Healthcare Reform: How Does it Affect Medicare Benefits?

Posted by:  :  Category: Medicare

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Notably, the coverage gap in Medicare’s Part D prescription drug program (infamously known as the “doughnut hole”) will be eliminated in 2020, with increasing discounts on brand name and generic drugs implemented each year until then. In addition, most preventive care options, including vaccines, physical exams, and many routine tests, will no longer require a copayment or deductible. Those covered will also be able to visit their doctor for a free “wellness” visit once each year.
Source: pondlehocky.com

Video: Medicare Explained

Medicare Part D is prescription drug coverage insurance that is provided by private companies approved by Medicare.

Example: Mrs. Smith didn’t join when she was first eligible-by June 15, 2009. She doesn’t have prescription drug coverage from any other source. She joined a Medicare drug plan with an effective date of January 1, 2012. Her drug coverage was effective January 1, 2010. Since Mrs. Smith was without creditable prescription drug coverage from July 2009-December 2011, her penalty in 2011 was 30% (1% for each of the 32 months) of $31.08 (the national base beneficiary premium for 2012), which is $9.32. The monthly penalty is rounded to the nearest $.10. She pays this late enrollment penalty of $9.30 monthly in addition to her plan’s monthly premium. Here’s the math: .30 (30% penalty) x $31.08 (2012 base beneficiary premium) = $9.32 $9.32 (rounded to the nearest $0.10) = $9.30 $9.30 = Mrs. Smith’s monthly late enrollment penalty
Source: medicare.gov

Human DNA Patent Law News Update: Supreme Court Says Human DNA Can’t Be Patented

Even if a company uses groundbreaking technology and techniques to discover new strands of DNA, like the BRCA1 and BRCA2 that are indicates for risk of breast and ovarian cancer, they cannot hold a patent on the DNA strands themselves. The decision rules against Myriad, a genetics company that has been selling a very expensive test to determine if women have these two strands.
Source: medicarebenefits.us

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

Study: Immigrants Pay More Into Medicare Than They Receive in Benefits

The authors also noted that many immigrants pay taxes that help fund the program but are not eligible for its benefits. For example, many undocumented immigrants use fake Social Security numbers to work, which means they and their employers pay Social Security and Medicare taxes. However, such residents are ineligible for either program. The Affordable Care Act also prohibits undocumented immigrants from obtaining other health benefits, such as the insurance subsidies intended to help U.S. residents purchase coverage through the health insurance exchanges that launch next year (“Politics Now,” Los Angeles Times, 5/29).
Source: californiahealthline.org

Daily Kos: Obama budget cuts Medicare benefits and provider payments

On the other hand, the proposals for seniors aren’t a positive move. At least Obama didn’t include the hike in the Medicare eligibility age that he had previously offered to Boehner, but what he does include could be another hit for seniors, on top of the chained CPI. Cutting out Medigap policies would increase out-of-pocket costs for seniors. Those costs have been steadily and steeply rising [pdf] for seniors already over the past two decades. Adding more means testing to the program (wealthier individuals already pay higher premiums for Part B, the part that covers physician services and supplies) shifts the program further from from universal coverage and opens it up to more and more means testing, and toward a stigmatized and politically vulnerable poverty program.
Source: dailykos.com

The Medicare Prescription Drug Benefit Fact Sheet

CBO estimates that Part D spending will total $60 billion in 2013 (net of premiums and state transfers).  The average annual Part D per capita growth rate was 3.7% between 2006 and 2011, but is projected to rise at a more rapid rate (5.6%) between 2011 and 2021 (2012 Medicare Trustees), in part due to slowing of trend toward greater generic drug use. Total spending depends on several factors: the number of Part D enrollees, their health status and drug use, the number of low-income subsidy recipients, and plans’ ability to negotiate discounts and rebates with drug companies and manage use (e.g. promoting use of generic drugs, prior authorization, step therapy, quantity limits, and mail order).  The MMA prohibits Medicare from negotiating drug prices directly.
Source: kff.org

Spillover Benefits From Medicare Advantage

[I]ncreasing MA monthly payments by $100 (about one standard deviation) would increase the share of beneficiaries in MA by just under 5 percentage points…This would increase total MA spending by $100 per month for the existing and new enrollees, or almost $5 billion in total for these states. Overall costs of hospital care is estimated to go down by something like 2% when MA penetration increases by 5 percentage points, off a base of total hospital costs for the [traditional Medicare] population remaining in these states (after the implied shift to MA) of just under $30 billion, or about $600 million. Hospital costs for those in [traditional Medicare] would thus go down by upwards of 10% of the increase in spending on MA.
Source: ncpa.org

Response to Medicare cuts: Health Management Associates reduces benefits

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Source: ocala.com

Medigap insurance provider in San Diego

Posted by:  :  Category: Medicare

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Medicare Advantage plans are comprehensive when it comes to coverage, and you can get all of your healthcare needs covered under one source. Some Medicare Advantage plans are cheaper than a combined Medicare and Medigap policy combined – it all really depends on your personal health needs. Medicare Advantage plans may require you to see certain specialists and doctors within a specific network of providers. Although Medicare Advantage plans can certainly be cheaper than other options, you may still need to pay a co-payment depending on the doctor visit and treatments sought.
Source: pomeradonews.com

Video: Medicare supplement Insurance Plans VS Medicare Advantage plans

Medicare Advantage Enrollment Reaches Record High

CQ HealthBeat: Medicare Advantage Plans Worry About Cuts, But Enrollment Keeps Growing The number of seniors in the private Medicare Advantage plans tripled in the past seven years, according to an analysis released Monday. But future payment cuts could cause insurers to reduce benefits or increase cost-sharing, says a Blue Cross and Blue Shield Association official. The Medicare Advantage program grew from 5.3 million people in 2004 to a record 14.4 million in 2013, according to the analysis by the Kaiser Family Foundation and Mathematica Policy Research Inc. From 2012 to 2013 alone, the program grew by 10 percent — or by 1 million people (Adams, 6/10).
Source: kaiserhealthnews.org

CMS: Health plans for dialysis patients on Medicare Advantage not impacted by sequester

The Centers for Medicare & Medicaid Services issued a memorandum last month affirming that Medicare Advantage Plans are exempt from the 2% cut. Part D plans are also exempt. Some insurance plans, including United Healthcare, Humana, and Anthem Blue Cross Blue Shield, had notified care providers that they should expect a 2% cut, according to Lexology, an industry newsletter published in cooperation with the Association of Corporate Counsel.
Source: homedialyzorsunited.org

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

New Report Shows Medicare Advantage Delivers High Quality Care for Seniors

3rd Party Studies ACOs Admin Costs affordability Age Rating Cadillac Tax Delivery System Reform Employers Essential Benefits Exchanges GRP Health Insurance Tax Health Plan Innovations Health Plan Satisfaction House hearings House legislation KI MA Medical Prices Medical Tests medicare medigap MLR Morning Headlines Patient Safety premiums Profits Provider Consolidation Quality Rate Review Reform RZ Senate hearings Senate legislation Small Business The Link Vilification Waste Fraud and Abuse
Source: ahipcoverage.com

