Medicare paid $5.1B for poor nursing home care

Posted by:  :  Category: Medicare

Running Amok Again by elycefelizOverall, the review raises questions about whether the system is allowing homes to pay for poor quality services that may be harming residents, investigators said, and recommended that the Centers for Medicare & Medicaid Services tie payments to homes’ abilities to meet basic requirements for care. The report also recommended that the agency strengthen its regulations and ramp up its oversight. The report did not name individual homes and did not estimate the number of patients who had been mistreated, but instead looked at the overall number of stays in which problems arose.
Source: publicradio.org

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

Bill aims to reduce hospital re

“This innovative RPM technology has the ability to revolutionize patient care and dramatically reduce the amount of money Medicare spends on hospital readmissions each year,” said Thune. “Not only could this technology reduce costs and improve health outcomes, but it also offers patients the individual freedom to stay in their homes, reducing costs associated with nursing homes and long-term care facilities. I’m pleased to have worked with many industry stakeholders in developing this legislation over the past few years, and I look forward to working with my colleagues on both sides of the aisle to move this legislation through Congress.”
Source: echopress.com

Why today's seniors object to the dissolution of Medicare

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

Medicare Secondary Payer Act Compliance

There are no simple answers when complying with the Medicare Secondary Payer Act in your workers’ compensation, no-fault/automobile or liability claim.  In any of these cases where future medical care and treatment is closed out, it is important to consider and protect Medicare’s future interests—do not forget about conditional payments too!  Failure to address these issues at the time of settlement may result in Medicare considering the entire settlement null and void, regardless of what “Medicare savings” language you use.
Source: mnbenchbar.com

Medicaid News: Minn. Effort To Expand Program Praised

California Healthline: Access Denied? Implications Of Medi-Cal Pay Cut In 2014, about 1.5 million adults in California are expected to gain access to Medi-Cal under the Affordable Care Act. However, insurance coverage could be all they get, as some observers say there might not be enough doctors willing to treat them. The fiscal year 2013-2014 budget proposal that Gov. Jerry Brown (D) released this month could be read as contradictory. On one hand, he makes it clear that California will pursue a full expansion of Medi-Cal, offering coverage to individuals with incomes up to 138 percent of the federal poverty level. At the same time, however, the governor’s budget plan also counts on $488.4 million in savings from a 10 percent cut to Medi-Cal reimbursements. Medi-Cal is California’s Medicaid program. State officials maintain that the provider pay cut should not hurt access to care during the expansion, but others fear the reduction could be implemented at the worst possible time (Wayt, 1/30).
Source: kaiserhealthnews.org

PoliGraph: DFL falsely links state lawmakers to Medicare

The flier states that Wiener “will be just another Republican vote against closing the Medicare prescription drug donut hole.” The DFL is referring to a kink in the Medicare Part D program, which covers drug benefits for seniors. Once Medicare beneficiaries reach a certain coverage threshold, they have to pay for their prescriptions until they reach the catastrophic coverage threshold.
Source: publicradio.org

Broker Agent Service Analyst

Positions in this function provide sales support and administrative services to non-employee sales producers such as broker agents, field marketing organizations, and independent contract agents. Ensures proper completion of contracts, marketing agreements, and documentation of sales targets. May administer programs and monitoring to ensure compliance with external agent credentialing and training requirements. Acts as internal liaison and customer service resource for external producers relative to enrollment and policy questions, systems issues, and coordination of materials fulfillment. As one aspect of broader support role, may manage administrative aspects of commission payments such as routine tracking, reporting, and troubleshooting issues relative to missing or disputed payments. (Jobs focused on agent incentive design belong in human capital, and jobs focused primarily on payment decisions and non-routine sales analysis/reporting belong in Finance.)
Source: insurancesalesweb.com

Minnesota Medicaid, Medicare fraught with overspending

The U.S. House of Representatives Committee on Oversight and Government Reform found that the state used an accounting trick in order to leverage federal reimbursement of state Medicaid spending as far back as 2010: “The state was intentionally lowering the rates paid to the managed care companies for plans outside the Medicaid program and increasing the rates within the Medicaid managed care program,” a House staff report reads.
Source: dailycaller.com

Online Medicare Lead Program (Exclusive and Shared Leads) « Insurance News from Crowe & Associates

Posted by:  :  Category: Medicare

Deal 3, Table 7: Initiation enter Trick A~ contract taker leads King of Risks by KevinHutchins314Crowe & Associates offers an online Medicare lead program to our brokers.  The program has two types of leads- Exclusive leads and shared leads.  The Exclusive leads are sent to only one broker and are never redistributed.  The shared leads are sent to multiple brokers at the same time.  The lead costs for street level (full compensation paid directly from the insurance company) contracted brokers are $15.00 for exclusive leads and $5.00 for shared leads.  The lead cost for our in-house lead program brokers (reduced compensation paid from Crowe & Associates) are $6.00 for exclusive leads and $1.00 for shared leads.
Source: croweandassociates.com

Video: Final Expense By Phone – The Truth

Obama Administration Plans to Cut Medicare Advantage Reimbursements

I think the landscape next year will look like 2005 and prior. There were MA plans in major metro areas and a few others here and there. The rural market will return mostly to supps. The difference is back then, most MA sales were done by a captive sales force. There were brokers here and there that did MA production, but most were captive agents. Now that agents know more about MA plans, I judge the broker community will still have some production, not as much as last year, but more than 2005 and prior. I also judge that larger FMO’s will be the ones handling MA production for brokers. Carriers may want to limit their liability with independent agents. May not happen next year, but I see that on the horizon. MA premiums will rise and other benefits (vision, hearing, health club) may go away. I know one of the main plans here in Kansas City was $50+ per month prior to 2005. The past 7 years it has hovered between $8 and $21 per month. Senior will be upset at the increase in premium, but since it will be a nationwide event and not just a handful of carriers, the market and seniors will just have to accept. Just my thoughts…I have been known to be wrong before.
Source: insurance-forums.net

Health care reform leads to telephone scam

“So far, the beneficiaries reporting this scam to SMP (Senior Medicare Patrol) have not become victims, but they have been concerned enough to report the incident,” said Alice Ierley, SMP Program Director. “We need to alert people to this so that they keep up their guard. We expect similar scams to pop up as the 2014 implementation date for healthcare reform approaches.”
Source: csbj.com

Confused About how Medicare Excess Charges Work?

