Is Obama Cooking the Medicare Books?

Posted by:  :  Category: Medicare

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• The Congressional Budget Office has studied the demonstration projects on three separate occasions (here, here and here) and each time has concluded that they are producing no serious savings and are unlikely to do so in the future. • Medicare’s Actuary has determined that reductions in payments to Medicare Advantage plans will not only result in lower benefits for the one in four seniors who are in these plans, but that about 7 ½ million enrollees will actually lose their coverage and have to seek more expensive Medigap insurance elsewhere. • Medicare’s Office of the Actuary also has concluded that the projected savings are unrealistic and will not materialize — since they will result in hospital closings and seniors’ inability to find accessible health care — a judgment reaffirmed in the Chief Actuary’s own statement in the latest Trustees report. • Even if the $200 billion in savings did materialize, it would not be a saving to taxpayers; instead, these savings have already been pledged to create a new health insurance entitlement for young people — leaving taxpayers just as burdened as they were before. • The administration’s report also claimed that health reform has created $60 billion in new benefits for seniors, without mentioning that for every $1 of new spending beneficiaries will lose $10 of spending somewhere else.
Source: townhall.com

Video: Understanding Medicare Advantage Plans

Comparing Part C Medicare Advantage to Original Democratic

The most important reason in my opinion for choosing A/B/C over Original Democratic-Party Medicare is that public Part C Medicare health plans must by law (or long-established CMS regulation) protect seniors against financial catastrophe. Original Democratic-Party Medicare has multiple types of lifetime limits (one for hospitals, another for skilled nursing facilities, another for durable medical equipment, etc.). This huge limitation of Original Democratic-Party Medicare is not changed by Obamacare Adding a private Medigap plan effectively provides such protection but does not guarantee it. In some states, private Medigap plans are available with catastrophic coverage.
Source: typepad.com

Year 2011 Medicare Supplemental Insurance Policy Coverage Changes

Should be it possible for the full coverage regulations to be good value? Take into mental this example even there is the particular family of give consideration to that engages about a travel present for a at least two week trip and so they end set up taking a scheme amounting to the particular hundred and 26 four thousand $ $ $ $ on a detailed travel insurance insurance option with provisions designed for accidental death then dismemberment, emergencies medical expenses, travel delays and cancellations, and lost collectibles. The normal top quality price range about such an an insurance policy policy will oven from two one hundred to two 100 and fifteen us for the person.
Source: flloecdelft.org

Engineered: The Center for Medicare and Medicaid Innovation (2/2)

Atlantic General Hospital Corporation (funding amount: $1.1 million, estimated 3-year savings: $3.5 million) “to improve care for Medicare beneficiaries [in Worcester County, MD] with either a primary or admitting diagnosis of congestive heart failure, chronic obstructive pulmonary disease or diabetes, who currently rely on high cost ER visits and Acute Care admissions.”
Source: typepad.com

Medicare Plan C or Part C??Are They the Same or Different? » Toni Says

, 2013 answers questions such as the difference in Plan C or Part C., donut hole, difference between “Original” Medicare, a Medicare supplement or Medicare Advantage Plan. These questions and many more will be answered at the Confused about Medicare Workshop to be held at The Abbey at Westminster Plaza, 2865 Westminster Plaza Dr., Houston, TX 77082 on Wednesday, May 15th
Source: tonisays.com

As boomers ease into Medicare, battle rages over health

For Truman it was a moment of political triumph. As president, in 1945, he had proposed a national health care system – for all ages. The American Medical Association, representing the nation’s doctors, called it “socialism” and fought him off. President John F. Kennedy revived the idea, but focused it on the elderly. The medical establishment fought that proposal too, with help from an up-and-coming conservative named Ronald Reagan. Southern whites opposed Medicare, as well, enraged that it would end the racial segregation of hospitals.
Source: spokesman.com

Cost Sharing in Medicare Supplements plans C and F

In a previous letter dated Dec. 19 the NAIC stated “We were unable to find evidence in peer-reviewed studies or managed care practices that would be the basis of nominal cost sharing designed to encourage the use of appropriate physicians’ services. Therefore, our recommendation is that no nominal cost sharing be introduced to Plans C and F. We hope that you will agree with this determination,”
Source: imms.com

Medicare Advantage Plans Texas – Eligibility and Plan Options

Posted by:  :  Category: Medicare

The Medicare Advantage plan comes as a significant part of the original medicare policy, and incorporates the coverage benefits of the traditional Plan A and Plan B Medicare plans, and other supplemental coverage as well. Any Texas resident can secure a medicare advantage policy, given that the individual qualifies the standard eligibility criteria for the same. To qualify for Medicare Advantage plans Texas, you must live in the constituency or area that has the plan, and must also have both the Medicare Plans Part A and B. However, if you are suffering from some end-stage renal disease, you may not qualify for the same. But a plan cannot drop you if you are diagnosed with the disease while already being a part of the plan.
Source: mclaininsurancegroup.com

Video: Dual-Eligible Budget Cut Crushing Patients, Doctors Across Texas

Texas Medicare: The Way To Go

At the end of the day, after carefully scrutinizing each health plan available, it all boils down to one question: “Which plan suits my needs?”   The answer to this can be arrived at by spending time analyzing your health needs vis-à-vis the available health plans offered by various companies.  We have to consider a lot of factors in choosing the right health care plan for us, especially because these health care plans can cost a lot of money.
Source: medicarebase.com

medicare coverage online tools 

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Source: texasfamilybenefits.com

