Kipsiro, Dibaba win BUPA Great Manchester Run, by Alfons Juck, note by Larry Eder

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GOTZIS (AUT, May 26): Canadian duo remained in the lead also after completing their events at the hypomeeting in Austrian Alps (IAAF CE Challenge). Damian Warner, fifth in the London 2012 Olympic Games, scored 8307 points to beat Brazil’s Carlos Chinin, who was second with a personal best of 8182 points while Theisen set a 2013 world-leading mark of 6376 points, just 64 points short of her best set last year when winning the American collegiate (NCAA) title for the third time. “It was an awesome weekend but it was pretty tough. It was not perfect but I really enjoyed the competition. The weather was bad but Gotzis has the best crowd. I was good in the Hurdles and in the Discus. The Pole Vault was pretty bad. The score is good but the most important thing was to win,” reflected Warner. Third US Gunnar Nixon 8136 PB ahead of Czech Adam Sebastian Helcelet who scored PB of 8075. As much as 11 athletes did not finish, including the German elite and Dutch Sintnicolaas. In the Heptathlon, Russia’s reigning World champion Tatyana Chernova won the long jump with 6.57m helped by a tailwind of +2.6 but managed only fourth place with 6284. Second Nadine Broersen 6345 PB ahead of her teammate Dafne Schippers 6287. Eurowinner Antoinette Nana Djimou was 10th (6058). “It means a lot to win in Gotzis. When you are so young, you don’t fully realise how important this event is. Once I get older, I will realise what I did. I really enjoyed the atmosphere, the crowd and the music. They gave me a lot of energy. I could not be happier. Everything was almost perfect,” reflected a tired but happy Theisen.
Source: runblogrun.com

Video: The Bupa story

e2 designs Bupa customer experience centre

Customer experience agency e2 partnered with Bupa to launch its Bupa Perth health experience centre. Moving away from the away from the traditional health insurance retail services model, e2 was responsible to creating the design elements of the new centre creating a more inviting, interactive and experience-driven environment that would enable Bupa to engage with customers. “Our brief to e2 was to create a branded environment that would set new industry standards and create an interactive customer experience,” said Gael Filippini, Bupa’s head of retail. “Beyond an innovative and intuitive design, we really wanted our new store environment to enable our consultants to provide our members and non-members with tailored advice to suit their healthcare needs.” Key components of the phased project included ideation of store design, customer journey mapping and development of a zoning strategy that delivers purpose and function to the customer and business. “We were delighted to work in partnership with Bupa to help bring its health partner strategy to life through a collaborative and interactive store environment,” said Robbie Robertson, Managing Director, e2. Bupa has also recently launched new retailing environments at Sydney’s Bondi Junction store and Melbourne’s Knox store.  
Source: com.au

Il Blog di Alberto Stretti: Farah wins his fifth consecutive Bupa London 10,000 title

From then on it was a procession, Farah enjoying every minute. He raced back towards Westminster along Victoria Embankment swapping hand-slaps and high fives with the mass runners jogging in the opposite direction along the other side of the carriageway. Many stopped to take photos and do the Mobot, Farah’s signature victory gesture.
Source: albertostretti.org

Proposal Would Raise Medicare Payments for Hospice Care Services

Posted by:  :  Category: Medicare

CMS also proposed changing quality-reporting requirements for hospices — beginning in FY 2016 — by replacing reporting on pain-management and structural measures with two other measures and requiring hospices — beginning in FY 2017 — to conduct a hospice experience-of-care survey for patients’ families and friends.
Source: californiahealthline.org

Video: Hospice & Medicare Rules & Regs – Pt 1

Saving Money While Providing Benefit In Medicare: A Standard Applied Only To Hospice

Hospice is an interdisciplinary approach to caring for persons believed to be within 6 months of death and can plausibly reduce Medicare expenditures by avoiding expensive hospitalizations in the last days and weeks of life. At its best, hospice typically replaces that default with the patients’ desire for a less medicalized death in the patients’ home, while maximizing quality of life. A recent paper published in Health Affairs confirmed past work showing that hospice reduces Medicare spending as compared to what it would have been during the most common periods of usage observed in Medicare. And hospice has been shown to improve patient and family member quality of life. Hospice has passed the market test; around half of all Medicare decedents used at least 1 day prior to death in 2010.
Source: healthaffairs.org

In FY 2012: Medicare Hospice Wage Index Increases 2.5%, Other Hospice Changes

Beginning October 2012, hospices will be required to start collecting quality of care data for submission in 2013.   This is the implementation of a hospice quality reporting program, as mandated by the Accountable Care Act (ACA).  Under the Quality Assessment and Performance Improvement (QAPI) program, hospices are required to submit data on quality measures to CMS or face a two-percentage point reduction to their annual market basket update, starting FY 2014.  Hospices may voluntarily being collecting QAPI data in October 2011 for submission in 2012.
Source: hallrender.com

Medicare Neglecting Hospice Program

What exactly is holding the people at the Center for Medicare & Medicaid Innovation, which is in charge of the project, up? According to the article, officials at the Center, “declined to discuss why the project has not begun or when it would start,” leaving us at a standstill. The issue can’t be ignored forever, though, especially given the amount of pressure being applied by both hospice advocates and medical professionals around the world. One way we can all lend a hand is to contact local members of Congress and ask them to look into the 2010 Medicaid joint hospice and curative treatments project. Perhaps with questions coming from both sides, the Center for Medicare & Medicaid Innovation will be unable to ignore the project any further.
Source: hospicecarecorp.org

OIG Reports Review Medicare Hospice Inpatient Care, Hospital Discharges to Hospice Care : Health Industry Washington Watch

Two recent OIG reports examine Medicare policies involving hospice services. The first report concentrates on hospice general inpatient care (GIP), under which short-term pain control or symptom management that cannot be managed in other settings is provided in an inpatient facility (a Medicare-certified hospice inpatient unit, a hospital, or a SNF). Medicare paid $1.1 billion for GIP in 2011, mainly for care in hospice inpatient units. Almost one-quarter of hospice beneficiaries received GIP that year, with one-third of the stays exceeding 5 days. On the other hand, 27% of Medicare hospices did not provide any GIP, and many of these hospices did not provide any level of hospice care other than routine home care. The OIG believes additional review is needed to ensure that hospices are using GIP as intended and providing the appropriate level of care. The OIG also suggests that CMS ensure that hospices that do not provide GIP are offering the necessary levels of care, such as through adoption of a quality measure regarding hospices’ ability to provide all hospice services.
Source: healthindustrywashingtonwatch.com

Hospice CEO suggests hospice facilities are a Medicare budget saver.

