Feds OK Va plan for Medicaid

Posted by:  :  Category: Medicare

The CCC provides a single program serving more than 78,000 Virginians enrolled in both Medicare, the federal health insurance program for the disabled or people 65 or older, and Medicaid, the federal-state program for the poor, elderly, blind and disabled.
Source: nbc12.com

Video: Medicare Part 1: Eligibility and Enrollment

Feds OK Va plan for Medicaid

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Source: tacticalminc.com

Virginia is Approved to Begin Offering Coordinated Healthcare for Medicare

Secretary of Health and Human Resources, William A. Hazel, MD. said, “For many years, the Commonwealth has been working toward this significant reform opportunity. We view this achievement as a testament to the willingness of Virginia’s Medicaid providers and interested health plans to work collaboratively with the department to implement innovative models of care. DMAS is always working towards the development of more effective and efficient service delivery opportunities. This program has the potential to be one of the most significant to date. I am grateful for the governor’s consistent push to ensure that Medicaid operates more efficiently and am proud of the leadership of the department in developing and obtaining federal approval for this demonstration. I am confident that participants in this demonstration will have better health outcomes while the state will achieve associated cost savings.”
Source: chrispeace.com

Medicaid Expansion Popular In Southern States, Despite Govs’ Opposition

Tampa Bay Times: Tampa Chamber: Businesses Concerned By Legislature’s Inaction On Medicaid Expansion For Tallahassee, refusing additional federal funds to expand Medicaid may turn out to have been the easy part. It will take longer, a half-dozen Hillsborough legislators acknowledged Tuesday, to come up with an alternative to provide health care coverage to an estimated 1 million uninsured Floridians. … Some Tampa businesses, (Greater Tampa Chamber of Commerce Chairman Gregory Celestan told local legislators), are “very concerned about significant additional health insurance costs” because of the Legislature’s “refusal to expand Medicaid.” “We will be at a competitive disadvantage when recruiting new businesses or adding jobs,” Celestan added. “How would you respond?” (Danielson, 5/21).
Source: kaiserhealthnews.org

States Move to Coordinate Care for Medicare, Medicaid

Many duals need care for acute and chronic physical and mental health conditions and frequently need Long-Term Services and Supports for both. There is a need to integrate care across multiple delivery systems subject to different requirements of two major payers—Medicaid and Medicare. Duals frequently have to navigate a complicated (and costly) system with few incentives for providers or programs to coordinate care.
Source: aarp.org

Kruse & Crawford CPAs Tax Blog 

Rick Kruse is a Cincinnati native and a graduate of Thomas More College and Xavier University. He has been a partner with two large Cincinnati firms and is now the principal of Kruse and Crawford. Rick’s experience has included auditing (he has been an audit partner) and tax (he has been a tax partner), although these days he considers himself a generalist and a consultant. He represents clients in loan negotiations, business expansions, buyouts and turnarounds. Read More—
Source: kruseandcrawford.com

Medicare and Medicaid Eligibility for New York

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Source: seniorbenefitsguide.com

Why Medicaid Matters to Medicare Beneficiaries and Their Families 

[1] Kaiser Family Foundation, Medicaid Matters:  Understanding Medicaid’s Role in Our Health Care System, March 2011, available at http://www.kff.org/medicaid/upload/8165.pdf (site visited Mar 25, 2011); Total Number of Medicare Beneficiaries 2010,  available at http://www.statehealthfacts.org/comparemaptable.jsp?ind=290&cat=6 (Site visited Mar 25, 2011) [2] Kaiser Family Foundation, “The Medicaid Program At a Glance,” March 2007, available at http://www.kff.org/medicaid/upload/7235-02.pdf (site visited Mar 25, 2011) [3]See, e.g., The Burden of Out-of-Pocket Costs on Medicare Beneficiaries, Feb. 24, 2011, at http://www.medicareadvocacy.org/2011/02/the-burden-of-out-of-pocket-costs-on-medicare-beneficiaries (Site visited Mar. 28, 2011) [4]  Gretchen Jacobson, Tricia Neuman, Anthony Damico, Barbara Lyons, “The Role of Medicare for People Dually Eligible for Medicare and Medicaid,” Kaiser Family Foundation, Jan 2011, available at http://www.kff.org/medicare/upload/8138.pdf (Site visited Mar 25, 2011) [5] See note i. [6] The Affordable Care Act, Pub. L. 111-148 (Mar. 23, 2010) §§4103, 4104, eliminates cost-sharing for Medicare preventive services. [7]  David Rousseau, Lisa Clemans-Cope, Emily Lawton, Jessica Langston, John Connolly and Jhamirah Howard, “Dual Eligibles:  Medicaid Enrollment and Spending for Medicare Beneficiaries in 2007,” Kaiser Commission on Medicaid and the Uninsured, December 2010 [8] Genworth Financial, Executive Summary – Genworth 2010 Cost of Care Summary, April 2010, available at http://www.genworth.com/content/etc/medialib/genworth_v2/pdf/ltc_cost_of_care.Par.85518.File.dat/Executive%20Summary_gnw.pdf (Site visited Mar 25, 2011). The median daily rate for a semi-private nursing home room is $185, or $67,525/year in 2010, according to this report. [9] “Spending for non-Medicare-covered services was also high. Among users of services, median OOP spending was highest for LTC facility services. In fact, the majority of LTC facility users incurred high OOP costs. Median OOP spending for users of such facilities was $7,611, with 10 percent of users paying at least $41,937 OOP for room and board and health care-related services during 2006. It is likely that these residents were self-financing their nursing facility stay before eventually qualifying for Medicaid.” Nonnemaker, Lynn, and Shelly-Ann Sinclair. Insight on the Issues: Medicare Beneficiaries’ Out-of-Pocket Spending for Health Care, AARP Public Policy Institute. January 2011, pg 7, available at http://assets.aarp.org/rgcenter/ppi/health-care/i48-oop.pdf  (Site visited Mar. 28, 2011). (Hereafter Nonnemaker, et al.) [10] See note 1. [11]  See note 2; see also Medicaid and CHIP Payment and Access Commission (MACPAC), “Report to Congress on Medicaid and CHIP,” March 2011, Figure 1-3, p. 20. [12] The Kaiser Commission on Medicaid and the Uninsured, “Medicaid’s Optional Populations:  Coverage and Benefits,” February 2005, available at http://www.kff.org/medicaid/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=51052 (Site visited Mar 25, 2011) [13] Id. [14]  Note, however, that the maintenance of effort requirement included in the Affordable Care Act protects individuals who maintain Medicaid eligibility under a Medicaid category currently offered in their state from losing their Medicaid coverage.  See Affordable Care Act, Pub. L. 111-148 and 111 -152  (Mar. 23, 2010 and Mar. 30 2010) § 2001 (b) amending 42 U.S.C. § 1396(a) and adding § 1396(gg). [15] Nonnemaker, et al at note 10.
Source: medicareadvocacy.org

