Hearing aids and health insurance: are you covered?

Posted by:  :  Category: Medicare

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While an adults’ struggle with hearing loss and the costs involved seems unfair, the situation is even more irritating when it comes to hearing aids for children.  Hearing is essential for a child’s development of speech, language, and social skills.  Children can feel even more isolated and depressed if their hearing loss goes unaided or unaddressed.  While generally as expensive as adult hearing aids, children’s hearing aids may require more adjustment and replacement as they grow and develop.  This only makes the price higher and places hearing aids further out of reach for more families.
Source: lasesana.com

Video: Older adults need hearing aid coverage!

In Minnesota Medicare Advantage plans

Minnesota seniors can choose from four Medicare Advantage, or MA (C section) plans, Medicare-approved health insurance plan provided by a private company. Each MA plan includes (Hospital) and Part B (medical) coverage, emergency and emergency medical services, and provide Part D (prescription drug) coverage. Some plans also offer dental, vision and hearing aid coverage, health and wellness programs. Other people are reading than Medicare Advantage. Medicare Supplement Plans Medicare Supplement Health Plan in Minnesota Blue Cross Blue Shield (BCBS) of its Medicare Advantage plans related to the Basel Committee on Banking Supervision provides three programs, plus a separate prescription drug plan and two supplementary program. As of May 2010, premiums range from $ 29 to $ 261 per month. The MedicareBlue PPO plans include co-payments for doctor visits and emergency care, the highest annual pocket costs and prescription drug coverage. Right MedicareBlue RX prescription drug plan, either blue or platinum plan senior gold, there is no drug coverage full coverage. Superior Gold has the highest monthly premium, but there is no co-pays, and pays no annual fee. A supplementary scheme extending basic welfare benefits could reach the highest level. Second supplemental cost-sharing scheme is to protect the gap.
Source: howfoodarticles.com

Covering the Bases: Some Medicare Advantage plans may help cover hearing …

Amy Rubino is director of the Senior Health Insurance Assistance Program and the Senior Medicare Patrol for the Anne Arundel County Department of Aging Disabilities. SHIP assists people with their Medicare-related questions; SMP assists people with issues related to Medicare fraud. You may contact either program by calling 410-222-4464 or ship_program@aacounty.org.
Source: hearing-aid-news.com

Why Doesn’t Medicare Pay For Hearing Aids Or Eyeglasses?

Hearing aids are elective to, just like glasses. Patients are responsible for 100% of the bill. However Medicare, in certain circumstances, will cover the cost of a prosthetic device. Often though, the cost of prosthetics far outweigh the costs of a hearing aid. This elective also extends to routine hearing tests, which are also the responsibility of the Medicare patient. Regulations vary by the state however, so there may be some exceptions to the contrary. Though most states operate under the same mindset. One exception, though limited, is coverage based on an advantage plan; a secondary premium insurance add on.
Source: seniorcorps.org

Guiding you in the right direction: Medicare and Hearing Aids

If Medicare and hearing aids are of concern to you, you should become a wise consumer. Learn as much as you can about the Medicare HMO you plan to choose and make sure that they offer additional benefits such as vision care and hearing aids. These plans will generally offer services for auditory evaluations and fittings for the hearing aid. Medicare sometimes pays the full amount and other times you may be asked to meet a deductible. It depends on your specific coverage.
Source: eldercareresources.info

Medicare Spending and Financing Fact Sheet

The Part A Trust Fund is projected to be depleted in 2024—eight years longer than in the absence of the health reform law—at which point Medicare will not have sufficient funds to pay full benefits, even though revenue flows into the Trust Fund each year.  Part A Trust Fund solvency is affected by growth in the economy, which directly affects revenue from payroll tax contributions, and by demographic trends:  an increasing number of beneficiaries, especially between 2010 and 2030 when the baby boom generation reaches Medicare eligibility age, and a declining ratio of workers per beneficiary making payroll contributions.  Part B and Part D do not have similar financing challenges, because both were structured to be funded by beneficiary premiums and general revenues, set annually to match expected outlays.  However, future increases in spending under Part B and Part D will require increases in general revenue funding and higher premiums paid by beneficiaries.
Source: kff.org

Hearing Aids and Medicare

Medicare doesn’t cover the cost of a regular hearing exam, or one that’s conducted during yearly check-ups. However, Medicare does cover a diagnostic hearing exam, which is based on an actual medical need. Consumers can tell roughly what Medicare will or won’t cover by asking this question: “Is this service/product medically necessary?” If your answer is yes, then it’s likely it will be covered by one of the many aspects of Medicare.
Source: boomers-with-elderly-parents.com

Medicare Skirting Own DME Bidding Rules in Tenn.

