Medicare Secondary Payer: The Shape of Things to Come

Posted by:  :  Category: Medicare

H.R. 1063, the Strengthening Medicare and Repaying Taxpayers (SMART) Act, had gained a significant amount of bipartisan support in both the House and Senate; however, with the election pending, the outlook seemed bleak that it would be passed by the 112th Congress. Well, on September 13, 2012, the Energy and Commerce Subcommittee on Health met in an open markup session and made certain adjustments to the bill to implement more automated functions to the conditional payment recovery process. The committee met again on September 20, 2012, and again made minor adjustments to the bill, then favorably forwarded it to the full committee and sent it back to the CBO for scoring. There was no further indication of progress until on December 19, 2012, a lesser version of the SMART Act emerged as Title II of the Medicare IVIG Access Act [H.R. 1845]. H.R. 1845 proposed a $45 million dollar demonstration project to study providing Medicare coverage for in-home administration of intravenous immune globulin (IVIG) to patients suffering from primary immune deficiency disease. Despite the sympathetic appeal of helping the bubble boy, H.R. 1845 needed to be off-set by a bill such as the SMART Act, which proposed to coincidentally save Medicare $45 million dollars over ten years, and the match was made. The new combined bill was nearly unanimously passed by the House on December 20, 2012, and passed by the Senate on December 21, 2012. On January 10, 2013, President Barack Obama signed the legislation, making it
Source: lexisnexis.com

Video: Navigating the Medicare Secondary Payer Act

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

Statement to the Record on the Medicare Secondary Payer and Workers’ Compensation Settlement Agreement Act

HR 5284 creates a system of certainty and allows the workers’ compensation settlement process to move forward while eliminating millions of dollars in administrative costs.  It will help create clear and consistent standards, currently lacking in the process, to address workers’ compensation issues.  Most importantly, it will benefit all parties involved – injured workers, employers, insurers and CMS.  
Source: house.gov

SMART Act Amends Medicare Secondary Payer Statute, Creates Three

The SMART Act requires the Secretary of Health and Human Services (“Secretary”) to establish a process by which a claimant (or his or her authorized representative) can dispute discrepancies with the statement of reimbursement amount. A claimant or authorized representative must submit documentation of the potential discrepancy and a proposed resolution to the Secretary. The Act states that the Secretary must determine whether there is a reasonable basis for including or removing a claim and provide a response within eleven (11) business days. Lack of a response is a deemed acceptance of the claimant’s proposal. If the Secretary determines that there is not a reasonable basis to include or remove claims, the proposal will be rejected. If the Secretary concludes that there is a discrepancy, but rejects the proposed resolution, documentation showing good cause for why the Secretary has rejected the proposal and establishing an alternate discrepancy resolution must be provided to the claimant. This process does not create an appeals process, however, and the SMART Act expressly forecloses the possibility of administrative or judicial review of the Secretary’s determinations. Final regulations must be promulgated by October 10, 2013, nine (9) months after the date of enactment, the effective date of this provision.
Source: crowell.com

MICHIGAN DISTRICT COURT HOLDS THAT MEDICAL PROVIDERS CAN BRING MSP PRIVATE ENFORCEMENT ACTIONS WHEN INSURER DENIES COVERAGE

, 656 F.3d 277 (6th Cir. 2011), which held that a health care service provider may bring a private action to enforce the MSP Act before a court or other adjudicative body has determined whether or not the insurer/primary payer is liable for the medical charges incurred. This means that where an insurance carrier refuses to cover a Medicare beneficiary’s bills for medical services rendered by a medical provider, the medical provider can sue the insurance carrier seeking double damages even when no determination has been made that the insurance carrier was liable for the beneficiary’s medical treatment.
Source: themedicarespa.com

Summary of SMART Act which amended Medicare Secondary Payer Act

The SMART Act requires parties to notify CMS of when they reasonably anticipate settling a claim (any time beginning 120 days before the settlement date). CMS then has 65 days to ensure the portal is up to date with all of the appropriate claims data. CMS can have an additional 30 days on top of the 65 days to update the portal if necessary. At the expiration of the 65 and potentially the 30 day periods, the parties may download a final conditional payment amount from the website. The final conditional payment amount is reliable as long as the claim settles within 3 days of the download.
Source: thehamiltonfirm.com

Petition of the day : SCOTUSblog

Issue: (1) Whether post office sidewalks that are open to the public are public fora, so that a prohibition of First Amendment activities must be narrowly tailored to further a significant governmental interest; and (2) even if post office sidewalks are not public fora, whether the 30 C.F.R. § 232.1(h)(4), the regulation banning signature gathering on petitions, is reasonable when it simultaneously permits the collection of signatures in voter registration drives on the same sidewalks, and when the justification for the latter provision (that it is the solicitation of a signature, rather than its collection, that may be disruptive) directly contradicts the justification for the former provision (that it is the collection of a signature, rather than its solicitation, that may be disruptive).
Source: scotusblog.com

