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

Posted by:  :  Category: Medicare

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

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

Medicare Advantage Plans Connecticut « Insurance News from Crowe & Associates

Aetna- Currently offer plans in Fairfield, Hartford, Litchfield and New Haven county. They have a $0 premium plan HMO, $94.00 HMO and a $90 PPO plan. The $0 premium plan has benefits second only to Wellcare when compared to the other $0 premium plans in the state. They also have a substantial network to go with the plan and allow for access to any Aetna Medicare HMO provider nation wide. The Aetna PPO is not competitive at this point due to a $1,000 out of network deductible.
Source: croweandassociates.com

BCBS Medicare Advantage Plans

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

Blue Cross Blue Shield of Michigan Offers New Medicare Plans

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

4 things to know about the changes to Blue Cross Blue Shield of Michigan

In testimony at the Capitol recently, Mary Ablan, executive director of the Area Agencies on Aging Association of Michigan, warned, “”Seniors living on the financial edge will be forced to drop their Medigap coverage and rely on bare Medicare with its large out-of-pocket costs. Research shows that seniors without sufficient income will forego medical care and prescription drugs that they desperately need.”
Source: michiganradio.org

BETTER SAFE THAN SORRY: NEED

Posted by:  :  Category: Medicare

State of the World - May 7 2006 by yonghokim4. Where Can I Find Resources to Help Choose the Best Medicare Supplement Plan? There are a variety of government as well as private resources, the main one being Medicare.gov. The pros and cons of checking out Medicare.gov is that there is so much information on the site that the answer to your specific question is probably buried under tons of other information and could take forever to find. An easier method may be one of the local or national groups like the Senior Advisors Group where Medicare insurance specialists are standing by to assist you with specific questions regarding anything having to do with Medicare enrollment, choosing the best Medicare supplement plan, Medicare Advantage, and Medicare Part D (prescription) plans.
Source: blog4safety.com

Video: Turning 65 Becoming Eligible for Medicare – 2011

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

Medicare and Medicaid: Eligibility, Coverage, and Costs

Medicare is composed of many different parts, and beneficiaries have the option to decide which plans they want to enroll in. Many eligible beneficiaries are automatically enrolled in Part A, which covers hospital care, and Part B, which covers certain medical services. Once enrolled, beneficiaries can opt to enroll in Medicare-approved private insurance plans to cover out-of-pocket costs not already covered and/or provide additional benefits. All individuals who are eligible for this program are also offered prescription drug coverage, which can be attained through a stand-alone Part D Prescription Drug Plan (PDP) or a Medicare Advantage plan with medication coverage.
Source: ehealthmedicare.com

Medicare Eligible. Can My Adult Child Stay On My Work Insurance?

Posted in Health Concerns, Health Reform, Insurance, You at Home, You at Work Tags: a health insurance agent in your area (California), adult children, age 26 and Medicare, age 65 health insurance, aging parents health insurance, an individual medical insurance plan, can I go on Medicare if my child is on my health plan, grandparents and health insurance, Health Care Reform, Health insurance, health insurance dependent, Health insurance for college students or health insurance for children, health insurance for seniors, individual health insurance plans, medical insurance quotes, medicare, medicare for seniors, medicare questions, working seniors
Source: eindividualhealth.com

Q and A: Medicare and Medicaid EHR Incentive Programs (Post 1 of 5)

Because most CMAs (AAMA) work under the direct supervision of “eligible professionals” (as defined in the rules of the Centers for Medicare and Medicaid Services [CMS]), this is the first of five upcoming posts focusing on some common questions surrounding the provisions of the Medicare and Medicaid Electronic Health Records (EHR) Incentive Program that are applicable to eligible professionals, not those provisions that are applicable to “eligible hospitals” and “critical access hospitals.”
Source: wordpress.com

Question about calculating Medicare eligibility date

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

OPINION: don't raise the Medicare eligibility age

Proponents of this idea say its time has come because starting in 2014, insurers will no longer be able to deny coverage to anyone because of age or health status, thanks to the Affordable Care Act.  People who can’t get coverage through the workplace will by then be able to shop for it on the state exchanges. But insurers will still be able to charge older people three times as much as younger folks. That would pose afinancial hardship for many seniors. The Kaiser Family Foundation estimates that two-thirds of 65 and 66–year-olds would have to pay at least $2,200 a year more for coverage than they would if they were on Medicare.
Source: publicintegrity.org

URGENT! Attest Now to Get Paid Medicare Rates for Medicaid Patients

Eligible services provided by all advanced practice clinicians providing services within their state scope of practice will receive the higher payment. Non-physician practitioners may use their own Medicaid number when billing for these services, however, it requires that an eligible physician have professional oversight or responsibility for the services provided by the practitioners under his or her supervision. If the state reimburses for services rendered by supervised advanced practice clinicians at a percentage of the physician fee schedule rate, it will continue to do so in 2013 and 2014.
Source: managemypractice.com

Celebrities Turning 65 in 2013

The oldest members of the baby boomer generation celebrated their 65th birthday on the first day of 2011, which amounted to roughly 10,000 individuals. According to the Pew Research Center, about 10,000 more Americans will cross that threshold every day for the next 19 years, which also includes a growing number of well known celebrities and public figures. Steven Tyler, Al Gore, and Olivia Newton-John are among the famous people born in 1948 to turn age 65 and become Medicare eligible this year. They will join the over 49 million individuals in 2012 already enrolled in the Medicare program, a population that is expected to reach a total of 80 million beneficiaries in 2030, double the number in 2000.
Source: planprescriber.com

Raising the Medicare Eligibility Age: A Costly and Dangerous Proposal 

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

General Dynamics to Help CMS Run Medicare Info Systems; Marcus Collier Comments

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 marsmet524Air Force Army ba BAE BAE Systems Boeing Booz Allen Hamilton business news CACI Contract Awards CSC Defense Contracting Defense Department Defense news Department of Defense Executive moves Financial News GD General Dynamics government contracting government contracting News Harris L-3 lmt Lockheed Martin ManTech market news Navy News noc Northrop Grumman NYSE: NOC nyse: sai nyse ba nyse gd nyse lmt nyse news nyse rtn Raytheon rtn SAIC Technology News U.S. Air Force u.s.army u.s navy Contract Awards (4185) Executive Moves (1252) Financial Report (963) M&A Activity (606) News (6771)
Source: govconwire.com

Video: Medicare & You: Open Enrollment General Information

– How can I get information on Medicare Part C?

