Medicare Advantage PPO and Medicare Advantage LPPO subscribers. The following Sutter Health facilities are affected: Sutter Roseville Medical Center – Roseville, CA Alta Bates Summit Medical Center – Alta Bates/Herrick – Berkeley, CA Alta Bates Summit Medical Center – Summit Campus – Oakland, CA California Pacific Medical Center – California – San Francisco, CA California Pacific Medical Center – Davies – San Francisco, CA California Pacific Medical Center – Pacific -San Francisco, CA California Pacific Medical Center – St. Lukes – San Francisco, CA Eden Hospital Medical Center – Castro Valley, CA Memorial Hospital Medical Center – Modesto – Modesto, CA Memorial Hospital of Los Banos – Los Banos, CA Menlo Park Surgical Hospital – Menlo Park, CA Mills Hospital – San Mateo, CA Novato Community Hospital – Novato, CA Peninsula Hospital & Medical Center – Burlingame, CA San Leandro Hospital – San Leandro, CA Sutter Amador Hospital – Jackson, CA Sutter Auburn Faith Hospital – Auburn, CA Sutter Coast Hospital – Crescent City, CA Sutter Davis Hospital – Davis, CA Sutter Delta Medical Center – Antioch, CA Sutter General Hospital – Sacramento, CA Sutter Lakeside Hospital – Lakeport, CA Sutter Maternity & Surgery Center – Santa Cruz, CA Sutter Medical Center of Santa Rosa – Santa Rosa, CA Sutter Memorial Hospital – Sacramento, CA Sutter Solano Medical Center – Vallejo, CA Sutter Tracy Community Hospital – Tracy, CA I expect that at some point a contract agreement will be reached and will post when that happens.
Source: blogspot.com

Medicare in Las Vegas, NV: Anthem Preferred PPO Is Leaving Las Vegas in 2013

In 2013, the Anthem Preferred PPO Medicare Advantage (MA) Plan will no longer be available in Clark County.  If you are a member of the Anthem PPO, you must choose another option before December 31, 2012, or you will go back to original Medicare on January 1, 2013. The fact that this plan is not continuing may be disconcerting, but it may also be a good opportunity.  If you have been denied a Medicare Supplement in the past due to health reasons, you can no longer be denied.  In other words, if you are on Anthem PPO right now, you have a guarantee issue right for a Medicare Supplement in 2013. As an Anthem member, you have two options:
Source: suncityfinancial.com

UPDATE: Medicare Revalidation: What FQHCs Need to Know

Posted by:  :  Category: Medicare

after such providers or suppliers receive notification from their MAC.  Once contacted by a MAC, suppliers and providers have 60 days from the date of the letter to submit complete enrollment forms. Please note that failure to submit the enrollment forms as requested may result in the deactivation of Medicare billing privileges. Additionally, the $505 Medicare enrollment fee that we told you about here also applies to revalidation.
Source: nachc.com

Video: Medicare Enrollment | Medicare Sign Up | Apply for Medicare

CMS Medicare Enrollment Dashboard

The Centers for Medicare & Medicaid Services (CMS) now has a Medicare Enrollment Dashboard for enrollees that provides a national summary, state demographics and historical trends for Fee-For-Service / Medicare Advantage as well as beneficiary coverage and status.
Source: wordpress.com

Hospice Care Enrollment Saves Millions in Medicare Dollars

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

ICYMI: More Lawmakers Speak Out Against CMS’ New Proposed Cut to Medicare Advantage

More members of Congress are joining the chorus of lawmakers raising concerns about CMS’ recent proposed cut to Medicare Advantage.  Over the past couple weeks, more than 130 members of Congress from both parties have sent letters urging CMS to reverse the proposed rate cut.  In recent days, several additional members have sent similar letters raising concerns about the impact this new cut would have on seniors in the program.  These new letters come less than a week before Medicare Advantage 2014 payment rates are scheduled to be finalized on April 1.
Source: ahipcoverage.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

CMS Announces PECOS Activation for May 1, 2013

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

Medicare Open Enrollment: last chance to review and compare plans

With the holiday season upon us, it’s easy to get busy this time of year. Some pretty important tasks can get left to the last minute. One of those important tasks is ensuring you are in the right health insurance plan in Medicare.  Selecting the right plan is a personal choice, and a lot of thoughtful consideration goes into finding the right match.  But just like the holidays, those key dates come whether or not you are ready.
Source: medicare.gov

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

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

Apollo Beach Seniors may qualify for Medicare Advantage Plan Silver Sneakers Free Health Club Membership

Posted by:  :  Category: Medicare

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

Video: Members Advocate for the SilverSneakers Fitness Program in Washington DC

Windsor Health Plan Announces Partnership With Healthways SilverSneakers Fitness Program

Healthways (NASDAQ: HWAY) is the largest independent global provider of well-being improvement solutions. Dedicated to creating a healthier world one person at a time, the Company uses the science of behavior change to produce and measure positive change in well-being for our customers, which include employers, integrated health systems, hospitals, physicians, health plans, communities and government entities. We provide highly specific and personalized support for each individual and their team of experts to optimize each participant’s health and productivity and to reduce health-related costs. Results are achieved by addressing longitudinal health risks and care needs of everyone in a given population. The Company has scaled its proprietary technology infrastructure and delivery capabilities developed over 30 years and now serves approximately 40 million people on four continents. Learn more at www.healthways.com or www.silversneakers.com.
Source: homehealthprovider.com

Blue Cross Blue Shield of North Dakota launches SilverSneakers® fitness program to Medicare Supplement members

About Healthways Healthways (NASDAQ: HWAY) is the largest independent global provider of well-being improvement solutions. Dedicated to creating a healthier world one person at a time, the Company uses the science of behavior change to produce and measure positive change in well-being for our customers, which include employers, integrated health systems, hospitals, physicians, health plans, communities and government entities. We provide highly specific and personalized support for each individual and their team of experts to optimize each participant’s health and productivity and to reduce health-related costs. Results are achieved by addressing longitudinal health risks and care needs of everyone in a given population. The Company has scaled its proprietary technology infrastructure and delivery capabilities developed over 30 years and now serves approximately 40 million people on four continents. Learn more at www.healthways.com or www.silversneakers.com.
Source: bcbsnd.com

Healthways’ SilverSneakers program treads on

Paramount, a health insurance company located in Maumee, Ohio, is the latest company to align itself with Healthways’ SilverSneakers program, an exceedingly popular senior adult fitness regime that has quite literally taken the health care market by storm since its inception in 1993.
Source: nashvillepost.com

Silver Sneakers Program at YMCA of Southeast Texas Port Arthur Branch : SETX Seniors

*access to conditioning classes, exercise equipment, pool, sauna and other available amenities *customized SilverSneakers classes designed exclusively for older adults who want to improve their strength, flexibility, balance and endurance *health education seminars and other events that promote the benefits of a healthy lifestyle *a specially trained Senior AdvisorSM at the fitness center to introduce you to SilverSneakers and help you get started *member-only access to online support that can help you lose weight, quit smoking or reduce your stress *SilverSneakers Steps for members without convenient access to a location
Source: setxseniors.com

