FAQ on Medicare doctor pay: Why is it so hard to fix?

Posted by:  :  Category: Medicare

Today’s problem is a result of yesterday’s efforts to control federal spending – a 1997 deficit reduction law that called for setting Medicare physician payment rates through a formula based on economic growth and known as the “sustainable growth rate” (SGR). For the first few years, Medicare expenditures did not exceed the target and doctors received modest pay increases. But in 2002, doctors reacted with fury when they came in for a 4.8 percent pay cut. Every year since, Congress has staved off the scheduled cuts.  But each deferral just increased the size – and price tag – of the fix needed the next time.
Source: medcitynews.com

Video: FAQ Medicare and ABN Forms

FAQ: Decoding The $716 Billion In Medicare Reductions

Ryan’s plan also calls for an overhaul of the program, offering beneficiaries a set amount of money that they would use toward buying a private plan or traditional Medicare. Democrats have argued that such a fundamental change could undermine the traditional Medicare program, because private plans might tailor their coverage to attract healthier beneficiaries, leaving sicker beneficiaries in traditional Medicare. Critics of Ryan’s plan also predict it will force seniors to eventually pay more for their health care because the federal payments will be capped at the rate of gross domestic product plus half a percentage point, an amount that may not keep up with the increase in medical costs. Under Ryan’s plan, insurers would have to provide benefits that are at least equal the value of those offered in traditional Medicare. 
Source: kaiserhealthnews.org

How does Sequestration Impact Medicare?

Additional discussions of reducing payments to skilled nursing facilities, and imposing a new 10 percent co-payment for people receiving home health care have been considered. Laboratory tests and imaging tests, such as the MRI, might have new co-payments imposed as well. Drugs and other therapies administered in the doctor’s office, such as costly chemotherapy treatments, could see increased payments.
Source: fora-costcontainment.com

Proposed Rule Would Increase Rewards to Medicare Fraud Whistleblowers to Nearly $10 Million : Whistleblower Protection Blog

The proposed rule would increase the potential reward amount for individuals who report information that leads to a recovery of Medicare funds from 10 percent to 15 percent of the final amount collected. The current program caps the reward at $1,000, meaning HHS pays a reward on the first $10,000 it collects as a result of a tip. HHS is also proposing to increase the portion of the recovery on which HHS will pay a reward up to the first $66 million recovered – this means an individual could receive a reward of $9.9 million if HHS recovers $66 million or more. 
Source: whistleblowersblog.org

HHS wants $10 million potential payday for Medicare fraud whistleblowers

“In order for an individual to be eligible to receive a reward, the information must relate to the activities of a specific individual or entity and must specify the time period of the alleged activities,” the proposed rule states. “Examples of specific activities include, but are not limited to, billing for services never rendered, and billing for supplies not ordered.”
Source: mcknights.com

Agent Pipeline Offers Cigna Medicare Supplement Solutions

Posted by:  :  Category: Medicare

Anytime we have the opportunity to offer a product from a carrier as prestigious and trusted as Cigna, we’re happy to do so. Cigna and its predecessor companies have been in the insurance field for more than 200 years. It is active in 30 countries and has 71 million customer relationships around the world. As a National Marketing Organization (NMO), we are pleased to be able to offer FMO, MGA and agent level contracts to our network of partners in the Senior Market.
Source: agentpipeline.com

Video: CIGNA Government Services TNCPE Excellence Award Recipient 2010

Cigna Medicare Plans: That Overview

Medicare will also endure requests on an incident by case structure. If you think that you might be able to enroll outside of the open enrollment period and never fall under on the list of special enrollment lessons that are pointed out then you can contact Medicare to brew a request directly by employing them. Medicare originally is thought as Part A, which is hospital insurance combined with Part B, can be medical insurance. This original an insurance plan allows for a number of but not every medical or medical service and offer you. There is insurance available, called Medigap or medicare supplement that shields expenses that are not covered under common Medicare Part An important and Part Cid. This includes things with regard to copayments, coinsurances, deductibles and expenses when you are traveling outside of united states. Believe it or the out connected pocket expenses may add up very in no time and before restrict it you could easily paid often the monthly premium of the Medicare Supplement Choose. Now, the bottom line, all the plans my friend offer the same. Did you might hear that, all of the plans are exactly the same? It a lot a flat screen t.v. any is being traded by multiple snowchains. It is the actually product but it may be less overpriced with one outlet verses another. So, you are encouraged to shop price, price, and more low price. That is the way you win mafia wars.. Do not choose to be fooled by its agent when these people tell you very own product or benefit is better. That is inconceivable. Their price can is lower, and that is something someone can hang an hat on. Coming through medical expenses as well as the costlier health has made it hard for people to master their health and as well financial savings together. This is even more so, for retired not to mention elderly people who have a meager price markdowns and little financial income. For such people, make use of of of Medicare Medigap Plans is most definitely a effective tool. Available across generally market, these supplement insurance schemes propose people a in order to nullify overhead and further expenses of hospital visits. The normal Medicare Supplements do end up with certain expenses which can left to possibly be paid by the victim themselves. Medicare Part B regularly referred to simply because physician services policy. This system refers regarding overhead incurred the particular doctor such as; Medicare accepted family doctor services, outpatient healthcare facility services and robust medical equipment. Since Medicare supplement blueprints and plans are categorized and yet each benefit is similar for all insurance cover companies, it would be easy for you to decide a company such as. Just make sure how the private insurance specialist where you gotten the plan are often there for anyone when the instance comes that want their help. As opposed to Medicare Part A, Medicare insurance Position B plans will involve payment on any month-to-month basis a good insurance premium. In 2007, the payments for Medicare insurance cover Part B (medical care insurance) were .50 and in 2008 they climbed to .40. Payments remained equal in 2009. In 2010, these were stated once new at .40. For those who will did not opt Part B rrnsurance policy when you first and foremost turned eligible, well then monthly cost of that particular insurance coverage will be elevated.
Source: typepad.com