N.C.’s nascent Medicaid reform

Differences in availability of Medicare Advantage plans by county are driven by the choices of private insurers. Private companies cannot be forced to offer a Medicare Advantage plan in a given county, and many offer different plans in different counties. To provide a sense of the variation, peruse this website that provides a great deal of information on Medicare Advantage plans in N.C. Selecting the subset of plans offering a $0 prescription drug deductible and seeking the lowest premium plans in 2013 yields the following list of plans (if you click the county name you will see all MA plans). This scanned map (NCMedAdvtantage.6.5.13_best) with my handwritten comparisons of what is available in selected counties is illustrative. In Durham county, there are two Medicare Advantage plans with a $0 prescription drug deductible that have no additional premium to be paid by a Medicare beneficiary choosing this plan, and another with an additional patient monthly premium of $6. In Lenoir county, there are two plans, but the lowest monthly premium to be paid by a beneficiary for such a plan is $75 per month. I have not done a comprehensive comparison of all Medicare Advantage plans; my point is that the Medicare Advantage market is county-based, driven by insurance companies deciding where they want to offer certain types of plans.
Source: wordpress.com

Enrollment in Medicare Advantage Plans Projected to Rise 50 Percent in Next Ten Years

This is why our agency has invested heavily in developing research, insights and marketing innovations, and tools to reach this rapidly growing segment of Seniors and retiring Boomers. And, that’s why we’re conducting a FREE webinar on increasing online enrollments. Click here to register. When you attend this FREE webinar, you’ll also receive our Website Lead Generation Guide, offering insights and practical steps you can take immediately to make your website produce more leads and conversions.
Source: dmn3.com

Take Advantage of Medicare Advantage Plans

Preventive Benefits: Preventive health care seems to be a hot topic these days. What most people aren’t aware of is that most Medicare Advantage plans have put a strong emphasis on preventive services throughout all of the conversation on the topic. Preventive medicine can have a huge impact on disease detection and early stage care, which then impacts costs for everyone involved. It is important to use the benefits provided to you which include regular health screenings as well as annual medical exam. Schedule yours today!
Source: vibrantusa.com

Projecting Medicare Advantage Enrollment: Expect the Unexpected?

It is not entirely clear why enrollment has continued to climb since 2010, or if the trend will continue at the current clip. Analysts believe that the bonus payments have certainly helped to mitigate the effects of payment reductions, and that plans appear to be doing more to reduce their costs. Some speculate that Medicare Advantage plans are benefitting from the slowdown in medical spending, enabling them to keep premiums low. Others ascribe the growth in enrollment to the influx of baby boomers who may have greater comfort with managed care plans than previous generations. As additional payment reductions are phased in over the next few years, the growth in enrollment could stall or even reverse, if plans pull out of the market because they feel they cannot operate profitably. Even if enrollment continues to increase, there is some speculation that plans may scale back benefits and/or increase cost-sharing in response to reductions in Medicare payments and the soon-to-be implemented annual fee on health insurance that was enacted in the ACA, which also applies to Medicare Advantage.
Source: hcafnews.com

Seven Choices Medicare Plans Will Need To Make In Order To Survive

Sales channels are a good example of this. Given the recent proliferation of channels, it is critical that MA plans optimize their mix by focusing on the needs of their customers, instead of looking at what has helped sell various Medicare products in the past. Traditional channel options include direct sales, brokers, groups, and the web; emerging channels include retail stores, payor partnerships, and private exchanges. Each avenue provides a unique experience for the customer, and the right match can determine the eventual buying decision. The range of channels increases complexity, but it also allows leading plans to tailor their engagement strategy by segmenting the customers and personalizing interactions on the basis of segment needs for sales and enrollment, as well as ongoing interactions with the member to improve experience and manage health outcomes.
Source: healthaffairs.org

Medicare failing to track “extreme providers”

Posted by:  :  Category: Medicare

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

Video: AT Network Webinar Training on Medicare Competitive Bidding for DME Providers

Medicare urges seniors to join the fight against fraud

“A beneficiary’s best defense against fraud is to check their Medicare Summary Notices for accuracy and to diligently protect their health information for privacy,” said Peter Budetti, CMS deputy administrator for program integrity. “Most Medicare providers are honest and work hard to provide services to beneficiaries. Unfortunately, there are some people trying to exploit the Medicare system.”
Source: medbill.net

JAMA Forum: The Medicare Trustees Report: Time for Reflection, Not Celebration

Still, it’s important to remember that any limited long-term budget for Medicare has to balance 3 objectives. One is the federal budget objective of a reasonable and sustainable future level of federal spending on the program. Another is to distribute financial risk in a way Americans deem to be fair. That means balancing the financial risk faced by today’s Medicare beneficiaries (in the form of premiums and out-of-pocket costs) and the financial risk to taxpayers and future generations of not effectively holding down Medicare spending on seniors. And the third objective is to squeeze down on the health system in such a way that it pushes providers and plans to look hard for innovations that result in cost reductions. That pressure must neither be too light (or providers won’t have enough pressure to find less costly ways to deliver services) nor too aggressive (or there will be disruptions and unacceptable declines in the quality and availability of services).
Source: jama.com

OIG: Two Medicare Provider Databases Inaccurate, Incomplete

Health care provider information in two Medicare databases is inaccurate and incomplete, according to a new report by HHS’ Office of the Inspector General, FierceHealthIT reports. The databases, used to determine provider identities to help prevent fraud, are the:
Source: ihealthbeat.org

Medicare Networks: ACOs “on Steroids”

Two-sided risk: Each Medicare Network would have a spending target, and Networks that meet quality and patient satisfaction goals could share in any savings under the target. Like existing ACOs, Medicare Networks would initially have individual spending targets based on the historical spending of their enrolled beneficiaries. Over time, BPC proposes a transition to regional spending targets based on per beneficiary spending. The new spending targets would be risk-adjusted and would encourage inefficient providers to improve their performance relative to others within their region. Additionally, all Medicare Networks would be required to take two-sided risk, meaning that, in addition to potentially sharing in any savings, providers would be responsible for absorbing a portion of any excess spending over the target. In this manner, Medicare Network providers would be accountable for their own outcomes and volume of services, but would have flexibility to adopt their own internal care and financial processes to best achieve high quality, cost effective care. While the current Pioneer ACOs will take two-sided risk, they still lack the requisite tools to engage patients and do not provide strong enough incentives for providers to form them.
Source: bipartisanpolicy.org

