Cuban regime medicare fraud money launderer sentenced to 4 years in prison

Posted by:  :  Category: Medicare

Mitt Mobile in the Final Stretch by DonkeyHoteyOscar Sanchez, a Cuban American and Florida resident who laundered millions of dollars in Medicare fraud proceeds that were transferred to banks in Cuba controlled by the Castro dictatorship was sentenced to four years in prison for his role in the scam. The Castro dictatorship has long been suspected of devising and carrying out Medicare fraud schemes in the U.S., which have netted the criminal regime in Havana millions of dollars deposited into their banks.
Source: babalublog.com

Video: Rubrica qua la zampa come medicare piccole ferite degli animali Antenna 2 TV 30042013

How Medicare is Improving Coordination of Your Care

Like the Patch many boards now require bloggers to post under our real names and photos, but still allow commentators to anonymously post under an alias or avatar. So I’m very happy to see so many standing up to the multi-alias cyber bullies & haters. For the record I have no problem with anyone posting under an alias/avatar as long as they add to the discussion, even by way of a heated disagreement. As long as it’s respectful. However, if you’re going to throw insults & lob hate bombs, then at least have the courage to post under your real name & photo. That way your friends, mother, boss and everyone else will see and know the real you. But we all know that won’t happen because such people are cowards of the highest order to begin with. In my perfect world everyone would be required to post under their real name & photo, but even I hope the need for that day never comes. Boards like this are at the heart of what the framers of the Constitution had in mind when they wrote the 1st Amendment. Although they never could have possibly dreamed of the internet & blogging as a media. Which in itself is ironic, because that is the same & most common argument applied to the 2nd Amendment! But I digress… Daylight and disclosure are what such vermin fear most, so charge on blog warriors! Because the mods can only do so much to keep this a safe & open environment. The real challenge is up to ‘we the posters’ to keep our house clean & hospitable for "everyone" to visit.
Source: patch.com

Medicare Advantage Fact Sheet

Since 2006, Medicare has paid plans under a bidding process.  Plans submit “bids” based on estimated costs per enrollee for services covered under Medicare Parts A and B; all bids that meet the necessary requirements are accepted.  The bids are compared to benchmark amounts that are set by a formula established in statute and vary by county (or region in the case of regional PPOs).  The benchmarks are the maximum amount Medicare will pay a plan in a given area. If a plan’s bid is higher than the benchmark, enrollees pay the difference between the benchmark and the bid in the form of a monthly premium, in addition to the Medicare Part B premium.  If the bid is lower than the benchmark, the plan and Medicare split the difference between the bid and the benchmark; the plan’s share is known as a “rebate,” which must be used to provide supplemental benefits to enrollees.  Medicare payments to plans are then adjusted based on enrollees’ risk profiles.
Source: kff.org

How Medicare is Improving Coordination of Your Care

Like the Patch many boards now require bloggers to post under our real names and photos, but still allow commentators to anonymously post under an alias or avatar. So I’m very happy to see so many standing up to the multi-alias cyber bullies & haters. For the record I have no problem with anyone posting under an alias/avatar as long as they add to the discussion, even by way of a heated disagreement. As long as it’s respectful. However, if you’re going to throw insults & lob hate bombs, then at least have the courage to post under your real name & photo. That way your friends, mother, boss and everyone else will see and know the real you. But we all know that won’t happen because such people are cowards of the highest order to begin with. In my perfect world everyone would be required to post under their real name & photo, but even I hope the need for that day never comes. Boards like this are at the heart of what the framers of the Constitution had in mind when they wrote the 1st Amendment. Although they never could have possibly dreamed of the internet & blogging as a media. Which in itself is ironic, because that is the same & most common argument applied to the 2nd Amendment! But I digress… Daylight and disclosure are what such vermin fear most, so charge on blog warriors! Because the mods can only do so much to keep this a safe & open environment. The real challenge is up to ‘we the posters’ to keep our house clean & hospitable for "everyone" to visit.
Source: patch.com

New Indiana Congresswoman: Freshman class will push Medicare changes

“Right now there are too many undocumented workers in the country that are not paying taxes and receiving benefits,” she said. “We need to reform the guest-worker program because there are a lot of people that want to work in this country and return to their native country.” ___
Source: medcitynews.com

Alphabet Soup a la Medicare

Medicare Part B:  This is your medical insurance.  This covers doctor and other health care provider services, hospital outpatient services (those ‘observation’/’accommodation’ stays!), durable medical equipment and skilled home health care services.  This will cover many preventive services as well.  BE AWARE:  Per CMS, “The copayment for a single outpatient hospital service can’t be more than the inpatient hospital deductible.  HOWEVER, your total copayment for all outpatient services may be more than the inpatient hospital deductible.”  This is the tricky part if you are in the hospital for several days without a formal admission!
Source: wordpress.com

La. drops plans to scrap Medicaid hospice program

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

Why the Politics of Obamacare Implementation Could Be Very Different From Medicare Part D

On the other hand, the implementation of Obamacare was designed to feature a mix of winners and losers. Low income people who qualify for Medicaid will be clear winners, yet many other people will see themselves as worse off because of the law. Certain middle income people who buy their own insurance could see big premium increases. Some business owners will be hit with a significant penalty for not providing insurance, while some workers might see their hours cut to avoid this penalty. Parts of the health care industry will also face new taxes.
Source: firedoglake.com