You’re welcome. One observation about the following statement: Non-PAR physicians would need to collect the full limiting charge amount roughly 35% of the time they provided a given service in order for the revenues from the service to equal those of PAR physicians for the same service. If they collect the full limiting charge for more than 35% of the services that they provide, their Medicare revenues will exceed those of PAR physicians. Although this may be true, physicians seek profit above just revenue; and know there are costs associated with collecting full limiting charges from patients as a non-PAR physician. Medicare pays non-PAR claims directly to the patient beneficiary, so the non-PAR physician must collect in full from the patient beneficiary. Thus Non-Par physicians would need to collect the full limiting charge at some percentage greater than 35% of the time in order for the profits from the service to equal those of PAR physicians for the same service. This helps further explain why the vast majority of physicians participate in Medicare. J. VanCleve
Source: insurance-forums.net

The Advantages And Disadvantages Of Medicare Augment Insurance

Online business Appointments: You want be appointed to sell at least 2 different companies that offer Medicare insurance Advantage and Medicare health insurance supplement plans in the area you will be working around. As season goes on it again will be tips to be equipped with most in the case when not all pointing to them but that would be on top of that overwhelming to begin the process. Two institutions will get the site done in the beginning. Again, use the website to get an idea of which one companies are competitive in your section. There have been also a information of Medicare Wholesales websites that would likely allow you that will help do basic comparisons in any distributed zip code.
Source: farabi-vu.com

Medicare Advantage Referrals Joint Venture

No. Medicare Advantage sales can not be performed by cold calling. Saying you are offering to do a free Medicare or insurance review with the intent of selling a MA plan is also against Medicare guidelines. Even if you are not making the calls, they are being transferred to you. If the prospect were to call you direct and started asking questions that would be allowed by Medicare, but I doubt having someone calling a book of business to get them to call another number would be very effective.
Source: insurance-forums.net

Daily Kos: President Obama considering putting social insurance cuts in his budget

follow his close actions (which some of your statements aren’t 100% accurate), this battle is far from over and it will take the Senate and Congressional Democrats to agree to them.  His stimulus package was a lot of tax breaks for middle-class Americans (as imperfect as it is).  He didn’t fire guys like Austan Goolsbee or Christie Romer, they left.  There are already Senate investigations going on and the secret promises were the last resort thing cause guys like Baucus killed the public option.  I’m not saying Obama is perfect or terrific at that matter and I’ve had my disappointments with him as well but your comment is contributing to the “we are doomed” narrative, no matter how factual or even exaggerated it may be.  If you at least made some call for action like putting the pressure on congressional or Senate Dems to not agree with these cuts, then I would say that you aren’t contributing to the “gloom and doom” narrative.  I would credit you for being pro-active.  I would credit you for acknowledging a problem and then taking action.  There was nothing in your comment that called for action.  Nothing, nada, zilch.  
Source: dailykos.com

Medicare Health Insurance Sup Related Articles

Their schemes offer regions to various systematic expenses either in some measure or fully depending on type of insurance plans. The policies offer insurance policies coverage to deductible amount and also on the way to coinsurance amount in order to paid by the most important Medicare recipients. Some of them policies cover educational costs related to elderly care and hospital bills or amount needed for certain major surgical treatments. The services of these procedures may be when limited periods perhaps by considerable amount or infinite amount. Now these types of an insurance plan schemes are available in other countries and also.
Source: espaigessap.com

Tavenner Nominated Again To Lead Medicare

Kaiser Health News: Grassley Calls For Senate Consideration Of Tavenner’s Nomination President Barack Obama Thursday once again nominated Marilyn Tavenner to head the Centers for Medicare & Medicaid Services, and a key GOP senator said the chamber should consider the nomination. “The Senate should give Ms. Tavenner every opportunity to show she is a worthy choice to lead the agency responsible for Medicare, Medicaid, the Children’s Health Insurance Program, and a lot of the implementation of the Obama health care law,” said Sen. Charles Grassley, R-Iowa., who is a member of the Finance Committee and its former chairman and ranking member. Grassley said he hoped the panel would give Tavenner’s nomination “due consideration through regular order” (Carey, 2/8).
Source: kaiserhealthnews.org

States Could Save $73 Billion by Negotiating Medicare Drug Prices

Posted by:  :  Category: Medicare

No doctor shopping here, buddy by Newtown grafittiWASHINGTON, D.C. March 19, 2013 – State governments could save as much as $73 billion cumulatively over the next ten years if the federal government were to negotiate Medicare prescription drug prices, according to a new issue brief by the Center for Economic and Policy Research (CEPR). As policy makers across the nation consider various state and federal budget options, they and the American public should be made aware of these significant potential savings. Each state’s individual substantial savings are cataloged in “State Savings with an Efficient Medicare Prescription Drug Benefit.” The authors draw from a previous CEPR report that focuses on potential savings to the federal government if Medicare drug costs were negotiated. Compared to the residents of other wealthy nations, Americans pay far higher prices for prescription drugs. The reason that people in other countries spend so much less is that their governments negotiate prescription drug prices with the pharmaceutical industry. “The United States was projected to spend over $880 per person on prescription drugs in 2012,” said Nicole Woo, Director of Domestic Policy at CEPR and an author of the new issue brief. “Other nations spend significantly less, ranging from around 70 cents in Canada for each U.S. dollar to 35 cents per dollar in Denmark.” Applying both a high- and low- savings scenario that mirrors the savings on prescription drug spending in Canada and Denmark, the authors show that California would see the most in potential savings – between $3.3 and $7.8 billion over ten years. Florida, New York, Texas, Pennsylvania, Ohio and Illinois could save at least $1 billion per year each over the same time period. Even those states with the least in potential savings — Wyoming, North Dakota and Vermont – could still save tens of millions of dollars over the next decade. The full list of savings for each state can be found here.
Source: yubanet.com

Video: Medicare Plan Finder Lesson 2: Entering Your Prescription Drugs

Armed With Powerful New Data, Progressive Groups Launch Grassroots Campaign to Enable Medicare Drug

The CEPR brief shows that the savings are undoubtedly achievable, as has been demonstrated for many years by numerous wealthy countries that pay significantly less for prescription drugs than the U.S. does. Some may object that lower prices would sap much of the revenue and incentive for financing research and development of new drugs, but the brief points out that they would also disincentivize improper marketing of medications and misrepresentation of quality and safety of drugs, which occurred in the case of Vioxx, the report said. There is a strong argument for developing a more efficient mechanism for financing drug research, and there is little reason for people in the United States to continue to overpay for a system that serves us poorly, according to CEPR.
Source: healthcareforamericanow.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

Should Medicare cover PET scans for the diagnosis of dementia?

