Providers Face Growing Demands From Increasing Number of Medicare Contractors

Posted by:  :  Category: Medicare

Jessica Sundheim by On BeingFirst there is the general category of claims processing contractors, now mainly known as “Medicare administrative contractors” (MACs) but also referred to, still, in statutes, laws and judicial decisions, as fiscal intermediaries or carriers. MACs are involved in the first level of appeals and may contact providers for a variety of reasons, including the resolution of issues regarding initial and renewal enrollment applications; providing education and guidance on procedures for billing Medicare; resolving issues regarding claims; requesting medical records related to claims that have been submitted so the MAC can perform a medical review; paying providers for approved claims or explaining why some claims are not processed or are denied; and recovering overpayments on claims previously processed. CMS uses Qualified Independent Contractors to conduct reconsiderations, the second level of appeals.
Source: wolterskluwerlb.com

Video: Introduction to Medicare – Strengths, Weaknesses, and Applications of Medicare Data

Medicare Advantage Plans grow amid pay cuts by the Obama Administration

“The Medicare Advantage program is stronger thanks to the health care law, with estimated premiums down 10 percent and enrollment up 28 percent since the law was enacted,” a spokeswoman for the Centers for Medicare & Medicaid Services said. “We are reducing taxpayer-funded overpayments to insurance companies, and giving more incentives for them to provide quality care for seniors.”
Source: medicarewire.com

Patient Assistance Applications In Place of Medicare Part D

The procedure calls for filling out types, proving your revenue (or lack there of) and your physician signing the form and submitting a prescription. The process can take numerous months for your medication to be approved and shipped to you. You will also have to reapply periodically how often you ought to reapply depends on the policies of that medication organization.  There is a group in Utah who specializes in filling out the paperwork for you for a little fee.
Source: fantasyfootballfiles.com

Patient Assistance Applications In Location of Medicare Portion D

The method demands filling out forms, proving your income (or lack there of) and your medical professional signing the form and submitting a prescription. The procedure can take numerous months for your medication to be authorized and shipped to you. You will also have to reapply periodically how usually you ought to reapply depends on the policies of that medication company.  There is a group in Utah who specializes in filling out the paperwork for you for a small fee.
Source: croatianantiagingcream.com

How To Enroll In A Medicare Supplement Plan F Insurance Policy

Finally, be sure to review your coverage each year. All Medigap policies are subject to inflation, just like any other insurance. Most people will see an increase once a year, although some carriers also have “birthday increases,” which means the policy costs will increase slightly whenever your turn a year older. The good news is that you can always shop your policy when rates go up. It’s very easy to change insurance companies as long as you can pass the medical health underwriting. By shopping your policy annually, you can be sure to get the most out of your healthcare insurance dollars each and every year.
Source: return2writing.com

Patient Help Applications In Location of Medicare Element D###

Some of the huge pharmaceutical firms offer you an assistance system to those who can not afford the price of medication and have no insurance coverage or government assist. This is genuinely a blessing for these who get this assist. This is an option to medicare component d The process needs filling out forms, proving your income (or lack there of) and your physician signing the form and submitting a prescription. The approach can take several months for your medication to be authorized and shipped to you. You will also have to reapply periodically how often you must reapply depends on the policies of that medication organization. There is a group in Utah who specializes in filling out the paperwork for you for a little fee. Find Out If You Qualify Some PAPs demand these with a slightly more substantial revenue to make a co-payment for a portion of the expense of their drugs. Other individuals charge no co-payment to any individual. Every single drug firm is free to set their personal guidelines on whom and how significantly they will assist low-earnings and uninsured patients. This is equivalent to the medicare element d "Additional Assist reporting medicare fraud" system. Due to the fact it can take quite a bit of time to be authorized for these applications, what can be accomplished in the meantime to obtain affordable medication? If your physician occurs to have samples, you might be in a position to get some or all of the medication you need till your PAP medicines arrive. Nonetheless, this is not usually the case. If you locate yourself un-insured although awaiting approval of a PAP, you will need to uncover the really lowest prices accessible although making specific you are obtaining top rated-good quality drugs. The new medicare portion d government program can be helpful, but has month-to-month fees and an annual deductible. A Very good Option Canadian mail order sources are possibly a greater alternative. To make certain that you are dealing with a legal and trustworthy supply, pick a business that calls for confirmation of your prescription by your U.S. medical doctor as nicely as sign off by a Canadian medical doctor. Just be cautious though, any business that advertises "no prescription necessary" is operating illegally as properly as without having regular pharmacy ethics. Most of these businesses have been shut down, but beware if you locate a company offering this type of service. Hopefully, you can get aid via PAPs if you need to have this assistance. However, several folks are turned down every year. To help you even though you are applying, search for and assessment Canadian mail order prescription services to locate the very best costs available. To locate the Utah group talked about above go here and click on the correct hand link that says "Free Prescriptions (Fee For Service)" Submitted by Darwin Corby Professional Services Canada 1-800-946-4820 Specializing in Canadian Pharmacy Services
Source: blogigo.com

Medicare Advantage Applications Grow

Participants Sleep Blood Pressure Cholesterol Health Care Seniors Respondents Baby Boomers University Of Michigan Alzheimer S Disease Journal Of Medicine Researcher Fruits Vegetables Enough Money Insurance Social Security Lexington Associate Professor Dementia Carrots Aarp Heart Health Exercise Likelihood Diabetes Recession Health Benefits Health Care Costs Nutrients Memory Loss Diet Risk Heart Disease Depression Risk Of Heart Attack Heart Attack Heart Failure Disease Control And Prevention Cancer Hospitalization Cognitive Impairment Fear School Of Medicine Two Thirds Type 2 Diabetes University Of Pittsburgh Antioxidants Quality Of Life Lead Job Prescriptions Elderly Medicare Phd Doctors Vitamins Drugs Medication Physical Activity Medications Wayne Thompson Heart Stroke Memory 10 Years High Blood Pressure Men And Women Mild Cognitive Impairment Walden Mortgage Group Longevity People Survey Kentucky Kentucky Reverse Mortgage Centers For Disease Control And Prevention Lifestyle Cognitive Decline Reverse Mortgages Older Adults Centers For Disease Control Adults Assistant Professor Healthy Diet Obesity Medicine Alzheimer Disease Brain Stroke Retirement Age Retirement Diseases Heart Attacks Memory Problems Reverse Mortgage Population Risk Of Heart Disease Health Long Term Care Nuts Money Mice
Source: reversemortgagekentucky.com

