Crescendo Bioscience® Announces Medicare Coverage for Vectra® DA to Measure Disease Activity in Patients with Rheumatoid Arthritis

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With Vectra DA, physicians have an absolute metric that doesn’t depend on subjective inputs that can vary significantly and be difficult to interpret. By providing a specific and precise way to measure RA disease activity that complements a clinician’s expert assessment, Vectra DA helps facilitate more efficient management of patients. In addition to the advantages this provides in the context of an individual patient, Crescendo Bioscience developed VectraView – an online disease analytics tool that allows rheumatologists to order and manage Vectra DA tests, as well as evaluate the test results of all of their RA patients as a group. Furthermore, the Company has developed a patient support tool, a free iPhone app called MyRA
Source: crescendobio.com

Video: Medicare Audit Guidelines for Chiropractors – Subsequent Visits

Medicare decision to restrict coverage for Alzheimer’s test raises outcry from experts

In addition to Lilly, the draft guidance could affect a similar imaging agent being developed by General Electric Co’s GE Healthcare called flutemetamol now under review by regulators in the United States and Europe. Both are radioactive tracers designed to light up deposits of an Alzheimer’s-related protein called beta amyloid when used in conjunction with brain scans known as positron emission tomography, or PET.
Source: medcitynews.com

Medicare Power Wheelchair Coverage Guidelines

When a patient calls in to Aeroflow to get the process of getting a power wheel chair or scooter started, we ask some preliminary questions. To get a power mobility device it must be a necessary alternative to manual devices like a cane or walker, so we ask if they have a history of using assistive equipment or not. If a patient has not used these devices, it is suggested that they attempt using them or a manual wheel chair prior to a power chair. A cane, walker, and manual wheel chair all must be ruled out by a doctor as insufficient for the patient to complete their activities of daily living inside the home. These activities include cooking, cleaning, moving from room to room, and grooming.
Source: aeroflowinc.com

On private insurance, but under Medicare Regulations. Anyone else encounter this?

I also like to point out that I think that the whole issue is ripe for a class-action suit, making decisions about treatment without medical contact, cutting medical records, etc. The “damages” aren’t huge on a case-by-case basis but I suspect they could be quantified. It also would help a case that we don’t really care about $$$$ as much as getting coverage, in which case the only people making money on it would be the attorneys, which would likely enhance their interest in the case. I suspect that the Medicare guidelines and the weak and conservative AMA guidelines for supply needs stem from budgetary shortfalls but I am certain that were the issue to be explored, there’s a significant probability that actionable graft and corruption that would be a hook for the case.
Source: tudiabetes.org

Edgepark & Medicare’s New DMEPOS Supply Guidelines

Competitive Bidding Legislation The Medicare Modernization Act of 2003 (MMA) required that CMS institute a Competitive Bidding Program for DMEPOS. According to the CMS, “Under the program, DMEPOS suppliers compete to become Medicare and Medicaid contract suppliers by submitting bids to furnish certain items in competitive bidding areas, and the Centers for Medicare & Medicaid Services (CMS) awards contracts to enough suppliers to meet beneficiary demand for the bid items.” The intent of competitive bidding, in part, is to address cost issues with DMEPOS and providing additional supplier oversight to ensure that beneficiaries (patients) receive quality items at reasonable prices. (Before the competitive bidding program was in place, certain DMEPOS items were reimbursed to suppliers through a fee schedule.)
Source: edgepark.com

Bariatric Weight Loss Surgery & Medicare Services

Using a New England of Medicine paper by Dr. Robinson, The U.S. National Institutes of Health recommends bariatric surgery for obese people with a body mass index (BMI) of at least 40, and for people with BMI 35 and serious coexisting medical conditions such as diabetes. Long term effects of Bariatric surgery are not clear; pursuing variatric surgery as a therapeutic measure for obesity should be carefully considered and only after less invasive measures are exhausted.
Source: medicarebenefits.us

Comparing Medicare Supplement Insurance Plan Coverage

Posted by:  :  Category: Medicare

Many Medicare Advantage plans also include vision and dental coverage and have lower copays than Medicare. Although the co-pays for more expensive services such as hospitilization and surgery tend to be higher. If seniors have had hospitalizations in the past, make sure to check out the limitations on hospital coverage with the Medicare Advantage plans.
Source: allabout101.com

Video: Medicare Supplemental Insurance Comparison

Comparing Medicare Supplemental Insurance Benefits

These plans, called “Medigap” plans, each have different medical care coverage. Variable benefits of coverage to be considered are: • Coinsurance plus coverage that last 365 days after medicare benefits end (Medicare Part A) • Coinsurance/Copayment for medicare part B. • Pints of blood (transfusions, first three pints) • Hospice care copayments or coinsurance • Coinsurance for Skilled Nursing Facilities • Part A medicare deductible • Part B medicare deductible • Part B excess charges • Emergencies during foreign travel • Preventative care coinsurance, per Medicare Part B If any of these are important for you to have covered, comparing medicare supplemental plans that include benefits is the only way to ensure they are included.
Source: seniorcorps.org