The Official Travel Nursing Blog

Since its creation in 1965, Medicare has long been one of the most beloved federal programs in the U.S. Now that program benefits are on the table for deep cuts, healthcare professionals and the patients they care for are optimistic that the Obama Administration and Congress can achieve small cuts to Medicare—just 2% across the board. Current healthcare reform proposes $500 billion in Medicare savings by exempting older patients from cuts, and relying on the lobbying and advertising clout of healthcare employers.  Endeavors such as these have led to Medicare Advantage plans that offer, in some states, programs like “Silver Sneakers” that encourage seniors to use the YMCA gym, free of cost.
Source: americantraveler.com

Wolf Total Fitness Announces That It Is Accepting SilverSneakers® Members

Wolf Total Fitness is now enrolling qualified prospective and current gym Members into the SilverSneakers program which fully subsidizes the cost of a basic membership based on their qualifying, sponsoring Medicare health plan. Membership at Wolf Total Fitness includes over 20 fitness classes a week, that are at no additional charge to Members, with classes ranging from a variety of cardiovascular aerobics, strength training, Yoga and Tai Chi.
Source: marketersmedia.com

SilverSneakers fitness classes offered at OJC

In addition to the SilverSneakers classes being offered this spring, community members can also enroll in Yoga, Aerobics, Step Aerobics/Body Bar, Zumba or Racquetball.  Yoga will be offered Mondays and Wednesdays from 6:45 to 7:45 a.m.; Aerobics will be Mondays, Wednesdays and Thursdays from 12:00 to 12:50 p.m.; Step Aerobics/Body Bar will be offered Mondays and Wednesdays from 5:30 to 6:30 p.m.; and Zumba will be offered Tuesdays and Thursdays from 6:00 to 6:50 pm and Saturdays from 9:00 to 9:50 a.m.  Days and times for the Racquetball class are yet to be announced.  Community members may gain access to the fitness center by enrolling in two credit hours of classes at the college.
Source: ushispanics.com

SilverSneakers senior fitness program expanding

Healthways, the leading well-being improvement company, offers the award-winning SilverSneakers® Fitness Program, founded in 1992, the nation’s leading exercise program designed exclusively for older adults, and Prime Fitness, a comprehensive physical activity program for adult health plan members and employees of large companies. Healthways fitness offerings are available to more than 7 million individuals at participating fitness and wellness centers in all 50 states, Puerto Rico and Washington, D.C. For more information on Healthways fitness programming, call 888-423-4632 or visit www.healthways.com or www.silversneakers.com.
Source: louisville.com

SilverSneakers Medicare Programs

So, what exactly is SilverSneakers?  SilverSneakers is essentially a gym membership or fitness club membership to participating centers across the country.  You can find participating gyms by going to www.silversneakers.com and typing in your zip code.  You can find out if your Medicare plan offers Silver Sneakers by calling 1-888-423-4632.  Here are some of the features offered by SilverSneakers.
Source: medicare-plans.net

CMS and Medicare Advantage Plans by Myco Dang

Posted by:  :  Category: Medicare

SAM_2063 by TakeDownCravaackIn response to recent adversarial position against the federal regulation, the Centers for Medicare & Medicaid Services (CMS) issued a memorandum regarding Medicare Secondary Payment Subrogation rights. (See attachment). CMS reaffirmed its intention in its regulations to give Medicare Advantage Organizations (MAOs) and Prescription Drug Plan (PDP) the right under the existing Federal law to be secondary payers. CMS reaffirmed its position that MAOs are entitled to exercise the same rights to recovery that the Secretary exercises under the Medicare MSP regulations. Despite recent court rulings to the contrary, CMS maintains that the existing MSP regulations apply to MAOs and PDPs and are not limited to seeking remedies in State Court.
Source: xerox.com

Video: Medicare Supplement vs. Medicare Advantage Plans – A Doctor’s Perspective

Identity Thieves Impersonate Medicare Employees to Target Senior Texans

Fortunately, a few wary senior Texans immediately questioned the callers’ request. But increasingly savvy identity thieves are prepared and attempt to create the false impression that they already have the senior’s personal information. As proof, the callers often repeat some of the call recipient’s personal information such as name, address and telephone number. But because this information is easy to obtain, the caller’s verification effort is actually just a devious ruse that attempts to mimic the practices of legitimate enterprises – like a bank or insurance company – in an effort to steal the call recipient’s Social Security and bank account number.
Source: kbtx.com

Hip replacement reduces heart failure, depression and diabetes risk

Using Medicare codes, researchers identified more than 43,000 patients with osteoarthritis of the hip from 1998 to 2009. These patients were divided into two groups – those receiving THR and those not receiving THR. The researchers followed all of the patients for at least one year, and nearly 24,000 for seven years, looking at annual Medicare payments, mortality, and new diagnoses of congestive heart failure, ischemic heart disease, artherosclerosis (hardening and narrowing of the arteries), diabetes and depression. The data was adjusted for differences in age, sex, race, buy-in status, region and Charlson score (standard quantification of the number and severity of comorbidities a patient presents with).
Source: sciencecodex.com

CPAP Replacement: Right on Schedule

Medicare provides health insurance to nearly 50 million Americans, so it is safe to say many of you who come to Sleep Right Solutions will use its coverage to help pay for your CPAP equipment. Medicare’s schedule doesn’t always make sense. For example, no one needs new tubing or nasal cushion every month. Below is the Medicare replacement schedule for various CPAP items along with our replacement recommendations in parentheses:
Source: sleeprightsolutions.com

The Trouble with Medicare Advantage

Fillman goes on to explain: “The new accounting rules issued by the Governmental Accounting Standards Board (GASB) place a tremendous strain on public retiree health benefits and add to the lure of these private Medicare plans.  The GASB rules require public employers to estimate future costs of their retiree health benefits – 35 years into the future – and publish them on their annual financial statements.  To reduce this paper liability, more public employers are proposing a switch from their own solid retiree health plans, which include traditional Medicare, to these private Medicare plans.  This is a major factor in public employers’ decisions to switch to Medicare Advantage private fee-for-service plans.
Source: healthbeatblog.com

Medicare open enrollment: Will Obamacare end Medicare Advantage?

Should you be worried that Medicare Advantage plans will economize by reducing your benefits? “The plans are required to provide all Medicare benefits, so there’s no way they can cut them,” Gold explains. That includes the free preventive services added to Medicare by the Affordable Care Act. And Advantage plans that include a drug benefit are closing the doughnut hole just the same as stand-alone Part D drug plans. The only area where plans can even consider cutting back are for optional services such as dental and vision benefits, but the plan finder on Medicare.gov still features plenty of plans that have these bonus features.
Source: consumerreports.org

Safety issues found at Hoag Hospital

In a January inspection of the Hoag Orthopedic Institute in Irvine, the Centers for Medicare and Medicaid Services issued a finding of immediate jeopardy – the highest level of potential patient harm – because flu and pneumonia vaccines and medications were stored at improper temperatures. Hoag Orthopedic Institute is a separately licensed for-profit hospital owned by surgeons and Hoag Hospital.
Source: ocregister.com

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

Insurer halts Medicare Advantage sales in Georgia

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

Early Evidence Suggests Medicare Advantage Pay For Performance May Be Getting Results

