Excellus BCBS holding free Medicare planning meetings for Kodak retirees

Posted by:  :  Category: Medicare

Kodak retirees who will lose their health care benefits by the end of this year can ask questions and get answers from Excellus BlueCross Blue Shield Wednesday. Excellus is offering free Medicare planning seminars. The first one is at 9:30 a.m. at the Wishing Well on Chili Avenue in Chili. Click here for dates of additional seminars.
Source: whec.com

Video: Excellus BlueCross BlueShield: “15 Minutes” :30

Local prescription drug plan earns top marks from Medicare

BlueCross BlueShield Rx PDP contracts with the federal government and is a stand-alone prescription drug plan with a Medicare contract. The plan is administered by Excellus BlueCross BlueShield in cooperation with Empire BlueCross, Empire BlueCross BlueShield, BlueCross BlueShield of Western New York and BlueShield of Northeastern New York. It’s available to Medicare eligible members who reside in New York State.
Source: readmedia.com

Medicare Enrollment Begins Today

Of course, many who might be interested are Kodak retirees. Kodak recently announced it had stuck a deal with the Retirees committee to end retiree health care and survivor income benefits by the end of the year. That means thousands could be shopping around for new plans soon. “Since 1935, our company has been taking care of our friends and neighbors and we want to continue doing that, especially when a major employer like Kodak is facing changes,” said Jim Redmond, Excellus BCBS. “For the Kodak employees, if they’re Medicare eligible, they’ve got a lot more choices. If they’re under the age of 64, the choices become a little more difficult. Every individual situation is different. You really do need to sit down and figure out what is going to be best for you.”
Source: ynn.com

NYS Health Benefit Exchange Update

To set the record straight to Charil and Caryn. I was on the GOP side of the US Senate HELP Committee writing healthcare policy for the physicians on the committee when the ACA and her two sisters (signed laws hat revise and repeal provisions of the ACA) were being drafted. Healthcare costs will actually go down as my committee and the finance committee added taxes on to premiums. Any insurance company that can prove to CMS that they have reduced their premiums will see these taxes be taken away. The taxes on the premiums are designed to go up every year. If the insurance companies are smart (which they are truly not), they will reduce their premiums and not subject themselves to the taxes. I would assume that their shareholders would want them to do everything they can to reduce their premiums so they can avoid the taxes.
Source: carynisaacs.com

Open Enrollment and Star Ratings for 2013

MA plans and PDPs have a number of concerns about the methodology used to establish the star ratings, including the age of the data (e.g. the 2013 ratings are based on 2011 data), the frequent changes in methodogy and the difficulty in improving scores from year to year. For most plans these ratings are good news and the star rating has gone up for most measures from 2012 to 2013. Three new measures focused on care coordination and improvement. For MA-PDs, the national average for the care coordination measure was 85 percent or 3.4 stars. Non-SNPs performed better on this measure than SNPs. The measure for net improvement showed that MA contracts on average achieved a score of 3.1 for Part C and 3.4 for Part D while PDPs achieved an average score of 4.1. However approximately 10 percent of the plans will see a lower bonus as a result of their new lower ratings and plans with 2.5 stars or less for three years in a row face the possibility of termination from the program.
Source: gormanhealthgroup.com

National Influenza Vaccination Week December 4

(BINGHAMTON, NY) – In observance of National Influenza Vaccination Week, the Broome County Health Department will be holding a flu clinic on Monday, December 5, 2011 from 1:00 p.m. to 4:00 p.m. at their offices located at 225 Front Street, Binghamton. The clinic is open to anyone ages three and up. The fee for the flu vaccine is $25 (cash or check only). If you are 65 years of age or older and subscribe to traditional Medicare Part B, Excellus Medicare Blue PPO, Today’s Options or CDPHP Medicare the health department will bill your insurance plan.
Source: gobroomecounty.com

Broome County Health Department Announces Seasonal Flu Clinics for Fall 2009

The fee for the flu vaccination is $20. The pneumonia shot is also available for Medicare Part B recipients aged 65 and older at Broome County Health Department sponsored clinics (*) only. There will be no out of pocket fee for the flu or pneumonia shots for Medicare Part B recipients. Individuals on Medicare must present all insurance cards to staff at the clinic. If you have signed up with Today’s Options-American Progressive or Excellus Medicare Blue PPO Medicare Advantage Plan, we can charge your plan. For other Medicare Advantage Plans, such as Aetna Golden Medicare, CDPHP Medicare Choice, etc, you need to go to your primary care provider for the flu shot or be prepared to pay by cash or check.
Source: gobroomecounty.com

Broome County Health Department Announces 2011

The clinics are open to anyone ages three and up. The fee for the flu vaccine is $25 (cash or check only). If you are 65 years of age or older and subscribe to traditional Medicare Part B, Excellus Medicare Blue PPO, Today’s Options or CDPHP Medicare the health department will bill your insurance plan. Pneumonia shots will also be offered at the flu clinics for Medicare Part B recipients age 65 and older. If your children’s immunizations are covered by medical insurance, parents are advised to seek flu shots for them at their regular medical provider. This can help cut down on out of pocket costs, especially for children who require a second dose of the vaccine because of their age. Children 6 months through 8 years of age who did not receive at least one dose of the 2010-2011 vaccine, or whom it is not certain whether the 2010-2011 was received, should receive 2 doses of the 2011-2012 seasonal vaccine.
Source: gobroomecounty.com

Medicare Advantage 2010 Data Spotlight: Plan Availability and Premiums

Posted by:  :  Category: Medicare

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While the number of plans available in 2010 declined somewhat from 2009, the analysis finds that Medicare beneficiaries on average have 33 Medicare Advantage plans to choose from. For Medicare Advantage enrollees who stay in the same plan in 2010, monthly premiums will increase by 32 percent on average, with a steeper 78 percent average increase for enrollees in private fee-for-service plans who do not switch plans.
Source: kff.org

Video: Medicare Supplement Plans – Changes for 2010

The Problem with Social Security and Medicare

The drawdown of Social Security and HI Trust Fund reserves and the general revenue transfers into SMI will result in mounting pressure on the Federal budget. In fact, pressure is already evident. For the seventh consecutive year, the Social Security Act requires that the Trustees issue a “Medicare funding warning” because projected non-dedicated sources of revenues primarily general revenues are expected to continue to account for more than 45 percent of Medicare’s outlays in 2013, a threshold breached for the first time in fiscal year 2010.Lawmakers should address the financial challenges facing Social Security and Medicare as soon as possible. Taking action sooner rather than later will leave more options and more time available to phase in changes so that the public has adequate time to prepare.
Source: investmentwatchblog.com

Medicare and the Affordable Care Act: What’s Next?

It is important to note that the Federal government, including the Centers for Medicare and Medicaid, have only partial control over Medicare Supplement, also known as Medigap, insurance policies. They can and do require that the basic benefits of policies in the 10 available plans are consistent from company to company and from state to state. However, each state has its own rules about premium amounts and increases. In Virginia, the Bureau of Insurance must approve requested rate hikes, based on a variety of data submitted by each company licensed to do business in our state.
Source: mauryriversc.org

Five Questions About President Obama’s Proposed Changes To The Medicare Payroll Tax

