Top Medicare Official: ‘We Can and Should Do More’ to Oversee Drug Plan

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Sen. Tom Carper, D-Del., who chaired the hearing, cited two new government reports on the program, known as Part D, from the inspector general of the U.S. Department of Health and Human Services. The first, issued last week, found more than 700 general-care physicians with extremely questionable prescribing patterns, including some whose prescriptions were filled at hundreds of pharmacies across dozens of states.
Source: propublica.org

Video: How to Understand Medicare Plans

Medicare Website Receives Top Marks

About Kaiser Permanente Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 9.1 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: kp.org/newscenter.
Source: kp.org

Should I Consider Medicare Advantage?

Another main dissimilarity is that a lot of Medicare Advantage packages have medicine coverage built in. With the Traditional Medicare, Part D medicine coverage has to be bought separately. Also, with the Traditional Medicare, you can visit any hospital or doctor that accepts Medicare. Numerous Medicare Advantage packages work with contracted providers such as hospitals and physicians with whom they have established a long-term relationship.
Source: leerogers2012.com

How to Get the Best Medigap Supplement Plans

Finally, various Medigap Supplement providers apply different methods when calculating the amount of premium to be charged on their customers. These include Attained Age rated method, community rated, and Issue Age rated. Companies that apply Attained Age method usually charge lower premiums and their premiums tend to increase after every 3 to 5 years. Companies that use Issue Age on the other hand base their premiums on the age of the applicant during the time of purchase. Medicare’s inflation adjustments will affect the changes in these premiums. The community-rated method charges a uniform premium irrespective of age for all those who live within the same area.
Source: medicareplansofamerica.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

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 SUPPLEMENT INSURANCE STILL IN VOGUE

When a Medicare enrollee purchases a Medicare supplement Plan N they are making a commitment to participate in their healthcare costs, while still maintaining their freedom to use the services of any physician or hospital. Plan N requires the insured to pay their annual Medicare Part B deductible, up to a $20 physician’s office co-pay, a $50 emergency room co-pay unless admitted to the hospital and any excess charges over and above the Medicare approved charge. One should note that Medicare excess charges very rarely even exist as almost all physicians and hospitals accept the Medicare approved charge as full payment. This is called Medicare assignment and the consumer can contact their physician’s insurance billing office to confirm that they accept assignment and are considered a “participating” provider. Healthy, typically younger Medicare enrollee’s see Medicare supplement Plan N is a viable alternative to a Medicare Advantage plan. Medicare supplement Plan N offers substantially reduced premiums when compared to a Medicare supplement Plan F while maintaining the “freedom of choice” not offered by a Medicare Advantage plan.
Source: askmedicareblog.com

Is A Medicare Advantage Plan Right for Me?

When it comes to picking a Medicare plan, it can be very difficult to decide which type of policy you need. When you are evaluating whether you need to get a Medicare Advantage plan or not, focus on your health history and see what you really need the most. For example, if you have a condition that will most likely cause you to be in the hospital at some point, then you obviously need Medicare Part A. If you make frequent trips to the doctor, then getting Part B makes sense too. If you would rather not have to deal with multiple policies, and you want other health benefits as well, then Medicare Part C makes a lot of sense for most people.
Source: wastedenergy.net

What is the difference between Medigap and Medicare Advantage?

Medicare Advantage Plans work differently than Medigap Plans, they are not supplements and they do not supplement Medicare. Medicare Advantage Plans take the place of Medicare as far as paying for medical services. If you have a Medicare Advantage Plan, Medicare will not pay your medical bill, the Medicare Advantage Plan will. Medicare Advantage Plans are administered by private company’s that are contracted with Medicare. You must have both Parts A & B of Medicare and continue to pay your Part B premium. Medicare Advantage Plans are also referred to as Medicare Part C.
Source: reed-insurance.net

Wyden: Let doctors see Medicare claim records

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Lawmakers enacted the SGR law in 1997, in an effort to tie increases in the Medicare physician pay rates to growth in the U.S. gross domestic product (GDP). Since then, physician fees have increased much more quickly than GDP, and Congress has stepped in every year to keep the SGR fee-setting system from taking effect.
Source: lifehealthpro.com

Video: Introduction to Medicare – Data to Supplement Medicare Claims and Enrollment Information

CMS Requiring HIPPS Codes on Medicare Advantage Claims

We expect additional details from CMS. At this time, home health claims should not be delayed and there should not be any problems with payment for Medicare Advantage claims that do not contain a HIPPS code for home health services. 
Source: leadingage.org