Medicare Supplemental Insurance A Quick Buyers GuidePopular Insurance Ezine

Medicare insurance Supplemental Insurance coverage is relatively clear to see in comparison to other kinds of insurance. Although it might appear overwhelming in the beginning, Medicare insurance Supplement Plans happen to be standardized through the Center for Medicare insurance Services, making the purchasing process simplified in comparison to car insurance, or individual medical health insurance. Basically Medicare insurance claims what benefits you are able to and cant buy since you must choose a pre-packed plan. Although this makes the purchasing process simpler, you will find still several things to consider including the organization that you get your plan from, just how much you have to pay, and also the method that you buy.
Source: popularinsuranceezine.com

Comparing Medicare Advantage To Medigap

A Medicare Advantage plan is merely another way to receive your Medicare benefits. Rather than getting your benefits directly from original Medicare, a private insurance company, which is approved and contracted with Medicare, delivers your benefits.
Source: medicareprofs.com

10 Million Beneficiaries Enrolled in Medicare Supplement Program

Reaching the 10 million member mark is a notable landmark for the Medicare Supplement business. Medicare Supplement plans offer coverage of certain costs such as additional hospital coverage up to 365 days after Original Medicare benefits are exhausted, Part A and Part B co-payment or co-insurance coverage, and Part A and Part B deductible coverage. For an additional monthly premium, beneficiaries have the ability to have other potentially higher costs covered through a Medicare Supplement plan. These plans are offered through different carriers and may be priced differently, so it is recommended that you compare plans in your area to find one that is right for your needs. PlanPrescriber offers a Medicare Supplement Plan Comparison Tool that allows you to make side-by-side comparisons of plans in your area.
Source: planprescriber.com

Baby Boomers are Purchasing Medicare Supplement Insurance over the Phone

“It really is the best way to purchase Medicare Supplement Insurance, our agents only specialize in Medicare, our agents represent all of the top A+ rated insurance companies, and NO PAPERWORK”, Robert Bache aka “MedicareBob”.
Source: srhealthcaredirect.com

Compare Medicare Supplement Insurance to Medicare Advantage Coverage

Furthermore, you simply may not be able to switch back to a traditional supplement if you have certain preexisting conditions.  Most Medicare supplement providers require medical underwriting if you have been enrolled in an Advantage plan for over one or two years.  In other words, you can be declined coverage.  Additionally, it can be difficult to disenroll from a MA plan if it is not the correct time of year.
Source: ohioinsureplan.com

Medtronic Settles Sprint Fidelis Family of Defibrillation Leads Lawsuits

Posted by:  :  Category: Medicare

Under the terms of the agreement, Medtronic has agreed, subject to certain conditions, to settle U.S. lawsuits and claims pending as of October 15, 2010 for a total payment of $268 million.  The payment includes an amount for attorneys’ fees and administrative expenses.  The parties will file joint requests to terminate the Multi-District Litigation (MDL) and Minnesota state court proceedings related to the Sprint Fidelis leads and to dismiss the plaintiffs’ appeals pending before the U.S. Court of Appeals for the Eighth Circuit and the Minnesota Court of Appeals. The parties will also request dismissal of other Fidelis-related cases throughout the country. Medtronic can cancel the agreement if certain conditions are not met, and the agreement can be terminated by either party if the MDL proceedings are not terminated.
Source: gustafsongluek.com

Video: Fidelis Care Training and Opportunity!

FTD/Dementia Support Blog: FTD and Medicare

Now that I was off the 17 pills a day after being misdiagnosed for six years my head was slowly clearing from being kept in a medically induced fog. It took me close to a year to recover to my FTD self. My behavior, language and 6 year history was like a checklist for a poster boy FTD patient.  I was having many new difficulties which was discovered by my friend David and Dr. Blatt to have been side effects of the only drug I was on, Aricept. Dr. Blatt had contacted Dr. Ted Huey, a well known FTD specialist at Columbia. Dr. Huey confirmed that many FTD patients were having difficulty with Aricept, a drug made for Alzheimer’s patients. Aricept is now on the “medications to avoid” list by UCSF. Dr. Blatt suggested that I start seeing Dr. Huey or one of the FTD specialists at Columbia. The only problem was my insurance didn’t cover Columbia or any of the doctors in it.
Source: blogspot.com

Fidelis Health Insurance Medical Insurance Comparison

Texas Department of Insurance HMO Profiles. NOTICE: New email domain as of 12/10/11 – @tdi.texas.gov. Update your TDI addresses. Education, vigilance and thinking for oneself are the best defenses against regressive stupidity and obtuse religiosity. Vincit omnia veritas. Get rankings of New York insurance plans from the experts at Consumer Reports Health. (716) 564-3630 Located in Amherst, N.Y., Fidelis Care New York is a Roman Catholic heath care center providing various health care programs and services, including. Visit Fidelis Care in your neighborhood! Do You Need Health Insurance? Children, Adults, and Families I was recently approved for Fidelis insurance. NYS, form of Medicaid. I was wondering if anyone knows what isn’t covered. Is testing to see Avoid the NHS queues by comparing cheap private insurance quotes, dental plans and health cash plans in the UK. The fast and easy way to find out about many health and human services programs and how to apply for them – anytime and anywhere.
Source: individualmandatehealthcare.com