Right now, that couple would pay $3,987.50 in Medicare taxes each year. Under the proposal, they would pay $4,212 on their wages and $4,350 on their investment income, $8,562, assuming all of that income is taxable. Congressional estimators predict any final policy would include some exemptions, such as the costs of generating investment income. 3. Who would be affected? Taken together, both the earned- and investment-income portions of the tax would hit the top 2.6 percent of U.S. households, according to The Tax Policy Center, a joint project of the Urban Institute and the Brookings Institution. That would allow Obama to keep his campaign promise not to raise taxes for 95 percent of the country’s households. The tax on investment income would not apply to some non-wage income from certain small businesses. Under current law, employees of S corporations, a type of company with a limited number of shareholders, are able to receive some of their income as distributions – a share of the companies’ profits – rather than as wages. Lobbying by business groups helped ensure that S corporations’ employees who are also shareholders wouldn’t face the new tax on their share of the profits. However, people who invest in S corporations, but do not participate in the operation of the business, would have to pay the new Medicare tax on any dividends or other unearned income they receive from the business. 4. How does the Obama plan compare to Democratic congressional proposals? Democratic leaders working toward a compromise between the House and Senate bills had tentatively reached a labor-backed compromise that included a Medicare tax on investment income less than a week before Republican Sen. Scott Brown’s Jan. 19 election in Massachusetts undercut Democrats’ filibuster-proof majority and stalled the debate. The investment-income tax was suggested last year by Sen. Debbie Stabenow, D-Mich., but senators rejected the plan. The Senate also refused to accept a House plan to increase taxes on the rich. However, the new taxes proposed by Obama have not provoked any serious complaints from Senate Democrats yet. The tax will likely have some appeal to the more liberal House members, who resisted the Senate’s Cadillac tax. Unions, an important constituency for liberal House lawmakers, have argued that the Cadillac tax would affect some middle-class union members with high-value health benefits. Obama’s proposal would subject fewer plans to that tax.
Source: kaiserhealthnews.org

Medicare Outlier Reimbursement Caps

In this months E-zine article, we discussed the changes that were made to outlier payments which became effective Jan 1, 2010. One of the interesting points that was brought up is how outliers were calculated prior to the changes. What was clear when writing the article was that outliers, while valuable to bridge the gap on high utilization on episodes, it never completely covered the cost in providing care. Some agencies have heard that many organizations have been using outlier payments to help increase their overall revenue intentionally. However, many times they are a cost of doing business. This is why there is additional reimbursement available to help accommodate for those situations.
Source: selectdata.com

Medicare Home Health Changes for 2011 & Beyond

The 36-month rule was actually put in place under the 2010 payment rule, but the 2011 payment rule provides further guidance on the application of the rule after a year of confusion. The 36-month rule prohibits the conveyance of the home health provider agreement to a buyer if the selling agency started within 36 months or a prior change of ownership took place in the last 36 months. Under these circumstances, the buyer must enroll in Medicare as a new, or initial, agency. The 2011 payment rule confirms it does apply to both asset and stock transactions. However, it will only be applied to changes in “majority” ownership, and several exceptions to the rule are provided, including death of an owner, indirect ownership changes and changes in entity structure. Take Action Now
Source: healthcarereforminsights.com

CMS identifies ‘large number of overpayments’ for incarcerated Medicare beneficiaries

Posted by:  :  Category: Medicare

If a beneficiary did not inform the SSA of his or her release from custody, this may result in his or her record being incorrect. If a provider believes this is the case, the provider may wish to encourage the beneficiary to contact his or her local SSA office to have his or her records updated. It can take up to one month for the beneficiary’s Medicare eligibility file to be updated with the revised SSA information. If the beneficiary tells the provider that SSA is updating his or her records, we suggest the provider contact the Medicare Administrative Contractor using the contact information on the overpayment demand letter.
Source: hmenews.com

Video: Medicare.com – greytv commercial

Understand the Impact of Obamacare on Medicare

Ross Blair has applied more than 26 years of technology experience to develop PlanPrescriber.com, a website that makes it easier for seniors and their caregivers to select and enroll in the best Medicare products for their specific needs. In his role as CEO, he has worked closely with pharmacists, insurers, physicians, caregivers and seniors to identify the most critical and complex aspects of Medicare and create a system that delivers this information to consumers in a format that is easy to use and understand. Google+
Source: ehealthmedicare.com

Families USA Executive Director Explains How To Understand Medicare Premiums

Part D premiums are similarly tied to the costs of prescription drugs. Medicare Advantage premiums are determined by a more complicated process, but they also reflect trends in costs. Because Part D and Medicare Advantage plans are run by private companies, premiums can vary a lot.
Source: smmirror.com

Making a Mint on Medicare: Private Businesses?

Gibson, the principal writer, spent 16 years at the Robert Wood Johnson Foundation, where she designed and led national initiatives to improve health care quality and safety, becoming, in effect, the chief architect of an over $200 million strategy to bring hospice to hundreds of hospitals around the country. In Medicare Meltdown, she and Singh weave in examples of how institutions that the public might hold in high regard, such as the American Medical Association (AMA), the American Hospital situation (AHA) and various physician associations have their own agendas as well.
Source: thefiscaltimes.com

ICYMI: Health Affairs Study

3rd Party Studies ACOs Admin Costs affordability Age Rating Cadillac Tax Delivery System Reform Employers Essential Benefits Exchanges GRP Health Insurance Tax Health Plan Innovations Health Plan Satisfaction House hearings House legislation KI MA Medical Prices Medical Tests medicare medigap MLR Morning Headlines Patient Safety premiums Profits Provider Consolidation Quality Rate Review Reform RZ Senate hearings Senate legislation Small Business The Link Vilification Waste Fraud and Abuse
Source: ahipcoverage.com

The Shadowy Cartel of Doctors that Controls Medicare

Affiliates 6 Dollar T-Shirts GoldSilver.com The Ready Store Onnit Labs Audible Audio Books Amazon.com Bulletproof Coffee Blue Host Blog Roll What Really Happened Cryptogon Strat Risks Citizens for Legit Gov. Full Specturm Dominance Information Liberation VICE Cryptome All Gov. Michael Snyder VoltaireNet The New American Raw Story Truth Dig Antiwar Drudge Report Breitbart Real News Network Alternet Information Clearing House VOA News Truth Out Common Dreams No Agenda News RINF Aangirfan Old Thinker News Activist Post Dark Politricks SGT Report Andrew Gavin Marshall Tom Burghardt Dana Gabriel Jacob Hornberger Media Monarchy Truth Is Treason Reason Lew Rockwell Strike The Root 10th Amendment Center Explosive Reports Gnostic Media Tragedy and Hope Vigilant Citizen Red Ice Wayne Madsen WhoWhatWhy Wtfrly From The Trenches WhoWhatWhy Boing Boing Freedom Outpost Resist Radio Wide Awake News News Blok 2 Against The Wall End The Lie Disinformation SHTF Plan ITHP The Excavator Open Secrets Project Censored Business / Economics Gold and Metals Prices Coin Values Zero Hedge Testosterone Pit Washingtons’s Blog Of Two Minds Money News Max Keiser Naked Capitalism Sovereign Man Business Insider Market Watch Bloomberg Wall Street Journal RTT News CNN Money Forbes Business Week Market Oracle Money Morning My Budget 360 Alt-Market Shadow Stats Azizonomics Economist Economy Watch Financial Times Fortune Magazine Daily Crux The Daily Economist The Daily Reckoning Energy Business Review Faux Capitalist Daily Bail Hang The Bankers Against Crony Capitalism Economic Policy Journal Gonzalo Lira Liberty Blitzkrieg The Burning Platform The Daily Bell Milplex / Intel / Defense Oil Price Phantom Report Global Research Foreign Policy Journal Global Post Intel News 1913 Intel F. William Engdahl Rick Rozoff Corbett Report Public Intelligence Boiling Frog Post Washington Technology Defense Industry Daily Global Security Geopolitical Monitor Defense Link Space War Jane’s Defense Tech Strategy Page Military Info Tech Strategy Page Homeland Sec. Newswire Science / Tech News Tech Dirt Ars Technica Wired Blast Magazine PHYSorg Science Daily Popular Science Tech Eye Engadget New Scientist DVice Mother Board EFF Technovelgy Next Big Future Singularity Hub H+ Magazine Science Magazine Seed Magazine CBR Online Science News SlashDot Scientific American Spectrum IEEE Technology Review io9 ZD Net The Register Tech News World Health & Environment Prevent Disease Food Freedom Farm Wars Medical Express Natural Society Waking Times Natural News Major US Newspapers New York Times New York Post New York Daily News Washington Post Washington Times L.A. Times USA Today Magazines The Atlantic Salon Slate ROAR Mag Time
Source: blacklistednews.com