2 Large Kansas Hospitals to Refund Medicare Overpayments

Both hospitals only partially agreed with the OIG’s audit. University of Kansas Hospital officials said they will repay $175,653 of their recommended total, but they contested the findings on 15 inpatient claims, saying the OIG did not consider the “extenuating circumstances” those patients had. Via Christi officials said they would refund about half of the OIG’s recommended total, but the remaining billed claims were justified as inpatient.
Source: beckershospitalreview.com

CMS: Demand Letters to Medicare Providers & Suppliers Associated with an Item or Service Provided to Incarcerated Beneficiaries

The “no legal obligation to pay” exclusion (see section 1862(a)(2) of the Social Security Act and 42 CFR 411.4) generally prohibits Medicare payment under Part A or Part B for individuals who are in custody of penal authorities. Individuals who are in custody include, but are not limited to, individuals who are under arrest, incarcerated, imprisoned, escaped from confinement, under supervised release, on medical furlough, required to reside in mental health facilities, required to reside in halfway houses, required to live under home detention or confined completely or partially in any way under a penal statute or rule.
Source: hcafnews.com

Medicare physicians exposed for abusing prescription drugs

• Beneficiaries with Part D claims: 28 million. • Average prescriptions per beneficiary: 40. • Average prescriptions per patient, per provider: 11. • Nearly three-fourths went to patients 65 and older; the rest were for disabled patients. • Prescriptions (including refills): 1.1 billion. • Number of prescribers: 1.7 million. • Of these providers, 350,000 wrote 50 or more prescriptions for at least one drug. • Portion of prescribers responsible for writing half of all prescriptions: 3 percent. • Retail price of all prescriptions: $78 billion. • Average retail price of a prescription: $70. • The state with the highest prescription costs: California ($7.1 billion). • State with the lowest prescription costs: Alaska ($55 million).
Source: naturalhealth365.com

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

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

HIPPS CODES FOR MEDICARE ADVANTAGE CLAIMS: Effective July 1,

If your present equipment has no such kit, create your policy and procedures identifying how your agency will protect the data on the machines.  Connecting printers to an internet accessible network may leave data vulnerable. If you will be trading in or selling present faxes, printers, scanners, or copiers, be certain the buyer/dealer gives you a certificate/letter of sanitization that will occur with the machine. Not securing the certificate means the entity selling the machine may run the risk of PHI breach. It could be significant depending on the data stored.
Source: selectdata.com

Medicare Supplemental Insurance Comparison Releases New Article “Five Tips for Saving on Medicare Supplemental Insurance”

Posted by:  :  Category: Medicare

(EMAILWIRE.COM, March 22, 2013 ) Los Angeles, Ca — Medicaresupplementalinsurancecomparison.net announced today that they have added and an informative new article on their website that teaches readers five important tips when searching for Medicare supplemental insurance. For many people searching for Medicare supplemental insurance can be a daunting process. Faced with thousands of websites that provide information that is questionable at best, for the discerning researcher finding reputable information is often times as hard is finding affordable insurance itself. Because of this, the website Medicare Supplemental Insurance Comparison (MSIC) has released a brand-new learning Center that helps researchers tackle some of the many questions they will face when looking for insurance companies. The learning Center talks about the different types of Medicare supplemental insurance and helps the readers navigate the often times confusing differentiations between the plans.

Medicare Part D 2010 Data Spotlight: The Coverage Gap

Posted by:  :  Category: Medicare

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In 2010, nearly all the private stand-alone drug plans have a coverage gap, though a small share do provide some help to beneficiaries in the coverage gap, usually covering only generics or a small number of brand-name drugs. One third of those plans with gap coverage charge more for generic drugs in the gap than they do for the same drugs in the initial coverage period.
Source: kff.org

Video: Medicare Part D Donut Hole

Medicare recipients in ‘donut hole’ to get price break on some drugs in 2011

“Regardless of what happens to the donut hole, the influx of the first wave of baby boomers will increase the demand for drugs and other medical services,” Moffit says. “All things being equal, that will mean increased costs for seniors and taxpayers alike.” According to the federal Centers for Medicare & Medicaid Services, your actual drug plan varies depending on what kind of prescriptions you buy, which plan you choose, whether you go to a pharmacy in your plan’s network, whether your drugs are on your plan’s formulary (list of approved drugs) and whether you belong to the Extra Help program. Extra Help is a Medicare program to help low-income people; it pays for Medicare prescription drug program costs, such as premiums, deductibles and coinsurance.
Source: insurancequotes.com

What on Earth is the Donut Hole? A Brief Explanation of Medicare Part D and the “Donut Hole” » The NeedyMeds Blog