Medicare RACs, Hospitals Spar Over New Fraud Legislation

Posted by:  :  Category: Medicare

Joe the Plumber - To Flush The System ... More scams aim to ensnare Brevard seniors - Their ingenuity is boundless, Archer said. (Jul 2, 2012) ... by marsmet524A bipartisan bill that would reform Medicare Recovery Auditors, or Medicare RACs, has enflamed a battle between hospitals that support it and the RACs that oppose it, according to a report from The Hill. Last month, House Reps. Sam Graves (R-Mo.) and Adam Schiff (D-Calif.) reintroduced the Medicare Audit Improvement Act. Under this bill, Medicare RAC record requests would be capped to 2 percent of hospital claims, with a maximum of 500 medical record requests every 45 days, among other measures. The American Coalition for Healthcare Claims Integrity, a non-profit RAC supporter group, argued the bill would result in billions of taxpayer dollars in improper hospital payments. “The bottom line is that recovery auditors bring accountability and transparency to the Medicare program,” ACHCI spokesperson Amanda Keating told The Hill. “If you want to send Medicare crashing to the ground, letting improper payments run rampant is a surefire way to do that.” The American Hospital Association, however, has long lobbied for a more “streamlined” solution to Medicare payment oversight, such as the proposed bill. “It’s understandable that the government wants to make sure they’re getting what they’ve paid for, but hospitals are having a very difficult time,” Michael Ward, senior associate director of policy with the AHA, said in the report. “It can take them two to three years to receive a final determination on a claim.”
Source: beckershospitalreview.com

Video: MO Dept. of Insurance warns Medicare Part D subscribers about scams

‘Hidden Health Care Tax’ Costs Missouri Businesses Billions Annually. Costs Will Explode Without Medicaid Reform.

“Cost shifting doesn’t increase the quality or efficiency of health care,” Kuhn said. “And, it is the poorest choice for managing the costs of health insurance for businesses and individuals. “Missouri has a stark choice. If we reform Medicaid, we can reduce the ‘hidden health care tax’ and allow Missouri business to decrease costs and Missouri workers to keep more of their earnings. If we fail to reform Medicaid, we will see the costs of the uninsured explode. Missouri businesses will struggle to remain competitive, and individuals will pay more for their insurance.”
Source: thepharmacyblog.com

Missouri Residents Weigh In on Medicare, Social Security Changes

When the new Congress convenes next month, policymakers are likely to consider changes to the programs, including an increase in the amount of income subject to the payroll tax that finances most of Social Security and some of Medicare, benefit reductions, an increase in the eligibility age for both programs, a curb in the cost-of-living increases for Social Security beneficiaries and higher Medicare premiums for higher-income enrollees.
Source: aarp.org

Nevada Daily Mail: Local News: Officials urge legislators to reconsider Medicaid issue (04/05/13)

Really people, who pays for the uninsured? You do (you being the reader of this post) and me. One way or the other somebody pays for those that can’t pay or in some cases won’t. You pay either by higher insurance premiums (including existing Medicare and Medicaid insured) or in higher costs at the provider level for those self insured (ie wealthy enough to pay without insurance). The alternative… rural hospitals in areas of high poverty go away (go broke) then no more local hospitals. Why? Because as stated in the article, hospitals can not refuse treatment. Or, picture this alternative where hospitals CAN refuse care…… there’s a traffic accident, and the victims roll in to the hospital on a gurney the first thing the hospital has to know is, are you insured or if not, can you pay (by the way we’ll need a credit card now)? If you are insured or you can pay, you get treated. If not, sorry you’re out of luck, you’ll need to go elsewhere. In that world what do you say and who gets to tell the heart attack victim “nope we can’t help you”.
Source: nevadadailymail.com

The recent boost to Medicare

Modern Principles of Economics Launching The Innovation Renaissance The Great Stagnation: How America Ate All the Low-Hanging Fruit of Modern History, Got Sick, and Will(Eventually) Feel Better Create Your Own Economy: The Path to Prosperity in a Disordered World Discover Your Inner Economist Good and Plenty: The Creative Successes of American Arts Funding Judge and Jury: American Tort Law on Trial Markets and Cultural Voices: Liberty vs. Power in the Lives of Mexican Amate Painters (Economics, Cognition, and Society) The Voluntary City: Choice, Community, and Civil Society (Economics, Cognition, and Society) Creative Destruction: How Globalization Is Changing the World’s Cultures Changing the Guard: Private Prisons and the Control of Crime What Price Fame? In Praise of Commercial Culture Entrepreneurial Economics: Bright Ideas from the Dismal Science
Source: marginalrevolution.com

Fraud Alert for People with Diabetes

Protect Your Medicare and Other Personal Information Do not provide your Medicare number or other personal information.  Be suspicious of anyone who offers free items or services and then asks for your Medicare or financial information.  These calls are not coming from Medicare, diabetes associations, or other similar organizations.  While the caller says the items are “free,” the items are still billed to Medicare.  Once your Medicare information is in the hands of a dishonest person or supplier, you are susceptible to further scams.  Alert others about this scheme, and remind them not to provide strangers Medicare numbers or other personal information.
Source: missourismp.org

Missouri Senior Medicare Patrol Launches Website

The SMP program, also known as Senior Medicare Patrol program, helps Medicare and Medicaid beneficiaries avoid, detect, and prevent health care fraud. In doing so, they help protect older persons and promote integrity in the Medicare program. Because this work often requires face-to-face contact to be most effective, SMPs have recruited nearly 4,500 volunteers nationwide to support this effort.
Source: ma4web.org

Intricate Underground City for Homeless Uncovered In Kansas City, Mo.