Posted by:  :  Category: Medicare

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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

Video: Tennessee Medicare

Medicare program eliminates 30 out

“I fear that the winning bid rates have been inaccurately calculated given the inclusion of now voided bids, and I worry that Medicare beneficiaries in Tennessee will not have sufficient options to receive necessary durable medical equipment given the large number of voided bids,” said U.S. Rep. Marsha Blackburn, R-Brentwood. “Patients in Tennessee could suffer the access-to-care issues that may arise given the volume of voided bids. Finally, I continue to have reservations about this program going live in less than two weeks with potentially similar problems in other states.”
Source: thecre.com

Expanding TennCare would hurt patients, taxpayers

Beacon Center budget business-friendly cities charter schools corporate welfare corporate welfare reform death tax dr. milton friedman education education reform energy policy entrepreneurs estate tax government government handouts government reform government waste Governor Bredesen Governor Haslam healthcare income tax inheritance tax jobs Justin Owen legislation mass transit nashville ObamaCare pork Pork Report property rights regulation school choice small business state budget stimulus taxation tax credits taxes taxpayers tenncare reform transparency transportation Trey Moore welfare
Source: beacontn.org

Tennessee Congressional Delegation Question Legality of Competitive Bidding

Memphis, Knoxville, Chattanooga, and Nashville metropolitan statistical areas are included in the Round 2 expansion of the DME competitive bidding program. We recently received reports that Medicare awarded DME contracts in Tennessee to suppliers not licensed to serve Medicare beneficiaries in the state. CMS clearly states in the “Request for Bids,” a document that spells out the rules for suppliers to initially compete, that “every supplier location is responsible for having all applicable license(s) for each state in which it provides services.” Nonetheless, CMS has awarded contracts to suppliers without a license in Tennessee. Tennessee law requires a physical location in the state as a prerequisite to obtaining a license to provide medical equipment.
Source: medbill.net

Elder Advocates, Knoxville, Tennessee based elderly health care guides Elder Advocates

Medicaid is a joint state and federal program that, among other things, pays for nursing home care when the patient meets all the medical, income, and asset eligibility criteria. In order for the federal government to help fund the State Medicaid program, federal law requires the State to institute an estate recovery program. This is so that the State may recover funds paid out for the Medicaid patient’s care. Usually, the only asset left in the patient’s “estate” after death is the home.
Source: yourelderadvocates.com

Tenn. Governor Refuses To Expand Medicaid

The Associated Press/Washington Post: Quinnipiac Statewide Survey Shows Sharp Gender, Racial Divides In Va. Over Medicaid Expansion A new statewide poll in Virginia shows a sharp societal divide over the question of whether to expand Medicaid — something that won’t happen for a while in the state because of reform hurdles Gov. Bob McDonnell has set for it. Quinnipiac University’s survey of 1,098 registered Virginia voters found 45 percent favor expanding the federal-state program that helps pay healthcare costs for the elderly, poor and disabled to about 400,000 Virginians just above the poverty level. Forty-three percent did not (3/28).
Source: kaiserhealthnews.org

Amy Schultz Clubbs grows passion fruit at Molina Healthcare as employees find giving back is the key to engagement

Posted by:  :  Category: Medicare

Track the life cycle Many companies were founded by an individual who was passionate about a particular product or service and who wanted reach as many people as possible to tell them about it and make them a customer. Just as it was with founder Dr. C. David Molina and offering affordable, quality medical care for the needy. Once that was established, it was logical step to also offer a health care plan exclusively for government-sponsored health care programs for low-income families and individuals. So the mission was clear from the beginning for Dr. Molina and it was just as clear to Clubbs when she became CEO a few years ago. Clubbs and her team took an empirical look at the entire process, to see if Molina Healthcare of Ohio was operating true to the corporate mission. “We kind of started looking at what is the life cycle of the member,” she says. “Where does it start? We followed that through the entire organization — what does the life cycle through our organization look like?” By following the life cycle, they were able to make sure that the right process and infrastructure was in place every step of the way to navigate the member through the organization. At every point in the process, it is necessary to keep the focus on the relationship that is being developed. “Molina doesn’t spend a large amount of money on commercials and billboard advertising because we really rely on the relationships that we develop with our community partners and with their provider partners as well really to educate potential members about what their health care options are,” Clubbs says. The examination of the life cycle showed the depth of engagement employees will need to demonstrate — and the importance of how critical it is to maintain that engagement. “The people who work for us are really passionate about what they are doing and the individuals we are providing services to, and so you need to really look to keep that passion in employees throughout the year,” she says. “It was just getting the right people in the right seats of the organization, and really developing people from what started out as building infrastructure to moving toward more of an operations life cycle of the company, and really keeping people engaged in the organization as you do that,” Clubbs says. As the Ohio division of a larger corporation, the entity had a template of sorts to follow when it was first started, but there was also a provision to adapt as needed. “A lot of it we developed from scratch, and a lot of it we were able to leverage,” Clubbs says. “With building relationships, we were definitely able to leverage best practices from our other states — and the Molina story as well. The company has been around for more than 30 years.” “We still run clinics today in many of our states, and are able to really leverage that history as we are building that relationship here locally as well,” Clubbs says.
Source: sbnonline.com

Video: 2009 Taste of Tuscany

Sr Medicare Account Rep occupation at Molina Healthcare in Miami

Detailed specification about this occupation opportunity kindly read the description below. Job Summary Responsible for increasing membership through direct sales and marketing of Molina Medicare products to dual eligible, Medicare-Medicaid recipients within approved mar! ket areas to achieve stated revenue, profitability and retention goals, while following ethical sales practices and adhering to established policies and procedures. Will also be responsible for the development and management of provider, community and partnership relationships, growth campaigns and tracking. Essential Functions Knowledge/Skills/Abilities – . If you were eligible to this occupation, please email us your resume, with salary requirements and a resume to Molina Healthcare.
Source: blogspot.com

