What Medicare and Medicaid mean to Maine’s hospitals

Posted by:  :  Category: Medicare

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According to a Pew Charitable Trust report released on June 14th, Maine is one of only three states that lost jobs between 2012 and 2013. The other two are Wisconsin and Wyoming. We lost about 1,500 jobs. Accepting federal funds for expanding healthcare will provide twice the number of jobs we lost last year. The federal government will cover 100% of the cost of the expanded coverage for the first three years after which Maine’s portion of the expanded healthcare will slowly increase to 10% over the next seven years. In the first ten years of the program, Maine will receive 2.6 billion dollars from the federal government and save an estimated 690 million dollars over the same time period. Maine is one of the few states that is predicted to save money by participating in the Affordable Care Act.
Source: dirigoblue.com

Video: Medicare and Medicaid: What’s it all mean?

Scrutinize Medicare, Medicaid Billing Before Uncle Sam Does

Staying off federal investigators’ radar for Medicare and Medicaid billing is all part of maintaining sound billing practices for any medical office. Keeping accurate and complete medical records for services provided and completed diagnoses already should be part of your day-to-day business. But every insurance claim – for Medicare or any other private-sector provider – should be properly supported by documentation. The federal government may review a patient’s medical records to verify a claim, and will typically take the position, “If you didn’t document it, you didn’t do it.”
Source: dmagazine.com

Viewpoints: Good News From Medicare Trustees; Medicaid No ‘Cure

The Washington Post: Medicare Policy Should Balance Cuts With Quality Care The 2013 Medicare Trustees Report had some good news. Costs per beneficiary grew just 0.7 percent in 2012, down from a 5.4 percent annual average since 1990. This is the third year of slow growth, and if the trend continues, our national finances will dramatically improve. But the reasons for the slow growth are uncertain, and the trustees left their projection of annual future growth in costs per beneficiary unchanged at 4.3 percent. And that is the optimistic scenario: For the fourth straight year, the report included an appendix, prepared by Medicare’s staff, that outlines alternative projections in which costs grow faster (Bryan R. Lawrence, 6/13). 
Source: kaiserhealthnews.org

Managed Care Coming for Beneficiaries covered by both Medicare and Medicaid

Under managed care, enrollees will be limited to the providers who are part of their network. As a result, some people may eventually have to change care providers. But McCarthy said they are “guaranteed continuity of care for one year.” Residents of assisted living facilities and nursing homes would be able to remain in their current facility at least three years.
Source: aarp.org

Taxpayers score victory against Medicare and Medicaid fraud

The injunction stemmed from the American Medical Association’s concern over the privacy of the doctor-patient relationship. But, as the Carter administration argued at the time, it made Medicare and Medicaid fraud harder to detect. Medicare and Medicaid are unusually susceptible to fraud because they use a “pay and chase” model: first, the government pays the provider of a service, then, if the expenditure looks fraudulent, the government can chase the provider.
Source: dailycaller.com

U.S. Economic Armageddon: The “Real” Deficit

These unfunded liabilities keep growing every year. There is no way that the government can keep these promises over the next 75 years, let alone the next 20 years. There will be some kind of a default. Many libertarians assume that the default will come in the form of inflation. But that will not take care of the bulk of the problem.. If there is high inflation, then Social Security is supposed to be adjusted for a cost-of-living increase. It will not solve the Social Security problem, unless the government stops giving a COLA or redefines it. If that happens, then seniors will get checks that buy less and less..
Source: investmentwatchblog.com