Urology Job in Southwest, New Mexico with Fidelis Partners :: Physicians Employment

To be considered for this urology opportunity, please contact Strider Murphy at (949) 325-7633 or forward your CV to smurphy@fidelismp.com. Job ID: UR 208573 For more urology opportunities, visit us online at www.fidelismp.com or follow us on Twitter @FidelisMP. You may also fax your CV to (949) 325-7011. All inquiries are considered confidential.
Source: physemp.com

An Exhaustive (and Exhausting) Medicare Roundup for November 18, 2011 Including the Revalidation Call Transcript, 5010 Enforcement Delay, Medicare Sends Less Collection Letters and ICD

Posted by:  :  Category: Medicare

Today the Centers for Medicare & Medicaid Services’ Office of E-Health Standards and Services (OESS) announced that it would not initiate enforcement action until March 31, 2012, with respect to any HIPAA covered entity that is not in compliance with the ASC X12 Version 5010 (Version 5010), NCPDP Telecom D.0 (NCPDP D.0) and NCPDP Medicaid Subrogation 3.0 (NCPDP 3.0) standards. Notwithstanding OESS’ discretionary application of its enforcement authority, the compliance date for use of these new standards remains January 1, 2012 (small health plans have until January 1, 2013 to comply with NCPDP 3.0).
Source: managemypractice.com

Video: Heartland Could be Removed from Medicare list of Providers Saturday

Kusserow’s Corner: Medicare Exclusion Database

Well, the answer to all these questions is simple.  Providers don’t need to worry about this.  Only those who are federal contractors to CMS are authorized access to the MED; and the MED is not accessible to the public, including the health care provider community.  The information is only available to those with “IACS IDs” – that is, “Individuals Authorized Access to the CMS Computer Services.”  The CMS credential/access system for the IACS requires potential users to register for different roles/systems and needs approval by CMS personnel.  Users must enter their account numbers and failure to do so will result in a rejected application.
Source: wolterskluwerlb.com

Your current Medicare provider may not be able to supply you with your medical supplies

PRLog (Press Release) – Jun. 10, 2013 – WELLINGTON, Fla. — What is the national mail-order program for diabetic testing supplies? A new national mail-order program for diabetic testing supplies is scheduled to start in July 2013. This program is designed to ensure that you continue to get quality supplies while you save money. When it starts, you’ll need to use a Medicare national mail-order contract supplier for Medicare to pay for your diabetic testing supplies that are delivered to your home. If you don’t want your diabetic testing supplies delivered to your home, you can go to a local store and buy them there, but you’ll probably pay more out-of-pocket costs. If you take advantage of the national mail-order program, diabetic supplies will be mailed or delivered to your home and Medicare will save money and your copayment will be lower. How does the program affect me if I use mail-order diabetic supplies? Starting in July 2013, Medicare will implement a national mail-order program for diabetic supplies that will affect everyone with Original Medicare in the United States and its territories. Can I still get my diabetic supplies from my local pharmacy? Yes, you can. The national mail-order program for diabetic supplies does not include pharmacies or other retail stores. However, if you go to your local store to get your supplies, you will probably pay more for these supplies than you would if you bought them from a mail-order Medicare contract supplier. Both you and the Medicare Program can save money each time you use a mail-order contract supplier. Where can a get a list of Medicare contract suppliers? Simply enter your zip code into the Medicare Supplier Directory search tool on the Medicare website at www.medicare.gov/
Source: prlog.org

What’s Covered by Medicare: Preventative Services

The Annual Wellness Visit (AWV) offers “Personalized Prevention Plan Services” (PPPS) and it covers nine key elements, many similar to what a Medicare beneficiary receives in their Initial Preventative Physical Examination. The AWV is a preventative wellness visit and not a “routine physical check-up”. In addition to the AWV, many vaccinations are also covered at no cost as well by Medicare; annual flu, pneumonia and hepatitis B. The shingles vaccine is covered, but you’ll pay a co-pay for the vaccination (This falls under your Part D Medicare coverage) and depending on what Medicare Supplemental or Advantage plan you have; a possible co-pay to the provider administering the vaccine.
Source: southcountymag.com

Buckeye Community Health Plan New Prior Authorization Process for Medicare Advantage

A dedicated fax line has been established for Advantage by Buckeye Community Health Plan (HMO SNP) prior authorization requests. Effective July 1, 2013, please send all Advantage by Buckeye Community Health Plan (HMO SNP) prior authorization requests to: 1-877-861-6722
Source: bchpohio.com