The thing is, we can right now help people along the above fronts, but we generally don’t. Our healthcare system is poorly set up to do these things, and we are lacking tools to facilitate. For instance, I don’t yet know of any apps that allow the lay public to easily spot medications that make cognition worse. We could use better resources and technologies to help families learn about delirium and other strategies for cognitive optimization. Re caregiver support and possible dementia, most of what I come across is framed for caregivers of people with a definite diagnosis. We need more for those facing the possible diagnosis. Furthermore, although several effective programs have been developed to support dementia caregivers — the suggestions I make above are pretty typical for supporting dementia caregivers — they are often hard to find on a local level. (I recently tried to find a place to refer caregivers to get the REACH program of education and support; no luck yet.)
Source: kevinmd.com

ABOUT MEDICARE: Getting what you need from your Medicare drug plan

David Sayen is Medicare’s regional administrator for California, Arizona, Hawaii, Nevada and the Pacific Trust Territories. You can always get answers to your Medicare questions by calling 1-800-MEDICARE (1-800-633-4227).
Source: times-standard.com

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

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

How Medicare’s Payment Cuts for Cancer Chemotherapy Drugs Changed Patterns Of Treatment

The Medicare Prescription Drug, Improvement, and Modernization Act, enacted in 2003, substantially reduced payment rates for chemotherapy drugs administered on an outpatient basis starting in January 2005. This study assessed how these reductions affected the likelihood and setting of chemotherapy treatment for Medicare beneficiaries with newly diagnosed lung cancer, as well as the types of agents they received. Contrary to concerns about access, the study found that the changes actually increased the likelihood that lung cancer patients received chemotherapy. The type of chemotherapy agents administered also changed. Physicians switched from dispensing the drugs that experienced the largest cuts in profitability, carboplatin and paclitaxel, to other high-margin drugs, like docetaxel. The authors state they do not know what the effect was on cancer patients, but these changes may have offset some of the savings projected from passage of the legislation. The ultimate message is that payment reforms have real consequences and should be undertaken with caution.
Source: rwjf.org

Four Things To Remember Before the Dec. 7 Medicare Enrollment Deadline 

Is your doctor still contracted with your Medicare Plan? Senior citizens need to check if their primary care doctor is still contracted with their Medicare plan. If the doctor is not, you will be assigned to a new doctor by the health plan. If you are seeing a specialist who serves a unique section of medicine, for example diabetic care, you need to make sure that your doctor is still accepting your Medicare plan. You do not want to be in a situation where your doctor does not accept your Medicare plan, and you have to look for another specialized doctor who does.  Most doctors contract with multiple Medicare plans, so keeping your doctor can be as easy as switching to a new Medicare plan.
Source: inlandempire.us

CONGRESSMAN PAYNE AND NJ SMALL BUSINESS OWNERS DISCUSS NEW REPORT ON RETIREMENT SECURITY

Posted by:  :  Category: Medicare

“Our small businesses are the backbone of our communities and truly have become the catalyst to economic growth,” said Rep. Donald M. Payne, Jr. “With small businesses creating two out of every three net new jobs, Congress must do everything in its power to protect small business owners and ensure that they have the resources and tools they need to hire and grow. The Republican approach to take a meat axe to government spending and end Medicare as we know it will hurt our small business community. Even just a three percent cut to these programs could eliminate more than $1 billion from New Jersey’s economy, meaning small businesses will have to figure out how to run a business with less consumer spending and revenue.”
Source: mainstreetalliance.org

Video: Applying for Medicaid in NJ Part I

Report Says Early Years of Medicaid Expansion in NJ Won’t Break the Bank

Every other advanced democracy (Israel, Sweden, Norway, Denmark, Finland, Australia, Japan, Taiwan, Canada, France, Austria, Switzerland, New Zealand, Germany, Holland, etc.) has some form or version of universal health care; everyone is covered and no one goes bankrupt from medical expenses as they do in the US. A national health care system was part of the 1912 campaign platform of Teddy Roosevelt. Truman tried to institute a national health care system throughout his presidency but was defeated by the GOP, the AMA and the one percenters. By some miracle, LBJ managed to enact Medicare and Medicaid in 1965. Without these programs, we would have about 100 million uninsured; we currently have 48.8 million uninsured according to the US Census. We have tens of millions more with inadequate crap insurance with high deductibles and many out of pocket expenses. When is enough enough in the US? We should have Medicare for all or a single payer health care system. Instead of that, we are talking about cutting and gutting Medicare and Medicaid. It’s just stupid and nuts.
Source: patch.com

Waiver Approval Clears Way for Massive Medicaid Reform in NJ

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

Medicare Targets Health Plans With Low Ratings

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

NJ Doctors Face Significant Cuts to Medicare ReimbursementsUnless Congress acts by end of year, healthcare providers in the Garden State could see Medicare payments shrink by more than 25 percent

Medicare, New Jersey, Medicare payments, primary care, primary care physicians, doctors, Eidus, cuts, federal healthcare, SGR, growth rate, sustainable growth rate, Summit Medical Group, Medicare recipients, costs, annual Medicare cuts, percent, Medicare SGR fix, Dr. Robert, New Jersey doctors, family, Dr. Robert Eidus, federal budget, family practice, medical costs, law, Medicare fees, McKean Kelly, primary care field, primary care physician, fewer primary care, automatic federal tax, federal healthcare law, Comprehensive Primary Care, Cranford Family Practice, actual medical costs, Brenner, New Jersey Hospital, particularly family physicians, federal healthcare costs, New Jersey Psychological, Affordable Care Act, coordinating patient care, federal healthcare programs, Dr. Robert Brenner, federal healthcare budget, chief medical officer, annual SGR rite, gross domestic product, Dr. Mary Campagnolo
Source: lwpolice.org

Senior Care in Mt. Laurel, NJ: 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: hometostayhc.com

Actuarial Job at Ezra Penland Actuarial Recruitment for FSA ASA Medicare Actuary NJ #43419 in , New Jersey

View All Actuarial Jobs Jobs by State Casualty Jobs Health Jobs Life and Annuities Jobs Pension Jobs Other Jobs Consulting Jobs View All States Arizona California Connecticut Florida Georgia Illinois Indiana Maine New York Michigan New Jersey North Carolina Ohio Pennsylvania Texas Virginia Cities Atlanta Boston Chicago Dallas Hartford Houston Los Angeles New York Orlando San Diego Seattle
Source: actuary.com

NJ Labor, Elected Officials, Clergy & Advocacy Groups Call for Fiscal Cliff Resolution

Speakers included Congressman Frank Pallone (D-06); Congressman  Bill Pascrell (D-08); Milly Silva, Vice President, SEIU NJ State Council, and Executive Vice President of 1199SEIU United Healthcare Workers East, New Jersey Region; Kevin Brown, SEIU NJ State Council Secretary/Treasurer, and NJ State Director for Local 32BJ; Charles Wowkanech, President, NJ State AFL-CIO; Phyllis Salowe-Kaye, Executive Director, NJ Citizen Action, and state partner of Americans for Tax Fairness; Samia Bahsoun, NJ Main Street Alliance; The Rev. Dr. J. Brent Bates, Grace Church; and Dr. Shoaib Afridi, Executive Vice President, SEIU Committee of Interns and Residents.
Source: seiunj.org

MSNJ’s Statement on NJ Medicaid Expansion

Founded in 1766, the Medical Society of New Jersey is the oldest professional society in the United States. The organization and its dues-paying members are dedicated to a healthy New Jersey, working to ensure the sanctity of the physician–patient relationship. In representing all medical disciplines, MSNJ advocates for the rights of patients and physicians alike, for the delivery of the highest quality medical care. This allows response to the patients’ individual, varied needs, in an ethical and compassionate environment, in order to create a healthy Garden State and healthy citizens.
Source: wordpress.com