In addition, prescription drug costs through TFL are less costly than under Medicare Part D. In fact, the Defense Department advises that the only people who may benefit from Part D coverage are those whose incomes are so low that they qualify for financial aid to pay their Medicare Part B premiums. Moreover, enrollment in Part D will preclude your use of the Tricare Mail Order Pharmacy program, under which you can get a 90-day supply of drugs for the same price that you would pay for a 30-day supply from a local retail pharmacy.
Source: militarytimes.com

Access Information On Medicare Health Insurance Supplements First

Just a few individuals become unclear when looking found at 5 steps to learning everything you need to know about Medigap plans. For you are various one particular firms and designs so the thorough area can always demanding when doing to comprehend what is really getting to be offered. Many can plus continually be differences among counties. So that you can manufacture an informed report on what form of of Ca Medicare health insurance is on the whole appropriate to be your circumstances and in addition future, you prefer to have a number straightforward information located on the range of aspects. As a way to commence you should be conversant your the majority to do with Medicare beneficiaries are over the age group ranges of sixty five different , but in you are extra youthful than this or critically disabled then you can plus signup.
Source: wordpress.com

Access Information On Medicare Supplements First

Lastly, CMS proposes into exempt physicians who e-prescribe, but primarily just for types pointing to visits that never will count toward 10-eRx minimum. Among the visits that do count, identified by other than fifty CPT codes, are almost five levels related to both the absolutely new patient and experienced patient office or sometimes other outpatient excursions (codes 99201-99205 as well as 99211-99214). To be able to the extent which is anesthesiologists or hurt physicians e-prescribe, not to mention submit claims for many outpatient or place of work visits to medicare supplement plan f, but do not actually normally write any other prescriptions associated from those visits, they might be able to demonstrate hardship and be presented exemptions.
Source: iranfemschool.com

IRS Releases New Information About Medicare Tax Surcharges

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

How to protect yourself against health care scams

Research has shown that the aging process causes changes in the brain that might make senior citizens more vulnerable to financial scams. If an older family member may be experiencing cognitive decline, help him or her keep track of financial records and health care records, and look for possible signs of fraud or identity theft.
Source: insurancequotes.com

General Dynamics IT Medicare Call Center Contract Extended

Accenture Air Force Army BAE Systems Boeing Booz Allen Hamilton CACI CGI cloud cloud computing communications contract contract award contract awards contracts CSC Cybersecurity Defense Department DOD engineering Executive Spotlight General general dynamics GSA Harris Healthcare IT HP IBM Information Technology IT Lockheed Martin mantech Microsoft NASA Navy news Northrop Grumman Raytheon SAIC Software Technology U.S. Air Force U.S. Army U.S. Navy Vivek Kundra
Source: executivebiz.com

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

Failure to enroll and maintain enrollment in Medicare Parts A and B upon eligibility may result in the subscriber being held financially responsible for the cost of all claims incurred, including prescription costs. Retirees and spouses enrolled in Medicare Parts A and B must provide a copy of their Medicare Identification Card to be enrolled in the state of Delaware Special Medicfill plan.
Source: udel.edu

New CMS Website: Medicare Secondary Payer Conditional Payment Information 

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

Medicare levy boost to pay for disability insurance scheme

Posted by:  :  Category: Medicare

Press Conference on Benefits of Health Insurance Reform to Seniors by Leader Nancy PelosiThe Australian federal government can decide important project agendas, example, health… in this case the NDIS which is in the health industry, and infrastructure, and print money to fund the projects at no cost to the citizen and the money printed not count towards a debt… the money for example, is provided for wages and materials for people in the project and is like a grant or sport sponsorship for example. The money is not expected to be returned and the government is deemed to be not in debt.
Source: theconversation.com

Video: What is a Medicare health insurance exchange?

Phase out GP consultation fees for a better Medicare

Fee for service is a simple system. Why complicate things even further? It would be more simple without third party payers, such as government or insurers. I as a doctor did not ask, or volunteer to participate in medicare; it is de facto conscription, because medicare makes it cheaper for the patients by the amount of the rebate. In a market sense, medicare corners, and monopolises the marketplace for medical services. Hypothetically, as a purely private practitioner, I cannot compete against a medicare subsided practitioner, as my fees would have to be lower by the rebate amount. For competition against a bulk billing doctor, for example, this would effectively mean paying the patient to see me, a clearly absurd consequence, therefore, I would be limited to competing against doctors who charge a gap fee. Thus, my standard private fee would be forced to be anything from under $17 to 29 per consultation, akin to what a low cost hairdresser might charge for their service. And, because medicare requires a provider number to enable allied health "EPC" consultations, specialist consultations and pathology/radiology rebates; a private practitioner effectively has no chance of making any money, because to perform his job and investigate medical problems appropriately, he is out-competed on price on all of the ancillary services too. Therefore, without being legally prescribed (therefore unconstitutional) to participate, I *have* to participate (this has been noticed in the HC judgement Wong vs comm 2009), or practice on the fringe ; e.g. become a quack peddling alternative medicine; or a botox injector rather that practice real general practice, what I love, and what I am good at.
Source: theconversation.com

Medicare Advantage – or DISAdvantage?