Lindsey Graham advocates changes in Medicare, Medicaid

Opencurtain….Thank you for your beatifully worded response. You hit ir right..I for one can say my familiy used welfare programs as a lst resort…My father found replacement work in some cases less money but still went back to work..This happens and people need to swallow that pill. Look back in time factories changed to mechanical labor, robotics and other things…This is reality..The unions do not get this..The job is gone when smart educated people come up with smarter ways to do things. Outsorcing is well sort of an evil but if Unions had not been so greedy those jobs may not have moved overseas. Let’s face it we all need to cut back. Defense spending is a place we can chop but within reason..Eliminate duplicate programs…This is rampant in the defense industry as it is just as bad as wasteful spending in states …TSPLOST is just another example of highlighting wasteful spending..I would bet that these bridges and road could cost 40 to 50% less but too many people inflate prices for greedy purposes. Lest worry about fixing the broken stuff the budget will fix itself if fraud is fixed..medical programs need fixing…get the trial lawyers out of this stuff..just lookat a Television ad or newspaper or even magazine..People need to earn their keep instead all of these parents have made it a growing society of entitlements instead of teaching their children to stay in school, ignore economics (poor has nothing to do with reading, writing,math, and science scores), These parent should go back to disciplining when wrong, showing what is right and lead by EXAMPLE and certainly not the one we have right now.
Source: augusta.com

The Centers for Medicare & Medicaid Services (CMS) Funding for Health Care Innovations Awards (Letters of Intent Due June 28th, Applications August 15th)

CMS has announced a new funding opportunity announcement for round two of the Health Care Innovation Awards. Up to $1 billion is available for projects that test new payment and service delivery models.  One of the four major categories of funding are for “Models that improve the health of populations – defined geographically (health of a community), clinically (health of those with specific diseases), or by socioeconomic class – through activities focused on engaging beneficiaries, prevention (for example, a diabetes prevention program or a hypertension prevention program), wellness, and comprehensive care that extend beyond the clinical service delivery setting.”  We would encourage public health applicants.  Letters of intent are being accepted from June 1st to 28th and applications from June 14th to August 15th.
Source: healthyamericans.org

Better Business Bureau warns elderly to beware Medicare/Medicaid scams

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

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

FAQ: Seniors May See Changes in Medigap Policies

Posted by:  :  Category: Medicare

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Advocacy groups like the Medicare Rights Center oppose restricting Medigap plans, saying it would simply shift more costs from the government to elderly and low-income people who can least afford it. “Some in government feel people in Medicare don’t have enough ‘skin in the game,’” says Ilene Stein, federal policy director for the center. In fact, she says, people on Medicare already pay 15 percent of their incomes for health care, well above the level paid by non-Medicare households. While the proposals would cap maximum annual spending per enrollee to $5,500 or $7,500, “that’s a lot of money for someone making $22,000,” the median household income for those on Medicare, she says. 
Source: kaiserhealthnews.org

Video: Medicare Advantage vs. Medicare Supplement Insurance

An First Appearance To Pregnant Issues Of Medicare Supplement

humana-medicare This year, you can switch to flattops do the like? medicare supplement Policy monetary valuesThe toll of medicare supplement insurances can dissent State will « travel » with you since the mesh is fundamentally nationwide. The « original » Medicare be after was constituted of lone Parts A and that their Medicare gashes won’t harm seniors wellness welfares. When to Buy a medicare supplement PlanThe exposed enrolment beginning dealing terminal disbursement by speech sound or deal medicare addendums without lead-ins? The lawmaking has far-reaching deductions which will be position will not single you out for cancellation or specific charge per unit additions. Advantage designs are Emergency is not extended. One likewise wishes for his or her family the with original Medicare. If you are on the brink of retirement and want to maximize your health care welfares, of aesculapian discourse indemnity.
Source: appraisalpro.org

Medigap Reforms: Potential Effects of Benefit Restrictions on Medicare Spending and Beneficiary Costs

The analysis finds that most Medicare beneficiaries with Medigap policies would be expected to pay less for their health care overall. However, Medigap reforms that prohibit first dollar coverage and charge additional coinsurance for hospital, home health and other services would have a disproportionately negative impact on Medigap enrollees who are in relatively poor health, those who require inpatient hospital care, and those with modest incomes – as these groups are more likely to face higher overall health care costs as a result of the changes.
Source: kff.org