Cigna Medicare Plans: Some Overview

Ahead of enrolling for 5 steps to learning everything you need to know about Medigap plans, the individual should know the current strength plan they have definitely enrolled for. The health offers that the game enthusiasts will have are already Medicare Part Any kind of a or Part Ymca. The correct time to enlist for a alternative healthcare policy is really a month after we turn 65. Although the policy itself is advised on a confirmed issue basis (there are no controlled screenings), applying just one month after forty eight means insurance enterprises can’t deny you the policy even if you do previous illness and the premium will stay the same. Actual Medicare provides high quality insurance, but this particular protection may always come close to being enough insurance coverage. For this explanation many Medicare receivers have chosen on supplement their protection or to pick out a Medicare Chapter C policy instead of depending on Original Medicare. Treatment Supplemental Plan M covers the A deductible, just what is 00 for 2010 and a new Part B every year deductible, which is 5 for ’10. In extension, the Medicare supplements Plan covers the 20% co-insurance just that genuine healthcare might not pay in Part A together with Part B. There are at the same time a few extensional profits including a trustworthy foreign trip stores and a “Part B excess Charges” benefit. This inclusive plan includes the perfect videos money can look for. This plan that provides insurance policy coverage for many outpatient services and general practitioner fees is called the Supplemental Medicare health insurance. Prosthetic devices, and constant medical equipment are covered under strategy. The gaps in strategy are as pursues. For seniors that are not covered by an The hmo or PPO type of plan during their own initial enrollment period, it is commended that they link up with Medicare Part Cid and Part Deb. They cover medical insurance and certain prescriptions, respectively. Most people are often automatically enrolled in Medicare Part Every when they emerge as eligible for Social media Security. Realistically are you right now waiting for? Reassurance and insurance plan for the end are only a couple of seconds away. Really do not necessarily wait until later on it can be much too late. It can be considerably better to be secure than sorry. Get hold of a person’s community northern California supplemental insurance source to obtain all by yourself established up and safeguarded. People comes across all the types of insurance, Medicare supplement rrnsurance policy attributes amongst some of these. It is forever better to be informed when it is one of the Medicare supplement insurance because there are stable changes regarding insurance policy; ordinarily a change for faster however at it is not really. It is significant to monitor these kinds of varying trends you may be previously on Medigap insurance or wish to register for the actual same. There is an important change to a plan; and even since the methods are being modified, the companies are perhaps commencing to saying the new bargains. This is the primary step related to change ever because of the fact 1992. Looking the right alternative healthcare plan will be quite a good difficult process. The right blueprint must be hired and include that this right benefits throughout the right quotes. In that day and age over 65s should probably find it excellent difficult to survive without a hospital plan altogether; containing the gaps within the Medicare course of action some over 65s will still ante up out a money for additional health care costs. A person’s Medigap plan, however, is a impressive option to ensure you don’t get hit with surprise medical bills. Have you ever got down to find Medigap Insurance strategize on line, you will know full practice definitely is often thoroughly strenuous and also annoying. Pursuing are for the most part 3 tips can help you products plan for most people without having verbalizing in the function.
Source: typepad.com

Aetna Inc. (NYSE:AET), CIGNA Corporation (NYSE:CI), WellPoint, Inc. (NYSE:WLP): Does the Medicare Advantage Announcement Make Healthcare Stocks a Buy?

