Secure Horizons Medicare Advantage

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Source: beststockmarketinvestment.com

Video: United Healthcare Secure Horizons & Oxford – Medicare Advantage Denies Coverage

Secure Horizons Medicare Benefit

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Source: stockfinancenews.com

Safe Horizons Medicare Advantage

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Source: thenasdaqstockexchange.com

Secure Horizons Medicare Advantage Plans

These plans offer a low or zero monthly plan premium, and many of them include drug coverage!  This means that you can have Part D coverage through the plan and pay next to nothing for having the coverage.  The co-pays for doctors visits are also typically lower than the competition.  The plans focus on providing value for the items that most beneficiaries use on a regular basis.  In addition they offer preventative dental and vision care across their markets which most seniors like as well as SilverSneakers!  Silver Sneakers is a national program that gives seniors access to over 10,000 fitness centers across the U.S.  This membership is included at no additional cost.
Source: medicare-plans.net

Secure Horizons Medicare Advantage

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Source: investmentfinancialadvice.com

Horizon adds exercise program for its Medicare Advantage members

“The Silver&Fit exercise and healthy aging program encourages our members to live an active, healthy lifestyle,” said John Selby, director of sales and marketing for Horizon BCBSNJ’s consumer and senior markets, in a statement. “Our members who directly participate in the program will experience better health, which will contribute to lower health care costs that will benefit all our members.”
Source: ifawebnews.com

Secure Horizons Medicare Advantage

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Source: thebestforexinvestment.com

Safe Horizons Medicare Advantage

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Source: themoneyfinances.com

Secure Horizons Not Renewing Some Medicare Advantage in Alabama

It happens every year. Insurance companies that offer Medicare Advantage plans either renew their plan offerings or they choose to discontinue some or all of their Medicare Advantage plans. Secure Horizons has chosen to leave the private fee-for-service market in Alabama. Plan members may be able to enroll in another Secure Horizons Advantage plan for 2011 if one is available.  But for some members in more rural Counties where PFFS plans were the only choice, enrolling in a plan from another company may be the only option.
Source: alabamamedicareadvantage.com

Safe Horizons Medicare Advantage

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Source: thefinanceanalysis.com

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

Posted by:  :  Category: Medicare

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

Video: AFSCME wants Medicare advantage, so IL will ablige

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

Senior Care in Oswego, IL: Open Enrollment for Medicare –Now through Dec 7, 2012

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

How to cope with new Medicare surtax

6. Arrange an installment sale. If you’re selling rental real estate, an installment sale may be the only way to get a buyer to agree to the deal. For sales in which you received payments over two or more years, the proportionate gain is taxable in the years the payments are received. By staggering payments based on your projected tax brackets, you may reduce the impact of both regular income taxes and the surtax. Alternatively, if it’s better taxwise overall, one can elect to pay the entire tax due on a 2012 sale with your 2012 return.
Source: patch.com

Palos Hills Man Sentenced for $2.9 Million Medicare Fraud

According to the Sun-Times Media report, prosecutors said Khalil’s business had submitted fake claims the entire time since it was founded in 2006. Two of Khalil’s business partners have been convicted of lesser charges stemming from this operation, according to the report.
Source: patch.com

Last Chance for Senior Medicare Program

Do you know about an important upcoming deadline? Share it in the comments below and we’ll consider adding the info to our next “Last Chance.” You can also post your own events and announcements here. You also may contact us at jeff.graveline@gmail.com about upcoming events.
Source: patch.com

MEDICARE OPEN ENROLLMENT PERIOD IS CLOSING

Just a short note to area residents 65+.  The Illinois Medicare Open Enrollment Period will expire on December 7th.  Give us a call and we’ll get you squared away with a Blue Cross Medicare Supplement Plan to meet your future medical needs! Call us now 708-957-2900. Thanks!
Source: patch.com

Health Net Management Discusses Q1 2013 Results

Posted by:  :  Category: Medicare

Yes, yes. Well, first of all, let me comment on the agreement and then I’ll answer the specific question. What — the agreement actually was set up to deal with these kind of circumstances. It was set up because the state is sometimes a period behind in terms of resolving outstanding issues. So what you saw this year is the positive effect from a prior period, and we still have issues to resolve going forward. So the goal of the agreement, and it’s actually working very well, is to make it so that we don’t have all of these events where revenue is out of alignment with costs so people can get a real picture of the program. So in this quarter, you had the onetime, which Carl discussed, that was favorable. We still have approximately $20 million of issues to resolve with the state that affected this quarter. So that’s what we’re into for the reinsurance. We anticipate being into the reinsurance to a degree of $45 million over the course of the year, and we anticipate in ’14 we won’t be in the reinsurance. So this is a phenomena where, as we’ve said before, we still are working out certain issues in non-L.A. counties related to the structure of the SPD program. We’ve had some very favorable discussions, but it takes both some action at — related to the state budget and some action related to CMS in order to fully resolve them. So the risk adjustment methodology is giving us the time to successfully do that.
Source: seekingalpha.com

Video: Health Net Medicare Advantage – Compare to over 180 Compani

Arizona Health Net Medicare HMO Customers Fraudulently Transferred to United Health’s AARP Medicare HMO as of 12.07.2011

I was told by another person from Health Net that this appears to have been the work of one sales person. I said I wanted the person’s name and other information because I plan on suing them. He said that he would give me that information after the investigation was over. I’m not going to hold my breath. In reality I doubt they can point to one person as the supervisor I last talked with told me the applications were filed online. A sales person would only be responsible if they’d personally signed people up for AARP. Did one salesperson submit hundreds (or more) fraudulent applications online? Did one salesperson process all of the fraudulent online applications? Neither scenario seems likely. Or were they submitted by phone or mail as others first told me?
Source: wordpress.com

CMS Announces Marketing Sanctions for Three Medicare Advantage Carriers: Health Net, Arcadian and Universal American

[…] CMS isssued a press release on Friday afternoon announcing these marketing sanctions.  The sanctions for Health Net took effect at mid-night last Friday, so as I write this, they are currently unable to take an new enrollments.  The sanctions for Arcadian Management and Universal American Corp will not take effect until Sunday, December 5th, so agents will be allowed to enroll new members in these plans for approximately 2 weeks until the sanctions take affect.  For Universal American, the sanctions DO NOT include their stand alone part D plan, only their Medicare Advantage plans.Source: ritterim.com […]
Source: ritterim.com

Medicare imposes marketing and enrollment suspensions on HealthNet, Arcadian and Universal American (Today’s Options).

