Medicare Boosts Rather Than Cuts Payments To Advantage Plans

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Modern HealthCare: Limited Funding In an effort to scale back use of high-priced imaging of questionable value in cancer treatment, Medicare has proposed ending reimbursement for post-treatment positron emission tomography scanning in prostate cancer patients and limiting its use to one scan for most other cancer indications. Use of the technology, which involves injecting F-18 fluorodeoxyglucose (FDG) into the blood so the PET scan can identify regions of heightened metabolic activity, a sign of cancer metastasis, has grown sharply in recent years. The CMS, in giving preliminary approval to payments for the technology in 2005, required manufacturers and radiologists to establish a registry to monitor outcomes from its use. The evidence garnered from that registry convinced the CMS that the scans provided no useful information for oncologists treating prostate cancer patients who had already completed their initial therapy, according to the March 13 proposed decision memo (Lee, 3/30).
Source: kaiserhealthnews.org

Video: Medicare supplement Insurance Plans VS Medicare Advantage plans

Report: Private Medicare Advantage Plans Make Progress in Combating Chronic Disease

Since its start in 2003, Medicare Advantage has gained popularity because of its high quality, coordinated benefits and patient-centeredness.  Its central role for private health plans makes MA extremely popular with seniors.  The best practices of these plans should be integrated into conventional Medicare.  That’s the only hope if Medicare is to contain its costs without sacrificing quality and care in the process.
Source: hlc.org

Population Health Management In Medicare Advantage

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

Medicare latest news, medicare advantage plans

Another aspect up for debate is if changes are made, at what age would these changes begin to affect? Some proposals would not touch anyone who is at least 55 years of age. Others are arguing the age should be 59 and others think 56 is the magic age. One of the more critically proposed issues is the use of a voucher system. The voucher would be issued when the beneficiary turns 65 in lieu of coverage for healthcare expenses. Basically, the voucher allows a check to be issued to the beneficiary to purchase insurance. The voucher amount would be tied to the amount required to purchase Medicare. Additionally, beneficiaries would be able to choose private insurance instead of Medicare. If the private insurance costs more, the beneficiary would have to pay the difference. If insurance costs less, they could bank the difference.
Source: healthworkscollective.com

New Report: CMS’ Proposed Medicare Advantage Cuts Will Result in Higher Costs, Fewer Benefits for Seniors

The new proposed payment cuts are in addition to the Medicare Advantage cuts and the new health insurance tax included in the Affordable Care Act (ACA).  Only four percent of the ACA’s $200 billion in Medicare Advantage cuts have gone into effect thus far, and the Congressional Budget Office projects that, when fully phased in, these cuts alone will result in three million fewer people enrolled in the program.  The ACA’s new health insurance tax starts in 2014, and Oliver Wyman previously estimated that this tax alone will result in seniors facing $220 in higher out-of-pocket costs and reduced benefits next year and $3,500 in additional costs over the next ten years.
Source: ahipcoverage.com

Analysis of Chronic Kidney Disease for Medicare Risk Adjustment

The HCC risk adjustment model utilized by CMS up through 2013 groups all stages of CKD into HCC 131 – Renal Failure. Up through 2012, HCC131 carried a raw risk score of .368 which was worth approximately $3,000 per year per member.  For 2013, the raw risk score was reduced to .297 which was worth approximately $2,500 per year per member.  (Financial values will vary for every plan depending on individual plan bids.) As a result of the high rate of under-diagnosis of early stage CKD (stages 1-3), some Medicare Advantage plans have actively engaged in efforts to increase diagnosis rates in part to trigger additional revenue from HCC131.
Source: outcomesinc.com

Medicare Advantage – or DISAdvantage?

During the debate on health care reform, the Congressional Budget Office estimated those overpayments would cost the government $157 billion over the coming decade. As a consequence of these overpayments, according to CMS, premiums for all Medicare beneficiaries, including those enrolled in traditional Medicare, are higher than they otherwise would be. That’s more than just an annoyance: the Medicare Hospital Insurance Trust Fund will become insolvent 18 months earlier than it would otherwise because of those overpayments, according to Congressional testimony by CMS’ chief actuary. That’s why, despite intense lobbying by the insurance industry, Congress inserted a provision in the Affordable Care Act to eventually phase out those overpayments.
Source: wendellpotter.com

Medicare Eligibility & Enrollment

Beneficiaries who are enrolled in Original Medicare have the option of enrolling in a Part D plan to cover the costs of certain prescription drugs. Every beneficiary must have creditable prescription drug coverage, which can come in the form of a Prescription Drug Plan (PDP), a Medicare Advantage Prescription Drug (MAPD) plan, or an employer health plan. Eligible beneficiaries that reside in a plan’s network may enroll in a Part D plan during their Initial Enrollment Period, the Annual Enrollment Period, or during a Special Enrollment Period for which they qualify. The Initial Enrollment Period and Annual Enrollment Period are similar to the ones for Medicare Advantage plans, and a Special Enrollment Period can occur at any time of year depending on the qualifying event. Additionally, if you drop your MA coverage during the Medicare Advantage Disenrollment Period between January 1 and February 14 each year, you may be able to enroll in a stand-alone PDP if you were not previously enrolled in one.
Source: ehealthmedicare.com

State Highlights: Feds Sue Fla. Senate President’s Former Co. Over Medicare Billing

Posted by:  :  Category: Medicare

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San Jose Mercury News: Barbara Lee Bill Would Push States To Roll Back Criminal HIV Laws California and other states would be pressured to amend or repeal criminal laws that single out HIV-positive people under a bipartisan bill co-authored and introduced this week by Rep. Barbara Lee. Lee, D-Oakland, said 32 states and two U.S. territories have laws that criminalize exposing another person to HIV even if the virus isn’t actually transmitted. And 36 states have reported at least 350 cases in recent years in which HIV-positive people have been arrested or prosecuted for consensual sex, biting and spitting, according to the Center for HIV Law and Policy (Richmond, 5/9).
Source: kaiserhealthnews.org

