Medicare Lags In Project to Expand Hospice

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 marsmet522The 2010 health law required Medicaid to pay for joint hospice and curative treatments, called concurrent care, for children. More than half the states have taken steps to implement that in the joint federal-state program for low-income residents. It also instructed the secretary of Health and Human Services to select up to 15 sites to test concurrent care for patients in Medicare, which provides health coverage to seniors and disabled people. That test is to last for three years, but Medicare has yet to take any concrete steps toward beginning it.
Source: kaiserhealthnews.org

Video: Medicare’s Blue Button: Data is ‘Oxygen for Innovation’

Filling the Medicare Doughnut Hole — Health — Bangor Daily News — BDN Maine

Critics of President Barack Obama and the Democratic majority in Congress – that is, the Republicans – portray the small checks as an attempt to buy votes during an election year in which the Democrats’ hold on their majorities in the House and the Senate are tenuous. REFORM IS LONG OVERDUEAnd there is probably some truth to that, given the timing of the checks. But addressing the potentially financially crippling doughnut hole, as well as the law’s ban on the nation’s largest health insurer being legally permitted to negotiate drug prices, are long overdue for reform.
Source: bangordailynews.com

Study Examines Readmissions within the Medicare Inpatient Psychiatric Facility Prospective Payment System

“As policymakers begin to examine the broad issue of hospital readmissions, NAPHS commissioned the study to help policymakers and healthcare providers have a baseline for understanding the characteristics of this specialty population and unique issues that may impact their readmission patterns,” said NAPHS President/CEO Mark Covall. “All readmission policy discussions to date have focused solely on acute-care hospitals paid under Medicare’s DRG system. This study offers the first look at readmissions in a Medicare population being treated specifically for psychiatric diagnoses in facilities paid under the inpatient psychiatric facility PPS. Facilities paid under the IPF PPS treat the majority (some 64% in 2008) of all Medicare inpatient psychiatric admissions, according to the Medicare Payment Advisory Commission (MedPAC).”
Source: newswise.com

Doctors billing Medicare patients at higher rates, report finds

“This is an urgent problem,” Dr. Mark McClellan, who directs the Engelberg Center for Health Care Reform at the Brookings Institution in Washington, told the CPI. McClellan, a former director of the Centers for Medicare and Medicaid Services, or CMS, said the agency must send a message that it “won’t stand by and do nothing … that they are paying attention to this.”
Source: nbcnews.com

Meet SMRC, Medicare's newest audit contractor

Medicare contracted with the Omaha, Neb.-based StrategicHealthSolutions to serve as a Medicare supplemental medical review contractor (SMRC) in 2012 to “identify and employ more efficient methods of medical review, such as data extrapolation” and lower improper payments for fee-for-service claims, according to its website.
Source: hmenews.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

MEDICARE PART D COSTS 2013

Posted by:  :  Category: Medicare

Rockefeller Introduces Legislation to Protect Almost 90,000 West Virginia Seniors and Reduce Deficit By $141.2 Billion by SenRockefellerTo 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

Video: 2012 Medicare Part D Drug Coverage Updates

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

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

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

Chart of the day: Medicare Part D drug price growth

AcademyHealth accountable care organizations Affordable Care Act announcement antitrust blogging books cbo comic competitive bidding costs cost shifting deficit employer-sponsored health insurance health care costs health insurance health insurance mandates health reform hospital readmissions hospitals insurance exchange market power Massachusetts Medicaid Medicare mortality obesity On The Record physicians politics PPACA premiums premium support prescription drugs prostate cancer quality reading list reflex RWJF single payer spending substance use tax uninsured xkcd
Source: theincidentaleconomist.com

Opinion: Medicare Part D helps seniors, keeps costs down

Part D empowers consumers to make choices in the marketplace, stimulating cost-containing competition. The program does that by working exclusively through private plans, whether they be standalone prescription drug plans or comprehensive health plans that offer prescription drugs and are covered under the Part C Medicare Advantage program. Different plans offer different options for coverage, co-payments and premiums, enabling beneficiaries to pick what will work best for them.
Source: healthpolicysolutions.org

Medicare Essential – Is this the future of Medicare?

The combined deductible idea is echoed in a recent article in Health Affairs that proposes unification of Parts A and B, and Part D drug benefits. The Health Affairs article also proposes reducing beneficiary cost sharing to levels comparable to Medicare Advantage plans, eliminating the need for Medicare Supplemental coverage. The new Medicare plan, called Medicare Essential, would become the default for people who qualify for Medicare for the first time. New Medicare beneficiaries could opt out and take old traditional Medicare, and go buy their own Part D and Medicare Supplement plans, or they could buy Medicare Advantage plans. Medicare Essential would have a much higher premium than Medicare Part B, but the authors of the article claim that the overall cost would be less than Part B plus Part D plus the full-coverage Medicare Supplement Plan F that most seniors select. So proponents could argue that the added cost of the increased premium is a bargain and that people could always opt out and avoid the higher cost if they wanted to. Medicare Essentials could show significant savings by avoiding the broker commissions that add to the cost of Medicare Supplemental and Medicare Advantage plans. Whether the new program would be able to achieve the supposed 2% administrative cost ratio sometimes claimed for Medicare is highly suspect, but elimination of the need to re-process claims to pay Supplement benefits, along with simplification of coverage rules overall, would probably yield some further efficiencies.
Source: gormanhealthgroup.com