Police in Kansas City, Mo, have uncovered an “underground suburb” where homeless people have been living, the likes of which homeless outreach groups have never seen, local station KMBC-TV reported. An intricate network of tunnels and caves had been carved underground, some as far down as 20 to 25 feet. Inside, police found rooms with bedding and candles. There were tents propped above ground, suggesting that several people were calling the unlikely place home. “This one kind of goes back,” Officer Jason Cooley said, in describing a tunnel to KMBC, while surveying the grounds. “The tents over here, I can guarantee you they’re still lived-in because of the condition they’re in. They’re clean. They were more than likely used just last night.” According to The Kansas City Star, some of the entryways to the underground tunnels were concealed, while others had wood stacked around them or were completely open. Police discovered the underground complex while investigating cases of copper theft in a nearby industrial area. They came back to evict the homeless “tenants” because of squalid conditions, KMBC reported. “We’re working to find out if, in fact, they’ve got kids down here because this is not a safe environment for that,” Cooley said. A pile of diapers had been found at the scene. Police used Bobcat bulldozers to dig up the debris surrounding the campsite and to fill in the tunnels dug underground. When police returned Friday with Hope Faith Ministries, an outreach group, to disassemble the camp, they found four people there. It wasn’t clear when the underground network was built or how many people were living there. Those suspected of living there are also thought to be connected to the rash of thefts in the area. Hope Faith Ministries offered services to the homeless residents, and three of the four said they would accept the help, the Star reported. “By providing help for these people in this manner, maybe they won’t feel the need to go out and steal because they’re getting services they need to be able to live and survive,” Cooley told KMBC. This is a sad case of people trying to survive by literally going underground, but we’ve seen much happier uses of underground spaces. Our favorite is the case English homeowner John Wiggins, who built a replica of an iron mine under his backyard. The mine has a 150-foot corridor that looks exactly like the mines that were prevalent in his area back in the 1800s.
Source: aol.com

Attorney General Koster

Large Companies Are Increasingly Offering Workers Only High Deductible Health Plans

Posted by:  :  Category: Medicare

Massachusetts Association of Health Plans’ Annual Conference by Office of Governor PatrickMatt Grove and his wife, Annie, own a bagel business in Upstate New York. They stopped offering a traditional health plan to their 14 full-time employees last year, leaving in place only a plan with a $5,000 deductible and a health savings account. The change reduced the premiums significantly, enabling the company to trim the amount employees paid for coverage from $173 a month to $43. The Groves deposit about $200 annually into each worker’s HSA account to help cover their medical expenses.
Source: kaiserhealthnews.org

Video: High-Deductible Plans ‘Quiet Revolution in Health Insurance’

California offers health plan ratings iPhone app

The app, which is free in the AppStore, allows users to view all the ratings of a single plan, or view how all the plans rate on a particular condition, such as asthma, heart disease, or diabetes. They can also see how other patients rate plans on non-care quality metrics like doctor communication, ease of setting up appointments, and customer service. In addition, the app provides contact information for health plans and general information for patients like how to make the most of a doctor visit.
Source: mobihealthnews.com

Minnesota health plans see dip in profits, increased reserves

Despite a 10 percent increase in hospital and emergency room patient care costs over 2011 levels, health insurers still posted an operating profit for 2012 of $120.1 million, according to figures from the Minnesota Council of Health Plans, a trade group based in St. Paul. That operating profit last year was down about 66 percent from 2011’s figure of $355.7 million.
Source: medcitynews.com

Vermont Is First State To Post Certain Health Plan Rates Under ACA

On Monday, Vermont published proposed 2014 insurance rates from two health plans for state residents who will purchase individual coverage through the state’s health insurance exchange under the Affordable Care Act, making Vermont the first state to make such information available to the public as required by the ACA, the
Source: californiahealthline.org

Health Policy Brief: The Multi

A new Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation discusses the Multi-State Plan Program created under the Affordable Care Act. Under the program, at least two health insurance plans choosing to participate will offer coverage through every state-run, federally facilitated, and partnership exchange created under the law. Insurance companies meeting the eligibility criteria have until March 29, 2013, to submit applications to participate in 2014.
Source: healthaffairs.org

ObamaCare Clusterfuck: Individual expatriate health insurance plans count toward the mandate

The FAQ also notes that expatriate health plans are a form of minimum essential health coverage under the ACA. This means that an individual covered by an expatriate health plan will not be subject to the individual mandate. In addition, employers will not be subject to the employer mandate penalty if they offer coverage under an expatriate health plan, provided the coverage is “affordable” and meets the minimum value requirement under the ACA.
Source: correntewire.com

Medicaid Prescription Drugs: Utilization in Medicaid Health Plans and Medicaid Fee

Nearly half of Medicaid prescriptions are now covered through Medicaid health plans, rather than fee-for-service (FFS).  The proportion of Medicaid pharmacy benefits provided through health plans will increase dramatically as states extend managed care to high-cost populations, such as dual eligibles and disabled SSI beneficiaries.  Medicaid health plan enrollment will also increase significantly as more adults enroll in Medicaid as a result optional Medicaid eligibility expansion under the Affordable Care Act (ACA), the woodwork effect of streamlined eligibility and enrollment, ACA crowd out of private coverage, and automatic screening of every Health Insurance Exchange applicant for Medicaid eligibility.  The portion of Medicaid drug benefits provided through health plans will also increase as states carve pharmacy benefits back into plans.
Source: piperreport.com

Medicare Health Plans and Dually Eligible Beneficiaries: Industry Perspectives on the Current and Future Market

The brief is based on interviews with senior executives at 13 large firms that contract with the Medicare and Medicaid programs and finds almost all of the insurers expect dually eligible beneficiaries will become more important to their business over time. The brief also looks at how insurers currently serve dually eligible beneficiaries, particularly through Special Needs Plans that are part of the Medicare Advantage program.
Source: kff.org

– Can Tricare pay other health plan’s deductible?

