Understanding Gerber Insurance Medicare Supplement

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Generally, Original Medicare health insurance is designed to help you pay for costs you incur when you receive health services. However, the coverage is designed not to provide coverage for certain services. Because paying for such services out of pocket can be very expensive, you will certainly need to look for additional coverage to cover the same and one of the policies you may consider buying to enhance your coverage is Gerber Insurance Medicare Supplement. .
Source: anoutfitforeveryseason.com

Video: Gerber Life Medicare Supplement

That You Simply Brief Overview To Gerber Medicare Supplements

Some Tax Lady Roni Deutch and the female law firm Roni Deutch, A Business Tax Corporation been recently helping taxpayers throughout the country find IRS tax bill relief for much more seventeen years. The firm employs experienced tax lawyers who can bout IRS tax liens on your part. Medicare insurance is the Associated with us health insurance plan for seniors and disabled people. It provides easy-to-follow medical coverage, and furthermore it really aids our seniors and furthermore disabled pay to get health care. But original Medicare does not pay for everything, and dental or vision benefits are not a lot of. Guys search at my photos of boomers like monoliths design. Having said that, living in fact, the Baby Boomers are distinctive brought on by each other slightly. For example, Medicare can possibly pay for a hospital stay in case of a perplexing dental procedure. But it could cover the actual dental work. For another example, Medicare does not likely usually cover eyewear or contacts. However, it is beneficial after intraocular contact cataract surgery. Using recent years, however, issues involving Why you should You Compare Medicare Supplement Plans and Benefits before purchasing one.have risen. Is all about about funding and simply universal health concern coverage plagued Medicare. There are in addition , issues that full coverage could usually sought with Medicare. Even the stuff involving the superior quality of health care that Medicare talks about have become some sort of source of inquiries from citizens. Such issues come to the spike in popularity connected with Medicare supplement plans, which are growing to be offered to Men and women by private insurance providers. Positive aspects plans are not ever standardized like Medigap Plans, so it’s in order to understand individual organize rules before you’ll enroll. Discover finding out that prescription drugs get covered. Tend to be all concerned thanks to our eyesight while teeth. Yet these services would be able to be expensive. It may wind up as time to look into some alternatives before you have a good emergency need. In absence of the specific insurance you dangers to be added to compensate rate of repair relating to another’s car and consequently expenses on rehab of the dupe. Therefore try to realize the good autoinsurance in the home business with high reputation. The good variant linked the insurance offers you side benefits, for example, danger of free towage of the poor car. Your initial of the clean proposed exemptions, participation in one of these two EHR Incentive Companies and adoption of a certified EHR system, is a response to critics who pointed out CMS that had been a conflict between the requirements of all of the eRx and its EHR Programs. Until there will most certainly be Medicare-certified EHRs about anesthesia services, technique exemption will not really of much consume to the homemade. Pain physicians may have adopted proficient EHR technologies, however, and if so, this exemption are inclined to shield them because of the 2012 eRx fee. Content management system estimates that 209,000 eligible professionals could be subject on the 2012 payment adjustment if they do not become eligible offerings – or order exemptions — based on claims data. In 2010, however, 100,444 professionals participated in the eRx Encouragement Program. Television . has certainly received hold in former specialties.
Source: typepad.com

A Real Brief Overview Of Gerber Medicare Vitamins

Also included in Medigap Plans is part B excess levies benefits. That available at total for plans F, I, and J, and 80 portion for plan T. Emergency care outside of the U.S acquired to cover 80 % of the are concerned costs during purchasers 60 days of every trip. This is available for insurance plans C through K. At home recovery reward is available when considering plans D, G, I, and C. It covers up with a certain amount on every custodial therapy visit after some sort of surgery, injury, or perhaps illness for up to a whopping a certain maximum benefit.
Source: starship7170.com

A Real Brief Overview Of Gerber Medicare Supplements

The specific Tax Lady Roni Deutch and her law firm Roni Deutch, A Top notch Tax Corporation already been helping taxpayers throughout the country find IRS duty relief for for seventeen years. The firm contains experienced tax lawyers who can bout IRS tax liens on your account. Medicare insurance is the Us all health insurance method for seniors and disabled people. It provides elementary medical coverage, and also it really products our seniors as well as a disabled pay relating to health care. But original Medicare insurance does not disburse for everything, in addition dental or eye-sight benefits are very limited. Men or women search at the photos of boomers like monoliths design. Having said that, at fact, the Baby Boomers are distinctive brought on by each other a bit more. Concerning example, Medicare perhaps pay for a major hospital stay in case of a perplexing dental procedure. But it nicely cover the actual dental work. For another example, Medicare does undoubtedly usually cover reading glasses or contacts. However, it pay after intraocular the len’s cataract surgery. Inside recent years, however, issues involving medicare supplement plan f.have risen. Is all about about funding and simply universal health correct care coverage plagued Medicare insurance. There are also issues that complete coverage could sometimes be sought with Treatment. Even the stuff involving the top notch of health treat that Medicare talks about have become some sort of source of questions from citizens. Such issues came to the rise in popularity related Medicare supplement plans, which are being offered to Men and women by private health insurance providers. Rewards plans are always standardized like Medigap Plans, so it’s in order to understand individual organize rules before your family enroll. Come about finding out which probably prescription drugs are covered. We are all concerned thanks to our eyesight and teeth. Unfortunately these services will likely be expensive. It may wind up as time to explore some alternatives before going to you have a certain emergency need. In absence of the specific insurance you exposure to be forced to compensate price of repair concerning another’s car and expenses on treatment of the dupe. Therefore try to search for the good autoinsurance in the company with high reputation. The good variant of the insurance offers you side benefits, for example, danger of free towage of the poor car. Early of the newly proposed exemptions, cooperation in one of the two EHR Incentive Courses and adoption within a certified EHR system, is a airport terminal attack critics who pointed out to CMS that there a conflict in between your requirements of the exact eRx and the EHR Programs. Until there seem to be Medicare-certified EHRs during anesthesia services, brand new strain exemption will stop being of much implementation to the profession. Pain physicians may have adopted competent EHR technologies, however, and if so, this exemption will shield them because of the 2012 eRx penalty. Content management systems estimates that 209,000 eligible professionals could potentially be subject on the 2012 payment resetting if they do not become eligible sellers – or maintain exemptions — centered on claims data. In 2010, however, 100,444 professionals participated in the eRx Incentive Program. The technology has certainly acquired hold in many other specialties.
Source: typepad.com