CMS: More Than 14k Providers Kicked Out of Medicare Since 2011

CMS has revoked 14,663 providers’ ability to participate in Medicare since March 2011 due to fraud control efforts. The providers were expelled from the program due to felony convictions, not operating at the address CMS had on file or non-compliance with CMS rules. In 2008, two years before the Patient Protection and Affordable Care Act was passed, the number of healthcare providers kicked out of Medicare stood at only 6,307. The PPACA established new screening and review requirements for Medicare participation. Since the law’s enaction, Medicare revocations have doubled in 35 states and quadrupled in 18 states. Florida led the country in the number of revocations with 2,064. Texas (1,417) and Pennsylvania (1,077) also topped the list. Along with these revocation figures, CMS also announced its newly redesigned Medicare Summary Notices for Medicare enrollees. The redesigned claims statements are said to be easier to review and are intended to help senior citizens better identify potential fraud, waste and abuse.
Source: beckershospitalreview.com

Funding Details: The Medicare Improvements for Patients and Providers Act: Medicare Low Income Subsidy, Medicare Savings Program and Medicare Prescription Drug Enrollment Assistance

The Medicare Improvements for Patients and Providers Act: Medicare Low Income Subsidy, Medicare Savings Program and Medicare Prescription Drug Enrollment Assistance grants provide funding to State Health Insurance Assistance Programs, Area Agencies on Aging, and Aging and Disability Resource Center programs for outreach to eligible Medicare beneficiaries regarding changes to benefits and coverage under the Affordable Care Act.
Source: raconline.org

Changes to Program Integrity Manual May Benefit Medicare Providers

Use of templates may help providers eliminate the subjectivity in documenting medical necessity, and thus eliminate a significant number of claim denials.  It is important to note, however, that templates must be created in a way to allow providers to document all relevant elements necessary to establish medical necessity under a specific LCD.  Templates cannot merely contain check boxes, predefined answers, limited space to enter information, etc.  According to Section 3.3.2.1.1(B) these types of templates “often fail to capture sufficient detailed clinical information to demonstrate that all coverage and coding requirements are met.”
Source: dmagazine.com

Obama v. Ryan on controlling federal Medicare spending

As under the health law, Obama would make direct cuts to benefits off limits. The health law created the Independent Payment Advisory Board (IPAB) to come up with proposals to reduce spending if Medicare grows at a higher rate than the target. But the board’s 15 members, who will be appointed by the president and confirmed by the Senate, are not allowed to recommend anything that would ration care or change benefits, eligibility or cost sharing for Part A (hospital services) or Part B (physician services). It also couldn’t do anything to change the percentage of premium that seniors pay for prescription drug coverage or the subsidies that low-income individuals get. The expectation is that reductions would come from medical providers, although hospitals are protected at first.
Source: nbcnews.com

Medicare Access in Tallahassee: Milestone or Millstone?

Capital Medical Society is the Tallahassee-based, local professional membership organization for physicians, representing more than 600 licensed physician members who live and work in Leon, Gadsden, Jefferson, and Wakulla Counties. A non-profit corporation, CMS is governed by an annually elected Board of Governors and offers a variety of services to both its members and to the public. In 1975, the physician members created a charitable foundation whose mission is to support the charitable efforts of physicians and others, increase access to healthcare, promote education and serve the community’s health needs through innovative projects that are exemplary, affordable and dignified. The CMS Foundation operates the We Care Network, with over 300 volunteer physicians, volunteer dentists, the hospitals and most of the allied health professionals in Tallahassee who donate medical and dental care to low-income uninsured patients from Leon, Jefferson, Gadsden, and Wakulla counties. These volunteers have donated more than $50 million in charity care since the program was founded in 1992.
Source: tallahassee.com

The Best of Florida Medicare

Posted by:  :  Category: Medicare

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The Best of Florida Medicare   Florida Medicare Component B is an elective insurance offering and is essentially for other necessary medical expenses such as home healthcare, wellness and outpatient benefits. Coinsurance for this part is placed at twenty percent. Premiums range from smallest $96 to highest amount of $110 but an increment of $46 to $253 monthly may be paid in case annual income exceeds $85,000. Also, a deductible of $162 is required yearly before Medicare pays 80% of the total amount.   The third level or Component C is a health chart known as “Florida Medicare Advantage”, which combines the first two parts and can contain the component D benefits. Deductibles and copayments are also present in this type of health plans. An advantage afforded by this part is its lower price or premium than a supplement plan under Medicare. Accordingly, a lot of Florida’s policies pertaining to component C charge no premiums.   Drug benefits fall under component D. These may be availed of under a stand-alone policy that a private insurance company in Florida offers. Component C Medicare Advantage plan however, can offer similar drug-related provision upon enrolment. Choosing between these options will be a personal consideration for any interested applicant, either cost-wise or by virtue of practicality.   A number of insurance product carriers offer part C drug policies in Florida. Medicare supplement options are likewise available from these carriers. Included in the roster of viable carriers in Florida are the AARP UnitedHealthCare, Humana, Blue Cross Blue Shield of Florida, Gerber and Mutual of Omaha. There are other existing carriers but the mentioned names have the biggest networks in Florida.   The ideal choice among present networks is a concern that will only be determined by research and personal impression. Also, especially for those with critical minds, it is always a good thing to ask questions. Providers are in the best positions to answer queries so that a proper and informed decision can be made. Comparisons between providers ought to be made, further ensuring that coverage needs and costs parallel those of the original Medicare policy.
Source: topdatum.com

Video: Best Florida Medicare Plans

Florida Projects Steep Margin Decline for Medicare Home Health

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

Analysis: Florida Home Health Medicare Margins on Steep Decline

Analyses developed with the support of Dobson DaVanzo and Associates and Avalere Health indicate that the current trajectory of Medicare home health reimbursement is on track to produce negative margins by 2017 in 10 states even if home health payments are not subjected to further legislative and regulatory reductions.  Under this ‘best case’ scenario and using the Medicare Payment Advisory Commission (MedPAC) methodology for calculating margins (which has been found to exclude many costs that home health agencies routinely bear), Florida’s Medicare home health margin will fall to 5.2 percent by 2017.
Source: hcafnews.com

Feds Arrest 36 More California & Florida Providers On Defrauding Medicare Of More than $66 Million

If you need assistance providing compliance or other training, reviewing or responding to these or other health care related risk management, compliance, enforcement or management concerns, the author of this update, attorney Cynthia Marcotte Stamer, may be able to help. Vice President of the North Texas Health Care Compliance Professionals Association, Past Chair of the ABA Health Law Section Managed Care & Insurance Section and the former Board Compliance Chair of the National Kidney Foundation of North Texas, Ms. Stamer has more than 24 years experience advising health industry clients about these and other matters. Ms. Stamer has extensive experience advising and assisting health care providers and other health industry clients to establish and administer medical privacy and other compliance and risk management policies, to health care industry investigation, enforcement and other compliance, public policy, regulatory, staffing, and other operations and risk management concerns. A popular lecturer and widely published author on health industry concerns, Ms. Stamer continuously advises health industry clients about compliance and internal controls, workforce and medical staff performance, quality, governance, reimbursement, and other risk management and operational matters. Ms. Stamer also publishes and speaks extensively on health and managed care industry regulatory, staffing and human resources, compensation and benefits, technology, public policy, reimbursement and other operations and risk management concerns/ She also regularly designs and presents risk management, compliance and other training for health care providers, professional associations and others.   Her publications and insights appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, World At Work, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications.  You can get more information about her health industry experience
Source: wordpress.com