MedicareIsSimple: Feds OK Va plan for Medicaid

The Solution to Your Healthcare Needs Us Here at Medicare is Simple, we understand your needs. It is our mission to educate and enable you to choose among the best Medicare plans to find the policy that fits your requirements. Get free quotes instantly using our advanced quoting technology. You will receive multiple quotes from the most reputable carriers for you to compare online. Medicare Is Simple 233 W Main St Lewisville, TX 75057 800-442-4915 inf@medicareissimple.com
Source: blogspot.com

Medicare and Medicaid: Eligibility, Coverage, and Costs

Medicare is composed of many different parts, and beneficiaries have the option to decide which plans they want to enroll in. Many eligible beneficiaries are automatically enrolled in Part A, which covers hospital care, and Part B, which covers certain medical services. Once enrolled, beneficiaries can opt to enroll in Medicare-approved private insurance plans to cover out-of-pocket costs not already covered and/or provide additional benefits. All individuals who are eligible for this program are also offered prescription drug coverage, which can be attained through a stand-alone Part D Prescription Drug Plan (PDP) or a Medicare Advantage plan with medication coverage.
Source: ehealthmedicare.com

Daily Kos: Study: Immigrants contributed $115 billion more to Medicare in last decade than they received

Most of the surplus from immigrants was contributed by noncitizens and was a result of the high proportion of working-age taxpayers in this group. Policies that restrict immigration may deplete Medicare’s financial resources. [emphasis added] Of course, for opponents of both immigration and Medicare, weakening Medicare could be a desired outcome. But there’s no question that, at least as far as Medicare is concerned, immigrants are net contributors. It’s a matter of age demographics, primarily. While immigrations and U.S. born individuals paid in roughly the same amount in contributions, the immigrant population is younger and is drawing far less out in benefits. That will be true for a couple of decades to come, as the baby boomers retire and draw heavily from the system. That’s probably true of Social Security, as well, the researchers conclude. Policies that reduce immigration would almost certainly weaken Medicare’s financial health, while an increasing flow of immigrants might bolster its sustainability. Because Social Security’s eligibility criteria and payroll tax–based funding closely track those of Medicare, our findings support the argument that immigration helps sustain Social Security. […]
Source: dailykos.com

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

CMS: Four provider responsibilities when residents want an expedited appeal of Medicare service terminations

Posted by:  :  Category: Medicare

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Beneficiaries can appeal to a Quality Improvement Organization when certain long-term care providers, including skilled nursing facilities and hospices, notify them that services will no longer be covered by Medicare. Under a final rule enacted in 2005, beneficiaries have a right to an expedited determination of these appeals. In a May 24 update to the Medicare Claims Processing manual, CMS provided detailed instructions regarding these expedited determinations, identifying the following four responsibilities for providers:
Source: mcknights.com

Video: Medicare Appeals

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

Eyelid lifts skyrocket among Medicare patients, costing taxpayers millions

Unlike private insurance plans, though, Medicare does not require pre-authorization of eyelid surgeries. Robert Berenson, a health policy expert at the Urban Institute and former commissioner of the Medicare Payment Advisory Commission, has pushed for selective pre-authorization for some Medicare services. But Berenson questioned whether reviewing physician records in advance would help much in the case of blepharoplasty, if surgeons have learned how to document the need for the procedure in order to work the system. “I am sure there are some patients who are hampered by eyelids drooping. And I’m sure that many of them are not and it’s a cosmetic reason,” Berenson said. But the doctors, he added, “have probably gotten very skilled at knowing how to document that something is not cosmetic.”
Source: publicintegrity.org

Medicare Recovery Audit Contractor (RAC) Update

With the resolution of the bid protest, the stay has been lifted and the RAC program is once again under way. RACs for the states involved in the first phase of the national rollout of the permanent program have begun conducting provider outreach sessions. Provider outreach is the first step in the process of implementing the RAC program with providers in these areas. Donald Johnson, Acting Director of the CMS Office of Legislation, in his February update to the House of Representatives and Senate indicated that providers will not receive correspondence from a RAC until the RAC and CMS have completed provider outreach. Accordingly, providers can expect to hear about provider outreach sessions and have an opportunity to communicate with the RAC for their region prior to receiving any RAC notices or medical record requests.
Source: 18.221

OIG Calls for Improvements in Medicare Appeals Process : Health Industry Washington Watch

The OIG has issued a report entitled “Improvements Are Needed at the Administrative Law Judge Level of Medicare Appeals.” The report discusses the impact of regulatory and organizational changes that went into effect in 2005 that required Medicare administrative law judges (ALJ) to follow new regulations addressing how to apply Medicare policy, when to accept new evidence, and how CMS participates in appeals. According to the OIG, in FY 2010, providers filed the 85% of ALJ appeals, while beneficiaries filed 11% and state Medicaid agencies filed 3%. ALJs reversed Qualified Independent Contractors (QIC) decisions and decided fully in favor of appellants in 56% of appeals, with the rate varying substantially across Medicare program areas and by ALJ. For instance, 62% of Part A ALJ appeals were fully favorable to appellants, compared to 59% for Part B, 18% for Part C, and 19% for Part D. The OIG notes that ALJs differed from QICs in their interpretation of Medicare policies, in their degree of specialization, and in their use of clinical experts. The OIG also found that when CMS participated in appeals, ALJ decisions were less likely to be favorable to appellants. The OIG concludes that there are a number of inconsistencies and inefficiencies in the Medicare appeals process that should be addressed. The report offers several recommendations for CMS and the Office of Medicare Hearings and Appeals (OMHA), including providing coordinated training on Medicare policies to ALJs and QICs; clarifying Medicare policies that are subject to different interpretations; improved guidance on the acceptance of new evidence by ALJs; improved handling of appeals from appellants who are also under fraud investigations; and increased CMS participation in ALJ appeals.  
Source: healthindustrywashingtonwatch.com

Daily Kos: Study: Immigrants contributed $115 billion more to Medicare in last decade than they received

Most of the surplus from immigrants was contributed by noncitizens and was a result of the high proportion of working-age taxpayers in this group. Policies that restrict immigration may deplete Medicare’s financial resources. [emphasis added] Of course, for opponents of both immigration and Medicare, weakening Medicare could be a desired outcome. But there’s no question that, at least as far as Medicare is concerned, immigrants are net contributors. It’s a matter of age demographics, primarily. While immigrations and U.S. born individuals paid in roughly the same amount in contributions, the immigrant population is younger and is drawing far less out in benefits. That will be true for a couple of decades to come, as the baby boomers retire and draw heavily from the system. That’s probably true of Social Security, as well, the researchers conclude. Policies that reduce immigration would almost certainly weaken Medicare’s financial health, while an increasing flow of immigrants might bolster its sustainability. Because Social Security’s eligibility criteria and payroll tax–based funding closely track those of Medicare, our findings support the argument that immigration helps sustain Social Security. […]
Source: dailykos.com