Home health care helps make Dallas’ Medicare spending among highest in nation

2010 2011 Apple Australia BCCI Business Bussiness Cancer care China Cricket CWG Education England Entertainment Environment Environmental Football Gadgets Games Gold Google Health Hockey India Indian IPL IT Lifestyle Life Style Marketing mental Mobile Obama Pakistan RBI Sensex Sports Technology Tennis Test Tourism Travel Travel & Tourism World Business (2427) Education (2966) Entertainment (785) Environment (878) Health (1567) Life Style (647) Marketing (1215) Sports (3501) Technology (1106) Travel & Tourism (744)
Source: yourdailyupdateblog.com

Delta Dental partners with Superior HealthPlan to provide dental benefits to Texas STAR enrollees

STAR+PLUS: STAR+PLUS is a Texas Medicaid managed care program for low-income people who have physical or mental disabilities or who are elderly. Offered in the San Antonio and Corpus Christi areas, the program includes such benefits as primary and specialty physician care, prescription drugs and medical supplies, mental health care, hospital care and vision services. It also offers many other services ranging from language interpretation and health care service coordination to meal delivery/preparation assistance, housekeeping and adult day care. The value-added dental services, available only to STAR+PLUS Members who are not enrolled in Medicare, include one periodic exam per benefit year, an emergency exam, certain x-rays and extractions. Effective June 1, Delta Dental also will administer the dental benefits for Members enrolled in the STAR+PLUS waiver program, which includes a $5,000 maximum benefit year. For more information, visit Superior’s website: http://www.superiorhealthplan.com/about-us/superior-healthplan-starplus/
Source: deltadentalins.com

A Cancer Doctor’s Take on Medicaid Expansion

Posted by:  :  Category: Medicare

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Third, compromise.  I agree with the governor that we need to reform health care and make it more accountable.  We at Mercy are “all in” when it comes to accountable care.  We have already developed an accountable care plan for our own employees.  We have developed an accountable care plan for our Medicare patients and we have developed an accountable care plan for a segment of our privately insured patients.  We have already had a meeting with the Medicaid office to discuss developing accountable care around Medicaid.
Source: iowahospital.org

Video: Medicare Information for Iowa by Medicare Pathways

Bleeding Heartland:: Latest Iowa Medicaid expansion news and discussion thread

Our estimates of new federal and state spending resulting from Medicaid expansion in Iowa differ from the Milliman, Inc. estimates.7 For example, this report uses the Urban Institute estimates of $459 million in direct Medicaid savings from 2014 to 2020 due to the Medicaid expansion, while Milliman estimates that the state will save $118 to $206 million, exclusive of the “woodwork” enrollment effect which would occur regardless of whether the state expands Medicaid.8 While the estimates vary in magnitude, they are similar in that they indicate a net state savings associated with a Medicaid expansion because of the higher federal matching rates for those who are newly eligible in an expansion. In contrast, our estimates for additional federal matching revenues generated by the Medicaid expansion ($4.1 billion from 2014 to 2020) is in the range of the federal revenue estimates produced by Milliman ($2.7 to $4.8 billion), so those are closer. All estimates-others and ours-are approximate since it is impossible to know in advance exactly what the condition will be of the state’s economy, how many people will participate or how high medical costs will be in the future. However, our projections provide a general sense of the overall magnitude and direction of expected economic and budgetary impacts.
Source: bleedingheartland.com

In brief: Numotion launches repair program, senators seek more transparent Medicare program

Another class action lawsuit has been filed against Invacare for allegedly issuing false statements to its investors, this time by the Lifshitz Law Firm, based in New York. The lawsuit alleges that Invacare failed to disclose their noncompliance with Food and Drug Administration guidelines to investors, among other alleged violations…Nonin Medical, a manufacturer of noninvasive medical monitoring products, was named a Prime Platinum Partner by Tri-anim Health Services for the second consecutive year. Selection is based on several parameters, including financial, operational and product innovation strength…ResMed is using Numera Social, a telehealth platform, to power its online patient engagement tool called SleepSeeker. Numera Social allows patients to upload readings, track progress, set goals and share updates with friends and family…The VGM Group has signed an agreement with Benefits365, a company that helps HME providers convert beneficiaries to Medicare Advantage plans. Ron Bendell, president of VGM and Associates, says the agreement will expand the options for his members…Brightree debuted at No. 79 on the Healthcare Informatics 100 list, a ranking of the top healthcare IT companies in the U.S. based on revenue during the past fiscal year. Since 2005, Brightree’s revenue has climbed at an average annual rate of 85%…Össur Americas, a manufacturer of prosthetics and braces, signed a deal with Canton, Ohio-based Harrington Management Group (HMG) to provide reimbursement support for prosthetists who supply Össur’s bionic prostheses…The DeVilbiss clinical education team has created a lineup of live webinars in which providers can earn continuing education credits (CEUs). The webinars have been pre-approved through the American Association for Respiratory Care (AARC) and the Canadian Society of Respiratory Therapists (CSRT) so sleep technologists and respiratory therapists can earn the professional credits.
Source: hmenews.com

