Medicare Advantage Fact Sheet

Posted by:  :  Category: Medicare

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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

Video: Medicare Supplement vs. Medicare Advantage Plans – A Doctor’s Perspective

Indiana Health Care Association: Indiana Health Coverage Program Change in Medicare Replacement Claim Processing

The Office of Medicaid Policy and Planning (OMPP) published notice on May 31, 2013 that a change will be made on Medicare replacement claim processing.  For claims received on or after June 27, 2013, the Indiana Health Coverage Programs (IHCP) will require a claim filing indicator of “16” when providers file Medicare replacement plan claims through an 837 electronic data interchange (EDI) transaction and Web interChange. Previously, providers were instructed to use a claim filing indicator of “MA” or “MB” when filing Medicare replacement claims. The IHCP will begin to validate Medicare replacement plan payer IDs based on the contract number published by the Centers for Medicare & Medicaid Services (CMS).  To view the posting, see http://provider.indianamedicaid.com/news,-bulletins,-and-banners/news-summary/the-ihcp-to-implement-change-in-medicare-replacement-claim-processing-.aspx.
Source: ihca.org

MedicareIsSimple: 2014 Medicare Advantage and Part D Maximum Commissions

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

Providers call out OIG for unnecessary report

It’s business. Medicare is officially a business just as every other health care payer.   The days of provider patient health care to benefit the patient are over.  The mentality for health care payers is lower the price first then reduce consumption.  The old one-two punch!  HMO’s and managed care companies became most successful lowering the reimbursement to health care Providers using the carrot guaranteeing Providers accessibility to Patient groups (offering volume sound familiar) then limited those services the HMO’s and Managed Care Companies paid!  HMO’s and Managed Care Companies had a wild card to add.  They, in order to enhance their bottom line began increasing the premiums to it’s members.  So HMO’s get a one-two-three punch.  Similar to “Cinderella Man” (Paulk Giamatti’s bop-bop-bam!).  I would anticipate a similar upward shift in both the medicare premium and deductible to follow in the not to distant future!  Giving them a one-two-three-four punch!
Source: hmenews.com

Transparent Medicare Physician Payment Reform Process Gains Momentum

The advanced draft legislation unveiled today incorporates feedback received from a broad range of bipartisan lawmakers and over 80 stakeholder organizations, representing ideas of committee Republicans and Democrats. The policy would repeal SGR and, in return, replace it with an improved fee for service system in which providers develop quality measures that will lead to better care in a more efficient manner. Better quality care will lead to better outcomes and put a greater emphasis on efficiency which can lead to cost savings. In addition, providers will have the option of leaving the fee for service system and opt instead for new ways of delivering care that put an even greater emphasis on quality and efficient care, particularly those that can mean more time with patients and more savings to the system. 
Source: house.gov

ICYMI: Health Affairs Article: Medicare Advantage Provides Higher

A recent article in the latest edition of Health Affairs provides further evidence that Medicare Advantage plans are delivering higher-quality care to seniors and people with disabilities than the fee-for-service (FFS) part of Medicare.  Data from the article show that Medicare Advantage beneficiaries utilize some health care services, such as the emergency department and ambulatory surgery or procedures, at a rate 20-30 percent lower than those in FFS Medicare.  This data suggests that Medicare Advantage enrollees “might use fewer services and be experiencing more appropriate use of services than enrollees in traditional Medicare.”
Source: ahipcoverage.com

How to replace the Medicare card is lost or stolen

If your Medicare card is lost, stolen or damaged, it is very important that you immediately get it replaced. This article on how to replace the Medicare card is lost or stolen, will provide you with the information they need in the least amount of time to get it replaced. Other people are reading How to get duplicate medical card lost Medicare card replacement instructions how you should do first. If you have recently moved, yet to do so, so you will need to report on social protection. Otherwise, replacement will be mailed to your address cards, social security and other aspects of your online. To do this, you can visit your local Social Security office, or you can call toll free at -800-772-1213.
Source: howfoodarticles.com

Medicare Replacement Plans

The problem of referring to a Medicare Advantage plan as a Medicare replacement plans becomes evident when people mistakenly believe that they have left the Medicare program. Once you become eligible for Medicare, you remain eligible for Medicare, as evidenced by the fact that you can choose to receive your benefits from original Medicare by not renewing your Advantage plan for the following calendar year.
Source: affordablemedicareplan.com

2013 Medicare Physician Fee Schedule Requires Face

Posted by:  :  Category: Medicare

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On November 16, 2012, CMS published the calendar year 2013 Medicare Physician Fee Schedule final rule.  In this final rule, CMS implements a Patient Protection and Affordable Care Act (“Affordable Care Act”) requirement that patients have a face-to-face encounter with a healthcare practitioner before receiving certain durable medical equipment (“DME”). The Affordable Care Act “requires for certain items of DME, a physician documenting that a physician, a physician assistant (“PA”), a nurse practitioner (“NP”), or a clinical nurse specialist (“CNS”) has had a face-to-face encounter with the beneficiary pursuant to the written order” for DME.
Source: nortonrosefulbright.com

Video: Medicare Physician Fee Schedule; the Never Ending Debate

Replacing Medicare's Ridiculous Fee Schedule

1. John C. Goodman, “Markets and Medicare,” Wall Street Journal, February 23, 2008, http://online.wsj.com/article/SB120373015283387491.html; John C. Goodman, “A Framework for Medicare Reform,” National Center for Policy Analysis, Policy Report No. 315, September 2008, http://www.ncpa.org/pdfs/st315.pdf; John C. Goodman, “Reforming Medicare the Right Way,” John Goodman’s Health Policy Blog, June 13, 2011, http://healthblog.ncpa.org/the-only-way/.
Source: ncpa.org