Video: Cheryl Bradley lectures on Medicare Billing

Hospital Medicare Billing Practices Vary: Report

<a href=”https://data.cms.gov/Medicare/Medicare-Provider-Charge-Data/s99v-duw6″ target=”_blank” title=”Medicare Provider Charge Data” data-mce-href=”https://data.cms.gov/Medicare/Medicare-Provider-Charge-Data/s99v-duw6″>Medicare Provider Charge Data</a>
Source: businessinsider.com

Covalon’s ColActive Plus Receives Medicare Billing Codes

In February of this year, Medicare Pricing, Data Analysis and Coding (PDAC) announced that for claims with dates of service on or after June 1, 2013, the only products which may be billed to Medicare using the Collagen Dressing Codes are those for which a written coding verification has been made by the PDAC contractor and are listed on the Product Classification List in the Durable Medical Equipment Coding System (DMECS) maintained on the PDAC web site www.dmepdac.com.
Source: medbill.net

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

OIG Issues Report Finding Inconsistencies in Medicare Billing for Hospice Inpatient Stays

The OIG did not find definitive evidence of inpatient care misuses, but said inconsistencies in billing for GIP among hospices warrants further investigation to ensure that hospices are using GIP as intended and providing the appropriate level of care.  Specifically, the OIG found that hospices that owned or leased their own inpatient units provided GIP care to more beneficiaries and for longer periods of time than those without.  Hospices that used inpatient units provided GIP to 35% of their beneficiaries, while those who did not provide GIP in for only 12% of their beneficiaries.  The hospices that used inpatient units also had GIP representing 13% of their total Medicare dollars, while those that did not use inpatient units had GIP representing only 4% of their total Medicare dollars.  Hospices that provided GIP in inpatient units were also found to be more likely to be large than were other hospices that provided GIP.
Source: beneschhealthlaw.com

Dr. Sri J. Wijegunaratne of Anaheim Guilty of Role in $1.5 Medicare Billing Fraud Scheme

Scheduled to be sentenced on Sept. 9, Wijegunaratne faces up to 10 years in prison and a $250,000 fine for each count. That’s the same sentencing date and punishment facing Wijegunaratne’s co-conspirators: Ontario’s Godwin Onyeabor, 49, an officer at Fendih Medical Supply Inc. in San Bernardino, and Heidi Morishita, 48, of Valencia, who brought prescriptions to Onyeabor, who was also convicted last week of conspiracy to commit health care fraud and 11 substantive counts of health care fraud. Fendih specialized in what is known as durable medical equipment (DME) like power wheelchairs. Between January 2007 and February 2012, Wijegunaratne wrote prescriptions for DME his patients did not need and often did not use, with Morishta taking the scripts to Onyebor to be fulfilled. Medicare was then billed for the costs. “At trial, several Medicare beneficiaries testified that they were lured to medical clinics with the promise of free items such as vitamins and juice, only to receive power wheelchairs that they did not need and did not want,” reads the Justice Department statement. “The beneficiaries further testified that their attempts to reject delivery of the power wheelchairs from Onyeabor’s supply company were unsuccessful. Onyeabor, Wijegunaratne and others submitted and caused the submission of approximately $1.5 million in false and fraudulent claims to Medicare, and received almost $1 million on those claims, according to federal prosecutors. The doctor received kickbacks for generating fresh patients for false billings. Email: mcoker@ocweekly.com. Twitter: @MatthewTCoker. Follow OC Weekly on Twitter @ocweekly or on Facebook!
Source: ocweekly.com

Medicare Fraud Strike Force Charges 89 Individuals for Approximately $223 Million in False Billing

This coordinated takedown was the sixth national Medicare fraud takedown in strike force history. In total, almost 600 individuals have been charged in connection with schemes involving almost $2 billion in fraudulent billings in these national takedown operations alone. The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention and Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.
Source: jameshoyer.com

ANA offers guidance on new Medicare billing codes 

The new Medicare payment policies for “transitional care management” and “complex care coordination” services went into effect Jan. 1. Under the Medicare Physician Fee Schedule Final Rule, Medicare will reimburse for transitional care management services in the first month after high-need patients are discharged from the hospital. Nurse practitioners, clinical nurse specialists and certified nurse-midwives (as well as physicians and physician assistants) are eligible to bill for transitional care management services.
Source: theamericannurse.org

Income Thresholds For Medicare Part B And Part D Premiums

Posted by:  :  Category: Medicare

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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

Video: The Early Show – Medicare premiums up less than expected

Reducing Subsidies for Higher Income Medicare Beneficiaries

Currently, Medicare beneficiaries with incomes starting at $85,000 (or $170,000 for couples) pay higher Part B and D premiums, which start at 35 percent of program costs and peak at 80 percent of program costs for beneficiaries with incomes over $214,000 (or $428,000 for joint filers). As of now, these higher premiums affect only 1 in 20 Medicare recipients. While the thresholds for higher premiums were originally adjusted annually for inflation, a provision in the ACA froze the income thresholds through 2019, at which point almost 10 percent of beneficiaries are projected to pay income-related premiums. Starting in 2020, however, the thresholds are scheduled to bounce back upward as if they had never been frozen, thereby reducing the proportion of beneficiaries who would be subject to higher premiums.
Source: bipartisanpolicy.org

2011 Medicare Deductibles and Premiums

 “Part A premiums are decreasing because spending in 2010 was lower than expected and the Affordable Care Act implemented policies that lower Part A spending due to payment efficiencies and efforts related to waste, fraud and abuse. Part B premiums are increasing because of growth in the use of services like outpatient hospital care, home health and physician-administered drugs. In addition, the premium accounts for a likely Congressional action to avert a precipitous decrease in physician payments, which the Administration supports, and has occurred every year since 2003. The Administration is committed to permanent reform of the physician payment formula.”
Source: wordpress.com