Supplementary Insurance Policy of Medicare to Maximize The Benefit

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 marsmet481One thing you should know that no active participation of government will be here. It is wholly administrated by private body. Several private companies are in this insurance business. Though this same policy can be marketed by different companies, but there are some strict rules which ought to be maintained by the all private companies. These rules include the same amount of premiums should be drawn from the policy holder. All the plans should be same with same benefits. According to the law the private insurance companies can offer only twelve standard Medicare Supplement Insurance Plans, named A through L. each of these plans have their own set of benefits, different from the others. However, almost all of the twelve Medigap policies provide the basic benefits of Medicare part A and B. Therefore it is always recommended to study all the Medigap plans before deciding to choose the one that would fit the best for you. Besides that the fact that should be kept in mind is that, no matter from whatever insurance company you may purchase a particular plan, all of the plans with the same letter cover must provide the same benefits. As for example if you purchase a Medigap plan C policy, it should cover the same benefits without depending on the company that is selling the plan. However, the premium rates may vary for different companies. Therefore you are free to purchase any Medigap policy from the company you like and be sure to get the same benefits provided by the other companies.
Source: malicous.com

Video: Medicare Explained

Why today's seniors object to the dissolution of Medicare

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

Colorado Springs To Benefit From Medicare Competive Bidding Program

Round 1 of the program has already been hugely successful, reducing money spent for equipment included in the program by over 42 percent in its first year of operation. Now the program’s benefits are coming to you, and there is some important information you need to know. Round 2 of the program is scheduled to begin on July 1, 2013, and expands it to 91 new areas across the country, including Colorado Springs, and is projected to save people with Medicare in Colorado Springs an average of 44 percent on certain DMEPOS items. Medicare will also be implementing a national mail-order program for diabetic testing supplies at the same time as Round 2, and beneficiaries nationwide will save an average of 72 percent on these supplies.
Source: ushispanics.com

Should Medicare cover PET scans for the diagnosis of dementia?

The thing is, we can right now help people along the above fronts, but we generally don’t. Our healthcare system is poorly set up to do these things, and we are lacking tools to facilitate. For instance, I don’t yet know of any apps that allow the lay public to easily spot medications that make cognition worse. We could use better resources and technologies to help families learn about delirium and other strategies for cognitive optimization. Re caregiver support and possible dementia, most of what I come across is framed for caregivers of people with a definite diagnosis. We need more for those facing the possible diagnosis. Furthermore, although several effective programs have been developed to support dementia caregivers — the suggestions I make above are pretty typical for supporting dementia caregivers — they are often hard to find on a local level. (I recently tried to find a place to refer caregivers to get the REACH program of education and support; no luck yet.)
Source: kevinmd.com

Daily Kos: President Obama considering putting social insurance cuts in his budget

follow his close actions (which some of your statements aren’t 100% accurate), this battle is far from over and it will take the Senate and Congressional Democrats to agree to them.  His stimulus package was a lot of tax breaks for middle-class Americans (as imperfect as it is).  He didn’t fire guys like Austan Goolsbee or Christie Romer, they left.  There are already Senate investigations going on and the secret promises were the last resort thing cause guys like Baucus killed the public option.  I’m not saying Obama is perfect or terrific at that matter and I’ve had my disappointments with him as well but your comment is contributing to the “we are doomed” narrative, no matter how factual or even exaggerated it may be.  If you at least made some call for action like putting the pressure on congressional or Senate Dems to not agree with these cuts, then I would say that you aren’t contributing to the “gloom and doom” narrative.  I would credit you for being pro-active.  I would credit you for acknowledging a problem and then taking action.  There was nothing in your comment that called for action.  Nothing, nada, zilch.  
Source: dailykos.com

More than 40,000 Seniors Have Contacted Congress to Oppose CMS’ Proposed Cut to Medicare Advantage

CMS recently proposed a 2.2 percent reduction in Medicare Advantage payments for 2014, at a time when medical costs are projected to increase by three percent. The new proposed payment cut compounds the hundreds of billions of dollars in Medicare Advantage cuts and new health insurance tax on Medicare Advantage policies included in the Affordable Care Act (ACA).  A recent report from Oliver Wyman estimates that the cumulative impact of these cuts and the new health insurance tax will result in an estimated 6.9 to 7.8 percent payment cut to Medicare Advantage plans in 2014, leading to benefit reductions and premium increases of $50 to $90 per month for a typical Medicare Advantage beneficiary.  New Oliver Wyman data provide a breakdown of how much seniors will be impacted in specific states.
Source: ahipcoverage.com

LeadingAge: Adult Day: Opportunities to Contract with Certain Medicare Advantage Plans

We are pleased that the Centers for Medicare and Medicaid Services (CMS) concurred with LeadingAge’s position that Medicare should allow Fully Integrated Dual Eligible Special Needs Managed Care Plans (FIDE-SNPs) to offer additional supplemental home and community-based benefits, such as adult day services, to its eligible subscribers beyond those supplemental benefits that Medicare Advantage (MA) plans are allowed to offer. 
Source: leadingage.org

Veterans Over 65 Get Medicare and VA Benefits

A Veteran can enroll in a Part D plan specifically to cover medications prescribed by health care providers outside the VA system, or drugs not paid for by the VA. In 2013, there are several Part D plans with a low- or zero-dollar copay for generic medications. Veterans could save money by enrolling in this type of a Medicare drug plan. For someone taking ten generic maintenance medications each month, the total copays at the VA pharmacy would be in the $80-$90 range. The average Part D drug premium is $37; by using a plan’s preferred network pharmacy, it is possible to obtain those same generic medications at a local pharmacy for $0 co-pay, making the monthly insurance premium your only expense.
Source: medicarewire.com

Medicare Insurance Benefits Teams Up with Meals on Wheels

Meals on Wheels provides 1/3 of the daily nutritional requirements for its meal recipients. The program, which has no federal funding and mainly relies on volunteers, allows recipients of daily meals a chance to boost their health, both mentally and physically. The community of Meals on Wheels volunteers provides added support to these people in need, it adds to their quality of life, and enables many to be more independent.
Source: imms.com

Advocates, Public Consider Medicare Cost Savings As Debate Continues

Medpage Today: Docs Need To Learn More About Billing, Coding Bigger steps should be taken to make physicians more aware of the inefficiencies that cause billions in lost health care dollars every year, according to Medicare officials. Physicians receive little education in how to manage and limit program inefficiencies, inappropriate payments, and exploitation, they wrote in a Viewpoint published in Wednesday’s Journal of the American Medical Association. More work is needed to ensure doctors are aware of “program integrity” — a term payers use to refer to losses due to inappropriate payments or exploitation, Shantanu Agrawal, MD, medical director for the Center for Program Integrity at the Centers for Medicare and Medicaid Services (CMS) in Baltimore, and colleagues wrote (Pittman, 3/19).
Source: kaiserhealthnews.org

L.A. County Partners With OneLA To Enroll Residents in Medi

Posted by:  :  Category: Medicare

OBAMAS DEATH PANEL------ GUESS WHAT FOLKS IT'S ALIVE AND WELL---"CRAZY PALIN" NOT SO CRAZY NOW by SS&SSKatie Murphy — managing attorney at Neighborhood Legal Services of Los Angeles County, which trained enrollment event volunteers — said, “Even though the county is moving as fast as it can toward health care reform,” it does not yet have adequate staff to conduct all necessary outreach initiatives. She said the program is meant to supplement the county’s other efforts to enroll residents in Medi-Cal. 
Source: californiahealthline.org