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

Aetna to cut pathology reimbursement to 45

In 2011, Medicare paid between 18 and 30 percent more than other insurers for 20 high-volume and/or high-expenditure lab tests. Medicare could have saved $910 million, or 38 percent, on these lab tests if it had paid providers at the lowest established rate in each geographic area. State Medicaid programs and 83 percent of FEHB plans use the Medicare CLFS as a basis for establishing their own fee schedules and payment rates, although most pay less. However, unlike Medicare, FEHB programs incorporate factors such as competitor information, changes in technology used in performing lab tests, and provider requests in their payment rates. Some State Medicaid programs and FEHB plans required copayments for lab tests, which, in effect, lowered the costs of lab tests for the insurer.
Source: pathologyblawg.com

Physicians! Another Chance to Avoid a 1.5% Reduction of All Medicare Payments in 2013

Beginning November 1, 2012, CMS will re-open the Quality Reporting Communication Support Page to allow individual eligible professionals and CMS-selected group practices the opportunity to request a significant hardship exemption for the 2013 eRx payment adjustment. Significant hardship request should be submitted via the Quality Reporting Communication Support Page (Communication Support Page) on or between November 1, 2012 and January 31, 2012. CMS will review these requests on a case-by-case basis. All decisions on significant hardship exemption requests will be final.
Source: managemypractice.com

Changes in Medicare for Diabetic Supplies, Wheelchairs and Other Medical Equipment

If a beneficiary lives in a contracted area such as Denver and travel outside of the area, they must use a contracted supplier that serves that area to avoid being charged for the medical equipment.  Also if beneficiaries live outside of a contracted area, special rules may apply. This is especially important for individuals who might live on the Western Slope and come to Denver for treatment.  Individuals who live on the Western Slope are outside of a contracted area; for them the Denver supplier will be paid differently, than if the beneficiary were purchasing the equipment from a supplier on the Western Slope. Most individuals who use multiple types of medical equipment will find themselves working with more than one supplier for equipment, as none of the national suppliers provide all types of medical equipment.
Source: myprimetimenews.com

Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline, CPT Code Billing: E

Attestation requirements DENOMINATOR/NUMERATOR/ THRESHOLD/EXCLUSION * DENOMINATOR: Number of prescriptions written for drugs requiring a prescription in order to be dispensed other than controlled substances during the EHR reporting period; or Number of prescriptions written for d rugs requiring a prescription in order to be dispensed during the EHR reporting period, NUMERATOR: The number of prescriptions in the denominator generated, queried for a drug formulary and transmitted electronically using CEHRT, THRESHOLD: The resulting percentage must be more than 50 percent in order for an EP to meet this measure,  EXCLUSIONS: Any EP who: (1) Writes fewer than 100 permissible prescriptions during the EHR reporting period; or (2) Does not have a pharmacy within their organization and there are no pharmacies that accept electronic prescriptions within 10 miles of the EP’s practice Location at the start of his/her EHR reporting period. Additional Information . The provider is permitted, but not required, to Limit the measure of this objective to those patients whose records are maintained using certified EHR technology (CEHRT), Authorizations for items such as durable medical equipment, or other items and services that may require EP authorization before the patient could receive them, are not included in the definition of prescriptions. These are excluded from the numerator and the denominator of the measure , * Instances where patients specifically request a paper prescription may not be excluded from the denominator of this measure, The denominator includes all prescriptions written by the EP during the EHR reporting period.  As electronic prescribing of controlled substances is now possible, providers can choose to include aII prescriptions or only permissible prescriptions as long as the decision applies to all patients and for the entire EHR reporting period, The determination of whether a prescription is a ”permissible prescription” for purposes of this measure should be made based on the guidelines for prescribing Schedule II-V controlled substances in effect on or before January 13, 2010 , * An EP needs to use CEHRT as the sole means of creating the prescription, and when transmitting to an external pharmacy that is independent of the EP’s organization such transmission must use standards adopted for EHR technology certification, * EPs should include in the numerator and denominator both types of electronic transmissions (those within and outside the organization) for the measure of this objective, *  For purposes of counting prescriptions ”generated and transmitted electronically,” we consider the generation and transmission of prescriptions to occur concurrently if the prescriber and dispenser are the same person and/or are accessing the same record in an integrated EHR to creating an order in a system tiat is electronically transmitted to an internal pharmacy, * Providers can use intermediary networks that convert information from the certified EHR into a computer-based fax in order to meet this measure as Long as the EP generates an electronic prescription and transmits it electronically using the standards of CEHRT to the intermediary network, and this results in the prescription being filled without the need for the provider to communicate the prescription in an alternative manner. * Prescriptions transmitted electronically within an organization (the same legal entity) do not need to use the NCPDP standards, However, an EP’s EHR must meet all applicable certification criteria and be certified as having tie capability of meeting the external transmission requirements of 170,304(b), In addition, the EHR that is used to transmit prescriptions within tie organization would need to be CEHRT,
Source: medicarepaymentandreimbursement.com