Cortes al Seguro Social y Medicare: No es un acuerdo favorable para los latinos

English Translation WASHINGTON — Los cortes que el Presidente Obama ha propuesto para el Seguro Social y el Medicare perjudicaría desproporcionadamente a los latinos y son impopular en nuestra comunidad. En vez de un “gran acuerdo,” estos cortes son una traición para un grupo que fue tan esencial para la victoria del Presidente. Como ya todos saben, los latinos fuimos la clave para la victoria del Presidente Obama en el 2.012. El Presidente Obama ganó sin precedente el 71 por ciento del voto latino alrededor del país, permitiendole superar a Mitt Romney en los estados claves de Colorado, Florida, Nevada y Nuevo México. Lo que muchos no saben es así como muchos de los simpatizantes de Obama, los latinos que votamos por el Presidente en gran parte, porque creímos que podríamos contar con el para proteger el Seguro Social, Medicare y Medicaid. Nosotros creímos al Presidente Obama cuando en su discurso Estado de Unión en el 2.011 dijo, Debemos “fortalecer el Seguro Social …sin apeligrar a los jubilados actuales, los más vulnerables, o los discapacitados; sin cortar los beneficios de futuras generaciones; y sin someter los ingresos de jubilación de los Americanos a los caprichos de la bolsa de valor.” El Seguro Social es importante para los latinos, porque dependemos de el más que ningún otro grupo. Más de 3 de cada 4 (77 por ciento) hogares latinos de 65 años de edad o mayores dependen del Seguro Social para la mayoría de sus ingresos y más de la mitad (55 por ciento), dependen de el para el 90 por ciento de sus ingresos. Eso significa que los ancianos latinos tienen el 18 por ciento más probabilidad de depender del Seguro Social para la mayoría de sus ingresos que el resto de la población y 52 por ciento más probabilidad de depender de el para 90 por ciento de sus ingresos. De modo que, cortes de beneficios como el índice de precios al consumo encadenado, que permite que la inflación deteriore los beneficios del Seguro Social a lo largo, golpearía duramente a los latinos. Y como somos propensos a tener más bajas ganancias durante nuestras carreras, nuestros beneficios del Seguro Social tienden a ser más modestos para empezar—$12,491 y $10,438 por año para el anciano latino promedio y la anciana latina promedio, respectivamente. Después de 20 años recibiendo beneficios bajo el índice de precios al consumo encadenado, el anciano latino promedio perdería un monto acumulado de $7,774 en beneficios, y la anciana latina promedio perdería $6,307. Después de 30 años, los cortes se incrementarían, resultando en un total de $17,049 en cortes de beneficios para la el anciano latino promedio y $13,832 para la anciana latina promedio Peor aún, el índice de precios al consumo encadenado castiga a los latinos por ser bendecidos con una expectativa de vida más alta que lo común. Como el índice de precios al consumo encadenado corta los beneficios más a medida que el beneficiado envejece, estos cortes golpeara más duros a los latinos con larga vida. No es ninguna coincidencia entonces que algunos de los expertos temen que el índice de precios al consumo encadenado incrementara la pobreza entre los ancianos latinos. Más de 1 en cada 4 anciano latino ya vive en la pobreza—casi el doble de la proporción que los ancianos blancos. La Casa Blanca dice que protegerá a “los más vulnerables” del índice de precios al consumo encadenado, pero en el pasado, estas excepciones han demostrado ser inadecuados. Un análisis conducido por Social Security Works demostró que la protección a grupos vulnerable eliminaría la mitad de los ahorros de esta provisión. Aun cuando un numero significante de latinos, debido a sus bajos ingresos, fuesen protegidos del índice de precios al consumo encadenado, esto podría tener consecuencias inesperados. Excepciones de cualquier tipo pueden ser malinterpretados como limosnas para las minorías. Ya tenemos que lidiar con suficiente estereotipos negativas de nosotros como destinarios de “asistencia social” o “limosnas de gobierno.” Los cortes en los beneficios de Medicare que propone el Presidente Obama es un paso en dirección equivocada que causara dolor a los latinos. En vez de encarar los altos costos médicos, el presupuesto transfiere los gastos de salud a los beneficiados incrementando los deducibles, las primas, los co-pagos, y creando un nuevo recargo. La Casa Blanca asegura que estos cortes harán que los beneficiados de Medicare sean mejores consumidores, pero este pensamiento es defectuoso. Son los doctores quienes determinan las decisiones médicas y no los beneficiados, de modo que es ridículo pensar que los ancianos podrán comparar precios. El resultado final más probable será que los ancianos latinos que no puedan afrontar los altos costos-de-bolsillos, se negarán de buscar cuidado médico. La medida conocida como comprobación de medios de Medicare no solo afectará a los ricos—a lo largo, incrementara las primas de Parte B y D de los ancianos latinos con ingresos de apenas $47,000 al año. Los ancianos gastan tres veces más de sus ingresos en costos-de-bolsillos para su salud que el resto de la población. Bajo el presupuesto del Presidente Obama, la reducción en los ingresos de los ancianos latinos serían el doble: ellos serían golpeados por el índice de precios al consumo encadenado, y en sima de eso los costos-de-bolsillos de sus gastos médicos incrementarían. Además, la medida requiriendo un co-pago de $100 por episodio de servicio de salud al hogar podría impactar severamente a los que dependen de los ayudantes de salud en el hogar para tratar su diabetes u otras enfermedades crónicas. Esto afectaría desproporcionadamente a los ancianos latinos, quienes padecen de más altos niveles de diabetes que el resto de la población. En Chicago, donde la frecuencia de diabetes es el más alto del país, el 25.8 por ciento de los latinos mayores de 65 sufren de diabetes comparados con 15 por ciento de los blancos. La Casa Blanca ha defendido los cortes del Seguro Social y Medicare como medidas “no ideal” pero necesarias para lograr un acuerdo con los Republicanos en el Congreso. No hay ninguna duda que el Presidente encara opciones difíciles mientras navega obstrucción Republicana sin precedencia. Pero por momentos, parecería que el Presidente Obama también ha adoptado el marco Republicano: que el problema de nuestro déficit se debe a una sobre generosidad de los beneficios del Seguro Social y Medicare. De hecho, el Seguro Social no contribuye ni puede agregar un centavo a la deuda o al déficit. Los altos gastos de Medicare se deben los altos costos de salud, lo cual el programa de Medicare ha demostrado que es mucho más capaz de controlar que su contraparte en el mercado de salud privado. Los latinos votaron para un Presidente suficientemente audaz para empezar una conversación sobre los desafíos de envejecimiento, la salud y la seguridad económica, no alguien que se adhiera a viejos puntos Republicanos. Una verdadera conversación “adulta” del envejecimiento de la población de “baby boomers” comenzaría con el reconocimiento que los Estados Unidos tiene una crisis de salud y crisis de seguridad durante la jubilación. El Seguro Social y el Medicare son la solución a esas crisis, no el problema. La comunidad latina agradece al Presidente Obama por su liderazgo en asuntos de inmigración y la reforma de salud. Ahora, esperamos que el Presidente honra su promesa a los latinos de proteger y fortalecer el Seguro Social y el Medicare. Eva Dominguez es directora ejecutiva de Latinos para una Jubilación Segura.
Source: newamericamedia.org

La Jolla cancer doc pleads guilty to Medicare fraud

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

Medicare Supplement Plan F from Anthem Blue Cross Covers All of Your Health Care Needs

Posted by:  :  Category: Medicare

It's all there in black and white by Dave77459In addition to all of this, Plan “F” also has a foreign travel emergency benefit, which is useful for seniors on the go. If this sounds like a program that you would be interested in, find out more information today by calling the insurance agents at Benefit Packages. At Benefit Packages, we are an independent insurance agency that works with many different insurance companies. We can help you find the best Medicare supplement for your situation.
Source: benefitpackages.com

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

Medicare Supplement Insurance Information

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

Save money on your Mutual of Omaha Medicare Supplement

 Is your United of Omaha or Mutual of Omaha Medicare Supplement premium increasing June 1st?  If so, our agency can help.  We represent many different insurance companies that offer seniors in Missouri the most competitive rates on Medicare Supplement insurance.  In the last few weeks, we have helped many clients find alternatives to these escalating premiums.
Source: medicareplansstcharles.com

Insurance: What is the Best Solution when you are still working at 65?

You have paid into Medicare through your payroll deduction. This means that you are entitled to Part A of Medicare at 65, which covers Hospitals, Skilled Nursing Facilities, Blood and Hospice. You must then enroll in Part B, which covers Professional Services. The cost of Part B for the average worker for 2013 is $104.90 and higher for individuals with modified adjusted gross income (MAGI) over $85,000 and couples with MAGI exceeding $170,000. Part A and B comprise the coverage for basic health plans. Once you enroll in Part B, then you must select a plan for Prescription Drugs and either a Medicare Supplemental plan or a Medicare Advantage plan. At age 65, a plan F Medicare supplement plan will cost approximately $125 per month and a prescription plan will run from $15 to $100. So, if you paid $50 for a prescription plan, $125 for the supplement and $104.50 for Part B, your total would be $279.50 per month. But here is the comparison; Plan F will pay all costs not paid by Medicare primary benefits. Most group health plans have Co-payments, Co-sharing (80/20 percent plans) and an out of pocket maximum to reach before they pay 100 percent of claims. Thus your true out of pocket will be a combination of the out of pocket maximum and the group premium. Group plans are the primary Payor or claims, not Medicare, and claims will be paid according to the Group plan model.
Source: desertstarweekly.com

Prosperity Protection Counselors

Without a doubt Medicare Supplement Plan F is by far and away the most popular plan for people on Medicare Part A and Part B. The reason it’s so very popular is that this plan covers 100 percent of the gaps in Medicare Part A and Part B. For a relatively low monthly premium you can simply show your Medicare card and your Medigap Plan F card to any doctor, specialist, or hospital in the country that accepts Medicare, get treatment, and go home with no bills. Not bad coverage huh? Yes this plan is the most expensive, but for many people who are coming off employer health care and used to deductibles along with getting 80 or 90 percent coverage this plan is usually far cheaper with substantially better coverage.
Source: ppc12.org