My thought on the matter is that the increase in health sector shares was a market reaction to just-released information. However, be cautious with insurers for a while and see what other pitfalls the Affordable Health Care Act have waiting for them. There could be more problems down the road that offset these current gains.
Source: marketdailynews.com

Cigna Medicare Plans: That Overview

The comes across all of the types of insurance, Medicare supplement insurance package attributes amongst these. It is forever better to be informed when it is about the Medicare supplement health insurance because there happen to be stable changes to insurance policy; usually a change for better however at time intervals it is not really. It is significant to monitor these kinds of varying trends whether you are previously on Medigap insurance or ought to register for the same. There is an important in order to a plan; much since the plans are being modified, the companies are commencing to quote the new rates. This is the primary step attached to change ever since 1992.
Source: wordpress.com

In Arizona, Poorest, Sickest Patients Get Coordinated Care

Posted by:  :  Category: Medicare

Racism by elycefelizJoseph Ford sits in his well-worn easy chair in the living room of his suburban Phoenix home. He’s 42 years old and disabled from a car accident. His attendant has just arrived and makes her way into the kitchen to prepare dinner. Later, she’ll change the sheets on Ford’s hospital bed. It’s pushed against the wall in the entry way where he sleeps every night, since Ford can’t make it up the stairs. His house is busy today: the case manager from his health insurance company, Dave Oxford, is here too.
Source: kaiserhealthnews.org

Video: Medicare in Arizona- 1.800.643.7544

GPM Life Medicare Supplements

Based in beautiful Jackson Hole, Wyoming, we currently market health insurance in 18 different states from our website IndividualHealth.com. I have worked in the domestic and international markets for most of my adult life. Recently we launched a newly revamped website www.tetonmarketing.com which has a primary focus on music and Native American Flutes and hand crafted items made in Wyoming. Check it out! I want the Insurance Simplified Blog to be a place you can visit from time to time and read about real world issues that individuals and families face daily. Our parent website IndividualHealth.com we like to think of as a virtual brochure. But with the blog I want to talk about the topics behind the brochure. Also check out our blog www.JacksonHoleTim.com which is “All Things Wyoming, Everything Jackson Hole” . If you love the Yellowstone basin this is blog for you! Then when you are ready check out our new Social Network site Jacksonholetim.ning.com – this is a place you can connect with other who visit and live in Wyoming. And finally we have just launched another new blog. Jackson Hole Tim (www.jacksonholetim.com) is a new place to visit that talks about “All things Wyoming, Everything Jackson Hole”. I hope you find these blog helpful.
Source: wordpress.com

Hospice Of Arizona Settles Medicare False Claims Allegations

The government alleged that Hospice of Arizona and its related entities, engaged in certain practices that resulted in the admission of ineligible patients or inflated bills, including pressuring staff to find more patients eligible for Medicare, adopting procedures that delayed and discouraged staff from discharging patients from hospice when they were no longer appropriate for such services, and not implementing an adequate compliance program that might have addressed these problems. As part of the settlement, American Hospice Management Holdings has agreed to enter into a corporate integrity agreement with the Inspector General of the Department of Health and Human Services that provides for procedures and reviews to be put in place to avoid and promptly detect conduct similar to that which gave rise to the settlement.
Source: newsroom-magazine.com

Medicaid Math Trumps Ideology for GOP Governors

Even if the exchanges function as intended, there will be holes in the safety net for the poor in states that opt not to expand Medicaid. In recognition of this problem, the Obama administration has relaxed rules on states in an effort to coax them into compliance. On Tuesday, a day after Obama declined in his second inaugural address to offer an olive branch to Republicans in Congress, the Department of Health and Human Services issued a regulation that extends a helping hand to states by allowing them to charge higher co-payments for some medical services and prescription drugs.
Source: realclearpolitics.com

Important Medicare Subrogation Decision From the 9th Circuit Court of Appeals : Day On Torts

The case is Parra v. PacificCare of Arizona, No. 11-16069 (9th Cir. April 19, 2013),  Parra was struck by car and was seriously injured.  His medical expenses were paid by Defendant, a Medicare Advantage Organization ("MAO").  Parra died from his injuries, and his survivors brought a claim under Arizona’s wrongful death law.  The MAO also asserted a claim for monies it paid for medical expenses.  GEICO, the tortfeasor’s insurer, issued a joint check to the parties for the full amount of the MAO’s claimed interest, to be held in trust pending the outcome of the dispute between the survivors and the MAO. 
Source: dayontorts.com

Can Florida Medicaid Learn from Arizona?