While imposing a co-payment could reduce Medicare costs, it does not consider the many Medicare patients who would have difficulty affording new co-payments for end-of-life care in a hospice care program. These individuals would ultimately be forced to be treated for acute problems at a hospital that are frightfully more expensive for the patient and Medicare as a whole.
Source: medicarewire.com

DOJ Accuses Hospice Giant Chemed Of Medicare Fraud, Shares Plunge

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

Reduce Medicare payments for hospice care in skilled nursing facilities, MedPAC suggests

Speaking at a public meeting last Thursday in Washington, D.C., the commissioners revisited recommendations from a 2011 report from the Department of Health and Human Services Office of Inspector General (OIG). That report gave advice to the Centers for Medicare & Medicaid Services in advance of an Affordable Care Act requirement to reform Medicare hospice payments after Oct. 1, 2013.
Source: mcknights.com

Many Years Young: Medicare’s Hospice Payment Plan Fosters Abuse

(Medicare NewsGroup) Hospice, which is a palliative care program that gives patients with life-ending illnesses a choice to forgo intensive treatment at the end and focus instead on dying more comfortably, has grown dramatically in recent years, becoming well-known and widely used. Over the past decade, Medicare spending on hospice has increased at a staggering average rate of 17 percent per year, totaling $13 billion for just 1.2 million patients in 2010, up from the 513,000 patients it served and $2.9 billion it cost in 2000. 
Source: manyyearsyoung.com

Proposed Rule Updates Wage Index And Payment Rates For The Medicare Hospice Benefit

.  Under section 3004 of the Affordable Care Act, hospices that fail to meet quality reporting requirements will receive a two percentage point reduction to their market basket update beginning in FY 2014. Hospices began reporting quality data in 2013. For the FY 2014 payment determination, hospices reported two measures: the NQF #0209/Pain Management measure and the Structural measure on participation in a /Quality Assessment and Performance Improvement (QAPI) program. The proposed rule solicits comments on the elimination of these two currently reported quality measures beginning with the 2016 payment determination and to replace these two with other measures.
Source: aq-iq.com

Hospice saves Medicare dollars while providing quality care

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Source: makemedicinebetter.org

Hospice Not Feeling the Love from Medicare

The article titled “Medicare Lags In Project to Expand Hospice” examines the very real conflict between “curative” treatment and “palliative” treatment. The former is meant to cure a condition and thereby prolong life, and the latter is meant to ease the pain caused by a condition without a focus on effecting a cure.
Source: thegrahamlawfirm.com

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: Medicare Part B_1.wmv

How Much Does Medicare Part B Cost?

[…] Not too long ago, everyone paid the same amount for Medicare. However, recent legislation has changed both the Part B and Part D premiums to now be based on your income. For individuals who have made less than $85K or couples who have earned less than $170K, Medicare Part B premiums are $104.90/month in 2013. The income assessment is based on tax records from 2 years priot. So if you are adding Part B in 2013, they will be looking at your 2011 taxes to determine what you will pay for Part B that year.Source: thebenefitsbuzz.com […]
Source: thebenefitsbuzz.com

The resource cannot be found.

Description: HTTP 404. The resource you are looking for (or one of its dependencies) could have been removed, had its name changed, or is temporarily unavailable.  Please review the following URL and make sure that it is spelled correctly. Requested URL: /404.aspx
Source: federaldaily.com

What to Know about Medicare Vision and Eye Care

Under Medicare Part A, vision is only covered when it pertains to a medical problem (such as the detached retina example above). Part B coverage is somewhat more encompassing, although the traditional examinations remain uncovered. Under Part B insurance, glaucoma screenings are covered for individuals who are high risk. High risk patients are classified as those with a family history of glaucoma, African Americans age 50 and older, and those with diabetes. In these cases, individuals must visit a state-approved vision care specialist and will pay the 20% Part B coinsurance for any vision costs approved by Medicare.
Source: ehealthmedicare.com

How to pick a Medicare plan

The Kaiser Family Foundation estimates that monthly premiums for Part D stand-alone prescription drug plans will rise by 10%, on average, to $40.72 in 2011. This assumes beneficiaries stay with their 2010 plans. Many experts advise consumers to shop around. For Medicare Advantage policies, Kaiser projects relatively modest price increases, with premiums rising about $2 a month to an average of $43. This is what’s called an enrollment-weighted premium, meaning that Kaiser has looked not only at insurance plan rates but also at the numbers of people in the plans. Plans with larger enrollments have more weight when projecting average premiums. All insurers offering Medigap plans must charge the same rate for comparable coverage. Medicare has an online tool that will allow access to local Medigap policies and rates by ZIP code.
Source: msn.com

A Medicare Part D Cost Saving Success Story

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Source: thrivinginthemiddle.com

RETIREE HEALTH CARE COSTS: THE ELEPHANT IN THE ROOM

Medicare.  Medicare provides Parts A and B insurance and is a gateway to supplemental insurance.  Their website, www.medicare.gov, offers Plan Finders to compare, price, and register for Part C and Part D plans.  Their booklet, Medicare and You, the “bible” on Medicare coverage, is free at http://www.medicare.gov/pubs/pdf/10050.pdf.
Source: retireusa.net

OIG Report: Medicare Part B Overpaying for Infusion Medications

OIG recommended that CMS “seek legislative change” over reimbursement policies or include the devices used with such drugs in the next round of competitive bidding. According to “RegWatch,” CMS “partially” has agreed to ask Congress to change the rules and said it will go forward with the competitive bidding suggestion (Wilson, “RegWatch,”
Source: californiahealthline.org

How to pick a Medicare plan

Posted by:  :  Category: Medicare

The Kaiser Family Foundation estimates that monthly premiums for Part D stand-alone prescription drug plans will rise by 10%, on average, to $40.72 in 2011. This assumes beneficiaries stay with their 2010 plans. Many experts advise consumers to shop around. For Medicare Advantage policies, Kaiser projects relatively modest price increases, with premiums rising about $2 a month to an average of $43. This is what’s called an enrollment-weighted premium, meaning that Kaiser has looked not only at insurance plan rates but also at the numbers of people in the plans. Plans with larger enrollments have more weight when projecting average premiums. All insurers offering Medigap plans must charge the same rate for comparable coverage. Medicare has an online tool that will allow access to local Medigap policies and rates by ZIP code.
Source: msn.com

Video: Parts A & B — Alphabet Soup

Medicare Supplement Enrollment

Need some guidance from Med Supp gurus. I have a client who has a Golden Rule (UHC) Med Supp she purchased while on SS Disability. She turns 65 this December 2013. Our intent is to switch her to a Plan G in her 6 month window. Since she is already enrolled in Medicare A and B, when does the Med Supp become effective? As soon as purchased within the 6 month window, or at age 65?
Source: insurance-forums.net

Medicare General Enrollment Ends March 31st: Opportunity for Some to Access QMB Coverage 

Even if unable to get a clear answer, one might pursue such enrollment as follows: Secure a Form 795 from the Social Security Administration (SSA) (available online at www.ssa.gov/online/ssa-795.pdf)  and type or write  into the large blank (lined) space the following:  "I wish to enroll for Hospital Insurance under Medicare on a monthly premium basis, which is in addition to my current coverage for Medical Insurance (or "I also wish to apply for Medical Insurance" if the client does not have Part B).  I understand that the State will pay my premium based on my eligibility for Medicaid (Medical Assistance) as a Qualified Medicare Beneficiary.  I also understand that if I am terminated under Medicaid (Medical Assistance) as a Qualified Medicare Beneficiary, I will have to pay my premium if I want to keep my Medicare Part A Insurance."  The beneficiary should give the form to SSA with her/his application for Part A, but also make a copy for her/himself to take to the Medicaid agency to apply for QMB benefits.
Source: medicareadvocacy.org

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

I NEED TO DISENROLL FROM MY MEDICARE ADVANTAGE PLAN!! » Toni Says

            Receiving Medicare Supplement Open Enrollment (Guaranteed Issue): Because you enrolled in Part B in December and are within your 6-month Medicare open enrollment period which ends on May 31, 2013, you can receive guaranteed issue.  Medicare’s definition for guarantee issue is your acceptance in any Medicare Supplement plan is guaranteed during your Medicare supplement open enrollment period which lasts for 6 months beginning the first day of the month in which you are either age 65 or older and have just enrolled in Medicare Part B.
Source: tonisays.com

Medicare Part B enrollment ends 3/31

In 2013, the standard monthly premium for Medicare Part Bi s $104.90. Some high-income individuals pay more than the standard premium. Your Part B premium also can be higher if you do not enroll during your initial enrollment period, or when you first become eligible.
Source: standard.net

Why Do You Need Medicare Supplements?