Medicare Supplement Plan F

The best and most popular plan to cover the gaps is Medicare Supplement Plan F. Plan F will get you the most complete coverage possible. When purchasing Plan F, you will likely have no out-of-pocket costs for hospital and doctor visits. This plan also includes hospitalization which pays Part A coinsurance plus coverage for 365 additional days after Medicare benefits end. This great plan also covers medical expenses which pays Part B coinsurance; generally 20 percent of Medicare-approved expenses or copayments for hospital outpatient services.
Source: allabout101.com

Medicare’s Annual Wellness Visit ‹ The Health Journal: Fitness, Nutrition, Wellness

Posted by:  :  Category: Medicare

Prior to your appointment, you will be asked to complete some questions about your health as part of a Health Risk Assessment. The doctor or other health care professional will review this with you and will do several screening tests. You will be asked questions about your lifestyle and health habits and your height, weight and blood pressure will be measured. Depression is also common in older people and will be evaluated as a part of your overall well-being. Home safety and fall risk will be addressed as well.
Source: thehealthjournals.com

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

Medicare biller for home health agency (Sterling, VA)

We are seeking a full time or flex time biller with experience in Medicare skilled home health, Virginia Medicaid (skilled and Waiver services), private insurance, managed care and workmans’ comp. We have some flexibility with work schedule. Five Star Home Health Care is a 7-year-old home health care company serving the Northern Virginia market, just outside of Washington D.C. We have 2 offices. We are accredited by The Joint Commission and are the only full service home health care agency in our market, providing skilled services under Medicare, Medicaid and insurance, pediatric private duty nursing, self-pay and Medicaid Waiver personal care services and we also operate 2 PCA caregiver certification schools. This position requires strong initiative, and the ability to work independently. Must be extremely organized, high energy, analytical and possess good time management skills. This individual must have a customer service mindset. We are not like most health care companies. We put our patients first in EVERYTHING we do. You must have a customer service mindset or you will fail with us. We have a unique edge in the crowded home health marketplace. We are a full service agency: we do not pick and choose payors or clients. We are true to our word with hospital discharge planners – we do what we say we’re going to do. We have an intense focus on chronic disease management and are implementing very extensive care plans for those individuals to set us apart from other providers. If you are interested in a position with us, please e-mail your resume, with your last salary and why you feel you are perfect for this position. Confidence and discretion is assured – your emails only go to me, Johnny Wilkinson, Co-Owner. Place “Biller” in the subject line. You will be contacted if I feel there is a fit within our company. Five Star Home Health Care Attention: Johnny Wilkinson 23430 Rock Haven Way Suite 220 Dulles, VA 20166 Visit our new web site: http://www.fshhc.com Visit our new Facebook page: http://www.facebook.com/fshhc Our Mission: We exist to enable individuals to remain safe, functional and comfortable in the place they choose to live to avoid institutional placement. Our Vision: To lead a new medical world based less upon process, quantity, volume and lucre, and more on quality, safety, speed, outcomes and patient-centered accountability. Our Values: http://www.fshhc.com/our-values
Source: perfectaccountingjobs.com

Sterling Life Insurance Medicare Supps.

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

Sterling Ridge Assisted Living

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

Sterling Health Insurance Company Review

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

18 Key Healthcare Reform Provisions That Could Affect You Immediately

CDHPs COBRA Compliance Cora Tellez Dependent Care Flexible Spending Accounts Dependent Care FSA Employees Employers Facebook Financing Healthcare Flex Flexible Benefit Plans Flexible Spending Accounts FSAs HDHPS Health & Wellness Healthcare Healthcare Flexible Spending Accounts Healthcare FSA Healthcare Reform Healthcare Reform Changes Health Reimbursement Accounts Health Reimbursement Arrangements Health Savings Accounts healthy menu ideas healthy menus Healthy Recipes High Deductible Health Plans HRAs HSA Contribution Limits HSAs IRS PPACA Second Harvest Food Bank Self Funding Self Insurance speakers Sterling HSA Sterling Self Insurance Administration Sterling SIA Taxes tax savings Transit & Parking Benefits Webinars Wellness
Source: sterlinghsa.com

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

Posted by:  :  Category: Medicare

bag & contents - Stolen by quadrapopBecause 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

Video: EHR: Medicare Incentive Program Attestation Webinar for Eligible Professionals

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

Air 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 (4188) Executive Moves (1253) Financial Report (964) M&A Activity (606) News (6776)
Source: govconwire.com

Future Health Software Founder & CEO Updates American Chiropractic Association Medicare Committee Federal EHR Incentive Program

The participation via registration in the EHR Incentive Program has increased to 7512 DC’s overall, yet that full number have not yet started their MU reporting period.  Currently only, 1981 have received their MU incentive check for a total of over $28M paid out to those providers. Because the data is current through January 2013, Kraus stated that he expects that with the large number of DC’s who began their reporting period in Q4 of 2012 that over the next 8 weeks there will be a significant jump in payments for the 2012 first year participants as well as the second year payouts to those who just completed their second year of MU. Kraus expects the total payouts to exceed $50M to DC’s as the year progresses in 2013.
Source: futurehealthsoftware.com

Cost Report Software: An Overview of the Medicare Software Packages Currently Available

CMS has approved several Medicare cost report software vendors. Please see: https://www.novitas-solutions.com/parta/arcenter/forms-instruct/app-cr-sware-vend.html. We do not guarantee that the information contained herein is up-to-date or accurate. We recommend you review the following features before making a purchase:
Source: costreportconsulting.com

CrossLink Professional Tax Software Blog: IRS Update: Additional Medicare Tax for High Income Taxpayers

The additional Medicare tax is calculated as 0.9% of the total of wages, other compensation, and self-employment income that is in excess of the taxpayer’s threshold amount. For self-employed taxpayers, the Medicare portion of their self-employment tax will be calculated as follows:
Source: blogspot.com

15 additional ACOs groups are participating in Medicare Shared Saving Program

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Source: medi101.com

Ct Seniors Sue Medicare To Close Nursing Home Coverage Gap

Today, lawyers representing 14 seniors, including 7 from Connecticut, will go to U.S. District Court in Hartford to ask a judge to eliminate the observation care designation because it deprives Medicare beneficiaries of the full hospital coverage they’re entitled to under Medicare, including coverage for follow-up nursing home care.  The Centers for Medicare & Medicaid Services (CMS), which runs the Medicare program, pays for doctor visits, hospitalization, nursing home care, prescription drugs and other benefits for nearly 50 million older or disabled Americans, including about 586,000 in Connecticut.
Source: ctwatchdog.com

Detroit Home Health Company Employee Pleads Guilty to Role in Medicare Fraud Scheme

According to court documents, Sharma worked at purported home health companies, including First Choice Home Health Care Services Inc. and Reliance Home Care LLC, where she and other conspirators agreed to submit false and fraudulent claims to Medicare for home health services. Court documents reveal that, among other things, Sharma organized and maintained company patient files, knowing that these files contained falsified patient visit notes that created the false impression that home health care had been provided to patients. Sharma admitted that she knew that these documents would be used by these companies to submit claims to Medicare for home health services that were not medically necessary and/or not provided.
Source: sandpointpr.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

MEDICARE PROGRAM; PART B INPATIENT BILLING IN HOSPITALS (CMS

Changes in the coding of pacemaker and Cardiodefibrillator (ICD) are at play in 2012. And that means major code and coding guideline changes is a mandate for hospitals and physician practices. No question. So when it comes to your hospital’s or practice reimbursement, ensuring that the changes are implemented and assigned properly are a must. In addition to major code and coding guideline changes for 2012, regulatory probes will continue. Such is the case with the National Government Service (NGS) representative who is reviewing one-day stays for patients with heart failure. How can an effective case management program assist with managing this issue? Over the last five years the codes and coding guidelines for pacemaker and ICD implantations have been under review by Medicare and the RUC committees of the AMA. As a result of this review major code and coding guideline changes are occurring in 2012. There is no transition period between last year’s code sets and those required for assignment in 2012. The effective date is January 1, 2012. Be successful by understanding the changes that will impact reimbursement at your facility or practice. Learning Objectives: From this webcast, you learn the following… An overview of how the new and revised codes and coding guidelines will provide appropriate reimbursement. Understanding of the elements of the “Probe” into one-day stays for heart failure. An understanding of the of the benefits of an effective case management program that will assist the physicians in deciding if a procedure should be performed as an inpatient or outpatient. Your Presenter Bernie Van Someren, BS, RT(R), CIRCC, is a Senior Healthcare Consultant for MedLearn. Bernie conducts IR and cardiology educational training seminars and he’s a contributing author to numerous MedLearn books relating to coding and billing for radiology, EP and cardiology procedures. He is also one of the authors of the CIRCC study guide and CIRCC test. Who Should Attend Compliance, HIM managers, coders, electrophysiology lab department manager, case management personnel
Source: wn.com

Software for healthcare record exchange from Proficient, LLC.