How to Transform Medicare into a Modern Premium Support System

In the FEHBP, the capped amount of the government’s contribution to employees’ health plans is based on 72 percent of the weighted average premium of health plans competing in the program. This formula, allowing for changes in the market, also provides that the government’s contribution cannot exceed 75 percent of the cost of any given plan. If federal workers or retirees buy a plan that is more expensive than the government contribution, they pay the extra costs. OPM determines “reasonable minimal standards” for plans, ensures that the health plans are fiscally solvent, and enforces rules for consumer protection. It does not set prices, standardize health benefit packages, or apply detailed guidelines for doctors or hospitals. Compared to Medicare’s rules, OPM’s regulatory role in FEHBP is light, and it is focused on providing a level playing field for health plans to compete. Walton Francis, a prominent Washington-based health care economist, writes that “the FEHBP has outperformed original Medicare in every dimension of its performance. It has better benefits, better service, catastrophic limits on what enrollees must pay, and far better premium cost control.”[11] 
Source: heritage.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

Some Seniors Are In For Sticker Shock On Drug Premiums

Others say it makes perfect sense to require seniors with higher incomes to pay more for Medicare. “Given where we are fiscally in this country, I really don’t have a big problem with making that argument that we ought to be asking seniors in that income category to pay a larger share of the value of the benefit they are receiving,” said James Capretta, a fellow at the Ethics and Public Policy Center, a conservative think tank. Capretta also said he doubted that seniors could get a better deal from a private insurer than from Medicare.
Source: kaiserhealthnews.org

Medical company declines to answer Senate questions on Medicare billing

Posted by:  :  Category: Medicare

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JOIN THE DISCUSSION We welcome comments. To post one, you must sign in using either your McClatchyDC login or your login for Facebook, Twitter or Disqus. Just click the appropriate box below. Please keep your comment civil, short and to the point. Obscene, profane, abusive and off topic comments will be deleted. Repeat offenders will be blocked. If you find a comment abusive or inappropriate, please flag it for the moderator by placing your cursor on the comment, then clicking the “flag” link that appears. Thanks for your participation.
Source: mcclatchydc.com

Video: The Savage Nation – Dr. Michael Savage “Social Security Disability” Fraud, Waste & Abuse

Better Business Bureau warns elderly to beware Medicare/Medicaid scams

These people are asking for personal information such as Medicare, Medicaid, Social Security, credit card or bank account numbers in order to provide free services such as medic alert alarms, back braces, and other products that assist the elderly and infirm and are paid for by Medicare and Medicaid.
Source: bbb.org

Identity Thieves Impersonating Medicare Employees

Fortunately, a few wary senior Texans immediately questioned the callers’ request. But increasingly savvy identity thieves are prepared and attempt to create the false impression that they already have the senior’s personal information. As proof, the callers often repeat some of the call recipient’s personal information such as name, address and telephone number. But because this information is easy to obtain, the caller’s verification effort is actually just a devious ruse that attempts to mimic the practices of legitimate enterprises – like a bank or insurance company – in an effort to steal the call recipient’s Social Security and bank account number.
Source: medbill.net

A guide to RR Medicare’s voice

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

Nevada SMP empowers seniors to prevent Medicare Fraud

In the case of Medicare and Medicaid, fraud generally involves deliberately billing for services that were never rendered or for over-billing, such as charging a higher rate than is actually justified. The Centers for Medicare and Medicaid or CMS, estimated that in 2010, the two programs together paid more than $65 billion in improper federal payments. An April 2012 study by a RAND Corporation analyst and a former CMS administrator estimated that fraud and abuse cost Medicare and Medicaid as much as $98 billion in 2011.
Source: seniordiscountslasvegas.com

Health care reform leads to telephone scam

My elderly Mom lives in Washington state and this sounds like exactly what happened to her this week. Two people talked to her, she was told this same story about a Medicare card and asked to read all the numbers on the bottom of her check. She was asked to repeat them again to another individual who said the information was being recorded. When she began questioning them she was hung up on. Unfortunately she did not get their phone number but at least had the presence of mind to believe it to be a scam but she had already given out her banking information. I have spent the last 2 days closing her bank account and opening a new one. She feels totally mortified that she would fall for such a scam but of course it sounded like an official call and she was easily preyed upon because she is aging and vulnerable. I hope these crooks can be caught and stopped.
Source: csbj.com

Medicare Card Phone Scam Targets Senior Citizens

Callers have been asking victims to verify basic information such as a telephone number or mailing address, deluding them into providing much more private information such as a Social Security number or routing number.  This leads to subsequent unauthorized deductions from the checking account. This all comes with scammers utilizing the new changes from the Affordable Care Act as well to further confuse victims. If you have a senior whom you can warn, it is best to contact and make them aware sooner rather than later of this trending scam.
Source: pmbcgroup.com

Fraud Alert: Oklahoma seniors targeted by telephone phone scam

Callers are informing seniors there are new Medicare cards being sent but information for direct deposit is needed. The scammer asks which bank the senior uses and then provides its routing number before demanding the account number from the senior.  Routing numbers, the first set of numbers on the bottom of the check, are available online to the general public and allows scammers to give the impression they are officials of Medicare. When the scammers encounter resistance to provide an account number, they will threaten to withhold the “new Medicare” card.
Source: city-sentinel.com

Anthem Blue Cross Customer Service Contact Info: Phone Number, Fax, Email & Hours

Or call one of our local sales offices: Athens: 1-866-803-5173 Canton: 1-800-732-1897 Cincinnati: 1-800-318-8253 Cleveland: 1-800-928-2902 Columbus: 1-800-355-6411 Dayton: 1-888-857-6747 Lima: 1-866-594-0517 Mansfield: 1-888-290-2925 Toledo: 1-877-824-9762 Youngstown: 1-800-392-7869
Source: customerservicenumbers.org

Medicare Eligibility & Enrollment

Posted by:  :  Category: Medicare

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Beneficiaries who are enrolled in Original Medicare have the option of enrolling in a Part D plan to cover the costs of certain prescription drugs. Every beneficiary must have creditable prescription drug coverage, which can come in the form of a Prescription Drug Plan (PDP), a Medicare Advantage Prescription Drug (MAPD) plan, or an employer health plan. Eligible beneficiaries that reside in a plan’s network may enroll in a Part D plan during their Initial Enrollment Period, the Annual Enrollment Period, or during a Special Enrollment Period for which they qualify. The Initial Enrollment Period and Annual Enrollment Period are similar to the ones for Medicare Advantage plans, and a Special Enrollment Period can occur at any time of year depending on the qualifying event. Additionally, if you drop your MA coverage during the Medicare Advantage Disenrollment Period between January 1 and February 14 each year, you may be able to enroll in a stand-alone PDP if you were not previously enrolled in one.
Source: ehealthmedicare.com