Vernie Fiorillo blog on Netlog

Posted by:  :  Category: Medicare

Behavior Therapy (Theories of Psychotherapy) book download Download Behavior Therapy (Theories of Psychotherapy) Rational Emotive Behavior Therapy (Theories of Psychotherapy) – Kindle edition by Albert Ellis, Debbie Joffe Ellis. The book is paired with a DVD (not included). Cognitive-Behavioral Therapy (Theories of Psychotherapy) by Michelle G. This book explores theories of reciprocal. Antony: Antony (psychology, Ryerson U., Canada). Behavior Therapy (Theories of Psychotherapy) by Martin M. Comprehensive in scope yet succinct in its descriptions and explanations, THEORIES OF PSYCHOTHERAPY & COUNSELING: CONCEPTS AND CASES, 5e equips readers with a solid. Antony. Cognitive-Behavioral Therapy (Theories of Psychotherapy) and over one million other books are available for Amazon Kindle. Theories of Behavior Therapy: Exploring Behavior Change Theories of Behavior Therapy compiles and explicates the spectrum of major. . Behavior Therapy (Theories of Psychotherapy): Martin M. Craske presents and explores this approach,. Craske:. person-centered therapy, behavior therapy, rational emotive behavior therapy,. In this book, Michelle G. This book examines with clarity and wit theories of counseling and psychotherapy.. Antony. functional analytic psychotherapy,. Download it once and read it on your Kindle device. Amazon.com: Rational Emotive Behavior Therapy (Theories of. Behavior Therapy (Theories of Psychotherapy) by Martin M. Theories of Counseling and Psychotherapy : A Case Approach. Learn more Cognitive-Behavioral Therapy (Theories of Psychotherapy): Michelle. Cognitive-Behavioral Therapy (Theories of Psychotherapy) by. Learn more Theories of Counseling and Psychotherapy: Concepts and Cases. Behavior Therapy (Theories of Psychotherapy) and over one million other books are available for Amazon Kindle
Source: netlog.com

Video: g0008 cpt

HCPCS Update: Prepare for Medicare’s July Coverage Changes to Zometa and Doxil Codes

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Source: inhealthcare.com

Secrets of the Medicare Physician Fee Schedule

The PFS is released in draft form each year in the Proposed Physician Rule and is finalized in late October in the final rule. RVUs get most of the attention because RVUs measure physician work and determine payment. CMS assigns CPT codes three values: work RVUs; practice expense RVUs; and malpractice expense RVUs. Work RVUs have become the most common measure of physician work, used in compensation agreements and to distribute bundled payments. Each of the three values is multiplied by Geographic Practice Cost Indices (resulting in different payments for the same CPT code, based on location), and then the sum is multiplied by a conversion factor to calculate how much is paid for the service. Some procedure codes have both facility and non-facility values— the practice value is lower than the facility value. Non-facility rates are higher and apply when the service is performed in a physician office or the patient’s home.
Source: physicianspractice.com

Failure to Pay for New Molecular CPT Codes Creates Money Crisis for Clinical Laboratories and Pathology Groups

“Pathologists and laboratory professionals have still been providing services since January without reimbursement [for claims submitted with the new molecular test CPT codes] . However, if these services are poorly reimbursed, people will say: ‘Why do I want to provide the services?’ Then, patients and other clinicians will not trust innovation in laboratory medicine. It’s a travesty to be held in this situation,” stated pathologist Mark Synovec, M.D., FASCP, on the website of the American Society of Clinical Pathology. Synovec will be speaking on this topic at the fall conference conducted by ASCP. (Photo by KaMMCo.com.)
Source: darkdaily.com

Agent Pipeline Offers Cigna Medicare Supplement Solutions

Posted by:  :  Category: Medicare

Anytime we have the opportunity to offer a product from a carrier as prestigious and trusted as Cigna, we’re happy to do so. Cigna and its predecessor companies have been in the insurance field for more than 200 years. It is active in 30 countries and has 71 million customer relationships around the world. As a National Marketing Organization (NMO), we are pleased to be able to offer FMO, MGA and agent level contracts to our network of partners in the Senior Market.
Source: agentpipeline.com

Video: Medicare Supplement Insurance Shopping

Agent Pipeline, Inc., One of America’s Largest NMOs Offers Cigna Medicare Supplement SolutionsSM Insured by American Retirement Life Insurance Company

Agent Pipeline, Inc. is pleased to announce that it will offer Cigna Medicare Supplement Solutions (SM), the first Medicare Supplement released by Cigna Supplemental Benefits. Its Medicare Supplement insurance plans have been filed in multiple states including: Alabama, Colorado, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Montana, Nebraska, Nevada, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, West Virginia, and Wyoming. The Medicare Supplement insurance plans offered through Cigna Medicare Supplement Solutions will be available February 4th, 2013, where approved.
Source: reviewpanda.com

