Study: Star Rating System Resonating With Seniors

Posted by:  :  Category: Medicare

YOU MIGHT WANT TO START PLANNING by SS&SSMedpage Today: Seniors Favor Higher-Rated Medicare Plans First-time enrollees in Medicare Advantage plans and those switching plans were more likely to enroll in ones with a higher star rating, a study of nearly 1.3 million Medicare beneficiaries found. An increase of one star in the ratings made it 9.5 percent more likely a first-time Medicare Advantage enrollee would choose a given plan, the study published in Tuesday’s Journal of the American Medical Association found. Similarly, for those switching plans, a higher star rating was associated with a 4.4 percent greater chance of enrollment. … But awareness and use of Medicare Advantage’s star-rating system has been mixed, Jack Hoadley, PhD, of the Health Policy Institute at Georgetown University, in Washington, wrote in an accompanying editorial (Pittman, 1/15).
Source: kaiserhealthnews.org

Video: Dr. Eric Larson on Medicare 5-Star Rating System Part 1

Health First Hosts Medicare Advantage Health Plans Seminars

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

Kaiser Permanente Leads the Nation with Six 5

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

Alaris Health at The Chateau has received an overall 5

Founded on a tradition of health care excellence, Alaris’ Member Health Centers are leading providers of short-term post hospital rehabilitation, long term and specialty care, with Member Health Centers throughout the state of New Jersey. The Chateau offers a warm, supportive environment for post-hospitalization, short-term rehabilitation patients, and long-term residents alike.  A highly regarded ventilator care program and state-of–the-art post-hospital rehabilitative therapies are just a few of the specialized medical features at The Chateau.  
Source: alarishealth.com

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

Medicare Star Ratings: Consumers Ignore, Industry Debates

best practice case examples brand/differentiation business advantage Centers for Medicare and Medicaid Services choose a doctor choose a hospital clinical quality consumerism customer service doctor interactions doctor ratings emotional needs empowered patients EMR electronic medical records hospital ammenities hospital ratings leadership online ratings online reputation patient-centered care patient experience patient ratings patient satisfaction pay-for-performance showcase social media staff attitude staff interactions technology video wait times
Source: patientexperience.com

Seaport Santa Monica Nursing Home Attains Medicare 5 Star Facility Rating

Finding quality nursing home and rehabilitation care is a major concern for the aging population in Santa Monica and their family members. Patients who are receiving nursing care services want to know that their health and safety are being held in the highest regard. The Medicare rating system is one way that patients can ensure that a nursing facility meets the highest standards of care.
Source: marketersmedia.com

Power in Comparing Medicare Stars

But star ratings are just one factor to consider if you are shopping for a Medicare plan.  You also want to make sure that the plan includes your preferred physicians and facilities.  So check to see if your doctors and hospitals are in the network. Going out of network with a Medicare Advantage plan can add up!  And when you are shopping price compare not just the premium, but the co-pays and deductibles you will be responsible for each time you use the plan.
Source: iquote.com

Single Stop submits comments to Center for Medicare and Medicaid Services

Posted by:  :  Category: Medicare

Benefit Security Card .. HALF of the U.S live in households that receive government benefits (26 May 2012) ...item 2.. Brevard man gets 4 years in Social Security fraud case (Jun 1, 2012 ) ... by marsmet481Single 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

Video: Medicare Enrollment | Medicare Sign Up | Apply for Medicare

Physicians Can Now Apply for Higher Medicaid Rates

The higher payments will benefit physicians who participate in both Medicaid fee-for-service and Medicaid HMO plans, said Helen Kent Davis, Texas Medical Association director of government affairs. Further, the rate increase will significantly help those physicians hurt by the cut in payment for the Medicare Part B coinsurance enacted in 2012. For those patients, Texas will not pay the 20-percent coinsurance if what Medicare pays is more than the Medicaid allowable for the same services. However, once the rate increase takes effect, eligible physicians will be paid the full coinsurance because the Medicare and Medicaid allowable for the service will be the same.
Source: dmagazine.com

Medicare Seeks To Limit Number Of Seniors Placed In Hospital Observation Care

A federal judge is holding the lawsuit’s first hearing Friday in Hartford, Conn., to consider the government’s request to throw out the case because the seniors should have followed Medicare’s lengthy appeals process before going to court. Three days ago, government lawyers submitted the proposed rule change to the judge to bolster its argument for dismissal, claiming that it clarifies “when we believe hospital inpatient admissions are reasonable and necessary, based on how long beneficiaries have spent or are reasonably expected to spend, in the hospital.”
Source: kaiserhealthnews.org

Mothers everywhere appreciate extra help

If your mother is cov­ered by Medicare and has lim­ited income and resources, she may be eli­gi­ble for Extra Help, avail­able through Social Secu­rity, to pay part of her monthly pre­mi­ums, annual deductibles, and pre­scrip­tion co-payments. The Extra Help is esti­mated to be worth about $
Source: thebellevuegazette.com

Need Help Understanding My Medicare Options? » Toni Says

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

Medigap Guaranteed Issue Rights & Protections

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

When should I apply for Medicare?