Low Volume Adjustment & Medicare Dependent Hospital Extension Rules

A number of MDHs that requested SCH status or dropped their rural classification did so with the proviso that if MDH status was reinstated, they wanted to remain MDHs. This question was raised in the FY 2013 final IPPS rules. A comment was made to CMS that hospitals should be allowed to retroactively rescind their request for SCH status and have MDH status seamlessly reinstated. CMS responded that if the MDH program was extended, it would “develop policy to implement the specific provisions of such legislation.” Many read that to mean CMS would allow MDHs to retroactively rescind SCH status. However, CMS does not state this in the final IPPS rules; it leaves the matter open to “the specific provisions” of the legislation that is passed. The taxpayer relief act simply changed dates, so in CMS’ interpretation there are no specific provisions in the law allowing hospitals now carrying the SCH or urban designations to be seamlessly returned to MDH status.
Source: healthcarereforminsights.com

CMS prepares to take exchange applications

A typical small business might need an average of about 13 minutes to submit a paper application for the Small Business Health Options Program (SHOP) exchanges, and an employee at a small business that uses a SHOP exchange might need an average of about 9.5 minutes to submit an employee SHOP application, officials said.
Source: lifehealthpro.com

Free government cell phone program isn’t funded with tax dollars

Posted by:  :  Category: Medicare

105/365 - July 2, 2008 - What's in My Bag by meddygarnetThis is totally incorrect and idiotic. You clearly have zero knowledge of how Ronald Regans program works. A tax is legislated by a government body not by a board of directors of a telecommunication firm. This service is NOT mandatory it is a telecommunication service and you choose to have a cellphone or home phone or internet. These are for profit firms and they can do what they want with their money and charge any fee they would like. They also can have whoever they would like to manage the fee, as they do in ethis case allowing the federal government tomanage the fees, you have a choice to not pay the fee by NOT having a telecommunication service. Hell, you can send smoke signals or write letters. There are not fees on written letters. You have a choice to pay the fee or not pay the fee. You DONT have a choice to pay taxes. they are required to be paid annually. There is HUGE difference, hence the reason will never be pulled because the government funds nothing only manages the program. Educate yourself, before speaking on topics.
Source: freegovernmentcellphones.net

Video: Nevada Medicare- 1-800-643-7544

Oklahoma Cancer Patients Worry About Cuts To Medicare Caused By

Once every three weeks, he spends three hours at Oklahoma Oncology, getting chemotherapy infusion treatment, but there are concerns there that patients like Joe may be forced to find a new place for treatment and it all stems from the sequester.
Source: newson6.com

Maintain A Positive Attitude And Live In Size With Medicare Health Supplement Plans

The very Top 5 VC funding deals throughout the 2012 were: Castlight Health, a service of healthcare globe wide web and mobile-based transparency solutions that enable comparisons of doctors, hospitals and treatment procedures based during price and quality, which raised 0 million, 23andMe, a personal genetics company that helps sufficient reason for the understanding associated with wellness and disease prevention through its personal genome service, which raised million, GoHealth, an online portal in which it helps compare while shop health health care insurance coverage, which mentioned million, Kinnser Software, a provider of clinical encourage to home health companies, which farmed million, and Practice Fusion, this provider of free web-based electronic medical records (EMR), that typically raised squillion.
Source: letsgocostabrava.org

William Blair Analyst: DaVita Set to Gain from Medicare Advantage Reimbursement Increase

The decision against a reduction in Medicare reimbursements was cited as a reduction in near-term headwinds, while also improving the company’s position in the long-term. DaVita was highlighted as one of the “best positioned” companies to benefit from this ruling, and is maintained at an Outperform rating.
Source: benzinga.com

Pricey Medicare Supplement Tempo OfferedWorld Order of Forest Watchers

A What Are The Long Term Affects To My Medigap Plan By Obamacare? requires every single the guesswork accessible of finding definitely being care policy cover. Rather of getting choose on from hundreds of numbers of approaches and coverage, all you will might want to concentrate concerned with is your budget, your well being, and then decide on which blueprint out of which the 12 perform the ideal for your own personal circumstance. In the case when later on around the road factors adjust, then you will certainly utilize to rethink plans, and the latest great agency am obliged to make that pursuits quite effortless with regard to you by making contact with you every 1 yr to make sure you are investing in the greatest charges obtainable to anyone.
Source: forestwatch.org

Analysis says state could save on Medicare negotiation

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Source: uwire.com

Have Not Fret: Elderly Home Care In Addition To The Medicare

It has to be emphasized strongly which unfortunately compare medicare supplement plans.supplement plans don’t intend to remove and replace Medicare as the main source of health care insurance. What they do for you to actually supplement Medicare health insurance. For example, in order to eat full use of a Medicare supplement plan, one must get yourself a medicare insurance insurance premium and see this also aspect can be covered by each of our Medicare supplement approach. Purged are the days or weeks when emails required serious business. Nowadays, most letter boxes get hundreds of spam messages every day week. What normally is important regarding note that selected of them are really so well written that you get convinced and end up sending personal vital information not unlike online banking details, social security number, and credit card account number, which exposes you to masterplans scams. You may may not identify that you ‘ve got been scammed until you observe a little bit of fraud transactions referring to your credit message or in banking account. As a way to insulate yourself by using such frauds, most people should never part your confidential expertise with anybody online. Baby Boomers were born over a post World Conflict II era factors why you should the Vietnam Battle. This means that seniors came of age during the your time where they struggled for civil legal rights in the Our nation. This will shows that you, as a section of the baby boomers population, know very well about your legal as a kama’aina ( of the America. A new benefits of any 12 Medigap Plans will differ. All plans package the basic benefits, and standardization of the plans owns helped to reduce consumer confusion when it comes to picking a plan. Keep in imagination that Texas Medicare supplement coverage only will commence once a insurance deductible has been encountered. The correct way will your fresh medications be mentioned under the plan you are thinking? If you take only start drugs, you should not have a irritation – but brand drugs can stay covered differently from plan to wish. Under alternative plans, co-pays with regards to the same brand name drug may want to be dramatically defined. This may add up into hundreds of us each year. Wellness and comfort probably not a reality. All non-exempt assets owned from the couple are involved together to determine your eligibility by Medicaid. Currently the spouse that proceeding into the nursing home is disqualified within receiving Medicaid just before individual spouses’ resources total ,000 or less. The opposite spouse can hire their non-excludible strategies to a more around 0,000 (it changes annually). States have different laws pertaining that can Medicaid eligibility. It is better to check with a state to learn exactly what the qualifying factors are already. It again is also central to remember that the bills have to have to be verified to ensure that everything has been applied correctly. If something comes to you equally a shock you should call in addition to the inquire about each of our charges. Doing this is true with the help of prescription drugs. Always ask about generic versions behind the medicine of which is needed. Also check as different pharmacies have definitely different costs joined with the charges of the medication. According to many aging population people having a huge proper Medicare is literally more than a sufficient quantity to cover to the top level their medical charge as and when need arises. However this is considered to be not true. Merely relaying upon Medicare can often be risky especially when it comes to the later years of life. Buying Medicare increase leads can seal in gaps that most Medicare failed in cover up. People will afterwards no longer consider these leads seeing as a burden as a way to them and does accept them comfortably. It is however very greatly important to understand these leads correctly together with see if you meet all ones own needs. Here in having such takes you all your controlled expenses can successfully be covered. This can transpire even without a additional financial input.
Source: typepad.com