Florida Hospital Repays $3M to Medicare While Overbilling Allegations Loom

Florida Hospital in Orlando has repaid $3 million to Medicare, a move seen by prosecutors as corroborating overbilling allegations and by hospital officials as the result of a routine audit, according to an Orlando Sentinel report. Lawyers representing whistleblowers who filed suit against Florida Hospital in Orlando say the organization’s repayment of $3 million to Medicare shows merit to overbilling allegations, but hospital officials say the repayment was the result of a “normal and routine” audit. Florida Hospital and six other hospitals under the Orlando-based Adventist Health System face allegations of improper Medicare billing. A whistleblower complaint filed in July 2010 and unsealed in August 2012 alleges that seven Adventist hospitals routinely submitted duplicate claims or overbilled for radiology services for 15 years. A second complaint, filed in October 2012, claims fraudulent billing occurred for emergency services, as well. Marlan Wilbanks, JD, an attorney representing the whistleblowers, says Florida Hospital’s recent repayments to the Medicare program “further proves the credibility of our case,” according to the report. But hospital spokesperson Samantha O’Lenick says the repayment was based on a third-party audit’s findings. “It is not uncommon for us, as well as others in the industry, to conduct normal and routine audits because of the highly complex governmental billing rules,” Ms. O’Lenick said in the report. “Sometimes in doing so, we correct overcharges and undercharges.” A district judge has called the whistleblowers’ evidence of the alleged wrongdoing “extensive and sufficient,” and denied Florida Hospital’s first motion to dismiss the case. He also denied another motion to dismiss the second claim, which was filed more recently. A trial for the case is set for Dec. 2.
Source: beckershospitalreview.com

Federal Judge Lifts Ban On Medicare Releasing Individual Doctor Data

Medpage Today: Report: Medicare Gets Doc Info Wrong Medicare provider information in two separate databases was inaccurate most of the time and generally inconsistent between the two, compromising the program’s ability to detect fraud and abuse, a government watchdog found. Data in at least one field were inaccurate in 48 percent of inspected records in the National Plan and Provider Enumeration System (NPPES) and in 58 percent of inspected records in the Provider Enrollment, Chain and Ownership System (PECOS), according to the Department of Health and Human Services Office of Inspector General. Moreover, provider data were inconsistent between NPPES and PECOS 97 percent of the time, and the Centers for Medicare and Medicaid Services (CMS) didn’t verify most provider information, the watchdog agency said in a report released Thursday (Pittman, 5/31).
Source: kaiserhealthnews.org

Dozens Arrested for Medicare Fraud in South Florida

Federal authorities arrested nearly 100 individuals across the country for their involvement in Medicare fraud. Twenty-five arrests were made in South Florida alone. Miami-Dade County is often considered to be the hotbed for healthcare fraud. Miami criminal lawyers have kept busy over the past few years representing clients arrested for Medicare fraud. The highest profile defendant arrested in the most recent sweep was Roberto Marrero, a Cuban born actor and businessman, who is accused of stealing millions of dollars from the federal healthcare program. Both Marrero and his wife were arrested for submitting $20 million in bills to Medicare. The bills were submitted to the program for home health care for diabetic patients. The indictment alleges that the treatments were either not necessary or never provided.
Source: miamicriminaldefenselawyerblog.com

Morning Notes: Trent Franks on pregnancy and rape, Baptists condemn Scouts, Medicaid debates

Posted by:  :  Category: Medicare

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Damien Echols, freed from Death Row in today’s West Memphis Three plea bargain, released the following statement today: To all my friends and family, my attorneys and advocates, and to those of you from every corner of this earth who have stood beside us these long years, please know that I will forever be indebted to all of you for helping me to become a free man. Each and every day I was the beneficiary of acts of kindness and humanity from people of all walks of life, of all ages, nationalities, religions and political persuasions.
Source: arktimes.com

Video: Arkansas Medicare Supplements

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

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

Brad DeLong : The Arkansas Medicaid Budget

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

The Arkansas Medicaid Model: What You Need To Know About The ‘Private Option’

A: No. The Department of Health and Human Services has said it will consider “a limited number” of Arkansas-style plans in which Medicaid beneficiaries would use federal dollars to buy private policies.  Arkansas must give HHS a detailed proposal.  A federal green light is no sure thing, given the plan’s departure from traditional practice and a requirement that it be cost effective. “We haven’t approved anything,” Marilyn Tavenner, acting administrator of HHS’s Centers for Medicare and Medicaid Services, said at a confirmation hearing in April.
Source: kaiserhealthnews.org

Arkansas Moving Forward With Plan to Accept Medicaid Expansion

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

Medicaid v. Private Insurance in Arkansas

[…] The logic behind the proposed changes rests in the different needs of the “three programs” represented within Medicaid. Those covered by acute care Medicaid (45-50 million persons) most of them pregnant women and children, are relatively inexpensive to care for on a per capita basis. Increasingly, such beneficiaries have trouble finding providers who will care for them, due to a double whammy of stigma (it is insurance for persons who are poor) and the fact that it pays providers below what Medicare pays, which is less than what private insurers pay. This has lead to a systematic access problem for some Medicaid beneficiaries who have trouble finding a physician willing to treat them. There is nothing inherently wrong with the structure of Medicaid; we could decide to make it the best payer of care tomorrow, but that of course, is not going to happen. Buying them into private insurance policies will mainstream their care and remove a layer of cost shifting. [emphasis added]Source: samefacts.com […]
Source: samefacts.com

Dan Rahn: Expanding Medicaid Critical for UAMS

Rahn, UAMS chancellor, on Tuesday told the Arkansas House Committee on Public Health, Welfare & Labor that the projected cost of treating uninsured patients at UAMS’ hospital would rise to $66 million in 2014 if Medicaid isn’t expanded. With expansion to cover Arkansans earning up to 138 percent of the poverty level, that cost could be reduced to $38 million — below the $42.5 million cost reported for 2010 in a study by the Arkansas Hospital Association.
Source: arkansasbusiness.com

Top 3 Excuses for passing the Largest Expansion of Government in Arkansas History

This is one of the simplest untruths to debunk. Medicaid is defined as a government subsidized health insurance program for families and individuals with low income and resources to pay for health care and is state-administered and financed by both the states and the federal government. The “private option” is a government subsidized health insurance program for families and individuals with low income and resources to pay for healthcare and is state administered and financed by both the state and the federal government. Medicaid expansion per the PPACA would add conservatively 250k more individuals to the government subsidized healthcare system not currently covered by Medicaid. The so called “private option” will add 250k to the government subsidized healthcare system not currently covered by Medicaid. The minutia in administration may be different but the program is still the same. Arkansas now has expanded its government subsidized health insurance program for families and individuals with low income and resources to pay for health care and is state-administered and financed by both the states and the federal government. See the difference? Not me and not any reasonable person applying a little truth to the debate. Let’s call it like it is and then the real debate can happen. Until then let the truth be known.
Source: libertypatriot.net