Medicare Part D oversight works against Iowa patients

The study demonstrated that physicians have administered elderly dementia patients extremely dangerous antipsychotic drugs in clear disregard of government warnings. Other doctors used pharmaceuticals in ways that medical experts claim have little scientific basis and may be harmful. In 2010, drugs that had been pulled from other markets years earlier were still being given to elderly patients en masse, even though professional organizations knew that seniors should not be taking them. In the past, nursing home abuse of this nature has resulted in deaths and multimillion-dollar court judgements against care providers.
Source: iowa-injury.com

AOA Washington office staff member earns accolades in Iowa

The effort to overturn the WPS coverage policy is a good example of how the AOA and its state affiliates work together to benefit optometrists at the state, regional and national levels, Peele said after the meeting. As AOA assistant director of regulatory policy and outreach, Peele’s primary focus is to direct association interaction with federal agencies, including the U.S. Department of Health & Human Services, which oversees Medicare. In that capacity, Peele advocates for federal health care policy that affects how AOA members practice and get paid. He is a registered lobbyist and is on the staff of the AOA Federal Relations Committee. Peele, whose parents were both doctors, was born in Washington, D.C. His upbringing ignited a passion in him for the health care industry and, more specifically, health care law and policy. He studied engineering before receiving his undergraduate degree in mathematics and philosophy from Duke University, where he also received a prestigious Senior Leadership Award.
Source: newsfromaoa.org

“Practicing Without A License”: Iowa Governor Must Personally Decide Whether Each Poor Woman On Medicaid Deserves Abortion Coverage

But now Iowa is going a step further. If a woman who gets her health care through Medicaid has an abortion that falls under one of the exceptions in the state’s abortion coverage ban — if she has been a victim of rape or incest, if her fetus has fatal abnormalities that won’t allow it to survive outside the womb, or if her life will be put in danger unless she ends the pregnancy — she’ll need to have her case approved by the governor’s office. Presumably, Branstad will choose whether to approve or deny each woman’s request for insurance coverage for her abortion. It’s the first law of its kind in any state.
Source: mykeystrokes.com

Groups push for Medicaid expansion

The loose coalition that included AARP, the American Cancer Society and Iowa Catholic Conference, has support of Democratic lawmakers. Sen. Jack Hatch, D-Des Moines, and Rep. Lisa Heddens, D-Ames introduced legislation Tuesday that would make more Iowans eligible for the program that provides health benefits for about 400,000 Iowans.
Source: thegazette.com

Editorial: Making the case for Iowa’s expansion of Medicaid

For Arnie, health insurance under Medicaid will mean he has access to primary care and case management, as well as to emergency room care and hospitalizations. This may enable him to better keep on his medications, manage his diabetes and be less prone to acute episodes resulting in high-cost hospitalizations and emergency room care. In any event, if he is hospitalized or receives emergency room treatment, the hospital will have a billing source, which will reduce the amount of charity care the hospital provides (which is factored into charges to insured patients).
Source: cciaction.org

Corrected: New Jersey’s Christie vetoes Medicaid expansion bill

Posted by:  :  Category: Medicare

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The vetoed bill would have removed the flexibility to opt out of the Medicaid expansion if the federal government changed the terms of the current favorable matching rate, the spokesman said. The governor had discussed publicly his intention to maintain this flexibility when he signed onto the expansion, the spokesman said.
Source: rawstory.com

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

Exchanging Medicaid for a Better Option in Georgia

What the article neglects to explain is that many of the people who would be forced into Medicaid will now have the opportunity to enroll in highly-subsidized, private coverage in the health insurance exchange. Private insurers in Georgia pay physician fees that are about 40% higher than what Medicaid pays for the same service. Using this ratio as a proxy for the higher insurance reimbursement, according to NCPA analysis Georgia doctors and hospitals would enjoy more than $2 billion over a decade in additional spending on the uninsured living at or above poverty compared to Medicaid if they had private coverage rather than Medicaid.
Source: ncpa.org

Los Angeles Medical Supply Company Owner Sentenced to Five Years in Prison in $8.4 Million Medicare Fraud Scheme

WASHINGTON—The owner and operator of a durable medical equipment (DME) supply company was sentenced today to serve five years in prison in connection with a health care fraud scheme involving Latay Medical Services, a DME company based in Gardena, California. The sentence was announced by Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division; United States Attorney for the Central District of California André Birotte, Jr; Glenn R Ferry, Special Agent in Charge for the Los Angeles Region of the United States Department of Health and Human Services Office of Inspector General (HHS-OIG); and Bill L Lewis, Assistant Director in Charge of the FBI’s Los Angeles Field Office. Bolademi Adetola, 47, of Harbor City, California, was sentenced today by United States District Judge George H Wu in the Central District of California. In addition to her prison term, Adetola was sentenced to serve three years of supervised release and ordered to pay $4,555,198 in restitution. On March 1, 2013, Adetola was convicted by a jury in federal court in Los Angeles of one count of conspiracy to commit health care fraud and 12 counts of health care fraud. During trial, the evidence showed that Adetola, as the former owner and operator of Latay, fraudulently billed millions of dollars to Medicare for DME that was either never provided to its Medicare beneficiaries or was not medically necessary. The trial evidence showed that between January 2005 and October 2009, Adetola paid cash kickbacks for fraudulent prescriptions for DME, such as power wheelchairs and hospital beds. The evidence at trial showed that a co-conspirator physician wrote prescriptions for power wheelchairs and other DME that the Medicare beneficiaries did not need and ultimately never used. The co-conspirator physician testified that Adetola paid him cash kickbacks for every fraudulent prescription that he wrote for the DME and that Adetola used his prescriptions to bill Medicare for the power wheelchairs and other DME. Several Medicare beneficiaries testified that they were lured to medical clinics with the promise of a free recliner sofa, only to receive power wheelchairs that they did not need and did not want. According to the testimony, the beneficiaries were unsuccessful in their attempts to reject delivery of the power wheelchairs from Adetola’s supply company. In addition, the trial evidence showed that Adetola billed Medicare for DME supposedly provided and delivered to Medicare beneficiaries who were deceased at the time of service. One particular claim submitted by Adetola to Medicare showed that the Medicare beneficiary’s death preceded the date the Medicare beneficiary supposedly signed for the service. As a result of this fraud scheme, Adetola submitted and caused the submission of over $8.4 million in false and fraudulent claims to Medicare and received over $4.5 million on those claims. The case is being prosecuted by Assistant Chief Benton Curtis and Trial Attorney Blanca Quintero of the Criminal Division’s Fraud Section. The case is being investigated by the FBI and the Los Angeles Region of HHS-OIG. The case was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the United States Attorney’s Office for the Central District of California. The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention and Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,500 defendants who have collectively billed the Medicare program for more than $5 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers. To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov. Reported by: FBI
Source: 7thspace.com