If you’re not receiving Social Security benefits, however, consider signing up soon. As does the Social Security Administration, Long recommends that you apply three months before your 65th birthday to ensure your coverage begins the month you turn 65.
Source: cnn.com

Howell Rule Applies When Medical Services Were Paid by Medicare, Court of Appeal Concludes : Insurance Litigation & Regulatory Law Blog

In Howell v. Hamilton Meats & Provisions, Inc. the California Supreme Court ruled that a plaintiff’s recovery of medical damages is limited to the amount paid by the plaintiff’s health insurer and accepted by the health care provider as full payment. The Supreme Court’s ruling was discussed by Larry Golub in Collateral Source Rule Inapplicable When Injured Person’s Medical Expenses are Discounted by Health Insurer.
Source: insurancelitigationregulatorylaw.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

Reed Tinsley, CPA: New Medicare claim denials begin May 1

Posted by:  :  Category: Medicare

BITCH ... Allen West calls Wasserman Schultz ‘vile’ and ‘not a lady’  (7/20/2011) ...item 2.. FSU News -  Yo Mama's Big Fat Booty Band grooves at Sidebar (Mar. 29, 2013) ...item 3.. Chaos - Doin' It Hard by thebootyband ... by marsmet522As such, you are encouraged to enroll online, not by paper. Online is much faster. Make sure and read the directions thoroughly. There is an Electronic Fund Transfer (EFT), Form 588, that has to be mailed in by paper with an original signature, but you have to establish a bank account first. If you are receiving Medicare checks in the mail, this will stop and the funds will be electronically sent to the bank. Waiting too long to begin this process could mean that your enrollment application may not be processed prior to the May 1, 2013, implementation date. If this happens, your claims will be denied.
Source: blogs.com

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

South Carolina’s Williston Rescue Squad Settles False Medicare Claim Case For $800,000

This resolution is part of the government’s emphasis on combating health care fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced by Attorney General Eric Holder and Kathleen Sebelius, Secretary of the Department of Health and Human Services in May 2009. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover nearly $10.2 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department’s total recoveries in False Claims Act cases since January 2009 are over $14 billion.
Source: newsroom-magazine.com

Seniors Need To Be Tenacious In Appeals To Medicare

Medicare officials say appeals are rare, though they would not provide statistics on how many appeals came from beneficiaries rather than from health-care providers, such as hospitals, doctors and nursing homes.  The inspector general’s office in the Department of Health and Human Services reported last month, however, that 85 percent of appeals in 2010 that reached the third level of review, which are decided by an administrative law judge, were filed by health care providers.  And for those who persevere and do appeal a third a third time, the OIG found that the judges reversed 56 percent of all unfavorable decisions in 2010.
Source: kaiserhealthnews.org

Maine Medical Center sues Sebelius over nearly $3M in unpaid Medicare, Medicaid claims

The head of the Centers for Medicare and Medicaid Services, acting for Sebelius, then reversed the review board’s decision in early February, citing MMC’s lack of documentation. In the suit, MMC described the decision to reverse the review board’s ruling as “arbitrary” and “capricious.” The hospital asked the court to instruct CMS to uphold the review board’s decision.
Source: medcitynews.com

Tea Party Patron Saint Ayn Rand Applied for Social Security, Medicare Benefits

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSCritics of Social Security and Medicare frequently invoke the words and ideals of author and philosopher Ayn Rand, one of the fiercest critics of federal insurance programs. But a little-known fact is that Ayn Rand herself collected Social Security. She may also have received Medicare benefits.
Source: firedoglake.com

Video: Blue Medicare Options Illinois or Medicare Options Illinois

Need your medical records? There’s an app for that

But it wasn’t one for Mostashari, who is leading an effort to give consumers more power over their health care with information and technology. Mostashari put his expertise to use by signing up his dad for the Medicare Blue Button, which downloads three years of a patient’s medical history, as well as the Humetrix iBlueButton, a smartphone app that translates and displays the information in a simple-to-understand way. The file includes names, phone numbers and addresses of physicians as well as diagnoses, lab tests, imaging studies, and medications.
Source: publicradio.org

What is Medicare Part B Medical Insurance?

Eligible individuals can automatically be enrolled in Medicare Part B, along with their Part A coverage, when they turn age 65 or after receiving Social Security or Railroad Retirement Board disability benefits for 24 or more months if they are younger. A red, white, and blue Medicare card is automatically mailed to eligible beneficiaries three months before the month they become eligible for the program. However, Medicare Part B is a voluntary program and beneficiaries can follow the instructions that come with the card to refuse enrollment.
Source: ehealthmedicare.com

Rick Perry Calls Social Security and Medicare “Ponzi Schemes”

Q: In Fed Up!, you criticize the progressive era and the changes it produced: the 16th and 17th Amendments, Social Security, Medicare, and so on. I understand being against these things in principle—of longing for a world in which they never existed. But now that they’re part of the fabric of our society, do you think we should actually do away with them?
Source: firedoglake.com