Ford’s house is busy today. Dave Oxford, the case manager from his health plan Mercy Care is here, too, peppering Ford with questions about the nagging wound on his foot and whether he needs to change any of his many medications. Oxford visits the homes of all of his clients in the Phoenix area who are old or disabled enough to qualify for Medicare and poor enough to qualify for Medicaid. Oxford’s visits every three months are part of a coordinated and concerted effort to keep patients like Ford out of pricey nursing homes and emergency rooms. Mercy Care is a contractor of the insurance giant Aetna, and like all health plans that compete for Arizona’s combined Medicare-Medicaid patients, it receives a monthly fee per person that it must use to cover all of a patient’s needs.
Source: hcafnews.com

Year One Report sheds light on Arizona Connected Care – Tucson Medical Center

Arizona Connected Care (AzCC, at www.azconnectedcare.org) is a leader in the new health care dynamic, focused on improving health while controlling costs. Partners in this venture include primary care physicians and specialists, with Tucson Medical Center as a minority shareholder.
Source: tmcaznews.com

Medicaid Expansion Is Delicate Maneuver for Arizona Governor

Ms. Brewer, who has become something of a conservative icon for her aggressive opposition to Mr. Obama’s policies, surprised many Legislature watchers at her State of the State address last week by saying she wanted to expand the state’s Medicaid program to include anyone who makes up to 133 percent of the federal poverty level, or $14,856 for an individual. The risk if Arizona does otherwise, she said, is losing the federal funds and the health care jobs that come with the changes.
Source: protectingmedicare.org

WellCare employees work to end hunger in Tampa BayHealth News

Posted by:  :  Category: Medicare

Founded in 1982, Feeding America Tampa Bay makes a difference in the lives of thousands of people each week through its distribution to a partnership network of more than 600 faith-based and other incorporated non-profit hunger relief organizations. The food bank

Referral Agents Take Note: DMEPOS Round 2 Contract Winners AnnouncedHall Render

Posted by:  :  Category: Medicare

The PARTY Is OVER ...item 4.. Today, Mitt Romney Lost the Election (Sep 17, 2012 6:02 PM ET) ...item 5.. James Brown - Get On The Good Foot, Soul Power, Make It Funky Soul Train 1973 ... by marsmet471Similar to the hospital exception above, the second exception permits beneficiaries to obtain a competitively bid walker or manual folding wheelchair from their physicians in limited circumstances.  The physician will be paid out at the Round 2 rate for those items.  Medicare physicians and treating practitioners who have also enrolled as Medicare DMEPOS suppliers may be eligible for an exception to the Round 2 contracting process.  This exception includes physicians, podiatrists, nurse practitioners, physician assistants and clinical nurse specialists.  Under this exception, a physician may furnish these items without being awarded a Round 2 contract, as long as the following requirements are met:
Source: hallrender.com

Video: Medical Billing Expert Series: Medicare Claims Processing Manual Chapter 20

CT Medicare Home Health TPL Project Year Five Instruction Packet 

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

CMS Revises Policy on Billing Part B for Inpatient Claim Denials

The hospital may submit a Part B inpatient claim (12x) for the Part B services that would have been payable to the hospital had the beneficiary originally been treated as an outpatient rather than admitted as an inpatient except where those services specifically require an outpatient status such as outpatient visits, emergency department visits, observation services, that are, by definition, provided to hospital outpatients and not inpatients. Consistent with existing Medicare policy, where no Part A payment is made because the inpatient admission is denied as not reasonable and necessary, hospitals may bill separately for outpatient services (13x) provided in the three-day payment window prior to the inpatient admission as the outpatient services that they were, including observation and other services that are furnished in accordance with Medicare’s requirements. See Section 10.12, Chapter 4 of the Medicare Claims Processing Manual (Pub. 100-04). Because services provided during the three-day payment window are outpatient services, they cannot be included on the Part B inpatient claim. Instead, hospitals should bill for these services on a Part B outpatient claim in accordance with this policy.
Source: healthcarereforminsights.com

Manual Medical Review of Outpatient Therapy Claims Effective April 1, 2013

Superior Medical Billing Solutions can complete a chart audit of your patient files to help make sure you are in compliance with professional standards of documentation for therapy services. We can also help with tracking a patient’s progression towards hitting their therapy caps and thresholds so you can be aware of patients that are getting close to both amounts. These are just part of the services provided by Superior Medical Billing Solutions to our clients. If you need a practice management company to help you in these increasingly regulated times, Superior Medical Billing Solutions is here to help you navigate these issues.
Source: medicalbilling-blog.com

Streamlining Your Thoracic and Cardiovascular Surgery Medical Billing Practices with Integrated PMS

Practice in Thoracic and cardiovascular surgery means expensive facilities that often need to be upgraded to clinical innovations. Despite such expensive cost outlays, continued shortage of physicians may still have allowed them to see more patients, thereby garnering revenues well over capital expenditure. But, severity of health care reforms and Medical Billing challenges has not allowed physicians in thoracic and cardiovascular practice to realize their dues fully. While Medicare, Medicaid, and private insurance fee schedules have greatly been reduced these days, accountability in terms of coding compliance, meaningful use of information technology, and reporting under accountable care organization model (ACO) has increased beyond the control of traditional practice management. As a result health care practitioners, particularly thoracic and cardiovascular surgery practitioners may need to streamline their medical billing in order to remain financially healthy.
Source: medicalbillersandcodersblog.com