Molina Healthcare Job Application

Career Opportunities: Following are the career options you can make choice from. Appeals Coordinator, Claims Examiner, Customer Service Representative, Claims Processor, Behavioural Health Clinical Care Coordinator, Credentialing Specialist, Sales Representative, Clinical Care Coordinator, Claims System Specialist, Data Specialist, Application Developer, Administrative Assistant, Complex Case Manager, Application Developer Engineer, Claims Recovery Processor, Clerical Assistant, Business Systems Analyst, Configuration Analyst, Clinic Front Desk Clerk, Claims Adjuster and Registered Nurse.
Source: topjobapplications.com

Questions Linger About Implementing Doctors’ Medicaid Pay Raise

–It’s not completely clear which doctors can get the higher pay. Traditional primary care doctors, such as family physicians, internists and pediatricians, are assumed to be covered. But some specialists, such as pediatric cardiologists, also could be eligible if they provide a certain amount of primary care, according to a preliminary regulation released by the Department of Health and Human Services in May. There is also come confusion about what services are covered under the pay raise. The regulation said the raise will apply to “evaluation and management” of patients, not procedures or performing diagnostic tests.
Source: kaiserhealthnews.org

Molina Healthcare to participate in Ohio’s integrated care system for dual eligibles

Molina Healthcare (NYSE: MOH) today announced that its health plan subsidiary, Molina Healthcare of Ohio, Inc., has been chosen to participate in the Southwest (Cincinnati), West Central (Dayton), and Central (Columbus) markets under the Ohio Integrated Care Delivery System (ICDS). The Ohio ICDS is intended to improve care coordination for individuals enrolled in both Medicaid and Medicare. The selection of Molina Healthcare of Ohio was made by the Ohio Department of Jobs and Family Services (ODJFS) pursuant to the request for applications for qualified health plans to serve in the ICDS issued in April 2012. The commencement of the ICDS is subject to the readiness review of the selected health plans, and the execution of three-way provider agreements between the health plans, ODJFS, and the Centers for Medicare and Medicaid Services (CMS). Enrollment of dual eligible members in the ICDS is expected to begin on April 1, 2013.
Source: medcitynews.com

FMO for Molina Medicare in FL

MedicarePlanSolutions – you are correct. Street level for FL is 450, but CMS allows reimbursement of expenses above and beyond the 450, plus overrides to managing agents for business written by their subagents. As I was saying before, if you are interested in a 473 or 493 contract level (depending on your production level and number of sub-agents), feel free to contact me at the above phone number. I also immediately vest ALL of my contracts.
Source: insurance-forums.net

Student Health Insurance Rates

today announced that U.S. News and World Report has ranked Molina’s subsidiary Medicaid insurance plans in New Mexico and Utah among. Molina Insurance is a multi-state managed care organization that has succeeded in providing needs to people that have not yet gotten the. Find out how Molina Healthcare Insurance differs from other plans; look into various affordable options. & wellness: quality: HIPAA: drug list: services: contact us. Welcome to Medicare in Texas! For 2011, Molina Medicare offers two (2) plans in Texas. Healthcare, a FORTUNE 500 company, has grown into one of the leaders in providing quality healthcare for financially vulnerable individuals and families. 120 listings of in on YP.com. Find reviews. Insurance; Email; Send to Mobile; Facebook; Twitter; Improve this listing Inaccurate result? 20. Healthcare has developed this website to help. including Medicaid and the State Children’s Program (SCHIP). Molina Healthcare offers. yourfreequotes is a free service that helps consumers compare prices on insurance plans in their area. Get quotes for individual insurance, family. Services in San Diego, CA; Health/Allied Services; Direct & Medical Insurance Carriers; Molina Healthcare in San Diego, CA is a private company. [USA] Provides managed healthcare in California, Washington, Utah, and Michigan, to individuals covered under Medicaid and related programs.
Source: individualmandatehealthcare.com

Molina Healthcare Selects Inovalon for Quality Measurement Analytics

Inovalon’s HEDIS Advantage solution provides health plans with National Committee for Quality Assurance (NCQA) certified administrative data analytics and coordinated hybrid medical record abstraction, as well as reporting capabilities, to satisfy Centers for Medicare and Medicaid Services (CMS), NCQA, and state-specific quality program specifications and requirements. Inovalon is NCQA Certified for its Quality Spectrum Insights (QSI
Source: virtual-strategy.com

Medicare Kansas City Health Insurance Basics

Posted by:  :  Category: Medicare

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Medicare Part A is also referred as the hospital insurance and it can cover medical services such as critical care, inpatient hospital care, hospice care, home health care and short term care in skilled nursing facilities. Medicare Part A can be obtained by people who are paying Medicare taxes when they are still working. However, if an individual cannot be eligible for free benefits from Medicare Part A then he can purchase Part A coverage provided that he can meet the eligibility requirements.
Source: ehealthmo.com

Video: Legislative Round Table: Impacts of Medicare Competitive Bidding Program in Kansas City

Kansas’ Great Hope: Managed Care Will Tame Medicaid Costs

According to Michael Sparer, a Columbia University professor of health policy, “good research” is surprisingly thin, and reaches the same conclusion: Medicaid managed care hasn’t yet produced the hoped-for results of lowering costs and raising quality in states where the concept has been tried. That’s mostly because much of the existing research focuses on managed care programs that serve low-cost Medicaid populations such as women and children. But he notes there may be more potential to save significant amounts of money when high-cost populations’ care is managed. 
Source: kaiserhealthnews.org