Proficient Health is a healthcare information technology company using software to turn cumbersome, paper-based processes into an efficient flow of information. Our affordable, online services connect physicians, hospitals and other healthcare providers – helping them gather data on strategic trends, improve service and care delivery, drive down costs, speed reimbursement and get more out of their electronic medical records platform. For more information on Proficient Health and the solutions it provides, visit www.proficienthealth.com.
Source: proficienthealth.com

Billing Software Vendor Advises Clients to Check Their Medicare Billing Rates

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

Obamacare and the Evolution of Medicare and Medicaid

For better or worse, Illinois is at the vanguard of innovation as evidenced by its recent agreement (known as a Memorandum of Understanding – MOU) with CMS to test a capitated model to integrate care and aligned financing for Illinois full-benefit duals (approx 135,825 persons). Think of a capitated model as a three-part agreement: a health-plan (i.e. managed care organization — MCO) enters into an agreement with the state, which in turn is contracted with CMS to receive a set risk-based payment from Medicare and Medicaid. If CMS is able to save money, then it will share the savings with the state. There are still many, many unknowns on how the model will be implemented. For example, duals are typically poorer and sicker then most Medicare beneficiaries and how well MCOs can meet the challenge of delivery person-centered health care and LTSS to this population has never been tested on this scale. Questions remain unanswered regarding the availability of ombudsmen to assist duals in navigating the complexities of the MCO system. Additionally, identification and implementation of quality standards and oversight have yet to be resolved. However, driven by the need to reduce Medicaid expenditures, the Illinois Department of Health and Family Services, is taking no prisoners in its drive to implement the MOU beginning on October 1, 2013.
Source: chicagonow.com

Sequestration and PECOS Update for Medicare Home Health and Hospice

A report will be provided to list your physicians and their status to help you identify the physicians associated with your agency who are not PECOS certified. Claims with non-certified physicians will be denied; a new PECOS Claims Hold will be available to help you capture problematic claims before they are generated. We will begin releasing these changes and provide updates in the next maintenance cycle on Wednesday, April 3rd.
Source: careanyware.com

Coventry Health Care Adds Cornerstone Health Care (P.A.) to their Advantra Medicare Advantage Provider Network in North Carolina.

Posted by:  :  Category: Medicare

Cornerstone Health Care has nearly 300 providers (including primary care and specialty physicians, and mid-level professionals) in more than 70 locations in High Point, Winston-Salem, Greensboro, Summerfield, Thomasville, Archdale, Trinity, Jamestown, Kernersville, Lexington, Asheboro, and Advance.
Source: wordpress.com

Video: Videos matching: advantra medicare advantage

Altius Health Plans Altius Advantra Medicare Review

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

Will Your Medicare Advantage Plans Still Be Available In 2010

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

Advantra Rx NOT Renewing Their Medicare Contract

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

Medicare Targets Health Plans With Low Ratings

Medicare officials are encouraging 525,000 beneficiaries to switch out of these 26 Medicare Advantage and drug plans that have received low ratings for three consecutive years and enroll in better plans for next year. The poor performing plans will have this warning symbol next to their names on Medicare’s plan finder website to steer shoppers to other plans.
Source: kaiserhealthnews.org

Coventry Medicare Advantages In A Nutshell

The last two remaining programs in the Coventry Medicare Plans are the Coventry Advantra-POS and the Coventry Advantra Freedom. The Advantra POS is still basically the same as HMO and PPO plans; they have the same coverage of benefits and a set of network providers.  But, they are given the privilege to see health care providers outside their network.  Of course, this comes with much higher premiums.  For a little more cost, enrollees can have the freedom to choose their own physicians with the Advantra Freedom plan.  CAF is a private-fee-for-service (PFFS) which also includes Part A and B benefits.  Enrollees may consult any physician or specialist they prefer without the need for any referrals, given that the provider accepts the guidelines and resolutions within the PFFS agreement.
Source: medicarebase.com

Pennsylvania Health Insurance

HealthAmerica’s Commercial and Medicare Advantage Plans Among Tops in Nation for Quality and Service on U.S.News & World Report/NCQA “America’s Best Health Plans 2008-09″ List Harrisburg and Pittsburgh, Pa. – November 10, 2008 — HealthAmerica’s HMO, POS, and Medicare Advantage plans were ranked among the nation’s top 20 best commercial and Medicare health plans according to a joint ranking by U.S.News & World Report and the National Committee for Quality Assurance (NCQA). Nationally, HealthAmerica was ranked 12th among 287 commercial plans; HealthAmerica’s Medicare Advantage plan, Advantra, ranked 18th among 216 plans nationally. HealthAmerica and HealthAmerica Advantra have ranked as one of the top 50 best health plans in the U.S. News/NCQA “Americaýs Best Health Plans” list* every year since 2005. “We are honored to be recognized among the best health plans in the nation,” said Kirk E. Rothrock, president and chief executive officer of HealthAmerica. “We are dedicated to providing the best possible quality and service, so we are pleased to see our efforts recognized by NCQA, U.S. News and World Report, and, most importantly, by our members and our customers.” The National Committee for Quality Assurance and U.S.News and World Report collaborated to rank the nationýs best commercial, Medicare, and Medicaid health plans. The ranking appears in the November 17 issue of U.S.News and on its website www.usnews .com/healthplans HealthAmerica”s and Advantra”s rankings are based on their Healthcare Effectiveness Data and Information Set (HEDISý)** 2008 scores and the results of a Consumer Assessment of Healthcare and Provider Systems (CAHPS) survey of members. HEDIS is a set of standardized performance measures covering effectiveness of care, preventive care, treatment, and customer satisfaction. CAHPS is a standardized survey in which members rate the quality of care and service that they receive from doctors, specialists, office staffs, and insurers. In these ratings, HealthAmerica’s commercial health plans were rated higher than the national average in all 15 key measures of medical services and member satisfaction and higher than the Pennsylvania state average in 12 of the 15 key measures***. HealthAmerica’s HMO, POS, and Medicare Advantage plans’ status of “Excellent” from NCQA was also a factor in determining the U.S. News/NCQA “America’s Best Health Plans 2008″ ranking**** The U.S.News/NCQA “Americaýs Best Health Plans 2008″ list is drawn from measures of prevention, treatment, and customer experience. These measures are compiled in NCQA”s Quality Compass 2008*****, which publicly reports comparative results of more than 400 commercial health plans covering 85 million Americans. Health plans throughout the country were evaluated on issues such as access to care, prevention efforts, treatment of diseases such as diabetes and heart disease, and members were surveyed on their satisfaction to calculate an overall quality score. * “America’s Best Health Plans” is a trademark of U.S. News & World Report. **HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). ***The source for this data is Quality Compass 2008 and is used with the permission of the National Committee for Quality Assurance (NCQA). Quality Compass is a registered trademark of NCQA. NCQA is a private, non-profit organization dedicated to improving health care quality. The 12 measures are: Child immunization (combo II), well child visits 3 to 6 years, colorectal cancer screening, prenatal care, first-trimester postpartum care, cervical cancer screening, breast cancer screening, diabetes-lipid profile (screen), controlling hypertension, cholesterol screening for patients with cardiovascular conditions, rating of all health care, rating of health plan. ****National Committee for Quality Assurance accreditation outcomes are: Excellent, Commendable, Accredited, and Denied. Applies to HMO and POS plans. *****Quality Compass is a registered trademark of NCQA. NCQA is a private, non-profit organization dedicated to improving health care quality. About HealthAmerica For over 33 years, HealthAmerica has provided health benefit solutions to employers across Pennsylvania. HealthAmerica offers a broad range of traditional and consumer-directed health insurance products, including managed care, HSAs, self-funded, Medicare, indemnity, nongroup and pharmacy plans. Serving 12,000 businesses and over 660,000 members as of December 31, 2007, in Pennsylvania and Ohio, HealthAmerica offers progressive medical management, innovative wellness programs, and statewide and national provider networks. HealthAmerica is ranked as one of “Americaýs Best Health Plans, 2006″ by U.S. News & World Report; its HMO and POS products have an “Excellent” accreditation by the National Committee for Quality Assurance. HealthAmerica has corporate offices in Pittsburgh and Harrisburg, Pennsylvania, and employs over 2,200 people in the commonwealth.
Source: blogspot.com