In 2013, you get out of the coverage gap when you have paid $4,750 out-of-pocket for covered drugs since the start of the year. When you reach this out-of-pocket limit, you get catastrophic coverage. The costs that help you reach catastrophic coverage include what you spent on drugs while in the donut hole and most of the discount on brand-name drugs you received in the coverage gap. If someone else pays for your drugs on your behalf, this will also count toward getting you out of the coverage gap. This includes drug costs paid for you by family members, most charities, State Pharmaceutical Assistance Programs, AIDS Drug Assistance Programs and the Indian Health Service. You continue to pay your drug plan’s monthly premium during the gap, but the premium does not count toward the $4,750 out-of-pocket limit. The amount your drug plan paid for your drugs in your initial coverage period also does not count.
Source: needymeds.org

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

Many seniors may not be aware that the infamous “doughnut hole,” or gap in coverage, is closing thanks to the Affordable Care Act. Before the health care law was passed, if beneficiaries reached the initial limit on total drug expenses ($2,970 in 2013), they had no prescription drug coverage until they spent an added $3,700 out of their own pockets. But in 2013, people in the doughnut hole are receiving discounts of 52.5 percent on name-brand drugs and 21 percent on generics. These discounts will result in significant savings for about 4 million Medicare beneficiaries in 2013. More importantly, the discounts will continue every year until 2020, when the doughnut hole will be completely eliminated.
Source: smmirror.com

A Lesson in Avoiding Medicare Coverage Gaps

Furiously logging into my insurance account did not, in fact, reveal a way for me to submit a claim for reimbursement. It revealed the fine print that I’d conveniently ignored. All of my prescriptions for the rest of December cost me hundreds more than I normally paid, because I’d reached the coverage gap in my insurance. Had I paid attention to the details, I’d have planned for this expense. Instead, I was sideswiped by massive added expenses at the worst possible time of the year. Ultimately, this mistake cost me $1,362.
Source: thesimpledollar.com

Medicare poses key financial questions for seniors

Part C is the Medicare Advantage Plan and includes all benefits and services covered under Part A and Part B. The plans often have more benefits than traditional Medicare, including dental and vision coverage, and usually include prescription drug coverage. These plans are provided through private insurance companies that have a contract with Medicare. Part D is the prescription drug coverage. The coverage is run by Medicare-approved private insurance companies and helps cover the cost of prescription drugs.
Source: theolympian.com

Understand how Medicare Part D works

An example of this would be if Jane turned 65 and in October declined to purchase a part D drug card then one year later decided she needed to have a prescription drug card dealt with the rising cost of for medications she would be responsible for a 1% penalty for every month since her open enrollment ended. Since you’re open enrollment is a total of seven months that’s three months before your birthday the month of your birthday and three months afterwards her penalty would start on month of February. So she would have a 9% penalty, at her drug plan of choice is $30 a month then she would paying after $2.70 after penalty.
Source: qooqe.com

2014 Medicare Part D deductible down as donut hole widens

The Executive Director of Families USA, Ron Pollac, said the move will have a positive and direct impact on what Medicare recipients spend from their pockets. This addresses some of the concerns people have about the sustainability of the program, which is likely to minimize the tendency to shift more cost burdens on the beneficiaries in future budget deliberations. Families USA is a Washington-based health consumer advocacy body.
Source: medicarewire.com

Medicare Part D Donut Hole, Coverage and Changes 2013

Medicare Part D 2013 Changes for this year include, once you hit the donut hole you will be eligible for a onetime $250 rebate cheque. You will also receive a 50% discount on brand name drugs in the donut hole; you will also pay less and less for your generic part D drugs in the donut hole. It is planned that as from 2020 the coverage gap will have been closed such that there will be no donut hole. In this case you will only pay 25% of the cost of your drugs until you reach the spending limit. You will also get continuous Medicare coverage throughout this time for your prescriptions as long as you are in the prescription drug plan There is no need to keep track of your retail drug costs or retail drug spending, your Medicare part D plan provider will gather all the retail costs and keep a keen track of your record till you reach the donut hole Phase. You can also check out:
Source: medicalbillingcodings.org

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July 22, 2013

Health Insurance Information You Should Definitely Know

Posted by:  :  Category: Medicare

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If you are looking for work, be sure to ask very pointed questions about the health coverage that is offered. Some companies offer health coverage, but not to all employees. For example, they may cover office staff but not maintenance workers. This may be because maintenance workers are contracted by another company or considered independent contractors. If insurance coverage is important to you, be sure you understand the company policy of any company you are considering working for.
Source: physyko.net

Video: Health Insurance Information Session – 2011

Watchdog: U students say new health insurance process causing headaches

One of these students was senior Megan Gosh. A few weeks into the fall semester, she found an old email from the Office of Student Health Benefits that said she had to “act now” or she was going to be charged for the university health care plan, even though at registration she had provided her private health insurance information from another provider. She told the Watchdog that she had two days to waive the University of Minnesota insurance and provide proof of other coverage before the original Sept. 17 deadline.
Source: twincities.com