A “Grand Bargain” To Improve Quality and Decrease Medicare Costs

The fourth recommendation, somewhat of an alternative of the second, begins with the realization that primary care is generally not expensive. Indeed it was originally the patient’s responsibility to pay for primary care and should be again. Medicare should institute high deductibles with the opportunity for a health savings account (HSA) to pay for primary care with tax advantaged dollars. Patients begin to ask questions and challenge recommendations when they are paying for primary care directly. They can request more time per visit. Both have the result that the care quality goes up and the overall cost to Medicare goes way down. The patient-doctor relationship is corrected to being a direct contractual relationship leading to better care at much lower cost. Most studies suggest that the deductible needs to be high enough to be meaningful, often about $1000 or more. This could be reduced for those of lesser means. Given the importance of preventive care, that might be excluded and continued to be paid for by Medicare. High deductibles will be politically difficult. Nevertheless, this would lead to a much more responsible use of the entire system with better care and much reduced costs.
Source: healthworkscollective.com

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

Viewpoints: Disability Insurance ‘Time Bomb;’ Leavitt On The Lessons Of Medicare Part D’s Rollout; Boys And Eating Disorders

The New York Times: Do Clinical Trials Work? [A]t the annual meeting of the American Society of Clinical Oncology last month, much of the buzz surrounded a study that was anything but a breakthrough. To a packed and whisper-quiet room at the McCormick Place convention center in Chicago, Mark R. Gilbert, a professor of neuro-oncology at the University of Texas M. D. Anderson Cancer Center in Houston, presented the results of a clinical trial testing the drug Avastin … Gilbert’s study found no difference in survival between those who were given Avastin and those who were given a placebo. … The centerpiece of the country’s drug-testing system — the randomized, controlled trial — had worked. Except in one respect: doctors had no more clarity after the trial about how to treat brain cancer patients than they had before (Clifton Leaf, 7/13). 
Source: kaiserhealthnews.org

21 Statistics on Medicare Spending Distribution in 2001 vs. 2011

Posted by:  :  Category: Medicare

Medicare spending distribution: •    Inpatient hospital: 24 percent •    Managed care: 23 percent •    Physician fee schedule: 12 percent •    Prescription drugs provided under Part D: 12 percent •    Other: 9 percent •    Skilled nursing facilities: 6 percent •    Other hospital: 6 percent •    Home health: 4 percent •    Hospice: 3 percent •    Durable medical equipment: 1 percent
Source: beckersasc.com

Video: Learn about the 2011 Medicare Open Enrollment Period: Get a Plan that Meets Your Needs

Important Information Regarding Medicare Claims and Payments for Part A Indiana and Michigan Providers

Posted by:  :  Category: Medicare

National Government Services, Inc. (NGS) recently announced important information regarding Medicare claims and payments for Part A Indiana and Michigan providers.  With the impending transition of these providers to Wisconsin Physician Services (WPS), NGS posted the following transition timeline:
Source: hallrender.com

Video: Audit Alert: Codes for Evaluation & Management Services Performed at Nursing Facilities

Transition to NGS as J6 MAC

, 2013 and affects all home care providers that currently bill claims under contractor number 00450. At the time of the change, you will need to ensure that you change the contractor number on your EDI claims to 06001. Please note that if you bill through the Direct Data Entry (DDE) system then you will not need to change the contractor number on your claims.
Source: glmi.com

National Government Service (NGS)

All Part B providers located in Illinois, Minnesota and Wisconsin will be transitioning to NGS.    All related education and communication will flow from the National Government Services Web site.  You can sign up for the listserv via www.http://NGSMedicare.com.  Select your line of business (A, B, HH&H, FQHC).  Select E-mail Updates under Publications.  The Web site offers up-to-date information on the following important topics:
Source: uycreative.com

Intermittent Connectivity Issue Reported by NGS

National Government Services (NGS), a Medicare intermediary, is experiencing intermittent connectivity issues. As a result, some claim files have not been successfully received by the payer. The clearinghouse is retransmitting affected claim files as impacted files are being identified. NGS is working diligently to resolve this intermittent connectivity issue. The following payers may be affected: CPID 1452 Connecticut Medicare CPID 3533 Connecticut Medicare CPID 1463 New York Medicare Upstate CPID 3519 New York Medicare Empire CPID 4442 New York Medicare Empire CPID 1773 NGS American CPID 8522 NGS American CPID 2528 New Hampshire Medicare CPID 3547 Maine Medicare CPID 5506 Illinois Medicare CPID 5512 Wisconsin Medicare CPID 5527 Massachusetts Medicare CPID 5578 Rhode Island Medicare CPID 5954 Vermont Medicare CPID 7401 New York Medicare GHI CPID 7475 Medicare DME MAC Jurisdiction A CPID 7476 Medicare DME MAC Jurisdiction B CPID 7477 Medicare DME MAC Jurisdiction C CPID 7478 Medicare DME MAC Jurisdiction D Please be aware of this processing issue. If you have any questions, please contact Client Services at 1-888-348-8457, option 2.
Source: collaboratemd.com

Upcoming Medicare and Reimbursement Changes: To Survive and Thrive

For those of you in charge of patient reimbursement, you will have to learn about these new programs, train and then get them correctly implemented.  You have many resources from which to learn, including: association seminars and webinars, the CMS website, Chirocode.com, NGS web site for those of you in the Midwest, the PM&A Members website and Facebook page.  There are other resources as well, but the point is that you will have to study, learn, and work it out and get it implemented.
Source: pmaworks.com

NGS to Administer Medicare Claims Payment in New York (S U P R A S P I N A T U S)

NGS will serve as the first point of contact for the processing and payment of Medicare fee-for-service claims from hospitals, skilled nursing facilities, physicians and other health care practitioners in the two states. The new Part A/Part B Medicare Administrative Contractor (A/B MAC) was selected using competitive procedures in accordance with federal procurement rules.
Source: nysbar.com

2013 Cost Projections for Medicare Programs

Posted by:  :  Category: Medicare

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

Video: Medicare Shared Savings Program Overview National Provider Call 12/7/11

Social Security and Medicare Programs Remain on Unsustainable Paths

The data show that both Social Security and Medicare programs remain on unsustainable paths. Even these grim numbers may be too optimistic because the expected revenue or cost savings assumed under current law may never materialize. In fact, a section at the end of the Trustees Report called “Statement of Actuarial Opinion,” (p. 273) makes that point very clearly. Paul Spitalinic, the acting chief actuary of the program, explains that “current law would require a physician fee reduction of an estimated 24.7 percent on January 1, 2014—an implausible expectation.”
Source: mercatus.org

Funding Opportunity: Support for Demonstration Ombudsman Programs Serving Medicare

The Advocacy Monitor is a project of the National Council on Independent Living, a leading cross-disability, grassroots organization run by and for people with disabilities that represents Centers for Independent Living (CILs), Statewide Independent Living Councils (SILCs), individuals with disabilities, and other organizations that advocate for the human and civil rights of people with disabilities throughout the United States.
Source: advocacymonitor.com

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

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

ICYMI: USA Today — “Medicare Advantage is a win

A new USA Today column highlights recent data that shows beneficiaries in Medicare Advantage plans receive higher quality care compared to those in the fee-for-service (FFS) part of Medicare.  These results further demonstrate the value of Medicare Advantage by promoting more effective and efficient health care practices. Furthermore, there is an increasing amount of evidence showing that the programs and services health plans have implemented are helping to reduce preventable hospital readmissions for patients compared to FFS Medicare.  Reducing preventable hospital readmissions will improve the quality of care for patients and help control the soaring cost of medical care.
Source: ahipcoverage.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