Following a 20-year career as a corporate insurance executive, Wendell Potter left his position as head of communications for Cigna in 2008 to advocate for comprehensive health care reform. He is now an analyst at the The Center for Public Integrity and president of Wendell Potter Consulting. He has also served as a consumer representative to the National Association of Insurance Commissioners. His book, Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans, was awarded the Ridenhour Book Prize for “outstanding work of social significance” in 2011. Previously, he wrote A helping hand for Marsha Blackburn and  Want to fix health care? Watch this movie. for the Health Insurance Resource Center Blog.
Source: healthinsurance.org

AHIP Launches TV Ad Campaign to Stop New Medicare Advantage Cuts

: Current discussions about the impact on seniors of the ACA’s $200 billion in cuts to Medicare Advantage have largely ignored the fact that only four percent of those cuts have gone into effect through the end of 2012.  The Congressional Budget Office (CBO) projects that, when fully phased in, these cuts alone will result in three million fewer people enrolled in the program.  In addition, Medicare Advantage enrollees also will be impacted by the new health insurance tax established by the ACA that starts in 2014.  Oliver Wyman previously estimated that this tax alone will result in seniors facing $220 in higher out-of-pocket costs and reduced benefits next year and $3,500 in additional costs over the next ten years.
Source: ahipcoverage.com

How to protect yourself against health care scams

Research has shown that the aging process causes changes in the brain that might make senior citizens more vulnerable to financial scams. If an older family member may be experiencing cognitive decline, help him or her keep track of financial records and health care records, and look for possible signs of fraud or identity theft.
Source: insurancequotes.com

Five Ways The President’s Budget Would Change Medicare

Provider Cuts: Hospitals are none too happy about Obama’s plans to cut their Medicare payments for bad debt and graduate medical education over the next decade. Medicare now pays hospitals 65 percent of debts resulting from beneficiaries’ non-payment of deductibles and co-insurance after providers have made reasonable efforts to collect the money. Starting in 2014, the president’s plan would decrease that amount to 25 percent over three years, which the administration says would be closer to private payers that typically pay nothing on bad debt. The reductions would be in addition to those hospitals and other providers face as part of the 2010 health law.
Source: kaiserhealthnews.org

Really Should You Choose Medicare Health Insurance Supplemental Insurance

Multiple medical requirements how the AARP Medicare will never cover are covered by AARP Medigap. New Jersey Medicare supplemental health insurance is one among the best places for anyone who want to have a private insurance policy. To get the supplemental statistics for this insurance, the New Shirt Medigap is info about the subject location to obtain it touch too. The policies for the medical insurance would cover the reduction in price of New Jersey Medicare. The new Jersey Medigap comes with twelve plans all in all. The www.medigapplansguide.com/medicare-supplement-rates Nj is depending on the topic of where you am living. If you are questioning just what plan will acquire for your values greater to read the subsequent paragraph.
Source: flloecdelft.org

Cutting Health Care Waste, Medicare Fraud

There are promising signs. Medical education is beginning to respond to these issues. "At bottom, the key agents are the physicians. They order the tests, prescribe the drugs and recommend the surgeries," said Darrell G. Kirch, M.D., president of the Association of American Medical Colleges. More physicians are weighing the cost of brand-name drugs against generics and questioning the effectiveness of commonly ordered tests. The American Board of Internal Medicine Foundation and 375,000 doctors are developing the "Choosing Wisely" campaign with a list of overused tests and procedures that starts with stress tests for healthy people, bone scans for those under 60 and diagnostic tests for common allergies.
Source: aarp.org

Raiding Medicare: How seniors will pay for Obamacare

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 marsmet524Other hospitals will be forced to operate in an environment of scarcity, with as many as 40 percent in the red, according to Foster. That will mean fewer nurses on the floor, fewer cleaners, and longer waits for high-tech diagnostic tests. It will affect all patients. Obamacare’s defenders say that cutting Medicare payments to hospitals will knock out waste and excessive profits. Untrue. Medicare already pays hospitals less than the actual cost of caring for a senior, on average 91 cents for every dollar of care. No profit there. Pushing down the reimbursement rate further, as the Obama health law does, will force hospitals to spread nurses thinner. When Medicare reduced payment rates to hospitals as part of the Balanced Budget Act of 1997, hospitals incurring the largest cuts laid off nurses. Eventually patients at these hospitals had a 6 to 8 percent worse chance of surviving a heart attack and going home, according to a National Bureau of Economic Research report.
Source: dailycaller.com

Video: Griffith on Strengthening Medicare for Seniors

Medicare insurance agent in La Jolla

The truth is that seniors across California need low cost medical care. When it comes to finding the right program for you or the loved one in your life, the services at South Bay Health Insurance & Services (SBHIS) may be the ideal fit. At SBHIS, our goal is to find the right medical coverage – even federal or state coverage – for you or the seniors in your life. Log onto http://SBHIS.net to find out how we can help you select the right Medicare or Medi-Cal plan for you. Or, feel free to call us direct at 1-888-988-8072 for a free consultation.
Source: lajollalight.com

Seniors Speak Out Against Medicare Advantage Cuts in AHIP’s New TV Ad

Current discussions about the impact on seniors of the ACA’s $200 billion in cuts to Medicare Advantage have largely ignored the fact that only four percent of those cuts have gone into effect through the end of 2012. The Congressional Budget Office (CBO) projects that, when fully phased in, these cuts alone will result in three million fewer people enrolled in the program. In addition, Medicare Advantage enrollees also will be impacted by the new health insurance tax established by the ACA that starts in 2014. Oliver Wyman previously estimated that this tax alone will result in seniors facing $220 in higher out-of-pocket costs and reduced benefits next year and $3,500 in additional costs over the next ten years.
Source: ahipcoverage.com

Why Medicare Cuts Will Quietly Kill Seniors

Suddenly slashing payments an organization has been counting on and assuming that they’ll simply adapt is very different than announcing a change in reimbursement rules that takes place gradually. When the BBA went into effect, some analysts predicted that hospitals would make up deep cuts by becoming more efficient. Instead, Wu and Shen found, the heart attack death rate spiked because hospitals cut back on staff to slash operating costs. Left unexamined by the researchers, but profoundly important in a policy context, is what happened as a result to Medicare patients being treated for all medical problems, not just heart attack.
Source: healthworkscollective.com

Daily Kos: Remembering the Medicare Catastrophic Coverage debacle: What happens when you piss off seniors