Pitfalls in Billing Pharmaceuticals to the Medicare Program

It is clear there are multiple pitfalls for the compliant billing of pharmaceuticals to Medicare Part B. Hospitals need to ensure, to the extent possible, that their pharmacy CDM is accurate with correct HCPCS and revenue codes, that unit conversion modules or tables are set up correctly, that self-administrable drugs have been identified as such and revenue code fields are set to toggle between 637 and 250 based on bill type. Noncovered drugs should be billed to the patient, not Medicare. Drugs integral to the procedure should be set up as supply items, not billed as noncovered. Nursing documentation, including that on an electronic medication administration record, should indicate date, time and nurse responsible for administration and the amount of drug given—and wasted—if any. Only wasted drugs in single-dose vials can be billed to the program and only if documentation in the medical record meets the requirements. 
Source: bkd.com

Loopholes to help you track Medicare Part B therapy billing

Unfortunately, there is no easy solution to this problem. But I have a few ideas. The current process of updating a resident’s cap amount is through checking the “Common Working File” (CWF). This file is a master list of all Medicare Part B therapy services billed for the year to date. It’s a good system, but it’s not always accurate. If another provider, such as another SNF, outpatient clinic, hospital, etc. is delayed in its billing of services, the Common Working File has no current record of these services. In terms of reimbursement, Medicare Part B pays whichever provider submits the claims first.
Source: mcknights.com

Medicare Advantage Plans: Are They For You?

Posted by:  :  Category: Medicare

To assist consumers, Medicare now rates Medicare Advantage programs using a star system. Using member satisfaction surveys and plan evaluations, plans are rated between one and five stars. In fact, at any time, you can switch into a five-star Medicare Advantage plan, but only if one is available in your region (only a few states have a five-star plan). Even if your area does not offer a top-rated plan, every state offers at least a four-star plan.
Source: figuide.com

Video: 2013 Humana Choice PPO MAPD

InsureBlog: Medicare Advantage Cuts

For just a few dollars more than most pay for a Medicare Advantage plan you could own a Medicare supplement insurance plan N and have much less out of pocket exposure than you will have under a Medicare Advantage plan.
Source: blogspot.com

What is Medicare Advantage (Part C)?

Health Maintenance Organizations (HMO): Provide access to a range of doctors and hospital insurance through a flat monthly rate with no deductibles. HMO plans have the strictest network guidelines, meaning all visits and prescriptions are subject to the plan’s approval. Going outside the established network of doctors, labs, hospitals, and pharmacies will result in a higher cost to the beneficiary. When enrolling in an HMO, the beneficiary must select a primary care physician who must approve all referrals to specialists.
Source: ehealthmedicare.com

Need Help Picking Right Medicare Advantage Plan for Mom!! » Toni Says

*Some plans are $175 co pay per day for 20 days which can be a maximum                                       $3500 if you are in the hospital for over 20 days or might be $150 co pay per                             day for days 1-5 with a maximum of $750 maximum stay if you are                                                 inpatient hospital for more than 5 days (example only)
Source: tonisays.com

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

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

CMS shows that the healthy go in and the sick come out of Medicare Advantage plans

Despite substantial changes in policies and market characteristics of the Medicare managed care program, disenrollment to FFS continues to occur disproportionately among high-cost beneficiaries. Disenrollees had higher risk scores and incurred higher risk-adjusted payments than beneficiaries in FFS. Their high risk scores are in contrast to the risk scores of the general MA population, most of which is enrolled in plans with average risk scores similar to or less than local FFS experience (United States Government Accountability Office, 2010). Recent studies have also shown that MA plans continue to experience favorable selection through enrollment of low-cost beneficiaries (MedPAC, 2012; Riley, 2012). These research findings suggest a pattern of selective disenrollment whereby disenrollees are sicker and more expensive than the beneficiaries who remain enrolled in MA plans. This selective disenrollment potentially increases Medicare costs through the return of high-cost beneficiaries to the FFS sector, leaving behind a healthier and lower-cost population in the capitated MA sector.
Source: pnhp.org

Medicare Advantage PPO Plans

These plans may or may not have a plan premium whereas several more of the HMO types hove none other than your normal Part B premium to Medicare. Also there will be both an in network out of pocket and an out of network out of pocket if you choose a provider not in network. The out of network providers must agree to accept the terms and conditions of the plan in order to get covered treatment; generally look for providers that accept Medicare on assignment.
Source: medicareinsurancetexas.com

Medicare Advantage: Will 2013 Bring Changes to Medicare Advantage PPOs in Las Vegas, NV?