Hospitals, Doctors Consider Changes Amid Medicare Hospital Readmissions Scrutiny

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

Report: Inaccurate Payments to Medicare Advantage Programs Continue to Cost Government Billions

A report by the U.S. Government Accountability Office (GAO) suggests the Medicare Trust Fund could save billions if the Centers for Medicare and Medicaid Services (CMS) would adjust payments for Medicare Advantage plans to more accurately reflect the health of those enrollees. The problem, according to the report, is Medicare pays Medicare Advantage plans a predetermined amount for each beneficiary based on risk scores, which are adjusted for health status. The methodology CMS uses to come up with the risk scores has led to overpayments to these plans. CMS has been working to correct the problem, but not enough. By more accurately paying for beneficiaries, the Medicare program would have saved between $3.2 to $5.1 billion in Medicare Advantage plan payments from 2010 to 2012, according to the GOA report. While Congress took action through the Affordable Care Act in 2010 to reduce excessive payments to private plans, CMS continues to use the risk score adjustment of 3.4 percent it used in 2010, ’11 and ’12. CMS officials have said they may revisit their methodology in the future. Recently, Energy and Commerce Ranking Member Henry A. Waxman, along with Ways and Means Ranking Member, Sander Levin, released an update to the GAO report. Waxman and Levin point out interesting inconsistencies in what the plans report. They say documented evidence shows that Medicare Advantage plans tend to report higher patient severity than is supported by medical records. The evidence also shows reported patient severity increases faster than for comparable patients in traditional fee-for-service Medicare. More information for Medicare fraud is located at the Nolan Auerbach & White website.
Source: medicare-fraud.net

No Revisions to Medicare Supplement Plans

Posted by:  :  Category: Medicare

The National Association of Insurance Commissions(NAIC) recommended in a letter to the Department of Health and Human Services (HHS) against nominal cost sharing or any other changes to Medicare Supplement plans. The NAIC indicated that they found no evidence that adding nominal cost sharing would encourage the appropriate use of physician services, and it could even result in delayed treatments that would increase Medicare costs in the long-run.
Source: benefitsbuzzblog.com

Video: Medicare Supplement Insurance Plans – Where Do I Start?

Compare Medicare Supplement Plans

Absolutely yes!  Medigap plans follow Federal and state laws for your protection and must be identified clearly as “Medicare Supplement Insurance”.  Medicare Supplement plans in most states are able to sell only “standardized” plans A through N.  Each standardized Medigap plan has to offer the same basic benefits, regardless which insurance company sells it.  Cost is typically the only difference between Medicare Supplement policies with the same letter sold by different companies.
Source: medicarehealthplans.com

Seniors See Value in Medicare Supplement Plan G

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

The Ins and Outs of Medicare Supplemental Insurance

Yes! So how does this relate to Medicare’s coverage? There is a general rule of thumb that is called the “80/20 rule.” Outside of some of the preventative items like mammograms, colorectal screenings, and some psychiatric care, Medicare covers the first 80 percent of medical bills, leaving you to cover the last 20 percent. Medicare will also cover certain medically-necessary pieces of equipment like seat lift mechanisms and diabetic shoes (fitted by a specialist, of course). It doesn’t seem so bad at first, especially if you’re a healthy individual, but if something happens that requires you to need urgent medical care or even an operation, you may have to spend tens- to hundreds-of-thousands of dollars. A June 2011 report from the Kaiser Family Foundation predicted that by the year 2020 the median out-of-pocket spending for seniors with Medicare is projected to reach 26 percent of all income, with the most money being spent in the last five years of their life. This is why supplemental Medicare insurance is a necessity for every senior. Not only do you really need Medicare supplemental insurance, you need it before something happens to you, and you likely won’t use it much until the last 5 years of life. So two points to keep in mind 1) If you wait until a procedure is needed or something unexpected happens to you, you’ve waited too long, and 2) Don’t make the mistake of cancelling your Medicare supplement policy because you’ve’ paid in more than you use. It’s health insurance and in this case it works best if it’s held to its natural end point.
Source: insideeldercare.com

Medicare Supplement Studies > Minnesota Medigap Companies > MedicareSupplement.com

While most of America (47 states) must consign to the National Association of Insurance Commissioners (NAIC) standardization of Medigap policies, Minnesota does not. Minnesota is one of the three waiver states that standardized their Medicare supplement plans before NAIC’s involvement in 1990. Because of this, so long as the plans offered cover the basic requirements, Minnesota (along with Massachusetts and Wisconsin) is able to continue issuing their Medicare supplement plans.
Source: medicaresupplement.com

Medicare Supplement Plan F

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

Ask The Experts: Retirement

A. You are asking for an opinion, which I can’t give. All I can tell you is that the combination of a Federal Employees Health Benefits plan and Medicare reduces out-of-pocket costs to a minimum. You’ll have to compare the costs and benefits of your current FEHB plan with those provided by a Medicare supplement plan and reach your own decision. Note: If you were to cancel your FEHB coverage, you wouldn’t be able to re-enroll if you were displeased with your Medicare supplement plan or you lost that coverage.
Source: federaltimes.com

You Important Information On Medicare Vitamin Supplements Plan N

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

Medicare Committee Meeting with Palmetto

Posted by:  :  Category: Medicare

Diamond Level Platinum Level Gold Level Biz Technology Solutions, Inc. First Citizens Bank rmsource, Inc. Wells Fargo Insurance Services Silver Level Ball Dermpath McGladrey Medical Protective SunTrust Bank United HealthCare Group Bronze Level Allegacy Business Solutions – JBA Benefits & Cooperative Payroll Allscripts Apex Technology Assured Waste Solutions, LLC Bactes Imaging Solution Bernard Robinson & Company, LLP Call-A-Nurse Capario ChoiceHealth, Inc. Coverys, Inc. DataMax Corp / Interstate Credit Collections The Doctors Company Eastman Kodak Company Fifth Third Bank Ford & Harrison GMK Associates, Inc. Gordon Asset Management, LLC Greenway Medical Henry Schein Medical Humana Konica Minolta LabCorp Marketing Works McNeary, Inc. Medicus Insurance Company Medstaff National Medical Staffing mindShift Technologies, Inc. MSOC Health NCHA Strategic Partners NextGen Healthcare ONLINE Information Services Physician Discoveries Physicians’ Alliance of America Prince Parker & Associates Professional Recovery Consultants SCA Collections, Inc. Solstas Lab Partners SouthData Stanley Benefits Stern & Associates, P.A. Attorney at Law Total Merchant Services Transworld Systems, Inc. TriMed Technologies Corp TriZetto Provider Solution – Gateway EDI
Source: wordpress.com

Video: Medicare Palmetto absolutely no help

MDx/CDx Focus: Crescendo's Vectra DA Gets Medicare Coverage; Cobas HPV Test Supplemental PMA

A set of carefully controlled secondary metabolites help the fungus species Fusarium fujikuroi produce a disease known as bakanae in rice, according to a genome sequencing study in PLOS Pathogens. An international team led by investigators in Germany put together a high-quality genome assembly for F. fujikuroi. Through comparisons with sequences from other species in the same genus — as well as experiments looking at the transcriptomic, epigenetic, proteomic, and metabolite profiles of the pathogen — the researchers tallied up dozens of secondary metabolites in F. fujikuroi, including plant hormones called gibberellic acids. Genes involved in producing the latter metabolite, known for contributing to rice infections, are present in other Fusarium species, study authors noted, though F. fujikuroi appears to be the only one that makes the gibberellic acids.
Source: genomeweb.com

Countdown to Proposed Cuts to Medicare Advantage

Palmetto Insurance of Anderson, South Carolina, would like to help you through the hard times that come when accidents happen! Please contact us for more information by calling us at 800-753-2487 or you can Email Us anytime, day or night and we will have one of our representatives contact you as soon as possible! dont forget to check us out on Facebook, LinkedIn and Twitter!
Source: imms.com