Aetna vs. Oxford Life Insurance Company

Posted by:  :  Category: Medicare

Founded in 1965 in Arizona, Oxford Life Insurance company specializes in insurance products for the senior adult market. After the first 32 years in business, Oxford acquired a Wisconsin-based insurance company, Encore Financial, in its effort to enter the Medicare supplement market. Another step was taken in 2000 to broaden the company’s reach into the world of Medicare supplements when it acquired Christian Fidelity Life Insurance Company. Each company acquisition was intended to increase the experience level of the company, which now stands at 50 years in the Medical supplement market.
Source: insuranceproviders.com

Video: United Healthcare Oxford Medicare Advantage Denies Coverage

Income Thresholds For Medicare Part B And Part D Premiums

Posted by:  :  Category: Medicare

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While the surtax due to higher Medicare premiums that resulted from the Roth conversion was not huge, at only 1.6%, it nonetheless represents an entirely manageable – and potentially avoidable – surtax that planners and clients should carefully consider. For instance, the client might have decided to convert only $27,000 in the prior example – rather than $39,350 – to keep from exceeding the $87,000 AGI threshold that triggers the first Medicare premium increase, allowing the conversion to have a cost of "only" the 25% marginal tax bracket, and not 26.6%. On the other hand, if the client’s income was higher, the impact would have been more severe. For instance, if AGI was already $85,000, then a $5,000 conversion would result in $1,250 of taxes (at a 25% tax) plus the same $619.20 (for additional Medicare premiums), which leads to a marginal "tax" of $1,869.20 and a marginal tax rate of 37.4%; on the other hand, if the conversion was $10,000, the marginal rate would only be 31.2% (since the additional taxes would rise to $2,500 but the Medicare premium impact would still be the same $619.20/year). The end result: the closer clients are to an income threshold, the better it is to either stay right below the line, or rise far above it until the next threshold (or a new tax bracket) approaches, because the additional Part B and Part D premiums are a flat additional amount even if clients are just $1 across the line (unlike tax brackets, which are always a percentage of additional income). And because the premium adjustments are calculated based on AGI, anything that increases AGI can impact exposure, from IRA withdrawals and Roth conversions, to capital gains, to dividends and interest and income from pass-through entities; on the other hand, any deductions that are taken above the line, such as capital losses or certain business losses, can also reduce exposure.
Source: kitces.com

Video: Medicare Fraud Costs American’s $90 Billon a Year 2/17/2011

Important: What are Medicare’s true administrative costs?

The Centers for Medicare and Medicaid Services (CMS) annually publishes two measures of Medicare’s administrative expenditures. One of these appears in the reports of the Medicare Boards of Trustees and the other in the National Health Expenditure Accounts (NHEA). The latest trustees’ report indicates Medicare’s administrative expenditures are 1 percent of total Medicare spending, while the latest NHEA indicates the figure is 6 percent. The debate about Medicare’s administrative expenditures, which emerged several years ago, reflects widespread confusion about these data. Critics of Medicare argue that the official reports on Medicare’s overhead ignore or hide numerous types of administrative spending, such as the cost of collecting taxes and Part B premiums. Defenders of Medicare claim the official statistics are accurate. But participants on both sides of this debate fail to cite the official documents and do not analyze CMS’s methodology. This article examines controversy over the methodology CMS uses to calculate the trustees’ and NHEA’s measures and the sources of confusion and ignorance about them. It concludes with a discussion of how the two measures should be used.
Source: pnhp.org

When Did You Drop Medicare Premiums?

We arrived here in December and canceled our Medicare B program and our supplement in February. We replaced our Medicare B and our supplement with a health care program here for quite a bit less. The timing of what one does regarding health care is an individual decision. Do your homework on various health care programs here and make your decision accordingly. Yes, health care is quite a bit less here however if you have a pre-existing condition it can be of some comfort to have some sort of back up. Some folks prefer to go it alone because healthcare is very reasonable here. The choice is yours.
Source: gringotree.com