Video: Medicare Y Usted: Mes de la Prevención del Cáncer Cervical

La. drops plans to scrap Medicaid hospice program

“I got goose bumps,” certified grief counselor and nurse Sue deRada said as she heard the program would be spared. “End-of-life care is just so vital for everybody. It’s sacred. It’s one of the most sacred times in people’s life next to being born. Why would we abandon people at such a critical time?” said deRada, who works for a hospice service in St. Tammany Parish, 40 miles north of New Orleans. The cut would have made Louisiana one of only two states that don’t pay for hospice care through its Medicaid program, and the plan faced strong resistance from state senators, who were seeking ways to avoid shuttering hospice to new adult recipients on Feb. 1. Sen. Fred Mills, vice chairman of the Senate Health and Welfare Committee, walked into the vigil crowd to deliver the news that the Jindal administration had backed away from plans to close the program. “The good Lord took care of us today, so we got a fix,” Mills, R-Breaux Bridge, told Rhonda Johnson, who works for a Baton Rouge-based hospice provider. Johnson said cutting the program would have been “throwing away poor people.” “The thought of ever eliminating hospice for poor people is just unreal,” she said. “This is a huge victory.” Oklahoma is the only state that doesn’t offer hospice care to adults through Medicaid, according to the nonpartisan Kaiser Family Foundation. Jindal made a series of budget reductions in mid-December to help close a nearly $166 million deficit in the current fiscal year that ends June 30. Many of the cuts fell on the Department of Health and Hospitals. Greenstein said when cuts are required to the Medicaid program, only a few optional benefits can be reduced without violating requirements for the state’s participation in the program it runs with the federal government. Hospice is an optional program the health department said has been available since 2002. By using the grant funding, DHH will keep the program running while still saving $1.1 million in state funding this year and an estimated $3.1 million in state funding for the 2013-14 budget year. The health department intends to make changes to the hospice services to shrink the costs of the care and improve the program, Greenstein said. “Just turning it back on didn’t make sense,” he said. “This is going to be something that we’re proud of because this going to be more efficient and effective.” More than 5,800 people received hospice services through Louisiana’s Medicaid program in the last budget year, according to the health department. Many of those, however, were eligible to receive the end-of-life care through Medicare. About 1,400 received the services in their homes and wouldn’t have been eligible through Medicare. Among the planned changes is a focus on community-based, at-home care, Greenstein said. Nursing home residents will not be eligible for hospice care through Medicaid, though most can get it through Medicare, he said.
Source: modernhealthcare.com

La Rochelle Tours commends Medicare EMR service » Medicare EMR

We have been members for more than 5 years and thankfully never needed their services personally or for our clients. HOWEVER, I have called them several times for emergencies where other people required urgent medical attention (like again today) and they have without fail arrived on the scene within minutes of making the call to assist. THANKS GUYS FOR YOUR DEDICATION!
Source: co.za

La Jolla cancer doc pleads guilty to Medicare fraud

I am a retired RN educator, & I am in disbelief about this. How is your mother doing? What is happening with his practice? Is he still in his office, or is someone covering for him? It is unbelievable that this is only a misdemeanor, & his only punishment is likely to be forfeiture of $$ for both of his charges (including Medicare fraud). No mention of nurses in the practice who knew about it. If so, I hope they are charged also. Hoping for the best with you mother, & let me know if I can help in any way. Gretchen Carter, RN, BSN, MSN
Source: fox5sandiego.com

Carson pastor pleads guilty to $11 million in Medicare fraud

Agbu admitted to owning Bonfee Inc., a fraudulent medical equipment supply company, and acknowledged that he paid patient recruiters to approach Medicare beneficiaries and convinced them to give him their Medicare information in exchange for specialized power wheelchairs, officials say.
Source: latimes.com

Blog: Medicare’s Competitive Bidding Will Save Money for People in Los Angeles County

I recently heard a presentation from a Medicare ombudsman in the LA area. Here are the things she refused to answer to. Beneficiaries in the areas where this program was first started are having a hard time getting the brands of equipment they need. They are forced to get the lowest-priced, least technologically advanced equipment. They are no longer visited regularly by medical professionals who help them use the equipment because providers cannot afford to make those visits under these new rules. Beneficiaries have lost peace of mind. In addition to this, when they want to complain to Medicare, they have to wait for long periods of time to find someone who (1) will answer the phone and (2) will answer a question correctly. CMS will not even consider their frustrations to be complaints when they are not there to answer the phone in a timely manner.
Source: patch.com

Medicare Revises Readmissions Penalties – Again

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

LA Acupuncture Clinic Owner on Medicare ‘Most Wanted’ List For Fraud

Photo via NorthJersey.com A man convicted of triple homicide has now been found guilty of fraud stemming from an identity theft ring which triggered the murders. Korean-immigrant Kyang-hyuk Choi was given a 15-month prison sentence to run concurrently with the three life terms he is already serving for the stabbing of a family. Choi is not eligible for parole until he has served at least 63 years behind bars. The stabbings, allegedly over payments for false residence documentation provided by Choi sent police on the trail of what would turn out to be a far-reaching and sophisticated crime ring. …
Source: iamkoream.com

Progressive Caucus Not Against Medicare Cuts

What about the other 54 members of the Progressive Caucus? Their absence from the letter is a clear message to the Obama White House, which has repeatedly declared its desire to cut the Social Security cost of living adjustment as well as Medicare. In effect, those 54 non-signers are signaling: Mr. President, we call ourselves “progressive” but we are unwilling to stick our necks out by challenging you in defense of Social Security, Medicare and Medicaid; we want some wiggle room that you can exploit.
Source: laprogressive.com

Baton Rouge, LA. Woman Sentenced for Involvement in Health Care Fraud Scheme

Thompson, along with the Anyanwus, also participated in a conspiracy to pay and receive illegal remuneration for the durable medical equipment billed by Lobdale. The Anyanwus paid Thompson and others a kickback for every claim for power wheelchairs and other durable medical equipment items that were submitted to, and paid by, Medicare. The kickback was based on a percentage of the reimbursement value of the equipment to the price of the particular item, thereby providing an incentive to recruit beneficiary claims for the most expensive models of durable medical equipment.
Source: sandpointpr.com

Blog: How Medicare Works with Other Insurance

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

Medicare System renueva toda la gama SALVAFIX

- Memory Pro es la categoría “Premium” de la gama. Este sistema patentado consiste en un código alfanumérico aplicado en los productos que permite utilizarlos de una manera más fácil, rápida y segura, además de permitir la articulación en el cinturón para realizar cambios posturales. Incluye también bandas laterales cosidas que evitan cualquier desplazamiento peligroso para el paciente y una doble fila de ollaos que mejoran la seguridad en la talla XL. Para utilizar estos sistemas es necesaria una formación especializada que la compañía ofrece a sus clientes a través especialistas en enfermería psiquiátrica.
Source: diariodicen.es

Does Medicare Supplement Plan F Cover it All?