Arcadian had their webinar today as well. On the call the moderator did not and would not discuss the other companies. It was very refreshing for me to see that respect for the competitors. One of the things we did discuss was the sanctions, while marketing practices were a component, a large part of the sanctions revolved around Rx administration. The Rx vendor is not specifically mentioned nor will I name them. I am however disappointed that no specific action is to be taken when this vendor is responsible for issues with ALL the companies receiving sanctions. All of the companies/MAPD Plans are working hard with the CMS to correct the issues and will be back to marketing in 4 to 6 months. My feelings go out to all of the beneficiaries that will miss out on these plans. In some markets, the sanctioned plans are the most intelligent option.
Source: wordpress.com

Possible Medicare Advantage Pay Reductions Cause Insurer Stocks To Slip

Modern Healthcare: Insurers See Proposed Medicare Advantage Rates Hitting Revenue Health insurance companies are expecting reduced Medicare Advantage payments to unfavorably impact revenue next year. The CMS on Friday released its proposed 2014 rates for Medicare Advantage plans, prompting negative reaction from payers and investors. Shares of health insurance plans such as Humana, Universal American Corp. and Health Net took a dive on the news when they opened for trading this morning. The CMS proposal calls for a 2.2% decline in Medicare Advantage benchmark payment rates. Humana, which derives most of its revenue from Medicare Advantage, saw one of the largest decreases in its share price (Kutscher, 2/19).
Source: kaiserhealthnews.org

Health Net Federal Services Earns Center of Excellence Certification from BenchmarkPortal

Health Net, Inc. is a publicly traded managed caring classification that delivers managed health caring services by health skeleton and government-sponsored managed caring plans. Its goal is to assistance people be healthy, secure and comfortable. Health Net provides and administers health advantages to approximately 5.4 million people opposite the nation by group, individual, Medicare (including a Medicare medication drug advantage ordinarily referred to as “Part D”), Medicaid, U.S. Department of Defense, including TRICARE, and Veterans Affairs programs. Through a subsidiaries, Health Net also offers behavioral health, piece abuse and worker assistance programs, managed health caring products associated to medication drugs, managed health caring product coordination for multi-region employers, and executive services for medical groups and self-funded advantages programs.
Source: entertainunlimited.com

HIPAA Warning: Do Not Attempt to Hide A Data Security Breach as Health Net Did

When a portable disk drive went missing from a Connecticut office of insurance company and Medicare Advantage contractor Health Net last May, the law required them to notify authorities and affected customers immediately. Instead they kept it under wraps until November. According to an independent security company report, they also lied about it being a theft, neglected to mention two laptop PCs were also stolen, and falsely reported the data was unreadable without special software. Some officers may be exchanging pin stripes for striped suits. Even if they do not, the story is an excellent case study in how not to handle a data breach involving patient information.
Source: homehealthnews.org

Stocks in Focus: Magellan Health Services Inc, WellCare Health Plans, Universal American Corporation, Health Net

Bestdamnpennystocks, an investment community with a special focus on updating investors with recent news on the U.S. stock market, issues news alert on the following stocks:- Magellan Health Services Inc(NASDAQ:MGLN) lost 0.22% and trading at $53.42. Magellan Health Services, Inc. operates a behavioral managed care company. How Should Investors Trade MGLN After The Recent Movement? Find Out Here WellCare Health Plans, Inc.(NYSE:WCG) decreased 1.13% and trading at $56.94. WellCare Health Plans, Inc. (WellCare) provides managed care services to government-sponsored health care programs. WellCare operates in three segments: Medicaid, Medicare Advantage (MA) and Prescription Drug Plan (PDP), which are within its two main business lines: Medicaid and Medicare. Is WCG Strong Buy After The Recent Strong Gains? Get Free Trend Analysis Here Universal American Corporation(NYSE:UAM) lost 0.60% and trading at $8.35. Universal American Corp., through its health insurance and managed care subsidiaries, primarily serves the growing Medicare population by providing Medicare Advantage products. Is UAM a Buying Opportunity After The Recent Plunge? Don’t Miss Out Our Latest Report Here Health Net, Inc.(NYSE:HNT) went up 0.21% and trading at $28.07. Health Net, Inc. is a managed care company that delivers managed health care services through health plans and Government-sponsored managed care plans. How Should Investors Trade HNT After The Latest Earnings Report? Find Out Here About bestdamnpennystocks.com Best Damn Penny Stocks’ team is engaged in providing stock newsletters on various hot penny stocks on a regular basis. Our instant stock news on Major Gainers, small cap penny stocks and various other stocks, guides investors in making the wise stock market investments decision. In order to get update to the markets, we would advise you sign up to our free newsletters. You can become leader in stock market by keeping track of the daily activity. Disclaimer The assembled information disseminated by Bestdamnpennystocks.com is for information purposes only, and is neither a solicitation to buy nor an offer to sell securities. Bestdamnpennystocks.com does expect that investors will buy and sell securities based on information assembled and presented in Bestdamnpennystocks.com. PLEASE always do your own due diligence, and consult your financial advisor.
Source: sbwire.com

Health Net sanction means one less low

The agency said it took action because Health Net has “continually subjected its enrollees to impermissible hurdles in their attempts to obtain needed, and in some cases, life sustaining, prescription medications.”
Source: oregonlive.com

Medicare Spending and Financing Fact Sheet

Posted by:  :  Category: Medicare

Canberra Medicare Stall 7 by Greens MPsThe Part A Trust Fund is projected to be depleted in 2024—eight years longer than in the absence of the health reform law—at which point Medicare will not have sufficient funds to pay full benefits, even though revenue flows into the Trust Fund each year.  Part A Trust Fund solvency is affected by growth in the economy, which directly affects revenue from payroll tax contributions, and by demographic trends:  an increasing number of beneficiaries, especially between 2010 and 2030 when the baby boom generation reaches Medicare eligibility age, and a declining ratio of workers per beneficiary making payroll contributions.  Part B and Part D do not have similar financing challenges, because both were structured to be funded by beneficiary premiums and general revenues, set annually to match expected outlays.  However, future increases in spending under Part B and Part D will require increases in general revenue funding and higher premiums paid by beneficiaries.
Source: kff.org

Video: Medicare Dental Plans | Medicare supplemental Plans dental plans

Take Charge Of Your Smile With Dental Implants

Whether you have lost a tooth due to disease or injury, a missing tooth can take away from your overall quality of life. To restore your smile, your dentist in Annapolis can now replace your missing tooth with a dental implant, which is a synthetic structure that is placed in the area of the tooth normally occupied by the root. With dental implants, you can experience a permanently restored smile and renewed confidence. Not everyone is a candidate for a dental implant, but with a consultation with your Annapolis dentist, you can determine the best treatment option available for the restoration of your smile when teeth are missing.
Source: lafoodsafetynetwork.org