Assisted Living Programs With Medicaid Waivers Skirting Compliance Rules

Posted by:  :  Category: Medicare

"Citizenship is a tough occupation which obliges the citizen to make his own informed opinion and stand by it." ~ Martha Gellhorn  by eyewashdesign: A. GoldenThe Innovation Series is Brought to you by Care Innovations, a joint venture between Intel Corporation and GE, committed to creating technology-based solutions that give people confidence to live independently, wherever they are. With GE’s expertise in healthcare and Intel’s expertise in technology – we’re innovating to change the way care and solutions are delivered.… Read More »
Source: seniorhousingnews.com

Video: Medicare Provider, Assisted Living

Medicare Overpayment Recovery Extended to Five Years

Critics say CMS should be able to handle overpayment recovery within three years, and auditing the additional two years will put an unreasonable burden on providers. In addition, the legislative process leading to this provision was not transparent and many lawmakers “might not even have known what they were voting on,” said Rick Pollack, executive vice president of advocacy and public policy at the American Hospital Association, in a Modern Healthcare report.
Source: about.com

Knollwood Pointe Assisted Living Community

Knollwood Pointe Assisted Living Community 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

Assisted Living Expansion and the Market for Nursing Home Care

Researchers wanted to see how an increase in the local supply of assisted living was associated with fewer private pay—and sicker—residents in nursing homes. They looked at 13 states for which there was detailed data available on assisted living facilities. For data on nursing homes, they turned to the Centers for Medicare & Medicaid Services (which certifies facilities), and to the Minimum Data Set for facility case mix, and resident clinical and functional status.
Source: rwjf.org

Integrating Medicare and Medicaid: What’s Happening Now, and What It Means for Assisted Living and Other LTSS

This webinar, sponsored by the Assisted Living Consumer Alliance, explains the dual eligible integration process, with a focus on how the new demonstrations will affect long-term services and supports (LTSS) and their significance to assisted living and other long term services and supports. Speakers are Georgia Burke and Eric Carlson, attorneys from the National Senior Citizens Law Center. Jody Spiegel, Director of Bet Tzedek’s Nursing Home & Assisted Living Advocacy Project, will be the moderator.
Source: nsclc.org

Is Your Assisted Living Facility Really an Assisted Living Facility?

The article also reports that there has even been fraud at some of the more established elderly assisted living homes. It’s unfortunate that the people running those facilities have engaged in unethical behavior to siphon money from Medicare and Medicaid programs. Examples of what they’re doing include claiming to offer services they don’t actually offer, patients making extra doctor visits and receiving unneeded prescriptions, unnecessary surgeries, therapies and costly procedures. However, the patients for the most part are not actually receiving these treatments. Instead, doctors and facility owners and managers split the funds with each other.
Source: shalomelderlycare.com

Assisted Living Los Angeles

This letter is in appreciation for the care given my mother, Rose Feingold, during more than three years that she was a resident at Raya’s Paradise. When she first came to you at the age of 98 she was frail and weak and I did not expect her life to last more than a few months at most. She soon began to rally, looking better and eating more. Her spirits lofted and she was much improved in a few weeks. It was clear that the improvement was due to the gentle, kind and loving care given by the staff. It was as if she was living in a home surrounded be her own family. She died quietly and peacefully as if her own home. The facility was always exceptionally tidy and clean. The meats were nutritious and tasty and the excellent home cooking was the reason. The patio and garden areas were carefully tended and the residents could enjoy the outdoors in good weather. I express my thanks to you for the fine care given to my mother and for the ease of mind I had during the years she was with you. Israel Feingold, M.D.
Source: rayasparadise.com

OIG Report: Assisted Living Facilities need better compliance with federal regulations for HCBS

In its December 2012 Report, “Home and Community-based Services in Assisted Living Facilities,” the Office of the Inspector General (OIG) took a deeper look into the Centers for Medicare & Medicaid Services (CMS) waivers that allow coverage of HCBS by State Medicaid Programs. The waivers examined in this report include 1915 (c) and Section 115 research and demonstration. HCBS services, according to 42 CFR § 440.180(b), can include case management and homemaker services, personal care services, home health aide services as well as other services that are meant to aid in keeping people from being moved to a more traditional long term care setting.
Source: cmscompliancegroup.com

Is United Healthcare Medicare Supplemental Insurance My Only Option?

Posted by:  :  Category: Medicare

For most United Healthcare Medicare supplemental insurance subscribers, the plan is a lifesaver—making accessible important, lifesaving health and medical treatments, surgeries and medicines. Many believe that because Medicare doesn’t cover a particular procedure or treatment, that this is the end of the road for them—hardly the case. Unfortunately, many that suffer from mental health disorders find themselves in this situation—for one reason or another, the CMS (the Center for Medicare & Medicaid Services) doesn’t cover very many mental health-related medicines and treatments.
Source: seniorcorps.org

Video: AARP Medicare Supplements | United Healthcare Supplement

Regional VP For United Healthcare In SoCal Discusses Important Medicare Information

[…] STUDIO CITY (CBSLA.com) — Regional Vice President for United Healthcare Medicare & Retirement in Southern California, Michael McCarthy, stopped by KCAL9 Sunday to make Medicare beneficiaries aware of the enrollment deadline!Source: cbslocal.com […]
Source: cbslocal.com

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

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

Nothing found for Wp Unitedhealthcare

A guide to affiliate & internet marketing. Learn the secrets some of the pros use to make money online via blogging, article marketing, and email advertising. Resources to help even the newest of internet marketer get started on the right track to success.
Source: hbimarketingblog.com