20/20/20 age appeal catastrophic cap child born out of wedlock claims continued care cost share death DEERS dental dependent disabled divorce doctor doctors FEHBP handbook health care reform hospital ID card marriage maternity care Medicare military treatment facilities other health insurance outside the U.S. parents Part A Part B pharmacy pre-existing condition pregnancy reserves secondary insurance social security spouse supplements surgery Tricare For Life Tricare Prime Tricare Standard Tricare Young Adult Program VA widow
Source: militarytimes.com

Departments Release Waiting Period Regulations for Group Health Plans

In addition, the proposed regulations make it clear that imposing a 90-day waiting period where coverage begins on the first day of the month following the expiration of such waiting period is no longer permissible, as the total waiting time for employees and dependents would exceed 90 calendar days. Plans containing such provisions would need to be amended prior to the start of the 2014 plan year. To avoid potential mid-month plan entry dates for employees and their dependents, a plan may wish to impose a shorter waiting period (such as 60 days), and allow entry on the first day of the calendar month following such shorter waiting period (provided that the total wait time does not exceed 90 calendar days).
Source: jdsupra.com

Will health reform make it easier to buy Medigap plans?

Posted by:  :  Category: Medicare

Gravel MediGap by Mike Licht, NotionsCapital.comIt’s also worth mentioning that fact that your premiums may have gone up because you bought a plan with so-called “attained-age” premiums. They’re deliberately designed to start out low when you’re 65 and increase the older you get. People buy them because they’re cheap, not realizing that when they get to be your age, they’re going to be the most expensive. We recommend purchasing policies that are community rated, meaning that premiums are the same no matter what your age. They’ll be a little more expensive when you first buy them, but less expensive than an attained-age policy when you get older.
Source: consumerreports.org

Video: Learn About Medigap Plans

Attributes Of Medigap Program D

Agencies can simply attempt to explain associate programs they could have whenever converting them in to medigap prospective customers along with each of the facilities they could comes from the many hospitals since many of some other health-related policies would likely not possible be providing them with. Now making full use of the web anybody can certainly get a quantity of medigap prospective customers and if you may make contact with and offer all of them some of your better medicare options than it really is without doubt maybe you have a multitude of conversion rate. You can test to clarify them in regards to the numerous deductibles that medicare insurance policy offers in their eyes if they are accepted in the clinic as most from it would probably be have the actual medigap insurance plan.
Source: carreiradaindia.net

The Importance Of Medigap Plans

Keep in mind that a Medigap policies are sold by private insurance companies. They are looked upon as Medicare Supplement Insurance. Depending on the Medigap plan you choose, will determine how much you will pay for the policy and what the policy will cover. There are various benefits of Medigap policies such as medical costs, inpatient hospital care, blood that you might need and other additional benefits such as emergency care and preventative care.
Source: iirojappinen.com

What is Medigap Insurance

Medicare has defined, and standardized, each type of Medigap Insurance policy that can be sold. The various types have a one letter designator that runs from A through N. The most popular is Medicare supplement Plan F. It is important to know that every company selling a Medigap Insurance plan has to sell the same standardized product. Some differences exist in Medigap coverage from state to state. Before purchasing any Medigap Insurance policy you should check with your state Medicare office. In general Medigap policies never cover long term, or assisted living care expenses. They also do not cover vision or dental expenses. If you are offered a Medigap Insurance policy, you should clearly understand exactly what you do not get under the policy. Then you can compare to verify what original Medicare covers. This will show you if there are any remaining gaps in your coverage.
Source: theglossy.com

Medigap Guaranteed Issue Rights & Protections

Because Medicare Supplement is an enhancement to Original Medicare, guaranteed issue rights only apply to those seeking Medigap coverage to complement Medicare Parts A and B. We have covered previous Medicare Supplement Insurance topics on the PlanPrescriber blog, including an introductory post, a discussion on the cost of Medigap plans and an examination of Medicare Supplement Insurance vs. Medicare Advantage plans.
Source: planprescriber.com

Compare Medigap Plans Medicare Supplemental Insurance Texas

It is hard to track down online scammers. Therefore, precaution sounds cure. You should never give your sensitive information online and not pay through wire-transfers. Do not click on accessories in emails out of unknown sources for the reason that may contain spy ware and spyware that put you at the risk of masterplans scams. Use the internet only from relied upon e-commerce stores and do not accept any job role offers online without requiring checking the experience of the work. By taking small precautions, you can enjoy a hassle-free from the internet experience and watch over yourself from rip-off.
Source: wholesomefood.org