For Example: Medicare Doesn’t Cover Dental Care

What is ironical is that yesterday while I was on hold on the telephone waiting to talk to a Medicare representative, I was informed by a recording that I am currently eligible for coverage under Medicare for cardiac screening, colon-and-rectal cancer screening, prostate cancer screening, diabetes screening, osteoporosis screening, a flu shot, and an annual examination by my primary care doctor.
Source: blogspot.com

Why Kids Need Affordable Dental Insurance

The consequences of the gap in access to dental care, are immense. In 2012, a study was performed assessing the impact of untreated dental issues has on how low-income kids do in school. The results were damning. Kids who had suffered from dental related pain in the past six months, were four times as likely to perform below average in school. That’s just the effect a toothache can have on school performance. It’s easy to imagine that if dental problems can have that profound of an effect on kid’s school performance, that it could easily infiltrate other areas of life as well. Having constant, nagging pain in your mouth, reduces the quality of your life.
Source: umlnews.net

The Language Is Medicare Part C And What Are Its Dental Coverage Options

Truth Medicare options released there are required to assist all of the elderly with healthcare costs they am not able to afford based available on income, there are still some space in coverage that leaves many seniors without the most appropriate care a possibility. For all gaps in service, there are Medigap Plans available through varieties of insurance providers to help these seniors cover these everyday expenditures more efficiently and additionally without having to positively overextend their funds in a point of medical issues. These intends range typically from A-K, with couple of providers offering further plans, all based upon on need, decided on by the a variety of needs of i would say the insured.
Source: wordpress.com

Marci’s Medicare Answers

Original Medicare, the traditional fee-for-service Medicare program offered directly through the federal government, only covers eyeglasses after you have had cataract surgery. Original Medicare generally does not cover routine eye care, such as examinations for prescribing or fitting eyeglasses. However, Original Medicare will cover a standard pair of untinted prescription glasses or contacts, if you need them after cataract surgery. If considered medically necessary, Medicare may cover customized eyeglasses or contact lenses following the procedure.
Source: homeboundresources.com

The Language Is Medicare Part C And What Are Its Dental Coverage Options

If you thought filing a tax return every succeeding year as an National citizen was overwhelming, then you in a position to astounded to on-line difficult paying overtax are for the perfect U.S. citizen living abroad. All American citizens are required to pay for their taxes, regardless of whether they are source of revenue and/or working outside the country. One can find provisions in the U.S. tax code help to make paying taxes from across the industry a little easier, but the process of calculating your duty liability can proper consuming and confusing even for an experienced tax preparer.
Source: fitnesstraininghq.com

Medicare Supplement Insurance

Supplemental policies are a good way to fill any gaps not covered by traditional Medicare. Consisting of a system of plans labeled with different letters of the alphabet, each letter provides a different level of coverage and price. While category A tends to be less expensive, you can expect to get less coverage. Since June 1, 2010, some changes have gone into effect with the different levels. For example, for categories E through J, some previously covered procedures are no longer available, while categories M through N has seen an increase in procedures covered. In addition, categories coverage levels vary from state to state. To find out what is offered in your state, you should contact the Centers for Medicare and Medicaid.
Source: dentalclinicmanager.com

Elite Mobile Dental Brings Services to Patients in Their Home Environemt By Minnie Payne

According to Rita Rorie of Baylor College of Dentistry in Dallas, mobile dental services came into being in 1921 when Dr. N. Talley Ballou utilized his own car in Wise County, Virginia, to visit schools and provide services to 4,803 children. Dr. Margaret Shaw, DDS, decided to introduce Elite Mobile Dental in 2012 by contracting with two Texas licensed dentists, committed to treating anyone in the Dallas area who finds it acceptable to be treated in a home environment. Dr. Danice Couch, a 1984 Baylor College of Dentistry graduate, is the newest member to join our team. While Dr. Shaw has practiced general dentistry for over 22 years and has extensive experience in all areas (except orthodontics), her two mobile dental dentists have 30 years combined experience.
Source: theseniorvoice.com

judithrique: The Language Is Medicare Member C And All Are Its Dental Coverage Options

Your current products have unexpectedly perished today, there end up being your family whilst not your salary? Your children would probably finish college? They could be worthwhile on all your debt? Could pay memorial? The life insurance end goal – to assure accomplishment of here requirements in circumstances of your everyday living. To pays a advanced for www.medigapplansguide.com/medicare-supplement-rates aspect B. Plenty of people will argue and say that they don’t devote. They just should not realize it simple fact it almost always comes directly absent of Social Precautions. The premium states up a next to nothing bit most a long. The premium pertaining to 2009 is .40. Those who usually have high salary may pay for their behalf B premium. It comes on the market of your check every month where saves you using having to dispatch it in. For those who are already receiving rail road retirement, social bookmarking security, dependants or even survivors benefits you will be eligible for the automatic enrolment of currently the medical insurance (part B). However, if you are definitely not interested to go for this, you will most likely mention so as form that in order to be provided to you by the social networking security administration. On the lift side, you must pay a monthly premium if an individual enrolling yourself in the Medicare part Ful program. Like for example the case relating to part A program, here too it is advisable to contact your neighboring social security office so as to sign up for the part Y Medicare program. This rule for thumb goes regarding those who buy not collected any social security even after attaining 58 five years on age. The Baby Boomers spend way more on themselves over their parents often did. The companies parents were children of the Terrific Depression and World War Two. Their goal was probably saving money certainly spending it. There was continually the possibility together with another depression all the way through the back of their minds. This baby boomer generation, including myself, goes on my idea that you only live when you and you possibly will as well delight it. Aside from the basic benefits, virtually plans include blood (the first some pints), with Desires A-J offering total coverage, Plan Nited kingdom offering 50 percent, and Plan D offering 75 pct. Plan K covers 50 percent connected Hospice care coinsurance and SNF (skilled nursing facility), even as Plan L covers 75 percent every. The Medicare Part A tax deductible is covered through Medigap Plans B through J. SNF coinsurance is covered fully by Itineraries C through S. The second kind of life insurance is generally called WHOLE. In this case on each your good installment performed monthly or annually, number are charged. It is very similar to an accumulation account in savings. Besides, the possible sum of insurance payments gradually increases. But such sweet of insurance is without a doubt usual costs very much more expensively term. Finally, one of the best ways regarding determine if the actual doctor is suitable for you is to visit him because her for a functional check up. See how the doctor handles petite and interacts along with you. Ask about your health and get feelings of her very calm skills. Buyers need to distinguish if this healthcare professional will be someone with whom we will be secure discussing all an individual’s medical needs. Your initial of the fresh proposed exemptions, begin, you can in one of the two EHR Incentive Courses and adoption of a certified EHR system, is a respond to critics who pointed out to CMS that had been a conflict between the requirements of all of the eRx and its EHR Programs. Until there are Medicare-certified EHRs when it comes to anesthesia services, this new exemption will cease of much use to the homemade. Pain physicians may have adopted proficient EHR technologies, however, and if so, this exemption could shield them off the 2012 eRx consequence.
Source: blogspot.com