Part B Versus Part D Coverage Determinations

Here’s what’s concerning me about your situation: Part B vs Part D drugs is a slightly grey area, but the line is generally drawn at if it’s provided in a physician office vs picked up at a pharmacy. I’ll admit I’ve been out of the Medicare game for a little while at this point, but I can’t think of how the drug can be covered under both. Either it’s a Part B drug or it’s not. Another question that comes to mind is that if he’s on a supp with such an expensive drug, how would he qualify for a different supp? Each state has it’s own rules and situations can vary, so that may not be important, but that’s a flag that’s going up for me. What I think answers your question is that a supp pays after Medicare. If Part A/B are covering something, they pay what’s left (such as they have to). If Medicare A/B pay 80% and the client has a plan F (to make things simple) then the supp is on the hook for the 20%. The supp can’t go back and cry foul because it’s up to Medicare A/B. If Medicare A/B kicks rejects the claim, then the supp will deny the claim because Medicare A/B kicked it. That make sense? That help? To put it another way, of patient was receiving XYZ drug at their doc with Medicare paying primary, changing supp wouldn’t change that and the new supp (provided they went through underwriting and any other applicable requirements) would be on the hook for the gap up to the coverage amounts. That answer your question?
Source: insurance-forums.net

AARP Supports Legislation to Require Drug Manufacturers to Provide Rebates to Medicare Part D Beneficiaries

AARP is a nonprofit, nonpartisan organization, with a membership of more than 37 million, that helps people turn their goals and dreams into real possibilities, strengthens communities and fights for the issues that matter most to families such as healthcare, employment and income security, retirement planning, affordable utilities and protection from financial abuse. We advocate for individuals in the marketplace by selecting products and services of high quality and value to carry the AARP name as well as help our members obtain discounts on a wide range of products, travel, and services.  A trusted source for lifestyle tips, news and educational information, AARP produces AARP The Magazine, the world’s largest circulation magazine; AARP Bulletin; www.aarp.org; AARP TV & Radio; AARP Books; and AARP en Español, a bilingual news source.  AARP does not endorse candidates for public office or make contributions to political campaigns or candidates.  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 Drug Savings Act of 2013: Drug Rebates & Part D Savings

The concept of prescription drug rebates isn’t new or exclusive to Medicare. For example, the Medicaid program is currently supported through federally determined rebates that keep the costs of generic and brand medications down. And drug companies provided rebates to the federal government for dual eligibles and lower-income beneficiaries before the 2006 creation of Medicare Part D. Under Rockefeller’s proposed Medicare Drug Savings Act, drug companies would simply offer these rebates again.
Source: planprescriber.com

Guest: Give Medicare the power to negotiate drug prices

Congressional leaders digging in on a contentious budget debate could profoundly reduce prescription-drug prices and the overall cost of the Medicare program by giving Medicare the authority to negotiate prescription-drug prices. Making this change would save so much money, it would not be necessary to cut Medicare benefits or to raise the eligibility age to keep Medicare solvent in the future.
Source: seattletimes.com

Income Thresholds For Medicare Part B And Part D Premiums

While 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

Critiquing The Medicare Part D Low

At the outset, however, it is important to note that we agree on the basic goal: a Part D program that displays effective cost containment in a very tight federal budgetary environment.  The good news is that the existing program is quite successful in this regard. Since 2007 per capita costs in Part D have grown at a compound annual rate of 1.8 percent, while costs in Part A and B have grown at 3.6 percent and 3.7 percent, respectively. The program’s negotiated rebates between large purchasers and drug manufacturers, and the ability for consumers to compare plan prices and benefits, have resulted in lower than expected Part D spending overall.  (In contrast, note that from 1990 to 2005, average annual drug cost growth in the Medicaid program was about 13.1 percent per year.)
Source: healthaffairs.org

U.S. Department of Social Security Mobile Site for Smartphone Users

Posted by:  :  Category: Medicare

Economically --- Challenged & illiterate .. CIA website forced offline (11th February 2012) ...item 2.. Anonymous turns its attention to the U.S. Senate over controversial bill -- upgrade your lifestyle (December 8, 2011) ... by marsmet526Carolyn W. Colvin, Acting Commissioner of Social Security, announced the agency is offering a new mobile optimized website, specifically aimed at smartphone users across the country. People visiting the agency’s website, www.socialsecurity.gov, via smartphone (Android, Blackberry, iPhone, and Windows devices) will be redirected to the agency’s new mobile-friendly site. Once there, visitors can access a mobile version of Social Security’s Frequently Asked Questions, an interactive Social Security number (SSN) decision tree to help people identify documents needed for a new/replacement SSN card, and mobile publications which they can listen to in both English and Spanish right on their phone.
Source: disabled-world.com

Video: Patty Duke Applies Online for Social Security Retirement Benefits . . . In Her Pajamas!