The Medicare Prescription Drug Benefit Fact Sheet

CBO estimates that Part D spending will total $60 billion in 2013 (net of premiums and state transfers).  The average annual Part D per capita growth rate was 3.7% between 2006 and 2011, but is projected to rise at a more rapid rate (5.6%) between 2011 and 2021 (2012 Medicare Trustees), in part due to slowing of trend toward greater generic drug use. Total spending depends on several factors: the number of Part D enrollees, their health status and drug use, the number of low-income subsidy recipients, and plans’ ability to negotiate discounts and rebates with drug companies and manage use (e.g. promoting use of generic drugs, prior authorization, step therapy, quantity limits, and mail order).  The MMA prohibits Medicare from negotiating drug prices directly.
Source: kff.org

How Does Sequestration Impact ASC Medicare Reimbursement?

Posted by:  :  Category: Medicare

Deputy Administrator and Director for the Center of Medicare at CMS Jonathan Blum visits Christiana Care to speak about accountable care organizations by Christiana CareQuestion: How will the 2 percent Medicare payment reduction as a result of sequestration impact ambulatory surgery centers? Scott Becker, JD, Partner at McGuireWoods: The government reduction in spending through the sequester has direct and indirect impacts on surgery centers. First, through its direct reduction in spending it should translate into a 2 percent reduction on a surgery center’s Medicare revenues. For example, if an ASC, has 50 percent of its revenues through Medicare and those amount to $3,000,000, then the ASC would suffer a loss of $60,000 a year. This is approximate and doesn’t take into account any impact on co insurance or on Medicaid. Second, in addition to the reduction in direct payments, the sequester adds another headwind to an already fragile economy. When you couple this 2 percent reduction with the increased taxes as of January 1, it amounts to close to 4 to 5 percent taken out of the private economy. This combined with already tepid growth rates will cause more caution in consumer spending and more delay in a great deal of surgical procedures. More Articles on Surgery Centers: HIPAA Compliance: What Providers Should Know About HITECH Act Mandatory Audits 10 ASC Administrators Discuss How Their Centers Stand Out 5 Weekly Benchmarks for ASCs to Track
Source: beckersasc.com

Video: How to Navigate Medicare Reimbursement

Medicare Hospital Payment: MedPAC Recommends One Percent Rate Increase for FY 2014

Hospitals face another year of tight Medicare reimbursement, with rates for FY 2014 falling farther behind cost increases and margins declining as a result.  Most hospitals already lose money on caring for Medicare and Medicaid patients.  Hospitals are entering a far more challenging new business environment under the Affordable Care Act, which will cut Medicare and Medicaid payments, cover millions of new consumers, fundamentally transform the health insurance marketplace, and force consolidation.  Meanwhile, purchasers and payors are reforming payment methods to drive increased efficiency in the hospital industry.
Source: piperreport.com

Sequestration Cuts Medicare Reimbursement Beginning April 1

In a statement released on March 1, American Medical Association President Jeremy Lazarus said, “Both Medicare beneficiaries and providers will feel real pain from the cuts. Sequestration will widen the already enormous gap between what Medicare pays and the actual cost of caring for seniors.” Congress and the president could halt some or all of the spending cuts, but it may take a surge of public indignation to motivate them to do so. Members of the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) have been encouraged to contact their elected officials to share their concerns over the impending cuts, which come on the heels of a significant decrease in Medicare reimbursement for EDX services.
Source: newswise.com

Explaining Health Reform: Medicare and the New Independent Payment Advisory Board

This brief describes how the new board created under the 2010 health reform law is expected to limit the growth in Medicare spending over time. Starting in 2014, if projected per capita Medicare spending exceeds targets set in the law, the board must recommend ways to reduce Medicare spending, while maintaining quality and access to care for beneficiaries. The board’s recommendations automatically take effect the next year unless Congress adopts an alternative plan to achieve an equivalent level of savings.
Source: kff.org

Lawmakers Might Have Time To Avert Medicare Payment Cuts

Call me American citizen. I first want to address Medicare I believe it is disrespectful that we would even consider cutting payments Doctors do not take plain Medicare patients due to payments being so low. We should never take our parents Social Security, Medicare, or the right to have quality medical care away. We should never have our Social Security or health care taken away or deceased.
Source: californiahealthline.org

Should You Accept New Medicare Patients?

Madelyn Young is a Content Writer for CareCloud and an expert on practice management, medical billing, HIPAA 5010, ICD-10 and revenue cycle management. You can read her work on Power Your Practice and the CareCloud Blog. Contact Madelyn with story suggestions, contributor articles, or any other feedback at madelyn@poweryourpractice.com or follow her on Twitter @madelyn_young.
Source: poweryourpractice.com

Oklahoma Cancer Patients Worry About Cuts To Medicare Caused By

Once every three weeks, he spends three hours at Oklahoma Oncology, getting chemotherapy infusion treatment, but there are concerns there that patients like Joe may be forced to find a new place for treatment and it all stems from the sequester.
Source: newson6.com

What If A NYC Elderly Daycare Center Is Accused Of Medicare Fraud?