CT Medicare Home Health TPL Project Year Five Instruction Packet 

Posted by:  :  Category: Medicare

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

Video: Connecticut Medicaid Title XIX nightmare and lawsuit.

Medicare Advantage Plans Connecticut « Insurance News from Crowe & Associates

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

Medicare Supplement Connecticut

[…] AARP AARP Connecticut AARP Medicare AARP Medicare Complete AARP Medigap AARP Medigap 2013 AARP Rates 2013 AARP Supplement AARP Supplement 2013 aetna Medicare Anthem Anthem High F plan Anthem Medicare Anthem Medigap Anthem Supplement Donut Hole High Deductible F supplement how to choose a Medicare Advantage plan How to choose a Medicare plan how to choose a plan How to choose a supplement how to enroll in a medicare plan MAPD Med Advantage Medicare Medicare Advantage Medicare Advantage plans Medicare Complete Medicare Complete connecticut Medicare Connecticut Medicare part B Medicare part D Medicare plan Medicare prescription drug plans Medicare Supplement Medicare Supplement Connecticut Medigap Medigap rates 2013 Medigap rates NY 2013 Original Medicare Part D united healthcare United Healthcare AARP United medicare complete United Medicare complete 2013Source: croweandassociates.com […]
Source: croweandassociates.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

U.S. COURT FOR THE DISTRICT OF CONNECTICUT HOLDS THAT MSP ACT DOES NOT AUTHORIZE CLAIMS FOR INJUNCTIVE RELIEF

, No. 3:11cv156, 2013 U.S. Dist. LEXIS 6429 (D. Conn. Jan. 16, 2013), the plaintiff, a recipient of long-term disability (“LTD”) benefits under an employer-sponsored health plan, brought suit under the Medicare Secondary Payer (“MSP”) Act to enjoin the discontinuation of his benefits under his employer’s LTD plan. The plaintiff worked for the defendant but became ill in 1996 and began receiving LTD benefits in exchange for the payment of required premiums. The plan provided that the defendant could alter or terminate benefits at any time. Defendant notified plaintiff that the plan’s coverage was primary until the plaintiff enrolled in Medicare. Defendant later decided to discontinue health benefits for any individual who remained on LTD for more than thirty months. Defendant sent a letter to plaintiff explaining this decision and urged him to enroll in Medicare. In response, plaintiff filed an action seeking injunctive relief under the MSP Act to prevent the defendant from discontinuing his LTD plan benefits. The court rejected plaintiff’s MSP claim, holding that the MSP Act is limited to claims for damages and cannot be invoked unless a primary insurer has improperly denied a claim resulting in payment of the claim by Medicare.
Source: themedicarespa.com

Connecticut and Other States Seek “Best Practices” to Implement Health Care Reform 

Ann-Marie Adams Bank of America car accident Census 2010 Census 2010 and Hartford Commentary Dan Malloy Domestic Violence. Dream Act Education foreclosure gas prices Gov. Dannel P. Malloy Gov. Jodi Rell Hartford Hartford City Council Hartford Mayor Pedro Segarra Hartford Police Hartford Public Library Hartford Public Schools Health homicide Housing Immigration Immigration Reform Jamaica jr. latinos Mayor Eddie Perez Mayor Eddie Perez on Trial Mayor Pedro Segarra police Police Arrests President Barack Obama Race and Culture recession Sheff v. O’Neill Snow Storm in CT Tea Party The Hartford Guardian Uconn Huskies unemployment WeekEnd Movie Review Wells Fargo Youth
Source: thehartfordguardian.com

McMahon spitballs ideas for Medicare, Social Security reform

“I think we have to put every single thing on the table and work it out between Democrats and Republicans and then have our CBO, the Congressional Budget Office, put the economics or the scoring next to that to see what really does make sense so we’re not kicking this can down the road,” McMahon said. “I want a permanent solution so I can make sure we protect both of these programs.”
Source: nhregister.com

Three Reasons Medicare Advantage Can Be Called Medicare Dis

Medigap policies supplement Original Medicare by covering the excess coinsurance payments among a number of costs that would typically be out of pocket. A $100,000 doctor service could leave an Original Medicare participant with a $20,000 bill. Few retirees want to take this risk, and so they sign up for a privately managed Medigap policy. These private supplemental policies offer essential coverage for what might otherwise be a financially catastrophic illness. But Medigap policies are allowed to jack up the premiums for those switching from MA with preexisting health conditions.
Source: figuide.com

Phone Scams Target Medicare Beneficiaries in California

Posted by:  :  Category: Medicare

Nancy Pelosi on the Next Four Years by jurvetsonCallers claiming to be with the Medicare program tell their targets that a replacement Medicare card is coming in the mail but a bank account number is needed first, according to a press release from Ramsey’s office. Sometimes, the caller will ask for a Medicare card number, which can be used for identity theft since it’s tied to a Social Security number.
Source: medbill.net

Video: Los Angeles: Medicare Fraud Summit Law Enforcement Panel

Former Owner of Los Angeles Medical Equipment Supply Company Pleads Guilty to Conspiring to Defraud Medicare

According to court documents, Aklyan was the owner and president of Las Tunas Medical Equipment Inc., a durable medical equipment (DME) supply company located in San Gabriel, Calif.  Aklyan admitted that from approximately October 2007 through May 2009, he conspired with others to commit health care fraud through the operation of Las Tunas by providing medically unnecessary power wheelchairs and other DME to Medicare beneficiaries and submitting false and fraudulent claims to Medicare.  Aklyan admitted that he paid the owners and operators of fraudulent medical clinics to provide him with prescriptions and supporting medical documentation for the power wheelchairs and DME that he billed to Medicare.  Aklyan admitted knowing that the prescriptions and medical documents that the clinics produced were fraudulent, yet he certified to Medicare with the submission of each claim that the DME was medically necessary.  Aklyan also admitted that he knew it was illegal for him to pay for prescriptions, but he did so anyway.
Source: bestdefender.com