Gerber Medicare Supplement

[…] What will happen if I decide to call or email you about a quote? I will reply promptly with the information you requested and your information will be shared with no one. If you decide that this is not the program for you, I will have no hard feelings and will thank you for the opportunity.Source: newjerseyinsuranceplans.com […]
Source: newjerseyinsuranceplans.com

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

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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 marsmet522Both 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: Medicare Part C Overview

Beware of insurancelibary.com and Other Insurance

It is absolutely wrong to tell people that they give up Medicare Parts A and B to join a Part C Medicare Advantage health plan. In fact, you cannot get a Part C Medicare health plan unless you have Parts A and B. When a senior signs up for C, by law he or she gets all the benefits of A and B — plus catastrophic coverage and annual OOP limits — almost always at a lower cost than A and B plus a Medigap policy. Or — more typically — the senior gets many more benefits than A and B and Medigap combined for about the same cost as if they bought a Medigap policy to go with their Original Medicare.
Source: typepad.com

Picking a Plan During the Annual Enrollment Period? Choose Carefully 

[1] See Center’s Weekly Alert, “Annual Enrollment for Medicare Advantage (Part C) and Part D: October 15 – December 7” (October 11, 2012), available at: http://www.medicareadvocacy.org/2012/10/11/annual-enrollment-for-medicare-advantage-part-c-part-d-october-15-december-7/ [2] See CMS’ October 12, 2012 CMS Press Release “People with Medicare Have More High Quality Choices” available at: http://www.cms.gov/apps/media/press/release.asp?Counter=4459&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=1%2C+2%2C+3%2C+4%2C+5&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date ; also see CMS’ 2013 Plan Quality Data available at  http://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/PerformanceData.html. [3] For a discussion of the 5-star and other SEPs that might be available outside the Annual Enrollment Period, see, e.g., the Center’s Weekly Alert on the 2012 Annual Enrollment Period (September 22, 2011) available at: http://www.medicareadvocacy.org/2011/09/22/annual-enrollment-starts-october-15-and-ends-december-7-for-medicare-part-c-part-d-plans/  and “Annual Enrollment Period Ends – What if You Missed It?” (December 7, 2011) available at: http://www.medicareadvocacy.org/2011/12/07/annual-enrollment-period-ends-what-if-you-missed-it/. [4] See CMS’ 2013 Plan Quality Data, infra. [5] Id. [6] Id. [7] CMS’ 2013 Call Letter – “Announcement of Calendar Year (CY) 2013 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter (April 2, 2012), available at: http://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/downloads/Announcement2013.pdf ; also see CMS’ October 12, 2012 Press Release, infra. [8] Health Affairs, October 2012 vol. 31 no. 10 2259-2265; the abstract of this article is available on their website at: http://content.healthaffairs.org/content/31/10/2259.abstract#aff-2.
Source: medicareadvocacy.org

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

What is Medicare Advantage (Part C)?

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

Medicare Part C, Medicare Advantage Plans, What Does It Cover, Who Is Eligible

Before you enroll in a Medicare Part C plan you will have to enroll in Medicare Parts A and B. Generally, individuals are automatically enrolled in both if they are already receiving Social Security. Otherwise you will need to contact your local Social Security office to enroll. Once you are enrolled in Parts A and B you can select a Medicare Advantage Plan. For most people, this can all be done at the same time, when they turn 65 years of age. There is a seven month window to enroll which starts three months before your birthday month and ends three months after.
Source: bradeninsurance.com

Timely Billing Requirements: Medicare Part C Claims | Price Fass & Co., LLC

Possibly in the wake of the United States Court of Appeals decision in Loma Linda University Medical Center v. Kathleen Sebelius, Case No. 10-5116, CMS published a clarification of their timely billing requirements regarding “shadow billing” Medicare Part C claims. The Provider prevailed in their appeal of not having timely billed. The Court concluded that the Medical Center did not receive notice “with ‘ascertainable certainty,’ of the billing deadline for seeking payment for medical education costs associated with Medicare+Choice (Part C) inpatient days.”
Source: pricefass.com

Massachusetts Health Stats: What Hypocritical Bastards: Massachusetts Democrats Urge Obama Not to Cut Part C Medicare Advantage

This also has to be completely tying up the far-left-wing bigots that run the super- secret Massachusetts Elder Affairs lobby in their knickers. The Elder Affairs politicians, lobbyists and business people — who are on Councils on Aging, run custodial-care nursing homes, sell long-term care insurance, etc. — have been putting out propaganda against the Part C Medicare voucher program for years. Through SHINE and material they put out at senior centers, the Elder Affairs lobby subtly points seniors away from Part C Medicare coverage, although unlike Original Fee for Service (FFS) Medicare, Part C has catastrophic coverage, annual limits, ER coverage outside the U.S. and many other benefits not included in the FFS version of Medicare. In addition — in Massachusetts but not necessarily everywhere in the U.S. — the combination of public Parts A/B/C cost less than the combination of A/B/D and private Medigap insurance.
Source: typepad.com

Libertyville Tax Expert Guides You Through The New World of Medicare Decisions

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

MEDICARE PART D COSTS 2013

To be in a position to participate in Part D, Medicare members are typically needed to confirm their enrollment.  The annual interval for enrollment commences on November 15 and concludes on December 31 each and every 12 months.  However, effective 2013, the enrollment period of time will now be from October fifteen up to December 7.  Suitable Medicare beneficiaries who are unsuccessful to make it within the enrollment period of time can nevertheless enroll for Part D protection by paying out a late enrollment penalty or LEP.  The LEP is computed as one% of the nationwide average high quality multiplied by the number of full months of eligibility in which no enrollment was made.  
Source: 2013m.org

Income Thresholds For Medicare Part B And Part D Premiums

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TWO YEARS OF RUIN by SS&SSWhile the surtax due to higher Medicare premiums that resulted from the Roth conversion was not huge, at only 1.6%, it nonetheless represents an entirely manageable – and potentially avoidable – surtax that planners and clients should carefully consider. For instance, the client might have decided to convert only $27,000 in the prior example – rather than $39,350 – to keep from exceeding the $87,000 AGI threshold that triggers the first Medicare premium increase, allowing the conversion to have a cost of "only" the 25% marginal tax bracket, and not 26.6%. On the other hand, if the client’s income was higher, the impact would have been more severe. For instance, if AGI was already $85,000, then a $5,000 conversion would result in $1,250 of taxes (at a 25% tax) plus the same $619.20 (for additional Medicare premiums), which leads to a marginal "tax" of $1,869.20 and a marginal tax rate of 37.4%; on the other hand, if the conversion was $10,000, the marginal rate would only be 31.2% (since the additional taxes would rise to $2,500 but the Medicare premium impact would still be the same $619.20/year). The end result: the closer clients are to an income threshold, the better it is to either stay right below the line, or rise far above it until the next threshold (or a new tax bracket) approaches, because the additional Part B and Part D premiums are a flat additional amount even if clients are just $1 across the line (unlike tax brackets, which are always a percentage of additional income). And because the premium adjustments are calculated based on AGI, anything that increases AGI can impact exposure, from IRA withdrawals and Roth conversions, to capital gains, to dividends and interest and income from pass-through entities; on the other hand, any deductions that are taken above the line, such as capital losses or certain business losses, can also reduce exposure.
Source: kitces.com