Arkansas college bans guns to make people feel safe

The board of trustees at Arkansas Northeastern College (ANC) voted Wednesday to prohibit concealed weapons on campus for everyone except licensed law enforcement officers. The decision is in line with a recent Arkansas law that allows schools throughout the state to set their own policies with respect to guns. Most state universities, including the University of Arkansas and Arkansas State University, have declared themselves gun-free zones.
Source: dailycaller.com

Support for Medicaid expansion from House Democrats, public

In more “awkward timing” news, the Arkansas Hospital Association released the results of a poll on Medicaid expansion yesterday, one day after the dramatic game-changer in the expansion debate. That said, though the mechanics are different, we’re still talking about accepting federal money to give coverage to uninsured, low-income people. And the poll found that 65 percent of Arkansans are in favor. I’ve called around and confirmed the obvious: the AHA — as well as various hospital administrators I spoke with — remain strongly in support of expansion. Indeed, the new “private option” will likely be an even better deal for hospitals because of higher reimbursements from private insurers. A better question is whether public support will remain as strong once folks find out that the new approach likely costs more.
Source: arktimes.com

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June 22, 2013

Texas man sentenced for Medicare scam

Posted by:  :  Category: Medicare

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Prosecutors say Kimble operated four ambulance companies in the Houston area from 2008 to 2010. He routinely billed the federal Medicare program for ambulance transports that were not provided, not needed or not ordered by a treating physician.
Source: ems1.com

Video: Medicare Supplement Plans, Medicare Advantage, Medigap Insurance, Texas Medicare Plans,Houston Texas

Ways to prevent Medicare fraud in Texas before it occurs

Strong evidence indicates that isolated pockets of home health providers are abusing the Medicare program. Analyses show, as detailed in your article, Texas is home to high levels of aberrant behaviors. In fact, just 18 of Texas’ 254 counties are responsible for more suspected home health fraud and abuse than any single state nationwide.
Source: dallasnews.com

Access To Primary Care Is A Challenge For Some Texas Medicare Patients

RAY SUAREZ: The independent Medicare Payment Advisory Commission also looked at the problem last June. Of the six percent of seniors they surveyed looking for a new primary care physician, one in four had a small or big problem getting an appointment. And Medicare itself says fewer than 10,000 doctors have officially opted out of the program in the past two years.
Source: kaiserhealthnews.org

What happens when a Texas doctor doesn’t take Medicare? : The Katy News

Finally, if you have a Medicare Advantage plan, also known as a Medicare private health plan, you should see doctors within your plan’s network. You typically pay the least if you go to a doctor who’s in the plan network. Check with your plan to see what rules apply.
Source: thekatynews.com

Medicare Data Show Huge Disparity in Charges by North Texas Hospitals for Inpatient Procedures

“The complex and bewildering interplay among charges, rates, bills and payments, across dozens of payers, public and private, does not serve any stakeholder well, including hospitals,” said Rich Umbdenstock, president of the American Hospital Association, in a statement. “This is especially true when what is most important to a patient is knowing what his or her financial responsibility will be.
Source: dmagazine.com

Texas governor reiterates opposition to Medicaid expansion

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

The Politics of Medicaid Expansion

Every time a situation like this arises, I think it is appropriate to ask of the opponents and the naysayers—I am referring mainly to Michael Quinn Sullivan and Empower Texans, but also of the anti-government faction generally—”What is your solution?” (Sullivan’s group has been hypercritical of Straus but has remained mute about senators who support expansion.) Is it better to turn down federal funds and to dump the cost of health care for the uninsured on hospital emergency rooms and ultimately on local-property taxpayers? Make no mistake about it: The health care costs of the uninsured in Texas are a hidden tax on property. Property taxpayers have to make up the difference in the health care costs of the uninsured, or see local taxes go up. I grant you that there is a cost to accepting federal funds. The cost is in the loss of control over health care policy in this state. But, let’s face it, health care policy in this state stinks. We have great hospitals, great research, and lousy government. I’d rather put the money  in the hands of the people who deliver the services than in the hands of the politicians. I suspect this is what Straus thinks too. Forget the ideology. Show me the money.
Source: texasmonthly.com

Dallas News: Home Health to Blame for County’s Medicare Spending

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

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June 22, 2013

Sightings Over Sixty: I Apply for Medicare, Part I

Posted by:  :  Category: Medicare

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     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

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

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

Medigap insurance provider in San Diego

Medicare Advantage plans are comprehensive when it comes to coverage, and you can get all of your healthcare needs covered under one source. Some Medicare Advantage plans are cheaper than a combined Medicare and Medigap policy combined – it all really depends on your personal health needs. Medicare Advantage plans may require you to see certain specialists and doctors within a specific network of providers. Although Medicare Advantage plans can certainly be cheaper than other options, you may still need to pay a co-payment depending on the doctor visit and treatments sought.
Source: pomeradonews.com

The sooner you apply for Medicare, the better

Can I still file for Medicare at age 65? This is a question we get at Social Security all the time. If you’re in your 60s, you probably know that the age to receive full retirement benefits has changed. However, it’s important to remember that the age to begin receiving Medicare has not — it is still 65. Even if you have decided to wait until after you are age 65 to apply for retirement benefits, most people should start getting Medicare coverage at age 65. This is especially true, if you don’t have insurance from your current employment situation. If you would like to begin your Medicare coverage when you first become eligible, we suggest that you apply within three months of reaching age 65. You can do it online in as little as 10 minutes at www.socialsecurity.gov/medicareonly. Why go online to apply for Medicare? Because it’s fast, easy, and secure. You don’t need an appointment and you can avoid waiting in traffic or in line. As long as you have ten minutes to spare, you have time to complete and submit your online Medicare application. People who started receiving Social Security retirement or disability benefits before age 65 do not need to apply; they will be automatically enrolled in Medicare. There is no additional charge for Medicare hospital insurance (Part A) since you already paid for it by working and paying Medicare tax. However, there is a monthly premium for medical insurance (Part B), for most $104.90 in 2013. If you already have other health insurance when you become eligible for Medicare, you should consider whether you want to apply for Medicare Parts A, B, and D. To learn more about Medicare and some options for choosing coverage, read the online publication, Medicare, at www.socialsecurity.gov/pubs/10043.html or visit www.Medicare.gov.
Source: seniorscene.org

When should I apply for Medicare?