Washington State Website Hacked, Drivers Licenses And Social Security Numbers Stolen

“Preparing for incidents is key to preventing small breaches from becoming big ones. The first step to protecting your assets is knowing what and where they are. You’ll be playing catch-up if you wait for a security incident to understand and document your IT systems, and time is precious in incident response scenarios.”
Source: inquisitr.com

Use the Social Security Database to Name Your Baby

Advertising automotive names automotive naming auto naming baby naming Branding brand name brand names Brand Naming car names car naming cell phone naming clothing brand names company name Company Naming creative names Food Branding food naming How To language Launching Your New Company Name Microsoft mobile phone naming name change name game Name Launch name review name that brand naming naming advice naming experts naming firm naming guide naming help naming manual naming specialist Naming Tips phone naming product name Product Naming renaming software naming technology names technology naming Trademark
Source: catchwordbranding.com

Daily Kos: House Democrats not receptive to Social Security cuts

I strongly believe we must balance the budget and get our fiscal house in order.  But, as I have repeatedly said, it cannot be on the backs of seniors, the middle class, and the most vulnerable.  While the budget put forward by the President makes some important investments to increase economic growth, I do not believe he should be pushing for a switch to the ‘chained CPI’ for Social Security recipients.  Iowans pay into Social Security all their lives for the promise of security in retirement. Bruce Braley (IA 01) and candidate for senate in 2014. I am very concerned about the president’s proposal to try to reduce the deficit by switching to a chained CPI calculation, particularly because budgets are moral documents, and they reflect our nation’s priorities. I believe it’s immoral to balance the budget on the back of seniors and disabled Americans, who are the ones who will be most dramatically affected by switching the consumer price index adjustment for Social Security benefits. From Bleeding Heartland.
Source: dailykos.com

Social Security for Your Smartphone

In addition, visitors to the new mobile site can learn how to create a personal my Social Security account to get an online Social Security Statement, learn more about Social Security’s award-winning online services, and connect with Social Security on Facebook, Twitter, YouTube, and Pinterest. For people unable to complete Social Security business online or over the telephone, the agency also unveiled a new mobile field office locator. The new mobile office locator has the capability to provide turn-by-turn directions to the nearest Social Security office based on information entered by the person.
Source: patch.com

State courts office hacked; Social Security, driver

— Names and driver’s license numbers may have been obtained from people who received a DUI citation in Washington state between 1989 through 2011; had a traffic case in Washington filed or resolved in a district or municipal court between 2011 and 2012; or had a superior court criminal case in Washington state that was filed against them or resolved between 2011 and 2012.
Source: seattletimes.com

Bill Gates’s social security number, address, credit report and more… published by hackers

Graham Cluley has worked in the computer security industry for more than 20 years, developing anti-virus software and doing quite a lot of talking about internet threats. He’s won awards for his blogging, but is proudest of the text adventure games he wrote when he was still wearing short trousers. You can learn more about those (the games, not the trousers) at grahamcluley.com. Email Graham, subscribe to his updates on Facebook, follow him on Twitter and App.net, and circle him on Google Plus for regular updates.
Source: sophos.com

How to win a social security disability claim

By working with that other company, we learned that there are three types of programs available through Social Security disability. The first is Social Security disability insurance, and it is funded primarily through payroll taxes that are accumulated throughout your lifetime. The longer you work, the more work credits you receive that count towards how much you can receive per month. If you haven’t worked at all, you won’t qualify for much; however, if you’ve worked steadily for many years, you’ll be eligible for much more. This varies – the only way to know what you qualify for is to log into the Social Security website and check. Most of the time your spouse and children will also receive benefits. This may or may not give you access to Medicare right away depending on your situation, which can post a huge problem if you need medical care or assistance with prescriptions. The state you live in may help out with free or reduced cost care and prescriptions until Medicare kicks in.
Source: 34wz.com

When Should You Take Social Security? 62 or Full Retirement Age?

Whether you started receiving Social Security at 62, 66, 70 or somewhere in between you know that it’s not enough to get by on each month. And every year we fall just a little further behind if we don’t take action now. To help you get started I’ve recently published the Money Forever Retirement Plan to show you how to protect your cash, grow your portfolio, and where to get yield in a near-zero interest rate environment. Click here for the story on how this works and then decide for yourself.
Source: ino.com

Potential Pact On Medicare Changes Could Lead To Budget Deal

Posted by:  :  Category: Medicare

Cassandra Q. Butts by Center for American ProgressThe New York Times: Talk of Medicare Changes Could Open Way to Budget Pact As they explore possible fiscal deals, President Obama and Congressional Republicans have quietly raised the idea of broad systemic changes to Medicare that could produce significant savings and end the polarizing debate over Republican plans to privatize the insurance program for older Americans. While the two remain far apart on the central issue of new tax revenue, recent statements from both sides show possible common ground on curbing the costs of Medicare, suggesting some lingering chance, however small, for a budget bargain (Calmes and Pear, 3/28).
Source: kaiserhealthnews.org