Cigna Medicare Plans: A Good Overview

Quit financial difficulties as a result expensive medical home remedies and high rates of medicines, it’s must that veggies secure your health reform costs in the future. Have a medicare supplement insurance plan a person personally so that can actually not have a trouble on your medical bills. With a Medicare supplemental insurance plan you can be sure that you are properly taken cared for while sick and then recuperating in a hospital bed. Treatment Component C: Medicare Component C (also named the Treatment Gain Program) pertains to a cope more detailed coverage coverage plans dished up to seniors because of personal insurance organisations and businesses. Component C’s positive areas contain protection offered underneath Areas A and B, as very well by means of dental, vision and other benefits. Aspect C commonly incorporates Portion In coverage as properly. Some Component C options require the payment amount of a separate top quality additionally to the uppermost quality needed with regard to Component B coverage. Medicare insurance Supplemental Plan N covers the Feature A deductible, which generally is 00 during 2010 and the Part B annual deductible, which is without a doubt 5 for ’10. In extension, the Medicare supplements Plan covers my 20% co-insurance of the fact that genuine healthcare definitely does not pay to work with Part A and furthermore Part B. There are quite possibly a few extensional profits including a foreign trip merit and a “Part B excess Charges” benefit. This inclusive plan includes the perfect coverage money can purchase. Location looking at get more info Plan F not to mention its fellow measures as something to be afraid with regards to. Embrace consumers because they handle you from finance ruin and assist you to make the medical care that you might want. Take per few minutes with read about this guidance and how which they work before a start shopping that that you will certainly be more prepared and informed because of what is driving your way. Most importantly, don’t ever sell yourself transient by rushing like a the process together with not getting the language you need, while you will regret it someday. If you looking for most efficient Medicare Insurance, workouts should keep a number of people important points in mind to go for long term security. The plans provided by the insurance vendors would not change, therefore you definitely should focus on cost Medicare insurance measures that you will be looking at affordable premium. Some plans to become more precious and long term to start with, but will have a slow growth growing in number over the lifetime of your policy. Prominently, it is the most effective Medicare health like plan to package all type with regards to health care overheads according to an individual’s expectations completely. People comes across all the types of insurance, Medicare supplement rrnsurance policy attributes amongst all of these. It is forever better to be knowledgeable when it is one of the Medicare supplement insurance plans because there happen to be stable changes with regard to insurance policy; ordinarily a change for a lot better however at it is always. It is significant to monitor these kinds of varying trends whether you are previously on Medicare supplement insurance or wish to register for the same. There is an important in order to a plan; perhaps even since the plans are being modified, the companies are perhaps commencing to cost the new monthly premiums. This is the primary step behind change ever due to the 1992. Prone to are eligible to change insurance companies towards Medicare Part D during the center of the year then your existing plan will take all of one’s own total drug cost amounts and total out of money amounts to increased plan. If you are in the coverage gap and your switch plans, you’ll then still be in the coverage gap. Every Medicare Thing D plan at this point in the years have a coverage gap so there is not a way of getting away from it if you are a lot linked medications. Number of obvious some plans currently available that will cover generic tier 1 medications during the protection gap.
Source: typepad.com

Low Rates to the Rescue! NEW Medicare Supplement from Cigna

About GarityAdvantage Agencies We are specialists in the Senior Market with over 75 years combined experience helping independent brokers grow their business and client base. As a national field marketing organization (FMO) specializing in the Medicare/Senior Market, we offer independant insurance agents outstanding service, competitive products and top commissions across a wide range of senior products including Medicare Advantage, Medicare Supplement, Final Expense, Funeral Trust, Hospital Indemnity and more.
Source: wordpress.com

Cigna Medicare Plans: That Overview

The comes across all of the types of insurance, Medicare supplement insurance package attributes amongst these. It is forever better to be informed when it is about the Medicare supplement health insurance because there happen to be stable changes to insurance policy; usually a change for better however at time intervals it is not really. It is significant to monitor these kinds of varying trends whether you are previously on Medigap insurance or ought to register for the same. There is an important in order to a plan; much since the plans are being modified, the companies are commencing to quote the new rates. This is the primary step attached to change ever since 1992.
Source: wordpress.com

Secure Medicare Solutions June 2013 Agency News

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

Kusserow’s Corner: Medicare Exclusion Database

Posted by:  :  Category: Medicare

Well, the answer to all these questions is simple.  Providers don’t need to worry about this.  Only those who are federal contractors to CMS are authorized access to the MED; and the MED is not accessible to the public, including the health care provider community.  The information is only available to those with “IACS IDs” – that is, “Individuals Authorized Access to the CMS Computer Services.”  The CMS credential/access system for the IACS requires potential users to register for different roles/systems and needs approval by CMS personnel.  Users must enter their account numbers and failure to do so will result in a rejected application.
Source: wolterskluwerlb.com

Video: Patty and Richard say, “Apply online for Medicare” (20 seconds) – Social Security

How to Apply Online for the CMS Hardship Exemption from the 2012 eRx Medicare Payment Reduction

To help eligible professionals and group practices understand the key provisions and impact of the 2011 Medicare Electronic Prescribing (eRx) Incentive Program Final Rule, A Quick Reference Guide has been posted to the eRx Incentive Program website on the “Educational Resources” page.  Frequently asked questions (FAQs) addressing the 2011 eRx Final Rule, as well as other information and resources about the eRx Incentive Program can be found at the eRx Incentive Program website here.
Source: managemypractice.com

FREE Webinar for Medicare Advantage Providers: How to Boost Online Enrollments

  You are not alone in dealing with this problem. We invite you and the members of your marketing team to join your colleagues for a FREE 55-miniute webinar to be hosted by two of our DMN3 online marketing experts. We’ll discuss ways to better reach your audience through online marketing. 
Source: dmn3.com

How Can I Apply For Medicare Online?