Seniors health insurance information program

This system can allow individuals to live their final days in pride. Sometimes the requirements can be difficult to fulfill, but the end result is a nice accommodations and get the proper care they need without having to worry about costs. This details will make the first visit to the State health programs workplace for that needed system.
Source: healthinsuranceforsenior.com

Autism Insurance and Mass Health – Time Sensitive Information

Mass Health is not subject to the autism insurance law known as ARICA. But for some people with Mass Health there is an upcoming window to purchase private insurance policies with financial assistance that covers some, or potentially all, of the cost of the policy. These private insurance policies are purchased through Commonwealth Choice, and are subject to the autism insurance law (aka ARICA). By purchasing a policy, people with just Mass Health are able to access the benefits mandated by ARICA. The window to purchase private insurance policies through Commonwealth Choice is July 1- August 15.
Source: karenspilka.com

Texas Groups Promote Health Insurance Exchange With No Help From State

The Texas Department of Insurance has made no extra effort to publicize the federal exchange, said John Greeley, an agency spokesman. In 2010, it conducted a federally financed campaign about health insurance options but has done nothing comparable since, he said, adding that those with questions could use the department’s website or telephone service.
Source: kaiserhealthnews.org

Need Help Understanding Health Insurance Then Follow These TipsTea Party Views & Health Insurance IssuesTea Party Views & Health Insurance Issues

Your first step in acquiring a new health insurance package should be crunching the numbers and coming up with a rough estimate of the total costs involved. Take into consideration all the costs coming your way, such as premiums, deductibles and co-pays. While these can be confusing at first, it is in your best interest to know the costs, and reasons, before you purchase a policy.
Source: tucsonteaparty.org

Zane Benefits Publishes New Information on Health Insurance Tax Subsidies

About Zane Benefits Zane Benefits was founded in 2006 to provide a revolutionized SaaS (Software-as-a-Service) administration platform ("ZaneHRA") for Health Reimbursement Arrangements (HRAs) and defined contribution health care. The flagship software provides a 100% paperless administration experience to small businesses and insurance professionals that want to offer better health benefits without a traditional group health insurance plan at lower costs. For more information about ZaneHRA, visit http://www.zanebenefits.com.
Source: virtual-strategy.com

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July 22, 2013

FAQ: Seniors May See Changes in Medigap Policies

Posted by:  :  Category: Medicare

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Advocacy groups like the Medicare Rights Center oppose restricting Medigap plans, saying it would simply shift more costs from the government to elderly and low-income people who can least afford it. “Some in government feel people in Medicare don’t have enough ‘skin in the game,’” says Ilene Stein, federal policy director for the center. In fact, she says, people on Medicare already pay 15 percent of their incomes for health care, well above the level paid by non-Medicare households. While the proposals would cap maximum annual spending per enrollee to $5,500 or $7,500, “that’s a lot of money for someone making $22,000,” the median household income for those on Medicare, she says. 
Source: kaiserhealthnews.org

Video: Medicare Home Health Changes: 2011 & Beyond

Medicare Changes for 2011

New Requirement for Face-to-Face Encounter as Part of Process for Certifying Beneficiary Home Health Care The Affordable Care Act (ACA) mandates that a physician conduct a face-to-face encounter to certify a beneficiary need for home health care services. The CMS rules to implement this provision require that the face-to-face encounter must occur within the 90 days prior to the start of home health care, or within the 30 days after the start of care. Review the details of this new requirement, which has significant impact on internists.
Source: acponline.org

In FY 2012: Medicare Hospice Wage Index Increases 2.5%, Other Hospice Changes

Beginning October 2012, hospices will be required to start collecting quality of care data for submission in 2013.   This is the implementation of a hospice quality reporting program, as mandated by the Accountable Care Act (ACA).  Under the Quality Assessment and Performance Improvement (QAPI) program, hospices are required to submit data on quality measures to CMS or face a two-percentage point reduction to their annual market basket update, starting FY 2014.  Hospices may voluntarily being collecting QAPI data in October 2011 for submission in 2012.
Source: hallrender.com

New Medicare Benefits and Changes for 2011

Once your total drug costs reach $4,550 (see the Ms. Medicare column "Paying Less for Drugs in the Doughnut Hole" for details about how this is calculated), you are eligible for "catastrophic coverage" and your prescription costs drop to a lower copay for the remainder of the year. Last year, when there were no doughnut-hole discounts, $250 rebate checks were sent to all affected Part D subscribers. Because of the discounts now in place, there will be no rebate checks for 2011 expenses. Another 2011 change for Part D subscribers is that if you have a high annual income (more than $85,000 for individuals and $170,000 for couples) and pay higher-income premiums for Part B, you’ll also pay a higher premium for Part D drug coverage.
Source: aarp.org