Article > Medicare drug rebate bills enter US Congress

Posted by:  :  Category: Medicare

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“In Medicare Part D, as in the broader market for prescription drugs, large and powerful private insurers and pharmacy benefit managers negotiate discounts and rebates. Some of these purchasers represent total patient populations equal in size to the population of some European G-8 countries, and also negotiate on behalf of private employers and the Federal Employee Health Benefit Program (FEHBP),” Matthew Bennett senior vice president at the Pharmaceutical Research and Manufacturers of America (PhRMA), pointed out. The competition between health plans in Part D is the secret to its ability to offer beneficiaries broad choice and high enrollee satisfaction at an affordable premium and, as a result, prescription drug costs in Part D are hundreds of billions of dollars less than projected, he said. “The fact is that Part D is working for seniors and taxpayers. It has greatly achieved seniors’ access to medicines, held down premiums, achieved billions of dollars of savings on other Medicare costs by improving health, and cost hundreds of billions of dollars less than projected,” said Mr Bennett. In contrast, he went on, the Democrats’ proposed legislation “would bring higher premiums and co-pays, more restricted access to medicines for seniors and Americans with disabilities, and diminished research on the next generation of medicines.”
Source: pharmatimes.com

Video: Medicare rebate – Nick Xenophon

private health insurance medical levy surcharge medical expenses tax offset

A high net worth individual client was paying high tax rates. He approached Gotsis Rubic & Barbariol to consider his circumstances and advise him on to how to reduce his tax liability. The client was not very keen to acquire shares as he felt that he would have no control over his investment in this area. He wanted to start building up his assets but in such a way that he remained in control of his investments.
Source: com.au

Obama’s Medicare Drug Rebate Plan Could Save The Government Money But Also Hit Drug Industry’s Bottom Line

The Associated Press/Washington Post: A Look At How Administration Says Automatic Budget Cuts Would Diminish Government Services The sequester law exempts Social Security, Medicaid, food stamps and Medicare recipients’ benefits from cuts, but most programs are vulnerable. … The National Institutes of Health would lose $1.6 billion, trimming research on cancer, drying up money for hundreds of other research projects and eliminating up 20,000 private research positions nationwide. Health departments would give 424,000 fewer tests for the AIDS virus this year. More than 373,000 seriously ill people may not receive needed mental health services (2/15).
Source: kaiserhealthnews.org

Obama Medicare rebate plan could hurt drug companies

“For most companies, it’s probably a couple of percent hit to earnings, which is something clearly negative for the industry but manageable,” said Barbara Ryan, a long-term pharmaceutical industry analyst, who now runs her own consulting firm. “Whether it could happen or not is another question, but it’s unequivocally going to be the hot potato that’s thrown around for the industry.”
Source: medcitynews.com

Congress Bill Targets $140bn Medicare Drug Rebate Savings

However, Senior Vice President at the Pharmaceutical Research and Manufacturers of America (PhRMA) Matthew Bennett countered that many of the large private plans that provide prescription drugs under Medicare Part D already negotiate rebates for their beneficiaries. He said that “In Medicare Part D, as in the broader market for prescription drugs, large and powerful private insurers and pharmacy benefit managers negotiate discounts and rebates. Some of these purchasers represent total patient populations equal in size to the population of some European G-8 countries, and also negotiate on behalf of private employers and the Federal Employee Health Benefit Program (FEHBP).”
Source: eyeforpharma.com

Part D Politics: Medicare Drug Rebates or Price Controls?

While health care was barely mentioned in the recent State of the Union address, President Obama generated some interest in his proposal to cut Medicare spending by reducing “taxpayer subsidies to prescription drug companies.” That’s code for requiring pharma marketers to pay rebates on medicines provided by Medicare Part D plans to low income “dual eligibles” who previously received prescription drugs through state Medicaid plans. Savings to Medicare are calculated at about $150 billion over ten years, and many Democrats and consumer advocates think it’s a great idea.  
Source: pharmexec.com

Money Well Spent? Dubious Medicine on Medicare

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Source: wordpress.com

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July 08, 2013

In attack on health reform, Republicans target Medicare advisory board

Posted by:  :  Category: Medicare

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Rockefeller argued that politics needed to be taken out of the equation when it comes to setting Medicare payments to providers. So he and others proposed a 15-member board of health care experts, appointed by the President for six-year terms, which is required to recommend Medicare spending reductions if costs exceed fiscal targets set out in the health care reform law. Its first report to Congress is due in 2014.
Source: ctmirror.org

Video: **Jim Himes – How To Fix Social Security & Medicare** Westport, CT July 1, 2012

CONNECTICUT STATE COURT FINDS MSA NOT NECESSARY WHERE BENEFICIARY WOULD INCUR FUTURE MEDICAL BILLS

The court concluded that the settlement agreement did not reflect compensation for future medical costs that might be covered by Medicare.  Rather, the settlement amount represented payments for noneconomic damages, with a small portion to be used for non-Medicare economic damages. While there were conditional Medicare payments made to the plaintiff, the court held that the sum would be reimbursed to Medicare after the settlement amount was conveyed to plaintiff’s counsel. As such, the court found that the defendants in the underlying personal injury suit, along with their carriers, lacked liability for the payment of plaintiff’s future medical expenses. Typically, courts will only determine whether a settlement requires an Medicare Set Aside (“MSA”) in the following two situations: (1) where the parties agree that an MSA is required, but cannot obtain the approval of CMS for the MSA arrangement; and (2)  where the parties have a settlement agreement but disagree as to whether the settlement agreement’s terms included the creation of an MSA.  The decision in Sterret is unique in that the court appears to provide an advisory opinion with respect to whether a MSA was required as part of the settlement in a personal injury case.  Click here for a discussion of Early v. Carnival Corp., No. 12-20478, 2013 U.S. Dist. LEXIS 16711 (S.D. Fla. Feb. 7, 2013).
Source: themedicarespa.com