If your plan is subject to change in 2013, you will have plenty of time to make a decision.  Announcements regarding 2013 plan changes will come in early October.  That gives you two months to decided what to do.  The important thing is that you know ALL of your options.  That is where Sun City Financial comes in.  We are licensed and contracted with all Medicare Advantage Plans and a dozen Medicare Supplements in Clark County and Las Vegas, NV.  We will help you navigate the changes and keep you informed on all of your options.  Call us at 702.551.4949 or visit our website at www.suncityfinancial.com for more information.
Source: suncityfinancial.com

Help Me with Medicare Advantage and Drug Question

hi all. my name is mike and i will retire in july. i am 66 years old and about to go on medicare for the first time. I recently met with two different agents to talk about medicare. one with bankers life and one with united health. and they are telling me two different things, and I dont know who is telling me the truth. Bankers life is telling Medicare advantage is bad. and I cannot have a separate Pt D plan with it (i can only do it, if the drug plan is built into it). and I should go with them and pay a premium i cannot afford for a medicare supplement. The united health guy is telling me I can have a pt d plan if the advantage plan does not have a drug plan built into it. This would be good for me, because the advantage plan has no monthly premium. He says I should do it like this because the PPO that he offers that does have the drug plan built in, wouldn’t cover some of my drugs, and it would be really expensive, but he was able to find a separate pt d plan that would keep my drug costs down. they are telling me two contradicting things, one is obviously lying. who is telling me the truth?
Source: insurance-forums.net

What the elderly should know about Medicare

Part C (Medicare Advantage): Part C allows beneficiaries to enroll in a private insurance plan, called a Medicare Advantage plan. Medicare Advantage plans are managed care plans, such as Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs). Medicare Advantage plans must cover all Part A and B services and usually include Part D (prescription drug coverage) benefits in the same plan. These plans sometimes cover additional benefits not covered by traditional Medicare, such as routine vision and dental care. All plans have an annual limit on your out-of-pocket costs for Part A and B services, and once you reach that limit, you pay nothing for covered services for the rest of the calendar year. The out-of-pocket limit can be high but may help protect you if you need a lot of health care or need expensive treatment. Out-of-pocket costs include deductibles, copayments and coinsurance
Source: alvitacare.com

Blue Care Network expands Medicare Advantage service area, Blue Cross and Blue Care Network add plan options

In addition, BCN Advantage members will now be able to “buy up” to more comprehensive dental and vision benefits for a modest additional premium. Members will receive partial coverage on restorative services such as fillings, root canals, crowns and crown repairs. They’ll also get an allowance for frames and lenses to improve their vision health.
Source: hcwreview.com

Diabetes screenings, supplies, and training – Medicare has you covered

Posted by:  :  Category: Medicare

The PARTY Is OVER ...item 4.. Today, Mitt Romney Lost the Election (Sep 17, 2012 6:02 PM ET) ...item 5.. James Brown - Get On The Good Foot, Soul Power, Make It Funky Soul Train 1973 ... by marsmet471If you’re at high risk for developing diabetes, Medicare covers up to two fasting blood glucose (blood sugar) tests each year. If your doctor accepts assignment, you pay nothing for these tests. You may be at high risk for diabetes if you’re obese, have high blood pressure, high cholesterol, or a family history of diabetes. Talk to your doctor to find out when you should get your free screening test.
Source: medicare.gov

Video: Medicare Agent Training

HCC University: New Medicare Web Based Training (WBT) Modules

SCAN is committed to partnering with our physician providers in offering high quality geriatric care to our members. A significant part of that effort is to assist our providers in the provision of accurate coding that will contribute to the quality of care and support the expected revenue from the Medicare program. To this end, we present the following tools and education for all the physicians and groups providing care to our members.
Source: scanhealthplan.com

Home Hemodialysis Patients Urge Medicare to Fix HHD Training Reimbursement

Home Dialyzors United relies on memberships and donations for the patient support, education and advocacy work we do. If you find this site helpful, please consider making a tax deductible donation or becoming a member!
Source: homedialyzorsunited.org

Volunteer Training About Medicare Benefits 

The Lincoln County SHIBA program (Senior Health Insurance Benefits Assistance) conducts volunteer training February 28 and March 1. Although the workshops are focused on training new SHIBA volunteers, it is an educational opportunity for anyone workingor volunteering in a field that encounters Medicare beneficiaries. Curriculum includes Medicare Parts A, B, and D, Medigap Supplements and Medicare Advantage plans. Training also includes how to handle difficult clients and challenging client needs.
Source: kyaq.org