Thus far, the traditional media has reported on opposition to President Obama’s inclusion of Social Security cuts in his budget as “liberal backlash.” Even Rachel Maddow, in introducing this segment that included an interview with David Alexrod, frames it so: “President Obama releasing today what he describes as his compromise budget, compromising with Republicans on cuts to Social Security especially, and in the process enraging some of his own liberal base. Is this a president who thinks he has much to lose by angering the otherwise loyal left, or is this a president who sees having a big visible fight with the left as a way to see himself look centrist, and therefore stronger?” A pissed off liberal base is the least of Obama’s worries, he doesn’t have to worry about running for election again. In fact, a pissed off anybody isn’t his worry. Sure, it could severely weaken him politically and turn him into a lame duck well before necessary, but at least he doesn’t have another race to worry about. However, it’s a bit more of a worry for Democrats who might be willing to support him on this, on two fronts. The first problem is the liberal base the traditional media loves to see get punched, which could most definitely get behind primary challenges to those supporting Social Security cuts. The flip side is a liberal base discouraged and frustrated and unenthused about turning out for a midterm election. See 2010.
Source: dailykos.com

Obama Budget Would Up Medicare Costs For Higher

The Associated Press: Upper-Income Seniors’ Medicare Hike President Barack Obama’s plan to raise Medicare premiums for upper-income seniors would create five new income brackets to squeeze more revenue for the government from the top tiers of retirees, the administration revealed Friday. First details of the plan emerged after Health and Human Services Secretary Kathleen Sebelius testified to Congress on the president’s budget …. Currently, single beneficiaries making more than $85,000 a year and couples earning more than $170,000 pay higher premiums. Obama’s plan would raise the premiums themselves and also freeze adjustments for inflation until 1 in 4 Medicare recipients were paying the higher charges. Right now, the higher monthly charges hit only about 1 in 20 Medicare recipients (Alonso-Zaldivar, 4/12).
Source: kaiserhealthnews.org

Medicare scams target elderly

Scambook, the Internet’s leading complaint resolution platform, is warning senior citizens on the trending phone scam capitalizing on a fraudulent Medicare. Scambook has received over 100 consumer complaints about one alleged benefits company that has conned elderly Americans out of more than $130,000 dollars.
Source: clarecountyreview.com

Medicare and Medicaid: Eligibility, Coverage, and Costs

Posted by:  :  Category: Medicare

Mashing the Aussie State: Geocoding Medicare office location data by ChiefTechMedicare is composed of many different parts, and beneficiaries have the option to decide which plans they want to enroll in. Many eligible beneficiaries are automatically enrolled in Part A, which covers hospital care, and Part B, which covers certain medical services. Once enrolled, beneficiaries can opt to enroll in Medicare-approved private insurance plans to cover out-of-pocket costs not already covered and/or provide additional benefits. All individuals who are eligible for this program are also offered prescription drug coverage, which can be attained through a stand-alone Part D Prescription Drug Plan (PDP) or a Medicare Advantage plan with medication coverage.
Source: ehealthmedicare.com

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

Helping Dad find his way in Medicare

My father is about to turn 65.  He’s been a little lost ever since my mother died a few years ago.  He is going to need help figuring out Medicare and all of that.  He takes a lot of pills every day, so he will need the prescription drug plan too.  I live a few hours’ drive away from him, so it would be hard for me to go with him to the government offices.  Where can I turn for help on this?
Source: bangordailynews.com

Medicare Fraud and Your Office

If found guilty? Fraudulent party would have to face strong penalties according to Federal Sentencing Guidelines and HHS program. The Inspector General for the U.S. Department of Health and Human Services under Public Law mandate 95-452 protects Medicare and Medicaid fraud. HHS department works in close collaboration with Federal Bureau of investigation to prevent Medicare Fraud. Defendants can expect to have jail for a substantial amount of time, compensations, fines and deportation from country if not a US citizen.
Source: medcaremso.com

Social Security and Medicare tax rates

Alabama    Alaska    Arizona    Arkansas    California    Colorado  Connecticut    Delaware    Florida    Georgia    Hawaii    Idaho    Illinois    Indiana    Iowa    Kansas    Kentucky    Louisiana    Maine  Maryland    Massachusetts    Michigan    Minnesota    Mississippi    Missouri   Montana    Nebraska    Nevada    New Hampshire    New Jersey    New Mexico    New York    North Carolina    North Dakota    Ohio    Oklahoma    Oregon    Pennsylvania    Rhode Island    South Carolina    South Dakota   Tennessee   Texas    Utah    Vermont    Virginia    Washington    West Virginia    Wisconsin    Wyoming
Source: socialsecurityoffices.us

Give Medicare Locals a chance to improve health equity

Medicare Locals are a good idea, but at this point in time are being starved of funding and also appear to have very little engagement with local health care workers. They appear to have been started with to plan on how they were going to fit into the overall health system. If they are suppose to be assisting with Primary Care and providing co-ordination, I know in my area (Brisbane South) they are doing a very poor job. They have already had to restrict service to Mental Health Care through the ATAPs program. They have not come up with a solution for after-hours care, despite funding being withdrawn from General Practice in under 3 months. This funding is being directed to the local Medical Local and yet we still have no idea how much if any will be available. This makes planning your after-hours service very difficult. I hope in the long run they succeed because their is an urgent need for coordinated chronic disease service delivery, this is where in my humble opinion medical locals will be able to provide a good service. After the failed GP super clinics lets hope the medical locals can do a better job of assisting and coordinating primary Health care
Source: theconversation.com

How Likely Are Physician Offices to Accept Medicare and Medicaid?

SK&A released its report titled, “Physician Office Acceptance Government Insurance Programs,” which showed 83.6 percent of medical providers accept Medicare and 67 percent accept Medicaid, though a decline may be imminent. The Patient Protection & Affordable Care Act will give 30 million Americans access to healthcare, many on Medicaid. But 31 percent of physicians said they would not accept new Medicaid patients, according to a National Ambulatory Medical Care survey. SK&A’s survey of 271,451 office-based physicians found larger, affiliated practices have higher Medicare and Medicaid acceptance rates, while smaller, non-affiliated practices have lower rates. Offices with daily volumes greater than 31 cases had an acceptance rate of 85.5 percent for Medicare and 69.6 percent for Medicaid. Also, healthcare system-owned and hospital-owned practices are more likely to accept Medicare, at 89.1 percent, compared with non-hospital or healthcare system-owned practices, at 82.7 percent. Medicaid acceptance is about 83 percent for hospital or healthcare-owned practices and only 64 percent for non-hospital or system owned. The top specialties accepting Medicaid are dialysis, critical care medicine and nephrology. The lowest acceptances rates come from bariatrics, occupational medicine and holistic medicine. More Articles on Revenue Cycle: Fitch: Non-Profit Hospitals May See Some Stability in 2013 Physician Groups Gear Up to Fight for SGR Repeal University Hospitals’ Fundraising Campaign Reaches $1B Goal
Source: beckershospitalreview.com