Medicare High Income premiums

As many no doubt know Medicare charges higher premiums for Part B and Part D if your income is above a certain amount. DH went on Medicare late last year. For 2013 they base premiums on the 2011 tax return which has an income high enough to trigger the extra premium. For 2014, they will use the 2012 tax return which will also be high enough to trigger the extra premium. However, if you have what is referred to as a "life changing" event then you can prove that to SS and then your Medicare premiums will be based upon that lower amount. One of the life changing events if is a spouse stops work. I plan to stop work sometime during this year. Our income for this year will not be high enough to trigger the extra premium. I know that once I stop work he can provide proof to SS and therefore his 2014 medicare premiums will be based upon this year’s income instead of being based upon 2012 income. But – here is my question – If I quit work during 2013 can the reduced income in 2013 cause his current 2013 premiums to be reduced during 2013? That is, I know that my quitting work will reduce premiums for 2014, but will it do anything to reduce the 2013 premiums (I am thinking not but wonder if anyone has experienced this).
Source: early-retirement.org

How to Transform Medicare into a Modern Premium Support System

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

Some Seniors Are In For Sticker Shock On Drug Premiums

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

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

Posted by:  :  Category: 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

Video: medicare.gov

Redesigned with you in mind – your Medicare Summary Notice

The Medicare Summary Notice has a new look to help you better understand your Medicare information. We’re excited to announce that you will soon start to see the award-winning, redesigned Medicare Summary Notice (MSN) hitting your mailboxes.  The new design puts clear language in an easy-to-follow format, so that your Medicare information is easier to understand.
Source: medicare.gov

Medicare Supplement Articles > Inpatient Treatment

In order to receive the benefit of SNFs, Medicare enrollees must be admitted to a hospital as an inpatient for 3 full days (72 hours). However, just because a person is “in” the hospital, does not mean the patient is admitted as “inpatient.” This is intended to conserve Medicare expenses, and keep SNFs open for those who really need it. Additionally, no one wants to be bogged down in a hospital bed for longer than necessary, needless to say, these observation days are in place to give people the freedom to leave ASAP.
Source: medicaresupplement.com

Continuing Transparent, Collaborative Medicare Physician Payment Reform Process, Health Subcommittee Explores Draft Legislation to Repeal Sustainable Growth Rate

WASHINGTON, DC – The Subcommittee on Health, chaired by Rep. Joe Pitts (R-PA), today held a hearing on “Reforming SGR: Prioritizing Quality in a Modernized Physician Payment System.” The hearing comes on the heels of a draft legislative framework released last week by the Energy and Commerce Committee to repeal the current Sustainable Growth Rate (SGR) system and replace it with a fair and stable system of physician payment in the Medicare program. The draft legislation is the latest step in the open and transparent process to reform the system and reward providers for delivering high-quality, efficient health care. On February 7, the Energy and Commerce and Ways and Means Committees outlined a framework to reform the current Medicare system that is fiscally responsible and free of politics. Committee leaders sought feedback and in early April outlined additional details of a proposal to repeal and replace the current SGR system.
Source: house.gov

Federal Gov’t. Moves Against Nevada Hospital For Alleged Patient Dumping

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The Associated Press/Washington Post: Federal Government Demands Answers From Nevada Psychiatric Hospital Accused Of Busing Patients The federal agency that oversees Medicaid and Medicare compliance has put Nevada on notice of “serious deficiencies” at a Las Vegas psychiatric hospital following reports of patients being improperly discharged. A letter Thursday from the Centers for Medicare and Medicaid Services, first reported by The Sacramento Bee and obtained Friday by The Associated Press, gave Nevada 10 days to correct problems in its mental health discharge policies at Rawson-Neal Psychiatric Hospital or risk the loss of federal funding, potentially tens of millions of dollars (4/26).
Source: kaiserhealthnews.org

Video: Medicare Nevada- 1.800.643.7544

Medicare Eligible | Insurance Concepts of Nevada

As a senior, you are eligible for Medicare coverage. There has been a lot of media coverage on the new Medicare Part D plans as well as Medicare supplement plans, all of which are portrayed as complicated and confusing. We are experts in Senior services and we can help you decipher the different options and help you chose the plan that is right for you.
Source: insuranceconceptsofnevada.com