Health Subcommittee Examines Proposals for Reform and Improvement of the Medicare Part B Drug Program

Reimbursement rates under Medicare Part B have caused the shift of some patient populations, including those with cancer and other rare diseases, from physician offices to hospital outpatient centers. The reimbursement shift, as coupled with community cancer centers closing, has caused an increased cost to the Medicare system and patients. As Brooks added, “Medicare payments for chemotherapy administration services in hospital outpatient settings have more than tripled since 2005, while payments to community cancer clinics have actually decreased by 14.5 percent.”
Source: house.gov

Medicare by the Scary Numbers

Take one source of optimism that the trustees are compelled to transmit in their latest report. Its predicted expenditures are based on the assumption built into the law that next Jan. 1 there will be a 25% decrease in the fees that Medicare pays doctors. That means that every doctor in America who participates in Medicare will take a 25% pay cut. The reason has nothing to do with ObamaCare. In the Balanced Budget Act of 1997, Congress declared that Medicare physician fees could grow no faster than the economy as a whole. Since then, though, Congress has postponed the cuts on 14 occasions, not allowing them to take place. Why assume things will be different now?
Source: ncpa.org

Physician Office Medicare Part D Reimbursement for Vaccines

With the TransactRx Part D Vaccine Manager, your practice can determine Part D eligibility in seconds by entering a patient’s name, date of birth, and the last four digits of their Social Security Number. You can also find out how much a patient has to pay for a specific vaccine and how much your practice would be reimbursed. Once a vaccine has been administered, you can send the Part D claim in real-time to the patient’s PBM with just one click. You can also verify the claim’s acceptance and check the status of payments on outstanding vaccine claims. Plus, the billing and coding rules built-in to our vaccine billing system allow physicians to submit accurately coded claims without any special training.
Source: transactrx.com

Medicare Access in Tallahassee: Milestone or Millstone?

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

Research Roundup: ‘Welcome

The Kaiser Family Foundation/University of California, Berkeley/University of California, Los Angeles: Transitioning Beneficiaries With Complex Care Needs To Medicaid Managed Care: Insights From California – According to the report, California’s Medicaid program for low-income individuals, known as Medi-Cal, transitioned close to 240,000 seniors and people with disabilities into Medicaid Managed Care between June 2011 and May 2012. This transition from a fee-for-service to managed care program, the authors add, did not include seniors and people with disabilities who were dually eligible for both Medi-Cal and Medicare, the federal health program for those 65 years and older. The researchers examined how health service providers, plan administrators and community-based organizations in Contra Costa, Kern, and Los Angeles Counties handled this transition. “Even when steps are taken to mitigate anticipated issues and concerns prior to the transition, as was the case with California, unanticipated challenges are likely to arise,” the authors write. Their findings, the authors highlight in this report, may serve as guide to inform similar transitions elsewhere (Graham et al., 6/25).
Source: kaiserhealthnews.org

Chris Christie blocks Medicare expansion for New Jersey

While that has failed because Democrats still hold a majority in the Senate, many states led by Republicans have attempted to undermine the law by refusing to expand Medicaid, a program created by the federal government and administered by the states to pay for medical services for the poor.
Source: realnewsnow.com

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July 03, 2013

Horizon Medicare Advantage Blue Value with Rx

Posted by:  :  Category: Medicare

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Please read through the full Horizon Medicare Blue Value with Rx HMO Summary of Benefits attached here for a more thorough review of the plan. I am also available to review this plan with you in a meeting if you wish. Due to marketing regulations, I have decided to list just the basics of the plan and but welcome appointments to discuss your full needs. Contact Mike at NewJerseyInsurancePlans
Source: newjerseyinsuranceplans.com

Video: Airport Assistence – New Horizon Medicare India

Medicare Marketing on the Horizon

Many thanks to the Council on Aging of Greater Nashville for this alert:  The Open Enrollment Period for Medicare, including Medicare Part D (Prescription Drug Benefits) and Medicare Advantage Plans, has started. That means that seniors will be receiving information on the many available plans.  Seniors should stay alert for information that will be mailed about possible changes to their current Medicare plan. 
Source: wholecareconnections.com

Medicare Changes On The Horizon

There are the kinds of items that are called “Durable Medical Equipment” and must come from the new list of approved suppliers if you want to get them paid for by Medicare.: -Oxygen, oxygen equipment and supplies -Standard power wheelchairs, scooters, and related accessories -Complex rehabilitative power wheelchairs and related accessories -Mail order diabetic supplies -Enteral nutrients, equipment and supplies (tube feeding) -CPAP (Continuous Positive Airway Pressure) equipment and RAD (Respiratory Assist Device) and related supplies -Hospital beds and related accessories -Walkers and related accessories
Source: kesq.com

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July 03, 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: Medicare Advantage Plan – What Does It Cost?