Authentic Coding For Treatment And Medicaid A Reimbursement

Costly Medigap supplemental approach is just compared to tricky as working out if families can buy the problem. The a specific thing that will stay true no be an issue where you select the insurance from is that due to it is licensed by the legal guidelines of the state and Federal united states government the benefits possible are the same to everyone. Although the insurance policy remains the matching no matter generally provider there will most certainly be differences amongst some of the insurance companies their own self. The discrepancies will be all over price, administrators most typically associated with the plan and the available Medicare supplement options.
Source: trujilloenelamazonas.com

5 Things You Need to Know About Medigap Insurance

Either Plan A, Plan C or Plan F Medigap policies must be made available by insurance companies who sell Medigap policies. Plan D and G policies issued before or on June 1, 2010 and Plan D and G policies prior to that date have different benefits. If you happen to have an older policy, such as Plan E, H, I, or J, you don’t have to purchase a new one, however, they are no longer sold. Medigap plans are regulated by the government. If you buy a California Medicare supplement, it will give you identical coverage as the same Florida Medicare supplement. In other words, Medigap Plan A is the same no matter where you reside, as is Plan B, Plan C, and so on.
Source: leerogers2012.com

Insurance Commissioners Reject Calls To Limit Seniors’ Medigap Policies

Medigap policies are popular with seniors because Medicare does not cap out-of-pocket expenses. The policies are not cheap — the average premium nationwide was $178 a month in 2010 — but they protect subscribers from unexpected high medical bills, which is important to people on fixed incomes. The C and F Medigap plans cover nearly all of the out-of-pocket costs that beneficiaries would usually pay.  Two thirds of people who buy Medigap plans have incomes below $40,000 a year — about the same income levels for all Medicare beneficiaries.
Source: kaiserhealthnews.org

Government Wants Seniors with Medigap Policies to Pay More Out

The NAIC was required by the Accountable Care Act to recommend to Kathleen Sebelius, Secretary of Health and Human Services (HHS), specific cost-sharing opportunities that could reduce Medicare spending for unnecessary treatments. This recommendation was to be based on peer-reviewed studies or successful managed-care practices, noted the Kaiser Health News article. The NAIC Seniors’ Task Force and Health Insurance Committee, in fact, determined that this idea could have the reverse effect, raising Medicare costs over time.
Source: darkdaily.com

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

The page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

Local prescription drug plan earns top marks from Medicare

Posted by:  :  Category: Medicare

BlueCross BlueShield Rx PDP contracts with the federal government and is a stand-alone prescription drug plan with a Medicare contract. The plan is administered by Excellus BlueCross BlueShield in cooperation with Empire BlueCross, Empire BlueCross BlueShield, BlueCross BlueShield of Western New York and BlueShield of Northeastern New York. It’s available to Medicare eligible members who reside in New York State.
Source: readmedia.com

Video: Excellus BlueCross BlueShield: “15 Minutes” :30

Medicare Enrollment Begins Today

Of course, many who might be interested are Kodak retirees. Kodak recently announced it had stuck a deal with the Retirees committee to end retiree health care and survivor income benefits by the end of the year. That means thousands could be shopping around for new plans soon. “Since 1935, our company has been taking care of our friends and neighbors and we want to continue doing that, especially when a major employer like Kodak is facing changes,” said Jim Redmond, Excellus BCBS. “For the Kodak employees, if they’re Medicare eligible, they’ve got a lot more choices. If they’re under the age of 64, the choices become a little more difficult. Every individual situation is different. You really do need to sit down and figure out what is going to be best for you.”
Source: ynn.com

Can I Have Medicare And Private Insurance At The Same Time?

I received info from Horizon Blue Cross, Advantage Plan with RX. Package makes it clear that they will control not only your doctor choice but have the control to refuse treatments. The huge package they sent after I signed up and was covered, tells me in many many pages, how they will control everything and my options to contest. I have 10 days to cancel my coverage. Tomorrow I am calling to cancel and will cancel officially by certified mail. Seems that the doctor they cover should make decisions and not the insurance company. Just the beginning of the death of Medicare in my opinion so I am staying with Medicare only.
Source: seniorcorps.org

Open Enrollment and Star Ratings for 2013

MA plans and PDPs have a number of concerns about the methodology used to establish the star ratings, including the age of the data (e.g. the 2013 ratings are based on 2011 data), the frequent changes in methodogy and the difficulty in improving scores from year to year. For most plans these ratings are good news and the star rating has gone up for most measures from 2012 to 2013. Three new measures focused on care coordination and improvement. For MA-PDs, the national average for the care coordination measure was 85 percent or 3.4 stars. Non-SNPs performed better on this measure than SNPs. The measure for net improvement showed that MA contracts on average achieved a score of 3.1 for Part C and 3.4 for Part D while PDPs achieved an average score of 4.1. However approximately 10 percent of the plans will see a lower bonus as a result of their new lower ratings and plans with 2.5 stars or less for three years in a row face the possibility of termination from the program.
Source: gormanhealthgroup.com

Excellus Bluecross Blueshield rebates $3.1 million to New Yorkers

“My office will continue to look out for New Yorkers who face improperly denied health insurance claims and ensure that they are repaid the money they are owed. We are pleased that Excellus Bluecross Blueshield has refunded money to thousands of New Yorkers,” stated Attorney General Eric T. Schneiderman.
Source: lifehealthpro.com