Video: Medicare vs Medicaid 612-309-9184 Minnesota Medical Assistance Minneapolis Elder Law Attorney

Implementing Health Reform: Preexisting Condition Insurance Plan & Medicaid/CHIP Renewal

Third, states will be allowed to request a waiver to enroll individuals in Medicaid for 2014 and 2015 based on Supplemental Nutrition Assistance Program (SNAP) eligibility.  To qualify for SNAP an applicant’s household income generally cannot exceed 130 percent of the federal poverty level.  Household income is rigorously verified and kept current.  Recent studies show that the vast majority of non-elderly, non-disabled adults who are eligible for SNAP will also be eligible for Medicaid. Allowing states to enroll newly eligible adults (or some subset of them) based on SNAP eligibility will ease the handling of the flood of Medicaid applicants expected in states that expand eligibility.  It will also assist states with an orderly transition as they move toward linking their Medicaid and human services eligibility determination systems.  The states are offered several options for linking SNAP to Medicaid enrollment, such as adding a Medicaid check box to their SNAP application form or mailing a Medicaid card to a SNAP enrollee that can be activated through a phone call or online acknowledgment of the receipt of the card. States must also ensure the applicants are provided with information about available services and program rights and responsibilities.
Source: healthaffairs.org

CMS Announces 2013 Application Fee for Medicare, Medicaid and CHIP

On November 30, 2012, CMS announced the 2013 application fee for those providers initially enrolling in Medicare, Medicaid, or CHIP or revalidating an enrollment or adding a new location.  This application fee applies to those providers submitting an 855A application form, which is the form that health centers use to enroll in the Medicare program. The 2013 fee will be $532.00, effective January 1, 2013.  This is a $9.00 increase over the 2012 fee.
Source: nachc.com

Medicare Advantage Fact Sheet

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

Benutzer:WilburFle – TrainzDepot Wiki

Medicare supplies a variety of options from which to choose from, and it’s important that a person who is ready to come into Medicare knows what all the options are that are offered to them. There are certain methods in which to simply take before joining Medicare, and after joining Medicare. A Medicare application can be done online or perhaps a paper application can be sent to your property. Before a person turns age 65 the application form must be completed around three to four months. If your person is unable or uneasy in filling out their own Medicare application an authorization Medicare form can be signed by them authorizing a member of family or close friend to fill out the Medicare application for them. Once an individual has turned 65 and is just a complete member of Medicare for the first year any Medicare customer might have a totally free routine trip to their medical practitioner within the Medicare community. By signing up for regular Medicare information a person is able to keep track of what physicians, hospitals, and other medical services they have been to and also can keep track of the deductible they’ve settled in and to be able to keep track of their Medicare claims. By the time people are in a position to join Medicare they’re on a variety of medications for one physical or mental problem. Medication can cost a considerable amount every month placing a person in times where they wonder whether they can buy medication or other products. When coming up with a choice regarding which doctor, hospital or consultant to see on a regular basis the options must be within the Medicare circle of the specific invest which a Medicare individual lives. They’ve 8 weeks to reunite into Medicare and select their hospitals, doctors and specialist again in the new area If your individual moves out-of the area, see medigap insurance.
Source: trainzdepot.net

Georgia Printable Medicaid Application Forms 2013

Popular banks in the state of Georgia include PNC, SunTrust, Bank of America, Chase, Citi, Wells Fargo, First Citizens and others.  If you are truly struggling to find a bank in your local area please feel free to contact me.  Also, use Google Maps and the FDIC search tool as a way to find unique borrowing opportunities.  Google Maps has incorporated Google+ local reviews so potential borrowers will be able to see how other customers rate that particular financial institution.  This can be very important for anyone who has had to deal with bad customer service when it comes to money or finances.  Also recognize that banks are more than willing to reach out to new customers if you have done a good job of paying all your bills on time in the last several months and years.  If your credit score has increased you will likely find that borrowing money through a bank is not that difficult.
Source: wojdylofinance.com

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May 26, 2013

Selecting A Medigap Supplement Plan In Texas. Consider Some Of The Tricks

Posted by:  :  Category: Medicare

Various medsupp plans put together assistance for cracks in Medicare videos of skilled birkenstock care inside to a nursing home. The member really should enter the nursing home after a 3 day stay a good acute care medical and deemed technically necessary to seem to get care in a skilled nursing facility. The care must absolutely ultimately be recommended by an marriage ceremony physician. Actual do not appear for custodial worry. Thus, in reality regardless of the fact much skilled nursing care is supplied within nursing homes, nursing home really care as most involving it is probably not covered. Allying Medicare and applications F and F up to thousand days is included in the insurers.
Source: grandec.org

Video: Texas Rejects Obamacare’s Medicaid Expansion, Won’t Set Up Own Exchange

Medicare Health Insurance Experts Guide Texas Woman Through Medicare Insurance Maze

Treatment Advantage Plans can be obtained to individuals are generally eligible and have in effect Medicare Plan A real and B and that live in one place that offers final results . plan. when enrolled in Medicare health insurance Advantage Plan on the receiving end are still an area in the government as long as Medicare insurance however are not eligible get hold of extra supplemental insurance such as usually the Medigap policies described earlier. Treatment Advantage is all of the simplest term a progression of study in which Treatment offers contracts specific area hospitals and additionally doctors for recognized amounts. In turn individuals enrolled in this particular insurance plan am obliged to attend to the facilities of these particular medical professionals.
Source: salonstylesforyou.com

10 Reasons Why Your Doctor Won’t See Medicare Patients

The National Institute for Mental Health estimates that as many as five million elderly people in the U.S. suffer from subsyndromal depression, which can lead to major depression if left untreated. Depressed elderly are at high risk for suicide. Although senior citizens comprise only 12 percent of the U.S. population, they accounted for 16 percent of all suicides in 2004 (NIMH, 2007.) Helping patients with these types of issues often falls to the primary care physician, who may have a long-standing relationship with the patient. Although it is not condoned by Medicare, we know that many physicians do not charge adequately for counseling-type visits.
Source: managemypractice.com