Posted by:  :  Category: Medicare

NYC TO WALL ST.: BUSH / CHENEY: DROP DEAD. by eyewashdesign: A. GoldenOn the other hand, the services must be provided to elderly people who are actually disabled, which in this context generally means someone who needs at least 120 days a year of home care to assist with tasks of daily living, such as self-care, taking medication, walking, etc. If your day care provides services to elderly people who are not disabled, your service is not eligible for Medicaid reimbursement.
Source: jpdefense.com

Video: Occupy activists observe 47th Anniversary of Medicare – NYC

Schneiderman catches top NYC hospital overbilling Medicare and Medicaid

According to the Complaints and Settlements filed in this case, the hospital double-dipped by billing New York and the federal government for psychiatric services provided by its physicians.  St. Luke’s-Roosevelt billed out-patient psychiatric services to Medicaid as a rate-based service, which included the care provided by the physician and all other related costs. At the same time, SLR billed the state and federal governments on a fee-for-service basis for the same care provided by the physician. Also, St. Luke’s-Roosevelt sought and received reimbursement from Medicare for non-reimbursable costs for outpatient psychiatric visits. As a result, the Hospital received Medicare and Medicaid payments that it was not entitled to receive.
Source: seniorlivingcare.com

When Is It Illegal To Recruit Clients For A NYC Adult Daycare Center?

Long Island Federal Defense Attorneys Long Island Federal Corporate Fraud Long Island Federal Bank Fraud Long Island Federal Healthcare Fraud Long Island Federal Medicaid Fraud Long Island Federal Insurance Fraud Long Island Federal Money Laundering Long Island Federal Bankruptcy Fraud Long Island Federal Mortgage Fraud Long Island Long Island Federal Mail and Wire Fraud Long Island Federal Computer Crimes Long Island Federal Tax Fraud Long Island Federal Drug Crimes Long Island Federal Sex Crimes Long Island Federal Weapons Charges International Extradition Long Island Federal White Collar Crimes Guide New York City Criminal Attorney
Source: jpcriminaldefense.com

Hospitals’ Medicare funds at risk

“Changing the way we pay hospitals will improve the quality of care for seniors and save money for all of us,” said U.S. Department of Health and Human Services Secretary Kathleen Sebelius in a press release when the agency launched the initiative last year. “Medicare will reward hospitals that provide high-quality care and keep their patients healthy. It’s an important part of our work to improve the health of our nation and drive down costs. As hospitals work to improve their performance on these measures, all patients – not just Medicare patients – will benefit.”
Source: thenewyorkworld.com

Medicaid/Medicare Administrator + Expert Panel on Future of Health Care: NYC Event + Live Webcast, Sun Oct 23

ABOUT 92nd Street Y 92nd Street Y is a world-class nonprofit community and cultural center that connects people at every stage of life to the worlds of education, the arts, health and wellness, and Jewish life. A community of communities, 92Y is a home for candid, thoughtful discussions on the most pressing issues of our time. We offer an outstanding range of experiences in the performing, literary and visual arts for both audiences and practitioners; unparalleled access to celebrated artists, teachers and thinkers; and a place to pursue personal journeys – spiritual, physical or intellectual. Through the breadth and depth of 92Y’s extraordinary programs, we enrich lives, create community and elevate humanity. Every year, more than 300,000 people visit 92Y’s New York City venues, and millions more join us through the Internet, satellite broadcasts and other digital media. A proudly Jewish organization since its founding in 1874, 92Y embraces its heritage and enthusiastically welcomes people of all backgrounds and perspectives. 92Y is an open door to extraordinary worlds.
Source: cision.com

Therapy Plateau No Longer Ends Coverage

Beneficiaries also often lose Medicare coverage for outpatient therapy because they hit the payment limit. But under the exceptions process Congress continued for another year, the health care provider can put an additional code on the claim that indicates further treatment above the $1,900 limit is medically necessary. When treatment costs reach $3,700, the provider can submit medical documentation to support a request for another exception to cover 20 more sessions. (A Medicare fact sheet provides some additional details, but has not been updated for 2013.)
Source: nytimes.com

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

Medicare’s Role for Dual Eligible Beneficiaries

This brief examines overall and per capita Medicare spending for these beneficiaries, including variations reflecting their diverse circumstances. It describes the characteristics of those with the relatively high and low Medicare costs and includes state-specific data on the share of Medicare beneficiaries who are also Medicaid-eligible.
Source: kff.org

New NYC Booklet on Medicare

The two articles re-published in this pamphlet were written to address the 50th anniversary of North America’s first public healthcare system for all citizens initiated in Saskatchewan on July 1, 1962. We were researching the prolific resources and books available on the subject in preparation for a forthcoming book on the fight for medicare in Saskatchewan and wanted to raise the profile of the anniversary as the actual anniversary approached. This pamphlet is intended as a short and quick resource for labour and health care activists as we celebrate 50 years of medicare.
Source: unionbook.org