Video: Aging is for Everyone Medicare Improvement Standard Changes

Medicare changes could hit middle

The latest proposal ramps up the reach of means testing and sets up a political confrontation between AARP and liberal groups on one side and fiscal conservatives on the other. The liberals long have argued that support for Medicare will be undermined if the program starts charging more for the well-to-do. Not only are higher-income people more likely to be politically active, but they also tend to be in better health.
Source: oregonlive.com

Medicare changes after Affordable Care Act discussed Wednesday

Before 2002, Holden served as associate area director for the Elderhostel Southeast Area Office in Newnam, Ga., and as the state director of the Tennessee Elderhostel. He was director of the University of Tennessee’s Department of Independent Study and Distance Education in its Outreach and Continuing Education Office.
Source: oakridgetoday.com

New Indiana Congresswoman: Freshman class will push Medicare changes

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

Hospitals Oppose Medicare Waiver Changes

State officials are trying to adopt a more modernized waiver as the way health care is delivered changes. The current test is based on an old health care model that focuses on inpatient hospital stays. Health care is moving toward a model of keeping patients out of the hospital by providing sufficient preventive and outpatient care.
Source: mdcounties.org

Schumer Supports Medicare Changes

Sen. Charles Schumer, D-N.Y., said he is proposing legislation that would change Medicare rules involving hospital stays and the rehabilitation that follows. Current standards require seniors to pay out of pocket for follow-up treatment if they were considered to have “observation status” while at a hospital.
Source: post-journal.com

DownWithTyranny!: Just Skip The First Paragraph

Posted by:  :  Category: Medicare

Undecided?  Still?? by Patrick FellerI’m looking very skeptically on any incumbents who haven’t signed onto the Grayson Takano letter which just states very clearly that “we will vote against any and every cut to Medicare, Medicaid, or Social Security benefits– including raising the retirement age or cutting the cost of living adjustments that our constituents earned and need.” Tuesday Blue America will be formally endorsing Pennsylvania state Senator Daylin Leach, who is running for the open congressional seat in northeast Philly/Montgomery County, which Allyson Schwartz is leaving. Daylin backs the Grayson Takano No Cuts approach. “At a time when corporate profits, executive compensation, the stock market and wealth disparity are at near record highs,” he told us, “it is obscene to even consider balancing our budget on the backs of seniors and veterans. I fully supported President Obama’s election, but I can’t support any drift towards corporatism to appease tea-party extremists. If we are really serious about ensuring the solvency of Social Security while preserving benefits well into the future, there is a simple solution. We should raise the cap on income subject to the payroll tax from $110,000 per year to $200,000 per year. This is fair, reasonable, and keeps faith with those who rely on Social Security to survive.”
Source: blogspot.com

Video: GOP: Pay Bondholders, Not Medicare Recipients, If US Nears Default

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

Health First Hosts Medicare Advantage Health Plans Seminars

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

Medicare With Other Insurance: Who Pays First? Oceanside,CA., Carlsbad, CA, Vista, CA

Medicare or any other health plan is called a “payer.” A payer is the party responsible for paying health care bills. When you are covered by more than one payer, there are rules that direct which payer pays first. The one that pays first is the primary payer. Your primary payer pays your medical bills up to the amount allowed by your coverage. If more is still owed, then the remaining amounts go to your secondary payer for payment. It’s important to know the difference because it can impact how much you have to pay out of your own pocket for the benefits and services you use.
Source: insr4u.com

Health First Hosts Free Medicare Advantage Seminars

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

Medicare Data Show Wide Variation In Hospital Pricing

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: kaiserhealthnews.org

bcbs of georgia medicare pdp 2011 formulary

Posted by:  :  Category: Medicare

319 | Tragedies of Medicine by The DoctrCompare 2012 / 2013 Medicare Part D PDP. Medicare Advantage plans offer all your Medicare benefits plus more. Individual and group plans. Medigap insurance policies supplement Original Medicare Part A and      hmo web   Wellcare PDP – Wellcare Classic or. Wellcare currently offers two PDP or Medicare Prescription drug plans. In 2012, the two plans offered are Wellcare Classic and Wellcare Signature. For 2013,
Source: rediff.com

Video: Medicare Part D Formulary

Part D Formulary Should Include All Your Drugs

When comparing Part D plans, the most important thing to consider is the formulary. If you drugs are not covered you will not only have made a poor choice but you will spend more money paying out of pocket for those drugs.
Source: partdplanfinder.com

California Pharmacist Jobs: Clinical Pharmacist, Medicare Part D! Irvine, CA! job at UnitedHealth Group in Irvine