Sightings Over Sixty: I Apply for Medicare, Part I

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

CMS Hosts Calls on Medicare Shared Savings Program Application Process : Health Industry Washington Watch

CMS has scheduled two calls to discuss the application process for the ACA’s Medicare Shared Savings Program for the January 1, 2014 start date. This initiative is designed to help providers participate in accountable care organizations to improve quality of care for Medicare patients. A June 20 call will feature an overview and updates to the Shared Savings Program application process, and a July 18 call will provide an opportunity to ask questions of CMS subject matter experts.
Source: healthindustrywashingtonwatch.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

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

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

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

CMS Announces 2013 Application Fee for Medicare, Medicaid and CHIP

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

To promote and expand the application of telehealth under Medicare and other Federal health care programs, and for other purposes. (2012; 112th Congress H.R. 6719)

The United States Code is the compilation of permanent laws enacted by Congress. Temporary and other non-permanent laws do not appear in the United States Code. (About half of the United States Code is the law itself, called positive law. The other half is merely a compilation of the laws but has no legal significance.)
Source: govtrack.us

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

Posted by:  :  Category: Medicare

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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

Video: Medicare Supplement AARP Plan F Select is A Good Option

Medicare Supplement Plan F

Medicare Supplemental Plan F is the most popular supplemental plan because it provides the most robust coverage, and the premiums are not much higher when the benefits are compared to the plans offering less coverage. A patient with Plan F can in many situations pay nothing additional out of pocket for doctor and hospital services. People eligible for a Medicare Supplemental Plan should compare the benefits and premiums of the plans and purchase the best coverage they can afford. For many patients, that is Plan F.
Source: wastedenergy.net

Seniors See Value in Medicare Supplement Plan G

Why would an insurance company charge a consumer $500 to cover a $147 expense? The better question might be; why would anyone pay it? The answer to the first question is two-fold, first of all, because they can and secondly, because of Federal laws which require Medicare supplement companies to accept without underwriting individuals losing group insurance and/or leaving a Medicare Advantage plan, companies incur greater claims losses since they can’t weed out the sick individuals. This law does not apply to Medicare Supplement Plan G. Now to answer the question, why would anyone pay so much to cover such a little difference? The answer is simply because they don’t know any better. Whose fault is it that they don’t know any better? That blames rests on the consumer themselves for not doing adequate research, the insurance agent who is not knowledgeable or unscrupulous, the insurance company which is profit driven and the Medicare system for not providing proper education.
Source: askmedicareblog.com

Blended Medicare Plan Could Save $180B Over 10 Years, Study Finds

Both studies — the Commonwealth Fund Medicare reform proposal and the Rand analysis of others’ Medicare reform proposals — are seriously flawed and illustrate no real-world understanding of Medicare. It is good that the Commonwealth Fund includes the catastrophic coverage and annual OOP limits that are not included in Original Medicare. All Part C plans and a few Medigap plans include such protection today. In fact, the Commonwealth Fund looks like a Part C health plan — except that it costs more than the average Part C plan and does not have as many other benefits (other than the OOP limits). The one-size-fits-all drug plan proposed by Commonwealth Fund will lead many low-income seniors back to the two-tier VA-like prescription drug coverage that pre-dated Part D (one inferior tier for low-income seniors, one better plan for the rest of us seniors). Because I cannot take Essential without taking this inferior two-tier drug plan is bad news for we middle-income seniors also
Source: californiahealthline.org

Medicare Supplement Plan F

Purchasing a Supplemental Plan F policy should prevent any out-of- pocket costs for the recipient. One of the benefits covered by Supplemental Plan F is hospitalization for up to 365 days after Medicare coverage ends. The plan will cover up to 20 percent of all Medicare approved expenses. If blood is required three pints of blood each year are covered under the plan. The plan also covers the expense of a stay in a skilled nursing care facility. One of the greatest benefits is that Supplemental Plan F covers any emergency medical assistance that may be required while traveling abroad.
Source: edvox.org

Government to Leave Plan F Alone

AIC Leads cancer insurance cigna closing CMS CMS data conference call dental Draft Dates e-app electronic application equitable equitable life final expense final expense by phone foresters guaranteed issue guarantee issue hearing Heartland National Hospital Indemnity Interview life insurance medicare advantage medicare supplements medico Missouri mutual of omaha New Era New Era Life objections orlando event phoenix life Plan F Plan F vs. Plan G Plan G planright predictive dialer Script stonebridge training Underwriting vision webinar where to market
Source: medicareagenttraining.com

The Major Benefits of the Medicare Supplement Plan F Program

By now you have certainly heard of the term “Medigap,” but do you know what it means?  Medigap refers to supplemental policies available for people on Medicare and serve as a way for people to enhance their current coverage.  Due to the way original Medicare is designed, there are breaches in coverage, and this is where these supplemental plans kick in.  There are all different kinds of Medicare plans including Medicare Part F which this article will be primarily about. The correct terminology is actually Medigap Plan F and this plan is available for those who want to get the most out of their coverage.
Source: edublogs.org