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

Doctor Groups Seem Less Wary of Medicare Changes

Although the association didn’t specify in its letter what changes they like or provide further comment, other doctor groups like the AMA said the physician community is happy they will be able to participate without losing money in the first three years and the federal government will allow certain doctor groups access to $170 million in initial Medicare savings to help them form ACOs. In addition, doctors said they were encouraged that the number of quality measures that need to be met was cut in half, but there will still be more than 30 or so benchmarks.
Source: nytimes.com

Older Americans Have Been Highly Resistant to Medicare Changes

The income gap among Republicans and Republican leaners is about as large as the difference between GOP supporters of the Tea Party and non-supporters. Among Republicans and Republican leaners who agree with the Tea Party, 57% view deficit reduction as more important than preserving Social Security and Medicare benefits as they are. Among Republicans and leaners who do not agree with the Tea Party, just 36% say that reducing the deficit is more important than maintaining benefits.
Source: people-press.org

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July 22, 2013

Medicare This Week: June 8th, 2012, 4010 Ends July 1st, ePrescribing Hardship Exemptions, Improvements to PECOS

Posted by:  :  Category: Medicare

Effective July 1, 2012 only ASC X12 Version 5010 (Version 5010) or NCPDP Telecom D.0 (NCPDP D.0) formats will be accepted by Medicare Fee-For-Service (FFS). Providers that are still conducting one or more of the Version 4010 transactions electronically, such as submitting a claim or checking claim status, or rely on a software vendor, billing service or clearinghouse to do this on their behalf, are affected by this change. Now is the time to contact your software vendor, billing service or clearinghouse, when applicable, if you have not done so already to ensure you are ready. Transactions conducted by Medicare Administrative Contractor (MAC), fiscal intermediary (FI) or carrier telephone interactive voice response (IVR) systems, Direct Data Entry (DDE) and Internet Portals, for those contractors with Internet Portals, are not impacted.
Source: managemypractice.com

Video: Audio Educator: Medicare Enrollment PECOS The CMS 855.mp4

Medicare PECOS Ruling Could Have An Effect On Payments By Medicare

CMS-ID is designed аnd used by Saіlors, Command Career Counselors and Command Perѕonnel. The Web-based syѕtem allows Sailors to view available jοbs and make their own applications οr through their Command Career Counselor. SaiƖors can view CMS-ID through a secure website located аt HTTPS://WWW.CMSID.NAVY.MIL Jаn Mater-Cavagnero MA, HCS-D, specializes in diagnoѕis coding for home health agencies , as well аs the wide variеty of issues thаt impact the hospіce industry. Jan іs an editor-in-chief fοr Eli Healthcare, where she has written Home Health ICD-9 Alert for fiνe years. Advіce: You should uѕe the present coԁes 77080-77082 and nοt the old onеs, CMS ‚s Amy Bassano said. About the Author
Source: com.pl

Reed Tinsley, CPA: Major Improvements to the Internet

The provider/supplier can access the enrollment information from the My Enrollment page. The information will display in an HTML view and can be saved and/or printed by the provider/supplier. Note: The CMS-855 PDF forms are no longer available and have been replaced with the new HTML views. The enrollment tutorial videos, located on the PECOS home page, have been updated to illustrate the most common enrollment scenarios completed by providers/suppliers. A new part B provider service has been established for Centralized Flu Billers. In addition, the Centralized Flu Biller Approval letter has been added as a type of Required/Supporting documentation for a CMS 855B enrollment. Centralized Flu Biller enrollments submitted via PECOS will be routed to Novitas Solutions, the designated Medicare Administrative Contractor (MAC) responsible for enrolling this provider service. A new “Durable Medical Equipment (DME) License Information” topic has been added to PECOS. This topic will display the DME license information currently on file for existing suppliers. The information is viewable only and cannot be edited or deleted by the supplier.
Source: blogs.com

OIG: PECOS, NPPES data 'inaccurate'

The OIG recommends that CMS implement program integrity safeguards for Medicare provider enrollment, require more verification of enrollment data, and better detect and correct inaccurate and incomplete data for new and established records, according to the release. CMS concurred with all three recommendations.
Source: hmenews.com

NAHC Participates in Call with CMS on Phase II PECOS Edits

The PECOS Ordering and Referring files do not include the date of physician enrollment. Since home health payments will be based on whether the ordering physician was enrolled in PECOS at the time services were provided, rather than at the time claims were submitted, how will home health agencies identify and track the effective dates of physicians’ PECOS enrollment? CMS will not provide this information to providers. Physicians’ date of enrollment is in both physicians’ effective date for billing Medicare notification letters and in the physicians’ PECOS files. Home health agencies must contact the physicians for this information in cases where they have concerns about an initial effective date or a gap in enrollment.
Source: medbill.net

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July 22, 2013

Does Medicare meet coverage requirements for health reform?