Medicare part d creditable coverage

CMS has clarified that if an employer is not applying since the subsidy, the employer might notice that its treatment remedy plan’s insurance is good if the program ideas meets everything four of the future criteria: Provides reasonably priced get admission to to retail providers and, optionally, as mail approach coverage; Is arranged to pay on standard at smallest amount 60 percentage of participants’ dose medicine expenses; and For employers that go through a stand-alone cure treatment plan; The dose antidote assurance has no annual profit maximum vantage or a maximum annual profit payable by the list of at smallest amount $25,000; or The healing medication insurance has an actuarial tension that the sum payable by the agenda will engagement at least amount $2,000 in keeping with Medicare eligible individual. For employers that go through integrated homeopathic coverage, the integrated medical diary has no extra than a $250 deductible consistent with year, has no annual advantage maximum or a maximum annual vantage payable by the schedule of at least amount $25,000 plus has no less than a $1,000,000 life combined advantage maximum.
Source: uni.me

Independent Career Agent Opportunity

Why contract with one of the leading organizations in health care to help improve the lives of millions? Entrepreneurial opportunity. Independence. The amazing velocity of our industry. The door-opening power of UnitedHealthcare. Not to mention the 10,000 Baby Boomers turning 65 every day*. You run your own business. And you reap the rewards with exceptional earning potential°. This is no small opportunity. It’s where you can do
Source: careers.org

United Healthcare Medicare plans

As an example, United Healthcare Medicare HMO plans are super easy to utilize and comprehend. Simply pay out a set fee whenever you will need healthcare providers. You understand upfront precisely what the expenses will be and are not surprised by a huge physician’s expenses. An HMO plan charge you a collection price with an doctor office visit, emergency room go to, and hospital stay. The particular fees are generally under you’d probably pay using conventional Medicare health insurance insurance coverage. The sole probable issue with the HMO program’s you need to utilize physicians inside community until you need crisis attention. If you are using a doctor outside of the system, you should spend entire out-of-pocket price.
Source: blogspot.com

Join UnitedHealthcare for a National Medicare Education Week Event!

Representatives from United Healthcare will share important Medicare information and give an overview on social media.  Hands-on computer training will follow the presentation and will help you explore online resources for understanding.
Source: wordpress.com

UnitedHealthcare patients in southern Arizona to benefit from improved care coordination and enhanced health services through AzCC – Tucson Medical Center

For example, if a patient is being treated for heart disease, all the tests, screenings and medications the patient is receiving will be collected into one record to ensure that the appropriate course of care is occurring, the care is coordinated, and the patient is receiving any and all necessary services. This model will help manage services for patients with chronic conditions, such as diabetes and heart disease, while keeping the focus on health and well-being, increased patient safety and care delivery well supported by science.
Source: tmcaznews.com

Mercy Health Plans Announces New Name for Their Medicare Advantage Plans: Mercy Medicare… ( ST. LOUIS July 23 /

Posted by:  :  Category: Medicare

Related medicine news : 1. Redskins' Draft Pick Malcolm Kelly Energized By Trip To Mercy Ship In Liberia 2. Mercy Corps Delivers Lifesaving Supplies to China Earthquake Survivors 3. INSPIRIS and Mercy Care of Arizona Named Winners in URACs Best Practices in Consumer Empowerment and Protection Awards 4. VIDEO from Medialink and Philips: Philips Electronics Unveils First Imagination Light Canvas at the New Mercy Medical Center in Rogers AR 5. AmeriHealth Mercy Family of Companies Acquires Community Behavioral HealthCare Network of Pennsylvania 6. Area Dentists, University of Detroit Mercy Team Up to Provide Free Dental Care to Low-Income, Uninsured Detroit-Area Children on Saturday, February 2 7. University of Detroit Mercy School of Dentistry Moves to Larger Facility on New Corktown Campus 8. Independence Blue Cross Finalizes New Multi-Year Agreements with Mercy Health System and St. Mary Medical Center 9. Alameda County Hosts National Initiative to Reduce Health Disparities 10. AARP the Magazine Names the Top 10 Healthiest Places to Live in America 11. Mosaica Partners Kolkman to Chair HIMSS Healthcare Information Exchange Steering Committee
Source: bio-medicine.org

Video: Medicare Myth – At Mercy of Insurance Companies

Obama’s Medicare: Leaving Seniors at the Mercy of Insurance Companies

“[T]he Obama administration has reciprocated AARP’s support by giving the group preferential treatment. “Obamacare” exempted Medigap insurance – a market AARP dominates – from virtually all its new mandates, including the ban on preexisting condition discrimination. The Department of Health and Human Services exempted Medigap plans from insurance rate review, though AARP, whose plan is the most popular form of Medigap coverage, makes more in profit the higher premiums rise. Though the administration has publicly attacked other insurance companies with much smaller profit margins, it has not openly criticized AARP’s business practices.”
Source: heritageaction.com

Integrated Managed Care Model for Dual Eligibles Reduces Readmissions

This analysis was subject to some limitations. For example, while we captured both full and partial duals in the Medicare FFS dual eligible control group, the Mercy Care Plan only enrolls full duals. Although our results were risk-adjusted, because partial duals may have access to greater resources than full duals, the difference in populations may have had some impact on our findings. Also, to identify the Medicare FFS dual eligibles in the 2009 Standard Analytic Files, Avalere was limited to using indicators known to either undercount or overcount duals depending on the state. The analysts used a linear regression method to risk adjust the measures of inpatient utilization, ED visits and adults’ access to preventive/ambulatory health services. Alternative methods are frequently used to model these types of quality measures, particularly for patient-level risk adjustment. We explored these other model structures and found these alternatives did not provide any considerable gains in model fit or predictive power.
Source: healthaffairs.org

Mercy Medical Center site for “Welcome to Medicare: 2011”

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Source: thesuburbanite.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

Study Finds Premium Support Plan Could Raise Medicare Premiums In Many Parts of Country

The study modeled the impact of a generic version of premium support, under which beneficiaries would receive a defined subsidy, or voucher, to buy health insurance in a competitive market instead of getting a guaranteed set of benefits, as Medicare has traditionally provided. That payment would be tied to the second-lowest-cost plan offered in an area or traditional Medicare, whichever is lower. This kind of a change is a central part of the House Republican budget written by Rep. Paul Ryan of Wisconsin, now the GOP’s vice-presidential candidate, and it has also been embraced by GOP presidential nominee Mitt Romney. Even a few Democrats have flirted with such a plan as a way to leverage market efficiency to rein in the spiraling cost of Medicare.
Source: aarp.org