Top Medicare Part D Plan Costs Spike in 2013

The opinions expressed in WebMD User-generated content areas like communities, reviews, ratings, or blogs are solely those of the User, who may or may not have medical or scientific training. These opinions do not represent the opinions of WebMD. User-generated content areas are not reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other reason except for compliance with our Terms and Conditions. Some of these opinions may contain information about treatments or uses of drug products that have not been approved by the U.S. Food and Drug Administration. WebMD does not endorse any specific product, service or treatment.
Source: webmd.com

Medicare Advantage Fact Sheet

Since 2006, Medicare has paid plans under a bidding process.  Plans submit “bids” based on estimated costs per enrollee for services covered under Medicare Parts A and B; all bids that meet the necessary requirements are accepted.  The bids are compared to benchmark amounts that are set by a formula established in statute and vary by county (or region in the case of regional PPOs).  The benchmarks are the maximum amount Medicare will pay a plan in a given area. If a plan’s bid is higher than the benchmark, enrollees pay the difference between the benchmark and the bid in the form of a monthly premium, in addition to the Medicare Part B premium.  If the bid is lower than the benchmark, the plan and Medicare split the difference between the bid and the benchmark; the plan’s share is known as a “rebate,” which must be used to provide supplemental benefits to enrollees.  Medicare payments to plans are then adjusted based on enrollees’ risk profiles.
Source: kff.org

MedPAC on Medicare plan competitive bidding

Consistent with the goal of encouraging beneficiaries to make cost-conscious choices, this chapter presents an overview of a model based on government contributions toward purchasing Medicare coverage—an approach we call competitively determined plan contributions (CPCs). The Commission uses the term CPC to broadly describe a federal contribution toward coverage of the Medicare benefit based on the cost of competing options for the coverage, including those offered by private plans and the traditional FFS program. Specifically, CPC has two defining principles: First, beneficiaries receive a competitively determined federal contribution to buy Medicare coverage; second, beneficiaries’ individual premiums vary depending on the option they choose.
Source: theincidentaleconomist.com

Per Medicare Supplement May Help Cover Your Individual Health Care Will Cost You

On top of the other hand, Medicare advantage markets the services presented by original Medicare health insurance. Advantage techniques fall into so many different categories like desired provider organizations quite possibly PPOs that payment less fees due to in-network providers, healthiness maintenance organizations or possibly HMOs that request the plan stands to use in-network providers, private service fee for service or even PFFS that consent to the plan holders and cases to visit many physician and super needs plans along with SNPs for the particular patients in ought of special consider or admitted near nursing home. Moreover, these intentions sometimes offer Well being Savings Accounts or even HSAs to and the original Medicare give away dollars that could certainly be used designed for healthcare services.
Source: 7wief.org

What is the Cost of Medicare: 2013 Medicare Costs for Coverage

Keep in mind that each insurance company decides how it wants to set its premiums for Medigap policies. There are three ways in which Medigap policies may be priced or “rated.” Community-rated plans, also known as no-age-rated plans, are priced at the same monthly premium for all beneficiaries enrolled in the policy, regardless of age. Issue-age-rated plans, also known as entry-age-rated plans, prices premiums based on your age when you are issued the policy. Pricing for attained-age-rated plans are based on your current age, which means that the premium for your plan will go up as you get older. Outside of these pricing factors, Medigap premiums may also go up because of inflation and other factors. Depending on how a Medigap policy is rated, it will affect the cost of your coverage now and in the future.
Source: ehealthmedicare.com

Automatic Budget Cuts Lead GOP To Sharpen Focus On Medicare Cost

The Medicare NewsGroup: Automatic Cuts Are Underway: A Primer On Sequestration And The Impact On Medicare Doctors, hospitals, insurers and other health care providers will be subject to the cuts starting April 1. Some parts of the government are subject to bigger cuts, while others, such as Medicaid, are exempt. But if a deficit reduction deal is eventually reached it could still result in cuts to Medicare. Providers may not escape unscathed in such a deal and it could have a direct impact on beneficiaries. President Obama is open to increasing the Medicare Part B and D premiums paid by higher-income beneficiaries, while House Speaker John Boehner proposed raising the Medicare eligibility age from 65- to 67-years-old during the fiscal-cliff standoff last December (Sjoerdsma, 3/1).
Source: kaiserhealthnews.org

Medicare Essential plan worth considering

According to a new report from the Commonwealth Fund and Johns Hopkins Bloomberg School of Public Health, beneficiaries could save $63 billion in direct costs through 2023, with anywhere from 17 to 40 percent lower out-of-pocket expenses than recipients currently lay out. Other savings would come through simplified administrative costs, additional value-based health care decisions, and shifting beneficiaries into patient-centered medical homes and accountable care organizations that meet high standards for care coordination and management of high-risk, high-cost conditions.
Source: wordpress.com