Medicare Supplement Rates Connecticut 2013

AARP AARP Connecticut AARP Medicare AARP Medicare Complete AARP Medigap AARP Medigap 2013 AARP Rates 2013 AARP Supplement AARP Supplement 2013 aetna Medicare Anthem Anthem High F plan Anthem Medicare Anthem Medigap Anthem Supplement Crowe and associates High Deductible F supplement how to choose a Medicare Advantage plan How to choose a Medicare plan how to choose a plan How to choose a supplement how to enroll in a medicare plan MAPD Med Advantage Medicare Medicare Advantage Medicare Advantage plans medicare b Medicare Complete Medicare Complete connecticut Medicare Connecticut Medicare part B Medicare part B cost Medicare part D Medicare plan Medicare Supplement Medicare Supplement Connecticut Medigap Medigap rates 2013 Medigap rates NY 2013 Original Medicare united healthcare United Healthcare AARP United medicare complete United Medicare complete 2013
Source: croweandassociates.com

Federal authorities target Medicare fraud

Earlier this month, the U.S. Centers for Medicare & Medicaid Services unveiled a plan to provide recipients with a new, easier to understand statement for claims and services. The new statements, which will be provided each quarter, should make it easier for people to understand exactly what their providers are billing. The redesigned statements, which are part of improvements made possible by the Affordable Care Act, should allow recipients to take a more active role in alerting authorities to possible instances of health care fraud – particularly when a provider bills for a service a patient did not receive.
Source: connecticutcriminaldefenseattorneyblog.com

Medicare Advantage Plans Connecticut « Insurance News from Crowe & Associates

Aetna- Currently offer plans in Fairfield, Hartford, Litchfield and New Haven county. They have a $0 premium plan HMO, $94.00 HMO and a $90 PPO plan. The $0 premium plan has benefits second only to Wellcare when compared to the other $0 premium plans in the state. They also have a substantial network to go with the plan and allow for access to any Aetna Medicare HMO provider nation wide. The Aetna PPO is not competitive at this point due to a $1,000 out of network deductible.
Source: croweandassociates.com

You’ve Earned a Say Connecticut Update: AARP Calling for Responsible Solutions, Not Harmful Cuts

In 2012, AARP launched a major national initiative called You’ve Earned a Say – to give our members and all Americans a voice in the continuing debate over the future of Medicare and Social Security.  In Connecticut, we hosted listening sessions and voter forums in local communities, and engaged thousands of residents through surveys and questionnaires.  Nationally, AARP engaged over 6.5 million people in the conversation.  We listened to your feedback and now we are taking the next step.  AARP is calling for responsible solutions that keep the promises our nation has made to seniors and their children and grandchildren, not harmful cuts.
Source: aarp.org

HealthSpring, Cigna Use Both Names To Market Medicare Plans

The television campaign is within the company’s existing marketing budget, said HealthSpring spokeswoman Graham Harrison. Cigna and HealthSpring researched each company’s brand to determine how to best market Medicare products in the future. The campaign is meant to build on Cigna’s strength as a known health service company and HealthSpring’s expertise in Medicare.
Source: courantblogs.com

$9.9 Million Settlement Reached In Connecticut Medicaid Fraud Case

Anusavice has also pled guilty to criminal charges which were brought by the United States government as a result of his involvement with the billing scheme.  Any restitution which Anusavice is ordered to pay as part of his plea agreement may be credited towards the $9.9 million settlement.  Under the terms of the settlement agreement, Anusavice and the companies are also barred from participating in any health care-related business in Connecticut or engaging in any other business with state agencies for at least ten years after he serves any prison time which may be imposed in connection with his conviction.  Interestingly, it appears that Anusavice had previously been convicted in Massachusetts for submitting false health care claims and was excluded by the U.S. Department of Health and Human Services from participating in Medicare and state health care programs, including Medicaid.  Connecticut alleged in its complaint that Anusavice violated this program exclusion by creating, through a series of corporations, a number of dental practices throughout the state that were operated by practicing dentists who billed Medicaid for services.  Connecticut also claimed that Anusavice violated his program exclusion by actively managing the practices by reviewing patient charts, suggesting dental procedures, reviewing billing records, reviewing income reports, interviewing and hiring dentists and providing overall management direction to the offices.  According to the state’s complaint, the dental practices failed to disclose the ownership interest Anusavice and/or his companies had in the practices as required by state and federal regulations.  This allowed Anusavice to implement the billing system that resulted in Medicaid being double billed for certain services or being billed for services which were not provided.  
Source: fraudwhistleblowersblog.com

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July 08, 2013

Newsroom – Blue Cross Blue Shield of Michigan broadens Medicare options with new Medicare Advantage PPO product