Salina Public Flu Vaccine Clinic To Be Held Wednesday

A drive-thru clinic for adults only will be conducted from 11:00AM-2:00PM in the east driveway behind the 4-H Building and Agriculture Hall.  Vehicle entry will be from the south in the dirt parking area across from the entrance to Kenwood Cove.  Participants at the drive-thru must be 18 years of age or older and are asked to wear short-sleeve shirts.
Source: todayinkansas.com

Department of Human Services introduces a Medicare Benefits Schedule (MBS) item enquiry email service

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 marsmet481Aboriginal and Torres Strait Islander people Australia Canada Case studies Centrelink Children Customer experience Data Department of Human Services Disabilities Disability services Egovernment Employment Error and Fraud Evaluation Families Gov 2.0 Health Homelessness Housing Information and Communications Technology Information and Data Management Innovation Internet Law and Legislation Local government Mental health Mobile Open Government Participation Privacy Public administration Public Sector Remote Seniors Service delivery Social inclusion Social media Statistics Surveys United Kingdom United States Vulnerable welfare Youth
Source: gov.au

Video: Medicare Australia and Seeing a Doctor: nib Health Insurance Explained

Medicare Benefits Schedule (MBS) iPhone App: 25 PROMO CODES AVAILABLE & $1.99 (Normally $5.49)

Designed for Aussie health professionals (doctors, nurses, proceduralists), myMBS offers the entire Australian Medicare Benefits Schedule directly on your mobile device. Made #2 ranking in the Medical section of the Apple App Store – now comes the latest update – myMBS 3.0.
Source: com.au

Continuity of midwifery carer under

The Maternity Services Review recognised that continuity of midwifery carer through pregnancy, birth and in the postnatal / new baby period is safe.  There are many other benefits to having your own midwife: lower rates of unnecessary intervention, a more positive and empowering birth experience, greater preparation for birth, a shorter labour, higher breastfeeding rates, and better support during the new parenting period. Overall, women who are cared for by one midwife report increased satisfaction with their care, greater self confidence after the birth of their child and reduced vulnerability to post natal depression.
Source: com.au

What is a Medicare Benefits Schedule number?

For in-hospital services, the Medicare rebate will pay 75% of the Medicare Benefits Schedule fee and if you have private health insurance your Health Fund pays the remaining 25% as a benefit towards your doctors’ bills.  Some doctors and specialists charge more than the MBS fee. If this happens, you have to pay the ‘gap’, which is the difference between the MBS fee and what the doctors charge.
Source: wordpress.com

Development of a quality framework for the Medicare Benefits Schedule: discussion paper

In the 2009-10 Budget, the federal government announced that it would provide $9.3 million over two years to develop and implement a new evidence-based framework for managing the MBS into the future – the MBS Quality Framework. The Quality Framework will establish new listing, pricing and review mechanisms that ensure that prospective and already listed items are effective and safe, likely to lead to improved health outcomes for patients and represent value for money. The government will consider the future of the program in the 2011-12 Budget.
Source: org.au

What Is The Medicare Safety Net Threshold?

In the event that a prospective Medicare recipient, in the past five years, hadn’t worked or otherwise contributed to the U.S. workforce and had FICA tax taken out of his / her pay, then in order for the recipient to be eligible to receive Medicare benefits, he / she would need to pay a monthly premium in order to become enrolled and stay in the program.
Source: seniorcorps.org

How Medicare Supplement Plans & Medicare Advantage Plans Work

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSWhen beneficiaries turn 65 and first become enrolled in both parts of Original Medicare, they fall into their six-month Medigap Open Enrollment Period (OEP), which starts the first day of the month they are both age 65 or older and enrolled in Part B. This may be the best time to buy a Medigap policy because if a beneficiary decides to enroll after this time, their options may be limited and they may have to pay more for coverage. At the same time, beneficiaries also fall into their Initial Enrollment Period (IEP), which runs for seven months starting three months before they turn age 65 and lasts until three months afterwards. During this time, beneficiaries can sign up for any MA or Part D plan that contracts in the county and state in which they reside.
Source: planprescriber.com

Video: Medicare Supplement Insurance Plans – Where Do I Start?

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

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

Stephen L Morgan’s Personal Blog: Medicare Open Enrollment Furthermore Supplemental Insurance

Low Income Subsidy (LIS)/State Pharmaceutical Assistance Tool (SPAP) Beneficiaries: Guys and women who qualify of LIS or SPAP are eligible toward enroll into an actual Medicare Part S plan at any other time during an year. That they are also certified to disenroll by means of Medicare Part M plans at whilst during the year. How eager the merchant is to walk over inexpensive well being insurance insurance coverage plan possibilities with you a too working agent is every additional red flag. An agent that sends a toll-no worth range and obviously consists of the actual electronic mail matter with earns a huge as well equally signal. Choosing the right 2nd healthcare plan will be quite an important difficult process. The right plan must be hired and include currently the right benefits in the right premiums. In certain day and grow old over 65s would find it somewhat difficult to survive without a healthcare plan altogether; with the gaps within the Medicare decide on some over 65s will still give out a money for additional medical costs. The Medigap plan, however, is a impressive option to be certain that you don’t purchase hit with shocking medical bills. Just enrolling in the Blue Cross Violet Shield Dental linked to Florida program, definitely one can preserve a number of dollars on dentistry methods and function. Near today’s hard times, this can from time to time be the big in between having something executed at this point and putting it off till it develops into one in particular thing even more difficult. BCBS of Tx understands the confusing nature of rrnsurance policy coverage and Treatment in distinct. That is why choose they have fixed with each other one an enlightening opinions packet to make certain you already have all your pros and cons answered prior and you sign -up for something. This will turn into needed to assure that you have a preference for the right 2nd strategy for you and your family. Medicare health insurance has never recently been this complicated! With so really changes in Medicare Reform over previous 18 months, seniors today have become experts to are familiar with which plan is right for them. Are you drinking around next 12 months? Can I switch if I am not saying happy with useful ?? These are all great questions to check with and better yet, know the at the centre of. You require bought Medicare area A and Treatment aspect B to qualify for that you simply medicare supplemental insurance policy. Although picking correct prepare for health-related wants, reach confident you aren’t searching for the cheapest plan only. The rewards unquestionably are packaged in various ways in every bachelor program. For those who are obtaining it hard to do to adhere to actually Medicare Supplemental Policy policies, there are usually resources obtainable which will aid you consider. Ahead of taking a closing determination, discover out how the insurance business sets your premium. Medicare insurance supplemental insurer may possibly depart. Should the place you are in isn’t lucrative for that firm, they can potentially cease providing the policy altogether. Hard work no assure for continuance or safety measures with supplemental insurance policy. This implies that at any provided time, your corporation can depart, frequently instances getting providing you appropriate detect. Could possibly be pressured to repay out a higher price at a challenger. Or you may possibly have to acquire yet a different type of supplemental insurance coverage. This new policy could hardly cover you during your preceding just 1 did. By way of example, a female, non-tobacco consumer, old sixty seven and dwelling in Macon, GA would compensate $155 per 30 days for Medigap strategies F from Glowing blue Cross. Should it be she have gone a very careful shopper she is able to come across not less than fifty percent twelve month period carriers providing the identical method for when tiny as $116 per 30 days. Medicare supplement ideas have numerous ratings that calculate how the charge of premiums will go up about point. There are 3 ratings: (one) Problem-Age-Rated, wherever premiums are established centered on your age when you acquire; (2) Community-Rated, where exactly everyone residing inside the defined neighborhood has the identical premiums; and (three) Attained-Age-Rated, where premiums rise as you age group. This final rating is lifting sort of Medicare supplemental insurance approach that stores for premium soars as you age. It is therefore advised that you choose an Situation-Age-Rated or perhaps Neighborhood-Rated plan if you would like for a much older person well being strategy involving Medigap coverage.
Source: blogspot.com