The ACA phases out higher payments previously given to all MA plans. Instead, Medicare in 2012 began paying bonuses only to plans with strong performance on clinical quality, service measures and patient experience of care measures. Medicare bases the 2012 bonus payments on 2011 plan performance, as rated by a five-star system. This system incorporates Health Effectiveness Data Information Set (HEDIS®) and other quality measures, Consumer Assessment of Health Plans (CAHPS®) patient experience results (See Note 1 below.), and results of the Health Outcomes Survey (HOS) that tracks patient-reported outcomes over time. It also includes metrics such as complaints Medicare received about the plan, customer service for drug benefit plans, and beneficiary access and performance problems identified in audits by Medicare.
Source: healthaffairs.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

VUMC testing new payment system for Medicare patients

Under this arrangement hospitals basically compete against their own past performance. In this case, the marker used for determining rewards and penalties is Medicare’s recent 90-day average cost for valvular heart disease patients treated at VUH, minus 2 percent. If Medicare’s cost comes in below that mark, VUMC will receive the difference, and if Medicare’s cost comes in above that mark VUMC must pay Medicare the difference. All providers, including VUH, receive payment as usual from Medicare, and the rewards and penalties are settled between VUMC and Medicare on a periodic basis.
Source: vanderbilt.edu

2013 Medicare Physician Fee Schedule

Posted by:  :  Category: Medicare

Benefit Security Card .. HALF of the U.S live in households that receive government benefits (26 May 2012) ...item 2.. Brevard man gets 4 years in Social Security fraud case (Jun 1, 2012 ) ... by marsmet481I also am new to the RVU process but have a fairly good understanding of what needs to be done. However, I have been unable to find any information on what a Transitioned Non-Facility verses a Fully Implemented non- Facility is. I noticed the PE RVU is higher for the Fully Implemented non-facility. Someone told me it represents where you are at in your implementation of EHR???? I am waiting for a callback from CMS but if anyone has an answer it would be appreciated. Pat Carlson Open Cities Health Center
Source: physicianspractice.com

Video: Medicare Physician Fee Schedule; the Never Ending Debate

Medicare Reimbursement for Ambulance Servcies

The ambulance fee schedule system currently contains two permanent and three temporary add-on payment policies. The permanent add-on policies are written into law without an expiration date and include: 1) the rural short-mileage ground ambulance add-on payment policy, which increases the standard mileage rate by 50 percent for ground ambulance transports if the pick-up ZIP code is rural and the mileage is between 1 and 17 miles; and 2) the rural air transport add-on payment policy, which reimburses providers and suppliers 50 percent more than the urban air ambulance base payment and the mileage rate if the point-of-pickup ZIP code is rural. The temporary add-on payment policies are written into law with expiration dates and include: 1) the ground ambulance add-on payment policy, which increases the base payment and mileage rate for ground transports by 3 percent for transports originating in rural ZIPs code and by 2 percent for transports originating in urban ZIP codes; 2) the super-rural add-on payment policy, which increases the base payment for ground ambulance transports by 22.6 percent where the point-of-pickup ZIP code is designated as super-rural; and 3) the air transport rural grandfathering add-on payment policy, which extends the benefits of the 50 percent add-on payment for air ambulance transports to urban areas that were formerly designated as rural. All Medicare ambulance transports are eligible for one of the five add-on payment policies, and many are eligible for multiple add-on policies if they originate in rural ZIP codes.
Source: healthcare-economist.com

Cliff Averted: Medicare Fee Schedule Intact

As CMS reminded providers in its 12/19/2012 bulletin, clean electronic claims are never paid sooner than 14 calendar days after the date of receipt. CMS has promised to issue further notification before January 11, 2013 with an update on its progress in updating its fee schedule (remember, CMS was forced to load the 2013 fee schedule with the projected pay cuts, since Congress acted so late in averting the cuts). It is our hope that CMS will be able to work quickly enough within these next two weeks in order to avoid having to reprocess claims for 2013 dates of service.
Source: healthcarebiller.com

Medicare ‘Doc Fix’ Hostage To Fiscal Cliff Negotiations

Medscape: Obama’s Fiscal-Cliff Plan Said To Repeal SGR President Barack Obama’s latest plan to save the nation from the fiscal cliff includes a repeal of Medicare’s sustainable growth rate (SGR) formula that otherwise will trigger a 26.5% cut in physician reimbursement on January 1, according to a source familiar with negotiations between Congress and the White House. The Medicare rate reduction is part of the automatic spending cuts and tax increases dubbed the “fiscal cliff” that take effect in January. … The SGR crisis, a yearly event for physicians over the past decade, is a fiscal-cliff sideshow. Most of the jawboning between Obama, Senate Democrats who rule that chamber, and House Speaker John Boehner (R-OH), has been over the expiration of the Bush-era tax cuts, which will raise everyone’s rates (Lowes, 12/19).
Source: kaiserhealthnews.org

Medicare’s 2013 Fee Schedule Compared to 2012

On November 1, 2012, the Centers for Medicare & Medicaid Services (CMS) released the final 2013 Medicare Physician Fee Schedule (MPFS) and its updated conversion factor. Under current law, providers paid under the MPFS will face significant cuts to reimbursement rates. Within the law governing reimbursement rates, a mechanism known as the Sustainable Growth Rate (SGR) automatically would have resulted in a significant decrease in Medicare reimbursement rates over the past several years. However, Congress has intervened each year to override the SGR, meaning rates have been generally flat each subsequent year. For 2013, if Congress does not intervene, the SGR will result in a 26.5 percent cut to the Medicare Part B conversion factor from $34.0376 to $25.0008.
Source: healthcarereforminsights.com

AARP Urges Congress to Address Medicare Physician Payments

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

House Panels Invite Comments on Medicare SGR/Physician Fee Schedule Reform : Health Industry Washington Watch

The Chairmen of the House Ways and Means Committee and House Energy and Commerce Committee are inviting comments on the outline of a proposal to permanently repeal the sustainable growth rate (SGR) formula for updating Medicare physician fee schedule payments and institute other payment reforms. The lawmakers are considering a three-phase proposal. In the first phase, the SGR formula (which Congress has repeatedly overridden to avoid sharp reimbursement cuts) would be repealed, which would eliminate an estimated 25% across-the-board rate cut in 2014 and any future SGR cuts. In its place, the plan would provide an unspecified “period of predictable, statutorily-defined payment rates.” In phase two, the plan would link payment to performance on physician-endorsed measures of quality of care, while in phase three, physicians could earn additional payments based on efficiency of care. The Committees also are considering addressing several other related issues, including gainsharing, medical liability reform, Independent Payment Advisory Board repeal, and private contracting/balance billing. Comments will be accepted on the plan until February 25, 2013 at SGRComments@mail.house.gov.
Source: healthindustrywashingtonwatch.com

Medicare releases its final rule on the 2013 physician fee schedule : Getting Paid

CMS delayed to July 1, 2013, the effective date of its requirement that a face-to-face visit be a condition of payment for certain high-cost durable medical equipment (DME) covered items. The list included many items that have historically been targets of Medicare fraud as identified by various program integrity experts. The encounter must occur within six months before the written order for the DME. CMS is not mandating additional documentation beyond what the physician or other qualified health professional would normally document during the actual face-to-face encounter.
Source: aafp.org

Congress Passes Bill to Avoid “Fiscal Cliff,” With Medicare Doc Fix, Other Medicare/Medicaid Extensions