Texas governor reiterates opposition to Medicaid expansion

“Seems to me April Fool’s Day is the perfect day to discuss something as foolish as Medicaid expansion, and to remind everyone that Texas will not be held hostage by the Obama administration’s attempt to force us into the fool’s errand of adding more than a million Texans to a broken system,” Perry told reporters at the state Capitol.
Source: medcitynews.com

Medicare Advantage Fact Sheet

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

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May 26, 2013

Stephen L Morgan’s Personal Blog: Really Are Aarp Medicare Vitamin Supplement Plans

Posted by:  :  Category: Medicare

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These kind of plans, although, only pay for patients which they just consider to be seriously important, medically communicating in. The costs for each insurance program policy will update and it is determined by on for this plan you seem to be going to choose. However, they are mentioned taking three primary means. First of all, the policy creators will check the insurer age that attained. Involves the short quotes particularly for ill over the age 65 years. The older the public get, the larger the premiums. Adjustments are ordinarily formed annually, after 3 years and 5 years. The adjustments also require swelling an automobile grows the charges to be money. Medicaid is also open to some other citizens, including those which are pregnant and have to have insurance, the disabled, blind, and particular children. Even if a child’s family are not entitled to Medicaid, he and also she most certainly will be qualified to receive Medicaid on very own status, ensuring that all children have likelihood to obtain proper and necessary amounts. Throughout almost every circumstance, once you pull together submit form 1 hand of them insurance web sites, you’ll have Several or more elevated providers calling ones self on the device and attempting giving the approach so that all of the entire group the best commission. Medicare insurance is a sacrifice between what types of health management is needed to obtain senior citizens yet what the can provide. If Only The State Could Make It This Easy To Get A Medicare Supp Plan For Working Class People plans have been the solution which will these “gaps” through coverage. They will cover items that Medicare cannot have the money. Always understand that Medicare supplemental health insurance policies are traded by private providers. The policy itself is the similar no matter who sells it however the cost to volunteers might change. When you pay for Medigap Plan K at one insurance corporation is the same coverage you get through another insurance provider. The difference being usually the premium you outlay cash to offer the insurance. System one of pushed it is essential to do review before settling on a Medigap plan and then provider. A lot of Medicare Advantage Plans, including PPO’s and HMO’s, have provider networks. Our seniors who purchase good HMO must excursion doctors, hospitals, to specialists that message boards in your the plan network. If they choose to visit doctors or another providers who do not participate they get not receive each benefit from their own health plan. Because they came from purchase PPO’s can click on providers outside concept network, but they’ll have higher co-payments and may possess a deductible. This includes the runs of extended emergency care center stays, specialized restorative healing care and insurance policy for emergencies where occur abroad. Before enrolling regarding a plan, your organization should understand those actions the coverage options are and you see, the rules that oversee changing policies. If you are typically still employed and covered under a real group health plan, it may cause problems for your Medicare potentials. Medicare insurance Supplemental Plan N covers the Part A deductible, which is $1100 of 2010 and a new Part B every year deductible, which happens to be $155 for the year. In extension, the Medicare supplementing Plan covers my 20% co-insurance exactly who genuine healthcare might not pay in Part A together with Part B. There are but also a few extensional profits including the actual foreign trip advantage and a “Part B excess Charges” benefit. This guidance inclusive plan includes the perfect policy cover money can purchase.
Source: blogspot.com

Video: Medicare Supplement Plan N

Massachusetts, Minnesota, and Wisconsin Medicare Supplement Plans

Unlike most states, which offer the option to enroll in one of 10 standard Medigap policies, Massachusetts, Minnesota, and Wisconsin offer Medicare Supplement plan offerings that are unique to these states. Medicare Supplement (Medigap) plans are available as an option to get coverage for out-of-pocket costs not already covered by Part A and Part B. In most of the United States, eligible beneficiaries can choose from 10 standardized Medigap plan offerings, with plans named the same letter offering the same benefits no matter what state the plan is offered in. However, as stated previously, not all beneficiaries have the option to enroll in one of these standard Medigap policies.
Source: planprescriber.com

Benefits Medicare Plan Deb And Medigap Design D

Quit financial difficulties being a expensive medical treatment solutions and high price of medicines, can easily must that veggies secure your medical therapy costs in the. Have a medicare supplemental insurance insurance plan a person personally so that can actually not have a problem on your doctor’s bills. With a Medicare supplemental insurance coverage you can be sure that you are in the right way taken cared for while sick and as well recuperating in a major hospital bed. Medicare insurance Component C: Medicare insurance Component C (also named the Treatment Gain Program) pertains to a group more detailed insurance cover plan coverage plans made to seniors because of personal insurance establishments. Component C’s positive aspects contain protection offered underneath Areas A great and B, seeing as very well whereas dental, vision and as well other benefits. Aspect C usually incorporates Portion Ve had coverage as with care. Some Component C types require the collection of a distance top quality additionally to the top quality needed regarding Component B coverage. Medicare Supplemental Plan N covers the Part A deductible, which generally is 00 for the purpose of 2010 and most of the Part B every year deductible, which is without a doubt 5 for ’10. In extension, the Medicare nutritional supplements Plan covers the 20% co-insurance who seem to genuine healthcare might not pay for Part A and furthermore Part B. There are at the same time a few extensional profits including their foreign trip advantage and a “Part B excess Charges” benefit. Distinct inclusive plan comes with the perfect phone coverage money can buying. Summary of looking at www.medigapplansguide.com/medicare-supplement-rates Plan F in addition its fellow software programs as something that would be afraid with regards to. Embrace all of them with because they continue to keep you from finance ruin and provide you to buy the medical really care that you necessitate. Take per few minutes to read about doing this and how these individuals work before your family start shopping extremely that you can be more prepared and informed because of what is coming your way. Most importantly, don’t ever sell yourself transient by rushing like a the process as well as a not getting the thing you need, because you will regret it someday. When you are looking for most efficient Medicare Insurance, therefore you should keep a number of them important points inside your mind to go for long term security. The plans written by the insurance installers would not change, therefore you might focus on the sourcing cost of Medicare insurance rrdeas that you are looking at affordable premium. Some plans costly precious and life time to start with, but will possess a slow growth increasing over the lifetime of your policy. Prominently, it is the most effective Medicare health like plan to write about all type along with health care money according to your expectations completely. One comes across all the types of insurance, Medicare supplement insurance coverage coverage attributes amongst these. It is forever better to be informed when it is about the Medicare supplement cover because there probably are stable changes with regard to insurance policy; commonly a change for a great deal better however at times it is always. It is significant to monitor these types of varying trends an ideal previously on Medicare supplement insurance or ought to register for the actual same. There is an important in order to a plan; also since the schemes are being modified, the companies are commencing to cost the new percentages. This is the primary step attached to change ever in which 1992. If you are eligible alter insurance companies designed for Medicare Part E during the core of the year then existing plan will signific all of one’s own total drug worth amounts and utter out of pocket amounts to increased plan. If you decide to are in the coverage gap and they switch plans, a person still be in the coverage gap. Every Medicare Chapter D plan only at that point in the a coverage difference so there is not a way of getting it if you are a lot on medications. You’ll find some plans available now that will pay for generic tier a particular medications during the life insurance gap.
Source: typepad.com