How To Enroll In A Medicare Supplement Plan F Insurance Policy

Finally, be sure to review your coverage each year. All Medigap policies are subject to inflation, just like any other insurance. Most people will see an increase once a year, although some carriers also have “birthday increases,” which means the policy costs will increase slightly whenever your turn a year older. The good news is that you can always shop your policy when rates go up. It’s very easy to change insurance companies as long as you can pass the medical health underwriting. By shopping your policy annually, you can be sure to get the most out of your healthcare insurance dollars each and every year.
Source: return2writing.com

Medicare Changes for 2011

Posted by:  :  Category: Medicare

BITCH ... Allen West calls Wasserman Schultz ‘vile’ and ‘not a lady’  (7/20/2011) ...item 2.. FSU News -  Yo Mama's Big Fat Booty Band grooves at Sidebar (Mar. 29, 2013) ...item 3.. Chaos - Doin' It Hard by thebootyband ... by marsmet522New Requirement for Face-to-Face Encounter as Part of Process for Certifying Beneficiary Home Health Care The Affordable Care Act (ACA) mandates that a physician conduct a face-to-face encounter to certify a beneficiary need for home health care services. The CMS rules to implement this provision require that the face-to-face encounter must occur within the 90 days prior to the start of home health care, or within the 30 days after the start of care. Review the details of this new requirement, which has significant impact on internists.
Source: acponline.org

Video: Medicare Home Health Changes: 2011 & Beyond

CMS Softens Medicare Advantage Funding Changes

Another difference is the name change to MA was also part of the Medicare Modernization Act that introduced part D in 2006 at which time Medicare + Choice had only about 5 % penetration of the 40 million medicare beneficiaries enrolled compared to 2013 where MA has about 27% of the 50 million Medicare beneficiaries enrolled. I think many of the people who have stayed on original Medicare have done it because they are seniors and that’s what older people do – keep the policy they already have.They don’t need any new fangeled type of Medicare insurance.Most of the T65 I speak with are already aware of the 2 options they have for Medicare and want to know about both -unless they have been ambushed by a Banker’s Life agent first and told of the horrors of an MA plan. I believe the MA train has left the station and it is going to play a big part of how people get their Medicare for a long time.
Source: insurance-forums.net

Medicare growth attributed to change in skilled nursing facility pay rates

Medicaid spending slowed significantly in 2011 on a year-over-year basis. The program grew 2.5% in 2011, a significant drop from 5.9% growth in 2010. The CMS report said budgetary pressure on states caused by the weak economy and the June 2011 expiration of federal aid to the states contributed to the slower growth.
Source: mcknights.com

health reform action: Talk of Medicare Changes Could Open Way to Budget Pact

Talk of Medicare Changes Could Open Way to Budget Pact http://tinyurl.com/cxqht3x This appears to be a major change proposed by the administration, which Obama first made in 2011.  This is a very significant change and appears from the article to be gaining much traction recently.  While the proposal makes a lot of sense, I am concerned that the increase in the deductible for physician office visits and related part B services will be a significant increase to many beneficiaries.  This could discourage the use of such services.  I hope a way is figured out to reduce the proposed increase for such services.  The overall concept of combining parts A and B seems very appropriate.  What do you think? 
Source: blogspot.com

CNN Poll: Majority Opposes Medicare Changes

A clear majority of Americans opposes the Republicans’ plan to change Medicare, according to a new CNN/Opinion Research Corporation poll, with seniors particularly opposed to any changes to the program. Just 35 percent of Americans favor the GOP plan, according to the poll, while 58 percent oppose it. Only 32 percent of seniors aged 65-and-over favor the plan, while 64 percent were in opposition. Among those under the age of 50, only 36 percent support the plan. Independents also side heavily against the Republicans’ proposal; only 34 percent favor the GOP proposal. As last week’s special election in New York showed, the Medicare provisions are beginning to define the GOP budget. Some Republican Senate candidates were hesitant to embrace Rep. Paul Ryan’s, R-Wis., proposal in House votes last week, and other GOP candidates facing competitive primaries are being pressured to go on record with statements of support or opposition.
Source: nationaljournal.com

Pelosi Again Rejects Proposal To Change Medicare

The Hill: Obama: Sequester Would Deal ‘Huge Blow To Middle-Class Families’ The president devoted a significant amount of his (weekly Saturday) address to outlining the real-world consequences that would result if the sequester was implemented. On Friday, top administrative aides warned the cuts would hamper law enforcement, hurt federal education programs, withhold mental health services and furlough thousands of workers. “If the sequester is allowed to go forward, thousands of Americans who work in fields like national security, education or clean energy are likely to be laid off,” Obama said. “Firefighters and food inspectors could also find themselves out of work – leaving our communities vulnerable. Programs like Head Start would be cut, and lifesaving research into diseases like cancer and Alzheimer’s could be scaled back” (Sink, 2/9). 
Source: kaiserhealthnews.org

Social Security Disability Insurance and Medicare

Posted by:  :  Category: Medicare

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

Video: If I am approved for Social Security Disability, will I get Medicare and Medicaid health insurance?