Those seniors who are already sick should get Medicare Supplement Insurance. Also, anyone who has a family history of illness should look into it as well. If you have a Medicare Advantage plan you do not need Medicare Supplement Insurance. You also would not need it if you are under another governmental program such as Medicaid or the Qualified Medicare Beneficiary program. Medicare has a cap that a person can reach. They pay so much of your medical bill and then your portion of the bill starts to increase while their payment portion is decreased. This puts you at being 100 percent responsible for your medical bills. This includes hospital stays and outpatient services such as physician visits, your routine visits and other medical needs
Source: besteasyweightloss.com

Medicare and Medicaid For Senior Citizens by David Crumrine

This entry was posted in Articles and tagged article source, citizen, citizens age, deductibles, ely, eve, ezine, flu shots, fri, health insurance, home health care, hospital insurance, Inc, insurance policy, least five years, lifetimes, medical insurance, medicare, medicare coverage, medicare part a and part b, medicare part b, medicare supplemental insurance, mp, preventative services, private insurance companies, senior, senior citizen, senior citizens, skilled nursing facility, target, time, traditional medicare, wh. Bookmark the permalink.
Source: nvseniorguide.com

Obama Administration Proposes Eliminating ‘Obsolete’ Medicare Regs

Posted by:  :  Category: Medicare

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The Medicare NewsGroup: Troubling Trends On Disability As A Back Door Into Medicare No publicly presented Medicare reform proposal has addressed the growing problem of those younger than age 65 who are finding their way into the program through permanent disability. Those who qualify for Social Security Disability Insurance (SSDI) and who have been disabled for at least two years are automatically enrolled in Medicare, no matter their age. That means a growing number of those under age 65 — at least five million people — are qualifying for lifetime benefits, according to a recent tally published in the journal Health Affairs. Policymakers are concerned about the rise in disabled adults because they often require expensive care, putting even more pressure on the health care system (Wasik, 2/4).
Source: kaiserhealthnews.org

Video: clinical chart documentation review crosswalking CMS Medicare 2010 regulations.mov

On private insurance, but under Medicare Regulations. Anyone else encounter this?

I also like to point out that I think that the whole issue is ripe for a class-action suit, making decisions about treatment without medical contact, cutting medical records, etc. The “damages” aren’t huge on a case-by-case basis but I suspect they could be quantified. It also would help a case that we don’t really care about $$$$ as much as getting coverage, in which case the only people making money on it would be the attorneys, which would likely enhance their interest in the case. I suspect that the Medicare guidelines and the weak and conservative AMA guidelines for supply needs stem from budgetary shortfalls but I am certain that were the issue to be explored, there’s a significant probability that actionable graft and corruption that would be a hook for the case.
Source: tudiabetes.org

HHS to Scrap Outdated Medicare Regulations

In a new move towards assisting the healthcare industry, the White House recently announced its intention to work with the Department of Health and Human Services (HHS) to focus on and eliminate certain regulations for Medicare and Medicaid that are now considered to be obsolete.  This is expected to significantly impact Medicare-Medicaid Reimbursement over time, particularly for the elderly patients that will be affected the most by these changes.  In a press release from the Department, Secretary Kathleen Sebelius noted that, “We are committed to cutting the red tape for health care facilities, including rural providers.  By eliminating outdated or overly burdensome requirements, hospitals and healthcare professionals can focus on treating patients.”
Source: healthworkscollective.com

US Proposes Scrapping Some Obsolete Medicare Regulations

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Source: charismamag.com

Court of Federal Claims Says Medicare Providers May Not Sue the Government for Breach of Contract over Regulatory Violations But May Pursue Takings Claims

Judge Mary Ellen Coster Williams characterized Plaintiff’s breach of contract claim as one that is “predicated solely on Defendant’s alleged failure to follow Medicare regulations” (and differentiated it from sure-to-fail breach of contract claims that are “merely a creatively disguised claim for benefits”). However, while Judge Williams recognized that the Court of Claims clearly has jurisdiction over a breach of contract claim against the United States, she found that AAA failed to “allege the elements of a contract with the Government – offer, acceptance, consideration, and authority of a Government agent.” The court noted that an implied-in-fact contract is only found when statues or regulations clearly “express the Government’s intent to enter into a contractual arrangement with program participants,” and that the Medicare Act includes no such language, but merely provides for a payment from the Government.
Source: nortonrosefulbright.com

Medicare updates regulations on revenue cycle management, documentation » Healthcare Scheduling Solutions Blog

The Center for Medicare and Medicaid Services creates industry standards for how information must be submitted to the public payors for reimbursement approval. When physician documentation is inaccurate or sloppy, medical billing and coding professionals may struggle to select the appropriate code to label the claims being sent off for reimbursement. Any misunderstanding in the standard billing and coding procedures can result in denied claims, penalties and other more significant losses if inaccuracies persist. Healthcare business analytics provide healthcare decision makers with insight into financial performance and areas in need of improvement to prevent backlash from the CMS or other payors.
Source: apihealthcare.com

Bundled payments, DMEPOS, regulatory reform, and ESRD

We also announced a major expansion of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program.  In its first year of operation, competitive bidding, where prices are based on suppliers’ bids, saved the Medicare program, and taxpayers, over $202 million, while maintaining access to quality products for Medicare beneficiaries in the nine areas of the country where the program launched.   It’s a great example of the Administration’s determination to put the brakes on runaway healthcare costs.  With this expansion in the program, Medicare beneficiaries in 91 major metropolitan areas will save an average of 45 percent on certain DMEPOS items beginning in July.  Between 2013 and 2022, we estimate that the expansion of the DMEPOS program will save Medicare $25.7 billion, while saving beneficiaries, who pay a percentage for medical equipment and supplies, $17.1 billion through lower prices.
Source: medicare.gov

IRS Issues Guidance On Additional Medicare Tax : ADP Compliance Insights

Background Effective for wages paid on or after January 1, 2013, the Medicare tax rate increases from 1.45 percent to 2.35 percent on wages earned above $200,000 for single filers and $250,000 for joint filers ($125,000 for a married individual filing separately).   This increase only applies to the employee portion of the Medicare tax. Employers do not have to match the increased Medicare tax amount. However, employers are still responsible for the withholding and reporting obligations with respect to the increased employee Medicare tax.  If an employer fails to withhold and deposit the additional Medicare tax amount AND the employee pays it with their tax return, the employer will not be required to pay the amount not deducted, but the employer will be subject to penalties for the failure to withhold the tax.   The employer is required to withhold the increased amount from all workers with wages exceeding $200,000 regardless of the marital status claimed on the employee’s Form W-4. Over- and under-withholding for the employee will be reconciled upon the filing of his/her individual tax return.
Source: adpcomplianceinsights.com