Kaine signs on to Medicare medication bill

Boston Marathon Caroline County Celebrate Virginia Live Chancellorsville 150 Civil War Colonial Beach crime Culpeper Culpeper County Dahlgren Daniel Harmon–Wright Dominion Raceway earthquake Falmouth intersection fatal fire Fredericksburg Fredericksburg Baseball Fredericksburg Va. Getting There Health Care Historic Half Hurricane Sandy Interstate 95 King George King George County Natatia Bledsoe National Slavery Museum Orange County outage power outage Rappahannock River roads robbery Spotsylvania Spotsylvania County Stafford Stafford County storm traffic transportation UMW University of Mary Washington VDOT Westmoreland County
Source: fredericksburg.com

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July 03, 2013

Medicare ensures no interruption in services as UHC and UHIC plans terminate

Posted by:  :  Category: Medicare

Affected beneficiaries can choose to enroll in another Medicare Advantage or Prescription Drug Plan if they do not want to remain in Original Medicare or the newly assigned PDP. They have been granted a special election period during which they may make one change in their Medicare health care and prescription drug plan coverage. This special election period is in effect now through May 31. Coverage in the new plan is effective the first of the month following their plan selection. If a beneficiary calls 1-800-MEDICARE by March 31 and enrolls in a plan, the beneficiary’s coverage in the plan will be effective on April 1.
Source: thisisreno.com

Video: Medicare Changes for 2013 — Nancy Oliker — UHC TV

United Healthcare Telesales

Are you an Insurance Forums member yet ? To sign up for your FREE INSTANT account, please fill out the form below ! Username:     Password:   Confirm Password:     E-Mail:   Confirm E-Mail:          Question of the day:   2+7 equals I agree to forum rules 
Source: insurance-forums.net

Is United Healthcare Medicare Supplement Insurance My Only Choice For a Medigap Plan?

Medicare is a federal program. However, state officials regulate and administrate private health insurance coverage, such as United Healthcare Medicare Supplement Insurance. Insurance companies send out advertisements in the mail and run commercials on televisions that encourage senior citizens to sign up. United Healthcare has been offering insurance access for decades and is a familiar household name to many senior citizens. However, when it comes to getting the right healthcare coverage, Medicare recipients may want to explore all options.
Source: seniorcorps.org

AARP/UHC Medicare Advantage

Are you an Insurance Forums member yet ? To sign up for your FREE INSTANT account, please fill out the form below ! Username:     Password:   Confirm Password:     E-Mail:   Confirm E-Mail:          Question of the day:   How many zeros does 100 have? I agree to forum rules 
Source: insurance-forums.net

Any UHC Medicare Producers?

I was recently denied commissions on seven enrollments for the Evercare Dual Eligible Mapd because they say I wasn’t certified to sell it .The website they use to take and track certification called Learnshare showed that I had completed the course and the friendly PHD reps had on more than one occassion told on the phone that all my certifications where up to date but in fact i had failed to go through the last 4 slides when I originally taken the course The whole module could be done in about three minutes and there was no test to take.I didn’t find out about this until recently when I audited my commissions and called the producer help line who told me the reason I was denied commisiions was because I had to go through the last 4 slides on the module.. I then sent a service request to appeal this decision but was denied so as it it stands right now iam SOL My question is what is the next step I could take to try to get paid or file a complaint.How is it that I am not certified to sell this plan yet these customers are actively enrolled on the plan and calling me constantly with questions like dual eligible customers always do.I am obligated to spend time servicing these clients if I an mot the agent of record as far as commissions go? Usually I would help these people but I am feeling very spiteful here.
Source: insurance-forums.net

MedicareIsSimple: UHC Maintains Medicare Supplement Growth

At Medicare is Simple, we look to educate and enable you to choose among Medicare plans to find the policy that fits your needs. Get free quotes instantly using our advanced quoting technology. HealthCare Reform is a topic of interest to people of all ages, so we look to keep you updated on the issues that are part of that sensitive topic. Medicare Is Simple 233 W Main St Lewisville, TX 75057 800-442-4915 inf@medicareissimple.com
Source: blogspot.com

UHC Announces Changes to its Medicare Advantage Audits

UHC will no longer use MedAssurrant, the contractor that previously conducted its payment integrity audits. UHC will also make changes in the way that it conducts its Risk Adjustment Date Validation (RADV) audits. These audit request letters will be more clear about the reason for the audit and provide consistent information on follow-up medical record review, audit requests, and post-audit claim payment determinations. UHC will also update its payment integrity and recovery practices. Currently, UHC asks physicians to refund the full amount paid on the original claim and then resubmit the claim using the recommended coding. In the first quarter of 2012 physicians will only need to resubmit the claim with the recommended coding and refund only the difference between the amount UHC originally paid and the amount that should have been paid using the new coding. Physicians who disagree with UHC’s recommended coding should appeal the claims.
Source: wordpress.com

ACS NSQIP® data is more accurate than administrative data for tracking 30

The UHC database collects administrative data from billing information at 407 academic medical centers and their affiliated hospitals and benchmarks results to comparator institutions, but the data is never reviewed by clinicians. Dr. Wick and her team looked at readmission data for patients who had colorectal operations between July 2009 and November 2011 at Johns Hopkins University Medical Center, which uses both ACS NSQIP and UHC. During that time, 735 patients underwent colorectal operations. When the researchers compared how accurately NSQIP, UHC and patient chart review captured information on these patients, they found several important differences: The NSQIP database reported that 107 patients had been readmitted, while the UHC database said that 129 had been readmitted within 30 days.
Source: sciencecodex.com