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

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

Medicare Advantage Plans and PFFS Plans

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Source: merchantcircle.com

The Sullivan Independent News

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

Canberrans urged to update address with Medicare

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 marsmet524From 30 January to 4 March, anyone who updates their Medicare address after moving to Canberra from interstate will be eligible to enter a competition to win $10,000 thanks to SERVICE ONE Members Banking. The competition closes at midnight on 4 March 2013.
Source: gov.au

Video: Weekly Address: Preserving and Strengthening Medicare

Single Stop submits comments to Center for Medicare and Medicaid Services

Single Stop USA’s comments focused on addressing the following topics: (1) Encouraging transparency in the application process; (2) Integrating Navigators, In-Person Assisters, Certified Application Counselors; (3) Leveraging eligibility results to connect individuals to multiple benefit applications; and (4) Addressing the concerns of immigrant applicants. In addition to submitting our own comments, Single Stop worked with the other national benefits access providers and interested policy groups to have a shared voice about ways to maximize this important opportunity to advance on-line benefits access.
Source: singlestopusa.org

History of medicare in Canada

By the time this shift in thinking occurred, decisions had been made about funding healthcare that set the pattern for the future. In terms of financing, many early reports assumed that some of the costs of medicare would be paid directly by patients or taxpayers. The 1939 Rowell-Sirois Report, which dealt with federal-provincial fiscal relations, assumed that contributions from employers and employees would raise most of the money. One of the intellectual architects of Canada’s social programs, Leonard Marsh, wrote in his 1943 report that there were “psychological” as well as financial benefits to having taxpayers pay a part of their healthcare costs. He linked the amount of coverage to the size of contribution made directly by individuals – that is, if more services were to be covered, then individuals would have to pay more directly from their pockets. Tom Kent, Prime Minister Lester B. Pearson’s key policy adviser when medicare was created in the 1960s, recommended that up to 25 per cent of healthcare costs should come from making healthcare a taxable benefit. Kent believed that there was a problem with healthcare being a “free good”. If even a small part of what patients and taxpayers paid for healthcare was related to their use of the system, there would be some restraint on the demand for services. Kent also knew that if medicare were to be funded solely from the general pool of taxes, governments would only be able to cover a narrow range of services.
Source: troymedia.com

Why the Politics of Obamacare Implementation Could Be Very Different From Medicare Part D

On the other hand, the implementation of Obamacare was designed to feature a mix of winners and losers. Low income people who qualify for Medicaid will be clear winners, yet many other people will see themselves as worse off because of the law. Certain middle income people who buy their own insurance could see big premium increases. Some business owners will be hit with a significant penalty for not providing insurance, while some workers might see their hours cut to avoid this penalty. Parts of the health care industry will also face new taxes.
Source: firedoglake.com

St. Luke's Named a Medicare Accountable Care Organization ← St Luke's News

The group announced today also includes 15 Advance Payment Model ACOs, physician-based or rural providers who would benefit from greater access to capital to invest in staff, electronic health record systems, or other infrastructure required to improve care coordination.  Medicare will recoup advance payments over time through future shared savings. In addition to these ACOs, last year CMS launched the Pioneer ACO program for large provider groups able to take greater financial responsibility for the costs and care of their patients over time. In total, Medicare’s ACO partners will serve more than 4 million beneficiaries nationwide.
Source: stlukesblogs.org

Primary Care Doctor Shortage

But in these times of shrinking federal budgets, it’s unclear how much ACA primary care money will be available as Congress juggles competing priorities. Congress, for example, already has chopped about $6.25 billion from the ACA’s new $15 billion Prevention and Public Health Fund, which pays for programs to reduce obesity, stop smoking and otherwise promote good health. In addition, federal support for training all types of physicians, including primary care doctors, is targeted for cuts by President Obama and Congress, Republicans and Democrats, says Christiane Mitchell, director of federal affairs for the Association of American Medical Colleges, who calls the proposed cuts "catastrophic."
Source: aarp.org

AARP Urges Congress to Address Medicare Physician Payments

“As you know, physicians and other health care providers are scheduled to receive a 27 percent cut on January 1, 2013, as a result of the flawed sustainable growth rate (SGR) formula.  This is in addition to the 2 percent reduction included in the planned sequestration.  Failure to adopt legislation to address the “doc fix” would create considerable instability in the Medicare program.  Such a significant reduction in reimbursement could cause providers to stop seeing Medicare beneficiaries or prevent them from accepting new ones.  We are disappointed that Congress has thus far been unable to develop a long-term solution to this perpetual problem.  However, even in the absence of a longer-term solution, the SGR cuts must not be allowed to occur.  Under current law, the Centers for Medicare and Medicaid Services may begin issuing the reduced payments on January 1.  A reduction for even a short time in reimbursement rates could disrupt access to care, as providers may delay seeing Medicare patients until updated rates go into effect. 
Source: aarp.org

Medicare levy boost to pay for disability insurance scheme

The 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

Upton to Highlight Medicare Physician Payment Reform Effort WEDNESDAY During Address to American Medical Association

WASHINGTON, DC – Energy and Commerce Committee Chairman Fred Upton (R-MI) will address the American Medical Association at the 2013 National Advocacy Conference on Wednesday, February 13, 2013, at 8:00 a.m. at the Grand Hyatt Washington. Upton will discuss the health care law’s impact on physicians and patients and outline the committee’s upcoming plans to address the outdated Medicare physician payment system. Last week, Upton and Ways and Means Chairman Dave Camp (R-MI) released a framework of their collaborative efforts to repeal the Sustainable Growth Rate formula and advance a permanent solution for the long troubled payment system. On Thursday, the Energy and Commerce Health Subcommittee will hold a hearing on SGR reform.  
Source: house.gov

Medicare postpones enforcement of new ordering/referring rule

Posted by:  :  Category: Medicare

Nancy Pelosi on the Next Four Years by jurvetsonAlthough a recent Medicare Learning Network Matters article, using terminology common in Medicare documents, indicated the new identification requirement applies to “ordering/referring” providers, the regulation actually applies to any provider who “orders” non-physician items or services for the beneficiary (such as DMEPOS, clinical laboratory services, or imaging services) or ”certifies” patients for home health services, according to the AOA Advocacy Group.
Source: newsfromaoa.org