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

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

Richland County South Carolina Medicare Supplement Quotes

Robert Bache aka MedicareBob owns and operates Senior Healthcare Direct. Senior Healthcare Direct is a National Telephonic Insurance Agency that represents over 26 Medicare Insurance Companies. It is our job to make sure that you always have the best price for your Medicare Supplement Plan.
Source: srhealthcaredirect.com

Medicare Supplement Plan F

One of the main reasons that Medicare Supplement Plan F is one of the most popular plans is that the cost sharing is available in many areas, from coinsurance and co-payments from Parts A and B, as well as excess charges, foreign travel emergency care, and preventative care. There are many supplemental insurance plans for the Medicare program. They are optional and have been designed to help you pay the expenses not covered by the original program.
Source: allabout101.com

Higher Deductible Medicare Supplement Plan F De Qui Buy It!Studio 99

Exactly why are people interested in Medicare Supplement Decide N? The bottom line could price. Medicare Supplement Plan D will be cheaper on a 31 day basis. However, if you have to have any Medical services at all, you will likely pay more in the long term and have greater out of savings costs if you purchase Plan T. The experts at Medicare Supplement Shop simply just recommend Plan N if you are typically extremely good health AND are within a strict budget. Keep in mind you may also need more medical services as you obtain older and you only have always on Guaranteed Issue period, which means you will need to make a wise decision one time you purchase a plan.
Source: sets-design.com

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June 26, 2013

CIGNA to Pull Out of PFFS Business in 2011.

Posted by:  :  Category: Medicare

Medicare Advantage has, over the past few years, been harder and harder to sell and become such a pain – with all of the regulations, Scope of Appointment form scrutiny, commission reductions, replacement prohibitions, etc. This has now been topped off by a president who wants to eliminate the medicare advantage altogether. See the video of President Obama saying so here. We are already starting to see the effects in one of the major carriers, CIGNA, pulling out of the 2011 Medicare Advantage bidding process. The Department of Health and Human Services fired off a letter to CIGNA and others, telling them that they must avoid raising rates on their members if they want to stay in the Medicare Advantage market. This, while they’re simultaneously cutting the subsidies to the carriers for providing the same service. CIGNA responded by declining to participate in national Medicare Advantage going forward. This is a trend that will continue. To the extent that they can get away with it – to remain profitable, the insurers will have to increase monthly premiums to their Medicare Advantage clients. They will also have to increase co-payments and other internal costs passed on to the members. HHS has made it clear, however, that they will not be approving such changes. So, backed into a corner, more will be making their exit from the marketplace. This will be a horrible blow to the seniors, as I predicted in this video that got rave reviews from all except for AARP – who wrote me a Cease & Desist letter for mentioning what they were up to. They got their bill, and now the results that I predicted are coming true. YouTube – Medicare News You Need to Know This will be a huge opportunity for those agents wanting to help potential clients with medicare supplement choices, as the Medicare Advantage market will begin to dwindle starting in November with thousands of members getting letters explaining that they have 1) Guaranteed issue into any medicare supplement provider for 1/1/11 and 2) They MUST pick a new plan/provider by 1/1/11 or the government will pick one for them. This happened last year when Coventry left the Medicare Advantage market and it was a huge boost to our enrollment in medicare supplements. That was just the first break, and the tidal wave is coming. Will it be hard for low income seniors? Absolutely. Somebody will have to write applications for seniors going onto medicare supplements, though, and it might as well be you. —- Agents wanting to take advantage of the new opportunities should visit: www.sellmedicarebyphone.com
Source: insurance-forums.net

Video: Chicago: “Cigna 7″ Arrested – Medicare for All

Eligible Georgia Retirees Switching to Medicare Advantage Plans

What Does the Change Really Mean for My Doctors? It was detailed in July 15th letter that your doctor (provider) would need to accept the changes in the plan to accept the MA terms. From all the research and discussions that I have had with both doctors and insurance vendors, it does not seem like there will be many changes they believe (view the letter with all enclosures by clicking here). There are no networks. You may see any provider that accepts Medicare and is willing to accept CIGNA/UHC’s terms and conditions. The really important point to make is to have your provider agree to accept the new plan changes (information on the plan was given in the July 15 letter). Along those lines, I have received a few emails talking about the problems with finding Medicare Advantage doctors. Numerous articles have said that the vast majority of doctors will not refuse Medicare or Medicare Advantage from current patients – they wish to continue the relationship. Some doctors may or may not accept new patients, but a study by the Center for Studying Health System Change found that nearly 75% of doctors accepted all or most new Medicare patients in 2008 (Study: Most Physicians Still Accepting Medicare Patients, Fierce Health Finance). How Much Will This Cost Me? First, remember that the State of Georgia is subsidizing your coverage by nearly 75% of the total costs. This is one of the benefits that was “given” to you, so if you were to opt out of the MA plan, it will cost you hundreds of dollars per month for the same coverage. In other words, unless you feel like you have no other option and money to burn, opting out is not an option… (who has money to burn??) The good news about the changes is that it will actually save you money every single month for your coverage. Currently, a PPO covered participant pays $32.90 for single coverage ($142.40 for family). The standard option MAPD PFFS plan will cost $19.30 for single coverage and $38.60 for family coverage (all dependents eligible for MA plan). A mix of eligible and non-eligible Medicare participants in family coverage will have higher costs, but that is to be expected. The premium coverage option for the MAPD PFFS plan will cost $59.30 for a single and $118.60 for a family (all dependents eligible for MA plan). The benefits here are a lower out-of-pocket maximum, lower hospital costs, reduced co-pays, and a better prescription drug benefit. The choice is yours, but weigh the costs by looking at your 2008 and 2009 medical expenditures. The standard plan could cost you more based on your needs… (Check the July 15 letter above to compare the coverages on the Plan Summary enclosure) If you want to check out the retiree rates as set by the SHBP, please click this link to open the PDF. What If I Don’t Choose? According to the information sent with the July 15 letter, “If you are not enrolled in a MAPD PFFS option and do not make an election during the ROCP, your coverage will roll to the MAPD PFFS option of the healthcare vendor you are currently covered. Kaiser members who do not make an election will default to the CIGNA Medicare Access Plus Rx (PFFS) – Standard Plan.” Conclusion Any change is tough to accept in anything… especially medical coverage. The unknown is more of a worry than the known even when it may be better. In five years, few people may even remember this change unless there are real problems. If that starts to happen though, you can almost be assured that the SHBP and its vendors will try to make things right. The State Health Benefit Plan covered 693,716 people as of September 1, 2009, and that is far too big a number to think that they will just accept mediocre results. Try to work with your doctors and try to work with the insurance vendors. The vendors are there to help, so let them help. Both CIGNA and UHC told me that if a doctor is not accepting the plan after you discuss it with them, get the vendor involved. They may be able to help explain it from an ease of use and payment perspective. Just a hint the vendors gave me.
Source: theeducatorsretirement.com