Similar to applying for Medicare at a Social Security office or by telephone, the applicant must be close to the age for enrolling in the program, i.e., online applicants must be nearing their “full retirement age.” Full retirement age varies depending on the applicant’s date of birth. In addition, online applicants must not currently be a recipient of Medicare benefits, must reside in the United States or one of its territories or commonwealths, and must not be in need of Social Security benefits at the time of applying for Medicare.
Source: seniorcorps.org

Doctor Ratings Data Added to CMS Physicians Compare Website, Medicare

The federal health care law requires the Centers for Medicare & Medicaid Services to publish performance data on doctors, including how patients rate them, how well the physicians’ medical interventions succeed and how well they follow clinical guidelines for basic care. The site has been up since 2010, but contained only basic information about doctors and group practices, such as their addresses, specialties and clinical training.
Source: aarp.org

Apply for Social Security Benefits Online

Patty Duke applies for benefits If you file online, you’ll be in good company. Stage, screen and TV actress Patty Duke recently celebrated her 65th birthday by going online to file for Social Security and Medicare benefits. As you’ll see if you watch this video, Duke had a bit of help from her husband, Michael Pearce, but her application took only a few minutes to complete. For the past three years, Duke has volunteered her time to promote Social Security’s online services in a series of public service announcements.
Source: aarp.org

Understanding Medicare premiums

A: For people with limited incomes and resources, the Part D Extra Help program covers all or most of their Part D premium, as well as other pharmacy costs. You can find out if you qualify and apply online at www.socialsecurity.gov/prescriptionhelp or by calling 1-800-MEDICARE. Each state also has Medicare Savings Programs that cover Part B premiums for people with limited incomes. In some cases, these programs also cover other Medicare costs. To learn more, call 1-800-MEDICARE and ask for a referral to your local state health insurance assistance program (SHIP), or go to this website www.familiesusa.org/resources/program-locator and click on your state.
Source: apalachtimes.com

Medicare won’t pay for Eli Lilly Alzheimer’s agent

The radioactive imaging agent works by binding to beta-amyloid plaques and causing them to show up on positron emission tomography, or PET, scans of the patient’s brain. The presence of these plaques may help indicate that a patient with cognitive problems has Alzheimer’s disease, although such a scan does not definitively show that.
Source: seattletimes.com

Hospitals, Doctors Consider Changes Amid Medicare Hospital Readmissions Scrutiny

Posted by:  :  Category: Medicare

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Medpage Today: Hospitals Already Feeling ACA Pinch Putting the Affordable Care Act (ACA) into practice has left some hospital-based physicians feeling trapped between two worlds. Although most care is still delivered in the fee-for-service realm, many have started to think in terms of a pay-for-performance model, with a focus on improving outcomes while simultaneously trying to make care cheaper. … A triumvirate of ACA reforms is driving most of the changes that serve an ultimate goal of improving outcomes in order to lower costs. These are reducing readmissions, diminishing hospital-acquired infections, and getting paid based on the value of service provided (Fiore, 6/28).
Source: kaiserhealthnews.org

Video: Access to Doctors Shrinks for Some Medicare Patients

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

Walking Away From Medicare

Thanks to the marvels of medical science, our parents are living longer than ever before. Adults over age 80 are the fastest growing segment of the population; most will spend years dependent on others for the most basic needs. That burden falls to their baby boomer children. In The New Old Age, Paula Span and other contributors explore this unprecedented intergenerational challenge. You can reach the editors at newoldage@nytimes.com.
Source: nytimes.com

Doctor Ratings Data Added to CMS Physicians Compare Website, Medicare

The federal health care law requires the Centers for Medicare & Medicaid Services to publish performance data on doctors, including how patients rate them, how well the physicians’ medical interventions succeed and how well they follow clinical guidelines for basic care. The site has been up since 2010, but contained only basic information about doctors and group practices, such as their addresses, specialties and clinical training.
Source: aarp.org

Surviving at Medicare Rates: An Exercise for Physicians to Consider

Step 5: Manual Option You will need to generate a charges and collections report by CPT code and find the top 25 codes to30 codes that likely generate 80 percent to 90 percent of your revenue and then manually multiple frequency by RVU weight and then use that total to divide into your cost. This will slightly overstate your cost but you’ll be close. Future payment models may provide for incentive payments that will get you above Medicare rates but, typically, these will be paid on a quarterly or annual basis so you will need to fund day-to-day operations from the basic rate. If you find that expenses exceed this basic rate, consider options for reducing operating costs (or your income) to bring the numbers in line. You might want to read an earlier blog about cost reductions to get some ideas.
Source: physicianspractice.com

Bill Would Offer More Ways To Avoid Medicare EMR Cut

It seems like the help with the cuts is needed for solo physicians in particular. According to the National Center for Health Statistics at t he CDC, only 29 percent of solo practitioners had adopted EMRs by 2011.  While that number may have climbed since 2011, solo docs are doubtless still way behind in adoption, and slapping them with reimbursement cuts simply may not make sense.
Source: must-llc.com