If you’re not receiving Social Security benefits, however, consider signing up soon. As does the Social Security Administration, Long recommends that you apply three months before your 65th birthday to ensure your coverage begins the month you turn 65.
Source: cnn.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

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

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

CMS Promotes Value for Seniors and Persons with Disabilities in Medicare Plans

With today’s regulation limiting overhead and profits for Medicare Advantage and prescription drug plans, the Affordable Care Act continues to promote value for consumers’ and taxpayers’ health care spending. These new requirements apply to Medicare health and drug plans offered by private insurance companies serving over 37 million seniors and persons with disabilities, and build on a similar regulation we issued last year requiring a minimum medical loss ratio for health plans serving consumers in the private insurance market. Medicare health and drug plans, beginning next year, must meet a minimum medical loss ratio, limiting their spending on non-health related items such as administrative costs, profit, or overhead. More specifically, this means that the plans must spend at least 85 percent of their revenue on direct benefits to Medicare enrollees such as clinical services, prescription drugs and quality improving activities.
Source: medicare.gov

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June 22, 2013

Funding Details: The Medicare Improvements for Patients and Providers Act: Medicare Low Income Subsidy, Medicare Savings Program and Medicare Prescription Drug Enrollment Assistance

Posted by:  :  Category: Medicare

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The Medicare Improvements for Patients and Providers Act: Medicare Low Income Subsidy, Medicare Savings Program and Medicare Prescription Drug Enrollment Assistance grants provide funding to State Health Insurance Assistance Programs, Area Agencies on Aging, and Aging and Disability Resource Center programs for outreach to eligible Medicare beneficiaries regarding changes to benefits and coverage under the Affordable Care Act.
Source: raconline.org

Video: How to Apply For Medicaid in Florida Online

Medicare Providers and Suppliers Must Begin Enrollment Revalidations

All providers and suppliers who enrolled in Medicare prior to March 25, 2011 will be required to revalidate their enrollment under the new risk screening criteria required by section 6401a of the Affordable Care Act (ACA).  Those who have revalidated or enrolled since then have already been subjected to the screening.  The MAC will send notice to individual providers and suppliers, between today and March 2013, to being the revalidation process.  Providers and suppliers are required to initiate the revalidation process as soon as they receive notice from their MAC, and must complete the process within 60 days of that notice. 
Source: hallrender.com

Medicare Part D is prescription drug coverage insurance that is provided by private companies approved by Medicare.

Example: Mrs. Smith didn’t join when she was first eligible-by June 15, 2009. She doesn’t have prescription drug coverage from any other source. She joined a Medicare drug plan with an effective date of January 1, 2012. Her drug coverage was effective January 1, 2010. Since Mrs. Smith was without creditable prescription drug coverage from July 2009-December 2011, her penalty in 2011 was 30% (1% for each of the 32 months) of $31.08 (the national base beneficiary premium for 2012), which is $9.32. The monthly penalty is rounded to the nearest $.10. She pays this late enrollment penalty of $9.30 monthly in addition to her plan’s monthly premium. Here’s the math: .30 (30% penalty) x $31.08 (2012 base beneficiary premium) = $9.32 $9.32 (rounded to the nearest $0.10) = $9.30 $9.30 = Mrs. Smith’s monthly late enrollment penalty
Source: medicare.gov

What is the Initial Enrollment Period for Medicare?

On the other hand, if you are 65 and not yet receiving benefits from SSA or RRB (because you’re still working), you will not be enrolled in Part A or Part B automatically even if you are eligible. You will need to sign up for Original Medicare during your Initial Enrollment Period or face a late enrollment penalty. You can submit an application online to the SSA, fill out a paper application at your local Social Security office, or call Social Security at 1-800-772-1213. If you worked for a railroad, you should contact the RRB. If you wait until your birthday or sign up during the last three months of your Initial Enrollment Period, your Medicare Part B start day will be delayed.
Source: ehealthmedicare.com

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

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

CMS Announces July 31 Deadline for Medicare Shared Savings Program Applications : Bridging Business & Healthcare

However, CMS has announced a July 31 deadline.  An accountable care organization intending to submit an application must file a Notice of Intent by May 31 and obtain a CMS User ID by June 10.  Failure to meet these deadlines will disqualify an organization from MSSP participation in 2014.  CMS has not yet published the Notice of Intent form or the application packet.    CMS will be hosting a national provider call regarding the 2014 MSSP application process on April 9.  A second call is scheduled for April 23.
Source: pyapc.com

National Provider Calls: Medicare Shared Savings Program Application Process

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

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

How to apply for the Medicare ACO program

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

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June 22, 2013

Medicare Part D is prescription drug coverage insurance that is provided by private companies approved by Medicare.

Posted by:  :  Category: Medicare

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Example: Mrs. Smith didn’t join when she was first eligible-by June 15, 2009. She doesn’t have prescription drug coverage from any other source. She joined a Medicare drug plan with an effective date of January 1, 2012. Her drug coverage was effective January 1, 2010. Since Mrs. Smith was without creditable prescription drug coverage from July 2009-December 2011, her penalty in 2011 was 30% (1% for each of the 32 months) of $31.08 (the national base beneficiary premium for 2012), which is $9.32. The monthly penalty is rounded to the nearest $.10. She pays this late enrollment penalty of $9.30 monthly in addition to her plan’s monthly premium. Here’s the math: .30 (30% penalty) x $31.08 (2012 base beneficiary premium) = $9.32 $9.32 (rounded to the nearest $0.10) = $9.30 $9.30 = Mrs. Smith’s monthly late enrollment penalty
Source: medicare.gov

Video: Determination of Medicare Coverage of Test and Treatments – Day 1 (CFSAC Spring 2013)

Medigap insurance provider in San Diego

Medicare Advantage plans are comprehensive when it comes to coverage, and you can get all of your healthcare needs covered under one source. Some Medicare Advantage plans are cheaper than a combined Medicare and Medigap policy combined – it all really depends on your personal health needs. Medicare Advantage plans may require you to see certain specialists and doctors within a specific network of providers. Although Medicare Advantage plans can certainly be cheaper than other options, you may still need to pay a co-payment depending on the doctor visit and treatments sought.
Source: pomeradonews.com

VIRGINIA MEDICARE COVERAGE OPTIONS

Medicare Advantage Plans availability is based on County. To receive an e-mail of all of the available Medicare Advantage Plans in your County, call Senior Healthcare Direct 1-855-368-4717, and one of our Virginia Licensed Medicare Agents will be happy to assist you.
Source: srhealthcaredirect.com

Supplemental Medicare coverage leads to spending growth

Golberstein and his collaborators from Harvard Medical School used data from the Medicare Current Beneficiary Survey from 1992 to 2005, before Medicare Part D prescription drug benefits were introduced, and analyzed a sample of 104,365 observations. The researchers found significantly higher rates of spending growth in all supplemental insurance categories compared to the category without supplemental insurance, even while controlling for sociodemographic status, disease, disability, and health behavior characteristics.
Source: umn.edu

Medicare Access in Tallahassee: Milestone or Millstone?