Posted by:  :  Category: Medicare

October 1 is the first day BCBSM and Medicare Advantage carriers across the nation can market their Medicare Advantage products for 2010. Beneficiaries in BCBSM Medicare Advantage products will receive letters in the next 10 days about the new product line-up. "Blue Cross remains fully committed to providing products to Medicare beneficiaries and will continue to have the broadest array of Medicare Advantage products in the state," said Mark Owen, BCBSM vice president for federal and individual business. "It’s important for Medicare beneficiaries to know that there is no immediate change to their coverage. They have until the end of the year to make their selection for 2010." In addition to the three BCBSM products for 2010, seniors also can select from three Medicare Advantage products offered by Blue Care Network, the BCBSM-affiliated HMO. "We will be working with insurance agents and other groups across the state to reach out to Medicare beneficiaries to help them navigate these product and premium changes," said Owen. Seniors who meet low income guidelines can receive subsidies from the state and/or federal government to pay for all or part of their premiums. Medicare Advantage premiums vary by product and region. The new PPO product is expected to provide beneficiaries with value for their premium. For example, the BCBSM Medicare Plus Blue PPO, which includes Part D prescription drug coverage, will cost between $61 and $141 a month (premiums vary by geographic region), while traditional BCBSM Medicare Supplemental (Medigap) Plan C plans cost $183 when combined with a stand-alone Part D BCBSM prescription drug program. Medicare Advantage plans offer Medicare benefits through private health insurance plans and most include Part D prescription drug coverage. When you purchase a Medicare Advantage plan, you do not need to also purchase a Medigap policy. Medicare Advantage plans are regulated solely by the federal government, while Medigap plans are regulated by the state. The announced product changes are only for Medicare beneficiaries who directly purchase their Medicare Advantage products, not for beneficiaries enrolled in a group plan. Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.
Source: bcbsm.com

Video: Excellus BCBS Medicare: What’s included in my Medicare Advantage Plan?

Blue Shield Insurance: Sell Blue Cross Blue Shield Insurance

“Hospital Services Corporation of Alabama” to open for business and sell hospital insurance. At that time, the organization employed only six people. We now have over simply showed their last receipt of payment as proof of insurance. Blue Cross and Blue Shield of Alabama – 1952 In
Source: blogspot.com

BCBS Medicare Advantage Plans

I would just cut your losses. Sitting around waiting for med advantage commish will destroy your focus. If it comes, then it comes. I would recommend never, ever selling that junk again and moving on. Sell a real insurance policy. If you don’t cut it off in your mind it will kill your focus, your sanity, and ultimately your business. There is nothing more insane then waiting to get paid by the govt’. Fool me once…
Source: insurance-forums.net

Blue Cross Blue Shield of Michigan Offers New Medicare Plans

HMO’s (health maintenance Organizations) let you select a primary care physician from the BCBS provider network and this PCP manages your overall care. He or she will refer you to a specialist or to a selected hospital for care should you need additional services beyond his scope of practice. Referring yourself to an outside provider will cause a forfeit of benefits and out-of-pocket costs. The four BCBSM HMO products, formerly known as Options 1, 2, and 3, will now be known as BCN Advantage Elements, Classic , and Prestige. The Blues Care Network will also continue to offer the BCN Advantage Basic Plan.
Source: emaxhealth.com

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July 08, 2013

Health Care Subsidy for Medicare

Posted by:  :  Category: Medicare

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“Please do not cut the Health Care Subsidy for Medicare-Eligible retirees.    The cutoff for the full $150 subsidy in the Senate budget is $1600 a month.  $1600/mo X 12 = $19,200/yr.  This amount is 124% of the federal poverty level.   You are jeopardizing the ability of retirees to continue to have health care, pay other bills and stay in their homes.  This is just not fair when there are tax loopholes that could be cut thereby hurting education, health care, senior citizens, disabled and disadvantaged people.”
Source: rpecwa.org

Video: Medicare Part 1: Eligibility and Enrollment

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

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

Study: Fewer Employers to Offer Pharmacy Benefits to Medicare

“With many medications having double-digit price increases, and with the continued consolidation among PBMs, this is a buyer’s market for PBM pricing,” said Paul Burns, a principal with Buck Consultants. “Employers should be aggressive in their negotiations. Any PBM contract that is 18 to 24 months old should be reviewed for pricing competitiveness as well as up-to-date contractual language.”
Source: industryweek.com

Medicare coverage for weight loss

If you are overweight and have excess abdominal fat, a weight-related medical problem, or a family history of such problems, you need to lose weight. Healthy diets and exercise can help people maintain a healthy weight, and may also help them lose weight. It is important to recognize that overweight is a chronic condition which can only be controlled with long-term changes. To reduce caloric intake, eat less fat and control portion sizes. If you are not physically active, spend less time in sedentary activities such as watching television, and be more active throughout the day. As people lose weight, the body becomes more efficient at using energy and the rate of weight loss may decrease. Increased physical activity will help you to continue losing weight and to avoid gaining it back.
Source: wordpress.com

Medicare’s Role for Dual Eligible Beneficiaries

This brief examines overall and per capita Medicare spending for these beneficiaries, including variations reflecting their diverse circumstances. It describes the characteristics of those with the relatively high and low Medicare costs and includes state-specific data on the share of Medicare beneficiaries who are also Medicaid-eligible.
Source: kff.org

Extending Social Security and Medicare Eligibility Ages

In light of the increase in life expectancy after age 65 and the decline in physically demanding jobs, it would be reasonable for the eligibility age for social security to rise to 68 or 70. The average age of retirement from the labor force for Japanese males is already only a little below 70, which shows that much higher retirement ages is feasible. Persons who are physically or mentally incapable of working would then opt for disability status. This is a rapidly growing category in most developed countries, despite the increase in physical and mental health of older persons, because of a weakening of qualifying standards. With more flexible labor markets for the elderly, such as reducing the fear of companies that they will be sued for discrimination against older workers, older men and women could retire from more demanding jobs, and take jobs that are less taxing. This is what happens to older men in Japan.
Source: becker-posner-blog.com

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

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

North Carolina Medical Society

Medicare eligible professionals (EPs) who do not demonstrate meaningful use for the Medicare Electronic Health Record (EHR) Incentive Program may be subject to payment adjustments beginning on January 1, 2015. Because payment adjustments are mandated to begin on the first day of the 2015 calendar year, the Centers for Medicare and Medicaid Services (CMS) will determine the payment adjustments based on meaningful use data submitted prior to the 2015 calendar year.
Source: ncmedsoc.org

MUST EMPLOYERS CARRY MEDICARE ELIGIBLE ACTIVE EMPLOYEES AND SPOUSES?