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

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

RRB awards Palmetto GBA new Medicare contract

“While Palmetto GBA has held the Railroad Medicare contract for more than 10 years, many of the staff here at our Augusta office have processed claims and answered inquiries for Railroad Medicare beneficiaries for more than 35 years,” Jenkins said. “We look forward to being here for you and providing the highest levels of customer service that you have come to expect, and most certainly, deserve.”
Source: utu.org

Palmetto, Medicare’s Biggest Carrier, Proposes to End Code Stacking for Molecular Clinical Laboratory Tests

Palmetto GBA is a Medicare Authorized Contractor (MAC) that serves Jurisdiction 1 (J1) and Jurisdiction 11 (J11). Two draft proposed local coverage determinations (one on molecular diagnostic tests (MDTs) and one on lab-developed tests (LDTs), and a molecular diagnostics pPalmetto GBA is a Medicare Authorized Contractor (MAC) that serves Jurisdiction 1 (J1) and Jurisdiction 11 (J11). Two draft proposed local coverage determinations (one on molecular diagnostic tests (MDTs) and one on lab-developed tests (LDTs), and a molecular diagnostics program (MolDx) have been proposed only for J1. If implemented, they would affect labs serving Medicare patients in California, Nevada, and Hawaii.
Source: darkdaily.com

Palmetto GBA’s Appeal Denied Again, Noridian Will Be The New Contractor!

of American Samoa, Guam and the Northern Mariana Islands. Jurisdiction E includes over 3.5 million Medicare fee-for-service beneficiaries, 500 Medicare hospitals and 86,500 physicians. MACs process Part A and Part B claims and perform other critical Medicare operational functions, including enrolling, educating and auditing Medicare providers.
Source: practicons.com

Medicare to Cover Crescendo Bio's RA Test

A set of carefully controlled secondary metabolites help the fungus species Fusarium fujikuroi produce a disease known as bakanae in rice, according to a genome sequencing study in PLOS Pathogens. An international team led by investigators in Germany put together a high-quality genome assembly for F. fujikuroi. Through comparisons with sequences from other species in the same genus — as well as experiments looking at the transcriptomic, epigenetic, proteomic, and metabolite profiles of the pathogen — the researchers tallied up dozens of secondary metabolites in F. fujikuroi, including plant hormones called gibberellic acids. Genes involved in producing the latter metabolite, known for contributing to rice infections, are present in other Fusarium species, study authors noted, though F. fujikuroi appears to be the only one that makes the gibberellic acids.
Source: genomeweb.com

Coalition to Strengthen the Future of Molecular Diagnostics

Another threat to the financial strength of laboratories and to the health of patients is the fact that many molecular diagnostic tests are no longer being covered by the MACs as in the case of Predictive Biosciences Inc., located in Cleveland, OH and Lexington, MA. This laboratory closed effective May 31, 2013, and laid off all 90 highly-skilled employees just 18 months after entering the market because of a coverage decision rendered in the gap-fill process, outside of the Local Coverage Determination (LCD) process. This unfortunate development has significantly negative consequences on patients with bladder cancer nationwide because no other laboratory in the country is conducting Predictive Biosciences’ highly specialized tests. Predictive Biosciences in early 2012 began marketing two novel and proprietary biomarker tests for bladder cancer – one to detect and one to monitor the disease. These breakthrough tests were noninvasive urine analyses that offered patients and oncologists an alternative to costly, time-consuming, painful and even risky bladder scoping procedures. The new option offered by Predictive Biosciences was less expensive, more efficient, and a less invasive and equally effective alternative for the patient. In just 18 months on the market, 10% of urologists around the country began utilizing the test. For the first 12 months of those 18, the test was reimbursed by Medicare under the stack codes which made up approximately 50% of Predictive Bioscience’s business. However, with the beginning of the gap-fill process, the local MAC ceased reimbursing the laboratory for any claims dated on or after January 1, 2013. Given the regular 45-day lag on payment, Predictive Biosciences did not become aware of the change until mid-February. After failed attempts to receive answers from the MAC directly, the laboratory requested help from its Members of Congress. This pressure led to two conference calls between Predictive Bioscience and the MAC where the laboratory discovered that the MAC had issued a new non-coverage determination, outside of the LCD process. By this time, banks were already denying loans to the laboratory and venture capitalists were growing weary of fronting more cash after investing over $77 million to bring the tests to market. After receiving details on the information and timeline required for a coverage appeal and determining that the chance of success was slim, the laboratory and its investors decided to close the laboratory.
Source: protectmdx.org

Heartland National Hospital Indemnity Plan | Medicare Agent Training

Posted by:  :  Category: Medicare

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

Video: Hospital Indemnity Plans Are HOT

Understanding the Different Types of Health Insurance Plans

Indemnity health insurance plans are those that allow you to choose any doctor of your choice, who then submits a claim to your insurance company for reimbursement. Indemnity plans typically insure 80 percent of customary costs, leaving you responsible for the remaining 20 percent. However, only specific medical expenses will be covered, meaning that only certain medical services and treatments will be reimbursed. Most indemnity plans also have deductibles and out-of-pocket maximums.
Source: businessinsuranceconnecticut.net

Why Doesn’t Medicare Cover Glasses or Dental? » Toni Says

There are 2 different types of dental plans: 1) Traditional or indemnity dental insurance plans which is generally higher in premium and the preventive services are usually covered at 100%, basic restorative is generally covered up to 80% and major procedures at 50%. Many of the traditional/indemnity dental plans may have a wait for services such as fillings, root canals, bridges, crowns, etc. 2) Discount dental plans are generally less expensive than traditional dental plans.
Source: tonisays.com

Hospital Indemnity Plan but Not GTL

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

Lack of dental insurance can take a bite out of your budget

Policies typically carry deductibles of about $50 for routine visits, with basic services such as root canals and fillings covered at 80 percent. Out-of-pocket maximums can range from $750 to $2,000. In-network dentists also offer discounts. So, for a $3,000 root canal and crown, it may be only $2,500 at an in-network dentist. The patient then would pay a $50 deductible as well as a $500 co-pay (20 percent) for services, for a total of $550. Chris Pyle, a spokesman for the Delta Dental Plans Association, says people may tend to drop dental insurance during tough economic times. A recent study by Delta Dental found that 10 million fewer Americans had dental insurance at the end of 2009 than did at the end of 2008.
Source: insurancequotes.com

Dental Indemnity Insurance Information

Dental Indemnity Insurance plans are also subject to calendar year/annual maximums. Those annual maximums can range from a low of around $1,000 to as high as $10,000 in some corporate and federal health plans.
Source: dentalinsuranceplanonline.com

What are the Different Types of Health Insurance?

High-deductible health plans typically have lower premiums than HMOs, PPOs or POS plans, but they come with the potential for higher out-of-pocket costs. To offset that risk, you (or your employer) can contribute up to $2,900 annually (individual) or $5,800 (family) to a tax-advantaged HSA account in 2008. Again, these figures change from year to year. These contributions reduce your taxable income (or they are tax-free if made by your employer), and money in your HSA can be used to pay any qualified medical expense now or in the future. An attractive feature of HSAs is that they can pay for expenses that your regular health plan ordinarily doesn’t cover, such as eyeglasses and hearing aids. In addition, while the money is in the account, it can be invested, and the investment gains are tax-free as long as they are used for qualified medical expenses.
Source: allinsurancesite.com

Denali Dental Indemnity Plan

Covered dental services include exams, cleanings, fillings and extractions, as well as crowns, bridges and dentures. This policy pays you for covered dental expenses based upon a percentage of the Reasonable and Customary (R&C) fees for those covered expenses after the $100 lifetime deductible has been satisfied.
Source: greatdentalinsurance.com