The legislation requires CMS, for services furnished on or after January 1, 2014, to adjust payments relating to the end stage renal disease (ESRD) bundled payment rate to reflect changes in utilization of certain drugs and biologicals. In making reductions, CMS must take into account the most recently available data on average sales prices and changes in prices for drugs and biological reflected in the ESRD market basket percentage increase factor. The legislation also delays until January 1, 2016, implementation of oral-only ESRD-related drugs in the ESRD prospective payment system. HHS also must conduct an analysis by January 1, 2016, of the case mix payment adjustments relating to ESRD bundled payments, and make appropriate revisions to such case mix payment adjustments. The Government Accountability Office (GAO), no later than December 31, 2015, must prepare a report to Congress on how HHS has addressed implementation of payments for oral-only ESRD-related drugs in the bundled ESRD prospective payment system.
Source: wolterskluwerlb.com

Cash Based Pelvic PT Clinic – Interview of Emily Wegmann MPT, OCS

Hi Ann and Teresa, These are great questions regarding Medicare and the fee schedule, and a topic often discussed in these and other forums. We will do our best to answer them fully! Can non-participating providers accept payment up front? Yes, non-participating providers are technically able to collect payment from patients at the time services are rendered. The claim is submitted to Medicare, and Medicare reimburses the patient directly and passes on the claim a secondary insurer, if applicable, for additional direct patient reimbursement. The patient is responsible for his or her deductible and any allowable charges not paid for by Medicare and other insurance providers. Sounds simple (kind of); HOWEVER, here are the things to be aware of when determining payment: Fee schedules, limiting charges and the like: We are not contracted with any insurance provider and are not bound by contracted fee schedule amounts with private insurers. Non-participating provider for Medicare are able to have a separate and distinct fee schedule for Medicare patients based on the physician fee schedule for non-participating providers (see below on how to determine the fee schedule in your region). The separate Medicare fee schedule cannot exceed the standard fee schedule. Not surprisingly, non-participating and participating Medicare providers have different fee schedules. If you consider this route, make sure you have the CORRECT fee schedule for starters. The non-participating fee is determined by your intermediary (if you live in NC, SC, VA or WV, you can find the fee schedule here on the Palmetto/GBA website; if you live in CA, HI, or NV find it here. See the follow-up answer for additional links if you reside in a different state). Non-participating providers are permitted to charge up to 115% of the designated fee per each code. When you look up the fee schedule for your region, you will find the fee assigned to each CPT code as well as the limiting charge (the highest allowable charge) for each code. Sounds easy, right? Just find the fee, tack on an additional 105-115%, and you are ready to go. Not so fast. MPPR (Multiple Procedure Payment Reduction): The MPPR, simply put, means that the highest billable unit charged is reimbursed at 100% of the allowable amount, and that the values of other codes charged during the same visit will be reduced when more than one code is billed on the same date. Currently, the reduction is 20% for those in private practice but is slated to increase to 50% in April. The APTA website does an excellent job of defining the MPPR and discussing the implications if the proposed 50% reduction goes into effect. Importantly, the patient may NOT be billed for the difference between the fee and the reduction created by the MPPR. This means another calculator and adjustment to the fee before you charge the patient. Secondary Insurance The good news is that Medicare automatically pushes any claims directly to the secondary insurance provider when applicable. The bad news is that there is another calculation to be made if a patient has secondary insurance. There is another calculator that further adjusts the fee amount if the patient has another insurer. At last inquiry, it was stated in these terms: ‘Using this calculator is an estimate, not a guarantee that the fee amount will be what we determine when the claim is processed.’ Bottom line: We are able to collect payment from Medicare patients up front as non-participating providers, but must consider at least three different calculators to determine the exact amount to bill the patient at time of service. Even with all three calculators it is difficult to determine the exact cost the patient would owe up front. For this reason, we have decided to forgo collecting cash at time of service and are now billing Medicare with traditional billing methods (still as non-participating providers). Once the claims are processed, we are informed of the remaining patient responsibility and bill them accordingly. We discuss this openly with patients when they call, let them know that there will be a component of payment that they will be responsible for and answer any questions. It is not ideal however it allows us to continue to work with these patients and make sure that we are charging the patient appropriately. Sound complicated? Well, we think it is. We are continuing to evaluate the best possible ways to accept all patients in a cash based model. In an ideal world, physical therapists would be able to opt out of Medicare just as physicians do. Ann, we are including a link to your blog (http://www.webpt.com/blog/post/medicare-issues-facing-cash-based-pts) for those who want to learn more about to take action to allow physical therapists to opt out and provide services to Medicare patients in a cased based model. Best, Emily & Sarah
Source: drjarodcarter.com

Part D Politics: Medicare Drug Rebates or Price Controls?

Posted by:  :  Category: Medicare

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

Video: Medicare Rebate [1998]

Health Insurance: Medicare Rebates and Private Health Insurance Cover for Osteopathic Treatment in Australia

If you want to commit an osteopathic treatment in Australia, it is important to know how your treatment will be covered by Medicare, the scheme of the government universal health care or private health insurance funds. Medicare One patient in Australia with a chronic disease (eg, a condition long musculoskeletal system), which is overseen by a family physician, is entitled to Medicare for up to five sessions of osteopathic treatment in a calendar year, such as by an osteopath with the Osteopathy Board of Australia are registered. However, there are certain conditions that can be applied in the order for a patient to be eligible for the rebate. First, the treatment must be an osteopath from a chronic disease management MBS physician services provided to the patient and the patient’s GP Management Plan (GPMP) and the detention orders are recommended. Team (ATC) A reference GP is necessary for a referral form, which is provided by the Australian Department of Health and Ageing, this form must be submitted to the osteopaths the first treatment. After all five sessions have been committed, if further treatment is necessary, a new benchmark GP is required. Second, if more than five sessions of osteopathic treatment is undertaken, the following sessions are not covered by Medicare. Third, the osteopath needed a reference GP written report. Usually at the end of treatment that provide detail the proposed treatment, tests or analyzes and plans for the future management of the patient A patient who has private health insurance, chose not to seek a guarantee that their osteopathic treatment, but to their Medicare claims is also entitled to the cost of five treatments each year civil claim above conditions are provided fulfilled. Private health insurance Osteopaths in Australia as allied health professionals are a patient with osteopathic treatment required by their private health insurance does not start treating doctor’s recommendation. Generally have a private health insurance either a form of collateral or Extras: right of a patient to a specific number of sessions of osteopathy during the calendar year, depending on the amount of coverage, or to pay a contribution towards the cost of osteopathic treatment, to for an agreed amount. However, it is important that patients check with their health insurance, that osteopathic treatment is covered in her special diet, and other expenses that they can be held accountable. It is also important that patients who decided to have not claim the cost of osteopathic treatment on their private health insurance, know, and instead to claim their Medicare rebate can not use their private health insurance for Any shortfalls between Medicare and fees to pay for the processing.
Source: blogspot.com

Drug Firms Say No to Rebates, Despite Billions in New Revenue From Part D

Before the Medicare Part D drug program was created in 2006, the pharmaceutical industry paid rebates to the government to help pay for those folks’ medications. The rebate program ended when Part D went into effect and the dual eligibles’ drug coverage was switched from Medicaid to Medicare. As a result, taxpayers are paying more now than before, even though drug companies are getting billions of dollars in revenue they never had before Part D was created. So the President will be asking Congress to reinstate the rebates, which the nonpartisan Congressional Budget Office says would save billions of dollars in government spending every year. That’s because even though dual eligibles comprise only 20 percent of the total number of people enrolled in Medicare, they account for almost a third of total Medicare spending.
Source: wendellpotter.com