More complete informations about this job opportunity please read the description below. As one of the largest pharmacy benefits managers in the United States, UnitedHealth Group provides a professional culture where you’re empowered an! d encouraged to exceed the expectations of our members, with better schedules than retail and more reach than any hospital. Join us and start doing your life’s best work.(sm) Irvine, CA! Formulary Submission and Operations! In this NEW and EXCITING role, the chosen candidates will support the day-to-day operations related to ensuring accuracy of formularies implemented in the claim system. The chosen candidates will be responsible for participating in Medicare Part D formulary submission and related formulary operations. Primary Responsibilities: Translate CMS, formulary, and pharmacy practice requirements into developing business/operational processes Support development and maintenance of clinical data attributes to support the audit process Ensure that implemented formularies are consistent with HPMS filed formularies Identify and trouble-shoot issues that require correction Part D formulary submis! sion Implementing initiatives related to the new CMS ! requirements Meeting CMS regulatory requirements for Part D Leading quality initiatives related to the formulary operations Ensuring compliance related to formulary administration Job Keywords: Pharmacy, Pharmacist, Clinical, Pharm D, Irvine, CA, California, Medicare, Part D, Formulary, UnitedHealth Group, OptumRx. Requirements: Must have a current and unrestricted Pharmacy License for the State of California. 3 years of experience as a licensed pharmacist Strong computer proficiency and experience with Excel is required Strong organizational skills Strong communication skills, written and verbal Preferred: PBM (Pharmacy Benefits Management) experience Residency Experience with data analysis and trending Formulary Operations and/or Submissions Managed Care experience is highly preferred Experience leading quality initiatives Part D experience Pharm ! D OptumRx is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. If you’re ready to talk about groundbreaking interactions, let’s talk about what happens when a firm that touches millions of lives decides to gather results from millions of prescriptions every month and analyze their impact. Let’s talk about smart, motivated teams. Let’s talk about more effective and affordable health care solutions. This is caring. This is great chemistry. This is the way to make a difference. We’re doing all this, and more, through a greater dedication to our shared values of integrity, compassion, relationships, innovation and performance. OptumRx is an empowering place for people with the flexibility to help create change. Innovation is part of the job description. And passion for improving the lives of our customers is a motivating factor in everything we do. In the largest and most personal sense, ! your impact can be greater than even you thought at OptumRx. Div! ersity creates a healthier atmosphere: equal opportunity employer M/F/D/VUnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing. – . If you were eligible to this job, please email us your resume, with salary requirements and a resume to UnitedHealth Group.
Source: blogspot.com

Part D Formulary Medical Review Awarded to Strategic

Strategic’s team of pharmacists and data analysts will work with CMS to monitor drug updates and evaluate Medicare Part D Plan formularies and benefits to ensure the Part D prescription drug program — offered through Medicare Advantage drug plans and stand-alone prescription drug plans — meets CMS formulary guidelines. These guidelines help ensure that Medicare beneficiaries receive clinically appropriate medications at the lowest possible cost and that Part D plans do not have formularies that discriminate against beneficiaries.
Source: strategichs.com

Gagnon: Rising drug costs unsustainable — not Medicare

This is how it works: An expensive new drug comes on the market, but provincial drug plans are reluctant to place it on their formulary given the cost and low net health benefit over existing lower-priced drugs. A drug company uses a larger player – such as Ontario – to add it to their formulary by enticing them with very significant cost rebates. Pressure builds in other jurisdictions – some from patient advocate groups funded by the drug companies – to have access to the same drug as Ontarians. Under intense political pressure, other provinces follow suit but do not know what Ontario paid, and end up negotiating much smaller discounts. Once it has been accepted by the provinces, the private insurance companies pay the full retail price.
Source: diablogue.org

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

Medicare Leaves Potential Hospice Savings Unexplored

Posted by:  :  Category: Medicare

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

Video: Health Insurance Information : About Hospice Medicare Benefits

Medicare’s hospice benefit comforts patients and their families

Chaplin Charlotte Bear of VITAS Innovative Hospice Care will help us learn the “Art of Active Listening” during an hour-long Spiritual Care Seminar starting at 1:30 p.m. Monday, June 17, in Los Gatos Conference Room 2. Active Listening is a critical communication skill in any kind of spiritual care, especially when people are vulnerable. This training defines the process of effective communication, discusses active listening and its components, explains the value of verbal and non-verbal communication and clarifies helpful and not so helpful responses to a patient or family’s personal story.
Source: wordpress.com

Chemed, Vitas Hospice Services Charged With False Claims To Medicare

The Medicare hospice benefit is available for patients who elect palliative treatment (medical care focused on providing patients with relief from pain and stress) for a terminal illness, and have a life expectancy of six months or less if their disease runs its normal course. When a Medicare patient receives hospice services, that individual no longer receives services designed to cure his or her illness. Medicare reimburses for different levels of hospice care, including continuous home care, also called crisis care, which is available for patients who are experiencing acute medical symptoms resulting in a brief period of crisis. Crisis care is available when a patient’s acute medical symptoms require the immediate and short-term provision of skilled nursing services in order to keep the patient at home. The reimbursement rate for crisis care services is the highest daily rate a hospice can bill Medicare, and hospices are paid hundreds of dollars more on a daily basis for each patient they certify as having received crisis care services rather than routine hospice services.
Source: newsroom-magazine.com