Choice, Numeracy, and Physicians

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Source: curemyway.com

Get trained to be a volunteer Medicare counselor

APPRISE is a statewide program with a local office at the Bucks County Area Agency on Aging. APPRISE has been providing free health insurance counseling for 20 years serving older adults in Bucks County. Its volunteers work in senior centers throughout Bucks County and county government offices in Doylestown.
Source: timespub.com

Superannuation – Medicare Super Clearing House (Login Errors)

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Source: com.au

Surviving in the Bush training manual » Medicare EMR

It is with great excitement that we announce that we are currently in the process of writing  of  a new manual that will not only be suitable for training purposes, but will be a great source of information for anyone who ventures out in the South African wild. It will contain beautiful full colour photographs and illustrations making it a practical and beautiful addition to anyone’s outdoor experience.
Source: co.za

Navigating Medicare's Open Enrollment Period

Posted by:  :  Category: Medicare

open enrollment by MedicareMallMedicare beneficiaries who are happy with their plans do not need to do anything, if they don’t want to change. But it is still a good idea to check options, Ms. Metcalf advises, to make sure a version of Medicare is the best one in terms of cost and coverage. If, for instance, you have the original version of Medicare and pay extra for prescription drug coverage (so-called Part D coverage), you may want to make sure important medications you need are still covered under your plan, to avoid having to pay more for them.
Source: nytimes.com

Video: Medicare Open Enrollment Preparations

Medicare open enrollment: Will Obamacare end Medicare Advantage?

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

Caregiving & Medicare Open Enrollment: It’s Time, But Not For Long!

Will Medicare pay for a home-health care worker if I am unable to continue caring for my loved one? Some home health care services are paid for by Medicare. However, if the only care your loved one needs falls under basic home help or “homemaker services” like bathing, dressing, using the bathroom, shopping, cleaning, and laundry, Medicare will not pay for these services. If a doctor certifies that your loved one is homebound, Medicare will cover the expenses of a home health aid. If your loved one is eligible for this type of care and you are considering using a home health service in 2013, be sure your loved one is enrolled in a plan that will cover these expenses. Click here for more information.
Source: nhcoa.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

Medicare open enrollment: What’s the best Medigap policy?

The difficulty for consumers is that the nature of Medigap makes it a lot harder to shop for than Medicare Advantage. Here’s why. Medicare Advantage plans are regulated and overseen on a national level. Medicare routinely collects all kinds of information on them about customer satisfaction and quality of care. In addition, the premium of a specific Medicare Advantage plan is the same for each customer. As a result, it’s possible (as I explained yesterday) to go to Medicare.gov and compare Medicare Advantage plans in detail, including quality ratings and price. It’s also why we can publish rankings of Medicare Advantage HMOs and PPOs through our partnership with the National Committee on Quality Assurance.
Source: consumerreports.org

Caregiving, Medicare Open Enrollment Chat

If you’re a caregiver who’s helping a person with Medicare review their coverage or have questions about Medicare options, this free live chat session is for you.  Submit your questions in advance by clicking on the above module! You may also like:
Source: aarp.org

Medicare Supplement Enrollment Periods

The best time for a Medicare beneficiary to enroll in Medicare Supplement insurance is during the Medicare Supplement Open Enrollment Period (OEP), which differs for each individual. This is a six month enrollment period that begins on the first day of the month that you are both 65 or older and enrolled in Medicare Part B. This six month period begins when you first enroll in Part B and may not be moved or changed. During this time, beneficiaries have the guaranteed issue right to a Medigap plan, meaning that insurance companies may not use medical underwriting to deny coverage or charge higher premiums to those who have any pre-existing conditions. If you do have a pre-existing condition, though, a Medigap plan may delay covering it.
Source: planprescriber.com

Home health providers seek help from Montana senators

Posted by:  :  Category: Medicare

I am finding it hard to beleave that our Medicare or CMS providers are above the Law with this NO JUDICIAL REVIEW In my eyes this is illegal and any Jude who allows it should be taken out of office.I work for a DME company for 13 years and see how these medicare patients look forward to having a company that puts there needs first. I am a shame of our CMS officials who do not put the needs of these patients first.Who worked so hard all their lives to have their right to chose their provider to be stripped away.
Source: vgm.com

Video: Social Security, Medicare, and Medicaid: Max Richtman Interviewed on Today in Montana

How Libby, Montana, Got Medicare for All | MyFDL

Less than two months after the passage of the health reform bill on March 23, 2010, Nancy Berryhill of the Social Security Administration in Denver joined personally in setting up an office in Libby to sign up these newly eligible people.  “This is a new thing,” Berryhill told the Missoulian.  “No other group like this has ever been selected to receive Medicare.”  Berryhill issued a nationwide alert to inform anyone who had lived or stayed in Lincoln County of their eligibility.  She opened a storefront in Libby at the old downtown city hall where she signed up 60 people on the first day.  She plastered the towns of Whitefish and Eureka with pamphlets explaining the program and added three new staffers to the office in Kalispell.  
Source: firedoglake.com