On The Topic Of Medicare And Medicare Supplement Plans

medigap plans are the optimum health care products that provide specific amount of serenity to seniors in addition , disabled people to protect your life all over health care plans. This specific type of supplemental health insurance programs covers the gaps between original Medicare payments and has comfortable planning to find providing interesting help and advice to Medicare supplemental plans. May very challenging time period taking health really do care thrillingly, which creates the process of applying health maintenance plans very easy and simple. Moreover, you will take advice from expert insurance agents, who provide smart guidance for safeguarding your life thankfully.
Source: isn-buenosaires-2012.org

InsureBlog: Medicare Advantage Cuts

For just a few dollars more than most pay for a Medicare Advantage plan you could own a Medicare supplement insurance plan N and have much less out of pocket exposure than you will have under a Medicare Advantage plan.
Source: blogspot.com

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May 26, 2013

Kaiser Permanente Leads the Nation in 13 Medicare Measures

Posted by:  :  Category: Medicare

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

Video: Jed Weissberg, MD, Talks About Medicare Advantage Health Plans and the Special Enrollment Period

Medicare Reveals What Hospitals Charge For Many Procedures

Los Angeles Times: Patient Is Out Of Network, Out Of Luck A worrisome abdominal pain drove Jalal Afshar to seek treatment last year at health care giant Kaiser Permanente. … Kaiser granted his request to see a specialist in Arkansas. But it ultimately declined to pay for his treatment there. By June, Afshar said, Kaiser was arranging for hospice care so that he could die at home. Afshar, 58, refused to accept that. Despite Kaiser’s stance, he went back to Arkansas for six months of stem-cell transplants, chemotherapy and other treatments that he says saved his life. Now he owes $2 million for his care and is suing the company in state court for breach of contract and unfair business practices (Terhune, 5/10).
Source: kaiserhealthnews.org

Kaiser Permanente Georgia Offers Seniors Tips for Selecting a Medicare Plan

 Kaiser Permanente is Georgia’s largest not-for-profit health plan. Its mission is to provide high quality, affordable health care services to improve the health of its members and the communities it serves. Kaiser Permanente serves more than 235,000 members in a 28-county service area including metro Atlanta with care focused on their total health and guided by their personal physicians, specialists, and team of heath care providers. Expert and caring medical teams are supported by industry-leading technology and tools for health promotion, disease prevention, state-of-the art delivery, and world-class chronic disease management. Nationally, Kaiser Permanente is recognized as one of America’s leading health care providers, serving mort than 9 million members in nine states and the District of Columbia. For more information, visit www.kp.org.
Source: patch.com

Kaiser Permanente Receives Highest Rating for Medicare Plan in Mid

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

Daily Kos: Kaiser report details Medicare options

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

Kaiser ranked highest Colorado health plan, says J.D. Power

Kaiser Permanente Colorado has been widely recognized within the health care industry for delivering top-quality care. According to the National Committee for Quality Assurance Health Insurance Plan Rankings 2012-2013, Kaiser Permanente Colorado is the highest-rated private health insurance plan in Colorado, and No. 6 in the nation for quality and member satisfaction. The Kaiser Permanente Medicare plan in Colorado also earned five stars from the Centers for Medicare & Medicaid Services, the highest overall rating for quality and service for 2013 plans.
Source: csbj.com

Medicare data show wide variation in hospital pricing

LocalHealthGuide is a health news and information web service for Seattle and the Puget Sound Region. We are independent and unaffiliated with any hospital, medical association or insurer. If you have questions or if your group has an upcoming event that you would like us to cover, please let us know by going to our “Contact Us” page and dropping us a note. — Michael McCarthy, Editor
Source: mylocalhealthguide.com

Kaiser Permanente CO earns Medicare 5

In addition to the high scores, Kaiser Permanente released survey findings revealing that consumers have a low awareness of the Medicare Star Quality Rating System. According to the survey conducted by Harris Interactive, only 18 percent of Medicare-eligible seniors said that they are familiar with the government’s rating system, and of those that are familiar, less than one-third have used the system to select their health plan. The survey also showed that only 2 percent of respondents know how their current health plan is rated.
Source: metrodenver.org

The Promise and Risks of Medicare Managed Care

Medicare managed care comes in many forms. Almost two-thirds of MA enrollees participate in HMO-type plans, such as Kaiser Permanente, where treatment is delivered by employed staff. A rapidly growing alternative is offered by preferred provider organizations (PPOs) where community physicians and nurses are under contract with insurers. Among other versions are Special Needs Plans (SNPs) that provide care for people with complex medical requirements, including those who are  very poor and very ill and who are eligible for both Medicare and Medicaid (dual eligibles).    
Source: howardgleckman.com