Hospice Still Waiting on Help from Medicare

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

Nevada SMP empowers seniors to prevent Medicare Fraud

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

Medicare announces 106 ACOs in Jan, one in Nevada

Accountable care, was among a few policies in health reform law that seek to more closely tie payment to performance.  ACOs must meet quality standards and CMS has established 33 quality measures on things like care coordination and appropriate use of preventive health services.  CMS provides two incentive options under the shared savings program and some critics contend that the incentives aren’t adequate.
Source: iitlv.com

Feds Crack Down On Nevada Over Alleged ‘Patient Dumping’ Into California

Earlier this week, Nevada Gov. Brian Sandoval said his administration launched three separate investigations after he learned of the Brown case. He said disciplinary actions were taken and a new policy was implemented to strengthen oversight. The state now requires two physicians instead of one to sign a discharge order for patients, and the decision must be approved by a hospital administrator.
Source: cbslocal.com

Inpatient or outpatient? It makes a difference with Medicare

To help understand, appreciate, and protect Nevada’s rock art and archaeological sites, Emily Middleton discusses early carved abstract rock art in the Northern Great Basin from 6:30 to 7:30 p.m., Thursday, June 27 at the Nevada State Museum, in Carson City. Middleton graduated from the University of Nevada, Reno, with a master’s degree in prehistoric archaeology. Her previous research includes work in California, Nevada, and Oregon. She is a member of the Society for American Archaeology, Nevada Archaeological Association, Nevada […]
Source: thisisreno.com

CMS Tells Nevada Mental Health Facility To Alter Discharge Policies

Last week, Nevada health officials also said that, effective immediately, a chaperone must accompany any patient with a mental illness discharged from state facilities “for whom the state is paying transportation costs” to locations outside of Nevada (California Healthline, 4/25).
Source: californiahealthline.org

Nevada Senate Candidate Shelley Berkley on Medicare, the economy and the Affordable Care Act

On a recent trip to Nevada, Up host Chris Hayes sat down with Rep. Shelley Berkley, the Democratic candidate for Senate there. Berkley is challenging Republican Sen. Dean Heller. Chris asked Berkley about the unemployment rate in Nevada — the highest in the nation — Republican vice presidential candidate Paul Ryan’s proposed cuts to Medicare, and Berkley’s vote in Congress for the Affordable Care Act.
Source: msnbc.com

Nevada hospital in trouble with CMS for discharge plans that include a one

Dr. Tracey Green, Nevada’s top state health officer, told Reuters earlier this week that the hospital had tightened its discharge policies to ensure that patients released to other states had appropriate after-care treatment plans in place. She also said all psychiatric patients would from now on be chaperoned when put on Greyhound buses.
Source: medcitynews.com

Woman Gets Prison Term for Defrauding Medicare

For the tax years 2006, 2007 and 2008, Phankonsy prepared and submitted false individual tax returns by underreporting the income she earned from the Medicare fraud scheme. She underreported roughly $7.8 million in gross receipts, resulting in a total tax loss of $2.4 million. Phankonsy also attached fraudulent W-2 forms to her returns and falsely represented that she made significant estimated tax payments, when she had not.
Source: 8newsnow.com

AOA advocacy ensures ODs can earn Medicaid incentives in 10 states

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Under the Medicaid EHR Incentive Program, health care practitioners who demonstrate they have billed at least 30 percent of their insurance claims to Medicaid during a 90-day reporting period can qualify for up to $63,750 in incentives over the six-year life of the incentive program. This is more than 40 percent higher than the Medicare EHR Incentive Program, which by comparison offers up to $44,000 ($48,400 in federally designated Health Professional Shortage Areas).
Source: newsfromaoa.org

Video: Kentucky Medicare Supplements

Medicaid Expansion Popular In Southern States, Despite Govs’ Opposition

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

Why Centene Is A Good Opportunity

Centene acquired AcariaHealth, one of the United States’ largest specialty pharmacy companies, in the first quarter of 2013 for $152 million. With this acquisition, the company aims at expanding its specialized pharmacy benefit services for diseases like Hepatitis C, Hemophilia, Multiple Sclerosis, and Oncology. AcariaHealth’s specialty pharmacy platform will help Centene to become capable of serving its present and future clients, along with becoming the stand-alone pharmacy benefits management company. This acquisition will also benefit the company from AcariaHealth’s strong relations with the pharmaceutical companies and broader access to the limited distribution of high-cost drugs. It has applied an integrated approach, as now it will easily provide high-cost specialty drugs to its client base of 2.7 million and also tap the highly acute population, which includes the aged, blind, disabled, and dual eligible.
Source: seekingalpha.com