DOJ Accuses Hospice Giant Chemed Of Medicare Fraud, Shares Plunge

“Vitas billed three straight days of crisis care for a patient, even though the patient’s medical records do not indicate that the patient required crisis care and, indeed, reflect that the patient was playing bingo part of the time,” DOJ said in a press release.
Source: investors.com

Hospice: A Benefit Covered by Medicare and Medicaid––Visiting Nurse Association

Hospice services are provided by a team of healthcare professionals typically comprised of a physician, registered nurse, social worker, home health aide, chaplain, and respite care volunteer. The team works closely with the patient’s primary care physician to continuously reevaluate services that may be needed.  The team assists in all aspects of care for the patient and family. Bereavement support is also available to the family and other loved ones following the death of the patient.
Source: livingwellmag.com

Is it time for another lawsuit? Advocating to change the Medicare Hospice Benefit eligibility requirements

I have decided that there is compelling evidence that the Medicare Hospice eligibility requirements are outdated and need to be re-written.  These policies are not driven by patient need and the evidence is mounting that limiting access to hospice and palliative services actually increases the cost of health care at the end of life.  Those with concerns about the rise in the cost of the Medicare Hospice Benefit appear to put undue focus on the increasing length of stay of a number of hospice patients without considering that hospice and palliative care can be more cost effective than usual care.  This cost reduction does not come from “irrationally rationing” health care but by facilitating conversations that allow patients and families to understand prognosis and verbalize preferences and goals about end-of-life care.  These conversations enable health care providers to guide patients away from costly treatments and interventions that do not facilitate attainment of patients’ goals or add to the quality or length of their lives. If you agree that it is time for a change to the eligibility requirements, what can we do as hospice and palliative medicine providers to advocate for our patients to receive high-quality palliative and end-of-life care in a manner that makes sense? Do we wait until the results of the concurrent care demonstration project are in? Do we ask AAHPM, NHPCO, and HPNA’s Public Policy and Advocacy Committees to weigh in on the matter?  Or do we wait until the lawyers file another class-action lawsuit against Medicare? by: Shaida Talebreza Brandon (all opinions expressed are my own)
Source: geripal.org

CMS PROPOSES UPDATES TO THE WAGE INDEX AND PAYMENT RATES FOR THE MEDICARE HOSPICE BENEFIT (CMS

(Source: CMS – Centers for Medicare & Medicaid Services) CMS PROPOSES UPDATES TO THE WAGE INDEX AND PAYMENT RATES FOR THE MEDICARE HOSPICE BENEFIT On April 29, 2013, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule [CMS-1449-P] that would update fiscal year (FY) 2014 Medicare payment rates and the wage index for hospices serving Medicare beneficiaries. The proposed hospice payment rule reflects the ongoing efforts of CMS to support beneficiary access to hospice. As proposed, hospices would see an estimated 1.1 percent ($180 million) increase in their payments for fiscal year (FY) 2014.
Source: wn.com

Daily Kos: Arkansas legislature passes ‘private option’ Medicaid expansion

Posted by:  :  Category: Medicare

Counter demonstration: wingnuts by tsweden….which is that privatizing the MediCare services means that taxpayers will be paying far more, and recipients will be getting far less, than if the MediCare system itself were providing the.implementation in Arkansas, as it is in most states. This is just one more of the near-infinite flood of data-points that prove, unambiguously, unequivocally, and undeniably, that the Publicans are lying thru their teeth when they claim that their motive and goal is to save taxpayers money. Anyone who votes Publican who is not in the ownership class — the top 2-5% — is a tool and a fool, being played as such by the very elites they claim to resent, and eagerly participating in their own abuse. Friends don’t let friends vote Publican!
Source: dailykos.com

Video: Strengthening Medicaid is a Good Deal for Arkansas

Brad DeLong : The Arkansas Medicaid Budget

The strangest part of the “private option” is that the plan grew out of pressure from local Republican lawmakers, the very same folks who had the loudest concerns about costs of the original Medicaid expansion. That’s strange because the new “private option” is going to cost more (not necessarily for the state — see here and here — but almost certainly for the feds)…. There are a number of reasons that offering coverage via private insurance is costlier than offering it via Medicaid but the main one ain’t rocket science: private insurers reimburse at higher rates. Even conservatives that like the “private option” better agree that it will cost more. Well here’s the thing. Despite a broad consensus about cost, Republicans at the forefront of advocating for a “private option” as a possible alternative to Medicaid expansion do not agree. They think that the “private option” might not be any more expensive for the feds, and could even cost less.
Source: typepad.com