Video: Medicare Enrollment Advice

Doctor’s Advice…Get Traditional Medicare…What’s That? » Toni Says

(In-patient Hospital Insurance) pays for your medical care while you have a hospital stay. Part A also pays some of the costs if you stay in a skilled nursing facility which has 100 day benefit, hospice, or if you receive home health care.  The Part A deductible for 2013 is $1,184.00 and can be used 6 times or 6 deductibles in a year.  Yes, Part A has a benefit period of 60 days, so every 60 days; there is a new deductible of $1184.00. If you go back in the hospital after a 60 day period, then you can have another deductible of $1,184.00.  Skilled nursing has a $0 co pay for days 1-20, but from days 21-100, there is $148.00 co pay per day.  After day 100, you pay all of the cost for each additional day. And yes they do bill you the additional cost.
Source: tonisays.com

Medicare Advantage Cuts in Obamacare: March 2013 Update

The Federal Government is nudging everyone to use the Exchanges instead of private healthcare providers.  This is especially true for Medicare recipients who choose supplemental care policies with private insurers.  Up to now, certain healthcare insurers received grants for being efficient and high-quality providers.  Now that goes away.  The result is an increase in premiums for these plans nicknamed “Medicare Advantage.” The healthcare providers that receive compensation for their services to Medicare patients must accept a fee schedule for medical services that are based upon a flat rate schedule, even if the patient is not eligible for the particular treatment regimen.  That is why a growing number of medical care providers no longer accept Medicare patients.  Some doctors and clinics now offer a subscription service called “Concierge Service” for a fixed annual fee.
Source: patriotactionnetwork.com

Medicare’s Annual Wellness Visit ‹ The Health Journal: Fitness, Nutrition, Wellness

Prior to your appointment, you will be asked to complete some questions about your health as part of a Health Risk Assessment. The doctor or other health care professional will review this with you and will do several screening tests. You will be asked questions about your lifestyle and health habits and your height, weight and blood pressure will be measured. Depression is also common in older people and will be evaluated as a part of your overall well-being. Home safety and fall risk will be addressed as well.
Source: thehealthjournals.com

Viewpoints: ‘Zombie’ Plans For Medicare; James Baker’s Grand Bargain Advice; Conservative Govs’ Choices

The New England Journal of Medicine: Reducing Administrative Costs and Improving the Health Care System The average U.S. physician spends 43 minutes a day interacting with health plans about payment, dealing with formularies, and obtaining authorizations for procedures. In addition, physicians’ offices must hire coders, who spend their days translating clinical records into billing forms and submitting and monitoring reimbursements. The amount of time and money spent on administrative tasks is one of the most frustrating aspects of modern medicine. … it may be necessary to establish a senior-level office in the DHHS focused solely on implementation and innovation in the realm of administrative simplification (David Cutler, Elizabeth Wikler and Peter Basch, 11/15).
Source: kaiserhealthnews.org

Medicare Premium Announces the Launch of New Company Website

As the leading online source for authentic medicare premium advice http://medicarepremium.org believes that adding Part B Medicare to their superb and growing inventory collection will provide both new and returning customers with a superior shopping experience when it comes to Medicare advice. Explore the reviews and deals page for health.. The website can be viewed at http://medicarepremium.org.
Source: imsoup.com

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

Duckworth Discusses Concerns About Cuts To Social Security, Medicare With Elgin Residents

Posted by:  :  Category: Medicare

Love it! Improve it! Medicare for All! by TheeErin“We’re sitting here looking at four major surgeries for cancer. We’ve just gotten through the fourth one … and we have tens of thousands of dollars worth of bills that are covered by Medicare,” Ceithaml said after meeting the congresswoman. “We would have lost our house three times over already if there had not been the present level of Medicare, and to make it a lower level is just unconscionable.”
Source: progressillinois.com

Video: Attention Residents on Medicare in Illinois: information on Medicare Supplements

Shocking Medicare and Medicaid fraud exposed at Illinois’ Sacred Heart Hospital

“Between January 2010 and February 2013, May allegedly received $74,000 in the form of 37 checks, for $2,000 each, disguised as ‘rental payments'; Moshiri, a podiatrist, allegedly received $86,000 in 38 checks pursuant to a purported contract to teach podiatry students; and Maitra allegedly received $68,000 in 34 checks pursuant to a purported teaching contract – and the $228,000 total in alleged kickbacks were all in exchange for their referral of patients to Sacred Heart, the charges allege.   “In a recorded conversation last month, Maitra allegedly explained to Administrator A that he used to make Novak ‘so much money’ performing almost daily penile implant procedures on patients, but that he no longer performed as many of those procedures because Medicare had decreased its rates of reimbursement for the procedure. Maitra did not comment on whether the patient need for the procedure had somehow changed, according to the affidavit.”   “On March 1, 2013, Administrator A recorded Novak stating that tracheotomies are Sacred Heart’s ‘biggest money maker’ and the hospital can make $160,000 for a tracheotomy if the patient stays 27 days. On March 7, 2013, the Intensive Care Unit case manager told Administrator A that she must often ‘stretch’ a tracheotomy patient’s stay to 28 days to maximize Medicare reimbursements ‘to make Novak happy.’”
Source: wordpress.com

Park Ridge Man Charged in Medicare Kickbacks

On March 4, 2013, investigators from CMS and the State of Illinois arrived at Sacred Heart to conduct an investigation of the hospital’s intubations and tracheotomies, and quality assurance and performance improvement protocols.  On March 6, Administrator A recorded Physician D acknowledging that Sacred Heart lacked policies for various aspects of intubations and tracheotomies and that he had given some practice guidelines and procedures obtained from other hospitals to the surveyors in response to their request for Sacred Heart’s policies.  At the same time, the ICU nurse manager told Administrator A that she had reviewed eight tracheotomy patient files in connection with the CMS investigation.  Physician D was the pulmonologist for all the patients and had performed all but one of the tracheotomies.  The nurse manager said that there was no documentation in the patient files explaining the decision to intubate the patients or any efforts to wean them from the ventilators.  The following day Administrator A reported the findings to Novak and others and regarding the lack of documentation, and Novak replied with an expletive, according to the affidavit.        
Source: patch.com

Page not found : HIV Health Reform

ADAP aids.gov AIDS2012 Bridge to 2014 California Healthcare Reform Case Stories comments to HHS Congress Deficit Reduction Dual Eligibles Election 2012 essential health benefits exchange & marketplace fact sheet featured federal budget federal implementation health care reform & prevention health home health reform & HIV 101 HHCAWG HIVMA HLS/TAEP Illinois Medi-Cal Questions Medicaid Medicare NASTAD National HIV/AIDS Strategy Navigators private insurance providers public input regulations Ryan White CARE Act Sebelius Spanish Speaking Resources state & local implementation state & local implementation state advocates Super Committee Supreme Court toolkits webinar women
Source: hivhealthreform.org

Financial Alignment Demonstrations for Dual Eligible Beneficiaries Compared: California, Illinois, Massachusetts, Ohio, and Washington

This policy brief compares demonstration programs in California, Illinois, Massachusetts, Ohio and Washington state that will introduce changes in the care delivery systems through which people who are dually eligible for Medicare and Medicaid receive services, as well as changing the payment approach and financing arrangements among the Centers for Medicare and Medicaid Services, the states and providers.
Source: kff.org

Retirement expert: Medicare already means

“Means-testing benefits, in their view, risks converting Medicare into another welfare-oriented program, with the possible erosion of popular support and potential exposure to the sort of reductions that such programs often suffer in difficult economic times,” Kaplan said. “Other policymakers oppose means-testing Medicare because they regard reducing promised benefits on the basis of income as a disguised tax, a penalty on ‘success,’ in their view.”
Source: sciencecodex.com