Health Law Expands Medicare To Montana Asbestos Patients

That program was set up because the Grace medical plan failed to cover everyone who needed help, said Benefield, who also been a leading advocate to get help for the town’s residents. The Grace program hires its own doctors to independently verify if applicants have the type of asbestos-related disease connected to the Libby mine. The government program doesn’t have this independent verification process. Applicants merely have to submit information from their own doctor certifying they had asbestos-related disease.
Source: kaiserhealthnews.org

Medicaid Expansion in Montana Will Cost $138 Million by 2022

Under Baucus authored Obamacare, it is illogical to think Montana would be able to cut uncompensated care funding. That’s because any state payment cuts would have to be implemented stacked on top of Obamacare’s tremendous federal payment cuts. Obamacare slashes federal Medicaid funding by $18.1 billion and Medicare DSH funding by $22.1 billion over the years 2014–2020. It is only a matter of time before state hospitals and clinics will be making the drive to Helena to lobby them for more state funding to replace cuts in federal payments. Thus, Medicaid expansion construes as a massive increase in federal and state spending.
Source: treasurestatepolitics.com

As ‘Global Resolution’ for Asbestos Settlements Nears, Montana Senators Seek Medicare Waiver for Victims

On October 20, 2012, the Daily Inter Lake reported that asbestos victims were working toward settlements with W.R. Grace & Co., BNSF Railway Co. and certain insurance companies in what Grace was deeming a “global resolution.” That same day, the newspaper also reported that Montana’s two US Senators were “working to get a full waiver of Medicare liens that have been placed on pending settlements for Libby asbestos victims.” As we have noted in the past, hundreds of Libby residents were poisoned by the toxic asbestos dust from Grace’s vermiculite mine that did not close until 1990.
Source: stanleyiolablog.com

Could Doctors Go to Prison Under Obamcare? See This Current Medicare Case . . .

Posted by:  :  Category: Medicare

ROBERT L. HUFFSTUTTER'S HEALTHCARE PLAN FOR AMERICA by roberthuffstutterThe fraud charges concerned whether Dr. Natale had billed for an operation more complex than the one he did, and were related to the upper end of the graft, not the lower end. All the patients had an abdominal aortic aneurysm that involved the renal arteries, so that the aorta had to be clamped above the branches supplying the kidneys. Dr. Natale did a reconstructive procedure to strengthen the aorta, so he did not have to cut the renal arteries off the aorta and sew them into the graft. There is no precise AMA-copyrighted code for this, so Dr. Natale used the closest one, which is not for a more complex procedure and which did not increase his payment.
Source: westernfreepress.com

Video: Make Money Providing Medical Equipment to Seniors and Obtain Free Medicare Leads

MHANJ Offers Free Medicare Benefits Counseling through “SHIP”

Counseling is free, objective and confidential and encompasses assistance with questions about Medicare, Medigap, Medicare Advantage, Medicare Part D, Long-Term Care Insurance and Dual-Eligibility. Sessions are conducted by telephone so that travel is not necessary.       
Source: mhanj.org

Competition and free market principles are saving Medicare

The Congressional Budget Office keeps finding cost savings in Medicare Part D – Medicare’s Prescription Drug Benefit Plan. That’s good news for the about 900,000 Illinois seniors who have Part D plans. Unlike other parts of Medicare, Part D is run entirely by private insurance companies who compete to sign up seniors and then bargain hard with drug companies for the best price on lifesaving drugs. Seniors get to choose what works best for them, and the competition keeps costs in check.
Source: typepad.com

Free information session on navigating Medicare March 21

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

FREE Medicare Cost Report Webinar

Progressive Provider Services recently added an innovative new feature to our HHA Form 1728 software.  Instead of tediously plotting the information from the PS&R into the Cost Report, we now offer a feature that allows for all of the information to be imported straight into the software with the touch of a button.
Source: ppsassistant.com

Free Medicare Counselling

The Monmouth County Connection is located adjacent to the Home Depot and across the street from Walmart in Neptune.  This new office of Monmouth County government offers a variety of services including passports, passport photos, free notary public, veterans’ IDs, election/voter information, senior and veterans’ services, public access computers and more.
Source: patch.com

Navigating Medicare: Free Information Session

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

Medicare: FREE Yearly Wellness Visits

Did you know that if you have Medicare, then you have access to a variety of preventive tests and screenings?  Most of those tests and screenings are at no cost to you. If you’re new to Medicare, your “Welcome to Medicare” preventive visit is now covered for free during your first 12 months of Part B coverage. This visit includes a review of your medical and social history related to your health and education and counseling about preventive services, including certain screenings, shots, and referrals for other care, if needed.
Source: seniorspotchicago.com