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July 03, 2013

Medicaid expansion opponents argue it will “harm” the health of the uninsured as well as the state budget

Posted by:  :  Category: Medicare

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For example, one anti-expansion speaker cited data from states that have made, over the years, smaller expansions of Medicaid that are unrelated to the Obamacare expansion. The speaker said those states, which include Arizona, have found that more people than expected signed up for the expansion, and their medical costs turned out to be much higher than expected.
Source: pennlive.com

Video: Medigap Insurance in Pennsylvania by Medicare Pathways

St. Luke’s, Easton Hospital in Pennsylvania Settle Medicare Overbilling Claims

St. Luke’s University Health Network in Bethlehem, Pa., and Easton (Pa.) Hospital will pay nearly $1.5 million to resolve allegations they improperly overbilled Medicare, according to a Morning Call report. St. Luke’s will pay approximately $1.03 million to resolve the allegations, while Easton Hospital will pay approximately $455,000. St. Luke’s allegedly overbilled Medicare from 2002 through 2012 for evaluation and management services that were not billable under Medicare regulations. Easton Hospital faced similar allegations from 2004 through 2009. The allegations specifically pertain to a claim called “modifier 25,” which is to be used for same-day services for a patient only when the service is “significant, separately identifiable and above and beyond the usual preoperative and postoperative care associated with the procedure,” according to the report. In a statement, St. Luke’s said its alleged overbilling was the result of “significant confusion … as to when a modifier 25 should be used.”
Source: beckershospitalreview.com

Diabetics on Medicare Face Critical Deadline, Need Information

Throughout the year, our writers feature fresh, in-depth, and relevant information for our audience of 40,000+ healthcare leaders and professionals. As a healthcare business publication, we cover and cherish our relationship with the entire health care industry including administrators, nurses, physicians, physical therapists, pharmacists, and more. We cover a broad spectrum from hospitals to medical offices to outpatient services to eye surgery centers to university settings. We focus on rehabilitation, nursing homes, home care, hospice as well as men’s health, women’s heath, and pediatrics.
Source: wphealthcarenews.com

Roundup: Feds Cut N.Y. Medicaid Payments $1.2B; 93,000 Fewer Kids Enroll In CHIP In Pa.

California Healthline: Changes Set Stage For ‘Shakeout’ Of Medical Suppliers, Services Shifts in contracting practices — part of the trickle-down effects of health care reform — are going to change the landscape of medical equipment and service suppliers in California, stakeholders predict. … Bob Achermann, executive director of the California Association of Medical Product Suppliers … predicted the number of California businesses providing medical supplies and services may be cut in half over the next few years. Two changes are at the heart of the “thinning of the herd,” as Achermann calls it. One is state-driven: California is shifting beneficiaries of Medi-Cal — California’s Medicaid program — from fee-for-service to managed care. The second is a federally mandated change in the way Medicare contracts with suppliers (Lauer, 4/1).
Source: kaiserhealthnews.org

Obama Delayed Medicare Cuts Past 2012 Elections

In a nutshell, last April the Obama campaign realized that the news of his draconian cuts to Medicare Advantage was going to come out in October, just weeks before the election. So Obama (illegally) transferred $8 billion dollars of DHS money to Medicare Advantage, so that these cuts could be pushed back past the election.
Source: sweetness-light.com

Medicaid Expansion is Good for Pennsylvania

 Pennsylvanians deserve the same access to affordable health care as people living in neighboring states. Across our state there are so many men, women, and families without health coverage who are trying to somehow make ends meet on individual incomes of less than $15,000 a year.  They may have lost their jobs and are now struggling to find new ones. In many cases, they are working in jobs without health benefits.  They are likely foregoing preventative health care that can save lives and can reduce the need for expensive emergency room care, which contributes to dangerous ER overcrowding and costs that affect us all. Medicaid expansion will provide access to health care coverage for people who desperately need it, and will also infuse the commonwealth’s economy with hundreds of millions of dollars.  The federal government will pay the cost of the Pennsylvania’s Medicaid expansion for three years beginning in 2014.  After that, the federal contribution will still be 90 percent.
Source: aarp.org

Texas and Pennsylvania Medicare Plan F

Both Texas and Pennsylvania Medigap plan F makes up a huge amount of the Medicare population.  It is known that Medicare Plan F is purchased by approximately 46% of the country.  What about Medigap plan G in Pennsylvania?  Well, people are catching on.  KSKJ life Medigap plan G is becoming very popular in Pa.  Mutual of Omaha Plan F and Blue Cross Medicare Advantage plans are big among the people but other companies are gaining steam.  AARP Medigap plans have done well because of the AARP Part D plan is so well known.  Texas Medicare Plan F is big because the state is so enormous.  Medigap plans in Texas will always compete with Pa Medicare numbers.  ANTEX is a fan favorite in Texas Medigap plans as well as Blue Cross.  In Pa, I think Aetna Plan F is the way to go.
Source: wordpress.com