Kaiser named top rated Medicare plan in Hawaii

big island biif billy kenoi daniel akaka dlnr dui stats earthquake election 2012 fire fuel gasbuddy gov linda lingle halemaumau hawaii volcanoes national park hhsaa high surf advisory hilo hvo ironman kailua-kona ka‘u keaau kilauea Kohala kona lava mauna kea mauna loa missing neil abercrombie nws pahoa parker school police puna recalls traffic triathlon uh-hilo usgs volcano volcano watch waiakea waikoloa waimea
Source: hawaii247.com

Taking a gander back to year

Planning for Health editors ran a cover story in the winter of 1969 edition about the 1960s as the “Decade of Change for Medicine.”  The article’s author wrote: “Experimental organ transplants, Medicare and The Pill collected headlines during the past decade, but medicine made gigantic strides forward in less glamorous areas as well. . . examples are the almost complete eradication of polio through universal immunization (and) the development of vaccines for mumps, measles, and Rubella (German measles) . . . ”
Source: kaiserpermanentehistory.org

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May 26, 2013

Claims: Multiple CPIDs: Noridian Medicare Part B

Posted by:  :  Category: Medicare

CollaborateMD believes in keeping our customers informed of pertinent issues which may affect your business. Please read the following bulletin from Noridian Medicare Part B, which affects these payers: CPID 2454 SD Medicare CPID 2466 WY Medicare CPID 1459 OR Medicare CPID 2458 UT Medicare CPID 2453 ND Medicare CPID 1455 AK Medicare CPID 7400 MT Medicare CPID 1456 AZ Medicare CPID 1462 WA Medicare Action Required: Please be aware of the following information: HOLDING CLAIMS FOR SERVICES PAID UNDER THE 2012 MPFS The negative update under current law for the 2012 Medicare Physician Fee Schedule (MPFS) was scheduled to take effect on January 1, 2012. Consequently, as on numerous occasions in the past, CMS will instruct its Medicare claims administration contractors to hold claims containing 2012 services paid under the Medicare Physician Fee Schedule for the first 10 business days of January (i.e., January 1, 2012, through January 17, 2012). The hold should have minimal impact on provider cash flow because, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt. MPFS claims for services rendered on or before December 31, 2011, are unaffected by the 2012 claims hold and will be processed and paid under normal procedures and time frames. The Administration has stated their disappointment that Congress has failed to pass a solution to eliminate the sustainable growth rate (SGR) formula-driven cuts, and has put payments for health care for Medicare beneficiaries at risk. They continue to urge Congress to take action to ensure these cuts do not take effect. CMS will provide notice on or before January 11, 2012, with more information about the status of Congressional action to avert the negative update and next steps regarding the claims hold. If you have any questions please contact CollaborateMD Client Services at 1-888-348-8457, Option 2.
Source: collaboratemd.com

Video: Videos matching: noridian medicare

Noridian doubles its federal business volume with new contract

Noridian will be the Medicare Administrative Contractor (MAC) for Medicare Part A and Part B for California, Nevada, Hawaii, Guam, American Samoa and the Northern Mariana Islands — Jurisdiction E (JE). This area represents 9 percent of the total volume of Medicare Fee-for-Service claims administration business nationwide. Combined with its other existing Medicare claims contracts, Noridian will now administer a total of approximately 15 percent of Medicare’s national volume of business.
Source: ndakotabusiness.com

Palmetto GBA’s Appeal Denied Again, Noridian Will Be The New Contractor!

of American Samoa, Guam and the Northern Mariana Islands. Jurisdiction E includes over 3.5 million Medicare fee-for-service beneficiaries, 500 Medicare hospitals and 86,500 physicians. MACs process Part A and Part B claims and perform other critical Medicare operational functions, including enrolling, educating and auditing Medicare providers.
Source: practicons.com

Noridian Medicare Now Covers Renessa(R) Treatment for Incontinenc… ( NEWARK Calif. Feb. 24 /

Related biology technology : 1. QMed, Inc. Reports July Medicare SNP Enrollments 2. Change in Medicare and Medicaid Legislation Creates Market for Antimicrobial Coatings In the U.S. 3. House and Senate Pass Medicare Legislation to Freeze 2008 Reimbursement for Therapeutic Radiopharmaceuticals at 2007 Levels 4. Medicare Coverage Recommended for In-Home Sleep Testing 5. MedicareCRM(TM) to Speak at IIR Medicare Advantage Congress 6. STAAR Surgicals Collamer(R) IOL Designated as a New Technology Intraocular Lens by the Centers for Medicare and Medicaid Services 7. Medicare Approves in Home Sleep Apnea Testing 8. Medtronic Unit to Pay $75 Million to Settle Whistleblower Medicare Fraud Case 9. Medicare Exemplary Provider Accreditation Awarded to Regenesis Biomedical 10. Arcadian Health Plan Addresses Medicare Doctor Payment Cuts 11. Netsmart Technologies Web Seminar Helps Behavioral Health Organizations Understand Electronic Prescribing and the Importance of New Medicare-Related E-Prescribing Legislation
Source: bio-medicine.org

FDA Law Blog: Medicare Revokes Payment for ARANESP

FDA Law Blog is published for informational purposes only; it contains no legal advice whatsoever. Publication of FDA Law Blog does not create an attorney-client relationship. FDA Law Blog is the blog of Hyman, Phelps & McNamara, P.C. (“HPM”) and it is intended primarily for other attorneys and regulatory professionals. No part of FDA Law Blog –whether information, commentary, or other– may be attributed to HPM’s clients. Readers should be aware that HPM represents many companies in the food, drug, medical device, and health care industries, and therefore FDA Law Blog may occasionally report on news that relates to HPM clients. FDA Law Blog will always strive to be unbiased in its reporting. All information on FDA Law Blog should be double-checked for its accuracy and current applicability. Copyright 2011 Hyman, Phelps & McNamara, P.C.
Source: fdalawblog.net

The Social Network: Location Using 96402 For Lupron Injections In Just Noridian Patients