Capital Medical Society is the Tallahassee-based, local professional membership organization for physicians, representing more than 600 licensed physician members who live and work in Leon, Gadsden, Jefferson, and Wakulla Counties. A non-profit corporation, CMS is governed by an annually elected Board of Governors and offers a variety of services to both its members and to the public. In 1975, the physician members created a charitable foundation whose mission is to support the charitable efforts of physicians and others, increase access to healthcare, promote education and serve the community’s health needs through innovative projects that are exemplary, affordable and dignified. The CMS Foundation operates the We Care Network, with over 300 volunteer physicians, volunteer dentists, the hospitals and most of the allied health professionals in Tallahassee who donate medical and dental care to low-income uninsured patients from Leon, Jefferson, Gadsden, and Wakulla counties. These volunteers have donated more than $50 million in charity care since the program was founded in 1992.
Source: tallahassee.com

Medicare’s Reset On ‘Coverage With Evidence Development’

a. Centers for Medicare and Medicaid Services (CMS) issued formal guidances on CED in 2005 and 2006. Several cases that we call CED predate these formal guidances. b. CMS, “Positron Emission Tomography (FDG) and Other Neuroimaging Devices for Suspected Dementia” (accessed on Feb. 28, 2013). c. Cancer types include brain, cervical, ovarian, pancreatic, small cell lung, and testicular. d. CMS, “Positron Emission Tomography (FDG) for Brain, Cervical, Ovarian, Pancreatic, Small Cell Lung, and Testicular Cancers” (accessed on Feb. 28, 2013). e. American College of Cardiology National Cardiovascular Data Registry (ACC NCDR) (accessed on Feb. 28, 2013), approved in 2005, is ongoing with collection of longitudinal data. f. CMS, “Chemotherapy for colorectal cancer” (accessed on Feb. 28, 2013). Nine NCI trials are investigating one or more off-label use of oxaliplatin, irinotecan, cetuximab, or bevacizumab. 2 trials remain closed; 6 trials are permanently closed to new accruals and 1 trial has been temporarily suspended. g. CMS, “Home use of oxygen“ (accessed on Feb. 28, 2013). Long Term Oxygen Trial (LOTT) began in late 2007. h. CMS, “Artificial Hearts” (accessed on Feb. 28, 2013), 3 Trials are ongoing. i. CMS, “Positron Emission Tomography (FDG) for Solid Tumors”  (accessed on Feb, 28, 2013), National Oncologic PET Registry (NOPR) is ongoing. j. CMS, “Pharmacogenomic Testing for Warfarin” (accessed on Feb. 28, 2013), 2 Trials are ongoing. k. CMS, “Positron Emission Tomography (NaF-18) to Identify Bone Metastasis of Cancer” (accessed on Feb. 28, 2013), National Oncologic PET Registry (NOPR) is ongoing for performing FDG and NaF-18 PET. l. CMS, “Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) for Myelodysplastic Syndrome” (accessed on Feb. 28, 2013), 1 Trial is ongoing. m. CMS, “Magnetic Resonance Imaging (MRI)” (accessed on Feb. 28, 2013); CMS site mentioned ClinicalTrials.gov identifier of NCT 090736, but it was not found on ClinicalTrial.gov website. n. CMS, “Transcatheter Aortic Valve Replacement (TAVR)” (accessed on Feb. 28, 2013), 6 Trials and 1 Registry are ongoing.
Source: healthaffairs.org

Medicare Hearing Coverage: Hearing Aids, Auditory Implants and Medicare Coverage Policy

Section 1862(a)(7) of the Social Security Act states that no payment may be made under part A or part B for any expenses incurred for items or services “where such expenses are for . . . hearing aids or examinations therefore. . . .” This policy is further reiterated at 42 CFR 411.15(d) which specifically states that “hearing aids or examination for the purpose of prescribing, fitting, or changing hearing aids” are excluded from coverage.
Source: medicarebenefits.us

Get ready for your summer trip

You have Medicare, so your health care services and supplies are covered when you’re in the U.S., which includes Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. But, if you plan to travel overseas or outside the U.S. (including to Canada or Mexico), it’s important to know if your Medicare coverage will be different.
Source: medicare.gov

Medicare Coverage and the Affordable Care Act – What the Health Care Marketplaces (Exchanges) Mean for YOU 

Assuming you have sufficient work history, you will automatically get Part A for free if you are receiving Social Security benefits when you turn 65.  You should also get Part B when you are eligible. You will want to enroll in a Medicare Savings Program (discussed on page 2) to pay for your Part B premium. Since you already have Medicaid, you should automatically go through a Medicaid redetermination upon becoming Medicare eligible, and you should be screened for the Medicare Savings Program (MSP) during this redetermination.[15] During the redetermination process the state Medicaid agency will ask you for information on your income and assets.[16] In most states, even if you no longer qualify for Medicaid after getting Medicare, you will likely qualify for an MSP.  Once you have an MSP, you will be “bought-in” to Part B, that is, you will be automatically enrolled without having to Pay a premium. Ideally, the process of redetermination and Part B enrollment should be automatically triggered and happen seamlessly. However, it is good idea to apply for an MSP with either the marketplace or the Medicaid office MSP one month before you are eligible for Medicare just be certain you are enrolled in an MSP and Part B as soon as you are eligible.
Source: medicareadvocacy.org

Health Insurance Coverage for Older Adults: Implications of a Medicare Buy

This Kaiser Family Foundation policy brief provides an updated profile of the more than 4 million uninsured people between ages 55 and 64 and examines historical proposals to allow uninsured older adults to purchase Medicare coverage. It also examines barriers to securing affordable coverage in the current marketplace, and the effect of premiums and eligibility criteria on the potential uptake of a Medicare buy-in.
Source: kff.org

Marci’s Medicare Answers

Dear Richard, Yes, you can have both Medicare and VA (Veterans Affairs) coverage. If you have been honorably discharged or released from the military, naval or air service, you may be able to get health coverage through the Department of Veterans Affairs (VA). You can also have Medicare, if you are eligible for Medicare due to age, disability, End-Stage Renal Disease (ESRD) or Lou-Gehrig’s disease (ALS). However, keep in mind that Medicare and VA benefits do not work together. Medicare does not pay for care that you receive at a VA facility. In order for Medicare to cover your care, you must receive care at a Medicare-certified facility that works with your Medicare coverage. Additionally, in order for your VA coverage to cover your care, you must usually receive health care services at a VA facility. Bear in mind that you may want to consider enrolling in Medicare Part B (Medicare medical insurance), even if you have VA coverage. Having Medicare Part B may guarantee you medical coverage outside the VA health system. Additionally, if you delay enrolling into Medicare Part B when you are first eligible to do so, you may incur a premium penalty and experience gaps in coverage. Some veterans use their VA drug coverage to get their medications, since VA drug coverage may offer more generous prescription drug coverage than Medicare Part D, the Medicare prescription drug benefit. Since VA drug coverage is also considered creditable (as good or better than the Medicare prescription drug benefit), those who use VA drug coverage can get their medications from a VA facility and delay enrolling into Medicare Part D without penalty. If you have questions about VA benefits and coverage, contact the VA Health Administration Center at 1-800-733-8387 or 1-877-222-VETS (877-222-8387).
Source: homeboundresources.com

Medicare coverage of ‘maintenance therapy’ determined by need for skilled care, CMS clarifies in Jimmo document