Posted by:  :  Category: Medicare

DAMN!! -- I THINK WE'RE F*%KED by SS&SSHowever, the revised Medicare supplement plan F is being offered by insurance companies as is. Because enrollees of Medicare supplement plans believe that plan J’s two distinct benefits are rarely used, beneficiaries might as well opt for a more affordable plan. Medicare supplement comparisons charts indicate that plan F still offers the same benefits: Medicare Part A and B deductibles, excess charges, hospice care, in-home nursing, foreign travel emergency, and blood supply.
Source: onlyburn.info

Video: Medicare Supplement AARP Plan F Select is A Good Option

Summit Medigap: What Is Medicare Supplement Plan F?

The basic and original coverages provided by Medicare are Part A (hospitalization) and Part B (doctor visits and required medical equipment). Currently, there are at least 11 supplement plans referred to as Medigap policies that fill any coverage gaps involved with Parts A and B. One of these is Plan F. It’s important to know that not every company offers all 11 supplement plans. However, if they do offer at least 2 of them, they are required to offer Plans C and F. Plan F premiums typically cost between $65 and $295 per month. The premium will vary depending on the insurance carrier and the state you live in. Coverage Provided By Plan F The coverage required of Medigap coverage plans is mandated and regulated by the Centers for Medicaid and Medicare. Plan F also has a “high deductible” plan because it will not pay for any type of services covered by Medicare until the plan beneficiary has paid an out-of-pocket minimum of $2,000. Once that deductible has been met, Plan F will cover 100% of the co-insurances, co-pays, and deductibles of Parts A and B including hospice care co-insurance as well as preventative services. If you get the regular Plan F you will have no deductibles or coinsurance. When speaking to an insurance professional it’s important to make sure which Plan F you are being quoted. Comparisons There are only two supplements that covers any deductible expense of Part B, one of which is Medicare supplement Plan F. Additionally, this is the only supplementary plan that covers excess Part B charges. These charges typically accrue if doctors can legally charge more than what Medicare considers as reasonable service charges. Other supplement plans will usually pay for expenses that Medicare classifies as allowable. Finally, the excess amount that is allowable according to Medicare is covered by F. Is Plan F Right For You? Medicare supplement Plan F is viewed as one of the most popular plans because it covers 100% of the gaps encountered with Plans A and B meaning that it provides the highest amount of coverage of any of the Medigap insurance plans. For many individuals, the plan may seem a bit confusing initially. However, if you answer a few questions, it will not only explain the plan more thoroughly, you will be able to decide whether or not it is right for you. Basically, if you are someone who is willing to pay for 100% coverage, then this plan is tailored to meet your personal needs. With Medicare supplement Plan F, your only expenses will be your monthly premiums. For more information regarding this supplement plan, you can visit the official Medicare website or speak to a licensed insurance professional.
Source: blogspot.com

Medicare Supplement Plan F

Plan F also pays for outpatient deductibles as well, so seeing the family doctor or specialist is no problem. Medicare Part A and Part B coinsurance and copayments are covered, as are hospital costs after Part A benefits have been exhausted. Plan F also covers up to three pints of blood if transfusions are given, skilled nursing facility care, hospice care coinsurance and copayments and any Part B excess charges incurred. These can happen if a doctor refuses assignment and charges more than Medicare approves. The remainder, or excess charge, is paid by the supplemental insurance. For those looking for a good supplemental policy, Plan F will fit the bill.
Source: alissapajer.org

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

Medicare plans Fitness & Activity Sterling Heights

Posted by:  :  Category: Medicare

 There are various things to think about before taking a medigap plan Such as medicare select this policy is a Medigap plan that is particularly lower in premium. When you enroll in this type of policy, you are required to visit only doctors and hospitals that are within the network. If in case you visit a doctor or hospital that is not on the network, you have to pay more. When you plan to leave the policy, your insurance company must offer you a Medicare supplement policy that provides the same benefits.
Source: tuffclassified.com

Video: Defend, Strengthen & Extend Medicare & Canada’s PUBLIC Health Care System

Rotary benefits Sterling, Baldwin, mobile dental clinic, others

We award high school scholarships, purchase turkeys and volunteer for the Sterling House Thanksgiving program that helps those in need, volunteer for the veterans breakfast at the Baldwin Center and help with other events when requested by Baldwin Center Director Diane Puterski, and we coordinate a hot dog lunch in August for day camp boys and girls at the South End Community Center. We have fun together with our families at various social events and we organize several fundraisers throughout the year.
Source: stratfordstar.com

Sterling Life Insurance Medicare Supps.

Has anyone heard of Sterling Life (captive company) reducing Medicare Supplement rates in PA. I talked to a man that claims that his insurance plan premium was reduced by around $40 per month without switching plans? Any Sterling agents on the forum? I am also interested in finding out what Sterling is going to do this year and next with their PFFS. If anyone has info, please post.
Source: insurance-forums.net

Sterling Health Insurance Company Review

Sterling Life prides itself on providing high quality personalized service to all its clients. The company motto is “Real People, Wise Choices.” The Sterling website provides a testimonial page featuring comments by current customers. Sterling members have access to an excellent interactive portal where they may file a claim, make a premium payment, download information and forms, or shop for a new insurance plan. Plans are available to fit the needs of any individual wherever they might live in the US.
Source: healthinsuranceproviders.com

Sterling Ridge Assisted Living

Sterling Ridge is an assisted living facility. Assisted living facilities are an apartment-style habitat designed to focus on providing assistance with daily living activities. They provide a higher level of service for the elderly which can include preparing meals, housekeeping, medication assistance, laundry, and also do regular check-in’s on the residents. Basically, they are designed to bridge the gap between independent living and nursing home facilities. When thinking about how to pay for care, assisted living facilities are generally less expensive than nursing homes, if assisted living is a viable option for your loved one.
Source: ourparents.com

Medicare paid $5.1B for poor nursing home care

Overall, the review raises questions about whether the system is allowing homes to pay for poor quality services that may be harming residents, investigators said, and recommended that the Centers for Medicare & Medicaid Services tie payments to homes’ abilities to meet basic requirements for care. The report also recommended that the agency strengthen its regulations and ramp up its oversight. The report did not name individual homes and did not estimate the number of patients who had been mistreated, but instead looked at the overall number of stays in which problems arose.
Source: publicradio.org

Sterling Insurance providing Medicare Supplement Policies in California

Health Plans Heath Plans Mediacre Insurance Policy Medicare Medicare Advantage Plans Medicare Effective Dates Medicare Health Plans Medicare Insurace Plans Medicare Insurance Medicare Insurance Plan Medicare Part A Medicare Part A and B Medicare Part B Medicare Part D medicare plan Medicare Plan D Medicare Plans Medicare Plans for your State Medicare Policy Medicare supplement Medicare Supplemental Insurance medicare supplemental insurance plans medicare supplemental insurance quotes medicare supplemental insurance rates Medicare Supplement Insurace Medicare supplement insurance Medicare Supplement Insurance Plan F Medicare Supplement Plan MEDICARE SUPPLEMENT PLAN G Medicare Supplements Plan Medigap Medigap Advantage Plans Medigap insurance company Medigap Insurance Plans Medigap Plan Medigap Plans Medigap Plans for your State Medigap Policy medigap quotes medigap rates Medigap Supplemental Plans Meidcare Plans Part D Prescription Plan Threat to Medigap Urgent Issue for Medigap
Source: medigap4seniors.com