National Influenza Vaccination Week December 4

(BINGHAMTON, NY) – In observance of National Influenza Vaccination Week, the Broome County Health Department will be holding a flu clinic on Monday, December 5, 2011 from 1:00 p.m. to 4:00 p.m. at their offices located at 225 Front Street, Binghamton. The clinic is open to anyone ages three and up. The fee for the flu vaccine is $25 (cash or check only). If you are 65 years of age or older and subscribe to traditional Medicare Part B, Excellus Medicare Blue PPO, Today’s Options or CDPHP Medicare the health department will bill your insurance plan.
Source: gobroomecounty.com

Broome County Health Department Announces Seasonal Flu Clinics for Fall 2009

The fee for the flu vaccination is $20. The pneumonia shot is also available for Medicare Part B recipients aged 65 and older at Broome County Health Department sponsored clinics (*) only. There will be no out of pocket fee for the flu or pneumonia shots for Medicare Part B recipients. Individuals on Medicare must present all insurance cards to staff at the clinic. If you have signed up with Today’s Options-American Progressive or Excellus Medicare Blue PPO Medicare Advantage Plan, we can charge your plan. For other Medicare Advantage Plans, such as Aetna Golden Medicare, CDPHP Medicare Choice, etc, you need to go to your primary care provider for the flu shot or be prepared to pay by cash or check.
Source: gobroomecounty.com

Get the facts on 2010 Medicare changes

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 marsmet522The final 2010 Medicare fee schedule projects an 11% drop in reimbursement to radiologists. The House has voted to delay implementation of the changes until March 2010. The Senate is expected to vote before the end of the year. Regardless of this annual circus, you should get a sense of what’s in store for you and prepare for the worst. This podcast on coding changes will help.
Source: diagnosticimaging.com

Video: Medicare Supplement Plans – Changes for 2010

Medicare Supplement Plans

Healthcare costs that are not covered by standard Medicare plans are not left uncovered with Medigap, also known as Medicare Supplement plans. Seniors, you are eligible for Medicare coverage if you are at least 65 years of age and/or have a qualifying disability. As the policies currently stand, there are 12 Supplement plans assigned the letters A through L. Each plan is important to consider for certain benefits relevant to your current situation, geographic location and health conditions. A basic change is occurring to all current plans with an addition of hospice care. Plan G will be undergoing a further alteration, that of a boost from 80 percent to 100 percent coverage for excess charges.
Source: allabout101.com

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 Benefit Redesign: Proposals to Restructure Could Hurt More than Help 

Posted by:  :  Category: Medicare

[1] See, e.g., "Talk of Medicare Changes Could Open Way To Budget Pact" by Jackie Calmes and Robert Pear, New York Times, (3/29/13), available at: http://www.nytimes.com/2013/03/29/us/politics/common-ground-in-washington-for-medicare-changes.html?pagewanted=all [2] "Talk of Medicare Changes Could Open Way To Budget Pact" by Jackie Calmes and Robert Pear, New York Times, (3/29/13), available at: http://www.nytimes.com/2013/03/29/us/politics/common-ground-in-washington-for-medicare-changes.html?pagewanted=all [3] For more information on the topic of Medicare benefit redesign and the potential impact on Medicare beneficiaries, see Written Statement Submitted Jointly by California Health Advocates, Center for Medicare Advocacy, and Medicare Rights Center on "Examining Traditional Medicare’s Benefit Design" Before the Subcommittee on Health of the Committee on Ways & Means, U.S. House of Representatives (2/26/13), available at: http://www.medicareadvocacy.org/2013/02/26/center-for-medicare-advocacy-testifies-on-medicare-redesign/.   Much of this Alert is based upon this Joint Testimony.  Also see, e.g., written testimony for the same hearing submitted by the Leadership Council of Aging Organizations (LCAO), available at: http://www.lcao.org/files/2013/03/Testimony-for-Ways-and-Means-Medicare-benefit-redesign-hearing.pdf. [4]  See Kaiser Family Foundation, "Restructuring Medicare’s Benefit Design: Implications for Beneficiaries and Spending" (November 2011), available at: http://www.kff.org/medicare/upload/8256.pdf. [5] Kaiser Family Foundation, "Restructuring Medicare’s Benefit Design: Implications for Beneficiaries and Spending" (November 2011), available at: http://www.kff.org/medicare/upload/8256.pdf. [6]  "Talk of Medicare Changes Could Open Way To Budget Pact" by Jackie Calmes and Robert Pear, New York Times, (3/29/13), available at: http://www.nytimes.com/2013/03/29/us/politics/common-ground-in-washington-for-medicare-changes.html?pagewanted=all.  MedPAC’s analysis of its own proposal also reveals that at least 20% of beneficiaries would pay an additional $250-$999 per year; their proposal coupled with a surcharge on Medigap plans would lead to 70% paying additional costs within this range.  See MedPAC Presentation, "Reforming Medicare’s Benefit Design" (March 2012), slide 10, available at: http://www.medpac.gov/transcripts/benefit%20design%20mar2012%20public.pdf [7] See, e.g., National Association of Insurance Commissioners, Senior Issues Task Force, Medigap PPACA Subgroup, "Medicare Supplemental Insurance First Dollar Coverage and Cost Shares Discussion Paper" (October 2011), available at: http://www.naic.org/documents/committees_b_senior_issues_111101_medigap_first_dollar_coverage_discussion_paper.pdf;  also see National Association of Insurance Commissioners letter to Secretary Sebelius (December 2012), available at: http://www.naic.org/documents/committees_b_sitf_medigap_ppaca_sg_121219_sebelius_letter_final.pdf. [8] See, e.g., Leadership Council of Aging Organizations (LCAO) Fact Sheet "Medicare Characteristics and Costs" (December 2012) and citations therein, available at: http://www.lcao.org/files/2013/02/LCAO-Medicare-Characteristics-Costs-Fact-Sheet-Dec20121.pdf.
Source: medicareadvocacy.org