Which Would You Prefer: A Medicare Free Wellness Visit or a Veterinarian?…I’d Rather See a Veterinarian

 Marilyn M. Singleton, MD, JD is a board-certified anesthesiologist and Association of American Physicians and Surgeons (AAPS) member. Despite being told, “they don’t take Negroes at Stanford”, she graduated from Stanford and earned her MD at UCSF Medical School. Dr. Singleton completed 2 years of Surgery residency at UCSF, then her Anesthesia residency at Harvard’s Beth Israel Hospital. She was an instructor, then Assistant Professor of Anesthesiology and Critical Care Medicine at Johns Hopkins Hospital in Baltimore, Maryland before returning to California for private practice. While still working in the operating room, she attended UC Berkeley Law School, focusing on constitutional law and administrative law. She interned at the National Health Law Project and practiced insurance and health law. She teaches classes in the recognition of elder abuse and constitutional law for non-lawyers. Dr. Singleton recently returned from El Salvador where she conducted make-shift medical clinics in two rural villages. Her latest presentation to physicians was at the AAPS annual meeting about challenging the political elite.
Source: medibid.com

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

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

Madame Defarge: Asking Center for Medicare & Medicaid Services Administrative Offices to Tackle lack of Mental Health Care for Humana’s Insured

e mail letter sent to Administrative Offices of CMS w/ cc to Senator Hagen (liason: Anna Abram) and Senator Burr (liason: Karen Wade) re: (obvious) change in contract between Humana and CMS regarding mental health care/ Part B for NC citizens w/ mental health needs “………Specifically, this is the problem: Humana, a Medicare Advantage company, whose clients I have been seeing and reimbursed for seeing—-for years—-has apparently, without notice, changed its PPO policy such that I can no longer provide services to their clients.  I have seen Humana PPO clients for the past five years. The company managing Medicare in NC is Palmetto.  They have no information. Humana has no information except to say that I now have to be “In-Network” whileas before by being a Medicare Provider of many years, I was able to work w/ this Medicare Advantage company. Palmetto personnel indicated that the Part B’s of these companies, such as Humana and United Health Care (had the same problem last year regarding one of their insured) are largely unregulated. The NC Insurance Commissioners Office was not helpful.  They believe that I am supposed to be an In-Network provider and they had no information about how to deal w/ this matter. Again, Humana will not allow me to become an In-Network provider. ***Does this not violate some part of the contract which must have been recently changed vis a vis CMS and Humana?*** Why doesn’t the NC Insurance Commissioner’s office not guide citizens with mental health concerns to avoid the Medicare Advantage companies given the company’s Part B unhelpful changes? How is it that citizens who have mental health challenges are challenged to come up with solutions that citizens with medical illnesses as associated with Part A Medicare —-are never required to address? There is supposed to be mental health parity.  There is no parity. Thank you for your response. Marsha V. Hammond, PhD  NPI 1194700591Clinical / Health Psychology
Source: blogspot.com

Cardiologist pleads guilty to $19 million Medicare fraud

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Source: uptonfirm.com

No Medicare Cuts in 2013 for Physician Offices

For our doctors and medical practices this means that we will not be holding any Medicare claims like we had to do in previous years. Our claims will be going out as usual.  Medicare payments will be the same as last year so we don’t have to adjust our fees and we will not have to cut back on office expenses due to the lower reimbursements (which usually means staff).
Source: capturebilling.com

Come Talk With Congresswoman Shea

Posted by:  :  Category: Medicare

Rockefeller Introduces Legislation to Protect Almost 90,000 West Virginia Seniors and Reduce Deficit By $141.2 Billion by SenRockefellerWHY: Today we are faced with one of most serious assaults on Medicare and Social Security since the program began. Together Granite Staters can ensure these programs are around today and for future generations. During the forum members of the National Committee to Preserve Social Security and Medicare will present the Congresswoman with over 400 petition signatures calling on her to protect benefits Granite Staters have worked for, paid for and earned; the petition also calls on Congress to oppose privatization and other proposals that threaten retirement and health security.
Source: nhlabornews.com

Video: Romney, Ryan defend Medicare plan with NH voters

CMS softens Medicare Advantage funding changes

The shares of several health insurers rose sharply in extended trading Monday following the CMS announcement. Medicare Advantage plans have become a key source of growth for insurers, which receive about $10,000 per member to provide customers with basic Medicare coverage topped with vision or dental coverage, or premiums lower than standard Medicare rates.
Source: nhjournal.com

NH Hospital Keeps Medicare Funding Despite Outbreak

Thousands of patients in Arizona, Georgia, Kansas, Maryland, Michigan, New York and Pennsylvania have since been tested for hepatitis C, a blood-borne viral infection that can cause liver disease and chronic health issues. In addition to the New Hampshire patients, a handful of patients in Kansas and one in Maryland have been found to carry the strain Kwiatkowski carries.
Source: cbslocal.com