Billing Software Vendor Advises Clients to Check Their Medicare Billing Rates

Posted by:  :  Category: Medicare

bag & contents - Stolen by quadrapopWhy: As I have previously written, most agreements with EHR or practice management software vendors often have language protecting them against any liability that may be caused by the use of its software. This can range from faulty diagnosis recommendations to coding wizards. In this case the vendor is reminding clients that since Medicare does not announce rate changes, it is up to the providers to collect that information. Always read the fine print and stay on top of coding and billing.
Source: medicalpracticetrends.com

Video: Medicare Billing www.AcuServeCorp.com Medicare Billing Specialist- ACU Serve

MEDICARE PROGRAM; PART B INPATIENT BILLING IN HOSPITALS (CMS

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Source: wn.com

A potentially dangerous Request.Path value was detected from the client (?).

[HttpException (0x80004005): A potentially dangerous Request.Path value was detected from the client (?).] System.Web.HttpRequest.ValidateInputIfRequiredByConfig() +9023321 System.Web.ValidateRequestExecutionStep.System.Web.HttpApplication.IExecutionStep.Execute() +35 System.Web.HttpApplication.ExecuteStep(IExecutionStep step, Boolean& completedSynchronously) +184
Source: ahrq.gov

New software to combat Medicare fraud finds $115 million in first year savings

The system approaches Medicare fraud differently than in the past.  Before, Medicare would pay claims and then go after the fraudsters (pay and chase).  Now, officials hope to be able to identify fraudulent claims before they are paid.  Since its start in 2011, the system has screened all Medicare claims (over one billion of them), started 536 new investigations and aided in 511 additional investigations already in progress.
Source: pathologyblawg.com

KHN Analyzes Regional Variations In Medicare Quality Payment Program

Modern Healthcare: EHR Tech Help, Quality Gains Linked: Study High-intensity technical assistance might be key to realizing quality gains from the use of electronic health-record systems among small-practice doctors and those practicing in underserved areas, a new study suggests. The study, published in Health Affairs and undertaken by researchers from Weill Cornell Medical College and the Primary Care Information Project of the New York City Health Department, found that EHR implementation alone was not enough to improve the quality of care provided by the primary-care physicians studied, who worked in small practices in underserved neighborhoods in New York. Physicians receiving assistance from the Primary Care Information Project scored higher on selected quality measures than physicians not receiving the assistance. The Primary Care Information Project provided subsidized EHR software, clinical-decision support and onsite technical assistance to about 3,300 physicians at roughly 600 primary-care practices, according to a Weill Cornell news release (Barr, 1/8).
Source: kaiserhealthnews.org

Important NARHC Announcement on Sequestration and Rural Health Billing

This listserv message is directed at the Medicare FFSprogram (i.e., Part A and Part B). In general, Medicare FFSclaims with dates-of-service or dates-of-discharge on or after April 1, 2013, will incur a 2 percent reduction in Medicare payment. Claims for durable medical equipment (DME), prosthetics, orthotics, and supplies, including claims under the DMECompetitive Bidding Program, will be reduced by 2 percent based upon whether the date-of-service, or the start date for rental equipment or multi-day supplies, is on or after April 1, 2013.
Source: ams-software.com

Best Medicare Supplemental Car Insurance For Better Will Benefit

Another thing to recognize is if currently the doctors you already use are proficient to be detected with the Medicare health insurance parts and software programs you choose. For instance, that includes the Medicare Advantage Plan only researchers who contract their services with Treatment can be encountered. These docs have pre-approved a set dollar quantities per services this Medicare has established upon as prolonged periods of time as you catch sight of a certain round of doctors. This may not necessarily quite bode well if you have recently with your medical doctor for 30 nicely years and are not wanting these types a drastic change in health health care providers at this amazing point in time.
Source: thepalmbeachsteakhouse.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

Medicare EHR Incentive Program Vulnerable to Abuse, Report Finds

For the report, OIG investigators analyzed audits of EHR incentive payment attestations, reviewed internal CMS and Office of the National Coordinator for Health Information Technology documents about the program and interviewed CMS personnel. The report covered the period from May 2011 through December 2011, when Medicare incentive payments totaling about $1.7 billion were made to providers.
Source: californiahealthline.org

Medicare paid $3.6 billion for electronic health records but didn't verify quality goals were met

Criticism from Republicans in Congress has mounted in the wake of the Center’s “Cracking the Codes” series published in September. The investigative project documented that thousands of medical professionals have steadily billed Medicare for more complex and costly health care over the past decade — adding $11 billion or more to their fees—and strongly suggested that the rapid growth in the use of electronic health records and billing software has contributed to the higher charges.
Source: publicintegrity.org

Will Medicare’s Annual Wellness Visit enhance physical & cognitive health? Probably

much of med­ical care, which is pri­mar­ily directed at treat­ing acute and chronic ill­nesses, the AWV aims to pre­vent the onset of dis­ease and dis­abil­ity or to slow the pro­gres­sion and exac­er­ba­tion of exist­ing ill­nesses… less than six per­cent of Medicare ben­e­fi­cia­ries received an AWV in 2011 (Editor’s bold). Many ben­e­fi­cia­ries do not know to ask for the AWV, and providers fre­quently do not pro­mote it. The real­ity is, how­ever, that AWVs can be effi­ciently deliv­ered by non-physician prac­ti­tion­ers (NPPs) in a frac­tion of the time required for a tra­di­tional “phys­i­cal” through the use of inno­v­a­tive soft­ware. While most physi­cians believe they offer well­ness ser­vices, the real­ity is that most do not offer the AWV. A true Medicare AWV involves not only a review of med­ical his­tory and med­ica­tions, but also a con­ver­sa­tion about the patient’s func­tional abil­ity and lifestyle issues that impact health. A list of risk fac­tors, con­di­tions and treat­ment options must be estab­lished. Cog­ni­tive func­tion must be assessed, and a 5–10 year pre­ven­tive screen­ing sched­ule created.”
Source: sharpbrains.com

Medicare PQRS Requirements for Physical Therapy

Finally, I’ve heard considerable confusion about relationship of PQRS, the new functional limitation reporting and g-codes. PQRS and Functional Limitation Reporting have nothing to do with each other. They share only one thing, they both use G-Codes to report information to CMS. G-codes are just a set of 5 digit codes that can be submitted like CPT codes but CMS uses them to cover additional requirements. Most people are familiar with G0283 being CMS’ own code for E-stim, but now they’ve branched out and used the series for both PQRS and Functional Limitations.
Source: clinicient.com