Claiming a Medicare rebate: :: Centred MGP

Every woman is entitled to have a midwife, unfortunately if you see your GP you don’t get to see a midwife until you go for your hospital visit at 19/20 weeks. This means you have missed out on vital information and building a valued relationship. This is regretable because it is beneficial for women to see a midwife from the moment she is pregnant or at least between 8 – 10 weeks. A midwife gives the woman unbiased information allowing the woman to choose different options of care, rather than the straight route to an obstetrician because she has private cover. Now with midwives having a Medicare provider number, this means that a pregnant woman can see a private midwife to discuss options of care and claim for a refund just like going to the doctors. Midwives work in collaboration with doctors and midwives are all to happy to refer the woman when it is required and the woman wishes to do so.
Source: centredmgp.com

Medicare rebate for obesity surgery likely to increase

Add your site to healthdirectory4u.com now! For as little as $10/year! Discover our new features such as Google map, image upload and featured box for your classified. To add your site select a category and then click on “Post a classified”.
Source: healthdirectory4u.com

White House Touts Medicare Rebates

“You the American people have made it clear that you don’t want Obamacare,” Mr. Herger said on the video. “You told the president and Speaker Pelosi at town hall meetings, public rallies and at the ballot box. They rammed their government takeover of health care through anyway. But House Republicans are listening. That’s why we have introduced a bill that would fully repeal Obamacare and replace it with common-sense, incremental solutions that would actually help bring down skyrocketing health care premiums by up to 20 percent.”
Source: nytimes.com

CT Medicare Home Health TPL Project Year Five Instruction Packet 

Posted by:  :  Category: Medicare

HERES YOUR TOP TEN by SS&SSExcept for “adjusted” bills as described above, you must submit RAPs to Medicare for all episodes as necessary to include all of the services identified for TPL review.  Except for Condition Codes, the information on the RAP must be consistent with the information on the final claim. (Condition Codes are not to be included on the RAP, but only on the final claim.) For this reason, you should read the instructions relating to final claims (see Section 10 below) as well as the instructions relating to RAPs before submitting the RAPs themselves. If a final claim is not accepted by Medicare because it contains information which is not consistent with the original RAP, then the original RAP may need to be canceled, a new RAP submitted, and the final claim (now consistent with the RAP) resubmitted. The process of correcting and resubmitting RAPs and claims will cause delays, which might jeopardize your ability to get your final claims filed timely.  Therefore, it is crucial that accurate PPS episodes be identified when RAPs are submitted.
Source: medicareadvocacy.org

Video: Medigap Plans in Connecticut by 1 800 MEDIGAP®

Seniors ‘brainwashed’ by controversial scooter ads, doctor says

longshank: You’re right that some government services can’t be run exactly like a business because some are inherently not money makers. Regarding health care, it’s clear that there was no reason for government to take over the entire industry. But, there’s no doubt that it can be run more efficiently, like a business. When taxpayers are paying for things like medical services, they have the right to expect that the system will be run efficiently. As such, it seems absurd to require, in a lot of cases, the poor to utilize the emergency rooms for non-emergency care as the laws provide that they can’t be turned away in those situations. It is absurd for the states not to invoke sovereign immunity when dealing with providing free health care to people. In the absence of malice or willful misconduct, there should be no liability for the government or the care providers that the government hires to serve in this capacity. That would save a ton of money and would also allow doctors to cut down on the CYA method of practice that causes lots of tests to be performed that really aren’t necessary. And, of course, when the government hires out such services, they should be following up to make sure that there isn’t excess waste and fraud occurring. Of course, one way of making sure that the system is run more efficiently is to require co-pay, even from the poor. Just as I don’t go running to the doctor with every sniffle (mainly because it will cost me money out of my pocket and I’d rather not spend it if I don’t have to) the system is less likely to be abused by the patients if they have a financial interest in each visit. Sure, if there are emergencies and things like that, then they get the care for free. But, when there’s a flu or cold running around there is no need for anyone, let alone the poor, to run to the doctor (unless they have known medical conditions such as respiratory conditions that do need to be treated), just because they have the sniffles or don’t feel good. That’s one reason why antibiotics are becoming less efficient. Doctors will prescribe them because the patients expect a doctor to “do something” and Doctors figure that, just in case it is bacterial, they should prescribe it, after all, no harm done if it was a virus, right?
Source: nbcnews.com

U.S. COURT FOR THE DISTRICT OF CONNECTICUT HOLDS THAT MSP ACT DOES NOT AUTHORIZE CLAIMS FOR INJUNCTIVE RELIEF

, No. 3:11cv156, 2013 U.S. Dist. LEXIS 6429 (D. Conn. Jan. 16, 2013), the plaintiff, a recipient of long-term disability (“LTD”) benefits under an employer-sponsored health plan, brought suit under the Medicare Secondary Payer (“MSP”) Act to enjoin the discontinuation of his benefits under his employer’s LTD plan. The plaintiff worked for the defendant but became ill in 1996 and began receiving LTD benefits in exchange for the payment of required premiums. The plan provided that the defendant could alter or terminate benefits at any time. Defendant notified plaintiff that the plan’s coverage was primary until the plaintiff enrolled in Medicare. Defendant later decided to discontinue health benefits for any individual who remained on LTD for more than thirty months. Defendant sent a letter to plaintiff explaining this decision and urged him to enroll in Medicare. In response, plaintiff filed an action seeking injunctive relief under the MSP Act to prevent the defendant from discontinuing his LTD plan benefits. The court rejected plaintiff’s MSP claim, holding that the MSP Act is limited to claims for damages and cannot be invoked unless a primary insurer has improperly denied a claim resulting in payment of the claim by Medicare.
Source: themedicarespa.com

Seniors’ Medicare Costs Will Be Reduced For Medicine

“Historically low growth” in health-care spending for the nation’s 50 million Medicare beneficiaries also led to a proposed 2.2 percent reduction in payments from the federal government to private Medicare Advantage plans offered by insurers including UnitedHealth Group Inc., the agency said in a statement. About one-quarter of Medicare’s participants choose Advantage plans, which provide extra benefits such as fitness programs and eye glasses compared with the traditional program.
Source: ctwatchdog.com

Connecticut comments: Obama Attacks Medicare

At the present time, 28% of all seniors over the age of 65 get their medical coverage through a Medicare Advantage insurance plan.  These plans provide healthcare for seniors at a lower cost than those incurred by the Medicare plan itself.  The plans function by having the government simply pass on what it would have paid for average individuals which, in turn, is used as premiums by the plans.  For some plans, there are additional costs; for example, the largest of the Medicare Advantage plans, the one run by United Healthcare and AARP has insurance with better benefits than Medicare for an additional $20 per month.  Today, we learned that the government is going to cut the reimbursement to these plans by 2.3% next year.  There already was a cut planned for medicare advantage that was part of Obamacare.  The 2.3% is a further cut which is to be made by the government.  So medical costs are rising, but the government wants the plans to get less. The simple truth is that this is just another move by the Obamacrats to try to drive private insurers out of the healthcare market.  A cut of 2.3% may not seem like much, but for many plans it means the elimination of all profit by the insurer.  If that happens, the companies will undoubtedly drop out of the market.  That will throw millions of seniors back into the regular medicare pool which will raise the costs of the medicare program.  Of course, if one’s goal is to end up with healthcare which is paid for in its entirety by the federal government, forcing insurance companies out of the market makes sense.  After all, if there is no alternative to government run healthcare, it will be the final result for sure. It is despicable that president Obama and the Obamacrats feel that they have to operate in such a dishonest way to achieve their goals.  They know that the American people will not agree to government run healthcare, so they are slowly and methodically killing off the alternatives.
Source: blogspot.com