Primary Insurance Change, Late Filing, Unpaid Claims, Collections Threat

Posted by:  :  Category: Medicare

Since 2000 I have had medical insurance with GHI with no problem. In April 1st of 2011 I acquired Medicare due to my disability. Now I have two medical insurances (GHI and Medicare). At this time I was unaware that Medicare took over as my primary insurance. In the end of the year 2012 my doctors sent my claims to GHI and GHI paid the claims. Then GHI realized that my primary insurance was Medicare. So they sent a collection notice to the doctors to reclaim the money. They also sent notice that they should re-file the claims with Medicare. By the time they figured all this out Medicare is denying some of the claims due to late filing. Now my Doctor is threatening me with collections and adding interest – and ruining my credit. I just find it odd … with two insurance coverages and no laps in insurance I’m being charged almost $2000. How Can I Fix This? Thanx a bunch ,,,,,,,,,,,,,,, Peter Q Response: Peter, What you’ve run into we see occasionally in billing for our providers – and it’s really not that uncommon. Here’s how we handle it – First the provider reimburses the payer that was mistakenly billed as primary – in your case this was GHI. We then submit the claims to Medicare with an explanation that these claims were mistakenly submitted to the secondary payer who has since been reimbursed. In these situations we would file an appeal with Medicare which typically requires we submit additional proof such as the original Explanation of Benefit’s (EOB) and other documentation to clear up the late filing denial from Medicare. Claims are then submitted to the secondary payer once the primary payer (Medicare) has paid on the claim(s). Really the providers I’ve worked with don’t threaten their patients with collections. We just work it out between the payer as I described above and bill the patient for the amounts they are contractually responsible for. Hopefully your doctor will not follow through with collection efforts. And really I don’t think that they would be very successful in doing so given you have adequate insurance coverage and have been cooperative in helping to figure all this out. You also may want to talk to Medicare and describe the situation and find out exactly what your rights are. Hope this helps answer your question.
Source: all-things-medical-billing.com

Video: What is the best health insurance company in New York for Medicare retirees? My

Emdeon Current: New Payer Transactions

Claims Management Services, Payer ID: 39141 Clarian Health Plans Inc., Payer ID: 95444 Connecticare – Medicare, Payer ID: 78375 CoreSource Little Rock, Payer ID: 75136 DiaTri LLC, Payer ID: 36439 Employee Benefit Systems, Payer ID: 42149 Fallon Community Health Plan, Payer ID: 22254 GHI – Medicare Private Fee for Service, Payer ID: 22937 GHI – New York (Group Health Inc.), Payer ID: 13551 GHI HMO, Payer ID: 25531 Geisinger Health Plan, Payer ID: 75273 Group Health Cooperative of South Central Wisconsin, Payer ID: 39167 Group Health Inc., Payer ID: 22937 HIP – Health Insurance Plan of Greater New York, Payer ID: 55247 Harrington Health-Kansas (formerly known as Fiserv Health-Kansas), Payer ID: 62061 Harvard Pilgrim Health Care, Payer ID: 4271 ISLAND HOME INSURANCE COMPANY, Payer ID: IU Medical Group Primary Care, Payer ID: SX172 Integra Group, Payer ID: 31127 LIFE Pittsburgh, Payer ID: 25181 Landmark Healthcare Inc, Payer ID: LNDMK MED PAY, Payer ID: 88058 MEDICA HEALTH CARE PLAN INC., Payer ID: 78857 March Vision Care Inc., Payer ID: Call Meritain Health / Agency Services, Payer ID: 64158 Meritain Health/North American Administrators, Payer ID: 64157 Metropolitan Health Plan, Payer ID: 10850 Montefiore Contract Management Organization, Payer ID: 13174 Network Health, Payer ID: 4332 Network Health Insurance Corp-Medicare, Payer ID: 77076 North American Administrators Inc., Payer ID: 64157 North American Health Plan, Payer ID: 64157 North American Preferred, Payer ID: 64157 Northstar Advantage, Payer ID: 60058 ODS Health Plan, Payer ID: 13350 PacificSource Health Plans, Payer ID: 93029 Paragon Benefits Inc., Payer ID: 58174 Prism-First Health, Payer ID: 37303 Screen Actors Guild, Payer ID: 99289 Touchstone Health PSO, Payer ID: 23856 Trellis Health Partners, Payer ID: 36397 Vytra Healthcare, Payer ID: 22264 Weyco Inc., Payer ID: 38232 Wisconsin Department of Corrections, Payer ID: 74101 Anthem Blue Cross, Payer ID: 47198 Associated Benefits, Payer ID: 50266 Blue Cross Blue Shield of New Mexico, Payer ID: SB790 Blue Cross Blue Shield of Oklahoma, Payer ID: SB840 Illinois Medicaid, Payer ID: SKIL0 Nebraska Medicaid, Payer ID: SKNE0 New Hampshire Medicaid, Payer ID: SKNH0 Eligibility Inquiry and Response Ameritas Group, Payer ID: AMERITAS Ameritas Life Insurance Company, Payer ID: 425 CoreSource – FMH, Payer ID: CORSE00204 CoreSource – FMH, Payer ID: CRSKC CoreSource – Little Rock, Payer ID: CORSE00205 CoreSource Little Rock, Payer ID: CRSAR Coresource – FMH, Payer ID: 204 Coresource Little Rock, Payer ID: 205 First Ameritas of New York, Payer ID: 426 First Ameritas of New York, Payer ID: AMTAS00426 First Reliance Standard Life Ins Co., Payer ID: 428 First Reliance Standard Life Insurance Company, Payer ID: AMTAS428 MMSI, Payer ID: 85 MMSI, Payer ID: MMSI Medica, Payer ID: 404 Medica, Payer ID: MEDIC Medical Mutual of Ohio, Payer ID: 211 Medical Mutual of Ohio, Payer ID: MMO00211 Nippon Life Benefits, Payer ID: NIPON Peoples Health, Payer ID: PPLSH Reliance Standard Life Insurance Company, Payer ID: 427 Reliance Standard Life Insurance Company, Payer ID: AMTAS00427 SAMBA Health Benefit Plan, Payer ID: SAMBA Standard Insurance Company, Payer ID: 429 Standard Insurance Company, Payer ID: AMTAS00429 Standard Life Insurance Company of New York, Payer ID: 430 Standard Life Insurance Company of New York, Payer ID: AMTAS00430 ameritas, Payer ID: AMTAS00425 Blue Cross Blue Shield of Pennsylvania (Highmark), Payer ID: BCPAC Blue Cross Blue Shield of Pennsylvania – Highmark, Payer ID: 440 Mountain State, Payer ID: MTNST Affinity Health Plan, Payer ID: AFNTY New Jersey Medicaid, Payer ID: AID19 New Jersy Medicaid, Payer ID: NJ South Dakota Medicaid, Payer ID: AID28 South Dakota Medicaid, Payer ID: SD Claim Status And Response: Ameritas Group, Payer ID: AMERITAS Ameritas Life Insurance Company, Payer ID: 425 CoreSource – FMH, Payer ID: CORSE00204 CoreSource – FMH, Payer ID: CRSKC CoreSource – Little Rock, Payer ID: CORSE00205 CoreSource Little Rock, Payer ID: CRSAR Coresource – FMH, Payer ID: 204 Coresource Little Rock, Payer ID: 205 First Ameritas of New York, Payer ID: 426 First Ameritas of New York, Payer ID: AMTAS00426 First Reliance Standard Life Ins Co., Payer ID: 428 First Reliance Standard Life Insurance Company, Payer ID: AMTAS428 MMSI, Payer ID: 85 MMSI, Payer ID: MMSI Medica, Payer ID: 404 Medica, Payer ID: MEDIC Nippon Life Benefits, Payer ID: NIPON Peoples Health, Payer ID: PPLSH Reliance Standard Life Insurance Company, Payer ID: 427 Reliance Standard Life Insurance Company, Payer ID: AMTAS00427 SAMBA Health Benefit Plan, Payer ID: SAMBA Standard Insurance Company, Payer ID: 429 Standard Insurance Company, Payer ID: AMTAS00429 Standard Life Insurance Company of New York, Payer ID: 430 Standard Life Insurance Company of New York, Payer ID: AMTAS00430 For all payers, visit https://access.emdeon.com/PayerLists/
Source: blogspot.com