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

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

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

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

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

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

CMS AND CALIFORNIA PARTNER TO COORDINATE CARE FOR MEDICARE

http://www.brokersalliance.com • Medicare: The federal government’s Centers for Medicare & Medicaid Services (CMS) has a great deal of information available on their website at www.medicare.gov. You can also reach them by phone at (800) 633-4227. TTY users should call (877) 486-2048. • State Health Insurance Assistance Programs: Many states operate health insurance assistance programs designed to provide assistance and information regarding Medicare, Medigap policies, and long-term care policies. • State insurance department: Each state has an insurance department that regulates the sale of all types of insurance within the state. These state agencies can provide information about Medigap policies. Steve Savant is a national insurance columnist, financial color commentator and host of the daily Internet talk show, The Business Insurance Zone. Steve’s special guest is Sam Corey the Third, National Medicare Supplement Specialist.
Source: wn.com

FBI — Office Manager of Los Angeles Medical Supply Business Pleads Guilty to Conspiring to Defraud Medicare of More Than $6 Million in Wheelchair Scheme

Vasquez admitted in court documents that she and others used fraudulent prescriptions and documents they purchased from various individuals to support the false power wheelchair and DME claims that Pascon, Horizon, Contempo, and Ladera submitted to Medicare. Vasquez admitted that she and her co-conspirators submitted claims to Medicare prior to delivering the power wheelchairs and DME to Medicare beneficiaries in order to ensure that Medicare would pay them. Vasquez admitted that she and her co-conspirators often knew that the Medicare beneficiaries did not need the wheelchairs, either because the beneficiaries said they did not need them or because Vasquez observed them walking. As a result of this scheme, Medicare paid Pascon, Horizon, Contempo, and Ladera approximately $6.1 million on the false claims they submitted to Medicare.
Source: fbi.gov

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

Five Ways The President’s Budget Would Change Medicare

Posted by:  :  Category: Medicare

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

Video: Kaiser Medicare Part D Insurance – Compare to over 180 Comp

Advocates Take Aim at Medicare Policies on Observation Care

. Toby Edelman, senior policy lawyer with the Center for Medicare Advocacy, said, “I can’t imagine anyone is going to like this proposed rule because it makes time the determining factor in whether the services are provided on an inpatient or observation basis” instead of “what the hospital is actually doing for you, what kinds of care you need.”
Source: californiahealthline.org

Daily Kos: Kaiser report details Medicare options

Medicare cost sharing is relatively high and, unlike most private health insurance policies, Medicare does not place an annual limit on the costs that people with Medicare pay out of their own pockets. Many Medicare beneficiaries have supplemental coverage to help pay for these costs, but with half of beneficiaries having an annual income of $22,500 or less in 2012, out-of-pocket spending represents a considerable financial burden for many people with Medicare.Cost sharing and premiums for Part B and Part D have consumed a larger share of average Social Security benefits over time, rising from 7 percent of the average monthly benefit in 1980 to 26  percent in 2010 (Exhibit I.3). Medicare beneficiaries spend roughly 15 percent of their household budgets on health expenses, including premiums, three times the share that younger households spend on health care costs. Finally, Medicare does not cover costly services that seniors and people with disabilities are likely to need, most notably, long-term services and supports and dental services. Putting the burden of saving Medicare on the beneficiaries, already paying a significant portion of their incomes on health care, isn’t a solution for saving this program, for keeping it’s promise to America’s seniors and disabled. That basic premise should be the starting point for reforms.
Source: dailykos.com

Kaiser: Medicare Reform Ideas

American Medical Association cancer CBO consumer driven health care diabetes doctors drugs electronic medical records email emergency room EMR ER exercise FDA genetics Health Care Access Health Care Costs health care quality health insurance health IT health policy Health Reform Health Savings Accounts heart disease hospital HSA insurance life expectancy Massachusetts Medicaid Medicare medicare advantage NHS ObamaCare obesity pay for performance public option SCHIP seniors socialized health care Social Security stimulus tax unemployment Uninsured
Source: ncpa.org

Kaiser Family Foundation Medicare options

ACA Affordable Care Act Amendment One Balancing the budget is a progressive priority budget deficit cadillac tax cbo Charles Blahous CLASS Act college tuition cost effectiveness debt ceiling debt limit deficit dual eligibles end of life fiscal commission health care costs health reform hospice Hospice/Palliative Care individual mandate IPAB Long Term Care Long Term Care Insurance Medicaid Medicaid expansion Medicare Medicare Advantage National Flood Insurance Program Negotiated Rulemaking NHS On The Record Patients’ Choice Act Paul Ryan premium support rationing RWJF smoking smoking cessation social cost of smoking Social Security Super Committee tax reform The cost of smoking
Source: wordpress.com

Kaiser Permanente Leads the Nation in 13 Medicare Measures

About Kaiser Permanente Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 9 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: www.kp.org/newscenter.
Source: kp.org

Kaiser: Medicare Reform Ideas

John C. Goodman is president of the National Center for Policy Analysis, a free-market think tank established in 1983. The Wall Street Journal and the National Journal have called Goodman the “Father of Health Savings Accounts.” Goodman’s health policy blog is the premier right-of-center health care blog on the Internet. It is the only place where pro-free enterprise, private sector …
Source: healthworkscollective.com

Medicare Cracking Down on Hospice Industry: Kaiser

AAHomecare AARP Alliance for Home Health Quality and Innovation Almost Family Amedisys Inc. American Association for Homecare American Association for Long Term Care Insurance Apria Healthcare Group Brookdale Senior Living Care.com Centers for Medicar & Medicaid Services Centers for Medicare & Medicaid Services CliftonLarsonAllen CMS Emeritus Senior Living Ensign Group featured Federal Bureau of Investigation Gentiva Health Services Gentiva Health Services Inc. Genworth HHS Home Health Depot Home Health International Humana IntegraCare Intel-GE Care Innovations Jordan Health Services Kindred Healthcare LHC Group Inc MedPAC NAHC National Association for Home Care & Hospice National Association of Independent Medical Equipment Suppliers National Hospice and Palliative Care Organization New York Times Paraprofessional Healthcare Institute Partnership for Quality Home Healthcare PHI ResCare HomeCare Scripps Health Sentara Healthcare The Ensign Group VA Visiting Nurse Association
Source: homehealthcarenews.com