Connecticut Doctor Decides to Pay Instead of Go to Trial 

badgercare plus Better Business Bureau charity scams credit card fraud credit card scams election fraud false claims act fraud fraud alert newsletter Frauds healthcare reform identity theft job scams medicaid fraud Medicare medicare fraud medicare overbilling medicare part D medicare reform mortgage fraud phishing scams podcasts prevent medicare fraud scams storm chasers storm scams telephone scams Training volunteer voter fraud wisconsin bbb wisconsin better business bureau wisconsin check fraud wisconsin child care fraud wisconsin election fraud wisconsin fraud wisconsin head start fraud wisconsin medicaid fraud wisconsin mortgage fraud wisconsin scam wisconsin scams wisconsin smp wisconsin smp training wisconsin unemployment benefits wisconsin unemployment fraud
Source: wisconsinsmp.org

McMahon spitballs ideas for Medicare, Social Security reform

“I think we have to put every single thing on the table and work it out between Democrats and Republicans and then have our CBO, the Congressional Budget Office, put the economics or the scoring next to that to see what really does make sense so we’re not kicking this can down the road,” McMahon said. “I want a permanent solution so I can make sure we protect both of these programs.”
Source: nhregister.com

Connecticut Races To Reach Uninsured, Open Health Insurance Marketplace

As in Massachusetts, Counihan and Access Health have had to balance the sometimes conflicting interests of health insurers, hospitals, doctors and other providers, employers, insurance agents and consumer advocates. Ellen Andrews, executive director of the Connecticut Health Policy Project, a consumer group, predicts the private plans offered by Access Health will be too expensive for many people, even those with subsidies to defray the costs. At least half of the people buying policies in the marketplaces are projected to qualify for subsidies.
Source: kaiserhealthnews.org

5th District debate focuses on Medicare, Social Security

“I’m not embracing any one of their particular recommendations, but I think they should be considered,” he said. Both candidates accused the other of fear-mongering — Esty accusing Roraback of using “scare tactics” culled from the U.S. Chamber of Commerce’s website and telling seniors that Social Security benefits are in danger, Roraback accusing Esty of promoting incorrect information in her advertisements.
Source: ct5thdistrict.com

Newsroom – Blue Cross Blue Shield of Michigan broadens Medicare options with new Medicare Advantage PPO product

Posted by:  :  Category: Medicare

October 1 is the first day BCBSM and Medicare Advantage carriers across the nation can market their Medicare Advantage products for 2010. Beneficiaries in BCBSM Medicare Advantage products will receive letters in the next 10 days about the new product line-up. "Blue Cross remains fully committed to providing products to Medicare beneficiaries and will continue to have the broadest array of Medicare Advantage products in the state," said Mark Owen, BCBSM vice president for federal and individual business. "It’s important for Medicare beneficiaries to know that there is no immediate change to their coverage. They have until the end of the year to make their selection for 2010." In addition to the three BCBSM products for 2010, seniors also can select from three Medicare Advantage products offered by Blue Care Network, the BCBSM-affiliated HMO. "We will be working with insurance agents and other groups across the state to reach out to Medicare beneficiaries to help them navigate these product and premium changes," said Owen. Seniors who meet low income guidelines can receive subsidies from the state and/or federal government to pay for all or part of their premiums. Medicare Advantage premiums vary by product and region. The new PPO product is expected to provide beneficiaries with value for their premium. For example, the BCBSM Medicare Plus Blue PPO, which includes Part D prescription drug coverage, will cost between $61 and $141 a month (premiums vary by geographic region), while traditional BCBSM Medicare Supplemental (Medigap) Plan C plans cost $183 when combined with a stand-alone Part D BCBSM prescription drug program. Medicare Advantage plans offer Medicare benefits through private health insurance plans and most include Part D prescription drug coverage. When you purchase a Medicare Advantage plan, you do not need to also purchase a Medigap policy. Medicare Advantage plans are regulated solely by the federal government, while Medigap plans are regulated by the state. The announced product changes are only for Medicare beneficiaries who directly purchase their Medicare Advantage products, not for beneficiaries enrolled in a group plan. Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.
Source: bcbsm.com

Video: Excellus BCBS Medicare: What’s included in my Medicare Advantage Plan?

BCBS Medicare Advantage Plans

I would just cut your losses. Sitting around waiting for med advantage commish will destroy your focus. If it comes, then it comes. I would recommend never, ever selling that junk again and moving on. Sell a real insurance policy. If you don’t cut it off in your mind it will kill your focus, your sanity, and ultimately your business. There is nothing more insane then waiting to get paid by the govt’. Fool me once…
Source: insurance-forums.net

Blue Cross Blue Shield of Michigan Offers New Medicare Plans

HMO’s (health maintenance Organizations) let you select a primary care physician from the BCBS provider network and this PCP manages your overall care. He or she will refer you to a specialist or to a selected hospital for care should you need additional services beyond his scope of practice. Referring yourself to an outside provider will cause a forfeit of benefits and out-of-pocket costs. The four BCBSM HMO products, formerly known as Options 1, 2, and 3, will now be known as BCN Advantage Elements, Classic , and Prestige. The Blues Care Network will also continue to offer the BCN Advantage Basic Plan.
Source: emaxhealth.com

Medicare Changes: Blue Cross Blue Shield Medicare Advantage for 2011

Start be making sure you are looking at the correct plans for your state and county.  BCBS offers several types of Medicare Advantage  and Prescription Drug Pans depending on your location.  For example, in Alabama BCBS offers a PPO, PFFS, and a SNP while Arkansas only has a PFFS plan available.  Both California and Florida offer a Regional PPO.  A quick review of the Florida Regional PPO shows a premium of $63/month, co-pays of $50 for specialists, $300 a day for hospital stays, and a lovely $150 Part D Drug deductible! 
Source: blogspot.com