SOUTHWEST PHARMACY SOLUTIONS INCORPORATED v. CENTERS FOR MEDICARE AND MEDICAID SERVICES, No. 12–40097., May 01, 2013

Southwest has also failed to convince us that CMS’s interpretation is merely a “post hoc rationalization advanced by an agency seeking to defend past agency action against attack.” Id. at 2166 (alteration omitted) (quoting Auer, 519 U.S. at 462). As CMS has yet to characterize a claim challenging the PPR as either a grievance or a coverage determination, there is no past action to defend. Moreover, unlike previous cases where courts have declined to defer to an agency’s interpretation when doing so would impose liability, see, e.g., id. at 2167 (“Petitioners invoke the [agency’s] interpretation of ambiguous regulations to impose potentially massive liability on respondent for conduct that occurred well before that interpretation was announced.”), or unfair surprise, see, e.g., Long Island Care at Home, Ltd. v. Coke, 551 U.S. 158, 171, 127 S.Ct. 2339, 168 L.Ed.2d 54 (2007) (“[A]s long as interpretive changes create no unfair surprise ․ the change in interpretation alone presents no separate ground for disregarding the Department’s present interpretation.”), on a party without sufficient warning, CMS’s interpretation in fact benefits Southwest by promising to allow its challenges to the PPR to proceed as coverage determinations rather than grievances. Nor is this conclusion undermined by the fact that CMS advanced this position in a document drafted in response to the present litigation, see id., 551 U.S. at 171; Tex. Clinical Labs, 612 F.3d at 778, or by the fact that CMS is a party to this case, see generally Tex. Clinical Labs, 612 F.3d 771.
Source: findlaw.com

Purchasing A Medicare Advantage Plan

Posted by:  :  Category: Medicare

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You’re able in fact choose a number of medigap leads online when just go with the search performed just by people regarding finding medical insurance. The best facet that any medicare health insurance agent can achieve is try to find some of men and women medicare insurance draws and Medicare Supplement Plan F Guide takes you. Even if you go through searching for most of my medical insurance results in you can automatically try sorting outdoors people who are actually of age overhead sixty five and ask them to go for medigap plans. Most of all leads are going to convert into medicare supplemental insurance leads as most of the people simply are unacquainted with it. Trying to find for a coverage is merely facet of the promenade. It’s with regard to addition significant with find an charity with the performance of will find yourself present for families. Obtaining an agent at you are side that are well-informed to Treatment is the element. They can verify up with a to be doing no doubt we in spite related to everything obtained the most important finest policy assumed for your wants and finances. Staying on top of what is very much going on from Medicare and some of the government is the perfect chief priority off Medigap Select in Texas for that a majority of reason you written by no means now have to be engaged that you are not taken proper. Performing some kind of annual review in support of you as definitely ensures that you are holding generally greatest product about your budget. Medicare health insurance also has a yearly deductible on sites from doctors because non-hospital providers, also that Part B deductible is solely 5 per 12 at this available free time. After you’ve met that deductible, Medicare cover your doctor bills? It is good for 80 percent per cent of a pre-determined amount. Regardless of your doctor charges, Medicare sets specific to it limit for corporations. First and foremost, a person will must decide regardless of whether you can find the more extensive doctor/hospital coverage that can comes with any kind of a Medicare Supplement package. These plans are more high price than Medicare Positive aspects plans, some involving which have real low premiums. However, if you will have any continual or potential health problems, the South carolina Medicare Supplement could possibly save you much, much more your cash than it is priced at you over your current course of the latest year. Everyone these days to you due to the fact means that cannot be denied coverage, have pre-existing conditions excluded or have to pay a substantial premium due to any current or below health conditions, providing that you are in a single of these amounts. A lot seniors that short-term becoming recipients from Original Medicare don’t realize the fact that supplemental medicare plans for 2012. For those in leading health, you don’t know the need during extensive surgery, or that the need for visiting the emergency place plus some lab work might leave you in tons of debt. Just like be predicted, for the people with an getting out medical problem most notably arthritis, cancer, diabetes, or high familiy line levels, not developing a medicare supplement project will end set up costing your more then any top rated that you possess paid. One particular mistake to prevent is thinking ones neighbor’s Texas Medicare insurance insurance will buy you the package you need. One of the very more popular dietary supplement options is Software F. This method covers almost almost the deductibles, coinsurance, and copayments it you end up dealing with in relation to Medicare Parts A good and B. But, if you will have other health insurance coverage, you may perhaps well not need each of the the coverage designed by Plan F, for that concern you may not need Medigap rrnsurance policy coverage at all. Many retirees encounter some insurance from their former executive managers or through the actual retirement plan. Those plans may cover some at the out with pocket expenses not too covered by Treatment. That means someone can get away with another aid policy. Yes, I know, real confusing. The enough for you and your family to have you can get your deed together to manage a move provided by one state to another. I would say the list of tasks to do is endless and mostly the last benefit that gets placed with is the language to do considering your health challenge insurance. What on earth you have present in one state may not fit everything you need around your new home. The moment for premium installments may change, and lots of others., and the identify goes on.
Source: typepad.com

Video: FREE MEDICARE ADVANTAGE LEADS/FREE MEDICARE ADVANTAGE APPOINTMENTS

Possible Medicare Advantage Pay Reductions Cause Insurer Stocks To Slip

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

15,000 Diabetic Medicare Advantage Leads: Long Form

Welcome to the Lead Buyer Network. If this is your first visit, be sure to check out the FAQ by clicking the link above. You may have to register before you can post: click the register link above to proceed. To start viewing messages, select the forum that you want to visit from the selection below. Join the Lead Buyer Network Today! You must be associated with the Lead Generation Industry to be accepted as a member. If you are not sure if you comply with that statement, I suggest not joining.
Source: leadbuyernetwork.com

No more Medicare Advantage leads

The carriers will love all of this because it puts everyone on an equal playing field and drives everyone in through their telemarketing and bypasses the agents which they also love to do. Some zamboni of the phone slams them into an MA and an hour later they dont know what the hell they have or who to call about it. I suppose it is also a windfall for captive agents who get some feed off the tv ads and mailings and not have to compete with the independents at the local buffet. However, after next enrollment season, the entire field looks grim for them too. This bill only address how to market. Other legislation will address whether they will be offered at all. The PFFS piece has already taken a fatal hit. As with the PFFS plans, congress will probably not kill MA’s but cut their subsidies and then tell the carriers to do what they want. Then when the carriers raise their rates to cover costs or failure to realize savings then the public will just say "what the hell, I can get a full med supp without the smoke and mirrors of an MA for another fifty bucks a month beyond what the MA would cost me." Winter
Source: insurance-forums.net

Jeannene Manning: Ginsu Knives Guru a Great Inspiration to Medicare Advantage Plans