Video: Medicare Part B_1.wmv

The Medicare Maze: Observation Stays, Nursing Home Costs, and “Invisible Patients”

We have all been traveling and have found ourselves party to a conversation because of proximity or bad cell phone etiquette. Some of these conversations are irritating, but I was looped into an interesting one the other day. Sitting in the Charlotte airport, two older men who looked like they were returning from a golf vacation started talking about enrolling in Medicare. One had just done it and the other had lots of questions. The recent enrollee said that he had registered through the Social Security web site; it took only ten minutes and was very easy. He told the other man that he only needed to sign up for part A, not for part B.
Source: wingofzock.org

Brace for higher Medicare Part B premiums

The Social Security Administration (SSA) uses the tax figures from two years ago to determine the Part B premiums. Thus, the MAGI reported on a taxpayer’s 2011 tax return determines whether the taxpayer must pay a higher monthly Part B premium in 2013. For example, a single filer with a MAGI of $150,000 in 2011 will have to pay a monthly Medicare Part B premium of $209.80 in 2013.  
Source: businessmanagementdaily.com

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

Both 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

Medicare Part B Premiums Up $5 Per Month Next Year

CQ HealthBeat: Medicare Part B Premium Increase Modest For 2013 With health care inflation relatively stable, officials at the Centers for Medicare and Medicaid Services released rules Friday that include a $5-per-month increase in Medicare Part B premiums and a $28 hike in the hospital inpatient deductible. The Part B premium will reach a milestone, however, topping $100 a month. The monthly payment for Part B, which covers doctor visits, outpatient hospital services, home health care and other items, will be $104.90 next year, compared to the current $99.90. And the deductible for inpatient hospital stays will go to $1,184 in 2013 from $1,156 this year. One item will be decreasing: the Part A monthly premium, which pays for inpatient hospital stays, skilled nursing facilities and some home care for about 1 percent of Medicare beneficiaries who do not automatically qualify for the program. That premium will be $441 a month, down $10 a month from this year (11/16).
Source: kaiserhealthnews.org

I’m Paying More than $104.90 for Medicare’s Part B!! How Can I Appeal This?? » Toni Says

            I don’t understand why I am paying more for my Part B premium.  When I called Social Security, the agent told me that Part B was $104.90, but my letter says that based on me and my husband’s income, Part B for me will be $230.70.  Now that I have retired, I don’t make what I did. What can I do if I do not think I should pay a higher Part B premium?  Thanks in advance…Susan K from Spring, TX
Source: tonisays.com

Mastering the Mysteries of Medicare

Medicare Part A is for hospital benefits; typically you have already paid into the system through work, so you don’t have a premium for Part A. Medicare Part B has a premium; it covers outpatient services, i.e., doctor visits. If you take advantage of both A and B, you’re eligible for Part C, the Medicare Advantage plan, which gives you medical and drug coverage under the same umbrella. However, Medicare Advantage Plans require that all your doctors be in the same medical group, and that group has to accept the Advantage plan.  Also, if you’re anticipating a hospitalization or outpatient surgery or an MRI exam, you should hone in on what your co-pays (what you will be expected to pay out of pocket) will be under the plan, Hogan says.
Source: womencentric.net

Ask The Experts: Retirement

A. Obviously. The first number you look at is always the cost of premiums for Part B, which would be in addition to your FEHB premiums. However, the arithmetic doesn’t stop there. You need to review your plan brochure to see how your plan will reimburse your medical insurance coverage services if you don’t elect Part B. Then you need to review the benefits that each plan provides to see if they either supplement each other or provide coverage where none would otherwise exist. Finally, put what you’ve learned up against what you think your current and future health needs will be. When you are done, you may conclude that you don’t need Part B, or that you do. The decision is up to you. However, do it with more thought than you have put into it so far.
Source: federaltimes.com

AARP Statement on 2013 Medicare Part B Premium Increase

AARP is a nonprofit, nonpartisan organization, with a membership of more than 37 million, that helps people 50+ have independence, choice and control in ways that are beneficial to them and society as a whole. AARP does not endorse candidates for public office or make contributions to either political campaigns or candidates. We produce AARP The Magazine, the definitive voice for Americans 50+ and the world’s largest-circulation magazine; AARP Bulletin, the go-to news source for the 50+ audience; AARP VIVA, a bilingual lifestyle multimedia platform addressing the interests and needs of Hispanic Americans; and national television and radio programming including My Generation and Inside E Street. The AARP Foundation is an affiliated charity that provides security, protection, and empowerment to older persons in need with support from thousands of volunteers, donors, and sponsors. AARP has staffed offices in all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. Learn more at www.aarp.org.
Source: aarp.org

Medicare open enrollment: Did Obamacare secretly increase Part B premiums?