HHS approves private plans for Arkansas Medicaid patients

Did I get this right? Health and Human Services has granted Arkansas a waiver to allow Medicaid dollars to be used to purchase private health plans in the state insurance exchange, even though they are much more expensive (and have more limited benefits than Medicaid). And they are doing this only so that state legislators can brag about using private insurers for a public program.
Source: pnhp.org

My View of the Arkansas Medicaid Waiver

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Source: ncpa.org

Arkansas Prepares to Launch Medicaid Inspector General Office

They’ll answer to the newly created Inspector General, who will be appointed by Beebe and confirmed by the state Senate. The proposal is among several aimed at curbing costs in the Medicaid program that lawmakers approved in conjunction with a plan to expand health insurance to 250,000 people using federal Medicaid dollars. The “private option” insurance plan, which still must get federal approval, is being touted as an alternative to expanding Medicaid’s enrollment under the federal health care law.
Source: arkansasbusiness.com

Medicaid, Obamacare get a boost in Arkansas

Arkansas’ acceptance of the Medicaid expansion is notable because the state spearheaded efforts to pair broadening of the program with privatizing it and delivering health benefits to poor residents through private health plans on Obamacare’s health insurance exchanges. Ohio, Florida and other states dominated by GOP politicians are weighing similar plans after rejecting a straight expansion of the traditional government-run Medicaid program.
Source: msnbc.com

Arkansas Moving Forward With Plan to Accept Medicaid Expansion

Speaking of Obamacare, it looks like the Arkansas plan to accept its expansion of Medicaid coverage is on track. This is good news coming from a conservative state. I’m agnostic about whether their proposal to privatize delivery is a smart idea—probably not, since it will increase costs, though you never know—but it’s nice to see that it’s going forward one way or the other.
Source: motherjones.com

The Role of the Basic Health Program in the Coverage Continuum: Opportunities, Risks & Considerations for States

Posted by:  :  Category: Medicare

Maryland Health Insurance Plan Federal Press Announcement by MDGovpicsThis brief assesses the potential benefits and drawbacks to states from implementing a Basic Health Program under the Affordable Care Act. The law gives states the option of creating a Basic Health Program, using federal tax money to subsidize insurance coverage for low-income residents who would otherwise be eligible to purchase coverage through a state exchange. Such a program would give states the ability to provide more affordable coverage for these low-income residents and improve continuity of care for people whose income fluctuates above and below Medicaid levels.
Source: kff.org

Video: Pissed Jeans – “Health Plan”

Department of Human Services reschedules health plan change

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Source: hawaii247.com

Chancellor announces return to Berkeley

Student leaders from the Associated Students of the University of California (ASUC), the Graduate Assembly, the campus Committee on Student Fees and the Student Health Advisory Committee felt strongly that it was in the best interests of UC Berkeley students to leave UC SHIP and return to a Berkeley-based plan. Although there are many possible advantages in a system-wide plan, there also are features in our health coverage which are best optimized campus by campus. The advantages of having a Berkeley-specific student health-insurance plan have been made to me very forcefully in a letter (PDF) from the ASUC and Graduate Assembly, and this letter helped me reach this decision.
Source: berkeley.edu

Hudson Health Plan joins MVP

Financial terms of the agreement were not disclosed. Officials said no significant changes to the Tarrytown company’s operations are immediately planned and it will continue to operate as Hudson Health Plan. Hudson serves clients enrolled in the state’s Medicaid Managed Care, Child Health Plus and Family Health Plus plans in Westchester, Dutchess, Orange, Rockland, Ulster and Sullivan counties. “MVP Health Care and Hudson Health Plan together will create a stronger combined company committed to serving Medicaid managed care and Child Health Plus members, and continuing our longstanding relationships in the Hudson Valley,” MVP Health Care President and CEO Denise V. Gonick said in the announcement.
Source: westfaironline.com

State Roundup: Calif. Lawmakers Push For Health Plan For Immigrants In U.S. Illegally

Sacramento Bee: Some California Leaders Want Low-Cost Health Care For Undocumented Immigrants About a million of California’s poorest undocumented immigrants would have access to basic low-cost health care under a plan being pushed at the Capitol. President Barack Obama’s federal health care overhaul excludes undocumented immigrants, but some California leaders want to fill that gap by offering a safety net of primary and preventive care that does not consider immigration status. The county-run program would give undocumented immigrants – and legal residents who can’t afford health insurance but don’t qualify for Medi-Cal – the ongoing opportunity to see a doctor, get tested and receive treatment before minor health problems become severe (Sanders, 4/19).
Source: kaiserhealthnews.org

Caregivers: 3 Easy Tips to Remember your Health Checkups

So how can we, as caregivers, move our own checkups, immunizations and regular screenings up the list? I’ll tell you what worked for me: Barb, a dear friend from college who is also a caregiver, left me a voice mail and compassionately, but firmly, said (repeatedly), “You are amazing, but you have to get your teeth cleaned, you have to do the things you need to do for you.” I know she has the same challenges, and knowing she took the time to call me was motivating. Or maybe it was just nice to have someone else tell me what to do when I am so tired of making decisions. Whatever it was, the direct support of a friend did the trick this time.
Source: aarp.org