Blended Medicare Plan Could Save $180B Over 10 Years, Study Finds

Posted by:  :  Category: Medicare

Romney Ryan Plan for Student Loans by DonkeyHoteyBoth studies — the Commonwealth Fund Medicare reform proposal and the Rand analysis of others’ Medicare reform proposals — are seriously flawed and illustrate no real-world understanding of Medicare. It is good that the Commonwealth Fund includes the catastrophic coverage and annual OOP limits that are not included in Original Medicare. All Part C plans and a few Medigap plans include such protection today. In fact, the Commonwealth Fund looks like a Part C health plan — except that it costs more than the average Part C plan and does not have as many other benefits (other than the OOP limits). The one-size-fits-all drug plan proposed by Commonwealth Fund will lead many low-income seniors back to the two-tier VA-like prescription drug coverage that pre-dated Part D (one inferior tier for low-income seniors, one better plan for the rest of us seniors). Because I cannot take Essential without taking this inferior two-tier drug plan is bad news for we middle-income seniors also
Source: californiahealthline.org

Video: How to Understand Medicare Plans

Obama Plan For Medicare, Social Security Draws Ire From Liberal Groups

McClatchy: Obama’s Bid To Squeeze Social Security Enrages His Core Backers Liberal groups angered by President Barack Obama’s proposed Social Security cuts say they’ll take a page from conservatives’ campaign playbook and work to oust Democratic lawmakers who go along with the plan. … As part of his budget plan now before Congress, Obama wants to slow the inflation calculator for Social Security benefits and payments to some military veterans, their survivors and college students. He’s also asking affluent Americans to pay higher Medicare premiums (Rosen, 5/2).
Source: kaiserhealthnews.org

Medicare Plan C or Part C??Are They the Same or Different? » Toni Says

, 2013 answers questions such as the difference in Plan C or Part C., donut hole, difference between “Original” Medicare, a Medicare supplement or Medicare Advantage Plan. These questions and many more will be answered at the Confused about Medicare Workshop to be held at The Abbey at Westminster Plaza, 2865 Westminster Plaza Dr., Houston, TX 77082 on Wednesday, May 15th
Source: tonisays.com

Must Employers Carry Medicare Eligible Active Employees and Spouses?

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: lexisnexis.com

Financial Success: Medigap & Medicare Advantage Plans

All Things Human by Patrice Passidomo, M.D. Amateur Palate Restaurant Reviews Animal Ark Rescue Arts and Entertainmet Arts Calendar by Carol Kantor Arts on the Lake Bits of Inspiration Brewster Theater Company Delaney’s Dugout Financial Success by Kurt Schlesinger FrOGS Happy Reading by Christine O’Neill Heart of the Matter: Pawling Real Estate by Todd Kesseman Intern and Student Contributors In The Shade by Thomas D Kersting Kitty Korner Living Landscape Journal by Pete Muroski Local Business Local Interest Meteorologist Mike Shustak’s Forecast Mizzentop Music Reviews by Zach Silva Our Town by Susan Stone Pawling Fire Department Pawling Garden Club Pawling Parents Pawling Public Library Pawling Public Radio Pawling School Sports Peace of Mind by Dr. Jeremy Stone Reflections on a Silver Screen by Ben Rendich Sherman Chamber Ensemble Spice: The Final Frontier by Lisa Kelsey The Art of the Brew by Mark Klinger The Computer Guy by Mike Pepper The Five Facets of Mom by Stephanie Nevins The Pawling High School Insider The Pet Professor by Mary Jean Calvi, LVT The Puppy Pad The Whole Tooth and Nothing But The Tooth by Dr. Thomas Bloom This Side of the Law Trinity Pawling Uncategorized Vegan Delights by Carole Baral What’s New by Susan Stone
Source: wpengine.com

9th Circ. Says Medicare Plan Can’t Sue Geico For Hospital Bills

The Ninth Circuit ruled Friday that while federal law allowed a Medicare Advantage plan to charge an auto company for $137,000 in hospital bills covering a man fatally hit by a car, the provider had no private right of action to recover the money. Read More…
Source: lexisnexis.com

AHIP Launches TV Ad Campaign to Stop New Medicare Advantage Cuts

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

Study: New "Medicare Essential" Option Could Save $180B

Medicare has been a popular health insurance program among beneficiaries since its inception, but a new benefits option could improve care and save an estimated $180 billion in national health spending over the next decade, according to a Commonwealth Fund report published in Health Affairs. Medicare currently covers the elderly and disabled for most hospital and physician treatment, but in order to be guarded against high out-of-pocket costs, beneficiaries still have to purchase supplemental plans — Medigap for copays and deductibles and Medicare Part D for prescription drugs. Researchers proposed a new benefits options called “Medicare Essential,” which would bundle hospital, physician, prescription drug and supplemental health coverage into one, all-encompassing health plan. They said Medicare Essential could “offer better financial protection than traditional Medicare does, including a limit on out-of-pocket spending,” and beneficiaries could also save money by “selecting medical providers that deliver high-value care.” Medicare Essential would basically set an out-of-pocket maximum for any beneficiary who wants to choose it, and it would be financed by traditional premiums — meaning it would not add to the federal deficit, and it would replace costly Medigap and Part D plans that mostly benefit private health insurers and pharmaceutical companies. Hospitals and physicians that agree to be reimbursed through Medicare Essential would be tagged as “high-value providers,” and Medicare beneficiaries who choose those providers could save money through reduced cost-sharing, the researchers wrote. “Given its potential, such an alternative should be a part of the debate over the future of Medicare. The nation needs a unified, patient-centered strategy to preserve access while securing a high-quality, more affordable health care system,” the authors wrote.
Source: beckershospitalreview.com