Posted by:  :  Category: Medicare

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Doug Dalrymple is a member of the communications team at eHealth, Inc. and has worked in the health insurance and technology industries for fifteen years. He works on communications strategy, content creation and management, project management, and corporate messaging.
Source: ehealthinsurance.com

Video: Understanding Healthcare Costs: Medicare Advantage

Medicare 101: A Free Informational Webinar

2012 employment laws ACA ADA avoiding lawsuits California employment laws California Labor Laws California Workers’ Comp cheap health insurance employee administration Employee Benefits employee documentation employee lawsuits employee management employment compliance Employment Laws Employment Practices FLSA Health Care Reform Health Care Reform Act HR compliance HR Consulting HR Laws HR Management HRO HR Outsourcing Human Resources human resources outsourcing labor laws in California layoffs management training motivating employees Obamacare outsource HR payroll tax PEO Professional Employer Organization Professional Employer Organizations recordkeeping reduce workers’ compensation sexual harassment small business medical insurance Value of HR in a weak economy Wage and Hour Workers’ Compensation Workplace Safety
Source: cpehr.com

Medicare Expands Competitive Bidding Program for Durable Medical Equipment

You can also get the supplies from a store or pharmacy that accepts "Medicare assignment." This means that the store will accept the Medicare-approved amount as payment in full and that you cannot be charged more than a 20 percent copay (after you meet your annual deductible). A Medicare contract supplier can’t charge you more than that for the equipment or supplies included in the competitive bidding program.
Source: aarp.org

Medicare Benefits and Cost

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

Rollout Resembles Some Of The Problems Of Medicare Part D

NPR: Messy Rollout Of Health Law Echoes Medicare Drug Expansion It hasn’t been a good week for the Affordable Care Act. After announcements by the administration of several delays of key portions of the law, Republicans returned to Capitol Hill and began piling on. “This law is literally just unraveling before our eyes,” said Rep. Paul Ryan, R-Wis., at a hearing of the House Ways and Means Committee. … [But] “About this time in 2005, the percentage of people who had an unfavorable opinion of the law was actually higher than those who had a favorable opinion,” says Sabrina Corlette, a research professor at the Georgetown University Health Policy Institute (Rovner, 7/12).
Source: kaiserhealthnews.org

Spillover Benefits From Medicare Advantage

[I]ncreasing MA monthly payments by $100 (about one standard deviation) would increase the share of beneficiaries in MA by just under 5 percentage points…This would increase total MA spending by $100 per month for the existing and new enrollees, or almost $5 billion in total for these states. Overall costs of hospital care is estimated to go down by something like 2% when MA penetration increases by 5 percentage points, off a base of total hospital costs for the [traditional Medicare] population remaining in these states (after the implied shift to MA) of just under $30 billion, or about $600 million. Hospital costs for those in [traditional Medicare] would thus go down by upwards of 10% of the increase in spending on MA.
Source: ncpa.org

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

Should I Consider Medicare Advantage?

Another main dissimilarity is that a lot of Medicare Advantage packages have medicine coverage built in. With the Traditional Medicare, Part D medicine coverage has to be bought separately. Also, with the Traditional Medicare, you can visit any hospital or doctor that accepts Medicare. Numerous Medicare Advantage packages work with contracted providers such as hospitals and physicians with whom they have established a long-term relationship.
Source: leerogers2012.com

ABOUT MEDICARE: When a doctor doesn’t take Medicare

An opt-out doctor is one who doesn’t accept Medicare. Doctors who have opted out of Medicare can charge their Medicare patients whatever fees the physicians choose. These doctors don’t submit any health care claims to Medicare. In addition, opt-out doctors aren’t subject to Medicare laws that limit the amount they can charge their patients.
Source: times-standard.com

Oral Health and Medicare Beneficiaries: Coverage, Out

This brief describes the oral health of Medicare beneficiaries, examines sources of dental coverage for the Medicare population, and examines the utilization of dental services, out-of-pocket spending on dental care, and access problems. This analysis uses data from the National Health and Nutrition Examination Survey (NHANES), the Medicare Current Beneficiary Survey Cost and Use file (MCBS), the National Health Interview Survey (NHIS) and the Kaiser Family Foundation Survey of Health Care Among Nonelderly People with Disabilities and Seniors on Medicare, 2008.
Source: kff.org