There is no legal way to remove just Medicare eligible spouses of active employees from an employer group plan or to have Medicare pay as the primary insurer for those individuals.  The Medicare Secondary Payer statute (MSP) 42 U.S.C. §1395y was specifically enacted in 2003 to ensure that Medicare benefits are secondary to employer plans when dealing with non-retirees.  In the context of Medicare, a primary plan is defined as “a group health plan or large group health plan, a workers’ compensation law or plan, an automobile or liability insurance policy or plan (including a self-insured plan), or no-fault insurance.”  The MSP does not allow Medicare payment for services for which it can reasonably be expected that payment will be made under a group health plan.  Medicare’s designation as the secondary insurer is upheld even if state law or the group health plan states that its benefits are secondary to Medicare.  The statute does exclude group health plans of small employers.  Small employers are defined by the statute as having less than twenty (20) employees for each working day in each of twenty or more calendar weeks in the current calendar year or the proceeding calendar year.   As you’ve probably guessed, the purpose of the MSP was to reduce federal health care costs by shifting the burden of primary coverage from Medicare to private insurance carriers. 
Source: sjlaboremploymentblog.com

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July 08, 2013

You Important Information On Medicare Vitamin Supplements Plan N

Posted by:  :  Category: Medicare

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Nattokinase is an molecule found in any kind of cheese like food, natto, made between fermented soybeans. There are hardy claims made because of properties. Personal it quickly decreases blood pressure, supervises cholesterol levels, plus prevents and equal breaks up thrombus. The heart is a a couple chambered, hollow muscle mass and double operating pump that can be found in the chest among the lungs. Heart failure diseases caused through process of high blood air pressure contributes to solidifying of the leading to tinnitus. Complementary and alternative medicine includes a number of different medical systems. Eastern cultures have been using traditional Chinese medicine, Ayurveda, and indian head massage for centuries.
Source: jndtecheng.com

Video: Health Insurance Information : About Medicare Dental Benefits

HHS Unveils Medicare Claims Data Detailing Hospital Price Information For Outpatient Treatment

Medpage Today: CMS Releases More Hospital Pricing Data The agency also released information on Medicare spending and utilization at the county, state, and hospital-referral region and the prevalence of certain chronic conditions among Medicare beneficiaries. Department of Health and Human Services (HHS) officials hope the additional publicly available data will help spur wiser decisions by consumers and provide researchers with better understanding of Medicare spending and utilization in more localized areas (Pittman, 6/3).
Source: kaiserhealthnews.org

How the Surge in Medicare Fraud Revocations Affects Physicians

Also, be vigilant when distributing sample pharmaceuticals to patients. Many drug companies provide physicians with free samples they can give to patients for free. It is perfectly legal to distribute these samples to patients free of charge, but not to sell them. Recently, the federal government has ramped up prosecutions against physicians billing Medicare for free samples.
Source: poweryourpractice.com

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

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

Transparent Medicare Physician Payment Reform Process Gains Momentum

The advanced draft legislation unveiled today incorporates feedback received from a broad range of bipartisan lawmakers and over 80 stakeholder organizations, representing ideas of committee Republicans and Democrats. The policy would repeal SGR and, in return, replace it with an improved fee for service system in which providers develop quality measures that will lead to better care in a more efficient manner. Better quality care will lead to better outcomes and put a greater emphasis on efficiency which can lead to cost savings. In addition, providers will have the option of leaving the fee for service system and opt instead for new ways of delivering care that put an even greater emphasis on quality and efficient care, particularly those that can mean more time with patients and more savings to the system. 
Source: house.gov

Redesigned with you in mind – your Medicare Summary Notice

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

Ban On Disclosure Of Information On Medicare Reimbursements Lifted

Dow Jones and another company, Real Time Medical Data – which uses Medicare data to help hospitals with marketing and strategic planning – subsequently moved to intervene in the Florida case.  Dow Jones argued that the 1979 injunction interfered with its ability to report on Medicare while Real Time Medical Data claimed that the public had an interest in the information given the billions of dollars which are spent in connection with Medicare.  According to Dow Jones and Real Time Medical Data, access to the reimbursement data could help expose Medicare fraud.  Dow Jones also argued that, “….the privacy interests of physicians no longer clearly outweigh the compelling public interest in monitoring a program that now consumes one out of every eight federal dollars.”  The court agreed and the 33 year old injunction has now been lifted.
Source: fraudwhistleblowersblog.com

Everything Elder Law: Medicare Blue Button Information Can be Accessed Using a Smartphone App