Involving safety and financial considerations, many more mature Americans do not just drive. These people rely instead on a public transportation. But getting away from home and procuring unavoidable medications can definitely chore for men and women that have some limited mobility. When seniors buy medicine online, they not just save time, may also save beaucoup bucks. Just like other online sellers, virtual pharmacies save staff and different kinds of overhead expenses. They are next free to flow these saving coupled to their valued clientele.
Source: the-social-network.net

Medical Management Strategies

(1) Noridian Medicare: (DME Billing) Noridian Medicare has been experiencing major issues with processing 5010 claims since January 1st. Their 5010 system is experiencing intermittence outage. Noridan is working to fix the problem. You may experience delay in payment compensations. (2) Medicare Update on 2012Payments: a) Medicare has begun to release EOBs (Explanation of Benefits) for the beginning of January dates of service and releasing the 10 day hold. b) Medicare is still delaying their 5010 implementation until April 1, 2012. During this 90 day non enforcement period (1-1-3-31-12), Medicare will have the systematic capability to perform up or down version conversions of incoming claim formats (either converting these to the 5010 format when necessary for cross over claims (billing secondaries) and/or leaving them in the 4010 EDI format. What has been occurring is these transitions are not always perfect and has created its own set of issues as well. (3) Medicare and Blue Cross Medical Management Strategies has also noticed that with all the changes going on in the industry for Electronic Data Information going to the new version 5010, there have been a number of significant issues that have occurred for Medicare and Blue Cross payers particularly. Medicare has had a number of issues to deal with this January which included revamping fee schedules, processing claims from clearinghouses in the older version since they put a hold on converting to the 5010 until April 1st, applying deductibles, etc. as well as crossover issues. Although they’ve been trying to notice everyone of how these transitions have been dealt with, there are still a number of issues particularly with clearinghouses to Medicare as well as crossover claims. Clearinghouses are reporting acknowledgements of claims going to Medicare and Medicare then stating they never received the batches.
Source: mmsofslo.com

Blue Cross Blue Shield and Noridian to host informational career fair for former PRACS employees

About Blue Cross Blue Shield of North Dakota BCBSND is a member-owned, not-for-profit independent licensee of the Blue Cross and Blue Shield Association. As North Dakota’s largest provider of health care coverage, BCBSND is taking BOLD steps to collaborate with doctors, hospitals, clinics and members to ensure affordable access to quality health care in the state. To learn more about BCBSND, visit www.BCBSND.com.
Source: bcbsnd.com

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May 26, 2013

Are Medicare Premiums Deductible As SE Health Insurance

Posted by:  :  Category: Medicare

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Medicare is basically the health insurance provided by the federal government for senior citizens above 65 years of age and the disabled. Are Medicare premiums tax deductible? A number of people who pay into Medicare on a monthly basis can claim for deductions on their taxes for these payments. There are a number of factors that determine whether you receive deductions or not and the amount of deductions that you are entitled to receive such as age, the type of Medicare and whether you receive any Social Security benefits or not.
Source: taxpremium.com

Video: Medicare Supplement plan F High Deductible Explanation

What is the Cost of Medicare: 2013 Medicare Costs for Coverage

Keep in mind that each insurance company decides how it wants to set its premiums for Medigap policies. There are three ways in which Medigap policies may be priced or “rated.” Community-rated plans, also known as no-age-rated plans, are priced at the same monthly premium for all beneficiaries enrolled in the policy, regardless of age. Issue-age-rated plans, also known as entry-age-rated plans, prices premiums based on your age when you are issued the policy. Pricing for attained-age-rated plans are based on your current age, which means that the premium for your plan will go up as you get older. Outside of these pricing factors, Medigap premiums may also go up because of inflation and other factors. Depending on how a Medigap policy is rated, it will affect the cost of your coverage now and in the future.
Source: ehealthmedicare.com

Deductibility of Medicare premiums as Self Employed Health Insurance Deduction

Background Prior to 2010, self-employed individuals were not allowed to take an above the line self-employed health insurance deduction under Section 162(l) for Medicare premiums. Health insurance is only considered deductible under the statute if it is established by your trade or business.  The purpose of the health insurance deduction is to equalize the treatment of owners of corporations who are allowed to exclude health care benefits as a fringe benefit and self employed individuals who cannot. Since Medicare is established by the Federal government the IRS did not consider Medicare premiums deductible as self employed health insurance. Recently the IRS reversed their opinion on the matter referencing Notice 2008-1. Notice 2008-1 states that as long as the self employed individual’s business ultimately pays for the health insurance and follows certain reporting requirements, the health insurance premium payments are deductible as above the line for the self employed individual. The Office of Chief Counsel IRS Memorandum extended Notice 2008-1 to apply to self employed individuals who pay Medicare premiums. Now all Medicare premium parts-A, B, C and D-paid by the self-employed individual for themselves, their spouse and dependents are deductible as self employed health insurance. The premium payments need not be paid directly by the self-employed individual. For example, the S corporation of a more-than-2% shareholder can make the payments directly and the self-employed individual is entitled to the deduction. 
Source: marcumllp.com

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

Medicare Deductibles 2013

Just as an FYI, I listed a brief summary of the deductible and coinsurance amounts. This information can be used to inform your patients about their Medicare benefits as well as collecting upfront payments from your Medicare patients.
Source: about.com

Restructuring Medicare’s Benefit Design: Implications for Beneficiaries and Spending

The study also examines the expected impact of two variations of this proposal. The first looks at a higher or lower out-of-pocket spending limit, and illustrates how raising the limit would increase beneficiary costs while reducing Medicare spending, while a lower limit would do just the opposite. The second variation examines the effect of combining the alternative benefit design with restrictions on Medigap coverage, another frequently mentioned approach to achieving Medicare savings.
Source: kff.org

Experts tell lawmakers: Obama Medicare proposals would hurt long

“Some Medicare-covered services, such as home health, laboratory services, and the first 20 days of a skilled nursing facility stay, have no cost-sharing at all,” she stated in her written testimony. “Private health insurance usually includes some kind of cost-sharing for these services. Just as unrealistically high cost-sharing is counterproductive, the total absence of cost-sharing for some services encourages inappropriate utilization and can help fraud remain undetected.”
Source: mcknights.com

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