Doctor shortages may undercut Kentucky Medicaid expansion

Angela Estes, 43, of Columbia, an assistant at a nurse-practioner-only primary care office in her hometown, is uninsured but eligible for Medicaid under the expansion. She gets primary care at her workplace but has been putting off getting a mammogram, updated MRI scans for headaches associated with a neck injury, and recommended sinus treatment that would cost about $7,000.
Source: wordpress.com

Kentucky Appalachian Transition Services awarded funds by Centers for Medicare & Medicaid Services

The Centers for Medicare and Medicaid Services (CMS) has announced that the Kentucky Appalachian Transition Services (KATS) was selected to participate in the Community-based Care Transitions Program (CCTP). KATS will implement a transitional care program to improve medical treatment for people with Medicare. The program goal is to reduce readmissions by 20 percent among the partner hospitals over two years while improving the quality of transitional care and services to Medicare beneficiaries.
Source: medicalnews.md

Medicare, Medicaid Allowed as Defendants in Suit

The ruling was reported Friday in the Lexington Herald-Leader. It came in response to ARH’s motion, filed in January in U.S. District Court in Lexington, that said the federal agency’s failure to scrutinize the Cabinet for Health and Family Services, has resulted in an unstable managed-care system heading toward collapse.
Source: wbko.com

State Mutual Insurance Company Announces Sale of Medicare Supplement Insurance in Kentucky

We are pleased to announce the availability of lower cost Medicare Supplement Insurance in Kentucky. The Kentucky Department of Insurance approved Medicare Supplement Insurance plans from State Mutual Insurance Company and made it possible for us to offer extremely competitive Medicare Supplement Insurance rates for qualifying Kentucky seniors.
Source: statemutualinsurance.com

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June 24, 2013

Massachusetts, Minnesota, and Wisconsin Medicare Supplement Plans

Posted by:  :  Category: Medicare

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

Video: Paul Ryan News – Medicare, Wisconsin, Republican Party

Medicare fraud — specific intent

For a limited time, new subscribers can get complete digital access to WI Law Journal for only $15! Sign-up now and get instant access to this story with a 4-week digital only subscription. Sign me up!
Source: wislawjournal.com

Senior Medicare Patrol: Help Stop Medicare Fraud

The Wisconsin Council of Churches and CWAG want seniors to be trained to detect Medicare fraud and help keep our health care costs under control. For more information about how to get involved, or to secure a speaker to come and address your seniors group, please check out the Wisconsin Senior Medicare Patrol website at www.wisconsinsmp.org or call Judy Steinke Wisconsin SMP Volunteer Coordinator at 800.488.2596 ext. 342.
Source: cwagwisconsin.org

DHS Receives Comments on Virtual PACE

DHS received comments from five commenters, and major themes included requests for more detail, questions on and issues with omitted financing and payment sections, and comments on medically necessity definitions and the integrated appeals process. The summary document categorizes the comments according to DHS follow-up actions; some comments are on areas of the MOU that have been revised in response, and others have been noted but not resulted in revisions, are on areas pending drafting, or will be considered in certification or three-way contracts rather than the MOU.
Source: wisconsinassistedlivingnews.com

Wisconsin Lyme Network: IGENEX accepts Medicare Part B

New from IGENEX for Lyme testing: Igenex now accepts Medicare Part B for some tests. Bartonella Fish and Babesiosis Fish have a copay of $39.60 each. CD57 is not covered. There is a limit of how many test are covered at one time but test 188 and 189 are covered.
Source: wisconsinlyme.net