Big pharma and greedy doctors

How does one explain an internist who wrote more than 900 prescriptions for the controversial and very expensive drug Lovaza, a drug approved to lower triglycerides, or a geriatric doctor who is the top prescriber of a very expensive heart medication known as Ranexa, or a cardiologist who neglects the less costly and generic statins, and presribes mostly Crestor, a very effective but also very costly drug, or just about any top prescriber of Tarka, an expensive blood pressure medication that combines two generic medications that can be purchased for pennies, into a brand drug that costs around $4.50 a  pill (something I discussed in a previous article “Drug Dealing For Big Pharma”)?
Source: theridgefieldpress.com

Check Out Your Doctor’s Rating on Medicare Search Tool

More Search and Ranking Tools to Come In another new, cool search function on the Medicare site, a silhouette of a body allows readers to click on the area of the body in which they require medical help. The CMS reports that additional data, such as locating and ranking group medical practices, is expected to be added to the site next year. The ranking information will be supplied by the Physician Quality Reporting System, which uses metrics for different specialties and medical conditions. The article gives the example of rating a doctor on what percentage of diabetic patients he screens for complications like glaucoma by doing a dilated eye exam.
Source: seniorsforliving.com

When Geriatricians Walk from Medicare

This is a great topic for discussion. I am a geriatric neuropsychologist and also do psychotherapy with older adults. Unfortunately Medicare has made such deep cuts to psychotherapy reimbursement (almost 30% in the past two years) that I can no longer afford to see older adults. There is no group therapy for older adults in my area because of reimbursement issues and you cannot find a psychiatrist in this area who will accept Medicare.
Source: 33charts.com

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

Posted by:  :  Category: Medicare

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

Video: The Future of Medicare: Policy Options and Political Realities

Uwe E. Reinhardt: The Complexities of Comparing Medicare Choices

Each private plan would have had to offer a benefit package that covered at least the actuarial equivalent of the benefit package provided by the traditional fee-for-service Medicare. Medicare’s contribution (or “premium support”) to the full premium for any of these choices, including traditional Medicare, would have been equal to the “second-least-expensive approved plan or fee-for-service Medicare” in the beneficiary’s county, whichever was least expensive. That premium support payment would have been adjusted upward for the poor and the sick and downward for the wealthy.
Source: nytimes.com

Understanding Your Medicare Options

Did you know you are liable for the harm a minor causes if you signed his or her application to drive? How much liability in terms of dollars might you incur? What steps can you take to limit your liability, or can you limit it? Find out what you didn’t know about signing a minor’s application to drive — before you do it!
Source: rbseniorservices.com

Regulations to Consider Before Opting Out of Medicare

There are three basic Medicare enrollment options for physicians: 1. Participating providers. A participating provider is enrolled in the Medicare program and accepts assignment on all Medicare claims. Accepting “assignment” means that the physician bills Medicare directly and accepts as full payment for a rendered service 80 percent of the Medicare fee schedule amount; plus 20 percent of the Medicare fee schedule amount from the patient (or the patient’s secondary insurance). A participating physician must accept assignment for all Medicare covered services; however, the physician can limit the number of Medicare patients he or she treats. 2. Non-participating providers. In many ways, non-participating providers are similar to participating providers. Both are enrolled in Medicare, both bill Medicare directly for services, and Medicare pays both 80 percent of the approved charge for a rendered service. There are, however, some important differences between these providers. For non-participating physicians, Medicare sets the approved amount for a service at 95 percent of what is approved for participating physicians. Accordingly, if Medicare makes payment based on an approved charge of $100 for a participating physician, Medicare will base payment for a non-participating physician on a charge of $95 for the same service. Non-participating physicians, however, are not limited to accepting only $95. They can charge up to 115 percent of Medicare’s allowed charge. For example, for a service with a Medicare-approved charge of $95, a non-participating provider can charge a total of $109.25. The provider would bill Medicare for $109.25 and Medicare would pay $76 (80 percent of the $95 Medicare-approved fee). Even though the physician would bill Medicare for this service, the payment would be made to the patient, and the physician would need to collect the amount directly from the patient. The patient or secondary-payer would be responsible for $19 (20 percent of the $95 Medicare approved fee). The remaining amount ($14.25) would be billed to the patient. 3. Opt-out providers. Physicians opting out of Medicare bill patients directly for services otherwise covered by Medicare. Unlike both a participating and non-participating provider, physicians who have opted-out of Medicare may not bill Medicare for services (with the limited exception of some emergency services), and Medicare beneficiaries receiving services from an opted-out provider may not seek reimbursement from Medicare. To privately contract with a Medicare beneficiary, a physician must enter into a written, private agreement with the patient that meets specific requirements, as set forth by Medicare regulations.  In addition to the private agreement, the physician must file an affidavit with Medicare that also meets certain Medicare regulatory requirements. The affidavit must be filed no later than 30 days before the first day of a calendar quarter. A physician has 90 days after the start of the opt-out period to revoke his or her decision and remain enrolled in Medicare. After that time, the opt out is effective for two-years.
Source: physicianspractice.com

Is Medicare or Medicare Advantage Better For Me?

About the same time you will receive many offers by mail, and some by phone. These will be from companies contracted with Medicare to make available a Medicare Advantage plan. Ask the representative of these companies why you should use a Medicare Advantage plan instead of original Medicare. They will tell you what they feel the benefits are. One benefit they will mention is the lower copay when you have outpatient medical visits. They will also point out that usually there is no extra premium for the extra benefits an Advantage plan offers.
Source: tablib.org

Do Seniors Want So Many Medicare Choices?