Medicare MSPRC contract change

Although there has not  been a formal announcement  it appears that the new contactor to perform recovery activities on behalf of Medicare will be Group Health Incorporated (GHI).  GHI is a familiar entity to Medicare as GHI has been the Medicare Coordination of Benefits (COB) since 1999. Under the new contract GHI will expand its role to include the recovery portion of the Medicare process.
Source: lienresolutiongroup.com

Medicare Secondary Payer: The Shape of Things to Come

H.R. 1063, the Strengthening Medicare and Repaying Taxpayers (SMART) Act, had gained a significant amount of bipartisan support in both the House and Senate; however, with the election pending, the outlook seemed bleak that it would be passed by the 112th Congress. Well, on September 13, 2012, the Energy and Commerce Subcommittee on Health met in an open markup session and made certain adjustments to the bill to implement more automated functions to the conditional payment recovery process. The committee met again on September 20, 2012, and again made minor adjustments to the bill, then favorably forwarded it to the full committee and sent it back to the CBO for scoring. There was no further indication of progress until on December 19, 2012, a lesser version of the SMART Act emerged as Title II of the Medicare IVIG Access Act [H.R. 1845]. H.R. 1845 proposed a $45 million dollar demonstration project to study providing Medicare coverage for in-home administration of intravenous immune globulin (IVIG) to patients suffering from primary immune deficiency disease. Despite the sympathetic appeal of helping the bubble boy, H.R. 1845 needed to be off-set by a bill such as the SMART Act, which proposed to coincidentally save Medicare $45 million dollars over ten years, and the match was made. The new combined bill was nearly unanimously passed by the House on December 20, 2012, and passed by the Senate on December 21, 2012. On January 10, 2013, President Barack Obama signed the legislation, making it
Source: lexisnexis.com

835 (ERN) FILES FROM MEDICARE

If your files have stopped coming, you need to complete the form. CLICK HERE and complete the 5010 Production Transition form online. It can take 5 to 10 business days to process the form. Once it is processed, you will receive a confirmation email from NGS. There is nothing else to set up or do once confirmed and you should start receiving your 835 ERN files thereafter.
Source: wordpress.com

U.S. Funding for Global Health: The President’s FY 2014 Budget Request

U.S. global health programs, like many U.S. programs, face the challenge of being implemented during a time of significant budgetary uncertainty, spending scale-backs, and potential trade-offs in funding between program areas. While funding for U.S. global health programs has fared relatively well in the current budget environment, it too has been subject to funding pressures and reductions in some areas. With funding levels for FY 2013 not yet finalized for all global health programs, including the unknown impacts of sequestration, combined with continued efforts to address budgetary constraints, uncertainty over final global health funding levels remains.
Source: kff.org

Intermittent Connectivity Issue Reported by NGS

National Government Services (NGS), a Medicare intermediary, is experiencing intermittent connectivity issues. As a result, some claim files have not been successfully received by the payer. The clearinghouse is retransmitting affected claim files as impacted files are being identified. NGS is working diligently to resolve this intermittent connectivity issue. The following payers may be affected: CPID 1452 Connecticut Medicare CPID 3533 Connecticut Medicare CPID 1463 New York Medicare Upstate CPID 3519 New York Medicare Empire CPID 4442 New York Medicare Empire CPID 1773 NGS American CPID 8522 NGS American CPID 2528 New Hampshire Medicare CPID 3547 Maine Medicare CPID 5506 Illinois Medicare CPID 5512 Wisconsin Medicare CPID 5527 Massachusetts Medicare CPID 5578 Rhode Island Medicare CPID 5954 Vermont Medicare CPID 7401 New York Medicare GHI CPID 7475 Medicare DME MAC Jurisdiction A CPID 7476 Medicare DME MAC Jurisdiction B CPID 7477 Medicare DME MAC Jurisdiction C CPID 7478 Medicare DME MAC Jurisdiction D Please be aware of this processing issue. If you have any questions, please contact Client Services at 1-888-348-8457, option 2.
Source: collaboratemd.com

Stefan G. Kantrowitz, M.D.

Dr. Kantrowitz graduated cum laude from the Sophie Davis School of Biomedical Education at the City College of New York, where he received a degree in Biomedical Science. He earned his medical degree from the State University of New York Health Sciences Center in Brooklyn (formerly SUNY Downstate). Dr. Kantrowitz completed his residency in Internal Medicine at St. Luke’s-Roosevelt Hospital Center in Manhattan. Dr. Kantrowitz is a member of the American College of Physicians.
Source: mhmg.net

Medicare Telehealth Reimbursement

Posted by:  :  Category: Medicare

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Medicare is federal health insurance for senior citizens. The first attempt at Medicare reimbursement for telehealth was the Balanced Budget Act of 1997 (BBA), which provided partial reimbursement through telehealth demonstrations. The BBA created coverage for telehealth consultations to Medicare beneficiaries living in rural health professional shortage areas (HPSA). HPSA’s are areas in which accessibility to healthcare professionals is limited and require the patient to travel many miles to their physician’s office. In this case, telehealth overcomes this barrier and allows access to their physician from the locality of their home. A caveat should be inserted here. Not all physician visits can be accomplished via telehealth. There are times when a physical visit is required. The BBA also set forth the requirement that a Medicare practitioner must be with the patient at the time of the consultation. This pretty much negates the benefit of telehealth.
Source: healthworkscollective.com

Video: Medicaid News – Rick Snyder, Congressional Budget Office, Harry Reid, Medicare