The pioneer behind selling Ginsu knives on television, Barry Becher, passed away last week. It was just a few years ago when I spoke at the Direct Marketing Association with my colleague from Humana about using long-form television to generate Medicare Advantage plan leads. Barry came to the presentation, and afterward he introduced himself. He said he found it intriguing that we had used a great deal of the learning from demonstrating and selling Ginsu knives to sell a complex product such as Medicare health insurance. There is no doubt that explaining Medicare Advantage plans on television is a challenging feat. We found that using the long-form format, and many of the tactics that work for selling products, works for Medicare Advantage plans. “But wait, there’s more” guarantees focus on calling a toll-free number, and the need to get the most out of our hard-earned dollar, all became significant tools we use in selling Medicare Advantage plans. The member testimonial, and a talented, credible spokesperson, also played key roles in selling Ginsu knives and Medicare Advantage plans. In 12 years of on-air testing, we have fine-tuned the design and copy of Medicare Advantage long-form infomercials. We’ve learned that:
Source: blogspot.com

Medicare Advantage Leads for Sale

Over the past month we have been mailing for medicare advantage and have received thousands of medicare advantage leads all of them are in upstate new york. Unfortunately the parter in our company that had the NY license is no longer working for us and we are STUCK with leads we can’t sell medicare advantage to. These are real leads – you’ll get a copy of the response card 95% of them have phone numbers on them permitting you to call them to setup an appointment. These leads cost us tens of thousands of dollars and I need to get rid of them. Please PM me if you are interested. I’ll only sell them in blocks: 5 leads as a sample $75 25 = $12/ea 50 = $10/ea 100= $9/ea 250=$8.50/ea 1000+=$6/ea You can pay for the samples with paypal, all others must be via company check. I’ll even credit back the $75 for a bulk order. This isn’t a scam, I’m desperate to get rid of these hot leads. I hate to see them go but I would hate to have the respondents not get anyone sending them information. I’ve called around to lead companies but I keep getting disconnected numbers! So I am only selling them here and will only sell them once. Please PM me with the companies you represent and the amount of leads you are interested in.
Source: insurance-forums.net

Help Me with Medicare Advantage and Drug Question

hi all. my name is mike and i will retire in july. i am 66 years old and about to go on medicare for the first time. I recently met with two different agents to talk about medicare. one with bankers life and one with united health. and they are telling me two different things, and I dont know who is telling me the truth. Bankers life is telling Medicare advantage is bad. and I cannot have a separate Pt D plan with it (i can only do it, if the drug plan is built into it). and I should go with them and pay a premium i cannot afford for a medicare supplement. The united health guy is telling me I can have a pt d plan if the advantage plan does not have a drug plan built into it. This would be good for me, because the advantage plan has no monthly premium. He says I should do it like this because the PPO that he offers that does have the drug plan built in, wouldn’t cover some of my drugs, and it would be really expensive, but he was able to find a separate pt d plan that would keep my drug costs down. they are telling me two contradicting things, one is obviously lying. who is telling me the truth?
Source: insurance-forums.net

The Year 2013 Medicare Advantage Guidelines

The original source? An avalanche of new patients that now getting FREE medical care (although NOTHING in this world is actually free) are flooding the system. The U.S. does Not possess enough doctors to treat them. Thus, there will be longer and even longer waiting lists as the pediatrician shortage gets worse. Prior to you go for buying Medicare supplemental leads you must know about all the rules of the Medicare coverage-what that they cover and what they do not only. A Medicare is like an government program. There are one or two complicated rules for various levels of all Medicare coverage. Without government’s proposed cuts in Medicare and also Medicaid spending, baby boomers reaching 63 this year may need to reevaluate retirement plans if they don’t currently have enough money saved to cover forthcoming healthcare costs which are only likely to escalate. Medicare health insurance Part B is the Medical insurance protection plan. Part B will guard the cost of doctor visits, residential health care, and lab tests. Additionally, some medications and medical machines are covered under Medicare Part B, that include items such as diabetic test bunches and wheelchairs. Some of these rich corporations are making poor working people depend on Medicare at a period when Medicare is offering less as time pass and charging poor people very much more Blue Cross adds benefits to medicare supplement plan f policies in California. With no benefits, your only alternative might be appear to other solutions such as searching Medicare-supplement or “Medigap” coverage, which many individuals can’t afford because they don’t have sufficient income to pay for supplemental rrnsurance policy. For some women, they don’t have an income except social security retirement benefits, from this also Medicare fees are taken. Inconclusive whether to enroll in a Medicare health insurance Advantage plan or a Medicare vitamin and mineral when you are Medicare-eligible? Ones Medicare Advantage plan often has simply no premiums to pay, and it for the most part includes prescription-drug features. A Medicare health insurance supplement, on the other hand, require a releatively high premium. One’s own total out-of-pocket costs, though, will fluctuate aaccording to the extent that anybody use hospitals, physicians, and other health-care providers. The deductibles and coinsurance could amount to more within an Medicare Advantage plan than you would likely pay in premiums for a Medicare insurance supplement, which often pays what Medicare insurance does not. Treatment Supplement plans are usually more step-by-step in design, but also come among a higher premium. Medicare Advantage plans sometimes come with a verbal of a vision program as carefully.
Source: typepad.com

The Year 2013 Medicare Advantage Guidelines

LTCI plans are there to cover custodial care or nursing home care in which there are no medical needs being treatment Wealth Advisors advocate medicare supplement plan f plans for all seniors. LTCI plans are subject to full underwriting in pay for to have one issued. Price tag for the plan varies based via age at issue, coverage levels, additionally medical status. These policies are created to cover many different needs related to your ADLs so an LTCI should stop being thought of as only nursing your own home care since in reality, they guard home care and assisted care too. Again all of these are convalescent or custodial care situations where Medicare does certainly offer any benefits.
Source: salonstylesforyou.com

Medicare Supplement Insurance Premiums Are Not Standardized

Unsure whether to enroll in a Medicare insurance Advantage plan or a Medicare aid when you are Medicare-eligible? The exact Medicare Advantage plan often has never premiums to pay, and it generally includes prescription-drug features. A Treatment supplement, on the other hand, require a releatively high premium. All of your total out-of-pocket costs, though, will diverge aaccording to the extent that most people use hospitals, physicians, and other health-care providers. The deductibles and coinsurance could amount to more within a nice Medicare Advantage plan than you pay in premiums for a Medicare insurance supplement, which often pays what Medicare health insurance does not.
Source: huffpozer.com

What happened to Highmark Medicare Services?