Here’s what’s happening. The 2003 law that set up these high-income premium surcharges also stated that the income thresholds were to increase every year to account for general inflation. But the Affordable Care Act freezes the thresholds at their current level through 2019, which will over the next six years snare more and more beneficiaries as incomes in general rise (or at least we hope they do). The Kaiser Family Foundation estimates that by 2019, about 14 percent of Medicare beneficiaries will be paying these higher premiums.
Source: consumerreports.org

Medicare Application, Medicare Official Site, Application Form For Medicare, : 2011 Medicare Trustees Report

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Source: projectedu.com

Video: Medicare.gov Ad with Leslie Nielsen 2

Medicare Essential Plan Worth Considering

According to a new report from the Commonwealth Fund and Johns Hopkins Bloomberg School of Public Health, beneficiaries could save $63 billion in direct costs through 2023, with anywhere from 17 to 40 percent lower out-of-pocket expenses than recipients currently lay out. Other savings would come through simplified administrative costs, additional value-based health care decisions, and shifting beneficiaries into patient-centered medical homes and accountable care organizations that meet high standards for care coordination and management of high-risk, high-cost conditions.
Source: healthworkscollective.com

www.mymedicare.gov Interactive Medicare Portal

www.mymedicare.gov Interactive Medicare Portal Register for a MyMedicare.gov account  free and secure online Web site providing Medicare, Welcome to Medicare’s free, protected on the internet assistance for obtaining customized details regarding your Medical wellness insurance benefits and solutions. The MyMedicare.gov website, which is Medicare’s protected on the internet assistance allowing people, or maybe your current designee, to access your individual.Medical wellness insurance details, such as medical care claims, precautionary solutions, Medicare Summary Notices (MSNs), and more.The Centers for Medical wellness insurance & State medicaid programs Services, a division of the Department of Health insurance coverage Human Services , is the federal agency that runs the Medical wellness insurance Program and watches State medicaid programs programs offered by each state.
Source: blogspot.com

Restoring The Republic II – Social Security, Medicare and Soylent Green

Clearly, this will not be a sustainable course of action. The size of these programs will grow. The demographics of our nation dictate that the number of people paying into them will decrease. We can do some simple mental calculus to demonstrate the approaching Big Government Chernobyl Event that will occur if this trend is left unchecked. The cost of entitlements is upward monotonic for an infinite period of time. The number and the wealth of the workers paying taxes grow infinitesimally small in comparison to the population of tax-eaters. These entitlement programs go out of business due the ridiculous balance of payments.
Source: redstate.com

Study Takes on the Myth of Medicare Cost Shifting

Contrary to the theory, I found that hospital markets with relatively slow growth in Medicare inpatient hospital payment rates also had relatively slow growth in private hospital payment rates during 1995–2009. Using regression analyses, I found that a 10 percent reduction in Medicare payment rates led to an estimated reduction in private payment rates of 3 percent or 8 percent, depending on the statistical model used.
Source: firedoglake.com

Superannuation – Medicare Super Clearing House (Login Errors)

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Source: com.au

A Viable Medicare Physician Payment Policy’ that Will Repeal SGR

ACP, Dr. Cutler noted, strongly believes that the patient-centered medical home (PCMH) and PCMH-Neighbor models are ready to be a part of this new, value-based health care payment and delivery system

USDOJ: Health Care Clinic Director Pleads Guilty in Miami for Role in $63 Million Fraud Scheme

Posted by:  :  Category: Medicare

Healthcare in America: Who's Paying Who? And Who's Getting What? (g1a2d0014c1) by watchingfrogsboilA former health care clinic director and licensed clinical psychologist pleaded guilty today in connection with a health care fraud scheme involving defunct health provider Health Care Solutions Network Inc. (HCSN), announced Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division; United States Attorney Wifredo A. Ferrer of the Southern District of Florida; Michael B. Steinbach, Special Agent in Charge of the FBI’s Miami Field Office; and Special Agent in Charge Christopher B. Dennis of the United States Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami office. Alina Feas, 53, of Miami, pleaded guilty before United States District Judge Cecilia M. Altonaga in the Southern District of Florida to one count of conspiracy to commit health care fraud and one substantive count of health care fraud.  During the course of the conspiracy, Feas was employed as a therapist and clinical director of HCSN’s Partial Hospitalization Program (PHP).  A PHP is a form of intensive treatment for severe mental illness.  HCSN operated two community mental health centers in Florida and one community mental health center in North Carolina. In her capacity as clinical director, Feas oversaw the entire clinical program and supervised therapists and other personnel at HCSN in Florida (HCSN-FL).  Feas also conducted group therapy sessions when therapists were absent.  According to court documents, Feas was aware that HCSN-FL paid illegal kickbacks to owners and operators of assisted living facilities (ALF) in Miami-Dade County in exchange for patient referral information to be used to submit false and fraudulent claims to Medicare and Medicaid.  Feas knew that many of the ALF referral patients were ineligible for PHP services because they suffered from either mental retardation, dementia or Alzheimer’s disease, which are not effectively treated by PHP services.  Court documents reveal that Feas submitted claims to Medicare for individual therapy she purportedly provided to HCSN-FL patients using her personal Medicare provider number, knowing that HCSN-FL was simultaneously billing the same patients for PHP services.  Feas continued to bill Medicare under her personal provider number while HCSN in North Carolina (HCSN-NC) simultaneously submitted false and fraudulent PHP claims. Feas was aware that HCSN-FL personnel were fabricating patient medical records, according to court documents. Many of these medical records were created weeks or months after the patients were admitted to HCSN-FL for purported PHP treatment and were utilized to support false and fraudulent billing to government sponsored health care benefit programs, including Medicare and Florida Medicaid.  During her employment at HCSN-FL, Feas signed fabricated PHP therapy notes and other medical records used to support false claims to government sponsored health care programs. At HCSN-NC, Feas was aware that her co-conspirators were fabricating medical records to support the fraudulent claims she was causing to be submitted to Medicare.  Feas was aware that a majority of the fabricated notes were created at the HCSN-FL facility for patients admitted to HCSN-NC.  In some instances, Feas signed therapy notes and other medical records even though she never provided services at HCSN-NC.  According to court documents, from 2004 through 2011, HCSN billed Medicare and the Florida Medicaid program approximately $63 million for purported mental health services. Fifteen defendants have been charged for their alleged roles in the HCSN health care fraud scheme, and 13 defendants have pleaded guilty.  On April 25, 2013, Wondera Eason was convicted, following a five-day jury trial, on one count of conspiracy to commit health care fraud for her role in the scheme at HCSN.  Alleged co-conspirator Lisset Palmero is scheduled for trial on June 3, 2013.  Defendants are presumed innocent until proven guilty at trial. This case was prosecuted by Trial Attorney Allan J. Medina and former Special Trial Attorney William J. Parente.  This case is being investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the United States Attorney’s Office for the Southern District of Florida.     Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,480 defendants who have collectively billed the Medicare program for more than $4.8 billion.  In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers. To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.  Contact: Department of Justice Main Switchboard – 202-514-2000 Reported by: US Department of Justice
Source: 7thspace.com