Grassley Continues Focus On Medicare Decision Trading Probe

The Washington Post: Hundreds In Government Had Advance Word Of Medicare Action At Heart Of Trading-Spike Probe Sen. Charles E. Grassley (R-Iowa) told The Washington Post late last week that his office reviewed the e-mail records of employees at the Department of Health and Human Services and found that 436 of them had early access to the Medicare decision as much as two weeks before it was made public. The number of federal employees with advance knowledge is surely higher; the figures Grassley’s staff compiled did not include people at the White House’s Office of Management and Budget who also saw the information. The e-mail records of those employees have not been made available to Grassley (Hamburger and ElBoghdady, 6/9).
Source: kaiserhealthnews.org

FDLE arrests three pharmaceutical drug trafficking suspects

MIAMI – The Florida Department of Law Enforcement Miami Regional Operations Center arrested Jorge L. Castillo, Miami Lakes, Fla., and two others for trafficking in contraband prescription drugs, conspiracy to traffic in contraband prescription drugs, money laundering and organized scheme to defraud following a five-year-long investigation of pharmaceutical product diversion. The investigation began in late 2008 in partnership with the Medicaid Fraud Unit and Statewide Prosecution of the Florida Office of Attorney General, the Federal Bureau of Investigation, and the U.S. Food and Drug Administration. The case is being prosecuted by the Office of Statewide Prosecution of the Florida Office of the Attorney General. Agents arrested Castillo on Monday, June 17, 2013 at his residence, 16450 NW 83 Court, Miami Lakes. He was booked into the Broward County Jail with a $3.5 million bond.
Source: capitalsoup.com

Moody’s: Longer Medicare Solvency Good News for Nonprofit Hospitals

Following the latest report from the Medicare Board of Trustees extending the projected solvent lifespan of the Hospital Insurance Trust Fund from 2024 to 2026, Moody’s Investors Service rated the trustees’ findings as credit positive for nonprofit hospitals, which lately have seen a slew of negative harbingers for their credit future. Nonprofit hospitals should find the news especially favorable for their future balance sheets, as Medicare is the single largest payer for most of them, contributing 44 percent of gross revenues on average, according to Moody’s Vice President and Senior Analyst Mark Pascaris in a report on the matter. In addition, Medicare’s slightly less imminent funding collapse reduces political pressure on Congress to make further cuts to the program, protecting a sizeable portion of nonprofit hospitals’ revenue streams, Mr. Pascaris wrote. However, as the Congressional Budget Office places Medicare and Medicaid as the single largest national expense at 23 percent of the federal budget, Mr. Pascaris wrote. Moody’s expects Medicare will not be immune to cuts, especially as the number of beneficiaries grows from about 50 million last year to as many as 73 million by 2025 — the year before Medicare is predicted to run out.
Source: beckershospitalreview.com

How Medicare Supplement Plan F Can Save You Money Healthcare and Technology for Seniors

Medicare Supplement Plan F is a secondary insurance that is used along with Medicare basic coverage to help curb any additional medical expense that may not be covered under the primary Medicare plan. Plan F covers the outstanding balance on any Medicare approved expense. Regardless if it is a visit to the physician’s office, a hospital stay, or a diagnostic analysis, you will be completely insured and have no balance left to pay. Plan F pays the difference on deductibles, co-payments, and co-insurance leaving you with no outstanding amount.
Source: accefoundation.org

Hundreds in Government Had Advance Word of Medicare Action at Heart of Trading

Grassley’s investigators have interviewed Hayes and private-sector political-intelligence consultants. But Grassley made clear Friday that while the SEC continues to investigate who made large trades in advance of the Medicare announcement, he will focus on adding transparency to the political-intelligence-gathering process, including asking more about “how the government handles market-sensitive information.” That kind of data, he said, “should be available to everyone at the same time, not handled loosely in a way that allows special access to some individuals.”
Source: fracturedparadigm.com

Gov’t Employees May Have Profited Off Insider Information About Changes To Medicare

Shares of private insurers spiked weeks prior to an April 1 announcement that The Centers for Medicare and Medicaid Services (CMS) planned to put $8 billion into the private-sector Medicare Advantage program, according to a report in The Washington Post. The Securities and Exchange Commission and the Justice Department are mounting an investigation into whether a number of federal employees who had advanced knowledge of that decision may have profited off their inside information.
Source: mediaite.com

Applying for Social Security Disability in Indiana: 5 Forms You May Need

Posted by:  :  Category: Medicare

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If you are an Indiana resident applying for Social Security disability, you should be aware that this can be a time-consuming and complicated process. Knowing what to expect and how to be prepared is best done with the help of an Indiana Social Security lawyer. A lawyer can explain the types of evidence you will need, which paperwork and forms need to be completed, and the timeframe in which all of this must be done. There are 5 forms of proof that may be necessary to start your Indiana Social Security disability application, including: 
Source: hensleylegal.com

Video: Social Security Disability tip: Functional Report Forms -3d parties

THE WANDERING TAX PRO: HOW IS SOCIAL SECURITY TAXED?

We are told that long-term capital gains and qualified dividends are taxed at the rate of 0% if you are in the 10%-15% brackets.  But this income increases your MAGI for purposes of calculating taxable Social Security or Railroad Retirement benefits.  So if you have $1,000 in qualified dividends, which you expect to be totally tax free due to the 0% bracket, you could end up paying tax on as much as $850 at your “normal” ordinary income rate!
Source: blogspot.com

Listing Forms for Social Security Disability Evaluation

If your doctor says that your medical condition meets the criteria of a listing from the Social Security Blue Book, you should be able to get approved for Social Security disability benefits, as long as the medical evidence backs up the doctor’s opinion. In order to provide Social Security with your doctor’s opinion, we’ve created “listing forms” for the most common medical conditions that Social Security sees. This form can help you at the initial application phase and the appeal phase.
Source: disabilitysecrets.com

Social Security changes gender identity rules

Today marks an important victory for the transgender community, even though it may appear to be a small paperwork technicality, reports ThinkProgress.org. “The Social Security Administration (SSA) has announced that it is now much easier for trans people to change their gender identity on their Social Security records. All that will now be required, according to the National Center for Transgender Equality, is for individuals to submit government-issued documentation reflecting a gender change, or a certification from a physician confirming they have undergone appropriate clinical treatment for gender transition. “This is a significant departure from the previous policy, which required documentation of complete sex reassignment surgery. Many trans people never undergo such procedures, either because they are too expensive, because they do not want to lose their procreative ability, or because it simply isn’t an important change for them to make to find authenticity in their identities. The SSA change eliminates this high standard for trans people to obtain the appropriate documentation for the gender that reflects how they live their daily lives. “Though Social Security cards do not display gender, the SSA does maintain that information as data, and it can impact other governmental programs. For example, individuals seeking coverage under Medicaid, Medicare, Supplemental Security Income, or other public benefits could face complications if their gender markers do not match from form to form and identification to identification. In addition to an invasion of their privacy, the discordance could even lead to a denial of benefits. The new change will eliminate the obstacles trans people can face to access protections they often need because of other forms of discrimination they otherwise experience in society.”   More at: http://thinkprogress.org/lgbt/2013/06/14/2161991/transgender-social-security/?mobile=nc
Source: worlding.org