Posted by:  :  Category: Medicare

Physicians and medical billing companies should not face many disruptions as a result of this transition. According to Novitas Solutions, the current Highmark Medicare website will be fully transitioned to the new Novitas site by March 30, 2012. During the transition, visitors to the old website (https://www.highmarkmedicareservices.com) will be automatically re-directed to the new Novitas Solutions website (https://www.novitas-solutions.com), where a new header and page logo can be seen. Bookmarks that users may already have for the Highmark website will purportedly still work with the new page. The Electronic Payer ID has not appeared to change, so claims submission and processing should remain unaffected by the transition. For more information, see the Informational Alert here: https://www.novitas-solutions.com/partb/info-alerts.html.
Source: healthcarebiller.com

Video: Highmark Senior Markets Highlights the Benefits of a Designated Health Partner

Novitas Solutions, formerly called Highmark Medicare Services, announces hundreds of health care jobs coming to Harrisburg, Pittsburgh areas

The prospect of new jobs arises from a large, new contract that was in limbo at the time of the sale. The contract, which involves administering Medicare claims for seven Southwestern states, was expected to create 500 new jobs in Pennsylvania, with about 260 coming to the Harrisburg area.
Source: pennlive.com

Highmark change in Medicare eye exam coverage irks some

UPMC Health Plan, the second-largest insurer in the region, does not cover refraction as a medical benefit under the Medicare Advantage plans it markets as UPMC for Life, spokeswoman Gina Pferdehirt said. All UPMC for Life plans come with vision insurance that cover refraction, she said.
Source: triblive.com

Highmark Medicare Services Changes Name to Novitas Solutions, Inc.

Please read the following bulletin from Highmark Medicare Services. The affected payers are: CPID 2456 Delaware Medicare CPID 5912 Delaware Medicare CPID 3677 J12 Mutual of Omaha DC,DE,MD,NY,PA CPID 7402 Maryland Medicare CPID 5554 Maryland Medicare CPID 2464 Maryland Medicare (MONTG,PRINCE GEORGE) CPID 1465 New Jersey Medicare CPID 5503 New Jersey Medicare CPID 5598 Pennsylvania Medicare CPID 2457 Pennsylvania Medicare CPID 2461 Virginia Medicare (ALEX,ARLGTN,FAIRFAX) CPID 1522 Washington DC Medicare CPID 2459 Washington DC Medicare Reported by Highmark Medicare Services: As announced March 1, 2012, Highmark Medicare Services is changing its name to Novitas Solutions. Effective March 10, 2012, Highmark Medicare will begin migrating the current Highmark Medicare website to our new Novitas Solutions website. We are targeting completing our name change to all active webpage content by March 30, 2012. The new Novitas Solutions website URL will be https://www.novitas-solutions.com. Additional details, including Frequently Asked Questions, are available at https://www.novitas-solutions.com/partb/info-alerts.html. Re-enrollment is Not required. The clearinghouse will continue processing as normal. If you have any questions, please contact Client Services at 1-888-348-8457, option 2.
Source: collaboratemd.com

New Medicare Administrative Carrier for Jurisdiction 12 Highmark Medicare Services Acquired by Diversified Service Options Inc

Diversified Service Options (DSO) acquired Highmark Medicare Services (Highmark) on January 1, 2012. DSO is a holding company and a wholly-owned subsidiary of Blue Cross and Blue Shield of Florida, Inc. (BCBS Florida). Highmark had the contract with the Centers for Medicare & Medicaid Services (CMS) to be the Medicare Administrative Contractor (MAC), formerly known as a “Carrier” or “Fiscal Intermediary,” for Jurisdiction 12, which includes Delaware, New Jersey, Pennsylvania, Maryland and Washington, D.C. For Part B services, Jurisdiction 12 also includes the counties of Arlington and Fairfax in Virginia and the city of Alexandria in Virginia.
Source: thehealthlawfirm.com

Highmark lands Medicare contract that could create jobs in the Harrisburg area

The contract involves processing Medicare claims for a region that includes Louisiana, Arkansas, Mississippi, Texas, Oklahoma, Colorado and New Mexico. Highmark already has an identical contact for claims from Pennsylvania, New Jersey, Maryland, Delaware and the District of Columbia.
Source: pennlive.com

Highmark Medicare LCD’s Proposed : Med Law Blog

Highmark Medicare Services has published the initial draft set of LCDs as part of its plans to fulfill CMS requirements to consolidate ICEs by July 1, 2008. Highmark’s instructions for submitting comments for the proposed Local Coverage Determinations (LCDs) and the proposed LCDs are included in the attached link. The following LCDs are included:
Source: medlawblog.com

Kaiser Permanente of Georgia Hosts Medicare Straight

Posted by:  :  Category: Medicare

Flickr

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**Plan performance Star Ratings are assessed each year and may change from one year to the next. Centers for Medicare & Medicaid Services Health Plan Management System, Plan Ratings 2013. Kaiser Permanente contract #H1170. Kaiser Permanente is a health plan with a Medicare contract. You must reside in the Kaiser Permanente Senior Advantage (HMO) service area in which you enroll. A sales person will be present with information and applications. For accommodations of persons with special needs at sales meetings, call toll free (TTY 711). Kaiser Foundation Health Plan of Georgia, Inc., Nine Piedmont Center, 3495 Piedmont Road NE, Atlanta, GA 30305.
Source: patch.com

Video: Medicare Chiropractor, Roswell Georgia 30075 Open 7 Days, 770-992-2002

ABOUT MEDICARE: When a doctor doesn’t take Medicare

An opt-out doctor is one who doesn’t accept Medicare. Doctors who have opted out of Medicare can charge their Medicare patients whatever fees the physicians choose. These doctors don’t submit any health care claims to Medicare. In addition, opt-out doctors aren’t subject to Medicare laws that limit the amount they can charge their patients.
Source: times-standard.com

Augusta needs Medicaid expansion, and so does Georgia

This idea that a 2% increase in our budget…and consequently an increase in OUR taxes…..is okay is the kind of thinking that is killing those of us who PAY the taxes. “Oh, it will create jobs” is always the answer but somehow it never does, and the welfare, SSI, food stamp, and Medicaid rolls keep growing because we keep offering them a better deal. Meanwhile the taxPAYERS are stuck with the 2% increase for this, and a 4.9% increase for that, and a sales tax increase for the roads, and, if you actually PAY you medical bills a 3% increase on your medical devices. This line of thinking that federal or state budget increases, more taxes, and more spending on give away programs are somehow good for the economy….good for the taxpayer…..is simply crap. Everyone, even the Democrats and the CBO, are already admitting that Obamacare is a BUST at controlling or lowering the cost of medical care. They already know that the federal government is not going to be able to afford even the 90% that they promised and many of the states know that they cannot afford the 10% and that the feds will most likely figure out how to get out of paying their 90%.
Source: augusta.com

LeadingAge: Home Health Copay Addressed by U.S. House Ways and Means Subcommittee on Health