Video: Medicare Provider Enrollment 3.wmv

Providers Face Growing Demands From Increasing Number of Medicare Contractors

First there is the general category of claims processing contractors, now mainly known as “Medicare administrative contractors” (MACs) but also referred to, still, in statutes, laws and judicial decisions, as fiscal intermediaries or carriers. MACs are involved in the first level of appeals and may contact providers for a variety of reasons, including the resolution of issues regarding initial and renewal enrollment applications; providing education and guidance on procedures for billing Medicare; resolving issues regarding claims; requesting medical records related to claims that have been submitted so the MAC can perform a medical review; paying providers for approved claims or explaining why some claims are not processed or are denied; and recovering overpayments on claims previously processed. CMS uses Qualified Independent Contractors to conduct reconsiderations, the second level of appeals.
Source: wolterskluwerlb.com

Study Takes on the Myth of Medicare Cost Shifting

Contrary to the theory, I found that hospital markets with relatively slow growth in Medicare inpatient hospital payment rates also had relatively slow growth in private hospital payment rates during 1995–2009. Using regression analyses, I found that a 10 percent reduction in Medicare payment rates led to an estimated reduction in private payment rates of 3 percent or 8 percent, depending on the statistical model used.
Source: firedoglake.com

beSpacific: Administration offers consumers unprecedented look at hospital charges

“As part of the Obama administration

Obama’s Shakedown of Medicare

Posted by:  :  Category: Medicare

The Congressional Budget Office (CBO) predicts that at least 7 million people will be dropped from their employer health plan because of Obamacare, but the CBO also said that the figure could well rise to 20 million. Of course employers will take advantage of Obamacare to shift the cost of health care onto individuals, in the same way that employers shifted away from defined pension plans and onto the 401(k) scheme. Several employer surveys have reported that companies plan to dump their employee health care plans by the millions.
Source: workerscompass.org

Video: AmericasDemocrats.org — Economist Galbraith Warns Against Compromising on Social Security, Medicare

Medicare Advantage 2012 Spotlight: Plan Availability and Premiums

This brief highlights trends in the Medicare Advantage marketplace, including the choices available to Medicare beneficiaries in 2012, premium levels and other plan characteristics. The brief was authored by researchers at Mathematica Policy Research and the Kaiser Family Foundation.
Source: kff.org

Debunking Medicare Myths: Drug Rebates for Dual Eligibles 

[1] Center for Medicare Advocacy, "So, What Would You Do? Real Solutions for Medicare Solvency and Reducing The Deficit", available at: http://www.medicareadvocacy.org/2011/06/so-what-would-you-do-real-solutions-for-medicare-solvency-and-reducing-the-deficit/. [2] Senator Jay Rockefeller, Press Release, available at http://www.rockefeller.senate.gov/public/index.cfm/press-releases?ID=617fffeb-4c5a-4123-a5b3-1f8b790e5f8b. [3] Ben Adams, InPharm, "U.S. Prescription Drug Prices Rise Above Inflation", August 27, 2010, available at: http://www.inpharm.com/news/us-prescription-drug-prices-rise-above-inflation. [4] AARP Public Policy Institute, Rx Watchdog Report: Brand Name Drug Prices Continue to Climb Despite Low General Inflation Rate, available at: http://assets.aarp.org/rgcenter/ppi/health-care/i43-watchdog.pdf. [5] Committee on Oversight and Government Reform, "Private Medicare Drug Plans: High Expenses and Low Rebates Increase the Costs of Medicare Drug Coverage", October 2007, available at: http://www.allhealth.org/briefingmaterials/housemajoritystaff-965.pdf. [6] Id. [7] GAO, Prescription Drugs: Trends in Usual and Customary Prices for Commonly Used Drugs, available at: http://www.gao.gov/new.items/d11306r.pdf. [8] PhRMA, 2011 Profile Pharmaceutical Industry, available at: http://www.phrma.org/sites/default/files/159/phrma_profile_2011_final.pdf. [9] Mac-Andre Gagnon, Joel Lexchin, "The Cost of Pushing Pills: A New Estimate of Pharmaceutical Promotion Expenditures in the United States", January 2008, available at: http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050001. [10] Center for Medicare Advocacy, "Keeping Medicare and Medicaid Strong?" available at: http://www.medicareadvocacy.org/2011/04/keeping-medicare-and-medicaid-strong/. 
Source: medicareadvocacy.org

Advocates Head To Court To Overturn Medicare Rules For Observation Care

When 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

Preserving Medicare for Future Generations: Market

America’s fee-for-service Medicare program represents the third-largest category of federal spending and has been under scrutiny for decades for spending more on health care benefits for enrollees than taxes can generate to pay for them. The CBO estimates that over the next 10 years, the number of Medicare enrollees will increase by one-third—approaching 67 million Americans.
Source: rwjf.org

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 Advantage – or DISAdvantage?

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

How the Sequester Could Affect Social Security, Medicare and More

What could happen to my retirement investments? That’s anyone’s guess. Many Wall Street analysts think the stock market will tumble as a result of the projected decline in gross domestic product — and the gridlocked situation in Washington. Others, though, think the markets will show little change — and even improve in the long run. So, depending on where your money is, this could have different effects on your portfolio. Still, all this is highly speculative at this point.
Source: aarp.org

Social Security Reform and Medicare Modernization Proposals

The time has come for realistic immigration solutions that will both strengthen national security and boost economic growth. America needs an immigration system that places more resources toward enforcement of laws, produces a more dynamic and skilled labor force, and enables U.S. businesses and workers to compete more effectively in the global marketplace. Getting reform right is essential to a healthier economy — accelerating growth, encouraging hiring and creating jobs.
Source: businessroundtable.org

Single Payer Advocates Says Medicare for All Remains the Solution in Light of US Supreme Court Ruling : Single Payer New York

Only a single payer system can provide truly universal comprehensive coverage without regard to age, income, health or employment status. It is a publicly administered non-profit system, accountable to the people, with no premiums, no deductibles, no co-pays and no co-insurance. It will comprehensively cover all medically necessary health care services. All Americans will have access to medical care when they need it with a right to choose physicians and hospitals.
Source: singlepayernewyork.org

A repeat trip down the expressway to cutting Medicare, Medicaid and repealing the ACA

“Can I be honest with you? I don’t have any money. But I can’t stand this anymore, I can barely walk it hurts so bad. Everybody told me I need to go the hospital but I don’t have any money and I don’t know what they are going to say. I got my wife and kids and I work, but you know I just don’t have more money for the hospital. And I need to go back to work. Can you just do something so I can go to work?”
Source: seiu.org

Centers for Medicare and Medicaid Release Mammography Booklet

Posted by:  :  Category: Medicare

In early March, the Centers for Medicare and Medicaid released the “Screening and Diagnostic Mammography” booklet in both a downloadable and hard copy format. This booklet is designed to provide education on early diagnosis and treatment of breast cancer. It includes information on screening mammography, diagnostic mammography, as well as other provider and beneficiary resources.
Source: ons.org

Video: TRS-Care Aetna Medicare Plans

A Simple Primer on Medicare Benefits Written for Patients and YOU!