Raising the Medicare Eligibility Age: A Costly and Dangerous Proposal 

Posted by:  :  Category: Medicare

When I'm 64 by Muffet[1] Congressional Budget Office: Raising the Ages of Eligibility for Medicare and Social Security, January 2012. Available at http://www.cbo.gov/publication/42683. [2]Center for Budget and Policy Priorities: Raising Medicare’s Eligibility Age would Increase Overall Health Spending and Shift Costs to Seniors, States, and Employers, August 2011.  Available at http://www.cbpp.org/cms/?fa=view&id=3564. [3] Henry J. Aaron, Ph. D, The Brookings Institution for AARP Public Policy Institute, Perspectives: Reforming Medicare: Option-Raise the Medicare Eligibility Age, available at http://www.aarp.org/content/dam/aarp/research/public_policy_institute/health/option-raise-the-medicare-eligibility-age-AARP-ppi-health.pdf. [4] Center for American Progress, The Senior Protection Plan, available at http://www.americanprogress.org/wp-content/uploads/2012/11/SeniorProtectionPlan.pdf. [5] Kaiser Family Foundation: Raising the Age of Medicare Eligibility: A Fresh Look Following the Implementation of Health Reform, July 2011, available at http://www.kff.org/medicare/8169.cfm. [6] Ibid. [7] Kaiser Family Foundation, Health Reform Subsidy Calculator, available at http://healthreform.kff.org/subsidycalculator.axpx [8] Ibid. [9] United States National Vital Statistics System. Available at http://www.cdc.gov/nchs/nvss.htm. [10] Health Affairs, Raising the Medicare Eligibility Age: Effects on The Young Elderly, July/August 2003, available at http://content.healthaffairs.org/content/22/4/198.full. [11] Medicare Rights Center, Paying More for Less: Raising the Eligibility Age, available at http://www.medicarerights.org/pdf/Paying-More-For-Less-Raising-Medicare-Age.pdf. [12] ABC News/WashingtonPost Poll, Langer Research Associates, November 2012, available at http://abcnews.go.com/blogs/politics/2012/11/among-cliff-avoidance-options-most-favor-targeting-the-wealthy/. [13] Center for Medicare Advocacy, Deficit Reduction and Medicare: Saving Money without Harming Beneficiaries, available at http://www.medicareadvocacy.org/2012/11/15/deficit-reduction-and-medicare-save-money-without-harming-beneficiaries/ [14] MRC. [15] Center for Medicare Advocacy, Investing in Our Future: Strengthening Medicare in 2012 and Beyond, available at http://www.medicareadvocacy.org/2012/02/09/investing-in-our-future-strengthening-medicare-for-2012-and-beyond/.
Source: medicareadvocacy.org

Video: Turning 65 Becoming Eligible for Medicare – 2011

Listen Up, White House! Take Medicare Eligibility Age Off The Table NOW.

…with the electorate. Act 1. A disaster scenario (created by the WH & Congress) aptly named a ‘fiscal cliff’ MUST be solved by Dec. or we’ll all die. Both parties posture and pose and pretend to hold out for a deal their base supports. Act 2. Media run non-stop stories about the fiscal cliff ‘disaster’. Theme: If no compromise is reached before (artificial) deadline life will end for us all. Good cop, bad cop drama ensues. Act 3.The WH/Congress leak Pete Peterson’s plan to a couple of insiders to float. Outrage from both bases. Media frenzy. WH/Congress wait out the storm. Act 4. Float a slightly more palpable plan with “tweaks”. Media insiders in both parties give it a tepid thumbs up claiming it was the best they could do given the intransigence of the other party. Act 5. Tweaked entitlement “reform” bill gets bipartisan support. Act 6: The public finds out 9 mos later about the poison pills lobbyists for Pete Peterson wrote into the bill. Act 7. Medicare age raised to 67. SS cola ‘tweaked’. Taxes raised 2% on millionaires. Captial Gains tax untouched. Defense cuts- not so much.
Source: crooksandliars.com

Daily Kos: Open thread for night owls: Raising Medicare eligibility age would hurt minorities most

un-Constitutional, since illness and injury are not age-dependent. Separating populations by age and income is little more than a sop to segregationist sentiments — sentiments which, in turn, merely satisfy an ideological commitment to hierarchy as a fundamental principle of society. Ranking humans in order to give some more or less authority over others is not natural. If humans are equal, admittedly an ideological commitment, but one that is enshrined in our organizing document, then hierarchy is in basic conflict. Insisting on it merely serves to undermine our democracy. Of course, we have a long history of not living up to our aspirations. But, that’s what moving forward is about. If we are going to make progress, then irrelevant distinctions have to be removed. Medicare should be an option for all, especially now that all income earners are paying into it. Money, btw, is a social utility. People who use it incur some obligations for our communal certification that their IOUs are good. If some people get along with handshakes, more power to them. We won’t expect them to pay in.
Source: dailykos.com

HCAN Fact Sheet: Raising the Medicare Eligibility Age Would Shift Costs to Seniors, States and Employers

The Congressional Budget Office (CBO) estimated the effects of delaying Medicare eligibility by two months for every year beginning in 2014. The Kaiser Family Foundation (KFF) took a more comprehensive look at the impact of the proposal if implemented immediately. KFF found that the proposal would generate $5.7 billion in net federal savings in 2014 alone but would shift costs of twice that amount ($11.4 billion) to individuals, employers and states.
Source: healthcareforamericanow.org

Viewpoints: Health Law’s ‘Sticker Shock;’ Changing Medicare Eligibility Age Is Not A Simple Solution

San Jose Mercury News: Pancreatic Cancer Finally Gets Federal Attention Pancreatic cancer is a devastating and unforgiving disease. My husband, Patrick Swayze, was diagnosed with this terrible cancer in January of 2008. … Of the top five cancer killers, pancreatic cancer is the only one with a five-year survival rate in the single digits — just 6 percent. Patrick fought valiantly before passing away almost 22 months later. While pancreatic cancer may have taken him in the end, it never beat him. And for me, just because he’s gone doesn’t mean this fight is over. Due in part to the lack of federal resources, scientific advances against this disease, whose statistics are shocking, have been minimal at best. No early-detection tools exist, and few effective treatment options are available. Further, despite its being one of the most deadly cancers, there has been no national plan to address pancreatic cancer (Lisa Niemi Swayze, 1/11).
Source: kaiserhealthnews.org

Oklahoma Medicare Eligibility Requirements

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

What Raising the Medicare Eligibility Age Means

Raising the eligibility age saves very little money, on the order of a few billion dollars a year. That’s because the 65 and 66-year-olds will have to get insurance somewhere, and many of them are going to get it with the help of the federal government, either through Medicaid or through the insurance exchanges, where they’ll be eligible for subsidies. However, since many Republican-run states are refusing to expand Medicaid in accordance with the Affordable Care Act, lots of seniors who live in those states will just end up uninsured, which will end up leading to plenty of financial misery and more than a few premature deaths. Put this all together, and the Center on Budget and Policy Priorities estimates that while the federal government would save $5.7 billion a year from raising the eligibility age, costs would increase by more than twice in other parts of the system—for the seniors themselves, employers, other enrollees in exchanges who would pay higher premiums, and state governments.
Source: prospect.org

Texas Medicare Eligibility Requirements

“I just wanted to write and let you know how pleased I have been with Jordan Kohanim. She has been very informative and helpful when it came to me acquiring my additional insurance. I really appreciate everything she has done for me. She was very professional and helped me in every way that I asked. She also keeps in contact with me to see if there is anything else I may need. We need more people like her working with new customers. Thank you for your time and I look forward to speaking with Jordan again! “
Source: texasmedicarehealth.com

Office of Statewide Benefits provides information on Medicare Parts A, B enrollment

Posted by:  :  Category: Medicare

Joe the Plumber - To Flush The System ... More scams aim to ensnare Brevard seniors - Their ingenuity is boundless, Archer said. (Jul 2, 2012) ... by marsmet524Failure to enroll and maintain enrollment in Medicare Parts A and B upon eligibility may result in the subscriber being held financially responsible for the cost of all claims incurred, including prescription costs. Retirees and spouses enrolled in Medicare Parts A and B must provide a copy of their Medicare Identification Card to be enrolled in the state of Delaware Special Medicfill plan.
Source: udel.edu