Obamacare and the Evolution of Medicare and Medicaid

For better or worse, Illinois is at the vanguard of innovation as evidenced by its recent agreement (known as a Memorandum of Understanding – MOU) with CMS to test a capitated model to integrate care and aligned financing for Illinois full-benefit duals (approx 135,825 persons). Think of a capitated model as a three-part agreement: a health-plan (i.e. managed care organization — MCO) enters into an agreement with the state, which in turn is contracted with CMS to receive a set risk-based payment from Medicare and Medicaid. If CMS is able to save money, then it will share the savings with the state. There are still many, many unknowns on how the model will be implemented. For example, duals are typically poorer and sicker then most Medicare beneficiaries and how well MCOs can meet the challenge of delivery person-centered health care and LTSS to this population has never been tested on this scale. Questions remain unanswered regarding the availability of ombudsmen to assist duals in navigating the complexities of the MCO system. Additionally, identification and implementation of quality standards and oversight have yet to be resolved. However, driven by the need to reduce Medicaid expenditures, the Illinois Department of Health and Family Services, is taking no prisoners in its drive to implement the MOU beginning on October 1, 2013.
Source: chicagonow.com

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

Illinois Attestation for Medicaid Payment Increase? Not Yet – Pediatric Inc

ICAAP and its partner medical associations have discussed this rate increase and urged HFS to act, at both individual meetings and Medicaid Advisory Committee meetings, beginning last year.  We have made recommendations to them and received some assurances that providers (rather than managed care or other third parties) will directly benefit from the increases, as required by the Centers for Medicare and Medicaid Services.  We have also been told they are making progress in determining rates, attestation processes, and other details but do not expect to receive final information for at least a few more weeks.  Technically, the state has until the end of March to determine and promote its processes.
Source: pediatricinc.com

From the Contributor’s Corner: Medicaid Sanction Screening

State Medicaid agencies must report final actions against providers that affect their participation in the Medicaid program promptly to Office of Inspector General (OIG). The OIG then determines whether to exclude the provider based on federal criteria for exclusion and includes the individual/entity on the OIG List of Excluded Individuals and Entities (LEIE).  Unfortunately all parties excluded by states may not appear on the LEIE.  In a study of state reporting conducted by the OIG, the office found that many were not sending their sanction information to the OIG.   The OIG noted that two-thirds of providers with final actions imposed by state agencies were not included on the LEIE. The majority of states even had a match rate of less than twenty-five percent.  The response from most of the states was that this was due to uncertainty about when to notify the OIG of such final actions and what kind of information to provide. I believe this is just an excuse. 
Source: wolterskluwerlb.com

Illinois Rolls Out Details of Duals Demo

• Adequacy of the capitated payment: Medicaid’s contribution to the capitated payment is determined by which of four categories a beneficiary falls into, based on his/her setting of care. And while the MOU wisely imposes a medical loss ratio threshold of 85 percent, it does not protect plans from catastrophic losses in the case of an extremely costly pool of enrollees. If plans cannot remain fiscally sound, beneficiaries may go without care they need. CMS and the state should develop strategies to ensure that plans are not exposed to major losses so beneficiaries will get the care they need.
Source: communitycatalyst.org

Phase out GP consultation fees for a better Medicare

Posted by:  :  Category: Medicare

KNOW WHO YOUR CZARS ARE --ENOUGH TO MAKE YOU SICK ---ONLY OBAMA COULD CREATE POSITIONS FOR THESE INCOMPENTENT COMMUNISTS AND SOCIALISTS by SS&SSFee 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

Video: Bill Clinton On Paul Ryan’s “Brass” & Medicare Claim DNC 2012 – Ora TV Network

CMS’ Proposed Rules on Observation Status Would Not Help Beneficiaries 

The proposed rules continue uncertainty for Medicare hospital patients about their status.  A patient may be classified as a hospital inpatient and go to a SNF for rehabilitation, all payable under Part A.  Then, months later (but within one year from the date of service in the hospital), a Medicare contractor may reject the Part A claim or the hospital, using self-audit, may decide to withdraw its Part A claim for reimbursement and submit a Part B inpatient claim instead.  At that point, the proposed rules say, the patient receives a refund of the Part A inpatient deductible and must pay the Part B co-payments and medication charges.  78 Fed. Reg., at 16,638.  CMS acknowledges, “some beneficiaries who are entitled to coverage under both Part A and Part B may have a greater financial liability for hospital services compared to current policy, as they would be liable for additional Part B services billed when the inpatient admission is determined not reasonable and necessary.”  78 Fed. Reg., at 16,639.  CMS does not discuss what happens to the Part A-covered SNF claim when the hospital withdraws the qualifying three-day inpatient stay.
Source: medicareadvocacy.org

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

A guide to RR Medicare’s voice

You need to know more about your Railroad Medicare benefits or specific claims.  Sometimes you’d like to find the information on your own, and other times, you want to speak with a Customer Service Representative (CSR).  Railroad Medicare, administered by Palmetto GBA, gives you the best of both of worlds. 
Source: utu.org

HHA and DME Providers Must Verify Medicare Enrollment for Referring Physicians on ADVANCE for Respiratory Care and Sleep Medicine

Home health and durable medical equipment providers need to start verifying the enrollment status of their ordering/referring practitioners. The Affordable Care Act (ACA) included a provision that requires physicians and other practitioners that order home health services and durable medical equipment to be enrolled in the Medicare program even if those practitioners do not submit claims to Medicare. Currently, Medicare is providing “informational messages” to home health and durable medical equipment providers and suppliers concerning the enrollment status and specialty status of the ordering/referring practitioner. Effective May 1, 2013, Medicare will start denying claims submitted by home health and durable medical equipment providers when the ordering/referring practitioner is not enrolled in Medicare and not of the correct type/specialty to order those services. In order to avoid denied claims, home health and durable medical equipment providers need to verify the enrollment status of their ordering/referring practitioners.
Source: advanceweb.com

Medicare postpones enforcement of new ordering/referring rule

Although a recent Medicare Learning Network Matters article, using terminology common in Medicare documents, indicated the new identification requirement applies to “ordering/referring” providers, the regulation actually applies to any provider who “orders” non-physician items or services for the beneficiary (such as DMEPOS, clinical laboratory services, or imaging services) or ”certifies” patients for home health services, according to the AOA Advocacy Group.
Source: newsfromaoa.org

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

Sequestration and PECOS Update for Medicare Home Health and Hospice

A report will be provided to list your physicians and their status to help you identify the physicians associated with your agency who are not PECOS certified. Claims with non-certified physicians will be denied; a new PECOS Claims Hold will be available to help you capture problematic claims before they are generated. We will begin releasing these changes and provide updates in the next maintenance cycle on Wednesday, April 3rd.
Source: careanyware.com

The Duals Technical Assistance Brief Health And Social Care Essay

In 2009 Tennessee used its COBA to receive CMS approval to use Medicare Parts A and B claims data for activities aimed at improving the quality of care for dual eligibles. Most of these activities focus on the use of claims data to evaluate managed care organization (MCO) performance. Because HEDIS measures focus primarily on primary and acute care (e.g., screenings, immunizations, etc.), dual eligibles are often excluded from state HEDIS measurements because of the lack of access to Medicare claims data. Availability of this data will allow Tennessee to use these measures to evaluate quality of care for all beneficiaries – dual and non-dual – using a standardized approach. Tennessee also received CMS approval to provide MCOs with access to Parts A and B claims data to allow care managers to work with duals to better coordinate Medicaid and Medicare services. The state believes that better coordination will ensure that dual eligible beneficiaries receive the most appropriate and cost-effective care possible. Similarly, the state was also granted permission from CMS to use Medicare claims data to identify duals who are eligible for disease management programs. The data also helps the state and its MCO partners track the delivery of appropriate services provided to those with chronic diseases.
Source: ukessays.com

MUST EMPLOYERS CARRY MEDICARE ELIGIBLE ACTIVE EMPLOYEES AND SPOUSES?