Strategist, Rehabilitation Management, MediServe a Mediware Company; Darlene is a PT with an MBA in Healthcare Management, in her role, as a Rehab Mgmt Strategist she brings information to leadership that help guide practice strategy. Her focus is to assist clients nationally in the use of charting data to drive clinical and financial performance in support of decisions for best practices in meeting rehabilitation compliance, outcomes, revenue and efficiency. Since February 2011, Darlene has visited more than 30 IRF locations to assist in guiding C.O.R.E. (Compliance, Outcomes, Revenue, Efficiency/Effectiveness), performance improvement plans. Working in rehab medicine for greater than 30 years, Darlene spent 12 years in executive leadership as a Director of Rehabilitation and Operations. Therapy oversight included three post-acute service lines: acute inpatient rehabilitation (IRF), skilled and outpatient hospital-based services and is LEAN trained in healthcare. At various points in her career, Darlene had oversight of rehabilitation admissions, marketing, quality improvement, dietary & maintenance. Her responsibilities have included compliance toward Federal Regulations and leading CARF and Joint Commission standards of practice. Her experience includes Quality Improvement Chair, Lean Healthcare Trainer Certification and Vice President of the Board of Directors for the Ohio Association of Rehabilitation Facilities (OARF). Darlene lectures and writes blogs on post acute care topics that include federal guidelines, post acute admissions, managing outcomes, documentation, and rehabilitation marketing. www.mediserve.com/blog
Source: mediserve.com

Medicare to Cover More Home Health Services

In the past, Medicare recipients were unable to receive home health services such as nursing care and therapies if they had a chronic condition. As a result of a court case that originated in Vermont, that is about to change. Vermont Chief Judge Christina Reiss signed off on the settlement after a hearing on January 24, 2013. The settlement will apply nationally, and it will mean a big change from the current practice. At present, the Medicare recipients had to have had a reasonable chance of recovering from the condition before they could receive rehabilitative services in the home. Of course, sometimes it is difficult to make that prediction, so this ruling represents a giant step forward for patients. Now, they will be able to receive skilled nursing services as well as speech therapy and occupational therapy in the home, despite the fact that the patient may not fully recover. Those enrolled in both fee-for-service Medicare and private Medicare Advantage plans will also have this option.
Source: 2020insight.com

UCSF HR/Benefits Open Enrollment 2010: Oops

You should know, there is inaccurate information about Medicare on page 4 of the hard copy of your Open Enrollment Booklet. The information indicates that employees/and or family members that become Medicare eligible must enroll in Medicare and in a Medicare coordinated plan. This is absolutely wrong! If you continue working at UC past age 65, you are not required to sign up for Medicare Part B. In fact, you may delay enrollment, without penalty and the University does not even provide a Medicare coordinated plan option for employees that have not yet retired. For more information, see the Medicare Factsheet [PDF] and/or contact Social Security at 800-772-1213. A corrected version of the Open Enrollment booklet is available online.
Source: blogspot.com

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Source: lefora.com

Wessays ™: 770 The Medicare Booklet

Guess they need the money to print up those pretty brochures. One “chapter” is called “We’re Always Right Here, Close at Hand.” So let’s make a phone call. Three minutes of introductory blahblah on cell phone prime time, and then someone answers the phone, but can’t answer the question which was “how much are the rates going to rise NEXT year.” “We’ll be sending out notices in the next week or so, sir. But I don’t have the information now.” Hell you don’t. You just don’t want to say because you don’t want your customers calling around to find a better deal. Are you going to call back to answer the question once you admit to having the information? Hold your breath.
Source: blogspot.com

CMS Proposes To Further Tighten Medicare Provider Enrollment Rules

Posted by:  :  Category: Medicare

Ms. Stamer has extensive experience advising and assisting health care providers and other health industry clients to establish and administer compliance and risk management policies and to respond to DEA and other health care industry investigation, enforcement and other compliance, public policy, regulatory, staffing, and other operations and risk management concerns. A popular lecturer and widely published author on health industry concerns, Ms. Stamer continuously advises health industry clients about compliance and internal controls, workforce and medical staff performance, quality, governance, reimbursement, and other risk management and operational matters. Ms. Stamer also publishes and speaks extensively on health and managed care industry regulatory, staffing and human resources, compensation and benefits, technology, public policy, reimbursement and other operations and risk management concerns including a number of programs and publications on OCR Civil Rights rules and enforcement actions. Her insights on these and other related matters appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, World At Work, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications.  You can get more information about her health industry experience here. If you need assistance with these or other compliance concerns, wish to ask about arranging for compliance audit or training, or need legal representation on other matters please contact Ms. Stamer at (469) 767-8872 or via e-mail here. 
Source: wordpress.com

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

Revalidation of Medicare Enrollment

All providers who enrolled with Medicare prior to March 25, 2011, will be required to revalidate their Medicare enrollment. Providers have 60 days from the date of the revalidation notice to submit their complete enrollment information. The fastest, easiest, and most secure way to complete revalidation is by Internet-based PECOS. For this reason, WPS Medicare encourages all providers to utilize the Internet-based Provider Enrollment, Chain and Ownership System (PECOS) for revalidating with the Medicare program. For more information about revalidation to to the WPS Medicare website.
Source: mi-osteopathic.org

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

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

From the Contributor’s Corner: CMS Proposes Increasing Rewards for Whistleblowers

The proposed rule would strengthen the Medicare provider enrollment process by authorizing enrollment denials under certain situations. Additional provisions would allow for Medicare enrollment denial or revocation if the provider or supplier has been convicted of any federal or state felony in the previous 10 years that CMS considers harmful to the program or engaged in Medicare billing patterns that did not meet Medicare standards.  It would also reduce the ability of ambulance providers to bill Medicare for services provided before they enrolled with Medicare and require providers and suppliers who have their Medicare enrollment revoked to submit any remaining claims within 60 days of the revocation. 
Source: wolterskluwerlb.com

Medicare Advantage 2012 Data Spotlight: Enrollment Market Update

This data spotlight examines the growth in private Medicare Advantage plan enrollment in 2012, with a record 13 million Medicare beneficiaries enrolled as of March, representing 27 percent of all Medicare beneficiaries. Enrollment jumped by more than 1 million enrollees from the previous year and increased in every state except Alaska and New Hampshire.
Source: kff.org

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

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

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

Roundup: Feds Cut N.Y. Medicaid Payments $1.2B; 93,000 Fewer Kids Enroll In CHIP In Pa.