Video: Medicare & You: Open Enrollment General Information

Daily Kos: President Obama’s budget will include cuts to Social Security, Medicare

blueoasis, Mary Mike, Sybil Liberty, Flyswatterbanjo, bookwoman, pierre9045, fenway49, Simplify, zerelda, Capt Crunch, turn blue, miracle11, greenbastard, Cassandra77, BOHICA, remembrance, quagmiremonkey, greenbell, PhilJD, Medium Head Boy, Jim P, Timothy J, enemy of the people, eddieb061345, kareylou, filkertom, Catsmeat, gneissgirl, Vetwife, Fury, Keone Michaels, Dem Beans, scurrvydog, Australian2, jaf49, forrest, Lady Libertine, GreyHawk, Matthew D Jones, FrugalWorld, NanaoKnows, SouthernLiberalinMD, absdoggy, coloradorob, liberaldemdave, Grendel, nupstateny, Dartagnan, salmo, ZedMont, jrooth, stevemb, ratzo, Bisbonian, kenwards, triv33, madgranny, len chaitin, leonard145b, side pocket, TheMomCat, ichibon, melfunction, BerkshireDem, kravitz, Cthulhu, a gilas girl, Dreaming of Better Days, betterdemsonly, Aunt Martha, Mike RinRI, poligirl, whataboutbob, jojogogo, aitchdee, Anima, mollyd, shevas01, paradox, Lily O Lady, Mr MadAsHell, Wolf10, brook, decisivemoment, RebeccaG, DianeinWA, Ender, m16eib, Joieau, chira2, vigilant meerkat, Thomas Twinnings, poorwriter, zinger99, Monitor78, 2laneIA, StuartZ, coral, demjim, Catkin, magnetics, JVolvo, valadon, Wife of Bath, praenomen, strangely enough, Philip Woods, equern, peptabysmal, Panama Pete, Liberal Lass, George3, HCKAD, jeopardydd, MundaneStudies
Source: dailykos.com

Sequester (GOP) Blamed for Medicare Woes, Not Obamacare Cutting $714 Billion Out of the Program

Washington Post says: “Legislators meant to partially shield Medicare from the automatic budget cuts triggered by the sequester, limiting the program to a 2 percent reduction — a fraction of the cuts seen by other federal programs.  But oncologists say the cut is unexpectedly damaging for cancer patients because of the way those treatments are covered.”  And even those cuts are not real. As the AP says, legislators exempted Medicare and Medicaid from the sequester.  There aren’t any cuts in Medicare.  All of this is manufactured and made up.  But the idea here is to — you’ve got, what, really in this year, $25 billion in sequester spending that’s being reduced.  They’re not budget cuts.  It’s spending being reduced.  Spending from a projected amount, not, again, reduced spending from a baseline.  The whole idea is Republicans have to be blamed for this.  And it’s Republicans causing cancer patients to die. 
Source: rushlimbaugh.com

CMS Adjusts Medicare RAC Documentation Limits

In an effort to reduce administrative burdens on hospitals and other providers, CMS has reduced the minimum medical record requests from Medicare Recovery Auditors — formerly known as Recovery Audit Contractors, or RACs. The new guidelines, which exclude physicians and suppliers, go into effect April 15. According to the CMS guidance, RACs may request a minimum of 20 records in a 45-day period from hospitals, down from the previous minimum of 35 records. The maximum number of record requests per 45 days is still 400, while hospitals with more than $100 million in MS-DRG payments still have a cap of 600. CMS also changed limitations on the type of claims RACs can review. Previously, 100 percent of a RAC’s record request could be used toward a single type of claim, such as inpatient or outpatient. Now, RACs can only select up to 75 percent of any claim type for review, while the remaining 25 percent would have to be for other types of claims. To read the entire update from the CMS regarding RAC documentation limit changes, click here.
Source: beckershospitalreview.com

Medicare Tax Update and Information for 2013

Earned income is defined as the money that you are paid from an employer including tips. The Medicare tax on that income is 2.9 percent. The taxes are withheld from your check by your employer at the rate of 1.45 percent from your pay and the employer pays another 0.9 percent on your earned income. For those who fall into the new Medicare surtax threshold, this means that you will owe another 0.9 percent of your earned income that you must pay out of pocket. Once your earned income reaches the MAGI threshold, your employer must begin withholding the additional 0.9 percent from your earned income, but it will not be enough to cover the amount that will be owed on income earned before the threshold was met.
Source: medicarebenefits.com

Reduce Medicare payments for hospice care in skilled nursing facilities, MedPAC suggests

Speaking at a public meeting last Thursday in Washington, D.C., the commissioners revisited recommendations from a 2011 report from the Department of Health and Human Services Office of Inspector General (OIG). That report gave advice to the Centers for Medicare & Medicaid Services in advance of an Affordable Care Act requirement to reform Medicare hospice payments after Oct. 1, 2013.
Source: mcknights.com