N.H. hospital in danger of losing Medicare funding

“CMS has determined that the deficiencies are of such a serious nature as to substantially limit the hospital’scapacity to provide adequate care,” the agency wrote in a letter to the hospital dated Oct. 11. In a statement Friday, the hospital said it will continue to work to thoroughly address each of the agency’s findings and that it already has taken steps to resolve many of them and is confident it will fix the rest in the next several weeks. “We take quality and patient safety extremely seriously and will continue to make all necessary improvements to further improve the health system,” CEO Kevin Callahan said. The centers’ full report won’t be made public for 30 days or when CMS receives an acceptable plan of correction, whichever comes first, a CMS spokeswoman said. The letter sent to the hospital outlines four areas where Medicare conditions have not been met: infection control, patient’s rights, the hospital’s quality assessment and performance improvement program and its governing body. In the July report, CMS said nurses at the cardiac lab left syringes unattended after removing medication from machines. The hospital has since implemented a policy that requires filled syringes to be placed in a locked drawer until needed. Kwiatkowski, a traveling medical worker whom prosecutors describe as a “serial infector,” was hired in Exeter in April 2011 after working in 18 hospitals in Arizona, Georgia, Kansas, Maryland, Michigan, New York and Pennsylvania. He moved from hospital to hospital despite having been fired twice over allegations of drug use and theft. Thousands of patients in those states are being tested to see if they, too, were infected with hepatitis C, a sometimes life-threatening virus. A handful of patients in Kansas also have been found to carry the same strain Kwiatkowski carries. “Hospitals across the country and the regulators who oversee them continue to learn from this tragic event that was created by an alleged criminal who circumvented some of the best systems and protocols at leading institutions across the nation,” Callahan said. Kwiatkowski, who has told authorities he did not steal or use drugs, has pleaded not guilty to illegally obtaining drugs and tampering with a consumer product. Prosecutors recently were given until Nov. 30 to indict him after saying they needed more time because investigators are still conducting interviews and performing scientific analysis in multiple states.
Source: modernhealthcare.com

Campaigning in New Hampshire, Obama ramps up attacks over Medicare, taxes

Complicating the argument for Republicans has been the vague nature of their plans for both Medicare and taxes. Romney has endorsed Ryan’s most recent budget, for instance, but more recently has backed away from it, saying he’ll offer his own plan sometime in the future. Also, while Ryan’s budget repeals most of the Democrats’ healthcare reforms, it keeps the more than $700 billion in Medicare cuts – the same cuts the Republicans are warning will devastate the program.
Source: thehill.com

Senior Care in Rochester, NH: Open Enrollment for Medicare –Now through Dec 7, 2012

Would a small increase in premiums result in a large reduction in health care costs you pay? Check, for example, what coverage is available for prescription drugs you take? Medicare representatives can create a report containing the costs and benefits of various insurance products if you supply them with a list of your drug prescriptions. Ask questions about participating doctors and clinics. Some Medicare Advantage plans limit which physicians a patient can visit.
Source: atlantichomelifeseniorcare.com

NH Medicare recipients' privacy violated

2012 elections banks barack obama budget Climate change debate DOMA environment fiscal cliff food foreign france Gay gay marriage GOP extremism gun control Herman Cain Hurricane Sandy iran Jon Huntsman marriage equality Medicare Michele Bachmann Middle East Mitt Romney Music Newt Gingrich oil paul cameron Paul Ryan pope porno scanners Rick Perry Rick Santorum Rick Warren Ron Paul Sandy Hook Sarah Palin Social Security Taxes Tennessee The 1% Tim Pawlenty TSA Video
Source: americablog.com

VIDEO: Kuster Talks Medicare in Salem

Kuster spoke to about 10 seniors at the Greystone Farm assisted living facility on Main Street Monday morning and read excerpts from the book she wrote with her mother, former longtime state legislator Susan McLane, called “The Last Dance: Facing Alzheimer’s with Love & Laughter.”
Source: patch.com

Medicare and Medicaid: Eligibility, Coverage, and Costs

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 marsmet524Medicare is composed of many different parts, and beneficiaries have the option to decide which plans they want to enroll in. Many eligible beneficiaries are automatically enrolled in Part A, which covers hospital care, and Part B, which covers certain medical services. Once enrolled, beneficiaries can opt to enroll in Medicare-approved private insurance plans to cover out-of-pocket costs not already covered and/or provide additional benefits. All individuals who are eligible for this program are also offered prescription drug coverage, which can be attained through a stand-alone Part D Prescription Drug Plan (PDP) or a Medicare Advantage plan with medication coverage.
Source: ehealthmedicare.com

Video: Does Medicare Cover Transportation Costs to the Doctor’s Office?

Harrisburg ambulance company pleads guilty for submitting false statements

The Indictment focused on an August 2010 audit conducted by Medicare and a June 2, 2011 search of Advantage’s business premises by federal law enforcement officers. In response to the audit Sivchuk submitted 14 ambulance Trip Sheets to Medicare that were prepared by Emergency Medical Technicians (EMTs) at the time of each ambulance transport. The Trip Sheets contained a narrative section that described the patient’s physical condition and ability to ambulate, and serve as the primary support document for each Medicare billed, ambulance transport claim. The June 2, 2011 search by the FBI and investigators from the Health and Human Services (HHS) Inspector General’s Office revealed Sivchuk did not submit the original trip sheets to the auditors but instead submitted copies that had been re-written and forged to conceal the fact the beneficiaries were ambulatory and capable of walking and standing.
Source: fox43.com

Dr. Sri J. Wijegunaratne of Anaheim Guilty of Role in $1.5 Medicare Billing Fraud Scheme

Scheduled to be sentenced on Sept. 9, Wijegunaratne faces up to 10 years in prison and a $250,000 fine for each count. That’s the same sentencing date and punishment facing Wijegunaratne’s co-conspirators: Ontario’s Godwin Onyeabor, 49, an officer at Fendih Medical Supply Inc. in San Bernardino, and Heidi Morishita, 48, of Valencia, who brought prescriptions to Onyeabor, who was also convicted last week of conspiracy to commit health care fraud and 11 substantive counts of health care fraud. Fendih specialized in what is known as durable medical equipment (DME) like power wheelchairs. Between January 2007 and February 2012, Wijegunaratne wrote prescriptions for DME his patients did not need and often did not use, with Morishta taking the scripts to Onyebor to be fulfilled. Medicare was then billed for the costs. “At trial, several Medicare beneficiaries testified that they were lured to medical clinics with the promise of free items such as vitamins and juice, only to receive power wheelchairs that they did not need and did not want,” reads the Justice Department statement. “The beneficiaries further testified that their attempts to reject delivery of the power wheelchairs from Onyeabor’s supply company were unsuccessful. Onyeabor, Wijegunaratne and others submitted and caused the submission of approximately $1.5 million in false and fraudulent claims to Medicare, and received almost $1 million on those claims, according to federal prosecutors. The doctor received kickbacks for generating fresh patients for false billings. Email: mcoker@ocweekly.com. Twitter: @MatthewTCoker. Follow OC Weekly on Twitter @ocweekly or on Facebook!
Source: ocweekly.com

How big is Medicare fraud?