Medicare Part D: Coverage, Costs, Eligibility

Ross Blair has applied more than 26 years of technology experience to develop PlanPrescriber.com, a website that makes it easier for seniors and their caregivers to select and enroll in the best Medicare products for their specific needs. In his role as CEO, he has worked closely with pharmacists, insurers, physicians, caregivers and seniors to identify the most critical and complex aspects of Medicare and create a system that delivers this information to consumers in a format that is easy to use and understand. Google+
Source: ehealthmedicare.com

Health First Hosts Medicare Advantage Health Plans Seminars

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

Ohio Senator Brown Introduces Legislation To Strengthen Medicare, Reduce Deficit and Save Tax Payers Money

Posted by:  :  Category: Medicare

Brown is Chairman of the Finance Subcommittee on Social Security, Pensions and Family Policy and has been a leader on efforts to ensure Ohioans can afford needed prescription drugs. In 2011, Medicare spent $67 billion subsidizing prescription drugs as a part of the Part D program. The Medicare Drug Savings Act introduced today is another step toward controlling costs without squeezing seniors. Brown is also a cosponsor of the Prescription Drug and Health Improvement Act which could save up to $24 billion annually. The legislation would allow Medicare to negotiate volume discounts on prescription drugs for seniors just as the Department of Veterans Affairs does for veterans. A recent study found that the VA was able to negotiate prices for the 10 most prescribed drugs at costs nearly 50 percent less than Medicare.
Source: medbill.net

Video: FOX NEWS: McConnell To Democrats Raise eligibility age for Medicare

Speaker Doesn’t Foresee Increase In Medicare Eligibility Age This Year

CQ HealthBeat: Boehner Says Medicare Eligibility Age Issue Can Wait Until Next Year House Speaker John A. Boehner indicated Tuesday that he would not insist on raising the Medicare eligibility age as part of a fiscal cliff package and that the issue could be addressed next year as part of a larger overhaul of entitlement programs. At a morning news conference, the Ohio Republican was asked how strongly he feels that the Medicare eligibility age needs to be part of a deal. Although President Barack Obama entertained the idea during debt limit negotiations in 2011, Democrats in both chambers have expressed strong opposition to the change over the past few weeks. “That issue has been on the table, off the table, back on the table. It’s an issue for discussion. But I don’t believe it’s an issue that has to be dealt with between now and the end of the year,” Boehner said. “It is an issue, I think, if Congress were to do entitlement reform next year and tax reform, as we envision, if there’s an agreement that issue will certainly be open to debate in that context” (Attias, 12/18).
Source: kaiserhealthnews.org

MUST EMPLOYERS CARRY MEDICARE ELIGIBLE ACTIVE EMPLOYEES AND SPOUSES?

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

Ohio Health Policy Review: Ohio Medicare

The federal Department of Health and Human Services announced last week that Ohio has been approved to undertake a pilot project to better coordinate care for 114,000 Ohioans who are eligible for both Medicare and Medicaid (Source: "State gets OK to alter Medicare, Medicaid," Columbus Dispatch, Dec. 13, 2012).
Source: healthpolicyreview.org

Taking Medicare’s eligibility age off the table

CARNEY: Again, as part of a big deal, part of a comprehensive package that reduces our deficit and achieves that $4-trillion goal that was set out by so many people in and outside of government a number of years ago, he would consider that the hard choice that includes the so-called chain CPI, in fact, he put that on the table in his proposal, but not in a cherry-picked or piecemeal way. That’s got to be part of a comprehensive package that asks that the burden be shared; that we don’t, as some in Congress want, ask seniors to bear the burden of further deficit reduction alone, or middle-class families who are struggling to send their kids to college, or parents of children who are disabled who rely on programs to help them get through.
Source: msnbc.com

What Raising the Medicare Eligibility Age Means

Raising the eligibility age saves very little money, on the order of a few billion dollars a year. That’s because the 65 and 66-year-olds will have to get insurance somewhere, and many of them are going to get it with the help of the federal government, either through Medicaid or through the insurance exchanges, where they’ll be eligible for subsidies. However, since many Republican-run states are refusing to expand Medicaid in accordance with the Affordable Care Act, lots of seniors who live in those states will just end up uninsured, which will end up leading to plenty of financial misery and more than a few premature deaths. Put this all together, and the Center on Budget and Policy Priorities estimates that while the federal government would save $5.7 billion a year from raising the eligibility age, costs would increase by more than twice in other parts of the system—for the seniors themselves, employers, other enrollees in exchanges who would pay higher premiums, and state governments.
Source: prospect.org