Free Insurance Agent Websites: Cigna Medicare Advantage plans

CIGNA Medicare supplement plans have been an integral part of the insurance industry with having served customers for over 220 years. This kind of insurance plan can be very beneficial for all people including senior citizens who may be suffering from constant medical issues due to their advanced ages. The company enjoys a lot of goodwill among the community and here are some of the benefits that come with buying this plan.
Source: blogspot.com

I have a Cigna plan, now what?

What does this mean to you? There is no change for customers during calendar year 2010. ·          There is no visible impact  in 2010. ·          There is no change in benefits or premiums; no one is losing coverage. ·          CIGNA will continue to provide all individual PFFS administration, such as processing enrollments, issuing ID cards and paying claims. ·          No change to contact information. Continue to use the same phone numbers, fax numbers, websites and land addresses to reach the same CIGNA teams as before. So there is nothing for you to do differently yet.
Source: ohiomedicaresupplementcompanies.com

Cigna Medicare Plans And Blue Cross Medicare Plans An Overview

HMO (Health Maintenance Organization) skeleton are the smallest costly option. The outcome of descend cost is reflected as limited access to illness care. Plans have a set monthly fee, casing doctors inside of the plan. If you revisit a doctor outward of the plan, you are then accountable is to bill. Within a since plan, you have since the correct to select a Primary Care Physician (PCP) who will look after your care. The HMO CIGNA medicare skeleton cover periodic and surety caring costs, referrals to a network dilettante or trickery when necessary, treatment for injuries and illness. There is no need of profitable any extra fees in HMO skeleton as it has no fees for doctor visits. The CIGNA Part D outline is called CIGNA Medicare Rx offers coverage for 94% of existing drugs, access to over 58,000 network pharmacies, no deductibles for select plans, no copayments for familiar drug and diseases similar to diabetes and drug pressure. The CIGNA outline D in spin offers 3 variety of skeleton namely, Plan 1, Plan 2 and Plan 3.
Source: yuanshyang.com

Cigna’s Management Presents at Barclays Global Healthcare Conference (Transcript)

Well, there’s a lot of resource and effort put into it. At the end of the day though, what you’re fundamentally talking about is changing the business operations of the primary care physician’s office to focus on a totally different set of metrics and incentives than they have in fee-for-service, and it’s extremely helpful. Here in Miami, the Leons only do business — the only patients they see are Medicare Advantage patients. So it’s not easy, but it’s at least a lot more practical to change those business operating models to focus on the right kinds of incentives. In most network models, you have a range of offices. You might have thousands of primary care doctors in some of these networks, some of whom only have 5% or 10% of their business in Medicare Advantage. And it’s a lot more challenging to get the kinds of changes it takes. The other thing for us that’s been a challenge — we’ve actually made pretty good progress on the Part C side. A couple of years ago, CMS changed the measures and more heavily weighted a lot of Part B measures on the pharmacy side. And we’ve been slower than I’d like to react to that. I hope we’re focused and have the right tools in place to improve our scores on Part D, but that’s really been more of what’s kept us below 4 stars in a lot of our markets.
Source: seekingalpha.com

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June 26, 2013

How Hospitals’ Treatment of Medicare Patients Will Be Changing PART TWO

Posted by:  :  Category: Medicare

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It is still too early to tell at this point what effect the Affordable Care Act will have.  It is also too early to determine if there is a shift in how patients will find the long term care services they need and whether hospitals, medical and long term care providers will be working more closely as Medicare seems to expect.  One thing, however, remains clear.  The number of people in this country needing long term care services will continue to grow.  How they find those services and pay for them may change but the basic need isn’t going to decline any time soon.
Source: estateplanandassetprotection.com