CMS never established an “improvement standard” that said Medicare payments would be withheld for treatment given strictly to maintain, rather than improve, a resident’s condition, the agency stated in the fact sheet. Therefore, the settlement in Jimmo — a case alleging improper withholding of Medicare payments for this type of maintenance —  did not eliminate the improvement standard or otherwise expand Medicare coverage. Instead, CMS agreed to take certain actions to ensure that claims are correctly evaluated “in accordance with existing Medicare policy.”
Source: mcknights.com

Medicare to Cover Addadictomy, Chopadickoffamy

RUSH:  The Medicare under Obamacare is now gonna start doing sex-change operations, is the point.  I didn’t finish that story.  “For the first time since 1981, when it dubbed sex-change operations ‘experimental,’ Medicare has opened the door to covering transexual operations, adding to the growing list of operations that would be allowed under Obamacare.  Acting on a new request, the Centers for Medicare & Medicaid Services said it is starting a new analysis that could lift the spending ban for sex-change operations with a goal of making a decision two days after Christmas and on the eve of Obamacare kicking in Jan. 1.”
Source: rushlimbaugh.com

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June 22, 2013

Medicare Part D is prescription drug coverage insurance that is provided by private companies approved by Medicare.

Posted by:  :  Category: Medicare

Flickr

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Example: Mrs. Smith didn’t join when she was first eligible-by June 15, 2009. She doesn’t have prescription drug coverage from any other source. She joined a Medicare drug plan with an effective date of January 1, 2012. Her drug coverage was effective January 1, 2010. Since Mrs. Smith was without creditable prescription drug coverage from July 2009-December 2011, her penalty in 2011 was 30% (1% for each of the 32 months) of $31.08 (the national base beneficiary premium for 2012), which is $9.32. The monthly penalty is rounded to the nearest $.10. She pays this late enrollment penalty of $9.30 monthly in addition to her plan’s monthly premium. Here’s the math: .30 (30% penalty) x $31.08 (2012 base beneficiary premium) = $9.32 $9.32 (rounded to the nearest $0.10) = $9.30 $9.30 = Mrs. Smith’s monthly late enrollment penalty
Source: medicare.gov

Video: Medicare Part D

Can Medicare Save Money? How The Part D Program Can Be More Cost

Many seniors may not be aware that the infamous “doughnut hole,” or gap in coverage, is closing thanks to the Affordable Care Act. Before the health care law was passed, if beneficiaries reached the initial limit on total drug expenses ($2,970 in 2013), they had no prescription drug coverage until they spent an added $3,700 out of their own pockets. But in 2013, people in the doughnut hole are receiving discounts of 52.5 percent on name-brand drugs and 21 percent on generics. These discounts will result in significant savings for about 4 million Medicare beneficiaries in 2013. More importantly, the discounts will continue every year until 2020, when the doughnut hole will be completely eliminated.
Source: smmirror.com

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

Kaine signs on to Medicare medication bill

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Source: fredericksburg.com

How Do You Get Medicare Part D?

As the nation’s largest drugstore chain with fiscal 2012 sales of $72 billion, Walgreens (www.walgreens.com) vision is to become America’s first choice for health and daily living. Each day, Walgreens provides more than 6 million customers the most convenient, multichannel access to consumer goods and services and trusted, cost-effective pharmacy, health and wellness services and advice in communities across America. Walgreens scope of pharmacy services includes retail, specialty, infusion, medical facility and mail service, along with respiratory services. These services improve health outcomes and lower costs for payers including employers, managed care organizations, health systems, pharmacy benefit managers and the public sector. The company operates 8,077 drugstores in all 50 states, the District of Columbia and Puerto Rico. Take Care Health Systems is a Walgreens subsidiary that is the largest and most comprehensive manager of worksite health and wellness centers and in-store convenient care clinics, with more than 700 locations throughout the country.
Source: womanaroundtown.com

As Hill Panels Focus On Medicare, Marketplace Examines How Part D Changed The Pharmaceutical Industry

MedPage Today: Focus On Medicare Cost Drivers, Congress Told A congressional hearing on increasing patient cost sharing as a mechanism for Medicare reform turned into a call for broad changes to provider incentives in the program. Health policy experts told lawmakers Tuesday that payments need to move away from a volume-based fee-for-service if policymakers want to generate savings in Medicare. The House Ways and Means Health Subcommittee called the hearing to examine bipartisan proposals for Medicare reform. Specifically, they wanted to discuss increasing the Part B deductible, increasing Part B and D premiums for wealthier seniors, and establishing a copay for home health services, subcommittee chair Kevin Brady (R-Texas) said. But experts called before the subcommittee called the proposals short-sighted and said they wouldn’t do much other than cause beneficiaries to pay more (Pittman, 5/21).
Source: kaiserhealthnews.org

Could Your Medicare Part D Costs Be Reduced? (infographic)

Thank you to Walgreens, who has provided editorial sponsorship for the writing of this article.  Walgreens  is in the network of hundreds of Medicare prescription drug plans and participates in the preferred networks of four national Part D sponsors. They offer savings of up to 75 percent on prescription co-pays over select pharmacies for a number of plans in which they are a preferred pharmacy so that is why we felt it was important to bring you this information.
Source: intentionalcaregiver.com

Special Delivery: Comparing Rural and Urban Medicare Part D Enrollment Patterns

Prior to 2006, approximately 59% of rural beneficiaries and 75% of urban beneficiaries had some type of drug coverage. Rural beneficiaries were more likely to have self-purchased Medigap drug coverage while urban beneficiaries were more likely to have obtained drug coverage through their employers. With the implementation of the Part D program, Medigap prescription drug policies are being phased out and employers are receiving subsidies encouraging them to retain employee drug coverage through the Retiree Drug Subsidy program. The potential benefits of Part D enrollment include improved access to drugs, reduced out-of-pocket drug expenditures, and better health outcomes. The degree to which rural beneficiaries benefit depends on a number of factors, including their health needs, their medication needs, and what type of drug coverage they had prior to Part D enrollment, if any…
Source: blogspot.com

Sr Contract Monitoring Analyst

Five to seven years experience in quantitative business analyses and statistical modeling (preferably healthcare related).Proven analytical experience using Enterprise Guide SAS, database query capabilities and ability to evaluate data at various levels of detail (preferably Enterprise Guide SAS) *Subject Matter Expert on Medicare Part D and CMS requirements and Pharmacy Benefit Manager (PBM) technical and operational experience is preferred
Source: kdnuggets.com

Analysis Finds Lax CMS Oversight of Prescribers in Medicare Part D

Further, the data showed that 50% of the top 20 prescribers of OxyContin in 2010 have been either criminally charged, convicted or settled fraud claims, or have been disciplined by their state medical boards. Among those, eight have been charged, convicted or barred from prescribing controlled substances, or been disciplined by licensing boards. However, all but one of those doctors still are able to prescribe drugs for Medicare.
Source: californiahealthline.org

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