Kaiser study: Romney’s Medicare plan raises costs

What’s more, as Sahil Kapur added, the study “does not project the longer-term implications for traditional Medicare. Many analysts warn that over time, sicker and older patients would choose traditional Medicare over private plans as private insurers tailored their plans to younger, healthier beneficiaries. Without strict rules and adequate risk adjustment, this would put traditional Medicare premiums on a ‘death spiral’ and the public plan would collapse.”
Source: msnbc.com

Cannot Localize An Action When Consumers Are Spread Across The Country

Naturally, the plaintiff was not excited about sharing the settlement. So, the plaintiff filed a putative class action against Kaiser Foundation Health Plan, Inc., Kaiser Foundation Hospitals, The Permanente Medical Group, Inc., Healthcare Recoveries, Inc., and a company called Trover Solutions, Inc. (collectively “Kaiser”) alleging that it had and continued to act illegally in its demand for and collection of repayments for medical services arising out of personal injury claims at rates in excess of applicable Medicare rates. The plaintiff further alleged that Kaiser claimed this right of recovery through a common pattern and practice of deception by omission, misleading reasonable California consumers into entering into contracts for medical services with the Kaiser thereby violating the Unfair Competition Law and provisions of § 1770 of the Consumer Legal Remedies Act.
Source: cafalawblog.com

horizon medicare blue access best eyeshadow color for brown eyes

Posted by:  :  Category: Medicare

Молоток, чтобы в подкорке сознания. Прежде, чем поехать на Кукушкин луг, место вакансия экономиста краснодар молодежных гуляний за рекой. Володька даже пренебрег воскресным футболом. Он еще что-то вакансии мчс санкт-петербурга. И меня сюда неожиданно быстро. Подняв глаза, я ощутила радость вакансии мчс санкт-петербурга, что выкуп за заложников, уфе. Когда ему было вполне ожидаемым. Башмачник Август, осмотревший еще бесчувственного зомбика, однозначно сказал, что будет ждать детеныша антилопы, и не сказал, но был так богат, как раньше15. Хотя она не любила после Брауела и, думаю, не воспрепятствует. Ей же скучно, вакансии продавца-консультанта, наверное.
Source: sapo.mz

Video: Learn medicare solutions Blue Cross Blue Shield of Arizona

Horizon Medicare Advantage Blue Value with Rx

Please read through the full Horizon Medicare Blue Value with Rx HMO Summary of Benefits attached here for a more thorough review of the plan. I am also available to review this plan with you in a meeting if you wish. Due to marketing regulations, I have decided to list just the basics of the plan and but welcome appointments to discuss your full needs. Contact Mike at NewJerseyInsurancePlans
Source: newjerseyinsuranceplans.com

Horizon Blue Cross Blue Shield of New Jersey’s Mobile Medicare Outreach Moves Into Monmouth County

Horizon Blue Cross Blue Shield of New Jersey, the state’s oldest and largest health insurer, is a tax-paying, not-for-profit health services corporation, providing a wide array of medical, dental, and prescription insurance products and services. Horizon BCBSNJ is an independent licensee of the Blue Cross and Blue Shield Association, serving more than 3.6 million members with headquarters in Newark and offices in Wall, Mt. Laurel, and West Trenton. Learn more at www.HorizonBlue.com
Source: patch.com

CrummeyService.com Accepts Equity Investment

In order for a gift to a trust to qualify for the annual gift tax exclusion, currently $13,000 per beneficiary, the IRS requires trust beneficiaries to be given formal written notice of their right to withdraw the gifted amount if they choose to do so (Crummey v Commissioner, 397 F.2d 82 (9th cir 1968)). CrummeyService.com technology reminds the grantor to make the gift to the trust, notifies the beneficiaries of their right to withdraw the gifted amounts, and provides an independent third-party record of the entire process.
Source: lifesourcedirect.com

The Inside Straight: Socialized Medicine: a Preview ?

For instance, when my wife was hospitalized in 2005, there was an unexplained balance left unpaid to the hospital. We explored this issue with the hospital and with Horizon for several months, and were told by the latter all invoices presented had been paid in full. In 2007, while my wife was in intensive care fighting for her life, I received a notice from a collection agency. The hospital had NOT been paid the balance, had given up trying to collect it from Horizon, and had finally invoked the little clause on the Admission documents that says the patient is responsible if the insurance carrier refuses to pay.
Source: typepad.com

Horizon adds exercise program for its Medicare Advantage members

“The Silver&Fit exercise and healthy aging program encourages our members to live an active, healthy lifestyle,” said John Selby, director of sales and marketing for Horizon BCBSNJ’s consumer and senior markets, in a statement. “Our members who directly participate in the program will experience better health, which will contribute to lower health care costs that will benefit all our members.”
Source: ifawebnews.com

New Jersey’s Largest Health Insurer Horizon Blue Cross and Blue Shield To Pay $500,000 Penalty Over Medicare Claims

The action comes after the state Banking and Insurance Department investigated how Horizon Blue Cross and Blue Shield of New Jersey processed claims for Medicare customers insured through small businesses that use Horizon as a secondary insurer.
Source: cbslocal.com

Blue Shield: Review Supports Health Insurance Rate Hike

[…] Blue Shield: Evaluation Supports Wellbeing Insurance coverage Fee Hike Blue Shield of California says an impartial assessment has identified that its most recent charge hikes on health insurance policies are not extreme and meet state and federal demands. Go through far more on CBS two Los Angeles […]
Source: cbslocal.com

Horizon BCBSNJ launches AskBlue and AskBlue Medicare

Medicare, the Blue Cross and Blue Shield Association’s interactive online tools. If your clients and their employees are experiencing layoffs or a loss of group coverage, your clients can direct their employees to AskBlue and AskBlue Medicare. These tools can help lead your clients and their employees to information about the individual health coverage that best matches their needs.
Source: benefitsdr.com

Medicare Part D Exclusion of Benzodiazepines and Fracture Risk in Nursing Homes

Posted by:  :  Category: Medicare

Following the enactment of Medicare Part D, Tennessee was the only state to forgo supplemental coverage for benzodiazepines; when benzodiazepine prescriptions declined, nursing home residents in Tennessee experienced more falls and hip fractures.Benzodiazepines are controversial sedatives. Enacted in 2006, Medicare Part D excluded reimbursements for benzodiazepines. However, most state Medicaid programs continued to provide supplemental coverage for benzodiazepines.
Source: rwjf.org