Video: Medicare Supplemental Policy in Massachusetts by Medicare Pathways

Massachusetts, Minnesota, and Wisconsin Medicare Supplement Plans

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

Letter from Massachusetts Delegation Raising Concerns about Impact of CMS’ Proposed Cut to Medicare Advantage

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

Mass. Medicare Reimbursement Rates Draw Scrutiny

When hospital executives talk about Medicare, they often bemoan low reimbursement rates, but Massachusetts hospitals have been enjoying reimbursement rates that are now drawing protests from 21 states. Medicare regulations require that all providers in a state receive reimbursement rates that are at least as high as those given to a state’s rural hospitals. In Massachusetts, only one hospital out of 82 qualifies as rural: Nantucket Cottage Hospital. The hospital serves the island of Nantucket’s approximately 10,000 permanent residents, though that total swells to approximately 50,000 people in summer. This is due to the amount of vacation homes on Nantucket, where the median home price is over $1 million.
Source: nonprofitquarterly.org

Alternative Quality Contract with Blue Cross Blue Shield of Massachusetts: A model for ACOs? (HealthBlawg)

David Harlow, a health care lawyer in Newton who writes the HealthBlawg, agrees [that the early findings are encouraging], calling the AQC a significant development for two reasons. First, it is an alternative to fee for service. “That’s appropriate because there is a need to change the incentives of health care providers in the system,” he adds. Second, the AQC is important because it has served as a model for the federal Centers for Medicare & Medicaid Services’ accountable care organizations. “The problem with past attempts to control health care spending is that adequate quality standards were not in place,” Harlow says. “It was all about keeping costs down. While this model represents an improvement over other models, the amounts at risk are relatively trivial and, standing alone, will not bend the cost curve. “Nevertheless, the AQC is different because no provider group can earn a quality bonus unless the physicians and hospitals achieve or exceed the quality standards.”
Source: healthblawg.com

Unraveling the Mysteries of Medicare in Massachusetts

Medicare in Massachusetts can be very mysterious to many people.  Let’s face it, insurance of any kind is complicated.  After spending the past six weeks attempting to understand the complexities of Medicare in my home state of Massachusetts, I decided to share what I’ve learned with others. During the next six weeks, I will provide some basics of Medicare, along with links for further information.  We’ll cover five topics: Medicare part A, part B, part C, part D, and supplemental/gap insurance. 
Source: blogspot.com

Medicare payment boost in Massachusetts prompts angry letter to Obama

Jesse M. Pines, M.D., is the director of the Center for Health Care Quality and associate professor of emergency medicine and health policy at George Washington University in Washington, D.C. His research focuses on emergency department operations and clinical care. Pines wrote two books on evidence-based diagnostics and visual diagnosis for emergency care and is a regular contributor to both peer-reviewed journals and popular media outlets.
Source: fiercehealthcare.com

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June 26, 2013

Senators Urge CMS To Reform Medicare Fraud Prevention Program

Posted by:  :  Category: Medicare

The OIG report looked into activities from April 2010 to March 2011 and found that the Medicare Drug Integrity Contractor, or MEDIC, program identified most of the few cases referred to law enforcement through passive and external means, such as a fraud hotline, rather than proactive, internal means, such as research and investigation. Specifically, the report found that:
Source: californiahealthline.org

Video: How to report Medicare Fraud

HHS Proposes Increasing Health Care Fraud Reporting Rewards To Up To $9.9 Million

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

How to Report Medicare Fraud

Silver Planet® helps Boomers guide their parents to age in place by offering services and products related to aging at home and housing options. Its Silver Advisors™ are professional geriatric care managers who provide phone consultations to resolve Boomers’ parents aging issues,  such as preventing falls, navigating  Medicare, and assessing seniors’ ability to drive safely, Silver Advisors clarify concerns, help prioritize next steps, and provide personalized written plans and recommendations.
Source: agewiseliving.com

Proposed Rule Would Increase Rewards to Medicare Fraud Whistleblowers to Nearly $10 Million : Whistleblower Protection Blog

The proposed rule would increase the potential reward amount for individuals who report information that leads to a recovery of Medicare funds from 10 percent to 15 percent of the final amount collected. The current program caps the reward at $1,000, meaning HHS pays a reward on the first $10,000 it collects as a result of a tip. HHS is also proposing to increase the portion of the recovery on which HHS will pay a reward up to the first $66 million recovered – this means an individual could receive a reward of $9.9 million if HHS recovers $66 million or more. 
Source: whistleblowersblog.org

13 Indicted For Medicare Fraud In Puerto Rico; Federal Officials Use Hotline To Find Medicaid Fraud

This is part of Kaiser Health News’ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.
Source: kaiserhealthnews.org

Jesup, Ga. family physician sentenced for health care fraud

First things first, if no one will come to Dr Lentz’s defense, I will. It seems so easy for the Federal Government to show up, charge someone, and convict them, a reporter to write about it and a paper’s readers to condemn him. However, Dr Lentz is the most honest, hard working man I know. He is up at 4am opening his gym for those who need to see him and exercise. He makes his hospital rounds and is ready to see his patients at 8 am. As you walk into his office you see mostly older patients. They come to him because they know he is will listen and talk to them and get to the bottom of their problems. Some cant pay the co-pay, others patients cant pay at all. But, he will still see them, without an appointment…. Isn’t it a sad time in this country when NOT forcing someone to pay a co pay for service is against the law? How about someone cooking a pie for a doctor, or cutting a Dr’s lawn, in exchange for medical treatment because they are poor, being considered against the law? (I guess it is too hard to figure out HOW to tax a doctor for that). When he is done seeing his patients for the day, he then teaches a judo class to a bunch of Wayne county kids after school.-more
Source: augusta.com