The government is working on the problem. In 2012, the Department of Justice and the FBI together recovered $4.2 billion in fraudulent payments. They opened 1,311 new criminal health care fraud investigations involving 2,148 defendants. Once these crooks are convicted, the Affordable Care Act authorizes more jail time. Medicare scammers will receive 20 percent to 50 percent longer sentences for crimes that involve more than $1 million in losses.
Source: bankrate.com

Health First Hosts Medicare Advantage Health Plans Seminars

Our four not-for-profit hospitals—Health First Cape Canaveral Hospital in Cocoa Beach, Health First Holmes Regional Medical Center in Melbourne, Health First Palm Bay Hospital in Palm Bay, and Health First Viera Hospital which opened in Viera on April 2, 2011- form the core of Health First’s family in Brevard County on Florida’s Space Coast. Other services include outpatient centers; the county’s only trauma center; home care; specialized programs for cancer, diabetes, heart, stroke, and rehabilitative services; central Brevard’s largest medical group; four fitness centers; and Medicare Advantage, commercial POS, and commercial HMO health plans.
Source: spacecoastdaily.com

Medicare Had Violated Federal Laws

Posted by:  :  Category: Medicare

The Anatomy of Obamacare (What's not to like?) by Third Wayccording to the two reports issued by the federal health officials, the tax-payer funded Medicare program paid more than $120 million from 2009 to 2011 in violation of the federal law for medical services for inmates and illegal immigrants. According to the federal law, generally Medicare does not give payments for either group of patients. According to the reports from the Department of Health and Human Services Inspector general, the bill however was billed for more than $33 million for inmate care and more than $91 million for illegal immigrant care over that period.
Source: thepointdaily.com

Video: Medicare Secondary Laws

USDOJ: Montana Hospitals Agree to Pay $3.95 Million to Resolve Alleged False Claims Act and Stark Law Violations

St. Vincent Healthcare, a hospital located in Billings, Mont ., and Holy Rosary Healthcare, a hospital located in Miles City, Mont ., have agreed to pay $3.95 million plus interest to resolve allegations that they violated the Stark Law and the False Claims Act by improperly providing incentive pay to physicians that made referrals to the hospitals, the Justice Department announced today. The Stark Law forbids a hospital from billing Medicare for certain services referred by physicians who have a financial relationship with the hospital unless that relationship falls within certain exceptions.   A prohibited financial relationship includes a hospital’s agreement to compensate a physician in a manner that takes into account the volume of the physician’s referrals or the revenue realized through those referrals. The settlement announced today resolves allegations that the hospitals paid several physicians incentive compensation that took into account the value or volume of their referrals by improperly including certain designated health services in the formula for calculating physician incentive compensation.   These issues were disclosed by the hospitals to the government. “The resolution of this matter underscores our commitment to ensure that services reimbursable by federal health care programs are based on the best interests of patients rather than the personal financial interests of referring physicians,” said Stuart F. Delery, Acting Assistant Attorney General for the Department’s Civil Division. “Combating health care fraud is a top priority of the Department of Justice and the Montana United States Attorney’s Office. St. Vincent Healthcare and Holy Rosary Healthcare allegedly put their financial interest ahead of their responsibility to provide cost effective health care.   The United States recovered $3,950,000 of taxpayers’ dollars from the hospitals.   The United States Attorney’s Office is committed to enforcing the Stark Law and False Claims Act, as well as other health care laws and regulations against wrongdoers.   This case also demonstrates how the Department of Justice will work with those health care providers who disclose their misconduct,” said Michael W. Cotter, United States Attorney for the District of Montana. “There is an expectation that corporations providing services to Medicare and Medicaid beneficiaries adhere to the provision of the Stark Law.   I applaud St. Vincent Healthcare and Holy Rosary Healthcare for recognizing their potential liability in this matter and making a disclosure,” said Gerry Roy, Special Agent in Charge for the Office of Inspector General of the United States Department of Health and Human Services region including Montana.   “Working closely with our partners at the Department of Justice, we will vigilantly protect federal health care programs against violations of the Stark Law.” This resolution is part of the government’s emphasis on combating health care fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced by Attorney General Eric Holder and Kathleen Sebelius, Secretary of the Department of Health and Human Services, in May 2009. The partnership between the two departments has focused on efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover $10.3 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department’s total recoveries in False Claims Act cases since January 2009 are over $14.2 billion. This case was handled by the United States Attorney’s Office for the District of Montana, the Department of Justice’s Civil Division, the Office of Inspector General of the United States Department of Health and Human Services, and the FBI.   The claims settled by this agreement are allegations only, and there has been no determination of liability.   Contact: Department of Justice Main Switchboard – 202-514-2000 Reported by: US Department of Justice
Source: 7thspace.com

Medicare expands coverage for chronic conditions

Under the terms of the settlement, patients who have “plateaued” in their treatment but still need the assistance of a skilled professional such as a nurse or therapist will be eligible for all of Medicare’s standard benefits. Seniors who are enrolled in Part A, which covers hospitalizations, will be eligible for up to 100 days in a skilled nursing facility (as long as it follows a three-day hospitalization), as well as up to 100 home visits following a hospitalization. Seniors who are enrolled in Part B, which covers doctor visits and other outpatient services, are eligible for potentially unlimited home visits.
Source: beliveaulaw.net

What Are the Medicare Lein Laws for Personal Injury Settlements?