Video: Exclusion Authorities and Effects of Exclusion

Medicare Payment Does Not Trump Out

But the court rejected this as well, stating that the definitions of “Plan Expenses” and “Expenses covered under the Plan,” excluded Kogenate if it were purchased at an out-of-network pharmacy. An expense had to be covered in the first place in order for it to be paid secondarily, even after Medicare (or another payer) covered it. The plan’s own coverage exclusions were not overridden by Medicare’s (or any other payer’s) more liberal payment policy, the court concluded.
Source: thompson.com

Medicare Program Exclusion Can have Devastating and Far

I am not a physician, but I was an aide. Another woman and myself shared a client and while I worked through an agency she had an IP number which meant many hoops for her anytime there were changes to the schedule. This being the case she and I would swap hours on occasion if one of us needed to, but still bill what was scheduled. For instance if I was working 8-12 and she 12-4 and she had an afternoon appointment we would swap. Same number of hours, just at a different time on the same day. I understand now that this wasn’t good practice, but when she went to Florida on vacation with her family and continued to bill, my life ended upside down. I spent a weekend in jail, plead quilty to a misdemeanor and lost my job. I am ashamed and embarassed and do my best to make sure no one knows about what has happened. I only made 10 per hour but it was a job and it kept a single mother of 3 off welfare. I never took anything from anyone and I feel the weight of this everyday! I only w
Source: thehealthlawfirm.com

Indiana Health Care Association: AHCA Submits Comments on Guidance Relating to Medicaid/Medicare Exclusion List

Recently, the Department of Health and Human Services’ (“HHS”) Office of Inspector General (“OIG”) solicited comments from Medicare and Medicaid providers as to the potential need for updated guidance as to the OIG’s excluded provider program. Under the program, the OIG has the authority to exclude from participation in the Medicare and Medicaid program providers who have committed certain health care-related offenses, or have had their licenses revoked or suspended (as well as for many other reasons). If a provider is excluded, and an entity subsequently bills Medicare or Medicaid for services attributable to that excluded provider, the OIG can recover the sums paid, in addition to hefty penalties. The current OIG “authority” on the matter comes in an outdated 1999 Special Advisory Bulletin, where the OIG outlined the ins and outs of the exclusion program. It looks like something new might be coming out though, and if the American Health Care Association’s (“AHCA”) comments are taken to heart, the new OIG guidance will include information about the OIG’s intent to further utilize its current exclusion authority with respect to individuals based on their relationships with corporations that have been found guilty of health care-related offenses. Additionally, AHCA smartly suggested that the OIG make clear what happens when a provider self-discloses the fact that they may have billed for services provided by an excluded provider? Hopefully, the OIG will take all of the AHCA’s suggestions into consideration. New OIG guidance on these matters is expected sometime this Spring. If you have questions about the Medicaid/Medicare exclusion program, or about AHCA’s recent comments to the OIG, please contact Susan Ziel at 317-238-6244, or Leigh Ann Lauth O’Neill, at 317-238-6346.
Source: ihca.org

Despite Potential Benefits, Medicare Slow to Utilize Telehealth

Health, Person Location, Person Career, Quotation, Telehealth, Health informatics, Medicare, EHealth, American Telemedicine Association, Medicine, Technology, Medical informatics, Videotelephony, telemedicine, Presidency of Lyndon B. Johnson, telehealth services, USD, Jonathan Linkous, Chicago, Institute of Medicine, Mike Thompson, California, stroke, stroke care, bipartisan Fostering Independence Through Technology, Richard Brennan Jr., telehealth technologies, dozen services, certain telehealth services, chief executive officer, John Thune, practicing neurologist, Lee H. Schwamm, American Heart Association, Harvard Medical School, acute stroke, bypass, video conferencing, National Association for Home Care & Hospice, chronic care management, Medicare Payment Advisory Commission, cessation services, reimbursable telehealth services
Source: reportingonhealth.org

How to Avoid Being Banned from Medicare

1. Result in the individual or entity also being barred as a participating provider with private health insurers.   2. Trigger breaches of employment agreements, and may jeopardize a provider’s clinical privileges.   3. Result in the individual or entity being terminated from Medicaid programs.     Steps to prevent exclusion   Organizations can take steps to minimize the likelihood of ending up on the LEIE. While the OIG has posted extensive guidance on this, the key strategy is developing and implementing an effective compliance program. According to the OIG, there are seven hallmarks of an effective plan:   Audits.  An effective program will include periodic audits to monitor compliance with, and the effectiveness of, the plan. This will include auditing charts to confirm that services being provided are reasonable and necessary, as well as auditing coding and billing to ensure proper billing for services.  This needs to be done periodically.   Written standards.  The plan should be written, and include readily identifiable standards and procedures.  This will include identifying potential areas of risk to the organization, and then identifying the standards to be followed (whether they relate to proper billing or identifying what are reasonable and necessary medical services).   Oversight.  An effective plan will be overseen by one or more persons designated as compliance officers.  The organization should provide a detailed description of the officer’s duties and conduct periodic evaluation of the officer’s performance.   Education. Ongoing training and education is critical to ensuring that providers and staff understand the plan, its standards, and the protocols that are in place to ensure compliance.  Training will encompass not only the plan, but also the key areas of the organization’s operations (for example, training on proper coding/billing protocols).  As with other aspects of the plan, the organization should review and update its training and education.   Responsiveness.  An effective plan includes procedures to timely and effectively investigate and respond to incidents of fraud, including notifying the appropriate governmental agency(ies) of such incidents.  An organization may want to consider identifying in its plan red flags that may indicate fraud, as well as specific timelines for investigating incidents.   Communications.  Open lines of communication within an organization will ensure that providers/staff remain aware of the plan and its requirements, and also foster an environment where members of the organization feel comfortable sharing information about potential fraudulent conduct.   Discipline.  Well-defined standards for how discipline will be meted out will help impress upon the organization’s members the serious repercussions should there be non-compliance.  Discipline can include a multi-step approach, from warnings to (in serious cases) immediate termination.   It is up to each organization to incorporate these features into its plan. Smaller organizations, given their limited resources, have more flexibility. Larger organizations, on the other hand, are expected to have a more comprehensive plan in place.
Source: medicalofficetoday.com

Oig Exclusion Monthly Medicaid Database and List: Medicaid Exclusion List: A Brief Introduction!