7 Social Security Disability Terms You Need To Know

If you are ill or injured and unable to work, you may be eligible to receive Social Security Disability payments and medical insurance. As Social Security lawyers, we understand that these payments and insurance will make your life much more comfortable and secure. We also acknowledge that applying for Social Security Disability benefits can be confusing, in part, because of the terminology. The Social Security Administration’s use of terms may not be the same as your every day use of the same terms. To help you understand your rights and potential benefits, we describe the 7 most commonly used terms in Social Security Disability law. However, if there are terms, concepts, or forms that you don’t fully understand or you wonder how they apply to your individual situation, consult with a qualified Social Security Disability attorney at (855) 773-4669 or by email info@hoppinglawgroup.com.) 1. Alleged Onset Date Alleged onset date (AOD) is the date you, as the Social Security Disability applicant, became disabled (i.e. the date you were injured or become too sick to work.) 2. Appeal If your application for Social Security Disability benefits is denied (as is quite common), you must tell the Social Security Administration that you want your case to continue (i.e. appeal), within the very limited time period of 60 days. 3. Disability In the Social Security Disability world, “disability” means that you are unable perform any substantial gainful activity because you are injured or ill (and your illness or injury is expected to last more than one year.) When defining “disability,” the Social Security Administration uses these words: You can’t work “by reason of any medically determinable physical and/or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.” 4. FICA Tax If you worked under the table and didn’t pay FICA taxes (Social Security and Medicare), you will not be eligible to collect Social Security Disability benefits. FICA is an abbreviation for the Federal Insurance Contributions Act. If you paid FICA taxes for two of the last five years and meet other eligibility requirements, you may be approved for benefits. 5. Medical Benefits Those approved for Social Security Disability benefits are eligible for Medicare health insurance two years after the approval date. Medicare is not just for older folks. 6. Social Security Disability Beneficiaries Applicants for Social Security Disability benefits must go through an application process to determine whether they qualify. Social Security Disability beneficiaries are those who have been found eligible for benefits because they have worked and paid into system (via FICA taxes) for two of the last five years and are unable to work due to injury or illness. 7. Social Security Lawyers A Social Security Disability attorney is a lawyer who focuses his or her practice on helping people obtain the social security benefits they need and deserve. The three main social security programs are Social Security Disability (SSD), Supplemental Security Income (SSI), and Widows’ or Widowers’ Disability benefits. Where to Get Help Obtaining Social Security Disability Benefits Our Texas Social Security Disability Benefit attorneys would be happy to assist you in getting the benefits you deserve and helping you to understand the terms and process. For more information visit our website. Your next step is to call our office at (855) 773-4669 or email us at info@hoppinglawgroup.com. We look forward to hearing from you.
Source: informationbible.com

Health insurance while waiting for Social Security Medicare

If you have been approved for Social Security disability (Title 2 – Social Security Disability Insurance), you already know your Medicare does not start until you receive 24 months of disability benefits. While this waiting period includes back period months, many people still have to wait a year or longer to become eligible for Medicare. So, you have some money coming in from Social Security. However it is not enough to get private health insurance. And, you may be getting too much in monthly Social Security benefits to be eligible for Medicaid.
Source: socialsecurityinsider.com

Medicare to Cover Addadictomy, Chopadickoffamy

RUSH:  The Medicare under Obamacare is now gonna start doing sex-change operations, is the point.  I didn’t finish that story.  “For the first time since 1981, when it dubbed sex-change operations ‘experimental,’ Medicare has opened the door to covering transexual operations, adding to the growing list of operations that would be allowed under Obamacare.  Acting on a new request, the Centers for Medicare & Medicaid Services said it is starting a new analysis that could lift the spending ban for sex-change operations with a goal of making a decision two days after Christmas and on the eve of Obamacare kicking in Jan. 1.”
Source: rushlimbaugh.com

Unwilling to Work; 25% in Hale County AL Collect Disability, 14 Million Nationwide; A Simple Solution

Category : United states. Tags: back, county, disability, easy, federal, job, kid, million, people, program, welfare, work. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.
Source: theworldnet.info

Does Medicare or Medicaid Come with Disability?

Do you get Medicare coverage if you were approved for SSI? Claimants who are approved for SSI only typically receive Medicaid coverage in most states. And like SSI, Medicaid is subject to income and asset limitations. Medicaid is a needs-based, state- and county-administered program that provides for a number of doctor visits and prescriptions each month, as well as nursing home care under certain conditions. Can you ever get Medicare if you get SSI? Medicare coverage for SSI recipients does not occur until an individual reaches the age of 65 if they were only entitled to receive monthly SSI disability benefits. At the age of 65, these individuals are able to file an uninsured Medicare claim, which saves the state they reside in the cost of Medicaid coverage. Basically, the state pays the medical premiums for an uninsured individual to be in Medicare so that their costs in health coverage provided through Medicaid goes down. 
Source: disabilitysecrets.com

Question about calculating Medicare eligibility date

Hi, I have a question about how to calculate my Medicare eligibility date and I’m finding some conflicting information on the web so I’m hoping someone here can provide a better answer. I filed for disability in 9/2012. SS determined that my medical onset date is 9/2010. They have my entitlement date as 9/2011. I understand that there is a 24 month waiting period before one is eligible for Medicare. My question is do they start counting from the onset date (the first date they found I was disabled) or the entitlement date (which is the 1 year prior to my application date, which is apparently as far back as they can go)? I’ve seen some sites say they go from the onset date (in which case I would be eligible) but other sites say you actually have to receive benefits for 24 months (so using the entitlement date, basically). I was at the SS office today and the lady helping me thought it was calculated from the entitlement date, but she wasn’t certain. I’m hoping someone here has had experience with this issue and can shed some light on it. Thanks for any information!
Source: psychcentral.com

Has disability become a ‘de facto welfare program’?