Seniors need more Medicare choices, or do they? The answer depends, of course, on who’s doing the asking. Republicans and others advocating a voucher plan for Medicare invoke the choice argument as the rationale for transforming Medicare from social insurance provided by the government to privatized arrangements between individuals and the marketplace. Under a voucher system, the government would give seniors and people who are disabled a fixed amount of money to buy insurance from private carriers much the way the rest of America does. Those on the other side believe there’s plenty of choice’even too much’in the Medicare program. I’m in that camp having found last year that as a new Medicare beneficiary I had more than 100 choices to cover gaps in Medicare benefits. The new Medicare Handbook for next year indicates that those in New York City have 83 choices for Medicare Advantage plans and 28 choices for prescription drug plans. Add to that another 50 or so choices for traditional Medigap policies and you’re talking about 160 different plans to consider. So who’s going to shop? That’s way too many, even for experts, to distill. Research, more scientific than mine, confirms my belief. Once seniors pick a plan’based on coverage, customer service, friendly salespeople, price, or whatever’they tend to stick with it even though they might be able to find a cheaper one if they went shopping. Medicare beneficiaries, it seems, are like bank customers. Once people pick a bank, they tend to stay put despite the heavy bank advertising enticing them to switch. A study from the National Bureau of Economic Research, a private, nonprofit research organization, found that if seniors with Medicare drug plans stayed in a plan too long, they could end up paying premiums that were ten percent higher than had they had switched to a new plan. Researchers examined data showing that new plans often had cheaper price tags than older ones that had been on the market for two or three years. That’s hardly surprising since insurance sellers, especially in competitive markets like Medicare plans, try to grab market share with low premiums and then jack up prices of older policies. You might call it a kind of a ‘bait and switch’ sales practice on the part of insurers. Remember: This is private insurance we’re talking about, and insurers have to make a profit. Researchers concluded that ‘a sizeable fraction’ of consumers either value other features not reflected in the cost of the plan or else don’t make the optimum choices. ‘Our results do not support the proposition that consumers can make and benefit from good choices in health insurance markets,’ they concluded. Were they blaming the victim for failing to sort through zillions of data points to ‘optimize’ their decision effectively, as they put it? Are seniors to blame for a system that generates a vast number of choices that even experts are barely able to navigate and optimize effectively? The researchers, apparently, are saying consumers lack the ability to make those choices. I would argue that most people believe the task is daunting and hopeless’too many data points to sort out and too little time to do it. So it’s easiest to stick with what you have even it costs an extra $50 a year, the trade-off for the aggravation of choosing and switching to a new plan. Perhaps it’s the system itself that makes the task of choosing so impossible. Decisions by policymakers to allow all kinds of sellers to make a buck off of seniors in the Medicare marketplace with a cornucopia of plans may actually be working against what they want the marketplace to do. If their aim is for market forces to drive insurers to provide seniors with the highest quality for the lowest cost, it will take more than lots of choices to make that happen.
Source: cfah.org

Strategies for Simplifying the Medicare Advantage Market

Most Medicare beneficiaries have at least 40 Medicare Advantage (MA) plan options to choose from this year. While some favor a robust marketplace, others argue that fewer plan offerings, or more transparent differences across plans designs, would help beneficiaries choose plans most likely to meet their individual needs. While consumers generally show interest in choice and economists see it as enhancing value, research shows that individuals faced with a large number of alternatives often avoid making a decision or choose options that may not be the best for them economically.
Source: kff.org

Need Help Understanding My Medicare Options? » Toni Says

If you have a doctor that is in the Medicare Advantage plan’s provider                                              directory, make sure you call to verify that he/she is still accepting that                                          particular Medicare Advantage plan.  Sometimes providers are in the                                             directory, but stopped accepting the plan long before it went to print.
Source: tonisays.com

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July 12, 2013

Medicare Annual Enrollment Period

Posted by:  :  Category: Medicare

As an agent, this is a great opportunity to make substantial commissions and add new clients to your book of business. The AEP for 2013 starts on October 15 and runs through December 7. You may also pre-sale members starting on October 1 and then pick up the applications starting October 15. As you may know, ten thousand people a day are turning 65 in our country. The baby boomers are coming into retirement age and there is a lot of potential for agents to help these seniors with their healthcare needs while earning very good income, as well.
Source: mysumrall.com

Video: Decisions – TexanPlus HMO Commercial

Daily Kos: Dancin’ Dave Gregory proves he doesn’t know anything about anything

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Source: dailykos.com

Rick Perry Calls Social Security and Medicare “Ponzi Schemes”

Q: In Fed Up!, you criticize the progressive era and the changes it produced: the 16th and 17th Amendments, Social Security, Medicare, and so on. I understand being against these things in principle—of longing for a world in which they never existed. But now that they’re part of the fabric of our society, do you think we should actually do away with them?
Source: firedoglake.com

Daily Kos: Romney and Bain profited from massive Medicare Fraud

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Source: dailykos.com

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