New Authorization Process for Social Security Authorization Form

There are many positive outcomes in regards to the new authorization process for the SSA-827 form. Before, waiting for the signed authorization form could add nine extra days to the process because Social Security and the claimant had to wait for the forms to be printed, sent, signed and returned to Social Security either by hand delivery from the claimant or by relying on the postal service. Now, the nearly-instant process of the authorization form cuts all the waiting time and will allow Social Security to obtain the records they need in order to make a decision on a disability claim. Social Security will also send copies to the claimant, so they can keep the form for their own records.
Source: disabilitylawyer.com

Suggestions To Change Social Security Benefits

Each first recorded wedding in Vegas most likely was in 1900s when California banned gin from being part of the ceremony, young lovers who were drunk coupled with in love were able to use hitched in Las Vegas. Specific unity certificate took only hours which can get stamped and outside the place of worship was a city of lights of their marriage celebration. Clark Gable was said to have been their first celebrity to get married to Vegas, and from then on the product became the top wedding destination with respect to celebrities and commoners alike. The following are five reasons why you has to consider getting hitched in the Amusement Capital of the World.
Source: isn-buenosaires-2012.org

Identity Theft: What to Do if Someone Has Already Filed Taxes Using Your Social Security Number

The above article is intended to provide generalized financial information designed to educate a broad segment of the public; it does not give personalized tax, investment, legal or other business and professional advice. Before taking any action, you should always seek the assistance of a professional who knows your particular situation for advice on your taxes, your investments, the law or any other business and professional matters that affect you and/or your business.
Source: intuit.com

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June 18, 2013

How to apply for the Medicare ACO program

Posted by:  :  Category: Medicare

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The second call will be held April 23 from 1:30 – 3:00 p.m. CMS subject matter experts will cover tips on completing a successful application, including information on how to submit an acceptable ACO Participant List, Participation Agreement Sample, Executed Participant Agreement pages, and Governing Body Template for the Shared Savings Program application. A question-and-answer session will follow the presentation.
Source: poweryourpractice.com

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

Do You Qualify for Free Medicare Part D?

If you decide to apply and find out you don’t qualify, don’t worry because there are other programs at the state level that may be able to help you cover your prescriptions.  Find out by visiting Medicare’s “Helpful Contacts” page- Click here to visit the page.  This page can help you find a program at the state level that may be able to provide some assistance to pay for prescription drugs.
Source: firstseniorfinancialgroup.com

Sightings Over Sixty: I Apply for Medicare, Part I

     My ex-wife is a year older than I am. Last year she turned 65 and applied for Medicare. I remember at one point asking her about the whole process of signing up for Medicare. How do you apply? Is it complicated? How do you know what coverage you’re getting?      She told me not to worry. A few months before you turn 65 you start receiving all kinds of information in the mail. She’d looked over the basics. “Then I was able to sit down with an insurance agent who specializes in Medicare,” she told me, “and he explained the whole system to me. He said he gets paid by the insurance companies, so it didn’t cost me a thing.”      So I didn’t worry. And now this year, in advance of my own 65th birthday, I expected to start receiving lots of literature in the mail, inviting me to join Medicare, showing me how to do it, and explaining all the benefits. I didn’t know who it would come from. The government? My insurance company? It wouldn’t be from my employer. I no longer have an employer. My company started shedding employees in the 1990s, and got around to shedding me in 2002, so I’ve been on my own for the last decade.      The calendar turned over, and the months came and went, but I heard not a word from anybody. Maybe my ex-wife was wrong, I thought. Maybe she got information in the mail, because of where she lives, or because of her insurance company, or because she’s a woman. But that doesn’t necessarily mean everyone gets information in the mail.      I started worrying. Maybe, somehow, I’ve dropped off the the Medicare “membership” list. Maybe my name got lost in the computer. Maybe they forgot about me!?!      So I finally decided I’d better find out. I realize that for many of you this is “old hat.” You’ve been through all this already. But anyway, like the modern tech-savvy person I am, I typed “How to apply for Medicare” into google. I found lots of general information. There’s Part A which is free, and it “helps pay” for inpatient care in a hospital. There’s Part B which you pay for, and that “helps pay” for doctor services.      Well, that’s pretty good, I thought, but also pretty vague. I found a link for Medicare Premiums and found out my premium for Part B would be $104.90 a month, as long as my MAGI is $85,000 or less. I know what MAGI means (Modified Adjusted Gross Income), although I’m not sure how to calculate it. But I’m pretty sure my MAGI is less than $85,000 so I’m not going to worry about it.      This is getting awfully complicated, I realized. And since I really couldn’t find out any specifics, I decided to call the Medicare 800 number, which is 1-800-772-1213. I understood what Parts A and B are, at least in theory. They pay for the majority of your doctor and hospital bills. But I wanted to know some of the particulars. Would they pay for my next colonoscopy? What if I needed surgery on my bad knee? Would it make a difference if I went to the hospital, or had it done in the doctor’s office? Could I go to a specialist if the specialist wasn’t in my medical group?      Plus, what about Parts C and D? What’s the difference between the various Medicare Advantage programs, and the Medigap program?      I negotiated the Medicare phone tree. I finally got to the option to talk with a real person. Then an automated voice announced the wait would be 10 minutes. Arghh! I must admit, I was too impatient. I didn’t want to wait and so I hung up.      I called my own current medical insurance company. Maybe they could help.      I negotiated the phone tree and eventually got a very nice lady on the phone. She spoke with a fairly heavy accent, but I understood most of what she was saying. Yes, my insurance company could provide me with a backup plan. There’s a PPO plan and an HMO plan. Actually, there are four different PPO plans, and a couple of HMO plans. “What”s your i.d. number?” she began.      The woman stayed on the phone with me for a good 15 or 20 minutes, trying to explain the basics of the different plans. But I had plenty of questions. How do I find out if my doctor is in the HMO network? She gave me a link on the website. How much would it cost? It depends what plan I picked, and what county I live in. Does the plan cover drugs? One of the plans does; another doesn’t. She wasn’t sure about the others. Are there any dental benefits? Again, it depends on the plan.      What if I moved? Like many retirees and pre-retirees, B and I are thinking of moving in a few years, probably to a different state. She told me that their plan was only good in my state. If I moved I’d have to switch plans.      I confess, I got tired of the conversation before the woman did. She must be used to people asking dumb questions. She finally offered to send me some published materials that would provide me with all the details. It would take about ten days or two weeks to get to me.      The woman did tell me one concrete and crucial thing. Regardless of what else I did, I should apply for Medicare Plans A and B. And I should do it right away, because if I waited and missed the deadlines, then there are restrictions about when you can apply, and I may be subject to higher rates … for the rest of my life.      You can apply by telephone (at the above 800 number), or in person. But I went back on the website where you apply for Medicare. I found the application. I filled it out. It was pretty easy.      And so as of right now, I await confirmation that I’m accepted into Medicare. And I await some materials in the mail which will presumably inform me what else I need to do to get more than the basic Medicare Parts A and B coverage.      I’d worried that I’d somehow fallen out of the system, or that it might be hard to sign up for Medicare. Bottom line:  Don’t worry, it’s easy to sign up. But it is hard to find out exactly what you’re signing up for, and to figure out what kind of backup medical insurance you should get.      More on that in Part II, after I’ve had a chance to look over those materials.        
Source: blogspot.com

Medicare Liens Including Medicare Set Asides Apply to Medical Damages Only!