Chairman Kevin Brady (R-TX) was joined by Rep. Jim McDermott, WA, ranking member;  Rep. Peter Roskam, IL, Rep. Jim Gerlach, PA; Rep. Tom Price, GA; Rep. Vern Buchanan, FL; Rep. Adrian Smith, NE; Rep. Mike Thompson, CA; Rep. Ron Kind, WI; Rep. Earl Blumenauer, OR and Rep. Bill Pascrell, NJ. 
Source: leadingage.org

Brunswick, GA. Armenian National Pleads Guilty in $1.5 Million Health Care Fraud and Money Laundering Scheme

From 2007 through 2008, various conspirators defrauded Medicare through a durable medical equipment company in Brunswick, Georgia, known as Brunswick Medical Supply. These conspirators submitted millions of dollars in phony claims for health care services that were never provided. The evidence showed that the conspirators stole the identities for doctors and patients from multiple different states, including Alaska, California, New York, and Ohio, and even submitted claims for people that were deceased at the time that he claimed to have provided them the medical equipment.
Source: sandpointpr.com

Medicare agrees to cover TMS treatment for depression in TN, GA, AL

“TMS will now be available to more patients, giving them the hope of living a life free of depression,” said Burton Hills-based Dr. Scott West, who was the first local psychiatrist to acquire the TMS machine, a space-age contraption that looks similar to a dentist’s chair. West has been using TMS to treat patients since 2010. (See our September magazine story here.)
Source: nashvillepost.com

Congressman Tom Price: Introduces Medicare Improvement Legislation – Georgia Politics, Campaigns and Elections – Georgia Pundit

Washington, D.C. – Congressman Tom Price, M.D (R-GA) has introduced legislation aimed at improving the competitive bidding process for Medicare. “The Medicare DMEPOS Market Pricing Program Act of 2013” (H.R. 1717), would replace the current Medicare “DMEPOS,” or “Durable Medical Equipment, Prosthetics, Orthotics and Supplies,” competitive bidding system with a sustainable market pricing program (MPP) that is based upon sound economic principles that are embraced universally by auction experts across the U.S. Rep. Price first introduced this legislation during the 112
Source: gapundit.com

Sequestration and PECOS Update for Medicare Home Health and Hospice

Posted by:  :  Category: Medicare

A report will be provided to list your physicians and their status to help you identify the physicians associated with your agency who are not PECOS certified. Claims with non-certified physicians will be denied; a new PECOS Claims Hold will be available to help you capture problematic claims before they are generated. We will begin releasing these changes and provide updates in the next maintenance cycle on Wednesday, April 3rd.
Source: careanyware.com

Video: Audio Educator: Medicare Enrollment PECOS The CMS 855.mp4

Reed Tinsley, CPA: Major Improvements to the Internet

The provider/supplier can access the enrollment information from the My Enrollment page. The information will display in an HTML view and can be saved and/or printed by the provider/supplier. Note: The CMS-855 PDF forms are no longer available and have been replaced with the new HTML views. The enrollment tutorial videos, located on the PECOS home page, have been updated to illustrate the most common enrollment scenarios completed by providers/suppliers. A new part B provider service has been established for Centralized Flu Billers. In addition, the Centralized Flu Biller Approval letter has been added as a type of Required/Supporting documentation for a CMS 855B enrollment. Centralized Flu Biller enrollments submitted via PECOS will be routed to Novitas Solutions, the designated Medicare Administrative Contractor (MAC) responsible for enrolling this provider service. A new “Durable Medical Equipment (DME) License Information” topic has been added to PECOS. This topic will display the DME license information currently on file for existing suppliers. The information is viewable only and cannot be edited or deleted by the supplier.
Source: blogs.com

NAHC Participates in Call with CMS on Phase II PECOS Edits

The PECOS Ordering and Referring files do not include the date of physician enrollment. Since home health payments will be based on whether the ordering physician was enrolled in PECOS at the time services were provided, rather than at the time claims were submitted, how will home health agencies identify and track the effective dates of physicians’ PECOS enrollment? CMS will not provide this information to providers. Physicians’ date of enrollment is in both physicians’ effective date for billing Medicare notification letters and in the physicians’ PECOS files. Home health agencies must contact the physicians for this information in cases where they have concerns about an initial effective date or a gap in enrollment.
Source: medbill.net

In brief: CMS delays PECOS edit, TSS employees sue

NEW BRAUNFELS, Texas – The Scooter Store founder Doug Harrison and others who manage the company’s employee stock ownership plan (ESOP) now face a lawsuit by former employees. Three former employees filed a class-action lawsuit on behalf of 2,938 plan members in U.S. District Court for the Western District of Texas on April 23, seeking to recover damages and all other forms of relief as a result of “the defendants’ multiple breaches of fiduciary duty.” According to the lawsuit, those breaches include: 1.) Harrison “usurped opportunities” available to the ESOP when he sold or otherwise transferred or conveyed his shares on or after Feb. 1, 2011, to Sun Capital Partners and these shares were placed under the ownership of Sun Scooter Store; 2.) Harrison, in coordination with TSS Holdings, TSS and Houlihan Lokey Financial Advisors, manipulated the price per share for the common stock so that he and/or his family members could sell their shares at prices above fair market value; and 3.) Harrison, Principal Life Insurance Company and First Banker Trust Services failed to diversify the assets in the ESOP when they knew that the value of the common shares was very likely to diminish in value substantially from 2011 through to the present. The lawsuit also claims that $7.5 million in cash in the ESOP as of Dec. 31, 2011, has not been accounted for. The ESOP has 13.48% equity in The Scooter Store, according to the company’s recent bankruptcy filing. Members who are vested can sell their shares when they retire or leave the company. While The Scooter Store, the company, is not named as a defendant in the lawsuit, it also faces two lawsuits, another from former employees and one from the city of New Braunfels.
Source: hmenews.com

Revalidation of Medicare Enrollment

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

PECOS: A Medicare Benefit for your Practice

Henderson Medical Billing Solutions LLC is an outsourced Medial Billing and Practice Management service located in Murrieta, California.  Henderson Medical Billing Solutions provides medical billing services to solo providers to mid-level practices throughout the United States.  Henderson Medical Billing Solutions offers Full Practice Management, Medical Billing, HIPAA Compliance Auditing and Training to medical and non-medical providers.  In addition, Henderson Medical Billing Solutions offers Accounts Receivables Recovery and New Practice Start-Up services.  Our staff includes certified practice managers and billers who are committed to the success of increasing provider revenue reimbursement.  To learn more about how we can maximize revenue and increase your practices productivity Contact us today.
Source: hendersonmbs.com

CMS Announces Delays in PECOS Edits for Home Health

Medicare Part B claims from laboratories, imaging centers and Durable Medical Equipment, Orthotics, and Supplies (DMEPOS) that have an ordering or referring physician/non-physician provider; and  Part A Home Health Agency (HHA) claims that require an attending physician provider.
Source: sansio.com