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July 03, 2013

CARR ALLISON Medicare Compliance Group: Workers’ Compensation Medicare Set

Posted by:  :  Category: Medicare

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The bill would also create a formal appeals process for parties in a workers’ compensation case to challenge CMS determinations. If CMS does not approve the MSA proposal, parties would have 60 days to file a reconsideration request, and CMS would have 30 days to respond or the original MSA proposal would automatically be deemed approved. Parties would have 30 days to request an ALJ hearing after an unfavorable response to a reconsideration request. If the ALJ issues an adverse decision or fails to issue a decision within 90 days, parties would then be able to seek judicial review of the CMS determination.
Source: blogspot.com

Video: Medicaid Set Aside

Workers’ Compensation: NJ Court Approves Medicare Set

“The court has thoroughly reviewed the sworn testimony of plaintiffs’ expert regarding the proposed set-aside amounts for future medical expenses relating to the underlying accidents/incidents, which would otherwise be covered or reimbursable by Medicare. The court finds that the proposed set-aside amount in each case fairly takes Medicare’s interests into account in that the figures are both reasonable and reliable. Therefore, the court is satisfied that Medicare’s interests have been adequately protected pursuant to the MSP. Plaintiffs shall set aside the proposed sums in self-administered interest-bearing accounts to be used solely for the purpose of satisfying future medical expenses related to the underlying accidents/incidents.” DUHAMELL, Plaintiff v. RENAL CARE GROUP EAST, INC., RCG Southern New Jersey, LLC, Philadelphia Suburban Development Corporation, Defendants. Catherine A. Ney, Plaintiff, et al,, — A.3d —-, 2013 WL 2102701 (N.J.Super.A.D.) Decided Dec. 7, 2012. May 16, 2013.
Source: blogspot.com

NJ Court Enforces Settlement notwithstanding “no review” status on Proposed Medicare Set

The court bases its decision today on notions of fairness and public policy. In the present case, both plaintiffs have submitted expert reports determining the proposed set-aside amounts for future medical expenses. Both reports were submitted to CMS for review, and CMS responded that they did not have resources to review the proposed set-asides. CMS does not provide any other policy or procedure for determining the adequacy of protecting Medicare’s interests for future medical expenses in conjunction with the settlement of plaintiffs’ claims. In light of the foregoing, and given the letters issued to plaintiffs lack the force of law, to require plaintiffs to force their case to trial when they have reached an amicable resolution outside of court, runs contrary to New Jersey’s strong public policy interests in encouraging settlements. Setting this type of precedent would cause a floodgate of litigation in our courts, resulting in expense and delay of the judicial process, where it would not otherwise be necesary. Such a result cannot be held to be in the interest of justice. Accordingly, the court finds it is necessary and appropriate to make a determination in the present matter.
Source: lienresolutiongroup.com

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

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

Workers’ Compensation Medicare Set

In an effort to address as many topics as possible, CMS is requesting stakeholders to submit non-case specific questions they would like to have addressed during the teleconference to the CMS MSP Central mailbox* prior to the teleconference. CMS will review and categorize the questions submitted and attempt to answer as many questions as possible during the teleconference. There may also be an opportunity for the stakeholders to ask questions after the presentation.
Source: medval.com

Medicare Set Aside Arrangements

Leading source of structured settlement information and news and expert opinion from John Darer, including settlement planning issues/ ideas, alternative deferred payment solutions, The Structured Settlement Watchdog™ commentary and exposes that may be helpful to attorneys, plaintiffs, claims adjusters, judges, the news media, sellers and buyers of structured settlement payment rights and interested others, Informative, irreverent and effective! Check back daily for something new, or simply ask structured settlement expert John Darer™ directly 203-325-8640
Source: typepad.com

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July 03, 2013

Medical Ins for first month until Medicare

Posted by:  :  Category: Medicare

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Source: australiaforum.com

Video:

Medicare Advantage Plan Star Ratings and Bonus Payments in 2012

To encourage Medicare Advantage plans to provide quality care, the 2010 health reform law authorized Medicare to pay plans bonuses beginning in 2012 if they receive four or five stars on the program’s five-star quality rating system, or are unrated. Building on that provision, the Centers for Medicare and Medicaid Services subsequently launched a demonstration that allowed more plans to receive bonuses and increased the size of the bonuses to encourage plans to maintain or improve their rating.
Source: kff.org

Can Your Insurance Agent Answer Medicare Questions?

As with standard medical insurance coverage, you can purchase Medicare supplemental plans (or Medigap plans). While with this plan you can cover most costs neglected by Parts A & B, neither plan includes the cost of prescription drugs. Covering these additional costs requires the purchase of another Medicare plan, Part D. With all these options combined, you should have practically all your medical costs covered and only the co-pay amounts for prescriptions to pay out-of-pocket. 
Source: findlocal-insurance.com

Medicare Advantage enrollees could take hit in 2014

“The Affordable Care Act helps us strengthen Medicare Advantage and Part D,” said Jonathan Blum, CMS acting principal deputy administrator and director of the CMS’ Center for Medicare in a statement last week. “We are working to ensure that people with Medicare have affordable access to health and drug plans, while making certain that plans are providing value to Medicare and taxpayers.”
Source: healthinsbrokers.com

Humana Medicare Advantage

Are you an Insurance Forums member yet ? To sign up for your FREE INSTANT account, please fill out the form below ! Username:     Password:   Confirm Password:     E-Mail:   Confirm E-Mail:          Question of the day:   How many zeros does 100 have? I agree to forum rules 
Source: insurance-forums.net

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