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: Humana Health Insurance Chiropractic Benefits Burlington NC

Altius Health Plans Altius Advantra Medicare Review

Altius Health Plans offers Medicare health insurance programs for residence of Utah and a county in Wyoming.  Altius Advantra and Altius Advantra Preference are Medicare Advantage HMO plans available in Box Elder, Cache, Daggett, Davis, Duchesne, Morgan, Rich, Salt Lake, Summitt, Tooele, Wasatch, and Weber counties in Utah as well as Uintah county in Wyoming.  Altius Advantra is an HMO-POS plan, and Altius Advantra Preference is a plain HMO only available in Davis, Salt Lake, and Tooele counties.  The coverage does include Part D drug coverage as well as health benefits.  Below is a review of the benefits they offer:
Source: medicare-plans.net

Will Your Medicare Advantage Plans Still Be Available In 2010

All plans must send you a notice of termination if there plan is terminating. When a plan terminates they do NOT enroll you in a part D plan. In some cases a plan may try to change you to another plan that they offer, however in they are still required to notify you in writing and give you the full details and you still have the option of changing plans if you are not satisfied with the benefits offered. In the case of Advantra Plans this year, you will need to choose another Medicare Plan. Some Advantra Freedom plans were offered as MAPD which means that the plan itself included the prescription drugs. You may also have a PFFS and a seperate Part D. If the part D is seperate you should still have RX coverage. If you do want to keep Advantra as your Part D you can still get a seperate Part D plan as long as it is a PFFS. You should call a broker and get a list of comparable options. You can ask for health plans only if you wish. Also if you just want an evidence of coverage you can call Advantra back or visit http://www.choicesformedicare.org and request one. Make sure you are specific in your request and they will know what to send.
Source: wordpress.com

Advantra Rx NOT Renewing Their Medicare Contract

one of my customer’s sent me a copy of the letter from AdvantraRX dates October 2. Here is what it says (sorry about typos, i type fast): Dear Mr. Smith, AdvantraRx Preimer by Coventry Life and Health Insurance Company, a stand-alone prescription drug plan with a Medicare Contract, will no longer operate as of January 1, 2011 so your Medicare Prescription drug coverage through AdvantraRx Premiuer will end December 31, 2010. If you want Medicare prescription drug coverage starting January 1, you need to join a new Medicare drug plan by December 31, 2010. Take Action by December 31 to avoid losing drug coverage. If you want Medicare Rx drug coverage after December 31, you need to join another Plan or medicare advantage plan that offers drug coverage. You can join a new medicare drug plan anytime between October 1 and January 31, 2011. However your AdvantraRx Premier coverage ends December 31, so you should join a new medicare drug plan by december 31 to make sure you have drug coverage january 1. If you join a new plan AFTER december 31, your new coverage won’t start until the month after you join. What happens if you don’t join another medicare drug plan? if you don’t join another medicare drug plan by January 31, your next chance to join will be from october 15 through december 7, 2011. You may also have a pay a late-enrollment penalty to join later. The the letter gives a list of a bunch of companies and the 1-800 Medicare number and website. It doesn’t state anything anywhere about automatically enrolling them into another plan if they do nothing. In fact, it states the opposite.
Source: insurance-forums.net

Medicare Advantage Plans and PFFS Plans

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Source: merchantcircle.com

Visting Nurse Association to hold flu shot clinic Jan. 16

The flu shot will be available for people 18 years of age or older and nonpregnant women. The cost is $27 a person. The VNA also accepts the following insurances: American Progress (Today’s Options), Advantra Freedome, Aetna Medicare Advantage, Federal Employee Program, First Priority, First Priority 65, Gateway Assured, Geisinger Gold, Geisinger Health Plan, Highmark Freedom Blue PPO, Humana Gold, Medicare Part B, Secure Horizons, Keystone Senior Blue and Unison Advantage.
Source: nursefuture.com

The Sullivan Independent News

The Visiting Nurses Association will hold a flu shot clinic at the Sullivan Senior Center on Tues., Oct. 13 from 12 p.m.- 3 p.m. In order to be sure a vaccine is available for you, you must call or stop by the Senior Center and have your name put on the vaccine list. The VNA will be bringing 150 vaccines, but more will be available if we see more people are signing up. This will be a one-time clinic. Those planning to receive their vaccine may show up anytime from 12 p.m.-3 p.m. To avoid the congestion and long waiting periods, you may wish to wait a little later and not all show up at 12 p.m. Insurances accepted by the VNA for this clinic include: Medicare Advantage Plans, Essence, Coventry Advantra Freedom, GHP, Advantra, GHP Advantra Freedom, GHP Gold Advantage, Humana Choice PPO, Humana Gold Choice PFFS, Humanna Gold Plus HMO and Mercy Medicare Advantage. Other insurances that did not contract with the VNA and will not be accepted are: Medicare Advantage Plans, Secure Horizons, Aetna Medicare, Anthem Senior Advantage, Cigna Medicare Access, Sterling Option, Wellcare, Evercare or any other Medicare Advantage or out-of-state plans. Medicaid is not accepted. If you have another primary insurance, you may not use Medicare or Medicare Advantage. Those wishing to pay “out of pocket” for the vaccine may do so. The cost is $30. Visiting Nurses Association is a non-profit community based organization dedicated to serving the healthcare needs of your community. Please help us by giving us your correct insurance at the time of service.
Source: mysullivannews.com

Kathie Bracy’s Blog: Will Ohio STRS retirees be ‘used as pawns so that the state could save a little bit on its OPEB liability’?

A forum for Ohio educators, sharing thoughts regarding their health care and pension system (STRS Ohio). Researcher John Curry manages a clearinghouse of related e-mails, articles, announcements, etc. His daily mailings include many items that do not make it to this blog. Contact John (curryfeezer@yahoo.com) if you wish to be on his e-mail list. Kathie Bracy: kbb47@aol.com.
Source: blogspot.com

Coventry Comments on Marketing PFFS/PPO/HMO (not SNP) plans to Dually Eligible Individuals (those with both Medicare and Medicaid)

Coventry is looking forward to a very exciting and successful new year and to great opportunities to continue our shared success in 2009! It is our goal to continue providing information and tools to support your efforts in assisting Medicare beneficiaries to make informed health care decisions. We want to remind you of some key considerations to guide your interaction with vulnerable populations such as: Medicare-Medicaid dual eligibles, institutionalized beneficiaries, beneficiaries in long-term care or assisted living facilities and seniors with chronic conditions.
Source: ritterim.com

HealthAmerica ranked top 20 by U.S. News & World Report

HealthAmerica provides its members with a greater combination of health benefits and services for their money suitable to their needs and wants. They offer more health benefits, like coverage for most preventive health services, including periodic checkups, coverage for hospital and surgical care, emergency care worldwide, and chiropractic services. They offer access to over 35,000 providers in Pennsylvania and Ohio and more than 350 hospitals.  As a member, you are also entitled to the WellBeing program. This program offers free wellness programs and discounts on a wide range of products and services such as:
Source: healthplanone.com