The Net Effect of Raising Medicare’s Eligibility Age

Over the past week, Congress and President Barack Obama’s administration have continued their spar over the “fiscal cliff” — a series of spending cuts and tax hikes that will go into effect at the end of this year without a deal — and recently, groups have insisted raising the Medicare age should be part of the compromise. Sam Baker of The Hill reported House Speaker John Boehner (R-Ohio) and other congressional Republicans are demanding $600 billion in healthcare cuts. Raising Medicare’ eligibility age from 65 to 67 is a key proposal right now to help achieve those savings. In the long term, raising the Medicare age would save the federal government roughly $86 billion over six years, according to the Congressional Budget Office. Essentially, seniors aged 65 and 66 would be phased into Medicare, and in the mean time, they would be responsible for their own healthcare coverage for an extra two years through employers, individual plans or other government plans. In July 2011, The Kaiser Family Foundation also conducted a study on raising the age of Medicare eligibility, finding that it would save the federal government an estimated $5.7 billion in 2014 alone. However, with the savings, there would also be massive increases in out-of-pocket costs and employer retiree healthcare costs, according to the same Kaiser report. There could be new increased costs up to $11.7 billion for states, employers and individual seniors in 2014 through higher premiums on healthier, younger individuals and deferred treatment of chronic conditions. John McDonough, professor of public health at the Harvard School of Public Health, and others have said raising the Medicare age may save somewhat in the very short term, but it is only a “cost shifting” maneuver — i.e., other people will be picking up those “saved” costs. For example, the 65- and 66-year-olds may be more inclined to stay on employer insurance, meaning other workers and the employer would foot more of the bill. “Yes, fewer people in Medicare would lower costs somewhat, but these 65/66-year-olds, while the most expensive part of a working adult population, are also the least expensive part of the Medicare population,” Mr. McDonough wrote in a Boston Globe op-ed. “So the smaller number of Medicare enrollees left behind would have higher average costs per person, and those costs would increase Medicare premiums about 3 percent higher than they would otherwise be.”
Source: beckershospitalreview.com

Mothers everywhere appreciate extra help

If your mother is cov­ered by Medicare and has lim­ited income and resources, she may be eli­gi­ble for Extra Help, avail­able through Social Secu­rity, to pay part of her monthly pre­mi­ums, annual deductibles, and pre­scrip­tion co-payments. The Extra Help is esti­mated to be worth about $
Source: thebellevuegazette.com

Universal Health Care Insurance Company Health Insurance Review

Posted by:  :  Category: Medicare

Under the Medicare PPO plans, policyholders may visit physicians, specialists, or hospitals within the PPO network or outside of the network. Benefits will vary depending on whether the provider is in or out of network. A provider directory can be provided to you by calling customer service or viewing it under the provider section on the company’s website.
Source: healthinsuranceproviders.com

Video: A MARK LEVIN Masterpiece SCREW CHRISTIE! SCREW OBAMA-CARE! 3-1-13 JIM BRIDENSTINE (R-OK)

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

Michael Gerson Pens a Modern Masterpiece

In cliff negotiations, Obama had one overriding goal: to make Republicans vote for rate increases on the wealthy. For 20 years the refusal to raise taxes has been one of the core issues that held together the disparate groups of the GOP. If Obama saw his job as bringing together a broad coalition to fix the long-term debt problem, he would have maneuvered Democrats to take on some of their core issues as part of a package, just as Republicans had to do. But Obama did not view his job this way. He wanted Republicans to swallow their humiliation pure.
Source: motherjones.com

Flood action shows Medicare Local’s worth

The Croakey blog is a forum for debate and discussion about health issues and policy. It is moderated by Melissa Sweet, a freelance journalist with a personal and professional bent towards public health perspectives. Regular contributors include members of the Crikey Health and Medical Panel.
Source: com.au

What Information Does The Medicare Website Provide?

The Medicare website is also useful resource in locating state organized sections of the Medicare program. Medicare is not the same in every state; however they are represented by many regional firms. This requires phone numbers and access, which Medicare provides as well as how often they do it. In this case from 7am to 7pm, Monday through Friday. There is also an automated 24 hour system in two languages, English and Spanish. Even when telephone help isn’t concerned, there is also an incredible amount of PDF’s to consult online.
Source: seniorcorps.org

Advocates Head To Court To Overturn Medicare Rules For Observation Care

Posted by:  :  Category: Medicare

Senate Dems Protest Medicare Cuts by Talk Radio News ServiceWhen seniors call Medicare to complain about observation status, the option to appeal is rarely mentioned. According to records of 316 complaints — the total Medicare said it received from beneficiaries or their representatives about observation since 2008 — a typical response was that Medicare “cannot intercede with hospital/physician regarding change of status.” In a response to one of dozens of congressional inquiries, officials “advised senators [Center for Medicare and Medicaid Services] cannot change a hospital stay classification.”
Source: kaiserhealthnews.org

Video: What is a Medicare health insurance exchange?