This is not that uncommon in cases of very serious injuries where significant and sometimes permanent medical treatment is required. However, there are numerous potential areas for negotiation with Medicare’s over inclusive liens. For instance, in cases of serious personal injury, there are often very significant recoverable damages unrelated to medical expenses, either past of future. Medicare is not entitled to claim liens against settlement amounts that are unrelated to medical expenses paid or to be paid by Medicare.
Source: newmexicoinjuryattorneyblog.com

I’m working past age 65. Do I need to apply for Medicare Insurance?

Many people don’t understand that even if you are 65 and still working, you do still need to apply for Medicare benefits. If you do decide to work past age 65, your Medicare Part A will become active no matter what, as long as you have worked 40 quarters (10years) over your working lifetime. If you have worked 40 quarters over your working life, then Medicare Part A will carry no premium to it.  The next step is to decide if you need to participate in Medicare Part B which carries a premium that generally will come out of your social security check. If you are working for a company past age 65 and, generally speaking, if the company has over 51 employees, then you should be able to opt out of Medicare Part B until you decide to retire. However if you are a company with 50 or fewer employees then you will need to put your Part B in place, as in most cases an insurance company will become a secondary payer to your Medicare Part A and Part B.
Source: columbiariverinsuranceservices.com

Physicians Can Now Apply for Higher Medicaid Rates

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

Does Obamacare help veterans?

Current eligibility for Medicard is based on income and other factors. So, non-disabled adults who are not pregnant or caring for dependent children don’t qualify in most states. The ACA will provide for an expansion of Medicaid so that those making less than 138 percent of the federal poverty level will be eligible for Medicaid based solely on income. However, this change will apply only in states that choose to expand the program since a 2012 Supreme Court decision allows states to opt out. Governors in 14 states, including Texas, Pennsylvania and Maine, have announced plans to opt out. So, whether low-income veterans will be eligible depends on where they live.
Source: insurancequotes.com

Medicare Help: How Do I Apply For Medicare?

At the Social Security office you may apply for Medicare Part A and Medicare Part B, which is also known as “Original Medicare”. In some instances you may want to delay applying for Medicare Part B. We can discuss your particular situation to help you determine whether or not you would want to activate your Medicare Part B.
Source: ocmedicare.com

Cape Cod Medicaid Home Health Care Introduced for 2013

Generally, the same requirements apply whether the applicant is applying for long term care in a facility or home health care. The individual cannot have any more than $2000 of assets (except for the certain exemptions described in our MassHealth & Medicaid information page). And, most importantly, the applicant and his spouse cannot have made any “gifts” defined by MassHealth as “disqualifying transfers” within the past 5 years. Qualifying for MassHealth is an area that we specialize in as attorneys, and we recommend that every family come see us before proceeding with an application. The risk of inadvertently disqualifying an applicant all too common, and all too expensive.
Source: cape-law.com

Single Stop submits comments to Center for Medicare and Medicaid Services

Single Stop USA’s comments focused on addressing the following topics: (1) Encouraging transparency in the application process; (2) Integrating Navigators, In-Person Assisters, Certified Application Counselors; (3) Leveraging eligibility results to connect individuals to multiple benefit applications; and (4) Addressing the concerns of immigrant applicants. In addition to submitting our own comments, Single Stop worked with the other national benefits access providers and interested policy groups to have a shared voice about ways to maximize this important opportunity to advance on-line benefits access.
Source: singlestopusa.org

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June 18, 2013

IF I Drop Medicare Select Can I Get A Medicare Supplement Plan?

Posted by:  :  Category: Medicare

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Dropping a Medicare Select plan does not mean a person has to go with a Medicare Supplement Plan. It just means he has to go with one of the standardized plans, provided he can find one. The Medicare select plans were offered prior to 1998. The process of getting the new plan is the same as it would be for someone else. Dropping one plan means he must go through the Medical underwriting process and he does not have a guaranteed issue rights, unless the company dropped him from a Medicare Select plan for any reason.
Source: seniorcorps.org

Video: Medicare Supplement Select Plans

A.M. Best Revises Outlook to Negative for Sentinel Security Life Insurance Company

Furthermore, A.M. Best believes Sentinel Security Life will be challenged to improve its net operating performance given the expense strains anticipated from projected new business growth and the challenges of managing its increasing levels of interest-sensitive liabilities through the current low interest rate environment. Expenses related to its continuing expansion efforts also could dampen earnings. A.M. Best notes that Sentinel Security Life does use reinsurance to partially mitigate the new business expense strains associated with its fixed annuity and Medicare business, and its fixed annuity business maintains adequate surrender charge protection. Additionally, the company has begun exploring strategies to further strengthen its capital position. A.M. Best notes that the company’s balance sheet includes moderate exposure to below investment grade bonds relative to total capital. Additionally, the company has increased its exposure to the real estate markets through investments in residential and commercial mortgage-backed structured securities. The performance of these securities can be influenced by the general conditions of the economy and could adversely affect the company’s operating performance and financial strength.
Source: sheryljmoore.com

Q&A With David Shapiro, VP Of Member Experience For Medicare And Retirement, UnitedHealth Group

Our Medicare members’ experience with their plan has always been important to us because of the way Medicare plans are sold. Unlike commercial insurance, which typically allows employees to choose from a small group of plans that their employer selected for them, Medicare is a true B2C industry. Beneficiaries have the opportunity to select the plan or plans that meet their needs when they first become eligible, and then annually they can switch to a different plan if they choose. These dynamics, combined with the exponential growth in the senior population as baby boomers age, has made for an extremely competitive environment, one in which it’s critically important that your members are pleased not only with their coverage but also with the experience of being enrolled in your plan.
Source: forrester.com

Questions to Ask Before Selecting a Medicare Plan

Whether you are new to Medicare or are deciding if you should change plans during Medicare’s Annual Enrollment Period, more commonly called Medicare open enrollment, you should gather information from a variety of sources.
Source: aarp.org

Medicare Select Supplement Insurance Plans

Much like Medicare Advantage plans, the primary disadvantage is simply the constraints of the network. It is important to be certain of any network limitations by first checking with the insurance company and/or the agent before purchasing a policy. And consumers must be aware that certain doctor groups and facilities may be in the approved network one year and out the next.
Source: ohioinsureplan.com

Medigap, Your Medicare Supplemental Insurance Plan

If you are in the Original Medicare Plan and you do have a Medigap policy, you can go to any kind of physician, hospital, or other healthcare provider that accepts Medicare. On the other hand, when you have the kind of Medigap plan called Medicare SELECT, you are required to use specific hospitals of the plans choice, and in most cases, specific physicians to utilize your full insurance benefits. It is also important that you understand that when you enroll in a Medicare Advantage Plan when you are 65, or drop your Medigap policy to join a Medicare Advantage Plan for the first time, you are allowed to dis-enroll from the plan any time during the first twelve months. This is called your trial period. If you choose to, you can return to the Original Medicare Plan on the 1st day of the following month, and there is a guaranteed right to purchase a Medigap policy.
Source: medigap-info.com

A Medicare Part D Cost Saving Success Story

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Source: thrivinginthemiddle.com

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