What happens when your dad who lives 1,000 miles away comes for a visit, gets sick, and needs medical care? How can local doctors access his medical information? MyMedicare.gov’s Medicare Blue Button is a computer program that allows patients on Medicare to download their medical history into a simple text file on their personal computers. Now, seniors can get the same Medicare data on their smartphones. Blue Button downloads three years of medical history and the Humetrix iBlueButton, a smartphone app, translates and displays the information in a simple-to-understand way on your mobile device. The file includes names, phone numbers and addresses of physicians as well as diagnoses, lab tests, imaging studies, and medications. The Blue Button service is available from the federal government for veterans as well as Medicare beneficiaries. More similar apps are in the development phases and will become available within the next twelve months. So, now when you take your dad who is visiting in for medical care, he can hand over his smartphone and provide his medical history to the doctor. There are privacy concerns, however, about electronic health records and this type of information being shared on smartphones. Federal Trade Commission rules don’t extend to medical information on a smartphone. Medical information on a smartphone app is not going to be protected beyond what’s in the privacy policy for the app or what’s the privacy policy for the social networking site. So be aware before you share! Did you know that, like medical records, your Advance Medical Directives can be stored electronically and available when they are needed most (on computers, but not via smartphone apps, yet)? These documents include your Living Will, Health Care Power of Attorney, HIPAA Release, Organ Donor Form, Funeral Arrangements, and all other Advance Directives. At The Fairfax Elder Law Firm of Evan H. Farr, P.C., we offer a service called
Source: blogspot.com

Patient Advisory: Important Information for Beneficiaries of Medicare Part B

jadtechnic Belleville, Ontario Canada worked in the plastic blow molding industry for over 30 years in many facets from inspection ( Quality control) to development team. Have had more then a passing interest in computers and the internet for over 20 years, some Web programming and design, on-line auctions and ecommerce from 1997 till 2006 . was involved with the online auction cooperative movement from 1999- 2002 .. ran my own Domains & web servers for online sales Store fronts , promoteing my auctions called Dman-N-Company , a niche type auction site Musicplus. Richard Dambrosi
Source: newscanada-network.com

Senator Asks States If They Alert Medicare to Problem Physicians

Chicago psychiatrist Michael Reinstein wrote an average of 20,000 prescriptions for the antipsychotic clozapine in Part D each year between 2007 and 2009, and another 14,000 in 2010. Last year, he was suspended from Illinois Medicaid, and the Department of Justice has sued him for fraud. But he remains able to provide services under Medicare. Reinstein has treated patients at more than 30 Chicago-area nursing homes and long-term care facilities. He has defended his prescribing in media interviews.
Source: propublica.org

Top 10 Online Resources for People on Medicare

Garrett Ball is the owner of Medicare-Supplement.US, as well as several other Medicare-related web resources. As an independent broker, Garrett assists people going on, or already on, Medicare with comparing the various Medicare plan options in an unbiased way and in a centralized place. Garrett’s position as an independent agent and experience specializing in this field give him the unique ability to help others navigate the Medicare “maze”.
Source: medicare-supplement.us

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July 08, 2013

As boomers ease into Medicare, battle rages over health

Posted by:  :  Category: Medicare

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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

Video: Understanding Healthcare Costs: Medicare Advantage

Health care law helps extend Medicare’s fiscal health

Despite many years of bipartisan support, Medicare has become a contentious partisan issue in recent years — Republicans have fought to eliminate the program and replace it with a voucher system in which seniors would get coupons they’d use to buy private insurance, while Democrats have pursued far more modest fiscal reforms. Both agree, however, on one thing: Medicare faces long-term fiscal challenges that will eventually need a remedy.
Source: msnbc.com

private health insurance medical levy surcharge medical expenses tax offset

A high net worth individual client was paying high tax rates. He approached Gotsis Rubic & Barbariol to consider his circumstances and advise him on to how to reduce his tax liability. The client was not very keen to acquire shares as he felt that he would have no control over his investment in this area. He wanted to start building up his assets but in such a way that he remained in control of his investments.
Source: com.au

Medicare Benefits and Cost

This fact sheet discusses Medicare cost-sharing requirements. Traditional fee-for-service Medicare imposes deductibles, coinsurance, and copays for Medicare services.  In addition, beneficiaries must pay premiums for receiving Part B (physician) and Part D (prescription drugs) coverage. Medicare does not cover certain essential services, such as vision, dental, and long-term care expenses, and beneficiaries must pay out-of-pocket for these services.  
Source: aarp.org

Immigration Reform And The Financial Health Of Medicare

Our study, published today as a Health Affairs Web First article, examines these variables as they relate to the Medicare program and finds evidence that contradicts the pervasive wisdom. We calculated the total dollars contributed to and received from the Medicare Hospital Insurance Trust Fund (“Trust Fund”), which pays primarily for inpatient care, for both immigrants and U.S. born citizens. We found that between 2002 and 2009, immigrants contributed $115.2 billion in excess of what they utilized. During this same time frame, US born persons withdrew $28.1 billion more than they contributed. Although we could not measure the contributions to the Supplementary Medical Insurance Trust Fund (which primarily pays for outpatient care), we examined average expenditures by immigrants and US-born persons to this fund and found that immigrants spent less than US born persons: $175 per year less on average.
Source: healthaffairs.org

5 Services Medicare Won’t Pay For

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 Health Insurance Counseling Volunteer Opportunity!