Daily Kos: NYC Mayor: Anthony Weiner (D) Proposes Single

The coverage devised by the task force, which he called Thrive (standing for Taskforce for Healthcare Reform, Innovation and Vitality for Everyone), could eventually be offered to all New Yorkers by being listed on the state insurance exchange required by the Affordable Care Act. Such an experiment could not be tried in places like Cincinnati or St. Paul, he went on, but “New York is the health care capital of the world,” with more than 560,000 health care workers, including tens of thousands of doctors and nurses in the city’s own employ. – New York Times, 6/20/13
Source: dailykos.com

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July 22, 2013

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

Posted by:  :  Category: 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

Video: Medicare Overview

Daily Kos: To attack Obamacare, Republicans forget the lessons of Bush’s Medicare reform

FDA approval Oral colchicine had been used for many years as an unapproved drug with no prescribing information, dosage recommendations, or drug interaction warnings approved by the U.S. Food and Drug Administration (FDA).[8] On July 30, 2009 the FDA approved colchicine as a monotherapy for the treatment of three different indications (familial Mediterranean fever, acute gout flares, and for the prophylaxis of gout flares[8]), and gave URL Pharma a three-year marketing exclusivity agreement[9] in exchange for URL Pharma doing 17 new studies and investing $100 million into the product, of which $45 million went to the FDA for the application fee. URL Pharma raised the price from $0.09 per tablet to $4.85, and the FDA removed the older unapproved colchicine from the market in October 2010 both in oral and IV form, but gave pharmacies the opportunity to buy up the older unapproved colchicine.[10] Colchicine in combination with probenecid has been FDA approved prior to 1982.[9] ~~~~ Marketing exclusivity in the United States As a drug predating the FDA, colchicine was sold in the United States for many years without having been reviewed by the FDA for safety and efficacy. In 2009, the FDA reviewed an NDA submitted by URL Pharma and approved colchicine for gout flares, awarding Colcrys a three-year term of market exclusivity, prohibiting generic sales, and increasing the price of the drug from $0.09 to $4.85 per tablet.[24][25][26]
Source: dailykos.com

Medicare Supplement Questions > will Obamacare affect Medigap

Concerning Medigap, a provision of the ACA required the NAIC to review the most popular Medigap plans (C and F) and determine whether or not employing “nominal cost-sharing” would deter enrollees from misusing physician services. The implication was that, because these Medigap plans fill in the gaps of Medicare (thereby covering 100% of Medicare fees) people are over utilizing doctor visits since it comes at no cost to them, and that employing more cost-sharing would help cut federal health care spending.
Source: medicaresupplement.com

AUSTIN, Texas: Medicare gives state hospital 90 days to shape up

The investigation began in April after the American-Statesman made the agency aware of the 2012 death of Terrell State Hospital patient Ann Simmons. The 62-year-old woman died at the hospital 30 miles east of Dallas after being left in restraints for 55 hours. Medicare investigators concluded that improper care was responsible for her death and a continued threat to the lives of other patients.
Source: heraldonline.com

Medicare Plans to Grade Hospitals with Stars

The proposal comes as Medicare confronts a paradox: Although the number of ways to measure hospital performance is increasing, those factors are becoming harder for patients to digest. Hospital Compare publishes a wide variety of details about medical centers, including death rates, patient views about how well doctors communicated, infection rates for colon surgery and hysterectomies, emergency room efficiency and overuse of CT scans.   In its proposed rules for hospitals in the fiscal year starting Oct. 1, the Centers for Medicare & Medicaid Services asked for ideas about “how we may better display this information on the Hospital Compare Web site. One option we have considered is aggregating measures in a graphical display, such as star ratings.”
Source: thefiscaltimes.com

UnitedHealth: Expect narrower Medicare Advantage networks

Gail Boudreaux, the company’s executive vice president, said during the earnings call that the company expects to sell coverage through Patient Protection and Affordable Care Act (PPACA) exchanges in about a dozen states in 2014 and sees the exchanges as a huge opportunity over the long term.
Source: lifehealthpro.com

ABOUT MEDICARE: When a doctor doesn’t take Medicare

An opt-out doctor is one who doesn’t accept Medicare. Doctors who have opted out of Medicare can charge their Medicare patients whatever fees the physicians choose. These doctors don’t submit any health care claims to Medicare. In addition, opt-out doctors aren’t subject to Medicare laws that limit the amount they can charge their patients.
Source: times-standard.com

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July 22, 2013

The effect of Obamacare’s Medicare payroll tax rate hike on NBA Players

Posted by:  :  Category: Medicare

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ehhh come on TErezOwens! we tired of hearin bout this hoe. give us some real news. we already know what this Thirsty hoe is all about n its nasty. Posted in Blake Griffin’s Dating Another Hot Blonde by
Source: terezowens.com