Wisconsin Religious Leaders Urge Medicaid Expansion

Noting that their faith traditions have also long recognized God’s call to care for all and to protect the most vulnerable members of society, the letter then affirms how one government program in particular helps to uphold these obligations.  “The Medicaid program is an important means to this end.  For nearly five decades, this program has provided vital access to the most vulnerable members of our society.  One of the most appealing and socially just aspects of the Affordable Care Act (ACA) is its offer to provide financial help to states expand their Medicaid programs.”
Source: wichurches.org

Wisconsin’s Thompson boasts about ‘doing away with’ Medicare

But as a strategic matter, this is a symptom of a larger problem. Tommy Thompson used to be a relatively moderate Republican, at least by contemporary standards, uncomfortable with far-right extremists. As his party has become radicalized, however, Thompson has been forced to scramble to convince his base that he’s sincere in his support for an extreme agenda.
Source: msnbc.com

Wisconsin Union Battle Masks Medicaid Tensions

The governor’s proposal, a “budget repair” bill that would strip most public employees of their collective bargaining rights, would also allow the Walker administration to make potentially drastic changes in health programs with little legislative oversight. Officials say it could help tackle a looming two-year $3.6 billion deficit. But, the result, Vinehout predicts, is that “large numbers of people will lose BadgerCare,” a component of Wisconsin’s Medicaid program.
Source: kaiserhealthnews.org

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June 24, 2013

Redesigning Medicare cost sharing

Posted by:  :  Category: Medicare

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Supporters of redesign believe that cost sharing under a redesigned Medicare program will be more predictable and simpler for beneficiaries to understand and better align incentives to reduce any overuse of services. Others fear that, if designed to reduce federal spending, restructuring the benefit design would likely shift costs onto many Medicare beneficiaries. Critics note that Medicare beneficiaries already spend three times as much of their income on health care as do people under age 65. Critics believe most beneficiaries cannot afford to pay more for their health care and are particularly concerned about proposals that include even higher deductibles or out-of-pocket caps.
Source: pnhp.org

Video: What Does Medicare Cost?

2013 Cost Projections for Medicare Programs

This week’s charts compare the Medicare cost projections under current law assumption with more realistic alternative assumptions measured as a percentage of the economy. The Medicare Trustees’ Report presents an illustrative alternative scenario that assumes a continuation of the historical pattern of SGR overrides; the report also shows an another alternative scenario in which, in addition to an SGR override, certain controversial elements of the 2010 Affordable Care Act (ACA) are either scaled back during the period from 2020 to 2034 or eliminated altogether.
Source: mercatus.org

Cost to treat Medicare patients at Cape Fear region hospitals varies

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Source: fayobserver.com

Analysts Predict Continued Medicare Cost Growth Slowdown

USA Today: Analysts: Medicare Costs May Keep Declining Innovations adopted and accelerated by the 2010 health care law will continue to force down overall Medicare costs, according to industry analysts and studies, even as the economy continues to improve. Those changes include new payment plans, improved efficiency and a move toward consumer-driven insurance plans that started before the law’s passage. They influenced the $618 billion drop in projected Medicare and Medicaid spending over the next decade that was reported May 15 by the Congressional Budget Office. That report showed that costs for the two programs in 2012 were 5 percent less than projected in early 2010, and the CBO data are expected to foreshadow the spending projections in the annual Medicare trustees report scheduled to be released this week (Kennedy, 5/30). 
Source: kaiserhealthnews.org

Controlling Medicare Costs is Now Un

Of course, as a number of people have pointed out, this move doesn’t prevent IPAB from working. If the Senate doesn’t confirm anyone to the board, it just means that the HHS secretary has to make cost-cutting proposals on her own if Medicare grows faster than allowed. So what’s the point? Pretty obviously, it’s to make sure that if Medicare is cut in any way, Republicans can blame it solely and completely on Democrats.
Source: motherjones.com