Please call Kimberlee Bluhm at Senior Community Services (952-541-1019 x 307) for more information and answers to any questions that you have. No insurance experience necessary, but the ability to be detail oriented and a year commitment are. There are ongoing trainings for current MHIC volunteers to keep all current on Medicare issues.  We are looking for people that have a willingness to learn about Medicare and help others with their questions.
Source: seniorcommunity.org

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July 08, 2013

Medicare Bill Would Reward Elderly for Good Health

Posted by:  :  Category: Medicare

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“As the population ages over the next decade, Medicare spending is projected to continue to grow at rates far outpacing inflation. This rate of growth is simply unsustainable, and if not checked, will eventually bankrupt the federal government. It’s critical Washington puts this vital program on a sustainable path by supporting cost-effective solutions that save and strengthen it,” said Portman. “By changing the focus of Medicare from dealing with people when they’re sick to incentivizing seniors to lead healthier lives, our Better Health Rewards bill will reduce Medicare’s soaring costs and save taxpayers’ money since healthier seniors who voluntarily opt-into the program will have fewer doctor and hospital visits and fewer chronic diseases. I’m glad it has the support of well renowned medical organizations such as the Cleveland Clinic and believe the Senate should take it up for bipartisan consideration.”
Source: medbill.net

Video:

New Report Shows Medicare Advantage Delivers High Quality Care for Seniors

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Source: ahipcoverage.com

Raiding Medicare: How seniors will pay for Obamacare

Other hospitals will be forced to operate in an environment of scarcity, with as many as 40 percent in the red, according to Foster. That will mean fewer nurses on the floor, fewer cleaners, and longer waits for high-tech diagnostic tests. It will affect all patients. Obamacare’s defenders say that cutting Medicare payments to hospitals will knock out waste and excessive profits. Untrue. Medicare already pays hospitals less than the actual cost of caring for a senior, on average 91 cents for every dollar of care. No profit there. Pushing down the reimbursement rate further, as the Obama health law does, will force hospitals to spread nurses thinner. When Medicare reduced payment rates to hospitals as part of the Balanced Budget Act of 1997, hospitals incurring the largest cuts laid off nurses. Eventually patients at these hospitals had a 6 to 8 percent worse chance of surviving a heart attack and going home, according to a National Bureau of Economic Research report.
Source: dailycaller.com

Seniors beware of Medicare scam

A new version of an ongoing scam is one where an “official” with Medicare is calling because Medicare is sending out new cards and he or she needs to verify some of your information. Of course the information they are looking for is your banking account information. Even the savviest seniors fall victim to these types of scams.
Source: sedalianewsjournal.com

Seniors' Knowledge and Experience With Medicare's Open Enrollment Period and Choosing a Plan: Key Findings from the Kaiser Family Foundation 2012 National Survey of Seniors

The survey finds one in four seniors say they are unaware of this annual opportunity to review and change their Medicare coverage, with even larger shares who say they are unaware of Medicare’s open enrollment period among blacks and Hispanics and those seniors in fair or poor health, with low incomes, and without a high-school diploma.
Source: kff.org

Medicare Urges Seniors To Fight Against Fraud

These newly redesigned Medicare Summary Notices are just one more way the Obama Administration is making the elimination of fraud, waste and abuse in health care a top priority. Because of actions like these and new tools under the Affordable Care Act, the number of suspect providers and suppliers thrown out of the Medicare program has more than doubled in 35 states.”
Source: ma4web.org

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July 08, 2013

Physician Office Medicare Part D Reimbursement for Vaccines

Posted by:  :  Category: Medicare

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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

Video: Medicare for All – MoKan demonstration at Blue Cross/Blue Shield offices in Kansas City, Missouri

Outpatient care vs. hospital care for Medicare beneficiaries may not be big money

For the new study, the researchers used data on emergency room and hospital care from 2009 and 2010 for a 5 percent sample of all Medicare patients – roughly 1.1 million people. Then, using computer models, they estimated how many hospital and emergency room charges could possibly be prevented with outpatient care.
Source: medcitynews.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

Federal authorities target Medicare fraud

Earlier this month, the U.S. Centers for Medicare & Medicaid Services unveiled a plan to provide recipients with a new, easier to understand statement for claims and services. The new statements, which will be provided each quarter, should make it easier for people to understand exactly what their providers are billing. The redesigned statements, which are part of improvements made possible by the Affordable Care Act, should allow recipients to take a more active role in alerting authorities to possible instances of health care fraud – particularly when a provider bills for a service a patient did not receive.
Source: connecticutcriminaldefenseattorneyblog.com

10 Reasons Why Your Doctor Won’t See Medicare Patients

The National Institute for Mental Health estimates that as many as five million elderly people in the U.S. suffer from subsyndromal depression, which can lead to major depression if left untreated. Depressed elderly are at high risk for suicide. Although senior citizens comprise only 12 percent of the U.S. population, they accounted for 16 percent of all suicides in 2004 (NIMH, 2007.) Helping patients with these types of issues often falls to the primary care physician, who may have a long-standing relationship with the patient. Although it is not condoned by Medicare, we know that many physicians do not charge adequately for counseling-type visits.
Source: managemypractice.com

Can A New York State Licensed Medical Provider Bill Medicare For Providing Medical Supplies For Beneficiaries Under A Medicare Certified Office For A Pending Certification Office?

Since the beginning of the year 2007, the federal government created the Medicare Fraud Strike Force to specifically investigate on Medicare fraud. Even if the medical provider is billing under a Medicare certified office while conducting the services in a pending Medicare certified office seems to fall under a grey area at the time, the OIG, and more specifically the Medicare Fraud Strike Force will not hesitate to launch a full-scale investigation once an investigator sees a discrepancy within the clinic’s billing process.
Source: jpdefense.com

Pharmacies unwilling to take loss on insulin for Medicare patients

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Source: tacticalminc.com

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