Your Personal Injury Attorney will report to the Coordination of Benefits Contractor (COBC) with information such as the Medicare number, injury, date of injury/loss, and other pertinent information.  Later, they must submit consent forms and proof of representation to the Medicare Secondary Payer Recovery Contractor (MSPRC).  Then you and your attorney can address any unrelated payments and dispute those payments. Finally, a settlement should be immediately reported to Medicare’s MSPRC.
Source: sandiegolegaloffice.com

Obama Admin. breaks Medicare law Again

Tags: Barack Obama, barack obama budget, breaks medicare law, Budget, budget fix, deadline, fix, fix imbalance, imbalance, imbalance medicare, law, Medicare, medicare funding, missed deadline, Obama, Obama Budget, obama budget fix, Obama plan, Plan
Source: politisite.com

Seniors should tell Obama to prevent Medicare Advantage cuts

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

Massachusetts Elder Law Attorney

The Medicare provisions in the Relief Act are not as harmful to the program as many of the dangerous proposals offered to Congress over the past few months.  There have been proposals made to double look back periods and decrease Medicare and Medicaid benefits.  Drastic cuts are still on the table as policy-makers seek to address the looming sequestration and debt ceiling with savings from health care programs. For real health savings that address the underlying problem of health care costs system wide, policy-makers and advocates should begin with solutions that improve the health and well-being of Medicare beneficiaries while preserving the Medicare program for those who depend on it now and in the future.
Source: estateplanandassetprotection.com

Happy Anniversary, Affordable Care Act 

[1]  Health Care Reform consists of two separate laws, the Patient Protection and Affordability Care Act of 2010 (PPACA), Pub.L. 111-148  (March 23, 2010),  and the Health Care and Education Reconciliation Act of 2010 (HCERA), Pub. L. 111-152 (March 30, 2010).  The laws often are collectively referred to as the Affordable Care Act (ACA). [2] Centers for Medicare and Medicaid Services, available at http://www.cms.gov/apps/files/MedicareReport2012.pdf. [3] Department of Health and Human Services, available at http://www.healthcare.gov/blog/2013/03/anniversary-consumer-protections.html. [4] See, e.g., MedPAC Report to Congress: Medicare Payment Policy (March 2010) noting that in 2010, overall payments to plans average an estimated 113 percent of original Medicare fee-for-service (
Source: medicareadvocacy.org

BETTER SAFE THAN SORRY: NEED

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SS4. Where Can I Find Resources to Help Choose the Best Medicare Supplement Plan? There are a variety of government as well as private resources, the main one being Medicare.gov. The pros and cons of checking out Medicare.gov is that there is so much information on the site that the answer to your specific question is probably buried under tons of other information and could take forever to find. An easier method may be one of the local or national groups like the Senior Advisors Group where Medicare insurance specialists are standing by to assist you with specific questions regarding anything having to do with Medicare enrollment, choosing the best Medicare supplement plan, Medicare Advantage, and Medicare Part D (prescription) plans.
Source: blog4safety.com

Video: Medicare Supplement Plans (Medigap Coverage) Overview

Medicare Supplement coverage

Medicare Supplement coverage has a number of programs available and all have been assigned a letter. The plans are standardized so that the cover is exactly the same with all companies. This means that it is a very wise thing to shop around for a policy before buying one. Although the Government requires the plan coverage, allow companies to decide the premium price that they are going to pay. This means that there can be a large price difference from one company to the next, even though the cover is exactly the same as required by the Government.
Source: allabout101.com

Which In Turn Medicare Supplemental An Insurance Policy Is Best Into Get

Automatic Loss Of Creditable Prescription Coverage: If you were dropped from one specific prescription plan that is considered creditable, suggests as good as compared to or better this Medicare Part R plan, then distinctive way points and a SEP to get into the Medicare health insurance Part D set up. You can enroll anywhere up to 3 months in front of time if sort you will grow to be dropped from your creditable coverage we only have sixty three days from day time that coverage corners or from day time that you turned out to be informed that the policy ended to begin a Medicare Percentage D plan. If you forget this 63 celebration window then might not be qualified for enroll again so that the open enrollment term.
Source: grandec.org

Need Help Understanding My Medicare Options? » Toni Says

If you have a doctor that is in the Medicare Advantage plan’s provider                                              directory, make sure you call to verify that he/she is still accepting that                                          particular Medicare Advantage plan.  Sometimes providers are in the                                             directory, but stopped accepting the plan long before it went to print.
Source: tonisays.com

Medicare Supplemental Insurance

Medicare was created to help senior citizens acquire health insurance at a reasonable price. The majority of people are in need of health insurance far more often in their senior years than in their younger ones. Realizing that seniors pose a bigger health risk to insurance companies than the younger generation, the United States government knew that if insurance providers were allowed to operate without any kind of regulation in how they dealt with seniors, they would charge much more expensive premiums to the elder generation. This would have priced many seniors right out of healthcare coverage.
Source: lindacoleman.org

Medicare Supplement Plan F Options

There’s a good reason why so many people are talking about Plan F. It offers the most comprehensive coverage and completely eliminates all out-of-pocket expenses not covered by Medicare. Basically, that means that there is no deductible, no coinsurance and no copayments – ever. Whenever you need health care, you can receive it and not worry about having to pay anything extra. In most cases, with Plan F, there’s a Medicare Select option available, giving you the chance to reduce your premiums simply by choosing Medicare Select participating hospitals and doctors.  
Source: oklahomamedicarehealth.com

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

Medigap: Providing Financial Security and Peace of Mind for Medicare Beneficiaries

Proponents of limiting first-dollar coverage in Medigap often cite the findings from a 1970’s RAND experiment to make the case zero cost-sharing leads to higher health care spending.  AHIP commissioned a white paper to examine the relevance of this study to current Medicare beneficiaries. The white paper found that the RAND study “was set in a reimbursement environment far different from today’s Medicare,” and noted that “a higher proportion of Medicare beneficiaries are low income (and low wealth), and so the impact of higher cost-sharing may be magnified for this population.” The authors conclude that “an across-the-board ban on first-dollar coverage Medigap plans is an overly blunt tool for lowering healthcare expenditures and invites adverse, unintended consequences.”
Source: ahipcoverage.com

Medicare Supplements and Medicare Advantage Plans Are Not the Same Thing

If you have Medicare Portion A and Element B, your Medicare dietary supplement strategy will shell out the part of your healthcare monthly bill that Medicare will not shell out. Of training course, Medicare dietary supplement ideas differ, and so you want to be informed of exactly which parts a Medicare Supplement strategy will pay prior to you indication up. For occasion, Medicare could be 80% of your healthcare facility monthly bill, and your supplement will select up the other 20%.
Source: wordpress.com