ALL ABOUT INSURANCE INFO: How To Choose A Health Insurance Plan

An Indemnity Plan offers the freedom to choose when and where you will seek medical assistance. Along with this freedom usually comes higher out-of-pocket costs. For many this is a fair trade-off. Managed Care Plans are more restrictive, and require you to utilize the medical professionals and institutions that are part of the plan’s “network.” Participants often need pre-approval for medical services that are beyond basic preventive care. The costs for this type of plan are usually lower than Indemnity Plans. For those who are basically healthy, don’t mind who provides their medical services, and who need to control medical costs, Managed Care Plans are usually the better choice. This is a very basic comparison of the types of health insurance plans available. It is a first step in your own data gathering and analysis process. Select The Right Company Once you’ve done your homework and know what you want, you need to choose the right health insurance company. Many companies offer health insurance, from well-known corporate giants to small independent outlets. As with any major purchase, you’ll want to research these companies before making a final decision. Also, find out which state or federal agency regulates the type of health insurance you’re considering, in case you have questions or experience problems. Each type of health care plan has advantages and disadvantages. It is in your best interest to research thoroughly, so that the health plan you choose will be the right one for you and your family. For today and for years to come
Source: blogspot.com

Advantages to Managed Care Plans

The other popular type of health insurance plans is managed care plans. The three types of policies categorized as managed care plans are HMOs, POSs, and PPOs. This type of insurance is more popular than the indemnity plan, as they offer more flexibility. With these types of options you either pay a monthly fee no matter how many times you see a doctor, or pay a co-payment but no monthly fee. With managed care plans, you are given options of care. The plan you choose and the amount of money you wish to pay determines how big of a network of doctors and specialists you can see and still be covered under the plan. Some managed car plans (most often PPOs) offer sponsorship programs from a network of hospitals and medical services. You can often get this kind of plan through your employer.
Source: imbargainhunter.com

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July 18, 2013

Coventry Medicare Advantages In A Nutshell

Posted by:  :  Category: Medicare

The last two remaining programs in the Coventry Medicare Plans are the Coventry Advantra-POS and the Coventry Advantra Freedom. The Advantra POS is still basically the same as HMO and PPO plans; they have the same coverage of benefits and a set of network providers.  But, they are given the privilege to see health care providers outside their network.  Of course, this comes with much higher premiums.  For a little more cost, enrollees can have the freedom to choose their own physicians with the Advantra Freedom plan.  CAF is a private-fee-for-service (PFFS) which also includes Part A and B benefits.  Enrollees may consult any physician or specialist they prefer without the need for any referrals, given that the provider accepts the guidelines and resolutions within the PFFS agreement.
Source: medicarebase.com

Video: Ultra Support Back Brace – Covered by Medicare

Coventry Health Care Adds Cornerstone Health Care (P.A.) to their Advantra Medicare Advantage Provider Network in North Carolina.

Cornerstone Health Care has nearly 300 providers (including primary care and specialty physicians, and mid-level professionals) in more than 70 locations in High Point, Winston-Salem, Greensboro, Summerfield, Thomasville, Archdale, Trinity, Jamestown, Kernersville, Lexington, Asheboro, and Advance.
Source: wordpress.com

Advantra Rx NOT Renewing Their Medicare Contract

one of my customer’s sent me a copy of the letter from AdvantraRX dates October 2. Here is what it says (sorry about typos, i type fast): Dear Mr. Smith, AdvantraRx Preimer by Coventry Life and Health Insurance Company, a stand-alone prescription drug plan with a Medicare Contract, will no longer operate as of January 1, 2011 so your Medicare Prescription drug coverage through AdvantraRx Premiuer will end December 31, 2010. If you want Medicare prescription drug coverage starting January 1, you need to join a new Medicare drug plan by December 31, 2010. Take Action by December 31 to avoid losing drug coverage. If you want Medicare Rx drug coverage after December 31, you need to join another Plan or medicare advantage plan that offers drug coverage. You can join a new medicare drug plan anytime between October 1 and January 31, 2011. However your AdvantraRx Premier coverage ends December 31, so you should join a new medicare drug plan by december 31 to make sure you have drug coverage january 1. If you join a new plan AFTER december 31, your new coverage won’t start until the month after you join. What happens if you don’t join another medicare drug plan? if you don’t join another medicare drug plan by January 31, your next chance to join will be from october 15 through december 7, 2011. You may also have a pay a late-enrollment penalty to join later. The the letter gives a list of a bunch of companies and the 1-800 Medicare number and website. It doesn’t state anything anywhere about automatically enrolling them into another plan if they do nothing. In fact, it states the opposite.
Source: insurance-forums.net

Altius Health Plans Altius Advantra Medicare Review

Altius Health Plans offers Medicare health insurance programs for residence of Utah and a county in Wyoming.  Altius Advantra and Altius Advantra Preference are Medicare Advantage HMO plans available in Box Elder, Cache, Daggett, Davis, Duchesne, Morgan, Rich, Salt Lake, Summitt, Tooele, Wasatch, and Weber counties in Utah as well as Uintah county in Wyoming.  Altius Advantra is an HMO-POS plan, and Altius Advantra Preference is a plain HMO only available in Davis, Salt Lake, and Tooele counties.  The coverage does include Part D drug coverage as well as health benefits.  Below is a review of the benefits they offer:
Source: medicare-plans.net

Do You Have An Advantra Freedom Medicare Plan??

[…] You can blame this on your congressmen, senators, and yes even the president. The funding for medicare and Medicare has been drastically cut causing  some companies to raise rates and lower benefits. Other companies have simply decided to drop out of the market (which produces less competition). I would suggest writing a letter to your congressman or senator.Source: wordpress.com […]
Source: wordpress.com

Coventry.Health.Care.Deleware / .Advantra.Silver.Coventry.Health.Care

coventry health care incorporated laws state delaware december 17 1997 successor coventry corporation coventry health care insurance map offers health insurance states coventry health care iowa coventry advantra gold advantra xp gold silv ppo pltn ma coventry health care iowa coventry advantra silver advantra 22 medicare insurance plan options offered new market ia 2010 coventry of advantra platinum ppo sw ppo health drugs coventry health care 46 highest-paid chief information officers list 21 pay packages worth 1 million dealing rising price medical services health insurance Ny source fox news 16 30 1 jun 2010 provinding health care north kivu
Source: bonafidelive.com

Medicare Targets Health Plans With Low Ratings

Medicare officials are encouraging 525,000 beneficiaries to switch out of these 26 Medicare Advantage and drug plans that have received low ratings for three consecutive years and enroll in better plans for next year. The poor performing plans will have this warning symbol next to their names on Medicare’s plan finder website to steer shoppers to other plans.
Source: kaiserhealthnews.org