Posted by:  :  Category: Medicare

OWS_18_oct_DSC_0144 by Michael FleshmanCalifornia Healthline: Changes Set Stage For ‘Shakeout’ Of Medical Suppliers, Services Shifts in contracting practices — part of the trickle-down effects of health care reform — are going to change the landscape of medical equipment and service suppliers in California, stakeholders predict. … Bob Achermann, executive director of the California Association of Medical Product Suppliers … predicted the number of California businesses providing medical supplies and services may be cut in half over the next few years. Two changes are at the heart of the “thinning of the herd,” as Achermann calls it. One is state-driven: California is shifting beneficiaries of Medi-Cal — California’s Medicaid program — from fee-for-service to managed care. The second is a federally mandated change in the way Medicare contracts with suppliers (Lauer, 4/1).
Source: kaiserhealthnews.org

Video: New York: Medicare Fraud Summit Closing Remarks

ICYMI: New York Times Economix Blog Highlights Higher Quality Care Medicare Advantage Plans Provide

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Source: ahipcoverage.com

Single Payer Advocates Says Medicare for All Remains the Solution in Light of US Supreme Court Ruling : Single Payer New York

Only a single payer system can provide truly universal comprehensive coverage without regard to age, income, health or employment status. It is a publicly administered non-profit system, accountable to the people, with no premiums, no deductibles, no co-pays and no co-insurance. It will comprehensively cover all medically necessary health care services. All Americans will have access to medical care when they need it with a right to choose physicians and hospitals.
Source: singlepayernewyork.org

Hospitals Charge Medicare ‘Wildly Different Amounts’

Collaborative Justice: Transforming Criminal Justice Services Through Unified Collaboration This issue brief examines video collaboration in every stage of the human justice process, demonstrating how this technology can not only make services more efficient, affordable, and accessible. Cloud-Based Services Accelerate Public Sector Adoption of Video Collaboration Today, thanks to new cloud technologies and high-quality networks, mobile video services – which provide not only cost savings but which help governmental interactions become more efficient – are more feasible than ever before. Modernization as a Service: Acquiring IT through Innovative Procurement Five Ways Collaboration is Driving Government Performance Mobile Video Collaboration: The New Business Reality
Source: govtech.com

Kazor.com World Community News

The state of New York has several major public health insurance programs, including Medicaid, commonly known as “Regular Medicaid.” While Regular Medicaid in New York offers extensive health care services including: dental care; diagnostic testing; home care; hospitalization; mental health support; out-patient care at hospitals and community clinics; and physical therapy, clients of Medicaid in […]
Source: kazor.com

Weekly Dose of Health News

Beginning in January of 2014, millions of low-income adults will gain health insurance through Medicaid under the terms of the Affordable Care Act.  A new study, called the Oregon Health Insurance Experiment , provides some insight on how access to Medicaid coverage will change the lives of the individuals who will have access to care.  The study is the first time that a randomized controlled design was used to evaluate Medicaid in the United States.  The study’s results new research suggests the government insurance plan for the poor has only a mixed record of improving health. However, the results also showed that Medicaid beneficiaries are less likely than the uninsured to have catastrophic medical expenses and significantly less likely to suffer from depression.
Source: newyorkhealthworks.com

Medicare Needs Fixing, but Not Right Now (The New York Times) 

In a story about the future of Medicare and how the government will pay for the care of older Americans, Elliott Fisher, a professor of medicine at The Dartmouth Institute for Health Policy and Clinical Practice (TDI), a professor of community and family medicine at the Geisel School of Medicine, and director of the Center for Population Health at TDI, tells The New York Times that Medicare spending per person varies widely throughout the United States regardless of the quality of the care. Bringing the entire country in synch with the prevailing hospital-stay lengths of Medicare enrollees in Oregon and Washington would result in a dramatic savings, Fisher tells the Times.
Source: dartmouth.edu

See What Area Hospitals Billed Medicare for Common Procedures

Partly sunny. Chance of showers during the predawn hours…then showers likely early in the morning. Slight chance of light showers in the afternoon. Breezy. Highs in the upper 50s. Light and variable winds during the predawn hours becoming southwest 10 to 15 mph early in the morning…then becoming northwest and increasing to 15 to 25 mph with gusts up to 35 mph in the late morning and afternoon. Chance of precipitation 60 percent.
Source: patch.com

Reader Response: Medicare Options and Quality of Care

Medicare beneficiaries self-select into traditional Medicare or Medicare Advantage plans. They may differ systematically in characteristics that could indirectly affect readmission rates. Age and health status are two characteristics that can usually be measured and might be included in the available data set; but there may be others not included. Researchers try as best they can to make statistical adjustments for differences in the characteristics among self-selecting beneficiaries, as the authors of all of the studies cited in my previous post did. But the adequacy of these adjustments depends on the available data. Typically researchers acknowledge such limitation of their studies forthrightly in their reports.
Source: nytimes.com

Nationalized health care would have saved Medicare an extra $34.1 billion in 2012, say advocates

“We’ve long known that Medicare has been paying private insurers more than if their enrollees had stayed in traditional fee-for-service Medicare, but no one had added up the total extra cost to the taxpayer since contracting with private insurers began 27 years ago,” said Hellander, lead author of the study. “Nor has anyone systematically examined the many ways that private insurers have gamed the system to maximize their bottom line at taxpayers’ expense. In 2012 alone, private insurers are being overpaid $34.1 billion, or $2,526 per Medicare Advantage enrollee.”
Source: sciencecodex.com