Posted by:  :  Category: Medicare

There is no legal way to remove just Medicare eligible spouses of active employees from an employer group plan or to have Medicare pay as the primary insurer for those individuals.  The Medicare Secondary Payer statute (MSP) 42 U.S.C. §1395y was specifically enacted in 2003 to ensure that Medicare benefits are secondary to employer plans when dealing with non-retirees.  In the context of Medicare, a primary plan is defined as “a group health plan or large group health plan, a workers’ compensation law or plan, an automobile or liability insurance policy or plan (including a self-insured plan), or no-fault insurance.”  The MSP does not allow Medicare payment for services for which it can reasonably be expected that payment will be made under a group health plan.  Medicare’s designation as the secondary insurer is upheld even if state law or the group health plan states that its benefits are secondary to Medicare.  The statute does exclude group health plans of small employers.  Small employers are defined by the statute as having less than twenty (20) employees for each working day in each of twenty or more calendar weeks in the current calendar year or the proceeding calendar year.   As you’ve probably guessed, the purpose of the MSP was to reduce federal health care costs by shifting the burden of primary coverage from Medicare to private insurance carriers. 
Source: sjlaboremploymentblog.com

Video: Medicare Part 1: Eligibility and Enrollment

Extending Social Security and Medicare Eligibility Ages

In light of the increase in life expectancy after age 65 and the decline in physically demanding jobs, it would be reasonable for the eligibility age for social security to rise to 68 or 70. The average age of retirement from the labor force for Japanese males is already only a little below 70, which shows that much higher retirement ages is feasible. Persons who are physically or mentally incapable of working would then opt for disability status. This is a rapidly growing category in most developed countries, despite the increase in physical and mental health of older persons, because of a weakening of qualifying standards. With more flexible labor markets for the elderly, such as reducing the fear of companies that they will be sued for discrimination against older workers, older men and women could retire from more demanding jobs, and take jobs that are less taxing. This is what happens to older men in Japan.
Source: becker-posner-blog.com

Oklahoma Medicare Eligibility Requirements

You’re not alone if the term “Medicare eligibility” leaves you scratching your head, wondering if you qualify for the full package of benefits. It’s true, there are a few restrictions, but for the most part, as long as you’re 65 or older and a permanent citizen, you should be qualified for health care benefits through Medicare. In some cases, it’s possible to be eligible for Medicare even if you’re younger than 65. If you have End-Stage Renal disease or have been on Social Security disability benefits for over 24 months, you’re eligible at any age.
Source: oklahomamedicarehealth.com

Medicare Eligibility Requirements for Hospice Care

Medicare coverage pays for many of the services offered by hospice. In order to be eligible, a patient must be covered under Medicare Part A and have a certification from a physician that the patient’s life expectancy is six months or less. This does not mean that the patient will lose their hospice benefits after six months. It simply means that in order to be eligible they must have a life expectancy of six months. As long as the individual continues to have a life expectancy of six months or less, hospice can go on indefinitely.
Source: michiganelderlawyer.com

The Medicaid Program at a Glance

Generally, the same Medicaid benefits must be covered for all enrollees statewide. However, states have flexibility to provide narrower or different benefits for some beneficiaries, modeled on four “benchmark” plans specified in the Medicaid statute. Most people who gain Medicaid eligibility due to the ACA expansion will receive “Alternative Benefit Plans” (ABPs) based on these benchmark plans, but all benchmark coverage must be modified to include the ten “essential health benefits” (EHB) identified in the ACA. States can align their ABPs and traditional Medicaid plans by adding benefits to either package to match the other. People with disabilities, dual eligible beneficiaries, medically frail individuals, and specified other groups are exempt from mandatory enrollment in benchmark benefits (or ABPs, beginning January 1, 2014) and remain entitled to traditional Medicaid benefits.
Source: kff.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

Proposed Rule Would Reward Medicare Fraud Tipsters up to $9.9 Million, Revise Medicare Provider Enrollment Regulations : Health Industry Washington Watch

In the proposed Medicare Incentive Reward Program rule, CMS explains that it “tentatively project[s] a net increase in recoveries of $24.5 million per year as a result of the proposed changes.”  In addition, CMS notes that it is modeling the proposed Incentive Reward Program changes on a “highly successful” Internal Revenue Services (IRS) reward program that returned “far greater sums than the existing Medicare [Incentive Reward Program].”  Notably, since the implementation of the current Medicare Incentive Reward Program in July 1998, CMS has collected only $3.5 million; in contrast, between 2007 and 2012, the IRS has collected almost $1.6 billion through its reward program.  CMS states in the preamble that it proposes to clarify that it will not pay an award if the same or substantially similar information was the basis for a relators share in a qui tam lawsuit under the federal False Claims Act or a state False Claims Act, or is the basis for a pending state or federal False Claims Act suit.  However, the proposed regulatory language that would codify this change, found at proposed 42 C.F.R. § 420.405(b)(3), does not specify that this provision would apply to state False Claims Acts.
Source: healthindustrywashingtonwatch.com

What Are the Medicare Eligibility Requirements?

Once reaching the age of 65 years old a person qualifies for medicare. One must also be a US citizen or a permanent legal resident. One of the last requirements is having paid into the medicare system while working. The general rule is having paid into the social security system with approximately 10 years of work, or 40 credits. An individual may also qualify off of their spouses working if necessitated. The spouse must be at least 62 and the qualifying individual must still meet the 65 year requirement. With additional proof an individual may also qualify based on the work benefits of a deceased or divorced spouse.
Source: seniorcorps.org

Know Your Medicare In Better Way

Medicare Eligibility: In order to be eligible for Medicare, there is an eligibility criterion that should be fulfilled. The guidelines for eligibility include age, nationality and various other factors. As far as age is concerned, people should be 65 years or above. Even people who are below 65 years of age can apply, but this is only when the applicant is disabled or suffering from end stage renal disease. As far as nationality goes, the applicant needs to be a U.S citizen in order to be eligible. Even non-Americans can be eligible if they have gained U.S citizenship at least 5 years before applying for the program. If an applicant’s spouse has worked for a minimum of ten years and has paid premiums into the Medicare program, it makes them eligible for coverage too. What Medicare Covers: The basic break down of Medicare coverage is divided into 4 parts. These include Part A, B, C and D, and each plan offers different benefits. Part A: This plan involves cover for expenses paid during hospital stays. For this reason, Medicare Part A is also called hospital insurance and it pays for expenses incurred for up to 90 days of hospital care. However, this requires the insured to pay a minimal annual deductable. The expenses covered under this plan comprise of: • Meals • Semi-private room • Medical tests • Medical supplies • Intensive care unit • Blood transfusion after the first three pints • Coronary care unit • Operating room • Medication supplied by the hospital
Source: triptomyblog.com

Viewpoints: Rising Cost Of Tricare; GOP Needs To Better Explain Medicare Eligibility Age Issue; Don’t Forget Adult Immunizations

Minneapolis Star Tribune: Mental Health Needs The Nation’s Attention Millions of people in our country are struggling every day with mental illness — but most aren’t getting help. Many don’t have a support system. They may not have parents or friends who understand or have resources to help. They may not have health insurance that covers the cost of treatment. Or perhaps they feel ashamed or embarrassed to seek help, because mental illness still carries a stigma in our society. As my family searches for some type of meaning and comfort in the depths of our grief, we hold out hope that perhaps Andrew’s story will help people have a greater understanding and compassion for those who struggle with mental illness (Chris Bauer, 3/25). 
Source: kaiserhealthnews.org