A quick primer: the Supplemental Security Income (SSI) program provides monthly cash assistance to people who are poor and disabled, including families with disabled children. The basic monthly SSI cash benefit is a set amount — currently $710 for an individual and $1,066 for a couple. The Social Security Disability Insurance (SSDI) program also provides monthly cash assistance, to disabled people who have worked in jobs covered by Social Security.  People who leave the workforce and go on disability also qualify for Medicare. 
Source: nbcnews.com

Take Social Security and Medicare Off the Bargaining Table

A little noticed fact exposes the grotesque hypocrisy of claiming to “fix the debt” by cutting entitlements. Billionaire Pete Peterson’s front, called “Fix the [National] Debt,” provides a teachable moment. It’s been possible for 51 years for individuals to make donations to a Treasury Account titled “Gifts to Reduce the Public Debt.” It’s even tax deductible. Yet in all that time only $85 million has been donated (see online: CNN Money, 11/20/12, “Americans Donate $8 million to cut national debt.”) Peterson and Fox owner Murdoch, with tools and dupes, grossly exaggerate the import of the national debt. If it’s so dangerous, where are their own example – setting, magnificent, patriotic donations? Didn’t they benefit at all in wealth – making from the $ trillions of dollars expended on infrastructure and on “defense” to protect them from USSR communists taking over and socializing their property? Main Street unemployment and personal debt are painfully slow in receding and debt peonage looms for college students. Government spending does, in fact, create or support millions of private industry jobs in defense and elsewhere. So spending cuts kill jobs and retard recovery more. Peterson, tools and dupes; on this national debt: PAY UP OR SHUT UP!
Source: prospect.org

Medicaid vs. Medicare & How SSDI or SSI Benefits May Apply

Medicaid, Medicare and SSDI are government programs that may help those with disabilities receive healthcare services and pay for basic necessities. Medicaid and Medicare are government healthcare programs that may be available, depending on the individual’s circumstances. Those who receive Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) for their disability could be eligible for one or even both healthcare programs.
Source: brentadams.com

Daily Kos: How ‘This American Life’ got the disability story wrong

What the story did that was of service was to put a focus on a dysfunctional economy that has no place in the workforce because they are too old, too sick or otherwise “obsolete.” That should have been the story Jaffe-Walt told, instead of an alarmist, incomplete and mythical picture of another “entitlement” gone out of control. She very clearly made the point that many of the people on disability don’t have other options. For example, many of the people on disability have bad backs, and there are no options for sit down jobs in this economy, especially rural areas that rely heavily on manufacturing or service jobs. Jobs that can accommodate people with injuries are virtually non-existent in these areas, therefore people are unable to find suitable jobs. I think this piece did a great job highlighting how government assistance is really acting as a safety net for many people who can’t find suitable work. Heart disease, diabetes and a shattered ankle. In the real world, those are called pre-existing conditions. In the real world, the only jobs available to these men are low-wage jobs that don’t provide health insurance. Heart disease and diabetes are conditions that require regular trips to the doctor, prescriptions and medical expenses. The cheaper alternative for them, and for a nation with a broken health care system, is to have them receiving $13,000 a year in disability income and regular medical care. The piece makes exactly this point, so I don’t understand what the issue is here. And this “Despite the ministrations of what Joffe-Walt labels the “disability industrial complex,” the majority of disability applicants are actually denied. SSI and SSDI are not boondoggles.” The CBPP analyzed Social Security records and determined that out of 1,000 applications for disability, 410 are allowed, more than one-third of those after appeals. She states this clearly. This was in her piece, that many disability claims are rejected. However, there are lawyers that get paid by the government to contest these rejections. And once a claimant hires a lawyer, their success rate increases dramatically. The lawyers who overturn the rejections get paid by the government, they receive a percentage of  back pay if they win.
Source: dailykos.com

Daily Kos: Insurers score another win, turn Medicare pay cut into increase

Posted by:  :  Category: Medicare

1st Medicare Iveco Daily by TheEssexTechMedicare Advantage plans are good business for the health insurance industry. Though only a little more than a quarter of Medicare beneficiaries buy these supplemental plans, they’re big business. They’re also relatively expensive for the federal government, which subsidizes them. In fact, the Government Accountability Office found that over the past three years, the federal government has overpaid insurers between $3.2 billion and $5.1 billion. That’s something the Obama administration wanted to change, needing to find every cost-cutting measure possible to implement Obamacare. That’s why the administration tasked the Centers for Medicare & Medicaid Services (CMS) with cutting those subsidies and why it proposed the 2.3 percent cut. The cut would have not been in benefits, but America’s Health Insurance Programs (AHIP) didn’t want MA enrollees to know that. So they did what every powerful industry group does: use some scare tactics and an Astroturf campaign.
Source: dailykos.com

Video: Green Party Presidential Candidate Calls For Medicare For All Healthcare System

IOM Panel Raises Concerns About Lowering Medicare Pay For High Spending Areas

The panel affirmed a conclusion of the Dartmouth Atlas: that the wide variations of spending between regions cannot be explained completely by the differences in the health and age of the populations. The panel did note that the use of services after a hospital stay, including skilled nursing home, home health and hospice care—”strongly influenced” the total spending in areas, accounting for 40 percent of the difference. As an example, the IOM researchers pointed out that 2 percent of Medicare beneficiaries in LaCrosse, Wis., used home health services, while 38 percent of beneficiaries in the Dallas-Fort Worth area used those services.
Source: kaiserhealthnews.org

Seniors should tell Obama to prevent Medicare Advantage cuts

When President Obama signed the Affordable Care Act into law, he simultaneously authorized $200 billion in cuts to the Medicare Advantage program. At the time, the Congressional Budget Office projected that the health care reform law’s cuts would result in three million fewer Medicare Advantage enrollees. Moreover, actuaries at Oliver Wyman predicted that the cost of the health insurance tax would mean an additional $3,500 in out-of-pocket expenses for seniors over the next 10 years.
Source: dailycaller.com

Four Models to Choose From

On the non-clinical side, for instance, the initiative can motivate surgeons to show up on time for their first operations in the morning so the hospital doesn’t have to roll late-day appointments to the next day, saving money. On the clinical side, a 10-day physician order for an IV antibiotic could be re-evaluated after day three and switched to a cheaper oral antibiotic, thereby reducing costs and maybe improving outcomes because it would lower the chance of an IV infection.
Source: mckesson.com

All About Medicare – Policy changes result from nationwide class action settlement

Medicare beneficiaries and legal advocates are familiar with Medicare’s practice of placing the burden of proof on the hospital consumer or patient to demonstrate a ‘likelihood of improvement’ before Medicare will pay for skilled care or continue skilled care in a rehabilitation facility after 20 days.  Most impacted are consumers who need skilled care at home and those who require physical or occupational therapy following a hospitalization for a fall, fracture, extended hospital stay, or diagnosis of a chronic disease.  To explain the denial or termination of Medicare coverage, medical professionals and nursing homes often used the terms ‘plateau’  or ‘stabilized’ or ‘not improving’.  When Medicare stops paying, the consumer must either privately pay for the needed care or therapy, or attempt to qualify for Medicaid.   
Source: wordpress.com