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

Duckworth, Seniors & Vendors Discuss Ways To Preserve Medicare & Social Security

Senior citizens, service providers and others at the discussion specifically said they’d like to see problem companies, such as those being raided by the FBI or being sued for how they conduct business, banned from placing competitive bids with the Centers for Medicare & Medicaid Services for certain durable medical equipment, prosthetics, orthotics and supplies.
Source: progressillinois.com

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

Posted by:  :  Category: Medicare

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

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

Cost Cutting as a Result of Medicare Competitive Bidding

Part of the Medicare Modernization Act of 2003 (MMA) required that the Medicare program keep the costs of Durable Medical Equipment (DME) down. The result was the establishment of an open-bidding system enabling Medicare to reduce equipment costs. This open-bidding system encouraged competition between DME suppliers to produce the lowest prices without sacrificing the quality of product. Under this section of the MMA, contract suppliers are required to comply with Medicare enrollment rules, as well as to be licensed and accredited. The underlying goal is to reduce the out-of-pocket costs for both beneficiaries and taxpayers.
Source: ehealthmedicare.com

Duckworth, Seniors & Vendors Discuss Ways To Preserve Medicare & Social Security

Senior citizens, service providers and others at the discussion specifically said they’d like to see problem companies, such as those being raided by the FBI or being sued for how they conduct business, banned from placing competitive bids with the Centers for Medicare & Medicaid Services for certain durable medical equipment, prosthetics, orthotics and supplies.
Source: progressillinois.com

CMS System Glitch Affects Processing of Home Health Final Claims

Posted by:  :  Category: Medicare

What this will mean to the home health agency billing staff will be the following: EOE claims can be submitted during this time frame, however, they will not show to be processing on the system and will not have a 277 report come back on these claims.  The claims will be held until April 15, 2013 then released to the processing system at this time if all problems with the technical issues have been resolved. No resubmission of these claims should be done during this time frame as this will only cause an increased back log of claims when the system is processing again. Once the issue is resolved and CMS lifts the hold, agency may want to consider re-submitting their claims if claims are not processing.  All RAP (Request for Anticipated Payment) claims will be processed during this time and should be submitted as usual.
Source: axxessweb.com

Video: Audit Alert: Codes for Evaluation & Management Services Performed at Nursing Facilities

NGS to Administer Medicare Claims Payment in New York (S U P R A S P I N A T U S)

NGS will serve as the first point of contact for the processing and payment of Medicare fee-for-service claims from hospitals, skilled nursing facilities, physicians and other health care practitioners in the two states. The new Part A/Part B Medicare Administrative Contractor (A/B MAC) was selected using competitive procedures in accordance with federal procurement rules.
Source: nysbar.com

Important Information Regarding Medicare Claims and Payments for Part A Indiana and Michigan ProvidersHall Render

National Government Services, Inc. (NGS) recently announced important information regarding Medicare claims and payments for Part A Indiana and Michigan providers.  With the impending transition of these providers to Wisconsin Physician Services (WPS), NGS posted the following transition timeline:
Source: hallrender.com

April 1 Diabetic Supplies Fee Schedule Allowables

On Wednesday, January 2, 2013, the President signed into law the American Taxpayer Relief Act of 2012.  Section 636 of this new law revises the Medicare non-mail order fee schedule amounts for diabetic testing supplies.  Effective for items furnished on or after April 1, 2013, the non-mail order fee schedule amounts for Healthcare Common Procedure Coding System (HCPCS) codes A4233, A4234, A4235, A4236, A4253, A4256, A4258 and A4259    will be recalculated by removing the 5 percent covered item update for calendar year 2009 and applying a 9.5 percent reduction.  This will result in the fee schedule amounts for non-mail order diabetic testing supplies being equal to the fee schedule amounts for mail order diabetic testing supplies (denoted by KL modifier). 
Source: vgm.com

Find Job Openings, Career Employment Opportunities, Post Jobs

With sophisticated technology we are able to present in real-time almost every newly listed job that has just been posted with thousands of sites. We simply aggregate (that is where we derive our name) each new job as it is posted with all the major sites. Now you don

Perform Getting The Extremely Medicare Supplement Results In

Posted by:  :  Category: Medicare

Another aspect of policy coverage for Medigap Plans is the first three pints of blood. This is paid for in all plans, but in intend K it is up to 50 percent, and plan S is up to 75 percent. This is true for the hospital deductible befit. The Skilled The nursing profession Facility daily coinsurance covers a specific amount per day for the 21-100 of an individual benefit period. This is a benefit of plans K through L. For plan K and L, it can be 50 percent and as well as 75 percent correspondingly. The part B per year deductible is accessible for plans C, F and S.
Source: hi-see.org

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

How Medicare Supplement Plans & Medicare Advantage Plans Work

When 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

Incorporated Income Tax Reform

Included as well in Medigap Plans is part B excess prices benefits. Desires to give available at total for plans F, I, and J, and 80 percentage points for plan Delaware. Emergency care outside belonging to the U.S acquired to cover 80 percent of the really do care costs during the first 60 days of every trip. This is available for systems C through N. At home recovery reward is available for plans D, G, I, and T. It covers up a new certain amount on every custodial proper care visit after an surgery, injury, plus illness for up to a certain maximum benefit.
Source: huronvalleyschool.org