Pennsylvania Health Insurance

HealthAmerica’s Commercial and Medicare Advantage Plans Among Tops in Nation for Quality and Service on U.S.News & World Report/NCQA “America’s Best Health Plans 2008-09″ List Harrisburg and Pittsburgh, Pa. – November 10, 2008 — HealthAmerica’s HMO, POS, and Medicare Advantage plans were ranked among the nation’s top 20 best commercial and Medicare health plans according to a joint ranking by U.S.News & World Report and the National Committee for Quality Assurance (NCQA). Nationally, HealthAmerica was ranked 12th among 287 commercial plans; HealthAmerica’s Medicare Advantage plan, Advantra, ranked 18th among 216 plans nationally. HealthAmerica and HealthAmerica Advantra have ranked as one of the top 50 best health plans in the U.S. News/NCQA “Americaýs Best Health Plans” list* every year since 2005. “We are honored to be recognized among the best health plans in the nation,” said Kirk E. Rothrock, president and chief executive officer of HealthAmerica. “We are dedicated to providing the best possible quality and service, so we are pleased to see our efforts recognized by NCQA, U.S. News and World Report, and, most importantly, by our members and our customers.” The National Committee for Quality Assurance and U.S.News and World Report collaborated to rank the nationýs best commercial, Medicare, and Medicaid health plans. The ranking appears in the November 17 issue of U.S.News and on its website www.usnews .com/healthplans HealthAmerica”s and Advantra”s rankings are based on their Healthcare Effectiveness Data and Information Set (HEDISý)** 2008 scores and the results of a Consumer Assessment of Healthcare and Provider Systems (CAHPS) survey of members. HEDIS is a set of standardized performance measures covering effectiveness of care, preventive care, treatment, and customer satisfaction. CAHPS is a standardized survey in which members rate the quality of care and service that they receive from doctors, specialists, office staffs, and insurers. In these ratings, HealthAmerica’s commercial health plans were rated higher than the national average in all 15 key measures of medical services and member satisfaction and higher than the Pennsylvania state average in 12 of the 15 key measures***. HealthAmerica’s HMO, POS, and Medicare Advantage plans’ status of “Excellent” from NCQA was also a factor in determining the U.S. News/NCQA “America’s Best Health Plans 2008″ ranking**** The U.S.News/NCQA “Americaýs Best Health Plans 2008″ list is drawn from measures of prevention, treatment, and customer experience. These measures are compiled in NCQA”s Quality Compass 2008*****, which publicly reports comparative results of more than 400 commercial health plans covering 85 million Americans. Health plans throughout the country were evaluated on issues such as access to care, prevention efforts, treatment of diseases such as diabetes and heart disease, and members were surveyed on their satisfaction to calculate an overall quality score. * “America’s Best Health Plans” is a trademark of U.S. News & World Report. **HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). ***The source for this data is Quality Compass 2008 and is used with the permission of the National Committee for Quality Assurance (NCQA). Quality Compass is a registered trademark of NCQA. NCQA is a private, non-profit organization dedicated to improving health care quality. The 12 measures are: Child immunization (combo II), well child visits 3 to 6 years, colorectal cancer screening, prenatal care, first-trimester postpartum care, cervical cancer screening, breast cancer screening, diabetes-lipid profile (screen), controlling hypertension, cholesterol screening for patients with cardiovascular conditions, rating of all health care, rating of health plan. ****National Committee for Quality Assurance accreditation outcomes are: Excellent, Commendable, Accredited, and Denied. Applies to HMO and POS plans. *****Quality Compass is a registered trademark of NCQA. NCQA is a private, non-profit organization dedicated to improving health care quality. About HealthAmerica For over 33 years, HealthAmerica has provided health benefit solutions to employers across Pennsylvania. HealthAmerica offers a broad range of traditional and consumer-directed health insurance products, including managed care, HSAs, self-funded, Medicare, indemnity, nongroup and pharmacy plans. Serving 12,000 businesses and over 660,000 members as of December 31, 2007, in Pennsylvania and Ohio, HealthAmerica offers progressive medical management, innovative wellness programs, and statewide and national provider networks. HealthAmerica is ranked as one of “Americaýs Best Health Plans, 2006″ by U.S. News & World Report; its HMO and POS products have an “Excellent” accreditation by the National Committee for Quality Assurance. HealthAmerica has corporate offices in Pittsburgh and Harrisburg, Pennsylvania, and employs over 2,200 people in the commonwealth.
Source: blogspot.com