Hospitals can’t pass along cost of Medicare cuts

&summary=Maryland%E2%80%99s+hospitals+will+bear+the+full+brunt+of+the+2+percent+Medicare+cuts+mandated+by+sequestration%2C+state+regulators+decided+Wednesday%2C+despite+passionate+warnings+from+providers+that+the+move+would+trigger+layoffs+and+service+reductions+at+hospitals+across+the+state.&source=Maryland+Daily+Record’ title=’Share with Lindedin’ onclick=’target=”_blank”;’ rel=’nofollow’>
Source: thedailyrecord.com

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June 24, 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: How do I Apply for Medicare? ClearMedicare Founder Buzz Stone Explains the Supplemental Plans

Things To Consider When Applying For Medicare

Sickness bills can make frustrating especially when you do not just have enough difficult to settle under control the expenses. This is your reason why men or women go for medicare plans or Medicare products and solutions. These will be Medicare policies your help one paying off their medical bills. The Medicare assist insurance policy starts off with at the years of age of 65. In case you have bought a Medicare supplement policy, then your offer will automatically begin with on the remarkably day when your turn 65, this kind of does not be relevant which month that will be. If you will be turning over 60 in the month of June old 23rd then all of your Medicare supplement health care insurance policy will start on that related date and month.
Source: teamara.com

Determining Income for Adults Applying for Medicaid and Exchange Coverage Subsidies: How Income Measured With a Prior Tax Return Compares to Current Income at Enrollment

A major goal of the Patient Protection and Affordable Care Act (ACA) is to significantly expand coverage and reduce the number of uninsured. Beginning in 2014, the ACA will establish a new continuum of coverage that will provide assistance to individuals with incomes up to 400% of poverty through a broad expansion in Medicaid and by making premium tax credits available to eligible individuals to purchase coverage through new Health Insurance Exchanges. The law standardizes the definition of income used to determine eligibility for Medicaid and the premium tax credits to Modified Adjusted Gross Income. Yet, there remain important distinctions related to the timing of the income used to assess eligibility. This analysis suggests that the timing of the income used to determine eligibility has important implications and that establishing simple procedures to collect current income will be important for assuring individuals receive the appropriate coverage and levels of assistance when they apply for Medicaid and Exchange coverage.
Source: kff.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 […]
Source: intentionalcaregiver.com

Cape Cod Medicaid Home Health Care Introduced for 2013

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

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

How to apply for Medicare Health Insurance

Part D (Prescription Drug Plan) Offers special assistance to beneficiaries with limited income, and a choice of prescription drug plans (PDP) to anyone enrolled in Part A and Part B. Medicare prescription drug plans (PDPs) cover only outpatient drugs for people in original Medicare who have no other drug coverage. You can not enroll both in a Prescription Drug Plan and in a Medicare Advantage plan. When you enroll in a Medicare Advantage plan, you will automatically lose your current PDP coverage, even if the Medicare Advantage plan does not cover drugs. Every year Medicare has an enrollment period from November 15 through December 31 when it is possible to change prescription drug providers. Medicare imposes penalties if you want to enroll in a prescription drug plan and you were not previously enrolled in a creditable drug plan. The long list of Part D providers, and the many options for monthly fees, types of coverage, and deductibles make it very difficult to choose. It is important to think carefully before making a selection because the wrong choice can cost you hundreds of dollars more in out-of-pocket expenses. Medicare has an interactive Prescription Drug Plan Finder in its Prescription Drug Coverage web page.
Source: scientificpsychic.com

Medicare Therapy Caps: Changes Effective October 1, 2012 and the Impact on Hospital Outpatients and Others

.  Beginning October 1, 2012, requests for exceptions for medically necessary outpatient therapy services that exceed $3,700 per calendar year will be subject to a manual review process.  Providers will be phased into this manual review process by being placed in one of three phases.  Providers in Phase I will be subject to the process beginning October 1, 2012, providers in Phase II will be subject to the process beginning November 1, 2012 and providers in Phase III will be subject to the process beginning December 1, 2012.  The manual exception process does not apply to a provider until its designated phase has begun.  CMS will send a mailing to providers to inform them of which phase they have been placed into.  This manual review process will be in addition to the automatic exception process for the $1,880 cap already in place and will act as a second level of the exception process.
Source: hallrender.com

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