Seniors Blow the Whistle on Medicare Fraud

A federal report Tuesday spelled out the results of the South Florida calls: $58.6 million in overpayments recovered, $10.7 million in questionable bills not paid, $3 million seized from fraudulent firms, 103 companies booted from Medicare, 106 companies flagged for extra scrutiny, 835 fraud investigations started, and 30 cases referred for prosecution.
Source: hcafnews.com

Hotline Being Used to Combat Medicare Fraud

The hotline was created in 2008 and was largely ineffective due to under staffing. Many complaints regarding fraud went unanswered and phone call were unlikely to be returned. At the cost of millions of dollars, the hotline expanded the operation to include 15 telephone operators and 15 investigators. The operators at the hot line speak both English and Spanish. They are responsible for taking down the beneficiaries information and billing history. Once the information has been collected, the information is passed on to the investigative team for follow-up. The majority of the phone calls are regarding billing mistakes while about 15% are related to unprovided services. If the information is considered related to fraud, it is sent to the investigative team that is headed up by a retired FBI agent.
Source: miamicriminaldefenselawyerblog.com

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June 26, 2013

Overweight? Let’s Call It a Disease

Posted by:  :  Category: Medicare

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Many analysts—particularly adherents of integrative medicine—believe that obesity is more of a risk factor for disease than a disease in and of itself. The symptom (fat) is also the defining feature (being fat): there are no other clinical or subclinical signs. Many people, especially those at the lower end of the range, suffer no obvious impairment because they are overweight, or no impairment that is unrelated to other disease factors like diabetes or heart conditions, other than failing to meet certain (somewhat arbitrary) standards of physical fitness, which some non-obese but sedentary people might also fail. Being obese is merely one manifestation among many of a body that is out of balance.
Source: anh-usa.org

Video: Medicare & You: High Blood Pressure and Osteoporosis

Medicare & You in 2013

* What is Medicare? * What are the different parts of Medicare? * What are my Medicare coverage choices? * Where can I get my questions answered? * How do I sign up for Part A & Part B? * If I’m not automatically enrolled, when can I sign up? * Should I get Part B? * How does my other insurance work with Medicare? * How much does Part A coverage cost? * How much does Part B coverage cost? * What does Part A cover? * What does Part B cover? * Want to keep track of your preventive services? * What’s NOT covered by Part A & Part B? * What if I need help deciding how to get my Medicare? * What should I consider when choosing or changing my coverage? * How does Original Medicare work? * What are Medicare Supplement Insurance (Medigap) policies? * What are Medicare Advantage Plans (Part C)? * Are there other types of Medicare health plans? * How does Medicare prescription drug coverage (Part D) work? * What if I need help paying my Medicare prescription drug costs? * What if I need help paying my Medicare health care costs? * What are my Medicare rights? * What’s an appeal? * How does Medicare use my personal information? *How can I protect myself from identity theft? * How can I protect myself & Medicare from fraud? * How do I plan for long-term care? * How do I pay for long-term care? * What are advance directives? * Where can I get personalized help? * How do I compare the quality of plans and providers? * Can I manage my health information online? * Are resources available for caregivers? * What are State Health Insurance Assistance Programs (SHIPs)
Source: wordpress.com

Ask The Experts: Retirement

Q. Can FEHB suspension be done only in retirement? How can suspension be done working as an active federal employee with Medicare and Tricare for Life? One may want to keep working for the government but not have to pay FEHB fees and use Medicare Part A with its fees along with Medicare Part B free and TFL benefits included due to being a military retire. Why would one want to have such overkill in health care benefits and costs? Could you explain the process in a scenario such as this, and could either a continuing active employee or a retiree reclaim their FEHB in the event the Medicare or TFL benefit degrades or goes away?
Source: federaltimes.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

If I am still working, do I have to start my Medicare?

No, as long as you or your spouse is still working and you have health insurance through your or your spouse’s employer, then you can defer your Medicare Part B and you will not be penalized. However, if/when you lose that coverage, you will have 60 days prior and 63 after that coverage ends to enroll into MedicarePart B.
Source: srhealthcaredirect.com

Trustees report provides financial status of Social Security, Medicare

We have a special “earnings test” rule we apply to annual earnings, usually in the first year of retirement. Under this rule, you get a full payment for any whole month we consider you retired regardless of your yearly earnings. We consider you retired during any month your earnings are $1,260 or less, or if you have not performed substantial services in self-employment.
Source: mysanantonio.com

Diabetics on Medicare face critical deadline, needed information

There is little question that this new system will be better in the long run.  The government will save money and you will see your co-pay and deductible amounts decrease.  For example, patients testing one time a day, before July 1, have an average co-pay of approximately $14.47 on their testing supplies.  After July 1, for the same order, the co-pay will decrease to approximately $4.49. This is a savings to you of almost 70%!  The actual cost may be even lower or no cost at all if you have secondary insurance.
Source: garlandjournal.com

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