Video: Social Security, Medicare and Other Taxes – www.atcmathprof.com

The New 0.9% Medicare Tax: Watch Out for Withholding Issues

Under the health care act, starting in 2013, taxpayers with earned income over $200,000 per year ($250,000 for joint filers and $125,000 for married filing separately) must pay an additional 0.9% Medicare tax on the excess earnings. Employers are required to withhold the tax beginning in the pay period in which wages exceed $200,000 for the calendar year — without regard to the employee’s filing status or income from other sources. So, it’s possible your employer:
Source: gallina.com

Increase in Medicare levy to affect other tax rates

Following the Federal Budget, the Medicare Levy Amendment (DisabilityCare Australia) Bill 2013 to increase the Medicare levy and other accompanying bills to amend other linked tax rates were introduced into the House of Representatives on May 15, 2013. These passed the House of Representatives and the Senate on May 15 and 16 respectively and became law on May 28, 2013 after receiving Royal Assent.
Source: com.au

5 ways to beat new Medicare surtax

For this purpose, NII is defined to include interest, dividends, capital gains, rents, royalties, nonqualified annuities, income from passive activities and income from the trading of financial instruments or commodities. Certain other income items, such as wages, self-­employment income, Social Security benefits, tax-exempt interest, operating income from a nonpassive business and distributions from qualified retirement plans and IRAs, are ­specifically excluded.
Source: businessmanagementdaily.com

IRS Issues Guidance On Additional Medicare Tax : ADP Compliance Insights

Background Effective for wages paid on or after January 1, 2013, the Medicare tax rate increases from 1.45 percent to 2.35 percent on wages earned above $200,000 for single filers and $250,000 for joint filers ($125,000 for a married individual filing separately).   This increase only applies to the employee portion of the Medicare tax. Employers do not have to match the increased Medicare tax amount. However, employers are still responsible for the withholding and reporting obligations with respect to the increased employee Medicare tax.  If an employer fails to withhold and deposit the additional Medicare tax amount AND the employee pays it with their tax return, the employer will not be required to pay the amount not deducted, but the employer will be subject to penalties for the failure to withhold the tax.   The employer is required to withhold the increased amount from all workers with wages exceeding $200,000 regardless of the marital status claimed on the employee’s Form W-4. Over- and under-withholding for the employee will be reconciled upon the filing of his/her individual tax return.
Source: adpcomplianceinsights.com

NBA MVP LeBron James Faces $157K Medicare Tax Hike Under Obamacare

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Source: tacticalminc.com

Affordable Care Act Update: Additional Medicare Tax Withholding Required in 2013

To help employers with ACA compliance, Bernstein Shur has assembled an ACA Team — a multi-specialty group of attorneys from employment law, litigation, business law and ERISA. The ACA Team is available for flat-fee, full compliance audits and half-day and full-day “bottom-line” workshops.
Source: jdsupra.com

MailBag: 0.9% Medicare Tax Withholding From Nonqualified Deferred Compensation And Separating Twitter Accounts For Personal And Business Use

Here’s an example of why it matters. I know that your firm’s account often shares and retweets some of the content I produce on Nerd’s Eye View, yet the reality is that much of the content I write is actually written for advisors, not clients. Consequently, it may feel relevant and interesting for you, personally (I hope!), but frankly it’s not really the kind of content you want/need to share from your firm’s account to your firm’s clients and prospects. Your clients don’t need to hear about the latest news from about the CFP certification’s progress towards the fiduciary standard, or why I think financial planners should have a Google+ page. Your clients needs to hear about what your firm has to share that’s relevant to THEM, not what’s relevant to YOU (at least, unless your target clientele really are people just like you!). That’s where having both a firm and a personal account matters; your firm can share and engage with what’s relevant to your target audience, and your personal account can share and engage with what’s relevant to you, personally.
Source: kitces.com

What are FICA & Medicare Payroll Tax Rates for 2013?

Employers must withhold a 0.9% additional Medicare from wages paid to an employee in excess of $200,000 in a calendar year. Employers are required to begin withholding additional Medicare Tax in the pay period in which wages in excess of $200,000 are paid to an employee and continue to withhold it each pay period until the end of the calendar year.
Source: osyb.com

2013 Federal Tax Rate Schedules

1) The taxpayer owes any special taxes, including alternative minimum tax; additional tax on a qualified plan, including an IRA, or other tax-favored account; household employment taxes; Social Security and Medicare tax on tips that were not reported to the employer, or on wages received from an employer who did not withhold these taxes; recapture of First-Time Homebuyer Credit; write-in taxes, including uncollected Social Security and Medicare or RRTA tax on tips reported to the employer or on group-term life insurance and additional tax on health savings account distributions; and recapture taxes
Source: excelinbiz.org

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