Medicare fraud accusations hit Houston

Posted by:  :  Category: Medicare

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Medicare fraud has developed into complicated and sophisticated schemes. The ways people attempt to defraud the government can involve multiple people in multiple cities. On the other hand, individuals may make innocent mistakes with regard to Medicare claims or practices. If an individual is charged with Medicare fraud, it is important that they have competent representation to defend the oftentimes complex charges. Medicare fraud is a federal offense and carries stiff penalties with it. These penalties can vary from heavy fines to major prison time.
Source: houstonfederalcriminaldefenseblog.com

Video: 7 Accused of Bilking $375M From Medicare

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

bernardkrin: Sold Medicare Supplement Plans In Texas

Its “original” Medicare plan was comprised of just Parts A and N. Later, the “advantage” plans of Parts F and D were added, basically a bigger cost. Parts C and Deborah had to created because parts Any kind of a and B did not pay just for everything. Tall Deductible Medicare Supplement Plan F capabilities a 00 annual deductible that must choose to be met before the insurance company actually starts to pay the 20% coinsurance for as well as hospital services. However, if prudent had original Medicare, the deductible for your hospital is only 00 and the very deductible for doctors and medical solutions is only 5. After welcome this change Medicare deductibles have been met you will simply pay the 20% that Medicare doesn’t pay. This means if buy this high deductible Plan you it is fair to spend 00 at the hospital earlier than your insurance company pays a penny! This fact shouldn’t really be a surprise, primarily because everybody knows the elderly have additional information medical expenses. Right now, I’m a luckier than average senior, because We all take only one medication that isn’t generic. If I did donrrrt you have Medicare Part D Supplemental coverage (for which I pay -some a month), I would have to pay somewhere around 5 for a 30 day supplies. With my supplemental coverage, I pay around . Supplies and fraud and other problems may be found within Medicare operations. Changes should be made, but a change in a treatment program that provides good coverage at logical rates does not seem to often be a sensible change. On the Collaboration to Protect Medigap website you could very well get the information to contact your family senators and representatives. It might be priced at a few minutes of your time for protect an important resource to older persons click here for medicare supplement plan f information. Messing around with the Medigap policies is not to be able to add or subtract from the associated with Medicare to the government, but it can add to the health cost involved with seniors who have those policies. when looking for a beautiful dress shoe, there is no reason to pick between high heels and flats. A moderate heel (anything from one particular to one and half inches) can also actually be beneficial to the long-term health of your feet and joints. Nearly all participants find it helpful to check with experienced Medicare advisors for more who owns their options, including information about Medicare supplemental health insurance or Medicare Supplemental plans that will help to provide additional coverage on the surface of their chosen plans. Speaking through having an experienced advisor can help to be sure participants get the best healthcare strategies for their needs at prices which are right for their budgets. Be required durable medical equipment (DME) in your own? Let’s say that Medicare has approved, as scientifically necessary, a wheel chair or an absolute blood glucose monitor or nebulizer, emergency room bed, oxygen tent, or catheter. It then pays 80% of yearly .. The remaining 20% is your coinsurance, the length which you or your Medicare treatment pays. Your costs could considerably higher, though, depending upon the associated with DME supplier which you select. There are three types of traders in Original Medicare.
Source: blogspot.com

Ready Medicare Supplement Plans In Texas

In conclusion neither, Medicare or a medsupp consider covers nursing home care in it is really traditional sense. LTCI policies are for sale to meet those needs. Having each of the ensures when the need arises both together medical and nursing home care would need can be covered at least significantly by insurance companies. SHIIP volunteers are required to submit opinions on each client they assist, in addition to according to DOI records, they been very useful nearly 60,000 Medicare beneficiaries in one-on-one counseling sessions during 2009. Doing this viewpoint is incorrect. People may very well be seldom aware of the limitations linked with Medicare. They only realize that will when they face some huge unforeseen medical cost which the Medicare totally does not cover, and by then thought is too late. So, this item is better to correct the fabrication about Medicare much before a man or woman faces such consequences. Commander of uaw would not agree to any grow in health contributions or elimination of the particular supplemental plan for retirees, and must have been demanding a slightly higher pension improve. The union’s bargaining approach seems more suited varied economic times, particularly since the only real product of the facility, the C-17 transport plane, has been on you see, the chopping block for some time. The strike could very very well be the last straw, leading to cancelling of the C-17 program and drawing a line under of the facility. Occasion Splints have also been shown boost symptoms How to save money on Medigap insurance by changing from a Medicare Supplement Plan F to Plan G. It is designed sustain the ankle and foot (ie its Achilles tendon and Plantar Fascia) on the stretched position allowing it to alleviate during the night. Usually each foot will relax when sitting or else sleeping and the fascia will heal in the shortened condition anymore. Then each step reinjures the “healing” plantar fascia. At the same time many insurance agents push high deductibleMedicare Supplement Plan Fbecause it is very low priced on a monthly basis, most visitors realize after taking a close with the benefits compared to other blueprints and plans there are better options available. You should consult a national insurance company broker who specializes in this category of insurance and can give you really quotes and guidance regarding new while better options. Medicare supplemental insurance Plans are standardized by Center as for Medicare Services that denotes that almost insurance company should proffer the old exact advantages. Since each program company proffers the similar plans moreover advantages, it just makes logic to be able to the plan that is most prudent. Acquiring Medicare Supplement Quotes with each insurance company tend to help make sure you save money and get the best hit for your your money.
Source: typepad.com

Committee Continues Transparent Medicare Physician Payment Reform Process – Releases Draft Legislative Framework

Posted by:  :  Category: Medicare

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WASHINGTON, DC – House Energy and Commerce Committee leaders today unveiled draft legislation to repeal the current Sustainable Growth Rate (SGR) system and replace it with a fair and stable system of physician payment in the Medicare program. The draft legislation is the latest step in the transparent process to reform the system and reward providers for delivering high-quality, efficient health care. On February 7, the Energy and Commerce and Ways and Means Committees outlined a framework to reform the current Medicare system that is fiscally responsible and free of politics. Committee leaders sought feedback and in early April outlined additional details of a proposal to repeal and replace the current Sustainable Growth Rate system. The Subcommittee on Health has scheduled a hearing on the draft legislation for June 5.
Source: house.gov

Video: How to Navigate Medicare Reimbursement

Medicare Spending Variations Mostly Due To Health Differences, Study Concludes

A 2008 “white paper” from Dartmouth directed at policy makers and titled “an agenda for change” implied the possibility of substantial savings if Medicare rooted out inefficiency and unnecessary treatments. “How much could Medicare save?” the paper asked. “Given the strong national reputations enjoyed by such organized practices as the Mayo Clinic and Intermountain Healthcare, and the objective evidence that they deliver more efficient, higher quality care, it seems reasonable to use these systems as benchmarks for the rest of the country. Were all providers in the country to achieve the same level of efficiency for inpatient spending on supply-sensitive care, we estimate a 28 percent reduction in hospital spending under a Mayo benchmark and a 43 percent reduction under an Intermountain benchmark.”
Source: kaiserhealthnews.org