Treasury Proposes Minimum Value Rules for Health Plans

Generally speaking, an employer-sponsored health plan fails to provide minimum value if the plan’s share of the total allowed costs of benefits provided under the plan is less than 60 percent of the costs. The proposed Treasury regulations indicate that minimum value is determined based on anticipated spending for a standard population related to essential health benefits (EHB), taking into account the employer’s choices regarding cost-sharing required of participants (deductibles, co-pays, co-insurance, etc.).To provide minimum value, a plan must have a minimum value percentage (MV Percentage) of at least 60 percent. The MV Percentage is calculated by dividing the plan’s anticipated covered EHB medical spending for a standard population by the total anticipated allowed charges for coverage of EHB provided to that population.
Source: jdsupra.com

Health plan may cover varicose vein treatment

Health plans will cover services that are medically necessary. Some plans have specific requirements for covering treatment for varicose veins. Other plans consider treatment to be cosmetic, and therefore not medically needed.  It’s possible that the person who told you it wasn’t covered had spider veins, and not varicose veins.  So for him or her, the treatment was not medically needed.  Don’t let their experience talk you out of pursuing it.
Source: bangordailynews.com

Weld County Board Renews Decision to Ban Plan B at Health Clinics

Dr. Mark Wallace, director of the Weld County Health Department, has offered testimony on several occasions to the board in which he explained that Plan B works by preventing the sperm and the egg from meeting, heading off fertilization, not by destroying fertilized eggs. Wallace’s position is the one advanced by the Office of Population Affairs behind Title X and the one supported unequivocally by current medical research.
Source: rhrealitycheck.org

$125 million more requested to implement Obamacare in Colorado

Health care exchanges are among the pillars of Obamacare, allowing individuals and small businesses to band together to shop for low-cost insurance. How they will look and operate will vary from state to state. Those that choose not to open an exchange will have one opened for them by the federal government.
Source: dailycaller.com

Phase out GP consultation fees for a better Medicare

Posted by:  :  Category: Medicare

A voluntary scheme that gives GPs the option to enrol some patients and receive (initially small) capitation payments alongside their Medicare rebates, would be a good place to start. The fee-for-service system could be slowly phased out by freezing rebate levels so they become less valuable in real terms over time. Concurrently, capitation payments could be gradually increased to make them more attractive.
Source: com.au

Video: MEDICARE REBATE: Review Your Health Insurance Before June 30.m4v

NDIS levy: Medicare levy increase to fund National Disability Insurance Scheme

I am more than happy to support the NDIS. The Productivity Commission report regarding disability in 2011 found that the current state of disability support within Australia is underfunded, ineffective, and is restrictive towards individual’s choice with their own care. The overarching message from Prime Minster Gillard and Tony Abbot is that the NDIS is important legislation and needs to be implemented. I feel we need to acknowledge that disability support needs to be changed within this country as one in four people with disabilities within this country live below the poverty line. The amount of people with disabilities that are within the Australian workforce has dropped to 2.9 percent. The NDIS propose not only vital and consistent funding towards to these individuals but also a focus on social and economic participation which include making employment more accessible. Allowing this excluded group to engage with the workforce will be good for the country as a whole.
Source: com.au

Cut back Medicare, think tank says

Dr Sammut also called for the reintroduction of compulsory co-payments for GP visits and for a means test on Medicare entitlements, so the government wasn’t paying for the health needs of the well-off.
Source: com.au

gerber medicare supplement

Medicare Supplement Plans, also referred to as Medigap Insurance policies, are strategies that are sold by private insurance companies to address health costs that are not covered by Medicare in Original Medicare Plans. People are qualified to receive Medicare healthcare protection if they are at.
Source: com.au

Additional Medicare charge to fund NDIS | disabilitydirectory.net.audisabilitydirectory.net.au

• Someone earning $30,000 a year will pay an extra 41 cents a day in Medicare levy, but still be paying $903 less income tax per year than they were in 2007; • Someone earning $70,000 a year will pay an extra 96 cents a day in Medicare levy, but still be paying $953 less income tax per year than they were in 2007; • Someone earning $110,000 a year will pay an extra $1.51 a day in Medicare levy, but still be paying $1903 less income tax per year than they were in 2007.
Source: net.au

Myer exec concerned about Medicare levy

The Motley Fool’s purpose is to help the world invest, better. Click here now for your free subscription to Take Stock, The Motley Fool’s free investing newsletter. Packed with stock ideas and investing advice, it is essential reading for anyone looking to build and grow their wealth in the years ahead.  This article contains general investment advice only (under AFSL 400691). Authorised by Bruce Jackson. Motley Fool contributor Ryan Newman does not own shares in any of the companies mentioned in this article.
Source: com.au

Facilitating Medicare Local meeting

Every conference and seminar can benefit from the services of a professional conference MC. Leaving the job to members of your committee is a poor second option and can make the difference between the success and failure of your event.
Source: com.au