Have the Tides Turned for Medicare Advantage Plans in New York? By Myco Dang

The Court then concluded that the New York statute is preempted as it applies to MAOs and that the Plaintiffs claims concerning MAOs reimbursement rights arise under the Medicare Act. (Potts, page 13). In its ruling, the Court looked at the Supremacy Clause of the Constitution, U.S.Const.Art. VI, cl.2, “[w]here a state statute conflicts with, or frustrates, federal law, the former must give way.” CSX Transp., Inc. v. Easterwood, 507 U.S. 658, 663 (1993). “If the statute contains an express preemption clause, the task of statutory construction must in the first instance focus on the plain wording of the clause, which necessarily contains the best evidence of Congress’ preemptive intent.” CSX Transp., 507 U.S. at 664. In turn, the Court ruled that the Medicare Act contains a very broad, express preemption clause. The statute provides that “[t]he Secretary shall establish by regulation other standards . . . for [MA organizations] and plans consistent with, and to carry out, this part.” 42 U.S.C. § 1395w-26(b)(1). The statute further provides, under a sub-paragraph headed “Relation to State Laws”: “The standards established under this part shall supersede any State law or regulation (other than Case 1:11-cv-09071-JPO Document 33 Filed 09/25/12 Page 13 of 22 14 See also 42 C.F.R. § 422.402. (Potts, page 13-14).
Source: xerox.com

Medicare Pulls Back Curtain On Hospital Bills

Take, Hartford, Conn., for instance, health insurance capital of the U.S. Hartford Hospital, the biggest one in town, charges a tad over $15,000 to treat a Medicare patient diagnosed with chest pain and receives $4,975 for the service. Little Charlotte Hungerford Hospital, in nearby Torrington, charges Medicare about $7,000 and receives $3,713.
Source: northernpublicradio.org

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

Posted by:  :  Category: Medicare

Yarmuth Meeting 3 by Greater Louisville Medical SocietyHospitals 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

Video: Rep. Gingrey Discusses Medicare Reimbursement Rates

Medicare Payment Rates Should Not Be Based on Region, IOM Panel Says

As long as FFS mentality drives reimbursement, this problem will simply waffle from one inintended consequence to another. Regions with much higher cost of living will have higher baseline hospital costs and physician overhead. Abrupt rate cuts there will predictably drive providers out of Medicare…and Medicare patients into trouble. On the flip side, waste in excessive admission rates and excessive procedures in low cost areas already hides behind geographic indices. You can’t solve both problems with one switch. Some regional adjustment coupled with palpable risk may solve it. It works here for Medicare Advantage. Meanwhile, the disconect between hospital regional rates and individual provider rates has been known for a decade…and stonewalled.
Source: californiahealthline.org

Medicare Plans to Boost Hospital Reimbursement Rates

“Dedicated professionals are working day and night in hospitals to provide the care that Medicare beneficiaries need,” Marilyn Tavenner, the acting administrator of the agency that runs Medicare, said in a statement. “The new policies in this proposed rule support hospitals’ important work and the people with Medicare who depend on them by promoting safety and care improvement.”
Source: medbill.net

Mass. Medicare Reimbursement Rates Draw Scrutiny

When hospital executives talk about Medicare, they often bemoan low reimbursement rates, but Massachusetts hospitals have been enjoying reimbursement rates that are now drawing protests from 21 states. Medicare regulations require that all providers in a state receive reimbursement rates that are at least as high as those given to a state’s rural hospitals. In Massachusetts, only one hospital out of 82 qualifies as rural: Nantucket Cottage Hospital. The hospital serves the island of Nantucket’s approximately 10,000 permanent residents, though that total swells to approximately 50,000 people in summer. This is due to the amount of vacation homes on Nantucket, where the median home price is over $1 million.
Source: nonprofitquarterly.org

UnitedHealth Jumps As Medicare Reimbursement Rates Raised

UnitedHealth may continue to witness a decline in its fully insured commercial customers in the near term as more businesses are seen covering healthcare costs themselves while they hire the insurer to manage healthcare benefits due to persistently high unemployment and weak macroeconomic conditions. High unemployment levels have had an adverse impact on the number of employer-sponsored health insurance enrollments while Medicaid enrollments have increased steadily. Additionally, many employers have cut healthcare benefits in response to market conditions. However, beginning 2014, we expect the economy to improve. This should increase employer-sponsored health coverage along with the quality of those plans (which will in turn bring higher premiums).
Source: trefis.com

Nationalized health care would have saved Medicare an extra $34.1 billion in 2012, say advocates

“We’ve long known that Medicare has been paying private insurers more than if their enrollees had stayed in traditional fee-for-service Medicare, but no one had added up the total extra cost to the taxpayer since contracting with private insurers began 27 years ago,” said Hellander, lead author of the study. “Nor has anyone systematically examined the many ways that private insurers have gamed the system to maximize their bottom line at taxpayers’ expense. In 2012 alone, private insurers are being overpaid $34.1 billion, or $2,526 per Medicare Advantage enrollee.”
Source: sciencecodex.com

Yikes! Medicare sticker shock!

You think our Chock Full o’ Nuts example is bad? Try these examples: • Treatment for heart failure in Denver can range from $21,000 to $46,000. • One Dallas hospital charged $14,610 to treat pneumonia, while another charged $38,000. • A joint replacement that costs $5,300 in Ada, Okla., can be billed for as much as $223,000 in Monterey Park, Calif. • Gallbladder surgery cost $40,000 at one hospital in St. Augustine, Fla., while another in nearby Orange Park charged $91,000.
Source: bankrate.com

Rate Boost To Medicare Advantage Plans Powers Insurers’ Stock Surge

Medpage Today: More $$$ Going To Medicare Advantage Plans Payments to Medicare Advantage plans will increase by 3.3% in 2014, Medicare officials said late Monday. Officials at the Centers for Medicare and Medicaid Services (CMS) based the payment increase on the assumption that Congress will override scheduled cuts in physician reimbursements for an 11th consecutive year, the agency said. “The policies announced today further the agency’s goal of improving payment accuracy in all our programs, while at the same time ensuring program stability and preserving beneficiary choice,” Jonathan Blum, PhD, CMS’ acting principal deputy administrator, said in a press release (Pittman, 4/2).
Source: kaiserhealthnews.org

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

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

Restoring Medicare Advantage Payment Rates: A Lesson in Procurement

Media coverage has focused on whether MA plans are profitable without getting into the underlying economic rationale for the cutbacks. To make real sense of the proposed cutbacks, it is necessary to spend a few moments considering how the federal government buys stuff. The government can’t let a “purchasing agent” decide what to buy; that approach is too easily corrupted. So the government usually allows open bidding in a process known as procurement. Whether buying bomber planes or mechanical pencils, the government tends to be very careful, because procurement has many pitfalls. Suppose the government wanted to purchase computers and made the following proposal: “We will purchase 10,000 computers from the lowest bidder.” We can imagine what would happen. Someone would make a lowball bid and then dump onto the government some third rate computers (Commodore 64s?). To avoid this, government procurement contracts for computers are highly detailed, specifying processing speed, memory, operating system, and so forth.
Source: wordpress.com

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