Study: Cuts to Medicare trim costs to insurers

Chapin White, a senior health researcher at the Center for Studying Health System Change, analyzed data on payment rates from 1995-2009 and found a widening gap between Medicare rates and private rates. Medicare had an average annual growth rate of 3 percent while private insurance grew more quickly — at 3.56 percent — he found.
Source: politico.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

Fact Check:Will Increased Longevity Bring Down Medicare?

The customary formulation of this myth is that Medicare is doomed by its own success in keeping its beneficiaries alive. Not only will the ranks of the program’s beneficiaries increase as the vaunted baby boom generation reaches the statutory age of eligibility, but because people are staying alive longer, Medicare’s costs will explode. The first part of this contention is indisputably true: entitlement to Medicare occurs when a person reaches age sixty-five, and the baby boom generation that is generally calibrated as starting in 1946 has arrived at that threshold. As a result, additional Medicare beneficiaries enter that program every day, and because the baby boom generation dwarfs any preceding age cohort, it is highly likely that more beneficiaries will be added to the program than are lost as older beneficiaries pass away. Consequently, the number of Medicare beneficiaries will inexorably increase over the next decade or so. Ceteris paribus, more beneficiaries mean higher aggregate costs.
Source: thehealthcareblog.com

Study: New "Medicare Essential" Option Could Save $180B

Medicare has been a popular health insurance program among beneficiaries since its inception, but a new benefits option could improve care and save an estimated $180 billion in national health spending over the next decade, according to a Commonwealth Fund report published in Health Affairs. Medicare currently covers the elderly and disabled for most hospital and physician treatment, but in order to be guarded against high out-of-pocket costs, beneficiaries still have to purchase supplemental plans — Medigap for copays and deductibles and Medicare Part D for prescription drugs. Researchers proposed a new benefits options called “Medicare Essential,” which would bundle hospital, physician, prescription drug and supplemental health coverage into one, all-encompassing health plan. They said Medicare Essential could “offer better financial protection than traditional Medicare does, including a limit on out-of-pocket spending,” and beneficiaries could also save money by “selecting medical providers that deliver high-value care.” Medicare Essential would basically set an out-of-pocket maximum for any beneficiary who wants to choose it, and it would be financed by traditional premiums — meaning it would not add to the federal deficit, and it would replace costly Medigap and Part D plans that mostly benefit private health insurers and pharmaceutical companies. Hospitals and physicians that agree to be reimbursed through Medicare Essential would be tagged as “high-value providers,” and Medicare beneficiaries who choose those providers could save money through reduced cost-sharing, the researchers wrote. “Given its potential, such an alternative should be a part of the debate over the future of Medicare. The nation needs a unified, patient-centered strategy to preserve access while securing a high-quality, more affordable health care system,” the authors wrote.
Source: beckershospitalreview.com

Cutting Health Care Waste, Medicare Fraud

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

Health Affairs Blog Post: Population Health Management in Medicare Advantage.

Wellnesss promotion.  A key component of PHM is the ability to promote health and wellness among all individuals, and MAOs reported extensive activities directly for members, including smoking cessation, wellness discounts, and the promotion of healthy lifestyles (exercise and nutrition).  In addition to promoting wellness, PHM requires monitoring of population risk and designing and implementing programs that manage sub-populations based on their risk.  Health risk assessments used universally by MAOs serve to segment populations at risk for disease.  For patients identified as being at risk for chronic conditions, common interventions include targeted health education or outreach to engage members in activities intended to reduce risk factors, enrollment in care management programs, and working with nurses in health education.
Source: ahipcoverage.com

Detroit health company worker pleads guilty in $24M Medicare fraud

If you enjoy the content on the Crain’s Detroit Business Web site and want to see more, try 8 issues of our print edition risk-free. If you wish to continue, you will receive 44 more issues (for a total of 52 in all), including the annual Book of Lists for just $59. That’s over 55% off the cover price. If you decide Crain’s is not for you, just write “Cancel” on the invoice, return it and owe nothing. The 8 issues are yours to keep with no further obligation to us. Sign up below.
Source: crainsdetroit.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

Is your Doctor Leaving the Medicare Program? Planning for Healthcare

Congress and the Obama administration continue to discuss the budget deficit, and cuts to Medicare are a part of the discussion. The Medicare sustainable growth rate (SGR) is a method the U.S. government uses to control spending on physician services by reducing the amount Medicare pays in order to reach target expenditures. The so-called “doc fix” has been used by Congress in the past to suspend or adjust these cuts. Now according to a 2010 American Medical Association (AMA) survey, one in five physicians are restricting the number of Medicare patients in their practice and one in three primary care doctors are restricting Medicare patients because of the ongoing threat of future payment cuts.
Source: parkinsonsresource.org

Feds 'listen' for sounds of Medicare billing abuse

The initial reaction from Sebelius and Holder came on the heels of the Center for Public Integrity’s “Cracking the Codes”  series, a year-long investigation which showed that thousands of medical professionals billed sharply higher rates for treating seniors over the last decade — adding $11 billion or more to their fees. The findings suggested billing abuses could be worsening as doctors and hospitals switch from paper to electronic health records.
Source: publicintegrity.org