Emdeon Current: New Payer Transactions Added Recently

Anthem Health Plans Of Kentucky – Osb High & Low, Payer ID: Cx083 Anthem Health Plans Of Virginia – Osb High & Low, Payer ID: Cx083 Anthem Health Plans Of Virginia – Ppob & Ppod, Payer ID: Cx083 Anthem Insurance – Osb High & Low, Payer ID: Cx083 Anthem Insurance – Ppob & Ppod, Payer ID: Cx083 Blue Cross Blue Shield Of Wisconsin – Ppod, Payer ID: Cx083 Blue Cross Of California – Osb High & Low, Payer ID: Cx083 Blue Cross Of California – Ppoa, Payer ID: Cx083 Blue Cross Of California – Plan Ss10 & Ss20, Payer ID: Cx083 Cal Optimal -Onecare, Payer ID: Cx083 Care 1st Health Plan Medicare Advantage, Payer ID: Cx083 Care 1st Php La & San Bernadino County, Payer ID: Cx083 Chinese Community Health Plan, Payer ID: 94302 ClaimsbrIDge MIDatlantic, Payer ID: Call ClaimsbrIDge MIDatlantic, Payer ID: Call ClaimsbrIDge Nw, Payer ID: Call ClaimsbrIDge Nw, Payer ID: Call ClaimsbrIDge North, Payer ID: Call ClaimsbrIDge North, Payer ID: Call ClaimsbrIDge South, Payer ID: Call ClaimsbrIDge South, Payer ID: Call Community Insurance – Hmoa & Ppob, Payer ID: Cx083 Community Insurance – Ppod & Ppof, Payer ID: Cx083 Easychoice Health Plan, Payer ID: Cx083 Empirehealthchoice Assurance – Osb Low & Ppob, Payer ID: Cx083 Empirehealthchoice Hmo, Payer ID: Cx083 Good Shepherd Hospice Inc, Payer ID: 76923 Good Shepherd Hospice Inc, Payer ID: 76923 Golden State Health Plan, Payer ID: Cx083 Harrington Health – Bpo, Payer ID: 59143 Harrington Health – Bpo, Payer ID: 59143 Health Net 21 – La & Sacramento, Payer ID: Cx083 Health Net Healthy Families A B & C, Payer ID: Cx083 Health Net Los Angeles Php, Payer ID: Cx083 Health Net Sacramento Gmc, Payer ID: Cx083 Healthy Alliance Life Insurance – Ppob, Payer ID: Cx083 Iehp, Payer ID: Cx083 La Care Health Plan, Payer ID: Cx083 Liberty Dental Plan, Payer ID: Cx083 Md Care Health Plan, Payer ID: Cx083 Memorial Integrated Healthcare, Payer ID: Call Mgm Resorts International, Payer ID: Cx083 Memorial Psn/Cms, Payer ID: Call MID America Benefits, Payer ID: Call MID America Benefits, Payer ID: Call Molina Healthcare, Payer ID: Cx083 Mutual Assurance Administrators, Payer ID: 37256 Ohana Health Plan, Payer ID: Cx083 Ohio Ppo Connect, Payer ID: Call Ozark Health Plan, Payer ID: Cx083 Palms Casino Resort, Payer ID: Cx083 Physicians United Plan-Pup, Payer ID: Cx083 Rocky Mountain Hospital & Medical Service – Osb High & High, Payer ID: Cx083 Sands Bethworks Gaming, Payer ID: Cx083 Santa Clara Family Health Plan, Payer ID: Cx083 Venetian, Payer ID: Cx083 Wellcare, Payer ID: Cx083 Highmark Blue Cross & Blue Shield Of Pennsylvania, Payer ID: Sb865 Pacificsource Medicare, Payer ID: 20377 Pacificsource Medicare, Payer ID: 20377 Eligibility Inquiry And Response: Advantra Freedom, Payer ID: Covty00453 Advantra Savings, Payer ID: 456 Advantra Savings, Payer ID: Covty00456 Altius Health Plan, Payer ID: 364 Altius Health Plan, Payer ID: Covty00364 Chc Carelink, Payer ID: Covty00160 Chc Carelink MedicaID, Payer ID: Covty00182 Chc Carenet, Payer ID: Covty00190 Chc FlorIDa/Vista/Summit, Payer ID: 512 Chc FlorIDa/Vista/Summit, Payer ID: Covty00512 Chc Group Health Plan (Ghp), Payer ID: Covty00184 Chc Health America / Health Assurance Of Pennsylvania (Hapa), Payer ID: Covty00148 Chc Southern Health Services (Shs), Payer ID: Covty00156 Chc Of Delaware, Payer ID: Covty00166 Chc Of Georgia, Payer ID: Covty00154 Chc Of Health Care Of Usa (Hcusa), Payer ID: Covty00186 Chc Of Iowa, Payer ID: Covty00170 Chc Of Kansas, Payer ID: Covty00172 Chc Of Louisiana, Payer ID: Covty00158 Chc Of Nebraska, Payer ID: Covty00176 Chc Of The Carolinas / Wellpath, Payer ID: Covty00164 Carelink Advantra, Payer ID: 160 Carelink Health Plan, Payer ID: 160 Carelink MedicaID, Payer ID: 182 Carenet, Payer ID: 190 Coventry Advantra (Texas New Mexico Arizona), Payer ID: 504 Coventry Advantra (Texas New Mexico Arizona), Payer ID: Covty00504 Coventry Health Care Federal, Payer ID: 509 Coventry Health Care Federal, Payer ID: Covty00509 Coventry Health Care Of Delaware Inc., Payer ID: 166 Coventry Health Care Of Georgia Inc., Payer ID: 154 Coventry Health Care Of Iowa Inc., Payer ID: 170 Coventry Health Care Of Kansas Inc., Payer ID: 172 Coventry Health Care Of Louisiana Inc., Payer ID: 158 Coventry Health Care Of Nebraska Inc., Payer ID: 176 Coventry Health And Life (Oklahoma), Payer ID: 441 Coventry Health And Life (Oklahoma), Payer ID: Covty00441 Coventry Health And Life (Tennessee Only), Payer ID: 455 Coventry Health And Life (Tennessee Only), Payer ID: Covty00455 Coventry Health And Life-Nevada, Payer ID: 505 Coventry Health And Life-Nevada, Payer ID: Covty00505 Coventry Healthcare National Network, Payer ID: 250 Coventry Healthcare National Network, Payer ID: Covty00250 Coventry-Missouri, Payer ID: 507 Coventry-Missouri, Payer ID: Covty00507 Coventrycares, Payer ID: 510 Coventrycares, Payer ID: Covty00510 Coventryone, Payer ID: Covon Coventryone, Payer ID: Covtycovon Diamond Plan, Payer ID: 177 Diamond Plan (Md MedicaID), Payer ID: Covty00177 Group Health Plan – Cmr, Payer ID: 184 Health America Inc./Health Assurance/Advantra, Payer ID: 148 Healthcare Usa, Payer ID: 186 Mhnet Behavioral Health, Payer ID: 514 Mhnet Behavioral Health, Payer ID: Covty00514 Mail Handlers Benefit Plan, Payer ID: 251 Mail Handlers Benefit Plan, Payer ID: Covty00251 Omnicare, Payer ID: Covty00413 Omnicare – A Coventry Health Plan, Payer ID: 413 Personalcare/Coventry Health Of Illinois, Payer ID: 179 Personalcare/Coventry Health Of Illinois, Payer ID: Covty00179 Southern Health Services Inc., Payer ID: 156 University Of Missouri, Payer ID: Covtycovum University Of Missouri, Payer ID: Covum Vista (MedicaID FlorIDa Health KIDs Long Term Care Products Only), Payer ID: 508 Vista (MedicaID FlorIDa Health KIDs Long Term Care Products Only), Payer ID: Covty00508 Wellpath, Payer ID: 164 Coventry Nebraska MedicaID, Payer ID: 511 Coventry Nebraska MedicaID, Payer ID: Covty00511 Ohio MedicaID, Payer ID: AID09 Ohio MedicaID, Payer ID: Oh Claim Satus And Response: Advantra Freedom, Payer ID: COVTY00453 Advantra Savings, Payer ID: 456 Advantra Savings, Payer ID: COVTY00456 Altius Health Plan, Payer ID: 364 Altius Health Plan, Payer ID: COVTY00364 CHC Carelink, Payer ID: COVTY00160 CHC Carelink MedicaID, Payer ID: COVTY00182 CHC Carenet, Payer ID: COVTY00190 CHC FlorIDa/VISTA/Summit, Payer ID: 512 CHC FlorIDa/VISTA/Summit, Payer ID: COVTY00512 CHC Group Health Plan (GHP), Payer ID: COVTY00184 CHC Health America / Health Assurance Of Pennsylvania (HAPA), Payer ID: COVTY00148 CHC Southern Health Services (SHS), Payer ID: COVTY00156 CHC Of Delaware, Payer ID: COVTY00166 CHC Of Georgia, Payer ID: COVTY00154 CHC Of Health Care Of USA (HCUSA), Payer ID: COVTY00186 CHC Of Iowa, Payer ID: COVTY00170 CHC Of Kansas, Payer ID: COVTY00172 CHC Of Louisiana, Payer ID: COVTY00158 CHC Of Nebraska, Payer ID: COVTY00176 CHC Of The Carolinas / Wellpath, Payer ID: COVTY00164 Carelink Advantra, Payer ID: 160 Carelink Health Plan, Payer ID: 160 Carelink MedicaID, Payer ID: 182 Carenet, Payer ID: 190 Coventry Advantra (Texas New Mexico Arizona), Payer ID: 504 Coventry Advantra (Texas New Mexico Arizona), Payer ID: COVTY00504 Coventry Health Care Federal, Payer ID: 509 Coventry Health Care Federal, Payer ID: COVTY00509 Coventry Health Care Of Delaware Inc., Payer ID: 166 Coventry Health Care Of Georgia Inc., Payer ID: 154 Coventry Health Care Of Iowa Inc., Payer ID: 170 Coventry Health Care Of Kansas Inc., Payer ID: 172 Coventry Health Care Of Louisiana Inc., Payer ID: 158 Coventry Health Care Of Nebraska Inc., Payer ID: 176 Coventry Health And Life (Oklahoma), Payer ID: 441 Coventry Health And Life (Oklahoma), Payer ID: COVTY00441 Coventry Health And Life (Tennessee Only), Payer ID: 455 Coventry Health And Life (Tennessee Only), Payer ID: COVTY00455 Coventry Health And Life-Nevada, Payer ID: 505 Coventry Health And Life-Nevada, Payer ID: COVTY00505 Coventry Healthcare National Network, Payer ID: 250 Coventry Healthcare National Network, Payer ID: COVTY00250 Coventry-Missouri, Payer ID: 507 Coventry-Missouri, Payer ID: COVTY00507 Coventrycares, Payer ID: 510 Coventrycares, Payer ID: COVTY00510 Coventryone, Payer ID: COVON Coventryone, Payer ID: COVTYCOVON Diamond Plan, Payer ID: 177 Diamond Plan (MD MedicaID), Payer ID: COVTY00177 Group Health Plan – CMR, Payer ID: 184 Health America Inc./Health Assurance/Advantra, Payer ID: 148 Healthcare USA, Payer ID: 186 Mhnet Behavioral Health, Payer ID: 514 Mhnet Behavioral Health, Payer ID: COVTY00514 Mail Handlers Benefit Plan, Payer ID: 251 Mail Handlers Benefit Plan, Payer ID: COVTY00251 Medical Mutual Of Ohio, Payer ID: 211 Medical Mutual Of Ohio, Payer ID: MMO00211 Omnicare, Payer ID: COVTY00413 Omnicare – A Coventry Health Plan, Payer ID: 413 Personalcare/Coventry Health Of Illinois, Payer ID: 179 Personalcare/Coventry Health Of Illinois, Payer ID: COVTY00179 Southern Health Services Inc., Payer ID: 156 University Of Missouri, Payer ID: COVTYCOVUM University Of Missouri, Payer ID: COVUM VISTA (MedicaID FlorIDa Health KIDs Long Term Care Products Only), Payer ID: 508 VISTA (MedicaID FlorIDa Health KIDs Long Term Care Products Only), Payer ID: COVTY00508 Wellpath, Payer ID: 164 Coventry Nebraska MedicaID, Payer ID: 511 Coventry Nebraska MedicaID, Payer ID: COVTY00511 For a complete list of the payers in our network, visit our website at www.emdeon.com/payerlists/
Source: blogspot.com

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