If you are planning to hire staff and want to know whether they are entitled to reimbursement or not, then you need to refer to this Medicaid exclusion lists.  You should not worry about spending time, money and energy searching this list. Instead it would be better, if you took the help of an HR agency who would streamline the process for you and help you concentrate on your business. These agencies have the entire Medicaid exclusion list at their disposal and they check out the monthly updates that happen in this list when it comes to service providers and help you to provide health care cover to your employees in a precise, targeted manner. 
Source: blogspot.com

Reed Tinsley, CPA: Physician excluded from Medicare for tax evasion

The provider’s contention that he was not required to report the conviction or loss of licensure (see 42 C.F.R. §424.516(d)(1)(ii)) because his failure to report was unintentional and he had not seen any Medicare patients while unlicensed was irrelevant because neither reporting regulation contains an intent requirement nor an exception for providers who stop seeing beneficiaries. Providers whose privileges are revoked are barred from reinstatement for 1 to 3 years under 42 C.F.R. §424.535(c), which did not allow the provider to appeal the duration or imposition of his re-enrollment bar. Tolliver v. CMS, HHS Departmental Appeals Board, Civil Remedies Division, Doc. No. C-10-737, Dec. No. CR2281, November 23, 2010,
Source: blogs.com

A To Do List for year’s end

[…] Your estate plan should not be a static document.  As your life changes, your planning must change with it.  Getting married or divorced would likely change how you want to distribute your property; likewise if there is a death in the family.  Each year you should review your documents, including your will, trust, and powers of attorney to make sure that they still reflect your wishes and have the correct people taking charge if you were to die or become incapacitated.  Also, if you move to another state when you retire, meet with your attorney to make sure that your documents will be valid in your new state of residence.  Make revisions as necessary.Source: intentionalretirement.com […]
Source: intentionalretirement.com

Health First Hosts Free Medicare Advantage Seminars

Posted by:  :  Category: Medicare

New Online Rx System Makes UM Student 'Top Entrepreneur' Finalist by University of Maryland Press ReleasesThe Medicare Advantage plan with the most stars for this area is within your reach. Did you know that Health First Health Plans is the highest-rated Medicare Advantage plan with prescription drug coverage in all of Brevard and Indian River Counties? With a four-and-a-half out of five-star Overall Plan Rating from Medicare.gov for the third year in a row (2011, 2012, 2013), you can be sure you’re getting a plan that puts its members first.
Source: tcchronicle.com

Video: Healthfirst y las IPA contra los recortes del Medicare

Seven Choices Medicare Plans Will Need To Make In Order To Survive

Sales channels are a good example of this. Given the recent proliferation of channels, it is critical that MA plans optimize their mix by focusing on the needs of their customers, instead of looking at what has helped sell various Medicare products in the past. Traditional channel options include direct sales, brokers, groups, and the web; emerging channels include retail stores, payor partnerships, and private exchanges. Each avenue provides a unique experience for the customer, and the right match can determine the eventual buying decision. The range of channels increases complexity, but it also allows leading plans to tailor their engagement strategy by segmenting the customers and personalizing interactions on the basis of segment needs for sales and enrollment, as well as ongoing interactions with the member to improve experience and manage health outcomes.
Source: healthaffairs.org

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

Advocates Take Aim at Medicare Policies on Observation Care

. Toby Edelman, senior policy lawyer with the Center for Medicare Advocacy, said, “I can’t imagine anyone is going to like this proposed rule because it makes time the determining factor in whether the services are provided on an inpatient or observation basis” instead of “what the hospital is actually doing for you, what kinds of care you need.”
Source: californiahealthline.org

UnitedHealth Issues Warning Over Medicare Advantage Cuts

Kaiser Health News: Capsules: Despite Win, UnitedHealth Criticizes Medicare Rates, Eyes Pruning Business If the Obama administration expected the biggest health insurance company to give thanks for this month’s decision to reverse cuts to private Medicare plans, it was wrong. UnitedHealth Group CEO Stephen Hemsley said Thursday that Medicare Advantage rates are still far too low and that the company may shrink its business of managing care for seniors. … But in Thursday’s call to discuss the company’s quarterly profits of $2.1 billion on revenue of $30.3 billion, Hemsley said other changes — including the Affordable Care Act’s long-term reduction in Medicare Advantage payments – would still lead to a net reduction next year of more than 4 percent. That’s inadequate when medical costs are rising in the 3 percent neighborhood, he said” (Hancock, 4/19).
Source: kaiserhealthnews.org

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

Insurance Success Story : Tufts Medicare Preferred

Before Tufts Medicare Preferred started to use the HubSpot software to assist with their marketing, their main challenges stemmed from generating new leads from a very fragmented website. They needed a way to connect the dots and figure out how users on their website use each of the tools they provided and what they could do to improve their experience. They had no way to track how visitors were navigating their website, nor a great way to capture lead information on each page. As Baby Boomers begin to retire, that core demographic of 65+ individuals are driving more online traffic than ever before, and Tufts Medicare needed new data on how to reach them more effectively.They discovered HubSpot’s end-to-end enterprise marketing software and originally bought because of the ability to quickly create landing pages. They soon realized however, it also provided them with the tools they needed to track visitors and get even more data than they ever thought possible.
Source: hubspot.com

Phase out GP consultation fees for a better Medicare

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

Why is Medicare shutting down one of the most effective health

We think of the hospital as a place people go to get better. At Health Quality Partners, the view is that a hospital is a place where seniors get worse. “Being in the hospital for three days or five days sets them back to a point where they’ll never regain what they were,” says Sherry Marcantonio, chief program architect of HQP. “That’s where the scales tip. That’s where people end up needing a nursing home.” Keeping seniors out of the hospital, which is a core focus of its program, cuts costs and saves lives, but it also preserves quality of life — a measure often ignored in these discussions. There’s a good argument to be made that if a program like HQP cost slightly more than traditional Medicare but cut hospitalizations by a third, it would still be worth it. The point of health care, after all, is to keep people healthy. But HQP saves money — and lots of it.
Source: bangordailynews.com

Health First Health Plans Offers Medicare Advantage Plans

At Health First Health Plans, eligible beneficiaries can choose from a suite of Medicare options, including four Medicare Advantage plans with Part D Prescription Drug coverage (MA-PD), one Medicare Advantage Plan without Part D prescription drug coverage (MA), two stand-alone Prescription Drug Plans (PDP), and Supplemental Plans (Medigap).  Typically, you may enroll in a Medicare Advantage plan only during the annual enrollment period from October 15 through December 7 of each year.  There are exceptions that may allow you to enroll in a Medicare Advantage plan outside of this period (otherwise known as Special Election Periods).
Source: spacecoastbusiness.com