Video: Health Insurance Information : About Medicare Dental Benefits

IRS Releases New Information About Medicare Tax Surcharges

The IRS released a lovely FAQ today about the 0.9% surcharge that applies wages, self-employment earnings and other compensation above $200,000 (single filers) / $250,000 (joint filers). When this surcharge applies to wages, employers are required to withhold it, but the withholding rules are a bit strange. Taxes won’t be withheld until you receive that first dollar in compensation in excess of $200,000; taxes might be withheld even if the surcharge won’t ultimately apply to you because your spouse is not employed; and taxes might not be withheld even if the surcharge will apply to you, because you and your spouse together earn more than the threshold. The FAQ explains these peculiar rules, both from the employee’s and the employer’s perspective.
Source: perkinsaccounting.com

Free information session on navigating Medicare March 21

Confused about Medicare and your health insurance options? You’re not alone! Join Human Resources for a free information session from 1:30 to 2:30 p.m. Thursday, March 21, in Light Hall, Room 202. The session is directed to employees aged 62 and older, but all are welcome to attend. No registration is required.
Source: vanderbilt.edu

New CMS Website: Medicare Secondary Payer Conditional Payment Information 

[1] Title II of H.R. 1845, entitled "Strengthening Medicare Secondary Payer Rules," amends 42 U.S.C. §1395y(b)(2)(B) of the Medicare Statute, Pub. Law No. 112-242 (January 10, 2013).  See http://beta.congress.gov/bill/112th-congress/house-bill/1845/text. The Bill Summary and status report are available at: http://thomas.loc.gov/cgi-bin/bdquery/z?d112:h.r.1845. The current Medicare Secondary Payer Recovery Contractor (MSPRC) website is located at www.msprc.info. Title I, Section 101 of H.R. 1845, sets out a demonstration project under Medicare Part B for the payment of supplies and services related to the administration of Intravenous Immune Globin (IVIG) for the treatment of primary immune deficiency diseases. [2] The Medicare Secondary Payer program is set out at 42 U.S.C. §1395y(b)(2). [3] The Center’s work on MSP matters can be accessed at: http://www.medicareadvocacy.org/medicare-info/medicare-secondary-payer-program/. In addition, the Center led a task force of the Public Policy Committee of the National Academy of Elder Law Attorneys (NAELA) (www.naela.org) on the use of set-aside arrangements involving future medical expenses. The task force made recommendations on how attorneys might approach "future medicals" pending guidance from the Medicare agency. See: http://www.naela.org/App_Themes/Public/PDF/Home%20Page/ISSUE%20Medicare%20Set%20Aside%20TF_2%20(2).pdf.  [4] See, for example, the joint findings and recommendations, sent to the Medicare Agency, by the Center for Medicare Advocacy, the Medicare Rights Center, and California Health Advocates, available at http://www.medicareadvocacy.org/2011/05/12/medicare-secondary-payer-practices-that-harm-medicare-beneficiaries/. [5] See §201of the Act.  Note, the term "website" includes any successor technology that might be developed. Id., at subclause (VII). [6] See §201of the Act, ("VI") Effective date. [7] See §201of the Act. [8]Id., amending §1862(b)(2)(B) of the Social Security Act, 42 U.S.C. §1395y(b)(2)(B), adding a new clause: (vii) use of website to determine final conditional reimbursement amount. [9] Id. [10] See §204, amending §1862(b)(8)(B) of the Social Security Act, 42 U.S.C. §1395y(b)(8)(B). [11] Id. [12] Id., at subclause "(III)." [13] Id., at subclause "(IV)." [14] Id. [15] Id. [16] Id. [17] Id. [18] Id., at subclause (V), protected period. [19] Id. [20] Id. In addition, the Secretary shall promulgate final regulations to carry out this clause not later than 9 months after the date of the enactment of this clause. Id. [21] Id., §202(a)(2) of the Act. [22] Id., §202(b). [23] Id., subclause "(D)"Report to Congress. [24] Id. [25] See §203, amending §1862(b)(8) of the Social Security Act, 42 U.S.C. 1395y(b)(8)( Required submission of information by or on behalf of liability insurance (including self-insurance), no fault insurance, and workers’ compensation laws and plans). [26] Id. [27] See §205, amending §1862(b)(2)(8)(iii) of the Social Security Act, 42 U.S.C. §1395y(b)(2)(8)(iii).
Source: medicareadvocacy.org

Identity Thieves Impersonate Medicare Employees to Target Senior Texans

Fortunately, a few wary senior Texans immediately questioned the callers’ request. But increasingly savvy identity thieves are prepared and attempt to create the false impression that they already have the senior’s personal information. As proof, the callers often repeat some of the call recipient’s personal information such as name, address and telephone number. But because this information is easy to obtain, the caller’s verification effort is actually just a devious ruse that attempts to mimic the practices of legitimate enterprises – like a bank or insurance company – in an effort to steal the call recipient’s Social Security and bank account number.
Source: kbtx.com

Senators Urge CMS to Provide Information about Medicare and Medicaid Reimbursement for Compounded Drugs

Public Citizen, a consumer advocacy group, has written a letter to HHS Secretary Kathleen Sebelius, asking her to direct the HHS Office of the Inspector General (OIG) to conduct an investigation into CMS’ policies with respect to reimbursement for compounded drugs. Public Citizen cited conflicting provisions of the Medicare Benefit Policy Manual that, on the one hand, instruct carriers to deny coverage for drugs that have not been approved by the FDA and, on the other hand, direct carriers not to deny coverage for such drugs unless directed to by CMS. Public Citizen also noted that CMS is aware of the dangers posed by compounded drugs. In 2007, its four regional Durable Medical Equipment (DME) Medicare Administrative Contractors (MACs) denied coverage for compounded inhalation drugs administrated via nebulizers, noting that the drugs were not FDA-approved and citing safety concerns. The senators, Public Citizen, and the public await the agencies’ response.
Source: wolterskluwerlb.com

North Carolina Medical Society

While Congress’ action to avert the fiscal cliff at the ninth hour is good news, the decision may have a slight impact on Medicare claims and payments. Palmetto GBA posted this useful article that provides some useful, early guidance. A few quick highlights:
Source: ncmedsoc.org

Biden offers senior Floridians misguided information on Medicare

Under President Obama, that coverage for the screening procedures was expanded as a result of new directives forcing insurers to cover only those preventive services recommended by the United States Preventive Services Task Force. These mandates are another symptom of the centralized control that Obamacare exerts over the practice of medicine. But under Mr. Obama, the colonoscopies have faced offsetting new restrictions that mostly make it harder for seniors to access many of the tests.
Source: aei-ideas.org

Navigating Medicare: Free Information Session

Confused about Medicare and your health insurance options? You’re not alone! Join Human Resources for a free information session on March 21 from 1:30-2:30 pm in Light Hall Room 202. The session is directed to employees aged 62 and older, but all are welcome to attend. Presented by Aetna, session topics will include: • Part A & B: What’s covered, how you qualify and how to enroll • Part C: Medicare Advantage plans • Part D: Medicare prescription drug plans • Health care reform and plans for Medicare-eligible participants • Resources to help you navigate plan selections Bring your questions! There will be plenty of time for Q&A at the end of the session.
Source: vanderbilt.edu