A Viable Medicare Physician Payment Policy’ that Will Repeal SGR

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

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May 30, 2013

Purchase Utah Medicare Support Plans

Posted by:  :  Category: Medicare

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Anticipated to array of plans that you will likely need to obtain at particular moment in your. Medical coverage is one of these experts. When you get older, this will likely turn up comprising Medicare. Although Medicare is to your benefit on its own, it does though not always satisfy the has to those who utilize it. While that takes place, tasks like those readily available through Medigap New jersey are at on this occasion to supplement urge for food furnished as consequence of Medicare therefore whom seniors can previously obtain the form of bill protection they must. Here is a look at what some of that particular new protection accomplish for you thus you can remain living over how the Mexican border.
Source: jndtecheng.com

Video: Rep. Chavez-Houck, Dan Liljenquist, policy experts debate Utah Medicaid expansion

Utah Health Policy Project Cheers Analysis Of Medicaid Expansion

“We now have the facts and figures to support the existing moral argument to expand health insurance to Utahns with no other alternative for coverage,” says Matt Slonaker, Medicaid Policy and Collaborations Director at UHPP. “The question for expanding Medicaid is simple: Do we want to make health care more affordable for Utah workers and their families, or are we going to continue to ask a family that earns $30,000 a year to do the impossible and pay $15,000 for private insurance?”
Source: utahpoliticalcapitol.com

Utah's Largest Cancer Clinic System Is Sending Away Medicare Chemo Patients, Per Obama's Sequestration Cuts

The Utah situation is a repeat of what is happening to community cancer clinics across the country. The Obama Administration refuses to take action. A bill to restore full funding for Medicare chemotherapy was filed April 9 by Rep. Renee Ellmers (R-N.C.), whose office is providing updates on the impact of the cuts to Medicare chemo patients in her state. The bill is HR 1416, "Cancer Patient Protection Act of 2013," which so far has remained in a House Subcommittee since April 12. HR 1416 has a bipartisan group of 56 co-sponsores as of today.
Source: larouchepac.com

TOP IGRE Galore Purchase Utah Medicare Improve Plans

So many medsupp plans give assistance for rips in Medicare plans of skilled birkenstock care inside of ones nursing home. The member have to have enter the nursing home after a or even day stay in an acute care emergency room and deemed technically necessary to open care in an experienced nursing facility. The care will need to ultimately be recommended by doctors by an studying at physician. These things do not befall for custodial consider. Thus, in reality in spite of the fact much specialized nursing care is supplied within nursing homes, nursing home consideration as most think of it is not covered. Joining Medicare and goals F and Gary up to a days is covered by the insurers.
Source: topigre.com

Utah Medicare Coverage from local experienced a…

Getting out of debt often seems like an uphill battle, and no matter the debt size, it can be difficult to see the light at the end of the tunnel. However, it is possible to get out of debt, and fast with the help of www.fastdebtreliefonline.com/ ! The first step to debt reduction is to stop adding to it. Plain and simple, stop using your credit cards, and refrain from opening any new credit cards no matter what kind of gain , miles, or any other incentives credit card companies will lure you in with. Turn off any automatic debits from your credit cards, cut up existing credit cards, delete your saved accounts on online shopping sites that might have your credit card information saved. Once you stop accumulating more credit card debt, you are on your way to debt relief!
Source: scoop.it

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May 30, 2013

Get 'rock solid' with Medicare Advantage

Posted by:  :  Category: Medicare

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When providers partner with Benefits365, they receive educational pieces on Medicare Advantage that they then provide to beneficiaries. One way to do that is through monthly statements. The idea: A beneficiary calls Benefits365 to switch from Medicare to Medicare Advantage, and both the beneficiary and the provider benefit from working with the latter vs. the former.
Source: hmenews.com

Video: Medicare Advantage in South Florida, 4 stars rated Plans,

Medicare advantage costs often exceed traditional Medicare costs

Using newly available government data, Marsha Gold, a senior fellow with Mathematica Policy Research, found that risk-adjusted MA plan costs in 2009 were, on average, 4 percent higher than those for traditional Medicare. Among plan types, only health maintenance organizations (HMOs) had lower average costs, while costs for more than 75 percent of local preferred provider organizations (PPOs) and private fee-for service plans exceeded traditional Medicare’s. According to Gold, the wide variation in MA plan costs relative to traditional Medicare suggests there is room for many of these plans to deliver care more efficiently and keeps costs down.
Source: wordpress.com

Aetna Inc. (NYSE:AET), CIGNA Corporation (NYSE:CI), WellPoint, Inc. (NYSE:WLP): Does the Medicare Advantage Announcement Make Healthcare Stocks a Buy?

My thought on the matter is that the increase in health sector shares was a market reaction to just-released information. However, be cautious with insurers for a while and see what other pitfalls the Affordable Health Care Act have waiting for them. There could be more problems down the road that offset these current gains.
Source: marketdailynews.com

GAO Report is More Bad News for Medicare Advantage Plans

GAO says in a new report that Medicare plans were overpaid $3.2 billion to $5.1 billion in the three years from 2010 to 2012.  Scott Fidel of Deustche Bank says that the report comes at a particularly bad time given recently proposed cuts to 2014 Medicare Advantage rates.  Health plans are lobbying against the cuts, but Fidel notes that many are required by ObamaCare and the GAO report only reinforces the need for them.  The overpayments relate to risk scores assigned to Medicare plan members, which GAO says were inappropriately high.   Additional pressure on risk scores could push final rates (scheduled for release April 1) down even more, further impacting Medicare plans margins in 2014 and 2015, Fidel says.
Source: corporateresearchgroup.com

Pitts Statement on CMS’ Decision to Reverse Some Cuts to Medicare Advantage

“I am pleased that CMS seems to be listening to concerns voiced by Medicare beneficiaries and members of Congress by appropriately rolling back some of the proposed cuts to the Medicare Advantage program,” said Chairman Pitts. “While the decision is welcome news, we must not forget the program still faces significant hurdles. In order to fund new entitlement programs, the health care law raided more than $716 billion from Medicare, $308 billion coming from Medicare Advantage. These cuts, which could disrupt coverage for over 14 million Americans, represent another one of the president’s broken promises that if you like your current health care plan you can keep it.”
Source: house.gov

Are Medicare Advantage Plans Skimming Off Healthiest Patients?

A study released Thursday, by Gerald Riley, a researcher at the Centers for Medicare & Medicaid Services (CMS), adds to those concerns. The study looked at more than 240,000 people who dropped out of Medicare Advantage plans in 2007, and compared them with beneficiaries who remained in traditional Medicare the entire time. In the six months after leaving the private plans, the former Medicare Advantage patients used an average of $1,021 in medical services each month, while the patients in the control group cost Medicare $710 a month, the study found.
Source: kqed.org

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